冠心病患者介入治疗前后焦虑抑郁障碍的心理干预与评价

Objective To discuss the effect of psychological intervention of depression in coronary heart disease after percutaneous coronary intervention (PCI). Methods The depression of 105 cases of coronary heart disease after PCI treatment was investigated. One hundred and five patients were randomly divided into intervention group and control group. The patientsin intervention group were treated with psychological intervention before and after PCI. The patients in control group were treated with normal treatment. Results There was not significant difference of incidence of depression an self-rating depression scale score between two groups. The depression in intervention group was less severe than that in control group ( P ＜ 0.01 ). Multivariate analysis showed: education level, the recent negative life events, household income, length of stay and sequelae of catheter intervention had significantly correlated with depression in coronary heart disease. Conclusion Psychological intervention can reduce the ratio of depression in coronary heart disease after PCI.     

冠心病患者介入治疗前后焦虑抑郁障碍的心理干预与评价

目的 研究冠状动脉粥样硬化性心脏病(冠心病)患者介入治疗前后焦虑抑郁障碍情况以及心理干预的效果.方法 采用Zung抑郁自评量表(SDS)对105例拟接受冠状动脉介入治疗的冠心病患者进行焦虑抑郁障碍调查评分.将105例患者完全随机分为干预组57例和对照组48例,干预组在手术前1～2 d和手术后7～10 d、3、6、12、24个月进行焦虑抑郁评定及心理干预,对照组常规治疗并于同时间进行焦虑抑郁评定.同时将影响因素与SDS评分之间进行多因素相关分析.结果 术前2组患者抑郁发生率、SDS评分差异无统计学意义.心理干预后干预组的抑郁障碍较对照组有明显改善[SDS评分:(37±4)分比(46±6)分,P＜0.01],对照组手术前后抑郁发生率无明显变化,而干预组术后抑郁发生率明显低于对照组,差异有统计学意义[15.8%(9例)比35.4%(17例),P＜0.05].多因素分析显示:教育程度、近期负性生活事件、家庭收入、住院时间、导管介入治疗后遗症与冠心病抑郁之间存在明显相关性(P＜0.01).结论 积极的手术前后心理干预可以有效减轻抑郁障碍情况.

Abstract：

Objective To discuss the effect of psychological intervention of depression in coronary heart disease after percutaneous coronary intervention (PCI). Methods The depression of 105 cases of coronary heart disease after PCI treatment was investigated. One hundred and five patients were randomly divided into intervention group and control group. The patientsin intervention group were treated with psychological intervention before and after PCI. The patients in control group were treated with normal treatment. Results There was not significant difference of incidence of depression an self-rating depression scale score between two groups. The depression in intervention group was less severe than that in control group ( P ＜ 0.01 ). Multivariate analysis showed: education level, the recent negative life events, household income, length of stay and sequelae of catheter intervention had significantly correlated with depression in coronary heart disease. Conclusion Psychological intervention can reduce the ratio of depression in coronary heart disease after PCI.     

冠心病患者冠脉支架植入前后Hs-CRP含量的变化及意义

Objective To detect the concentration of C-reactive protein in patients with coronary heart disease before and after percutaneous coronary intervention (PCI).Methods Forty patients with coronary heart disease that treated with PCI were enrolled.The serum concentration of C-reactive protein (CRP) was analyzed before and after the PCI.Results After PCI,the concentration of CRP were significantly increased compared with that before PCI[(13.91±3.61 ) mg/L versus ( 7.86±3.58 )mg/L,P＜0.01].Conclusion The concentrations of CRP in patients with coronary heart disease were significantly increased after PCI.The level of serum Hs-CRP may reflect inflammatory state of atherosclerosis plaque and it may be important to the prevention and treatment of complications after PCI.     

个体化心理干预在胃镜检查中的应用

Objective To investigate the role of individualized psychological intervention in gastroscopy.Methods 286 patients first underwent gastroscopy were randomly divided into the intervention and control groups,143 patients in each group. Individualized psychological intervention were provided for intervention group,and the patients of control group were just given routine nursing care. All the patients were measured by self rating anxiety scale (SAS) ,which were as measuring standards before and after intervention. At the same time,the blood pressure and heart rate were compared before and after intervention. Visual analogue scale (VAS) was observed to investigate the satisfaction of patients after operation. Results Compared with control group,anxiety rate and degree,blood pressure and heart rate in intervention group were lower( P ＜ 0. 05 ). The test of VAS revealed that the satisfaction of patients in intervention group was significantly higher than that in control group ( P ＜ 0. 05). Conclusion Individualized psychological intervention could improve negative emotion and relieve anxiety and affliction of patients underwent gastroscopy, and the satisfaction degree for gastroscopy was improved.     

中青年男性冠心病患者PCI前后性生活质量的变化

Objective To investigate the effect of percutaneous coronary intervention (PCI) on the sexual quality of life among young and middle-aged male patients with coronary heart disease (CHD) by using Sexual Life Quality Questionnaire(SLQQ).Mothods 78 patients cured by PCI were kept in operation group and the drug therapy group contained 80 patients.The sexual quality of life one day before hospitalization and six months after discharge was surveyed with a retrospective questionnaire in both two groups.Results The sexual quality of life in 6 months after discharge in both groups was better than before hospitalization (P＜0.01);the operation group improved more obviously compared to the drug group (P＜0.01).Conclusions PCI can significantly improve the sexual quality of life among young and middle-aged male patients with CHD.     

缬沙坦联合贝那普利治疗慢性心力衰竭的疗效观察

Objective To observe the effect of valsartan combined with benazepril in treatment of patients with chronic heart failure. Methods 60 patients with heart failure of New York Heart Association (NYHA) class Ⅱ -Ⅳ and LVEF less than or equal 40% were selected and randomly divided into two groups. The patients in control group were given benazepril(10mg/d) alone,and the patients in treatment group were given valsartan(80mg/d) combined with benazepril(10mg/d). After 8 months therapy, the changes of the parameters of left ventriclular function and ventriclular dimension of the patients with chronic heart failure were compared before and after treatment. And the clinical efficacy was compared between two groups. Results The ventriclular dimension of the patients with chronic heart failure was decreased,and left ventriclular function was improved. The patients of the combination therapy group were improved especially after treatment. Conclusion Angiotensin-converting-enzyme(ACE) inhibitor could improve heart function of patients with chronic heart failure. Therapy of valsartan combined with benazepril was more effective.     

肝癌介入治疗中疼痛患者应用心理干预的效果分析

Objective To investigate the psychology characteristics of liver cancer patients with pain and the effect of psychological intervention during the operation,Methods 216 eases of liver cancer were tested preoperative by SCL (SCL-90).Psychological intervention and analgesic drugs were orderly carried out when intraopsrative pain happened.And the pain degree of patients was tested by digital scale (NRS-10) before the psyehological intervention,after the psychological intervention and after the drug treatment.Statistical analysis was performed using the SPSS 11.0 software package.Results Each factor score of SCL-90 has significance statistical difference compare with domestic norm (P ＜0.05).The pain degree of patients in order decreased before the psychological intervention,after the psychological intervention and after the drug treatment,and there was statistical significant difference among them (P＜0.01).By psychological intervention,five eases were complete remission (2.31%),63 cases were effective remission (29.17%).All patients' pain was alleviated by drug therapy.The three SCL-90 scores:somatization,anxiety and fear of preoperative and that of pre-psyehological intervention was positively correlated (P＜0.05).Conclusion The psychological intervention as an effective means of pain control may alleviate liver cancer pain,and has a complementary role to drug therapy.     

左室射血分数降低的冠心病患者冠状动脉造影观察

Objective To explore coronary angiography detection in coronary heart disease patients with left ventricular ejection fraction decreasing. Methods The clinical data of 120 coronary heart disease patients were retrospectively analyzed. And the patients were divided into observation group and control group by decreasing of left ventricular ejection fraction. Results The incidence rate of more affection, anterior descending branch, convolution branch,left bole affection were higher than control group;The Gensini points of detection group were higher than control group( P ＜ 0. 05) ,and the difference was statistical significance. Conclusion Close attention on the changes of left ventricular ejection fraction in the clinic could provide reliable theory base.     

盐酸氟哌噻吨美西辛辅助治疗肠易激综合征66例疗效分析

Objective To investigate the effect of deanxit in adjuvant treatment of the patients with irritable bowel syndrome and the psychologicalon of the patients. Methods Clinical data of 66 patients with irritable bowel syndrome were retrospectively analyzed. The control group was treated by conventional therapy, and the observation group was given deanxit based on the treatment of the control group. Then the curative effect were observed. Results In 132 patients,98 cases were troubed with anxiety,9 cases with athymia, the incidence rate was 81%. After treatment the SAS and SDS score of the observation group reduced,compared with before treatment,and the difference was significant( P ＜0. 05 ); Before and after treatment the SAS and SDS score of the control group had no significant difference(P ＞0. 05). Compared with the control group,the excellence and total effective rate increased significantly in the observation group(P ＞ 0. 05). Conclusion Adjunctive therapy with deanxit could improve the anxiety and athymia,and elevate clinical curative effect.     

腹腔镜下手术治疗老年胆石症临床分析

Objective To explore the clinical effect of laparoscopy in treatment of elderly patients with cholelithiasis. Method The clinical data of 120 elderly patients with cholelithiasis were retrospectively analyzed,which were divided into observation group and control group. Result The operation time, hemorrhage amount of operations,length of stay and recurrence rate after operation of the observation group were lower than that of the control group, and the stone clearance rate in the observation group had significantly higher than that of the control group ,the difference was statistical significance( all P ＜ 0. 05). Conclusion The clinical curative effect of laparoscopy in treatment of elderly patients with cholelithiasis was good.     

综合心理干预对冠心病介入治疗患者的影响

目的探讨综合心理干预对冠心病介入治疗患者心理及并发症发生率的影响。方法 100例冠心病介入治疗患者随机分为心理干预组和对照组。在冠心病介入治疗期间,对心理干预组患者,除常规的生理卫生教育和监督外,进行综合心理干预;利用症状自评量表(SCL-90)、焦虑自测量表(SAS)、抑郁自测量表(SDS),在介入治疗开始前和出院时,进行心理状态测定;并统计各组介入治疗患者并发症发生情况。结果心理干预组患者在SCL-90中的躯体化、强迫症状、抑郁、焦虑、敌对等项的分值,在SAS和SDS中的总分值明显低于对照组(P<0.05),心理干预组并发症中的低血压、其他并发症、总发生率均明显低于对照组(P<0.05)。结论适当的综合心理干预对于提高生活质量及并发症预防有积极的作用。     

自我效能干预在经皮冠状动脉介入治疗术后患者中的应用效果

目的 探讨自我效能干预在经皮冠状动脉介入治疗(PCI)术后患者中的应用效果.方法 选取2020年7月至2021年6月肇庆市第二人民医院收治的82例PCI术后患者作为研究对象,采用随机数字表法将其分为干预组与对照组,每组各41例.对照组患者采用常规PCI术后护理干预,干预组患者在对照组的基础上进行自我效能干预.比较两组患...     

经皮冠状动脉介入治疗患者康复运动的护理干预

目的评价经皮冠状动脉介入治疗患者由护士进行为期4周的康复运动干预后的效果。方法65例经皮冠状动脉介入治疗患者作为研究对象,随机分为2组,实验组33例,对照组32例。对照组接受一般性出院指导,干预组接受常规出院指导。同时接受4周的康复运动干预,干预措施包括讲授康复运动知识、观看并分发与运动相关的光盘、进行有监护运动训练、协助制订运动计划、电话随访康复运动情况等。干预结束时评价内容包括运动能力运动依从性、生理状况、心理状况和生存质量等方面。结果通过康复运动干预,实验组患者运动能力明显提高,运动依从性显著提高,心理状态明显改善,生存质量方面两组间差别不显著。结论由护士开展院外康复运动项目能有效地改善患者的生理、心理功能。     

围术期护理干预对冠脉支架术后并发症的影响

目的：探讨经皮冠状动脉支架植入术（PCI）患者围术期进行护理干预的重要性。方法：将80例接受PCI术的心肌梗死患者随机分为干预组（40例）和对照组（40例）,对照组在围术期采用常规护理,干预组在常规护理基础上增加心理和行为干预等多种护理干预措施。结果：干预组术前焦虑程度较对照组明显降低（P〈0.05）,术后急性冠脉闭塞和心律失常、对比剂肾病发生率两组比较,差异无统计学意义（P〉0.05）,干预组术后尿潴留、穿刺局部并发症、血管迷走反射、腰酸背痛、下肢深静脉血栓形成等并发症较对照组少,差异具有统计学意义（P〈0.05）。结论：PCI围术期积极的护理干预可调动患者的积极性,有效地减少术后并发症和不良反应的发生率,促进患者康复。     

Cost-effective intervention in stroke

A rigorous assessment of current practice in all branches of medicine is necessary to ensure that we are minimising the costs and maximising the effectiveness of management and treatment. This is especially important in cerebrovascular disease which imposes a large burden of death; it is the third commonest cause of death after cancer and heart disease in most developed countries, and the commonest cause of long term disability on society. Stroke consumes up to 5% of healthcare expenditure in developed countries, and costs can be expected to remain static or increase with an increase in the proportion of elderly (who are at high risk of stroke) in the community over coming decades. This article reviews the epidemiology of stroke (risk factors, incidence, prevalence and the burden of disability and handicap), the various studies dealing with the community and individual costs of stroke, and the cost-effectiveness of interventions to prevent stroke such as control of hypertension, reduction in cigarette intake, encouragement of a healthy lifestyle, antiplatelet or anticoagulant therapy, and carotid endarterectomy. Acute treatment of stroke remains an area of major potential therapeutic benefit, but no widely applicable therapy currently exists, although many treatments are being investigated. Rehabilitation after stroke is costly, but may result in significant reduction in disability and handicap with reduced need for long term institutional care. The clinical implications of these studies and the potential for future research are also discussed.     

Genetics and therapeutic intervention

Elucidating the molecular mechanisms involved in metabolic diseases can, in many cases, characterize individual susceptibility resulting from mutations altering genetic inheritance. Better knowledge of this genetic component emphasizes the importance of revising disease classifications and diagnostic procedures which are currently based on phenotypic examination and may result in heterogeneous groupings of patients with different etiologies. By taking into account interindividual variability of therapeutic response, a new field of pharmacology, called Pharmacogenetics, may help evaluate and optimize therapeutic procedures in more homogeneous groups of patients.     

Pharmacist clinical intervention program

Our efforts have helped us demonstrate the positive impact of pharmaceutical care for patients. Our experience with the Clinical Notes section of our computer system leads us to recommend that such capabilities be sought in all pharmacy computer systems. A significant advantage to avoiding paper-based systems for documenting and collecting information relevant to clinical interventions, ADRs, DUE data, and patient outcomes has been proven in our institution. Various ways to categorize intervention data have been reported in the literature. We recommend clinical intervention categories be based on the eight categories of drug misadventuring so that data from different hospitals can be tabulated or compared. The success of our system is that it is one system rather than many systems. The importance of pharmacist documentation demands that it be simple, efficient, and painless, or it will be nonexistent.