社区空巢老人述情障碍现状及其影响因素分析

目的了解社区空巢老人述情障碍现状并分析其影响因素。方法2018年10月至2019年5月,便利抽样法选取重庆市主城区6个社区的425名空巢老人为研究对象,采用一般资料调查表、多伦多述情障碍量表、阿森斯失眠量表、日常生活活动能力量表(activities of daily living scale,ADLs)及社会支持评定量表对其进行调查。结果社区空巢老人述情障碍的发生率为19.8%,总分为(50.52土8.63)分,各维度得分从高到低依次为外向性思维、情感表达障碍和情感识别障碍。述情障碍得分与ADLs及其各维度得分呈正相关(均P<0.05),与社会支持及其各维度得分呈负相关(均P<0.05)。多元线性回归分析发现,文化程度、婚姻状况、体育锻炼、睡眠质量、日常生活活动能力及主观社会支持是社区空巢老人述情障碍的重要影响因素(均P<0.05)。结论社区空巢老人述情障碍发生率较高,医护人员可从多种影响因素着手,制定切实可行的干预措施,以改善空巢老人的述情障碍。     

Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumors: Analysis of surgical aspects based on histological types

BACKGROUND: The aim of this study was to evaluate whether hormonal functions of the tumor influence the operative results of laparoscopic adrenalectomy, and to analyse the clinical outcomes in patients with various hormonally active adrenal tumors. METHODS: Clinical and pathological records of 68 patients were reviewed. The average age of patients was 40 years (range 20-75); 39 were women and 29 men. For the comparison, patients were divided into the non-functioning tumor group (n = 22) and the functioning tumor group (n = 46). RESULTS: All laparoscopic adrenalectomies were finished successfully, and no open surgery was necessary. The median operative time and blood loss in the two groups were similar; however, in subgroup analysis, operative time for pheochromocytoma was significantly longer than that for non-functioning tumor (P = 0.044). No difference was noted in intra- and postoperative data between the groups. Of the 22 patients with aldosteronoma, 18 (81.8%) became normotensive and no longer required postoperative blood pressure medications. Adrenalectomy led to an overall reduction in the median number of antihypertensive medications (P < 0.001). All patients with Cushing adenoma had resolution or improvement of the signs and symptoms during follow-up periods. There was no evidence of biochemical or clinical recurrence in any patient with pheochromocytoma. CONCLUSION: The results of this retrospective review document that laparoscopic adrenalectomy is a safe and effective treatment for functioning as well as non-functioning adrenal tumors, although endocrinologic features may play a significant role.     

剖胸术后经鼻导管气管吸痰方法的探讨

目的 探讨剖胸术后无效咳痰病人的有效吸痰方法.方法 对34例剖胸术后未建立人工气道而清理呼吸道无效的病人,使用手法触诊肺部痰鸣音明确主支气管存在无法咳出的痰,采用自身对照的方法对经鼻插入吸痰管15 cm后在病人吸气时将吸痰管迅速插入支气管吸痰,与常规经鼻吸痰的方法进行比较.结果 试验组气管吸痰成功率为86.08%,吸痰有效,痰量多,吸痰后肺部触诊痰鸣音明显消失,常规组支气管吸痰成功率为48.92%,吸痰量少.2组比较有统计学意义(P＜0.01).结论 剖胸术后病人吸气时掌握好吸痰的时机和吸痰的深度可以提高气管吸痰的成功率.     

Effects of tocolytic treatment with ritodrine on cardiovascular autonomic regulation.

OBJECTIVE: To study the acute effects of tocolytic treatment with intravenous ritodrine on cardiovascular autonomic regulation. DESIGN: Validated methods to assess cardiovascular autonomic nervous function-heart rate and blood pressure variability and vagal cardiac baroreflex sensitivity-were measured before and during ritodrine infusion. SETTING: Turku University Central Hospital, Turku, Finland. SAMPLE: Twelve pregnant women admitted to hospital for threatened preterm labour. METHODS: Electrocardiogram and continuous noninvasive finger blood pressure signals were recorded in each woman, resting in a supine position. Autoregressive spectrum analysis was used to quantify short term heart rate and blood pressure variability. Vagal cardiac baroreflex sensitivity was measured as the bradycardia response to an intravenous bolus injection of phenylephrine. MAIN OUTCOME MEASURES: Vagal cardiac baroreflex sensitivity and spectrum analysis indices of short term heart rate and blood pressure variability. RESULTS: Ritodrine significantly decreased vagal cardiac baroreflex sensitivity as well as total (0.00-0.40 Hz), low frequency (0.04-0.15 Hz) and high frequency (0.15-0.40 Hz) power bands of the heart rate variability spectrum. Ritodrine significantly increased mean heart rate and the low frequency power band of the systolic blood pressure variability spectrum. CONCLUSIONS: In pregnant women with threatened preterm labour intravenous administration of ritodrine decreases vagal cardiac baroreflex sensitivity and vagal modulation of heart rate, and increases sympathetically mediated blood pressure variability. Decreased baroreflex sensitivity and heart rate variability are known to be associated with a poor prognosis in some patient groups, so the effects of ritodrine tocolysis may be unfavourable in women with impaired circulatory homeostasis.     

Iodixanol,a new non-ionic,dimeric contrast medium in cardioangiography: a double-masked,parallel comparison with iopromide

Iodixanol (320 mg I/ml) was compared with iopromide (370 mg I/ml) in a double-masked, parallel group, randomised trial of 120 patients undergoing cardioangiography in order to evaluate and compare safety, tolerability and radiographic efficacy. The overall diagnostic information and radiographic density were mainly optimal and no differences between the contrast media were detected. No serious adverse events were reported in either group, and there were no clinically relevant changes in blood chemistry. A statistically significant difference was found between the groups regarding discomfort during injection of contrast medium, the intensity of warmth being less for iodixanol (P = 0.003). Blood pressures and heart rate remained practically unchaged during coronary arteriography in both groups. During left ventriculography, the peak systolic pressure decreased after injection of iopromide (mean change ±SD: – 7.9 ± 11.1 mm Hg, P < 0.001), while there was no significant change after injection of iodixanol (mean change± SD: 0.9 ± 8.3 mm Hg). The results indicate that both contrast agents are effective, safe and well tolerated in cardioangiography, but administration of iodixanol results in a less intense sensation of warmth and a slightly better haemodynamic profile than does administration of iopromide. Correspondence to: H. Manninen     

The dose–response effects of terbutaline on the variability, approximate entropy and fractal dimension of heart rate and blood pressure

Aims To study the dose-response effects of intravenous terbutaline on the cardiovascular and respiratory autonomic nervous regulation.
Methods The study followed a randomized, placebo-controlled crossover design in six healthy adult volunteers. The terbutaline dose ranged from 10 to 30  μg  min⁻¹. We continuously measured electrocardiogram, finger systolic arterial pressure (SAP) and flow-volume spirometry in supine and upright positions at baseline and during 3  h drug infusion. The periodic variability components of R-R intervals (time between successive heart beats) and SAP in relation to respiration were assessed using spectral analysis techniques. The regularity of the time series was assessed by approximate entropy (ApEn) and the convolutedness by fractal dimension (FD).
Results Terbutaline dose-dependently decreased total variability of R-R intervals, low frequency (LF) variability of R-R intervals (10  s waves), high frequency (HF) variability of R-R intervals (respiratory variability), total variability of SAP, HF variability of SAP, baroreflex sensitivity, plasma potassium concentration, approximate entropy of R-R interval and of SAP as well as fractal dimension of R-R interval. Terbutaline dose-dependently increased heart rate, LF/HF ratios of R-R intervals and of SAP, LF variability of SAP, minute ventilation and plasma terbutaline concentration.
Conclusions Terbutaline infusion decreases parasympathetic cardiovascular reactivity, baroreflex sensitivity, dimensionality of heart rate and plasma potassium concentration; it increases sympathetic dominance in cardiovascular autonomic balance, minute ventilation, and the regularity of heart rate and blood pressure time series.     

聚醚类离子载体添加剂对绵羊和荷斯坦杂种牛增重的影响

选择体重相近的80只当年生羯羊,随机分为对照组和试验组,每组40只;选择年龄1.5-2岁,体重相近的20头荷斯坦杂种公牛,随机分为对照组和试验组,每组10头。在饲养管理一致的条件下,试验组羊、牛精饲料中按0.5%添加量分别添加聚醚类离子载体添加剂,育肥期均为50d。试验结束时,试验组绵羊平均日增重235.8±61.55g/只·d,比对照组的168.2±45.23g/只·d提高40.2%,差异极显著(P<0.01),获利增加27.02元/只;试验组肉牛平均日增重1.82±0.25kg/头·d,比对照组的1.63±0.21kg/头·d提高11.66%,差异显著(P<0.05),获利增加63.0元/头。     

系统性红斑狼疮并发贫血的类型分析

目的 分析系统性红斑狼疮（SLE）并发贫血的类型,并探讨其易于发生的危险因素.方法 根据贫血相关实验室指标和骨髓检查结果对239例SLE患者中并发贫血患者的贫血类型进行分析,并与无贫血的SLE患者的临床和实验室资料进行对比分析.结果 239例SLE患者中有127例（53.1%）发生贫血,对127例中89例资料完整患者的贫血类型分析结果显示,慢性疾病性贫血（ACD）有35例（39.3%）,缺铁性贫血（IDA）有32例（36.0%）,自身免疫性溶血性贫血（AIHA）有21例（23.6%）,其他类型贫血9例（10.1%）.同时有上述2种或2种以上类型贫血者7例（7.9%）.贫血程度以AIHA最为严重,其次为IDA,ACD则多为轻度贫血.AIHA和ACD以正细胞正色素性贫血为主,分别占90.5%和85.7%,而IDA则以小细胞低色素贫血为主,占87.5%.与34例无贫血的SLE患者对照,并发AIHA的患者关节炎、浆膜炎的发生率更高（P均〈0.05）,肾脏损害程度更重（P〈0.05）,补体C3水平明显降低（P〈0.05）,SLE病情活动指数（DAI）积分较无贫血组明显增高（P〈0.05）,而ACD和IDA患者合并白细胞减少者明显多于无贫血组患者（P〈0.05）,合并血小板减少和ANA滴度在AIHA、ACD和IDA患者均显著高于无贫血的SLE患者（P均〈0.05）.结论 SLE并发的贫血以ACD和IDA常见,其次为AIHA,且多见于活动性病情严重的患者.在不同类型的贫血患者并发白细胞和血小板减少者均高于无贫血患者,提示SLE中不同血细胞损害可能存在部分共同病理机制.