消化系恶性肿瘤患者的心理状况及生活质量调查

目的探讨恶性肿瘤患者的心理健康状况及相关因素。方法使用抑郁自评量表（SDS）、焦虑自评量表（SAS）、生活质量综合评定问卷（GQOLI-74）收集相关资料，对数据进行统计学分析。结果恶性肿瘤患者的SAS和SDS评分高于正常对照（P值均〈0．01），恶性肿瘤患者的GQOLI-74总分、各维度分均低于正常对照（P值均〈0．01），恶性肿瘤患者的生活质量总分与疾病状况、社会支持存在明显相关性。结论恶性肿瘤患者的心理健康状况较差，积极改善肿瘤患者的心理健康状况有助于提高患者生活质量和生存时间。     

老年高血压病并冠心病患者负性情绪评估及其综合干预

目的:评估老年高血压病并冠心病患者抑郁、焦虑负性情绪情况,并观察综合干预的效果。方法:对60例老年高血压病并冠心病患者采用Zung抑郁自评量表(SDS)及焦虑自评量表(SAS)分别在入院时进行评估,然后进行6周的药物、心理和物理疗法的综合康复干预,并再次进行评估。结果:老年高血压病并冠心病患者存在不同程度的抑郁及焦虑,经6周综合干预后,SDS及SAS评分分别由57.34±8.57和49.97±6.82降为47.38±6.59和41.45±5.38(P<0.01),抑郁、焦虑发生率分别由78.3%和86.7%降为40%和65%(P<0.001,<0.01)。结论:老年高血压病并冠心病患者抑郁及焦虑负性情绪发生率高,药物、心理及物理疗法综合干预疗效好。     

住院冠心病患者1083例心理状况的调查与相关分析

目的 探讨住院冠心病患者焦虑和抑郁症状的发生情况及相关因素.方法 采用现况调查研究,自2007年6月至2009年5月连续入选经冠状动脉造影诊断的住院冠心病患者.选用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对入选患者进行心理测评,同时对受试者的经济状况、家庭情况、生活及工作场所环境等因素进行流行病学调查.统计学处理采用Student's t检验、卡方检验和多元逐步logistic回归分析.结果 共入选住院冠心病患者1083例,年龄(64.8±10.2)岁,其中男性863例,女性220例.单纯焦虑、单纯抑郁、焦虑合并抑郁的症状患病率分别为7.9%、28.3%和14.3%.女性患者焦虑、抑郁的症状患病率明显高于男性(29.5%比20.3%,P=0.003;50.0%比40.7%,P=0.012);老年(≥65岁)患者焦虑症状的患病率明显高于非老年患者(25.9%比17.9%,P=0.001);老年人、受教育年限少于9年、睡眠质量差与焦虑症状的发生显著相关,相应OR值分别为1.63(95%CI:1.21～2.21,P=0.002)、1.54(95%CI:1.15～2.07,P=0.004)和1.62(95%CI:1.34～1.96,P=0.000);长期工作地噪音、合并慢性疾病及睡眠质量差与抑郁症状的发生显著相关,OR值分别为1.52(95%CI:1.18～1.98,P=0.002)、1.36(95%CI:1.06～1.75,P=0.016)和1.27(95%CI:1.08～1.50,P=0.005);女性、老年人、长期工作地噪音、合并慢性疾病、睡眠质量差与焦虑合并抑郁症状的发生显著相关,OR值分别为1.91(95%CI:1.22～2.98,P=0.005)、1. 84(95%CI:1.23～2.76,P=0.003)、1.61(95%CI:1.07～2.42,P=0.022)、1.84(95%CI:1.24～2.71,P=0.002)和1.73(95%CI:1.35～2.21,P=0.000).结论 在住院冠心病患者中,约50%患者并发不同程度的焦虑和(或)抑郁症状,女性和老年患者是高发人群.受教育年限少于9年、合并慢性疾病、睡眠质量差、工作地噪音等与焦虑、抑郁症状的发生相关.     

慢性肾脏病患者焦虑抑郁状况的调查

目的观察慢性肾脏病(CKD)患者的焦虑抑郁状况。方法入选2018年6月至2019年4月期间在江苏省人民医院老年医学科住院治疗的CKD患者225例为研究对象。采用慢性肾脏病流行病学合作研究公式计算估算的肾小球滤过率。采用汉密尔顿焦虑量表(HARS)和汉密尔顿抑郁量表(HDRS)对患者进行评估。采用SPSS 23.0软件进行数据处理。多因素logistic回归分析筛选出独立危险因素。Pearson相关分析研究观察指标间的相关性。结果依据HARS评分结果分为3组:无焦虑组(n=95),轻度焦虑组(n=110)和中重度焦虑组(n=20)。依据HDRS评分结果分为3组:无抑郁组(n=72),轻度抑郁组(n=119)和中重度抑郁组(n=34)。低的估算的肾小球滤过率(焦虑:OR=1.35,95%CI 1.04～1.76;抑郁:OR=1.93,95%CI 1.40～2.66)和增龄(焦虑:OR=1.04,95%CI 1.02～1.76;抑郁:OR=1.03,95%CI 1.00～1.05)是CKD患者合并焦虑及抑郁症状的危险因素(P0.05)。焦虑评分和抑郁评分呈显著正相关(r=0.694,P0.001)。结论肾功能下降和增龄是CKD患者出现焦虑抑郁症状的独立危险因素。随着肾功能下降及年龄增加,不同程度焦虑抑郁的发生率均显著增加。     

综合医院住院心血管疾病患者的焦虑抑郁状况调查

目的：了解综合医院住院心血管疾病患者并发焦虑抑郁的状况。方法：对120例心血管疾病患者和100例健康体检者采用焦虑自评量表（SAS）和抑郁自评量表（SDS）进行问卷调查,对其评分进行比较分析。结果：与正常对照组比较,心血管病患者的SAS[（39.13±8.15）分比（56.91±10.39）分]、SDS[（40.21±9.30）分比（59.36±11.42）分]评分均明显高于正常对照组（P均〈0.01）;120例心血管疾病患者中合并焦虑抑郁71例,占59.17%,其中焦虑状态35例（29.17%）,抑郁状态22例（18.33%）,焦虑抑郁状态14例（11.67%）。结论：心血管疾病住院患者中有较高的焦虑、抑郁发病率。     

老年脑卒中后抑郁患者心理状况调查分析

脑卒中后抑郁(post stroke depression,PSD)占脑卒中发病率的20%～50%[1].本文通过68例PSD患者的心理状况调查,分析脑卒中后出现抑郁的原因.     

社区高血压病患者依从性的观察

高血压病是常见的、多发的心血管疾病,也是冠心病和脑中风的重要危险因素.治疗高血压的目的不仅在于降血压本身,还在于全面降低心血管病的发病率和死亡率.     

心力衰竭患者长期应用卡维地洛对心理状况的影响

目的:了解心力衰竭患者长期应用卡维地洛对患者心理状况的影响。方法:对100例慢性充血性心力衰竭(CHF)患者在常规治疗的基础上,开始服用卡维地洛,从小剂量开始,逐渐递增,实验中严密检测各项相关指标。结果:随访98周,随访期间猝死1例。与治疗前比较,99例患者治疗后心功能有明显改善[(2.24±0.79)∶(3.05±0.65)级,P<0.05];6min步行距离有明显进步[(312.71±152.39)∶(203.67±134.86)m,P<0.01];超声心动图示左室射血分数明显增加[(38.9±6.7)%∶(32.8±4.9)%,P<0.01];明尼苏达生活质量量表评分有显著的改善[(23.86±9.64)∶(41.63±13.76)分,P<0.05];反映抑郁状态的SDS评分均稍有改善,但差异无统计学意义(P>0.05);焦虑状态的SAS评分有明显变化(P<0.01)。结论:卡维地洛长期治疗CHF患者除了能明显提高患者的活动耐量、改善心功能外,还能改善其焦虑状况,但对抑郁状况无明显影响。     

103例血压控制在正常范围的老年高血压患者心理健康状况调查

目的了解血压控制在正常范围的老年高血压患者的心理健康状况。方法对血压控制在正常范围的老年高血压患者,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行调查和统计学分析。结果血压控制在正常范围的老年高血压患者,其焦虑抑郁得分明显低于常模(P<0001);有心、脑、肾、及糖尿病等合并症的患者,其焦虑抑郁情绪与无合并症的患者相比无明显差异(P>01)。结论血压控制在正常范围的老年高血压患者,无明显焦虑抑郁情绪。     

绍兴市社区高血压病患者药物治疗情况调查

近年的调查表明,绍兴市社区人群高血压病患病率呈持续上升趋势,已由1979年的7.82%上升至1998年30.33%[1],防治形势十分严峻.为了有针对性地开展药物治疗,于2002年8月至2003年3月,开展了绍兴市社区高血压病患者药物治疗的调查分析工作.了解绍兴市社区高血压病患者药物治疗率,比较不同性别、年龄、学历层次以及不同病情的高血压病患者在药物治疗率上的差异,分析药物治疗的效果.     

Correlates associated with mental health and nutritional status in Lebanese older adults: A cross-sectional study

ObjectiveTo assess correlates of mental and nutritional health among elderly in Lebanon, inside nursing homes compared to their private homes.MethodsThis cross-sectional study was conducted between June and August 2016 on 500 elderly.ResultsHigher somatic (Beta = 0.259) and cognitive anxiety (Beta = 0.508), increased age (Beta = 0.174) were significantly associated with higher depression, whereas having a secondary (Beta = −4.006) and a university (Beta = −6.829) levels of education compared to illiteracy, living home (Beta = −2.557) compared to living in a nursing home and male gender (Beta = −1.280) were significantly associated with lower depression.Increased BMI (Beta = 0.056), a married (Beta = 0.687) and a widowed (Beta = 1.022) status compared to a single status were associated with a better nutritional status, whereas an increased somatic anxiety (Beta = −0.061), secondary (Beta = −0.79) and university (Beta = −1.196) educational levels compared to illiteracy were significantly associated with a worse nutritional status.Increased cognitive (Beta = 1.160) and affective (Beta = 0.788) anxiety and age (Beta = 0.191) were associated with higher stress, whereas a primary (Beta = −6.991), secondary (Beta = −11.812) and university (Beta = −13.927) educational levels, male gender (Beta = −2.015) were significantly associated with lower stress compared to females.A significantly higher mean depression score was found in patients living in nursing homes compared to those living at home (13.74 vs. 11.18). No difference was found between the two groups concerning the nutritional status and stress score.ConclusionLiving in nursing homes was associated with more malnutrition and depression. An increased awareness of the personnel working in nursing homes and family members of these older adults can help improve their psychological status.     

综合干预对原发性高血压患者疗效的影响

目的 探讨综合干预对原发性高血压患者降压疗效的影响.方法 对244例原发性高血压患者进行分组：试验组126例予综合干预,对照组118例予一般治疗管理,随访1年,分析其临床调查及综合干预的临床资料.结果 试验组生活行为变化率90.48%,服药依从率85.71%,血压控制率76.19%;对照组生活行为变化率72.88%,服药依从率45.76%,血压控制率32.20%,两组比较差异有统计学意义（P〈0.05）.结论 综合干预是防治高血压的重要措施.     

高血压病左室肥厚与心律失常的相关性临床研究

目的 探讨高血压病左心室肥厚与心律失常的关系。方法 选择2001-2003年上海交通大学附属第一人民医院心内科246例原发性高血压患者,进行静息同步12导联心电图,动态心电图及超声心动图测定,监测左室重量指数等指标。结果 左心室肥厚组平均左室重量指数水平为(151.6±15.8)g/m~2,和左心室正常者相比差异有显著性(P<0.01)。左心室肥厚组定性心律失常及复杂性定性心律失常的检出率为93.27％和51.92％,明显高于左心室正常组(35.21％,10.56％),差异有显著性(P<0.001)。结论 原发性高血压左心室肥厚相关性心律失常,尤其是复杂性心律失常,与左室肥厚的程度及是否合并左房肥大有明确的规律关系。     

门静脉高压症合并肝癌的外科治疗

报道门静脉高压症（ＰＨＴ）合并肝癌（ＰＨＣ）患者９例,施行肝叶切除术及脾切除、断流术８例,另１例因左、右肝均 灶,仅行剖腹探查术,术后随访６个月至３年,１例多发肿瘤患者于术后９个月死亡;１例肝癌复发并肺内转移者于术后１８个月死亡;余７例肝癌无复发,未发生消化道出血,情况良好,其中５例已恢复术前工作,提示ＰＨＴ合并ＰＨＣ患者只要条件允许,应同期施竽肝叶切除加脾切除、断流术,可延长生存时间,改善生活质量。     

The prevalence of mental health medication use in a cohort of New Zealand patients with diabetes

AimsDiabetes is associated with depression, anxiety and psychosis via complex bidirectional relationships that are affected by factors such as the type of diabetes and socioeconomic status. The aim of the study was to estimate the prevalence of mental health conditions in patients with diabetes in a New Zealand primary care population using proxy medication dispensing data.MethodsPrimary care data (July 1 2016 – June 30, 2018) was collected from the Patient Management System of 15 different general practices, and was linked via National Health Index number to clinical records at the Waikato District Health Board and the New Zealand Ministry of Health Pharmaceutical database.ResultsA total of 3978 patients with diabetes were identified from an enrolled patient population of 74,250. Of these, 18.0% of patients with diabetes were dispensed an antidepressant, anxiolytic, or antipsychotic. These medications were prescribed more in New Zealand Europeans (20.9% versus 13.9% in Māori), women, type 2 diabetes, those on insulin, and those with a higher BMI (all P < 0.001).ConclusionsApproximately one fifth of patients with diabetes in primary care have mental health disorders. Appropriate management requires concomitant treatment of both the diabetes and the mental health disorder to improve patient outcomes.     

糖耐量异常对原发性高血压患者血压变异性的影响

目的观察糖耐量异常对原发性高血压患者血压变异性的影响情况。方法入选正常血压及原发性高血压患者260例,按动态血压水平及是否合并糖耐量异常分为正常血压组（n=68）,正常血压合并糖耐量异常组（n=60）,原发性高血压组（n=70）,原发性高血压合并糖耐量异常组（n=62）。所有受试者进行24小时动态血压监测,观察各组血压变异性特点。结果原发性高血压合并糖耐量异常组24小时收缩压变异系数[（0.12±0.03）vs.（0.10±0.02）]、白天收缩压标准差[（15.37±2.66）vs.（13.34±2.27）]、变异系数[（0.12±0.02）vs.（0.10±0.02）]均高于原发性高血压组（P〈0.01）;正常血压合并糖耐量异常组与正常血压组各时间段血压标准差、变异系数差异无统计学意义（P〉0.05）。结论糖耐量异常影响原发性高血压人群血压变异性（以收缩压为主）,对正常血压人群无明显影响。     

琥珀酸美托洛尔缓释片治疗轻中度原发性高血压的临床研究

目的观察选择性β1受体阻滞剂琥珀酸美托洛尔缓释片(Betaloc ZOK,简称倍他洛克缓释片)治疗轻中度原发性高血压的疗效和安全性。方法30例轻中度原发性高血压患者服用倍他洛克缓释片47.5~95 mg/d 8周。治疗前后测量坐位血压,监测肝肾功能、血糖、血脂,记录药物不良反应。结果治疗8周后,收缩压和舒张压分别下降(13.70±17.70)mm Hg和(11.03±9.85)mm Hg(P均<0.001),26/30例患者血压<140/90 mm Hg,降压达标率为86.7%。心率、肝功能和血糖、血脂指标治疗前后差异无统计学意义。血肌酐显著下降[(0.92±0.2)mg/dlvs.(0.79±0.20)mg/dl,P<0.001]。结论倍他洛克缓释片能有效治疗轻中度原发性高血压,无明显不良反应,患者依从性良好。     

厄贝沙坦联合阿托伐他汀治疗原发性高血压80例临床研究

目的 探讨联合应用降压药物厄贝沙坦和调脂药物阿托代他汀治疗原发性高血压的临床疗效.方法 将160例原发性高血压患者随机分成对照组和观察组各80例.对照组单纯给予厄贝沙坦或加用硝苯地平缓释片治疗,观察组在此基础上加用阿托伐他汀片治疗.6个月后对比分析两组的动态血压、血脂、血尿酸.结果 两组患者血压均得到有效控制,治疗6个月后两组24 h平均收缩压（24hSBp）及24 h平均舒张压（24hDBp）差异无统计学意义（P＞0.05）;观察组24 h平均压（24hpp）及血脂水平均低于对照组（P＜0.05）.结论 联合应用降压药物厄贝沙坦和调脂药物阿托代他汀治疗原发性高血压能有效降低患者24 h平均压及血尿酸,从而更有效地保护靶器官.     

高血压病患者心率变异的变化及其与室性心律失常的相关性研究

目的 探讨高血压病(EH)者24h心率变异性(HRV)的变化及其与室性心律失常(VA)的关系.方法 采用动态心电图(DCG)记录96例患者(A组)和40例对照者(B组)的24h心电信号,分析其HRV变化及其与VA的发生情况.结果 EH者HRV各项时城指标和额域指标中的LF、VLF、HF均较B组显著降低,并有随着VA程度的加重而降低的趋势;时域指标中的SDNN、SDANN、ASDNN、PNN50与VA程度呈弱负相关(P<0.05);SDANN为EH者VA的保护因素.结论 EH者HRV明显降低,HRV与EH者VA程度呈弱负相关.SDANN为EH者VA的保护因素.早期对自主神经功能紊乱进行干预治疗,可能有利于减少EH者VA的发生.     

Association of mental health with the risk of coronary artery disease in patients with diabetes: A mendelian randomization study

Background and aimsObservational studies have shown an association between mental health and coronary artery disease (CAD) in patients with diabetes. Nevertheless, whether these associations are causal is still unknown. In this two-sample Mendelian randomization (MR) study, we aimed to assess the causality between mental health and CAD in patients with diabetes.Methods and resultsSingle-nucleotide polymorphisms (SNPs) associated with: depression (807,553 individuals), anxiety (83,556 individuals) and neuroticism (329,821 individuals) were identified from the largest genome-wide association studies (GWAS). Summary-level data for CAD were extracted from the recently published GWAS of 15,666 diabetic patients (3968 CAD cases and 11,696 controls). The inverse-variance weighted (IVW) method was used for the main analysis. Sensitivity analyses included weighted median, maximum likelihood, and the MR-Egger method. Genetic liability to depression was significantly associated with a higher risk of CAD in patients with diabetes (odds ratio [OR], 1.286; 95%CI,1.018–1.621;p = 0.035). For anxiety and neuroticism, no causal association with CAD in patients with diabetes was observed. Consistent results were obtained in most sensitivity analyses.ConclusionsThis MR study provides genetic evidence that depression is a potential risk factor for CAD in patients with diabetes. However, anxiety and neuroticism were not causally associated with CAD in patients with diabetes. Mental health treatments should be enhanced to prevent CAD in patients with diabetes.