不同术式喉癌患者136例术后心理状态分析

目的:分析喉癌术后患者的心理特征,比较不同术式喉癌患者心理状态差异。方法:2002-01/2004-01在辽宁省肿瘤医院头颈外科接受手术治疗的喉癌患者136例。根据患者手术方式的不同,分为全喉切除组(n=52)和部分喉切除组(n=84),选择到头颈外科病房探视患者的正常人136例为对照组。采用问卷调查法:①症状自评量表测定调查对象的心理健康水平,采用5级评分,各项得分越高,精神症状越多(总分≥160分),表明心理健康水平越差。②Zung抑郁自评量表、Zung焦虑自评量表评估患者的抑郁及焦虑状况,均为4级评分(1～4),界定值50分,得分越高,表明抑郁及焦虑程度越重。主要观察不同术式患者症状自评量表,Zung抑郁自评量表,Zung焦虑自评量表评分结果,并与正常对照组进行比较,样本间比较采用t检验。结果:所有调查对象全部进入结果分析,无脱落。①各组症状自评量表评分比较:全喉切除与部分喉切除患者症状自评量表评分总分≥160分者分别为35例(67.3%),40例(47.6%)。除焦虑因子外,全喉切除组症状自评量表总分及其他因子分均高于部分喉切除组(t=2.120～3.778,P<0.001～0.05),两组症状自评量表总分及其他所有因子分均显著高于对照组(t=2.042～8.388,P<0.001～0.05)。②各组Zung焦虑自评量表、Zung抑郁自评量表评分比较:全喉切除组Zung焦虑自评量表得分及Zung抑郁自评量表得分≥50分者,分别为30例(57.7%),40例(76.9%),部分喉切除组两量表得分≥50分者分别为51例(60.7%),41例(48.8%)。全部喉切除组患者Zung抑郁自量表标准分均值明显高于部分喉切除组(t=2.816,P<0.01),全喉切除组与部分喉切除组Zung焦虑自评量表、Zung抑郁自量表标准分均值均显著高于对照组(t=3.159-6.462,P<0.01)。结论:喉癌术后患者的心理健康状况较差,全喉切除术后患者的心理问题及抑郁情绪较部分喉切除术后患者严重,为提高患者生存质量,外科治疗方面应尽量行部分喉切除术,术后应及时对不同术式患者有区别地进行心理干预。     

轻度认知功能损害患者负性情绪与脑缺血指数研究

目的:探讨轻度认知功能损害(MCI)患者负性情绪与脑缺血指数的关系。方法:用Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)和Hachinski缺血指数量表(HIS)对MCI组(98例MCI患者)进行测试,并与国内常模或对照组(98名健康人)比较。结果:MCI组存在明显抑郁、焦虑,SDS和SAS评分均显著高于国内常模(P<0.05,0.01);MCI组HIS评分显著高于对照组[(1.58±0.96)分,(0.64±0.74)分,P<0.05];SDS及SAS评分与HIS评分呈显著正相关。结论:MCI患者常伴有负性情绪,慢性缺血可能是MCI的高危因素,MCI患者脑缺血越明显则抑郁和焦虑症状越重。     

心理因素对难治性前列腺炎患者的影响

目的:探讨心理因素对难治性前列腺炎患者的影响。方法:将165例前列腺炎患者分为难治性前列腺炎组(n=80)和非难治性前列腺炎组(n=85),心理因素焦虑和抑郁的评分采用Zung氏焦虑自评量表、Zung氏抑郁自评量表进行调查,勃起功能通过国际勃起功能指数-5(IIEF-5)进行评分,并对数据进行分析。结果:难治性前列腺炎患者焦虑评分、抑郁程度明显增高(P<0.05),心理障碍程度与病程呈正相关;性功能减退在有心理障碍的慢性前列腺炎患者中更为多见(P<0.05)。结论:难治性前列腺炎患者普遍有心理问题,对此类患者的治疗不仅注意躯体疾病,更要重视对患者的心理疏导。     

心理护理对乳腺癌患者术后的影响

目的:探讨心理护理对缓解乳腺癌患者术后心理问题的作用。方法:将104例乳腺癌术后患者随机分为实验组和对照组各52例,对照组患者进行常规护理,实验组在此基础上给予心理护理。采用Zung氏抑郁自评量表和焦虑自评量表评价两组患者心理障碍。结果:两组患者经护理后抑郁和焦虑评分均明显降低(P<0.01),实验组患者的抑郁和焦虑评分明显低于对照组(P<0.01)。结论:乳腺癌患者均有不同程度的心理障碍,实施护理干预后可缓解患者心理障碍,增加心理护理效果。     

梗死部位对脑卒中患者执行功能与自我效能的影响

目的探讨不同梗死部位脑卒中患者执行功能和自我效能的情况。方法选取基底节区、顶枕叶区、额叶区、其他部位梗死患者各80例,以同期在该医院进行体格检查的健康人80名为对照组。对所有对象应用威斯康星卡片测验系统(WCST)、画钟实验(CDT)、Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)、一般自我效能量表(GSES)进行评测。结果不同部位脑卒中患者WCST各项评分和CDT评分、GSES得分均差于对照组(P<0.05);病例组组间比较显示,额叶区和基底节区卒中组WCST中的4项及CDT、GSES评分均差于顶枕叶区和其他部位卒中组(P<0.05)。各组间SDS和SAS评分无显著性差异(P>0.05)。结论脑梗死可造成患者执行功能障碍和自我效能水平降低,以额叶区和基底节区损伤患者最为明显。     

脑卒中后抑郁的相关因素分析

目的调查分析患者脑卒中后抑郁的相关因素。方法应用Zung自评抑郁量表对76例脑卒中住院患者进行回顾性分析,分析患者脑卒中后抑郁的相关因素。结果患者发生脑卒中后抑郁与年龄、职业、日常生活活动能力有关(P<0.05);与性别无关(P>0.05)。结论应用Zung自评抑郁量表可以明确患者发生脑卒中后抑郁的相关因素,临床护理人员应对存在相关因素的患者采取针对性的护理措施,以降低脑卒中后抑郁的发生率。     

疼痛管理联合中医特色护理对扁桃体术后患者疼痛程度的影响观察

目的探讨疼痛管理联合中医特色护理对扁桃体术后患者疼痛程度的影响。方法选取就诊的88例慢性扁桃体炎(CTS)患者,按随机数字表法分为研究组、对照组各44例。对照组术后行常规护理,研究组在对照组基础上行疼痛管理联合中医特色护理。对比两组心理状态[Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)评分]、疼痛程度[视觉模拟评分法(VAS)评分]、并发症。结果护理后两组SDS、SAS、VAS评分均低于护理前,且研究组均较对照组低(P<0.05);与对照组相比,研究组术后并发症发生率较低(P<0.05)。结论疼痛管理联合中医特色护理可有效改善扁桃体术后患者心理状态,减轻术后疼痛,降低并发症发生率。     

Zung抑郁自评量表的临床应用与评价

目的 探讨Zung抑郁自评量表(Self-rating Depression Scale,SDS)在诊断抑郁症中的应用价值,并分析抑郁症与患者性别、年龄、文化程度及婚姻状况的相关性.方法 选择就诊的673例咨询者为研究对象,使用Zung抑郁自评量表对其进行测验,并进行抑郁症分级.结果 无抑郁症状146例,轻度抑郁168例,中度抑郁214例,重度抑郁145例;4种症状的Zung抑郁自评量表评分差异有高度统计学意义(P＜0.01);抑郁症与患者性别、文化程度及婚姻状况相关(P＜0.01或P＜0.05);20～49岁者较其他年龄段抑郁症发病率高,差异有高度统计学意义(P＜0.01).结论 Zung抑郁自评量表可作为诊断抑郁症的一个有效的检测工具,并可用于评价抑郁症的疗效.     

Zung抑郁自评量表的临床应用与评价

目的 探讨Zung抑郁自评量表(Self-rating Depression Scale,SDS)在诊断抑郁症中的应用价值,并分析抑郁症与患者性别、年龄、文化程度及婚姻状况的相关性.方法 选择就诊的673例咨询者为研究对象,使用Zung抑郁自评量表对其进行测验,并进行抑郁症分级.结果 无抑郁症状146例,轻度抑郁168例,中度抑郁214例,重度抑郁145例;4种症状的Zung抑郁自评量表评分差异有高度统计学意义(P＜0.01);抑郁症与患者性别、文化程度及婚姻状况相关(P＜0.01或P＜0.05);20～49岁者较其他年龄段抑郁症发病率高,差异有高度统计学意义(P＜0.01).结论 Zung抑郁自评量表可作为诊断抑郁症的一个有效的检测工具,并可用于评价抑郁症的疗效.     

无症状性脑梗死患者智能、记忆和情感的相关性

目的：探讨无症状性脑梗死asymptomaticcerebralinfarction,ACI智能、记忆和情感的关系。方法:采用龚氏修订的韦氏成人智力量表中国版、记忆量表中国版、抑郁及焦虑自评量表,对60例ACI患者及相匹配的40例正常对照组以及50例症状性脑梗死(symptomaticcerebralinfarction,SCI)组进行检查研究。结果:ACI组大部分分测验值明显低于正常对照组(P<0.01～0.05),但与SCI组无显著差异;38例智力低于正常,其中14例出现智能障碍;47例记忆力低于正常,其中记忆障碍者25例;不同梗死区域及数量有认知功能损害的特点;ACI组抑郁发生率及SDS标准分均明显高于正常对照组(P<0.01),SAS标准分与正常对照组比较无差异;有抑郁症状者29例;抑郁组各智商及记忆商显著低于正常组(P<0.01),非抑郁组语言智商(verbalintelligencequotient,VIQ)显著低于正常组(P<0.05)。结论:ACI患者存在明显认知功能障碍,多发性梗死、双侧梗死和抑郁情绪更易产生认知功能障碍。     

慢性疲劳综合征个体的情绪特征研究

目的：分析慢性疲劳综合征（CFS）个体的情绪特征,为今后临床干预提供理论依据.方法：采用疲劳评定量表（FS-14）和症状自评量表（SCL-90）,对329例慢性疲劳综合征及363例健康对照者进行调查.结果：CFS人群疲劳总分和躯体疲劳因子分显著高于对照组,差异具有显著性意义（P＜0.01）;CFS人群SCL-90总分、抑郁、焦虑、躯体化、强迫、偏执及精神病性等因子分均显著高于正常对照组（P＜0.01）.结论：CFS人群的疲劳以躯体疲劳为主,普遍存在抑郁、焦虑、强迫、躯体化和偏执等情绪问题,疲劳越重,抑郁和躯体化症状越明显,影响工作效率和生活质量.     

Alteration of cortical excitability in patients with fibromyalgia

We assessed cortical excitability and intracortical modulation systematically, by transcranial magnetic stimulation (TMS) of the motor cortex, in patients with fibromyalgia. In total 46 female patients with fibromyalgia and 21 normal female subjects, matched for age, were included in this study. TMS was applied to the hand motor area of both hemispheres and motor evoked potentials (MEPs) were recorded for the first interosseous muscle of the contralateral hand. Single-pulse stimulation was used for measurements of the rest motor threshold (RMT) and suprathreshold MEP. Paired-pulse stimulation was used to assess short intracortical inhibition (SICI) and intracortical facilitation (ICF). Putative correlations were sought between changes in electrophysiological parameters and major clinical features of fibromyalgia, such as pain, fatigue, anxiety, depression and catastrophizing. The RMT on both sides was significantly increased in patients with fibromyalgia and suprathreshold MEP was significantly decreased bilaterally. However, these alterations, suggesting a global decrease in corticospinal excitability, were not correlated with clinical features. Patients with fibromyalgia also had lower ICF and SICI on both sides, than controls, these lower values being correlated with fatigue, catastrophizing and depression. These neurophysiological alterations were not linked to medication, as similar changes were observed in patients with or without psychotropic treatment. In conclusion, fibromyalgia is associated with deficits in intracortical modulation involving both GABAergic and glutamatergic mechanisms, possibly related to certain aspects of the pathophysiology of this chronic pain syndrome. Our data add to the growing body of evidence for objective and quantifiable changes in brain function in fibromyalgia.     

严重急性呼吸综合征患者血清白细胞介素-6水平的动态变化

目的：观察SAILS患者血清白介素-6（IL-6）含量变化。方法：用放射免疫法检测29例SARS患者血清白介素含量,与正常对照组比较.结果：进展期SARS组患者血清IL-6含量高于正常的百分率为18／29（62．1％）,低于正常的百分率为3／29（10．3％）。发病后21天和病后2．5个月SARS组患者中血清IL-6含量高于正常的百分率分别为10／29（34．4％）和4／29（13．7%）：低于正常的百分率分别为3／29（10．3％）和2／29（6．9％）。重型SARS组患者进展期与发病21天后血清IL-6含量明显高于普通型SARS组。结论：SARS患者存在免疫反应异常,血清白细胞介素-6含量变化可能是SARS发病机制中一个环节。     

Fatigue after myocardial infarction: Relationships with indices of emotional distress,and sociodemographic and clinical variables

Alsén P, Brink E, Brändström Y, Karlson BW, Persson L‐O. International Journal of Nursing Practice 2010; 16 : 326–334
Fatigue after myocardial infarction: Relationships with indices of emotional distress, and sociodemographic and clinical variables Fatigue and depressive symptoms are relatively common among patients recovering from myocardial infarction (MI). The symptoms of depression and fatigue overlap. The present study aimed at identifying patient fatigue and at examining the incidence of fatigue, particularly without coexisting depression, after MI. The sample comprised 204 consecutive patients who had completed the questionnaires Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory–20 after MI (1 week and 4 months). The results showed that fatigue had decreased after 4 months compared with the time of MI onset. Compared with the general population, patients reported significantly higher levels of fatigue. Furthermore, fatigue was associated with depression, but 33% of the sample reported fatigue without coexisting depression after 4 months. In order to prevent or treat patients' symptoms of fatigue after MI, the concepts of fatigue and depression should be assessed separately so as to exclude overlapping effects.     

Peripheral blood mononuclear cell beta-endorphin concentration is decreased in chronic fatigue syndrome and fibromyalgia but not in depression: preliminary report

OBJECTIVE: The aim of this study was to examine the possible role of the immune system in the pathophysiology of chronic fatigue syndrome and fibromyalgia syndrome and in the differential diagnosis of depression by investigating changes in peripheral blood mononuclear cell levels of beta-endorphin, an endogenous opioid known to be involved in regulation of the immune system function. DESIGN: Beta-endorphin concentrations were measured by radioimmunoassay in peripheral blood mononuclear cells from healthy controls (n = 8) and patients with chronic fatigue syndrome (n = 17), fibromyalgia syndrome (n = 5), or depression (n = 10). RESULTS: Beta-endorphin concentrations were significantly lower in patients with chronic fatigue syndrome or fibromyalgia syndrome than in normal subjects and depressed patients (p <0.001 and p <0.01, respectively). They were significantly higher in depressed patients than in controls (p <0.01). CONCLUSIONS: Evaluation of peripheral blood mononuclear cell beta-endorphin concentrations could represent a diagnostic tool for chronic fatigue syndrome and fibromyalgia and help with differential diagnosis of these syndromes versus depression. The results obtained are also consistent with the hypothesis that the immune system is activated in both chronic fatigue syndrome and fibromyalgia syndrome.     

SARS患者白细胞及T细胞亚群的变化

[目的]探讨严重急性呼吸综合征(SARS)患者外周血白细胞和T淋巴细胞亚群的变化及其临床意义。[方法]用全自动血细胞分析仪检测44例SARS患者外周血白细胞计数及分类．用流式细胞仪检测SARS患者外周血T淋巴细胞亚群;并与正常对照组比较。[结果]与对照组比较．SARS组患者白细胞总故显著下降,淋巴细胞百分数和绝对数显著下降．粒细胞绝对数显著下降,粒细胞百分数显著增如：CD、CD2^-和CD8^-细胞绝对数显著下降,CD3^-、CD4^-、CD8^-细胞百分数和CD4^-／CD8^-比值与对照组比较无显著性差异。1年后,恢复期SARS患者的上述各项指标均恢复正常。[结论]SARS冠状病毒感染损伤患者中性粒细胞和细胞免疫功能,但这种损伤是可逆的。     

Longitudinal study of cognitive dysfunctions induced by adjuvant chemotherapy in colon cancer patients

Background

Chemotherapy can induce cognitive impairment in cancer patients. The main goal of this longitudinal study was to determine the incidence, characteristics, and duration of cognitive dysfunction in patients treated with adjuvant chemotherapy for colon cancer.

Patients and methods

We assessed cognitive function, quality of life, anxiety and depression, fatigue, and hemoglobin levels in colon cancer patients at three assessment points: pre-chemotherapy (n?=?81), post-chemotherapy (n?=?73), and after 6-month follow-up (n?=?54). All patients were treated with oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX4) for 6 months.

Results

Thirty patients (37 %) had cognitive impairment in the pre-chemotherapy evaluation, mainly in processing speed and psychomotor executive function (Trail Making Test A and B). At the end of treatment, the main domain affected was the verbal memory, with an acute decline detected in 56 % of patients. Fifty-four percent of the patients improved their dysfunction after 6 months of follow-up, whereas 18 (33 %) of them showed worsening in at least one test. Cognitive impairment was most common in older patients and in those with less years of education. Quality of life, anxiety, depression, fatigue, and hemoglobin did not influence the results of the cognitive tests.

Conclusions

Adjuvant FOLFOX4 in patients with colon cancer can have a negative effect on verbal memory. This deterioration is usually mild and transient.     

反应性抑郁症、抑郁性神经症患者听觉事件相关电位P300的改变

背景反应性抑郁症和抑郁性神经症为心因性情绪障碍,临床上均有记忆力减退、注意力不集中、反应迟钝、思维迟钝等认知功能损害的主诉,患者这种主观体验是否属实,对这类疾病认知功能损害客观的实验室的依据较少.目的了解反应性抑郁症及抑郁性神经症患者听觉事件相关电位P300改变与认知功能损害的情况.设计病例-对照实验.单位解放军第三军医大学附属医院神经内科临床心理咨询中心.对象选择1997-09/1998-03解放军第三军医大学西南医院职工为正常对照组40人,男21人,女19人;年龄20～50岁.同期从本院心理咨询门诊选择与正常对照组年龄相匹配的患者80例,其中反应性抑郁症(简称反应症组)40例,男29例,女11例;抑郁性神经症(简称神经症组)40例,男24例,女16例.随机追踪10例P300异常改变患者为随访组,其中反应性抑郁症4例,抑郁性神经症6例. 方法所有入组的首诊患者及正常被试者在本院脑电生理研究室均采用听觉事件相关电位P300经典方式进行测试,同时由经过心理测评培训过的专业人员对两组患者情绪状态用Zung症状自评量表进行评定.主要观察指标①80例患者首诊和治疗4周、8周后听觉事件相关电位P300的检测结果及Zung症状自评量表评分,正常对照组听觉事件相关电位P300的检测结果.②10例P300异常改变者治疗前、治疗后P300结果及Zung症状自评量表评分.结果参加实验的反应性抑郁症患者40例,抑郁性神经症患者40例,正常对照组40人,全部进入结果分析.①两组患者各波潜伏期均显著长于正常对照组(P＜0.05～0.01).两组患者听觉事件相关电位各波波幅较正常对照组低,N1,P2,N2三波波幅呈总体下降趋势,接近显著水平;而反应症组P3波幅明显低于正常对照组[(10.39±4.40),(15.11±4.16)μV,P＜0.001].神经症组各波波幅则明显低于正常对照组.③10例患者治疗前后随着情绪的改善P3潜伏期及波幅相比,P3潜伏期治疗前后差异无显著性意义[(314.10±44.08),(295.4±20.74)ms,t=1.21,P＞0.05],而P3波幅治疗后明显增大并恢复至正常范围[治疗前(6.38±2.50)μV,治疗后(14.22±2.51)μV,t=-7.012,P＜0.001].结论反应性抑郁症及抑郁性神经症患者均存在认知功能的损害,听觉事件相关电位P300可以作为反应性抑郁症及抑郁性神经症患者认知功能评定、疗效观察的辅助指标.     

Fatigue, depression and quality of life in cancer patients: how are they related?

In a study concerning a group of cancer patients undergoing radiotherapy three research questions were addressed. (1) Is fatigue a valid criterion for depression in these somatically ill patients? (2) What is the 'cause-and-effect' relation between fatigue and depression? (3) To what extent are fatigue and depression related to patients' quality of life. A heterogeneous sample of cancer patients (n?=?250) were interviewed before treatment, 2 weeks after treatment and 9 months later. Fatigue was measured using the MFI, a self-report instrument covering five dimensions of fatigue. Depression was assessed with the non-somatic items of the CES-D. Quality of life had to be indicated on a Cantrill ladder. Fatigue and depression do not follow the same course over time. Just after radiotherapy, fatigue had either increased or remained stable, depending on the dimension under consideration. Depression, in contrast, decreased. Nine months later fatigue had decreased, whereas levels of depression remained stable. Concurrent relations between fatigue and depression were mostly moderate. There was no strong evidence for a cause-and-effect relationship between depression and fatigue. Depression showed highest concurrent relationships with quality of life, especially before treatment. Prospectively, depression and the dimension of physical fatigue were the main predictors for quality of life. Fatigue is not a valid criterion for depression in these patients. Nor is there a strong cause-and-effect relationship. Both depression and physical fatigue are relevant to patients' quality of life.     

流式细胞术三色绝对计数T淋巴细胞亚群对传染性非典型肺炎早期诊断的意义

目的　探讨传染性非典型肺炎(又称严重急性呼吸综合征,SARS)患者急性期和康复期T淋巴细胞亚群的改变及在早期诊断中的意义。方法　流式细胞术检测40例急性期SARS患者外周血T淋巴细胞亚群(总T细胞、Th细胞、Ts细胞)绝对计数。动态观察了22例SARS康复期患者不同时期T淋巴细胞亚群计数值的变化。结果　与对照组比较急性期SARS患者总T细胞明显减低(P=0 .013),Th细胞及Ts细胞计数值均明显减低(P<0. 001)。康复组与对照组比较以及康复患者治愈出院、出院后3个月、出院后6个月3次T淋巴细胞亚群绝对计数值均无组间差异(P>0 .05)。结论　急性期SARS患者的细胞免疫功能严重受损,早期患者的总T细胞、Th细胞和Ts细胞的绝对计数值均明显减低,可以作为SARS早期诊断的辅助指标。康复期患者总T细胞、Th细胞和Ts细胞的百分率和绝对数值逐渐恢复正常。