失眠症心理护理的临床观察

失眠症是睡眠障碍常见的一种表现形式,表现为持续相当长时间对睡眠质量的不满意.我国一般人群中有10～20%患有失眠症[1],国外报道达30～35%[2].慢性失眠患者常伴有抑郁、焦虑、烦恼和紧张,对自身健康过分关心等[3],单纯依靠催眠药物难以受到满意效果.为此我们在失眠症临床治疗的基础上辅以心理护理观察.现报告如下.     

失眠症心理护理的临床观察

失眠症是睡眠障碍常见的一种表现形式 ,表现为持续相当长时间对睡眠质量的不满意。我国一般人群中有 10～ 2 0 %患有失眠症[1] ,国外报道达 3 0～ 3 5 % [2 ] 。慢性失眠患者常伴有抑郁、焦虑、烦恼和紧张 ,对自身健康过分关心等[3 ] ,单纯依靠催眠药物难以受到满意效果。为此我们在失眠症临床治疗的基础上辅以心理护理观察。现报告如下。对象与方法一、对象2 0 0 0年 2月～ 2 0 0 3年 1月在济宁市精神病防治院和鱼台县人民医院门诊就诊的患者 ,符合中国精神疾病分类方案和诊断标准第三版 (CCMD 3 )失眠症的诊断标准 ,排除患有某种躯体疾…     

热浸酸枣仁治疗冠心病失眠患者60例护理体会

失眠是指经常不能获得正常的睡眠，其临床表现为难以入睡，甚至彻夜不眠，或睡后易醒，醒后难以人眠，或似睡似醒，醒后仍感困乏。失眠包括入睡困难、清晨觉醒过早、睡眠时间短、睡眠中断、白昼睡眠时间过多。它约占内科门诊的10％左右。WHO的一项研究表明，全球约有27％的人遭受睡眠病症的困扰。引，我国有40％的人睡眠不足。因此，改善失眠症病人睡眠质量，是护理工作的重要内容之一。我院近年来对60例失眠症病人给予热浸酸枣仁治疗的同时，结合辨证施护，取得了较好的临床效果，现将护理体会报告如下。     

纽曼系统模式护理程序在失眠症患者护理中的应用

目的 探讨纽曼系统模式护理程序在失眠症患者护理中的应用.方法 将62例失眠患者随机分为2组,对照组30例,采用常规护理方法;实验组32例,除常规治疗护理外,针对患者各种压力进行干预,采用一级预防、二级预防、三级预防措施,评价患者的睡眠时间、睡眠质量、睡眠效果.结果 干预后实验组对睡眠时间、睡眠质量、睡眠效果满意比例均明显提高.结论 纽曼系统模式护理程序体现了"以患者健康为中心"的整体护理内容,提高了护理质量,改善了失眠症患者的生活质量.     

失眠症患者抑郁障碍及相关因素的研究

目的评估失眠症患者抑郁障碍的共病率及其相关因素。方法对失眠专病门诊就诊的失眠患者进行前瞻性登记，连续收集专病门诊中符合ICD-10非器质性失眠症诊断标准、并能配合问卷及量表调查的患者，通过自编问卷进行详细的人口学资料及失眠临床特征调查，应用汉密顿抑郁量表（HDRS17）进行抑郁障碍的筛选，同时应用多元Logistic回归分析，研究失眠症患者存在抑郁障碍的相关因素。结果52．8％失眠症患者存在抑郁障碍，14．0％为重度抑郁。总睡眠时间少（OR1．618，95％CI1．239～2．114）、经济状况较差（OR1．755，95％CI1．210～2．544）、生活不规律（OR2．395，95％CI1．321～4．343）、女性（OR1．899，95％CI1．139—3．166）为失眠症患者合并抑郁障碍的独立危险因素。结论失眠症患者有较高的抑郁障碍共病率，对总睡眠时间少、经济状况较差、生活不规律、女性的失眠人群要特别重视与抑郁障碍其病的可能。     

失眠患者心理因素分析及护理对策

目的 :探讨心理因素对失眠症患者睡眠的影响及干预效果。方法 :对 76例失眠症患者进行心理分析 ,结合多导睡眠图评价进行心理～行为矫正。结果 :76例患者中 ,评估性失眠 2 3例(30 2 % )、疑病性失眠 14例 (18 0 % )、依赖性失眠 17例 (2 2 4 % )、紧张性失眠 2 2例 (2 8 9% ) ;经干预后 ,睡眠潜伏期缩短依赖性和紧张性失眠显著 (P <0 0 1)、睡眠时间增加以紧张性失眠显著 (P <0 0 1)、依赖性失眠REM睡眠改变有显著性 (P <0 0 1)。结论 :失眠与心理因素有关 ;对患者实施心理～行为干预可缩短睡眠潜伏期、增加睡眠时间 ,提高疗效     

改善睡眠障碍的护理干预和相关护理进展

睡眠障碍是失眠症的主要表现，已成为威胁人类健康的危险因素之一。对失眠患者进行有效的护理干预，并进行个体化的整体护理，从多方面提高患者的健康睡眠意识，从而提高睡眠质量。     

综合治疗失眠症53例体会

失眠症是持续相当长时间的对睡眠的质和量的不满意状况。目前治疗失眠症的方法虽多 ,但疗效多不满意 ,我们采用磁疗、低频电及运动等疗法综合治疗失眠症 ,疗效显著 ,报道如下。资料和方法1　病例资料　失眠症患者 1 0 6例、男 73例 ,年龄 2 3岁～ 72岁 ,平均 49岁 ,病程半月～ 1 9年 ,主要表现为夜晚入睡困难、睡眠不深、多梦 ,白天思睡、缺乏清醒感。将 1 0 6例患者随机分为 2组 ,各 5 3例 ,观察组采用磁疗、低频电、运动等综合治疗 ,对照组仅采用磁疗法 ,各种躯体疾病或其它精神疾病所致的失眠症除外。2　采用方法　皇城牌Ｄ -95Ｅ型心脑…     

护理干预对失眠症患者改善睡眠的影响

目的：探讨护理干预对失眠症患者改善睡眠的影响。方法：对70例失眠症患者随机分为干预组和对照组各35例,对干预组患者实施护理干预,进行干预前后的评价,并与对照组比较。结果：干预前失眠症患者有明显的睡眠潜伏期长,总睡眠时间减少;实施护理干预后患者睡眠潜伏期和总睡眠时间明显好于对照组,两组差异有统计学意义（P〈0.01）。结论：对失眠症患者实施护理干预对改善睡眠,可取得明显效果。     

慢性失眠症药物治疗概述

1．引言 慢性失眠症影响到约10～15％的成人人口。不过，尽管失眠症十分流行，但至今仍未得到充分认识且此疾病的诊断率和治疗率均偏低。例如，近三分之二具有失眠症症状患者未主动将该信息告知医师，而医师也常不向患者询问他们的睡眠状况。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.