心理干预对慢性乙型肝炎患者家属抑郁及焦虑情绪的影响

目的：探讨心理干预对慢性乙型肝炎患者家属抑郁焦虑情绪的影响。方法选择慢性乙型肝炎患者家属68例,采用随机数字表法随机分为观察组（34例）和对照组（34例）。对照组给予常规护理健康教育,观察组在此基础上给予心理干预,家属均应用抑郁自评量表（ SDS ）及焦虑自评量表（SAS）评估干预前后的心理健康状况。结果干预前,患者家属 SDS 及 SAS评分分别为（39．81±5.34）,（34．67±4．61）分,均高于国内常模,差异有统计学意义（t值分别为9．71,8．92;P＜0．05）;干预前,两组患者家属SDS及SAS评分差异无统计学意义（ P＞0．05）;干预后,观察组患者家属SDS及SAS评分低于对照组,差异均有统计学意义（ t值分别为3．61,2．85;P＜0．05）。结论慢性乙型肝炎患者家属存在一定程度的抑郁焦虑状况,心理干预能改善患者家属的抑郁焦虑状况。     

悟言点击术对慢性心力衰竭患者焦虑抑郁情绪的干预研究

目的评价悟言点击术对慢性心力衰竭患者焦虑、抑郁情绪的干预效果。方法将200例研究对象按住院治疗的单、双号分为试验组和对照组。试验组采用悟言点击术进行心理干预,对照组采用传统的心理疏导和认知疗法进行心理干预,干预时间均为3个月。干预前后,两组患者均采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS)进行测试,比较两组患者干预前后焦虑、抑郁情绪的改善情况。结果干预后两组SAS和SDS得分均有所下降,试验组患者处于轻度的焦虑和抑郁状态,但对照组患者仍存在中度焦虑和抑郁状态,差异具有统计学意义(P0.01)。结论实施悟言点击术可有效改善慢性心力衰竭患者的焦虑、抑郁情绪。     

综合干预改善慢性前列腺炎焦虑抑郁情绪的效果

目的 探讨综合干预改善慢性前列腺炎患者的焦虑、抑郁情绪的效果,以提高其生活质量.方法 采用Zung自我评定焦虑量表SAS和抑郁评定量表SDS,将SAS评分≥47分或SDS≥45分的174例慢性前列腺炎患者随机分为干预组87例和对照组87例.对干预组患者进行心理疏导、认知行为教育、寻求社会支持及护理措施管理等综合干预,并将患者入院时、出院时的SAS、SDS自我评价值与国内常模进行对比.结果 患者入院时干预组SAS得分为（54±3.09）分,SDS得分为（52±4.34）分,对照组SAS得分为（53±3.91）分,SDS得分为（52±3.86）分,两组患者差异无统计学意义（P＞0.05）;出院时干预组SAS得分为（37±3.72）分,SDS得分为（35±2.82）分,对照组SAS得分为（48±2.34）分,SDS得分为（47±3.43）分,两组患者差异有统计学意义（P＜0.05）;干预组出院时评定分值较国内常模SAS得分为（42±11）分,SDS得分为（37±13）分,略有下降.结论 慢性前列腺炎患者受诸多因素影响,其焦虑、抑郁情绪将影响患者的生活质量和疾病的康复;在治疗慢性前列腺炎的同时,应注重改善患者的焦虑、抑郁情绪,提高患者的生活质量.     

认知行为干预对老年病人首次血液透析时心理状况的影响

[目的]探讨认知行为干预对老年病人首次透析时心理状况的影响。[方法]选取2009年3月—2010年11月60例首次接受血液透析的老年病人,按入院先后顺序随机分为观察组和对照组,对照组给予常规护理和心理支持,观察组在此基础上进行认知行为干预。入院后第2天及透析后第2周使用焦虑自评量表（SAS）、抑郁自评量表（SDS）测试病人的焦虑及抑郁情况。[结果]干预前两组病人SAS、SDS评分差异无统计学意义（P〉0.05）,干预后观察组SAS、SDS评分较对照组明显降低（P〈0.05）。[结论]认知行为干预可有效改善老年首次血液透析病人的焦虑、抑郁情绪。     

心理干预对胃癌术后患者抑郁焦虑情绪及生活质量的影响

目的探讨心理治疗对胃癌根治术患者抑郁焦虑情绪的干预效果及其对生活质量的影响。方法将100例胃癌根治术患者随机分为干预组和对照组每组各50例,干预组手术前后实施心理干预。干预4周末评定并比较2组焦虑自评量表（SAS）、抑郁自评量表（SDS）、健康状况问卷（SF-36）得分结果。结果治疗4周后,干预组SAS评分（36．85±6．81）分,对照组（56．29±7．28）分;干预组SDS评分（42．33±7．12）分,对照组（51．62±9．51）分;SF-36除生理机能外,其他指标干预组均优于对照组;2组比较差异均有统计学意义（P〈0．05）。结论心理干预能降低胃癌根治术患者焦虑抑郁情绪,提高患者的生活质量。     

术前访视应用聚焦解决模式对全子宫切除患者焦虑抑郁的影响

目的：探讨术前访视中应用聚焦解决模式对全子宫切除患者焦虑、抑郁的影响,为临床工作提供理论帮助。方法选取择期全子宫切除患者120例,随机分为对照组和观察组,每组各60例。对照组给予一般的术前访视,观察组在此基础上应用聚焦解决模式进行护理干预。采用焦虑自评量表（ SAS）、抑郁自评量表（ SDS）评价两组患者干预前后的焦虑和抑郁状况。结果观察组干预后轻度、中度、重度焦虑患者分别为25,11,10例,对照组分别为15,28,17例,两组差异有统计学意义（ Z＝-1．98, P＜0．05）;观察组干预后中度、重度抑郁患者分别为12,8例,对照组分别为24,18例,两组比较差异有统计学意义（Z＝-1．94,P＜0．05）。结论术前访视中应用聚焦解决模式能有效缓解全子宫切除患者术前的焦虑、抑郁情绪。     

心理护理干预对老年慢性心力衰竭病人情绪及心功能影响的研究

[目的]探讨心理护理干预对老年慢性心力衰竭病人焦虑、抑郁情绪及心功能的影响。[方法]选择确诊的老年慢性心力衰竭病人98例,随机分为干预组（48例）和对照组（50例）,对干预组实施心理护理和行为指导,两组病人均在住院后及出院前填写焦虑（SAS）、抑郁（sDs）自评量表并进行6min步行运动试验。[结果]干预后病人焦虑、抑郁评分干预组显著低于对照组（P〈0．01）,6min步行距离明显长于对照组（P〈0．01）。[结论]心理护理干预可有效控制慢性心力衰竭病人焦虑、抑郁情绪,促进心功能改善。     

颌面肿瘤患者术后情绪障碍的评估及心理行为干预对情绪的影响

目的：对颌面肿瘤患者手术前后的心理状况进行评估，保持心理行为干预前后患者情绪（SDS积分）的变化。方法：将62例颌面肿瘤患者按术后颜面及功能改变情况分为轻度（n=36)和中度（n=26)两组。应用焦虑自评量表（SAS），抑郁自评量表（SDS）、症状自评量表（SCL－90）量表随机对其进行术后心理状况调查以及对SDS＞40分的患者进行干预后再进行SDS评定。结果：（1）轻度和中度以上两组比较，SAS、SDS和SCL－90的躯体化、人际关系、抑郁、敌意、其他因子差异均有显著性（P＜0．01）。（2）术后SDS＞40分的患者心理行为干预前、后比较SDS差异有显著性（P＜0．001）。结论：颌面肿瘤患者术后颜面及功能改变严重的患者，其抑郁、焦虑情绪反应较轻度改变者明显，且术后患者抑郁情绪在进行心理行为干预后得到了明显的改善。     

认知行为干预对充血性心力衰竭病人心理状态的影响

[目的]观察认知行为干预对充血性心力衰竭(CHF)病人心理状态的影响。[方法]将64例CHF病人随机分为观察组和对照组各32例,对照组给予常规治疗和护理,观察组在常规治疗和护理基础上给予认知行为干预。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价病人干预前后焦虑、抑郁状况。[结果]观察组病人干预后SAS和SDS评分降低且低于对照组(P<0.05)。[结论]认知行为干预能改善CHF病人的焦虑、抑郁状况。     

认知干预护理对原发性高血压患者焦虑抑郁的影响

目的：探讨认知干预护理对原发性高血压患者的焦虑、抑郁情况的影响。方法选择伴有焦虑和／或抑郁症状的54例原发性高血压患者作为研究对象,采用随机数字表法分成干预组和对照组。对照组患者进行医院常规治疗和护理,干预组患者在此基础上进行认知干预护理,分别在干预前后对两组患者进行焦虑自评量表（ SAS）和抑郁自评量表（ SDS）进行评价,比较两组患者干预前后的评分情况以及血压水平。结果干预后干预组患者SAS、SDS评分分别为（36．67±8．61）,（37．88±8．56）分,收缩压和舒张压分别为（143．66±10．25）,（84．12±8．81）mmHg;对照组患者SAS评分、SDS评分分别为（41．99±7．83）,（42．92±9．75）分,收缩压和舒张压分别为（156．79±14．69）,（89．99±8．72）mmHg,两组比较差异均有统计学意义（t值分别为2．3753,2．0185,3．8088,2．4606;P＜0．05）。干预后干预组SAS评分、SDS评分、收缩压和舒张压均低于干预前,差异有统计学意义（ t值分别为3．1410,2．3081,3．4094,2．9423;P＜0．05）。干预后对照组患者各项指标与干预前比较,差异无统计学意义（P＞0．05）。结论认知干预护理可降低原发性高血压患者的焦虑、抑郁评分,有效控制患者的血压,提高临床治疗效果。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.