心理干预对康复期精神分裂症患者心理状况及生活质量的影响

目的探讨心理干预对改善精神分裂症患者心理状况及生活质量的作用。方法将60例康复期精神分裂症患者随机分为干预组和对照组各30例,干预组在临床治疗的同时,采用心理干预治疗,心理干预内容:①心理疏导,②用药指导,③家庭气氛干预,④指导患者提高社会功能。于入组时、入组后4周对患者进行焦虑自评量表(SAS)和抑郁自评量表(SDS)、康复疗效评定量表(IPROS)心理测评。入组后4周用生活质量综合评定问卷(GQOLI-74)对所有患者进行评定。结果:入组后4周,研究组IPROS、SAS、SDS评分显著下降(P<0.01),对照组下降不明显(P>0.05);研究组IPROS、SAS、SDS评分显著低于对照组(P<0.01)。入组后4周研究组患者GQOLI-74每一维度的客观状态和主观满意程度的因子累积评分(除物质功能维度外),均显著高于对照组(P<0.05)。结论心理干预治疗能有效改善康复期精神分裂症患者的心理状况及生活质量。     

家庭干预对精神分裂症患者社会康复的作用

目的探讨家庭干预对精神分裂症患者社会康复的作用。方法将符合精神分裂症诊断标准的患者随机分为家庭组和对照组。家庭组在接受抗精神病药物治疗的同时,给予家庭干预治疗,对照组单一给予药物治疗。采用社会功能残疾评定量表（DAS）和生活质量量表（QOULI）评定精神分裂症患者的残疾程度和生活质量。结果家庭组治疗依从性显著高于对照组,复发率显著低于对照组。社会功能残疾家庭组显著轻于对照组,生活质量家庭组显著好于对照组。结论精神分裂症给予精神药物治疗配合家庭干预可以提高依从性,减少复发率,降低社会残疾程度和改善社会功能。     

结合认知行为治疗对首发男性精神分裂症的疗效研究

目的探讨抗精神病药结合认知行为治疗对首发男性精神分裂症的临床疗效、社会功能、生活质量的影响。方法首发男性精神分裂症60例按随机分组法分为2组,即单用抗精神病药治疗组和认知行为治疗组,疗程6个月。分别于0、4、12、24周末用PANSS评定临床疗效,大体评定量表(GAS)、生活质量综合评定问卷(GQOLI-74)评定患者的社会功能和生活质量。结果治疗后,2组PANSS总分显著低于治疗前,社会功能、生活质量总分显著高于治疗前。结论结合认知行为治疗对首发男性精神分裂症患者的临床疗效、社会功能及生活质量均明显高于单用抗精神病药组,值得临床试用。     

社会心理干预促进精神分裂症患者康复的研究

目的：探讨社会心理干预对精神分裂症患者精神症状、认知功能和社会功能的影响。方法将60例精神分裂症患者随机分成药物治疗组和药物治疗与社会心理干预组（综合治疗组）,每组30例。在治疗前和治疗的第12周采用PANSS量表评定精神症状,采用数字划销测验(CT)、修订韦氏成人记忆量表(WMS-RC)、威斯康星卡片分类测验(WCST)评估认知功能,以GAF和PSP评定社会功能。结果治疗12周后,两组患者的精神症状、认知功能和社会功能均较治疗前显著改善。而综合治疗组在这些方面的改善优于药物治疗组,并存在明显统计学差异（P<0.05）。结论社会心理干预能促进精神分裂症患者的康复。     

社区综合干预对精神分裂症患者服药依从性和生活质量的影响

目的探讨社区综合干预对精神分裂症患者服药依从性和生活质量的影响。方法将112例经治疗后出院的精神分裂症患者随机分为研究组和对照组,各56例。两组患者均接受抗精神病药物维持治疗,对研究组进行为期1年的综合干预(包括家庭访视、药物依从性干预、家庭干预及应急处置等),对照组则采用常规电话随访和门诊复诊,并对患者的服药依从性、再次住院率及生活质量进行评定。结果干预后研究组患者服药依从性显著高于对照组(P0.01);再次住院率显著低于对照组(P0.01);生活质量评分显著高于对照组(P0.01)。结论社区综合干预有助于提高精神分裂症患者的服药依从性,降低再次住院率,提高患者的生活质量。     

综合干预对精神分裂症缓解期及残留期患者康复的影响

目的 探讨综合干预在精神分裂症缓解期及残留期患者康复中的应用价值.方法 300例精神分裂症患者在急性期将该组患者分为观察组和对照组各150例,对照组采用非典型抗精神病药治疗,观察组在对照组的基础上给予健康心理治疗,将进入缓解期及残留期精神分裂症的234例患者分成综合干预治疗组及用单纯药物治疗组各117例,比较两组患者的生活质量、社会功能缺陷和认知功能.结果 观察组治疗总有效率、依从性均明显高于对照组(x2 =3.78、3.15,均P＜0.05).观察组的副反应量表(TESS)评分显著低于对照组(t =2.58,P＜0.05).进入缓解期及残留期后,综合干预组生活质量评分、认知功能评分均显著高于对照组、社会功能缺陷总分显著低于单纯药物治疗组(t =8.97、2.27,均P＜0.05).结论 综合干预有利于减少精神分裂症缓解期及残留期患者的社会功能缺陷,提高治疗效果,促进认知功能恢复,改善患者的生活质量.     

临床药物护理干预对缓解期精神分裂症患者的维持治疗及生存质量的影响研究

目的探讨临床药物护理干预对缓解期精神分裂症患者的药物维持治疗及生存质量的影响。方法将100例缓解期精神分裂症患者随机分为临床药物护理干预组和对照组各50例,两组均接受抗精神病药物治疗,而干预组合并药物护理干预措施,分别于入组时,入组后3个月、6个月、9个月、1年时进行简明精神病评定量表(BPRS)、WHO生存质量评定量表简表(WHOQOL-BREF)、治疗依从性、复发率和再住院率的评定。结果跟踪3个月到1年,干预组患者在WHOQOL的生理、领域、领域的评分显著高于对照组(P<0.05),治疗依从性明显高于对照组(P<0.01)。治疗依从性明显高于对照组(P<0.01)。结论临床药物护理干预保证了缓解期精神分裂症患者维持治疗的依从性,使患者生存质量改善。     

齐拉西酮对精神分裂症患者生活质量的影响

目的探讨齐拉西酮对精神分裂症患者生活质量的影响。方法对80例精神分裂症患者,随机使用齐拉西酮和氯丙嗪治疗组,疗程6个月。采用阳性与阴性症状量表(PANSS)评定疗效,采用治疗中出现的症状量表(TESS)评定不良反应,以生活质量综合评定问卷(GQOLI-74)评定生活质量。结果两组均有显著疗效,齐拉西酮可显著提高生活质量。两组间无显著差异(P>0.05)。氯丙嗪组不良反应比齐拉西酮组多。结论齐拉西酮和氯丙嗪对精神分裂症疗效相当,齐拉西酮不良反应较少,对提高患者生活质量的效果明显优于氯丙嗪。     

家庭干预对精神分裂症患者照料者心理的影响

目的探讨家庭干预对精神分裂症患者照料者心理健康的影响。方法选择临床"痊愈"出院的112例精神分裂症患者随机分为干预组(57例)和对照组(55例)。两组患者均给予抗精神病药物维持治疗及一般的健康教育,干预组在此基础上进行为期6个月的家庭干预。对照组只进行药物治疗。同时采用症状自评量表(SCL-90)和简明精神病评定量表(BPRS)在干预前、3月末、6月末对两组患者进行评定。结果①干预组6个月后的SCL-90各因子分及总分均显著低于对照组,差异有显著意义(P<0.01);②干预组6个月后的BPRS总分低于对照组,差异有显著意义(P<0.01)。结论家庭干预能够改善家庭照料者的心理健康水平。     

护理干预对首发精神分裂症患者疗效的影响

目的探讨护理干预对首发精神分裂症患者的疗效和社会功能康复的影响。方法选取80例在护理干预科病房住院治疗的首发精神分裂症患者为干预组,80例在非护理干预科病房住院的首发精神分裂症患者为对照组,对照组单用抗精神药物治疗,干预组在药物治疗的同时辅助心理和社会综合干预措施,于干预前,出院后随访6个月及1年末,采用自编一般资料调查表,阳性症状与阴性症状量表（PANSS）,社会功能缺陷筛选量表（SDSS）评定临床疗效及社会功能改善情况。结果PANSS评分出院后随防6月及1年末干预组总分及阴性症状分均显著低于对照组（P〈0.01）,SDSS评分出院后随访6个月及1年末干预组职业和工作、社会活动、家庭职能、生活自理、责任性和计划性等因素均显著低于对照组（P〈0.01）。结论护理干预措施有助于提高精神分裂症患者的疗效和促进社会功能的康复。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.