80例慢性酒精中毒性精神障碍患者临床分析

目的探讨慢性酒精中毒性精神障碍患者的临床特征。方法对2005～2009年收治的80例慢性酒精中毒性精神障碍患者的临床资料进行回顾性分析,并按饮酒量、饮酒时间分组对出现精神障碍的时间及对躯体情况的影响进行比较。结果患者多为男性、文化程度低、体力劳动者。主要精神症状为幻觉(82.5%)、妄想(77.5%)、人格改变(35.65%);伴各种躯体疾病者66.3%;饮酒量对出现精神障碍的时间和躯体损害的影响有统计学差异;饮酒时间对躯体损害的影响有统计学差异。结论慢性酒精中毒可造成严重精神障碍、躯体损害,应引起全社会对本病防治的重视。     

去甲万古霉素在造血干细胞移植患者中应用的安全性和有效性研究

目的评价注射用去甲万古霉素在造血干细胞移植(HSCT)患者中应用的安全性和有效性,为临床用药提供依据。方法观察去甲万古霉素静脉用药的HSCT住院患者在用药期间发生的任何不良事件,判断不良事件与药物的关系、计算不良反应发生率,并观察疗效。结果2004年5月至2007年5月共入选病例95例,其中可进行临床和实验室安全性评价者93例。出现不良反应者共15例,不良反应发生率为16.1%。其中肾功能损害7例(7.5%)、肝功能损害4例(4.3%)、肝肾损害伴血尿者1例(1.1%)、肠道菌群失调1例(1.1%)、耳鸣1例(1.1%)、血栓性静脉炎1例(1.1%)。年龄≥45岁,合并应用其他易造成肾脏损伤药物(氨基糖苷类抗生素、两性霉素B、膦甲酸钠)都是造成肾脏损害的高危因素。而以上因素均不是肝脏损害的高危因素。可评价疗效的81例中,47例有效,总有效率58.0%。结论注射用去甲万古霉素在HSCT患者的临床应用中有一定的疗效,但不良反应发生率较一般人群高,合并应用其他易造成肾脏损伤药物(氨基糖苷类抗生素、两性霉素B、膦甲酸钠)易发生肾脏损害。     

临床抗感染决策对NICU新生儿败血症心肌损害的影响

目的 研究临床首选不同抗生素的抗感染决策对NICU新生儿败血症心肌损害发生率的影响.方法 采用前瞻性临床研究方法,分析了入住NICU的112例新生儿败血症患儿心肌损害的发生率与首选不同的抗生素及其抗感染治疗效果的关系.结果 治疗有效者88例,心肌损害的发生率为43%,显著低于无效者(79%,P＜0.05).抗感染疗效差,5 d内需更换抗生素者心肌损害的发生率显著高于不需更换者(P＜0.05).头孢地嗪(CDZ)组43例,心肌损害的发生率为33%,显著低于首选其他抗生素组,即复方抗生素组和单方抗生素组(70%,56%,P＜0.05).结论 尽早选择安全、有效的抗生素,减少抗生素的更换率,可降低新生儿败血症心肌损害的发生率.CDZ治疗新生儿败血症临床疗效好.     

新生儿缺氧缺血性脑病并发心肌损害56例分析

新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)与围生期窒息有关,可导致多脏器损害,尤以心肌损害多见,临床上常易被漏诊.我院2004年1月～2007年5月收治HIE患儿162例,56例并发心肌损害,发生率为34.56%,现报告如下.     

甲状腺功能亢进合并肝损害临床分析

目的探讨甲状腺功能亢进(甲亢)合并肝损害的临床特点及治疗措施。方法回顾性分析59例甲亢合并肝损害患者的临床资料。结果甲亢性肝损害的发生率为28·78%,年龄越大、甲亢病程越长,肝损害发生率越高;肝损害症状多数轻微(64·40%);肝功能损害以碱性磷酸酶(ALP)升高为主(61·02%)。结论甲亢易合并肝损害,肝损害的程度与年龄、病程及病情有关,应尽早合理治疗。     

甲亢性肝损害120例临床分析

目的 :探讨甲亢性肝损害的临床特点及治疗措施。方法 :回顾性分析 1 2 0例甲亢性肝损害的临床资料。结果 :(1 )甲亢性肝损害的发生率为 4 3.5 % ,年龄越大 ,甲亢病程越长 ,肝损害发生率越高 (P <0 .0 5 ) ;(2 )肝损害症状多数 (6 8.2 % )轻微或无症状 (2 2 .5 % ) ,食欲大多数正常或亢进 (86 .7% ) ;(3)肝功能损害以ALT升高 (88.3% )及AKP升高 (6 2 .5 % )多见 ;(4 )治疗以控制甲亢为主 ,护肝治疗为辅。结论 :甲亢容易合并肝损害 ,肝损害的程度与年龄、病程及病情密切相关。甲亢性肝损害如诊断及时 ,治疗积极 ,预后良好     

HIV感染者/AIDS疼痛病人躯体及心理症状的相关性分析

[目的]了解人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)疼痛病人躯体、心理症状并探讨其相关性。[方法]根据艾滋病病人躯体症状自评量表和抑郁症筛查量表(PHQ-4)设计调查问卷,采用系统抽样法调查255例门诊或住院HIV感染者/AIDS病人的躯体症状和抑郁发生情况。[结果]255例病人中,111例自述伴有疼痛,疼痛病人发生躯体症状较多的有疲乏(69. 37%)、头痛(69. 37%)、食欲下降(69. 37%);发生心理症状较多的有感到做事提不起兴趣(42. 34%)、感到压力很大(41. 44%)、感到心情低落(39. 64%)、无法控制焦虑(39. 64%)。疼痛病人的21项躯体、18项心理症状发生率高于非疼痛病人(P0. 05)。疼痛病人的躯体症状发生率与心理症状发生率呈正相关(r=0. 578,P0. 001)、焦虑症状发生率与抑郁症状发生率呈正相关(r=0. 759,P0. 001)。[结论]HIV感染者/AIDS疼痛病人的多项躯体、心理症状发生率较高,躯体症状伴随心理症状发生,焦虑症状伴随抑郁症状发生,护理人员应对HIV感染者/AIDS疼痛病人采取积极有效的疼痛管理,以提高HIV感染者/AIDS病人的生活质量。     

婴幼儿轮状病毒肠炎肠道外多器官损害的临床研究

目的 探讨婴幼儿ＨＲＶ肠炎患儿肠道外多器官损害状况及其与预后的关系。方法 采用前瞻性调查方法,对１２０例ＨＲＶ肠炎患儿呼吸、心、肝、肾、脑及胰的临床损害及其与预后的关系进行分析。结果（1）HRV肠炎的肠道道外器官损害中,1个器官损害发生率为18.33%（22/120）,2个器官损害的发生率为45.83%(55/120）,3个器官损害的发生率为12.50%(15/120)。4个器官损害的发生率为11.66%(14/120）;（2）HRV肠炎的肠道外器官损害中,以呼吸系统最多,占88.33%(106/120),其次是心脏,占65,83%(79/120）,肝、肾分别为24.16%(29/120)和12.50%(15/120),胰、脑占的比例最少,分别为3.33%(4/120)和2.50%(3/120);（3）肠道外器官损害多随腹泻症状的好转而逐渐恢复正常。结论 （1）HRV肠炎的肠道外多器官损害拓临床上比较多见,并以2个器官损害的发生率最多;（2）HRV肠炎的肠道外器官损害中,以呼吸系统最多,提示HRV肠炎患儿可能先有呼吸系统感染,后经血行播散到肠道及身体其他器官;（3）HRV腹泻患儿的肠道外损害多数症状轻微,为一过性损害,很少引起严重后果。     

狼疮性脑病的临床观察及护理体会

目的 探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)合并中枢神经系统(central nervous system,CNS)损害的临床特点及护理对策.方法 回顾分析合并CNS损害的SLE 18例的临床资料,并与无CNS受累的SLE 80例对照.结果 SLE合并CNS损害的表现为癫癎(33.3%)、精神异常(50.0%),CNS损害组的重要器官损害发生率及病情活动性均明显高于对照组(P＜0.05).CNS损害组患者抗poly、Neuro-2a和Asialo-GM1 抗体阳性率明显高于对照组.CNS损害组经应用甲泼尼龙冲击治疗,明显改善或好转16例(88.89%),死亡2例(11.11%).结论 全面细致的病情观察与护理有利于SLE合并CNS损害(SLE-CNS)的治疗和患者症状的恢复.     

硫酸依替米星注射剂不良反应的临床观察

目的:分析硫酸依替米星不良反应的临床特征、相关因素,为硫酸依替米星所致不良反应的防治提供可靠的参考依据。方法:对2003年11月～2004年5月我院使用硫酸依替米星注射剂的住院患者出现的不良反应及联合用药情况进行调查分析。结果:使用单一抗生素1096例,联合用药2029例;不良反应发生率为4.54%(142/3125),听觉和前庭功能损害16例,发生率为0.5%(16/3125);泌尿系统损害14例,发生率为0.45%(14/3125);肝胆系统损害4例,发生率为0.13%(4/3125)。结论:硫酸依替米星是氨基糖苷类抗生素中安全性较高的药物。为了预防和减少不良反应的发生,需注意用药剂量、浓度、滴速配伍禁忌。     

Lymphopenia in heavy drinkers--reversibility and relation to the duration of drinking episodes

Seventy-four addictive alcoholic subjects were investigated shortly after a period of excessive drinking and were compared with 18 alcoholic subjects who had not been drinking for at least six months. No difference was observed in total white cell count or number of circulating granulocytes. Lymphocyte count was significantly lower in alcoholics whose last alcoholic bout had been three months or more, but after 30 days of abstinence the difference had disappeared. The depressed lymphocyte count did not correlate with other components of the drinking pattern. These results show that lymphopenia in alcoholics is a time-dependent and reversible event.     

Sickness absenteeism and mortality in patients with excessive drinking in somatic out-patient care

In a study of 2114 patients attending somatic outpatient clinics, 208 were classified as excessive drinkers. Sickness benefit days and sickness periods per year, disability pension, and mortality were studied for the years 1981 to 1985. The excessive drinkers as a group had 13 to 27 more sickness days per year than the other patients. They also had more sickness periods and a higher rate of disability pension than patients without alcohol overconsumption. The study thus showed that a group with varying degrees of excessive drinking had an increased need for sickness benefits. The mortality was considerably increased among the excessive drinkers. The patients who had undergone treatment or were registered because of alcohol problems had most sickness benefit days. The excessive drinking patients without advanced alcohol problems did not have more sickness days than the other patients. Most of these patients (75%) were sick-listed without recognition of their excessive drinking by their doctor. This emphasizes the importance, in terms of sickness benefits and mortality, of better identification of patients with excessive drinking.     

Alcoholic liver disease in women

In 1972-1977, 130 patients with alcoholic liver disease (123 men and 7 women) were admitted. A half of the women had occupations which are related with alcohol consumption and a half were housewives. Daily consumption of alcohol in the women was the same as in the men. Duration of excessive drinking was 11.4 years in the women and 17.1 years in the men, but the difference was not statistically significant. Though the difference of the incidence of alcoholic hepatitis in the women (57%) and in the men (27%) was not statistically significant, frequency of ascites was significantly higher in the women (43%) than in the men (7%). Women seem to be more susceptible to severe form of alcoholic liver damage.     

Health education as prevention of alcoholism in young people

The close correlation between road accidents and excessive consumption of alcoholic beverages, as well as the lowering of the minimal age for alcohol drinking, prompted the Authors to examine the acute and chronic effects of alcohol on the human organism; therefore, they analyze the metabolic effects of alcohol and, after having described it's few beneficial effects, they furnish some suggestions to avoid above all "the havoc of Saturday evening", outlining in detail the causes and progressive states of alcoholic intoxication. The Authors, in agreement with the current views of prevention, professed by the scientific community, emphasize information and health education as the main tools that guarantee primary prevention in young people who, as it is well-known, belong to the most vulnerable segments of the population. To such purpose they created a poster, to which a CD will follow, that could be distributed and discussed in schools with the purpose to encourage social debate and constructive involvement of students, teachers and their parents.     

An electrodiagnostic study in chronic alcoholic subjects

Electrodiagnostic tests were performed on 16 alcoholic subjects and 15 age-matched controls. The tests were done to determine whether nerve conduction parameters differentiate between healthy and alcoholic subjects, and if so, which of these are most useful. Significant differences between alcoholic subjects and controls were found in the following variables: median nerve motor velocity; median nerve sensory latency, amplitude and velocity; ulnar nerve motor amplitude and velocity; ulnar nerve sensory amplitude, latency and velocity; sural nerve sensory amplitude and velocity; and peroneal motor amplitude and velocity. The combination of ulnar and sural sensory conduction velocity tests identified 85% of the chronic alcoholic subjects by stepwise discriminant analysis. Tibial nerve H-reflex latencies were either absent or prolonged in 63% of the subjects. Bilateral facial nerve amplitudes and latencies were normal. The ulnar sensory amplitude and ulnar sensory velocity inversely correlated with the duration of excessive alcohol drinking.     

Personality factors explain differences in alcoholic consumption among young adults

The study addresses a possible relationship between personality factors and alcoholic consumption in an age and ethnically homogenous non-clinical population of young adults. Contrasting group design in which the total population (n = 300; 201 women, 99 men; mean age 24.5 years, SD = 4.8) was split into three different drinking groups (low-middle-high) according to percentile scores of the population's total yearly alcoholic consumption. We assessed personality factors using the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Arnett Inventory of Sensation Seeking (AISS). Multivariate analyses of variance (MANOVA). Controlling for gender in multivariate ANOVAs, we found that both low and elevated scores on the schizoid and avoidant scales, elevated scores on the histrionic, the anti-social, and the anxiety and the bipolar-manic disorders scale were all linked to increased alcoholic intake. Elevated scores on the compulsive scale were linked to less drinking. The MCMI scales assessing the probability of drug and alcohol dependence and the AISS sensation-seeking scores were associated with increased drinking. These two last MCMI scales and the AISS could be used as simple screening instruments for assessment of drinking problems. The results are relevant for designing targeted prevention and early intervention programmes for reduced drinking among young adults.     

Effects of an intervention brochure on emergency department patients' safe alcohol use and knowledge

Alcohol abuse is a leading cause of morbidity and mortality in the United States, contributing to over 100,000 deaths and costing society over 185 billion dollars each year. The objective of this study was to evaluate the effects of the American College of Emergency Physician's brief alcohol use intervention brochure on patients' hazardous drinking behavior and knowledge of safe alcohol use. We conducted a controlled trial comparing Emergency Department (ED) subjects receiving the alcohol use intervention brochure vs. receiving no brochure. One-month outcome measures included the following: 1) change in days of hazardous drinking; 2) change in knowledge of safe alcohol use; and 3) movement along a readiness-to-change continuum for excessive alcohol use. Of 277 subjects, 252 (91.0%) agreed to participate, and 188 of these (74.6%) were successfully contacted for 1-month follow-up assessment. We did not find any significant decreases in days of hazardous drinking or increases in knowledge of safe drinking limits for either the intervention or comparison groups. However, among the subgroup of excessive alcohol users (n = 100), we found that significantly more intervention subjects had advanced along the readiness-to-change continuum than comparison subjects (p < 0.01). This effect was even greater among the intervention group subjects who stated that they read the brochure (p < 0.001). A brief alcohol use intervention brochure does not affect ED patients' hazardous drinking behavior or knowledge of safe alcohol use. The brochure, however, may affect certain patients' motivation to change their drinking behavior. Changing drinking behavior requires more than simply handing out a brochure in the ED; referral to community resources for those motivated to change is likely an important component to successful management of this problem.     

Biomarkers of alcohol consumption in patients classified according to the degree of liver disease severity

OBJECTIVE: In the search for optimal biomarkers of excessive drinking, only a few studies have been conducted to compare the relationships between ethanol consumption, liver status, and various laboratory markers of ethanol-induced diseases. MATERIAL AND METHODS: Concentrations of carbohydrate-deficient transferrin (%CDT and CDTect methods), serum sialic acid (SA), gamma-glutamyl transferase (gamma-GT), aspartate aminotransferase (ASAT), mean corpuscular volume (MCV), and a marker of fibrogenesis (PIIINP) were studied in 102 alcoholics with (n=59) or without (n=43) alcoholic liver disease. Controls were 34 healthy volunteers who were either social drinkers or abstainers. RESULTS: Although concentrations of all markers were significantly higher in the alcoholic patients than in the healthy controls, their diagnostic characteristics showed a considerable degree of variation. The %CDT, SA, and MCV showed the strongest correlations with the amount of recent alcohol intake. The presence of liver pathology notably influenced the results of CDTect, GT, ASAT, and PIIINP. In ROC analyses, the highest rates of diagnostic accuracy for detecting hazardous drinking were reached with GT (0.94), CDT (0.86), and SA (0.85), followed by MCV (0.79) and ASAT (0.77). Upon abstinence, the estimated times for normalization varied between 10 days (CDTect) and 25 days (GT). CONCLUSIONS: Our data suggest distinct differences in the clinical characteristics of biological markers of ethanol consumption. While the overall accuracy of CDT and GT appear to be highest in the detection of problem drinking, serum SA and PIIINP measurements are of further value when the effects of liver pathology and ethanol drinking need to be differentiated.     

Alcoholic heart disease

Alcoholic heart disease is caused by a lifestyle in which alcoholics are continue to consume an excessive amount of alcohol over a long period of time. Total abstinence is a very effective way to treat them to prevent the development of the final stage of this disease. In contrast, repetitive drinking of massive amount of alcohol is very harmful and causes exacerbation of this disease. From our clinical studies, six candidates were nominated as symptoms of alcoholic heart disease, namely(1) tachyarrhythmias (incidence: 33%), (2) left ventricular hypokinesis(17%), (3) QT interval prolongation(17%), (4) hyperthickened LV wall(13%), (5) LV dilatation with pump failure: alcoholic cardiomyopathy(0.1%), and (6) sudden cardiac death (unknown %). In the beginning of alcoholic heart disease, the patient usually complains of no symptoms, and physical signs are quite poor. Ordinarily, either transient atrial fibrillation and/or left ventricular hypertrophy which is initially documented by electrocardiography or echocardiography is one of the first signals in the diagnosis. Without such early signals, an early diagnosis is impossible. To make a definite diagnosis of alcoholic heart disease, a clinical follow-up is by all means necessary. Improvement of cardiac function after total abstinence, it's worsening after drinking again, and again improvement after abstinence a second time is a diagnostic clue. In this follow-up study, electrocardiography and echocardiography were employed as important ways to gather date. In treatment, total abstinence is essential. To achieve this therapeutic goal, education of the patient is necessary, because approximately 70 per cent of patients with alcoholic heart disease fail to continue abstinence within two years even if they have good training.     

Sobriety, friends, and gay men

The purpose of this study was to learn how sobriety affected friendship circles of gay men recovering from alcoholism. Twenty gay recovering alcoholic men, each with at least 1 year of sobriety, were interviewed in depth. Before sobriety, the typical picture portrayed by the men was that of losing friends, having many heavily drinking acquaintances, and having difficulty meeting the responsibilities in friendships. In sobriety, the typical gay man realized that most of the gay men that he had thought were his friends were actually only drinking buddies. As sobriety time lengthened, the men reported expanding their friendship circles to include primarily gay men of Alcoholics Anonymous and others who were either normal drinkers or abstainers. Finally, nursing implications of this study are discussed.