慢性精神分裂症男性患者吸烟原因分析及对策

目的分析维持男性精神分裂症患者吸烟行为的原因,为制订护理对策提供依据。方法收集慢性精神分裂症男性吸烟患者188例,采用阳性和阴性症状量表评定患者的临床精神病理症状;尼古丁依赖量表评定患者烟草的依赖程度;吸烟原因问卷评估患者吸烟的原因。结果慢性精神分裂症男性吸烟患者吸烟原因问卷中社会心理维度的享乐分量表得分最高,中位数为6分;其次是药理维度的刺激分量表得分,中位数为4分;尼古丁依赖总分与阴性症状分量表得分呈负相关(r=-0.166,P=0.026),与患者目前服用的抗精神病药物剂量(氯丙嗪当量)呈正相关(r=0.221,P=0.003)。结论对精神分裂症患者吸烟行为的干预不宜采取强制突然中断的方式;结合工娱治疗等正性情绪强化措施,采取缓慢、有步骤的控烟措施更可行。     

精神分裂症与吸烟行为的关系

目的:临床中发现,精神分裂症患者与普通人群相比,具有更高的吸烟率,对尼古丁的依赖程度也更大。本文就精神分裂症与吸烟行为的研究进展作一综述。资料来源:应用计算机检索HighWire Press 1844/2006有关精神分裂症和吸烟相关的论文,检索词为“schizophrenia,smoking”,限定语言种类为英文。同时检索维普数据库1989/2006有关文献,检索词为“精神分裂症,吸烟”,并限定语言种类为中文。资料选择:纳入标准:选择探讨吸烟与精神分裂症之间的关系及相关影响因素或内在机制的文章。排除标准:排除综述类文献。资料提炼:对资料进行初审,并查看引文。共收集到30篇符合以上要求的文献,涉及精神分裂症患者的吸烟情况调查、尼古丁依赖情况、吸烟对精神分裂症的影响及精神分裂症患者高吸烟率发生的机制等方面。资料综合:精神分裂症与吸烟行为的某些性状之间存在相关性。精神分裂症患者的吸烟年龄早于其发病年龄,患病不会使他们的吸烟行为发生,只会使其吸烟性状加重。并且吸烟对精神分裂症的阴性症状、阳性症状以及认知功能都有影响,比较一致的结论是吸烟可以缓解精神分裂症患者认知功能的损害。但吸烟也会降低抗精神病药物的血药浓度,且突然中断吸烟可能诱发或加重某些药物副反应。吸烟行为可能作为精神分裂症发病的一个危险因素,其相对危险度尚无肯定结论。结论:吸烟行为和精神分裂症患者的发病及症状之间相互影响,并可能作为精神分裂症的内表型之一存在。其内在的作用机制尚不明确,尼古丁受体基因的研究可能是一个突破口,有待进一步的研究证实。     

高频重复经颅磁刺激干预精神分裂症患者吸烟有效性研究

目的研究高频重复经颅磁刺激(rTMS)减少精神分裂症患者吸烟量及尼古丁渴求的有效性。方法本研究为随机双盲安慰剂对照试验,将60名符合入组条件的受试者随机分配至rTMS刺激组及rTMS伪刺激组各30例,研究组使用rTMS治疗(10Hz刺激左侧前额叶背外侧皮质、110%运动阈值、10s/串、间歇30s、20串/d),对照组使用伪rTMS设备干预,两组均每周治疗5次,为期3周,并随访至第6周。采用受试者自我报告的方式获悉每日吸烟数量、烟草依赖自评量表评估尼古丁渴求,使用阳性阴性症状量表(PANSS)、蒙哥马利抑郁量表(MADRS)和卡尔加里精神分裂症抑郁量表(CDSS)评定患者阴性抑郁症状。结果 (1)治疗3周末及随访期可观察到rTMS刺激组吸烟量及烟草依赖自评量表评分明显降低,与伪刺激组对比具有统计学差异(P0.01)。(2)阴性、抑郁症状变化和吸烟量改变之间未发现明显关联。结论刺激左侧前额叶背外侧皮质的高频rTMS可以减少精神分裂症患者的吸烟量及尼古丁渴求。     

精神分裂症有自杀行为患者的特点调查分析与护理对策

目的 了解精神分裂症有自杀行为患者的特点和临床特征,以便更好掌握这些高危因素,及时观察自杀先兆,防止自杀行为的发生。方法 用自设一般资料问卷,并检测阳性和阴性症状量表（PANSS）,锥体外系症状评定量表（SAES）,和异常不自主运动量表（AIMS）,吸烟严重程度采用问卷调查和尼古丁依赖测试评估（FTND）,并通过与家属和患者访谈,查阅病例资料,对我院住院的341名精神分裂症患者进行调查。结果 有自杀行为者发生率为9.7%,其中,男性为10.1%（24/238）,女性为8.7%（9/103）,男女之间比较,无统计学意义（P〉0.05）。与无自杀行为者相比,有自杀行为者单身人数较多、年龄较轻和住院次数较多（P〈0.05）。虽然有自杀行为者与无自杀行为者吸烟率比较差异无统计学意义（P〉0.05）,但有自杀行为者开始吸烟年龄早、每天吸烟量较多、尼古丁依赖FTND总分较高（P〈0.05）。另外有自杀行为者PANSS抑郁因子高于无自杀行为者（P=0.01）,差异有统计学意义。多元逐步Logistic回归分析显示,抑郁因子与自杀行为呈显著相关。结论 精神分裂症有自杀行为患者比一般人群高。护士应掌握这些人口学特点和临床特征,以便防止自杀行为的发生。     

吸烟行为对男性精神分裂症患者临床结局的影响

目的分析吸烟对慢性精神分裂症男性患者疾病状况的影响,探讨住院慢性精神分裂症患者吸烟行为的管理策略。方法收集长期住院的慢性精神分裂症男性患者99例,其中吸烟53例,不吸烟46例。采用阳性和阴性症状量表(Positiveand Negative Symptoms Scale,PANSS)、住院患者护士观察量表(Nurses Observation Scale for In-patient Evaluation,NOSIE)评价患者精神及日常状况。结果精神分裂症吸烟患者在PANSS总分、阴性症状分量表分,NOSIE精神病、迟缓、总消极因子分显著低于非吸烟患者(P0.05),吸烟患者NOSIE社会能力、社会兴趣、总积极因子分及总分显著高于非吸烟患者(P0.05);相关分析未发现吸烟量与PANSS、NOSIE各评分存在显著相关(P0.05)。结论吸烟可能对慢性精神分裂症患者具有自我治疗作用,对住院患者吸烟行为采取"疏导式管理"可能对患者的康复更有益。     

郊区吸烟者的吸烟现状及戒烟意愿调查

目的调查郊区吸烟者的吸烟现状与戒烟意愿,从而为医务人员有针对性地为郊区吸烟者开展戒烟干预提供依据。方法选择北京市郊区某综合性医院门诊的228例成年吸烟者,以匿名方式进行尼古丁依赖量表问卷调查。结果在228例现在吸烟者中,男性占81.58%,文化程度在高中及以下者占77.63%,合并慢性疾病者占58.77%,烟龄中位数达20年,每日吸烟者占94.30%,每日吸烟量中位数为18.32支,尼古丁依赖程度较重(中度及以上者占56.59%),从未尝试过戒烟者占71.05%;尼古丁依赖评分与年龄、每月买烟费用、总烟龄、每日吸烟量呈正相关(P0.05),与文化程度呈负相关(P0.05),居住在周边农村及山区的吸烟者尼古丁依赖评分明显高于居住在县城的吸烟者(P0.05),合并慢性疾病的吸烟者尼古丁依赖评分显著高于未合并慢性疾病的吸烟者(P0.05),每日吸烟者的尼古丁依赖评分显著高于偶尔吸烟者(P0.05)。医疗付费方式(自费)、总烟龄长、吸第一支烟年龄早是影响戒烟意愿的阻碍因素。结论北京市郊区吸烟者存在吸烟行为居高不下、戒烟意愿低的严峻现状,应当全面实施戒烟干预,尤其应注意增强医疗付费方式为自费、总烟龄长、吸第一支烟年龄早的吸烟人群的戒烟动机。     

脑卒中吸烟患者尼古丁依赖现状及影响因素分析

目的 调查脑卒中吸烟患者的尼古丁依赖现状,明确脑卒中吸烟患者尼古丁依赖的相关因素。方法 选取2020年12月—2021年3月在天津市脑系专科医院的神经科入住的207例脑卒中患者进行问卷调查,使用一般资料调查表、吸烟情况调查表、尼古丁依赖评估量表和拒烟自我效能量表进行调查。采用多元线性回归分析脑卒中吸烟患者尼古丁依赖的相关因素。结果 脑卒中吸烟患者尼古丁依赖总体得分为（4.90±2.40）分。不同年龄、文化程度、家庭月收、平均每日吸烟量、吸烟年数、吸烟态度、家庭吸烟规定、工作吸烟规定、每周接触二手烟的时长、有无戒烟意愿和拒烟自我效能总分的脑卒中患者尼古丁依赖差异有统计学差异（P<0.05）。多元线性回归分析显示,平均每日吸烟量、家庭吸烟规定、每周接触二手烟的时长和拒烟自我效能总分是尼古丁依赖的影响因素,可解释尼古丁依赖水平62.9%的变异量。结论 神经科脑卒中吸烟患者尼古丁依赖处于中等水平,医护人员对吸烟患者多加关注与劝诫,鼓励患者减少每日吸烟的数量和接触二手烟的时长,同时提高患者的拒烟自我效能水平;家庭内部应加强对吸烟的规定与限制,鼓励家庭成员对其劝阻与监督可降低其对于尼古丁的依...     

精神分裂症患者的吸烟情况调查

目的了解重庆市汉族部分精神分裂症患者的吸烟情况。方法应用自制吸烟问卷、耐受问卷修订版（RTQ）,对精神分裂症患者的一般人口学资料和吸烟行为特点等进行系统评定。结果精神分裂症女性患者吸烟率为5．1％,男性57．8％,重度尼古丁依赖者占35．8％;首发与复发的患者吸烟率差异无统计学意义,而复发患者的RTQ分值较首发者高（P〈0．05）。结论首发和复发患者吸烟率差异无统计学意义,但后者的尼古丁依赖程度更高。     

男性精神分裂症患者冲动行为现状及影响因素分析

目的 了解男性精神分裂症患者冲动行为的现状并探讨其影响因素.方法 采用便利抽样法,抽取安徽省芜湖市第四人民医院2015年6月—2016年6月268例男性精神分裂症住院患者作为研究对象.采用一般资料问卷、住院患者护士观察量表、阳性与阴性症状量表、巴瑞特冲动性量表及社会支持评定量表进行调查.采用多元逐步回归分析患者冲动行为的影响因素.结果 268例患者中210例有冲动行为,占78.4%.多元逐步回归分析结果显示:固定职业、阳性症状、客观支持进入回归方程(P<0.05).结论 78.4%的男性精神分裂症患者有冲动行为,护士应应特别关注无固定职业、阳性症状明显、客观支持低的患者,并以提高劳动能力、控制阳性症状、加强客观支持为目地,制定有效的护理方案.     

长期住院慢性精神分裂症患者的生活质量

目的:评估长期住院的慢性精神分裂症患者的生活质量,并分析影响因素。方法:纳入2004-01/08在北京回龙观医院住院的慢性精神分裂症患者163例。以年龄、性别、受教育程度为匹配条件,按照2∶1的比例选择本院职工及医院所在社区内82例健康自愿者为对照组。采用健康状况调查问卷进行生活质量评价:包括36个条目,归纳为8个分量表:生理机能,生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能和精神健康。分数越高,表明该方面的功能状况越好,生活质量越高。结果:发放调查问卷245份,收回有效问卷245份。①精神分裂症患者健康状况调查问卷各维度评分均低于对照组,两组比较差异有显著意义。②相关分析发现长期住院的慢性精神分裂症患者健康状况调查问卷评分与阳性与阴性症状量表评分、副反应量表呈负相关(P<0.05～0.001)。健康状况调查问卷评分与性别呈正相关(P<0.05～0.001),与年龄、婚姻状况、病期、住院时间、目前状态、躯体疾病呈负相关(P<0.05～0.001)。结论:长期住院的慢性精神分裂症患者的生活质量低下,影响因素包括精神病状态、药物副反应、年龄、性别、病期、住院时间、婚姻状况、躯体疾病。     

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.     

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.