康复训练对慢性精神分裂症患者日常生活能力和社会功能的影响

目的探讨康复训练对慢性精神分裂症患者日常生活能力和社会功能的影响。方法将58例慢性精神分裂症患者随机分为训练组30例,对照组28例。两组均常规应用抗精神病药物治疗及护理,训练组在此基础上接受为期12周的临床康复训练。采用阳性与阴性症状量表、住院精神病人社会功能评定量表评定临床效果。结果训练组训练12周末阳性与阴性症状量表总分及各因子分均较训练前显著下降,且显著低于对照组（P〈0．01）;住院精神病人社会功能评定量表总分及各因子分均较训练前显著升高,且显著高于对照组（P〈0．05或0．01）。结论慢性精神分裂症患者在药物治疗基础上联合康复训练,能显著缓解各种精神症状,提高日常生活能力,改善社会功能。     

慢性精神分裂症社会技能训练的研究

目的：探讨社会技能训练对慢性精神分裂症患者社会功能与生存质量的影响。方法：对象取自无锡市4个街道中病程5年以上的精神分裂症患者113例。随机分配到社会技能训练组（以下简称“训练组”）50例和对照组63例。对训练组按顺序进行药物处置能力训练、社交技能训练、职业培训和俱乐部活动。全疗程13个月。结果：社会技能训练前两组的精神症状、住院率、肇事率、社会功能和生存质量满意度差异无显著性意义。治疗期间训练组住院次数、住院天数和肇事率都显著低于对照组（分别为：t=3．358，P〈0．01；t=2．954，P〈0．01；t=2．891，P〈0．01）。训练组的PANSS总分明显低于对照组（t=3．300，P〈0．001），其中阴性症状分和一般病理症状分都显著低于对照组（分别为：t=3．272，P〈0．001；t=3．123，P〈0．01；），阳性症状分差异无显著性。治疗后训练组的SDSS分显著低于对照组（t=2．106，P〈0．05），GAF分显著高于对照组（t=2．154，P〈0．05）。训练组WHOQOL-BREF总分及4个单项分均显著高于对照组。回归分析显示，GAF分与参加训练次数呈正相关（R=0．2891，F=4．3788，P=-0．0417）。结论：社会技能训练能改善慢性精神分裂症患者的精神症状、社会功能和生存质量，降低或延缓精神残疾，降低复发率和肇事率，是当前较为有效的精神康复措施。     

药物自我处置技能训练程式在社区慢性精神分裂症患者康复中的应用

目的 探讨药物自我处置技能训练对降低社区精神分裂症患者复发率,提高社会功能的作用.方法 选择4个街道社区病程在5年以上的精神分裂症患者100例,随机分成药物自我处置技能训练组(简称训练组)和对照组各50例,对训练组施以药物自我处置技能训练,共12周,随访1年,对照组不参加康复训练,但提供与训练组类似的资料,采用大体评定量表(GAS)、社会功能缺陷筛选量表(SDSS)、阳性和阴性症状量表(SAPS和SANs),对2组患者分别于3个月末、1年末进行康复状态的评估,并比较患者的服药依从性、复发情况和再住院情况.结果 与入组时比较,训练组GAS、SDSS、SAPS和SANs评分明显优于对照组,服药依从性高于对照组(P《0.01),1年内训练组复发率(10%)和再住院率(17%)均明显低于对照组(32%和43%).结论 药物自我处置技能训练能够提高慢性精神分裂症患者的药物依从性,改善患者阳性和阴性症状、社会功能和社交技能,降低复发率,是当前较为有效的精神康复措施之一.     

两种技能训练对社区精神分裂症患者康复作用的随访研究

目的：探讨药物自我处置和症状自我监控两种技能训练对预防社区精神分裂症患者复发和康复其精神残疾的作用。方法：将133例出院后的精神分裂症患者随机分成技能训练组（以下简称训练组，66例）和对照组（67例），对训练组患者分组进行技能训练，共20周，两组均有64例完成1年随访，以简明精神病评定量表（BPRS），社会功能评定量表（SSSI）和自制的监护人及患者药物依从性评分表进行评定。结果：训练组的监护人与患者药物信从性评分，复发率，再住院率和精神残疾程度减轻有效率发别明显优于对照组（P＜0．01），结论：两种技能训练对预防社区精神分裂症患者复发和康复其精神残疾具有重要意义。     

社会技能康复训练对精神分裂症患者生活质量的影响

目的探讨社会技能康复训练对精神分裂症患者恢复社会功能的影响。方法选择80例恢复期精神分裂症患者作为研究对象,在药物治疗和传统护理的基础上,联合生活、人际交往技能及健康教育等。于训练前和训练后8周分别采用阴性症状量表、大体评定量表（GAS）日常生活能力量表（ADL）和住院患者观察量表（NOSIE）评定临床效果。结果训练后阴性症状量表评分研究组各因子分及总分较训练前下降（P〈0．01）,大体评定量表较训练前评分明显提高,日常生活能力量表评分较训练前有显著下降（P〈0．01）,社会能力、社会兴趣、个人整洁因子评分显著高于训练前,激惹、精神病性表现、退缩和抑郁因子分低于训练前。结论社会技能康复训练能显著提高住院精神分裂症患者的康复效果和生活质量。     

康复训练对慢性精神分裂症患者社会功能的影响

目的探讨院内分类康复训练对慢性精神分裂症患者社会功能康复的影响。方法将120例慢性精神分裂症患者随机分为训练组与对照组各60例;训练组根据功能独立性评定量表评分分为轻度组（≥80分）30例,重度组（〈80分）30例;两组均维持原用抗精神病药物治疗和一般日常管理,训练组在此基础上根据轻、重度分类进行系统康复训练,观察24周。于训练前及训练第4周、12周、24周末采用功能独立性评定量表、阴性症状量表进行评定分析。结果对照组训练前后功能独立性评定量表、阴性症状量表评分均无显著变化（P〉0．05）;训练组训练后各时段功能独立性评定量表评分均呈持续性升高,而阴性症状量表评分均呈持续性下降。轻度组各时段功能独立性评定量表评分均显著高于重度组及对照组（P〈0．05或0．01）;重度组训练前及训练4周末均显著低于对照组（P〈0．05或0．01）,而训练24周末显著高于对照组（P〈0．01）。轻度组训练前及训练后各时段阴性症状量表评分均显著低重度组及对照组（P〈0．01）;重度组训练前显著高于对照组（P〈0．05）,而训练第12周、24周末显著低于对照组（P〈0．01）。结论在药物治疗基础上,联合院内分类康复训练,能显著缓解患者的阴性症状,改善社会功能,提高功能独立性。     

自信心训练对慢性精神分裂症患者日常生活能力的影响研究

目的探讨自信心训练对慢性精神分裂症患者日常生活能力的影响。方法将120例慢性精神分裂症患者随机分为两组，每组各60例，均给予常规抗精神病药物治疗，研究组联合自信心训练，观察3mo。于自信心训练前及训练3mo末，采用阳性症状评定量表、阴性症状评定量表和日常生活能力量表评定临床疗效。结果阳性症状评定量表评分训练前后及同期两组问比较均无显著性差异（P〉0．05）。阴性症状评定量表及日常生活能力量表评分研究组训练3mo末较训练前均有显著下降（t=4．21，2．61，P〈0．01），对照组无显著变化（P〉0．05）；两组间比较训练前无显著性差异（P〉0.05），训练后均有极显著性差异（P〈0.01）。结论自信心训练能改善或缓解慢性精神分裂症患者的阴性症状，显著提高患者的日常生活能力。     

应用药物自我处置技能训练慢性精神分裂症住院患者

目的：分析应用药物自我处置技能训练对慢性精神分裂症住院患者社会功能和社交技能的改善作用。 方法：于2000—02／2004—02将符合纳人标准的北京回龙观医院慢性精神分裂症住院患者100例，随机分为社会技能训练组（以下简称训练组，n=50）和对照组（n=50）。在抗精神病药物治疗不变的前提下，对训练组按照Liberman编写的《社会独立生活技能》训练程式进行训练，训练内容：①获得抗精神病药物治疗的知识．②了解正确的自我服用药物的方法并对其评价。③识别药物的副反应。④与健康照料者商讨药物治疗问题。每一技能部分分成7个学习活动：介绍技能：录相带和问／答；角色演练；资源管理；结果问题；现场练习；安排并分派家庭作业。每个部分的内容着重训练患者解决在实际生活中遇到的问题。共12周。期间每4周评定1次简明精神病评定量表、刚性症状量表，治疗前后各评定1次社交技能评定表、社会功能缺陷量表和进行药物处置相关知识的测验。简明精神病评定量表包含焦虑抑郁因子、缺乏活力因子、思维障碍因子、活动性因子和敌对态度因予；阴性症状量表包含情感平淡因子、思维贫乏因子、意志缺乏因子、情感缺乏因子和注意障碍因子。社交技能评定表包括目光接触、姿势／身体的运动／手势、面部表情、语音、言语的流畅性、交往中的精神状态等6个条目，按照《社会技能和独立生活技能》训练程式手册所列的评分标准，与写实录像的比较，分3级评定社交技能。 结果：训练组有45例、对照组46例完成实验并进入结果分析。①训练组和对照组简明精神病评定量表的焦虑抑郁、缺乏活力、思维障碍、活动性和敌对态度因子的减分率从训练的第8或12周与对照组间差异出现显著性（P〈0．05）。②训练组的阴性症状量表情感平淡、思维贫乏、意志缺乏因子分的减分率从训练的第8周起，与对照组之间差异出现显著性（P〈0．05）。③训练组治疗前后及治疗后与对照组之间的社会功能缺陷量表的评定结果差异均有显著性。④训练组治疗后在药物自我处置相关知识掌握程度较治疗前明显提高，也较对照组显著提高，差异均有显著性。⑤训练组冶疗后社交技能的日光接触、姿势／身体的运动／手势、面部表情、交往中的精神状态及总分均显著高于对照组，差异有显著性。 结论：药物自我处置技能的训练能够不同程度的改善慢性精神分裂症住院患者的阴性症状、社会功能和社交技能，是其精神康复的有效手段夕一．     

社区慢性精神分裂症病人社会技能训练的康复护理

[目的]探讨技能训练对社区慢性精神分裂症病人社会功能与生活质量的影响。[方法]选择4个街道、病程在5年以上的精神分裂症病人97例．随机分成为技能训练组49例和对照组48例,时照组仅接受药物治疗．技能训练组实施药物治疗和6个月的技能训练。[结果]训练后6个月、12个月．技能动练组大体评定量表（GAS）、社会功能缺陷筛选量表（SDSS）、精神症状阳性量表（SAPS）、精神症状阴性量表（SANS）、世界卫生组织生存质量测定量表（WHOQOL—BREF）评分与时照明组比较差异有统计学意义;服药依从性高于对照组;1年复发率低于对照组。L结论]技能动练程式有利于改善社区慢性精神分裂症病人的生活质量和社会功能,提高服药依从性,降低复发率。     

手工与车缝技能训练对慢性精神分裂症住院患者康复的影响

目的：探讨手工与车缝技能训练对慢性精神分裂症住院患者康复的影响。方法将60例慢性精神分裂症住院患者随机分为两组,每组30例,两组均维持原用抗精神病药物治疗、日常生活技能训练及常规健康教育等,在此基础上研究组予以手工技能训练,对照组予以车缝技能训练,观察6个月。训练前后采用阳性与阴性症状量表及住院精神病患者康复疗效评定量表评定临床效果。结果训练6个月后,两组阳性与阴性症状量表总分及阴性症状因子分均较治疗前显著下降（P＜0．05或0．01）,研究组较对照组下降更显著（P＜0．01）;住院精神病患者康复疗效评定量表总分及各因子分均较治疗前显著下降（ P＜0．05或0．01）,研究组关心和兴趣因子分较对照组下降更显著（P＜0．01）。结论手工与车缝技能训练均能提高慢性精神分裂症住院患者的康复效果,但手工技能训练在改善患者的精神面貌、阴性症状、对外界事物的关心和兴趣等方面优于车缝技能训练,值得大力推广。     

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.