接受体外受精-胚胎移植者不同阶段的心理健康分析

背景：随着体外受精-胚胎移植技术迅速发展,体外受精-胚胎移植患者心理压力不断增加,全面了解其心理特点,探索有效的心理干预模式,是生殖医学工作者面临的重要问题。目的：调查体外受精-胚胎移植患者心理健康状况。方法：选取2012年10至11月进入周期的体外受精-胚胎移植患者92名,采用症状自评量表（SCL-90）对患者心理健康状况进行调查。结果与结论：体外受精-胚胎移植患者进入周期首日症状自评量表中除精神病性因子外其他8个因子评分均高于国内常模（P ＜0.05）。体外受精-胚胎移植患者在进入周期首日、取卵日、胚胎移植后第7日3个阶段的症状自评量表评分中,除精神病性因子之外其他8个因子在治疗不同阶段评分差异有显著性意义（P＜0.05）,且人际关系、抑郁、焦虑3个因子评分在进入周期首日、取卵日、胚胎移植后第7日依次升高（P ＜0.05）。提示体外受精-胚胎移植患者心理状况普遍较差,且在试管助孕的过程中,心理健康问题始终困扰着患者,并在取卵、等待妊娠结果的过程中呈加重的趋势,应根据不同治疗阶段针对性的采取干预措施,改善患者的心理健康。     

原发性不孕症行体外授精-胚胎移植妇女心理状况的调查

目的探讨原发性不孕症行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)妇女的心理状况,以期为制订针对性的干预措施提供参考。方法 2015年5-8月,采用便利抽样法,选择在长沙市内大型生殖与遗传专科医院生殖中心准备行IVF-ET的381例原发性不孕症妇女为研究对象,采用一般资料调查表及症状自评量表(symptom check list 90,SCL-90)对其进行调查。结果原发性不孕症妇女的SCL-90量表的总分为(125.56±35.43)分,低于全国女性常模(P0.05),其中人际关系、抑郁、偏执3个因子的得分均低于全国女性常模(均P0.05);而阳性项目数及躯体化、强迫、焦虑、敌对性、恐怖、精神病性等因子的得分与全国女性常模比较,差异均无统计学意义(均P0.05);影响原发性不孕症妇女心理状态的主要因素为夫妻关系、职业状态、疾病经验。结论护理人员应针对原发性不孕症行IVF-ET妇女的心理状况积极采取干预措施,帮助患者积极面对治疗,促进患者尽快康复。     

IVF—ET妇女治疗过程中的心理反应和家庭社会支持的相关性研究

目的探讨不孕症采用自然周期行体外受精和胚胎移植（IVF—ET）治疗过程中妇女的心理反应及家庭、社会支持状况，分析产生心理反应的影响因素，为临床医护人员对IVF—ET妇女进行心理支持提供依据。方法使用症状自评量表（SCL-90）和社会支持量表进行取样问卷调查。结果IVF—ET治疗妇女家庭功能普遍较好，心理反应除精神病性因子外，其他各因子得分与常模比较有显著性差异，且与家庭功能显著呈负相关性，社会支持与常模比较有显著性差异（P〈0．05，P〈0．01）。结论关注IVF—ET治疗过程中妇女的心理反应，采取正确方式加强其家庭功能。同时，医务人员应在已婚妇女中及时普及生育保健知识。     

心理干预对2型糖尿病患者心理健康状况的影响

目的探讨心理干预对2型糖尿病患者心理健康状况的影响,为临床干预提供理论依据。方法对122例2型糖尿病患者采用症状自评量表进行评定,根据评定结果予以有针对性的心理干预,观察6个月。于心理干预6个月末再次采用症状自评量表进行评定,并与全国成人常模进行对比分析。结果2型糖尿病患者心理干预前症状自评量表总分、总均分及躯体化、抑郁、焦虑、恐怖因子分均显著高于全国成人常模（P〈0.05或0．01）;心理干预后症状自评量表总分及躯体化、抑郁、恐怖因子分均显著低于心理干预前（P〈0．01）,但总分及抑郁、焦虑因子分仍显著高于全国成人常模（P〈0.05）。结论2型糖尿病患者存在有不同程度的心理问题,焦虑抑郁问题尤为显著,心理干预能明显改善患者的心理健康状况,对促进患者的康复具有重要意义。     

心理干预对乙型肝炎患者配偶生活质量影响的研究

目的 探讨心理干预对乙型肝炎患者配偶生活质量的影响.方法 对68例乙型肝炎患者的配偶进行心理干预,并应用症状自评量表（SCL-90）和生活质量综合评定问卷对乙型肝炎患者配偶进行调查.结果 心理干预前乙型肝炎患者配偶SCL-90得分及躯体化、强迫、人际关系、抑郁、焦虑、敌对和恐怖7项因子分均高于国内常模;心理干预后乙型肝炎患者配偶各因子分（除抑郁外）与国内常模比较,差异无统计学意义;心理干预前从事医疗工作的患者配偶的强迫、人际关系因子分高于从事非医疗工作的患者配偶.患者配偶中女性躯体化、抑郁、焦虑、人际关系4项因子分均高于男性;心理干预后生活质量综合评定问卷总体评价维度得分高于心理干预前.结论 对乙型肝炎患者的配偶及时给予心理干预可明显提高其生活质量.     

女性精神分裂症患者家属心理状况与心理干预

目的探讨首发女性精神分裂症患者家属的心理状况及心理干预的效果。方法将141例首发女性精神分裂症患者的156名家属随机分为心理干预组和非心理干预组各78例,分别在患者入院时和出院时采用症状自评量表进行评定。结果研究组及对照组在其患者入院时症状自评量表评定结果与国内常模比较,各因子差异均有显著性（P〈0.05或0.01）;两组家属在其患者出院时症状自评量表评分与入院时症状自评量表减分率差异均有显著性（P〈0.05或0.01）。两组家属出院时症状自评量表评分与常模比较,有显著差异的因子数研究组少于对照组。结论首发精神分裂症患者家属的心理负担较重,应进行心理干预。     

正念减压疗法对体外受精—胚胎移植失败患者心理弹性及正念注意觉知的影响

目的探讨正念减压疗法对体外受精—胚胎移植失败患者心理弹性及正念注意觉知的影响。方法采用方便抽样方法,选取2018年9月—2019年1月吉林大学第一医院生殖妇科住院的既往有移植失败史的体外受精—胚胎移植患者作为研究对象,接受8周正念减压疗法治疗,分别于干预前、干预后1周末及干预后3个月末采用心理弹性量表及正念注意觉知量表评估干预效果。结果共有48例患者完成测评,干预后1周末、干预后3个月末,本组体外受精—胚胎移植失败患者心理弹性总分及正念注意觉知总分均高于干预前(P0.001)。结论对体外受精-胚胎移植失败患者实施正念减压疗法,可提高其心理弹性及正念注意觉知水平。     

精神科护士心理健康状况分析与应对

目的:了解精神科护士心理健康状况,为精神科护士的心理调适提供合理化建议,提高精神科护理工作质量。方法:采用症状自评量表对我院90名护理人员进行问卷调查,所得结果与全国常模比较。结果:在量表的9个因子中,除了躯体化外其它因子均高于全国常模,尤以强迫症状、人际关系敏感、恐怖三项得分明显高于全国常模。精神科护士症状自评量表得分与全国常模比较有高度显著性差异(P<0.01)。结论:精神科护士在不同程度上存在一定的心理问题,她们的心理健康状况不容忽视,应给予良好的社会支持,加强心理健康教育。精神科护士自己也应学会心理健康的自我维护,使自己具备良好的心理素质,为精神科临床提供高质量的护理服务。     

儿童精神科病房陪伴家属的心理健康状况调查及干预

目的：了解住院精神疾病患儿陪伴家属的心理健康状况。方法：选取56例儿童精神科疾病住院患儿的陪伴家属为观察对象。采用SCL-90症状自评量表。于心理干预前、后两次对该群体进行测查,将测查后获得的两组数据分别与全国常模进行对比。结果：心理干预前,精神疾病患儿陪伴家属的SCL-90测评,其人际关系、恐怖两个因子得分显著高于全国常模（P〈0.01）,其躯体化、抑郁、焦虑3个因子得分高于全国常模（P〈0.05）,心理干预后,除人际关系得分高于全国常模（P〈0.05）外,其余各项因子得分接近于全国常模,（P﹥0.05）。结论：采取恰当的心理干预措施,可以解决家属诸多的心理问题,取得良好的临床效果。     

慢性重症肝炎50例心理状况调查及护理干预

目的:探讨慢性重症肝炎患者的心理状况及护理方法.方法:采用症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对50例慢性重症肝炎患者进行测评,对心理问题突出者给予相应的护理干预,干预后再次进行评定,将干预前的测评结果分别同全国常模、护理干预后的测评结果进行比较.结果:慢性重症肝炎患者干预前SCL-90、SAS、SDS得分均高于全国常模,具有非常显著性差异(P＜0.01);干预前后得分比较差异具有非常显著性(P＜0.01).结论:慢性重症肝炎患者普遍存在心理问题,及时有效的护理干预能改善其心理状况.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.