临床专业与护理专业本科生心理状况调查分析

目的 研究临床与护理2个专业的本科生抑郁、焦虑症状的发生情况及与其相关的心理社会因素.方法 采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和自制调查问卷,对245例大学生进行测评.结果 此次调查的医学生抑郁发生率为38.78%,临床组抑郁评分平均值(0.47±0.10)分,护理组平均值(0.46±0.08)分;焦虑发生率为14.7%,临床组焦虑评分平均值(39.97±10.70)分,护理组平均值(40.14±8.76)分.2组抑郁、焦虑发生情况无显著性差异(P＞0.05).在心理社会因素中,就业压力与抑郁、焦虑情绪状况有高度相关性(P＜0.05).结论 此次调查的医学生心理健康状况整体水平处于正常范围,部分学生存在心理问题.护理专业与临床专业同样面临心理压力.     

心理护理干预对初治青少年及年轻成人急性白血病患者心理状况的影响

目的 探讨心理护理干预对初治青少年及年轻成人急性白血病患者心理状况的影响.方法 观察初治青少年及年轻成人急性白血病患者SCL-90症状自评量表特征,比较常规护理及心理护理前后汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分.结果 2组入院时一般特征及SCL- 90症状自评量表特征比较差异无统计学意义,入院时2组患者SCL- 90抑郁、焦虑因子分分别为(2.33±0.33),(2.23±0.33),(2.41±0.83),(2.61±0.73)分;心理护理干预可明显改善HAMA、HAMD评分;而常规护理对患者HAMA、HAMD评分无显著影响.结论 初治青少年及年轻成人急性白血病患者常伴有抑郁、焦虑表现,心理护理干预能明显改善患者的抑郁、焦虑状况.     

护理专业本科生焦虑抑郁状况及其与睡眠质量的关系

目的调查护理专业本科生的焦虑抑郁状况以及其与睡眠质量的关系,为改善护理专业本科生焦虑抑郁状况、提高睡眠质量提供依据。方法采用整群抽样的方法从某本科医学院校护理学院抽取150人作为研究对象。以焦虑自评量表(self anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)及阿森斯失眠量表(athens insomnia scale,AIS)为评价工具,调查其焦虑抑郁状况的发生情况以及睡眠质量。采用SPSS 19.0统计软件进行数据分析。结果护理本科生的焦虑、抑郁症状的发生率分别为16.11%和20.13%,SAS、SDS总分分别为(41.32±7.94)和(44.70±9.94)分,评分显著升高,与常模比较差异有统计学意义(P0.01);护理本科生AIS总分为(9.78±4.77)分,其中89.9%的学生存在睡眠问题,80.5%的学生存在失眠状况;相关分析表明,SAS、SDS总分与AIS总分呈显著正相关性(P0.01)。结论需要调控护理专业本科生的焦虑抑郁情绪,加强心理疏导,及时查找原因,增加体育锻炼,消除影响其睡眠质量的因素,以促进护理专业本科生身心的全面发展。     

唐山地区护理专业实践环境现状及与护士心理健康状况的关系

[目的]了解唐山地区护理专业实践环境现状及其与护士心理健康状况的关系。[方法]采用护理工作环境量表(PES)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对唐山市7所三级医院2 158名临床护士进行调查。[结果]PES总分为(84.05±6.89)分,总均分为(2.52±0.35)分,SAS评分为(40.20±13.74)分,SDS评分为(44.34±10.37)分;PES总分及各维度得分与护士SAS、SDS评分呈负相关。[结论]护理工作环境与护士焦虑、抑郁水平关系密切,医院应采取有效措施改善临床护士的工作环境,提高护士心理健康水平。     

个性化心理干预计划表对妇科住院患者焦虑、抑郁的影响

目的：探讨个性化心理干预计划表对妇科住院产后抑郁患者焦虑、抑郁的影响。方法将57例妇科住院产后抑郁的患者随机分为实验组和对照组,对照组给予常规护理,实验组患者采用个性化心理干预计划表进行护理干预。对比分析两组患者护理效果。结果实验组护理后焦虑自评量表评分(8.39±1.62)分、抑郁自评量表评分(9.50±1.43)分明显低于对照组患者﹝(21.40±2.58)分、(23.41±3.38)分﹞,两组差异有统计学意义( P<0.05)。结论个体化心理干预计划表在产后抑郁症患者临床护理中的应用,可降低SAS评分与SDS评分,改善患者的心理状况。     

优质护理干预对宫外孕手术患者心理状况的影响

目的探讨优质护理干预对宫外孕手术患者心理状况的影响。方法在2014年6月~2015年5月本科收治行宫外孕手术患者中随机选择100例做为护理干预对象,并根据患者入院顺序分为观察组和对照组,每组50例。观察组术前与术后均采取宫外孕相关知识教育与健康信念为模式的优质护理干预措施,而对照组只给予常规护理。采用抑郁自评量表(SDS)和焦虑自评量表(SAS)对两组心理状况进行调查和评估分析,比较护理干预前后两组心理状况改变情况。结果两组均存有不同焦虑和抑郁等不良心理,其中高学历宫外孕患者焦虑和抑郁心理显著高于低学历患者,未婚患者焦虑和抑郁心理高于已婚患者,城市和农村患者的焦虑和抑郁心理比较无差异性。经采取不同护理干预后,观察组焦虑和抑郁情绪显著低于对照组,即观察组SDS评分(49.32±8.24)分,SAS评分(41.51±9.10)分;而干预后的对照组与干预前评分无显著性差异,即SDS评分(57.41±8.54)分,SAS评分为(62.23±8.17)分;两组干预后比较差异有统计学意义(P0.05)。结论通过对宫外孕患者进行相关知识教育与健康信念等优质护理干预后,可见患者对本病的认知度明显提高,焦虑和抑郁情绪等得到显著减轻和改善。     

妊娠丢失与非意愿妊娠患者人工流产术前心理和社会支持状况的调查分析

目的了解妊娠丢失与非意愿妊娠患者行人工流产术前的心理和社会支持情况,为妊娠丢失患者临床护理方案的设计提供依据。方法采用便利取样法,对82例妊娠丢失患者和84例非意愿妊娠患者在行人工流产术前进行焦虑自评量表、抑郁自评量表和社会支持评定量表测评。结果妊娠丢失组患者的焦虑自评量表评分(50.34±8.66)分、抑郁自评量表评分(60.68±4.96)分,非意愿妊娠组患者的焦虑自评量表评分(47.26±5.42)分、抑郁自评量表评分(55.93±7.17)分,比较差异均有统计学意义;两组患者社会支持评定量表评分相近,比较差异无统计学意义。结论妊娠丢失患者的焦虑和抑郁水平明显高于非意愿妊娠患者,但并未获得更多的社会支持。     

酒精戒断综合征患者综合护理干预的对照研究

目的 探讨临床综合护理干预对酒精戒断综合征患者的临床疗效.方法 将60例酒精戒断性震颤谵妄患者随机分成综合护理干预组(研究组)和一般护理干预组(对照组),每组各30例.研究组在药物治疗的基础上配合一般性护理、心理护理、认知行为矫正、健康教育等措施;对照组只在药物治疗的基础上给予一般性护理措施.采用酒精戒断综合征评定量表、抑郁自评量表(SDS)、焦虑自评量表(SAS)、临床疗效总评量表(CGI)评定其疗效.结果 研究组戒断综合征评定量表和临床疗效总评量表(CGI)在治疗后第14天评分分别为(2.56±0.70),(3.10±0.20)分,对照组为(8.56±1.05),(4.10±0.20)分;抑郁自评量表(SDS)、焦虑自评量表(SAS)第14天的评分与对照组相比,均有统计学意义(P<0.01).结论 在药物治疗的基础上合并综合护理干预措施有助于提高酒精戒断综合征患者的疗效,巩固其康复效果.     

不稳定型心绞痛高龄患者负性心理调查及护理

目的 探讨不稳定型心绞痛(UA)患者的心理状况,为临床心理康复提供客观依据.方法 采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和A型行为问卷,对63例住院不稳定型心绞痛患者进行调查.结果 不稳定型心绞痛患者SAS标准分＞38分46例,焦虑发生率37％;SDS标准分≥43分28例,抑郁发生率43％;A型行为评分...     

胎儿异常引产孕产妇焦虑及抑郁心理干预的效果研究

目的目的研究心理干预对胎儿异常引产孕产妇焦虑及抑郁的干预效果。方法采用便利抽样法,选取2017年1～12月四川某三甲医院收治的144因胎儿异常引产孕产妇作为研究对象,采用抑郁自评量表、焦虑自评量表调查胎儿异常引产孕产妇焦虑及抑郁得分情况,并研究心理干预效果。结果胎儿异常引产孕产妇焦虑得分(44. 67±6. 09)分,抑郁得分为(50. 27±4. 28)分,焦虑发生率24. 30%(35/144),抑郁发生率49. 30%(71/144);干预后观察组焦虑评分下降为(23. 46±4. 03)分,抑郁评分下降为(28. 16±4. 28),差异有统计学意义(P 0. 01)。结论心理干预能有效降低胎儿异常引产孕产妇焦虑及抑郁水平。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

VEGF和NSE在良恶性嗜铬细胞瘤中的表达及意义

目的探讨肿瘤标志物血管内皮生长因子（VEGF）和神经元特异性烯醇化酶（NSE）在良、恶性嗜铬细胞瘤组织中的表达,分析其可能的临床价值及病理学意义,为临床鉴别良、恶性嗜铬细胞瘤提供辅助依据。方法应用免疫组化（SP法）检测16例恶性嗜铬细胞瘤、18例良性嗜铬细胞瘤及17例正常肾上腺髓质组织中细胞因子VEGF和NSE表达情况,显微镜下判断组织切片的染色结果。结果①恶性嗜铬细胞瘤VEGF表达明显强于正常肾上腺髓质和良性嗜铬细胞瘤（P〈0.01）。良性肿瘤和正常肾上腺髓质的VEGF表达差异无统计学意义（P〉0.05）。恶性嗜铬细胞瘤强阳性率明显高于良性嗜铬细胞瘤（P〈0.01）。②良、恶性嗜铬细胞瘤NSE表达差异有统计学意义（P〈0.05）,良性嗜铬细胞瘤NSE的表达高于正常肾上腺髓质的NSE表达（P〈0.05）。恶性嗜铬细胞瘤强阳性率高于良性嗜铬细胞瘤（P〈0.05）。③VEGF和NSE共同阳性表达在良、恶性嗜铬细胞瘤之间差异有统计学意义（P=〈0.01）。结论临床上检测VEGF和NSE可能为鉴别良、恶性嗜铬细胞瘤提供辅助依据,共同检测VEGF和NSE可能提高良、恶性嗜铬细胞瘤鉴别的敏感性。