原发性高血压患者心理症状与社会支持的相关性研究

目的探讨原发性高血压患者的心理症状与社会支持之间的关系。方法采用症状自评量表(SCL-90)和社会支持量表(SSPS),以随机抽样的方法对297例原发性高血压患者的心理状况和社会支持情况进行了调查,并与国内常模进行比较,分析患者一般情况与心理症状及社会支持的关系,心理症状各因子与社会支持的关系。结果原发性高血压患者的心理症状总分为(137.40±0.35),与国内常模分(129.6±0.32)比较,在统计学上有显著性差异(t=2.51,P<0.01);各因子中躯体化、人际关系敏感、抑郁、焦虑、恐怖与常模相比,在统计学上有显著性差异;社会支持得分(37.93±10.41),属于中等水平;心理症状各因子与社会支持之间的关系存在较弱的相关性。躯体化症状与客观支持呈显著负相关;人际关系敏感与主观支持呈显著负相关;抑郁与对支持的利用度呈显著负相关,有统计学意义。结论原发性高血压患者有明显的心理症状,主要表现在躯体化、人际关系敏感、焦虑、抑郁和恐怖5个方面;原发性高血压患者的社会支持属于中等水平,不同性别、年龄、文化程度的高血压患者获得的社会支持有统计学差异;心理症状与社会支持之间呈负性相关。     

原发性高血压患者心理症状与社会支持的相关性研究

目的探讨原发性高血压患者的心理症状与社会支持之间的关系.方法采用症状自评量表(SCL-90)和社会支持量表(SSPS),以随机抽样的方法对297例原发性高血压患者的心理状况和社会支持情况进行了调查,并与国内常模进行比较,分析患者一般情况与心理症状及社会支持的关系,心理症状各因子与社会支持的关系.结果原发性高血压患者的心理症状总分为(137.40±0.35),与国内常模分(129.6±0.32)比较,在统计学上有显著性差异(t=2.51,P＜0.01);各因子中躯体化、人际关系敏感、抑郁、焦虑、恐怖与常模相比,在统计学上有显著性差异;社会支持得分(37.93±10.41),属于中等水平;心理症状各因子与社会支持之间的关系存在较弱的相关性.躯体化症状与客观支持呈显著负相关;人际关系敏感与主观支持呈显著负相关;抑郁与对支持的利用度呈显著负相关,有统计学意义.结论原发性高血压患者有明显的心理症状,主要表现在躯体化、人际关系敏感、焦虑、抑郁和恐怖5个方面;原发性高血压患者的社会支持属于中等水平,不同性别、年龄、文化程度的高血压患者获得的社会支持有统计学差异;心理症状与社会支持之间呈负性相关.     

脑卒中后抑郁患者领悟社会支持的相关性研究

目的探讨脑卒中后抑郁(PSD)患者领悟社会支持及其影响因素。方法应用领悟社会支持评定量表(PSSS)对64例PSD患者进行问卷调查及分析。结果PSD患者领悟社会支持得分为(60.81±12.73)分,其中领悟家庭内支持为(22.78±4.31)分,领悟家庭外支持为(38.03±9.89)分。60岁以内患者领悟社会支持明显高于对应组(年龄组t=2.4011,P<0.05),病程1年以内领悟家庭外支持明显高于对应组(t=1.9931,P<0.05),已婚患者领悟家庭内支持明显高于单身患者(t=2.2151,P<0.05)。结论PSD患者领悟社会支持呈中等水平,其中领悟家庭内支持高于家庭外支持;年龄、病程、婚姻与领悟社会支持有密切关系,这对向PSD患者提供社区卒中康复支持网络非常重要。     

女性乳腺手术病人焦虑与社会支持相关性研究

目的探讨社会支持对女性乳腺手术病人焦虑影响的相关性。方法对 74例女性乳腺手术病人应用焦虑自评量表 (SAS)评定其主观感受。采用社会支持量表 (SSRS)测量病人所获得的社会支持的状况。结果焦虑评分为 4 2 2 7± 7 5 8分 ,与国内常模 (2 0 78± 0 4 6 )分比较 ,差异有极显著性意义 (P <0 0 0 1)。病变良恶性程度和乳房切除范围与焦虑状态呈正相关 (P <0 0 1)。本组病人社会支持得分为 4 5 83± 6 6 5。与常模分 (34 5 6± 3 73)比较 ,差异有显著性意义 (P <0 0 0 1)。社会支持总体及客观支持、主观支持与焦虑呈负相关。乳腺手术病人焦虑与社会支持得分均较高 ,二者间呈显著负性相关 (r=- 0 75 5 ,P <0 0 0 1)。结论社会支持可作为对乳腺手术病人护理干预的手段之一 ,降低患者的焦虑情绪 ,增强其对手术和术后辅助治疗的承受力。     

新冠肺炎疫情下定点医院发热门诊患者焦虑与心理弹性的相关性研究

目的 调查新型冠状病毒肺炎(COVID-19)疫情防控期间上海市某医疗救治定点医院发热门诊患者的心理状况,为采取针对性心理干预提供参考。方法 采用焦虑自评量表(SAS)、心理弹性量表(CD-RISC)对医院196名发热门诊患者进行焦虑及心理弹性测评,并将结果与国内常模比较。结果 该院发热门诊患者焦虑得分(42.87±16.70)分,高于国内常模的(29.78±0.46)分,差异有统计学意义(t=2.483,P<0.05);患者心理弹性得分总分61.97±17.60分,低于国内常模(65.4±13.9)分,差异有统计学意义(t=49.29,P<0.05),其中坚韧性维度(31.39±9.57)分,力量性维度(20.91±6.35)分,乐观性维度(9.62±3.01)分;相关性分析显示,发热门诊患者焦虑与心理弹性及坚韧性、力量性、乐观性各维度呈显著负相关,具有统计学意义(P<0.05)。结论 新冠肺炎定点医院发热门诊患者存在明显的焦虑,发热门诊患者的心理弹性能够影响其焦虑水平,可以从提高患者心理弹性水平的角度及时采取有效的积极心理干预方法,促进患者的身心健康。     

血液肿瘤患儿父母焦虑状况与应对方式的调查

目的:了解血液肿瘤患儿父母焦虑状况、应对方式及其相关性。方法:采用状态—特质焦虑问卷和应对方式量表,随机抽样调查2002-10/2003-12四川大学华西第二医院儿童血液肿瘤科98位血液肿瘤患儿父母。结果:血液肿瘤患儿父亲和母亲的状态焦虑得分(52.56±11.07和60.75±16.87)均高于国内常模,差异有显著性(t=6.90,15.69;P均<0.01);高中以下文化程度的父母焦虑得分(56.43±4.67)高于大专及以上文化程度者(43.32±4.79),差异有显著性(t=13.45,P<0.05);农村父母得分(60.16±10.26)高于城市(53.11±9.76),差异有显著性(t=3.32,P<0.05);患儿父母积极应对得分(31.11±2.75)与焦虑呈负相关(r=-0.913),消极应对得分(8.83±1.03)与焦虑呈正相关(r=0.872)。结论:血液肿瘤患儿父母存在较高焦虑状态,且与文化程度、地域有关;采用积极应对方式者焦虑程度轻,采用消极应对方式者焦虑重。     

医学生焦虑水平与社会支持的相关性研究

目的：探讨医学生焦虑水平与社会支持的相关性。方法对350名医学生采用焦虑自评量表、领悟社会支持量表进行测评分析。结果不同性别、生源地、恋爱状况医学生焦虑自评量表总分比较差异无显著性（P＞0．05）;女生领悟社会支持量表评分显著高于男生（P＜0．01）,恋爱学生领悟社会支持量表总分及其他支持维度分显著低于未恋爱学生（P＜0．01）。医学生焦虑自评量表总分与领悟社会支持量表总分及家庭支持、朋友支持、其他支持维度分呈显著负相关（P＜0．01）。结论医学生焦虑水平与社会支持状况存在显著负相关。     

乙型肝炎患者领悟社会支持与生活质量的相关性研究

目的探讨住院乙型肝炎(乙肝)患者领悟社会支持和生活质量的现状及相互关系。方法采用领悟社会支持量表(PSSS)、美国简明生活质量表(SF-36)对59例住院乙肝患者进行问卷调查。结果住院乙肝患者PSSS得分为(59.47±12.83)分,领悟社会支持状况为中等水平;SF-36得分为(47.94±22.99)分,呈较差水平;领悟社会支持与生活质量间呈正相关(r=0.604,P=0.000)。结论护理人员应对患者及家属加强健康教育,提供高质量、个性化的社会支持,以提高患者的生活质量。     

系统性红斑狼疮患者疲乏与社会支持相关性研究

目的 通过调查系统性红斑狼疮患者的疲乏程度和社会支持现状,分析社会支持对系统性红斑狼疮患者的疲乏程度的影响。 方法 采用中文版FS-14疲乏量表和感悟社会支持量表对105名系统性红斑狼疮患者进行测量。 结果 该群体系统性红斑狼疮患者社会支持总分为(44.91±4.22)分,各维度中家庭支持得分最高为(17.65±2.91)分,;疲乏总分为(8.91±1.27)分,一般资料中患者的年龄、工作状况、睡眠时间对患者的疲乏程度产生影响(P＜0.05);宗教信仰对患者的朋友支持产生影响(P＜0.01),婚姻状况对患者的家庭支持产生影响(P＜0.05),工作状况对患者其他支持产生影响(P＜0.05);社会支持与SLE患者疲乏程度呈负相关(P<0.01)。 结论 该群体系统性红斑狼疮患者存在慢性疲乏状况,其社会支持系统有待提高,;社会支持与与疲劳程度密切相关,良好的社会支持有利于降低系统性红斑狼疮患者的疲乏感。     

精神科护理人员焦虑抑郁状况与社会支持的调查分析

目的探讨精神科护士抑郁、焦虑状况及社会支持程度。方法采用自评焦虑量表(SAS)、抑郁自评量表(SDS)及领悟社会支持量表(PSSS)对109名精神科护士进行问卷调查。结果精神科护士焦虑、抑郁得分平均分别为(45.06±11.16)分和(42.05±8.10)分,明显高于国内常模,差异有非常显著性(P<0.01);焦虑检出率为31.2%,抑郁检出率为58.1%,中度抑郁情绪占30.3%;社会支持总分及各类支持分均较高,社会支持程度与焦虑水平高低、抑郁情绪严重程度呈负相关。结论精神科护士的焦虑、抑郁状况较严重,而社会支持程度较高,有较好和比较稳定的社会支持。精神科护士焦虑、抑郁状况与社会支持具有相关关系。     

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.