儿童神经性厌食症心理行为疗法的护理

心理行为疗法是治疗神经性厌食症特别是儿童神经性厌食症的较好方法之一。本文就我院精神科 1 990年 5月～1 999年 6月住院治疗的 1 2例神经性厌食症患儿 ,运用心理行为治疗均收到好的效果 ,现将护理体会报告如下。1　临床资料1 1　一般资料 :男性 2例 ,女性 1 0例。年龄 1 2～ 1 4岁。1 2例均有自尊心强 ,爱美偏食 ,固执胆怯 ,灵活性差及自我中心等个性特点。 1 2例均无躯体病及脑外伤病史。1 2　临床特点 :(1 )节食心理 :1 2例患儿皆有追求线条美 ,因怕胖而节食、拒食等发病心理因素 ;(2 )进食情况 :1 2例患儿主食每天限制在 0～ 1 5 0 …     

青少年神经性厌食症1例

神经性厌食症(anorexia nervosa,AN)是以恐惧发胖、严格限制进食、体重明显下降至低于正常标准或严重营养不良的进食障碍,女性终身患病率为0.5%～1%,男性为女性的1/10。AN与心理和社会文化因素密切相关,治疗相当困难,单用药物治疗作用有限且容易复发,成功的治疗往往需要早期干预,并在药物的基础上综合多种心理治疗。报告1例采用药物联合多种心理疗法综合治疗神经性厌食症的病例。     

1例神经性厌食合并重度营养不良的护理

神经性厌食症（AN）是患者自己有意地严格限制进食,造成身体的极度消瘦或营养不良,体重下降至明显低于正常标准,并有青春期发育停止、闭经,器官萎缩,功能障碍,衰竭而死亡。此时患者仍恐惧发胖或拒绝正常进食。患者害怕发胖和对体型对体重歪曲的认识与期望是神经性厌食症的重要心理病理特征。我院于2008年8月成功抢救了1例神经性厌食合并重度营养不良的患者,现报道如下。     

进食障碍与心理障碍

进食障碍（Eating Disorder,ED）与心理障碍的关系是当前的研究热点。临床现象显示,心理因素与进食障碍的临床现象常相互交织并相互作用。进食障碍以严重异常的进食行为为特征,主要包括了神经性厌食症（Anorexia Nervosa,AN）和神经性贪食症（Bulimia Nervosa,BN）两大综合征。害怕发胖和对体型对体重歪曲的认识与期望是神经性厌食症和神经性贪食症共同的重要心理病理特征。     

儿童神经性厌食症社区干预的综合分析

目的：研究儿童神经性厌食症的病因及其综合治疗方案。方法：抽样举例对患儿基本情况进行的临床分析,并作对比。结果：儿童神经性厌食症对儿童的影响极为强烈,心理因素为主要病因表现,通过适当的心理干预可以很好地减缓患儿的临床表现。结论：要转变儿童的进食情况,就需从家庭、社会、医院三方面着手,将心理治疗和药物、针灸治疗结合到一起。     

1例儿童神经性厌食症的护理

神经性厌食症是一种与行为、心理紊乱有关的心身疾病，表现为患者自己有意地严格控制进食，造成身体的极度消瘦或严重的营养不良，体重下降至明显低于正常标准，并有青春期发育停滞、闭经等症状。近年的研究证实。儿童神经性厌食症已日渐增多。是儿童心理卫生领域应广泛关注的问题。我院消化内科收治了1例儿童神经性厌食症患者，通过细致的心理护理及合理的营养支持，取得了较好的疗效。现报告如下：     

进食障碍与心理障碍

进食障碍（Eating Disorder，ED）与心理障碍的关系是当前的研究热点。临床现象显示，心理因素与进食障碍的临床现象常相互交织并相互作用。进食障碍以严重异常的进食行为为特征，主要包括了神经性厌食症（Anorexia Nervosa，AN）和神经性贪食症（Bulimia Nervosa，BN）两大综合征。害怕发胖和对体型对体重歪曲的认识与期望是神经性厌食症和神经性贪食症共同的重要心理病理特征。     

校内医护对神经性厌食症患者心理护理干预的治疗效果研究

目的:对12例神经性厌食症患者进行心理护理干预的结果进行分析与探讨。方法:对我校2012年1月至2013年3月的12例神经性厌食症患者的临床资料进行统计分析,运用明尼苏达多相个性调查方法来对实验前后患者进行评分。比较校内医护心理护理干预前后患者的治疗恢复情况。结果:对临床资料进行统计发现,校内医护心理护理干预之后患者的各项指标都较之前有好转,体重指数较之前提高19%,有显著性差异。结论:校内医护对神经性厌食症患者心理护理干预治疗明显,而且复发率较低,值得在临床上进一步推广。     

立体定向功能神经外科治疗神经性厌食症——从现在到未来

目的研究立体定向功能神经外科治疗神经性厌食症的可行性与未来发展方向。方法以近期国外回顾性的长期随访研究、影像学研究与功能神经外科治疗神经性厌食的随访研究文献为主,进行系统分析立体定向功能神经外科在治疗神经性厌食的结果。结果立体定向功能神经外科是治疗神经性厌食症的有价值治疗方案,特别是针对难治型及具有生命危险的严重神经性厌食症患者。然而,术后的跟进精神治疗（包括药物及心理-行为）的重要性绝对不低于手术本身的意义。仍有许多问题有待进一步阐明,如神经性厌食症的病理与功能神经外科治疗精神病的机制。结论作为神经性厌食症的治疗方案,立体定向神经外科手术在近年得到了国内外功能神经外科及精神科的重视。随着脑内环路及神经性厌食症发病机制的进一步阐明,功能神经外科在治疗神经性厌食症的临床疗效及安全性将获得进一步提升。     

神经性厌食症的营养支持及心理护理

神经性厌食症是指病人有意地严格限制进食,造成身体的极度消瘦或严重的营养不良,体重下降至明显低于正常标准,并有青春期发育停滞、闭经等症状,此时仍恐惧发胖或拒绝正常进食为主要特征的一种进食障碍.神经性厌食症主要发生于青少年女性,近几年有上升的趋势.此病可对患者的身心健康造成破坏性的影响.故重视患者的营养支持和心理护理,对疾病的康复有重要的意义.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.