老年抑郁症防治的进展

阐述老年抑郁症的流行病学研究,从预防、非药物治疗、心理治疗、药物治疗、电休克治疗方面综述老年抑郁症防治的进展。     

男性抑郁症患者的护理策略进展

男性抑郁症患者对于其疾病本身的看法和应对策略与女性不同，这直接影响到他们的治疗和康复计划。目前尚没有关于男性抑郁症患者非药物治疗策略的系统研究报道。本文从护理策略的角度入手，着重探讨了男性抑郁症患者的护理策略以及其治疗依从性对疾病预后的影响。     

男性抑郁症患者的护理策略进展

男性抑郁症患者对于其疾病本身的看法和应对策略与女性不同,这直接影响到他们的治疗和康复计划.目前尚没有关于男性抑郁症患者非药物治疗策略的系统研究报道.本文从护理策略的角度入手,着重探讨了男性抑郁症患者的护理策略以及其治疗依从性对疾病预后的影响.     

中青年与老年抑郁症患者临床特征及药物治疗的对比研究

目的对267例成年抑郁症患者的临床特征及治疗药物特点进行回顾性分析,探寻中青年与老年抑郁症患者在临床特征及治疗方面有无差异。方法采取回顾性分析方法,调阅2010~2011年南方医科大学附属南方医院中医科门诊及病房299例抑郁症患者病历,选择其中病历资料完整并符合本研究要求的267例进行分析,中青年组234例,老年组33例。结果 2组患者在年龄、文化程度及婚姻构成比差异有统计学意义,在性别及家族史阳性差异无统计学意义;在生活事件方面,中青年组与老年组相比差异无统计学意义（P〉0.05）。老年组合并躯体疾病发生率高于中青年组（P〈0.05）。老年组在情绪改变、自杀意念及躯体化症状发生率高于中青年组（P〈0.05,P〈0.01,P〈0.05）,尤其在自杀意念及躯体化症状表现上更为明显。2组患者在药物治疗方面,包括抗抑郁药合用中药的治疗方式,差异无统计学意义。结论成年抑郁症患者在起病诱因上有差异,随着年龄的增长,以躯体疾病为诱因引发抑郁症的比例会增大。成年抑郁症患者在临床症状也存在差异,相对中青年患者,老年患者有更多的情绪改变、自杀意念及躯体化症状。成年患者在抗抑郁药物选择上差异无统计学意义。     

抑郁症认知功能损害患者非药物干预研究进展

在2020年中华中医药精神病学分会抑郁症认知症状评估与干预专家共识的基础上对抑郁症认知功能非药物干预方法、现状等进行总结,以期在抑郁症认知功能损害患者的临床护理中提供依据及更多的非药物干预方案的选择,辅助提高认知功能损害患者临床疗效。     

帕罗西汀联合其他疗法治疗抑郁症的研究进展

抑郁症(MDD)在当代社会已是一种较为常见的精神疾病,发病机制虽不明确,但有多种学说。临床治疗抑郁症仍采用药物疗法,虽然疗效确切但不良反应问题也同样突出。近年来发展的非药物疗法以其非侵入性、安全、无副作用的特点成为治疗抑郁症的辅助手段,帮助药物获得更好的临床效果。本文以帕罗西汀联合的其他疗法为例,列举近年常用的非药物疗法,以期为临床治疗抑郁症提供新方法和新思路。     

小组认知行为联合药物治疗对老年抑郁症的疗效评估

目的：探讨小组认知行为联合药物治疗对老年抑郁症的疗效。方法：将126例老年抑郁症患者随机分为两组,一组行单纯药物治疗,另一组行药物合并小组认知行为治疗。于治疗前及治疗后2,6,12个月,采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和自动想法问卷（ATQ）评定患者的临床疗效;同时行连续执行测验（CPT）评定患者的认知功能;并于治疗后2个月末,进行两组疗效因子评分比较。结果：联合治疗组较单纯药物组抑郁症状改善明显,情绪宣泄、人际学习（获取）、人际学习（付出）、团体凝聚力、自我了解等5个因子在疗效因子评估中占优。结论：小组认知行为治疗联合药物治疗能提高对老年抑郁症的疗效,有效改善患者功能失调性认知、应对方式,提高患者的生活满意度,远期疗效较好。     

儿童青少年抑郁症临床治疗进展

儿童抑郁症与成年人抑郁症的关系目前尚不确定,治疗成年人抑郁症疗效显著的药物用于未成年人时．其疗效和不良反应可能有很大的不同,而未成年人抑郁症的药物治疗研究十分有限,为此,作者对目前有关儿童青少年抑郁障碍（MDD）的研究结果进行了综述,以期对临床能有所帮助。     

音乐治疗对抑郁症的疗效研究

目的:研究音乐治疗对抑郁症患者的治疗效果。方法:抑郁症患者112例随机分为联合治疗组56例和药物治疗组56例,2组均给予草酸艾司西酞普兰片治疗,联合治疗组另外给予系统的音乐治疗,治疗12周。应用Hamilton抑郁量表(HAMD)及贝克自评问卷(BDI-13)进行评定,观察2组治疗参与度。结果:治疗8周后,联合治疗组的HAMD及BDI-13评分低于药物治疗组(P<0.05),治疗12周后2组HAMD量表及BDI-13评分有显著性差异(P<0.01)。治疗第12周末联合治疗组的治疗参与度高于药物治疗组(P<0.05)。结论:音乐治疗能有效改善抑郁症的精神症状,提高其治疗参与度。     

改良无抽搐电休克治疗抑郁症所致记忆损害临床干预策略

改良无抽搐电休克治疗(Modified electroconvulsive therapy,MECT)是目前治疗抑郁症非常有效的一种物理治疗方法,然而大部分接受MECT治疗的抑郁症患者都表现出不同程度的记忆功能损害,限制了其在抗抑郁治疗中的应用。本文将从新型麻醉剂、电休克治疗参数、改善记忆功能的药物及物理治疗等方面介绍MECT治疗抑郁症所致记忆损害的临床干预策略进行综述。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.