心理护理对癌症患者负性情绪及生活质量的影响

目的：探讨心理护理对癌症患者负性情绪及生活质量的影响。方法将安徽省某医院2011年1月～2013年1月收治的60例癌症患者随机分为实验组和对照组各30例,对照组给予常规治疗护理,实验组在此基础上增加心理护理。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、SF -36健康调查量表（SF -36）比较2组患者焦虑、抑郁情绪和生活质量的情况。结果干预后实验组焦虑、抑郁情绪评分明显低于对照组,差异有统计学意义（P ＜0．05）;干预后实验组 SF -36的8个维度得分均高于对照组,差异有统计学意义（P ＜0．05）。结论心理护理可以减轻患者的心理不适,改善患者部分躯体症状,提高患者生活质量。     

心理护理干预对慢性心力衰竭患者焦虑抑郁和生活质量的影响

目的：探讨心理护理干预对慢性心力衰竭（CHF）患者焦虑抑郁心理状态和生活质量的影响。方法选择2010年9月至2013年9月海军总医院收治的C H F患者120例,随机分为观察组和对照组,每组各60例。对照组进行常规护理,观察组在常规护理基础上进行心理护理干预,比较干预后Zung氏抑郁自评量表（SDS ）和焦虑自评量表（SAS）评分变化情况,并采用生活质量综合评估问卷（GQOL-74）评估患者生活质量。结果观察组干预后SDS和SAS评分均较对照组干预后降低,差异有统计学意义（P＜0．05）。观察组GQOL-74评分明显优于对照组,差异有统计学意义（ P＜0．05）。观察组患者护理满意度为96．67％,明显高于对照组的73．34％,差异有统计学意义（P＜0．01）。结论实施有效的心理护理干预能缓解CHF患者焦虑抑郁的心理状态,可改善患者生活质量,提高患者护理满意度。     

HIV／AIDS患者心理干预前后焦虑、抑郁状况分析

目的：探讨心理干预对艾滋病病毒（HIV）感染者和艾滋病（AIDS）患者焦虑、抑郁情况的影响。方法：将被确诊为HIV／AIDS的80例患者随机分为实验组和对照组各40例。对照组给予传统常规护理措施,实验组在常规护理的基础上实施规范化心理护理方案。采用焦虑自评量表（SAS）、抑郁自评量表（SDS）对患者进行问卷调查。结果：实验组40例HIV／AIDS患者心理干预后焦虑、抑郁情绪较对照组明显减轻（P〈0．01,P〈0．05）。结论：心理干预可有效改善HIV／AIDS患者的焦虑、抑郁程度,明显提高其生活质量。     

聚焦解决模式心理干预对骨折患者焦虑抑郁情绪的影响

目的：探讨以聚焦解决模式为基础的心理干预对骨折患者焦虑抑郁情绪的影响。方法将100例骨折伴焦虑抑郁情绪患者按随机数字表法分为两组,每组50例,均予以常规治疗及护理干预,观察组在此基础上实施以聚焦解决模式为基础的心理干预,观察住院全程。干预前后采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况,统计患者的满意度。结果干预后两组汉密顿焦虑量表、汉密顿抑郁量表评分均较干预前显著下降（P＜0．01）,但观察组评分显著低于对照组（ P＜0．01）;观察组总满意率为96．0％,对照组为78．0％,观察组总满意率显著高于对照组（P＜0．01）。结论以聚焦解决模式为基础的心理干预能显著缓解各种骨折患者的焦虑抑郁情绪,增强治疗信心,提高治疗依从性及满意度。     

心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响

目的：探讨心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响。方法将120例康复期脑卒中伴抑郁焦虑障碍患者随机分为两组,每组60例。两组均予以神经内科常规治疗及训练,研究组联合心理干预,观察12个月。于干预前后采用焦虑自评量表、抑郁自评量表评定焦虑抑郁情绪,症状自评量表评定心理健康状况,总体幸福感指数量表评定幸福感, Barthel指数量表评定日常生活活动能力;干预12个月评估两组患者的治疗依从性。结果干预前两组各量表评分比较差异无显著性（ P＞0．05）;干预12个月两组焦虑自评量表、抑郁自评量表及症状自评量表评分较干预前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;干预后各时间点两组Barthel指数量表评分和研究组总体幸福感指数量表评分较干预前显著升高（P＜0．01）,研究组显著高于对照组（P＜0．01）。干预后研究组依从率为96．7％,对照组为81．7％,研究组显著高于对照组（ P＜0．01）。结论心理干预能有效缓解或消除脑卒中患者的焦虑抑郁情绪,提高其心理健康水平、总体幸福感及日常生活活动能力,有利于疾病的预后。     

中重度烧伤患者心理应激及心理干预效果

目的：探讨中重度烧伤患者的心理应激状况及心理干预效果。方法将172例中重度烧伤患者随机分为两组,分析烧伤患者存在的心理应激反应。两组均予以烧伤科常规治疗及护理,研究组联合心理干预,观察治疗全程。采用抑郁自评量表、焦虑自评量表评定心理干预效果。结果本组患者主要出现焦虑、抑郁、恐惧、不合作、失眠及孤独等心理应激反应。心理干预前,两组抑郁自评量表、焦虑自评量表评分比较差异无显著性（P＞0．05）;心理干预后,两组均较干预前显著降低（P＜0．01）,且研究组显著低于对照组（P＜0．01）。结论中重度烧伤患者存在不同程度的心理应激反应,心理干预能有效缓解患者的不良情绪,减轻患者痛苦。     

人性化护理干预对胆结石患者术前情绪的影响

目的：探讨人性化护理干预对胆结石患者术前情绪的影响。方法选择胆结石手术患者84例,根据随机数字表法分为对照组和观察组,每组各42例。对照组给予常规护理,观察组给予人性化护理干预,采用焦虑自评量表（ SAS）和抑郁自评量表（ SDS）比较两组患者入院时和术前焦虑、抑郁状态,比较两组护理满意度。结果入院时,两组患者的SAS和SDS评分差异无统计学意义（P＞0．05）。观察组术前SAS和SDS评分分别为（33．7±10．0）,（42．0±13．0）分,明显低于对照组的（48．3±12．0）,（55．0±15．0）分,差异有统计学意义（t值分别为3．54,3．67;P＜0．05）。观察组护理满意度为95．2％,较对照组（81．0％）明显升高,差异有统计学意义（χ2＝4．09,P＜0．05）。结论对胆结石手术患者给予人性化护理干预,能够改善患者术前负性情绪,提高护理满意度,值得推广。     

首发精神分裂症患者父母情绪状况调查及心理干预效果分析

目的：了解首发精神分裂症患者父母的情绪状况及心理干预效果。方法将72例首发精神分裂症患者的父母按随机数字表法分为两组,每组36例。于入组时采用焦虑自评量表及抑郁自评量表评定焦虑抑郁情绪,研究组根据测评结果予以有针对性的心理干预,对照组仅提供一般性指导,观察4周;于干预后再次采用上述量表进行测评分析。结果干预前两组焦虑自评量表及抑郁自评量表评分均显著高于常模（P＜0．01）;干预后两组各量表评分均较干预前显著降低（ P＜0．05或0．01）,研究组显著低于对照组（ P＜0．05或0．01）、与常模比较差异无显著性（P＞0．05）,对照组仍显著高于常模（P＜0．01）。结论首发精神分裂症患者的父母存在明显的焦虑抑郁情绪,心理干预可显著缓解其焦虑、抑郁情绪。     

综合性干预对精神病患者家属焦虑抑郁情绪的影响

目的：探讨综合性干预对精神病患者家属焦虑抑郁情绪的影响。方法将80名精神病患者家属随机分为两组,每组40名,研究组给予综合性干预,对照组不给予任何干预。观察患者住院全程。于干预前后采用焦虑自评量表、抑郁自评量表评定干预效果。结果干预后研究组焦虑自评量表、抑郁自评量表评分较干预前显著降低（P＜0．01）,对照组则无显著变化（P＞0．05）,研究组显著低于对照组（ P＜0．05或0．01）。结论对精神病患者家属予以综合性干预能有效缓解或消除其焦虑抑郁情绪。     

风湿性关节炎患者行关节护理的临床效果评价

目的：研究关节护理在风湿性关节炎患者护理中的临床效果。方法选取2012年12月至2014年2月在我院门诊确诊为风湿性关节炎并入院治疗的患者105例,根据患者确诊时间的先后将患者分为实验组（55例）和对照组（50例）,护士对实验组患者使用关节护理;对照组采用传统方法进行护理。评价实验组和对照组患者的焦虑自评表（ SAS）和抑郁自评表（ SDS）评分、疗效、护理满意度。结果实验组在护理前、后的焦虑自评量表（ SAS）和抑郁自评量表（ SDS）两表的评估数据有明显差异（ P＜0．05）;两组患者疗效和护理服务满意度差异具有统计学意义（P＜0．05）。结论对风湿性关节炎患者行关节护理,可提升患者疗效、护理服务满意度,降低患者焦虑和抑郁水平。     

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.     

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.     

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.     

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.