终末期肾病患者睡眠质量与焦虑抑郁情绪的相关性研究

目的探讨终末期肾病患者的睡眠质量与焦虑、抑郁情绪及其相关性。方法对83例终末期肾病患者采用匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)进行调查。结果终末期肾病患者PSQI总分为(11.45±5.37)分,SAS评分为(46.25±8.58)分,SDS评分为(43.67±7.92)分;PSQI与SAS、SDS呈显著正相关(均P0.01)。结论终末期肾病患者睡眠质量较差,焦虑、抑郁情绪严重,且睡眠质量与焦虑、抑郁情绪有相关性。需运用心理干预治疗提高终末期肾病患者的睡眠质量。     

术后炎症性肠梗阻患者抑郁和焦虑情况调查

目的探索术后炎症性肠梗阻(PISBO)患者抑郁和焦虑情绪的具体程度,为其临床治疗提供依据。方法前瞻性收集甘肃省兰州市第二人民医院普外科于2008年1月至2014年10月期间收治的79例PISBO患者,选用抑郁自评量表(SDS量表)和焦虑自评量表(SAS量表)进行测查,并与常模比较,同时探讨PISBOS患者抑郁和焦虑的影响因素。结果本组患者的抑郁标准分为(49.23±11.39)分,焦虑标准分为(50.31±6.25)分,均高于相应常模得分(P0.05)。logistic回归分析结果显示:病程、疾病性质、术后其他并发症发生及失眠情况均是PISBO患者抑郁和焦虑的影响因素(P0.05),病程15 d、罹患恶性疾病、术后有并发症发生及失眠者的抑郁和焦虑发生率均较高。结论 PISBO患者存在明显的抑郁和焦虑情绪,在临床治疗中应予以干预。     

未婚人工流产手术妇女术前焦虑抑郁与心理压力的关系研究

目的：探讨术前人工流产术妇女术前焦虑抑郁与心理压力的状况及其关系。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和中文版知觉心理压力量表（CPSS）对200例术前未婚人工流产术妇女进行术前调查,分析SAS 、SDS与CPSS之间的关系。结果术前人工流产术妇女CPSS评分总分为（27.52±6.39）分,HRS者检出率为39％;SAS、SDS评分分别为（56.38±13.25）分、（53.38±11.25）分,明显高于国内常模（37.23±12.58）分、（41.38±10.57）分（t=193.47、14.64,P＜0.01）。术前未婚人工流产术妇女焦虑抑郁与心理压力存在显著正相关（P＜0.01）。结论焦虑抑郁情绪会加重术前未婚人工流产术妇女的心理压力,消除焦虑抑郁情绪能够缓解心理压力。     

1164例早泄患者心理障碍调查分析

目的 了解早泄( premature ejaculation,PE)患者心理障碍的患病情况及相关因素,探讨心理障碍与PE的关系. 方法 2009年9月至2010年10月我们应用焦虑自评量表(SAS)和抑郁自评量表(SDS)、中国早泄患者性功能评价表(C1PE-5)、国际前列腺炎症状指数表(NIH-CPSI)、国际勃起功能指数表(IIEF-5)及自制相关因素调查表对1164例PE患者心理状况进行调查.分析SAS、SDS评分及焦虑抑郁症状检出率与NIH-CPSI评分、CIPE-5评分、勃起功能、年龄、病程、职业、文化程度、性格特点等因素的相关性. 结果 1164例PE患者SAS、SDS评分分别为(43.87 ±10.53)分、(44.05 ±9.81)分,按SAS≥50分、SDS≥53分判定,有焦虑症状者341例(29.3％),有抑郁症状者217例(18.6％).SAS、SDS评分和焦虑抑郁症状检出率与CIPE-5评分、NIH-CPSI评分、勃起功能、病程、性格特点等有相关性(P＜0.05),与年龄、职业、文化程度等无相关性(P＞0.05). 结论 PE患者普遍存在焦虑、抑郁情绪,并与前列腺炎症状、勃起功能障碍、病程、性格特点等因素有关.     

类风湿关节炎患者心理状况的调查分析

目的探讨类风湿关节炎患者的心理状况.方法采用焦虑自评量表 (SAS) 和抑郁自评量表 (SDS)对40例住院类风湿关节炎患者进行调查并评定.结果类风湿关节炎患者SAS评分为37.68±10.31,显著高于国内常模(P<0.05),而SDS评分与国内常模比较,差异无显著性意义(P>0.05);疼痛,担心致残、药物不良反应及医疗费用是影响类风湿关节炎患者情绪的相关因素.结论类风湿关节炎患者存在明显的焦虑情绪,应进行针对性的心理干预.     

骨肿瘤患者情感障碍相关因素调查分析

目的 了解骨肿瘤患者抑郁、焦虑情绪的发生率,并对其相关因素进行分析.方法 对210例骨肿瘤住院患者,应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和自行设计的情感障碍影响因素调查表,进行情感状况及其相关因素的调查和分析.结果 骨肿瘤患者抑郁和焦虑的发生率分别为52.9%和21.4%;患者的SDS、SAS标准分显著高于常模(均P＜0.01);不同病期骨肿瘤患者的情感障碍阳性率比较,差异有显著性意义(均P＜0.01).影响骨肿瘤患者的情感因素诸多,但以对医疗费用(73.3%)、治疗效果的担心(62.9%)最为显著.结论 骨肿瘤患者情绪障碍严重,应及早给予心理干预和必要的社会支持,以提高患者的治疗效果及生存质量.     

优质护理对颜面部烧伤患者焦虑抑郁的影响

目的:探讨优质护理对颜面部烧伤患者焦虑、抑郁情绪的影响。方法:按入院先后顺序,将62例颜面部烧伤患者分为试验组和对照组,试验组实施优质护理,对照组实施常规护理,干预前后均采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定患者的焦虑和抑郁情绪。结果:干预后,试验组和对照组SAS评分、SDS评分明显低于干预前;干预后试验组SAS评分、SDS评分试验组均明显低于对照组。结论:优质护理有助于改善颜面部烧伤患者焦虑、抑郁情绪。     

晚期肿瘤患者家属负性情绪及应对方式调查分析

目的 探讨晚期肿瘤患者家属的焦虑、抑郁情绪及采取的应对方式,以指导心理干预,提高其生活质量.方法 选用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS),简易应对方式量表(SCSQ)对236名晚期肿瘤患者家属(观察组)和236名慢性病患者家属(对照组)进行调查.结果 观察组SAS和SDS评分与对照组和国内常模比较,差异有显著性意义(均P＜0.01);观察组积极应对和消极应对总分与对照组比较,差异无显著性意义(均P＞0.05).观察组SDS评分与积极应对分呈负相关(P＜0.01).结论 晚期肿瘤患者家属多伴有焦虑和抑郁情绪,并受多种因素影响,帮助他们改善应对方式,可以提高生活质量.     

术侧上肢功能锻炼对开胸术后患者心理状态的影响

目的 探讨开胸术后术侧上肢功能锻炼对患者心理状态的影响.方法 将114例肺癌开胸术患者随机分为观察组和对照组各57例,对照组按常规进行围术期护理,并针对患者心理状况进行心理干预;观察组在此基础上于术前3 d开始行术侧上肢功能锻炼,直至术后第3天.采用抑郁自评量表(SDS)、焦虑自评量表(SAS)于术前3 d和术后第3天测评两组抑郁、焦虑程度.结果 对照组术后抑郁、焦虑评分为(68.57±3.46)、(69.64±7.49)分,观察组别为(49.77±4.64)、(51.14±6.38)分,两组比较,差异有显著性意义(均P＜0.05).结论 对开胸术患者进行术侧上肢功能锻炼,可缓解患者心理压力,减轻术后抑郁、焦虑程度,有利于患者早日康复.     

150例急性肠套叠患儿家属焦虑抑郁情绪的相关因素分析及护理干预

目的:调查分析住院解肠套叠住院患儿家属焦虑与抑郁患病情况及其相关的影响因素.方法:收集中国医科大学附属盛京医院小儿外科病房肠套叠住院患儿的直系家属150例,应用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行测评并对结果进行分析.结果:肠套叠家属的焦虑、抑郁自评量表的焦虑得分(61.30±14.21)分,抑郁评分(54.00±14.89)分,与正常人群国内常模比较有显著性差异(P＜0.01);文化程度和年龄在焦虑和抑郁得分上的差异均具有统计学意义(P＜0.01;P＜0.01);性别对焦虑和抑郁得分的影响不显著(P＞0.05).结论:肠套叠患者家属的焦虑和抑郁状况受到多种因素不同程度的影响,而文化程度和年龄对焦虑和抑郁的程度影响较大,临床上应采用不同的措施来降低肠套叠家属的焦虑和抑郁情绪.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.