盐酸文拉法辛合并舒肝解郁胶囊治疗躯体形式障碍疗效分析

目的 探讨盐酸文拉法辛合并舒肝解郁胶囊对躯体形式障碍的不良反应和依从性.方法 采用随机分组的方法,将124例躯体形式障碍患者分为治疗组(盐酸文拉法辛合并舒肝解郁胶囊)60例,对照组(单纯使用盐酸文拉法辛胶囊)64例,治疗8周,用TESS评定不良反应.结果 治疗组与对照组对躯体形式障碍的不良反应方面差异有统计学意义,脱落率差异有统计学意义.结论 盐酸文拉法辛合并舒肝解郁胶囊与盐酸文拉法辛比较对躯体形式障碍不良反应小,依从性好,值得临床应用.     

躯体形式障碍的心理治疗方法

目的：分析躯体形式障碍病人的心理治疗方法。结果：发现躯体形式障碍患者的主要问题为：抑郁和焦虑，躯体不适，睡眠障碍，饮食障碍，角色强化，社会和家庭功能损害。方法：对45例躯体形式障碍病人的临床主要表现进行心理维护及治疗，应用对策为：心理维护及心理治疗方法。结论：躯体形式障碍患者同其他精神疾病及内科疾病相比有其独特的心理治疗。     

抑郁发作与躯体形式障碍的症状比较

目的比较抑郁发作与躯体形式障碍的异同。方法了解患者临床情况及就医方式，以自编访谈提纲及汉米顿抑郁量表（HRSD）对66例抑郁发作患者和46例躯体形式障碍患者进行调查。结果两组患者性别及首次就医方式有显著性差异；在常见的14项躯体症状中，9项差异显著。两组的（HRSD）总分和7个因子分均有显著性差异。除焦虑，躯体化因子在躯体形式障碍组显著高于抑郁发作组外，其余各项均低于抑郁发作。结论抑郁发作和躯体形式障碍患者各有其临床特点。     

度洛西汀治疗躯体化障碍和持续性躯体形式疼痛障碍对照研究

目的：探讨度洛西汀治疗躯体化障碍和持续性躯体形式疼痛障碍患者的临床疗效。方法将33例躯体化障碍患者设为A组,37例持续性躯体形式疼痛障碍患者设为B组,两组均口服度洛西汀治疗,观察12周。于治疗前后采用汉密顿焦虑量表及视觉疼痛模拟量表评定临床疗效。结果治疗12周末A组有效率77．42％,B组为97．06％,A 组显著低于B组（χ2＝4．10,P＜0．05）。结论度洛西汀对躯体化障碍和持续性躯体形式疼痛障碍患者均有较好疗效,但对持续性躯体形式疼痛障碍患者的疗效更显著。     

对以慢性疼痛为主的躯体化障碍患者心理干预的效果观察

躯体形式障碍在中国精神障碍分类与诊断标准第3版(CCMD-3)[1]属神经症之一,它包括躯体化障碍(Briguets综合症)、未分化躯体形式障碍、疑病症、躯体形式自主神经紊乱、持续性躯体形式疼痛障碍等.在临床实践中,这些障碍极难清楚地划分开,它们常常交叉或相互共存,常伴有明显的焦虑、抑郁情绪.该类障碍表现为对健康特征多种形式异常的态度,可涉及躯体各个系统和区域.其中,与胸、腹、头、颈有关的症状特别常见[2], 1/2以上患者存在疼痛症状,头痛、胸痛、腹痛、腰痛都多见.作者对本院收治的20例以疼痛表现为主的躯体化障碍患者进行了心理干预,取得了良好的效果,现报道如下.     

文拉法辛与帕罗西汀治疗躯体形式障碍对照研究

【目的】探讨文拉法辛和帕罗西汀对于躯体形式障碍的治疗作用。【方法】对60名躯体形式障碍患者分别用文拉法辛或帕罗西汀治疗8周。采用汉密尔顿抑郁量袁（HAMD）及简明健康测量量表（SF-36）评定药物的疗效。【结果】治疗后两组HAMD评分较治疗前减少,SF-36评分较治疗前提高,差异有显著性（P〈0．01）。8周末文拉法辛组显效率为66．7％,帕罗西汀组显效率为63．3％,两者之间没有显著性差异。【结论】文拉法辛与帕罗西汀对于躯体形式障碍均有治疗作用,两者疗效相当。     

认知行为疗法联合文拉法辛治疗躯体形式障碍

目的 探讨认知行为疗法联合文拉法辛治疗躯体形式障碍患者的临床疗效及安全性.方法 对30例躯体形式障碍患者采用认知行为疗法联合文拉法辛治疗,疗程8 w.于治疗前及治疗8 w末评价各系统症状的发生率,并采用焦虑自评量表和抑郁自评量表评定临床疗效.结果 治疗8 w末,患者各系统症状发生率较治疗前均有明显下降;焦虑自评量表和抑郁自评量表评分均较治疗前有极显著性下降(P＜0.01);不良反应轻微.结论 认知行为疗法联合文拉法辛治疗躯体形式障碍疗效显著,安全性高,依从性好.同时可避免患者反复就诊于其它各综合医院,降低了医疗费用.     

躯体形式障碍患者家庭功能与心理防御特征研究

目的探讨躯体形式障碍患者的家庭功能和心理防御方式的临床特征。方法采用生活事件量表、防御方式问卷对42例躯体形式障碍患者（研究组）以及45例健康志愿者（对照组）进行检查,分析躯体形式障碍患者的家庭功能和心理防御特征。结果研究组生活事件和负性生活事件的频度及严重度、不成熟防御机制评分高于对照组,而家庭环境状况明显低于对照组,差异均有统计学意义（P〈0．05）。结论负性生活事件、不成熟防御机制和家庭环境与躯体形式障碍的发病密切相关,躯体形式障碍患者的家庭支持系统不良,心理防御机制存在不成熟倾向。     

西酞普兰合并认知行为疗法治疗躯体形式障碍的对照研究

目的 研究西酞普兰与认知行为疗法联合治疗与单用西酞普兰治疗躯体形式障碍的临床疗效.方法 将58例躯体形式障碍的患者,按就诊时间顺序,29例给予认知行为疗法与西酞普兰联合治疗,29单用西酞普兰药物治疗.结果 联合治疗组在治疗后4、8、12周的HAMD总分和HAMA总分明显低于药物组,其减分率明显高于药物组.结论 西酞普兰与认知行为疗法联合治疗躯体形式障碍优于单药治疗,并可减少用药剂量.     

综合医院持续性躯体形式疼痛障碍1例报道

<正>持续性躯体形式疼痛障碍是一类临床上较为常见的躯体形式障碍。本病缺乏可以解释的躯体病变,但受社会心理因素或情绪冲突影响明显~([1])。长期疼痛往往给患者带来沉重的心理压力~([2]),由于影响社会功能而出现新的情绪冲突可加重症状,形成恶性循环。目前,本病患者多因疼痛求助于综合医院,但因我国医疗体系长期受生物医学模式的影响,临床医生心理知识掌握情况一般,对本病识别率较低,导致患者得不到正确的诊治以致病情迁延,由于反     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。