认知行为干预对抑郁症患者抑郁情绪和自杀态度影响的研究

目的探讨认知行为干预对抑郁症患者抑郁情绪和自杀态度的影响。方法选择2005年9月1日—2006年5月31日入院的抑郁症患者,共80例,随机分为两组。对照组采用精神科护理常规、支持性心理护理,干预组在此基础上实施针对性的认知行为干预。运用汉密顿抑郁量表(Hamilton depression rating scale for depression,HAMD)和自杀态度问卷(Questionnaire of suicide attitude,QSA)对干预效果进行评定。结果入院第3周末及第6周末干预组HAMD量表分值显著低于对照组,干预组HAMD的总平均减分值显著大于对照组的总平均减分值,入院第6周末干预组对自杀行为性质的认识和对自杀者、自杀者家属及安乐死的态度分值显著高于对照组。结论认知行为干预对改善抑郁症患者的抑郁情绪和自杀态度有着明显的影响。     

抑郁症与抑郁焦虑障碍共病临床特征对照研究

目的探讨抑郁症与抑郁焦虑障碍共病患者的临床特征。方法对34例抑郁焦虑障碍共病患者（研究组）和44例抑郁症患者（对照组）采用自拟一般人口学资料问卷统计一般资料,采用汉密顿抑郁量表及汉密顿焦虑量表评定两组患者的抑郁和焦虑状况,对评定结果进行对比分析。结果两组患者一般人口学资料均无显著性差异;研究组汉密顿抑郁量表总分、焦虑／躯体化、认知障碍、阻滞因子分以及自杀条目分均显著高于对照组（P〈0．01～0．05）;汉密顿焦虑量表总分、躯体性焦虑、精神性焦虑因子分,以及焦虑心境、紧张、抑郁心境、肌肉系统症状、感觉系统症状、心血管系统症状、胃肠道症状、植物神经症状及会诊时行为表现单项条目分均显著高于对照组（P均〈0．01）;其他因子或条目分均无显著性差异（P〉0．05）。结论抑郁焦虑障碍共病患者较单纯抑郁症患者的抑郁和焦虑症状更严重、自杀风险大。     

艾司西酞普兰联合团体心理治疗对抑郁症疗效及治疗依从性的影响

目的：探讨艾司西酞普兰联合团体心理治疗对抑郁症患者的疗效及治疗依从性的影响。方法将64例抑郁症患者按随机数字表法分为观察组和对照组,每组32例,均口服艾司西酞普兰治疗,观察组联合团体心理治疗,观察8周。治疗前后采用汉密顿抑郁量表评定抑郁症状,世界卫生组织生存质量测定量表评定生存质量,自知力与治疗态度问卷量表评定患者的自知力及治疗态度。结果治疗后两组汉密顿抑郁量表评分均较治疗前显著下降（P＜0．01）,观察组治疗各时点评分显著低于对照组（ P＜0．05或0．01）;两组世界卫生组织生存质量测定量表各领域评分及自知力与治疗态度问卷量表评分均较治疗前显著升高（ P＜0．05或0．01）,观察组显著高于对照组（ P＜0．05或0．01）。结论艾司西酞普兰联合团体心理治疗对抑郁症具有协同增效作用,起效快,效果显著,有利于提高患者的生存质量及治疗依从性。     

理性情绪疗法对精神分裂症后抑郁患者心理状态的影响

目的：探讨理性情绪疗法对精神分裂症后抑郁患者心理状态的影响。方法将84例精神分裂症后抑郁患者分为两组,每组42例。两组均予以精神科常规治疗及健康宣教,研究组在此基础上联合理性情绪疗法治疗。观察6周。于治疗前后采用自尊量表、自我接纳问卷、汉密顿抑郁量表评定干预效果。结果治疗后两组汉密顿抑郁量表评分均较治疗前显著降低（P＜0．05或0．01）,研究组显著低于对照组（ P＜0．05）;自尊量表、自我接纳问卷评分均较治疗前显著升高（P＜0．05或0．01）,研究组显著高于对照组（P＜0．05）。结论理性情绪疗法能显著改善精神分裂症后抑郁患者的抑郁情绪,提高其自尊水平及自我接纳程度。     

阅读疗法对康复期抑郁症患者应对方式及社会支持影响对照研究

目的探讨阅读疗法对康复期抑郁症患者应对方式及社会支持的影响。方法将137例抑郁症患者随机分为干预组69例和对照组68例。两组均给予抗抑郁药物治疗和一般康复治疗,干预组在此基础上联合阅读疗法,疗程30d。干预前后采用汉密顿抑郁量表（24项）、应对方式问卷、社会支持评定量表对两组患者进行评定分析。结果汉密顿抑郁量表总分干预后两组均较干预前有显著下降（P〈0.05）;应对方式问卷评分干预后干预组解决问题、求助因子分较对照组升高显著,自责因子分较对照组下降显著（t解=5.465,6.527,-2.757,P〈0.01）;社会支持评定量表评分干预后两组各项因子分均较干预前升高,干预组较对照组升高显著,其中对支持利用度因子分差异有极显著性（t=5.965,P〈0.01）。结论阅读疗法对抑郁症患者的药物治疗有较好的辅助作用,能显著改善康复期抑郁症患者的应对方式和社会支持状况。     

米氮平联合心理干预治疗抑郁症对照研究

目的 探讨米氮平联合心理干预治疗抑郁症的临床疗效.方法 将82例抑郁症患者随机分为观察组47例、对照组35例,两组均每晚口服米氮平治疗,观察组在此基础上联合心理干预治疗,观察8周.于治疗前及治疗8周末采用汉密顿抑郁量表评定临床疗效.结果 治疗前两组汉密顿抑郁量表评分差异无显著性(P＞0.05);治疗8周末,两组汉密顿抑郁量表评分均较治疗前显著下降(t=21.03、11.90,P＜0.01),但观察组较对照组下降更显著(t=8.21,P＜0.01);观察组总有效率为95.74%,对照组为74.29%,观察组显著高于对照组(χ2=7.95,P＜0.01).结论 米氮平联合心理干预治疗能有效改善抑郁症患者的抑郁状态,提高临床疗效,有利于患者快速获得全面的康复,显著优于单用米氮平治疗.     

聚焦解决模式心理干预对骨折患者焦虑抑郁情绪的影响

目的：探讨以聚焦解决模式为基础的心理干预对骨折患者焦虑抑郁情绪的影响。方法将100例骨折伴焦虑抑郁情绪患者按随机数字表法分为两组,每组50例,均予以常规治疗及护理干预,观察组在此基础上实施以聚焦解决模式为基础的心理干预,观察住院全程。干预前后采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况,统计患者的满意度。结果干预后两组汉密顿焦虑量表、汉密顿抑郁量表评分均较干预前显著下降（P＜0．01）,但观察组评分显著低于对照组（ P＜0．01）;观察组总满意率为96．0％,对照组为78．0％,观察组总满意率显著高于对照组（P＜0．01）。结论以聚焦解决模式为基础的心理干预能显著缓解各种骨折患者的焦虑抑郁情绪,增强治疗信心,提高治疗依从性及满意度。     

舍曲林联合丁螺环酮治疗抑郁症伴性功能障碍对照研究

目的：探讨舍曲林联合丁螺环酮治疗抑郁症伴性功能障患者的临床疗效。方法将100例抑郁症伴性功能障碍患者随机分为两组,每组50例,两组均口服舍曲林治疗,观察组联合丁螺环酮合治疗,观察8周。采用汉密顿抑郁量表、抑郁自评量表评定抑郁状况,Olson婚姻质量问卷评定婚姻质量,性生活满意度量表评定性生活满意度。结果治疗后两组汉密顿抑郁量表、抑郁自评量表评分均较治疗前显著下降（P＜0．01）,观察组较对照组下降更显著（P＜0．01）;两组Olson婚姻质量问卷评分均较治疗前显著升高（P＜0．01）,观察组较对照组升高更显著（P＜0．01）;观察组性生活总满意率显著高于对照组（χ2＝7．48,P＜0．01）。结论舍曲林联合丁螺环酮治疗抑郁症伴性功能障患者效果显著,能显著提高患者的性生活满意度和婚姻质量,显著优于单用舍曲林治疗。     

参与型护理对抑郁症病人生存质量和自杀态度的影响

[目的]探讨参与型护理模式对抑郁症病人生存质量和自杀态度的影响。[方法]将符合入组标准的160例抑郁症病人随机分为实验组和对照组各80例,在应用抗抑郁药物治疗的同时,实验组病人实施参与型护理模式,对照组实施精神科常规护理。于病人入组时和干预8周后采用世界卫生组织生存质量测定量表（WHOQOL-BREF）和自杀态度问卷（QSA）进行评定。[结果]两组病人8周后在生理领域、心理领域和社会关系领域生活质量评分比较差异有统计学意义（P〈0.05或P〈0.01）,且实验组对自杀行为性质的认识和对自杀者、自杀者家属及安乐死的态度评分高于对照组病人（P〈0.01）。[结论]参与型护理模式可以改善抑郁症病人生活质量,影响其自杀态度,预防自杀。     

艾司西酞普兰与曲唑酮治疗抑郁症对照研究

目的：探讨艾司西酞普兰与曲唑酮治疗抑郁症的临床疗效和安全性。方法将68例抑郁症患者随机分为两组,每组34例,研究组口服艾司西酞普兰治疗,对照组口服曲唑酮治疗,观察6周。于治疗前后采用汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应。结果治疗后两组汉密顿抑郁量表总分均较治疗前显著下降（P＜0.01）,研究组治疗1周末汉密顿抑郁量表总分较对照组下降更显著（P＜0.01）,显效时间显著快于对照组（P＜0.01）。治疗6周末研究组显效率为64.7％、总有效率为88.2％,对照组分别为58.8％、85.3％,两组显效率、总有效率比较差异无显著性（ P＞0.05）。两组不良反应均较轻微,但研究组治疗各时点副反应量表评分显著低于对照组（ P＜0.05或0.01）。结论艾司西酞普兰与曲唑酮治疗抑郁症疗效显著,总体疗效相当,不良反应轻微,但艾司西酞普兰起效较快,安全性更高,依从性更好。     

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.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.