腹膜透析患者社会支持和应对方式与创伤后成长的相关性研究

目的研究腹膜透析患者社会支持、应对方式与创伤后成长的关系。方法采用领悟社会支持量表、医学应对方式问卷、创伤后成长评定量表对上海市某三级甲等医院135例腹膜透析患者进行调研。分析患者社会支持、应对方式与创伤后成长的关系。结果腹膜透析患者领悟社会支持评分为(66.36±8.51)分,创伤后成长总分为(62.04±12.26)分;创伤后成长总分与社会支持呈正相关(r=0.518),与面对评分呈正相关(r=0.620),与回避和屈服评分呈负相关(r=-0.663,r=-0.491)。结论腹膜透析患者创伤后成长处于中等水平,社会支持和面对能有效提高腹膜透析患者创伤后成长水平,回避和屈服则阻碍其创伤后成长。     

血液透析患者创伤后成长状况及其相关因素研究

目的探讨分析血液透析患者创伤后成长状况及其相关因素。方法选取2017年1—12月在我院行血液透析的患者93例作为研究对象,选用一般资料调查表、创伤后成长量表、事件相关反刍性沉思问卷与心理弹性量表的方式调查血液透析患者创伤后成长状况。结果血液透析患者创伤后成长总分为(963.95±12.34)分;血液透析患者的创伤后成长与性别、年龄、目的性反刍性沉思、心理弹性及透析龄相关。结论血液透析患者创伤后成长的水平表现为中等,同时与多项因素相关。医护工作者应给予相应的干预以使其心理弹性提升,引导其创设正确的目的性反刍性沉思,从而使其更好地成长。     

老年腹膜透析患者低钾血症的危险因素分析

目的调查老年腹膜透析患者出现低钾血症的状况,并分析其可能的危险因素。方法采用横断面研究。184例腹膜透析患者,其中老年组患者100例。调查患者的一般资料、透析状况、血清钾水平、饮食钾摄入量、经尿和腹膜透析液钾丢失量及合并症发生情况。结果老年组腹膜透析患者低钾血症的发生率为27.0%,血钾水平与腹膜透析剂量呈负相关（r=-0.257,P=0.021）,腹膜透析剂量是该组患者出现低钾血症唯一独立性影响因素（P=0.009）。结论腹膜透析剂量与老年腹膜透析患者发生低钾血症有关。     

同伴支持教育对腹膜透析患者自我管理、创伤后成长及生活质量的影响

目的:探讨同伴支持教育对腹膜透析患者自我管理、创伤后成长及生活质量的影响。方法:回顾性分析2018年4月1日～2019年6月30日108例行腹膜透析患者的诊疗情况;根据干预方式分为对照组48例和研究组60例,对照组采用常规教育管理,研究组在常规教育基础上采用同伴支持教育;采用自我管理量表、创伤后成长评定量表(PTGI)、肾病透析生活质量量表(KDTA)对患者进行评估。结果:干预后,两组自我管理总分及各维度得分均高于干预前(P0.05),且研究组自我管理总分及换液技术操作外的各维度得分均高于对照组(P0.01);干预后,两组PTGI总分及各维度得分均高于干预前(P0.05),且研究组PTGI总分及与他人关系、自我转变、人生哲学3个维度得分均高于对照组(P0.05,P0.01);干预后,两组KDTA总均分及各维度得分均高于干预前(P0.05),且研究组KDTA总均分及肾脏疾病影响、肾脏疾病负担、认知功能、社交质量、社会支持5个维度得分均高于对照组(P0.05,P0.01)。结论:同伴支持教育可改善腹膜透析患者自我管理能力、创伤后成长水平及生活质量,值得广泛应用。     

腹膜透析患者心理状况调查

目的了解腹膜透析患者的心理状况及其影响因素。方法采用症状自评量表分别调查66例腹膜透析患者,30例慢性肾病患者和30例健康者的心理状况。结果腹膜透析患者的心理症状多,心理状况差;心理状况与年龄和总病程成正相关。结论在腹膜透析治疗中不但要重视透析监护,而且特别要重视对患者的心理状况的观察和了解,有针对性地解除患者不利的心理因素,提高腹膜透析的治疗效果。     

原发性肝癌患者创伤后成长与心理韧性的关系研究

目的调查原发性肝癌患者创伤后成长和心理韧性现状,并分析心理韧性对创伤后成长的影响。方法采用创伤后成长评定量表和中文版韧性量表对204例原发性肝癌患者患者进行问卷调查。结果患者创伤后成长和韧性评分分别为(64.40±16.54)分和(65.26±15.12)分。创伤后成长各维度评分与韧性各维度评分均呈正相关(P0.05)。分层逐步回归分析结果显示,卡氏评分、文化程度、年龄、坚韧性、乐观、自强为患者创伤后成长的影响因素(P0.01或P0.05)。结论原发性肝癌患者创伤后成长和韧性水平不高,韧性、卡氏评分、文化程度和年龄均为其创伤后成长的影响因素。     

康复期乳腺癌患者创伤后成长及其影响因素分析

目的探讨康复期乳腺癌患者创伤后成长状况及其影响因素,以便更好地指导临床护理工作。方法采用创伤后成长量表对153例康复期乳腺癌患者进行问卷调查。结果康复期乳腺癌患者创伤后成长量表得分为(75.42±3.20)分,分数转化后发现,患者欣赏生活维度得分最高,精神改变维度得分最低。经多元线性逐步回归分析,病程、人均月收入、疾病分期和其他慢性病为康复期乳腺癌患者创伤后成长的影响因素。结论医护人员应采用各种心理干预方式尽可能帮助患者度过疾病诊断后的早期阶段,促进创伤后成长的发展,为乳腺癌患者建立战胜疾病的信心,同时积极治疗患者合并的其他慢性病。     

首发脑梗死患者创伤后成长及影响因素分析

目的 分析首发脑梗死患者创伤后成长(PTG)状况及影响因素。 方法 采用患者一般资料问卷、创伤后成长评定量表(PTGI)、领悟社会支持量表和心理弹性量表,对120例首发脑梗死患者进行调查。 结果 首发脑梗死患者PTG得分为(58.36±13.22)分,其中人际关系维度得分最高,新的可能性维度得分最低。文化程度、家庭经济状况、社会支持、心理弹性是患者PTG的影响因素。 结论 首发脑梗死患者的PTG受多种个体因素的影响,应及时采取相应措施提高患者的PTG。     

乳腺癌患者和配偶的创伤后成长及与积极心理资本的关系

目的 调查乳腺癌患者及其配偶的创伤后成长状况,探究患者和配偶的积极心理资本对自身及彼此创伤后成长的影响。方法 采取方便抽样方法,应用一般资料调查表、创伤后成长量表及积极心理资本量表,于2021年3月—6月对在天津市某三级甲等医院就诊的女性乳腺癌患者及其配偶共132对进行调查,130对完成调查。结果 乳腺癌患者及配偶创伤后成长得分分别为（2.43±1.11）、（2.34±1.27）分,均显著低于量表理论中值3.5分（均P<0.001）,处于中等偏下水平;患者的积极心理资本总分低于配偶（P=0.033）;在患者积极心理资本维度中,韧性水平相对较低。主客体互倚模型分析表明,患者及配偶的积极心理资本均正向预测自身的创伤后成长（Ps<0.001）;乳腺癌患者的积极心理资本正向预测配偶的创伤后成长（P<0.05）,而配偶的客体效应差异无统计学意义（P>0.05）。结论 乳腺癌患者及配偶的创伤后成长处于中等偏下水平;患者的心理韧性低于其积极心理资本的其他维度。乳腺癌患者和配偶的积极心理资本与创伤后成长关系的客体效应呈现不对称性,配偶的积极心理资本对于乳腺癌患者的创伤后成长的支...     

心理韧性对重症监护室转出患者创伤后成长的影响

目的 :调查重症监护室转出患者创伤后成长和心理韧性现状,并分析心理韧性对创伤后成长的影响。方法:采用中文版创伤后成长评定量表和中文版CD-RISC心理韧性量表对356例重症监护室转出患者进行问卷调查。结果:患者创伤后成长评分为(65.12±15.83)分,心理韧性评分为(65.23±13.32)分。心理韧性各维度评分与创伤后成长各维度评分均呈显著正相关(P0.05)。分层回归分析结果显示,机械通气、文化程度、年龄、坚韧性、乐观、自强为患者创伤后成长的影响因素(P0.05)。结论 :重症监护室转出患者创伤后成长和心理韧性水平不高,心理韧性为其创伤后成长的影响因素。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.