初产妇母亲角色适应与应对方式及社会支持的相关性研究

目的 探讨初产妇产褥期母亲角色适应与应对方式及社会支持的关系.方法 产后第43天,应用母亲角色适应问卷、应对方式量表和社会支持量表调查187例初产妇产褥期母亲角色适应状况.结果 母亲角色适应良好43倒(23.0％)、中等99例(52.9％)、差45例(24.1％);不同文化程度、是否计划妊娠初产妇母亲角色适应程度构成比比较,差异有统计学意义(P＜0.05);母亲角色适应与积极应对、社会支持、主观支持、支持利用度呈正相关,与消极应对呈负相关;回归分析显示,是否计划妊娠、积极应对、消极应对、主观支持、支持利用度是影响母亲角色适应的重要因素.结论 积极的应对方式、良好的主观支持及支持利用度能帮助初产妇更好地适应母亲角色.     

耐多药肺结核患者社会支持与应对方式的比较研究

目的了解耐多药肺结核(MDR-TB)患者社会支持与应对方式的特点,为临床护理和心理护理提供依据。方法采用社会支持评定量表和简易应对方式问卷对我科住院治疗的53例MDR-TB患者进行调查,并作相关分析。结果MDR-TB患者的社会支持总分、主观支持、客观支持和支持利用度均分均低于对照组(t=3.776,2.897,2.818,3.09,P<0.01),多采取消极应对方式(P<0.01),社会支持总分和对支持利用度与积极应对方式呈正相关(r=0.548,0.670,P<0.01),社会支持总分和对支持利用度与消极应对方式呈负相关(r=-0.698,-0.786,P<0.01)。结论提高MDR-TB患者社会支持度和对支持利用度有利于建立积极应对方式,提高MDR-TB患者的治疗依从性。     

社会支持及应对方式对产妇分娩方式的影响

[目的]了解产妇社会支持、应对方式对其选择分娩方式的影响。[方法]对184例产前无明显剖宫产指证的产妇(其中阴道分娩117例,剖宫产手术分娩67例),应用社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ),采用χ2检验、t检验、Pearson相关、非条件Logistic回归进行统计分析。[结果]阴道分娩组对支持利用度和积极应对得分均高于剖宫产组,客观支持、消极应对得分低于剖宫产组(P0.05);多因素分析结果显示,对支持利用度和积极应对是产妇选择阴道分娩的积极促进因素。[结论]社会支持和应对方式是产妇选择分娩方式的重要影响因素,应注重培养产妇的积极应对技巧,提高其对家庭及社会支持的主观利用程度,增强自然分娩信心,降低剖宫产率。     

维持性血液透析患者心理健康状况与其应对方式、社会支持的调查研究

目的调查维持性血液透析患者心理健康状况、应对方式和社会支持度,比较他们心理健康状况、应对方式、社会支持度与健康对照组的异同,并且探讨其应对方式和社会支持度对其心理健康状况的预测度。方法用症状自评量表、简易应对方式问卷和社会支持评定量表对患者组和对照组进行问卷调查,使用SPSS15.0统计软件对数据进行t检验、积差相关和多重逐步回归分析。结果患者心理健康状况、社会支持和积极应对方式显著低于对照组,消极应对方式则高于对照组。其积极应对、社会支持度总得分、主观社会支持度以及客观支持度与其心理健康状况有显著相关。同时两种应对方式和主观社会支持度被纳入多重回归。结论患者较健康群体心理健康状况低下,具体应对方式和社会支持度对其心理健康状况有显著预测作用。     

5·12地震后PTSD症状严重性和社会支持之间的相关性研究

目的:探讨社会支持与创伤后应激障碍(PTSD)之间的相关性。方法:地震后1年半,应用德国埃森创伤问卷(ETI)及社会支持评定问卷(SSRS),以震区454名普通群众为被试,对ETI得分和SSRS得分进行相关性分析。结果:①被试社会支持水平与PTSD整体症状水平存在显著负相关。②被试社会支持各维度的水平与PTSD各症状群均为显著负相关,但相关程度不同。负相关程度排序依次为对支持的利用度、主观支持和客观支持。结论:社会支持水平是PTSD的保护性因子,社会支持中的主观支持和支持利用度与PTSD负相关程度更明显。     

银屑病病人特质应对方式、社会支持与抑郁的相关性研究

[目的]了解银屑病病人抑郁状况,分析抑郁与特质应对方式、社会支持的关系。[方法]应用一般资料调查表、特质应对方式问卷(TCSQ)、抑郁自评量表(SDS)、社会支持量表(SSRS)对100例银屑病病人进行调查。[结果]银屑病病人SDS得分为(59.44±10.94)分,显著高于常模,抑郁与消极应对呈正相关(P<0.05),与积极应对、社会支持总分、主观支持、支持利用度呈负相关(P<0.05)。对病人抑郁影响因素进行逐步回归分析结果显示,消极应对和对支持利用度是抑郁的最重要预测因素,二者可解释43.5%的变异量。[结论]银屑病病人抑郁状况较严重,应对方式和社会支持是其重要的影响因素,医务工作者应加强对银屑病病人应对方式的健康教育,同时调动有效的社会支持来源帮助银屑病病人克服抑郁心理障碍。     

糖尿病患者的主观幸福感调查及影响因素分析

目的研究糖尿病患者的主观幸福感及其影响因素。方法用纽芬兰纪念大学幸福度量表(MUNSH)、社会支持评定量表(SSRS)、生活事件评价问卷、Zung氏焦虑与抑郁自评量表(SAS和SDS)分别对35例门诊糖尿病患者和33例健康对照组的主观幸福感、生活事件评价、社会支持、情绪状态进行评价,并对患者的躯体状况(疾病严重程度、疾病持续时间、有无并发症等)进行评分。结果与正常对照组相比,糖尿病患者的主观幸福感明显降低(对照组为10±8,糖尿病患者为5±6),且患者的主观幸福感与生活事件评价、焦虑抑郁程度呈负相关(相关系数分别为0.25,0.23,0.13);与总社会支持呈正相关(相关系数为0.28)。结论糖尿病患者的主观幸福感与多种因素有关,其中生活事件评价是重要影响因素之一。     

NICU住院早产儿家属心理弹性与应对方式及社会支持的研究

[目的]探讨新生儿重症监护室(NICU)住院早产儿家属心理弹性与应对方式及社会支持的关系。[方法]应用一般资料问卷、心理弹性问卷(CD-RISC)、应对方式量表及社会支持量表对128例NICU住院早产儿家属进行调查,应用Pearson单因素分析NICU住院早产儿家属心理弹性与应对方式及信息支持的关系,应用Logistic多元回归分析影响NICU住院早产儿家属心理弹性的相关因素。[结果]NICU住院早产儿CD-RISC评分为(57.10±4.56)分,积极应对方式评分为(25.36±3.45)分,社会支持评分为(58.36±4.25)分。经Pearson单因素分析,NICU住院早产儿家属心理弹性与积极应对方式、主观支持、客观支持、对支持利用度呈正相关(P0.05)。经Logistic多元回归分析,患儿家庭收入、出生时周龄、患儿合并症、应对方式及主观支持、对支持利用度是影响NICU住院早产儿家属心理弹性的相关因素。[结论]NICU住院早产儿家属心理弹性与应对方式及社会支持有密切的关系,给予早产儿家属足够的社会支持,鼓励患儿家属积极面对疾病将有助于提高患儿家属心理弹性、改善患儿家属心理状况。     

耐多药肺结核患者社会支持与应对方式的比较研究

目的了解耐多药肺结核(MDR-TB)患者社会支持与应对方式的特点,为临床护理和心理护理提供依据.方法采用社会支持评定量表和简易应对方式问卷对我科住院治疗的53例MDR-TB患者进行调查,并作相关分析.结果MDR-TB患者的社会支持总分、主观支持、客观支持和支持利用度均分均低于对照组(t=3.776,2.897,2.818,3.09,P＜0.01),多采取消极应对方式(P＜0.01),社会支持总分和对支持利用度与积极应对方式呈正相关(r=0.548,0.670,P＜0.01),社会支持总分和对支持利用度与消极应对方式呈负相关(r=-0.698,-0.786,P＜0.01).结论提高MDR-TB患者社会支持度和对支持利用度有利于建立积极应对方式,提高MDR-TB患者的治疗依从性.     

脑卒中患者生活质量与应对方式及社会支持的相关性分析

目的了解社区脑卒中患者的生活质量、应对方式及其社会支持情况，为提高社区脑卒中患者生活质量提供护理依据。方法采用生活质量综合评定问卷、医学应对问卷及社会支持评定量表对52例社区脑卒中患者（观察组）及52例健康自愿者（对照组）进行测评。结果观察组生活质量总分及躯体功能、心理健康、社会功能评分均低于对照组；医学应对问卷中的面对分值观察组低于对照组、屈服分值高于对照组；观察组社会支持总分及客观支持、主观支持、支持利用度评分均低于对照组；脑卒中患者生活质量总分及躯体功能、心理健康、社会功能评分与面对及社会支持总分、客观支持、主观支持、支持利用度分值呈正相关，而与屈服分值呈负相关。结论社区脑卒中患者生活质量偏低，与应对方式及社会支持有关。     

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.     

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.     

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.     

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.