认知行为联合药物治疗对青少年抑郁症患者临床症状及应对方式的影响

目的 探讨认知行为联合舍曲林药物治疗对青少年抑郁症患者临床症状和应对方式的影响。方法 选择2019年7月至2021年6月在郑州大学第五附属医院门诊就诊的140例青少年抑郁症患者作为研究对象,按照随机数字表法分为观察组(n=70)和对照组(n=70)。两组患者均接受口服盐酸舍曲林片治疗,观察组在此基础上接受认知行为治疗,治疗时间为3个月。治疗前和治疗3个月时,采用汉密顿抑郁量表(HAMD)和贝克抑郁量表第二版(BDI-Ⅱ)进行临床症状评价,采用简易应对方式量表(SCSQ)进行应对方式评价。结果 治疗3个月时,两组患者HAMD和BDI-Ⅱ评分均降低,并且观察组低于对照组,差异有统计学意义(P<0.05);治疗3个月时,两组患者SCSQ量表中积极应对和消极应对维度评分均有改变,并且观察组积极应对维度评分高于对照组,消极应对维度评分低于对照组,差异有统计学意义(P<0.05)。结论 认知行为联合舍曲林药物治疗能够有效控制青少年抑郁症患者的临床症状,对于应对方式的改变具有积极意义。     

正念认知法联合抗抑郁药物对抑郁症患者认知功能和心理状态的影响

目的研究正念认知行为的团体治疗与抗抑郁药物治疗对抑郁症患者认知功能和心理状态的影响。方法选取抑郁症患者130例,随机均分为对照组和正念认知组。对照组予以常规抗抑郁药物治疗,正念认知组在对照组基础上进行正念认知行为的团体治疗,比较两组临床治疗疗效及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易应对方式问卷(SCSQ)以及威斯康星卡片分类测试(WCST)。结果正念认知组治疗总有效率明显高于对照组(P＜0.05)。与治疗前比较,治疗后两组HAMD、HAMA评分均降低,且正念认知组下降程度大于对照组(P＜0.05);两组SCSQ评分均有所改善,且正念认知组改善程度大于对照组(P＜0.05);两组WCST均有所改善,且正念认知组应答总数、非持续性错误应答数多于对照组(P＜0.05),持续性错误应答数少于对照组(P＜0.05)。结论正念认知行为的团体治疗联合抗抑郁药物治疗抑郁症患者,能有效促进患者认知功能恢复,改善对应方式,缓解患者焦虑及抑郁情绪,值得临床上进一步推广。     

认知行为疗法联合常规药物治疗双相情感障碍抑郁发作青少年患者的效果

目的：观察认知行为疗法联合常规药物治疗双相情感障碍抑郁发作青少年患者的效果。方法：选取2020年1月至2022年1月该院收治的70例双相情感障碍抑郁发作患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各35例。对照组采用常规药物治疗,观察组在对照组基础上加用认知行为疗法,比较两组治疗前后汉密尔顿抑郁量表（HAMD）评分、简易应对方式问卷（SCSQ）评分和家庭功能评定量表（FAD）评分。结果：治疗后,两组HAMD评分、SCSQ消极应对评分低于治疗前,且观察组低于对照组;两组SCSQ积极应对评分、FAD评分高于治疗前,且观察组高于对照组,差异均有统计学意义（P<0.05）。结论：认知行为疗法联合常规药物治疗双相情感障碍抑郁发作青少年患者可降低HAMD评分,提高FAD评分,以及改善SCSQ评分,效果优于单纯常规药物治疗。     

认知行为干预对抑郁症患者防御方式的影响

目的：探讨认知行为干预对抑郁症患者防御方式的影响．方法以住院抑郁症患者为研究对象,共入组146例,按照入组顺序分为研究组和对照组．研究组采用认知行为干预,对照组采用抑郁症常规护理．采用汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）、简易应对方式问卷（SCSQ）,防御方式问卷（DSQ）评估抑郁症患者的症状改变和防御方式变化．结果研究组掩饰型因子分、积极应对分干预前后差异有统计学意义（P＜0.05）;第6周研究组和对照组间掩饰型因子分、积极应对分差异有统计学意义（P＜0.05）;干预前后2组HAMD、HAMA评分差异均有统计学意义（＜0.05）;HAMD分与积极应对因子分成负相关（P＜0.05）,与掩饰型防御方式成正相关（P＜0.05）,HAMA分与掩饰型防御方式成正相关（P＜0.05）．结论认知行为干预可以改善抑郁症患者抑郁焦虑症状及其防御方式．     

认知行为指导对抑郁症患者照顾者情绪状态及应对方式的影响

目的:观察认知行为指导对抑郁症患者照顾者情绪状态及应对方式的影响。方法:选取126例抑郁症患者照顾者作为研究对象,依据随机数字表法分为对照组与观察组各63例,对照组行常规指导,观察组在此基础上实施认知行为指导。比较两组抑郁症患者照顾者的情绪状态及应对方式变化情况。结果:经3个月指导后,观察组汉密顿抑郁量表(HAMD)评分、汉密顿焦虑量表(HAMA)评分均低于对照组,差异有统计学意义(P<0.05)。观察组积极应对评分高于对照组,消极应对评分低于对照组,差异均有统计学意义(P<0.05)。结论:于常规指导基础上开展认知行为指导有助于改善抑郁症患者照顾者的不良情绪,减轻心理负担,促使其积极应对,可以更好的照顾患者,促使患者早日回归家庭和社会。     

心理剧治疗对抑郁症患者的作用

目的:探讨心理剧治疗对抑郁症患者的影响.方法:将44例抑郁症患者随机分为研究组和对照组,两组均使用抗焦虑、抑郁药物和常规护理,对研究组辅以心理剧治疗,采用抑郁自评表(SDS)、汉密尔顿抑郁量表(HAMD)和简明应对方式问卷(SCSQ)对两组进行效果评定.结果:SDS、HAMD前后比较有统计学意义(P＜0.01),而组间比较差异无统计学意义(P＞0.05).研究组治疗后积极应对因子高于对照组,消极应对因子低于对照组,差异具有统计学意义(P＜0.01).结论:心理剧治疗能改善抑郁症患者负性情绪,提高心理健康水平.     

药物联合认知行为治疗青少年伴非自杀性自伤抑郁症的效果观察

目的：探讨药物联合认知行为治疗青少年伴非自杀性自伤抑郁症的效果。方法：选取2021年1月—2022年3月徐州市东方人民医院收治的36例青少年伴非自杀性自伤抑郁症患者作为研究对象，按治疗方案不同分为对照组与研究组，各18例。对照组给予药物治疗，研究组在对照组基础上联合认知行为治疗。比较两组临床疗效、抑郁程度、应对方式评分、生活质量评分。结果：研究组治疗总有效率高于对照组，差异有统计学意义(P=0.035)。治疗前，两组汉密尔顿抑郁量表(HAMD)、蒙哥马利抑郁评定量表(MADRS)评分比较，差异无统计学意义(P>0.05)；治疗后，研究组HAMD、MADRS评分低于对照组，差异有统计学意义(P<0.05)。治疗后，研究组积极应对评分高于对照组，消极应对评分低于对照组，差异有统计学意义(P<0.05)。治疗后，研究组各项生活质量评分均高于对照组，差异有统计学意义(P<0.05)。结论：药物联合认知行为治疗青少年伴非自杀性自伤抑郁症的效果显著，可明显改善患者抑郁程度、应对方式以及生活质量。     

家庭心理护理对抑郁症患者应对方式和防御方式的影响

目的探讨针对家庭结构的心理护理对抑郁症患者应对方式和防御方式的影响。方法选择124例住院治疗的抑郁症患者,按入院时间顺序入组,分为研究组和对照组各62例。研究组采用针对家庭结构的心理护理,对照组采用抑郁症常规护理。两组分别在第0、12、24周对患者进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),简易应对方式问卷(SCSQ)、防御方式问卷(DSQ)评定。结果在入组第12、24周,研究组的HAMD、HAMA评分、SCSQ积极应对分、消极应对和不成熟型因子分评分与入组时比较差异均有统计学意义(P<0.01),和对照组比较差异均有统计学意义(P<0.05);HAMD减分数与消极应对和不成熟型因子分呈正相关(P<0.05),与积极应对呈负相关(P<0.05);HAMA与消极应对呈正相关关系。结论针对家庭结构的心理护理可以改善抑郁症患者应对方式、防御方式,促进患者抑郁症状的好转。     

认知行为治疗对产后抑郁症疗效的对照研究

目的探讨认知行为治疗(CBT)对产后抑郁患者的疗效。方法将120例产后抑郁患者随机分为研究组(CBT组)和对照组(西酞普兰组)各60例,研究组给予认知行为治疗每周2次,每次50min;对照组给予西酞普兰治疗,疗程为8周,于治疗前后进行功能失调性状况评定量表(DAS)和汉密顿抑郁量表(HAMD)评定,比较两组疗效及认知改善程度。结果治疗前两组DAS评分和HAMD评分差异无统计学意义;治疗8周,研究组DAS总分、脆弱性、完美化、依赖性及自主性态度评分较治疗前明显下降(P均<0.01),HAMD总分较治疗前明显下降(P<0.01);对照组DAS各项评分与治疗前比较差异无统计学意义(P>0.05),HAMD总分较治疗前明显下降(P<0.01)。两组间比较,治疗后研究组DAS总分、脆弱性、完美化、依赖性、自主性态度因子分较对照组显著降低(P<0.05或P<0.01),HAMD总分差异无统计学意义(P>0.05)。结论CBT和西酞普兰对产后抑郁症同样有明显疗效;但CBT能明显改善患者功能失调性认知损害。     

中等强度有氧运动联合认知行为治疗对轻中度抑郁症患者症状及生活质量的影响

目的 探讨中等强度有氧运动联合认知行为治疗对轻中度抑郁症患者症状及生活质量的影响。方法 选择台州市第二人民医院2018年6月至2019年10月门诊治疗的轻中度抑郁症患者100例为本研究对象,采用随机数字表法将其分为对照组与观察组(每组各50例)。对照组接受认知行为治疗,完成日常活动;观察组在对照组基础上给予3次/周,40 min/次,持续12周的中等强度有氧运动训练。采用抑郁自评抑郁量表(SDS)、汉密尔顿抑郁量表-17项(HAMD-17)评价抑郁情况,采用我院自制《有氧运动健康知识问卷》、《运动依从性调查表》评价有氧运动相关知识知晓度及依从性,采用世界卫生组织生存质量测定量表简表(WHOQOL——BREF)评价生活质量。结果 观察组完成46例,对照组完成45例,干预后观察组SDS、HAMD-17评分均低于对照组,差异有统计学意义(t值分别=3.627,4.844,P0.05);有氧运动健康知识及运动依从性评分均高于对照组,差异有统计学意义(t值分别=13.585,11.695,P0.05);生理领域、心理领域、社会关系领域、环境领域评分均明显高于对照组,差异有统计学意义(t值分别=3.553,4.145,4.014,5.088,P0.05)。结论 中等强度有氧运动联合认知行为治疗可明显改善抑郁症患者抑郁程度,提升生活质量。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.