咽喉反流性疾病患者焦虑抑郁状况分析及其对疗效的影响

目的分析咽喉反流性疾病(Laryngopharyngealrefluxdisease,LPRD)患者的焦虑抑郁状况及其对疗效的影响。方法 86例经反流症状评分表(Refluxsymptomindex,RSI)和反流体征评分表(Refluxfindingscore,RFS)证实为LPRD的患者(试验组)和90名健康志愿者(对照组)参与此项研究。采用医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)对两组治疗前以及试验组质子泵抑制剂(Proton pump inhibitor,PPI)治疗后行问卷调查,评估并比较各组间的焦虑、抑郁状况,以及试验组焦虑、抑郁程度与疗效的相关性。结果试验组治疗前HADS量表抑郁分数为(12.89±5.73)分,高于对照组的(3.41±1.83)分,焦虑分数为(14.34±6.42)分,高于对照组的(4.53±2.16)分,两组比较差异有统计学意义(P<0.01);试验组治疗后HADS量表抑郁分数为(7.60±2.21)分,低于治疗前的(12.89±5.73)分,焦虑分数为(8.93±2.74)分,低于治疗前的(14.34±6.42)分,2组比较差异有统计学意义(P<0.01);相关性分析显示LPRD患者治疗前HADS评分与RSI及RFS评分呈显著正相关,治疗后HADS评分改善与RSI及RFS评分改善呈显著负相关。结论 LPRD患者存在焦虑抑郁情绪,反流症状和体征越明显,其程度越严重,PPI治疗效果越差。     

运动疗法强化干预对糖尿病患者血糖、焦虑及抑郁状况的影响

目的观察运动疗法强化干预对糖尿病患者血糖、焦虑及抑郁状况的影响。方法选取138例糖尿病患者随机分为观察组(68例)与对照组(70例),均给予常规降糖、饮食控制、健康教育等措施治疗。观察组在此基础上实施运动疗法强化干预治疗3个月,观察两组治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h-PG)、血糖控制所需时间、汉密尔顿抑郁焦虑量表(HAMD)焦虑及抑郁评分。结果两组治疗后FPG、2 h-PG水平均低于治疗前(P<0.01),血糖控制所需时间观察组短于对照组(P<0.01),治疗后两组患者焦虑及抑郁评分均低于治疗前(P<0.01),观察组较对照组下降明显(P<0.01)。结论对糖尿病患者在常规治疗基础上实施运动疗法强化干预,能有效降低血糖、缩短血糖控制所需时间,并有利于促进焦虑及抑郁情绪的改善。     

全程优质护理模式对口腔颌面外科手术患者负性心理情绪的影响

目的探讨全程优质护理模式对口腔颌面外科手术患者负性心理情绪的影响。方法将120例接受口腔颌面外科手术患者随机分为试验组和对照组,每组60例。试验组给予全程的优质护理服务,对照组给予传统护理。采用Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)对2组患者手术前1d(护理前)、出院时(护理后)的焦虑、抑郁情绪进行评分,并比较2组患者的住院时间。结果护理后试验组SAS、SDS评分较护理前显著降低,差异有统计学意义(P<0.01),对照组SAS、SDS评分较护理前均有降低,但差异无统计学意义(P>0.05);试验组护理后SAS、SDS评分与对照组比较降低更为显著(P<0.01)。试验组住院时间与对照组比较显著缩短(P<0.01)。结论全程优质护理模式应用于口腔颌面外科手术患者能有效减少其负性心理情绪,还能缩短患者住院时间。     

心理干预对糖尿病患者焦虑抑郁心理及血糖控制的影响

目的:探讨心理干预对糖尿病患者焦虑抑郁心理及血糖控制的影响。方法:用汉密顿抑郁量表(HAMD)及汉密顿焦虑量表(HAMA)评估糖尿病患者的精神状况,研究组给予心理干预,然后比较研究组与对照组的评分值及研究前后两组的空腹血糖和餐后2小时血糖。结果:两组糖尿病患者均存在明显的焦虑抑郁心理,研究组心理干预后症状明显改善(P<0.01),且对血糖的控制有显著改善(P<0.01);而对照组改善不明显。结论:对糖尿病患者要重视心理干预,有助于改善其抑郁、焦虑情绪,使血糖更易于控制,生活质量得到提高。     

团体认知行为治疗对2型糖尿病患者的影响

目的:探究团体认知行为治疗对2型糖尿病患者的影响。方法:将125例2型糖尿病患者随机分为对照组(63例)和研究组(62例)。对照组患者仅进行常规治疗和健康教育;研究组患者在此基础上给予团体认知行为治疗,比较两组患者的治疗效果。通过焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量量表(SF-36)及血糖指标评估两组患者治疗前后心理指标和血糖指标的变化。结果:研究组患者经团体认知行为治疗后其抑郁评分及焦虑评分均低于对照组。研究组患者生活质量各维度评分均高于对照组(P<0.05)。研究组患者在治疗后其空腹血糖、餐后2 h血糖及糖化血红蛋白均低于对照组。结论:团体认知行为治疗能改善2型糖尿病患者的抑郁、焦虑情绪及生活质量,并且能够影响血糖水平。     

松静诱导康复训练结合风险质控对脑卒中患者负性情绪及睡眠质量的影响

目的:探讨松静诱导训练结合风险质控对脑卒中恢复期患者负性情绪及睡眠质量的影响。方法:选取2018年1月至2020年6月浙江省金华市人民医院神经内科收治的90例脑卒中患者,按照入院时间分为两组,每组各45例。对照组使用常规干预,试验组在对照组干预基础上使用松静诱导训练干预措施。统计两组治疗前后的匹兹堡睡眠质量指数量表(PSQI)、医院焦虑抑郁量表(HADS)、脑卒中专用生活质量量表(SS-QOL)评分变化情况及干预效果情况。结果:两组治疗前的PSQI、HADS及SS-QOL评分比较,差异均无统计学意义(P>0.05);干预后,试验组的匹兹堡睡眠质量指数(PSQI)7个维度评分及总分均低于对照组,差异有统计学意义(P<0.05)。在焦虑抑郁(HADS)评分方面,干预后,试验组的得分显著低于对照组,差异有统计学意义(P<0.05);试验组的干预效果优于对照组,差异有统计学意义(P<0.05)。结论:对脑卒中患者进行松静诱导训练结合风险质控干预,可显著降低患者的焦虑与抑郁水平,提升睡眠质量,改善患者的生活质量。     

糖尿病患者早期合并焦虑抑郁的相关因素分析

目的分析2型糖尿病患者早期焦虑抑郁状态的相关因素。方法采用汉密尔顿焦虑自评量表(HAMA)和抑郁自评量表(HAMD)对200例2型糖尿病早期患者进行横断面调查,评价焦虑和抑郁患病情况,从不同性别、年龄、经济状况、文化程度等方面进行分析,并对血糖控制情况、是否合并高血压、血脂异常、糖尿病慢性并发症等因素进行相关性分析。结果糖尿病患者HAMD评分(38±9)分、HAMA评分(26±9)与国内常模比较,差异有统计学意义(P<0.01),且男女之间、不同年龄段、文化程度、经济状况及合并其他慢性病及糖尿病并发症患者进行HAMD、HAMA评分比较,差异具有统计学意义(P<0.05,P<0.01)。结论糖尿病早期患者常存在焦虑、抑郁心理,且受性别、年龄、文化程度和经济状况的影响,同时血糖控制差、合并有高血压、高血脂及糖尿病慢性并发症者,抑郁倾向更加显著;焦虑和抑郁2种负性心理状态易同时并存。     

心理护理对2型糖尿病合并抑郁症的影响

目的:探讨护理干预对2型糖尿病合并抑郁症患者的影响。方法:采用汉密尔顿抑郁量表(HAMD)评估160例2型糖尿病患者,其中合并抑郁的患者70例,分为干预组35例和对照组35例。对照组患者采用常规治疗,干预组患者在对照组治疗方案的基础上给予心理行为干预。记录2组患者治疗前和治疗8周后(治疗后)的HAMD量表评分、糖尿病生存质量特异性量表(DSQL)、空腹血糖、餐后2h血糖以及糖化血红蛋白,进行疗效评价。结果:两组患者治疗前HAMD评分、DSQL评分、空腹血糖、餐后2h血糖以及糖化血红蛋白组间比较,差异均无统计学意义(P>0.05);治疗后干预组各项数值较组内治疗前均有显著改善,差异有统计学意义(P<0.01),且与对照组治疗后比较,差异亦有统计学意义(P<0.01)。结论:有效的护理干预能缓解2型糖尿病患者抑郁情绪,有效地控制血糖,提高2型糖尿病患者生活质量。     

实施健康教育路径对2型糖尿病患者血糖及心理变化影响

目的 探讨2型糖尿病健康教育路径对患者血糖及心理变化影响。方法 随机将260例2型糖尿病患者分为2组,实验组患者住院期间实施系统2型糖尿病健康教育路径,对照组患者住院期间延续既往制定常规护理措施,观察2组2型糖尿病患者掌握相关知识和相关技能水平以及血糖控制率,并分别通过应用Zung抑郁症自测量表(self-rating depression scale,SDS)和Zung焦虑症自测量表(self-rating anxiety scale,SAS)对入选病例进行心理测试。结果 与对照组比较,对2型糖尿病相关知识、相关技能掌握水平,血糖控制率,糖化血红蛋白控制率以及焦虑和抑郁程度,实验组患者得到显著改善(P<0.05)。结论 实施全面系统2型糖尿病健康教育路径,能够控制2型糖尿病患者病情,减轻患者抑郁和焦虑情绪,改善患者治疗和护理依从性,提高其生活质量。     

赋能教育对慢性阻塞性肺疾病患者自我效能、负面心理及呼吸功能的影响

目的：研究赋能教育对慢性阻塞性肺疾病(COPD)患者自我效能、负面心理及呼吸功能的影响。方法：选取COPD患者210例为研究对象,按照随机数字表分为试验组和对照组,各105例。对照组给予常规入院治疗和健康教育,试验组在对照组基础上给予赋能教育。利用自我效能感(GSES)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、阻塞性肺疾病功能量表(CAT)和改良版呼吸困难评级量表(mMRC)比较分析干预前后两组的自我效能、焦虑、抑郁、肺功能和呼吸困难程度以评价干预效果。结果：干预前,两组GSES评分、SAS自评分、SDS自评分、CAT评分和mMRC等级比较,差异无统计学意义(P>0.05)。干预后,试验组GSES评分高于对照组,试验组SAS、SDS、CAT和mMRC等级分值均低于对照组,两组差异均有统计学意义(P<0.05)。结论：赋能教育不仅能增强COPD患者的自我效能,而且在改善患者的负性情绪、呼吸功能方面也有显著效果。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.