保留子宫对子宫破裂产妇的精神与性心理的影响

目的：观察子宫破裂保留子宫与产妇精神心理的关系。方法：６８例妊娠子宫破裂的产妇根据病情进行手术治疗，并依据孕产情况分初产妇组、经产妇组；按手术的方式分保留子宫（修补术）组、子宫切除组；并同时采用汉密顿焦虑量表（ＨＡＳ）和抑郁量表（ＨＤＳ）评定产妇手术后的精神状态；对术后性心理状态、性生活情况进行１～２年随访。结果：产妇手术后焦虑发生率４５％，抑郁发生率３５％，焦虑并抑郁发生率２５％。子宫切除组的焦虑评分和抑郁评分明显高于保留子宫（修补术）组（Ｐ＜０．０５），子宫切除组中焦虑评分和抑郁评分初产妇组高于经产妇组（Ｐ＜０．０５）；子宫切除组产妇术后性心理状态及性生活质量均明显低于保留子宫（修补术）组（Ｐ＜０．０５）。结论：子宫切除给子宫破裂产妇的精神性心理带来消极影响。     

体外循环心脏术后并发精神障碍65例临床分析

目的　提高对体外循环心脏手术后并发精神障碍的认知与防治。方法　分析体外循环心脏手术后出现精神运动性障碍和情感障碍的病人的临床表现和转归。结果　本组并发精神障碍的发生率为 3 .2 5 % (65/ 2 0 0 0 ) ,61例病人精神障碍治愈 ,2例有阳性精神病家族史的患者好转出院 ,2例死亡。结论　体外循环中脑血流灌注不足 ,术后并发心、脑、肺、肾功能障碍及感染是病人出现精神障碍的主要原因。对于有阳性精神病家族史的病人 ,手术创伤可能是精神障碍的诱发因素。及时治疗躯体疾病及心理治疗 ,病人大多可获治愈。     

严重脑外伤急性期颅内压与血儿茶酚胺变化的关系及其意义

报告５１例严重脑外伤急性期持续ＩＣＰ监护和血ＣＡ测定结果，发现脑外伤组血ＣＡ明显高于对照组（Ｐ＜０．００１）。脑外伤后２４小时内ＩＣＰ与血ＮＥ、Ｅ水平显著呈正相关（ｒ＝０．７３０，Ｐ＜０．００１和ｒ＝０．５４２，Ｐ＜０．００１），脑外伤后第三天ＩＣＰ与血ＮＥ、Ｅ亦显著呈正相关（ｒ＝０．６０４，Ｐ＜０．００１和ｒ＝０．４５１，Ｐ＜０．０１）。伤后２４小时ＩＣＰ正常或轻度增高者，６５％恢复良好．３５％恢复差，而ＩＣＰ＞５．３ｋＰａ组病人，９０％以上死亡。伤后第三天ＩＣＰ仍高于５．３ｋＰａ的４例病人全部死亡。     

ABC－ELISA法检测重症肌无力患者三种自身抗体的研究

本文利用ＡＢＣ－ＥＬＩＳＡ法检测了９７例ＭＧ病人血清内三种抗体：ＡｃｈＲａｂ、Ｐｒ－Ｍａｂ、ＣＡＥａｂ。结果发现：（１）全身型ＡｃｈＲａｂ、ｐｒ－Ｍａｂ阳性率明显高于眼肌型（Ｐ＜０．０１）；ＡｃｈＲａｂ与Ｐｒ－ＭａｂＰ／Ｎ值呈线性正相关（ｒ＝０．７９７Ｐ＜０．０１）。（２）合并胸腺异常者ＣＡＥａｂ阳性率为８４．２％，明显高于对照组（Ｐ＜０．０１）；此组病人ＡｃｈＲａｂ与ＣＡＥａｂＰ／Ｎ值呈显著正相关，Ｐｒ－Ｍａｂ与ＣＡＥａｂＰ／Ｎ值呈非常显著正相关。（ｒ＝０．５１２和ｒ＝０．５９８Ｐ＜０．０１）。（３）８例病人作了治疗前后抗体检测。激素治疗后或切除异常胸腺后，抗体滴度多数下降或有转阴趋势。     

速可平保留灌肠治疗溃疡性结肠炎并植物神经紊乱的临床研究

目的：探讨蝎毒制剂－速可平（ＳＶ）对溃疡性结肠炎（ＵＣ）的治疗效果。方法：６０例ＵＣ患者随机分组，采用蝎毒制剂—速可平保留灌肠（治疗组），同时与用柳氮磺胺吡啶（ＳＡＳＯ）肛栓剂（对照组）进行前瞻性对照研究。结果：两组治疗后主要症状、体征及肠粘膜结构积分均有明显改善（Ｐ＜０．０１或Ｐ＜０．０１），且治疗组较对照组改善更明显（Ｐ＜０．０１）；主要实验室指标治疗前后也均有显著的改善（Ｐ＜０．０１或Ｐ＜０．０１），且治疗组较对照组改善更明显（Ｐ＜０．０１）；治疗组平均治疗时间为３４天，而对照组为４８天（Ｐ＜０．０５），治疗组治愈率及总有效率分别为６０％和９３．３％与对照组３３．３％和８０％相比，差异有显著性（Ｐ＜０．０１或Ｐ＜０．０５）；治愈病例进行６个月及１２个月的随访，治疗组复发率分别为１１．１％和１６．７％与对照组４０％和６０％相比，有显著性差异（Ｐ＜０．０１或Ｐ＜０．０１）；两组副作用发生率分别为３％和１３．３％（Ｐ＜０．０１）。结论：速可平对ＵＣ具有较好治疗效果，同时能改善ＵＣ相关的免疫学指标，无明显副作用。     

卒中后癫痫的临床与机理探讨（附148例报告）

对１４８例卒中后癫痫的临床及发病机理与卒中类型进行分析研究，结果为卒中后癫痫的发生率为６．４％，早期癫痫发作４．３％，迟发性癫痫２．１％。卒中后癫痫的发生率与病灶部位（皮质／皮质下）有明显的相关性（Ｐ＜０．０１），与卒中类型无明显差异（Ｐ＞０．０５）。脑水肿是早期癫痫发作的重要致痫因素，迟发性癫痫可因胶质疤痕形成癫痫灶所致。     

体外循环心脏术后精神障碍的护理

目的 总结体外循环心脏术后精神障碍的临床特征、病因和防护措施.方法 回顾性分析632例体外循环心脏术后并发精神障碍31例的临床资料.结果 本组体外循环心脏术后并发精神障碍发生率为4.9%,主要表现为抑郁状态14例,谵妄状态11例,经治疗26例治愈,5例死亡.结论 体外循环导致的脑损害是精神障碍的主要原因,应加强围术期的护理,采取综合措施预防,给予心理干预,积极治疗.     

中风后癫痫的危险因素

探讨中风后癫痫的危险因素。方法队列研究一对６４１例中风患者追踪观察。结果癫痫发生率为９．２０％（５９／６４１）。年龄、性别及中风类型对中风后癫病发生的危险度无影响,相对危险度（Ｒｅｌａｔｉｖｅｒｉｓｋ,ＲＲ）分别为１．２０、１．２９、１．２５（Ｐ均＞０．０５）。病变累及皮层、多脑叶或伴发头痛者癫痫的危险度显著增加,ＲＲ分别为３．１９（Ｐ＜０．００１）、１．８０（Ｐ＜０．０５）、２．０２（Ｐ＜０．０１）。脑出血后癫痫多属早期发作（８／１１）,而脑梗塞多属晚期发作（４０／４８）（Ｐ＜０．０１）。结论病损累及皮层是重要的致病因素,多脑叶受累或伴发头痛使癫痫发生的危险性增加。早期和晚期癫痫发作的机理、治疗和转归不同。     

小剂量阿斯匹林预防缺血性脑血管病的长期随访研究

８１５例轻型缺血性卒中（ＭＩＳ）或ＴＩＡ病人随机分为阿斯匹林（ＡＳＡ）组（４１３例）与对照组（４０２例），随访１２～６０（平均２９．４）个月，结果发现：ＡＳＡ组卒中与死亡发生率（１５．３％）明显低于对照组（２４．４％）（Ｐ＜０．０１），ＡＳＡ组卒中与死亡危险性较对照组降低３７％［相对危险性（ＲＲ）为０．６３，９５％可信区间为０．４６～０．８６］；ＡＳＡ组卒中、血管性死亡及心肌梗塞发生率（２２．３％）显著低于对照组（３５．４％）（Ｐ＜０．００１），ＡＳＡ组卒中、血管性死亡及心肌梗塞危险性较对照组降低３６％（ＲＲ为０．６６，９５％可信区间为０．５０～０．８４）；ＡＳＡ组副作用发生率为１８．４％，严重副作用为２．７％。     

经颈前入路显微外科手术治疗老年颈椎病

目的 介绍并讨论前路显微外科手术治疗老年颈椎病。方法 对６０例病人实施了颈间盘、后纵韧带及椎体后缘骨赘显微手术切除椎体融合术,对２４例病人实施了椎体切除显微手术减压椎体融合钛板固定术。结果 ６６例（７９％）术后症状改善,１４例（１７％）无变化,２例（２％）症状加重,２例（２％）死亡（１例死于冠心病,１例死于肺栓塞）。统计学分析表明,病人手术前后神经功能状况的差异有显著性,术后明显优于术前（Ｐ〈０．     

成人心脏外科术后并发精神障碍31 例临床分析

目的提高对成人心脏外科手术后患者并发精神障碍认识与防治。方法分析620例成人心脏手术后出现精神障碍患者的临床表现和转归。结果本组并发精神障碍的发生率为5%(31/620),29例患者精神障碍治愈,2例死亡。结论长时间体外循环中脑血流灌注不足,微栓形成,术后并发心、肺、脑等脏器功能障碍及感染可能是精神障碍的诱发因素和出现精神障碍的主要原因。提高认识,及时有效地治疗躯体疾病及心理治疗,绝大多数患者预后良好。     

体外循环心脏术后并发精神障碍的临床分析

目的探讨对体外循环(CPB)心脏术后并发精神障碍的可能原因和防治方法。方法回顾性分析我院2010-01～2010-12施行的1 128例体外循环心脏术后并发精神障碍45例的临床资料和防治措施。结果除2例因多脏器衰竭而死亡,其余均经治疗1～2周内康复而出院。随访1～3个月均未再出现精神障碍表现。结论体外循环心内直视手术后发生精神障碍是包括体外循环、生理功能、环境、心理等多因素共同作用的结果,应采取综合防治措施。     

Effect of open heart surgery on intellectual performance

Abstract

The interrelationship between postoperative psychosis, neurologic symptoms, and changes in tests of cognitive performance have been studied in a series of 60 cardiac valvular patients who underwent open heart surgery. The effects of preoperative psychological, psychiatric, and cardiologic factors on postoperative cognitive changes were analyzed. The investigation period was from five months before up to five months after the operation. There was a general trend towards improvement in intellectual performances. The psychotic group, however, still showed a persisting impairment in some visual and psychomotor tests several months after the surgery. The group with neurologic symptoms showed impairment in one visual test. Of the preoperative variables, mitral valve disease, a high level of hypochondriasis and anxiety, and poor performance in some visual and psychomotor tests predicted postoperative intellectual impairment. The results suggest two types of cerebral complications of open heart surgery. Postoperative psychosis reflects diffuse brain dysfunction manifesting itself in psychological tests long after the clinical symptoms have resolved. The presence of neurologic symptoms refers to a focal or lateralized injury. Both the neurologic and neuropsychologic findings indicate that the right hemisphere may be more prone to dysfunction than the left hemisphere.     

Psychosis prediction: 12-month follow up of a high-risk ("prodromal") group

Intervention in the prodromal phase of schizophrenia and related psychoses may result in attenuation, delay or even prevention of the onset of psychosis in some individuals. However, a "prodrome" is difficult to recognise prospectively because of its nonspecific symptoms.This study set out to recruit and follow up subjects at high risk of transition to psychosis with the aim of examining the predictive power for psychosis onset of certain mental state and illness variables.Symptomatic individuals with either a family history of psychotic disorder, schizotypal personality disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were assessed and followed up monthly for 12 months or until psychosis onset.Twenty of 49 subjects (40.8%) developed a psychotic disorder within 12 months. Some highly significant predictors of psychosis were found: long duration of prodromal symptoms, poor functioning at intake, low-grade psychotic symptoms, depression and disorganization. Combining some predictive variables yielded a strategy for psychosis prediction with good sensitivity (86%), specificity (91%) positive predictive value (80%) and negative predictive value (94%) within 6 months.This study illustrates that it is possible to recruit and follow up individuals at ultra high risk of developing psychosis within a relatively brief follow-up period. Despite low numbers some highly significant predictors of psychosis were found. The findings support the development of more specific preventive strategies targeting the prodromal phase for some individuals at ultra high risk of schizophrenia.     

The prognostic significance of depressive symptoms for predicting quality of life 12 months after gastric bypass

OBJECTIVE: This study was conducted to examine the relative prognostic significance of weight and depressive symptoms for 12-month postoperative health-related quality of life (HRQL) in extremely obese gastric bypass patients. METHODS: Participants comprised 137 extremely obese patients undergoing gastric bypass surgery. Presurgery and 12 months postsurgery participants completed the Medical Outcomes Study Short Form-36 Health Survey, a standard measure of HRQL, and the Beck Depression Inventory (BDI). Regression analyses were performed to predict HRQL, both before and 12 months after surgery, by using demographic variables, and measures of body mass index (BMI) and depressive symptoms as predictors. RESULTS: At baseline the predictors accounted for 19% of the variance of physical HRQL, and 56% of the variance of mental HRQL. At 12 months after surgery, the predictors accounted for 32% of the variance of physical HRQL and 48% of mental HRQL. In the prediction of 12-month postoperative HRQL, baseline BMI, BMI unit change, baseline BDI, and improvements in BDI score made significant contributions to most of the Medical Outcomes Study Short Form-36 Health Survey scales. Demography contributed little to these predictor analyses. Depressive symptoms made greater contributions than weight and demography, and change in BDI score made the greatest contributions (ranging from 3% to 37%) of all the variables tested. CONCLUSIONS: Measures of weight and depressive symptoms were useful in predicting quality of life both before and 12 months after gastric bypass surgery; however, this is the first study to document that improvements in HRQL postsurgery may be largely related to improved depressive symptoms.     

经皮冠状动脉支架置入和冠状动脉搭桥后再发胸痛患者的心理健康状况◆

背景：许多学者极力呼吁对冠状动脉粥样硬化性心脏病患者进行生物学治疗的同时也应进行心理学的干预,并建构整合生物-心理-社会治疗和干预计划。但要进行有针对性的心理干预,首先需要了解冠状动脉粥样硬化性心脏病患者的心理健康状态究竟如何。 目的：应用问卷调查评估法对经皮冠状动脉支架置入和冠状动脉搭桥后再发胸痛患者的心理健康状况进行主成分分析,并寻找其主要因素。 方法：选择经皮冠状动脉支架置入和冠状动脉搭桥后再发胸痛的冠状动脉粥样硬化性心脏病患者40例作为观察对象,其中男25例,女15例,年龄(60±10)岁。以中国人身心健康状态综合评估与诊断系统为测评工具,利用主成分分析方法对患者躯体症状、积极情绪、消极情绪、认知问题、行为问题、自我评价、社会适应问题等7个分量进行评估。 结果与结论：提取的主成分有4个(其累积贡献率达到83.89%),第一主成分主要涉及行为问题和社会适应问题,其贡献率达40%,第二主成分主要涉及消极情绪和积极情绪,第三主成分主要涉及认知问题和自我评价,第四主成分主要涉及躯体症状。结果说明应该对经皮冠状动脉支架置入和冠状动脉搭桥后再发胸痛冠状动脉粥样硬化性心脏病患者的行为问题和社会适应问题给予高度重视,同时应该从心理角度引导患者的积极情绪,减低消极情绪。     

Screening for mental disorders in cardiology outpatients

The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86 were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic and mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had major depression, six (7.0%) minor depression, six (7.0%) anxiety disorder, two unspecified somatoform disorder, seven (8.1%) dementia, one alcohol abuse and one psychosis. Three of the patients were in long-term psychopharmacological treatment. Although the cardiologists predicted mental disorder significantly better than chance, none of the patients was in relevant treatment for their mental disorder. At 3-year follow-up, 20 (24%) of the patients had died. Age and severity of heart disease predicted mortality, while the presence of a mental disorder did not. Mental disorders, especially depression, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment.     

立体定向术对阿片类药物依赖者心理障碍治疗前后的对照研究

目的观察立体定向手术治疗对阿片类药物依赖病人术后近期病理性心理症状的影响。方法选择自愿要求手术的戒毒病人26例,采用90项症状自评量表（SCL-90）进行评估。治疗前后选择自身配对t检验,治疗前后与国内常模比较、治疗后与强制戒毒、冷火鸡脱毒、美沙酮脱毒治疗后比较采用单样本t检验。结果术后73.1%病人总体病理性心理障碍症状完全改善。57.7%病人的躯体不适症状、73.1%病人的强迫症状得到矫治。手术消除了80.8%病人的抑郁症状、69.2%病人的焦虑症状。同时手术也改善了69.2%病人的人际关系、57.7%病人的恐怖、73.1%病人的敌对、61.5%病人的偏执、57.7%病人的精神病和65.4%病人其他不良症状。与常模比较,术前SCL-90各项差异均有统计学意义（P〈0.05）,术后仅躯体症状差异有统计学意义（P〈0.001）。与强制戒毒组比较,术后SCL-90各项差异均有统计学意义（P〈0.05）;与冷火鸡组比较,仅躯体症状差异有统计学意义;与美沙酮组比较,躯体症状、抑郁、焦虑差异有统计学意义。结论手术能够不同程度地矫治阿片类药物依赖病人的病理性心理障碍,且近期疗效好于强制戒毒、冷火鸡和美沙酮疗法。     

Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features

The identification of individuals at high risk of developing a psychotic disorder has long been a goal of clinicians because it is thought that early treatment of this group may prevent onset of the disorder. However, little is known of predictive factors of psychosis, even within a high-risk group. This study followed up 104 young people thought to be at 'ultra high risk' for schizophrenia and other psychotic disorders by virtue of having a family history of psychotic disorder combined with some functional decline or the presence of subthreshold or self-limiting psychotic symptoms. All subjects were therefore symptomatic, but not psychotic, at intake. Thirty-six subjects (34.6%) developed frank psychotic symptoms within 12 months. Measures of symptom duration, functioning, disability and psychopathology were made at intake, 6 and 12 months. Poor functioning, long duration of symptoms, high levels of depression and reduced attention were all predictors of psychosis. A combination of family history of psychosis, a recent significant decrease in functioning and recent experience of subthreshold psychotic symptoms was also predictive of psychosis. Combining highly predictive variables yielded a method of psychosis prediction at 12 months with good positive predictive value (80.8%), negative predictive value (81.8%) and specificity (92.6%) and moderate sensitivity (60.0%). Within our symptomatic high-risk group, therefore, it appears possible to identify those individuals who are at particularly high risk of developing a psychotic disorder such as schizophrenia. Given the very high PPV and low false positive rate with this two-step process, it may be justifiable to target these individuals for intensive monitoring of mental state and even low-dose neuroleptic medication or other biological and psychosocial treatments depending on clinical condition. This indicated prevention approach could be further developed and preventive strategies in the psychoses refined.     

Preventing the incidence of new cases of mental disorders: a meta-analytic review

To assess the results of studies examining the effects of preventive interventions on the incidence of mental disorders, we conducted a systematic review. A literature search resulted in 13 high-quality randomized trials, six on depressive disorder (including postpartum depression), one on anxiety, one examining both anxiety and depression, three on posttraumatic stress disorders, one on psychosis, and one on any mental disorder. The overall relative risk (RR) was 0.73 (95% CI, 0.56-0.95), indicating a reduction of the risk to become a new case of a mental disorder. The seven studies on prevention of depressive disorder resulted in a RR of 0.72 (95% CI, 0.54-0.96). The risk of posttraumatic stress disorder was somewhat increased after debriefing, but not significantly (RR=1.33), indicating a possible adverse effect. Prevention of new cases of mental disorders seems to be possible and may be an important way of reducing the enormous burden of these disorders.