精神病人院内感染的临床分析及护理对策

笔者对我院住院病人发生感染的状况进行了回顾性调查 ,目的是提出防范措施。报道于后。1　临床资料1 1　一般资料　本组病例为 1994年 1月～ 2 0 0 1年 12月我院发生的较严重的院内感染者 ,主要为胃肠道感染和下呼吸道感染 ,分别为 32 4例和 118例 ,其中胃肠道感染者男性 2 4 3例 ,平均年龄 (41 5 3±14 6 3)岁 ;女性 83例 ,平均年龄 (34 33± 11 0 3)岁。下呼吸道感染者男性 81例 ,平均年龄 (5 3 98±7 72 )岁 ;女性 37例 ,平均年龄 (5 1 0 0± 12 2 5 )岁。1 2　诊断　在 118例下呼吸道感染者中 ,精神分裂症 82例 ,情感性精神障碍 35例 …     

精神病人院内感染的预防及护理

精神病人由于兴奋吵闹、违拗或生活懒散、反应迟钝和行动缓慢等症状，常造成生活自理能力明显下降。加之病人对疾病缺乏自知力，常无就医欲望，故不配合治疗，这些因素都增加了他们院内感染的机会。现就我院精神病人院内感染的预防及护理措施介绍如下。     

住院精神病人合并躯体感染临床资料分析

目的：为临床提供住院精神病人感染及其治疗的参考资料,方法：调查1994年10月至1997年10月住院精神病人感染及治疗的情况,对有关资料进行整理及统计学分析。结果：住院期间患者感染率为31．25％。其中呼吸系统感染占71．43％,消化系统占18．27％,系统抗感染治疗占79．07％,使用抗生素者占治疗的76．05％,青霉素使用率最高,为56．35％,磺胺类居第二位,为21．85％,治疗总有效率为96．64％,≤20岁及≥51岁组病人感染率高于其他年龄组（P＜0．05）。精神分裂症、情感性精神病患者感染率高于轻型精神疾病患者（P＜0．05）,结论：应重视住院精神病人躯体感染的诊断和治疗。     

老年住院精神病人肺部感染的相关因素分析

随着人口老龄化的加速,老年精神病人的患病人数也在明显增加。住院老年精神病人的增加,老年病人住院期间肺部感染的患病人数也在增加。本文101例住院老年精神病人中,肺部感染32例,感染率31．08％。老年病人由于高龄和伴有躯体疾病缺乏肺部感染的典型临床表现,给早期诊治带来一定的困难,加上病人患有精神疾病,不能正确地诉说感染症状,应引起高度重视。     

住院精神病人并发肺部感染的有关因素分析

本文报告住院精神病人并发肺部感染的发生率为９．８‰。分析其诱发因素，多为抗精神病药物副反应，ＥＣＴ及ＩＳＴ等治疗副作用。     

96例住院精神病人院内感染的相关因素分析

医院感染不仅给病人增添了新的痛苦,而且影响了病床的周转率和疾病的治愈率,降低了医疗质量,特别是精神病人因受精神症状的影响,不能客观地反映继发感染症状,易造成误诊、漏诊甚至危及生命,更应引起重视。作者通过初步分析我院９６例院内感染者资料,以探讨住院精神...     

探讨住院精神病人死亡原因的变迁与护理对策

目的　探讨不同年代住院精神病人死亡原因的变迁 ,并从护理角度提出应注意的问题。方法　对我院 1972年— 2 0 0 1年期间住院病人 2 2 6 32例中死亡的 4 3例作回顾性调查。结果　总死亡率 0 .19% ,精神病合并躯体疾病死亡者逐年有明显下降 ,死亡原因以治疗并发症最多 (37.2 % ) ,其次为全身衰竭 (2 5 .6 % )。结论　加强病房的安全管理及对渐趋衰退的患者进行行为干预为主的综合护理 ,以降低死亡率     

长期住院精神病患者院内感染的防治

目的了解长期住院精神病人院内感染情况。方法对自1984年2月～2003年10月住进我院的长期住院精神病人,在胃肠道感染和乙型肝炎病毒感染情况,进行了初步的调查分析。结果乙型肝炎病毒感染率为8．21％,胃肠道的平均期间患病率为26．87％,其感染率高。结论应结合精神病院的特点,对精神病患者特别是长期住院精神病患者的院内感染进一步的监测和防治。     

神经内科住院患者院内感染的监测与护理

1对象与方法1·1观察对象2004年1~12月我院神经内科住院患者,男786例,女698例,年龄30~86岁,平均56岁;住院时间15~60d,平均25d,住院时间<24h者除外。1·2方法及标准专职医生及护士动态监测住院患者,根据医院感染诊断标准(试行)〔1〕确定为院内感染者即列入观察对象,并及时进行统计调查与分析。2结果2004年调查住院患者1416例,发生院内感染156例,感染率为11·0%。住院患者中>60岁510例,发生院内感染92例,感染率18%;<60岁者906例,发生院内感染64例,感染率为7%。病情危重者院内感染高,占21%。Ⅱ级护理及生活能自理者感染率为3·5%,有意识障碍者…     

住院老年痴呆患者监护人的心理状态及其影响因素

目的探讨住院老年痴呆患者监护人的心理状态及其影响因素。方法采用一般情况调查表、症状自评量表（SCL-90）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）及AD病理行为评分表（BEHAVE-AD）对住院老年痴呆患者及门诊老年痴呆（AD和VD）患者和其监护人进行评定,并与正常老人的监护人和老年非痴呆患者的护理人员进行比较。结果住院痴呆患者监护人SCL-90总分及因子分比正常对照组和老年非痴呆患者护理组评分高,但较门诊痴呆组评分低,均有显著差异（P〈0．01-0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格、病程、与患者的关系及有无躯体疾病之间SCL-90总评分均具有非常显著差异（P〈0．01）：逐步回归分析显示影响监护人心理状态的因素依次为患者痴呆的严重程度、精神行为症状、与患者关系、性别及社会支持。结论住院老年痴呆患者监护人的心理状态较差,影响因素是多方面的,应引起社会高度重视。     

The closure of a mental hospital in Sweden: Characteristics of patients in long-term care facing relocation into the community

Summary A political decision to decentralize psychiatric care in a county of Sweden was made in October 1984, leading to the closure of the only large mental hospital in the area (290,000 inhabitants). The hospital is of the traditional type, with 490 beds and 1,294 staff members. It has units for long-term care, short-term care and rehabilitation and a unit for research and education. The long-term care is to cease completely and be replaced by community based alternative types of care. In this study, the long-term population (n=199) was characterized and their levels of functioning were measured. The results showed that 91% of the patients were 65 years old or more and that more than half of them were organically demented. Only 20% were chronic schizophrenics. All patients were cognitively impaired and 80% were also impaired in ADL functioning. A correlation between length of stay in hospital and ADL functioning was found in the organically demented group, but not in the group of chronic psychiatrically ill patients. Thirty-nine per cent of the population were severely impaired in ADL functioning and needed nursing care around the clock; 34% were moderately impaired and needed help and support that could be given in alternative types of care; 27% were not impaired at all to midly impaired and could be relocated to some type of service apartment. Thus, all patients needed sheltered living arrangements and care provided by staff with adequate training.     

综合医院心理门诊就诊人群心理健康状况分析

目的 探讨综合医院心理门诊就诊人群心理健康状况.方法 首先就664例就诊者的职业、性别构成和病种构成进行分析.使用症状自评量表（SCL-90）对就诊者进行评定,将就诊者分为有诊断有问题组、有诊断无问题组、无诊断有问题组和无诊断无问题组,并将就诊者的SCL-90得分情况与中国成人常模比较.结果 综合医院心理门诊就诊者女性多于男性,就诊比例较多的依次为退休人员、待业人员、学生、工人和教师.疾病分布以抑郁障碍、焦虑障碍、精神分裂症、躯体化障碍、双向情感障碍为多见.就诊者的SCL-90评分总分、总均分、阳性项目数和各因子分均高于常模（P＜0.05）.68.37%就诊前有诊断者SCL-90各条目均高于常模,尽管31.63%就诊前有诊断者各因子分均在正常范围内,但他们的量表总分和阳性项目数均高于常模;62.61%的就诊前无诊断者SCL-90总分、总均分、阳性项目数和各因子分均高于常模.就诊者中心理健康状况异常与正常者分别为73.64%与26.36%.结论 综合医院心理门诊就诊者多数为心理健康状况异常者,仅约1/4多的就诊者心理健康状况正常.     

The closure of a mental hospital in Sweden

Summary A political decision to decentralize psychiatric care in a county of Sweden was made in October 1984. This will lead to the closure of the county's only large psychiatric hospital. Short-term psychiatric care will be provided by three smaller hospitals in the county, while long-term care in hospital will cease completely and be replaced by district-based psychiatric services. All patients (n=199) in the large hospital's long-term unit were studied over 5 years of the transition period. The results showed that 42% of patients were discharged during the period, mainly to other institutions. Only 8 patients were provided with alternative types of care, such as group homes. Sixty-eight per cent of all patients died, most of them before being discharged (80% of the organically demented patients and 51% of the others). The mortality rate for patients with severely impaired activities of daily living (ADL functioning) was 92% for those who were also organically demented and 84% for the others. The patients who survived the 5-year period were mainly (80%) nondemented patients with relatively well-preserved ADL functioning, but with behavioural disturbances.     

Embedding integrated mental health assessment and management in general hospital settings: feasibility,acceptability and the prevalence of common mental disorder

Objective

To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder.

Method

A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7.

Results

The proportion of patients screened varied widely across specialties (40.1–98.2%). The decline rate was low (0.6–9.7%) and the minority required assistance (11.7–40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD.

Conclusion

Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.     

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

OBJECTIVE: Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU. METHOD: Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. RESULTS: Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only. CONCLUSION: HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.     

OEC管理模式对衰退期住院精神疾病患者自护能力的影响

目的 研究OEC管理模式对衰退期住院精神疾病患者自护能力的影响.方法 选择2006年7月～2008年6月实施OEC管理模式前衰退期住院精神患者100例为对照组;2008年7月～2010年6月实施OEC管理模式后衰退期住院精神患者100例为观察组.比较OEC管理模式前后患者的自护能力,采用日常生活能力评定Barthel指数量表进行评价.结果 OEC管理模式让每位护士的工作业绩一目了然,促进了优质护理,使衰退期住院精神患者在进食、洗澡、穿衣、修饰、如厕、日常活动等方面自理能力得到很大提高,两组比较差异有统计学意义（P＜0.05）.结论 OEC管理模式对衰退期住院精神疾病患者的自护能力有明显提高作用.     

综合医院住院患者的自测健康状况及影响因素分析

目的了解综合医院住院患者的自测健康状态及其影响因素。方法选择综合医院符合条件的住院患者，科室测评名额按其现有住院人数比例分配。由受过培训的专业人员对患者进行指导自评，患者躯体疾病的严重程度，由经治医生评定。结果综合医院住院患者的自测健康较低，不同性别、已未婚、有无职业、职业是否稳定及不同居住地之间存在显著差别，年龄、受教育程度和疾病严重性对自测结果影响明显，呈显著相关。经治医生对躯体疾病严重程度的评价与患者自测健康的结果是一致的。结论综合医院住院患者的健康状况不仅包括躯体健康，同时也包括心理和社会健康，关注患者的健康，要同时关注他的躯体、心理和社会健康一．     

The effects of infection on severe stroke patients in the neurological intensive care unit in China

Objective: To study the effects of infection on severe stroke patients in the neurological intensive care unit and to find the related risk factors for mortality of severe stroke patients.

Methods: We conducted a retrospective study including 343 patients with ischaemic or haemorrhagic stroke and staying for more than 2 patient-days in the neurological intensive care unit at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyse the infection features of patients with severe stroke in the neurological intensive care unit. All analyses were conducted using SPSS 18.0.

Results: The mortality rate, hospital staying time and hospital costs between infected and uninfected stroke patients were higher in the infected patients than in the uninfected patients, P < 0.05, and except for the hospital staying time, the mortality rate and hospital costs were both significantly higher in the infected patients. Respiratory tract infection was the most common infection type at all time periods, P < 0.05. However, urinary tract infection increased at 72 h after stroke compared with infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stroke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P < 0.05.

Conclusion: Infection can significantly influence the mortality rate and hospital costs of stroke patients, and is an independent risk factor for mortality of stroke patients.     

精神疾病伴垂体瘤患者溴隐亭治疗联合心理护理的效果观察

目的：探讨溴隐亭对重症精神疾病伴垂体瘤患者的治疗效果,并总结临床心理护理的方法及重要作用。方法我院2012‐02—2014‐01精神疾病合并脑垂体瘤门诊患者56例随机分组,研究组和对照组各28例。所有患者均常规给予抗精神病类用药积极治疗,并配合健康教育和心理护理,研究组在此基础上加用甲磺酸溴隐亭片治疗。结果研究组总有效率100％,对照组64.3％,2组比较差异有统计学意义（P＜0.01）。2组治疗后SAS和SDS评分均显著低于治疗前,组内比较差异有统计学意义（P＜0.01）;治疗前后2组间比较SAS和SDS评分比较差异无统计学意义（P＞0.05）。结论精神疾病伴垂体瘤患者应用溴隐亭治疗联合心理护理具有良好的效果,可改善不良心理状态,提高疗效。