早期心理干预对脑卒中后抑郁/焦虑患者神经功能康复的影响

【目的】探讨早期心理干预对卒中后抑郁／焦虑患者神经功能康复的影响。【方法】采用抑郁自评量表（SDS）、焦虑自评量表（SAs）对200倒脑卒中患者进行抑郁／焦虑状态评定，其中惠有卒中后抑郁合并焦虑的63名患者分别分为常规治疗＋黛力新治疗组（Ⅰ组）、常规治疗＋黛力新联合心理干预治疗组（Ⅱ组）以及单一常规治疗对照组各21例。采用中国卒中量表（CSS）、Barthel指数（BI）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评测治疗前后的疗效。【结果】急性脑卒中病人卒中后抑郁并焦虑患病率为31．50％。治疗Ⅰ组和治疗Ⅱ组HAMD、HAMA、中国卒中量表评分减少和BI评分增加与对照组比较均有显著性差异（P〈0．001），治疗Ⅱ组HAMD、HAMA、中国卒中量表评分减少和BI评分增加较治疗Ⅰ组有显著差异（P〈0．05）。【结论】脑卒中后的抑郁／焦虑病人单用黛力新治疗、黛力新联合心理干预治疗均能提高患者神经功能康复程度和生活能力恢复，而且黛力新联合心理干预治疗疗效更满意。     

氟西汀配合康复训练治疗脑卒中后抑郁的临床研究

目的：观察氟西汀配合康复训练治疗脑卒中后抑郁的临床疗效。方法：87例脑卒中后抑郁患者分为康复组45例和对照组42例,均每日口服氟西汀20 mg,康复组患者同时配合康复治疗;分别于治疗前后对2组进行Barthel指数（BI）、Fugl-Meyer运动量表（FMMS）、Zung抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）检测。结果：治疗3个月后,2组SDS、HAMD评分与治疗前比较减分明显,BI、FMMS评分明显上升（均P〈0.01）;2组间比较康复组显示更明显（P〈0.05）。抑郁状态比较,康复组SDS及HAMD总有效率明显高于对照组（77.8%、78.6%与60.0%、52.4%,P〈0.05和0.01）。结论：氟西汀配合康复训练治疗脑卒中后抑郁有明显的临床疗效。     

二甲医院卒中单元的运作与效果评价

目的通过在二甲医院建立和运作康复卒中单元，以探讨脑血管病的卒中单元管理模式及效果研究。方法将病情稳定、Barthel指数（BI）评分低于39分的1040例脑卒中患者分别在康复卒中单元病房（观察组）和普通病房（对照组）进行为期7d的相关治疗，运用BI、Fugl-Meyer评估（FAM）以及汉密尔顿抑郁量表（HAMD）对患者日常生活能力、肢体运动功能以及抑郁和焦虑程度进行评定，比较患者的综合康复疗效。结果治疗前BI FMA HAMD在两组之间均无显著性差异（P〉0．05），治疗后对照组以及观察组与其治疗前相比均有显著性差异（P〈0．05），观察组与治疗组相比也有显著性差异（P〈0．05）。结论两组患者的治疗有效，但是康复卒中单元的效果更明显，康复卒中单元是二甲医院实施脑血管病治疗更好的管理模式。     

早期干预对卒中后抑郁的影响

目的探讨早期康复干预对脑卒中后抑郁状态的影响。方法将86例脑卒中后抑郁患者随机分为康复组（研究组）46例,常规治疗组（对照组）40例;两组均进行常规药物治疗．康复组同时进行神经康复治疗。采用改良的Barthel指数评定日常生活活动,汉密尔顿抑郁量表评定抑郁状态,分别于治疗前及治疗第40d末各评定1次。结果治疗40d末,研究组Barthel指数、汉密尔顿抑郁量表评定均有明显改善。差异有显著性（P〈0．05）,对照组治疗前后改变不明显（P〉0．05）;两组间比较研究组明显优于对照组,差异均有显著性（P〈0．05）。结论早期康复干预不仅能有效改善脑卒中后抑郁患者心境,同时可提高患者的日常生活能力,降低致残率。     

休闲娱乐康复对卒中后抑郁的影响

[目的]探讨休闲娱乐康复对脑卒中病人焦虑、抑郁及日常生活能力的影响。[方法]将符合CCMD-3诊断标准的68例脑卒中后抑郁病人随机分为康复组和对照组，对照组病人按脑卒中康复常规进行药物治疗、运动治疗、作业治疗及理疗，康复组在此基础上给予休闲娱乐康复治疗，疗程8周。以汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）、日常生活能力量表（ADL）为评定工具。于治疗前及治疗8周末进行临床疗效及日常生活能力评定。[结果]治疗后6周、8周两组MD、HAMA评分有统计学意义（P〈0.05）。8周末康复组显效率为79．41%，对照组为52．94％；日常生活能力评定两组有统计学意义（P〈0．05）。[结论]休闲娱乐康复能明显缓解脑卒中病人的负性情绪，改善日常生活能力。     

帕罗西汀联合心理干预治疗卒中后的心理护理

目的 探讨帕罗西汀联合早期心理干预对卒中后抑郁/焦虑患者日常生活能力和神经功能康复的影响.方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对272例脑卒中患者进行抑郁/焦虑状态评定,其中患有卒中后抑郁合并焦虑的81名患者分别接受单用帕罗西汀治疗、帕罗西汀合并心理治疗以及不干预.采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评测治疗前后的疗效.结果 急性脑卒中病人卒中后抑郁并焦虑患病率为29.78％,抑郁与焦虑共病率为65.85％;治疗组Ⅰ和治疗组ⅡHAMD、HAMA、SSS评分减少和BI评分增加与对照组比较均有显著性差异(P均＜0.01),治疗组ⅡHAMD、HAMA、SSS评分减少和BI评分增加较治疗组Ⅰ有显著差异(P均＜0.05).结论 卒中后抑郁/焦虑病人单用药物帕罗西汀或给予帕罗西汀合并心理干预治疗均能提高患者神经功能康复程度和生活能力恢复,而且帕罗西汀合并心理干预治疗疗效更满意.     

逍遥散加味结合心理疗法治疗产后抑郁症的临床研究

目的：观察逍遥散加味结合心理疗法治疗产后抑郁症的临床疗效。方法：将确诊为产后抑郁症的80例患者随机分为观察组（逍遥散加味结合心理疗法组）40例,对照组（逍遥散加味）40例,用汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）比较治疗前及治疗后2、4、8周评分,并比较2组临床疗效。结果：观察组显效率90．0％,有效率95．0％;对照组显效率70．0％,有效率80．0％。在显效率方面差异有显著性（P〈0．05）;在治疗2周末及治疗8周末观察组HAMD评分与HAMA评分均低于对照组,2组差异有显著性（P〈0．05）。结论：逍遥散加味结合心理疗法治疗产后抑郁症疗效显著,可供临床借鉴。     

早期中西医结合心理与康复护理对轻中度脑卒中患者的影响

目的：探讨早期中西医结合心理与康复护理干预对轻中度脑卒中患者神经功能康复效果的影响作用。方法将符合入选标准的86例患者按照随机数字表法分为观察组和对照组各43例,两组患者均接受常规神经内科治疗及一般护理,观察组患者在此基础上进行早期心理和康复护理干预措施,以汉密尔顿焦虑量表（ HAMA）与汉密尔顿抑郁量表（ HAMD）评价患者的焦虑和抑郁情况,以脑卒中神经功能缺损评分表（ CSS）评价患者神经功能康复效果。结果护理干预前两组患者的HAMA和HAMD评分差异均无统计学意义（P＞0．05）,干预后4周,观察组患者的 HAMA,HAMD 评分分别为（8．42±3．13）,（7．32±4．56）分,均优于对照组的（14．74±2．86）,（12．76±4．41）分,差异有统计学意义（t分别为9．7745,5．6233;P＜0．05）;护理干预前两组患者的CSS评分差异无统计学意义（P＞0．05）,干预后4周,观察组患者的CSS评分为（5．79±2．52）分,低于对照组的（8．83±4．21）分,差异有统计学意义（t＝4．0628,P＜0．05）。结论早期中西医结合心理和康复护理干预措施不仅能改善轻中度脑卒中患者的焦虑和抑郁症状,还能够有效提高患者神经功能的康复效果。     

早期综合康复对脑卒中患者功能恢复及继发并发症的影响

要目的：探讨早期综合康复对脑卒中患者功能恢复及并发症的影响。方法：将183例脑卒中患者随机分为康复组和对照组．其中康复组90例。在常规药物治疗的基础上采用B0bath法、心理康复和健康教育的方法进行训练；对照组93例仅进行常规药物治疗。对神经功能缺损程度（NIHSS评分）、ADL能力、焦虑、抑郁和并发症进行评估。结果：①治疗4周后两组NIHSS评分明显减少，运动功能、ADL积分均明显增加，焦虑、抑郁得分明显降低，两组的变化均数相比，康复组优于对照组（P〈0．05）。②在并发症方面，康复后两组肩关节半脱位情况差异无显著性意义（P〉0．05）；其余4项两组差异有显著性意义（P〈0．05）；康复组继发并发症明显少于对照组（P〈0．05）。结论：脑卒中患者早期综合康复与对照组相比，在降低其神经功能缺损积分、减少并发症、提高运动功能、ADL积分上效果更好。     

早期综合康复治疗对脑卒中后抑郁的影响

目的：探讨早期综合康复治疗对脑卒中后抑郁的治疗效果。方法：脑卒中患者126例分为早期康复组62例和对照组64例，均进行常规药物对症治疗。康复组同时配合早期综合康复训练。治疗前后2组均进行欧洲卒中评分（ESS）、ADL及情感状态（HAMD）评分比较。结果：治疗1、3及6个月时ADL、ESS及HAMD评分，康复组均明显高于对照组（P〈0．05或P〈0．01）。结论：早期综合康复治疗能显著促进脑卒中患者神经功能的恢复，有效减少抑郁的发生。     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

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.