艾司西酞普兰与文拉法辛治疗老年焦虑症的疗效观察

目的探讨艾司西酞普兰和文拉法辛治疗老年焦虑症的疗效。方法选取我院2012年3月~2014年3月收治的老年焦虑症患者50例,将其随机分为对照组(文拉法辛)和观察组(艾司西酞普兰),各25例。结果治疗前两组老年焦虑症患者HAMA评分对比,差异无统计学意义(P0.05),治疗后观察组患者HAMA评分明显优于对照组患者,且观察组患者不良反应发生率更低,差异有统计学意义(P0.05)。结论与文拉法辛对比,采用艾司西酞普兰治疗老年焦虑症患者疗效更为显著,不仅可有效缓解其焦虑症状,且不良反应少。     

雌激素替代疗法及心理干预结合艾司西酞普兰治疗围绝经期抑郁症的疗效

目的观察激素替代疗法(HRT)与心理干预结合艾司西酞普兰治疗围绝经期抑郁症的疗效。方法按照纳入、排除标准纳入80例围绝经期抑郁症患者,随机分为对照组和观察组,分别接受HRT结合艾司西酞普兰治疗和心理干预结合艾司西酞普兰治疗。观察临床疗效、改良Kupperman评分及生存质量测定量表(WHOQOL-BREF)评分的变化。结果以汉密尔顿抑郁量表(HAMD-17)评定临床疗效,发现心理干预结合艾司西酞普兰较HRT结合艾司西酞普兰临床疗效更好,但组间差异不显著(P>0.05)。两组改良Kupperman评分变化显示两种疗法均能有效改善患者更年期综合征的各种症状,且HRT结合艾司西酞普兰对症状的改善显著优于心理干预(P<0.05)。而WHOQOL-BREF评分亦显示两种疗法均能改善患者的生活质量,且HRT结合艾司西酞普兰对患者生活质量的改善优于心理干预,但差异不显著(P>0.05)。结论两种疗法疗效相当,心理干预结合艾司西酞普兰善于改善抑郁状态,HRT结合艾司西酞普兰优于改善躯体症状和生活质量。     

右美托咪定对结直肠癌腹腔镜手术老年患者术后认知功能障碍及血清神经元烯醇化酶、S100β蛋白、肿瘤坏死因子-α水平的影响

目的探讨右美托咪定对结直肠癌腹腔镜手术老年患者术后认知功能障碍及血清神经元烯醇化酶(NSE)、S100β蛋白、肿瘤坏死因子(TNF)-α水平的影响。方法行结直肠癌腹腔镜手术的96例老年患者随机分为对照组和试验组各48例。诱导麻醉后,对照组泵注给予生理盐水,试验组泵注给予右美托咪定。应用简易精神状态量表(MMSE)对患者术前、术后1、3 d进行评分,统计并比较两组MMSE评分。计算并比较两组术后3 d的认知功能障碍发生率。检测并比较两组术前、术后1、3 d血清NSE、S100β蛋白及TNF-α水平。结果试验组术后3 d的认知功能障碍发生率明显低于对照组(P<0.05);对照组术后1、3 d MMSE评分均明显低于术前(P<0.05),且低于试验组(P<0.05)。两组术后1 d血清NSE水平明显高于术前,且试验组明显低于对照组,术后1、3 d血清S100β蛋白水平明显高于术前,TNF-α水平明显低于术前,且试验组S100β蛋白、TNF-α水平均明显低于对照组(均P<0.05)。结论右美托咪定能够明显改善结直肠癌腹腔镜手术老年患者术后认知功能,降低认知功能障碍发生率,降低血清NSE、S100β蛋白及TNF-α水平。     

心理干预对手术室老年围术期手术患者焦虑心理的影响

目的研究心理干预对手术室老年围术期手术患者焦虑心理的影响。方法选取2013年4月至2014年4月该院收治的600例老年手术患者,随机分为研究组和对照组各300例,对照组给予常规护理,研究组在对照组的基础上给予心理干预,应用汉密尔顿焦虑量表(HAMA)评价两组患者的焦虑情况,比较两组患者手术前1 d、手术当天以及术后第3日的心率、血压以及HAMA评分。结果两组患者术前1 d的HAMA评分比较无统计学意义(P>0.05),研究组手术当天以及术后第3日HAMA评分显著优于对照组(P<0.05);两组患者手术前1 d以及术后第3天心率和血压比较均无统计学意义(P>0.05),手术当天研究组心率和血压值显著优于对照组(P<0.05)。结论心理干预能显著减轻手术室老年围术期手术患者的焦虑心理,降低患者血压和心率的变化幅度。     

沈氏达郁汤加减方联合艾司西酞普兰对肝癌介入术后抑郁患者生活质量的影响

目的:观察沈氏达郁汤加减方联合艾司西酞普兰对肝癌动脉化疗栓塞术(TACE)后抑郁患者生活质量的影响,探索其临床疗效。方法:选择TACE后抑郁患者100例,随机分为治疗组和对照组,每组50例,对照组患者口服艾司西酞普兰片10mg/次,1次/d。治疗组患者在对照组的基础上加用沈氏达郁汤加减方。治疗6周后观察两组患者生活质量及汉密尔顿抑郁量表评分的变化。结果:治疗后治疗组患者在汉密尔顿抑郁量表评分、4个单一项目积分(失眠、食欲减退、呼吸困难、腹泻)、3个症状子量表积分(疲劳、疼痛、恶心呕吐)方面低于对照组,差异有显著性意义(P0.05);在5个功能子量表积分(躯体、角色、认知、情绪和社会功能)、总体健康状况积分方面高于对照组,差异有显著性意义(P0.05)。结论:沈氏达郁汤加减方联合艾司西酞普兰可以明显改善肝癌介入术后抑郁患者的抑郁状态,明显提高患者的生活质量,为中西医结合治疗该类患者提供了有效方法。     

术前心理干预对老年结直肠癌患者术后认知功能及神经元特异性烯醇化酶的影响

目的术前对行结直肠癌手术的老年患者实施心理干预,明确术前心理干预对术后认知功能及神经元特异性烯醇化酶(NSE)的影响。方法筛选择期在全身麻醉下行结直肠癌手术患者60例,年龄65～75岁,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,随机分为心理干预组和对照组。对照组组进行常规术前访视;心理干预组术前行常规访视同时给予心理干预,手术当天进入手术室后进行第三次干预。记录术前2 d(T0)、入室后静卧5 min(T1)、麻醉诱导时(T2)、切皮时(T3)、手术开始2 h(T4)、手术结束时(T5)、拔管时(T6)、术后1 d(T7)等8个时间点的血压(BP)、心率(HR);于T0、麻醉诱导前5 min、T5、术后24 h、48 h收集血液标本,测定NSE含量;于T0、T7、术后3 d、7 d随访登记简易精神智能状态量表(MMSE)评分、连线测验(TMT)完成时间。结果入手术室后两组SAS评分差异具有统计学意义(P<0. 05); T7、术后3 d组的MMSE评分明显高于对照组(P<0. 05); T7、术后3 d心理干预组的TMT完成时间明显短于对照组(P<0. 05);麻醉诱导前、T5、术后24 h、术后48 h对照组NSE含量明显高于心理干预组(P<0. 05); T7对照组POCD发生率明显高于心理干预组(P<0. 05)。结论术前心理干预可改善老年结直肠癌手术患者的心理应激,减少认知功能障碍的发生。     

围手术期BPSD干预对老年痴呆髋部骨折患者治疗效果及术后并发症的影响

目的 观察围手术期痴呆伴发精神行为障碍(BPSD)干预对老年痴呆髋部骨折患者治疗效果及术后并发症的影响。方法 选取本院于2018年1月—2020年1月收治的老年痴呆髋部骨折患者80例，参照其干预方案进行均分组，其中对照组40例(围手术期给予常规干预模式),观察组40例(围手术期在常规干预模式基础上给予BPSD干预)。比较两组术前准备时间、手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况，记录两组术前及术后的视觉模拟评分(VAS)的变化，观察两组神经精神科问卷(NPI)评分、简易智能状态检查量表(MMSE)评分的差别。结果 观察组术前准备时间、手术时间、术中出血量、住院时间及骨折愈合时间均短于对照组，住院费用少于对照组，差异有统计学意义(P<0.05)。与术前比较，两组术后1、3、7 d及出院当天的VAS评分下降(P<0.05),观察组术后1、3、7 d及出院当天的VAS评分低于对照组(P<0.05)。与干预前比较，两组MMSE评分升高(P<0.05),NPI评分下降(P<0.05),观察组干预后MMSE评分高于对照组(P<0.05),NP...     

功能性消化不良辅以艾司西酞普兰联合坦度螺酮临床疗效研究

[目的]研究有精神症状的功能性消化不良FD患者辅以艾司西酞普兰及艾司西肽普兰联合坦度螺酮的临床疗效对照。[方法]选取2017-10-2018-04期间就诊的FD患者100例,分观察组、对照组各50例,对照组行常规药物治疗辅以艾司西酞普兰,观察组在对照组治疗基础上再辅加坦度螺酮,疗程8周,消化道症状以GSRS积分,精神症状以HAMD评分指标观察。[结果]治疗后GSRS积分,观察组减分率为80.98%,对照组减分率为27.37%;治疗后HAMD评分,观察组减分率为50.35%,对照组减分率为27.93%,观察组疗效优于对照组,2组比较差异有统计学意义(P0.05)。[结论]有精神症状的FD者,采用辅以艾司西酞普兰联合坦度螺酮疗效优于单辅艾司西肽普兰。     

艾司西酞普兰与文拉法辛缓释剂治疗老年卒中后抑郁的疗效对比研究

目的探讨艾司西酞普兰与文拉法辛缓释剂治疗老年卒中后抑郁的临床效果。方法选取2012年10月—2013年10月我院收治的老年卒中后抑郁患者200例,将其随机分为文拉法辛缓释剂组和艾司西酞普兰组,各100例。文拉法辛缓释剂组采用文拉法辛缓释剂治疗,艾司西酞普兰组采用艾司西酞普兰治疗,两组患者均治疗8周。治疗前,治疗后第1周末、第2周末、第4周末及第8周末采用汉密顿抑郁量表(HAMD)[4]对两组患者进行评分;统计治疗过程中因不良反应退出治疗的例数。结果治疗前,治疗后第2周末、第4周末及第8周末两组患者HAMD评分比较,差异均无统计学意义(P0.05);治疗后第1周末,艾司西酞普兰组HAMD评分低于文拉法辛缓释剂组(P0.01)。文拉法辛缓释剂组因恶心、困倦及口干退出率均高于艾司西酞普兰组(P0.05)。结论艾司西酞普兰治疗老年卒中后抑郁优于文拉法辛,其起效快,不良反应轻微,值得临床推广应用。     

老年结直肠癌患者根治术后认知功能障碍的高危因素分析

[目的]分析老年结直肠癌患者根治术的术后认知功能障碍(postoperative cognitive disfunction, POCD)高危因素，探讨防范措施，提升老年结直肠癌根治术患者围术期安全及预后质量。[方法]选择行结直肠癌根治术的老年患者228例为研究对象。术后2 d采用MMSE评分(2 d MMSE评分)对患者进行认知功能测评，较术前2 d MMSE评分下降2分为POCD者(观察组，57例),其他为认知功能正常者(对照组，171例)。收集整理2组患者个体资料及临床资料行组间比较，组间比较有差异的指标纳入多因素Logistic行高危因素分析。[结果](1)单因素分析显示，年龄、受教育时间、合并疾病、术前ASA分级、舒芬太尼用量、术中显著低氧血症、术中显著低血压、术中输血量、术后SIRS评分、术后是否符合入住ICU指征与POCD发生相关；(2)多因素Logistic分析显示，合并糖尿病、合并高血压、术中显著低氧血症、术中显著低血压、术后SIRS评分≥3分、术后符合入住ICU指征为发生POCD的高危因素。[结论]老年结直肠癌患者麻醉根治术发生POCD的高危因素以患者个体特征及术中...     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.