护士学校学生心理健康状况的调查研究

目的 调查研究护士学校学生(下文简称护校生)的心理健康状况。方法 采用问卷法,对170名护校生进行症状自评量表(SCL-90)、抑郁自评量表(SDS)、焦虑自评量表(SAS)的测壹,并对量表标准分大于60分的学生进行面谈。结果 在170名护校生中,SCL-90测壹．人际关系因子分大于3分者人数最多(30人)．占17．6％。其次是偏执、敌对、强迫。SDS标准分大于50分的有68名,占总人数的40％,25名SDS标准分大于60分的学生中,面谈有3名符合CCMD-3抑郁发作症状标准,无1名达到抑郁症病程标准和严重程度标准。SAS标准分大于50分的有31名,占总人数的18．2％。结论 护校生中存在的主要心理健康问题是人际关系问题。部分护校生存在押郁情绪,但真正构成抑郁症临床诊断的极少。护校生中焦虑较少,程度也轻。     

流行性感冒患者情绪障碍调查

作者采用抑郁自评量表（SDS）和焦虑自评量表（SAS）,对流行性感冒患者的情绪障碍进行调查,结果显示,患者在急性期SDS和SAS总标准分显著高于国内常模,有38．81％抑郁严重、26．67％焦虑明显。随访两周发现,SDS分在治疗一周时仍然显著高于常模。提示在治疗初期及至少一周内,临床医生应密切注意流感患者的情绪障碍,尤其是抑郁情绪。     

女性精神分裂症患者配偶心理状况的调查

目的：探讨女性精神分裂病患者配偶的心理健康状况。方法：对173例女性患者配偶采用症状自评量表(SCL-90)社会支持评定量表(SSRS)、焦虑自评量表(SAS)，抑郁自评量表(SDS)进行测评。并以60例与这相匹配的非女性精神病的配偶为对照。结果：女性患者配偶SCL-90总分及各因子分均高于对照组，心理健康水平与社会支持水平呈负相关。城市与农村患者配偶除抑郁、焦虑、敌对、人际敏感，因子分外，总分及其余各因子分比较差异无显著性。且两组SAS、SDS总分和标准分均有差异。结论：女性精神分裂症配偶存在不同程度的心理问题．与社会支持、文化经济状况等有显著关系，城市患者配偶存在更多的心理问题。     

肾移植前后行维持性血液透析患者的心理健康状况测评

背景：移植肾功能丧失也是导致终末期肾病的常见原因之一,维持性血液透析患者的生存期有明显的改善。 目的：测量和评估肾移植前后实施维持性血液透析患者的心理健康状况。 方法：选取维持性血液透析患者106 例,同时选取慢性肾功能不全患者100例未接受任何透析治疗为对照。应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)和艾森克人格问卷(EPQ 成人)为测量工具,采用自评方式,对比两组评分,且将两组得分与常模比较。 结果与结论：两组患者在SCL-90 量表各因子上的得分均显著高于常模;维持性血液透析患者在人际关系敏感性、抑郁、焦虑、睡眠、饮食等方面明显高于对照组(P < 0.05);在躯体化方面,对照组的因子分比维持性血液透析患者的因子分高 (P < 0.01);两组患者SDS和SAS量表得分(标准分)显著高于常模,维持性血液透析患者SDS和SAS量表得分明显高于对照组(P < 0.01);在人格量表中E 和N 量表的分值维持性血液透析患者偏高(P < 0.01)。提示终末期肾病患者在开始规律透析治疗后仍存在着躯体和精神方面的问题,尤其在人际关系敏感性、抑郁、焦虑、睡眠等方面较透析前加重,而且透析患者情绪不太稳定,因此在充分透析基础上,应该增加对维持性血液透析患者心理及精神方面的治疗。     

尖锐湿疣病人的抑郁状况分析

目的　了解尖锐湿疣病人的抑郁状况。方法　采用抑郁自评量表 ( Self-Rocting Depression Scule,SDS)进行问卷调查。结果　尖锐湿疣病人总粗分 ,标准分均高于国内常模 ,经统计学 t检验 ,P<0 .0 1 ,有显著差异。结论　提示尖锐湿疣病人抑郁状况明显     

低年级医学生心理健康现状调查及教育对策

目的 调查低年级医学生的心理健康状况,研究心理健康教育对策.方法 采用症状自评量表(SCL-90)、抑郁自评量表(SDS)、焦虑自评量表(SAS)对195名一、二年级医学生进行测查,测查时将评定时间跨度由最近1周改为最近3个月,并对SDS量表标准分大于60分的学生进行面谈.结果 SCL-90测验结果,42.05%强迫因子分＞2,37.95%人际关系因子分＞2,22.05%抑郁因子分＞2,但未检出符合抑郁症诊断的个体.结论 低年级医学生总体心理健康状况良好,部分学生存在人际关系、强迫、抑郁等心理问题,对其进行心理健康教育时,要特别注重人际关系方面的训练及培养多角度全方位看问题的思维习惯.     

团体认知行为干预对维持性血液透析患者抑郁的研究

目的探讨团体认知行为干预对维持性血液透析伴有抑郁患者的应用价值。方法选取在我院血透室进行维持性血液透析治疗的终末期肾病患者60例,随机分为观察组与对照组各30例,对照组给予常规护理,观察组给予团体认知行为干预,干预前后采用Zung抑郁自评量表(SDS)及焦虑自评量表(SAS)对患者进行评分,并在两组间进行对比。结果观察组干预后SDS、SAS评分均显著低于干预前(t=5.1372,P=0.0000;t=7.6616,P=0.0000),且显著低于对照组(t=3.2612,P=0.0019;t=5.1975,P=0.0000);对照组干预前后差异无统计学意义(t=1.7392,P=0.0873;t=1.8691,P=0.0667)。结论团体认知行为干预可显著改善MHD抑郁患者的心理状态。     

尿毒症血液透析患者抑郁状况及相关因素

目的探讨尿毒症血液透析患者抑郁状况及其相关因素,为进一步干预积累临床资料。方法对100例血液透析患者,用一般情况调查表、社会支持量表(SSRS)和抑郁自评量表(SDS)进行调查,分析患者一般资料和SSRS评分与患者SDS评分的关系。结果本组患者SDS评分显著高于国内常模(t=9.645,P=0.000),阳性率44%;多元回归分析,经济状况、SSRS评分、婚姻状况和户籍4个因子进入SDS逐步回归方程(F=34.052,P=0.000),并能预测SDS评分总变异的57.2%。结论尿毒症血液透析患者抑郁情绪的发生率较高,经济状况较差、社会支持度较低、无配偶、农村患者更易发生抑郁且程度更重。     

口吃患者人格特征与临床症状的研究

目的探讨口吃患者的情绪状态与口吃程度及其人格特征之间的相互关系,为临床治疗提供理论依据.方法应用焦虑自评量表(SAS),抑郁自评量表(SDS)、艾森克个性人格问卷(EPQ)对108例口吃患者,110名正常人,103例强迫症患者,137例抑郁性神经症患者进行测评.结果口吃组抑郁、焦虑高于正常组,低于抑郁组、强迫症组(p＜0.01).口吃患者的E分低于正常组,高于抑郁组、强迫组;N分高于正常组,低于抑郁组、强迫组(p＜0.01).E分与N分呈显著正相关.SAS、SDS得分与E分呈显著负相关.与N分呈显著正相关.SAS与SDS呈显著正相关.结论口吃患者的人格倾向于抑郁质,其负性情绪可能与人格特征有关.     

心钠素和甲状旁腺素对血液透析低血压的影响

为探讨血透患者血清心钠素(ANF)和甲状旁腺素(iPTH)水平与血液透析低血压的关系, 采用放射免疫分析和免疫放射分析法分别测定36例维持性血透患者透析前后血清ANF和iPTH水平变化, 并分析其与低血压的关系. 结果发现: 血透患者ANF和iPTH总体水平显著高于对照组, 透析后总体水平显著低于透析前(P均小于0.01); 低血压组患者透析前血清ANF和iPTH水平均高于正常血压组(P均小于0.05); 透析后低血压组患者ANF水平较透析前显著降低(P＜0.05),但iPTH水平较透析前进一步增高(P＜0.05).结论: 血透中发作性低血压与患者血清ANF和iPTH水平升高有一定联系.     

维持性血液透析患者并发症的发病机制分析

肾脏综合症并发急性肾衰竭是临床治疗棘手的疾病之一,其重症阶段主要体现为心血管疾病及相关并发症。维持性血液透析是该病的有效方法之一,但透析的并发症较多,且风险较大。本文着重对透析并发症的发病机制进行研究,并分析了高血压、低血压、失衡综合征、贫血、发热、心律失常和心力衰竭等并发症的典型症状,目的是减少透析并发症的发生,减轻患者痛苦,提高其生活质量,延长血液透析患者的存活率。     

80岁以上并发心血管病患者行全髋关节置换术围术期处理

目的探讨并发心血管疾病的80岁以上高龄患者行全髋关节围术期处理的特殊性。方法总结行这类手术患者60例，术前行各项检查，评估心血管系统功能异常程度，并作相应的准备，选择合适的麻醉方法、药物、监测及调控措施，预防术中心肌氧供需失衡和心血管事件发生。结果术前心血管疾病以心肌供血不足的发生率（76．7％）居首位，其次是高血压（61．7％），列居第三位的是各种类型心律不齐（48.3％）。接受扩冠脉血管治疗3例，营养心肌治疗48例，抗高血压治疗31例，抗心律失常治疗19例。手术选用椎管内麻醉或气管内插管麻醉。术中心肌供血不足、高血压和心律不齐的发生率分别较术前下降35．0％、43．4％和11．6％。手术后72h内心肌供血不足、高血压和心律不齐的发生率分别较术前下降25．1％、35．0％、3.3％，低血压和心动过速分别较术前升高18.3％、56．6％。结论高龄患者并发心血管疾病以心肌供血不足最常见，术前充分准备、麻醉选择适当、术中调控合理是安全渡过围术期的重要措施，手术后的低血压和心动过速应予以关注。     

高龄老年人体位性低血压与心左室结构和功能的相关性研究

 目的：研究高龄老年人群体位性低血压（orthostatic hypotension, OH）的发生率以及OH与左心室结构及功能的关系。方法：对我科≥80岁的126例高龄老年住院患者进行立卧位血压测定,统计高龄老年人群中OH的发生率;并将患者分为OH组(n=45)与非OH（n=81）组,对2组患者行心脏超声检查,检测和计算左室的结构和功能指标,分析OH与心脏结构及功能的相关性。结果：高龄老年人群总的OH发生率为35.7％。与非OH组比较,OH组左心室质量指数、舒张末期左心室内径和收缩末期左心室内径均明显偏高,2组比较差异有统计学意义（P<0.05）;OH组左心室射血分数和左心室短轴缩短率显著低于非OH组,2组比较差异有统计学意义（P<0.01）。相关分析显示OH与左室结构指标呈正相关(P<0.05),与左室功能指标呈负相关（P<0.01）。结论：OH患者在高龄老年人群中比例较高。OH与左心室结构和功能密切相关,与非OH患者相比,OH患者左室结构和功能受损更严重。     

Head-up tilt test in complicated neurocardiogenic syncope in children.

To confirm the usefulness of head-up tilt test (HUT) in neurocardiogenic syncope (NCS) with complicating clinical features, retrospective analysis were done on 12 selected children. The age at onset was 12.7 +/- 1.9 (mean +/- SD) years. Associated clinical features were postoperative congenital heart disease (PO CHD) in 3, coexistent arrhythmia in 8 (persistent ventricular arrhythmia during exercise in 3, premature ventricular contractions in 2, ventricular couplets in 1, sinoatrial exit block in 1 and resting sinus bradycardia in 1) and ST segment depression during exercise in 1. Four of them had a history of exercise-related syncope. All 3 patients with PO CHD had arrhythmia (ventricular tachycardia in 1, sinus bradycardia in 1 and atrioventricular block in 1). HUT provoked NCS in 8 (2 during baseline tilt, 6 during isoproterenol infusion). In one each, ventricular tachycardia and loss of consciousness without hypotension and bradycardia were induced. Atenolol was tried in 5 with improvement of NCS in 4 and aggravation of dizziness in 1. During follow-up, 7 became asymptomatic (2 with atenolol) and 5 were stationary. In conclusion, HUT was valuable in diagnosing NCS even in children with complicating clinical features such as arrhythmias or PO CHD. HUT could be done as apart of initial diagnostic tests if the past history suggests NCS, regardless of associated clinical features. In some cases, the unexpected results of the test turned out useful in managing children with syncope or dizziness.     

综合性医院老年病人抑郁症状的调查分析

目的 :分析综合性医院老年病人的抑郁症状特征及影响因素。方法 :应用中文版流调用抑郁量表 (CES -D) ,调查同济医院住院和门诊的 3 15例老年患者 (年龄≥ 60岁 )。结果 :①在 3 15例老人患者中 ,共有 70例老年患者 (占 2 2 2 % )肯定有抑郁症状 ,5 3例 (16 8% )可能存在抑郁症状 ;②CES -D总分女性组明显高于男性组 (t=2 0 3 2 ,P <0 0 1) ,且教育程度越低抑郁症状越明显 (F =3 75 6,P <0 0 1) ;③CES -D总分的多元逐步回归分析提示所有被调查老人及内科组老人的CES -D总分明显受其教育程度的影响。结论 :在综合性医院对老年病人进行抑郁症状的常规筛查是必要的     

老年高血压患者血压变异性对左心室肥厚的影响

目的　观察血压变异性 (BPV)对老年性高血压患者左心室肥厚的影响 .方法　老年性高血压患者 10 0例 ,根据左室重量指数 [LVMI]分为两组 :左室肥厚组和非左室肥厚组 ,进行 2 4小时动态血压监测 ,以各时段 (日间、夜间及 2 4小时 )血压的标准差作为血压变异性的量化指标 .结果　左室肥厚组日间、夜间及 2 4小时收缩压BPV显著高于非左室肥厚组 (p <0 .0 1) ,日间、夜间及 2 4小时收缩压BPV与LVMI呈正相关 ,舒张压BPV与LVMI无相关性 .结论　收缩压BPV与高血压左室肥厚的发生和肥厚程度有关 ,老年性高血压患者更容易出现左室肥厚 ,在治疗老年性高血压时 ,要注意平稳降压     

Efficacy and safety of sofosbuvir and daclatasvir with or without ribavirin in elderly patients with chronic hepatitis C virus infection

Hepatitis C virus (HCV) infection is considered as a major public health problem that, worldwide, chronically affects 170 million people. Elderly patients are more likely than younger patients to have increased duration of infection, increased rate of disease progression, and subsequently increased incidence of advanced liver disease. Natural history models predicted that the prevalence of HCV infection and its chronic sequelae as well as extrahepatic manifestations will eventually increase through the next decade and will mostly affect those who are greater than 60 years of age. Moreover, polytherapy and polypharmacy are frequent in elderly patients due to associated comorbidities. As advanced age is associated with increasing risk of development of cirrhosis and hepatocellular carcinoma, elderly patients are in special need of safe and effective antiviral therapies. Achievement of sustained viral responses (SVR) is associated with reduced liver-related complications and overall mortality in such patients with the advanced liver disease. With the recent introduction of interferon-free direct-acting antivirals, successful treatment for chronic HCV infection had dramatically improved, with overall cure rates that exceed 90% SVR. In our study, we aimed to study the efficacy and safety of combined sofosbuvir and daclatasvir, with or without ribavirin, in management of chronically infected HCV elderly patients who are more than 60 years old.     

Right atrial thrombi complicating use of central venous catheters in hemodialysis

BACKGROUND: There has been an increase in the use of central venous catheters for temporary hemodialysis access. In this report, we describe a case series of 12 patients on hemodialysis who developed intracardiac clots associated with the use of central venous catheters, their outcomes and review the literature on this syndrome. METHODS: Retrospective, single-center case series of 12 patients with right atrial thrombi associated with central venous catheter use for dialysis vascular access. These patients were treated between June 1, 2001 and June 30th 2002 at the three University of Rochester affiliated dialysis clinics. The medical records of these patients were reviewed to obtain information concerning demographics, dialysis history, dates of catheter insertion, catheter complications, identification and dimensions of intracardiac thrombi, echocardiographic data, and outcome of anticoagulant therapy. RESULTS: Right heart thrombi were identified in 12 patients in our hemodialysis population over the study interval. Anticoagulation for 6 months led to clot resolution in more than 50% of our patients. Bacteremia recurred in 6 patients (50%), in spite of catheter replacement. There was zero mortality related to presence of clots in the short term. One patient with non-bacteremic right atrial thrombus suffered sudden cardiac arrest, but was successfully resuscitated. CONCLUSION: Right atrial thrombi may occur in hemodialysis patients who use central venous catheters for dialysis access. These clots are frequently found in the right atrium or right atrial-superior vena caval junction. Ten of 12 patients (83%), had catheter-associated bacteremia, but the precise relationship between bacteremia and intracardiac clots is unclear. Chronic anticoagulation for 6 months lead to resolution of these clots in more than 50% of patients in our series.     

Wczesna niehematologiczna toksyczność po chemioterapii w wysokich dawkach i autologicznym przeszczepieniu komórek krwiotwórczych u chorych na nowotwory limfoidalne powyżej 60. roku życia

Early non-haematological toxicity of high dose therapy (HDT) and autologous haematopoietic cell transplantation (autoHCT) can be more hazardous in older patients (pts) with comorbidities. The aim of the study was to analyze incidence and grade of the organ-related early complications up to 30 days post-transplant period in elderly lymphoma patients. Between January 2005 and November 2011, 44 consecutive lymphoma pts underwent HDT followed by autoHCT. Median age of pts was 62 years (range 60–67). Conditioning regimens were: BEAM(carmustine, etoposide, cytarabine, melphalan) in 16, melphalan 200 in 22, cytarabine, melphalan or cyclophosphamide – in 6 pts. 32% pts had comorbidities: in 71% cardiovascular. Early non-haematologic complications within 30 days after autoHCT were reported in 84% of pts. The most common events were gastrointestinal (77%): 55% pts had prolonged (more than 7 days) diarrhoea grade III—IV, nausea and vomiting occurred in 40% of pts, 50% of pts demonstrated mucositis (grade III—IV in 34% of pts). Neutropenic fever was reported in 59% of pts with sepsis in 1.9% of pts. Cardiac events occurred in 9% of pts. Median hospitalization was 21 days (range 16—45). One patient died from transplanted related toxicity. HDT resulted in high incidence of non-hematologic toxicity in elderly patients during early post-transplant period. The toxicity of this procedure is acceptable, with mortality rate of only 2% in the elderly transplanted patients. The most common toxicities were: neutropenic fever, gastrointestinal toxicity and cardiac complications