抗精神病药物对精神病患者短暂性脑缺血发病影响的临床研究

目的：探讨抗精神病药物对精神病患者短暂性脑缺血发病影响。方法：对比研究服用抗精神病药物的患者,并采用某社区不服用抗精神病药物中老年人群作为对照组,经5～10年随访,进行统计学分析。结果：服用抗精神病药物的患者短暂性脑出血的发病率（21.7%）明显高于对照组（5.3%）,且女性发病率高于男性,值得临床医师关注。结论：抗精神病药物潜在的诱发高血脂等不良反应应该引起临床医师的注意。     

正确区分精神药品和抗精神病药物

随着抗精神疾病药物不断开发和应用以及精神病人用药方案的进一步科学和完善,抗精神病药物使用情况也在不断地发生变化。本文通过精神药品与抗精神药物的相关知识介绍,促进合理用药,减少医疗差错。     

非典型抗精神病药物与强迫症状

由于非典型抗精神病药物的作用谱广，锥体外系等副作用小，安全性好等优点，在临床上得到广泛应用。近年来其引，起的强迫症状越来越受到重视。现综述如下。     

新型抗精神病药物对代谢综合症的影响研究进展

自非典型抗精神病药物如氯氮平（clozapine）、奥氮平（alozapine）、利培酮（risperi-done）、奎硫平（quetiapine）、阿力哌唑（aripiprazole）、齐拉西酮（ziprasidone）及舍吲哚（sertindole）等问世以来,由于此类药物对精神分裂症的阳性、阴性和情感症状均有效,认知损害少,引发锥体外系的不良反应危险低,其使用已经超过传统的抗精神病药物,     

安定与抗精神病药物联合应用引起意识模糊状态1例

<正> 患者,男性,25岁,该患者于1994年6月在部队因工作不顺心而出现精神症状,主要表现孤僻,不愿与人接触,无故发笑,经常在周围无人时能听到有人与自己讲话等。入院诊断为“精神分裂症”入院后口服冬眠灵50～300mg,2/d治疗,一个月后上述精神症状消失,但晚间睡眠欠佳,故增服安定5mg,2/d。2d后患者出现反应迟钝,动作缓慢,意识清晰度下降。对时间的定向力亦有障碍,常分辨不出上午或下午,讲话时思维不联贯。晚间睡眠未得到明显改善,且出现尿床现象。当时立即停用安     

抗精神病药物所致便秘的原因分析及护理干预

目的：探讨住院精神分裂症患者服用抗精神病药物所致便秘的原因分析及护理干预。方法对2015年1月～2015年12月住院的112名精神分裂症患者服用抗精神病药物是否引起便秘进行统计分析。结果各类抗精神病药物均能引起便秘,最高达27％,最低达3％。结论便秘与使用抗精神病药物具有明显的相关性,是抗精神病药物的常见不良反应。     

动脉粥样硬化患者介入术后服用抗血小板药物的依从性及其影响因素

目的 探讨动脉粥样硬化患者介入术后服用抗血小板药物依从性及其影响因素。方法 选取上海市某三级甲等医院血管外科351例行介入手术出院后需长期服用抗血小板药物的动脉粥样硬化患者作为研究对象,以问卷调查的方法收集资料。采用中文修订版Morisky服药依从性量表及自行设计药物相关知识问卷对于患者服药依从性进行调查,采用单因素分析和多因素logistic回归分析动脉粥样硬化患者介入术后服药依从性的独立危险因素。结果 343例患者服药依从性得分为7.0(5.5～8.0)分。单因素分析显示,性别、年龄、下肢动脉硬化闭塞症、高血压病史、家属提醒服药、知晓药物剂量、工作状态、生活自理能力等是可能影响患者服药依从性的相关因素（均P<0.05）;经多因素logistic回归分析显示,年龄与文化程度是影响患者服药依从性的独立危险因素（P<0.05）。结论 动脉粥样硬化患者介入术后服用抗血小板药物依从性有待进一步提高,应针对不同患者采取不同的干预措施,提高服药依从性。     

缺血性脑卒中患者抗血小板药物服药依从性及影响因素

目的:对缺血性脑卒中患者抗血小板药物服药依从行为的现状进行调查,探讨药物依从性的影响因素.方法 选取2017年6月至12月期间在本院住院的缺血性脑卒中患者585例,根据服药依从性情况,将研究对象分为依从性好的患者280例,依从性差的患者305例,通过Logistic回归分析影响缺血性脑卒中患者抗血小板药物服药依从性的影响因素.结果 A组患者的文化程度、家庭收入、有医保、居住在城市、合并糖尿病、合并高血脂症复诊的比例均显著高于B组,多因素Logistic回归结果显示,患者抗血小板药物服药依从性的影响因素有年龄、文化程度、家庭年收入、医保、合并糖尿病、合并高脂血症、复诊(P＜0.05).结论 缺血性脑卒中患者服用抗血小板药物的服药依从性有待进一步提高,应重点针对低年龄、文化程度不高、无医保、无合并其他慢性病的人群进行个性化干预,加强宣传缺血性脑卒中患者的二级预防,提高患者的服药依从性.     

抗精神病药物致麻痹性肠梗阻的X线与超声诊断价值探讨

目的：探讨抗精神病药物所致麻痹性肠梗阻的X线和超声表现及其诊断价值。方法：回顾性分析临床确诊的47例抗精神病药物所致麻痹性肠梗阻的X线和超声检查资料，对比其影像学表现和诊断符合率。47例均行立位X线腹部平片和透视检查，其中36例同时行B超检查。结果：依据其典型影像学表现判定，X线诊断符合率为87．2％（41／47），6例漏诊；超声诊断符合率为83．3％（30／36），6例漏诊；卡方检验两者无显著性差异（P〉0.05）。结论：X线检查是诊断抗精神病药物所致麻痹性肠梗阻的首选方法，超声对肠腔积液的发现具有优越性。两者结合能够提高诊断符合率。     

A small scale qualitative study to investigate the interaction between psychiatric patients and diagnostic radiographers in one Irish hospital

Background

A substantial number of patients with psychiatric illnesses present to the Imaging Department across the Irish Republic each year. Patients who have a psychiatric illness may present difficulties for the radiographer during a radiographic examination. These difficulties may include communication difficulties, and an increased prevalence to become violent due to their illness.

Aims

To investigate if radiographers feel confident interacting with psychiatric patients. To ascertain if radiographers need more training in this area of patient interaction.

Method

A qualitative approach was used drawing upon six radiographers working in a regional hospital with a psychiatric unit attached. The radiographers were interviewed individually and the results were thematically analysed.

Results

The results indicated that the level of the radiographers own confidence in relation to interacting with psychiatric patients was influenced by the number of years since qualification. The majority of radiographers in the study displayed a poor knowledge of psychiatric conditions and how they affect patients.

Conclusion

Based upon this small study, the results suggest that newly qualified radiographers do not feel confident in their own abilities when interacting with psychiatric patients and would welcome and benefit from specific training with regards to strategies to deal with psychiatric patients. The radiographers reported that particular areas which may be improved upon are more information on psychiatric illnesses, manifestations of different types of psychiatric illness and the subsequent effect on patients. A larger study encompassing the whole of the Republic of Ireland would be valuable as a precursor to a European comparative study in order to investigate this phenomenon at a deeper level. Additionally it is recommended that further research is conducted within a wider European context on student radiographers and lecturers teaching on undergraduate radiography courses to ascertain if this topic is addressed at undergraduate level.     

腹腔镜胆囊切除术复杂病例的处理

目的：总结复杂病例的腹腔镜胆囊切除术的经验。方法：回顾分析319例复杂情况的腹腔镜胆囊切除术，其中急性胆囊炎51例，胆囊周围及／或腹腔粘连91例，萎缩性胆囊炎46例，慢性嵌顿性胆囊结石131例。结果：302例成功地施行了LC，中转开腹17例，中转开腹率5.3％。术后并发胆漏1例，发热1例，全组病例无死亡。结论：比治疗复杂情况的胆囊结石安全、有效。应注意合理地选择病人、仔细操作及充分的术前准备，以提高手术成功率，减少并发症的发生。     

血清8种胆固醇脂肪酸与胆囊结石成因分析

为分析胆结石形成与胆固醇脂肪酸的关系,采用气相色谱法(HPLC)测定结石组59例、非结石组43例血清中8种胆固醇脂肪酸含量。经统计学处理,发现20:5、20:4、18:2、14:0、18:1均有显著差异,认为肥胖及高胆固醇血症是胆囊结石的高危因素。     

Oesophageal motility disorders in patients with psychiatric disease

Clinical and experimental observations indicate that the motility of the oesophagus may be affected by emotional stimuli. The aim of this study was to evaluate the incidence of oesophageal contractility impairment in patients suffering from a psychiatric disorder. Fifty-one patients admitted to the psychiatric department were submitted to an oesophageal transit study by means of krypton-81m. All patients with an abnormal oesophageal transit underwent manometry and endoscopy. The level of depression and anxiety was evaluated by the treating psychiatrist, using the Hamilton Depression and Anxiety Rating Scales. The oesophageal transit was abnormal in 13 patients. Two of these 13 patients refused manometric investigation. In ten of the 11 remaining patients, the manometry revealed functional motor abnormalities. Endoscopy, performed in all these ten patients, was normal. In conclusion, a high percentage of oesophageal contractility disturbances was found in psychiatric patients complaining of anxiety and/or depression. These abnormalities were detected by scintigraphy as well as by manometry. Owing to the normal endoscopic findings, these contraction abnormalities are likely to reflect a functional motor impairment.     

Clinical,laboratory, psychiatric and magnetic resonance findings in patients with Sydenham chorea

The objective of this study was to determine the clinical and laboratory characteristics, psychiatric manifestations and magnetic resonance imaging (MRI) findings in children and adolescents with Sydenham chorea (SyC). The imaging examination was repeated 1 year after the acute phase of SyC. There were 19 patients with a mean age of 11.7 years and a predominance of females (79%);68% had generalized chorea and 53% moderate chorea. SyC presented as an isolated manifestation in 74%. No association between SyC and obsessive-compulsive disorder was found. Mental health problems were present in 45% of the patients. MRI analysis revealed persistent alterations in the caudate nucleus in three patients (16%), who presented recurrent episodes of chorea during the study. In one patient, MRI revealed the presence of nodular heteropathy close to the caudate nucleus region. We conclude that attention problems can be associated with acute clinical features of SyC and persistent alterations in the basal nuclei, evidenced by MRI, can be found in some patients who tend to suffer prolonged attacks and a greater number of recurrences.     

光比浊法评价老年心血管疾病患者阿司匹林抵抗的现患率及相关危险因素

 目的 光比浊法评价老年心血管疾病患者阿司匹林抵抗的现患率及可能的潜在危险因素.方法 454例老年心血管疾病患者,平均(73.91±8.12)岁,口服阿司匹林(≥75 mg) 1个月以上.结果 光比浊法检测结果 显示,38例(8.4%)发现为阿司匹林抵抗,166例(36.6%)为阿司匹林半抵抗,阿司匹林不敏感者(含阿司匹林抵抗和半抵抗)总计204例(45%).多因素回归分析表明,血管紧张素转换酶抑制药/血管紧张素受体拮抗药(ACEIs/ARBs) (OR=0.638,95% CI:0.414～0.983,P=0.042) 和硝酸酯类药物(OR=0.570,95% CI:0.367～0.884,P=0.012) 为阿司匹林不敏感者的保护性因素.结论 实验室检测提示,老年心血管疾病患者阿司匹林抵抗发生率较高,ACEIs/ARBs,硝酸酯类药物为阿司匹林不敏感者的保护性因素.     

Compound analysis of gallstones using dual energy computed tomography—Results in a phantom model

Purpose

The potential of dual energy computed tomography (DECT) for the analysis of gallstone compounds was investigated. The main goal was to find parameters, that can reliably define high percentage (>70%) cholesterol stones without calcium components.

Materials and methods

35 gallstones were analyzed with DECT using a phantom model. Stone samples were put into specimen containers filled with formalin. Containers were put into a water-filled cylindrical acrylic glass phantom. DECT scans were performed using a tube voltage/current of 140 kV/83 mAs (tube A) and 80 kV/340 mAs (tube B). ROI-measurements to determine CT attenuation of each sector of the stones that had different appearance on the CT images were performed. Finally, semi-quantitative infrared spectroscopy (FTIR) of these sectors was performed for chemical analysis.

Results

ROI-measurements were performed in 45 different sectors in 35 gallstones. Sectors containing >70% of cholesterol and no calcium component (n = 20) on FTIR could be identified with 95% sensitivity and 100% specificity on DECT. These sectors showed typical attenuation of −8 ± 4 HU at 80 kV and +22 ± 3 HU at 140 kV. Even the presence of a small calcium component (<10%) hindered the reliable identification of cholesterol components as such.

Conclusion

Dual energy CT allows for reliable identification of gallstones containing a high percentage of cholesterol and no calcium component in this pre-clinical phantom model. Results from in vivo or anthropomorphic phantom trials will have to confirm these results. This may enable the identification of patients eligible for non-surgical treatment options in the future.     

精神科与其他临床科室护理人员心理状况对照调查分析

 目的 了解精神科护理人员的心理状况.方法 采用焦虑自评量表(SAS)、症状自评量表(SCL-90)、抑郁自评量表(SDS)和社会支持评定量表(SSRS)对工作在精神科的护理人员及其他临床科室的护理人员进行对照调查.结果 两组人员的SAS、SCL-90、SDS及SSRS总分无统计学意义(P＞0.05),但是精神科护理组在SCL-90中抑郁因子、焦虑因子分高于对照组(P＜0.05),说明长期工作在精神科对她们的心理有一定的影响,表现为焦虑抑郁情绪.对精神科护理组人员进行心理疏导,两周后复测SCL-90抑郁因子、焦虑因子分与对照组无统计学意义(P＞0.05),精神科护理组得分与国人常模青年组比较无统计学意义(P＞0.05),说明对有一定焦虑抑郁情绪的人员及时进行心理疏导后可恢复至正常.结论 精神科护理人员与其他临床科室护理人员的心理健康状况无统计学意义,但精神科护理人员的抑郁、焦虑水平高于对照组,经心理疏导后,心理状况可恢复到正常水平.     

Percutaneous extraction of gallstones in 20 patients

Percutaneous cholecystolithotomy (PCL) was accomplished successfully without general anesthesia in 17 of 20 consecutive symptomatic patients from an outpatient gallstone center who were at risk for or had refused cholecystectomy. The other three patients underwent cholecystectomy because of a gallbladder collapse before admission, a tight stone-bearing phrygian cap, and a cannula slippage, respectively. A subhepatic approach was preferentially used after the fundus of the gallbladder was stabilized with a percutaneous anchor to prevent invagination and bile leakage. Retrograde slippage of the anchor into the tract in the first six patients was remedied by elongating the anchor from 2 to 3 cm. Calculi were removed in one session (11 patients) or two consecutive sessions (six patients). Morbidity included rehospitalization for stitch infection (n = 1) and dehydration (n = 1), cannula slippage (n = 1), broken guide wire (n = 1), vasovagal reaction (n = 1), and unextractable anchors (n = 3). Gallbladder endoscopy enabled identification of stones not visible at cholecystography. Hospitalization lasted 3-5 days; outpatient gallbladder drains were removed in 2-3 weeks in 10 patients and 4-6 weeks in seven (older) patients. No retained stones were seen at 6 months. The authors recommend PCL for patients at risk for surgery.     

胆石症患者血清,胆汁,胆石相关元素分析和胆石成因的研究

利用火焰原子吸收法，对２７例胆石症患者血清、胆汁和胆石的相关元素进行测定，结果表明，胆石症患者血清钙明显高于正常人，而血清铜则明显低于正常人（Ｐ＜０．０１）；胆汁中钙、铜、钠、镁等元素明显低于对照组（Ｐ＜０．０１）；胆色素结石组钙、钠、镁等元素亦明显高于胆固醇结石组，说明血清钙、铜代谢异常及胆汁中钙、铜、钠、镁等元素含量的改变与胆石形成有密切关系。