系统性综合干预对慢性精神分裂症患者康复的影响

目的 探讨系统性综合护理干预对慢性精神分裂症患者康复的影响.方法 将72例慢性精神分裂症患者随机分为两组,每组36例,两组均维持原用药物治疗方案,研究组进行系统性综合护理干预,对照组采取常规护理,观察3个月.于干预前后采用阴性症状量表和生活质量综合评定问卷-74评定干预效果.结果 干预后两组阴性症状量表评分均较干预前显著下降(P＜0.01),且研究组较对照组下降更显著(P＜0.01);两组生活质量综合评定问卷-74躯体功能、社会功能维度评分和总体生活质量因子分及研究组心理功能维度评分均较干预前显著升高(P＜0.05或0.01),且研究组躯体功能、心理功能、社会功能维度评分及总体生活质量因子分较对照组升高更显著(P＜0.01).结论系统性综合护理干预能有效缓解慢性精神分裂症患者的精神症状,改善社会功能,提高生活质量.     

康复工场活动对社区精神分裂症患者社会功能的影响

目的 探讨提高社区精神分裂症患者社会功能的方法.方法 指导50例社区精神分裂症患者积极参加康复工场活动,随机选择50例没有参加专业康复训练的社区精神分裂症患者作为对照组,采用阳性和阴性症状量表(PANSS)和个人与社会功能量表(PSP)进行1年随访.结果 1年后,研究组PSP总分较对照组高,PANSS总分和阴性症状因子分较对照组低(P＜0.05).研究组1年前后PSP总分、PANSS总分和阴性症状因子分都有显著性差异(P＜0.05),对照组无显著性差异.结论 社区精神分裂症患者通过参加康复工场活动,可以改善病情和社会功能.     

心理干预对精神分裂症病人生活质量及社会功能康复的影响

[目的]探讨心理干预对精神分裂症病人生活质量及社会功能康复的影响.[方法]将130例精神分裂症病人随机分为对照组和研究组,对照组单纯用抗精神病药物治疗,实施常规护理,研究组在药物治疗的同时给予心理干预,用阳性与阴性症状量表(PANSS)、生活质量综合评定量表(GQOLI)、社会功能缺陷筛选量表(SDSS)分别评估病人的疗效、生活质量、社会功能及康复效果.[结果]治疗后两组PANSS评分与同组治疗前比较差异有统计学意义(P<0.01);治疗后研究组GQOLI的躯体健康维度、心理健康维度、社会功能维度评分及SDSS总分、各因子分均高于对照组(P<0.01).[结论]对精神分裂症病人给予心理干预可以提高病人的生活质量、促进社会功能的恢复.     

探讨精神分裂症社区康复患者精神症状与家庭负担的相关性及康复干预效果

目的探讨精神分裂症患者社区康复干预的效果及其精神症状与家庭负担的相关性。方法将康复中心治疗后于社区康复的80例精神分裂症患者作为研究对象,采用随机数字表法分为对照组(常规社区干预)和观察组(积极性社区康复干预)各40例。分析精神症状与家庭负担的相关性,并对比两组干预后家庭负担量表(FBS)评分、阳性和阴性综合征量表(PANSS)评分。结果 FBS总分与一般病理分、PANSS总分呈正相关(P0.05);观察组干预后FBS总分、一般病理分、阴性症状分、阳性症状分及PANSS总分均显著低于对照组,差异具有统计学意义(P0.05)。结论精神分裂症患者的精神症状与家庭负担呈正比,应用社区康复干预效果明显,能有效改善其阳性、阴性症状。     

莘庄社区基于阳光心园的康复服务对精神分裂症患者康复效果的影响

目的:探讨基于阳光心园康复服务对社区精神分裂症患者康复的效果。方法:莘庄社区精神分裂症患者160例分为干预组和对照组各80例,干预组进入阳光心园接受康复训练课程和家庭教育,为期6个月,对照组接受常规服务。采用自知力与治疗态度问卷(ITAQ)、阳性与阴性症状量表(PANSS)、个人和社会功能量表(PSP)进行评估。结果:干预6个月后,干预组TAQ及PSP评分均较干预前及对照组明显提高(P<0.05),PANSS评分较干预前及对照组明显下降(P<0.05);对照组干预前后差异无统计学意义。干预后,干预组主动服药依从率较干预前及对照组明显提高(P<0.05),对照组主动服药依从率较干预前及干预组明显下降(P<0.05);干预后,干预组复发率明显低于对照组(P<0.05)。结论:阳光心园康复服务有利于提高患者自知力和服药依从性,改善精神症状和社会功能,并有效预防复发。     

护理干预对首发精神分裂症患者疗效的影响

目的探讨护理干预对首发精神分裂症患者的疗效和社会功能康复的影响。方法选取60例在护理干预科病房住院治疗的首发精神分裂症患者为干预组,60例在非护理干预科病房住院的首发精神分裂症患者为对照组,对照组单用抗精神病药物治疗,干预组在药物治疗的同时辅以心理和社会综合干预措施。于干预前、出院后随访6mo末及1a末采用自编一般资料调查表、阳性症状与阴性症状量表、社会功能缺陷筛选量表评定临床疗效及社会功能改善情况。结果阳性症状与阴性症状量表评分出院后随访6mo末及1a末干预组总分及阴性症状分均显著低于对照组(P均<0.01);社会功能缺陷筛选量表评分出院后随访6mo末及1a末干预组职业和工作、社会活动、家庭职能、生活自理、责任性和计划性等因子分均显著低于对照组(P均<0.01)。结论护理干预措施有助于提高精神分裂症患者的疗效和促进社会功能的康复。     

精神分裂症患者述情障碍与生活质量和精神症状的相关性研究

目的 探讨精神分裂症患者述情障碍与生活质量和精神症状的相关性,为药物治疗和心理干预提供依据.方法 将170例精神分裂症患者设为研究组,同期随机选取170名身心健康者设为对照组,对两组采用多伦多述情障碍量表和生活质量综合评定问卷-74进行测评分析,对研究组采用阳性与阴性症状量表评定精神症状.结果 研究组多伦多述情障碍量表总分及各因子分显著高于对照组(P＜0.01),生活质量综合评定问卷-74总分及各维度分显著低于对照组(P＜0.01);研究组多伦多述情障碍量表总分和因子III与生活质量综合评定问卷-74总分、心理功能、社会功能和物质生活状态维度呈显著负相关(P＜0.05或0.01),因子II与生活质量综合评定问卷-74总分、社会功能和物质生活状态维度呈显著负相关(P＜0.01);研究组多伦多述情障碍量表总分和因子II与阳性与阴性症状量表总分、阳性症状和阴性症状因子分呈显著正相关(P＜0.05或0.01),因子I与阳性与阴性症状量表总分和阳性症状因子分呈显著正相关(P＜0.01),因子III与阳性与阴性症状量表总分和阴性症状因子分呈显著正相关(P＜0.05或0.01).结论 精神分裂症患者的述情障碍与生活质量和精神症状存在一定的相关性,精神症状越严重,述情障碍越明显,生活质量越低.     

艺术性情感干预对住院精神分裂症阴性症状的矫治效果

目的 探讨改善精神分裂症阴性症状、促进自知力恢复、提高心理康复的护理干预措施.方法 对30例精神分裂症患者进行为期2个月的艺术性情感护理干预(研究组),与未使用艺术情感护理干预的30例精神分裂症患者(对照组)进行比较,采用阴性症状评定量表(SANS)、住院病人护士观察量表(NOSIE-30)、症状自评定量表(SCL-90)综合评价精神分裂症患者的精神状况和康复效果.结果 治疗结束后,研究组阴性症状评定量表(SANS)各因子分值和症状自评量表(SCL-90)各因子分间分值均明显高于对照组(P<0.01),住院病人护士观察量表(NOSIE-30)中的积极因素和消极因素评分值的变化均显著优于对照组(P<0.01).结论 艺术性情感护理干预措施能够改善精神分裂症患者的阴性症状,促进其自知力恢复,对精神分裂症患者精神康复具有积极的作用.     

社区独立技能训练预防精神分裂症复发的研究

目的探讨社区独立技能训练对降低精神分裂症患者复发率、提高社会功能的作用.方法将120例临床康复出院的精神分裂症患者随机分为技能训练组和对照组.采用精神分裂症阳性症状量表(SAPS)、阴性症状量表(SANS)、简明精神病评定量表(BPRS)、自知力及治疗态度问卷(ITAQ)和社会功能缺陷量表(SDSS)对两组患者进行1年内康复状态的评估.结果 1年末训练组BPRS、 ITAQ、SDSS评分明显优于对照组,两组间差异有非常显著性意义(P<0.01);训练组服药依从性及自行管理药物的能力也明显优于对照组(P<0.01); 1年内训练组复发率(9%)和再入院率(6%)均明显低于对照组(分别为36%和30%),两组间差异有显著性意义(P<0.05).结论社区独立技能训练有助于改善精神分裂症残留症状,降低社会残疾程度,对保持精神分裂症患者良好的远期疗效具有积极作用.     

生活技能训练对住院精神分裂症患者阴性症状的影响

目的:探讨生活技能训练对住院精神分裂症患者阴性症状的影响。方法:对30例住院精神分裂症患者进行生活技能训练,并以30例患者作为对照组,用护士观察量表(NO ISE)、阴性症状量表(SANS)、住院精神患者社会功能评定量表(SSPI)进行效果评定。结果:训练组训练后NO ISE评分在总积极因素、总消极因素、病情总估计与对照组比较有明显差异(P<0.01);SANS总分明显低于对照组(P<0.01);SSPI各因子分与对照组比较有明显差异(P<0.01)。结论:生活技能训练能够明显改善住院精神分裂症患者的阴性症状,提高其独立生活能力,促进康复。     

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.