关节训练配合体位护理对急性期脑卒中患者预后观察

目的 探讨关节训练及体位护理在急性脑卒中偏瘫患者中应用的疗效.方法 对60例偏瘫患者随机分组:实验组30例,入院后生命体征稳定后开始进行关节训练配合体位护理;对照组30例,神经内科常规护理.采用Barthel指数及FuglMeyer量表评价两组患者关节活动度和日常生活能力.结果 两组Barthel指数分别为:实验组75.43±4.71、对照组49.53±5.9(t=18.65,P＜0.05);Fugl-Meyer运动功能评分分别为:74.83±1.683、56.67±2.354(t=34.38,P＜0.05);病人满意度分别为9.62±1.38、8.69±1.48(t=32.51,P=0.00).结论 关节训练与体位护理能够改善急性脑卒中偏瘫患者肢体运动功能、提高日常生活能力和病人的满意度.

Abstract：

Objective To observe the prognosis of joint training combining nursing position in acute stroke patients with hemiplegic Methods Sixty patients were randomly divided into two groups, experimental group (n = 30) and control group ( n = 30) .Control group was applied conventional nursing.Experiment group was adopted joint training combining nursing position after patients vital signs stabilization.Results The Barthel index scores of the two groups were different with the experiment group of 75.43 4.71 and the control group of 49.53 5.9 (t =18.65, P＜0.05) .And Fugl-Meyer motor function index scores was 74.83 1.683, 56.67 2.354 (t =34.38, P＜0.05) respectively of the two groups; there was a higher, satisfaction score in experiment group with 9.62 1.38 than that of control group with8.69 1.48 (t=32.51, P=0.00) .Conclusions The joint training combining nursing position could improve bemiplegic stroke patients'motor function and elevate the patients'daily activity and the patients' satisfaction.     

Reduction of risk associated with stent implantation using prophylactic application of aortic balloon counterpulsation in high-risk patients with myocardial infarction北大核心CSCD

Objective To evaluate the effect of prophylactic intra-Aortic balloon pump (IABP) on reduction of the incidence of major adverse cardiovascular events (MACE) occurred during perioperative period. Methods A total of 246 high-risk patients with AMI admitted from October 2013 through October 2016 were divided into two groups; prophylactic IABP group (n = 144) and remedial IABP group (n = 102). The likely complications associated with IABP were observed such as dissecting aneurysm, thrombocytopenia, lower extremity thrombosis, anemia, hematoma at puncture site. The comparison of postoperative heart failure, cardiogenic shock and refractory arrhythmia, and nosocomial death between two groups was carried out. The difference in length of time for treatment with IABP between two groups was compared. Statistical analysis of measurement data expressed in x ±s using independent sample t test. Count data expressed in percentage were compared with chi-square test. Non-normal distribution data were checked with median ± interquartile range. P <0. 05 for the difference was concerned statistically significant. Results Censini score was higher in prophylactic IABP group (t = 2. 311, P <0. 05). In remedial IABP group, the operative time was longer (t = 2. 626, P < 0. 05) , the higher rate of using therapeutic medicine was significant ( x2 = 60. 105, P <0. 01) , the no reflow rate was higher ( x2 = 19. 920, P < 0. 01), the amount of contrast agent used was greater (/ = 2. 437, P < 0. 05 ) , the in-hospital incidence of heart failure was higher ( x2 -31. 638, P <0. 01) , the rate of nosocomial postoperative cardiogenic shock was higher (x2 = 7.793, P <0. 01), and the number of in-hospital death increased (x2 =4. 827, P < 0.05). Compared with prophylactic IABP group, higher BNP (t = 7.447, P<0.05) , and lower LVEF (t = 3. 557, P<0. 05) were found in remedial IABP group. Conculsion Prophylactic employment of IABP for the treatment of high-risk AMI patients effectively improved the survival rate and reduced peri-opearative MACE.     

Diagnostic value of procalcitonin in distinguishing Gram-negative bacterial blood stream infection from Gram-positive bacterial infection in early stage of sepsis北大核心CSCD

Objective To investigate the diagnostic values of procalcitonin (PCT), high sensitive C-reactive protein (hs-CRP), white blood cell (WBC) and percentage of neutrocyte ( NEU% ) in Gram- negative and Gram-positive bacterial blood stream infection in early stage of sepsis in order to investigate the correlation between PCT and APACHE II score as well as between PCT and SOFA score, and the prognostic value in assessment of Gram-negative and Gram-positive bacterial blood stream infection. Methods Clinical data of patients admitted to ICU from January 2012 through December 2014 were retrospectively analyzed. A total of 124 sepsis patients with blood stream infection were checked with PCT, hs-CRP, WBC and NEU% tests, and APACHE II score and SOFA score were calculated. The differences in APACHE II score and SOFA score were compared between Gram-negative group (n = 41) and Gram-positive group (n = 83). The correlation between PCT and APACHE II score as well as between PCT and SOFA score was analyzed. The differences in diagnostic values of PCT, hs-CRP, WBC and NEU% between Gram-negative group and Gram- positive group were analyzed by using receiver operating characteristic (ROC) curve and it was plotted to assess the prognostic values of PCT, hs-CRP, WBC and NEU% for septic patients with blood stream infection. Results Compared with Gram-positive group, the levels of PCT [55. 32 (22. 01, 97. 11) vs. 2.13 (0.27, 5.27 )] (P<0.01), hs-CRP [ 105.09 ( 69.97, 186.12) is. 70.54 (42.37, 138.63)] (P = 0. 508), NEU% [88.30 (75.79, 93.52) w. 55.32 (22.01, 97.11)] (P=0.302) were higher but WBC was lower [13.59 (10.74, 17.58) vs. 13. 73 (11.32, 20.90)] (P = 0.058) in Gram-negative group. The ROC curve analysis of PCT showed the area under the curve (AUC) was 0. 867 (957c CI: 0. 789 - 0. 946). When the optimal cutoff point of PCT was 17.48 ng/mL, the largest Youden's index was found to be 0. 661 with 76. 9% sensitivity and 89. 2% specificity. Between two groups, there were significant 'differences in APACHE II score and SOFA score ( 27.46 ± 9. 60 vs. 23. 67 ± 7. 74, P - 0. 020; 8.05 ±3. 38 vs. 6. 59 ± 3. 45, P = 0. 028 ). There was significant difference in diagnostic value between PCT and SOFA (r =0.536, P =0.036) in Gram-negative group but no significant difference in Gram-positive group. Conclusions Higher PCT levels are found in Gram-negative group and it can play a role in differntiation between the Gram-negative group and Gram-positive group rather than hs-CRP, WBC and NEU%. PCT can be a better indicator for evaluation of severity of sepsis as well as for prognosis of sepsis patients with Gram-negative bacterium infection.     

精神科开放病房实施人文关怀护理管理的效果研究

目的 探讨精神科开放病房护士对精神分裂症患者实施人文关怀护理管理的临床效果.方法 选取2010年1～5月住院精神分裂症患者120例为测试对象,按住院时间段分为对照组和研究组,各60例.两组在接受抗精神病药物系统治疗的基础上,对照组接受常规护理管理,研究组接受人文关怀护理管理.于出院时,采用心理舒适感问卷调查表、症状自评量表(SCL-90)、护士用住院精神病人观察量表(NOSIE)和住院病人满意度调查表等评价工具对两组进行效果评定.结果 出院时,两组心理舒适感评估,研究组安全感为86.7%、满足感为95.6%、尊重感92.5%,对照组安全感为45.6%、满足感为57.8%、尊重感41.3%.两组比较存在显著差异(χ2值分别为23.2、49.6、36.5,P均＜0.01);两组心理健康水平评比,研究组SCL-90总均分为(1.45±0.73)分,对照组为(1.76±0.52)分,两组比较,差异显著(t=2.68,P＜0.01);两组行为障碍评比,研究组NOSIE病情总估计为(186.79±9.84)分,对照组为(165.12±9.21)分,两组比较,差异显著(t=13.10,P＜0.01);两组护士总体满意度评比,研究组为(4.87±0.77)分,对照组为(4.32±0.54)分,两组比较,差异显著(t=4.53,P＜0.01).结论 实施人文关怀护理管理,提供高品质的护理服务,一方面能够提高精神科住院病人满意度,另一方面,能够促进精神分裂症患者的心理和行为障碍的改善,对病人总体康复具有明显的促进作用.

Abstract：

Objective To explore the clinical efficacy of the humanistic nursing management that was implemented by the nurses who was in the psychiatry open ward. Methods There were 120 patients hospitalized patients with schizophrenia who were tested objects in hospital from March to December, 2009. According to the length of stays, they were devided into study group and contral group. There was 60 patients in each gruoup. Two groups were on the basis of system treatment of the antipsychotic drug, the contral group was accepted the ward conventional nursing management, the study group was accepted the humanistic nursing management. When they left the hospital, the clinincal effects were evaluated by the psychological comfort questionnaire , SCL-90, NOSIE and the hospital patient satisfaction questionnaire for both groups. Results When they left the hospital, the feeling of safety in study group was 86. 7%, satisfaction was 95.6%, feeling respect was 92. 5%. The feeling of safety in contral group was 45.6%, satisfaction was 57.8%, feeling respect was 41.3%. There were significant differences between two groups (x2 respectively was 49. 6 , 36. 5 and 23.2, P ＜ 0. 01 ). The total score of SCL - 90 in the study group was ( 1.45 ± 0. 73), it was ( 1.76 ± 0. 52) in the concral group, there was significant differences between two groups ( t = 2. 68, P ＜0. 01 ). Two groups of behavioral problems were comparied, the illness total score estimates of NOSIE in the study group was (186. 79 ±9. 84), in the contral group it was ( 165. 12 ±9. 21 ), there were sigpificant differences between two groups (t = 13. 10, P ＜0.01 ). The overall satisfaction in the study group was (4. 87 ±0. 77), in the contral group it was (4. 32 ± 0. 54), there was significant differences between two groups ( t = 4. 53, P ＜ 0. 01 ) . Conclusions Implementing humanistic nursing management, and providing the high quality nursing service could enhance psychiatric hospital patient satisfaction, and promote schizophrenia patients with mental and behavioural disorders,it would have significant positive effects for the overall recovery of schizophrenia patients.     

血必净与低分子肝素对严重脓毒症患者凝血功能及预后的影响

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.     

叙事护理对乳腺癌患者术后焦虑抑郁情绪及病耻感的影响分析

【 】 Objective To analyze the influence of narrative nursing on the bad mood and stigma of breast cancer patients. Methods Taking August 2021 to August 2022 as the time line, 60 patients with breast cancer who underwent surgery in our hospital during this period were selected as the research object. According to the order of admission, the first 30 patients were classified as the control group, and the other 30 patients were classified as the experimental group. The control group was given routine nursing care, while the experimental group was given narrative nursing care, and the changes of adverse emotions between the two groups were compared. Results The nursing satisfaction of the experimental group was higher than that of the control group (P < 0.05). Before nursing, there was no difference between the two groups (P > 0.05). After nursing, both groups improved, and the effect of the experimental group was better (P < 0.05). Before nursing, there was no difference in the scores of anxiety and depression between the two groups (P > 0.05). After nursing, both groups improved, and the effect of the experimental group was better (P < 0.05). Conclusion Narrative nursing can effectively alleviate the anxiety and shame of breast cancer patients, which is worth applying.     

卡培他滨单药在老年胃癌辅助治疗中的临床应用

Objective To evaluate the short-term efficacy and adverse effects of capecitabine as adjuvant chemotherapy of gastric cancer after resection in aged patients. Methods Sixty aged patients with gastric cancer (Ⅱ-Ⅲstage) after resection were randomized to two groups: the high dose group,in which 30 patients were treated least 6 therapeutic cycles (3 weeks for 1 cycle). Efficacy and adverse effects were assessed after 2 cycles. Results Two years' survival was 80% (24/30) in the high dose group and 77% (23/30) in the low dose group (χ2=0.54,P=0.45). The recurrence-free survival time was 19.2 months and 19.0 months respectively (χ2=0.82,P=0.36). Patients in the high dose group experienced more significant nausea/vomiting (Ⅰ-Ⅱ grade) than patients in the low dose group (χ2 = 9.82,P=0.02). However,there was no significant difference on grade Ⅲ-Ⅳ nausea/vomi-ting between the 2 groups(χ2=0.34,P=0.71). The incidence of grade Ⅰ-Ⅳ mucositis,hyperbilirubinemia and hand-foot syndrome (HFS) in the high dose group were higher than in the low dose group( P=0. 04,0. 02 and 0.04,respectively). There was no difference on weakness,lack of appetite and neutropenia between the two groups. in aged patients with similar efficacy and better tolerance of adverse effects compared to capeeitabine [2500 mg/     

卡培他滨单药在老年胃癌辅助治疗中的临床应用

Objective To evaluate the short-term efficacy and adverse effects of capecitabine as adjuvant chemotherapy of gastric cancer after resection in aged patients. Methods Sixty aged patients with gastric cancer (Ⅱ-Ⅲstage) after resection were randomized to two groups: the high dose group,in which 30 patients were treated least 6 therapeutic cycles (3 weeks for 1 cycle). Efficacy and adverse effects were assessed after 2 cycles. Results Two years' survival was 80% (24/30) in the high dose group and 77% (23/30) in the low dose group (χ2=0.54,P=0.45). The recurrence-free survival time was 19.2 months and 19.0 months respectively (χ2=0.82,P=0.36). Patients in the high dose group experienced more significant nausea/vomiting (Ⅰ-Ⅱ grade) than patients in the low dose group (χ2 = 9.82,P=0.02). However,there was no significant difference on grade Ⅲ-Ⅳ nausea/vomi-ting between the 2 groups(χ2=0.34,P=0.71). The incidence of grade Ⅰ-Ⅳ mucositis,hyperbilirubinemia and hand-foot syndrome (HFS) in the high dose group were higher than in the low dose group( P=0. 04,0. 02 and 0.04,respectively). There was no difference on weakness,lack of appetite and neutropenia between the two groups. in aged patients with similar efficacy and better tolerance of adverse effects compared to capeeitabine [2500 mg/     

卡培他滨单药在老年胃癌辅助治疗中的临床应用

Objective To evaluate the short-term efficacy and adverse effects of capecitabine as adjuvant chemotherapy of gastric cancer after resection in aged patients. Methods Sixty aged patients with gastric cancer (Ⅱ-Ⅲstage) after resection were randomized to two groups: the high dose group,in which 30 patients were treated least 6 therapeutic cycles (3 weeks for 1 cycle). Efficacy and adverse effects were assessed after 2 cycles. Results Two years' survival was 80% (24/30) in the high dose group and 77% (23/30) in the low dose group (χ2=0.54,P=0.45). The recurrence-free survival time was 19.2 months and 19.0 months respectively (χ2=0.82,P=0.36). Patients in the high dose group experienced more significant nausea/vomiting (Ⅰ-Ⅱ grade) than patients in the low dose group (χ2 = 9.82,P=0.02). However,there was no significant difference on grade Ⅲ-Ⅳ nausea/vomi-ting between the 2 groups(χ2=0.34,P=0.71). The incidence of grade Ⅰ-Ⅳ mucositis,hyperbilirubinemia and hand-foot syndrome (HFS) in the high dose group were higher than in the low dose group( P=0. 04,0. 02 and 0.04,respectively). There was no difference on weakness,lack of appetite and neutropenia between the two groups. in aged patients with similar efficacy and better tolerance of adverse effects compared to capeeitabine [2500 mg/     

卡培他滨单药在老年胃癌辅助治疗中的临床应用

Objective To evaluate the short-term efficacy and adverse effects of capecitabine as adjuvant chemotherapy of gastric cancer after resection in aged patients. Methods Sixty aged patients with gastric cancer (Ⅱ-Ⅲstage) after resection were randomized to two groups: the high dose group,in which 30 patients were treated least 6 therapeutic cycles (3 weeks for 1 cycle). Efficacy and adverse effects were assessed after 2 cycles. Results Two years' survival was 80% (24/30) in the high dose group and 77% (23/30) in the low dose group (χ2=0.54,P=0.45). The recurrence-free survival time was 19.2 months and 19.0 months respectively (χ2=0.82,P=0.36). Patients in the high dose group experienced more significant nausea/vomiting (Ⅰ-Ⅱ grade) than patients in the low dose group (χ2 = 9.82,P=0.02). However,there was no significant difference on grade Ⅲ-Ⅳ nausea/vomi-ting between the 2 groups(χ2=0.34,P=0.71). The incidence of grade Ⅰ-Ⅳ mucositis,hyperbilirubinemia and hand-foot syndrome (HFS) in the high dose group were higher than in the low dose group( P=0. 04,0. 02 and 0.04,respectively). There was no difference on weakness,lack of appetite and neutropenia between the two groups. in aged patients with similar efficacy and better tolerance of adverse effects compared to capeeitabine [2500 mg/     

超声造影评估脑血流循环时间在无创颅内压监测中的应用

目的:应用超声造影评估脑血流循环时间(cerebral blood flow circulation time,CCT)探索不同程度颅内压时CCT的变化规律,为无创颅内压监测提供新方法。方法:选取2019年1-12月空军军医大学唐都医院的10例颅内压增高的出血性脑卒中或急性颅脑创伤患者,在有创颅内压(invasive ...     

理性情绪疗法对2型糖尿病患者应对方式及自我管理行为的影响

目的：探讨理性情绪疗法对2型糖尿病患者应对方式及自我管理行为的影响。方法将90例住院2型糖尿病患者按照随机数字表法分为对照组与干预组各45例。对照组给予常规健康教育,干预组在此基础上采用理性情绪疗法进行心理干预,两组均随访3个月,分别在干预前、干预后3个月评估患者的应对方式、自我管理行为。结果两组患者干预前应对方式、自我管理行为差异无统计学意义（P＞0．05）,干预组干预后的应对方式得分中,面对为（22．44±3．33）分,高于对照组的（19．36±2．87）分,回避为（13．33±2．53）分,低于对照组的（14．93±2．61）分,屈服为（10．00±2．63）分,低于对照组的（11．93±3．03）分,差异均有统计学意义（t分别为-4．63,2．91,3．17;P＜0．05）;干预组干预后自我管理行为得分为（108．19±7．48）分,显著高于对照组的（100．95±6．24）分,差异有统计学意义（t＝-4．90,P＜0．05）。结论理性情绪疗法能改善2型糖尿病患者的应对方式、提高患者的自我管理行为。     

酒依赖患者共情缺陷与述情障碍的关系

目的调查酒依赖患者共隋能力与述情能力,探讨共晴缺陷与述隋障碍间的关系。方法采用人际反应指针量表（IRI-C）、多伦多述情障碍量表（TAS-20）对52例酒依赖患者进行评估,与52名正常对照者比较。结果IRI-C总分实验组为（51．92±9．49）分,对照组为（54．62±5．26）分,差异无统计学意义（t=-1．79,P〉0．05）;TAS-20总分实验组为（55．19±9．42）分,对照组为（42．46±10．09）分,差异有统计学意义（t=6．65,P〈0．01）;实验组IRI—C总分与TAS-20总分呈负相关（r=-2．01,P〈0．05）。结论酒依赖患者存在广泛的共情缺陷及述情障碍,提示加强酒依赖患者情绪表达及情绪理解的能力,对帮助患者恢复社会功能具有重要意义。     

创伤性颅脑损伤患者血清 miR-422a，miR-212-5p表达水平与病情和预后的相关性研究

目的　探讨创伤性颅脑损伤患者血清 miR-422a,miR-212-5p表达与病情和预后的相关性,分析 miR-422a,miR-212-5p诊断创伤性脑损伤患者预后的价值。方法　连续性选择 2018年 4月～ 2020年 6月山东省菏泽市中医院收治的 173例创伤性颅脑损伤患者（创伤组）和同期 125例志愿者（对照组）。根据格拉斯哥昏迷量表（ GCS）评分将创伤组患者分为轻度组（ GCS评分 13~15分,57例）,中度组（ GCS评分 9~12分,63例）和重度组（ GCS评分 3~8分,53例）,追踪临床结局,根据格拉斯哥预后量表（ GOS）评分将患者分为预后不良组（ GOS评分 1~3分,62例）和预后良好组（ GOS评分 4~5分,111例）。检测所有受试者血清 miR-422a,miR-212-5p表达,比较组间差异,分析 miR-422a,miR-212-5p与创伤性颅脑损伤患者预后的关系以及 miR-422a,miR-212-5p预测患者预后的价值。结果　创伤组血清 miR-422a表达高于对照组（3.02±1.02 vs 0.95±0.21）,miR-212-5p表达低于对照组（ 1.03±0.28 vs 2.85±0.61）,差异均有统计学意义（ t=22.340,     

血浆S1P和HDL-C表达水平与帕金森病患者临床症状的相关性研究

目的　分析帕金森病（ Parkinson’s disease，PD）患者血浆鞘氨醇 1磷酸（ sphingosine 1 phosphate，S1P）、高密度脂蛋白胆固醇（ high density lipoprotein cholesterol，HDL-C）表达水平，探讨二者与 PD患者临床症状的关系。方法　选择 2018年 7月～ 2021年 3月于保定市第二中心医院确诊的 PD患者 100例作为研究对象（ PD组），根据 HoehnYahr分期将患者分为轻度组（ 1～ 2期）35例、中度组（ 2.5～ 3期）36例和重度组（ 4～ 5期）29例。另选取同期健康体检者 105例为对照组。测定血浆 S1P和 HDL-C表达水平；比较不同严重程度 PD患者运动症状及非运动症状评分；采用 Pearson法分析 PD患者血浆 S1P和 HDL-C表达水平与运动症状评分和非运动症状评分相关性； Logistic回归分析影响重度 PD的危险因素。结果　PD组患者血浆 S1P（298.77±142.22 pmol/ml ）和 HDL-C（0.96±0.24 mmol/L）表达水平显著低于对照组（ 512.66±201.31 pmol/ml，1.87±0.33mmol/L），差异有统计学意义（ t=8.744，20.327，均 P =0.000）。轻度、中度和重度组血浆 S1P（395.33±156.66 pmol/ml，290.73±142.60 pmol/ml，210.25±113.07 pmol/ ml）与 HDL-C（1.36±0.29 mmol/L，1.07±0.25 mmol/L，0.45±0.16 mmol/L）表达水平依次降低，差异有统计学意义（F=14.090，113.414，均 P =0.000）。轻度组、中度组和重度组统一帕金森病评定量表第Ⅲ部分（ uni.ed parkinson’s disease rating scale Ⅲ ,UPDRS Ⅲ）评分（ 26.89±8.63分，43.11±16.66分，56.79±27.27分）、汉密尔顿抑郁量表（Hamilton depression scale ，HAMD）评分（ 12.35±3.96分，19.63±4.87分，25.18±5.17分）与汉密尔顿焦虑量表（Hamilton anxiety scale,HAMA）评分（ 8.86±2.67分，16.93±3.89分，26.79±5.83分）依次升高，差异均有统计学意义（ F=20.648， 61.097，146.366，均 P=0.000）。简易精神状态检查（ mini-mental state examination ，MMSE）评分（ 23.67±4.37分， 16.58±3.67分，12.06±2.15分）依次降低，差异有统计学意义（ F=85.925，P=0.000）。PD组患者血浆 S1P表达水平与 HDL-C表达水平呈正相关（ r=0.633，P=0.007），二者与 UPDRS Ⅲ评分、 HAMD评分和 HAMA评分均呈负相关（r=-0.605～ -0.480，均 P＜ 0.05），与 MMSE评分呈正相关（ r=0.587，0.518，均 P＜ 0.05）。血浆 S1P，HDL-C表达水平降低是影响重度 PD的独立危险因素 [OR（95%CI）为 1.936（1.265～ 2.962）和 2.011（1.372～ 2.947）]（均 P＜ 0.05）。结论　血浆 S1P和 HDL-C异常低表达可能与 PD患者临床症状有关。临床可以通过监测血浆 S1P和 HDL-C表达水平，评估 PD发生、严重程度及临床症状的变化，可作为 PD的辅助诊断手段。     

帕金森病疲劳的影响因素及补充维生素D的意义

目的:研究血清维生素D水平与帕金森病(Parkinson disease,PD)疲劳的关系,以及补充维生素D后疲劳的改善情况。方法:收集2018年11月至2019年8月在山西医科大学第一医院住院部及门诊就诊的39例PD伴疲劳患者,31例PD非疲劳患者,同时收集39例经相关检查无器质性病变的头晕患者作为对照组。收集3组的年龄、性别、血清25(OH)D水平、甲状旁腺激素(parathyroid hormone,PTH)水平、钙离子(calciumion,Ca²⁺)水平,以及P D疲劳组和P D非疲劳组的病程、简易精神状态检查量表(Mini-Mental State Examination,MMSE)评分、蒙特利尔认知评估量表(Montreal CognitiveA ssessment,MoCA)评分、日常生活能力评定量表(Activities of Daily Living,ADL)评分、汉密尔顿焦虑(Hamilton Anxiety,HAMA)评分、汉密尔顿抑郁(HamiltonDepression,HAMD)评分、情感淡漠评定量表(Modified Apathy Evaluation Scale,MAES)评分、疲劳严重度量表(Fatigue Severity Scale,FSS)评分、统一PD评定量表第3部分(Unified Parkinson Disease Rating ScalePar t3,UPDR S-III)评分、Hoehn-Yahr分级(Hoehn-Yahr,H-Y)、等效左旋多巴剂量(Levodopa Eq u i va l entDo ses,LED)等资料,分析P D疲劳的影响因素,给疲劳组维生素D低的患者补充12周1200U/d的维生素D滴剂,观察P D疲劳组的疲劳改善情况。结果:P D疲劳组、PD非疲劳组、对照组的维生素D水平差异有统计学意义,遂进行两两组间比较,发现PD疲劳组维生素D水平显著低于对照组[维生素D水平分别为(25.39±16.93)nmol/L,(47.14±22.34)nmol/L,U=–4.342,P<0.001],PD非疲劳组维生素D水平显著低于对照组[维生素D水平分别为(35.20±17.86)nmol/L,(47.14±22.34)nmol/L,U=–2.276,P=0.023],P D疲劳组维生素D水平低于P D非疲劳组[(25.39±16.93)n m o l/L,(35.20±17.86)n m o l/L,U=–2.855,P=0.004]。P D疲劳组的U PDRSIII(32.08±9.44,26.42±8.54,t=–2.598,P=0.011)、H-Y分级[2(2,3),2(1.5,2),U=–2.831,P=0.005]、汉密尔顿焦虑评分(12.18±3.84,9.29±4.76,t=–2.814,P=0.006)、汉密尔顿抑郁评分(11.03±4.09,8.61±5.21,t=–2.171,P=0.033)、情感淡漠评定量表评分(14.62±9.20,10.26±6.58,t=–2.222,P=0.030)均高于PD非疲劳组。根据影响PD疲劳的相关因素分析,结果显示PD疲劳与维生素D水平(r=–0.239,P=0.046)、病程(r=0.386,P=0.001)、UPDRS-III评分(r=0.260,P=0.030)、H-Y分级(r=0.297,P=0.013)、HAMA(r=0.275,P=0.021)、H A M D(r=0.303,P=0.011)相关。Logistic回归分析显示UPDR S-III评分为PD疲劳患者的独立危险因素(OR=1.103,P=0.003),维生素D水平是PD疲劳的独立保护因素(OR=0.961,P=0.015)。补充维生素D前后疲劳分数的比较发现差异无统计学意义(t=1.880,P=0.069)。结论:维生素D水平虽然是PD疲劳的独立保护因素,但短期补充维生素D不能改善疲劳症状。     

α-硫辛酸注射液联合甲钴胺和前列地尔治疗2型糖尿病周围神经病变的临床效果观察

目的 观察α-硫辛酸注射液联合甲钴胺和前列地尔对2型糖尿病周围神经病变患者的疗效和安全性.方法 2011年1月至2012年12月于我院内分泌科住院治疗的160例DPN患者,将所有病例按就诊先后分为两组,试验组80例和对照组80例.研究中试验组有3例、对照组5例由于自身原因提前出院退出研究.研究实际完成试验组77例、对照组75例.两组均在降糖治疗基础上联合应用甲钴胺500 μg,肌肉注射,隔日1次;前列地尔10μg,静脉注射,1次/d.试验组同时加用α-硫辛酸600 mg,静脉滴注,1次/d.两组治疗均持续10～ 14 d.观察治疗前后症状的改善、神经病变总症状（TSS）评分和神经传导速度的变化、满意度和不良反应.结果 α-硫辛酸静脉滴注10 d后,试验组与对照组相比,TSS总积分[（3.5±2.5）分与（4.3±2.1）分,t=2.11,P＜0.05]、刺痛积分[（1.1±0.4）分与（1.5±0.5）分,t=1.86,P＜0.05]、烧灼感积分[（0.9±0.7）分与（1.3±0.5）分,t=1.83,P＜0.05]、感觉减退积分[（1.3±0.4）分与（1.7±0.5）分,t =1.87,P＜0.05]、麻木积分[（1.3±0.9）分与（1.9±0.4）分,t=1.91,P＜0.05]明显降低;正中神经运动传导速度[（53.6±1.4） m/s与（48.5±2.7） m/s,t=-4.94,P＜0.05]、腓总神经运动传导速度[（49.6±1.1） m/s与（43.9±2.1） m/s,t=-5.36,P＜0.05]、正中神经感觉传导速度[（47.3±1.1） m/s与（41.6±1.8） m/s,t=-5.09,P＜0.05]、腓总神经感觉传导速度[（48.2±1.9） m/s与（43.2±2.5） m/s,t=-4.27,P＜0.05]明显提高.试验组97.4％（75/77）的医师和92.2％ （71/77）的患者对治疗效果满意,对照组84.0％（63/75）的医师和78.7％（59/75）的患者对治疗效果满意.研究过程中试验组颜面潮红3例、头晕1例,对照组颜面潮红2例、头晕1例,未经特殊处理自行缓解.结论 α-硫辛酸静脉滴注治疗DPN疗效显著,同时具有良好的安全性.     

踝关节骨折后创伤性骨性关节炎患者外周血IL-1β和MMP-13水平及其与关节功能的相关性研究

目的 探讨踝关节骨折后创伤性骨性关节炎患者外周血白介素-1β(interleukin-1β,IL-1β)和基质金属蛋白酶-13(matrix metalloproteinase-13,MMP-13)水平变化与关节功能的相关性。方法 选取2018年9月～2020年6月解放军第九六九医院骨科收治的93例踝关节骨折后创伤性骨性关节炎患者作为研究组,另选取同期健康体检者79例作为对照组。两组均采用酶联免疫吸附实验检测外周血IL-1β,MMP-13水平及行踝关节功能测评[踝-后足功能评分（AOFAS）与Kofoed踝关节评分]并对比,另比较研究组不同严重程度患者外周血IL-1β,MMP-13水平及踝关节功能评分,且采用Pearson相关性分析法分析研究组患者外周血IL-1β,MMP-13水平与AOFAS评分、Kofoed踝关节评分的相关性。结果 研究组外周血IL-1β(50.36±7.82pg/ml),MMP-13水平（2.09±0.35ng/L）与对照组（9.84±1.13pg/ml,1.16±0.22 ng/L）比较均升高,差异有统计学意义（t=45.632,20.431,均P <0....     

健康教育对精神分裂症自尊、社会功能及应激能力的影响

目的通过对精神分裂症患者实施健康教育,探讨健康教育对精神分裂症自尊、社会功能及应激能力的影响。方法将96例精神分裂症患者随机分配至研究组和对照组各48例,其中脱落5例。对照组行常规抗精神病药治疗,研究组在此基础上实施健康教育,疗程均为8周,随后进行为期6个月的随访。采用自尊量表(SES)及社会功能缺陷筛选量表(SDSS)分别于健康教育前及随访结束时进行评定,并于随访结束时进行简易应对方式问卷(SCSS)评定。结果随访结束时,①研究组患者的SES评分为(28±5)分,明显高于对照组的(19±4)分(t=9.49,P<0.01),而SDSS评分为(6±3)分,则明显低于对照组的(8±4)分(t=2.69,P<0.01);②研究组患者的SCSS中积极应对因子评分为(1.8±0.5)分,明显高于对照组的(1.5±0.7)分(t=2.35,P<0.05),而消极应对因子评分为(1.6±0.6)分,则明显低于对照组的(1.9±0.6)分(t=2.38,P<0.05)。结论健康教育可提高精神分裂症患者的自尊水平、社会功能及心理应激能力。     

急性缺血性脑卒中溶栓患者延续性护理方案的建立及其应用效果

目的建立急性缺血性脑卒中患者延续护理的方案,并探讨其临床应用效果。方法便利抽样法选取2015年1-12月在上海市某三级甲等医院急诊科治疗的急性缺血性脑卒中溶栓住院患者89名研究对象。按随机数字表法将其分为观察组(n=48)和对照组(n=41)。对照组患者予以常规护理,而观察组患者在此基础上实施延续性护理方案。评价两组患者出院12周内的治疗依从性、生活质量和护理满意度。结果出院前2 d,两组患者生活质量评分、对护理的满意度评分差异均无统计学意义(均P0.05);出院12周时,观察组和对照组患者的治疗依从性总分分别为(9.51±1.597)和(7.45士1.631)分,差异有统计学意义(￡=3.017,P0.01),两组患者生活质量评分、对护理的满意度评分差异均有统计学意义(P0.05或P0.01)。结论延续性护理方案能有效提高出院患者的治疗依从性、生活质量及满意度,值得推广应用。