经胸壁超声心动图联合血浆BNP检测对脑卒中医院感染患者心功能评估效果研究

目的探究经胸壁超声心动图联合血浆B型尿钠肽原(BNP)检测对脑卒中医院感染患者心功能评估效果。方法选取2014年8月-2016年8月医院收治的80例脑卒中医院感染患者作为研究对象,根据是否有心功能不全分为对照组和研究组,各40例;对患者心功能分级与血浆BNP水平及经胸壁超声心动图进行相关性分析,对比两组患者经胸壁超声心动图检查及血浆BNP水平,及心功能分级的灵敏度和特异度。结果研究组患者血浆BNP水平及左室舒张末内径(LVIDD)值均高于对照组,左室射血分数(LVEF)值低于对照组(P0.05);不同心功能Killip分级患者的血浆BNP水平、LVIDD值和LVEF值比较差异有统计学意义(Z=5.302,4.652,9.038;P=0.016,0.024,0.001);脑卒中医院感染患者心功能Killip分级与血浆BNP水平呈正相关(r=0.84,P=0.040),与LVEF值呈负相关(r=-0.87,P=0.039);经胸壁超声心动图检查联合血浆BNP检测,对脑卒中医院感染患者合并心功能不全有较高的灵敏度及特异度。结论经胸壁超声心动图联合血浆BNP检测不仅可评估脑卒中医院感染患者心功能水平,同时具有较高灵敏度及特异度,对指导临床治疗具有重要意义。     

超声心动图联合血浆B型脑钠肽原检测评价急性有机磷农药中毒患者心功能

目的 探讨不同心功能分级的急性有机磷农药中毒（AOPP）患者血浆B型脑钠肽原（BNP）水平及超声心动图改变，进一步阐明二者联合检查对AOPP患者左心功能的评价效能。方法 回顾分析72例AOPP患者（轻度36例、中度20例、重度16例）的临床资料，其中心功能不全25例、心功能正常47例。应用M型超声心动图测量患者的左室舒张末内径（LVIDd）及左室射血分数（LVEF）值，将心功能分级（Killip分级法）结果与LVEF、BNP水平进行相关性分析；进一步分析超声心动图、血浆BNP检测以及两者联合应用对诊断AOPP并发心功能不全的特异度和灵敏度差异。结果 心功能不全组患者LVIDd值和BNP水平明显高于心功能正常组（t=11.375，P=0.030；t=9.015，P=0.037），LVEF值明显低于心功能正常组（t=9.793，P=0.028）。心功能分级与BNP水平呈正相关关系（r=0.91，P<0.05），与LVEF值呈负相关关系（r=-0.792，P<0.05）。超声心动图检查、BNP检测及超声心动图联合BNP检测对于诊断AOPP并发心功能不全的特异度和灵敏度的差异有统计学意义（P<0.05）。结论 超声心动图检查联合血浆BNP水平检测可明显提高AOPP患者并发心功能不全的诊断率，对临床治疗有重要的价值。     

血浆B型脑钠肽与急性心肌梗死心功能及预后的相关研究

目的:研究急性心肌梗死(AMI)后血浆B型脑钠肽(BNP)水平的变化及其对AMI后近期心功能不全及预后的预测价值。方法:入选100例初发急性心肌梗死患者,入院24 h内测定血浆BNP浓度、进行超声心动图检查测定左室射血分数(LVEF)、测定心肌酶谱、肌钙蛋白I定量,并记录患者心功能Killip分级等项目。所有患者观察随访4周,4周时记录观察期间死亡的发生与否。结果:①AMI后急性期血BNP与心功能Killip分级呈正相关;②死亡组BNP、Killip分级、CK-MB均显著高于存活组(P<0.01);AMI后近期死亡与急性期血BNP、CK-MB浓度及Killip分级正相关。结论:血BNP在AMI后的高危患者中显著升高,与急性期心功能Killip分级显著相关,可以尝试用于AMI后心功能不全的早期判别及AMI后近期死亡危险性的早期评价。     

血清脑钠素改变在心脏疾患合并心力衰竭患儿中的意义

目的:分析心脏病合并心力衰竭的患儿血清脑钠素(BNP)的表达水平,为临床诊治提供参考。方法:选择住院治疗的心力衰竭患儿40例作为观察组,心功能正常的上呼吸道感染住院治疗的患儿20例作为对照组,比较两组患儿血清脑钠素水平;并对观察组患儿作超声心动图记录左室射血分数等心脏功能指标,分析其与血清脑钠素改变的关系。结果:①观察组血清BNP水平明显高于对照组,差异有统计学意义(P<0.05)。②组间单因素方法分析发现,随着心功能降低,LogBNP水平升高,LVEF和LVFS均下降(P<0.05)。③经Spearman相关性分析,观察组血清LogBNP与LVEF、LVFS具有负相关性,血清LogBNP与观察组患儿心功能分级的相关系数明显优于LVEF、LVFS与心功能分级的相关系数,提示LogBNP对于预测心衰的严重程度较LVEF及LVFS更好。结论:BNP是反映心功能受损的敏感指标,与心功能分级具有明显的正相关性,临床检测对心衰患儿诊断和治疗具有重要意义。     

慢性心力衰竭患者高密度脂蛋白胆固醇、高敏肌钙蛋白T水平与心功能的相关性

目的分析慢性心力衰竭患者高密度脂蛋白胆固醇(HDL-C)、高敏肌钙蛋白T(Hs-c Tn T)水平与心功能的关系。方法选取2013年2月-2016年6月某院心内科收治的慢性心力衰竭住院患者200例,设为慢性心衰组,并根据美国心脏病协会心功能分级分为Ⅱ级、Ⅲ级、Ⅳ级3个亚组;另选取同期健康体检者86例,设为健康对照组。比较慢性心衰组和健康对照组及亚组间血清HDL-C、Hs-c Tn T水平,所有患者均行超声心动图检查,测定左室射血分数(LVEF),采用Pearson线性相关分析慢性心力衰竭患者血清HDL-C、Hs-c Tn T水平与心功能分级、LVEF及HDL-C与Hs-c Tn T的相关性。结果与健康对照组比较,慢性心衰组患者血清HDL-C水平明显降低,血清Hs-c Tn T水平明显升高,差异具有统计学意义(P0.05);慢性心衰组不同心功能分级患者血清HDL-C、Hs-c Tn T水平比较,差异均具有统计学意义(P0.05);Pearson相关分析显示,慢性心衰组患者血清HDL-C水平与心功能分级呈负相关,与LVEF呈正相关,血清Hsc Tn T水平与心功能分级呈正相关,与LVEF呈负相关,血清HDL-C水平与血清Hs-c Tn T水平呈负相关(P均0.05)。结论慢性心力衰竭患者HDL-C水平降低,Hs-c Tn T水平增高,其血清水平与患者心功能状态有良好的相关性,两者水平检测对监测和控制慢性心力衰竭的发生、发展具有一定意义。     

老年冠心病心力衰竭患者N-末端脑钠肽前体、C反应蛋白与左室射血分数的相关性研究

目的探讨老年冠心病心力衰竭患者的N-末端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-pro BNP)、C反应蛋白(C-reactive protein,CRP)水平与左室射血分数(left ventricular ejection fraction,LVEF)的相关性。方法选择2012年2月—2015年6月在本院住院的116例老年冠心病心力衰竭患者作为观察组,纳入同期58例健康体检者作为对照组,比较两组的NT-pro BNP、CRP、LVEF值,并进行相关性分析。计量资料比较采用t检验及方差分析,两两比较采用LSD法,计数资料比较采用χ2检验,P0.05为差异有统计学意义。结果两组研究对象NT-pro BNP、CRP及LVEF[(5 059.4±5 125.3)ng/L、(22.3±15.8)mg/L、(44.8±4.7)%与(297.4±97.2)ng/L、(5.3±0.3)mg/L、(57.4±2.8)%]比较,差异均有统计学意义(均P0.05)。观察组患者NT-pro BNP、CRP与LVEF值呈负相关(r=-0.394、-0.431,均P0.05);心功能分级与CRP水平呈正相关(r=0.545、0.495,均P0.05),LVEF值与心功能分级呈负相关(r=-0.725,P0.05)。结论血清NT-pro BNP、CRP水平与冠心病心力衰竭患者心功能分级呈正相关,与LVEF值呈负相关。     

血清TNF-α与IL-6和BNP指标在检测心力衰竭合并感染患者中的应用价值分析

目的研究血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、脑钠肽(BNP)指标在检测心力衰竭合并感染患者中的应用价值,为临床防治提供参考。方法选取2016年1月-2017年5月于医院接受诊治的80例心力衰竭合并肺部感染患者作为研究组,另选取同期医院80例健康体检人员作为对照组。观察并比较两组受检者血清TNF-α、IL-6、BNP表达水平,并对研究组不同心功能患者间血清TNF-α、IL-6、BNP水平进行分析。Spearman相关法分析血清TNF-α、IL-6、BNP指标与心力衰竭合并感染患者心功能分级的关系。结果研究组血清TNF-α、IL-6、BNP水平均高于对照组,两组比较差异有统计学意义(均P0.05);研究组心功能分级Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级患者间血清TNF-α、IL-6、BNP表达水平比较差异有统计学意义(P0.05),且随着心功能分级增加而升高;Spearman相关性分析显示:血清TNF-α、IL-6、BNP指标与心力衰竭合并感染患者的心功能分级均显示正相关(P0.05)。结论心力衰竭合并感染患者血清TNF-α、IL-6、BNP表达水平均升高,且随着患者心功能分级增加而逐渐升高,可作为临床检测心力衰竭合并感染、判定心功能分级重要指标。     

高敏C反应蛋白、B型钠尿肽与急性心肌梗死患者心功能关系的临床研究

目的 分析探讨急性心肌梗死(AMI)患者血浆超敏C反应蛋白(hs-CRP)与B型钠尿肽(BNP)的变化及其临床意义.方法 选择60例AMI患者为观察组,并选择同期非急性心肌梗死患者60例作为对照组,采用免疫散射比浊法检测hs-CRP水平,同时以彩色多普勒检测并计算左室射血分数(LVEF)、左室后壁收缩期增厚率(△T％),并测定BNP水平.结果 AMI Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组中血清hs-CRP和BNP水平明显高于对照组,并随心功能Killip分级的增加而升高,血清hs-CRP与BNP水平和心功能Killip分级呈正相关(P＜0.05).AMI患者hs-CRP和BNP水平与左心室射血分数(LVEF)呈负相关(P＜0.05),与左心室舒张末期内经(LVEDD)呈正相关(P＜0.05).结论 血浆hs-CRP和BNP水平与AMI预后显著相关,均是独立的不良的预测因子,可以作为评价梗死后心功能状态和近期预后的敏感指标,亦可用于AMI的危险分层及判断预后.     

阿托伐他汀对慢性心力衰竭患者心功能及脑利钠肽水平的影响

目的 观察阿托伐他汀对慢性心力衰竭患者心功能和血清脑利钠肽(BNP)水平的影响.方法 112例慢性心力衰竭患者(NYHA心功能分级Ⅱ～Ⅲ级)随机分为治疗组(56例)和对照组(56例).对照组仅给予常规药物治疗,治疗组在常规药物治疗基础上加服阿托伐他汀10 mg/d,治疗1年.治疗前后行心脏彩色超声检查,评估心功能;同时观察治疗前后血清BNP水平的变化.结果 治疗组治疗后血清BNP水平由(96±15)ng/L降至(70±13)ns/L;左室收缩末期内径(LVESd)由(48±10)mm减小至(40±10)mm;左室射血分数(LVEF)由(42±11)%升至(48±13)%,差异均有统计学意义(P<0.05),同时与对照组治疗后比较,差异也有统计学意义(P<0.05).治疗组治疗后症状改善率高于对照组,再次住院率和病死率均低于对照组.结论 阿托伐他汀能显著降低血清BNP水平,平衡神经激素和改善心功能,有益于慢性心力衰竭患者的治疗和预后.     

子痫前期患者血清BNP、PⅢNP表达与心功能关系

目的:探讨子痫前期患者血清脑钠肽(BNP)、Ⅲ型前胶原氨基端肽(PⅢNP)表达水平与心功能相关性。方法:选取2018年12月—2020年10月本院治疗的62例子痫前期患者为子痫前期组,78例妊娠期高血压患者为妊娠期高血压组,80例产前检查健康孕妇为正常妊娠组。收集各组一般资料,采用彩色多普勒超声诊断仪对孕妇进行心脏超声检测,获取左室射血分数(LVEF)、心脏指数(CI)、心输出量(CO)、舒张早期峰值速度(E)、舒张晚期峰值速度(A)、E/A;采用酶联免疫吸附法检测血清BNP、PⅢNP水平;采用Pearson法分析子痫前期患者血清BNP、PⅢNP水平与心功能指标相关性。结果:正常妊娠组、妊娠期高血压组、子痫前期组BNP、PⅢNP、A、CO、TG水平依次升高,E、E/A、LVEF、CI水平依次降低(均P0.05)。子痫前期患者血清BNP与PⅢNP水平呈正相关,BNP和PⅢNP与A、CO均呈正相关,与E、E/A、LVEF、CI均呈负相关(均P0.05)。结论:子痫前期患者血清BNP、PⅢNP水平与超声心动图指标相关,临床可采用BNP、PⅢNP水平检测结合超声心动图检查对子痫前期患者病情发展给予及时判断。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.