心理干预并语言训练治疗变声后假声

目的:探讨心理干预并语言训练在治疗变声后假声中的应用。方法:选择2000-09/2003-10在第四军医大学唐都医院耳鼻咽喉科就诊的变声后假声患者23例,并选择50名同年龄段正常发音男性青年作为对照。患者在接受治疗前对其进行适当的心理干预,采用认知疗法让患者了解发病原因、影响因素、治疗及预后等相关知识,指导患者掌握音乐疗法、行为疗法及放松疗法等,使患者达到自我心理疏导调节,以稳定的心理状态积极配合语言训练治疗。语训方法:由专业语言师结合主观听觉与声谱图客观描述对患者进行指导。患者在接受语训前、后利用语图仪在发“a”及“i”音状态分别记录基频数值、共振峰频率。发声训练分4个阶段进行,语训1次/d,1h/次。训练过程中注意解除患者心理障碍,给予适当鼓励。应用嗓音分析系统对治疗前后的声样作声学分析,获取有关声谱图,并对嗓音质量作客观评估。结果:23例患者均随访1年以上,无脱落。①治疗后23例患者的声谱图波形较治疗前均有不同程度改变,声学分析参数接近成人正常参考值。②6例患者经正规有效语训无需手术发音得到矫正,发“a”音、“i”音基频与矫治前相比明显下降犤(203.5±32.8),(259.9±31.7)Hz;(198.4±32.9),(248.8±31.6)Hz,P<0.01犦,与正常男性青年相比差异不显著犤(191.2±30.5),(180.1±29.1)Hz,P>0.05犦。③17例患者因病史长,经语训1周无明显改变,行手术矫正治疗后发音混有频繁破音,经语言训练指导,均在3d内达到正常连续发音。结论:对变声后假声患者进行心理治疗可使患者认识到变声是生长发育过程中的一种正常的生理现象。结合语训师的主观听觉与嗓音分析系统的客观描述对患者发音进行指导,为患者提供了关键性的反馈信息,便于患者寻找和及时校正发音部位与方法,使其基频迅速得以控制,且患者可随时看到自己的成绩,有利于其增强进一步训练的信心。变声后假声患者,无论其是功能性的还是器质性的,无论保守治疗还是手术治疗,均应进行有效的言语训练。     

心理干预并语言训练治疗变声后假声

目的：探讨心理干预并语言训练在治疗变声后假声中的应用。方法：选择2000—09／2003—10在第四军医大学唐都医院耳鼻咽喉科就诊的变声后假声患者23例，并选择50名同年龄段正常发音男性青年作为对照。患者在接受治疗前对其进行适当的心理干预，采用认知疗法让患者了解发病原因、影响因素、治疗及预后等相关知识，指导患者掌握音乐疗法、行为疗法及放松疗法等，使患者达到自我心理疏导调节，以稳定的心理状态积极配合语言训练治疗。语训方法：由专业语言师结合主观听觉与声谱图客观描述对患者进行指导。患者在接受语训前、后利用语图仪在发“a”及“i”．音状态分别记录基频数值、共振峰频率。发声训练分4个阶段进行，语训1次／d，1h／次。训练过程中注意解除患者心理障碍，给予适当鼓励。应用嗓音分析系统对治疗前后的声样作声学分析，获取有关声谱图，并对嗓音质量作客观评估。结果：23例患者均随访1年以上，无脱落。①治疗后23例患者的声谱图波形较治疗前均有不同程度改变，声学分析参数接近成人正常参考值。②6例患者经正规有效语训无需手术发音得到矫正，发“a”音、“i”音基频与矫治前相比明显下降[（203．5&;#177;32．8），（259．9&;#177;31．7）Hz；（198．4&;#177;32．9），（248．8&;#177;31．6）Hz，P〈0．01]，与正常男性青年相比差异不显著[（191．2&;#177;30．5），（180．1&;#177;29．1）Hz，P〉0．05]。③17例患者因病史长，经语训1周无明显改变，行手术矫正治疗后发音混有频繁破音，经语言训练指导，均在3d内达到正常连续发音。结论：对变声后假声患者进行心理治疗可使患者认识到变声是生长发育过程中的一种正常的生理现象。结合语训师的主观听觉与嗓音分析系统的客观描述对患者发音进行指导，为患者提供了．关键性的反馈信息，便于患者寻找和及时校正发音部位与方法，使其基频迅速得以控制，且患者可随时看到自己的成绩，有利于其增强进一步训练的信心。变声后假声患者，无论其是功能性的还是器质性的，无论保守治疗还是手术治疗，均应进行有效的言语训练。     

发声障碍与嗓音康复疗法

本文报导用嗓音康复疗法治疗发声障碍105例,其中变声后发声障碍66例,发声无力27例,痉挛性发声障碍10例,女声男音化2例。经实践后,提出一套系统的治疗方法并称为“嗓音康复疗法”。治疗前后,用“最大发声时”(Maximum Phonation Time)、“声喉图”(Phone-Laryngograph)、“声门频率分析仪”(Glottal Freguency Analyzer)检测对比。结果满意,总治愈率83.8％,全部有效。     

1，6二磷酸果糖治疗心肌梗死后心力衰竭的临床观察

采用 1,6二磷酸果糖 (FDP)治疗心肌梗死 (心梗 )后心力衰竭 (心衰 )疗效满意 ,报告如下。1　病例与方法1.1　病例 :80例心梗患者 ,心衰均为 ～ 级 (NYHA标准 )。其中男 47例 ,女32例 ;年龄 2 2～ 78岁 ,平均 40岁 ;原发病 :前壁梗死 43例 ,前间壁梗死 2 1例 ,下壁梗死 16例。表 1　 80例患者 FDP治疗前后心功能参数变化 (x± s)EF SV(ml) CO(L/min) CI(L·m in- 1·m- 2 ) E/A治疗前 0 .2 3± 0 .17　 3 7.0± 4.0 　 3 .2 9± 0 .78　 1.89± 0 .5 4　 0 .90± 0 .5 1　治疗后 0 .42± 0 .13 * 62 .1± 9.1* 4.66± 1.14 * 3 .1…     

嗓音训练对职业用声者声带息肉术后发音质量的效果观察

目的 探讨动态喉镜下嗓音训练对职业用声者声带息肉术后发声质量的疗效评估。 方法 选取2016年3月-2017年1月收治的98例职业用声声带息肉患者作为研究对象,按照随机数字表将患者分为实验组和对照组,对照组给予常规治疗及护理,实验组在对照组基础上给予嗓音训练。2组患者在训练前及训练3个月后行嗓音声学检测,采用嗓音障碍指数量表(pediatric voice handicap index-30,VHI-30)评估并分析效果。 结果 训练3个月后,实验组患者的声学值基频微扰(jitter)、振幅微扰(shimmer)及VHI-30各项评分低于对照组,嗓音障碍严重指数(dysphonia severity index, DSI)和最长发音时间(maximum phonation time,MPT)高于对照组。 结论 嗓音训练可以降低职业用声者嗓音障碍程度,提供发声时呼吸动力支持,改善职业用声者声带息肉术后的嗓音质量。     

重组人生长激素对肝硬化患者低蛋白血症的临床疗效

【目的】观察哺乳动物细胞重组人生长激素 (r hGH )对肝硬化患者低蛋白血症的治疗作用。【方法】5 2例肝硬化患者随机分为两组 ,A组 (治疗组 )在常规保肝及对症治疗基础上给予r hGH 4IU ,皮下注射 ,每日 1次 ,连续 2 0d ;B组 (对照组 )仅给予常规保肝及对症治疗。两组患者在治疗前 1周内及治疗后 1周内分别检测血清白蛋白、血清前白蛋白、血清胆红素、凝血酶原时间及其他肝功能指标的变化 ,并记录其临床症状和体征 ,包括腹围、尿量、下肢水肿以及神志变化等。【结果】两组病例在治疗前肝功能状态及其分级等一般资料均无显著差异 ,A组和B组治疗前血清白蛋白分别为 (2 4 .98± 2 .96 ) g/L和 (2 5 .0 8± 4 .5 0 )g/L ,血清前白蛋白分别为 (12 0 .89± 6 3.0 1) g/L和 (12 1.6 0± 71.11) g/L ;疗程结束后A组血清白蛋白为 (30 .32±4 .2 1)g/L ,血清前白蛋白为 (187.0 1± 6 6 .96 ) g/L ,均显著高于治疗前 (P <0 .0 5 ) ;B组患者治疗后血清白蛋白为 (2 6 .6 6± 4 .32 ) g/L ,血清前白蛋白为 (12 4 .92± 83.0 5 )g/L ,与治疗前均无显著差异 (P >0 .0 5 )。疗程结束后A组患者一般状况较前有明显好转 ,但其他肝功能指标与B组比较无统计学差异。【结论】r hGH对肝硬化患者低蛋白血症有良好的治疗作用 ,且对     

发声显微外科和发声治疗

目的探讨声带良性肿瘤喉显微外科手术后发声训练对言语康复的作用。方法由专业嗓音训练师对其进行是否具有发声训练治疗依从性的评估后将声带良性病变患者117例分为单纯手术组(手术组,57例)和喉显微外科手术联合发声训练组(联合组,60例),治疗前后分别采用GRBAS评估和Xion嗓音声学分析对手术组、联合组患者进行主客观嗓音障碍程度评估。结果 GRBAS评估手术组、联合治疗组后嗓音总嘶哑度(G)、粗糙声听感知(R)得分均较治疗前明显下降(P<0.05);但联合组治疗后的嗓音总嘶哑度(G)、粗糙声听感知(R)得分更下降(P<0.05);嗓音声学分析手术组、联合治疗组后jitter和shimmer值均较治疗前明显降低,DSI明显升高(均P<0.05),而联合治疗组的jitter和shimmer值更低,DSI更高(均P<0.05)。结论发声显微外科联合发声治疗有助于提高声带良性肿瘤患者手术后的发声质量。 更多还原     

血清淀粉样蛋白测定对慢性肾盂肾炎患者病情判断的价值

目的测定慢性肾盂肾炎 (chronicpyelitis)患者治疗前后及正常人群血清淀粉样蛋白A(serumamyloidA ,SAA)水平 ,以探讨其对病情活动判断的应用价值。方法以 45例慢性肾盂肾炎患者为研究对象 ,以 40例健康体检人群为正常对照 ,ELISA法检测血清SAA ,以临床表现及尿常规检查判断慢性肾盂肾炎患者的病情活动。结果所有患者经治疗后均由活动转为稳定 ,临床症状消失 ;45例慢性肾盂肾炎患者治疗前血清SAA(10 .44± 10 .2 6 )mg/L ;治疗后血清SAA(0 .2 1± 0 .6 1)mg/L ;正常对照组血清SAA(0 .12± 0 .0 86 )mg/L。慢性肾盂肾炎组治疗前与治疗后血清SAA进行配对t检验 ,有显著差异 (P <0 .0 1) ;治疗前与正常对照组血清SAA进行两组t检验 ,亦有显著性差异 (P<0 .0 1) ;治疗后与正常对照组血清进行组间t检验 ,无显著差异 (P >0 .0 5 )。结论血清SAA可作为慢性肾盂肾炎患者病情活动程度的灵敏的监测指标     

辛伐他汀对非高脂血症2型糖尿病患者一氧化氮和C反应蛋白的影响

目的　探讨非高脂血症 2型糖尿病 (T2DM)患者血清一氧化氮 (NO)和C反应蛋白 (CRP)的变化及辛伐他汀对其影响。方法　 12 5例非高脂血症T2DM患者随机分为常规治疗组和辛伐他汀组。辛伐他汀组在常规治疗的基础上加辛伐他汀 2 0mg ,每晚 1次。用化学法和免疫比浊法分别测定治疗前及治疗 1、2、3和 6个月后血清NO和CRP含量 ,以 6 0例正常人为对照。结果　非高脂血症的T2DM患者血清NO浓度明显低于正常人 [(9.6 3± 3.2 1) μmol/Lvs(13.87± 4 .76 ) μmol/L ,P <0 .0 5 ];而血清CRP含量显著高于正常人 [(4.11± 1.6 3)mg/Lvs(2 .36± 1.5 7)mg/L ,P <0 .0 5 ]。辛伐他汀治疗 1个月后NO显著升高 [(9.6 3± 3.17) μmol/Lvs(11.2 6± 2 .87) μmol/L ,P <0 .0 5 ],2个月后CRP也显著降低 [(4.13± 1.82 )mg/Lvs(3.32± 1.76 )mg/L ,P <0 .0 5 ]。结论　非高脂血症T2DM患者也存在着动脉内皮功能损伤和动脉内膜的慢性炎症反应 ,辛伐他汀治疗可减轻这些患者内皮损伤和动脉内膜的炎症反应。     

发声训练在电子喉镜下手术治疗声带良性病变及嗓音康复的应用

目的探讨发声训练在电子喉镜下手术治疗声带良性病变对嗓音康复的效果。方法将符合入组的400例患者随机分为两组,A组200例为实验组,B组200例为对照组。对照组采用常规方法,实验组在常规方法的基础上实施系统的发声训练。并于手术后1、3、6个月返院回访,行电子喉镜检查及嗓音主观听感知分析(听觉)进行效果评价。结果术后1个月,A、B两组患者术后恢复状况差异无显著意义(P0.05)。术后3个月、6个月,两组嗓音康复情况与电子喉镜复查结果差异有显著意义(P0.001)。结论发声训练对电子喉镜下手术治疗声带良性病变患者的嗓音康复有效。     

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.