认知干预对抑郁症患者抑郁程度及自理能力的影响观察

目的探讨认知干预对抑郁患者抑郁程度及生活自理能力的影响。方法将抑郁症患者56例随机分为两组,进行为期4周的对照研究,分别实施医院常规治疗护理（对照组）和医院常规治疗联合认知干预（研究组）;采用汉密顿抑郁量表（HAMD）和精神科护士量表（NOSIE）评定。结果研究组在经过4周的认知干预后HAMD、NOSIE评定结果与入院初比较,差异均有统计学意义（P〈0．01）。结论认知干预在改善患者认知。降低其抑郁程度,提高患者的生活自理能力方面有着积极的意义。     

女性抑郁症患者对抑郁严重程度的自我识别及其相关因素

目的研究女性抑郁症患者对抑郁严重程度的自我评估和临床评估的差异及其相关因素。方法对68例女性抑郁症患者进行汉密尔顿抑郁量表（HAMD）、抑郁自评量表（SDS）、症状自评量表（SCL-90）评估及一般资料调查。抑郁严重程度的临床评估依据HAMD总分分为轻度、中度和重度三级,自我评估依据SDS抑郁严重程度指数分为无抑郁、轻度、中度和重度四级,然后根据自我评估和临床评估的分布一致性将自我识别分为一致、低估和高估三级,分析三组患者一般资料和SCL-90因子分的差异。结果自我评估和临床评估不一致（K=-0.056,P=0.518）,一致、低估和高估比例分别为23.5%、35.3%和41.2%;高估组SCL-90躯体化、强迫、敌对、焦虑、偏执等因子均分高于一致组（P〈0.05）;工作状态（r=-0.420,P=0.002）、精神疾病家族史（r=-0.310,P=0.026）及病程（r=0.276,P=0.042）和轻中度抑郁患者的自我识别相关。结论女性抑郁症患者自我识别的抑郁严重程度和临床评估的一致性差,全职工作、有精神疾病家族史者倾向于低估,而病程长,伴发躯体、强迫、焦虑等症状更明显者倾向于高估。     

Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia

IntroductionPrevious studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP.Materials and methodsEighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample.ResultsThe levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112).ConclusionAlthough COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians.     

The effects of depression and smoking on pain severity and opioid use in patients with chronic pain

Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (n = 1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P = .001) and clinical pain (P = .001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P = .005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27 mg/d), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids.     

影响冠状动脉病变程度的危险因素与抑郁状态分析

目的研究冠状动脉病变程度不同的冠心病（CHD）患者糖脂代谢异常的情况及抑郁状态。方法选择2008年4月—2009年6月初次行冠状动脉造影的患者117例,根据造影检查结果分为冠状动脉正常组（Control）,冠状动脉狭窄组（AS）及经皮冠状动脉支架置入术组（PCI）。所有研究对象均测量简易体脂参数,空腹血糖（FPG）,餐后2 h血糖（2hPG）,糖化血红蛋白（HbA1c）,糖化白蛋白水平（GA）,血脂谱,并使用Zung自评抑郁量表（SDS）测定抑郁程度。结果①冠脉病变程度与年龄及GA水平正相关,而与高密度脂蛋白（HDL-c）水平负相关。②校正年龄性别后,AS组与PCI组的抑郁评分与Control组差异有统计学意义（P〈0.05）。③多因素分析显示,年龄、HDL-c是冠状动脉病变的独立危险因素。结论冠心病患者抑郁程度高于正常人,护理工作需兼顾心理疏导。     

前降钙素在创伤性脑损伤患者病情评估和预后判断中的应用价值

目的：探讨前降钙素在创伤性脑损伤患者病情评估和预后判断中的应用价值。方法选择2010年3月-2013年3月期间我院收治的创伤性脑损伤患者92例,根据入院时格拉斯哥昏迷指数评分分为轻度脑损伤组（53例）和重度脑损伤组（39例）。同时,根据患者入院1周内有无发生感染分为感染组（39例）和无感染组（53例）。所有患者均在入院后第1、3、5、7天检测前降钙素水平,比较轻度脑损伤组与重度脑损伤组、感染组与无感染组患者的前降钙素水平;同时采用 Kaplan-Meiers 生存分析比较入院前降钙素水平正常和升高患者的28天生存情况。结果重度脑损伤组患者入院第1、3、5、7天的前降钙素水平均显著高于轻度脑损伤患者（均 P ＜0．05）;患者入院时格拉斯哥昏迷评分与前降钙素水平呈负相关（r＝0．532,P ＜0．05）;感染组患者入院第3、5、7天的前降钙素水平均显著高于无感染组患者（均 P ＜0．05）;入院时前降钙素水平正常的患者28天生存率显著高于入院时前降钙素水平升高的患者（χ2＝5．821,P ＝0．016）。结论动态监测前降钙素水平变化情况,对创伤性脑损伤患者病情的评估、感染的诊断和预后的判断均具有重要的临床意义。     

两种抑郁自评量表对心血管疾病患者抑郁症状评定的一致性研究

目的探讨医院焦虑抑郁量表抑郁亚量表(HDAS-D)和抑郁自评量表(SDS)对心血管疾病患者抑郁症状评定的一致性。方法抽取615例心血管疾病患者应用HADS-D、SDS进行测评,并对30例患者在首次测评2周后进行重测。计量资料间比较采用F检验,计数资料间的比较采用χ2检验。采用同质性信度Cronbach’sα系数、重测信度检测量表的信度。HADS-D与SDS评分之间的相关性采用Pearson相关分析。量表评定的一致性检验,计算Kappa值。结果 HADS-D、SDS同质性信度Cronbach'sα系数分别为0.806和0.842,HADS-D、SDS重测信度组内相关系数(ICC)分别为0.932和0.938。HADS-D与SDS总分间的Pearson相关系数为0.663(P<0.001)。量表评定的一致性检验显示,以HADS-D≥8分作为抑郁划界分,与SDS≥50分一致性检验,Kappa值为0.59(u=16.94,P<0.001)。结论 HADS-D与SDS均具有较好的信度,HADS-D与SDS间抑郁评定一致性为中等程度。     

慢性失眠患者失眠程度、抑郁情绪与生活质量的相关性

目的 通过探讨慢性失眠患者失眠严重程度、抑郁情绪与生活质量的相关性,评估影响患者生活质量的主要因素.方法 连续收集126例成年慢性失眠患者,根据失眠严重程度指数量表(ISI)得分分为亚临床、中度、重度失眠三组,根据贝克抑郁问卷(BDI)得分分为伴和不伴抑郁两组,用SF-36健康调查量表(SF-36)评分,分别对生活质量进行比较.结果 失眠程度重的患者SF-36(除机体疼痛外)得分低(P<0.01);伴有抑郁情绪的患者SF-36(除机体疼痛外)得分低(P<0.05);相关性分析得出ISI得分与SF-36(除机体疼痛外)得分呈负相关(P<0.05),BDI得分与SF-36得分呈显著负相关(P<0.01);控制BDI变量偏相关分析,ISI得分与SF-36(生理功能、生理职能、总体健康、活力和生理健康)得分呈负相关(P<0.05);控制ISI变量偏相关分析,BDI得分与SF-36得分(除生理机能和机体疼痛外)呈显著负相关(P<0.01).结论 慢性失眠患者失眠严重程度与生活质量相关,但与慢性失眠相关的抑郁情绪起到主要作用,这提示慢性失眠治疗中应注重改善患者情绪问题.     

Daily assessment of severity of illness and mortality prediction for individual patients

OBJECTIVE: To refine the prognosis of critically ill patients using a statistical model that incorporates the daily probabilities of hospital mortality during the first week of stay in the intensive care unit (ICU). DESIGN: Prospective inception cohort. SETTING: Fifteen adult medical and surgical ICUs in Spain. PATIENTS: A total of 1,441 patients aged > or =18 yrs who were consecutively admitted from April 1, 1995, through July 31, 1995. INTERVENTIONS: Prospective data collection during the stay of the patient in the ICU. Data collected included vital status at hospital discharge as well as all variables necessary for computing the Mortality Probability Models II system at admission and during the first 7 days of stay in the ICU. MEASUREMENTS AND MAIN RESULTS: Four logistic regression models were obtained. These models contained survival status at hospital discharge as a dependent variable and the following explanatory variables: (model 1) only the probability of dying at admission; (model 2) only the probability of dying during the current day; (model 3) the probability of dying at admission and during the current day; and (model 4) the probabilities of dying at admission and during the previous and current days. Models were evaluated using the Hosmer-Lemeshow statistic and the area under the receiver operating characteristic curve. For survivor and nonsurvivor patients, mortality probabilities obtained using the aforementioned models were compared using linear regression and the paired Student's t-test. Although severity at admission was a statistically significant variable, models 2 and 3 produced almost the same probabilities of hospital mortality, as shown with the linear regression and paired Student's t-test results. CONCLUSIONS: To have an accurate measurement of the prognosis, it is necessary to update the severity measure. The best estimate of hospital mortality was the probability of death on the current day. Severity at admission and at previous days did not improve the assessment of prognosis.     

Diagnosis of depression

The importance of the identification of depressions in clinical practice is emphasised. The author suggests the use of modern operationalized diagnostic criteria. In atypical depressions and depressions with comorbid psychiatric disorders the diagnosis is sometimes missed. Occasionally, it is impossible to decide if a depression is present or not. In such cases it is in general indicated to try antidepressive treatment.     

脑卒中后抑郁与卒中发生部位及神经功能缺损

目的:探讨脑卒中后抑郁障碍与卒中发生部位及神经功能缺损程度的关系及抗抑郁治疗的干预效果。方法:2001-09/2004-09泰山医学院附属医院神经内科住院的脑卒中急性期732例患者。从中筛选出268例有不同程度抑郁障碍(抑郁自评量表标准分≥50分)患者,男196例,女72例;年龄(57±10)岁。基底核区受损198例,皮质受损36例。将268例患者随机分为治疗组(n=134)和对照组(n=134)。两组均给予常规治疗,治疗组在常规治疗基础上给予盐酸多塞平片治疗。两组治疗前后用流行病学调查中心的抑郁量表和脑卒中临床神经功能缺损程度评分分别评定患者抑郁障碍的严重程度和神经功能缺损程度,了解不同程度抑郁障碍与受损部位的关系。结果:按意向处理分析,进入结果分析脑卒中后抑郁患者268例。①98例(36.6%)抑郁自评量表总分20～25(轻度抑郁)中基底核和皮质受损患者85例(31.7%);153例(57.1%)抑郁自评量表总分>25(中重度抑郁)中基底核和皮质受损139例(51.9%);轻度抑郁患者中基底核和皮质受损患者数明显少于中重度抑郁者(χ2=18.89,P<0.01)。有17例(6.3%)抑郁自评量表总分16～19(有抑郁倾向)中基底核和皮质受损10例(3.7%)。②治疗组和对照组治疗前神经功能缺损评分无明显差异(23.95±9.31,24.01±9.70,P>0.05);而治疗组治疗后神经功能     

Diagnosis of anxiety and depression

The differential diagnosis of anxiety and depression is often difficult as symptoms of generalized anxiety, panic disorder, and depression frequently coexist.     

妄想性与非妄想性抑郁症的临床对照研究

为探讨妄想性与非妄想性抑郁症的临床特征差异,对71例妄想性抑郁症与132例非妄想性抑郁症进行了临床对照研究。结果显示,妄想性抑郁症的精神病家族史、幻觉、自责自罪、绝望、自杀行为等出现率显著高于非妄想性抑郁症;妄想性抑郁症的自杀行为危险性是非妄想性抑郁症的1.99倍;妄想性抑郁症可能需联合治疗。提示妄想性抑郁症可能是抑郁症中的一种独特的亚型,值得进一步探讨。     

Disease severity and symptoms of depression in Black Americans infected with HIV.

The purpose of this study was to examine depressive symptomatology in a sample of human immunodeficiency virus (HIV) infected Black Americans and to determine the extent to which measures of HIV disease severity were associated with depressive symptoms. Seventy-nine HIV-infected Black men and women (ages 25 to 68 years) participated. Measures included the Center for Epidemiologic Studies Depression Scale (CES-D) and multiple HIV disease severity variables including CD4+ lymphocyte count, CDC HIV stage, and HIV RNA viral load. Levels of self-reported depressive symptoms were high, with 58% (n = 48/79) of study participants exhibiting elevated depressive symptoms (CES-D score of > or =16). No relationship was found between CD4+ count, CDC HIV stage, sociodemographic variables, and depressive symptoms. Viral load, however, was positively correlated with elevated depressive symptoms. Although the level of depressive symptomatology was high, only two participants were receiving antidepressant medication. This study suggests that there is a significant unmet need for identification and treatment of depressive symptoms among Blacks receiving routine care for HIV disease.     

MEWS评分结合年龄和既往史在急诊患者危重程度评估中的应用价值

目的 探讨MEWS评分结合年龄和既往史在急诊危重患者分诊评估中的应用价值。 方法 选取2018年4月在我院急诊就诊的4 200例患者作为研究对象,对每位患者进行MEWS评分和MEWS结合年龄、既往史(MEWS⁺)评分,通过HIS系统对患者的去向进行追踪。绘制2种评分方法对4 200例急诊患者的ROC曲线,比较2种评分系统中患者转归情况。 结果 MEWS评分和MEWS结合年龄、既往史评分ROC曲线下的面积分别为0.68和0.84;2种方法评分<4分的患者,24h告病危、死亡的比例存在统计学差异(χ²=41.497,P<0.001)。 结论 应用MEWS结合年龄、既往史评分更能准确评估患者病情,对急诊患者病情危重程度评估有重要价值。     

Diagnosis and assessment of pain

Good management of pain depends on accurate assessment. We describe some approaches to the measurement of pain or suffering, including visual analogue scale, the MacGill Pain Questionnaire and behavioral observation scale. Patient's self-reporting provides the most valid information, because pain is a personal and subjective. Behavioral approaches to pain measurement, such as behavioral observation scale are useful for pain assessment for infants, children without language skills. Intravenous barbiturate, phentolamine(alpha-adrenergic antagonist), lidocaine(Na channel blocker), morphine(opioid), or ketamine(NMDA antagonist) may contribute to pain assessment as diagnostic tools for the investigation of the etiology of pain, especially neuropathic pain.     

D-二聚体联合C反应蛋白监测在急性胰腺炎临床分型及严重程度评估中的意义

目的研究D-二聚体及C反应蛋白(CRP)与急性胰腺炎的分型、严重程度及预后是否存在相关性,以探讨D-二聚体水平联合CRP在急性胰腺炎患者分型及严重程度评估中的价值。方法选择2008年1月—2012年11月入院的急性胰腺炎患者80例,其中重症急性胰腺炎(SAP)25例,轻症急性胰腺炎(MAP)55例。随机选取同期因腹痛入院的非急性胰腺炎患者40例为对照组。检测不同时间点患者D-二聚体、CRP在外周血中表达水平,并进行相关性研究分析。结果 SAP组CRP水平显著高于MAP组及对照组,且在入院7 d内一直保持较高水平。SAP组各时间点D-二聚体浓度水平显著高于MAP(P<0.05)。在入院3 d内MAP组CRP浓度水平亦高于对照组(P<0.05);SAP组D-二聚体值与CRP存在正相关。结论 D-二聚体联合CRP能够作为急性胰腺炎患者分型的重要标志物,能较好地判断患者严重程度,具有重要的临床应用价值。