突发公共卫生事件下医护人员心理评价系统调查

目的：考察各类医护人员对突发公共卫生事件的初级评价和二级评价状况。方法：采用自编的心理问题调查表对某综合医院内医护人员的心理状况进行调查。结果：突发公共卫生事件下，不同工作性质的医护人员群体对突发公共卫生事件的初级评价部分有差异，二级评价有显著性差异。进修人员群体评估危险度最高，更多会采取无效或消极的应对措施。而SARS病房群体虽然初级评价危险较高，但二级评价无效或消极的最少，合理应对最高。已婚和未婚、有子女和无子女的医护人员对突发公共卫生事件的初级评价有显著性差异。较之未婚和无子女群体，已婚群体和有子女群体倾向高估突发公共卫生事件的危害。结论：突发公共卫生事件下，家在外地，处境特殊，身份游离，个体的应对资源和心理储备不足的群体，容易产生有破坏性或不愉快体验的应激。而事前知情，心理准备充分，相关知识培训系统，预防措施完备的群体，即使有一定程度的应激，也是正性和积极的。已婚群体和有子女群体的医护人员，可能有更多的家庭责任、义务和牵挂，他们在突发公共卫生事件下容易产生负性应激。     

对参与突发性公共卫生事件医护人员的心理调节

目的 探讨突发公共卫生事件这一应激源对医护工作者心理调节的影响.方法 将本院参加突发公共卫生事件处理的120人、根据追踪记录和调查、将其分为干预组和对照组.用焦虑自评量表及开放式问卷进行调查,干预组运用小组谈话、辅导讲座等多种方式进行心理疏导.结果 调查对象普遍存在焦虑、认知力缺乏及自我评价丧失等应激反应.结论 建议管理者应及时掌握动态、制定对策、及时咨询;将教育管理与关心体恤相结合;建立心理档案,实施有效对策,从而稳定医护人员的心态,这也更有利于突发公共卫生事件的解决.     

对参与突发性公共卫生事件医护人员的心理调节

目的 探讨突发公共卫生事件这一应激源对医护工作者心理调节的影响.方法 将本院参加突发公共卫生事件处理的120人,根据追踪记录和调查,将其分为干预组和对照组.用焦虑自评量表及开放式问卷进行调查,干预组运用小组谈话、辅导讲座等多种方式进行心理疏导.结果 调查对象普遍存在焦虑、认知力缺乏及自我评价丧失等应激反应.结论 建议管理者应及时掌握动态、制定对策、及时咨询;将教育管理与关心体恤相结合;建立心理档案,实施有效对策,从而稳定医护人员的心态,这也更有利于突发公共卫生事件的解决.     

应对突发公共卫生事件医护人员的心理调节

目的:探索突发公共卫生事件这一应激源对医护工作者心理调节的影响。方法:将本院参加突发公共卫生事件处理的120人,根据追踪记录和调查,将其分为干预组和对照组。用焦虑自评量表及开放式问卷进行调查,干预组运用小组谈话、辅导讲座等多种方式进行心理疏导。结果:调查对象普遍存在焦虑、认知力缺乏及自我评价丧失等应激反应。结论:建议管理者应及时掌握动态、制定对策、及时咨询;将教育管理与关心体恤相结合;建立心理档案,实施有效对策,从而稳定医护人员的心态,这也更有利于突发公共卫生事件的解决。     

基层医院护士应对突发公共卫生事件的护理对策

目的 学习突发公共卫生事件应对护理方法.方法 通过了解突发卫生事件的特点,探讨应对突发卫生事件的护理对策,进一步熟练掌握处理的要点.结果 通过完善突发卫生事件的准备和突发卫生事件病人的护理,提高医护人员的心理素质及反应能力.结论 完善好对突发卫生事件预防工作,科学管理,提高优化护理人员的心理素质是医护管理工作者的重要任务.从实际需求出发,制定实施有效对策,从而更好地应对突发公共卫生事件.     

医护人员SARS患者心理状况分析

目的了解心理因素在SARS患病中的作用,为今后制定切实可行的针对医护人员及SARS病人的心理干预方案提供客观的依据.方法用SCL-90、EPQ人格问卷及自编的认知观念问卷对35例患SARS的医护人员进行调查,同时与工作在SARS病房而未患病的医护人员进行对照.结果患病的医护人员在SCL-90的9个因子中,有6个因子分与健康的医护人员相比差异有显著性.人格类型与SARS患病无直接关系,病人与健康人在认知观念、自信心及情绪状态上有显著的差别.结论患病的医护人员的心理状态不佳,病人非理性的认知观念、负性情绪状态对SARS患病有一定影响.应更加注意医护人员的心理素质培养工作的针对性、实效性和持久性.     

医护人员SARS患者心理状况分析

目的 了解心理因素在SARS患病中的作用，为今后制定切实可行的针对医护人员及SARS病人的心理干预方案提供客观的依据。方法 用SCL-90、EPQ人格问卷及白编的认知观念问卷对35例患SARS的医护人员进行调查，同时与工作在SARS病房而未患病的医护人员进行对照。结果 患病的医护人员在SCL-90的9个因子中，有6个因子分与健康的医护人员相比差异有显著性。人格类型与SARS患病无直接关系，病人与健康人在认知观念、自信心及情绪状态上有显著的差别。结论 患病的医护人员的心理状态不佳，病人非理性的认知观念、负性情绪状态对SARS患病有一定影响。应更加注意医护人员的心理素质培养工作的针对性、实效性和持久性。     

突发公共卫生事件应对能力评价工具研究

自2003年的严重急性呼吸综合征（SARS）事件以来,突发公共卫生事件已成为我国社会备受关注的一个话题。SARS、苏丹红添加剂事件、安徽流脑恐慌、四川猪链球菌感染和禽流感等事件的接踵而至,促使我国政府高度重视突发公共卫生事件工作。然而,我国突发公共卫生事件防治尚处于一个初步阶段,对于如何构建科学的、符合我国国情的突发公共卫生应对系统并不是十分清楚。突发公共卫生事件应对能力评价工具对于引导一个国家和地区的突发公共卫生事件应对体系建设起着至关重要的作用。在目前国内尚无突发公共卫生事件应对能力评价工具的情况下,我们针对突发公共卫生事件应对能力评价工具研制提出建议。     

在校学生突发公共卫生事件认知情况调查分析

目的了解在校学生对SARS及突发公共卫生事件认知和重视程度。方法采用整群抽样方法,从二年级每个专业中随机抽取1个班,进行不记名问卷调查。结果学生普遍缺乏突发公共卫生事件相关知识,对这些课程持欢迎态度。结论应对学生加强公共卫生教育,提高他们对突发公共卫生事件的防范能力。     

二炮某部军人心理应激水平与心理弹性、认知偏向和积极情绪的关系

目的 探讨军事心理应激水平与军人心理弹性、认知偏向及积极情绪的关系.方法 采用军事心理应激自评问卷(PSET)、心理弹性量表(CD-RISC)中文版正负性情绪量表(PANAS-C)和正负性认知偏向量表(APNIS)对536名二炮某部官兵进行抽样调查.结果 ①心理应激总分与负性情绪、负性认知偏向呈显著正相关(r值分别为0.44、0.41,P＜0.01);与正性情绪、心理弹性和正性认知偏向均呈显著负相关(r值分别为-0.29、-0.30、-0.27,P＜0.01).②心理应激高分组与低分组在心理弹性、正负性情绪、正负性认知偏向上均存在显著差异(P＜0.01).③负性情绪、负性认知偏向、正性认知偏向和积极情绪可有效预测军事心理应激水平,总解释率为36％.④积极情绪在正性认知偏向对心理应激水平的影响中起部分中介作用,在心理弹性与心理应激水平之间起完全中介作用.结论 军人心理应激水平与其心理弹性、正负性情绪和认知偏向密切相关.积极的情绪、合理的认知以及心理弹性的增加都有助于缓减军人心理应激症状,促进心理健康.     

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.