护理干预改善造血干细胞移植患者术前焦虑的研究

目的探索护理干预对缓解、减轻造血干细胞移植患者术前焦虑的有效方法。方法将准备行造血干细胞移植的住院患者随机分为干预组（n=25）和对照组（n=24）,对照组采用常规护理,干预组除采用常规护理外并给予层流室参观、观看录像、音乐疗法等干预措施。采用焦虑自评量表（SAS）和汉密顿焦虑量表（HAMA）对两组患者焦虑状况进行测评。结果2组患者干预前均有不同程度的焦虑存在,SAS得分均值与常模总分均值比较,明显高于正常人常模（P〈0.01）,干预后2组患者SAS得分均值之间的比较有明显差别（P〈0.01）,干预组焦虑情绪术前1d明显低于对照组。结论行造血干细胞移植的患者均有不同程度的焦虑,采用有效的护理干预措施可明显改善患者的焦虑状态。     

护理干预改善外周血干细胞采集供者术前焦虑的研究

目的探讨护理干预对外周血干细胞采集前供者焦虑的影响及减轻其焦虑的有效方法。方法将50例准备外周血造血干细胞采集的供者随机分为干预组（n=25）和对照组（n=25）,对照组采用常规护理,干预组除采用常规护理外并提前给予参观采集病室、观看采集全过程录像、音乐疗法等干预措施。采用焦虑自评量表（SAS）和汉密顿焦虑量表（HAMA）对两组供者焦虑状况进行测评。结果两组供者干预前均有不同程度的焦虑存在,两组供者之间差异无统计学意义（P〉0．05）;SAS得分与常模比较,明显高于常模有统计学意义（P〈0．01）。干预后两组患者HAMA得分比较有明显差别（P〈0．01）,干预组焦虑情绪术前1d明显低于对照组。结论外周血干细胞的供者采集前均有不同程度的焦虑,采用有效的护理干预措施可明显改善供者的焦虑状态。     

心理干预对行造血干细胞移植的白血病患者抑郁、焦虑及生存质量的影响

目的：探讨心理干预对行造血干细胞移植的白血病患者抑郁、焦虑及生存质量的影响。方法：行造血干细胞移植的白血病患者52例随机分为观察组和对照组各26例。对照组仅给予白血病移植患者常规护理,观察组在此基础上同时配合心理干预。干预前后采用焦虑自评量表（SAS）、抑郁自评量表（SDS）评价患者的焦虑、抑郁程度,皮茨堡睡眠质量指数量表（PSQI）评估睡眠质量。结果：干预2个月后,观察组SAS、SDS及PSQI评分均较治疗前及对照组明显下降,对照组治疗前后各项评分比较均差异无统计学意义。结论：心理干预措施能有效改善对行造血干细胞移植的白血病患者心理状况及睡眠质量,提高患者的生存质量。     

造血干细胞移植患者亲属焦虑和抑郁倾向的护理干预效果

目的：探讨心理干预对造血干细胞移植患者亲属的心理状态影响。方法对本院收治的120例进行造血干细胞移植患者的亲属（试验组）采用焦虑和抑郁自评量表进行评分,同时对同期收治的120例非造血干细胞移植患者亲属（对照组）的焦虑和抑郁采用同样方法进行评分,试验组予护理干预。结果干预前2组的 SAS 及 SDS 得分无明显差异（P ＞0．05）;干预后试验组 SAS 及 SDS得分显著降低（P ＜0．01）,对照组干预后的 SAS 及 SDS 得分虽有所降低,但降低幅度很小,差异无统计学意义（P ＞0．05）。干预后干预组 SAS 及 SDS 得分显著低于对照组（P ＜0．01）。结论在临床上,造血干细胞移植患者的亲属存在心理障碍,护理人员需要对其亲属进行必要的护理干预,改善其不良情绪,以免对患者的治疗造成影响。     

经桡动脉及股动脉行冠心病介入治疗患者术前焦虑状况的比较研究

目的比较经桡动脉和经股动脉行PCI患者术前焦虑状况。方法采用调查问卷的方式。调查问卷包括两部分：患者一般情况调查表和焦虑自评量表（SAS），分别对30例经桡动脉行PCI患者和30例经股动脉行PCI患者的焦虑状况进行测评。结果两种途径行PCI患者SAS得分均值与常模总分均值比较，明显高于正常人常模（P〈0．01）；两种途径行PCI患者SAS得分均值之间的比较，有明显差别（P〈0．01）。结论两种途径行PCI患者术前都有焦虑，经股动脉行PCI患者比经桡动脉行PCI患者焦虑程度更高，对2组患者应根据其焦虑的不同程度进行心理干预。     

心理干预对造血干细胞采集亲缘供者心理状态的影响

目的探讨心理干预对造血干细胞亲缘供者心理状态的影响。方法将64例造血干细胞亲缘供者随机分为干预组（n=32）和对照组（n=32）,对照组采用常规的术前健康教育,干预组在此基础上行心理干预。干预前后采用Zung抑郁自评量表（SDS）、焦虑自评量表（SAS）对两组供者的心理状态进行评分,同时记录两组供者的心率、血压并进行相关分析。结果干预组血压、心率与干预前比较差异无统计学意义（P〉0．05）,与对照组比较差异均有统计学意义（P〈0．01）。干预组抑郁、焦虑得分与干预前比较均下降（P〈0．05）,与对照组比较差异均有统计学意义（P〈0．05）。结论对造血干细胞亲缘供者实施心理干预,可减轻其焦虑、抑郁心理和维持血压、心率的稳定。     

经桡动脉及股动脉行冠心病介入治疗患者术前焦虑状况的比较研究

目的比较经桡动脉和经股动脉行PCI患者术前焦虑状况.方法采用调查问卷的方式.调查问卷包括两部分:患者一般情况调查表和焦虑自评量表(SAS),分别对30例经桡动脉行PCI患者和30例经股动脉行PCI患者的焦虑状况进行测评.结果两种途径行PCI患者SAS得分均值与常模总分均值比较,明显高于正常人常模(P＜0.01);两种途径行PCI患者SAS得分均值之间的比较,有明显差别(P＜0.01).结论两种途径行PCI患者术前都有焦虑,经股动脉行PCI患者比经桡动脉行PCI患者焦虑程度更高,对2组患者应根据其焦虑的不同程度进行心理干预.     

心理干预对乳腺癌患者术前焦虑抑郁情绪的影响

目的探讨心理干预对乳腺癌根治术病人术前焦虑、抑郁情绪的影响。方法将80例乳腺癌手术患者随机分为实验组（n=40）和对照组（n=40），两组病人均于手术前1d应用焦虑自评量表（SAS）和抑郁自评量表（SDS）测量对术前焦虑抑郁程度。针对存在的问题实验组接受术前心理干预，对照组接受常规护理后于术日晨分别再次进行SAS、SDS测量。结果两组病人手术前1 dSAS、SDS评分变化差异无显著性（P〉0.05）；而手术日晨实验组SAS、SDS明显减低，与对照组比较存在明显差异（P〈0.001）。结论术前心理干预能够解除或减轻手术患者术前焦虑、抑郁情绪，降低心理应激反应，对保障手术顺利完成有积极意义。     

马斯洛需要层次论在白内障患者心理护理中的应用

目的调查白内障患者的心理需求及焦虑状况,探讨以马斯洛需要层次论为指导的心理护理方式对白内障患者焦虑状况的作用。方法将符合纳入标准的白内障患者随机分成实验组和对照组,人院时两组采用自制的问卷及焦虑自评量表（SAS）调查患者的心理需求及焦虑状况。对照组采用常规心理护理方法,实验组采用以马斯洛需要层次论为指导的心理护理方式进行干预。干预后再次采用SAS量表评定两组患者的焦虑程度。结果术前两组患者均存在不同程度的焦虑,焦虑程度无明显差异,两组接受干预后SAS得分均降低（P〈0．01）,实验组焦虑得分明显低于对照组（P〈0．01）。结论白内障患者术前术后均存在不同程度的焦虑,以马斯洛需要层次论为指导的心理护理方式较常规的心理护理方式可以明显改善白内障患者的焦虑状况,值得临床推广。     

指导性心理干预对青光眼局麻患者术前焦虑及血压心率的影响

目的探讨指导性心理干预对在局麻下行小梁切除术的青光眼患者术前焦虑及血压心率的影响。方法选取住院行小梁切除术的青光眼局麻患者80例,随机分为干预组和对照组,每组40例。对照组患者给予常规心理护理及健康宣教,干预组患者在常规护理方式基础上术前由手术室护士给予有针对性的指导性心理干预。采用焦虑自评量表（SAS）比较两组患者干预前后的SAS评分,观察两组患者人院时和手术开始前血压、心率的情况。结果干预后干预组SAS评分明显低于对照组（P〈0．05）,术前收缩压低于对照组（P〈0．05）,舒张压低于对照组（P〈0．05）,心率显著低于对照组（P〈0．05）。结论通过术前有效的指导性心理干预使青光眼患者术前焦虑状况得到改善,血压、心率得到一定程度的控制,为患者在术中控制血压和心率奠定了基础,为手术成功提供了有力保障。     

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.     

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.