关于少年儿童拔牙患者畏惧程度的问卷调查和分析

目的 调查分析12～18岁少年儿童患者对拔牙术各．方面、各环节的畏惧程度,为心理治疗提供帮助。方法 采用问卷调查方式,设计15个问题,原则上由患者独立填写完成,对每个问题按评方标准计分,以例数、百分率或得分均值进行比较或排列顺序。结果 重度畏惧中女性明显高于男性（P〈0．05）。12～14岁（青春前期）和15～18岁（青春期）两年龄组中,重度畏惧者无明显差别。检查时触击或叩击到患牙剧痛,局部麻醉注射,用牙钳运动患牙脱位拔出,是畏惧程度最重要的3个环节,排序分别为第7、第6、第5位。重度畏惧受亲友、周围人群和自身痛苦拔牙经历的影响较大。结论 患者对拔牙术各方面、各环节畏惧程度不同,应对拔牙料方面,特别是对听过、看过或有痛苦拔牙经历者及上述畏惧程度最重要的3个环节,做好心理疏导工作,才能取得良好疗效。     

不同测量方法评估位点保存术后牙槽嵴高度变化

目的 采用锥形束CT（CBCT）结合3D打印数字导板、直接观测、平行投照根尖片测量三种方法评估拔牙后位点保存6个月后牙槽骨高度的变化,比较各方法的测量效果。方法 选择我院2015年7月~2017年5月收治的20例患者,共20颗需拔除的患牙,微创拔除患牙后即刻行位点保存术。术中行临床直接测量记录牙槽骨高度,术后即刻及6个月拍摄根尖片并佩戴数字导板行CBCT检查,种植术中翻瓣再次测量牙槽骨高度,比较三种方法检测牙槽嵴高度的变化。结果 术后6个月颊侧中点牙槽嵴及近、远邻面牙槽嵴高度均有降低,非磨牙区分别为（0.85±1.56）mm、（0.15±0.44）mm、（0.16±0.53）mm,磨牙区分别为（0.82±1.20）mm、（0.14±0.25）mm、（0.15±0.89）mm。直接探查与CBCT结合3D打印数字导板测量的牙槽嵴高度结果比较,差异无统计学意义( P＞0.05) ;平行投照根尖片检测结果与另外两种方法比较,差异有统计学意义（P＜0.05）。结论 直接测量与CBCT结合3D打印数字导板对牙槽骨高度变化的评估基本一致,3D打印数字导板结合CBCT检测具有无创、精准且可重复的特点,可用于临床其他环境下的牙槽骨各水平变化的评估中。     

重度神经损害的特发性面瘫42例临床与神经电生理分析

目的：分析重度神经损害的特发性面瘫患者的临床、神经电生理及其对预后的评价。方法：回顾性分析42例重度神经损害的特发性面瘫患者的临床资料,使用肌电图诱发电位仪对这些患者在发病重度神经损害的第1个月、3个月及6个月时分别进行肌电图与神经传导检查,并结合相应的临床疗效进行分析。结果：42例重度神经损害的特发性面瘫患者治疗前后临床神经功能的恢复无明显改善（P〉O．05）;患侧面神经复合肌动作电位潜伏期均延长,运动传导速度均明显减慢,所引出的M波波幅均低于正常的70％,患侧面神经所支配的肌肉均可见失神经电位,以上4个参数结果在治疗到第1个月、3个月、6个月时与正常值比较差异均有显著意义（P〈0．01）,不同治疗时间后比较无显著改变（P〉0．05）。结论：重度神经损害的特发性面瘫患者经内科综合治疗无明显效果;神经传导与肌电图可以给重度神经损害的特发性面瘫患者的预后评估提供客观的依据,且内科综合治疗到第6个月后面神经功能在Ⅴ、Ⅵ级者,是否采取手术治疗以及手术治疗的时机选择与预后需作进一步探讨。     

急性炎症期拔牙279例

2004～2009年,笔者通过对口腔门诊首诊279例急性炎症期病源（灶）牙拔除患者的观察,认为急性期拔牙可以及时解除患者痛苦,缓解症状,减少并发症,适合基层医院开展口腔疾病治疗。     

矿化胶原与镁钙合金的复合材料用于犬拔牙位点保存的实验研究

目的　研究矿化胶原复合镁钙合金用于犬拔牙位点保存的可行性。 方法　拔除8只杂种犬下颌双侧第4前磨牙,共32个拔牙窝（近中和远中牙槽窝各16个）,随机分为A、B两组。A组植入矿化胶原复合镁钙合金材料,B组仅植入矿化胶原材料,于术后12,24周处死实验犬,制备组织标本,通过大体观察、CBCT、肝肾组织学切片观察以及X射线显微镜检测评价拔牙窝愈合情况及肝肾组织的损伤情况。 结果　两组材料在拔牙窝愈合过程中,逐渐被降解吸收,新生骨组织不断形成。术后12周,实验A组的相对骨密度值以及新生骨组织数量均多于B组,差异有统计学意义（P＜0.05）。术后24周,A、B两组的新生骨组织数量逐渐增多,两组相对骨密度值差异不显著（P＞0.05）。 结论　矿化胶原与镁钙合金的复合材料可用于犬拔牙位点的保存,可促进新骨再生,减缓牙槽嵴的吸收。     

牙科临床畏惧调查表的初步编制

目的：编制适合于我国牙科临床的牙科临床畏惧调查表（CVDHFS）。方法：以Cynthia C等人的研究为基础，根据拔牙临床情况编制出新问卷，在223名被试中测试该问卷并检验其信效度，30名被试参加测试检验其效标效度。结果：问卷包含一般性焦虑、特定性畏惧、不信任、灾祸感等四个分量表，共22个条目。各分量表内部条目间的相关均达到显著性水平（r=0．13—0．78，P〈0．01）；各分量表分之间以及分量表分与全量表总分的相关系数r=0．53—0．85（P〈0．01），整个问卷α系数为0．91；主成分分析抽取的4个成分基本验证了理论构思，条目Gl—G5、S7、C5在一般性焦虑成分上因素负荷0．58—0．82，条目S1—S6在特定性畏惧成分上因素负荷0．52～0．79，条目D1—D5在不信任成分上因素负荷0．66—0．80，条目C1—C4在灾祸感成分上因素负荷0．51～0．87，4个成分能解释72．40％总变异；全量表总分与状态一特质焦虑问卷的状态焦虑得分相关系数为0．62（P〈0．01）。结论：牙科临床畏惧调查表有较好的信效度，可以作为评估牙科患者焦虑畏惧的测评工具。     

半导体激光照射预防下颌阻生第三磨牙拔除术后肿痛的自身对照研究

目的探讨半导体激光预防下颌阻生第三磨牙拔除术后肿胀和疼痛的效果。方法选择需拔除双侧下颌阻生第三磨牙的患者20例,其中男性9例,女性11例;年龄17~42岁,平均年龄27.55岁。随机将一侧设为试验组,另一侧为对照组。试验组采用左布比卡因行下牙槽神经、舌神经及颊长神经麻醉,切开翻瓣,采用涡轮钻去骨劈冠,用微创牙挺分块拔除患牙,缝合伤口,术后口服阿莫西林,并用激光口腔治疗仪照射口内拔牙创口及拔牙创口对应颊部各5min,每天1次,连续5d,术后7d拆线。对照组除不用激光照射治疗外,其他治疗措施同试验组。观察术后肿胀和疼痛情况。结果术后第1、2、3、5天肿胀程度和第1、2、3天疼痛程度两组间差异有统计学意义(P0.05)。术后第7天的肿胀程度和第5、7天疼痛程度两组间差异无统计学意义(P0.05)。结论半导体激光照射治疗能减轻下颌阻生第三磨牙拔除术后肿胀、疼痛。     

磁共振全脑容积动脉自旋标记成像评价单侧颈动脉狭窄患者脑血流动力学的初步研究

目的探讨磁共振全脑容积灌注3D动脉自旋标记（3DASL）成像在单侧颈动脉狭窄或闭塞中的应用价值。方法对连续36例单侧颈动脉狭窄患者（经数字减影血管造影（DSA）验证）行颈部磁共振血管成像（MRA）与头部MR3DASL检查。检验颈部MRA与DSA在狭窄程度上诊断的一致性。以DSA诊断的狭窄程度为标准,将36例患者分成轻、中、重3组,对3DASL所测得的患侧,健侧脑血流量（CBF）比率进行方差分析。以临床症状为标准,将重度狭窄的患者分为有症状组和无症状组,分析2组患侧,踺侧CBF比率的统计学意义。结果颈部MRA与DSA在动脉血管狭窄程度上的诊断,经Kappa行一致性检验,有很强的一致性（Kappa〉0．75,P〈0．05）。轻、中度狭窄组间患侧楗侧CBF比率差别无统计学意义（P〉O．05）;重度狭窄组与轻、中度狭窄组患侧健侧CBF比率差别均有统计学意义（P〈0．01）。重度狭窄患者的有症状组与无症状组患侧,睦侧CBF比率差别有统计学意义（P〈0．01）。结论3DASL技术作为一种安全、无创和可重复的检查方式,配合颈部MRA,对评价单侧颈动脉狭窄患者脑血流动力学状况在临床诊治方面有重要意义。     

脂肪肝供肝对肝移植术后早期肝功能的影响

目的 探讨脂肪肝供肝对肝移植术后早期肝功能的影响,评估脂肪肝供肝肝移植术的临床疗效和安全性。方法 回顾性分析2007年1月—2012年3月在南京军区福州总医院行经典原位肝移植的26例肝细胞肝癌患者的临床资料。根据供肝（均为尸肝）病理检查结果,按其脂肪变性程度将26例患者分成3组：无脂肪变性组（正常组）10例,轻度脂肪变性组（轻度组）10例,中度脂肪变性组（中度组）6例。观察比较各组分别于术后第1、3、5、7、14天肝功能指标恢复情况。结果 3组患者手术均顺利完成,术中无意外情况发生,术后各组无一例移植物原发性无功能。与正常组相比,轻度组术后第1、3、5、7、14天的ALT、AST、凝血酶原时间（PT）、总胆红素（TBIL）差异均无统计学意义（P值均〉0．05）;中度组术后第1、3、5天ALT、AST、PT均明显高于正常组和轻度组（P值均〈0．05）,而TBIL术后第1、3、5、7、14天与正常组及轻度组相比,差异均无统计学意义（P值均〉0．05）。26例患者术后随访20～75个月,平均（38．6±18．2）个月。正常组、轻度组及中度组术后1年生存例数分别为8例、9例、5例,差异均无统计学意义（He=0．379,P=0．828）。结论 轻度脂肪肝供肝对术后早期肝功能无明显不利影响,可安全应用于临床肝移植;中度脂肪肝供肝肝移植术后早期肝功能恢复较无脂肪变性者和轻度脂肪变性者慢,临床上可以用于一般状况较好的患者。     

根管治疗期间急症的发生程度与相关因素分析

目的分析根管治疗期间急症（EIAE）发生率、急性发作指数（FUI）及相关因素。方法按纳入标准选取204例在湖南旺旺医院口腔科就诊需行根管治疗的患牙,随机分成两组,A组101例患牙采用双敞法制备根管;B组103例患牙采用根向深入法制备根管。记录相关数据,如患者年龄、性别、牙位、患牙治疗前状况（包括牙髓及根尖周状况、治疗前疼痛、窦道）及根管器械制备后1周内出现的症状。结果 204例患牙EIAE的发生率为13.24%（27/204）,FUI值为3.51±1.36。双敞法组EIAE的发生率（21.78%）明显高于根向深入法组（4.85%）,二者差异有统计学意义（P〈0.01）。双敞法组FUI值（5.53±1.09）明显高于根向深入法组（1.79±0.76）（P〈0.01）。根尖X线透射阴影阳性患者EIAE的发生率和FUI值明显高于根尖X线正常者（P〈0.05）;治疗前有疼痛和无窦道患者EIAE的发生率和FUI值明显高于无症状者（P〈0.05）;EIAE的发生率与患者的年龄、性别和牙位无显著相关性（P〉0.05）。结论根向深入法制备根管能显著降低EIAE的发生率及急性发作程度,根尖X线透射阴影阳性、治疗前疼痛和根尖无窦道的患牙能增加EIAE的发生率及急性发作程度。     

Blushing propensity and psychological distress in people with rosacea

Rosacea is a chronic skin disorder, characterized by persistent painful facial flushing and often accompanied by papules and pustules. To evaluate the psychological and social impacts of rosacea, 31 individuals with rosacea filled in the Blushing Propensity Scale, the Fear of Negative Evaluation Questionnaire, the Depression Anxiety and Stress Scale, the Social Interaction Anxiety Scale and the Social Phobia Scale. The questionnaires were also completed by 86 controls. Participants with extensive facial papules and pustules had higher blushing propensity, stress and social phobia scores than controls or others without papules or pustules. Childhood blushing was also reported more frequently by participants with rosacea than controls. Cognitive-behavioural therapy appeared to be helpful for managing social anxiety in three individuals with rosacea with a fear of blushing. These findings suggest that people with severe rosacea are anxious about the social consequences of blushing and generally prefer to avoid situations that might involve scrutiny by others. Persistent facial flushing could prime interoceptive cues of blushing or increase anxiety about facial coloration in provocative situations. Treatments that target fear of blushing may help to reduce social anxiety in people with severe rosacea. Copyright ? 2011 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Blushing propensity scores are elevated in people with severe rosacea. Fear of blushing may contribute to social anxiety and avoidance in such cases. Cognitive-behavioural therapy for fear of blushing may help to reduce social anxiety in people with severe rosacea.     

化疗患者PICC置管前后心理体验的质性研究

目的 探讨化疗患者PICC置管前后的心理体验,为PICC健康教育工作的开展提供参考依据。方法 采用深入访谈的方法收集11例PICC置管患者的心理体验资料,采用现象学方法进行分析、归纳、整理。结果 提炼出PICC置管前4个方面的主题:对置管感到恐惧、携带管路生活不方便、不信任医护人员、管路维护便利性不足;置管后3个方面的主题: 坦然接受PICC导管、努力学习PICC相关知识、管路维护不及时。结论 化疗患者对PICC导管的认识及维护相关知识欠缺,护理人员应耐心倾听患者的心声,加强宣教力度,全方位、多角度进行健康教育,保证化疗患者PICC导管的顺利使用。     

Reactions to pain among subjects high and low in dental fear

Differential pain tolerance might account for the diversity of reactions commonly seen in response to stressful medical and dental procedures. College students reporting themselves either highly fearful or nonfearful of dental work were compared in several aspects of their reactions to dental and nondental pain. The two groups did not differ in pain threshold or pain tolerance assessed during tooth pulp stimulation or during electrical stimulation of the forearm. High-dental fear subjects, however, retrospectively rated tooth shock (but not arm shock) more painful than low-fear subjects. High-fear subjects also showed significantly greater affective reactions assessed via the Anxiety Differential during both tolerance tests, with the group differences greater in magnitude during tooth shock than arm shock.This research was supported by USPHS Grant DE-04976 from the National Institute of Dental Research awarded to the first author.     

中青年淋巴瘤患者的心理痛苦及相关因素

目的:了解中青年淋巴瘤患者的心理痛苦现状及其相关因素。方法:选取住院中青年淋巴瘤患者145例,采用心理痛苦温度计(DT)、疾病认知问卷简版(BIPQ)和恐惧疾病进展简化量表(FoP-Q-SF)评估患者的心理痛苦程度、负性疾病认知程度和恐惧疾病进展水平。DT≥4分为显著心理痛苦(4~6分为中度心理痛苦、7~10分为重度心理痛苦)。结果:中青年淋巴瘤患者的显著心理痛苦检出率为81.4%,中度检出率为42.8%,重度检出率为38.6%。多重线性回归分析结果显示,BIPQ和FoP-Q-SF得分与心理痛苦得分正向关联(β=0.27、0.28,均P<0.05),已婚、家庭月收入较高的患者其心理痛苦程度较低(β=0.25、-0.16,均P<0.05)。结论:中青年淋巴瘤患者的显著心理痛苦检出率高,婚姻状况、家庭月收入、疾病认知和恐惧疾病进展是心理痛苦的重要相关因素。     

Views of patients and physicians regarding the importance of various aspects of arthritis treatment. Correlations with health status and patient satisfaction

This study examines whether the health status of patients with rheumatoid arthritis, and their satisfaction with their treatment, were more strongly associated with patient-physician agreement about the importance of various aspects of the treatment program, or with the extent to which patients' concerns about their care were reduced during a clinic visit.Questionnaire responses from 82 rheumatologist-patient dyads showed that patients whose concerns were reduced tended to be satisfied with the visit, and to exhibit good overall health status and low levels of psychological distress. In contrast, patient-physician agreement was not associated with general or psychological health status, and was negatively associated with patient satisfaction.Although this cross-sectional analysis does not prove causality, the results are consistent with the premise that reducing the concerns of patients has a beneficial impact on clinical outcomes. Mere concordance between the patient and physician regarding the importance of various aspects of the treatment program, however, may not produce these beneficial effects.     

Administration of nasal nafarelin as compared with oral danazol for endometriosis. A multicenter double-blind comparative clinical trial

Treatment with nafarelin, a gonadotropin-releasing hormone agonist, reversibly inhibits ovarian function and induces hypoestrogenemia. To determine the efficacy of such hormonal manipulation in the treatment of endometriosis, we randomly assigned 213 patients with laparoscopically confirmed endometriosis to receive, for six months, either nafarelin by nasal spray (400 or 800 micrograms per day) or oral danazol (800 mg per day). Placebo nasal spray and placebo tablets were used to double blind the study. Pretreatment and post-treatment laparoscopies were compared by means of the American Fertility Society's scoring system. More than 80 percent of the patients in each treatment group had a reduction in the extent of disease as assessed by laparoscopy. The mean laparoscopic scores decreased from 21.9 to 12.6 with 800 micrograms of nafarelin, from 20.4 to 11.7 with 400 micrograms of nafarelin, and from 18.4 to 10.5 with danazol (P = 0.0001 within each group; there were no statistically significant differences between the groups). The percentage of women with severely painful symptoms of endometriosis decreased from about 40 percent to 5 to 10 percent, whereas the percentage with no or minimal discomfort rose from 25 to 70 percent. Of the 149 patients who tried to become pregnant, 58 (39 percent) succeeded after the completion of treatment; similar rates of pregnancy applied to the three treatment groups. Danazol use decreased high-density lipoprotein levels and increased low-density lipoprotein levels. These changes were not observed in nafarelin users, but a higher percentage of them reported hot flashes and decreased libido. We conclude that nafarelin is an effective agent for treating endometriosis and has few side effects other than hypoestrogenism.     

Physical and psychological correlates of severe heart disease in men

Seventy eight men were assessed one month before coronary artery bypass graft surgery using standardized measures of psychiatric morbidity and personality as well as a measure of emotional expression (the CECS). All patients had at least one coronary vessel occluded by 75% or more of its diameter, and functional capacity was assessed by calculating the exercise treadmill time (in seconds) for each patient. Most of the variance in exercise treadmill time was accounted for by the following variables: young age, short duration of symptoms, and less severe angina. Only one of five men was designated a psychiatric 'case'. The only psychological measure significantly associated with atherosclerosis was expression of fear (on the CECS). A measure of Type A behaviour (Bortner score) was related to exercise treadmill time, but not to any of the angiographic or clinical indices of coronary heart disease (CHD). Like other measures of Type A behaviour, the Bortner scale is psychometrically impure and has doubtful validity. More valid behavioural variables (such as those measured by the CECS) require further investigation. Future studies on the relation between psychological factors and the extent of CHD should take account of not only sex differences but also patients without significant CHD: high rates of psychiatric morbidity in such patients confound the relation between psychological trait measures and atherosclerosis.     

The Application of Xenograft Materials in Patients with Minimally Invasive Tooth Extraction and Implant Restoration

Objective: The application effect of xenograft materials in patients with implant restoration after minimally invasive tooth extraction is explored. Methods: From February 2016 to December 2019, 80 patients with minimally invasive dental implants were treated in our hospital and selected as the research object. They were divided into the observation group and the control group based on to the random number table methods, and 40 patients in each group. The patients in the control group were sutured directly after minimally invasive tooth extraction. After the minimally invasive tooth extraction in the observation group, Bio-Oss Collagen was implanted into the alveolar fossa, which was covered with Bio-Gide absorbable biofilm. Changes in the height of the mastoid, the width and height of the crest crest, and the width of the lip between the two groups of patients immediately and 6 months after the tooth extraction were compared.Results: Changes of the alveolar ridge height and width in the observation group were less than those in the control group, and the difference was statistically significant(t=5.816, 3.997,and P=0.000); the width of lip and tongue and the height of the interdental mastoid in the observation group. The amount of change was less than that in the control group, and the difference was statistically significant(t=7.384, 10.686,and P=0.000). Conclusion: Bio-Oss Collagen and Bio-Gide absorbable biofilms have significant clinical effects on patients with minimally invasive tooth extraction and implant restoration, helping to maintain the stability of the alveolar ridge height and width, which is conducive to the creation of later dental implants in good conditions.     

音乐疗法在严重烧伤患者整体治疗中应用的研究进展

严重烧伤患者特殊的病情,使得患者一般都有不同程度的焦虑、忧郁、恐惧等心理障碍,这些心理上的问题会影响患者的治疗效果,影响患者的各项生理指标,生理上的改变反过来加重患者的不良情绪,对患者的治疗极为不利。严重烧伤患者不仅需要良好生理治疗方案,同时也需心理方面治疗的支持。临床心理治疗的常用方法较多,大部分都需要治疗者和患者有较多的交流或者进行适当的按摩抚触,但烧伤患者大多处于制动状态,难以和治疗者进行有效交流,更难采取按摩抚触措施对患者进行放松疏解。音乐疗法只需要患者具备一定的听力能力即可实施,是很适合烧伤患者的一种心理治疗方法。近年来,音乐疗法在烧伤患者整体治疗中有了一定的进展,取得一定的临床效果,本文对近年来音乐疗法在严重烧伤患者整体治疗中的应用进行整理综述,为临床严重烧伤患者的心理治疗提供参考,为进一步研究音乐疗法在严重烧伤患者整体治疗中的效能提供思路。