酒依赖与社会、文化相关问题的探讨

目的：探讨酒依赖病人形成依赖的相关因素及对社会、家庭的危害。方法：对144例酒依赖住院病人的性别、职业、文化程度、婚姻、民族，初次饮酒平均年龄、成瘾平均年龄、时间、自杀、对社会、家庭危害等方面的相关问题进行了临床资料整理分析。结果：酒依赖发生以男性、文化水平初中以下、体力劳动者为主。成瘾平均时间11．1年，有16例在饮酒5年内成瘾，与饮酒量及频度有关。4例女性成瘾时间6年．较男性提前。发生自杀未遂14例。对家庭危害有家庭纠纷100％，伤人、毁物占半数以上．离婚22．2％。对社会危害以打架伤人、毁物、扰乱公务为主．丧失劳动能力、下岗、刑事犯罪。结论：酒依赖发生与性别、职业、文化水平、饮酒量、频度有一定相关性，酒依赖引起家庭、社会问题相当普遍，给社会带来一定不良影响，提示应提高民族文化素养，对高危人群进行饮酒健康教育．对有害饮酒实行早期干预，防止酒依赖发生。     

酒依赖者戒酒追踪护理

目的 帮助酒依赖者戒酒。方法 对46例酒依赖者进行追踪护理。结果 成功戒断35例，占76．09％，未戒断11例，占23．91％。结论 酒依赖者饮酒时间的长短及饮酒量的多少不是戒酒成功与否的关键因素，而文化程度较高、家庭关系良好、从事职员及工人的酒依赖者戒酒成功的机会较大，而且追踪护理是戒酒成功的重要促进因素。     

碳酸锂治疗酒依赖疗效分析

目的 评估碳酸锂治疗酒依赖的临床疗效。方法 对符合DSM-3诊断标准的36例酒依赖患使用碳酸锂治疗，并配合认知疗法，随访3a。结果 36例患住院17-60d，平均30d，均痊愈出院。经3a随访，36例中发现有12例(33．3％)完全戒断饮酒，均坚持服用碳酸锂；有15例(41．7％)能控制饮酒，间断服用碳酸锂；有9例(25％)重新喝酒，均未坚持服用碳酸锂。结论 碳酸锂能减轻酒依赖患的酒醉，减少持续饮酒的欲望。碳酸锂治疗酒依赖安全度高，疗效肯定。     

厌恶疗法戒酒影响因素分析

目的探讨阿朴吗啡或呋喃唑酮厌恶疗法戒酒疗效及影响因素 . 方法 32例经以上两种药物戒酒治疗出院后复饮再次住院酒中毒病人 , 按复饮原因分主动饮酒 I组、被动饮酒 II组 . 比较两组疗效、住院时间和人格特征对疗效的影响 . 并探讨酒依赖时间与复饮时间的相关性 . 结果 I组住院时间长 , 但出院后疗效差 ( P<0.01) , 饮酒史、酒依赖史两组无差异 ( P>0.05) . 明尼苏达多项人格测定 Pd分两组有差异 ( P<0.01) . 酒依赖时间和饮酒史及精神症状与复饮时间无相关 ( P>0.05) . 结论酒中毒病人伴有人格改变者 , 厌恶疗法戒酒效果差 .     

酒依赖患者认知功能障碍临床研究

目的评估慢性酒依赖患者的认知功能状况。方法分别应用韦氏成人智力量表和韦氏记忆量表,对53例男性酒依赖患者和34名匹配的正常对照组进行智能和记忆功能的评定,比较两组之间的差异,并对酒依赖患者认知功能损害的危险因素进行相关分析。结果慢性酒依赖者的智商为（86.03±9.87）,记忆商为（61.07±10.13）,均显著低于对照组（P〈0.01）;智能和记忆量表的各因子分均低于对照组P〈0.05或0.01）。相关分析显示：慢性酒依赖患者的智商和记忆商数与饮酒时间呈显著负相关（r=0.4,P〈0.01）,与教育程度及习惯性饮酒开始年龄呈正相关（r=0.2,P〉0.05）。结论慢性酒依赖患者存在显著的认知功能障碍。     

酒依赖患者自杀行为的生物学标记

酒依赖指个体长期反复饮酒导致对饮酒的控制能力丧失为其特征的慢性进行病变,引起精神及躯体变化和社会、法律问题等。就个体而言酒滥用和酒依赖均会造成各种危害。酒滥用和酒依赖是当今世界严重的社会问题和医学问题。有报道显示,酒依赖是一种死亡率很高的疾病,主要与酒依赖患者的高自杀率有关。本文对酒依赖患者自杀行为的生物学标记进行综述如下。     

酒依赖患者的婚姻状况及分析

酒依赖指饮酒者反复大量饮酒而导致的躯体和精神两方面对酒精的强烈渴求与耐受性。这种渴求导致的行为已极大地优先于其他重要活动,此类患者的社会功能有明显损害。随着生活水平的提高,人们的社会交往活动日益频繁,饮酒人群不断扩大,酒依赖的发生率赤愈来愈高。在国外,酒依赖是列于心血管疾病、恶性肿瘤以后占第三位的最严重的三个公共卫生问题之一。作者对32例临床确诊为酒依赖的住院患者的婚姻状况进行了调查,发现酒依赖患者的婚姻存在严重问题,现将结果报告如下。     

酒依赖综合征复饮影响因素分析

目的 探讨酒依赖综合征复饮的影响因素.方法 将228例酒依赖综合征患者分为两组,复饮组（128例）及非复饮组（100例）.统计两组患者的一般资料,并应用家庭亲密度和适应性量表、社会支持评定量表及生活事件量表进行测评分析.结果 两组受教育时间、饮酒时间、日饮酒量,生活事件量表的生活事件、负性事件维度分,社会支持评定量表总分及各维度分,家庭亲密度和适应性量表的2个维度分比较差异有显著性（P＜0.05或0.01）;logistic回归分析显示,负性事件、饮酒时间是酒依赖综合征复饮的危险因素,客观支持、受教育时间为复饮的保护因素.结论 酒依赖综合征复饮的影响因素复杂,其中饮酒史长、负性事件是其危险因素,客观支持度及患者的受教育时间是保护因素.     

团体心理干预对酒依赖患者自我效能感及复饮率的影响

目的探讨系统的团体心理干预对住院酒依赖患者自我效能感及复饮率的影响。方法对在解放军第91中心医院精神科接受戒酒住院治疗的115例酒依赖者采用单纯随机抽样方法划分为研究组58例和对照组57例,组织研究组患者实施系统的团体心理干预,9周为一疗程。疗程结束后采用一般自我效能感量表对两组分别进行评定,并对入组患者进行出院后3个月、6个月、1年、3年跟踪调查复饮率,分析所得数据。结果研究组自我效能感得分为(24.3±5.7)分,明显高于对照组(19.7±6.4)分,差异有高度统计学意义(P0.01),且研究组复饮酒率明显低于对照组。结论对住院酒依赖患者进行系统团体心理干预可提高自我效能感,有效降低患者的复饮率。     

酒依赖者戒酒追踪护理

目的帮助酒依赖者戒酒.方法对46例酒依赖者进行追踪护理.结果成功戒断35例,占76.09%,未戒断11例,占23.91%.结论酒依赖者饮酒时间的长短及饮酒量的多少不是戒酒成功与否的关键因素,而文化程度较高、家庭关系良好、从事职员及工人的酒依赖者戒酒成功的机会较大,而且追踪护理是戒酒成功的重要促进因素.     

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.