普鲁卡因与垂体后叶素治疗大咯血临床观察

目的:对比普鲁卡因与垂体后叶素治疗大咯血的止血效果和不良反应。方法:回顾性分析2006年3月到2011年2月间收治的36例普鲁卡因治疗的大咯血病人以及32例垂体后叶素治疗的大咯血病人。结果:普鲁卡因治疗和垂体后叶素治疗对病人的止血效果无统计学差异(P>0.05),但垂体后叶素治疗的不良反应明显高于普鲁卡因(P<0.05)。结论:在垂体后叶素不能使用时,普鲁卡因是治疗大咯血有效且安全的药物。     

奥曲肽联合立止血治疗肺结核并大咯血的临床观察

目的观察奥曲肽联合立止血治疗肺结核大咯血的疗效。方法肺结核并大咯血患者52例,随机分为治疗组与对照组。治疗组奥曲肽与立止血联合使用,对照组仅垂体后叶素,观察其疗效和不良反应。结果治疗组显效率为63.0%,总有效率92.6%;对照组显效率40.0%,总有效率76.0%。两组有效率、显效率有显著差异(P<0.05)。结论奥曲肽联合立止血治疗肺结核大咯血比单用垂体后叶素治疗止血速度快,疗效显著,且副作用小。     

临床观察酚妥拉明联合立止血治疗大咯血

目的:观察酚妥拉明联合立止血治疗大咯血的治疗效果。方法:将128例大咯血患者随机分为两组。治疗组:65例,采用酚妥拉明加立止血治疗;对照组60例,采用脑垂体后叶素、止血敏、止血芳酸治疗,其余治疗两者同。结果:治疗组显效率80.0%,总有效率95.0%;对照组显效率50.0%,总有效率84.5%,两组显效率及总有效率比较具有显着差异(P<0.05)。结论:酚妥拉明联合立止血治疗大咯血较传统使用脑垂体后叶素辅以止血敏、止血芳酸疗效显着,不良反应少。     

垂体后叶素治疗肺结核大咯血致严重水中毒昏迷36例临床分析

咯血是肺结核病人的常见临床表现,大咯血南于咯血量大,易冈窒息而危及牛命,垂体后叶素作为内科止血钳是治疗大咯血的首选药物,但在使用中往往会出现许多不良反应如腹痛、恶心、呕吐、血压升高等,作者自2003年3月至2008年6月在治疗肺结核大咯血146例病人中发现有36例病人出现了严重的水中毒、昏迷,现将相关临床资料分析如下:     

骨折病人术前焦虑抑郁的心理干预研究

随着现代医学模式的转变,心理干预对疾病的发展、预后的作用日益受到重视.人一旦患病,就会产生一定的心理反应,尤其是手术病人,更会产生较强烈的生理与心理应激反应,比如焦虑、恐惧等,且这些不良情绪能引起神经内分泌的改变,削弱机体的免疫力,使病人手术耐受性降低,增加手术的危险性,且不利于手术后的康复.通过对术前两组病人的心理学调查,发现心理干预对其焦虑、抑郁等不良情绪和血压、心率有一定的影响.方法 随机将64例骨折手术病人分为心理干预组和对照组各32例,两组病人均于入院后进行心理学调查(焦虑SAS、抑郁SDS)和测量血压、心率.对照组常规进行健康教育,干预组除常规进行健康教育外进行认知行为疗法,待手术前日再次进行SAS、SDS测评和监测血压、心率.结果 两组病人入院后SAS、SDS标准分和血压、心率均无显著差异(P＞0.05);而手术前日干预组SAS、SDS标准分及血压明显降低、心率亦明显减慢,而对照组SAS、SDS标准分及血压明显升高、心率明显增快,与对照组比较存在明显差异(P＜0.05),有统计学意义.结论 手术病人术前进行心理干预有助于减轻或消除焦虑和抑郁等不良情绪的影响和维持血压、心率的稳定.     

奥曲肽治疗上消化道大出血的临床疗效观察

目的 观察奥曲肽在治疗上消化道大出血中的疗效。方法 将60例上消化道大出血患者随机分为2组，治疗组30例，对照组30例。治疗组应用奥曲肽，对照组应用垂体后叶素和硝酸甘油。观察两组的止血效果。结果 奥曲肽（善宁）治疗组的止血有效率明显高于对照组（P〈0．05）。结论 奥曲肽治疗上消化道大出血效果显著。     

术前心理护理对手术病人的干预意义

目的 通过对术前心理护理干预和非心理护理干预两组病人的心理学调查，发现心理护理干预对其焦虑、抑郁、恐惧、烦躁等心理影响，以及病人血压、心率的改变。方法 随机将128例下肢、腹部手术病人分为医学心理护理干预组和对照组各64例，两组病人均于入院后进行心理学调查（焦虑SAS、抑郁SDS）和测量血压、心率。干预组进行心理学支持疗法（PPST），对照组则不予任何心理支持，待手术前日再次进行SAS、SDS和监测血压、心率。结果 两组病人入院后SAS、SDS和血压、心率均无显著差异（P〉0.05）；而手术前日干预组SAS、SDS明显减低，血压、心率亦明显减慢，而对照组SAS、SDS血压、心率明显增快，与对照组比较存在明显差异（P〈0．05），有统计学意义。结论 手术病人术前进行心理护理干预有助消除焦虑和抑郁的心理和维持血压、心率的稳定。     

ICU病人的心理特征及护理

ICU病人病情危重,均有不同程度的心理问题,如焦虑、抑郁、惊恐等,很大程度影响了治疗效果及患者的生存质量。 1 ICU病人心理反应 1.1 初期焦虑 病人进入病房1～2天呈不同程     

药物及心理应激因素对中心性浆液性视网膜脉络膜炎治疗的影响

观察药物及心理应激等因素对中浆治疗的影响。对 75例中浆患者进行回顾性分析 ,对发病诱因、全身情况及不同治疗环境下的病程等因素进行分析。其中一组 (松弛组 )为 44例 ,服药的同时做松弛训练 ,让病人脱离原工作环境住院或疗养、低脂饮食 ,并每日练习 1次太极拳或其他稳定情绪的治疗。二组 (非松弛组 ) 31例 ,仅服药未做松弛训练。结果 :75例中浆患者发病年龄平均 42 3± 12岁。初诊时血压高于正常 2 7例 (36 %) ,82 4 %有明确发病诱因 ,其中职业场所的问题占6 6 6 7%。病程 :一组 31 8± 10 7天 ,二组 48 2± 15 3天 ,(P <0 0 5 )。结论 :支持心理应激因素是中浆的重要病因 ;在治疗时脱离应激环境可缩短病程 ,加快康复。     

心理干预对冠脉综合征患者不良情绪的影响

目的探讨心理干预对冠脉综合征患者焦虑抑郁不良情绪的影响。方法将56例冠脉综合征患者随机分为2组,观察组27例,对照组29例,2组均给予心血管内科常规治疗。观察组在此基础上联合心理干预,观察6周,于心理干预前及干预2周、6周末采用焦虑自评量表、抑郁自评量表评定两组患者的焦虑抑郁状况。结果心理干预前2组患者焦虑自评量表、抑郁自评量表评分均无显著性差异(t=0.704和0.523,P>0.05),干预2周后观察组评分均显著低于对照组(t=2.077和2.081,P<0.05),干预6周末后观察组评分也均显著低于对照组(t=2.244和2.209,P<0.05)。结论心理干预能显著改善冠脉综合症患者治疗过程中的焦虑抑郁不良情绪,有利于提高患者的生活质量。     

Association of presence of Aspergillus antibodies with hemoptysis in patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma

Old tuberculosis and bronchiectasis are the two most important causes of chronic structural changes of lungs in our locality. In the absence of radiologically visible mycetoma, the cause of hemoptysis in these two groups of patients is largely unknown. A 17-month prospective study was carried out to compare the prevalence of Aspergillus fumigatus and Aspergillus flavus antibodies in hemoptysis patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma (cases, n = 38), hemoptysis patients with other diagnosis (control group 1, n = 29), and patients with old tuberculosis or bronchiectasis but no hemoptysis (control group 2, n = 47) by a recently developed sensitive and specific A. fumigatus and A. flavus antibody assay. There were a significantly larger number of patients with antibody against A. fumigatus or A. flavus among the cases than among the patients in control groups 1 and 2 (P < 0.05 in both comparisons). Molds were not recovered from any of the patients. Among the 10 cases with Aspergillus antibody, eight and two had antibody against A. flavus and A. fumigatus, respectively. We conclude that there was an association between the presence of Aspergillus antibodies and hemoptysis in patients with old tuberculosis or bronchiectasis, suggesting that these patients probably had occult infections caused by the corresponding fungi. Development of serological tests against other Aspergillus species as well as other causes of mycetoma will probably increase the detection of occult mold infections in patients with existing parenchymal lung diseases, and treatment of fungal microinvasion may help to alleviate hemoptysis in these patients with bronchiectasis or old tuberculosis who have Aspergillus antibodies.     

Diagnostic Yield of Bronchial Washing Fluid Analysis for Hemoptysis in Patients with Bronchiectasis

Purpose

Bronchiectasis is the main cause of hemoptysis. When patients with bronchiectasis develop hemoptysis, clinicians often perform bronchoscopy and bronchial washing to obtain samples for microbiological and cytological examinations. Bronchial washing fluids were analyzed from patients with bronchiectasis who developed hemoptysis, and the clinical impacts of these analyses were examined.

Materials and Methods

A retrospective observational study of patients who underwent fiberoptic bronchoscopy for hemoptysis in Seoul National University Bundang Hospital, a university affiliated tertiary referral hospital, between January 2006 and December 2010 were reviewed. Among them, patients who had bronchiectasis confirmed by computed tomography and had no definite cause of hemoptysis other than bronchiectasis were reviewed. The demographic characteristics, bronchoscopy findings, microbiological data, pathology results and clinical courses of these patients were retrospectively reviewed.

Results

A total of 130 patients were reviewed. Bacteria, non-tuberculous mycobacteria (NTM), and Mycobacterium tuberculosis were isolated from bronchial washing fluids of 29.5%, 21.3%, and 0.8% patients, respectively. Suspected causal bacteria were isolated only from bronchial washing fluid in 19 patients, but this analysis led to antibiotics change in only one patient. Of the 27 patients in whom NTM were isolated from bronchial washing fluid, none of these patients took anti-NTM medication during the median follow-up period of 505 days. Malignant cells were not identified in none of the patients.

Conclusion

Bronchial washing is a useful method to identify microorganisms when patients with bronchiectasis develop hemoptysis. However, these results only minimally affect clinical decisions.     

灼口综合征患者的心理分析及心理综合疗法研究

目的 应用以森田疗法为核心的心理综合治疗方案治疗灼口综合征，评价其临床效果。方法 对纳入于本院首诊的灼口综合征患者46例施行以森田疗法为核心的心理综合治疗方案，在治疗前及治疗后第2、4、6、8周分别对患者进行精神卫生自评量表（SCL-90）和Hamilton抑郁量表分析。结果 根据SCL-90量表，46例灼口综合征患者可分为强迫症型（7例，占15．2％）、疑病型（7例，占15．2％）、恐惧症型（4例，占8．7％）及混合型（28例，占60．9％）。治疗后SCL-90和HAMD评分较治疗前显著下降，临床治愈率30．4％，显效率47．8％。结论 应用以森田疗法为核心的心理综合治疗方案治疗灼口综合征有较好疗效。     

Etiology of hemoptysis in children: a single institutional series of 40 cases

Purpose

The aim of this study was to determine the causes of hemoptysis in a pediatric age group.

Methods

We conducted a retrospective chart review of all patients who were admitted to Samsung Medical Center between 1996 and 2008 with a chief complaint of hemoptysis. Patients with trauma or underlying bleeding tendency such as leukemia were excluded. Patients were divided into three groups according to age (0 to 5 yr, 6 to 10 yr, and 11 to 18 yr). The amount of hemoptysis was classified as mild (≤20 mL/day), moderate (20-100 mL/day), or massive (>100 mL/day). Causes and duration of hemoptysis, disease course, and mortality were also investigated.

Results

A total of 40 patients (18 males and 22 females) were identified. Their median age was 6.3 yr (range, 10 months to 18 yr). Twenty-five patients manifested mild hemoptysis; moderate and massive hemoptysis were found in nine and six patients, respectively. Respiratory tract infection was the most common cause of hemoptysis. Other causes included congenital heart disease, Heiner syndrome, neoplasm in the airway, vasculitis syndrome, and bronchiectasis. In most patients (87.5%), hemoptysis disappeared during medical treatment that included antibiotics or transfusion. Hemoptysis recurred in 12 patients, and the overall mortality rate was 5%.

Conclusions

The most common cause of hemoptysis in children was respiratory tract infection. Most cases had a benign course, but recurrence and mortality occurred in a minority of patients. An accurate diagnosis of the underlying etiology is essential for treatment.     

159例独生子女厌食治疗分析

目的：探讨由非器质性因素致病的独生子女厌食症的治疗方法：方法（1）单纯中药治疗：补气健胃方剂。（2）单纯心理治疗：直接对家长进行心理辅导和喂养指导。（3）中药合并心理治疗：补气健胃方剂,作用类似于安慰剂;心理治疗采用中药禁忌的方式间接进行。结果（1）单纯中药治疗40例（25．1％）,治愈11例,治愈率27．5％;（2）单纯心理治疗44例（27．7）,治愈14例,治愈率31．8％;（3）中药合并心理治疗75例（47．2％）,治愈率89．3％。治疗方法差异显著,x^2=57.830,P=0.000。讨论：（1）单纯中药治疗采用补气健胃方剂,被治愈患者的饮食结构和喂养方式可能并无不当。对未治愈者,初步推断厌食可能由家长非正常的心理因素引起。（2）单纯心理治疗方案：家长的非正常心理是厌食的根本原因,直接对家长进行心理辅导有一定的效果,干扰因素无法控制导致治愈率低。（3）中药合并心理治疗方案将中药作为安慰剂,心理治疗采用中药禁忌的方式间接进行,疗效显著。     

Which Neurotic Patients Are Offered Which Psychotherapy?

Of the 336 new cases of neurosis referred to a regional psychiatric service 166 (49%) were offered supportive, dynamic or behavioural psychotherapy. The most frequently provided treatment was the first (40%); 34% of patients were offered dynamic psychotherapy and the remainder (26¹%) were allocated to behavioural psychotherapy. The factors related to the type of psychotherapy provided were diagnosis, duration of illness, the psychiatric team to which the patients had been referred, marital status and the distance the patients lived from the hospital. Sex, age, socio-economic status, employment status and a history of alcohol abuse or of deliberate self harm had no association with the type of psychotherapy offered.     

Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior?

OBJECTIVE: This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study. METHODS: A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors). RESULTS: Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness. CONCLUSIONS: The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.     

综合性心理治疗对脑卒中患者心理障碍的干预效应

目的 探讨脑卒中后患者存在的心理障碍,综合性心理治疗对脑卒中后心理障碍的干预效果及其对患者生活质量的影响。方法 采用心理量表对225例卒中患者应用SCL-90、SDS、SAS进行心理评估。将存在,心理障碍的脑卒中患者随机分为实验组及对照组,实验组增加了阶梯式心理治疗。评定与比较两组患者SCL-90、SDS、SAS、SF-36的分值及其临床疗效。结果 70．67％脑卒中患者存在一定程度的心理障碍,以抑郁、焦虑多发。实验组SDS、SAS评分显著低于对照组,其临床疗效及生活质量评分显著高于对照组。结论 脑卒中后患者易出现心理障碍;综合心理治疗能显著改善脑卒中患者的心理障碍,可以提高临床疗效、患者的躯体功能及生活质量。     

应对策略在癌症患者心理干预中的中介作用

目的：探讨在对癌症患者实施心理干预过程中应对策略及其相关因素的中介作用。方法：运用病例对照实验设计，对实验组病人进行了为期3个月的心理干预，选用疾病应对问卷作为主要测查工具，采用多因素综合分析统计方法，对120名住院化疗病人进行了比较分析。结果：干预组病人在干预后较多运用主动认知和主动行为策略，较少运用回避方法，对照组则变化不大；干预后病人情绪状态、功能状况以及生活质量的改善与所采用的应对方法有一定关系：与主动认知应对方法呈正相关，与回避性应对方法呈负相关，与主动行为应对方法则关系不明显。结论：应对策略及其相关因素在癌症患者心理干预中起一定的中介作用。