中专护生心理健康状况调查分析

采用症状自评量表(SCL-90),对在校一至三年级446名护生及一年级5个班期末学习成绩平均分前10名(高分组)和后10名(低分组)的护生进行心理健康状况调查.结果446名护生SCL-90各因子分均显著高于全国青年常模(均P<0.01),其中二年级护生SCL-90各因子分均低于一、三年级护生;高分组强迫、人际敏感、忧郁、焦虑、敌对和偏执因子分显著低于低分组(P<0.05,P<0.01).提示中专护生心理健康状况水平较低,一年级护生面临新的环境不适应及三年级护生面临就业压力而发生更多的心理健康问题;心理健康问题对学习成绩可能产生负面影响.     

民办与公办学院护理本科生心理健康状况的比较

目的 探讨民办与公办学院护理本科生的心理健康状况有无差异.方法 采用症状自评量表(SCL-90)对248名公办统招护理本科生和205名民办护理本科生进行调查.结果 除躯体化、恐怖因子外,公办护理本科生SCL-90其余7个因子分显著高于民办护理本科生(P＜0.05,P＜0.01).结论 民办护理本科生心理健康状况好于公办护理本科生,应对公办护理本科生加强心理健康教育.     

护理专业女大学生心理状况调查分析

目的了解护理专业女大学生的心理状况.方法采用症状自评量表(SCL-90)和自编的基本情况调查表对513名护理专业女大学生进行调查.结果护理专业女大学生SCL-90总均分,躯体化、强迫症状、抑郁、焦虑、敌对、精神病性等6个因子分均明显高于全国青年常模,差异均有显著性意义(P<0.01,P<0.05);而人际关系敏感、恐怖、偏执等3个因子分与全国青年常模比较,差异无显著性意义(均P>0.05).对护理专业的满意度低、自感学习生活的压力大、同学关系较差、有心理问题不愿求助于他人等是其心理健康的主要影响因素,同时来自农村学生的心理健康状况不如城市学生.结论护理专业女大学生心理状况不容乐观,应针对学生的健康问题进行心理疏导.     

更年期女性心理健康状况与人格特征相关性研究

目的 了解更年期女性心理健康状况与人格特征之间的关系,为制订提高更年期女性心理健康和生活质量干预措施提供依据.方法 采用症状自评量表(SCL-90)与艾森克个性问卷(EPQ)对715名更年期女性进行无记名调查.结果 更年期女性SCL-90与全国成人常模比较,10个因子除躯体化和焦虑因子分高于常模外(均P＜0.01),其余8个因子分类似(均P＞0.05)或显著低于常模(P＜0.01);城市更年期女性躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对6个因子分显著低于农村更年期女性(P＜0.05,P＜0.01),仅偏执因子分高于农村更年期女性(P＜0.05);SCL-90各因子评分与EPQ各量表(除E量表与敌对、恐怖、偏执、精神病性、其他,P量表与其他,L量表与躯体化、强迫症状外)均有显著相关关系(P＜0.05,P＜0.01).结论 更年期女性心理健康总体水平正常,其心理健康与个性特征密切相关;城市更年期女性心理健康水平及个性特征优于农村更年期女性.对农村更年期女性应给予更多的心理支持及健康教育,以提高其心理健康水平.     

自体脂肪填充行面部年轻化就医者的心理健康与自尊水平探讨

目的:探讨自体脂肪填充行面部年轻化就医者心理健康水平与自尊状况。方法:对60例自体脂肪填充面部年轻化就医者(观察组)在术前采用症状自评量表(SCL-90)和罗森伯格自尊量表(SES)进行问卷调查,同时选取60名志愿者作为健康对照组进行罗森伯格自尊量表(SES)问卷调查。结果:观察组SCL-90测评结果显示,躯体化、抑郁、焦虑、偏执、精神病性因子得分均高于全国常模,差异有统计学意义(P0.05);强迫、人际关系敏感因子得分显著高于全国常模,差异有显著性意义(P0.01)。观察组SES评分为(28.52±9.82)分显著低于对照组的(32.36±5.51)分,差异有统计学意义(t=-2.62,P0.01)结论:自体脂肪填充行面部年轻化就医者的心理健康状况和自尊水平低于一般人群,提示在临床医护工作中需要特别关注该类就医者的情绪和自尊心。     

西安市中医院护士的人格特征与心理健康调查分析

目的:探讨西安市中医医院护士人格特征与心理健康水平的关系。对象:采用抽样方法对西安市中医医院197名临床护士进行了问卷调查。方法:采用艾森克人格问卷(EPQ)和90项症状清单(SCL-90)对197名临床护士的人格特征和心理健康状况进行调查研究。结果:中医医院护士的人格特征中的内外向得分显著高于全国常模,神经质、精神质、掩饰性得分低于全国常模,其中精神质和掩饰性与全国常模比较,差异具有统计学意义;护士在躯体化、强迫症状、抑郁、焦虑、敌对、精神病性6个因子得分高于全国常模,其中强迫症状、抑郁、焦虑、敌对与全国常模比较,差异具有统计学意义;护士心理健康各因子(除敌对外)均与人格特征中的内外向和掩饰性呈显著负相关,与神经质和精神质呈正相关。结论:中医医院护士的人格特征有较高的外倾性;心理健康状况低于一般人群;护士的心理健康受其人格特征的影响。     

消化性溃疡患者的心理健康水平和应付方式的相关性

目的:研究消化性溃疡患者心理应付方式与心理健康的关系.方法:选择120例消化性溃疡患者,采用症状自评量表(SCL-90)、、应付方式问卷(CSQ)进行测评.结果:消化性溃疡患者SCL-90各因子分均显著高于常模(p<0.01),采用混合及不成熟型应付方式的消化性溃疡患者心理健康状况相对较差.结论应付方式与心理健康水平存在较高相关性,采用积极、成熟的应付方式有利于消化性溃疡患者维持良好的心理健康状态.     

近5年我国护士心理健康SCL-90调查结果的元分析

目的对2011~2015年我国护士心理健康SCL-90的调查结果进行元分析,以全面、客观地认识护士心理健康状况,建立起新时期护士SCL-90的常模,为评估护士心理健康状况提供可靠依据。方法在中国知网、维普和万方数据库对运用SCL-90进行护士心理健康相关研究的文献进行全面检索。经筛选后获得研究文献367篇,研究数据632组,被试共计79 663名。以1986年确定的中国成人常模和2011年建立的SCL-90中国护士常模为比较标准,根据元分析的相关公式,运用SPSS 11.5软件进行元分析相关统计指标的计算。结果我国护士SCL-90各症状因子的平均效应量为0.06~0.49。79 663名护士SCL-90各症状因子的得分显著高于中国成人常模(均P0.01);除抑郁得分显著低于2011年元分析结果外(P0.01),其余8个症状因子的得分显著高于2011年元分析结果(均P0.01)。结论护士心理健康SCL-90的评判标准需要更新,可考虑将本研究大样本所获得的SCL-90各症状因子得分作为评估护士群体心理健康的参考常模。     

社会支持对糖尿病患者心理健康状况的影响

目的:研究社会支持对糖尿病患者心理健康状况的影响.方法:2011年11月～2012年2月期间,在唐山市某医院内分泌科门诊选取糖尿病患者200例进行问卷调查.结果:糖尿病患者SCL-90量表各因子阳性检出率在85％～89％;SCL-90量表总分、总均分及各因子得分均显著高于常模(P＜0.01);高社会支持组SCL-90总分、总均分及各因子得分均显著低于低社会支持组(P＜0.01).结论:社会支持对糖尿病患者心理健康状况有重要影响,社会支持高的患者心理健康状况较好.     

Relationship between quality of life and mental health among patients with cardiovascular diseases

目的 探讨心血管疾病患者心理健康、生活质量状况以及两者之问的关系,为制定科学的临床干预措施提供依据.方法 分别采用生活质量评定简表(SF-36)中文版和症状自评量表(SCL-90)评估121例心血管疾病患者的生活质量水平和心理健康状况,并进行相关性分析.结果 患者的SF-36 8个维度中生理机能、躯体疼痛、活力、心理健康4个维度评分显著低于国内常模(均P＜0.01),SCL-90因子除强迫、抑郁、精神病性外,其余6个因子评分显著高于国内常模(P＜0.05,P＜0.01).患者SF-36部分维度评分与SCL-90部分因子评分呈显著负相关(P＜0.05,P＜0.01).结论 心血管疾病患者的生活质量不高,心理健康欠佳,且两者之间密切相关;护理人员应加强心理护理,尤其通过扎实的生活护理和健康教育,改善患者的心理健康状态,提高患者生活质量.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.