心理干预对地震灾害所致创伤后应激障碍并支气管哮喘急性发作期患者的影响

目的 探索心理干预对地震灾害所致创伤后应激障碍合并支气管哮喘急性发作期患者的影响.方法 将来自地震灾区的符合美国精神病协会制定的创伤后应激障碍诊断标准的支气管哮喘急性发作期患者40例分为对照组及干预组,分别给予支气管哮喘常规治疗、支气管哮喘常规治疗联合心理干预,比较两组PTSD检查量表(PCL-C)、ACQ5、FEV1％pred、PEF％ pred、外周血嗜酸粒细胞(EOS)的变化;分析干预组中PCL-C与ACQ5、FEV1％pred、PEF％ pred、EOS之间的关系.结果 干预组的PCL-C、ACQ5、FEV1％pred、PEF％ pred较之对照组有明显改善,两组之间的差异有统计学意义(P＜0.05);但EOS改善不明显,两组之间的差异无统计学意义(P＞0.05);干预组中PCL-C与ACQ5呈正相关(r =0.61,P＜0.05),与FEV1％pred、PEF％ pred呈负相关(r值分别为 0.53、-0.57),与EOS无直线相关关系(P＞0.05).结论 用心理干预联合支气管哮喘常规治疗的方法治疗地震灾害所致PTSD并支气管哮喘急性发作期患者的疗效优于单纯的常规治疗,但对EOS改善作用不大.     

颅脑急性创伤后应激障碍及心理干预研究

目的研究急诊颅脑创伤患者创伤后应激障碍水平,为预防和治疗颅脑创伤患者创伤后应激障碍,维护和提高急诊颅脑创伤患者心理健康和生活质量提供科学依据。方法运用创伤后应激障碍症状自评量表(PTSD-SS)对急诊颅脑创伤患者创伤后应激障碍状况进行调查,运用SPSS13.0统计软件对资料进行统计学分析,比较与一般疾病患者的差异是否有统计学意义。结果急诊颅脑创伤患者创伤后应激障碍阳性率为23.6%,PTSD-SS总分及其5个维度包括主观评定、反复重现体验、回避症状、警觉性增高和社会功能受损与一般疾病患者比较,差异有统计学意义(P0.05)。颅脑创伤患者创伤后应激障碍主要受性别、家庭收入及负债状况的影响。结论颅脑创伤患者创伤后应激障碍水平较高,疾病对患者造成较大的心理影响,给予心理干预措施维护和提高颅脑创伤患者心理健康和生活质量。     

闭合性肝外伤患者创伤后应激障碍早期干预的疗效

肝脏是人体最大的实体性腹腔脏器,质地脆弱而易受损伤.闭合性肝外伤是腹部外伤最常见的死亡原因之一[1].创伤后应激障碍(PTSD)是指亲身经历或亲眼目击导致或可能导致自己、他人发生严重躯体伤害的意外事件、严重创伤的强烈反应[2],早期表现主要以情感焦虑和抑郁为主.交通事故和意外伤害作为现代社会常见的人体伤害事件之一,是导致PTSD最常见的因素.本文就闭合性肝外伤后患者的PTSD进行治疗干预,对比观察其对情感方面的影响.     

中老年创伤后应激障碍的相关因素

目的 调查影响中老年人发生创伤后应激障碍(PTSD)相关因素.方法 经历过创伤性事件的患者106例,其中发生PTSD 54例,统计患者一般资料,调查PTSD组创伤性事件暴露情况;应用事件影响量表修订版(IES-R)对PTSD组进行评分,比较创伤性事件暴露情况不同时患者IES-R总评分;通过Logistic回归分析确定中老年人发生PTSD相关因素.结果 性别、民族、文化程度和婚姻状况不同的患者PTSD发生率存在显著差异(P＜0.05);经历过亲朋去世、心理暴力和恐怖经历的中老年人更易发生PTSD.结论 导致中老年人发生创伤后PTSD相关因素有性别、民族、婚姻状态、文化程度、经历过亲朋去世、心理暴力和恐怖经历.     

14例创伤后应激障碍的调查

为了解重大创伤事件对幸存者心理健康的影响,2007年9月对2004年3月7日哈密露天矿透水事件的幸存者进行了调查,现将结果报告如下. 1对象与方法     

截肢术后后应激障碍20例心理干预效果观察

创伤后应激障碍（PTSD）是由异乎寻常的威胁性或灾难性心理创伤导致的延迟出现和长期持续的精神障碍,主要表现为反复出现闯人性的创伤性体验,持续的高警觉和回避。截肢给患者带来一系列生理、心理和社会方面的变化,易出现PSTD。2001～2008年,我们对20例截肢手术后PTSD患者进行了,疗效较好。现报告如下。     

创伤后应激障碍的老年患者心率变异性分析

目的 探讨老年患者发生创伤后应激障碍（PTSD）时自主神经功能改变的特点.方法 采用心率变异性（HRV）分析指标,检测PTSD老年患者（A组,n=32）的HRV参数并与同年龄创伤后未发生PTSD者（B组,n=30）以及同年龄组健康人群（对照组,n=80）进行对比分析.结果 ①A组、B组与对照组相比,SDNN、SDANN、SDNN Index差异均有显著统计学意义（均P＜0.01）;②夜间HRV各项参数与白天比较,SDNN Index [（33.32±22.38）ms、（28.05±19.02）ms]差异有统计学意义（P＜0.05）,SDNN[（48.00±26.55）ms、（43.18±19.91）ms]、rMSSD[（29.18±14.79）ms、（28.00±14.56）ms]、PNN50[（7.81±2.37）ms、（7.57±2.78）ms]及SDANN[（30.18±18.10 ）ms、（29.77±12.98）ms]差异均无统计学意义（均P ＞0.05）.结论 PTSD可引起老年患者自主神经张力异常及调节功能失衡,这种损害以夜间明显.在治疗原发病的同时,应重视PTSD的发生及其对老年人自主神经功能的影响.     

认识创伤后应激障碍

我曾经接触过一位孤独症,老人,她是一名教师：善于与人交谈,表达能力很强。可自从三年前,她的老伴出车祸突然离去,自己又被诊断为糖尿病后,她说话变得结结巴巴,语言表达不清。慢慢地断绝了与朋友的一切来往,也不愿意接受孩子的关心。她的孩子怕她做傻事,无奈之下,只好请了一位保姆在家里照顾她。但是,她的心门一直紧闭,始终生活在自己的世界中。     

交通事故伤后急性应激障碍预测后期应激障碍的价值

目的 探讨交通事故幸存者早期急性应激障碍(ASD)不同症状簇对后期创伤后应激障碍(PTSD)的预测作用.方法 206名交通事故幸存者于事故后2～23 d行ASD量表(ASDS)评估;事故后4～12个月行PTSD检测表一特定事件版(PCL-S,17个项目)评估.结果 206名幸存者中共有61例为可能的ASD患者,发生率为29.6％;61例中51例为可能的PTSD患者,发生率为83.6％;ASD严重程度可预测PTSD严重程度(β=0.37,P＜0.001);ASD再体验症状、高唤醒症状(β=0.22、0.16,P＜0.05)能够预测PTSD严重程度;ASD再体验症状能够预测PTSD再体验症状(β=0.46),ASD回避症状能够预测PTSD回避症状(β3 =0.19),ASD高唤醒症状能够预测PTSD高唤醒症状(β=0.43),且显著性水平均达到P＜0.001.结论 创伤事件早期的ASD症状严重程度能很好地预测后续的PTSD症状,其中ASD的再体验与高唤醒症状能更好的预测后续的PTSD症状.     

创伤后应激障碍与心血管疾病

创伤后应激障碍（post-traumatic stress disorder,VFSD）普遍存在于经历过重大身体和心理创伤的普通人群以及退伍或现役军人中。目前临床及流行病学研究已经证实,PTSD可增加高血压病、高血脂、肥胖和心血管疾病的患病风险。PTSD主要的作用机制是,交感肾上腺轴兴奋导致儿茶酚胺分泌增加,进而影响心脏、血管和血小板的功能,增加心血管疾病的发生。本文主要综述PTSD与高血压病和其他心血管病危险因素之间的联系,并阐述PTSD与心血管疾病之间的关系。     

支气管哮喘急性发作期激活转录因子-3的表达及作用

目的探讨支气管哮喘（简称哮喘）急性发作期激活转录因子-3（ATF3）的表达及作用。方法 30只健康雄性豚鼠,按随机数字表法分为对照组（A组）、哮喘组（B组）及地塞米松治疗组（C组）,每组10只。卵清蛋白致敏法复制哮喘模型。收集支气管肺泡灌洗液（BALF）并进行细胞总数及分类计数;观察豚鼠肺组织病理学改变;检测豚鼠肺组织及BALF中ROS含量;采用免疫组织化学和Westernblot法测定豚鼠肺组织中ATF3蛋白的表达和量的变化;原位杂交、RT-PCR法检测ATF3 mRNA的表达变化;免疫细胞化学检测豚鼠BALF细胞中ATF3蛋白的表达。结果①哮喘组豚鼠BALF中炎细胞总数、嗜酸粒细胞百分比（EOS%）显著高于对照组（P〈0.01）,哮喘组豚鼠肺组织可见大量炎症细胞浸润及明显气道重塑改变,且哮喘组ROS含量显著升高,而地塞米松治疗组上述变化明显减低（P值均〈0.01）;②ATF3蛋白及mRNA表达哮喘组明显高于对照组（P值均〈0.01）;③ATF3蛋白及mRNA的表达变化与ROS含量及BALF炎细胞总数、EOS%变化均呈正相关。结论哮喘急性发作期豚鼠肺组织及BALF细胞中ATF3的表达升高,可能与气道炎症反应和氧化应激有关;给予地塞米松治疗后ATF3表达下降,可能在哮喘的防治中起重要作用。     

支气管哮喘的介入治疗

支气管哮喘一种全球范围内的常见病、多发病。近年来经支气管镜介入的支气管热整形术以其新的观念、新的方法,给支气管哮喘患者带来了新的希望。     

Effect of aging on the relationship between asthma severity and bronchial hyperresponsiveness in children with asthma.

An association between asthma and bronchial hyperresponsiveness (BHR) has been demonstrated. It is possible that the relationship between asthma severity and BHR in children with asthma is different in infants and in adolescents. The aim of this study is therefore to evaluate the effect of aging on the relationship between the severity of asthma and BHR in children with asthma. We measured BHR in 386 subjects ranging from 2 to 20 years of age. The subjects consisted of 323 children with asthma (boys:girls = 193:130, mean age 9.7 years) and 63 age-matched controls (boys:girls = 25:38, mean age 8.2 years). BHR was measured using the methacholine inhalation challenge by measuring the transcutaneous oxygen pressure (tcPO2) in children less than 6 years of age (Dmin-PO2) and by measuring the respiratory resistance (Rrs) in children 6 years of age and older (Dmin-Rrs). Throughout the whole age range, both the Dmin-PO2 and Dmin-Rrs in each asthma severity group were higher than those in the controls. In the asthmatics aged 2-5 years, the Dmin-PO2 levels in the mild asthma group were higher than those in the moderate and severe asthma groups (p < 0.001, p < 0.001, respectively), and the Dmin-PO2 levels in the moderate asthma group were also higher than those in the severe asthma group. This tendency was also found in the age ranges of 6-9 years and 10-13 years. In the asthmatics aged 14-20 years, the Dmin-Rrs levels were not significantly different among the three groups. Taken together, these data show that aging has an effect on the relationship between the severity of asthma and BHR during childhood and that BHR may not be the sole determinant for the severity of asthma in adolescence.     

孟鲁司特治疗支气管哮喘急性发作的临床疗效观察

目的了解孟鲁司特治疗支气管哮喘急性发作的临床效果。方法将支气管哮喘急性发作患者76例随机分为两组,实验组39例,对照组37例;对照组常规吸入β^2受体激动剂、糖皮质激素吸入或静点、二羟丙茶碱口服或静点。实验组在相同对照组治疗基础上,加用LT调节剂孟鲁司特10mg,一次／日,口服。治疗前和治疗后第2天、第4天分别观察症状、体征及动脉血PaO2变化。结果治疗前两组患者均为支气管哮喘急性发作,动脉血PaO2平均值比较差异无统计学意义;治疗后第2天、第4天,两组症状、体征缓解率比较,动脉血PaO2值,两组比较差异有统计学意义。结论LT调节剂孟鲁司特治疗支气管哮喘急性发作具辅助疗效,可加速缓解哮喘症状、缩短住院日期。     

Effect of verapamil inhalation on bronchial asthma

The effect of inhaled verapamil 20 mg on pulmonary functions and arterial blood gases in 15 patients with extrinsic bronchial asthma was studied in single-blind fashion. A significant decrease (p less than 0.05) in airway resistance and a significant increase (p less than 0.01) in specific conductance was observed after verapamil inhalation. A small increase (p less than 0.1) was observed in forced vital capacity and peak expiratory flow rate after verapamil inhalation; however, this was not statistically significant. None of the parameters of pulmonary function tests showed a significant change after normal saline inhalation. A significant fall in PaO2 (p less than 0.05) and PaCO2 (p less than 0.05) was noted after normal saline inhalation. PaCO2 showed a significant fall (p less than 0.01) after verapamil inhalation. Alveolar arterial oxygen gradient P(A-a)O2 widened significantly (p less than 0.001) after normal saline inhalation. A larger dose (20 mg) of verapamil inhalation produces a significant bronchodilator effect on large airways, but does not produce a significant change in arterial oxygen tension from the baseline value in patients with bronchial asthma.     

Atypical pathogen infection in adults with acute exacerbation of bronchial asthma

In a serologically based prospective study, acute infections with four atypical pathogens were determined in 100 adults hospitalized for acute exacerbation of bronchial asthma, and compared with the corresponding rate in a matched control group. Paired sera were tested using immunofluorescence or enzyme immunoassay methods to establish the serologic diagnosis. In 18 patients (18%), there was evidence of acute infection with Mycoplasma pneumoniae, compared with 3% in the control group (p = 0.0006). In 10 of these patients there was evidence of infection with at least one additional pathogen, a respiratory virus in 7. There was no significant difference between the study groups in the rates of acute infection by Chlamydia pneumoniae (8% in the hospitalized patients versus 6% in the control subjects), Legionella spp. (5 versus 3%, respectively), or Coxiella burnettii (no patients in either group). We conclude that of these four atypical pathogens, only infection with M. pneumoniae is associated with hospitalization for acute exacerbation of bronchial asthma. In most of these M. pneumoniae patients there is evidence of infection with a respiratory virus as well. The pathophysiologic and therapeutic significance of these findings should be tested in further studies specifically designed to address these questions.     

女性急性支气管哮喘患者129例临床分析

目的分析女性急性支气管哮喘患者急性发作的严重程度与年龄、民族等的关系,为预防及治疗提供参考。方法对女性急性支气管哮喘患者129例的临床资料进行回顾性分析。结果老年组患者哮喘急性发作时重度、危重所占比例高于中年组,中年组所占比例高于青年组,差异有统计学意义（P〈0．05）。呼吸道感染为哮喘发作主要的诱发因素,油烟对女性支气管哮喘患病的影响较大。结论老年支气管哮喘患者急性发作时的严重程度比中青年高,环境是女性支气管哮喘患病的重要影响因素。