224例老年高血压患者心理状况调查分析

目的了解社区老年高血压患者的心理状况,为实施科学的心理干预措施提供指导。方法2002年1月-2005年1月随机抽取在我院就诊的老年高血压患者224例,用Zung抑郁自评量表(SDS)进行询问和评估调查。结果老年高血压患者与普通人群SDS值的差异有统计学意义(P<0.01);不同性别、婚姻状况及家庭状况患者SDS值的差异有统计学意义(P<0.01);不同患病程度高血压患者SDS值的差异无统计学意义(P>0.05)。结论老年高血压患者抑郁状态的发生率高,医护人员应加强其心理干预。缺乏高血压防治知识、主动测血压、规律服药的患者较多,应加强此方面的健康教育。     

心理干预对慢性乙型肝炎患者家属抑郁及焦虑情绪的影响

目的：探讨心理干预对慢性乙型肝炎患者家属抑郁焦虑情绪的影响。方法选择慢性乙型肝炎患者家属68例,采用随机数字表法随机分为观察组（34例）和对照组（34例）。对照组给予常规护理健康教育,观察组在此基础上给予心理干预,家属均应用抑郁自评量表（ SDS ）及焦虑自评量表（SAS）评估干预前后的心理健康状况。结果干预前,患者家属 SDS 及 SAS评分分别为（39．81±5.34）,（34．67±4．61）分,均高于国内常模,差异有统计学意义（t值分别为9．71,8．92;P＜0．05）;干预前,两组患者家属SDS及SAS评分差异无统计学意义（ P＞0．05）;干预后,观察组患者家属SDS及SAS评分低于对照组,差异均有统计学意义（ t值分别为3．61,2．85;P＜0．05）。结论慢性乙型肝炎患者家属存在一定程度的抑郁焦虑状况,心理干预能改善患者家属的抑郁焦虑状况。     

心理护理干预对维持性血液透析患者的临床影响观察

目的：探讨心理干预对维持性血液透析患者的临床影响（透析疗效及生存质量）。方法将80例行维持性血液透析的慢性肾功能衰竭患者随机分为干预组和对照组,每组各40例。对照组采用常规护理;干预组在常规护理的基础上加强心理护理。采取Zung抑郁评定量表（Self－Rating Depression Scale,SDS）和焦虑评定量表（Self－Rating Anxiety Scale,SAS）,观察比较两组患者干预前后的心理状况。结果干预前两组SDS、SAS评分比较,差异无统计学意义（ P＞0．05）;干预后对照组SDS、SAS均高于干预组评分,差异有统计学意义（P＜0．05）;干预组干预前SDS、SAS均高于干预后评分,差异有统计学意义（P＜0．05）;对照组干预前后SDS、SAS比较,差异无统计学意义（ P＞0．05）。结论护理人员采取恰当的心理护理干预措施,可以提高维持性血液透析患者的透析疗效,提高患者的生存质量。     

强直性脊柱炎96例心理健康状况调查与心理干预

目的：探讨强直性脊柱炎患者的心理健康状况及心理干预的效果。方法：采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对96例强直性脊柱炎患者进行心理问卷调查，根据患者存在的焦虑、抑郁心理问题实施心理干预2周，再次进行SAS和SDS自评量表评分。结果：本组心理干预前SAS、SDS评分较国内常模高，两组比较有极显著性差异（P〈0．01）；干预后患者SAS、SDS评分较干预前低，两组比较有极显著性差异（P〈0．01）。结论：强直性脊柱炎患者存在明显的焦虑、抑郁心理，实施心理干预后患者焦虑、抑郁心理有明显改善。     

强直性脊柱炎96例心理健康状况调查与心理干预

目的：探讨强直性脊柱炎患者的心理健康状况及心理干预的效果。方法：采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对96例强直性脊柱炎患者进行心理问卷调查，根据患者存在的焦虑、抑郁心理问题实施心理干预2周，再次进行SAS和SDS自评量表评分。结果：本组心理干预前SAS、SDS评分较国内常模高，两组比较有极显著性差异（P〈0．01）；干预后患者SAS、SDS评分较干预前低，两组比较有极显著性差异（P〈0．01）。结论：强直性脊柱炎患者存在明显的焦虑、抑郁心理，实施心理干预后患者焦虑、抑郁心理有明显改善。     

唇腭裂患儿家长的心理状况调查与心理护理

目的：分析唇腭裂患儿家长的心理状况并探讨其心理护理方法。方法调查94例唇腭裂患儿家长的心理状况,并给予心理护理干预,探讨干预效果。结果94例患儿家长均存在不同程度心理问题,心理护理干预前自我评定抑郁量表（SDS）及自我评定焦虑量表（SAS）评分均明显高于国内常模（P＜0．01）;经心理护理干预,SDS及SAS评分均明显降低（P＜0．01）,且干预后评分与国内常模比较差异无统计学意义（P＞0．05）。结论唇腭裂患儿家长普遍存在不同程度心理问题,心理护理干预可有效改善其心理状况,对患儿积极接受治疗及健康成长均具有重要意义。     

放松训练在顽固性原发性高血压伴抑郁的老年患者治疗中的应用

目的 探讨放松训练在顽固性原发性高血压伴发抑郁心理的老年患者治疗中的应用效果，为提高原发性高血压患者的康复治疗提供更多的依据。方法 对应用药物及心理疏导干预效果欠佳的16例顽固性原发性高血压伴发抑郁的老年患者进行放松训练。应用老年抑郁量表（GDS）测评训练效果，并对血压进行监测。结果 观察到16例患者经放松训练后平均收缩压和舒张压均有下降，经统计学处理，差异有统计学意义（P〈0．01）。GDS得分干预后下降明显，人组前与干预半年后比较f=5．77，人组前与干预1年后比较t=13．05，P〈0，01，差异有统计学意义。结论放松训练不仅对原发性高血压治疗具有良好的促进作用，还能有效改善老年患者伴发的抑郁症状。     

护理干预对功能性消化不良病人抑郁焦虑心理的影响

目的 探讨护理干预对功能性消化不良病人抑郁焦虑心理的影响。方法 应用焦虑自评量表（SAS）和抑郁自评量表（SDS）评定病人情绪状况，并给予护理干预，包括功能性消化不良病人的健康宣教，娱乐疗法，给药治疗等，比较护理干预前后的评分值。结果 功能性消化不良病人存在明显的抑郁焦虑心理，与国内常模相比，有显著性差异（P＜0．01），护理干预后症状明显改善（P＜0．01）。结论 对功能性消化不良病人应实施常规的，多层次的护理干预。     

温馨护理对老年冠心病伴负性情绪的影响研究

目的：探讨老年冠心病伴焦虑抑郁的临床特点及温馨护理对其影响。方法选取老河口市第一人民医院2010年2月到2012年10月入院治疗的70例冠心病伴焦虑抑郁的患者，随机分为治疗组35例与对照组35例，治疗组在药物治疗基础上，采取关注患者心理状况的温馨护理。两组患者入院时及治疗后4周分别进行焦虑自评量表（SAS）、抑郁自评量表（SDS），比较两组患者焦虑抑郁评分结果及临床疗效。结果治疗组与对照组入院时首次 SAS 、SDS 评分差异无统计学意义（P＞0．05）。经过4周治疗，治疗组 SAS 、SDS 评分明显低于对照组，差异有统计学意义（P＜0．05）；治疗组疗效明显优于对照组，差异有统计学意义（P＜0．05）。结论对老年冠心病伴焦虑抑郁的患者采取针对其临床特点的温馨护理，关注其心理状况变化较单纯的药物治疗疗效明显，能够很好地提高患者生存质量，具有临床应用价值。     

心理干预在老年下肢骨折患者围术期中的护理效果分析

目的：对心理干预在老年下肢骨折患者围术期中的护理效果进行分析。方法选取2013年1～12月我院收治的老年下肢骨折病人60例为研究对象,入选患者按照住院单双号分为试验组和对照组各30例,对照组行常规护理,试验组患者在对照组患者的基础上加用心理护理干预。结果两组患者干预前的SAS、SDS评分差异无统计学意义（ P＞0．05）;两组干预后的SAS、SDS评分差异有统计学意义（P＜0．05）;试验组患者自评焦虑、抑郁得分均低于对照组,差异有统计学意义（P＜0．05）;两组患者干预前的HAMA、HAMD评分差异无统计学意义（P＞0．05）;两组干预后的HAMA、HAMD评分差异有统计学意义;护理人员对试验组患者焦虑、抑郁状态的评分均低于对照组,两组患者干预后对治疗依从性和对护理工作满意度的比较差异有统计学意义,试验组患者的治疗依从性和对护理工作的满意度显著高于对照组,差异有统计学意义（ P＜0．05）。结论对老年下肢骨折病人实施围术期心理护理干预,可以显著改善患者的不良心理,提高其治疗依从性及对护理工作的满意度,具有重要临床推广意义。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.