血液透析患者心理状况及社会支持的临床研究

目的探讨尿毒症血液透析患者的心理健康状况及社会支持情况.方法采用症状自评量表(SCL-90)和社会支持评定量表对80例尿毒症血液透析患者进行调查分析,并与对照组进行对比分析.结果尿毒症血液透析患者组症状自评量表(SCL-90)中抑郁[(3.12±0.83)分]、焦虑[(2.82±0.57)分]、恐怖[(2.84±0.61)分]、躯体化[(2.58±0.58)分]等各项因子分明显高于对照组(P＜0.01),在社会支持评定量表中主观支持[(19.27±2.19)分]和对社会支持利用度[(9.66±2.11)分]明显低于对照组(P＜0.01或＜0.01).结论尿毒症血液透析患者存在有明显的抑郁、焦虑、恐怖、躯体化不适等不良心理状况,在社会中受支持程度和对支持的利用度较低.     

心脏起搏患者术前社会心理状况及其影响因素

目的了解心脏起搏患者术前社会心理状况及其影响因素.方法采用症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、社会支持评定量表(SSRS)评价125例心脏起搏患者心脏起搏术前社会、心理状况及其影响因素.结果症状自评量表调查显示:125例心脏起搏患者存在以焦虑(60人)、躯体化(57人)、恐怖(38人)、抑郁(55人)、人际关系(34人)为主要表现的心理问题,其因子得分均高于国内常模,差异有显著性(P均＜0.01).焦虑自评量表(SAS)、抑郁自评量表(SDS)积分明显高于25例对照组,差异有显著性(P均＜0.01),而社会支持评定量表(SSRS)积分则明显低于对照组,差异有显著性(P＜0.01).多元逐步回归分析显示症状自评量表(SCL-90)积分与经济收入、病情严重程度、人际关系、家庭生活显著关联(P均＜0.01).收稿: Oct. 16, 2003结论心脏起搏患者存在焦虑、躯体化、恐怖、抑郁、人际关系等明显心理问题,社会支持不满意.同时经济收入、病情严重程度、人际关系、家庭生活是影响患者心理状况的主要因素.     

企业外来工人心理健康与生活事件、应付方式的相关性研究

目的 了解企业外来工人心理健康状况、生活事件及应付方式.方法 应用症状自评量表(SCL-90)、生活事件量表(LES)、应付方式问卷(CQ),对企业工人进行调查.结果 外来组SCL-90总分、躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐怖、偏执及精神病性因子分[(165.34±42.05)分、(1.69±0.53)分、(2.06±0.54)分、(1.97±0.56)分、(1.88±0.58)分、(1.79±0.54)分、(1.85±0.59)分、(1.67±0.56)分、(1.87±0.54)分、(1.73±0.50)分]均高于本地组,两者差异有显著性(P<0.05).相关分析显示,企业工人SCL-90因子分除恐怖因子外均与LES总分、因子分呈正相关(P<0.05,P<0.01);CQ因子分中合理化、求助、幻想、自责、退避与SCL-90各因子分呈显著正相关(P<0.05),解决问题与SCL-90因子分中强迫症状、人际敏感、抑郁、恐怖及附加因子分明显负相关(P<0.01).结论 企业外来工人心理健康状况较差,生活应激因素较多.     

II型糖尿病患者的心理状况调查分析

目的:了解II型糖尿病患者的心理状况。方法:采用症状自评量表(SCL-90),抑郁自评量表(SDS)和焦虑自评量表(SAS)对50例II型糖尿病患者进行心理状况问券调查,并对50例体检正常者进行对照。结果:II型糖尿病患者在SCL-90量表总分,阳性项目分、躯体化、焦虑、抑郁、恐怖以及SAS、SDS量表得分与对照组相比,差异有显著性(P<0.05~0.01)。结论:II型糖尿病患者存在明显的心理障碍,主要表现为躯体化、焦虑、紧张、抑郁、恐惧,因此对II型糖尿病患者在药物治疗的同时,还应进行积极的心理干预。     

早期复极综合征患者负性情绪障碍及心理行为干预疗效观察

目的探讨早期复极综合征患者负性情绪障碍及心理行为干预的疗效。方法心电图确诊的早期复极综合征(ERS)患者,共68例,随机分为研究组、对照组,每组各34例。两组均进行常规药物治疗,并对研究组进行心理行为干预。分别于入组时、治疗12周后进行焦虑自评量表(SAS)、抑郁自评量表(SDS)、症状自评量表(SCL-90)的测评。结果干预12周后,研究组SAS、SDS评分较对照组显著下降,分别为(43.56±6.54)分、(44.63±7.61)分,与对照组比较差异有显著性(P<0.01);且研究组SAS、SDS评分较干预前〔(63.21±9.86)分、(65.32±8.08)分〕评分显著下降,差异有显著性(P<0.01)。干预12周后两组SCL-90评分比较,研究组SCL-90总分、躯体化、强迫症状、人际关系、抑郁、焦虑、敌对及恐怖因子分,较对照组显著下降,差异有显著性(P<0.01或P<0.05)。结论ERS患者常有焦虑、抑郁等负性情绪,其心理状况较差,心理行为干预能有效的消除ERS患者的负性情绪,改善其心理状况,提高治疗效果。     

家庭功能缺失学生心理健康状况调查

目的 了解家庭功能缺失学生的心理健康状况.方法 采用症状自评量表(SCL-90)和家庭功能评定量表(FAD)对舟山市千荷实验学校110名家庭功能缺失学生(研究组)进行测评,并与普通家庭寄宿制学生(对照组)进行对照.结果 家庭功能缺失学生在SCL-90中的总分、躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分[(157.38±52.37)分、(1.54±0.60)分、(1.94 ±0.59)分、(1.93±0.70)分、(1.81±0.71)分、(1.73±0.64)分、(1.82±0.69)分、(1.61±0.62)分、(1.79±0.63)分、(1.62±0.63)分]显著高于对照组[(123.76±35.14)分、(1.25±0.41)分、(1.67±0.56)分、(1.53±0.58)分、(1.30±0.39)分、(1.37±0.52)分、(1.33±0.44)分、(1.25±0.35)分、(1.42±0.57)分、(1.27±0.32)分,t=5.487,4.145,3.296,4.477,6.504,4.498,6.132,5.158,4.459,5.065,P<0.01];家庭功能缺失学生的SCL-90总分及躯体化、强迫、人际关系敏感、抑郁、焦虑、恐怖、偏执和精神病性因子分与FAD中的沟通、角色、情感反应、情感介入及总的家庭功能等因子分呈显著正相关(P<0.05或P<0.01).结论 家庭功能缺失学生心理状况差,应引起社会各界的重视.     

256名外来教师心理健康状况和生活事件应付方式的研究

目的 了解东莞市外来教师心理健康状况、生活事件及应付方式.方法 应用症状自评量表(SCL-90)、生活事件量表(LES)、应付方式问卷(CQ),对中学教师进行调查和分析.结果 外来教师组SCL-90总分[(150.74±44.57)分]、躯体化[(1.69±0.56)分]、强迫症状[(1.84±0.58)分]、抑郁[(1.77±0.60)分]、焦虑[(1.63±0.55)分]、敌对[(1.68±0.61)分]、精神病性因子分[(1.54±0.48)分]均高于本地组,两者差异有显著性(P＜0.01).相关分析显示,外来教师 SCL-90因子分与LES总分及因子分均呈显著正相关(P＜0.05,P＜0.01);SCL-90因子分与CQ评分中解决问题因子分呈明显负相关(P＜0.01),与CQ其他因子分呈显著正相关(P＜0.01).结论 东莞市外来教师心理健康状况较差,生活应激因素较多,应付方式欠妥.     

中青年与老年面部创伤患者心理状态比较及诊疗模式分析

目的 比较中青年与老年面部创伤患者心理状态.方法 采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、UCLA孤独量表等心理学量表对88例面部创伤患者的心理健康状况进行测量.结果 中青年患者焦虑评分[(50.96±6.21)分]、抑郁指数[(0.58±0.06)]明显高于老年患者[(40.45±5.29)分,(0.44±0.04)](P<0.01),老年患者的孤独评分[(60.62±5.43)分]明显高于中青年患者[(38.22±6.64)分](P<0.01).结论 不同年龄层次的面部创伤患者心理障碍情况有很大不同,在临床处理上应区别对待.     

发热门诊医务人员“非典”时期的心理状态

目的:了解“非典”期间发热门诊医务人员的心理状态。方法:应用症状自评量表(SCL-90)和焦虑自评量表SAS和抑郁自评 量表SDS,分别对83名发热门诊医务人员和92名非发热门诊医务人员进行心理状态及情绪的评定。结果:发热组SCL-90中躯体化、强迫 焦虑和恐怖因子分高于非发热组,差异具有非常显著性意义(P<0.01),两组医师比较,发热组躯体化和恐怖因子分高于非发热组(P<0.05) 两组护士比较,发热焦虑和恐怖因子分高于非发热组,差异具有非常显著性意义(P<0.01)。除发热组医师在焦虑自评中的评分与非发热组 的差异无统计学意义外,焦虑、抑郁的自评得分发热组均明显高于非发热组,差异具有非常显著性意义(P<0.01)。结论:发热门诊医务人员 非典期间存在明显的心理问题,应给于心理疏导。     

卒中后抑郁96例调查分析

目的:探索卒中后抑郁患者心理状态及社会支持问题。方法:采用SCL-90症状自评量表、领悟社会支持量表(PSSS)对96例卒中后抑郁患者进行调查,并将SCL-90调查结果与常模进行对照分析研究。结果:卒中后抑郁患者躯体化、人际关系、抑郁、焦虑、恐怖、精神病等因子分显著高于常模。PSSS分值为(37.16±10.93)分,低支持状态占60.59%。结论:卒中后抑郁患者存在明显的心理问题,缺乏社会支持系统,应多加关注。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.