农村孕妇情绪状态调查分析

[目的]调查农村孕妇情绪状态并探讨影响情绪状态的因素。[方法]采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评价孕早、中、晚三个阶段197例农村孕妇的情绪状态,将其SDS、SAS均分与我国常模SDS、SAS均分比较。[结果]农村孕妇的抑郁、焦虑情绪状态与全国常模比较有统计学意义(P<0.01),影响孕妇的情绪状态的因素主要有生理、心理及社会因素。[结论]农村孕妇情绪状态需要引起关注,可采用提高孕妇的正确认识,完善社会支持系统改善孕妇的情绪状态。     

心理干预对不孕症病人焦虑抑郁状态的影响

[目的]探讨心理干预对不孕症病人焦虑、抑郁状态的影响。[方法]对100例不孕症病人采用Zung编制的焦虑自评量表（SAS）和抑郁自评量表（SDS）进行焦虑、抑郁状态评定,分别进行针对性心理干预,比较心理干预前后病人SAS、SDS评分。[结果]病人心理干预后SAS、SDS评分降低（P〈0．05）,焦虑、抑郁发生率下降。[结论]焦虑、抑郁是不孕症病人常见的情绪障碍,心理干预可缓解不孕症病人的焦虑、抑郁状态。     

支气管哮喘病人的个性特征分析及影响因素

[目的]探讨支气管哮喘病人的个性特征及心理社会影响因素。[方法]对哮喘急性发作期的成人住院病人进行焦虑自评量表（SAS）、抑郁自评量表（SDS）、艾森克人格测验（EPQ）、哮喘知识的调查，并进行心理干预，测定生理指标肺功能（PEF）和动脉血氧饱和度（SaO2），并对其影响因素进行多元逐步回归。[结果]与正常人比较，哮喘病人的性格偏内向，情绪不稳定的比例高于国内常模（P〈0．05）；影响PEF和SaO2的因素：抑郁焦虑情绪、心理干预、个性特征、疾病知识、病情严重程度。[结论]个性特征、情绪状态等心理社会因素对支气管哮喘的发病和转归作用较明显，在常规治疗的同时辅以心理干预，可以缓解心理压力，稳定情绪，促使哮喘发作快速控制。     

CCU急性冠状动脉综合征病人焦虑与抑郁现状调查

[目的]了解冠心痛监护病房（CCU）急性冠状动脉综合征（ACS）病人焦虑与抑郁状况。[方法]采用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对CCU48例ACS病人进行问卷调查。[结果]SDS总分高于国内常模,19例病人出现抑郁,占39．6％;SAS总分与国内常模相近,3例病人出现焦虑,占6．3％。不同年龄ACS病人抑郁评分比较差异有统计学意义。[结论]应关注ACS病人焦虑与抑郁状况,提高CCU病人护理质量。     

肠造口患者焦虑抑郁的认知治疗及护理

目的评估肠造口患者焦虑及抑郁状态并观察认知疗法的疗效。方法通过对14例肠造口患者进行抑郁自评量表（SDS）和焦虑自评量表（SAS）测评，计算评分并与国家常模比较，应用认知疗法进行干预后重新测评，治疗前后评分比较。结果肠造口患者SDS和SAS评分明显高于国家常模（P〈0．001），应用认知疗法干预后SAS、SDS评分较治疗前明显下降（P〈0．001）。结论肠造口患者具有明显的焦虑、抑郁情绪，认知疗法可有效消除上述不良情绪。     

高血压病病人主观幸福感与情绪状态的调查

[目的]探讨高血压病病人主观幸福感与情绪状态的关系。[方法]采用幸福感指数量表、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对69例高血压住院病人进行测量。[结果]高血压病病人幸福感体验低下，负性情绪较严重，其负性情绪状态与幸福感体验呈负相关。[结论]高血压病病人幸福感与焦虑、抑郁负性情绪密切相关，对高血压病病人予心理干预，改善其情绪状态，可提高病人生活质量，增强主观幸福感，促进身心健康。     

53例癫痫患儿心理状态调查及心理护理

目的 探讨癫痫患儿的心理状态及心理护理的作用。方法 采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对53例癫痫患儿的心理状态进行评定，并与我国常模进行对比。结果 通过加强心理护理，患者的焦虑、抑郁情绪有所改善。癫痫患儿的焦虑、抑郁情绪与常模差异有高度显著性（P＜0．01）。将护理前后患儿的SAS、SDS评分进行统计学处理，差异有高度显著性（P＜0．01）。结论 心理护理在小儿癫痫的治疗中有重要作用。     

心理护理干预改善住院癌症病人情绪状况的临床研究

[目的]调查住院癌症病人的情绪状况并探讨心理护理干预对情绪状况的影响。[方法]随机选取53例住院癌症病人采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和症状自评量表（SCL-90）评定其情绪状况,并对其进行为期4周8次心理护理干预,观察比较病人在心理干预前后SAS、SDS和SCL-90评分结果。[结果]住院癌症病人心理干预前后焦虑、抑郁阳性检出率比较差异均有统计学意义（P均〈O．01）;心理干预后SCL-90总分、躯体化、抑郁、焦虑因子分、阳性项目数评定显著低于干预前（P均〈0．01）。[结论]癌症病人有明显的焦虑、抑郁情绪,心身状况较差,进行心理干预能有效改善癌症病人情绪。     

前置胎盘孕妇期待疗法期间的心理状况调查

[目的]了解前置胎盘孕妇期待疗法期间的妊娠妇女的心理状况.[方法]采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对102例前置胎盘期待疗法孕妇和108例正常孕妇进行心理状况调查.观察并比较两组孕妇SAS评分、SDS评分情况.[结果]前置胎盘孕妇期待疗法期间SAS评分和SDS评分均明显高于正常孕妇(P＜0.05).[结论]前置胎盘孕妇期待疗法期间普遍存在焦虑和抑郁情绪,应采取针对性的心理干预措施.     

精神科护士心理健康状况影响因素研究

[目的]探讨精神科护士心理健康状况的相关因素.[方法]对精神科147名护士进行抑郁自评量表（SDS）、焦虑自评量表（SAS）、工作压力问卷（JCQ）、付出回报失衡问卷（ERI）和工作倦怠量表（MBI）统计分析.[结果]精神科护士SAS、SDS分值明显高于全国常模;工作倦怠量表的情绪绪竭、去人性化、个人成就感3个维度评分与SAS、SDS呈正相关（P〈0.05）;付出回报失衡问卷中付出及内在投入分值与SAS、SDS呈正相关,回报与SAS、SDS则呈负相关.[结论]精神科护士心理健康状态应引起医院管理者重视,建议采取措施提高护士心理健康水平.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

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.     

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.