益气补肺汤联合穴位埋线对COPD稳定期（肺气虚证）患者的临床效果观察

目的探究益气补肺汤联合穴位埋线对慢性阻塞性肺疾病(COPD)稳定期(肺气虚证)患者肺功能及简明健康状况量表(SF-36)评分的影响。方法选取2016年12月～2018年12月我院收治的COPD稳定期(肺气虚证)患者96例,简单随机化分为对照组和观察组各48例。对照组给予常规西药治疗,观察组基于对照组给予益气补肺汤联合穴位埋线治疗,连续治疗8周。观察两组中医疗效,对比治疗前后肺功能指标:FEV1占预计值的百分比(FEV1%)、用力肺活量(FVC)、第1s用力呼气容积/用力肺活量比值(FEV1/FVC),评价两组治疗前后SF-36评分。结果观察组治疗总有效率为93.75%,高于对照组的75.00%,差异有统计学意义(P0.05);与对照组比较,治疗后观察组FVC、FEV1/FVC、FEV1%较高,差异有统计学意义(P0.05);与对照组比较,治疗后观察组SF-36评分较高,差异有统计学意义(P0.05)。结论益气补肺汤联合穴位埋线治疗COPD稳定期(肺气虚证)患者疗效确切,可改善肺功能,提高SF-36评分。     

医院焦虑抑郁量表评价重症肌无力患者生活质量分析

目的:应用医院焦虑抑郁量表(HAD)评价重症肌无力(MG)患者的生存质量,并比较其和简明健康调查表(SF-36)在评价结局方面的一致性。方法:MG患者29例(病例组)和健康人27例(对照组)纳入研究,收集2组基本资料,分别采用HAD和SF-36对2组进行评定,比较2组情绪状况和生活质量的差异及HAD和SF-36评价的一致性和相关性。结果:病例组HAD量表的总分、焦虑亚量表和抑郁亚量表得分均高于对照组(P<0.05)。病例组SF-36量表中生理功能、生理职能、情感职能、生命活力、社会功能维度得分和总得分均低于对照组(P<0.05)。SF-36总评分与HAD总得分、HAD焦虑量表得分和HAD抑郁量表得分具有明显的相关性。结论:MG患者的焦虑抑郁情况普遍存在,生存质量明显下降,HAD和SF-36疗效评价结局一致性良好。     

肺移植患者术后医学应对模式与生存质量的现状及相关性

目的:调查肺移植术后患者医学应对模式及生存质量现状,并分析其相关性。方法:采用医学应对模式问卷(Medical Coping Mode Questionnaire,MCMQ)及简明健康问卷(Short-Form Health Sur vey,SF-36)对30例肺移植患者进行横断面调研。结果:肺移植术后患者面对和屈服维度的评分明显低于常模水平,回避维度评分明显高于常模水平;肺移植患者在SF-36各维度评分均明显低于全国常模水平。相关性分析显示:肺移植术后患者生理职能、情感职能、社会功能、精神健康和一般健康维度的评分与面对维度呈显著的正相关性。SF-36各维度评分与回避维度无明显相关;SF-36各维度与屈服均呈显著的负相关。结论:肺移植术后患者生存质量明显低于常模水平,且对疾病的应对模式是影响生存质量的重要因素。     

广东省工伤职业康复者SF-36量表评价参考值

目的:探讨SF-36量表应用于广东省工伤职业康复人群的价值。方法:采用SF-36[简明健康状况调查表(中文版)]对1027例职业康复住院患者最近一个月的生存质量进行评价,与一般人群常模进行比较;用统计学方法计算不同病程、性别、学历人群生存质量各维度的参考值。结果:职业康复人群各维度的生存质量远低于普通人群,该人群生理职能(RP)及情感职能(RE)地板效应显著,情感职能(RE)天花板效应显著。多元线性回归分析显示病程、性别、学历影响该群体的生存质量。结论:SF-36量表在职业康复人群具有较高的应用价值,初步制定了广东省不同病程、性别、学历职业康复者的SF-36评价参考值。     

基于需要的层级护理干预对老年慢性阻塞性肺疾病患者运动机能的影响

目的:探讨基于需要的层级护理干预对老年慢性阻塞性肺疾病(COPD)患者运动机能的影响。方法:将68例老年COPD患者采用随机数字表法分为对照组和观察组各34例,对照组采取常规护理干预,观察组采取基于需要的层级护理干预,比较两组干预前后肺功能相关指标[肺活量(VC)、呼气流量峰值(PEF)、第1秒用力呼气容积(FEV1)/用力肺活量(FVC)的比值(FEV1%)]、运动机能、心理状态[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]及生活质量[采用医学结局调查简易量表(SF-36)]。结果:干预后,两组VC、PEF、FEV1%、运动机能、SAS评分、SDS评分及SF-36评分均优于干预前(P<0.05),且观察组优于对照组(P<0.05)。结论:基于需要的层级护理干预能有效促进老年COPD患者的肺功能和运动机能恢复,改善其负性情绪和生活质量。     

后期放射毒性对鼻咽癌病人生活质量的影响

[目的]探讨后期放射毒性对鼻咽癌病人生活质量的影响.[方法] 采用问卷调查法,应用医学结局研究简明调查表(SF-36)对86例放射治疗后至少2个月回院复查的鼻咽癌病人进行生存质量测评.[结果] 86例鼻咽癌放射治疗后病人生存质量总体处于较低水平;SF-36评分8个维度中生理机能、精力、躯体疼痛评分较高,生理职能、精神健康、一般健康状况等评分较低.[结论]放射治疗的后期毒性对鼻咽癌病人的生存质量造成较严重影响,应及时、及早评估,制订综合性护理干预方案,以预防或减轻鼻咽癌病人放射治疗后的毒性反应,提高康复期的生存质量.     

慢性阻塞性肺疾病患者生存质量与应对方式的相关性研究

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者生存质量与应对方式之间的关系.方法 2008年9月-2009年6月,应用健康状况调查问卷(Short Form 36 Health Survey Questionnaire,SF-36)、呼吸道疾病问卷修订版(The Airways Questionnaire 20-Rised,AQ20-R)和医学应对问卷(Medical Coping Modes Questionnaire,MCMQ)对102例COPD患者进行调查.结果 SF-36中得分最低的是生理职能维度,其次是一般健康状况维度;AQ20-R总分为(8.73±3.74)分;与常模相比,COPD患者较少采用面对、回避的应对方式;经Spearman相关分析显示,SF-36的生理职能维度与面对应对方式呈正相关;精力和情感职能维度与回避应对方式呈负相关;AQ20-R总分与回避应对方式呈正相关;SF-36除躯体疼痛维度以外的各维度均与屈服应对方式呈显著负相关;AQ20-R总分与屈服应对方式呈显著正相关.结论 COPD患者所采取的应对方式在一定程度上影响患者的生存质量,护理人员应从生理、心理、社会功能等方面评估健康状况,帮助患者采取积极应对,减少消极应对.     

家属参与肺康复引导式教育训练对COPD患者肺功能、心理健康及生活质量的影响

目的:探讨家属参与肺康复引导式教育训练对慢性阻塞性肺疾病(COPD)患者肺功能、心理健康及生活质量的影响。方法:将108例COPD患者随机分为对照组和观察组各54例,对照组给予常规肺康复训练,观察组在此基础上给予家属参与肺康复引导式教育训练。观察比较两组干预前后第一秒用力呼气量百分比(FVE1%)、峰值流速(PEF)、肺活量(FVC)及最大呼气中段流量(MMEF)水平值,采用简式简明心境问卷(POMS-SF)、疲劳评定量表(FAI)、美国简明健康状况调查问卷(SF-36)评价两组干预前后心理健康状态、疲劳感及生活质量。结果:干预后,两组FVE1%、PEF、FVC及MMEF、POMS-SF评分、FAI评分、SF-36评分与干预前比较差异有统计学意义(P0.05),观察组改善幅度显著强于对照组(P0.05)。结论:家属参与肺康复引导式教育训练可有效提高COPD患者肺功能,改善患者不良心理健康状态及疲劳感,提高患者生活质量。     

运动疗法联合自我效能训练在中晚期慢性阻塞性肺疾病患者中的应用研究

目的:研究分析运动疗法配合自我效能训练在中晚期慢性阻塞性肺疾病(COPD)患者中的应用及对患者运动功能及预后生存质量的影响。方法:选取2017年3月至2018年3月我院接诊中晚期COPD患者120例纳入研究,依据随机数分对照组、观察组,各60例。对照组采用运动疗法,观察组患者给予运动疗法配合自我效能训练。对比两组治疗前、后运动功能、肺功能、生存质量情况。结果:两组治疗前的运动功能指标(6MWT)差异无显著性意义(P0.05);两组治疗后3个月6MWT相比治疗前提升,观察组高于对照组,差异有显著性意义(P0.05);治疗后3个月两组FEV1、FEV1/FVC)均相较治疗前改善,差异有显著性意义(P0.05);治疗前,两组患者的生存质量SF-36评分差异无显著性意义(P0.05);治疗后3个月两组患者生存质量SF-36评分均高于治疗前,且观察组高于对照组,差异有显著性意义(P0.05)。观察组治疗总有效率93.3%(56/60)高于对照组的61.7%(37/60),差异有显著性意义(P0.05)。结论:运动疗法配合自我效能训练能有效改善患者运动功能,增强患者体质,提高患者肺功能,延缓COPD进展,降低家庭及社会经济负担,患者生存质量高,值得临床推广。     

温针、呼吸锻炼结合布地奈德福莫特罗粉吸入剂治疗COPD稳定期患者的效果观察

目的研究温针、呼吸锻炼结合布地奈德福莫特罗粉吸入剂对慢性阻塞性肺疾病(COPD)稳定期患者肺功能及生活质量的影响。方法选取某院COPD稳定期患者98例,随机数表法分为两组,每组各49例。对照组于常规治疗基础上采用布地奈德福莫特罗粉吸入剂治疗,研究组于对照组基础上联合温针、呼吸锻炼治疗。对比两组治疗效果、治疗前后肺功能指标[第1秒用力呼气量(FEV1)、FEV1占用力肺活量百分比(FEV1/FVC)]及生活质量(SF-36)评分变化情况。结果研究组治疗总有效率93.88%(46/49)高于对照组的75.51%(37/49),P0.05;治疗后研究组FEV1、FEV1/FVC及SF-36评分高于对照组(P0.05)。结论温针、呼吸锻炼结合布地奈德福莫特罗粉吸入剂治疗COPD稳定期患者的疗效显著,能有效改善肺功能,提高生活质量。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.