维持性血液透析患者认知功能障碍及相关危险因素分析

目的 探讨维持性血液透析(MHD)患者认知功能障碍情况及相关危险因素。方法 76例MHD患者根据蒙特利尔认知评估量表(MoCA)评分结果分为认知功能障碍组及非认知功能障碍组,分析其相关危险因素。结果 76例MHD患者中47例MoCA得分<26分,认知功能障碍发生率为61.84%;2组患者在性别、年龄、受教育年限、Kt/v、糖尿病及脑卒中病史方面存在显著差异(P<0.05);多重逐步回归分析显示,年龄大、教育年限低及脑卒中病史为MHD患者发生认知功能障碍的独立危险因素(P<0.05)。结论 认知功能障碍在维持性血液透析患者中普遍存在,年龄大、教育年限低及脑卒中病史是患者发生认知功能障碍的独立危险因素。     

保定市5个社区857例2型糖尿病合并认知功能障碍患者的相关危险因素分析

目的:分析患有2型糖尿病社区居民合并认知功能障碍的相关危险因素。方法:于2002-06/2004-07选择保定市5个生活小区的2型糖尿病患者为调查对象。以简易智能精神状态量表对每位受检者的智能精神状态进行测验,每位患者分别由2名医师评分,取均数作为最后量表评分。采集患者的性别、年龄、文化程度、职业、身高、体质量、家族史、发病年龄、病程、空腹血糖、餐后2h血糖、糖化血红蛋白及降糖药物、低血糖及糖尿病酮症酸中毒发生情况、糖尿病并发症等资料。以各项调查指标为自变量,简易智能精神状态量表评分为因变量的进行多元逐步回归分析,简易智能精神状态量表包括定向力、识记、注意和计算、回忆、语言5个方面的检查,满分为30分,分数≤26为认知功能障碍。按评分结果将患者分为认知功能障碍组(≤26分)和认知功能正常组(27～30分)。结果:所有患者均获得全部资料并进入结果分析。①简易智能精神状态量表评分30分115例,27～29分539例,≤26分203例,即认知功能障碍组203例,认知功能正常组654例。②认知功能障碍组病程、体质量质数、-5收缩压、胆固醇、三酰甘油、糖化血红蛋白、空腹血糖高于认知功能正常组(P<0.05),年龄、舒张压、餐后2h血糖显著高于认知功能正常组(P<0.01)。③以各项调查指标为自变量,简易智能精神状态量表评分为因变量进行多元逐步回归分析,2型糖尿病认知功能障碍相关危险因素依次为年龄(标准偏回归系数0.3128)、餐后2h血糖(0.3096)、舒张压(0.3026)、空腹血糖(0.2904)、病程(0.2672)、体质量指数(0.2308)、胆固醇(0.2006)等。结论:年龄老化、高血压、餐后高血糖是2型糖尿病并发认知障碍的主要危险因素,另外,超重、血脂异常、病程等也是发病的相关因素。     

保定市5个社区857例2型糖尿病合并认知功能障碍患者的相关危险因素分析

目的：分析患有2型糖尿病社区居民合并认知功能障碍的相关危险因素。方法：于2002—06／2004—07选择保定市5个生活小区的2型糖尿病患者为调查对象。以简易智能精神状态量表对每位受检者的智能精神状态进行测验，每位患者分别由2名医师评分，取均数作为最后量表评分。采集患者的性别、年龄、文化程度、职业、身高、体质量、家族史、发病年龄、病程、空腹血糖、餐后2h血糖、糖化血红蛋白及降糖药物、低血糖及糖尿病酮症酸中毒发生情况、糖尿病并发症等资料。以各项调查指标为自变量，简易智能精神状态量表评分为因变量的进行多元逐步回归分析，简易智能精神状态量表包括定向力、识记、注意和计算、回忆、语言5个方面的检查，满分为30分，分数≤26为认知功能障碍。按评分结果将患者分为认知功能障碍组（≤26分）和认知功能正常组（27～30分）。结果：所有患者均获得全部资料并进入结果分析。①简易智能精神状态量表评分30分115例，27—29分539例，≤26分203例，即认知功能障碍组203例，认知功能正常组654例。②认知功能障碍组病程、体质量质数、-5收缩压、胆固醇、三酰甘油、糖化血红蛋白、空腹血糖高于认知功能正常组（P〈0．05），年龄、舒张压、餐后2h血糖显著高于认知功能正常组（P〈0．01）。③以各项调查指标为自变量，简易智能精神状态量表评分为因变量进行多元逐步回归分析，2型糖尿病认知功能障碍相关危险因素依次为年龄（标准偏回归系数0.3128）、餐后2h血糖（0．3096）、舒张压（0．3026）、空腹血糖（0．2904）、病程（0．2672）、体质量指数（0．2308）、胆固醇（0．2006）等。结论：年龄老化、高血压、餐后高血糖是2型糖尿病并发认知障碍的主要危险因素，另外，超重、血脂异常、病程等也是发病的相关因素。     

终末期肾病患者维持性血液透析前后认知功能状况及危险因素分析

目的调查终末期肾病患者在维持性血液透析前后认知功能变化情况及其可能的危险因素。方法收集42例患者病历资料和血液透析前实验室检查结果,采用中文版蒙特利尔认知评估量表对患者进行血液透析前后认知水平评估,对血液透析前后评估数据进行分析,并对认知功能降低的单因素进行分析。结果血液透析前后患者蒙特利尔认知评估量表评分分别为(26.3±2.7)分、(25.1±2.6)分,差异有统计学意义(P0.01);随透析时长延长蒙特利尔认知评估量表评分降低程度增加。单因素分析:高血压、糖尿病、低血红蛋白、血脂异常及透析时长为认知功能降低危险因素(P0.05)。结论终末期肾病维持性血液透析患者普遍存在认知功能降低,高血压、糖尿病、低血红蛋白、血脂异常及透析时长是血液透析后认知功能降低的可能危险因素。     

慢性血液透析患者Kt/V标准差(σKt/V)与血清白蛋白浓度的关系探讨

目的血清白蛋白浓度是评价慢性肾功能衰竭患者营养状况的重要指标,了解慢性维持性血液透析患者Kt/V标准差(σKt/V)与血清白蛋白浓度关系,对分析σKt/V在慢性血液透析质量评估中的作用有重要意义.方法本研究选择慢性维持性血液透析患者74例,随机选择5次透析,测定其血液透析前血清白蛋白浓度及透析前、后血尿素氮值,计算每位透析患者σKt/V,观察其与血清白蛋白浓度的相关关系. 结果血液透析患者σKt/V与血清白蛋白浓度呈负相关. 结论血液透析患者血清白蛋白浓度是评估其基本状况及血液透析治疗效果的重要指标之一.慢性血液透析患者σKt/V范围是反映血液透析患者血液透析治疗质量的重要参数.本研究中血液透析患者σKt/V与血清白蛋白浓度呈负相关的现象进一步表明σKt/V可作为透析患者临床基本状况分析的一项重要指标.     

162例房颤患者口服华法林依从性现状及影响因素分析

目的 探讨房颤患者口服华法林的依从性现状及其影响因素.方法 采用一般情况调查表、Morisky服药依从性量表、简易疾病认知问卷,对162例房颤患者进行问卷调查,采用多元逐步回归分析其影响因素.结果 Morisky服药依从性总分为(6.25±1.36)分,处于中等水平.多元逐步回归结果显示,年龄、文化程度、治疗康复程度是口服华法林依从性的主要影响因素(均P<0.05).结论 房颤患者口服华法林的依从性处于中等水平,应结合患者特点给予个性化的健康教育,尤其要关注年龄大、文化程度低的患者,加强健康教育和随访,提高其对华法林治疗的认知,从而提高其服药依从性.     

认知功能障碍患者的自知力损害研究

目的:探讨认知功能障碍患者的自知力损害的情况及其影响因素.方法:认知功能损害患者81例,采用临床痴呆评定量表(CDR)、痴呆病觉缺失问卷(AQ-D)、简易智能精神状态检查量表(MMSE)、日常生活活动能力(ADL)量表及老年抑郁量表(GDS)对患者进行测评和分析.结果:本组存在自知力损害患者28例(34.5％)；认知障...     

影响维持性血液透析患者血压控制不良因素分析

目的:探讨维持性血液透析患者高血压控制不良的相关危险因素.方法:观察并记录145例维持性血液透析患者性别、年龄、透析时间、透析剂量、超滤量、体质量、透析方式、血压,血清尿素氮、肌酐及电解质、血白蛋白、血红蛋白、全段甲状旁腺激素、Kt/V、残肾功能,并根据血压控制情况分为血压达标组和控制不良组,进行单、多因素分析.结果:单因素分析结果显示2组患者血清甲状旁腺激素、促红细胞生成素应用量、Kt/V、透析间期体质量增加率、干体质量是否达标、残肾功能以及是否定期行血液透析滤过等指标比较差异有统计学意义(P相似文献   

广西壮族自治区巴马县甲篆乡壮族老人认知功能的筛查结果分析

目的:调查广西壮族自治区巴马长寿地区65岁上老人的认知功能,探讨应用中文版简易智能状态检查对农村壮族老人进行认知功能筛查的可行性。方法:于2004-03-12/03-28在广西壮族自治区巴马县甲篆乡以村委会为单位进行整群抽取65岁以上老人320人。应用长寿地区老人心理健康调查表,包括人口学资料,国际通用的标准化工具中文版简易智能状态检查等。中文版简易智能状态检查分两阶段进行调查,第一阶段为对每个调查对象逐个进行检查。其阳性分值由教育程度决定,文盲组即文化程度<1年,中文版简易智能状态检查总分<17分;小学组即文化程度1～6年,总分<20分;中学组即文化程度>7年,总分<24分为阳性。第二阶段为对第一阶段中文版简易智能状态检查阳性的调查对象进行神经心理测试和精神检查,最后确定诊断进行痴呆分型。不改变量表内涵的前提下对量表的内容进行适当的修改。中文版简易智能状态检查的一致性测验组内相关系数(ICC)为0.89。采用描述性统计分析、卡方检验、t检验、多元逐步回归分析等统计方法。结果:发放问卷320份,剔除资料填写不全问卷2份,收回合格问卷318份,有效率99.4%。①中文版简易智能状态检查结果:文盲组(19.37±4.28)分,小学组(24.82±3.84)分,中学组(25.13±5.19)分;阳性检出率文盲组最高,中学组次之,小学组最低。②男性的中文版简易智能状态检查总分显著高于女性,差异有显著性意义犤(22.33±5.61),(19.12±3.53),P<0.01犦。③65～74岁、75～79岁、80～84岁3组间中文版简易智能状态检查总分接近,差异无显著性意义;超过85岁后,随着年龄的增长,中文版简易智能状态检查总分逐渐减少。④本调查最后被确诊为痴呆的被试仅2人,总分阳性者80人,据此得到中文版简易智能状态检查的敏感性为100%和特异性为75.3%。⑤影响认知功能的Logistic多元逐步回归分析得到回归方程:Y(年龄)=91.204 4.196×(是否经常锻炼身体)-1.827×(受教育程度)-3.357×(自我心理感觉) 1.527×(与邻居见面次数),提示该地区老人的年龄与是否经常锻炼及到邻居家拜访的间隔时间成正相关,与受教育程度、自我心理感觉成负相关。结论:广西壮族自治区巴马县甲篆乡老人总体认知功能良好,中文版简易智能状态检查的敏感性较高而特异性较低。适用于农村老人认知功能筛查。     

脑卒中患者认知障碍及相关因素调查分析

目的 探讨并分析脑卒中患者认知障碍及其相关因素.方法 采用自行设计的患者基本情况调查表、简易智力状态检查量表(MMSE)、日常生活能力评价(Barthel指数)对北京市三所三甲医院474例脑卒中患者进行调查.结果 474例脑卒中患者中认知功能障碍发生率为50.61%,体重高、文化水平低、日常生活能力低、情绪低落的脑卒...     

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.