植入心力衰竭预警心律转复除颤器一例

心源性猝死最有效的预防方法是植入植入型心律转复除颤器(ICD),对于心力衰竭(心衰)患者若能在病情恶化早期进行及早的干预,则能有效防止心功能进行性恶化。最近拥有监测肺水肿状态的ICD开始应用于临床,我院于2008年6月13日成功完成全国首例心衰预警的植入型心律转复除颤器(VirtuosoICD)手术,现报道如下。     

经静脉植入心律转复除颤器1例

1．1病例资料患者男性,47岁。因反复晕厥和阿-斯综合征发作半年,于2004年12月25日入院。患者于2004年6月和10月有2次晕厥发作,当时心电图证实为持续性室速,患者有大汗、低血压和抽搐,很快室速演变成室颤,经胸200J电击除颤抢救成功。既往患者无高血压、糖尿病、心肌梗死病史。入院查体：血压110／80mmHg,双肺无啰音,心界向左下扩大,心率92次／min,心尖区Ⅱ／6级收缩期杂音。超声心动图（UCG）：左室大（61mm）,室壁弥漫性运动减弱,EF38％。冠状动脉造影（CAG）：冠状动脉未见明显异常。入院诊断：扩张型心肌病。患者同意植入埋藏式心内除颤器（ICD）,     

植入型心律转复除颤器不适当电击的发生特点及优化管理

目的分析植入型心律转复除颤器(ICD)术后不适当电击的发生特点及处理方法。方法通过腔内心电图判定ICD不适当电击的发生原因,针对发生原因进行个体化治疗。结果在我科2011-2014年植入ICD的189例患者中,20例发生了不适当电击,发生比例约10.6%,心房颤动(AF)伴快速心室率、室上性心动过速(SVT)及过感知是主要原因。其中,70%(14/20)患者是由于AF伴快心室率进入了室颤的诊断区间,发生了不适当电击;15%(3/20)误将SVT识别为室速;10%(2/20)肌电干扰过感知是由于发生了电极导线故障;5%(1/20)T波过感知。17例调整药物治疗方案及ICD优化程控设置,2例植入起搏感知电极进行手术干预故障电极,T波过感知通过调整起搏电极的感知极性,均未再发生严重误电击事件。结论AF快心室率是引起不适当电击的主要原因,长期有效的药物治疗结合ICD鉴别诊断参数优化是主要的治疗方法,对于特殊病因需采用必要的手术治疗进行干预。     

急性心肌梗塞患者运用健康教育路径改善疾病不确定感的护理研究

目的：应用健康教育路径改善急性心肌梗塞患者疾病不确定感。方法：选取有较高疾病不确定感的急性心肌梗塞患者130例。按我院自行设计AMI患者健康教育路径表格实施健康教育。疾病不确定感分别在患者入院第一天、出院时,以及出院后第6个月评分。结果：患者在出院时疾病不确定感比入院第一天显著降低（P〈0．01）,出院后第6个月比出院时显著降低（P〈0．01）。结论：急性心肌梗塞患者健康教育路径的实施,不仅显著降低了患者疾病不确定感,还提高了患者治疗依从性。     

卵巢癌患者疾病不确定感、希望水平与社会支持的相关性分析

目的 探讨卵巢癌患者疾病不确定感、希望水平与社会支持的相关性,以为临床干预提供参考.方法 选择2018年3月-2019年10月收治的60例卵巢癌患者为研究对象,所有入选者均接受疾病不确定感量表(MUIS)、Herth希望量表(HHI)、社会支持评定量表(SSRS)评估,分析该疾病患者疾病不确定感、希望水平与社会支持的相...     

COPD患者自我护理能力与不确定感及应对方式的关系研究

慢性阻塞性肺疾病(COPD)是我国老年人群常见的呼吸系统疾病,患者病情反复,不仅增加其精神及肉体上的痛苦,同时也给家庭及社会增添负担[1]。自护能力是指患者促进及维护身心健康所获得一种能力,是个体形成自我护理行为的基础[2]。COPD作为慢性终生性疾病,患者如拥有良好的自护能力,可促进其康复及提高其生存质量。相关研究指出[3],患者对疾病的应对方式及不确定感可影响其康复效果,但关于其与COPD患者自护能力的关系目前国内报道较     

Deep Learning-Based Algorithm for the Detection and Characterization of MRI Safety of Cardiac Implantable Electronic Devices on Chest Radiographs

ObjectiveWith the recent development of various MRI-conditional cardiac implantable electronic devices (CIEDs), the accurate identification and characterization of CIEDs have become critical when performing MRI in patients with CIEDs. We aimed to develop and evaluate a deep learning-based algorithm (DLA) that performs the detection and characterization of parameters, including MRI safety, of CIEDs on chest radiograph (CR) in a single step and compare its performance with other related algorithms that were recently developed.Materials and MethodsWe developed a DLA (X-ray CIED identification [XCID]) using 9912 CRs of 958 patients with 968 CIEDs comprising 26 model groups from 4 manufacturers obtained between 2014 and 2019 from one hospital. The performance of XCID was tested with an external dataset consisting of 2122 CRs obtained from a different hospital and compared with the performance of two other related algorithms recently reported, including PacemakerID (PID) and Pacemaker identification with neural networks (PPMnn).ResultsThe overall accuracies of XCID for the manufacturer classification, model group identification, and MRI safety characterization using the internal test dataset were 99.7% (992/995), 97.2% (967/995), and 98.9% (984/995), respectively. These were 95.8% (2033/2122), 85.4% (1813/2122), and 92.2% (1956/2122), respectively, with the external test dataset. In the comparative study, the accuracy for the manufacturer classification was 95.0% (152/160) for XCID and 91.3% for PPMnn (146/160), which was significantly higher than that for PID (80.0%,128/160; p < 0.001 for both). XCID demonstrated a higher accuracy (88.1%; 141/160) than PPMnn (80.0%; 128/160) in identifying model groups (p < 0.001).ConclusionThe remarkable and consistent performance of XCID suggests its applicability for detection, manufacturer and model identification, as well as MRI safety characterization of CIED on CRs. Further studies are warranted to guarantee the safe use of XCID in clinical practice.     

强化心血管植入型电子器械植入无菌操作流程对术后感染发生率影响

目的探讨强化心血管植入型电子器械(CIED)植入无菌操作流程能否降低CIED感染发生率。方法选择自1998年1月至2015年9月沈阳军区总医院心内科收治的3 501例植入CIED的患者,将2011年8月前收治的植入CIED患者1 926例作为对照组,2011年8月后收治的1 575例采用强化CIED植入无菌操作流程手术的患者作为强化组,统计CIED深部感染发生率。结果强化组CIED深部感染发生率为0,明显低于对照组1.6%,差异有统计学意义(P<0.05)。结论强化CIED植入无菌操作流程能够降低CIED感染发生率。     

积极心理干预对肝癌患者介入治疗创伤后成长及乐观倾向的影响

目的 探讨适合原发性肝癌介入治疗患者的积极心理干预方案,并验证其对患者创伤后成长及乐观倾向的作用.方法 将126例患者随机分成对照组和研究组.对照组(63例)予以常规心理护理,研究组(63例)在对照组基础上接受以积极心理学理论为基础的护理干预,心理干预周期为4周,每周1次,每次20～30 min.结果 干预4周后研究组的创伤后成长及乐观倾向两方面均优于对照组,差异有统计学意义(P＜0.01).结论 实施积极心理干预能够提高肝癌介入治疗患者积极情绪,促进其心身功能康复.     

高龄晚期胃癌患者不同姑息性介入治疗前后生活质量及焦虑状态的临床观察

【摘要】　目的?观察高龄晚期胃癌患者两种不同姑息性介入治疗对生活质量及焦虑状态的影响,探索对其身心双重治疗的最佳策略。方法?入选62例≥75岁确诊晚期胃癌患者,根据患者及家属治疗意愿,分为动脉灌注化疗栓塞组（TACE组）37例和金属支架置入组（支架组）25例。记录基本临床资料,所有患者术前及术后3、7、28 d进行肿瘤患者生活质量评分（QOL）及汉密尔顿焦虑量表（HAMA）评分。结果?①与术前比较,化疗栓塞组术后3 d QOL评分无统计学差异（P=0.05）,术后7、28 d均升高（P＜0.05）;支架组,术后QOL评分均升高（P＜0.05）。组间比较,术后3 d QOL评分TACE组低于支架组（P＜0.05）;28 d则高于支架组（P＜0.05）。②与术前比较,TACE组术后3 d HAMA评分变化不显著,术后7、28 d显著下降（P＜0.05）;支架组,术后HAMA评分均下降（P＜0.05）。组间比较,术后3 d TACE组HAMA评分高于支架组（P＜0.05）;而28 d则低于支架组（P＜0.05）。结论?两种姑息性介入治疗对高龄晚期胃癌患者在躯体、心理两方面均可获益。支架组患者生活质量和焦虑状态在短期内可迅速改善,而TACE组患者更受益于远期疗效。     

STA无痛麻醉对缓解老年高血压患者拔牙焦虑的临床研究

目的 了解STA无痛麻醉仪对于缓解老年高血压患者拔牙焦虑的效果.方法 对同一组患高血压病的老年患者分别使用STA无痛麻醉仪(实验组)和传统麻醉方法进行麻醉,比较两种方法的麻醉效果及患者术中焦虑程度.结果 (1)实验组患者在麻醉后、拔牙后与麻醉前相比,收缩压、舒张压均无明显变化,与对照组相比差异有统计学意义(P＜0.05).(2)实验组视觉模拟评分法(visual analogue scale,VAS)、改良的牙科焦虑量表(modified dental anxiety scale,MDAS)均值均显著低于对照组,差异有统计学意义(P＜0.05).(3)局部组织舒适度上,实验组得分(1.1±0.3)显著低于对照组(2.8±0.5),差异有统计学意义(P＜0.05).结论 应用STA无痛麻醉仪进行口腔局部麻醉能有效缓解老年高血压患者的拔牙焦虑,提高临床舒适度.     

介入术后肿瘤患者睡眠质量与焦虑抑郁情绪的相关性分析

目的了解介入科肿瘤患者的睡眠质量、焦虑抑郁的现况,探讨两者之间的相关关系,为临床护士采取干预措施,减少患者痛苦,改善生活质量提供依据。方法采用便利抽样方法,对2018年9月至10月入住北京某三甲肿瘤专科医院介入科的100例肿瘤患者进行问卷调查,调查内容包括患者一般资料调查表、匹兹堡睡眠质量指数量表、医院焦虑抑郁自评量表。采用均数、标准差、频数、百分比进行统计描述,采用Pearson相关、t检验、方差分析、多元线性回归进行统计推断。结果共回收82例有效问卷,48.8%患者匹兹堡睡眠质量指数量表得分大于7分,存在睡眠障碍;15.8%可疑存在焦虑,14.6%肯定存在焦虑;15.8%可疑存在抑郁,29.3%肯定存在抑郁。经多元线性回归分析,结果显示抑郁情绪、24 h数字评价量表(NRS)评分是肿瘤患者睡眠质量的独立影响因素,可解释总变异的30.5%。结论介入科肿瘤患者睡眠障碍的发生率较高,患者的抑郁情绪及疼痛强度均会影响患者的睡眠质量,为改善介入科肿瘤患者的睡眠质量,亟需护理人员探索有效的措施,积极干预。     

The study of 201Tl, 123I-IMP-SPECT before and after radiation therapy of brain tumor

201Tl, 123I-IMP-SPECT were performed in 17 patients with brain tumors before and after radiation therapy, compared with X-CT. 15 of 17 patients showed enhanced areas on X-CT and higher accumulations on 201Tl-SPECT in the same lesions before radiation therapy. There was significant correlation between enhanced lesions on X-CT and lesions of higher accumulation on 201Tl-SPECT before and after radiation therapy. But, the patients with residual enhanced lesions on X-CT did not always show higher accumulation on 201Tl-SPECT after radiation therapy. And, 2 patients with radiation injury after radiation therapy for brain tumor did not show higher accumulation on 201Tl-SPECT, though one patient showed enhanced lesion on X-CT. 201Tl-SPECT was expected to evaluate viability of brain tumor. 123I-IMP-SPECT was useful to recognize the site of higher 201Tl accumulation and evaluate blood flow around brain tumor. It is concluded that 201Tl, 123I-IMP-SPECT is useful for the evaluation of treatment effect of brain tumor and for the differentiation of cerebral radiation injury from recurrent tumor.     

The effects of exergames on anxiety levels: A systematic review and meta-analysis

There are currently many different approaches to performing exergames and there is still no consensus as to whether exergames are able to reduce anxiety levels, as well as whether exergames provide greater reductions on anxiety levels when added to traditional forms of clinical interventions. Therefore, the aim of the present systematic review and meta-analysis was to access data from studies that evaluated the effects of exergames on anxiety levels in humans. PubMed, Scopus and Cochrane databases were searched up to 22 February 2019. Inclusion criteria were acute and chronic (short-term and long-term interventions) studies which evaluated the effects of exergames in anxiety levels as primary or secondary aim. Of the 1342 studies found, 17 and 10 were included in qualitative analyses and meta-analyses, respectively. The within-group analysis found that exergames (standardized mean difference [SMD]: −0.57 [95% Confidence interval (CI): −0.86 to −0.28], P < .001) and usual care (SMD: −0.21 [95% CI: −0.34 to −0.08], P = .002) resulted in significant improvements on anxiety levels. However, the between-group meta-analysis on the effects of control interventions vs exergames (SMD: 0.02 [95% CI: −0.55 to 0.60], P = .939) found no significant difference between groups in anxiety levels reductions. There was also no significant difference (SMD: −0.04 [95% CI: −0.32 to 0.25], P = .805) between usual care vs exergames plus usual care interventions in anxiety levels reductions. Although exergames demonstrated within-group improvements in anxiety levels across different clinical populations, it was not greater than the effects from non-exercise interventions. Also, given the paucity of studies, small sample sizes, different research designs, and different population investigated, the existing evidence is insufficient to support the advantages of usual care supplemented by exergame intervention over usual care standalone in anxiety levels reduction.     

2009年新疆针刺事件被刺人员焦虑、抑郁情绪及影响因素研究

目的评估2009年新疆针刺事件中被刺人员心理状况,研究其影响因素,为社会危机管理和维护公众心理健康提供依据。方法依被刺人员总样本的人口学和伤情特征,选取40人作为代表性样本,采用自制被刺人员情况问卷和焦虑、抑郁自评量表,一对一访问、测试。结果被刺人员焦虑情绪标准均分为46.78±11.46,显著高于中国常模（37.23±12.59）,阳性率检出为47.50%;抑郁情绪标准均分为45.31±13.08,显著高于中国常模（41.88±10.57）,阳性检出率为45%;被刺人员的焦虑、抑郁状况均与被刺的时间,伤口愈合、红肿、感染情况,家庭收入情况无关;焦虑组与非焦虑组在职业状况、文化程度、家庭支持、对政府的信任度方面差异具有统计学意义;抑郁组与非抑郁组在性别、家庭支持、对政府信任度方面差异具有统计学意义;焦虑情绪与年龄、家庭支持、职业状况、对政府信任呈中等程度相关（r=0.317～0.595）,抑郁情绪与性别、家庭支持、对政府信任呈中等程度相关（r=0.325～0.562）。结论新疆针刺事件被刺人员焦虑、抑郁情绪得分显著高于我国正常人群,且与躯体伤情无关,社会心理因素是其主要影响因素。