471例吉林省老年人健康状况与抑郁情绪关系研究

目的研究老年人抑郁情绪与健康状况现状,并分析探讨二者之间的关系。方法采取《老年人抑郁量表》和《健康状况问卷》对便利取样的471例老年人进行研究。结果在不同婚姻状况的分析中发现,独居者和非独居者老年人在抑郁总分(P0.01)、生理机能(P0.01)、生理职能(P0.05)、一般健康状况(P0.01)、精力(P0.01)、社会功能(P0.01)、精神健康(P0.01)等方面得分差异具有统计学意义;在不同家庭经济状况的分析中发现,低保户和非低保户在抑郁总分(P0.01)、生理职能(P0.05)、一般健康状况(P0.05)、精力(P0.05)等方面得分差异具有统计学意义;在抑郁和健康状况相关分析中发现,老年人抑郁得分与健康状况问卷中各因子(P0.01)均存在显著的负相关;在抑郁和健康状况回归分析中发现,精力、生理职能、社会功能和精神健康等四因子进入了回归方程,对抑郁的解释率为40.2%。结论老年人抑郁情绪与健康状况紧密相关,要重视对独居者和低保户老年人的关心。     

高血压患者不同舒张压分层中血压与血脂间的关系

目的 探讨高血压患者不同舒张压分层中舒张压(DBP)和收缩压(SBP)与血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(ApoA1)、载脂蛋白B(ApoB)和脂蛋白a[Lp(a)]等血脂诸项之间的关系.方法 以健康对照为A组,高血压患者中DBP<100mm Hg(1 mm Hg=0.133 kPa)者设为B组,DBP≥100mm Hg者设为C组.分别用比色法检测健康对照组和高血压患者组血清TC以及TG、HDI-C、LDL-C水平,用免疫比浊法检测ApoA1、ApoB和Lp(a);由专人负责检测收缩压与舒张压.结果 SBP:B、C与A组比较,差异有统计学意义,P<0.001;B、C组问差异有统计学意义,P＜0.01.DBP:A、B、C 3组间两两比较,差异有统计学意义,P＜0.001.TG:B、C与A组之间差异有统计学意义,P＜0.05.ApoB:C与A组比较,差异有统计学意义,P＜0.01;B与C组比较,差异有统计学意义,P＜0.05.LDL-C:C与A组、B与A组、B与C组比较,差异有统计学意义P＜0.005.Lp(a):C、B与A组比较,差异有统计学意义P<0.05.3组中仅B组DBP与TG相关,r=0.459,P＜0.05.结论 针对不同舒张压分层的高血压患者进行治疗时,采取个性化的控制血脂的方案可能更妥当.     

白血病患儿照护者希望水平与心理弹性及家庭功能的相关性分析

目的分析白血病患儿照护者希望水平与心理弹性及家庭功能的相关性。方法选取2017年2月~2019年1月我科白血病患儿照护者185例,观察相关资料,评定照护者希望水平等级、心理弹性状态、家庭功能,明确希望水平与心理弹性、家庭功能相关性。结果随着心理弹性水平和家庭功能状态升高,希望水平低等构成比均逐渐下降、中等构成比先升高后下降、高等构成比持续升高,差异有统计学意义(P<0.05)。心理弹性低等水平和家庭功能严重障碍者希望水平均以低等构成比最高,心理弹性中等水平和家庭功能中度障碍者以中等构成比最高,心理弹性高等水平和家庭功能良好者希望水平均以高等构成比最高,差异有统计学意义(P<0.05)。希望水平分别与心理弹性、家庭功能状态呈显著正相关关系,差异有统计学意义(P<0.05)。结论白血病患儿照护者希望水平与心理弹性、家庭功能密切相关,提高照护者希望水平对增进其心理弹性、维持良好的家庭功能,确保患儿治疗效果、生活质量等具有一定指导性意义。     

哀伤护理对癌症丧亲亲属的焦虑、抑郁的效果观察

目的 观察哀伤护理对癌症丧亲亲属的焦虑、抑郁的干预效果.方法 将50例癌症丧亲亲属随机分为观察组和对照组,观察组25例,采用哀伤护理,对照组25例,实施常规护理.结果 观察组和对照组进行对比,焦虑、抑郁低于对照组,差异有统计学意义(P＜0.05).结论 哀伤护理能减轻癌症丧亲亲属焦虑、抑郁情况,值得推广.     

临床护士健康心理表现值与社会属性的相关性分析

目的:探讨临床护士健康心理表现值与社会属性的相关性.方法:采用无记名自愿的形式对枣庄市三级医院在编临床(病房)护士(310名)进行随机抽样问卷调查,内容包括症状自评量表(SCL-90)、生活事件量表(LES)、社会支持评定量表(SSRS).结果:临床护理人员心理健康表现值偏低,不同职称护士心理健康表现值与常模比较差异有统计学意义(P＜0.05,P＜0.01);家庭生活事件严重影响临床护理人员的心理健康,负性生活事件是影响护师、主管护师、副主任护师的主要因素,家庭生活事件的发生是其主要方面;工作学习方面是影响护士的主要事件.社会支持对心理健康起到良好的缓冲作用,护士的支持利用率高.社会支持、生活事件与SCL-90各因子表现值相关性有统计学意义(P＜0.05,P＜0.01).结论:临床护理人员的心理健康表现与负性生活事件、工作学习、家庭生活具有相关性,社会支持在临床护理人员的心理健康表现中占重要作用.     

超声检测心肌梗死患者颈动脉结构与缓冲功能的研究

目的 应用超声检测心肌梗死患者颈动脉血管结构与缓冲功能的改变.方法 超声检查40例心肌梗死患者和30例健康者为对照组的颈动脉,测量颈动脉内-中膜厚度(IMT)、舒张末期内径(Dd)和收缩末期内径(Ds),并测量受检者肱动脉收缩压与舒张压,计算颈动脉弹性系数(Ep)、僵硬度(β)与顺应性(AC)3个参数以评价颈动脉缓冲功能.结果 心肌梗死患者颈动脉IMT较对照组增厚,差异有统计学意义(P＜0.05);心肌梗死患者颈动脉Ds和Dd较对照组增加,但差异无统计学意义(P＞0.05);心肌梗死患者颈动脉Ep和β较对照组增大,差异有统计学意义(P＜0.01);心肌梗死患者颈动脉AC较对照组减小,差异有统计学意义(P＜0.05).结论 心肌梗死患者颈动脉IMT增厚,Ep和β增大,AC减小;IMT结合Ep、β与AC能更全面反映心肌梗死患者颈动脉结构和功能改变,对临床诊断和治疗方案的选择与评估有重要参考价值.     

医护人员、阿尔茨海默病患者及其照料者对阿尔茨海默病认知现况的调查

目的 了解和比较医护人员、照料者及患者对阿尔茨海默病(AD)认知的现状.方法 采用判断抽样抽取3所医院的医护人员、AD患者及其照料者各200名,采用阿尔茨海默病知识测评量表(ADKS)调查并比较3组人群对AD的认知情况.结果 医护人员、AD患者及其照料者对阿尔茨海默病的认知程度均较低.医护人员、AD患者及其照料者ADKS总得分分别为(16.61±2.59)、(10.49±2.96)、(16.70±2.84)分,3组人群ADKS得分差异具有统计学意义(F=239.52,P＜0.01);经多重比较,AD患者ADKS得分低于其照料者(=21.89,P＜0.01)和医护人员(t=21.71,P＜0.01),医护人员与AD患者照料者ADKS得分差异无统计学意义(t=-0.32,P=0.74).医护人员、AD患者及其照料者在ADKS量表涉及的7个维度的得分都不高;在阿尔茨海默病的症状、评估和诊断、对生活的影响3个领域,医护人员得分均低于AD患者的照料者;对AD患者的照料得分医护人员高于AD患者及其照料者;危险因素、病程、治疗和管理、对AD患者照料4个领域医护人员得分高于AD患者;AD患者7个领域的得分均低于其照料者,差异均有统计学意义(P＜0.05).结论 医护人员、照料者及患者对阿尔茨海默病的认知程度都不高,均需加强对阿尔茨海默病的认识.     

社会支持、家庭功能对产后抑郁情绪的影响

[目的]探讨产妇的社会支持、家庭功能状况与产后抑郁的关系.[方法]调查住院产妇119例,采用Zung抑郁自评量表(SDS)、肖水源设计的社会支持评定量表、家庭APGAR问卷调查分析产妇社会支持、家庭功能与产后抑郁的关系.[结果]产妇的社会支持处于较好的水平,社会支持得分40.52分±7.63分;家庭功能得分7.62分±2.07分,整体处于较高的水平;产妇抑郁总的发生率15.13%, SDS总分(38.68分±10.70分)与国内常模(33.46分±8.55分)比较,差异有统计学意义(P＜0.001);家庭功能各组间抑郁发生率差异有统计学意义(P＜0.001),家庭功能与抑郁发生率呈负相关(r=-0.663,P＜0.001);主观支持和对支持的利用度与产后抑郁呈负相关(P＜0.05).[结论]产妇抑郁发生率高于普通人群,家庭功能对产妇抑郁情绪有影响.以产妇为中心,提供家庭、社会支持及有效的心理支持可减轻产妇的抑郁症状.     

男性吸烟者急性心肌梗死患者血脂特点

目的 探讨男性吸烟者急性心肌梗死(AMI)患者的血脂特点.方法 将222例男性AMI患者按是否吸烟分为两组:A组77例为未吸烟组;B组145例为吸烟组,分析两组血脂六项的差别.结果 与未吸烟组相比,吸烟组的平均年龄较低,差异有统计学意义(P＜0.01);低密度脂蛋白胆固醇(LDL-c)和载脂蛋白B(apoB)的增高差异有统计学意义(P＜0.05);总胆固醇(TC)和甘油三酯(TG)的增高差异有统计学意义(P＜0.01).结论 男性吸烟者可使血脂增高,致使AMI早发10年余.     

药物流产不全及失败的相关因素分析

目的 探讨药物流产不全及失败的相关因素.方法 回顾我院2898例经米非司酮配伍米索前列醇终止妊娠的临床资料,分析药物流产不全及失败的相关因素.结果 孕周＞7周者药物流产不全及失败率高于孕周≤7周者,差异有统计学意义(P＜0.01);经孕者药物流产不全及失败率高于初孕者,差异有统计学意义(P＜0.01);孕囊直径≥20 cm者药物流产不全及失败率高于孕囊直径＜20 cm者,差异有统计学意义;后倾后屈位置子宫药物流产不全及失败率高于前倾水平位置子宫,差异有统计学意义(P＜0.01).结论 药物流产不全及失败率与孕周、孕次、孕囊大小、子宫位置有关.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.