轻度烧伤病人抑郁发生情况分析及护理

目的探讨轻度烧伤病人抑郁发生情况及影响因素,进一步做好轻度烧伤病人的护理。方法采用抑郁自评量表对68例轻度烧伤病人进行调查。结果病人抑郁发生率为39.71%,抑郁评分明显高于常模(t=7.98,P<0.05)。头面部和手部烧伤仅和下肢烧伤之间有显著性差异,而与其他部位无显著差异。抑郁与烧伤面积之间的关系,用方差分析,F=3.15,P=0.02,有显著性差异,再通过线性趋势检验(F=9.80,P=0.003),说明随着烧伤面积的增大抑郁程度加重。结论提示轻度烧伤病人抑郁的发生与烧伤部位、面积有关。应提高对轻度烧伤病人的心理反应及心理护理重要性的认识,并提出了4点护理措施。     

骨科创伤患者心理应激状态分析与干预

目的 调查骨科创伤后的心理应激状态,给予针对性的心理干预.方法 应用医院焦虑抑郁量表(HAD)对90例骨科创伤患者进行筛查,异常者用焦虑自评量表(SAS)及自评抑郁量表(SDS)进一步测评并采取心理干预.于3周后或出院前用SAS、SDS再次测评,评价心理干预效果.结果 90例患者中有54.44%的患者有不同程度的焦虑、抑郁倾向;及时针对性的心理干预效果明显;性别、年龄是影响心理应激的因素,损伤部位、程度在早期无明显统计学意义.结论 骨科创伤患者存在明显心理应激状态,及时发现并采取针对性的心理干预,努力纠正骨科创伤患者的心理失衡状态,对降低日后焦虑、抑郁发生率具有十分重要的意义.     

烧伤患者创伤反应与其重返社会工作的相关性分析

目的:探讨创伤反应对烧伤患者重返社会工作的影响。方法:抽取我院2014年1月~2016年6月收治的150例烧伤患者作为研究对象,根据患者烧伤程度分为Ⅰ组80例(轻度烧伤)、Ⅱ组50例(中度烧伤)、Ⅲ组20例(重度烧伤),运用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评估患者创伤后的心理状况,并随访6~24个月调查三组患者重返社会工作情况。结果:(1)三组HAMA、HAMD评分比较差异有统计学意义(P0.05),Ⅲ组Ⅱ组Ⅰ组。(2)三组住院时间、重返工作时间比较差异有统计学意义(P0.05),Ⅲ组Ⅱ组Ⅰ组;三组重返原岗位工作率比较差异有统计学意义(P0.05),Ⅲ组Ⅱ组Ⅰ组。结论:烧伤程度越重,患者心理创伤反应越严重,重返社会工作的时间就越长,提示医护人员应加强患者的心理康复、功能康复训练,帮助患者重塑自我,为患者重返社会创造有利条件。     

烧伤患者可疑急性创伤后应激障碍及其相关因素分析

目的:采用创伤后应激障碍筛查量表探讨烧伤患者可疑创伤后应激障碍的发生率及其相关因素。方法:于2003-05/2004-07作者收集了大连市大化医院和鞍山市烧伤医院烧伤入院患者100例作为调查对象。所有对象在入院第10天接受调查。采用自制一般问卷进行一般情况的调查;采用症状自评量表评定心理健康状况;采用艾森克人格问卷评估人格特征(神经质、内外向、精神质、掩饰);采用领悟社会支持量表评定对社会支持的感受程度(家庭内、家庭外);采用生活事件量表评定烧伤前一年对生活事件的判断情况(正性、负性);采用特质应对方式问卷调查应对方式(积极、消极)。在入院1个月时,接受创伤后应激障碍筛查量表测查,并进行与美国精神疾病诊断与统计手册第4版创伤后应激障碍的诊断及各量表、问卷的符合性判定,采用Logistic逐步回归分析创伤后应激障碍筛选列表阳性者的危险因素。采用t检验分析症状自评量表评分与常模的比较,烧伤患者的创伤后应激障碍筛阳性与阴性者之间的人格差别,社会支持差异,应对方式差异;采用χ2检验分析创伤后应激障碍筛选列表阳者的婚姻、烧伤部位、支付、性别和担心等多个方面的差别。结果:18例因各种原因脱落,完成所有问卷者82例。①经创伤后应激障碍筛选列表筛选,可疑急性创伤后应激障碍阳性者19例,占烧伤人数的23%;符合急性创伤后应激障碍筛诊断14例,占烧伤人数的17%。②急性创伤后应激障碍患者症状自评量表的躯体化、焦虑和偏执因子明显高于常模(P<0.05)。③创伤后应激障碍筛选列表检出阳性患者与检出阴性患者比较,艾森克人格问卷中的神经质、内向得分、精神病质评分更高;应对方式以消极应对为主;生活事件评定对以负性事件为多。④可疑创伤后应激障碍患者与非可疑患者的性别、婚姻状况和付费方式之间无差别(P>0.05);而担心内容(毁容、经济、残疾)和烧伤的部位(非功能区,功能区)各项之间差别显著(P<0.05)。⑤可疑创伤后应激障碍发生的相关因素是烧伤面积、神经质、内向人格、家庭支持、精神病性(P<0.05)。结论:烧伤患者普遍存在抑郁、焦虑、强迫等心理问题,急性创伤后应激障碍的烧伤患者心理问题的发生率更高;可疑性创伤后应激障碍发生的相关因素中,人格因素(神经质、内向得分、精神病质)非常重要。与可疑性创伤后应激障碍的成因关系最密切的可能是烧伤面积、神经质、内向人格、领悟社会支持和精神病质。     

心理教育在促进飞行员事故创伤后成长及心理康复中的应用研究

目的探索心理教育在飞行事故创伤后成长及心理康复中的作用,并分析需求建立"事故后飞行人员心理教育库"。方法将事故后飞行员53人作为心理教育组,并设与之匹配的50人作为对照组进行对比研究。采用飞行事故创伤流调问卷、创伤反应自评量表以及三维危机检查分类他评量表,从自评和他评角度评估两组飞行员心理反应状况;对心理教育前后满意度及心理教育需求分类进行调研。结果教育组与对照组在创伤影响程度及TAF评估量表分卡方检验,PTSD-SS量表总分t检验,两组差异具有统计学意义(P<0.05,P<0.01);心理教育满意度中等以上比例为79.3%;飞行职业、家庭关系和心身健康3个方面心理教育需求,经教育后需求变化差异有统计学意义(P<0.05)。结论心理教育有利于促进飞行人员创伤后成长及心理康复。     

烧伤病人创面瘙痒发生现状及与负性情绪的相关性分析

目的:调查烧伤病人创面瘙痒发生现状,探究创面瘙痒症与负性情绪的相关性,为后期采用针对性心理疏导提供参考依据。方法:随机选取医院2018年6月—2021年1月烧伤科264例烧伤病人,收集研究对象基本信息,包括年龄、性别、吸烟史、饮酒史、致伤原因、是否植皮、全身烧伤面积。采用视觉模拟评分(VAS)评价病人烧伤创面瘙痒程度,使用焦虑自评量表(SAS)和抑郁自评量表(SDS)对烧伤病人负性情绪进行评估。采用Spearman相关性分析探讨烧伤病人创面瘙痒状况与负性情绪的相关性。结果:264例烧伤病人创面瘙痒发生率为70.83%,创面瘙痒组病人的SAS、SDS评分均明显高于创面无瘙痒组(均P<0.001);不同烧伤创面瘙痒程度的病人SAS、SDS评分比较差异有统计学意义(均P<0.001),即创面瘙痒越严重,烧伤病人负性情绪越严重。Spearman相关性分析同样显示创面瘙痒程度与焦虑、抑郁呈明显正相关(r值为0.580、0.462,均P<0.001)。结论:烧伤病人瘙痒发生率较高,病人出现创面瘙痒往往伴随负性情绪,临床中应重视此类人群的心理护理,采取针对性措施用于缓解病人的负性情...     

急诊创伤病人的负性情绪及其影响因素

[目的 ]探讨急诊创伤病人的负性情绪及其影响因素。 [方法 ]采用焦虑自评量表 (SAS)、抑郁自评量表 (SDS)及视觉模拟量尺(VAS)恐惧测定量表对我院 2 0 0 3年收治的有应答能力的 3 96例急诊创伤病人进行创伤后负性情绪测定 ,分析病人对事件的应对方式以及病情、年龄、文化程度对其负性情绪的影响。 [结果 ]急诊创伤病人焦虑、抑郁评分明显高于国内常模组 ;不同的应对方式、病情、年龄、文化程度病人之间负性情绪的评分有统计学意义。 [结论 ]急诊创伤病人存在明显的负性情绪 ,病人对事件的应对方式、病情、年龄、文化程度对其有较大影响。     

重度烧伤早期病人的创伤反应、功能体位与睡眠质量之相关分析

目的分析烧伤早期病人的创伤反应、功能体位与睡眠质量之间的相关性,为烧伤护理提供依据。方法随机将1999年3月～2001年3月收治的127例重度烧伤病人(BSA30%～50%,Ⅲ度占10%～20%)分为实验组和对照组,两组分别采用汉密顿焦虑量表(HAMA)、抑郁量表(HAMB)及维-辛氏睡眠量表对创伤反应、睡眠质量进行评估。实验组采用心理支持、放松疗法及功能体位舒适护理。结果实验组睡眠质量明显好于对照组(P<0.01)。结论烧伤病人的创伤反应、功能体位与病人的睡眠质量呈正相关。     

创伤病人心理状态的调查及对策探讨

目的探讨创伤骨科病人的心理状态及提出相应的对策。方法采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对50例创伤骨科病人进行测评,并将结果进行分析。结果创伤骨科病人在焦虑和抑郁的自评得分均明显高于国内常模(P<0.01)。结论创伤骨科病人存在明显焦虑和抑郁症状。早期心理干预不但可以减轻或消除病人焦虑状态,还可以减轻或消除病人的疼痛,提高其生活质量。     

心理干预对烧伤病人负性情绪的影响

[目的]探讨心理干预对烧伤病人负性情绪的影响。[方法]将60例烧伤病人随机分为对照组和观察组,每组30例,对照组采取常规护理措施,观察组在常规护理基础上给予心理干预措施。采用Zung编制的焦虑自评量表(SAS)和抑郁自评量表(SDS)评价两组病人心理干预前后的焦虑、抑郁状态。[结果]观察组病人心理干预后第10天SAS、SDS评分下降且低于对照组(P<0.05)。[结论]心理干预能缓解烧伤病人的焦虑、抑郁情绪。     

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.     

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.