应激干预抑郁症患者心理生理指标的变化

目的:介绍抑郁患者心理生理指标的特点及测量,探讨应激干预对抑郁患者心理生理指标的影响。资料来源:应用计算机检索Medline 1996-01/2006-12与应激干预抑郁患者及抑郁患者心理生理指标相关的文章,检索词为"stress-coping,relaxation training,inactivity,depression,anxiety,heart-rate-variability",限定文献语种为"English";万方数据库2004/2007有关文章,检索词为"应激干预,放松训练,静坐,抑郁症,焦虑,心率变异性",并限定文章语言种类为中文。资料选择:共搜集到300余篇文献,选择与放松训练及静坐相关的临床研究文献,无论是否随机、有无对照组都纳入,排除基础研究和重复文献。资料提炼:共纳入35篇文献进行综述,其中9篇介绍应激与抑郁及应激干预方式,18篇陈述抑郁患者心理生理指标的特点及测量,另外8篇探讨应激干预对抑郁患者心理生理指标的影响。资料综合:①早期应激会导致个体抑郁易感性,成年期抑郁障碍是由于素质因素和应激的交互作用而产生的。较低的心率变异性是患有抑郁症的心脏患者的死亡率比没有抑郁症的心脏患者死亡率高的原因。②目前较常用的测量心理生理的指标有皮电、心率及心率变异性。③抑郁症的应激干预包括早期和成年期间应激干预,临床上以成年期应激干预为主。放松技术作为最常用的应激干预技术对抑郁症有着较好的应用效果。放松训练和静坐都可以让正常人和抑郁症患者放松,使交感神经活动下降,但是放松训练的效果要好于静坐放松训练。结论:放松训练对抑郁症和正常人都有效果,但从皮电和心率等指标可以发现,抑郁症伴焦虑症患者的反应效果要好于单纯抑郁患者和正常人,故放松训练对抑郁症伴焦虑症患者是一种很好的辅助治疗方法。     

综合性放松训练对肝癌患者焦虑抑郁状态的疗效

目的：观察综合性放松训练对肝癌患者焦虑抑郁状态的影响.方法：于2003-07/2004-09选择中国医科大学附属一院消化内科和肿瘤内科住院患者100例,符合标准的患者共有60例,随机分为观察组（30例）和对照组（30例）.对照组给予常规内科治疗,观察组在常规内科治疗基础上,进行综合性放松训练,包括：①由专业护士和患者谈心.②对患者进行健康教育.③调动患者心理、社会支持系统.④肌肉放松训练和内心意念引导训练.于治疗3周后用焦虑自评量表评定两组患者的精神状态.焦虑自评量表按焦虑分值分为重度（＞60分）,中度（50～60分）,轻度（30～49分）.临床疗效评定痊愈者为焦虑症状缓解,焦虑自评量表评分恢复正常.显效者焦虑症状基本缓解,焦虑自评量表评分较前下降2级,但未恢复正常.有效者焦虑症状有所改善,焦虑自评量表评分较前下降1级,但未恢复正常.无效者焦虑症状无改善,焦虑自评量表评分下降不明显,或反而有所上升.结果：共收治患者100例,纳入分析60例,无脱落者.①两组患者临床疗效观察结果：观察组痊愈10例（33%）,好转11例（37%）,显效7例（23%）,无效2例（7%）;对照组痊愈3例（10%）,好转6例（20%）,显效9例（30%）,无效12例（40%）.观察组评分总有效率明显优于对照组（93%,60%,χ^2=12.6,P＜0.01）.②两组患者的焦虑自评量表评分结果比较：观察组患者经综合性放松训练后,评分低于对照组（40.46&;#177;5.63,49.37&;#177;6.28,P＜0.01）.结论：综合性放松训练可有效缓解肝癌患者的焦虑抑郁症状.     

放松训练对颅内肿瘤患者生命体征的影响

为探讨放松训练对患者生命体征的影响，2004-09～2005-02我科对102例颅内肿瘤患者采取放松训练，并观察其生命体征变化情况，现将结果报道如下。     

综合性放松训练对肝癌患者焦虑抑郁状态的疗效

目的:观察综合性放松训练对肝癌患者焦虑抑郁状态的影响。方法:于2003-07/2004-09选择中国医科大学附属一院消化内科和肿瘤内科住院患者100例,符合标准的患者共有60例,随机分为观察组(30例)和对照组(30例)。对照组给予常规内科治疗,观察组在常规内科治疗基础上,进行综合性放松训练,包括:①由专业护士和患者谈心。②对患者进行健康教育。③调动患者心理、社会支持系统。④肌肉放松训练和内心意念引导训练。于治疗3周后用焦虑自评量表评定两组患者的精神状态。焦虑自评量表按焦虑分值分为重度(>60分),中度(50～60分),轻度(30～49分)。临床疗效评定痊愈者为焦虑症状缓解,焦虑自评量表评分恢复正常。显效者焦虑症状基本缓解,焦虑自评量表评分较前下降2级,但未恢复正常。有效者焦虑症状有所改善,焦虑自评量表评分较前下降1级,但未恢复正常。无效者焦虑症状无改善,焦虑自评量表评分下降不明显,或反而有所上升。结果:共收治患者100例,纳入分析60例,无脱落者。①两组患者临床疗效观察结果:观察组痊愈10例(33%),好转11例(37%),显效7例(23%),无效2例(7%);对照组痊愈3例(10%),好转6例(20%),显效9例(30%),无效12例(40%)。观察组评分总有效率明显优于对照组(93%,60%,χ2=12.6,P<0.01)。②两组患者的焦虑自评量表评分结果比较:观察组患者经综合性放松训练后,评分低于对照组(40.46±5.63,49.37±6.28,P<0.01)。结论:综合性放松训练可有效缓解肝癌患者的焦虑抑郁症状。     

对初产妇产后抑郁进行护理干预的效果探讨

随着医学科学的发展和现代医学模式的改变,心身医学日益受到临床多学科的重视,妇产科也不例外,尤其是孕产妇的心理保健,越来越受到了人们的普遍关注.     

放松训练对焦虑症患者疗效的影响

目的 探讨放松训练对心理科住院患者中焦虑性神经症焦虑症状疗效影响.方法 将60例焦虑性神经症患者随机分为治疗组和对照组各30例,对照组单纯使用抗焦虑药物,治疗组则是抗焦虑药物联合放松训练,在患者应用放松训练前及放松训练的第3、6周分别焦虑自评量表(SAS)进行疗效评定.结果 治疗6周后两组分别采用HAMA评分和SAS评分较治疗前都有所下降,尤其治疗组在放松训练的第6周HAMA评分和SAS评分下降更明显,与对照组比较差异有统计学意义(P<0.01).结论 与单纯应用抗焦虑药物相比,放松训练联合抗焦虑药物治疗焦虑性神经症患者,焦虑性神经症患者的焦虑症状明显缓解.     

以放松训练为基础的心理干预对埋伏阻生智齿拔除术患者身心应激、依从性的影响

目的:探讨以放松训练为基础的心理干预对埋伏阻生智齿拔除术患者身心应激、依从性的影响。方法:选取2017年1月至2019年1月首都医科大学附属北京口腔医院进行埋伏阻生智齿拔除术的患者130例为研究对象,根据入院顺序的先后等分为参照组和研究组。参照组患者在术前给予常规护理,研究组患者在术前给予放松训练为基础的心理干预,调查并比较两组患者护理前后的身心应激情况、依从性及对护理的满意度。结果:实施以放松训练为基础的心理干预后,研究组患者的身心应激指标变化显著优于参照组,差异有统计学意义(P<0.05);研究组患者的治疗依从率显著高于参照组,差异有统计学意义(P<0.05);研究组患者的护理满意率显著高于参照组,差异有统计学意义(P<0.05)。结论:以放松训练为基础的心理干预能有效缓解埋伏阻生智齿拔除术患者术前的身心应激反应,提高其治疗依从性,有利于手术顺序开展。     

抑郁症患者加工情绪面孔的心率变异性研究

目的 在情绪面孔识别任务下,评估抑郁症患者社会认知和自主神经系统功能。方法 对90例抑郁症患者和90例正常人进行汉密尔顿抑郁量表测评,采集两组被试在情绪面孔识别任务下的心率变异性(HRV),对比分析两组被试对情绪面孔的识别情况及心率变异性指标。结果 观察组总体、正性、中性情绪面孔识别情况均低于对照组(P<0.05);观察组HRV指标中SDNN、RMSSD、PNN50、TP、LF、HF、SD1、SD2、SD1/SD2低于对照组(P<0.05);观察组HAMD总分与SD1/SD2指标呈负相关(P=0.039);LF/HF指标诊断抑郁症的曲线下面积为0.601(P=0.019),诊断临界值为0.655,敏感度为0.711。结论 抑郁症患者存在明显的社会认知功能障碍,伴自主神经功能紊乱。抑郁严重程度越重,自主神经系统功能越紊乱,LF/HF指标对诊断抑郁症具有一定的参考价值,敏感性较好。     

放松训练对脑卒中后抑郁患者心率变异性的影响

目的：本文旨在对脑卒中后抑郁患者放松训练前后的心率变异性进行前瞻性分析.方法;将59例脑卒中后抑郁患者随机分为观察组30例和对照组29例,2组均接受常规运动疗法,观察组另外接受放松训练;训练前后,采用汉密尔顿抑郁量表对抑郁症的严重程度进行评定,并进行心率变异性（HRV）分析,观察指标有低频成分（LF）、高频成分（HF）、低频高频比（LF/HF）.结果：训练1个月后,观察组抑郁程度较训练前及对照组训练后明显减轻（P＜0.05,0.01）.训练后HRV比较,观察组HF较治疗前及对照组治疗后明显下降,LF/HF较治疗前及对照组治疗后明显上升（P＜0.01,0.05）.结论：放松训练有助于减轻脑卒中后抑郁患者的症状,改善患者的心率变异性,从而降低脑卒中后患者的死亡风险.     

瑜伽放松训练对抑郁症患者负性情绪和自我效能的影响

目的探讨瑜伽放松训练对抑郁症患者负性情绪和自我效能的影响。方法将60例抑郁症住院患者随机分为对照组(抗抑郁药物治疗)和观察组(抗抑郁药物治疗加瑜伽放松训练),每组各30例。分别于治疗前、治疗后评定焦虑自评量表(SAS)、自评抑郁量表(SDS)及一般自我效能感量表(GSES)。结果治疗前观察组和对照组SAS、SDS、GSES量表总分差异无显著意义(P0.05)。治疗后观察组和对照组SAS、SDS、GSES量表总分差异有显著意义(P0.05)。结论瑜伽放松训练能有效改善抑郁症患者的抑郁焦虑情绪,提高自我效能感。     

12周运动康复对冠心病患者心脏变时性功能和心率恢复值的影响

目的:探讨12周运动康复对冠心病患者心脏变时性功能和心率恢复值(HRR1)的影响。方法:对30例男性冠心病患者进行递增负荷运动试验,根据实验结果将其分为两组,变时性功能正常组(G1,n=19,HRR%≥0.8);变时性功能不全组(G2,n=11,HRR%0.8),并测定受试者运动前、运动中和运动后心率(HR)、摄氧量(VO2)、ST段下降数值和血压。12周运动康复后再次进行递增负荷运动实验,对患者的运动能力和上述指标进行测定分析。结果:与康复程序前相比,12周康复程序后,G1和G2组的VO2peak、HRR1均有显著增加(G1,8%,P0.01;G2,4%,P0.05)、(G1,18.6±3.3—23.8±4.5,P0.01;G2,12.8±4.2—13.7±3.5,P0.05),而G1比G2提高的更加明显。ST段降低显著改善(G1,-0.7±0.5—-0.2±0.5,P0.05;G2,-0.9±0.5—-0.3±0.6,P0.05)。HRR%有显著增加(G1,84.2±2.5—88.9±6.1,P0.05;G2,60.2±8.3—75.8±3.8,P0.05)。结论:12周运动康复可以改善冠心病患者(包括变时性功能正常者和变时性功能不全者)的运动能力,提高冠心病患者运动时自主神经的调节功能,上述积极作用对变时性功能正常者的体现则更为明显。     

Clinical assessment of a monitor MedStorm (Norway) of galvanic skin response correlates with preoperative stress

Clinical trials were performed by Russian anesthesiologists of pain monitor based on measuring galvanic skin response (skin conductance). 5 pations were studied the monitor showed lower sensitivity to assess the level of analgesia during combined anesthesia which allows to not recommend it for use in clinical practice.     

慢性压力对冠心病患者心率变异性的影响

冠心病是一种公认的心身疾病,严重威胁人类健康,慢性压力在冠心病发生和发展的整个过程中起到了重要作用,心脏神经功能紊乱可能是慢性压力导致冠心痛的机制之一.心率变异性分析（HRV）是一种快捷无创的检查,可用于评价心脏自主神经系统的功能,并且HRV也被认为是急性冠脉综合征（ACS）患者重要的危险分层因子.本文就近年来关于慢性压力对冠心病患者HRV影响的研究成果进行简述.     

Concordance between galvanic skin response and spinal palpation findings in pain-free males

The concordance between areas of paraspinal low resistance, i.e., galvanic skin response (GSR) and positive palpatory findings in pain-free male subjects was investigated. The concordance between vertebral segments implicated by GSR and by palpation was not found to be significantly different from chance concordance as determined by a t-test comparison of experimental results to randomly generated simulations, and by the application of Cohen's Kappa index of concordance to experimental data. This was true even when the locations of low resistance areas along the dorsal trunk were compared to only those vertebral palpatory findings rated as "severe." When test-retest reliability of GSR was examined, only 27% of vertebral segments implicated by GSR on initial examination were also implicated in the same subjects 4 h later. It was noted that low resistance areas detected by GSR were always punctate in nature and appeared to correspond well to known acupuncture loci. Further investigation revealed that, indeed, the GSR unit was not only effective in locating those acupuncture points that happened to be in a state of lowered resistance at the time but was also able, within about 5 sec, to decrease the resistance of any particular point not already in its lowest state of resistance to a level sufficient to generate a positive and persistent GSR reading where none had been detected previously. It is suggested that GSR may not be a reliable predictor of the location of vertebral pathology, at least as assessed by palpation in pain-free subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Depressed heart rate response to vasodilator stress for myocardial SPECT predicts mortality in patients after myocardial infarction

Background As heart rate (HR) response during vasodilator stress myocardial perfusion studies can be a marker of HR variability, we investigated its prognostic value in patients after myocardial infarction (MI).Methods Subjects were 147 survivors of MI who underwent vasodilator stress thallium-201 scintigraphy. HR response was measured as peak to basal (P/B) ratios during vasodilator infusion. End points for survival analysis were all-cause deaths, non-fatal recurrent MI, and soft events. Results: HR response was significantly depressed in the post-MI patients compared to controls (p<0.0005). HR response correlated to LVEF (r=0.37, p<0.0001) and summed stress scores (r=−0.18, p<0.05), but not with antianginal medication. During 58±30 mo of follow-up, there were 15 deaths, 7 recurrent MI, and 11 soft events. Low HR response, old age, low LVEF, and high difference score were significant univariate risk factors for death. Multivariate analysis identified low HR response (p=0.03), high stress score (p=0.02), and low LVEF (p=0.05) as independent predictors of mortality. The predictive value of HR response was incremental to that offered by other variables (p=0.02). Conclusions HR response, readily attained during vasodilator stress myocardial perfusion studies, may provide useful additional prognostic information in post-MI patients.     

家庭干预对冠心病患者心率变异性的影响

目的探讨家庭干预对冠心病患者心率变异性的影响。方法将92例冠心病患者分为2组,对照组46例,进行常规冠心病健康宣教;干预组46例,在常规冠心病健康宣教的同时进行家庭干预,时间1年。对两组患者进行心率功率谱时域和频域分析。结果两组患者心率变异性（HRV）时域及频域指标均有改善;与对照组相比,干预组HRV值改善更为明显,其中R-R间期的标准差、每5分钟R—R间期均值标准差、SDNN的均值、正常相邻R—R间期差值的均方根、正常相邻R—R间期差值〉50ms的百分比均有改善,超低频（VLF）、低频（LF）和高频（HF）改善均有统计学意义（P〈0．05）。结论家庭干预可明显改善冠心病患者的心率变异性。     

The response of skin microcirculation to hyperthermic stress in tumour patients

Summary. Hyperthermia and its effect on tissues are topics of great interest to scientists working in the area of radiation biology and medicine. It has been shown by many workers, that blood flow in malignant tissue displays a different response to heating than that in normal tissue. Initially, the blood flow in tumour tissue is greater than that in normal tissue, and when heat is applied there is an increase in blood flow. The extent of the increase in flow with increasing temperature is greater in normal tissue than in tumour tissue. In our laboratory we studied the effect of temperature on skin blood flow. The skin overlying tumour tissue was compared with skin with no underlying abnormality in cancer patients, and with the skin in healthy control subjects. The instrument used was a Laser Doppler Perfusion Monitor, Pf3 (Perimed, Stockholm, Sweden). We found that the skin overlying tumour tissue showed higher basal perfusion than the skin at the contralateral site with no underlying abnormality. The skin above tumour tissue showed a reduced perfusion response to an increase in temperature (vascular sluggishness) compared to skin at the contralateral site and skin in healthy controls. The reduction in thermal response depends on the size of the tumour.     

阿托伐他汀对原发性高血压合并高脂血症患者的心率变异性的影响

目的探讨原发性高血压合并高脂血症患者的心率变异性（HRV）特点及阿托伐他汀对其影响。方法 50例原发性高血压合并高脂血症患者,口服阿托伐他汀（10 mg/d）8周,观察治疗前后HRV变化并与正常对照组（40例）比较。结果原发性高血压合并高脂血症患者的HRV时域参数（SDNN、SDANN、SDNN Index）治疗前明显低于正常组,给予阿托伐他汀8周干预治疗后HRV指标明显上升。低频功率与高频功率比值（LF/HF）显著降低（P〈0.01）。结论原发性高血压合并高脂血症患者自主神经活动明显受损,其迷走神经张力降低,交感神经张力相对增高,发生心源性猝死的危险性明显增加。阿托伐他汀能有效地提高心脏迷走神经张力,降低交感神经张力,有可能减少心律失常性死亡。     

β-受体阻滞对不稳定型心绞痛患者心率变异性的影响

目的 :观察 β 受体阻滞剂倍他乐克对不稳定型心绞痛患者心率变异性 (HRV)的影响。方法 :将不稳定型心绞痛患者(UAP) 84例随时机分为两组 :倍他乐克组 44例 ,对照组 40例 ,两组均接受消心痛或鲁南心康片扩管 ,阿期匹林抗凝 ,含镁激化液处理 ,用药两周后行三通道动态心电图检查 ,观察两组患者HRV的时域指标 :2 4小时连续正常R -R间期标准差 (SDNN) ,2 4小时内连续 5min节段的平均正常的R -R间期标准差 (SDANN ) ,2 4小时内连续 5min节段的平均正常的R -R间期标准差平均数(SDNNindex) ,2 4小时内连续正常的R -R间期差值均方的平方根 (RMSSD) ,相邻R -R间期差值大于 5 0ms心搏数占所有分析信息期内心搏数的百分比 (PNN50 )。结果 :倍他乐克组HRV中反映交感神经张力各项指标较对照组明显延长 (P <0 0 1) ,而反映迷走神经张力的各项指标与对照组无显著差异 (P >0 0 5 )。结论 :行 β 受体阻滞剂倍他乐克干预的不稳定型心绞痛患者HRV升高 ,增加心律的变异范围 ,在不稳定型心绞痛患者应用 β 受体阻滞剂是有益的。