心理韧性和领悟社会支持在首发缺血性脑卒中患者感恩与健康促进行为间的中介效应

目的探讨心理韧性、领悟社会支持在首发缺血性脑卒中患者感恩与健康促进行为间的中介作用。方法 2020年11月至2021年4月,采用便利抽样法选取上海市2所三级甲等医院神经内科收治的首发缺血性脑卒中患者为研究对象,采用一般情况调查表、 6项目感恩问卷(the gratitude questionnaire-6,C-GQ-6)、健康行为能力自评量表(self rated abilities for health practices scale, SRAS)、心理韧性评定量表(Connor-Davidson resilience scale, CD-RISC)及领悟社会支持量表(perceived social support scale, PSSS)对其进行调查。结果首发缺血性脑卒中患者SRAS总分为(77.46±15.81)分,感恩与健康促进行为呈正相关(r=0.462,P0.01),心理韧性、领悟社会支持在感恩与健康促进行为之间发挥完全中介作用,总间接效应为0.516。结论心理韧性、领悟社会支持在首发缺血性脑卒中患者感恩与健康促进行为间的多重中介作用成立,医护人员应以感恩影响健康促进行为的路径为依据制订干预策略,提高患者健康促进行为水平,加快康复进程,预防卒中复发。     

中青年首发脑卒中患者心理一致感在领悟社会支持与创伤后应激障碍的中介效应

目的 探究心理一致感在中青年首发脑卒中患者领悟社会支持与创伤后应激障碍之间的中介作用。方法 采用便利抽样法，选取河南省南阳市1所三级甲等医院于2022年2—7月入住神经内科病房的302例中青年首发急性缺血性脑卒中患者作为研究对象，应用一般情况调查表、领悟社会支持量表、心理一致感量表、创伤后应激障碍自评量表进行问卷调查，构建并检验中介效应。结果 中青年首发脑卒中患者领悟社会支持得分为（54.69±7.28）分，心理一致感得分为（55.57±8.71）分，创伤后应激障碍得分为（37.54±8.18）分。领悟社会支持与心理一致感呈正相关（r=0.705,P<0.001），领悟社会支持与创伤后应激障碍呈负相关（r=-0.605,P<0.001），心理一致感与创伤后应激障碍呈负相关（r=-0.673,P<0.001）。心理一致感在中青年首发脑卒中患者领悟社会支持与创伤后应激障碍间起部分中介作用，中介效应效应值为-0.423，效应占比为59.3%。结论 本组中青年首发脑卒中患者领悟社会支持处于中等水平，心理一致感处于中等偏低水平，创伤后应激障碍处于中度水平。心理一致感在中青年首发...     

首发缺血性脑卒中病人照顾者家庭适应现状及影响因素

目的:调查首发缺血性脑卒中病人照顾者家庭适应现状及影响因素,为开展干预性研究提供参考。方法:采用一般资料调查表、家庭适应性量表、照顾负担量表、简易应对方式问卷和领悟社会支持量表对253名首发缺血性脑卒中病人的照顾者进行调查。结果:首发缺血性脑卒中病人照顾者家庭适应得分为（49.25±7.63）分,照顾负担得分为（26.79±12.76）分,应对方式得分为（29.06±8.09）分,领悟社会支持得分为（63.25±8.57）分。首发缺血性脑卒中病人照顾者家庭适应总分与照顾负担总分和责任负担维度得分呈负相关（P<0.05）,与积极应对总分、社会支持总分及各维度得分呈正相关（P<0.05）。多元线性回归分析表明,积极应对、社会支持和照顾者文化程度是首发缺血性脑卒中病人照顾者家庭适应的影响因素（P<0.05）。结论:首发缺血性脑卒中病人照顾者家庭适应处于较低水平,医护人员应关注文化程度低、社会支持水平低及采取消极应对方式的病人照顾者,针对性地实施个性化干预。     

领悟性社会支持在急性心肌梗死患者感恩与创伤后成长中的中介作用

目的探讨领悟性社会支持在急性心肌梗死患者感恩与创伤后成长之间的中介作用。方法采用一般资料调查问卷、简体中文版创伤后成长评定量表、领悟性社会支持量表、中文版感恩问卷对重庆市陆军军医大学第三附属医院心内科的213例首发性急性心肌梗死患者进行调查。结果急性心肌梗死患者创伤后成长总分为(63.33±10.23)分,感恩得分为(29.99±4.28)分,领悟性社会支持总分为(59.46±7.12)分;创伤后成长与感恩呈密切正相关(r=0.401,P0.01),与领悟性社会支持呈密切正相关(r=0.411,P0.01);结构方程模型表明:领悟性社会支持在感恩与创伤后成长中起部分中介作用,中介效量占总效应量的24.2%。结论领悟性社会支持在急性心肌梗死患者感恩与创伤后成长之间起部分中介作用。医护人员可从提高患者感恩和社会支持水平2个角度来帮助患者实现创伤后成长。     

肺癌患者心理韧性现状及影响因素分析

目的 调查肺癌患者的心理韧性现状,探究其影响因素,为开展肺癌患者心理韧性干预措施提供参考。方法 采用便利抽样法,选取四川省成都市某三级甲等医院2020年10月—2021年8月入院治疗的192例肺癌患者作为调查对象,使用一般资料调查表、一般自我效能感量表、领悟社会支持量表及压力知觉量表进行问卷调查,采用多元线性回归模型分析其影响因素。结果 肺癌患者心理韧性总分均分为（62.60±16.77）分。多元线性回归分析显示,文化程度、自我效能感、领悟社会支持感及压力知觉共解释肺癌患者心理韧性变异度的48.1%。结论 本研究发现,肺癌患者心理韧性水平处于中等偏下水平,受文化程度、自我效能感、领悟社会支持感及压力知觉因素的影响。医护人员应对压力感知明显的肺癌患者采取针对性心理干预,同时引导其增加自我效能感与领悟社会支持感,从而有效提高心理韧性。     

心理资本在恢复期脑卒中患者领悟社会支持与患者积极度的中介效应分析

目的 探讨心理资本在领悟社会支持与患者积极度间的中介作用,为提升患者积极度水平提供参考。方法 2021年1—9月,采用便利抽样法,选取浙江省某三级甲等医院的304例脑卒中恢复期患者作为研究对象,应用一般资料调查问卷、领悟社会支持量表、积极心理资本量表及患者积极度量表对其进行调查。结果 本组脑卒中恢复期患者领悟社会支持总分为（60.17±10.26）分,心理资本总分为（119.50±21.34）分,患者积极度总分为（53.03±10.92）分;领悟社会支持与心理资本呈正相关（r=0.451, P<0.01）,领悟社会支持、心理资本与患者积极度均呈正相关（r=0.451、0.578, P<0.01）;心理资本在领悟社会支持与患者积极度之间起部分中介作用,中介效应效应值为0.327,效应占比为51.2%。结论 本组脑卒中恢复期患者领悟社会支持、心理资本处于中等偏上水平,患者积极度处于较低水平。领悟社会支持、心理资本均可直接影响患者积极度,领悟社会支持也可通过心理资本间接影响患者积极度,护理人员应制定以影响患者积极度的路径为依据的干预策略,培养患者对社会支持的领悟能力,挖掘患者积极...     

首发老年脑卒中患者社会关系质量与韧性的相关性研究

目的调查首发老年脑卒中患者社会关系质量及韧性的现状,分析两者的相关性,为脑卒中康复干预的韧性研究提供参考依据。方法采用便利抽样法,选择2017年1-12月上海两所三级甲等医院450例首发老年脑卒中患者,采用社会关系质量量表、中文版韧性量表(Connor-Davidson resilience scale-Chinese,CD-RISC)进行调查,采用Pearson相关分析法和回归分析法探讨社会关系质量与韧性的相关性。结果首发老年脑卒中患者社会关系质量总分为(39.78±6.75)分,韧性总分为(54.13±8.17)分;社会关系质量各维度评分与韧性各维度评分呈显著正相关(均P0.05);回归分析结果显示,社会关系质量可解释老年首发脑卒中患者韧性69.4%的变异量(P0.05)。结论老年首发脑卒中患者社会关系质量及韧性均处于中等水平;社会关系质量是韧性的影响因素,直接影响患者的康复;脑卒中的康复干预可以社会关系质量为切入点,以改善社会关系、获取积极的社会支持为契机,来提高患者的韧性水平,从而促进其康复,并可应用于脑卒中二级预防。     

首发脑卒中偏瘫患者康复期自我效能感及影响因素

目的:探讨首发脑卒中偏瘫患者康复期自我效能感现状,并分析影响因素。方法:采用脑卒中患者一般资料调查问卷、脑卒中自我效能量表、Barthel指数评定量表、领悟社会支持量表,对83例首发脑卒中偏瘫患者进行研究。结果:首发脑卒中偏瘫患者康复期自我效能总体得分为(66.47±14.41)分,其中日常生活活动效能得分为(40.37±10.08)分、得分率为67.28%,自我管理效能得分为(26.10±6.27)分、得分率为52.20%。经多元线性回归分析显示,Barthel指数、领悟社会支持程度及文化程度是首发脑卒中偏瘫患者自我效能感的影响因素,可解释自我效能感76.7%的变异量。结论:首发脑卒中偏瘫患者康复期自我效能水平有待进一步提高,医护人员在进行健康教育、出院计划等护理干预时,应注重提高患者日常生活活动能力,为患者争取更多社会支持,同时着重关注文化程度较低患者,提高患者自我效能感及治疗依从性,以促进康复,进而提高患者生活质量。     

希望水平在脑卒中恢复期患者社会支持与心理韧性之间的中介效应

目的 探讨希望水平在脑卒中恢复期患者社会支持与心理韧性之间的中介效应,为医护人员实施心理护理提供参考和借鉴。方法 采用便利抽样法,选取2020年10月至2021年5月某康复医学中心的210例脑卒中恢复期患者,采用自行设计的一般资料问卷、心理韧性量表（connor-davidson resilience scale,CD-RISC）、社会支持评定量表（social support rating scale,SSRS）、Herth希望指数量表（herth hope index,HHI）进行调查。运用Pearson相关分析法探讨社会支持、心理韧性和希望水平间的相关性;采用Process宏程序和Bootstrap程序进行中介效应分析和验证。结果 脑卒中恢复期患者的心理韧性得分为（59.9±16.1）分,社会支持得分为（36.2±8.0）分,希望水平得分为（35.8±5.6）分。社会支持对心理韧性存在直接效应（标准化β=0.180,95%CI:0.110～0.624）,并通过希望水平的部分中介效应间接影响心理韧性（标准化β=0.323,95%CI:0.459～0.882）,其中介效应占总效应的6...     

首发急性心肌梗死患者心理韧性现状及其影响因素分析

目的探讨首发急性心肌梗死(AMI)患者心理韧性现状及其影响因素。方法本研究为横断面研究。采用便利抽样法, 选取2021年3—9月在首都医科大学附属北京友谊医院心内科住院的120例首发AMI患者为研究对象。采用心理韧性量表(CD-RISC)、医疗社会支持量表、简易应对方式问卷、疾病不确定感量表对其进行调查。本研究共发放问卷120份, 回收有效问卷120份。结果 120例首发AMI患者的CD-RISC总分为(66.35±16.69)分。多重线性回归分析结果显示, 积极应对、社会互动性合作和不明确性是首发AMI患者心理韧性的影响因素(P<0.05)。结论首发AMI患者的心理韧性处于中等水平。患者对疾病的不明确性对首发AMI患者心理韧性具有负向预测作用, 积极应对和社会互动性合作对心理韧性具有正向预测作用, 应加强与患者及其家属有效沟通、早期宣教, 挖掘患者的积极情绪, 从而提高患者的心理韧性水平。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.