HPLC-ECD法对精神分裂症患者脑脊液单胺类神经递质的检测

目的　探讨精神分裂症患者脑脊液 (CSF)中多巴胺 (DA)、高香草酸 (HVA)含量的变化及立体定向手术对其的影响。方法　立体定向手术治疗 2 2例精神分裂症患者 ,高效液相色谱 电化学HPLC ECD法检测CSF中的DA及HVA水平。结果　精神分裂症患者手术前CSF中DA[(3.2 3± 0 .36 ) μmol/L]、HVA[(1.99± 0 .4 9)μmol/L]水平显著高于对照组 [(2 .4 4± 0 .32 ) μmol/L、(1.4 1± 0 .37) μmol/L](P <0 .0 1) ;手术后DA[(2 .4 9± 0 .35 ) μmol/L]、HVA[(1.4 2± 0 .2 8) μmol/L]水平明显下降 (P <0 .0 1)。 结论　支持精神分裂症中枢DA亢进假说 ,立体定向手术具有明显的DA传导阻滞作用。     

HPLC-ECD法对精神分裂症患者脑脊液单胺类神经递质的检测

目的探讨精神分裂症患者脑脊液(CSF)中多巴胺(DA)、高香草酸(HVA)含量的变化及立体定向手术对其的影响.方法立体定向手术治疗22例精神分裂症患者,高效液相色谱-电化学HPLC-ECD法检测CSF中的DA及HVA水平.结果精神分裂症患者手术前CSF中DA[(3.23±0.36)μmol/L]、HVA[(1.99±0.49)μmol/L]水平显著高于对照组[(2.44±0.32)μmol/L、(1.41±0.37)μmol/L](P<0.01);手术后DA[(2.49±0.35)μmol/L]、HVA[(1.42±0.28)μmol/L]水平明显下降(P<0.01).结论支持精神分裂症中枢DA亢进假说,立体定向手术具有明显的DA传导阻滞作用.     

利培酮治疗首发精神分裂症20例临床观察

目的　评价利培酮治疗首发精神分裂症的疗效及安全性。方法　采用口服利培酮治疗 2 0例首发精神分裂症患者 ,于治疗前及治疗后 1、2、4、6、8周分别进行一次阳性和阴性症状量表 (PANSS)、临床总评量表 (CGI)及锥体外系症状量表 (RSESE)的评定 ,按我国现行的四级标准进行疗效评定。结果　痊愈 7例 ,明显进步 8例 ,进步 4例 ,无效 1例 ,显效率 75 % (15 /2 0 ) ,有效率 95 % (19/2 0 )。PANSS、CGI及RSESE评分治疗前后有显著差异。仅 3例出现轻度锥体外系症状 ,1例出现窦性心动过速。结论　利培酮治疗首发精神分裂症安全、有效。     

血浆置换治疗高胆红素血症患者的护理

目的　探讨血浆置换治疗高胆红素血症的疗效。方法　采用免疫吸附系统 (KM - 890 0系统 )对 5例高胆红素血症患者进行血浆置换 ,血浆交换速度 30ml/min ,以等量的同型血浆或 4 %白蛋白稀释液为置换液 ,每次血浆交换量 2 5 0 0～ 30 0 0ml,每例血浆置换次数为 1～ 3次。结果　血浆置换前直接胆红素 (2 78.3± 74 .2 ) μmol/L ,间接胆红素为 (6 37.4± 1 2 2 ) μmol/L ,总胆红素 (91 5 .8±1 82 .8) μmol/L ,血浆置换后直接胆红素 (2 2 8.4± 78.3) μmol/L ,间接胆红素 (4 2 8.4± 1 75 .8) μmol/L ,总胆红素 (6 5 6 .8± 1 78.2 ) μmol/L ,治疗后明显低于治疗前(P <0 .0 5 )。结论　血浆置换可有效治疗高胆红素血症。     

氯氮平和利培酮对精神分裂症患者血糖代谢的影响

目的　探讨精神分裂症患者服用抗精神病药物氯氮平和利培酮对糖耐量的影响。方法　6 8例精神分裂症患者随机分为氯平组和利培酮组,各34例,两组患患治疗前和治疗后第4周末分别检测糖耐量。正常对照组30例,同时检测糖耐量。结果　氯氮平组餐后(5 .8±1.4 )mmol/L明显升高(P <0 .0 5 ,P <0 .0 1)。而利培酮组无明显变化。治疗后氯氮平组(2 0 .6 % ,7例)患者糖耐量减低的发生率高于利培酮组(2 .9% ,1例) ,差异有显著性(X2 =5 .1,P <0 .0 5 )。结论　氯氮平对精神分裂症患者餐后血糖有影响     

阿立哌唑替换利培酮治疗对精神分裂症患者血清催乳素水平的影响

目的:研究阿立哌唑替换利培酮治疗对精神分裂症患者血清催乳素水平的影响。方法:伴有高催乳素血症的精神分裂症患者128例,随机分为利培酮组(维持利培酮治疗)和阿立哌唑(阿立哌唑替代利培酮治疗)组,治疗8周。于第0、1、2、4、6及8周测血清催乳素水平及身体质量指数(BMI);在入组时和治疗8周时采用阳性与阴性症状量表(PANSS)和临床总体印象量表(CGIS)测定疗效。结果:可用于评估的数据101例,利培酮组53例,阿立哌唑组48例。阿立哌唑组替换治疗后第1周血清催乳素水平即明显下降,第8周时,显著低于利培酮组(P<0.001);2组BMI、PANSS及CGIS评分及变化差异无统计学意义。结论:阿立哌唑替换利培酮可降低伴有高催乳素血症的精神分裂症患者的血清催乳素水平。     

奈替米星对老年患者血尿系列微量蛋白的影响

目的 :探讨奈替米星治疗后对老年患者早期肾功能的影响。方法 :测定 36例经奈替米星治疗老年患者用药前和用药后第 7天血转铁蛋白 (TRF)、β2 微球蛋白 (β2 MG)和肌酐 (Cr) ,尿微量白蛋白 (mAlb)和尿α1 微球蛋白 (α1 MG)。用药第 7天检测奈替米星血药谷、峰浓度。结果 :用药前血TRF、β2 MG、Cr,尿mAlb、尿mAlb/Cr、尿α1 MG及α1 MG/Cr分别为 (2 .5 4± 0 .2 1)g/L、(3.2 4± 1.75 )mg/L、(6 1.92± 15 .77) μmol/L、(4 1.5 8± 5 2 .4 3)mg/L、(12 .2 0± 14 .79)g/mol、(35 .2 1± 2 7.11)mg/L和 (12 .5 2± 10 .0 7)g/mol;用药后分别为 (2 .5 6± 0 .35 )g/L、(3.4 8± 1.70 )mg/L、(6 2 .5 0±17.39) μmol/L、(4 2 .86± 6 2 .10 )mg/L、(13.2 1± 14 .7)g/mol、(4 0 .71±2 8.31)mg/L和 (15 .98± 12 .4 3)g/mol。治疗后血TRF、β2 MG、Cr和尿mAlb较治疗前的差别无显著性 (P >0 .0 5 ) ;治疗后尿α1 MG、尿mAlb/Cr和尿α1 MG/Cr较治疗前升高 ,有统计学差异 (P <0 .0 5 ,<0 .0 5 ,<0 .0 1)。奈替米星血药峰、谷浓度分别为 (6 .6 9± 2 .2 7)、(0 .4 8± 0 .4 3) μg/ml。结论 :血尿系列微量蛋白可作为老年患者奈替米星治疗期早期肾毒性的标志物。     

文拉法辛缓释片联合利培酮治疗慢性精神分裂症阴性症状的对照研究

目的探讨文拉法辛缓释片联合利培酮治疗慢性精神分裂症阴性症状的效果及不良反应。方法 92例慢性精神分裂症阴性症状患者随机分为研究组(文拉法辛缓释片+利培酮)和对照组(利培酮),比较2组治疗前及治疗第2、4、8、12周末的阳性和阴性症状量表(PANSS)评分、不良反应量表(TESS)评分和不良反应。结果研究组总有效率为73.9%,高于对照组的52.2%。治疗后2组PANSS总评分均较治疗前显著下降(P0.05)。治疗后2、4、8、12周末,研究组阴性因子评分较对照组显著下降(P0.05)。2组不良反应无显著差异(P0.05)。结论文拉法辛缓释片联合利培酮治疗慢性精神分裂症阴性症状起效快、疗效好,安全性较好。     

左旋肉碱治疗急性病毒性心肌炎的临床疗效分析

目的　探讨国产左旋肉碱 (L CN)治疗急性病毒性心肌炎 (AVM )的临床疗效及血浆游离肉碱浓度 (f CN)与临床疗效的关系。方法　观察 11例用常规方法治疗 2周效果不佳的AVM患者加用国产L CN静脉滴注治疗的疗效 ,并用放射同位素酶化学法测定 30例正常人对照及患者治疗前后血浆f CN的水平变化。结果　AVM患者治疗前血浆f CN (4 3.6 3± 2 0 .4 4 ) μmol/L低于正常人 (5 5 .30± 8.5 8) μmol/L ,P <0 .0 5 ;治疗后升高至 (78.0 6± 16 .2 2 ) μmol/L ,与治疗前相比 ,有显著差异 (P <0 .0 1)。患者经L -CN治疗后临床症状、心电图ST T及心律失常均较治疗前明显改善。结论　部分AVM患者血浆f CN下降 ,体内可能有肉碱缺乏 ,外源性左旋肉碱的补充可明显改善临床症状 ,是治疗AVM的有效药物之一。     

低剂量氟哌啶醇治疗首发精神分裂症有效性的研究

目的探讨低剂量氟哌啶醇对首发精神分裂症患者疗效及神经认知功能的影响。方法将90例符合条件的首发精神分裂症患者随机分成两组,分别给予低剂量氟哌啶醇(n=45,2~6mg/d)与利培酮(n=45,2~6mg/d)治疗12w。采用阳性和阴性症状量表(PANSS)评定疗效、MATRICS成套认知功能测试(MCCB)中文版评估神经认知功能、副反应量表(TESS)评定药物副反应。结果 (1)两组治疗12w后PANSS总分及阳性量表、阴性量表、一般精神病理量表分值均较治疗前显著下降,两组间上述指标及有效率无显著性差异。(2)两组治疗12w后词语学习分值均显著升高,但组间无显著差异;利培酮组治疗后空间记忆分值显著升高,组间差异具有统计学意义。结论低剂量氟哌啶醇和常规剂量利培酮治疗首发精神分裂症临床疗效相当,小剂量氟哌啶醇能改善认知领域中词语学习、视觉学习缺陷。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.