脑卒中患者主要照顾者负担与社会支持的相关性分析

目的 了解脑卒中患者主要照顾者负担与社会支持的相关性方法选取50例脑卒中患者主要照顾者,用自制的脑卒中患者及照顾者基本情况调查表、Zarit照顾者负担量表、社会支持评定表进行评定.结果 脑卒中患者主要照顾者负担总分为（43.5±12.97）分,表示有中、重度负担;相关性分析显示主要照顾者对社会支持的利用度与身体负担呈负相关（r=-0.44）,客观支持与经济负担呈负相关（r=-0.81）,差异有统计学意义（P＜0.05）.结论 提高脑卒中主要照顾者对社会支持的利用度及客观支持可有效降低主要照顾者的身体及经济负担,以促进主要照顾者的身心健康,提高脑卒中患者的照顾质量,最终促进脑卒中患者的康复.     

上海市城区失能老人主要照顾者照顾负担现状及其影响因素的研究

目的 调查上海市城区失能老人主要照顾者照顾负担现状,并分析其影响因素,为后期提供针对性干预方案提供依据。 方法 于2016年7月-12月采用便利抽样法对上海市浦东新区金杨社区440名失能老人的主要照顾者应用Barthel指数评定量表、照顾负担量表(zarit burden interview,ZBI)、社会支持量表、一般自我效能感量表(GSES)、医学应对方式问卷(MCMQ)和自制一般人口社会学情况调查表进行调查。 结果 失能老人主要照顾者照顾负担总分为47.93±13.03,呈中等程度负担水平;单因素分析显示照顾者负担在患慢性病数量、失能时间(个月)、Barthel指数、照顾者年龄、照顾者文化程度、照顾者是否在婚、与被照顾者之间的关系、每日照顾小时数、照顾者自评健康状况等级、家庭月收入等变量上分布差异有统计学意义;多因素回归分析显示,应对方式、社会支持、自我效能、Barthel指数、与被照顾者之间的关系、照顾者自身文化水平、失能老人患慢性疾病情况、每天照顾小时数是照顾负担的影响因素,多元相关系数R=0.812,决定系数R2=0.659。 结论 上海城区失能老人主要照顾者照顾负担处于中等水平,照顾负担的影响因素来自失能老人以及照顾者多方面。社区护士应同时评估失能老人和主要照顾者的情况,根据影响因素采取针对性的措施以减轻照顾者的负担。      

脑瘫患儿家庭主要照顾者负担与社会支持的相关性研究

目的:探讨脑性瘫痪(CP)患儿家庭主要照顾者负担与社会支持的相关性。方法:采用Zarit照顾者负担量表(ZBI)和社会支持评定量表(SSRS)对80例CP患儿家庭主要照顾者进行调查。结果:83.8%的CP患儿主要照顾者的ZBI评分处于轻、中度水平。CP患儿主要照顾者的SSRS各维度评分均明显低于国内常模,均P0.01。CP患儿的Zarit照顾者负担量表总评分与客观支持、主观支持和支持利用度呈显著负相关,均P0.01。结论:社会支持与CP患儿主要照顾者的照顾者负担密切相关,护理人员应加强其社会支持系统,从而提高CP患儿的照顾质量。     

痴呆患者配偶的心理负担与社会支持度的相关性研究

目的:了解居家照顾痴呆患者配偶的心理和照料负担与社会支持度之间的关系.方法:选取46例居家照顾痴呆患者的配偶,用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、自编痴呆患者照顾者负担量表、自编痴呆患者照顾者社会支持量表进行评定.结果:照顾者的负担重(总分66.59±15.51),他们抑郁情绪(SDS平均分为38.6±8.2,40分以上者43%)和焦虑情绪(SAS平均分为34.5±7.6,40分以上者23.9%)明显;负担水平和社会支持度之间存在着负相关(r=-0.51,P<0.01).结论:照顾者的心理负担重,焦虑和抑郁情绪明显;提高社会支持度可有效降低其负担水平,促进照顾者的身心健康,并最终提高照顾质量.     

骨癌患者照顾者抑郁状况与社会支持的相关性分析

目的观察骨癌患者照顾者的抑郁与社会支持状态,探讨两者之间的相关性,为促进骨癌患者照顾者的心理健康提供依据。方法运用抑郁自评量表(SDS)及社会支持量表(SSRS)对入选100例的骨癌患者照顾者进行抑郁及社会支持分值的评定,并与国内常模进行比较;检测骨癌患者照顾者抑郁及社会支持各因子的Pearson相关性分析,从而探讨两者的相关性。结果骨癌患者照顾者的抑郁得分为44.53±10.56,高于国内常模(t=13.52,P<0.05);社会支持总分为38.76±9.91,客观支持分值为9.52±9.13,主观支持分值为28.76±11.23,支持利用度分值为7.77±11.06,支持总分及各维度与国内常模比较,差异均存在统计学意义(t值分别为6.01,-4.83,8.89,-6.16,P值均<0.05);抑郁评分与客观支持、主观支持和对支持的利用度均呈负相关(相关系数分别为-0.73,-0.61,-0.69,-0.58,P值均<0.05)。结论骨癌患者照顾者相比于普通人群,存在较高的抑郁情绪,支持总分较高,且抑郁状况与社会支持水平呈明显负相关,应采取相关措施来改善骨癌患者照顾者的抑郁状况。     

痴呆患者配偶的心理负担与社会支持度的相关性研究

目的:了解居家照顾痴呆患者配偶的心理和照料负担与社会支持度之间的关系。方法:选取46例居家照顾痴呆患者的配偶,用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、自编痴呆患者照顾者负担量表、自编痴呆患者照顾者社会支持量表进行评定。结果:照顾者的负担重(总分66.59±15.51),他们抑郁情绪(SDS平均分为38.6±8.2,40分以上者43%)和焦虑情绪(SAS平均分为34.5±7.6,40分以上者23.9%)明显;负担水平和社会支持度之间存在着负相关(r=-0.51,P<0.01)。结论:照顾者的心理负担重,焦虑和抑郁情绪明显;提高社会支持度可有效降低其负担水平,促进照顾者的身心健康,并最终提高照顾质量。     

广州市越秀区居家失能老人主要照顾者照顾负担现况及影响因素分析

目的 了解广州市越秀区居家失能老人主要照顾者的照顾负担现状及其影响因素.方法 采用方便抽样对广州市越秀区197名居家失能老人的主要照顾者应用照顾者负担量表(ZBI)、抑郁自评量表(SDS)及一般人口学资料进行调查.结果 居家失能老人主要照顾者的照顾负担总分为(31.03±14.99)分,有79.2%的照顾者存在不同程度的照顾负担,42.1%的照顾者存在不同程度的抑郁症状.多元线性回归分析显示影响居家失能老人主要照顾者负担的因素有老人的婚姻状况、失能原因、患慢性病种类数及其照顾者的性别、工作状态、照顾的内容、有无协助人员、对目前生活满意程度和抑郁状况.结论 广州市越秀区居家失能老人主要照顾者负担为轻度,但普遍存在照顾负担,照顾负担受失能老人及照顾者多方面因素的影响.     

肿瘤患者家庭照顾者社会支持影响因素及与疾病家庭负担的相关性研究

目的 了解肿瘤患者家庭照顾者的社会支持与疾病家庭负担现状以及两者之间的相关性,探讨社会支持的影响因素.方法 采用方便抽样的方法选取样本,共计发放问卷130份,回收有效问卷123份;运用社会支持评定量表和疾病家庭负担量表进行问卷调查;研究对象一般资料采用描述性统计分析,社会支持与疾病家庭负担采用Pearson相关分析,影响因素分析主要应用t检验、方差分析以及多元线性逐步回归.结果 社会支持得分(36.72±9.96)分略高于国内常模且差异具有统计学意义(P＜0.05).疾病家庭负担量表得分(30.13±11.36)分,其中家庭经济负担、家庭娱乐活动、家庭日常活动负担程度为中等及以上.Pearson相关分析结果显示,社会支持与疾病家庭负担呈负相关,且除家庭娱乐活动外,各维度相关性均具有统计学意义(P＜0.05).多元线性逐步回归分析结果显示,家庭月收入、家庭关系与家庭成员躯体对社会支持有影响(P＜0.05).结论 肿瘤患者家庭照顾者社会支持度一般且疾病家庭负担沉重,建议多举措提高其社会支持水平并减轻其照顾负担,以维持家庭照顾者身心健康,进而改善家庭护理质量.     

血液透析患者与家属焦虑及其相关性分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者焦虑状态与社会支持度及其主要家庭照顾者焦虑和抑郁状态的关系.方法 选取MHD患者及其相应主要家庭照顾者85组为研究对象,使用焦虑自评量表(Self-Rating Anxiety Scale,SAS)评估MHD患者焦虑状态,根据SAS标准分是否≥50将MHD患者分为焦虑组36例与非焦虑组46例,使用社会支持评定量表(SSRS)测定焦虑组和非焦虑组患者社会支持度,SAS及抑郁自评量表(Self-rating depression scale,SDS)评定焦虑组和非焦虑组患者对应主要家庭照顾者焦虑/抑郁状态,统计分析MHD患者焦虑与其社会支持度以及对应主要家庭照顾者焦虑/抑郁状态的关系.结果 MHD患者SAS得分(45.71±8.09)分,焦虑发生率为43.9％;对应主要家庭照顾者SAS得分为(43.67±7.71)分,焦虑发生率为39.5％;SDS得分为(41.17±6.68)分,抑郁发生率为14.6％,均显著高于国内常模得分(均P＜0.001).焦虑组与非焦虑组患者在SSRS(包括社会总支持分及客观支持分、主观支持分、支持利用度3个因子)得分和主要家庭照顾者焦虑/抑郁发生率存在统计学差异(均P＜0.05).结论 MHD患者焦虑及其主要家庭照顾者焦虑/抑郁得分高于正常人群,社会支持度低者及其主要家庭照顾者存在焦虑/抑郁的MHD患者焦虑发生率高.     

住院肿瘤患者亲属照顾者主观负担及相关因素

目的探讨肿瘤患者亲属照顾者主观负担现状及其与一般社会性因素、家庭关系质量的相关性。方法用一般社会学指标、照顾者反应评估工具、家庭关系指数和家庭功能评定问卷对71名住院肿瘤患者照顾者和45名普通内科住院患者照顾者(对照组)进行测量。结果肿瘤患者照顾者的健康问题(P<0.05)、时间受打扰(P<0.01)和经济压力(P<0.001)显著高于对照组。家庭关系指数与健康问题(P<0.01)、时间受打扰(P<0.05)、经济压力(P<0.01)、家庭支持缺乏(P<0.05)呈显著正相关,与自尊(P<0.001)呈显著负相关;情感介入与健康问题(P<0.05)、家庭支持缺乏(P<0.05)呈显著正相关,与自尊(P<0.05)显著负相关。年龄、婚姻状况等与主观负担的部分维度呈显著相关。结论住院肿瘤患者照顾者的主观负担高于一般内科患者照顾者;照顾者的主观负担与家庭关系、情感介入、年龄、婚姻状况等因素相关。     

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.