精神分裂症患者氯氮平使用现况调查

目的:了解精神分裂症患者氯氮平的使用现状。方法:按一定的抽样比例,抽取10个省市46家专科医院或综合医院精神科,于2002年4月22日至24日,采用自制问卷对4779例门诊和住院精神分裂症患者进行氯氮平使用情况调查。结果:39.0%(1863/4779)的患者使用氯氮平治疗,平均剂量为(216±133)mg/d;其中41.2%的患者为联合用药,合并使用抗胆碱能药物者为19.2%。与未使用氯氮平的患者比较,使用氯氮平的患者病程较长、家庭收入较低;男性及住院患者更多使用氯氮平,氯氮平治疗者疗效指数低于非氯氮平治疗者。患者的性别、就诊部门、家庭收入和是否首次住院以及抑郁和攻击症状为是否使用氯氮平治疗的影响因素。结论:精神分裂症患者氯氮平使用率为39.0%,其中41.2%为联合用药。是否使用氯氮平治疗与患者的经济状况和临床特征等因素有关。     

低血糖指数食物饮食教育对2型糖尿病患者血糖的影响

目的观察低血糖指数食物饮食教育对2型糖尿病患者血糖的影响。方法将90例2型糖尿病患者随机分为对照组和观察组各45例。观察组采用低血糖指数食物饮食教育，对照组给予常规饮食教育，两组均随访观察4周。结果干预后对照组与观察组空腹血糖、餐后2h血糖比较，差异有显著性意义（均P〈O．01）。结论低血糖指数食物饮食教育有助于2型糖尿病患者提高饮食依从性和平稳控制血糖。     

孕妇凝血指标的数学模型及指标异常变化警戒值探讨

目的探讨孕妇不同孕期凝血指标变化趋势的数学模型及凝血指标异常变化的警戒值估计,帮助临床医生及预防保健人员及早期发现高危人群,有效预防产科出血和凝血并发症的发生。方法对214例孕妇的孕期凝血指标进行回顾性追索,根据聚类分析的结果,建立方差分析、回归分析及ARIMA时间序列分析模型,比较各检测指标在不同孕期的变化规律。结果所建模型均能够很好的模拟不同孕期凝血指标的变化规律,结果显示:PLT指标值在孕晚期出现明显的下降(P0.05),PT与INR指标值在妊娠中期的下降明显(P0.01),APTT在整个妊娠期均下降(P0.01),FG指标值在妊娠晚期出现上升(P0.01),不同孕期凝血指标的警戒值表达式为:μ±2σ。结论所建模型能够较好的模拟不同孕期凝血指标变化规律,不同孕期凝血指标的正常参考值范围及异常警戒值具有一定的医学应用价值。     

Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations

In studies evaluating the efficacy of clinical interventions, it is of paramount importance that the functional outcome measures are responsive to clinically relevant change. Knowledge thereof is in fact essential for the choice of instrument in clinical trials and for clinical decision-making. This article endeavours to investigate the sensitivity, specificity and clinically significant improvement (responsiveness) of the Danish version of the Oswestry disability index (ODI) in two back pain populations. Two hundred and thirty three patients with low back pain (LBP) and/or leg pain completed a questionnaire booklet at baseline and 8 weeks follow-up. Half of the patients were seen in the primary (PrS) and half in the secondary sectors (SeS) of the Danish Health Care System. The booklet contained the Danish version of the ODI, along with the Roland Morris Questionnaire, the LBP Rating Scale, the SF36 (physical function and bodily pain scales) and a global pain rating. At follow-up, a 7-point transition question (TQ) of patient perceived change and a numeric rating scale relating to the importance of the change were included. Responsiveness was operationalised using three strategies: change scores, standardised response means (SRM) and receiver operating characteristic (ROC) analyses. All methods revealed acceptable responsiveness of the ODI in the two patient populations which was comparable to the external instruments. SRM of the ODI change scores at 2 months follow-up was 1.0 for PrS patients and 0.3 for SeS (raw and percentage). A minimum clinically important change (MCID) from baseline score was established at 9 points (71%) for PrS patients and 8 points (27%) for SeS patients using ROC analyses. This was dependable on the baseline entry score with the MCID increasing with 5 points for every 10 points increase in the baseline score. We conclude that the Danish version of the ODI has comparable responsiveness to other commonly used functional status measures and is appropriate for use in low back pain patients receiving conservative care in both the primary and secondary sector.     

氯胺酮和依托咪酯的BIS50及其对脑电双频指数的影响

目的 分别测定氯胺酮和依托咪酯诱导时半数患者入睡时的脑电双频指数(BIS)即BIS50和半数有效量(ED50)，比较他们对BIS的影响。方法 选择40例无服用精神药物和镇静催眠药、无术前用药的择期手术患者(ASAⅠ～Ⅱ级)，随机分为氯胺酮组(K组，n=20)和依托咪酯组(E组，n=20)，以半数效量序贯法分别进行氯胺酮和依托咪酯诱导的睡眠观察，以对语言指令不应和睫毛反射消失为入睡指标，同时记录BIS的变化。对取得的数据以直线回归的方法和加权均数法分别求得氯胺酮、依托咪酯的BIS50和ED50。结果 氯胺酮和依托咪酯诱导后，BIS明显下降(P=0.000983)，但两者各自BIS下降幅度在入睡与未睡患者之间没有明显差异(P=0.920501和0.956263)。氯胺酮的BIS50和ED50分别是78．81(95％可信区间67．27～97．10)和0.757mg／kg(95％可信区间0.535～1．071mg／kg)，依托咪酯的BIS50和ED50分别是60．00(95％可信区间49．74～76．95)和0.089mg，／kg(95％可信区间0.073～0.107mg／kg)。结论 氯胺酮和依托咪酯皆显著降低BIS，但仅凭BIS难以准确预计是否进入睡眠状态。     

Cerebral perfusion during human liver transplantation

Summary. During transplantation of the liver cerebral perfusion was monitored by transcranial Doppler determined middle cerebral artery mean flow velocity (V_mean) and pulsatility index (PI) in six fulminant hepatic failure patients and 11 patients with chronic liver disease. In both groups of patients V_mean, PI and central haemodynamic variables were recorded during (1) the last preanhepatic hour; (2) the anhepatic phase; (3) the first 15 min of reperfusion; and (4) for the following 45 min of reperfusion. No significant differences were detected between the two groups of patients with respect to changes of variables with time. The V_mean (40±13 cm s^-1 [mean±SD]), thoracic electrical impedance (TI) (30±7 Ohm), heart rate (97±19 beats min^-1), mean arterial pressure (84±9 mmHg) and arterial carbon dioxide tension (PaCO₂, 4.5±0.4 kPa) remained stable in the anhepatic phase, while cardiac output (CO, 7.6±2.7 to 5.4±1.41 min^-1), stroke volume (SV, 79±26 to 56±15 ml) and PI (1.2±0.3 to 0.9±0.2) decreased (P<0.05). During reperfusion, CO (9.9±4.01 min^-1), SV (105±40 ml), Pa_CO2 (5.5±0.6 kPa), Vmean (57±17 cm s^-1) and PI (1.2±0.2) became elevated. Taken together, during the anhepatic phase of the liver transplantation a maintained central blood volume as indicated by the constant TI served for a stable blood pressure and in turn cerebral perfusion, whereas revascularization of the graft increased cerebral perfusion concomitant with an elevated carbon dioxide tension.     

Thymidine labeling index in breast tumors

The relationship between primary tumor proliferative activity and clinical and pathologic characteristics was analyzed in relation to menopausal status in 32 patients with malignant or benign breast disease. The thymidine labeling index (TLI) showed significantly higher median values in the cancer patients (3.48 per cent) than in the patients with benign diseases (1.02 per cent). TLI was not significantly affected by delayed incubation at room temperature for about 1 hour. In the breast cancer patients, TLI did not significantly correlate to tumor size, the presence of axillary lymph node metastasis or pathologic nuclear grading. The only significant difference was limited to the breast cancer patients without axillary lymph node metastasis in relation to menopausal status; the TLI in the premenopausal patients (5.10 per cent) was significantly higher (p<0.05) than that in the postmenopausal patients (2.28 per cent). These data thus suggest that among premenopausal patients without axillary lymph node metastasis, those with a high TLI could be potential candidates for adjuvant chemotherapy.     

浙江医科大学附二院门诊处方中精神药物使用调查

本文对浙江医科大学附属二院１９９３年７月间３１３７８张合格处方进行统计分析，并用限定日剂量（ＤＤＤ）和药物使用指数（ＤＵＩ）为指标，分析镇静催眠药物使用情况。结果表明苯二氮　类药方２０６７张，占总处方量的６．５９％，巴比妥类药方４９张，占０．１６％，麻醉药方１１１张；占０．３５％。苯二氮　类药方中．女性处方量１２０２张，男性处方量８６５张，男、女组间比较有显著性差异。苯二氮　类药方多分布在神经内科，常用的药有舒乐安定和阿普唑仑。九种常用的苯二氮　类药和麻醉性镇痛药的ＤＵＩ均小于１。提示药物滥用现象少见，该院对这类药物的管理比较严格。麻醉性镇痛药中二氢埃托啡处方占６７．５７％。     

塑料镜片材料的发展动向

概述光学塑料的基本材料，讨论塑料镜片材料的主要品种及其应用，并着重分析影响塑料镜片材料性能的主要因素及其发展趋势。