基于多导睡眠监测失眠患者心理因素的中西医研究

【】目的：研究心理因素对失眠患者的影响。方法：选取我院睡眠障碍门诊就诊的失眠病人31例和27名年龄,性别,教育程度相匹配的健康对照者纳入研究。分别行匹兹堡睡眠质量指数量表(Pittsburgh sleep qualitySindex,PSQI),90项症状清单(Symptom Checklist 90,SCL-90),多导睡眠监测(Polysomnography,PSG)等评定患者睡眠状况及心理状况。结果：失眠组PSQI得分(16.61±1.961),PSG睡眠潜伏期得分(36.77±2.680),SCL90总分(156.03±7.255)及人际关系敏感项(2.06±0.182),抑郁项得分(2.13±0.172),焦虑等项得分(2.12±0.171)均明显高于对照组(结果分别为：7.26±1.457,25.63±1.944,135.89±7.587,1.41±0.150,1.42±0.160,1.46±0.107)。PSG睡眠时间(254.06±25.893),PSG睡眠效率(0.73±0.295)得分明显低于对照组(结果分别为363.67±38.331,0.82±0.212)。多元回归分析显示,PSG监测结果与PSQI问卷结果有明显相关,监测睡眠潜伏期延长和焦虑情绪有明显相关(r=0.763,P<0.01)。结论：心理因素影响患者的睡眠状况,尤其以焦虑情绪为主。     

老年住院患者睡眠质量与心理社会因素分析

目的了解老年住院患者睡眠质量、抑郁、焦虑、生活满意度、社会支持现状及睡眠质量的影响因素。方法应用匹兹堡睡眠质量问卷(PSQI)、老年抑郁量表(GDS)、贝克焦虑量表(BAI)、生活满意度指数A(LSIA)、社会支持评定量表(SSRS)对400名≧60岁老年住院患者进行问卷调查。结果 (PSQI)平均得分为(10.17±4.53)分,睡眠质量差者占70.3%;GDS平均分为(10.19±5.89)分,GDS总分与PSQI总分进行相关分析,r=0.416,P0.01;BAI平均得分为(31.63±9.71)分,BAI总分与PSQI总分进行相关分析,r=0.310,P0.01;LSIA平均得分(25.19±7.15)分,LSIA总分与PSQI总分进行相关分析,r=0.096,P0.05;SSRS平均得分为(42.69±6.74)分,SSRS总分与PSQI总分进行相关分析,r=0.232,P0.05。结论老年住院患者睡眠质量较差,老年住院患者的睡眠质量与其抑郁、焦虑心理状态及所获得的社会支持有关。     

绝经期妇女抑郁和焦虑症状与绝经年限及雌激素水平的关系

目的:分析绝经期妇女抑郁和焦虑的临床特征,寻求进行干预的可能性。方法:109例绝经期妇女在体检时接受了Zung编制的抑郁自评量表(SDS)和焦虑自评量表(SAS)的测评,并与她们的绝经年限及雌激素水平进行比较。结果:109例受试者中SDS标准分≥50分者67例(61.5%),标准分均值为(46.84±10.96)分,明显高于正常人常模(41.88±8.55,t=2.586,P<0.02)。SAS标准分≥50分者69例(63.3%),标准分均值(44.62±10.31),明显高于正常人常模(40.06±10.52,t=2.347,P<0.05)。109例受试者按绝经年限分组后,≤3年组的SDS和SAS标准分明显高于3～8年和>8年组(t=2.196～2.365,P均<0.05)。在按雌激素不同浓度分组比较中,低雌二醇组(<100pmol/L,68例)的SDS和SAS标准分明显高于雌二醇组(≥100pmol/L,41例)(t=2.218和2.156,P均<0.05),而高睾酮组(≥30mmol/L)、高促卵泡素组(≥30μg/L)和高促黄体生成素组(≥40μg/L)的SDS和SAS标准分明显高于浓度低各组(t=2.197～2.295,P均<0.05)。结论:绝经期妇女的抑郁和焦虑情绪表现的与绝经年限和雌激素水平密切相关。     

围绝经期维生素D缺乏对妇女睡眠障碍的影响因素

目的：探讨影响围绝经期低维生素D水平妇女睡眠质量的因素。方法：选取2020年3月至2021年12月东莞市东坑医院妇产科收治的围绝经期维生素D缺乏妇女50例作为观察组,选取同时期收治的围绝经期维生素D水平正常妇女50例作为对照组。采用匹兹堡睡眠质量指数量表(PSQI)评估2组患者的睡眠质量,采用抑郁自测量表(SDS)和焦虑自测量表(SAS)评估2组患者的焦虑抑郁情况,检测2组患者的维生素D水平。结果：1)观察组患者的PSQI评分明显高于对照组,2组比较差异有统计学意义(P<0.05);2)观察组患者的SDS评分及SAS评分均明显高于对照组,2组比较差异均有统计学意义(均P<0.05);3)观察组患者的血清维生素D水平明显低于对照组,2组比较差异有统计学意义(P<0.05)。结论：围绝经期妇女多数存在睡眠障碍,而焦虑抑郁的负性情绪、活动减少、血清维生素D缺乏是影响睡眠质量的重要因素,应及早采取有效的干预措施,提高围绝经期妇女维生素D水平,改善其睡眠质量,提高其生命质量。     

慢性阻塞性肺疾病缓解期患者抑郁和焦虑表现与社会支持的相关性分析

目的:分析慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)缓解期患者抑郁和焦虑表现与社会支持状况的相关性,寻找可能的干预方法。方法:77例COPD缓解期患者接受了Zung编制的抑郁自评量表(SDS)和焦虑自评量表(SAS)测评,并与同时评估的社会支持得分(肖永源,社会支持评定量表)比较。结果:77例COPD缓解期患者中抑郁症(SDS标准分≥50)患者31例(40.3%),标准分均值为45.92±10.63,明显高于正常人常模(41.88±8.55)(t=2.176,P<0.05)。焦虑症(SAS标准分≥50)患者28例(36.4%),标准分均值(44.73±9.84)明显高于正常人常模(40.06±10.52)(t=2.209,P<0.05)。主观支持维度得分比较中,“您与朋友和“您与家庭成员条目高得分者的SDS和SAS均值明显低于低得分者(t=2.138～2.284,P均<0.05),客观支持维度中所有条目高得分者的SDS和SAS均值均明显低于低得分者(t=2.153～2.241,P均<0.05),个人利用度维度比较中,仅有求助方式高得分者的SDS和SAS均值明显低于低得分者(t=1.965和2.193,P均<0.05)。结论:COPD缓解期患者抑郁和焦虑表现与社会支持得分密切相关,对于前者加强社会支持,有可能改善SDS和SAS评分,提高生活质量。     

心理护理干预对围绝经期妇女心理障碍的效果分析

目的探讨心理护理干预对围绝经期妇女心理障碍的效果分析。方法选择在本院妇科就诊的144例患者,其中围绝经期心理障碍妇女69例为观察组,正常更年期妇女75例为对照组,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估其心理状况,给予围绝经期妇女针对性的心理护理干预。比较干预前后焦虑抑郁评分、心理症状评分、生存质量。结果围绝经期妇女SAS评分、SDS评分明显高于对照组(P0.05);干预4周后,围绝经期妇女SAS评分、SDS评分明显低于干预前(P0.05),躯体化、强迫、人际关系、抑郁、焦虑、敌对性、恐怖、偏执、精神病性症状等心理症状评分均明显低于干预前(P0.05),生理机能、心理、独立性、社会关系、环境、生活质量总分等生存质量评分明显高于干预前(P0.05)。结论围绝经期妇女可出现不同程度的心理障碍,心理护理干预有助于缓解围绝经期妇女负性情绪,改善心理症状,提高生活质量。     

护士围绝经期综合征与抑郁的相关性研究

[目的]探讨护士围绝经期综合征常见症状分布情况及其与抑郁的相关性。[方法]采用一般资料问卷、改良Kupperman评分量表及抑郁自评量表(SDS)对唐山市10所二级、三级医院40岁～55岁的540名围绝经期护士进行调查。[结果]围绝经期护士抑郁症状和围绝经期综合征的发生率分别为50.00%和63.70%,其中疲乏无力、肌肉及骨关节疼痛、失眠的发生率明显高于其他项目,分别为92.73%,80.52%,77.91%,且围绝经综合征程度越重,中重度抑郁的发生率越高,且各种症状与抑郁均具有相关性(P<0.05),差异有统计学意义。[结论]护士围绝经期综合征与抑郁有一定的相关性,在积极缓解症状的同时,应广泛开展围绝经期护士的心理保健工作,从而提高护理人员的生存质量。     

围绝经期妇女抑郁症状的现况及心理护理对策

目的:了解围绝经期妇女抑郁症的患病情况,探讨对其的心理护理对策。方法:在广东地区采用分层整群抽样的方法,选取4500份40～65岁的围绝经期妇女资料,对其抑郁症状评价采用Zung自评抑郁量表(SDS)进行调查。结果:对4489份有效资料进行分析发现有抑郁症状者1344例,患病率29.94%。农村患病率是45.12%,城市是17.28%。抑郁症状随着年龄的增长而增加,家庭经济收入少、农民、职员、家庭主妇、退休下岗的妇女患病率高。结论:围绝经期抑郁症状患病率高,心理护理是围绝经期妇女抑郁症状干预措施中的重要环节。     

上海宝山地区癌症俱乐部成员132例心理社会相关因素分析

目的:探讨癌症生存者心理状态及相关因素。方法:自编相关因素调查表,选用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)、社会支持评定量表(SSRS),对129例癌症康复俱乐部生存者进行调查。结果:癌症生存者的SCL-90总分(115.22±29.45),SDS总粗分(27.69±8.59)和SAS总粗分(27.03±6.62)与常模比较,差异有显著性意义(t=3.05,6.49,2.08,P<0.05);癌症生存期与SCL-90总分,SAS总分、SDS总分、SSRS总分显著性相关(P均<0.000)。男性SCL-90恐怖因子分(7.52±0.99)小于女性(8.21±2.47),差异有显著性意义(t=2.13,P>0.05)。结论:癌症康复俱乐部生存者的心理状态趋于平静,生存期长短与心理社会因素相关。     

“减压坊”对精神科护士心理健康状况的影响

目的 :分析"减压坊"的减压技术对精神科护士心理健康状况的影响。方法 :随机纳入阳性项目数大于30的护士60名,随机分为干预组和对照组,每组30人。干预组采用"减压坊"的减压技术进行心理干预,干预前后分别用症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹斯堡睡眠指数(PSQI)和社会支持量表(SSRS)对两组人员进行评估。结果 :1干预前,干预组和对照组SCL-90、SAS、SDS、PSQI、SSRS评分比较差异无统计意义(P0.05);2干预后,干预组与对照组SAS评分比较,差异有统计学意义(P0.05),干预组与对照组SDS、PSQI、SSRS得分比较,差异无统计学意义(P0.05);3干预组自身干预前后SAS、SDS、PSQI、SSRS差异有统计学意义(P0.05)。结论 :"减压坊"的减压技术可减轻精神科护士的心理压力,缓解焦虑、抑郁等不良情绪,改善睡眠状况,提高了医疗、护理质量。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.