缓解期双相情感障碍患者述情障碍影响因素研究

目的 探讨缓解期双相情感障碍患者述情障碍的影响因素,为临床干预提供依据.方法 对100例缓解期双相情感障碍患者(研究组)与100名健康志愿者(对照组),采用多伦多述情量表中文版、Beck抑郁自评量表进行测评分析.结果 研究组多伦多述情量表总分和各因子分及Beck抑郁自评量表总分均显著高于对照组(P＜0.01).研究组患者多伦多述情量表总分及情感辨别不能、情感描述不能因子分均与抑郁总分呈显著正相关;其他不同维度与性别、受教育年限、工作学习应激等因素具有显著相关性.患者住院、与他人交流、抑郁总分依次进入情感辨别不能因子回归方程;抑郁总分、工作学习应激、性别依次进入情感描述不能因子回归方程;受教育年限、住院与他人交流依次进入外向性思维因子回归方程;抑郁总分、治疗信心依次进入总分的回归方程.结论缓解期双相情感障碍患者存在明显的述情障碍,影响因素不尽相同,其中性别、受教育年限、抑郁严重程度等是影响双相情感障碍患者述情障碍的重要因素.     

中青年永久性结肠造口患者配偶述情障碍及成人依恋现状及其相关性

目的了解中青年永久性结肠造口患者配偶述情障碍及成人依恋现状,探讨二者之间的关系。方法采用一般资料调查表、亲密关系体验量表(experiences in close relationships inventory,ECR)及多伦多述情障碍量表(twenty-item Toronto alexithymia scale,TAS-20)对128名中青年永久性结肠造口患者配偶进行调查。结果中青年永久性结肠造口患者配偶述情障碍得分为(57.32±12.15)分;依恋焦虑维度(69.74±14.58)分,依恋回避维度(48.22±13.29)分。依恋焦虑维度及依恋回避维度与述情障碍均呈正相关(P0.01)。回归分析显示,控制一般资料变量后,依恋焦虑与依恋回避可解释中青年永久性结肠造口患者配偶述情障碍得分的18.9%的变异。结论中青年永久性结肠造口患者配偶述情障碍处于临界状态,依恋焦虑处于中等偏高水平,依恋回避处于偏低水平。护理人员可从关注中青年永久性结肠造口患者配偶成人依恋水平入手,帮助其建立积极的应对方式,从而改善其述情障碍。     

女性偏头痛患者述情障碍对其心理健康的影响

目的:调查女性偏头痛患者述情障碍的现状,分析述情障碍的特点及其对患者心理健康的影响。方法:采用一般资料调查表、多伦多述情障碍评定量表、视觉模拟量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表对223例女性偏头痛患者和175例正常女性对照进行调查问卷。结果:1)观察组多伦多述情障碍量表(TAS-20)总分、识别情感能力(DIF)、描述情感能力(DDF)显著高于对照组,外向性思维(EOT)显著低于对照组,两组比较差异均有统计学意义;2)女性偏头痛患者述情障碍总分为(49.85±9.99)分,识别率为45.7%,焦虑症状的发生率为46.6%,抑郁症状的发生率为69.9%。3)不同述情障碍水平女性患者在焦虑、抑郁及疼痛的感知上均存在显著性差异;述情障碍各因子及总分均与疼痛、焦虑、抑郁水平呈显著正相关,抑郁、焦虑、疼痛是女性偏头痛患者述情障碍的重要影响因素。结论:女性偏头痛患者存在一定程度的述情障碍,识别和改善述情障碍对其临床症状改善及心理健康有重要意义。     

精神分裂症患者述情障碍治愈前后的比较研究

【目的】探讨精神分裂症患者临床治愈前后述情障碍的变化及相关因素。【方法】比较36例精神分裂症患者临床治愈前、后以及与40例正常人的多伦多述情障碍量表（TAs）评定结果。【结果】述情障碍在-l占床治愈前组的发生率为（63．9％）,显著高于正常对照组（15％）。精神分裂症患者治愈前、后TAs总分及各因子分有显著差异（P〈0．01或P〈0．05）;患者治愈前TAS总分和情感辨别不能、情感描述不能因子分均显著高于治愈后（P〈0．05）,外向性思维因子分无明显差异（P〉0．05）;临床治愈前组TAs总分和各因子分均显著高于对照组（P〈0．05）;临床治愈后组TAS总分和外向性思维、情感辨别不能因子分显著高于对照组（P〈O．05）,情感描述不能因子分均无明显差异（P〉0．05）;进行相关分析,发现治愈前TAS评分与发病次数具有显著的正相关（r=0．453,P〈0．01）,与病程、文化、年龄和性别均无显著相关性（P〉0．05）。【结论】精神分裂症患者治疗前、后均存在述情障碍,治愈后述情障碍得到明显改善。     

抑郁症患者的述情障碍程度与社会支持状况的相关分析

目的了解抑郁症患者的述情障碍程度与社会支持的关系。方法应用多伦多述情障碍量表（TAS）和社会支持评定量表（SSRS）对86名抑郁症患者进行调查研究。结果抑郁症患者（75．22±13．93）分在多伦多述情量表上的得分明显高于正常组得分（60．19±9．27）分（P〈0．01）,抑郁症患者在因子1描述情感能力和因子2区别情感和躯体感受能力方面的得分最高,明显高于中间值,除了主观支持与述情障碍量表的各个因子都无相关（P〉0．05）之外,描述情感的能力与社会支持总分和其他因子的得分均呈显著的负相关（P〈0．01）,幻想与社会支持总分和其他因子的得分均呈显著的正相关（P〈0．01）。结论抑郁症患者的述情障碍程度与其社会支持状况有关,可以通过解决抑郁症患者的述情问题,来提高其社会支持情况。     

肝豆状核变性患者述情障碍研究

目的:探讨肝豆状核变性(hepatolenticular degeneration,HLD)患者的述情障碍与中医证型的相关性,为中医药早期干预提供参考依据。方法:采用多伦多述情障碍量表(The twenty—item Toronto Alexithymia Scale,TAS-20)对165例HLD患者和42例健康人群进行问卷调查,运用t检验,方差分析对结果进行分析。结果:(1)HLD患者TAS-20得分情感辨别不能[(17.70±3.83)分]、情感描述不能[(18.82±3.97)分]、外向性思维[(19.24±4.22)分]高于正常组[分别为(7.36±1.86)分,(8.64±1.32)分,(8.17±1.58)分],差异具有显著性(P0.01)。(2)各证型HLD患者情感辨别不能、外向性思维均受影响,差异具有显著性(P0.01)。结论:HLD患者存在述情障碍,情感辨别不能、外向性思维方面更严重。     

精神分裂症患者述情障碍与自动思维相关性研究

目的 探讨精神分裂症患者述情障碍与负性自动思维的相关性,为临床治疗提供依据.方法 将72例精神分裂症患者设为研究组,抽取同期健康志愿者66名设为对照组,采用自拟一般资料调查表、多伦多述情障碍量表和自动思维问卷对两组进行测评,同时采用阳性与阴性症状量表对研究组进行评定,对上述评定结果进行对比分析及相关分析.结果 研究组多伦多述情障碍量表总分及各因子分和自动思维问卷总分均显著高于对照组(P＜0.05或0.01),阳性与阴性症状量表总分和阳性症状、阴性症状因子分及抑郁症状项目分与多伦多述情障碍量表、自动思维问卷评分均无显著相关(P＞0.05),自动思维问卷评分与多伦多述情障碍量表总分及描述自身情感的能力、认识和辨别情感和躯体感受的能力因子分呈显著正相关(P＜0.05或0.01).结论 精神分裂症患者存在较高水平的述情障碍和负性自动思维,述情障碍与自动思维存在相关,提示在认知治疗的过程中,开展述情能力的情绪加工能力训练治疗,对患者的功能康复具有积极意义.     

失眠症患者的述情障碍研究

为探讨失眠症患者的述情障碍问题,应用多伦多述情障碍量表(TAS),将失眠症患者与正常人对照研究。结果,失眠症组量表得分显著高于对照组(P<0.01),女性患者TAS总分及因子Ⅳ得分显著高于男性患者(P<0.05)。说明失眠症患者存在较严重的述情障碍,且女性患者更显著。     

以躯体症状为主的抑郁症患者述情障碍特征分析

目的探讨以躯体症状为主的抑郁症患者述情障碍的临床特征。方法对52例以躯体症状为主诉(A组)和56例以情感症状为主诉(B组)的抑郁症患者与50名正常健康者(C组),采用汉密顿抑郁量表和多伦多述情障碍量表进行评定分析。结果A组汉密顿抑郁量表焦虑/躯体化、睡眠障碍及绝望感因子分和多伦多述情障碍量表因子Ⅲ评分均显著高于B组及C组(P<0.05或0.01);多伦多述情障碍量表评分除B组因子Ⅲ与C组比较无显著性差异外,A、B两组总分和其他各因子分均显著高于C组(P均<0.05)。结论以躯体症状为主的抑郁症患者可能有更多的消极观念,并且缺乏幻想和想象力。     

中年男性失眠症患者述情障碍的临床特征

目的:探讨中年男性失眠症患者述情障碍的特征。方法:分别对50例中年男性失眠症患者(失眠组)及50例健康男性(对照组)采用多伦多述情障碍量表(TAS-20)及明尼苏达多相个性调查问卷(MMPI)进行评估比较。结果:失眠组TAS总分及因子Ⅰ、Ⅱ、Ⅳ评分均高于对照组,其MMPI各临床量表中疑病、抑郁、癔症、男性-女性化、精神衰弱平均T分值均高于对照组,差异均有统计学意义(P0.05)。失眠组TAS因子I与精神衰弱正相关,因子Ⅱ、因子Ⅲ与抑郁正相关,因子Ⅳ与癔症正相关(r分别为0.012、0.045、0.049、0.007,P0.05)。结论:中年男性失眠症患者存在述情障碍,且有一定的人格基础,这两者存在相关性。     

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.