心理学方法治疗心肌梗死创伤后应激障碍的研究进展

介绍了创伤后应激障碍(PTSD)常用心理治疗方法,即认知行为治疗、眼动脱敏和再加工治疗;并阐述了国内外临床心肌梗死后PTSD病人的心理护理方法。     

玉树地震31例伤残藏民创伤后应激障碍分析

目的了解玉树地震后50天住院地震伤残人员创伤后应激障碍（posttraumatic stress disorder,PTSD）的患病情况。方法采用创伤后应激障碍检查量表平民版（PTSD Checklist-Civilian Version,PCL-C）调查玉树地震发生后50天地震伤残人员与同期骨科普通患者PTSD的发生情况,并进行比较。结果地震伤残人员PTSD发生率为48.4%,同期骨科普通住院患者PTSD发生率为0,差异有统计学意义（P〈0.01）。结论地震伤残人员PTSD发生率明显高于同期骨科普通住院患者。在对地震患者进行手术等物理治疗、康复时应同时加强对其进行心理康复治疗。     

虚拟现实暴露疗法对创伤后应激障碍的疗效:系统评价和Meta分析

目的:对虚拟现实暴露疗法(virtual reality exposure therapy,VRET)治疗创伤后应激障碍(posttraumatic stress disorder,PTSD)的有效性进行系统回顾和Meta分析。方法:计算机检索PubMed、Science Direct、Embase和Medline数据库从1995年至2022年2月21日的相关文献,搜索VRET治疗PTSD的临床随机对照试验,由2位研究者独立对文献进行资料提取和质量评价后,使用RevMan 5.4和Stata16软件进行Meta分析。结果:发现VRET治疗PTSD疗效的研究12项(478例),大多数VRET研究的质量较低,结果参差不齐。Meta分析显示,与对照组相比,VRET治疗组患者PTSD症状明显缓解[SMD=-0.45,95%CI(-0.84,-0.06)]。之后进行2次亚组分析,以分析其异质性来源。结论:VRET可以有效缓解PTSD症状。VRET治疗方法优于等待对照组,与其他治疗方法效果相当。结合多模态运动辅助VRET技术作为改良后的治疗方法应得到关注,并需要更多的被试来验证其治疗PTSD的效果。     

创伤后应激障碍的针灸治疗

正当一个人看到或经历了某创伤性事件后可能会产生创伤后应激障碍(PTSD)。在多种针对PTSD的治疗方法中,补充与替代疗法(CAM)的应用越来越多。已有部分文献总结了针灸治疗PTSD症状的疗效,本篇文献综述和荟萃分析旨在进一步分析针灸治疗对创伤后应激障碍症状的疗效。我们用医学电子数据库搜索了从2016年1月以来的相关文献。共纳入7篇原始文献,719名受试者。针灸治疗时间为每次30~60分钟,一周2~4次,持续3~12周。疗效评估时间到治疗后6个月。荟萃分析发现,与任何对照组相比针灸治疗改善PTSD症状均有明显的短期疗效(P=0.05)和长期疗效(P=0.04)。传统中药治疗和耳穴针刺治疗的疗效     

腕踝针治疗工伤创伤后应激障碍的疗效

目的研究腕踝针治疗工伤所致创伤后应激障碍(PTSD)的疗效及安全性.方法将62例工伤 PTSD 患者分为观察组(n=30)和对照组(n=32).观察组予腕踝针及口服帕罗西汀治疗,对照组予单纯口服帕罗西汀治疗.在治疗前及治疗6、12周后,分别进行 PTSD 临床监测量表(CAPS)、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评定.结果治疗后,两组 CAPS、HAMD 和 HAMA 评分均明显优于治疗前(P<0.01),观察组各量表评分减分率大于对照组(P<0.05).结论腕踝针能提高工伤所致PTSD 的疗效.     

住院地震伤残人员创伤后应激障碍及相关因素分析

目的 了解地震后100天住院地震伤残人员创伤后应激障碍(posttraumatic stress disorder,PTSD)的患病情况及相关因素.方法 采用创伤后应激障碍检查量表平民版(PTSD Checklist-Civilian Version,PCL-C)调查5·12汶川大地震发生后100天仍在我院住院治疗的70例地震伤残人员,并对相关因素进行分析.结果 地震后100天住院地震伤残人员PTSD的患病率为26%;PTSD的发生与患者年龄、目前伤残程度、前期是否进行心理危机干预、家庭成员伤亡情况密切相关(P<0.01),与性别、文化程度等无关(P>0.05).结论 目前仍住院治疗的地震伤、残人员有较高的PTSD发生率,躯体残疾程度、亲人遇难和是否得到及时的心理干预是导致PTSD主要因素.在进行物理康复治疗的同时,应加强心理康复治疗.     

蛛网膜下隙出血病人创伤性应激障碍研究进展

对蛛网膜下隙出血(SAH)病人创伤后应激障碍(PTSD)的常用测量工具,研究现状,PTSD对SAH病人生活质量、睡眠、疲劳的影响及对家属的影响,常用的治疗方法进行综述。     

癌症对青少年幸存者生命质量的影响

过去的 30年儿童肿瘤患者的生存率已显著提高 ,随之他们的生存质量也变得日益重要。新近关于癌症是心理创伤的概念加深了人们对癌症本身及其治疗对病人的长期心理影响的认识。罹患癌症后引起的心理创伤性精神障碍 ( PTSD)的症状已有报道 ,但缺乏应用测量手段建立明确的 PTSD诊断及PTSD是否有临床应用价值的研究。作者的研究的目的是检验 PTSD是否干扰了其正常的心理发育 ,重点探索 PTSD与生命质量( QOL) /心理痛苦之间的关系。方法　研究对象来自洛杉矶儿童医院( CHLA)儿童肿瘤治疗中心。入选条件 :1确诊为癌症时的年龄 <1 8岁 ;…     

日记法在ICU病人创伤后应激障碍早期干预的效果研究

[目的]了解重症监护室(ICU)病人治疗后生存者创伤后应激障碍(PTSD)发生情况,探讨日记法对预防ICU病人创伤后应激障碍早期的干预效果。[方法]选取104例ICU治疗后病人,采用临床随机对照实验,分为干预组和对照组,干预组采用ICU日记法(记录病人在ICU期间的日记,记录内容包括病情、主要治疗措施,家属探视等,同时拍摄相应有意义的照片以辅助说明,对照组采用基础护理,对比两组病人在出ICU第1个月和第3个月创伤后应激障碍检查表(PCL-C)总分情况。[结果]ICU病人出ICU后第1个月PCL-C总分为(42.46±5.16)分,有19.2%的病人PTSD阳性,63.4%的病人存在一定的PTSD症状。ICU病人出ICU后第3个月PCL-C总分为(36.83±6.66)分,有7.9%的病人PTSD阳性,38.5%的病人存在一定的PTSD症状。病人出ICU后第3个月(日记法干预后),干预组的病人PCL-C总分为(34.29±6.87)分,对照组病人PCL-C总分为(39.37±5.40)分,两组评分差异有统计学意义(P0.05)。[结论]ICU病人治疗后生存者PTSD发生率较高,以日记法为主要干预手段的暴露疗法对预防ICU病人PTSD早期干预效果明显。     

灾后吸烟与创伤暴露及创伤后应激障碍的关系研究

目的 了解吸烟与创伤暴露及创伤后应激障碍(Post-traumatic stress disorders,PTSD)之间的关系.方法 对1056名参加汶川抗震救灾的一线救援军人PTSD的患病率及吸烟情况进行调查.结果 创伤暴露后,吸烟人数和吸烟量未有明显改变.PTSD组中吸烟率为76.8%,显著高于非PTSD组(60%).多元Logistic回归分析显示,服役满意度低、创伤暴露后患PTSD、军龄长是地震现场救援军人创伤暴露后吸烟行为增加的危险因素.结论 创伤暴露对吸烟无明显影响,吸烟主要与PTSD有关,吸烟会增加创伤暴露后患PTSD的危险,而患PTSD后又会增加吸烟的危险.     

膀胱全切术后精神障碍的临床护理观察

目的探讨膀胱全切术后精神障碍的发生原因及护理措施。方法回顾性分析123例行膀胱癌患者的临床资料,评价全麻膀胱全切术后精神障碍的发生情况。结果 123例膀胱癌患者行全麻膀胱全切术后,12例发生精神障碍,发生率为9.8%,男性11例,女性1例;轻度症状患者8例,重度4例;术后第1天出现症状者1例,术后第3天8例,术后第5天3例。结论膀胱全切术后精神障碍患者以老年男性多见,多数发生在术后3~5 d,故有必要采取针对性护理措施以降低术后精神障碍发生率。     

肝癌开腹射频消融术与常规肝癌开腹切除术后护理指标的对比研究

目的观察肝癌开腹射频消融术（IRFA）与常规肝癌切除术后临床护理的异同点，以便进行针对性护理。方法90例肝癌患者分2组，其中开腹射频消融术42例为观察组，常规肝癌切除48例为对照组；分别观察2组术后并发症情况及恢复情况并进行统计学比较。结果肝癌开腹射频消融术较常规肝癌切除术并发症少、损伤小，恢复快，有显著性差异，除黄疸指数无显著性差异（P〉0．05）外，术后2组发热、出血、腹水、胸腔积液人数，下床、肛门排气、住院天数均有显著性差异（P〈0．05或P〈0．01），IRFA术也有不同的并发症即血红蛋白尿，临床医疗护理不能忽视。结论肝癌开腹射频消融术拓宽了治疗肝癌的范围，其损伤小、并发症少、恢复快，但其并发症的观察还要不断总结。     

Disability and the post-2015 development agenda

Abstract

Purpose: The article considers the extent to which disability has been recognized and included in two main documents produced to date as part of the United Nations Post-2015 Development agenda process. This is the process that is defining the Sustainable Development Goals (SDGs), which will succeed the UN Millennium Development Goals (MDGs) after the latter reach their target date in 2015. The two documents examined in the article are the Outcome Document (July 2014) of the Open Working Group (OWG) on SDGs and the Report (August 2014) of the Intergovernmental Committee of Experts on Sustainable Development Financing (ICESDF). The OWG consisted of 30 seats shared by 70 UN Member States and was in charge of proposing goals and targets for the SDGs. The ICESDF worked in parallel to the OWG and its report proposed options on an effective financing strategy. The article emphasizes the importance of including persons with disabilities in the Post-2015 Agenda, especially in view of the latter’s overarching focus on eradicating poverty. Results: The inclusion of persons with disabilities is being recognized in the Post-2015 Agenda discussions as central to achieving sustainable development. Disability has been explicitly mentioned in the OWG and ICESDF documents. Conclusion: Although the results so far have been very good, more work still needs to be done to ensure that these explicit references are maintained in the final version of the SDGs, which will be adopted in September 2015. Furthermore, the new framework needs to have a stronger human rights foundation on which to ground these references and future indicators. Light for the World is an international confederation of national development non-governmental organizations (NGOs) aiming at an inclusive society, where the rights of persons with disabilities are realized without discrimination. Through a rights-based approach, Light for the World supports 175 programs in 25 countries in the areas of prevention of blindness, rehabilitation, inclusive education, awareness raising and advocacy, both at EU and UN level. Light for the World has been advocating for the inclusion of persons with disabilities in the Post-2015 Agenda, working closely with the International Disability and Development Consortium (IDDC), of which it is a member, and the International Disability Alliance (IDA).

• Implications for Rehabilitation

• The new Post-2015 development agenda is a fundamental opportunity to ensure that persons with disabilities are fully included in future development efforts.

• Inclusive development, as enshrined in the UNCRPD, has clear implications for the disability community and for policy makers.

• Advocacy from the disability community is critical to help keep the inclusion of persons with disabilities high on the agenda of the Post-2015 process.

     

加强术后访视工作,提高患者对护理工作满意度

目的了解术后访视工作中存在的问题,进行有针对性的学习和改进,提高术后访视效果。方法通过向患者发放问卷,了解患者对访视者仪表、服务态度、理论知识的满意度以及对手术室护理工作的意见和建议。结果100%的患者认可访视者的服务态度,对手术室护理工作满意度达99%。结论不断征求患者的意见和建议,及时进行改进,可以提高手术患者对手术室护理工作的满意度。     

心脏骤停后综合征动物模型的建立

目的 建立一种稳定的、能进行心脏骤停后综合征研究的动物模型.方法 大耳白兔30只,随机分为3组,每组10只.兔麻醉后逆行气管插管、右侧股动脉插管,静脉注射司可林后,在呼气末夹闭气管插管,当达到心脏骤停标准后,分别维持4、5、6 min,然后开始进行常规心肺复苏,观察动脉血压变化、复苏后综合征发生情况和生存时间.结果 夹闭气管插管后5～7 min内,所有兔均达到心脏骤停标准.心脏骤停持续4、5、6 min组心肺复苏即刻成功率分别为100%、86%、77%,24 h存活率分别为100%、63%、27%,兔存活时间分别为(120.00±0.00)h,(58.00±41.52)h,(28.00±39.80)h,差异有统计学意义(P＜0.01).复苏后综合征发生情况则随心搏停止持续时间的延长而加重.结论 兔心脏骤停持续时间以5 min为适宜,心肺复苏成功率及复苏成功后24 h生存率高.该模型稳定,可重复性好,可作为心脏骤停后综合征研究的动物模型.     

Effects of tertatolol on post- and prejunctional beta adrenoceptors

The effects of tertatolol, a new and powerful beta adrenoceptor blocking drug, on post- and prejunctional beta receptors were investigated; canine vascular tissues (saphenous veins, coronary arteries and splenic arteries) and guinea-pig trachea and atria were used. At concentrations below 10(-5) M, tertatolol did not alter basal tension or contractile responses to electrical stimulation, norepinephrine, K+ or prostaglandin F2 alpha; at doses at or above 10(-5) M the drug-evoked contractions which were reduced by phentolamine and were absent in denervated veins. Tertatolol at 10(-5) M and 3 X 10(-5) M augmented the basal efflux of [3H] norepinephrine in saphenous veins labeled with the 3H-transmitter. In veins, 10(-5) M of tertatolol depressed the contractions caused by electrical stimulation without affecting those to exogenous norepinephrine; this concentration of the drug also inhibited the stimulation-induced overflow of [3H]norepinephrine. The major part of the present study was designed to test the beta receptor blocking properties of tertatolol and to compare its effects with those of propranolol. Tertatolol inhibited, in a concentration-dependent manner, the relaxations caused by isoproterenol in saphenous veins, splenic arteries and coronary arteries and the relaxations evoked by norepinephrine and epinephrine in coronary arteries; the potency of tertatolol was higher than that of propranolol. In trachea and right atria of the guinea-pig, tertatolol inhibited, in a concentration-dependent manner, the dose-response curves to isoproterenol; the relative potency of tertatolol was higher than that of propranolol. In dog saphenous veins, previously incubated with [3H]norepinephrine, tertatolol (10(-7)M) blocked the increased stimulation-evoked overflow of the 3H-transmitter induced by isoproterenol.(ABSTRACT TRUNCATED AT 250 WORDS)     

脑卒中后抑郁的相关因素研究

目的探讨脑卒中后抑郁状态(PSD)的发生与相关因素的关系。方法采用Hamilton抑郁量表17版,对53例脑卒中患者进行调查评分,并对各相关因素进行分析。结果 PSD患者18例,总发生率为33.9%。其中轻度8例,占44.5%;中度6例,占33.3%;重度4例,占22.2%。PSD以轻、中度抑郁为主,占77.8%。病前身体健康状况、文化程度与PSD的发生无关。性别、病后身体状况、家庭关系与PSD的发生有关(P<0.05)。结论性别、病后身体状况、家庭和睦情况为PSD的相关因素。教育程度和病前身体状况与PSD无关。     

玻璃体视网膜显微手术病人出院护理干预

随着眼科显微手术技术的迅速发展,以往常规手术方法难以治愈的复杂性视网膜脱离,现在通过玻璃体切割视网膜显微手术并行眼内填充而获得满意的疗效。故加强术后的护理是手术成功的关键,尤其是出院前的护理干预。     

EEG-BOLD correlations during (post-)adolescent brain maturation

The transition from adolescence to adulthood is a critical stage in the human lifespan during which the brain still undergoes substantial structural and functional change. The changing frequency composition of the resting state EEG reflects maturation of brain function. This study investigated (post)adolescent brain maturation captured by two independently but simultaneously recorded neuronal signals: EEG and fMRI. Data were collected in a 20 min eyes-open/eyes-closed resting state paradigm. EEG, fMRI-BOLD signal and EEG-BOLD correlations were compared between groups of adults, age 25 (n=18), and adolescents, age 15 (n=18). A typical developmental decrease of low-frequency EEG power was observed even at this late stage of brain maturation. Frequency and condition specific EEG-fMRI correlations proved robust for multiple brain regions. However, no consistent change in the EEG-BOLD correlations was identified that would correspond to the neuronal maturation captured by the EEG. This result indicates that the EEG-BOLD correlation measures a distinct aspect of neurophysiological activity that presumably matures earlier, since it is less sensitive to late maturation than the neuronal activity captured by low-frequency EEG.     

气管切开术后气道护理进展

为加强气管切开病人气道管理,从重建生理湿化状态、有效吸痰方法、湿化液选择、气道湿化方法等方面进行了综述。