阶梯式心理护理对突发性聋患者焦虑抑郁情绪、睡眠质量的影响

目的 探究阶梯式心理护理对突发性聋患者焦虑抑郁情绪、睡眠质量的影响。方法 现从2020年1月12月随机选择80例突发性聋患者作为研究对象，随机数字表法分为2组各40例，对照组采用常规护理，观察组患者在此基础上联合阶梯式心理护理，比较两组护理前后依从性、焦虑抑郁情绪状态、睡眠质量情况。结果 观察组患者依从行为得分均优于对照组（P<0.05）。护理1个月，实验组自评焦虑量表（SAS）、自评抑郁量表（SDS）评分均低于对照组（P<0.05）。护理1个月，实验组匹兹堡睡眠质量指数（PSQI）和睡眠障碍发生率明显低于对照组（P<0.05）。结论 对突发性聋患者采取阶梯式心理护理可有效改善患者不良情绪并提高睡眠质量，有助于提升其治疗依从性。     

心理干预在扁桃体手术前后护理中的应用

目的 分析研究心理干预在扁桃体手术前后护理中的应用价值。方法 将本院2020年7月-2022年03月接受治疗的50例扁桃体手术患者作为探究对象，以随机综合平衡法分为对照组（25例）、观察组（25例）。对照组患者实施常规干预，观察组患者应用心理干预，比较护理满意度、SAS评分、SDS评分、平均呼吸恢复时间、平均睁眼时间、平均住院时间。结果 观察组患者和对照组患者的护理满意度96.00%、72.00%对比差异显著，P<0.05。观察组患者干预前和对照组患者干预前SAS评分、SDS评分对比差异显著，P>0.05；观察组患者干预后和对照组患者干预后SAS评分、SDS评分对比差异显著，P<0.05。观察组患者和对照组患者的恢复时间对比差异显著，P<0.05。结论 在扁桃体手术期间，通过予以心理干预，不良情绪减少，呼吸恢复时间、平均睁眼时间、住院时间均缩短，患者对护理服务的满意度较高，很大程度上提高了护理水平。     

心理干预对鼻咽癌患者放疗后精神症状及生活质量的影响

目的本文通过对103例鼻咽癌患者进行全程心理干预,探讨全程心理干预对鼻咽癌患者放疗后精神症状及生活质量的影响。方法对本院收治的186例鼻咽癌患者,随机分干预组103例,对照组83例,在对各组患者进行常规治疗同时,另对干预组患者于不同治疗阶段患者实施心理干预治疗。结果治疗前两组患者SDS/SAS评分及QOL无明显差异,干预治疗后干预组患者SDS、SAS评分明显较对照组减低(P<0.05),干预组的生活质量较对照组有明显提高,差异有统计学意义(P<0.05)。结论全程心理干预治疗对鼻咽癌患者放疗后的心理状态及患者的生活质量有积极影响。     

联合心理护理对突发性聋患者临床治疗效果的影响

目的探讨联合心理护理干预对突发性聋患者临床治疗效果的影响。方法 60例突发性聋患者按随机原则分为对照组(30例)和观察组(30例)。对照组给予常规护理措施+常规药物,观察组在对照组的基础上给予心理护理干预,比较两组的临床疗效以及两组患者治疗前后抑郁自评量表(SDS)与焦虑自评量表(SAS)的评分结果。结果治疗后两组患者的听力均有所提高,但观察组总有效率93.3%,对照组总有效率79.2%,两组比较统计学有显著性差异(P<0.05)。两组在入院2天内的SAS与SDS评分结果无明显差异(P>0.05);在治疗2周后,观察组SAS与SDS评分结果较对照组下降幅度有显著差异(P<0.05)。结论早期联合心理护理治疗突发性聋,能显著改善患者的焦虑抑郁状态,临床治疗效果亦有很大程度的提高,对其预后有着十分重要的意义。     

心理护理改善耳鼻咽喉恶性肿瘤患者术前焦虑情绪的临床效果观察

目的探讨心理护理在耳鼻咽喉部恶性肿瘤患者术前情绪调节的应用价值。方法随机数字表法将2019年6月至2020年11月收治的60例耳鼻咽喉恶性肿瘤患者分为2组,对照组(30例)予以常规护理,实验组(30例)加用心理护理,收集患者护理干预前后的SAS评分及SDS评分。结果护理干预前,两组患者的SAS及SDS评分相近(P>0.05);护理干预后,试验组的SAS及SDS评分明显低于对照组(P<0.05)。结论心理护理可改善此类恶性肿瘤术前患者的焦虑抑郁情绪,提高患者的治疗依从性。     

创伤性单纯鼓膜穿孔患者治疗前后心理状况评估

目的　评估创伤性单纯鼓膜穿孔患者治疗前后的心理状态,分析患者治疗前后心理变化。方法　对2015年1月~2017年1月西安交通大学第二附属医院耳鼻咽喉科门诊初诊的创伤性单纯鼓膜穿孔患者108例进行前瞻性研究,所有患者于初诊时及治疗2个月后填写抑郁自评量表（self-rating depression scale,SDS）及焦虑自评量表（selfrating anxiety scale,SAS）,对比治疗前后量表评分有无差异,并分析引起抑郁及焦虑症状的可能因素。结果　108例创伤性单纯鼓膜穿孔患者治疗前SDS评分、SAS评分均明显高于治疗后评分（t SDS=3.056,t SAS=2.797,P <0.05）,其中穿孔愈合组患者在治疗后评分明显低于治疗前,差异有统计学意义（t SDS=3.376,t SAS=2.945,P <0.05）。治疗后伴有抑郁及/或焦虑的例数下降,其中愈合组患者治疗后伴有抑郁及/或焦虑的例数下降明显,差异有统计学意义（χ2抑郁=8.270, χ2焦虑=7.296 ,P <0.05）。他伤、高听力的职业需要、伴有耳鸣耳闷以及头晕是抑郁和/或焦虑症状的危险因素。结论　在治疗创伤性单纯鼓膜穿孔患者躯体疾患的同时也应关注患者的抑郁及焦虑情绪,尽早促进穿孔愈合,改善躯体症状有助于减轻患者的抑郁及焦虑症状。     

护理干预在良性阵发性位置性眩晕患者前庭康复训练中的应用效果评价

目的 探讨护理干预措施对良性阵发性位置性眩晕患者实行家庭前庭康复训练的应用效果评价。方法选择2020年10月至2021年10月期间就诊于甘肃省人民医院诊断为良性阵发性位置性眩晕共计64例患者，均在住院期间进行复位治疗，复位成功后采用随机数字表法分为对照组（32例）和研究组（32例），对照组采用常规护理，研究组采用综合护理干预联合护士指导进行家庭自主康复训练，观察两组患者治疗前后前庭症状指数（VSI）、眩晕残障程度量表（DHI）、Berg平衡量表（BBS）评分、焦虑自评量表（SAS）、抑郁自评量表（SDS）评分、治疗有效率、复发率、康复训练的依从性及护理满意度。结果 两组患者在干预前各评分比较，差异均无统计学意义（P>0.05）；干预后，研究组VSI、DHI、SAS、SDS评分均低于对照组；BBS评分高于对照组，差异均有统计学意义（P<0.05）；且研究组相较于对照组总治疗有效率提高，患者的康复依从性及满意度提高，差异均有统计学意义（P<0.05）。结论 护理干预指导进行家庭自主前庭康复训练能够改善良性阵发性位置性眩晕患者临床症状，减轻眩晕程度，提高平衡能力，同时降低复...     

肉毒杆菌毒素治疗痉挛性发音困难(喉肌张力障碍):12年来治疗900多例患者的经验

该文对１２年来肉毒杆菌毒素治疗的９１３例痉挛性发音困难的病例进行回顾性分析，其中内收肌痉挛性发音困难（挤卡音）７４７例（８１．８％），外展肌痉挛性发音困难（耳语音）１５４例（１６．９％），内收肌呼吸性发音困难（声带矛盾运动）１２例（１．３％）。所有患者均进行全面的头颈部及神经系统检查，纤维光源喉动态镜检查，声学和空气动力学测试，发音评估，包括国际痉挛性发音困难分级和喉肌电图检查。在肌电图指导下对受累肌肉注射向毒杆菌毒素。患者仰卧，伸颈，用涂有聚四氟乙烯的单极空心ＥＭＧ针抽吸肉毒杆菌毒素Ａ（ＢＯＴ…     

老年非变应性鼻炎患者焦虑抑郁状态分析与生活质量评估

目的 研究老年非变应性鼻炎(non-allergic rhinitis,NAR)患者的焦虑抑郁状况及生活质量。方法病例组为老年NAR患者82例,选择同期健康老年人75名为对照组。病例组在治疗前后以及对照组均采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)以及鼻结膜炎生活质量调查量表(rhinoconjunctivitis quality of life questionnaire,RQLQ)进行问卷调查。结果 病例组患者治疗前SAS评分(58.75±7.67)与SDS(54.86±6.81)评分指数均高于治疗后(49.07±6.89,48.91±6.08)和对照组(41.93±7.27,40.16±5.97)且治疗后SAS评分与SDS评分指数仍高于对照组(P均<0.01);病例组患者治疗前RQLQ各维度评分均高于治疗后和对照组且治疗后评分仍高于对照组(P均<0.01);与老年NAR患者焦虑情绪相关的生活质量维度包括鼻部症状、眼部症状、实际问题、非鼻眼症状、睡眠、日...     

综合护理模式对耳鸣耳聋患者睡眠质量和心理压力的影响观察

目的研究综合护理模式对耳鸣耳聋患者睡眠质量和心理压力的影响。方法选取2018年8月~2019年12月我院收治的120例耳鸣耳聋患者作为主要研究对象,按随机数字表法分对照组与观察组,每组60例,分别对两组患者的护理前后的睡眠质量(PSQI)、焦虑程度(SAS)以及抑郁程度(SDS)进行比较。结果护理后,两组患者的PSQI、SAS、SDS评分明显低于对照组,且观察组明显低于对照组(P<0.05)。结论对耳鸣耳聋的患者开展综合护理干预,能够在缓解患者心理压力的同时,改善其睡眠质量,值得在临床推广应用。     

Management of facial spasm with Clostridium botulinum toxin, type A (Oculinum)

One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients. Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.     

Botulinum toxin treatment in patients with hemifacial spasm

Hemifacial spasm is nearly always a unilateral disease of the facial musculature and is characterized by involuntary tonic or clonic cramps that considerably reduce the affected patient's quality of life. In the past, a number of different conservative and operative therapeutic procedures have been applied for the treatment of hemifacial spasm. In many cases these attempts failed to control the disease permanently or resulted in unwanted, sometimes strong, side effects. We report our own experiences with botulinum therapy in 29 patients with hemifacial spasm (78 therapeutic sessions). In our patients the mean duration of an effect after treatment with botulinum toxin was 18.2 weeks. Side effects were rare. Our results since 1990 at the University of Göttingen demonstrate that subcutaneous application of toxin from Clostridium botulinum to involved facial muscles represents a reliable method for successful treatment of hemifacial spasm.     

Psychological evaluation in vertiginous patients

Four psychological tests, namely the Cornell Medical Index (CMI), the Manifest Anxiety Scale (MAS), the self-rating depression scale (SDS), and the self-rating anxiety scale (SAS) were performed to investigate the role of psychological factors in vertigo, in a study of 111 vertiginous patients and 81 controls. Vertiginous patients comprised the following three groups: 56 vertebrobasilar insufficiency (VBI group), 29 autonomic nervous dysfunction (AND group), and 26 Ménière's disease (MD group). The incidence of abnormal scores by CMI and SAS in the vertiginous patients was significantly higher than that in the controls (p < 0.01). No significant difference between the vertiginous patients and the controls was observed with respect to MAS and SDS scores. The abnormal rates by CMI in the VBI and AND groups were significantly higher than in controls (p < 0.01). Also, the abnormal rates by SAS in the VBI and MD groups were significantly higher than in controls (VBI group: p < 0.01, MD group: p < 0.05). However, no significant differences between the three groups of vertiginous patients and controls were found with respect to MAS and SDS scores. The average score from other psychological tests in the CMI-abnormal group was significantly higher than that in the CMI-normal group (p < 0.01). There were significant correlations between the MAS and SDS, MAS and SAS, and SDS and SAS scores (r = 0.682-0.688, p < 0.01). The matched data rate between the psychological tests was about 70-80%. Considering the results of MAS and SAS, vertigo induces anxiety forwards vertigo, and thereby initiates a vicious cycle. In vertiginous patients, CMI and SAS are most useful for determining whether or not psychological factors play a role in the onset of and persistence of vertigo. But CMI consist of 195 factors, and therefore, is time concerning. On the other hand, SAS has 20 factors and takes only 5 minutes to complete, thus, SAS is more suitable for screening psychological factors.     

Botulinum toxin for treatment of gustatory sweating. A prospective randomized study]

BACKGROUND: Botulinum toxin A has meanwhile become a proven method for treatment of gustatory sweating (focal hyperhidrosis, Frey's syndrome). Clear-cut recommendations regarding dosage of botulinum toxin A in Frey's syndrome are currently not available. The aim of this prospective randomized study therefore was to investigate botulinum toxin A with respect to its efficacy in Frey's syndrome, the ideal dose yielding maximal duration of the effect, and patient contentedness as well as unwanted side effects in patients of the Clinic of OMF Surgery at the Ruhr-University of Bochum. PATIENTS AND METHOD: Twenty patients suffering from severe Frey's syndrome as a result of operations of the parotid gland were examined with the starch iodine test according to Minor. The gustatory skin areas were re-examined after intracutaneous injection of botulinum toxin A for up to 1 year. The patients ( n=20) were randomly assigned to two different treatment groups (group I: 2 MU/cm(2), n=10; group II: 3 MU/cm(2), n=10). RESULTS: Mean sweating skin areas in the two treatment groups ranged between 39+/-9 and 32+/-12 cm(2), respectively. A single injection of 3 MU botulinum toxin A resulted in a nearly complete blockade of gustatory sweating for the observation period of 1 year. In the group treated with 2 MU botulinum toxin A, 44% of the total gustatory skin areas were still sweating, thus necessitating a second injection of botulinum toxin A in these patients. CONCLUSION: Intracutaneous injection of botulinum toxin A represents a highly effective and minimally invasive procedure for the treatment of Frey's syndrome. This study shows for the first time that a dosage of 3 MU/cm(2) of botulinum toxin A achieves a complete and reliable blockade of gustatory sweating lasting for at least 12 months. This dose may therefore be recommended for treatment of this syndrome.     

声刺激联合认知行为治疗慢性耳鸣的初步探讨

目的 探讨声刺激联合认知行为治疗(CBT)对慢性耳鸣的临床疗效。方法 本研究将49例慢性耳鸣患者按照随机数字表法分为干预组(25例)和对照组(24例),所有患者均行声音刺激1个月。干预组患者同时接受持续1个月的个体化的CBT,对照组患者不接受个体化CBT。所有患者在治疗前和治疗后30 d均需填写问卷,包括耳鸣残疾评估量表(THI)、焦虑自评量表(SAS)及匹兹堡睡眠质量指数(PSQI)。结果 两组患者均完成临床试验。治疗1个月后观察,对照组患者THI、SAS、PSQI的平均值分别下降15.58、15.46、4.96,干预组患者THI、SAS、PSQI的平均值分别下降40.52、41.76、7.72, 差异具有统计学意义(P＜0.05);且干预组患者THI、SAS、PSQI的得分均明显低于对照组。结论 声音刺激和CBT可以预测治疗效果,声音刺激联合CBT的治疗效果优于单独的声音刺激。性别、年龄和听力障碍是耳鸣最相关的危险因素。     

鼻中隔偏曲及慢性鼻窦炎鼻息肉患者的精神心理状态调查

目的 初步调查鼻中隔偏曲(DNS)、慢性鼻窦炎鼻息肉(CRSwNP)患者的精神心理状况,观察其手术前后的心理变化。 方法 利用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估44例CRSwNP、41例DNS、31例声带息肉患者(对照组)手术前后焦虑、抑郁症状。另取39例健康者作健康对照。 结果 术前各组的SAS和SDS评分依次为:健康组(36.74±10.39; 38.51±11.30)、对照组(38.52±10.99; 42.26±10.42)、CRSwNP组(42.00±13.54; 43.84±15.44)、DNS组(45.02±10.80; 48.32±11.21)。健康组、对照组与DNS组之间的SAS和SDS评分差异有统计学意义(P<0.01)。CRSwNP组和DNS组的术前、术后的SAS和SDS评分差异有统计学意义(P<0.05)。约1/3的DNS组和CRSwNP组的患者术后仍出现焦虑或抑郁症状。 结论 DNS、CRSwNP患者存在一定的焦虑、抑郁症状,术后其评分较术前改善,但约1/3的患者术后仍有焦虑、抑郁症状,必要时应给予心理干预。     

连续性院外管理对喉癌患者术后生活质量的影响

目的 探讨连续性院外管理对喉癌患者术后生活质量的影响。 方法 选择2016年1月至2017年6月于宜宾市第二人民医院进行手术治疗的喉癌患者82例,采用分层随机化方法随机分为对照组38例和干预组44例,对照组给予常规性院外随访,干预组进行连续性院外管理,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、成人希望特质量表(ADHS)、一般健康状况量表(SF-36)、癌症病人生活质量问卷(QLQ-C30)及癌症功能评价专用头颈量表(FACT-HN)评估患者生活质量,分析两组患者情绪、认知和生活质量的差异。 结果 出院6个月后对照组与干预组焦虑发生率分别为42.1%、15.9%,两组比较差异有统计学意义(χ2=6.933, P=0.013);对照组与干预组抑郁发生率分别为39.5%、9.1%,两组比较差异有统计学意义(χ2=10.573, P=0.001)。出院后6个月对照组与干预组SAS评分分别为(49.2±10.3)、(41.3±8.7)分,SDS评分分别为(47.4±9.2)、(40.5±7.0)分,ADHS评分分别为(27.1±7.8)、(34.7±6.9)分,两组比较差异均有统计学意义(t分别为3.77、3.85、4.68, P均<0.01)。在SF-36量表中,除一般健康状况(GH)和精力(VT)2个维度差异无统计学意义外,其余6个维度(生理机能、生理职能、躯体疼痛、社会功能、情感职能、精神健康)差异均有统计学意义,干预组高于对照组(t分别为2.31、2.54、4.15、2.66、3.59、2.59, P分别为0.02、0.01、<0.001、0.01、<0.001、0.01)。在QLQ-C30量表中,两组患者整体健康状况评分(t=2.42, P=0.02)、5个功能量表(躯体、认知、角色、情绪和社会)评分(t分别为3.06、3.95、2.27、2.23和0.01, P分别为<0.001、<0.001、0.03、0.03和0.01)和“失眠”和“食欲下降”2单项评分(t分别为2.69和2.33, P分别为0.01和0.02)差异有统计学意义。两组患者癌FACT-HN总分和3个维度(社会/家庭状况、情感状况和附加关注)差异有统计学意义(t分别为2.89、2.55、3.07和2.14, P分别为0.01、0.01、<0.001和0.04)。 结论 连续性院外管理能一定程度纠正喉癌患者心理问题,提高患者获得感和生存质量。     

Functional study of four neurotoxins as inhibitors of post-traumatic nerve regeneration

OBJECTIVES/HYPOTHESIS: Chemical inhibition of nerve regeneration was studied as a potential adjunct in the treatment of injuries to the facial or recurrent laryngeal nerve. We propose that by treating selected muscles with an inhibitor of nerve regeneration shortly after injury, synkinesis may be controlled. STUDY DESIGN: Nerve regeneration after crush injury was studied in the rat posterior tibial and sciatic nerves, well-established models for the study of peripheral nerve injuries. METHODS: Four days after controlled crush injury to the posterior tibial nerve, the gastrocnemius muscle was injected with saline (control, n = 8), phenol (n = 6), doxorubicin (n = 6), or vincristine (n = 11). Injection without crush injury was performed using vincristine (n = 4) or botulinum toxin (n = 4). Four rats underwent crush injury to the sciatic nerve followed 4 days later by botulinum toxin injection to the gastrocnemius muscle. The percent of functional recovery (%FR) of the nerve was assessed using walking track analysis. RESULTS: Vincristine significantly retarded nerve regeneration. Five weeks after injury, %FR returned to normal in controls, as well as in the phenol, doxorubicin, and botulinum toxin groups, while in the vincristine group %FR was less than 60% of baseline (P <.0001). Vincristine injections without crush injury showed no significant reduction in print length factor. Functional recovery in the botulinum/crush group was more rapid than the botulinum without crush group. CONCLUSIONS: Application of vincristine to the gastrocnemius muscle significantly inhibits regeneration of the posterior tibial nerve after crush injury. Botulinum toxin does not prolong functional recovery after nerve injury; rather, crush injury protects against the prolonged chemodenervation seen with botulinum toxin. Doxorubicin and phenol injection did not prolong functional recovery at the doses tested.