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1.
目的探讨神经危重症患者床旁肌电图检查对患者诊断及预后判断的意义。 方法对2016年11月至2017年4月在南方医科大学南方医院神经危重症病房(NCU)住院、且住NCU时间超过3 d的58例神经危重症患者进行床旁肌电图检查。检查项目包括运动神经传导、感觉神经传导、直接肌肉刺激。对超过两个肢体共计3条及以上运动和/或感觉神经传导出现异常定义为多发神经传导异常,并进行分组后病因分析、临床特点和电生理特点的比较。 结果48.3%(28/58)患者呈多发神经传导异常,为多发神经传导异常组,其余30例患者为对照组。与对照组比较,多发神经传导异常组的急性病生理学和长期健康评价(APACHE)Ⅱ评分[(12 ± 5)分vs.(16 ± 6)分]、在院最高脓毒症相关器官衰竭评分(SOFA)分值[4(3,6)分vs. 7(4,11)分]、脓毒症[11/30 vs. 21/28]及多器官功能障碍综合征(MODS)发生率[2/30 vs. 10/28]均更高,预后情况中机械通气时间[0(0,4)d vs. 6(0,16)d]、ICU住院时间[8(5,13)d vs. 14(7,20)d]均更长,出院后30 d [4(3,4)分vs. 5(5,6)分]及90 d [3.0(2.0,4.0)分vs. 6.0(4.2,6.0)分]的改良Rankin评分(mRS)分值、30 d(2/30 vs. 12/28)及90 d(4/30 vs. 15/28)病死情况均更高(P均< 0.05)。多因素Logistic回归分析发现,多发神经传导异常是出院后30 d及90 d病死情况的独立危险因素(P均< 0.05)。多发神经传导异常患者电生理特点显示与其他病因组(14例)比较,危重病性神经肌病(CIPNM)组(14例)运动神经传导未引出复合肌肉动作电位(CMAP)波形的比例更高(6/90 vs. 15/87),而感觉神经传导异常占比均更低(58/83 vs. 28/81、29/37 vs. 14/37、29/44 vs. 14/44;P均< 0.05)。 结论神经危重症患者常存在周围神经肌肉病变,且病因复杂多样,床旁肌电图检查对神经危重症患者的病因鉴别具有重要意义,且对神经危重症患者预后判断具有重要价值。  相似文献   

2.
A descriptive study of meaning of illness in chronic renal disease   总被引:5,自引:0,他引:5  
AIM: To explore the subjective meaning of illness in a sample of renal patients. BACKGROUND: Patients' illness representations, such as the meaning they attach to illness, may affect their coping and adaptation. Improved understanding in this area may therefore benefit patient care. Meaning of illness has not previously been explored in renal disease. DESIGN AND METHODS: Cross-sectional survey (n=405) in a single regional renal unit in the North of England. Ethical approval was obtained and patients gave written consent. The instrument used was an eight-item schema, based on the work of Lipowski (1970, Psychiatry in Medicine 1, 91-102). Field notes regarding rationale for choice were recorded concurrently, then content analysed to enable identification of themes. The chi-square test (significance level P < 0.05) was used to analyse differences in selected meaning in older and younger patients; males and females; and patient groups (predialysis, haemodialysis and transplant). FINDINGS: 'Challenge' was selected by most patients (n=253, 62.5%), with similar results in all three patient groups. Slightly more older than younger patients selected 'challenge', although the difference was not statistically significant and older patients more commonly had a fatalistic interpretation of the option. More men selected 'challenge' than women. Those selecting 'challenge' and 'value' appeared to have a more positive outlook than other patients. CONCLUSIONS: Patients had identifiable meanings for their illness, and these may be associated with their response to renal disease. The schema appeared to be comprehensive, but is in need of further refinement. Consideration of the possible influence of social desirability is necessary.  相似文献   

3.
The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI-S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI-S. A corrected inter-item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI-S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open-minded and pro-integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the 'new CAMI-S'. Statements exemplifying how something 'ought to be' in an impersonal way have a good degree of stability over time and place.  相似文献   

4.
This study examined the potential mediating/moderating influence of both illness intrusiveness and asthma severity on the association between illness uncertainty and depression in a college sample of older adolescents and young adults (N = 40) with histories of childhood asthma. There was a significant association between increased illness uncertainty and increased levels of depression. However, analyses indicated that neither illness intrusiveness nor asthma severity served as mediators in the uncertainty–depression relationship. Examination of moderator effects of intrusiveness and severity on the uncertainty–depression relationship revealed an interaction for severity only; thus, the significant effect of uncertainty on depression was at its maximim under conditions of increased illness severity. Results suggest that cognitive appraisal mechanisms involving decreasing ambiguity about illness may be worthwhile targets for intervention.  相似文献   

5.
Illness self-concept (ISC), or the extent to which individuals are consumed by their illness, was theoretically described and evaluated with the Illness Self-Concept Scale (ISCS), a new 23-item scale, to predict adjustment in fibromyalgia. To establish convergent and discriminant validity, illness self-concept was compared to self-esteem and optimism in predicting health status, illness intrusiveness, depression, and life satisfaction. The ISCS demonstrated good reliability (alpha = .94; test-retest r = .80) and was a strong predictor of outcomes, even after controlling for optimism or self-esteem. The ISCS predicted unique variance in health-related outcomes; optimism and self-esteem did not, providing construct validation. Illness self-concept may play a significant role in coping with fibromyalgia and may prove useful in the evaluation of other chronic illnesses.  相似文献   

6.
The Self-regulation Model (SRM) proposed by Leventhal and colleagues (H. Leventhal, Meyer, & Nerenz, 1980) argues that cognitive representations of a health threat guide coping with the threat, which in turn affects physical and emotional outcomes. The current study tested these hypothesized relationships between cognitive perceptions of infertility, ways of coping with infertility and its treatment, and emotional outcomes, in a sample of 310 women undergoing treatment for infertility. The data provided evidence for direct and indirect relationships between cognitions and emotions and underscored the importance of examining illness cognitions and attending to both positive and negative emotions in research and therapy.  相似文献   

7.
Emily Ricks 《Physiotherapy》2007,93(2):151-156
Critical illness polyneuropathy is the most commonly occurring neuromuscular dysfunction on the intensive care unit, and is often described in conjunction with critical illness myopathy. Both conditions are significant causes of weakness, increased length of stay, delayed weaning and prolonged rehabilitation. Sepsis, systemic inflammatory response syndrome and multi-organ dysfunction syndrome are the most reliable independent risk factors. The current evidence regarding critical illness polyneuropathy and critical illness myopathy is reviewed; in particular, the implications for weaning and rehabilitation.  相似文献   

8.
目的 观察危重病患者的低磷血症的发生情况,探讨其临床意义。方法 对入住EICU186例危重病人的血磷进行检测,并进行急性生理学及慢性健康状况评分(APACHEⅡ),根据血磷值、APACHEⅡ评分值、年龄及死亡分组。结果 死亡组低磷血症发生率、APACHEⅡ评分值均明显高于存活组;老年组低磷发生率明显高于中青年组(P〈0.05)。结论 危重病时常常伴有低血磷的发生,低磷血症在一定程度上提示疾病的危重性,及时诊断并治疗低磷血症有利于危重病人的抢救,改善预后。  相似文献   

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10.
Purpose. Compared to patients with explained illness, patients with medically unexplained illness (MUI) may be at elevated risk of applying for disability. Accordingly, patients with MUI may account for a disproportionate number of disability claims and for a disproportionate percentage of salary reimbursement costs. The study was conducted to determine: (a) The prevalence of MUI among disability insurance claimants; (b) the cost of salary reimbursement; and (c) the impact of psychiatric comorbidity on length and cost of disability.

Method. An insurance database of 26,451 short-term disability (STD) recipients with long-term disability (LTD) coverage was analyzed to determine the prevalence and salary reimbursement costs of MUI. Applicants with medically explained and psychiatric illness were included for comparison.

Results. The prevalence of MUI among STD recipients was lower than clinical and community rates. Rates of application and receipt of LTD benefits for MUI were similar to explained illness. When LTD payments were projected to retirement age, costs associated with unexplained back pain and fibromyalgia were comparable to those of explained illness. The length of disability and salary reimbursement costs were greater when comorbid psychiatric illness was present.

Conclusions. Patients with MUI did not account for a disproportionate number of disability claims or amount of the money spent on salary reimbursement. Comorbid psychiatric illness increased the length and cost of disability.  相似文献   

11.

Background

The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs.

Aim

To examine severity of illness in women with severe maternal morbidity.

Methods

A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002–2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28).

Results

137 women participated in the study: ICU (n = 33), HDU (n = 46) and DS (n = 58). The mean APACHE II score was 8.6 (95% CI 7.7–9.5) and mean TISS 28 score was 22.5 (95% CI 21.2–23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3–16.9) and TISS 28 (mean 31.5, 95% CI 28.2–35.5) compared to women not admitted to ICU (p < .005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5–9.9) and DS (7.0, 95% CI 5.2–8.8; p = .20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19–8.97). Known risk factors like multiple pregnancy, age ≥35 years and nulliparity were not associated with ICU admission.

Conclusions

There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.  相似文献   

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13.
Exertional heat stroke (EHS) is an acute life-threatening emergency that necessitates the immediate institution of cooling measures. Reported here is a case of EHS in a nonacclimatized young woman who was undergoing strenuous exercise. The patient developed many of the characteristic features of EHS, including central nervous system disturbances, lactic acidosis, rhabdomyolysis, coagulopathy, and abnormal myocardial conduction. While EHS is relatively common in young men, the condition is rare in women. This case presentation addresses gender differences in the response to the thermal stress of intense physical activity.  相似文献   

14.
15.

Background

Mental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness.

Objective

The objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared.

Methods

All consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed.

Results

A total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending.

Conclusions

The idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses.  相似文献   

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18.
危重病患者血清胃泌素测定的临床意义   总被引:6,自引:0,他引:6  
报告8个病种325例危重病患者血清胃泌素的测定结果并与58例正常人对比。结果表明:危重病患者不管是否伴有消化道出血,其血清胃泌素均有意义地升高(P<0.001)。说明危重病患者有高胃泌素血症存在。并与消化道出血和pH值降低可能有一定关系。提示在危重病治疗时,不管是否有消化道出血,及早应用抑制胃泌素分泌的药物对保护胃粘膜,预防消化道出血可能有一定益处。  相似文献   

19.
影响老年慢性病患者运动能力的相关因素研究   总被引:2,自引:0,他引:2  
目的 探讨成都市住院老年慢性病患者的运动能力水平及其影响因素。方法 采用方便抽样方法对 110名住院老年慢性病患者进行调查 ,运用老年人运动能力量表、多元回归等方法分析老年人的运动能力及其影响因素。结果  1)本组老年患者多患 2种以上疾病 ;2 )运动能力的损害率为 38.18% ;3)多元回归结果显示 ,高龄、丧偶、人均月收入低、病重及受照顾多者 ,其老年人运动能力量表得分较低 (P <0 .0 5 )。结论 多种因素影响老年慢性病患者运动能力 ,其中病情严重与否是最主要的因素 ,其次是受照顾情况  相似文献   

20.
危重病人血浆甲状腺激素含量变化及其临床意义   总被引:10,自引:1,他引:9  
目的 探讨危重病人血浆甲状腺激素( T H) 的变化及其临床意义。方法 应用放射免疫分析法测定73 例危重病人和60 例健康人( 对照组) 的血浆 T H 含量。结果 危重病人血浆 T3/ F T3 含量〔(105 ±046)n mol/ L〕/〔(285 ±141)pmol/ L〕明显低于对照组〔(198 ±051)nmol/ L, P< 001〕/〔(637 ±131)pmol/ L, P<0001〕;死亡组 T3/ F T3 水平与非死亡组 T3/ F T3 水平相比较有显著差异( P< 005/ P< 001) 。结论  T H 参与了危重病人的病理生理过程,监测危重病人血浆 T H 水平可作为反映病情程度和评估预后的一项参考指标。  相似文献   

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