首诊终末期肾病患者心理状况影响因素的研究

目的 探讨终末期肾病(ESRD)首诊患者的焦虑-抑郁水平及其影响因素.方法 采用住院患者焦虑-抑郁评分系统(hospital anxiety and depression scale,HADS)对137例首诊ESRD患者行2次评分,同时对研究对象进行一般资料的登记.结果 肾外器官损害数、中年是首诊ESRD患者HADS指数的高危因素(P＜0.05),性别因素与HADS指数无明显相关性.护理干预使HADS评分焦虑指数下降到(10.01±0.11)分,抑郁指数下降到(7.85±0.36)分;2者较入院时皆有统计学差异(P＜0.05).结论 首诊ESRD患者应常规评估焦虑-抑郁水平,有高危因素患者应立即进行护理干预,良好的护理心理疏导能显著改善首诊ESRD患者的焦虑-抑郁状态.     

首诊肺结节患者感知压力与睡眠质量的关系：焦虑抑郁的中介作用

目的：探讨焦虑抑郁在首诊肺结节患者感知压力与睡眠质量中的中介作用。方法：选取2020年10月至2023年10月电子科技大学医学院附属绵阳医院首诊肺结节患者410例为研究对象。分别采用医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)、感知压力量表(Perceived Stress Scale,PSS)、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评估患者焦虑抑郁情绪、感知压力及睡眠质量。分析首诊肺结节患者HADS、PSS、PSQI评分之间的关系及焦虑抑郁在感知压力与睡眠质量中的中介作用。结果：410例首诊肺结节患者HADS焦虑、抑郁评分分别为12.36±3.28、10.97±3.05,PSS、PSQI评分分别为32.89±4.82、12.69±2.98。PSS与PSQI评分呈正相关(r=0.522,P<0.001),HADS焦虑、抑郁评分与PSS(r=0.591,r=0.613)、PSQI评分(r=0.293,r=0.326)均呈正相关(均P<0.05)。控制混杂因素后,H...     

帕金森病照料者的焦虑和抑郁症状分析

目的:评价、分析帕金森病(PD)照料者的焦虑、抑郁情况。方法:PD患者及其主要照料者55对纳入研究。使用综合医院焦虑抑郁量表(HADS)对患者进行评分,判定分析PD照料者的心理状态及其影响因素。结果:55例照料者HADS焦虑评分为(8.04±4.85)分,HADS抑郁评分为(8.07±6.13)分。55例照料者中,女性HADS焦虑评分为(9.68±5.11)分,高于男性的(5.92±3.57)分;女性HADS抑郁评分为(9.65±6.69)分,高于男性的(6.04±4.71)分(均P0.05)。55例照料者中,有罹患焦虑症风险20例(36.36%),其中女15例(71.42%),男5例(23.81%);有罹患抑郁症风险24例(43.64%),其中女18例(75.00%),男6例(25.00%);2组女性患者比例均占优势(P0.05)。相关分析结果显示,HADS焦虑评分与PD患者年龄呈正相关(r=0.292,P0.05),与PD病程呈正相关(r=0.38,P0.05),与H-Y评分呈正相关(r=0.328,P0.05);HADS抑郁评分与PD病程呈正相关(r=0.274,P0.05),与H-Y评分呈正相关(r=0.203,P0.05)。结论:部分PD照料者存在焦虑、抑郁情绪;女性照料者更容易产生焦虑抑郁情绪;焦虑抑郁情绪的产生与PD患者的年龄、病程和H-Y评分有关。     

梅毒性动脉炎所致脑卒中患者焦虑、抑郁状况的调查及心理护理

目的探讨梅毒性动脉炎所致脑卒中患者的焦虑、抑郁状况及其影响因素,并初步评价心理护理干预的效果。方法应用综合医院焦虑／抑郁量表（HADS）对26例梅毒性动脉炎（观察组）及26例动脉粥样硬化（对照组）所致脑卒中患者进行调查,并了解其影响因素。对被确定为焦虑／抑郁阳性患者给予心理护理干预,干预后再次行HADS评分并进行对比分析。结果观察组患者焦虑评分明显高于对照组[（9．50±4．88）比（7．11±3．20）分];抑郁评分高于对照组[（9．76±3．91）比（7．34±4．57）分],差异均有统计学意义（t分别为2．081,2．054;P〈0．05）,其产生焦虑、抑郁的影响因素更为复杂且具有相当的特殊性。经心理护理干预后,各组中焦虑／抑郁阳性患者的焦虑／抑郁评分较前均有明显下降,差异均有统计学意义（t分别为9．122,7．289,5．050,10．420;P〈0．05）。结论梅毒性动脉炎所致脑卒中患者存在较严重的焦虑、抑郁状况,其影响因素复杂而特殊,实施心理护理干预可有效缓解患者的焦虑、抑郁情绪,帮助患者康复。     

个性化心理干预计划表对妇科住院患者焦虑、抑郁的影响

目的：探讨个性化心理干预计划表对妇科住院产后抑郁患者焦虑、抑郁的影响。方法将57例妇科住院产后抑郁的患者随机分为实验组和对照组,对照组给予常规护理,实验组患者采用个性化心理干预计划表进行护理干预。对比分析两组患者护理效果。结果实验组护理后焦虑自评量表评分(8.39±1.62)分、抑郁自评量表评分(9.50±1.43)分明显低于对照组患者﹝(21.40±2.58)分、(23.41±3.38)分﹞,两组差异有统计学意义( P<0.05)。结论个体化心理干预计划表在产后抑郁症患者临床护理中的应用,可降低SAS评分与SDS评分,改善患者的心理状况。     

护理流程图对腹膜透析患者护理质量的影响

目的 分析护理流程图对腹膜透析患者护理质量的影响.方法 选取2017年6月—2018年6月于我院接受腹膜透析治疗的患者80例,采用随机数字表法将患者分为观察组与对照组各40例,对照组予以基础护理,观察组在此基础上予以护理流程图干预,比较两组患者的护理质量.结果 观察组患者的基础护理质量评分(92.17±4.56)分、安全管理质量评分(93.22±3.76)分、病房管理质量评分(95.74±2.68)分、专科护理质量评分(93.88±3.69)分明显高于对照组,两组比较差异具有统计学意义(P<0.05).干预后,两组患者的焦虑症状、抑郁症状明显较干预前程度更轻(P<0.05);观察组干预后的焦虑症状评分(34.27±5.33)分、抑郁症状评分(36.42±6.67)分明显较对照组更低,两组比较差异均具有统计学意义(P<0.05).干预后,两组患者的生活质量评分明显高于干预前(P<0.05);观察组干预后的生活质量评分(63.24±9.71)分明显高于对照组的(55.41±6.14)分,两组比较差异具有统计学意义(P<0.05).结论 运用护理流程图护理可有效提高腹膜透析患者的护理质量,并改善患者的生活质量,护理效果良好,值得推广.     

综合护理干预对慢性心衰患者自护能力及负性情绪的影响

探讨慢性心力衰竭(CHF)患者自护能力的影响因素及护理干预的价值。将于我院住院的60例CHF患者抽签随机均分为两组。对照组实施常规护理,观察组实施综合护理干预。采用一般自我效能量表(GSES)、综合医院焦虑抑郁量表(HAD)、心衰自我护理量表(SCHFI)分别对两组患者的自我效能、负性情绪及自护能力进行评分。护理后两组GSES(31.45±8.43)分、SCHFI(34.63±5.82)分评分较护理前及对照组护理后(23.84±7.68)分、(30.76±5.14)分显著较高(P<0.05),护理后两组患者焦虑(6.23±0.64)分、抑郁评分(5.47±0.87)分较护理前及对照组护理后(7.04±0.46)分、(6.82±0.69)分显著较低(P<0.05)。对CHF患者实施综合护理模式,消除影响患者自护能力的负性情绪,提供疾病相关知识,有利于患者的自我效能提高,促使患者健康行为的维持,进而提高患者的自我护理能力。     

ICU患者抑郁焦虑发生的危险因素分析

目的探讨ICU患者住院期间抑郁焦虑的发病率及出院后抑郁焦虑的危险因素。方法前瞻性研究,入选在我院ICU进行治疗的250例神志清楚及智力正常的患者,记录患者的性别、年龄、教育程度、原发病的严重程度[以Charlson Co-morbidity index(CCI)量表评估]、APACHEⅡ评分、呼吸机使用天数、每日睡眠时间、入住ICU的时间等10项资料,在入院4 d后以医院焦虑抑郁量表(HADS)来测评其住院期间抑郁焦虑的发病率;在患者出院2个月内,成功随访195例,以HADS量表再次测评患者出院后抑郁焦虑的发生情况,采用多元线性回归分析找出与患者出院后抑郁焦虑发生的有关危险因素。结果 ICU患者住院期间抑郁焦虑的发生率为24%;多元线性回归分析表明:CCI评分(P<0.01),住院期间HADS评分(P<0.05),入住ICU时间(P<0.01)3项为患者出院后抑郁发病的危险因素;CCI评分(P<0.01),APACHEⅡ评分(P<0.05),住院期间出现谵妄(P<0.05),住院期间HADS评分(P<0.05),入住ICU时间(P<0.01)5项因素为患者出院后焦虑发生的危险因素。结论 ICU患者住院期间抑郁焦虑的发病率较高。原发病较重,住院期间出现精神症状,入住ICU时间长是患者出院后出现抑郁症状的危险因素;原发病较重,APACHEⅡ评分较高,且住院期间出现精神、谵妄症状,入住ICU时间长是患者出院后出现焦虑症状的危险因素。     

心理干预对泌尿系统肿瘤伴发焦虑抑郁的影响

目的:泌尿系统肿瘤和其他恶性肿瘤一样,可以导致患者出现明显的焦虑或抑郁情绪,探讨心理干预对泌尿系统肿瘤伴发的焦虑抑郁的影响。方法:94例伴发焦虑抑郁的泌尿系统肿瘤患者随机分为心理干预组45(例)和对照组49例),心理干预组接受心理干预联合常规药物治疗;对(照组只接受常规药物治疗;两组患者均采用抑郁和焦虑自评量表(SDS,SAS)作为治疗效果的测查指标。结果:心理干预组抑郁指数在治疗后比治疗前显著下降(40.1±4.6比57.6±5.0,P<0.01);焦虑指数也显著下降36.5±5.6比59.7±5.1,(P<0.01)。而对照组治疗后比治疗前抑郁指数下降不明显(56.9±6.2比53.6±5.1,P>0.05),焦虑指数下降较明显36.5±5.6比47.6±6.2,(P<0.05);但在治疗后两组组间比较两项指数,对照组均明显高于心理干预组(P<0.05)。结论:心理干预对泌尿系统肿瘤的整体康复有促进作用。     

认知行为干预在慢性心力衰竭患者中的应用

目的探讨认知行为干预在慢性心力衰竭患者中的应用效果。方法将100例符合纳入标准的慢性心力衰竭患者,按随机数字表法随机分为观察组和对照组各50例。对照组接受常规护理,观察组在常规护理的基础上实施认知行为干预。采用综合医院焦虑抑郁量表(HADS)、明尼苏达量表(MLWHFQ)、多普勒超声诊断仪器、6min步行试验,对2组患者的焦虑抑郁情绪、心功能及生活质量进行测评。结果干预前2组患者焦虑抑郁评分比较,差异无统计学意义(P0.05),干预后观察组评分(7.12±3.09)分明显低于对照组(10.33±4.06)分,比较差异有统计学意义(P0.05);干预后观察组生活质量评分(61.07±9.25)分低于对照组(68.67±10.45)分、干预后观察组左室射血分数(LVEF)(45.6±9.4)%、6min步行距离(356.4±46.3)m评分均高于对照组(41.5±10.1)%、(246.5±51.7)m,比较差异有统计学意义(P0.05)。结论认知行为干预是一种能够改善慢性心力衰竭患者负面情绪和心脏功能,提高其生活质量的有效护理方法。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.