老年药源性精神障碍32例临床分析

临床用药致老年患者精神障碍日益受人们重视。本文对我院近１０年临床所遇老年药源性精神障碍３２例进行分析。１临床资料１．１一般资料本组３２例均是住院患者。男１８例,女１４例,年龄６０～８５岁,平均６６２岁。既往均无精神病史及家族史,住院期间病情稳定,无...     

老年人手术后精神障碍临床分析

目的了解老年病人手术后精神障碍的发生率,探讨与之相关的影响因素。方法老年医学科重症监护室收治的208例老年手术患者,分为有精神障碍组和无精神障碍组,比较2组间年龄、基础疾病及术后用药差异。结果老年人术后精神障碍发生率约为12%,与年龄密切相关(P<0·01)。患者的基础疾病脑梗死是精神障碍发生的易发因素(P<0·05),术后奥美拉唑、复合氨基酸的使用与精神障碍的发生有关(P<0·01和P<0·05)。结论老年人术后精神障碍的发生与年龄、基础疾病脑梗死、术后使用奥美拉唑、复合氨基酸有关。     

老年期精神障碍352例临床分析

目的 探讨老年期精神障碍的临床特点及疗效。方法 对符合CCMD－2－R的352例老年期精神障碍患者进行临床及相关因素分析。结果 老年期精神障碍患病率女性高于男性（1．38：1）,阳性家族史在功能性精神障碍中更为显著（P＜0．05）,发病诱因较多（54．5％）,起病以急性和亚急性多见（54．0％）;功能性精神障碍与器质性精神障碍之比为1．59：1,而器质性精神障碍70岁以后明显增多,其中脑血管病所致精神障碍常见（47．1％）,其次为阿尔茨海默病（39．0％）。结论 脑器质性精神障碍患病率随年龄增加而增多,早期治疗疗效较好。     

老年妇女术后精神障碍分析

目的 探讨老年妇女手术后精神障碍的发病原因、机制及防治措施。方法 对869例老年妇女手术病人进行术后连续7d的床边认识评分，并进行评价分析。结果 168例（19．33％）老年女病人发生不同程度的术后精神障碍，精神障碍发生率在术后4d内较高，以后逐渐下降。根据病人临床症状不同，168例老年妇科术后精神障碍病人分为三类临床亚型：焦虑型（49％），安静型（33％），混合型（18％）；死亡人数占发病人数的4．17％。结论 老年妇女术后精神障碍发病率较高，应当重视预防。     

精神障碍为首发症状的老年病毒性脑炎21例临床分析

老年病毒性脑炎临床表现复杂多变,极少有发热等典型脑炎病程,部分病例可因精神行为异常为首发或唯一症状而误诊为痴呆或精神疾病。本文拟通过对我院近年确诊的以精神障碍为首发症状的21例老年病毒性脑炎临床资料进行分析,提高临床医师对本病的认识,达到早期诊断和治疗。1 临床资料 1．1一般资料 2000年1月至2013年4月解放军总医院第一附属医院神经内科和干部病房二科收治的病毒性脑炎患者56例,其中年龄60～87（65．0±3．1）岁21例,男13例,女8例。临床诊断依据[1]：（1）急性或亚急性起病,有感染症状或明确的病前感染史;（2）有不同程度的意识障碍,可随疾病的进展而逐渐加深;（3）精神症状及神经系统体征,临床上有似病毒感染所致脑炎实质受损征象;（4）脑脊液压力及白细胞和蛋白质轻度升高或正常,但查不到细菌（包括结核分枝杆菌等）感染的证据;（5）脑电图有弥漫性异常（有些可局灶化）。     

输血后丙型肝炎的临床分析

输血后丙型肝炎的临床分析王守义，郎永秀我科自１９９１年１月至１９９６年５月共收治丙型肝炎、（丙肝）１３３例，其中输血引起者９９例，占７４．４％，现报道如下。临床资料一般资料本组９９例输血后丙型肝炎患者均为各科手术、外伤及胃、十二指肠溃疡出血等多种疾病...     

心脏手术后老年患者精神障碍原因分析及临床干预

正术后精神障碍通常是指手术前并无任何精神异常的患者在手术后出现大脑功能活动紊乱,而导致不同程度的精神障碍。心脏手术通常具有耗时较长、创伤较大、风险较大的特点,再加上老年患者年龄偏大,体外循环(CPB)破坏了患者正常的生理循环,这些都使得术后精神障碍的发生率居高不下。目前对于此类术后精神障碍的治疗并无定论,本文回顾分析采取心理和药物干预对治疗心脏手术后老年患者精神障碍的效果,为其临床应用提供依据。     

老年性精神障碍的临床特征及相关因素分析

目的对100例80岁以上住院期间发生精神障碍病人的临床相关资料进行分析,以期更好地指导临床实践。方法收集2017～2018年在住院期间发生精神障碍的100例病人(精神障碍组)及未发生精神障碍的100例病人(对照组)的临床病例资料。对比分析2组病人的相关临床资料,并进一步行Logistic回归分析精神障碍的相关影响因素。结果精神障碍组合并痴呆、肺部感染、贫血、低白蛋白血症的比例明显增多,并在住院期间常应用曲马多,与对照组相比,差异有统计学意义(P<0.05)。精神障碍组日常生活能力(ADL)受损的比例及严重程度均高于对照组(P<0.05)。Logistic回归分析显示痴呆(OR=3.218,95%CI:1.469～7.048)、低白蛋白血症(OR=3.125,95%CI:1.548～6.307)与老年性精神障碍的发生有关。结论老年性精神障碍病人多伴有痴呆、肺部感染、贫血、低白蛋白血症,多应用曲马多,ADL受损较严重。其中,痴呆及低白蛋白血症与老年性精神障碍的发生有关。     

丙泊酚治疗老年急性术后精神障碍临床观察

将32例急性术后精神障碍(POP)的老年患者(年龄69~84岁,A SAⅡ~Ⅲ级)随机分为观察组和对照组各16例。观察组用注射泵持续静脉注射丙泊酚0.4m g/(kg.h),对照组注射咪唑安定0.05 m g/(kg.h),治疗时间均为12h。比较两组R am say镇静评分、治疗有效率、药物起效时间和停药后清醒时间,监测呼吸、循环相关参数,随访肝肾功能。结果观察组达到5分镇静程度者(14例)明显多于对照组(6例),P<0.01,精神状态改善率(94%)明显高于对照组(63%),平均起效时间和平均清醒时间明显短于对照组(P<0.01);两组用药后HR、Bp、SpO2、RR比用药前均明显下降(P<0.05),心电图及其他监测指标无异常。证实丙泊酚可用于治疗老年急性POP,其特点为提高睡眠质量,改善精神症状,副作用小。     

老年人输血后HCV感染状况的调查

老年人各器官功能减退,免疫功能低下,易发生感染,为探讨老年人输血(浆)后丙型肝炎病毒感染状况,采用EIA法检测有输血史半月以上的老年人30例,现报告如下。资料与方法: 一、病例选择 30例为本院内外科1990年至1992年4月住院,曾有输血(浆)半月以上的老年人及本科现症老年病人。既往均无肝炎病史,年龄60～74岁,平均66岁,另选10例正常健康人为对照组。根据采血时是否已发生输血后肝炎,分成发病、未发病2组。     

酒精所致精神障碍72例临床分析

目的探讨酒精所致精神障碍的临床特征。方法对2009年9月到2012年2月在我院治疗的72例酒精所致精神障碍患者的临床资料进行回顾性分析。结果酒精所致精神障碍患者分布具有典型的特征:多为男性、文化程度较低、多数从事体力劳动;患者社会功能明显受损,幻视、幻听、妄想、行为紊乱是其最主要的症状,可能伴有抑郁情绪;对患者采取综合治疗可促进其转归。结论酒精所致精神障碍对人体损害很大,应早期戒酒对症治疗。     

血小板输注效果的临床分析

目的:观察血小板的输注疗效,探讨血小板抗体以及年龄因素对临床血小板输注所产生的影响。方法:搜集2013-04-2013-10进行机采血小板输注的92例患者的血清或血浆标本及临床资料,采用固相凝集法对血小板抗体进行筛查,计算血小板回收率和血小板计数增高指数评价血小板输注效果,分析血小板输注无效的影响因素。结果:92例患者血小板输注无效率为44.56%,血小板抗体阳性率为27.17%;血小板抗体阳性组的输注无效率为68%,明显高于抗体阴性组的输注无效率35.82%,两者比较差异有统计学意义(P0.05);以年龄段分组的4组患者输注无效率分别为16.67%、45.45%、48.39%、80.00%,比较差异有统计学意义(P0.05);4组患者抗体阳性率分别为29.17%、27.27%、21.88%、35.71%,比较差异无统计学意义(P0.05)。结论:血小板抗体可引起血小板输注无效;血小板输注无效率随年龄的增高而增加;暂无法确定年龄因素对血小板抗体阳性的影响。     

Recent care of common mental disorders in the united states

OBJECTIVE: To relate the presence of recent mental disorders to use of mental health services. DESIGN: Cross-sectional survey. STUDY POPULATION: The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage. CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.     

Brief screens for mental disorders in primary care

We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [κ] 0.63), drug dependence (SE 0.50; PPV 0.50; κ 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; κ 0.44), major depressive disorder (SE 0.71; PPV 0.52; κ 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; κ 0.21), and panic disorder (SE 0.71; PPV 0.43; κ 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care. This work was supported by a grant from the Upjohn Company, Kalamazoo, Mich. Gerald L. Klerman, MD, was the initial principal investigator on the SDDS-PC project until his death in 1992. W. Eugene Broadhead, MD, PhD, was principal investigator from 1992 to 1995. Roger Kathol, MD, is currently the principal investigator. The Upjohn Company, Kalamazoo, Mich., sponsored and supported the development of the SDDS-PC through its Pharmacosurveillance Unit, Mr. James A. Coleman, Director, and Andreas Pleil, PhD, Senior Health Economist. Drs. Leon, Olfson, Weissman, Blacklow, Broadhead, and Hoven have served as consultants to Upjohn. Allen Frances, MD (Duke University), and Michael Leibowitz, MD (Columbia University), provided advice, Carrie Miller, PhD, was project manager at Kaiser Permanente. Lena Verdeli, MA, MSc, trained the nurses and assisted in the coordinating of the QAP. Laura Portera assisted in data analysis, and Joy Pelayo assisted in data management. The participating physicians and nurses and the Scientific Advisory Committee members who met with investigators and provided input into the project are listed below. Scientific Advisory Committee: Macaran Baird, MD, SUNY Health Science Center; Dave Baron, DO, American Osteopathic Association; Susan Blumenthal, MD, Assistant Surgeon General; Jorge A. Costa e Silva, World Health Organization; Leah Dickstein, MD, University of Louisville School of Medicine; Mary Jane England, MD, Washington Business Group on Health; Shervert H, Frazier, MD, McLean Hospital; Roman H, Hendrickson, MD, American Academy of Family Physicians; Norman B. Kahn, MD, American Academy of Family Physicians; Kathryn Magruder, PhD, National Institute of Health; Harold A. Pincus, MD, American Psychiatric Association; Darrell A. Regier, MD, MPH, National Institute of Mental Health; Rene Rodriguez, MD, National Confederation of Hispanic American Medical Association; Richard Rupper, MD, American Society of Internal Medicine; Norman Sartorius, MD, World Health Organization; Richard Steinhilber, MD, Cleveland Clinic Foundation; William Van Stone, MD, Department of Veteran Affairs; Elinor Walker, Agency for Health Care Policy and Research; and Paul Young, MD, American Board of Family Practice. Their presence on the Advisory Council in no way signifies an endorsement by these individuals or organizations. SDDS-PC is a registered trademark of the Upjohn Company.     

临床输血申请单质量分析

目的：分析近8个月内输血申请单质量缺陷的种类以及比例,探讨输血申请单质量缺陷的发生因素以及提高方案。方法：分析统计近8个月内输血申请单中3大类,共20个小类质量缺陷。结果：经整理统计分析：输血同意书未填、配备血用途填写混淆、缺少输血前4项占输血申请单前3位。相对于其他17类质量缺陷差异有统计学意义。但是输血申请单整体信息中20小类质量缺陷仍需要同等重视。结论：有效提高输血申请单填写质量,规范临床用血行为,增强医护人员责任心和自我保护意识,才能够真正提高临床用血安全,避免因输血产生的医疗纠纷。     

Survival after transfusion in the Netherlands

Background Cost‐effectiveness analyses of blood safety interventions require estimates of the life expectancy after blood product transfusion. These are best derived from survival after blood transfusion, per age group and blood component type. Study design and methods In the PROTON (PROfiles of TransfusiON recipients) study transfusion recipient data was collected from a hospital sample covering 28% of the total blood use between 1996 and 2006 in the Netherlands. The dataset includes date of transfusion, blood component type transfused and recipient identification details. PROTON data were individually matched to mortality data of the Netherlands. Survival after first transfusion and after any transfusion was calculated, per blood component type and age group. PROTON mortality rates were compared to mortality rates in the general population. The results were used to estimate survival beyond the study period and to estimate life expectancy after transfusion. Results Of all 2 405 012 blood product transfusions in the PROTON dataset, 92% was matched to the national Dutch Municipal Population Register, which registers all deaths. After 1 year, survival after any transfusion was 65·4%, 70·4% and 53·9% for RBC, FFP and PLT respectively. After 5 years, this was 46·6%, 58·8% and 39·3% for RBC, FFP and PLT, respectively. Ten years after transfusion, mortality rates of recipients are still elevated in comparison with the general population. Conclusion Mortality rates of transfusion recipients are higher than those of the general population, but the increase diminishes over time. The mortality rates found for the Netherlands are lower than those found in comparable studies for other countries.     

临床输血病历缺陷分析与防范对策

<正>输血病历是临床输血治疗疾病、抢救患者实施输血的原始记录,是输血过程的法律依据。在输血医疗中由于病历书写质量缺陷导致医疗纠纷屡见不鲜[1],输血病历记录不及时、不准确、不真实及医护记录不一致等将会埋下医疗纠纷隐患。随着人们法律意识的普遍增强,因输血引起的医疗纠纷时有耳闻[2],因此医务人员不仅要有好的医疗技术,更要有强烈的法律意识,只有依