适当调整基本医疗保险政策降低精神病人住院费用负担

目的了解和反映淮南市现行基本医疗保险制度下，精神病人个人承担住院医疗费用情况，为调整和改进基本医疗保险政策提供依据。方法对2004年度该市住院治疗并已结算出院的参加基本医疗保险的139例精神病人住院医疗费用，采用均数和构成比等描述性统计方法进行分析。结果在现行的基本医疗保险结算方法下．精神病人个人负担的住院医疗费用比例偏高。结论建议基本医疗保险管理部门在制定、调整、改进医疗保险政策时，应充分考虑精神病人这一特困残疾人群体的实际困难，适当降低个人支付费用的比例。从基本医疗保险政策上体现对精神病人的特殊照顾。     

刍议基本医疗保险中精神病患者住院费用的负担

安徽省淮南市第四人民医院是一所二级精神病专科医院 ,承担着本市２００万人口及周边地区精神疾病的防治工作。在基本医疗保险启动一年来 ,该医院治愈出院的参保病人 (以下称参保职工 )共６８例 ,占同期出院病人总数的５．３% ,住院医疗费用为１９．２万元。下面就参保职工住院医疗费用负担情况作统计分析。一、资料来源资料源于该医院收治并已出院的参保职工的基本医疗费用结账单。二、有关指标说明１．参保年度 :这是基本医疗保险启动和结算的起止期间。该市为２０００年１０月１日至２００１年９月３０日。２．基本医疗费用 :指符合基本…     

体位和一日内变动对TC及HDL-C的影响

血清总胆固政（TC）增高是冠状动脉的正危险因子，高密度脂蛋白低下是重要的贸危险因子，脂类的高低直接影响人们的身体健康。一般说，体内TC和HDL－C在一日内变动较小，体内高分子白蛋白同样由于体位变化而循环的血浆调节白蛋白发生变化。笔者为了扫清楚在体位变化后调节白蛋白水平对脂类含量的形叼能否修正，以及一天内脂类的变化能否被修正，对健康自愿者和糖尿病患者进行了脂类的TC、HDL．C和白蛋白测定分析。笔者共检测了6名健康自愿者和30名住院糖尿病患者。自愿者检测前天晚饭后，不再吃任何东西，零点坐位采血，然后安静躺下…     

氯氮平对家兔海马齿状回突触传递及神经递质释放的影响

目的：观察给予氯氮平前后齿状回反应及细胞外多巴胺（DA）和5-羟色胺（5-HT）水平的变化规律。方法：15只成年家兔,将刺激用微电极置于海马穿通纤维处,记录用微电极和收集神经递质的引导插管置于同侧齿状回处,经10d康复后随机分为对照组（C组）、强直刺激组（T组）和无强直刺激组（N组）,每组各5只。整个实验180min,分3阶段（60min/阶段）。全程给予齿状回单极方脉冲电刺激,60min时分别腹腔注射20mg/kg氯氮平溶液（T组和N组）或空白溶剂（C组）,120min时给予强直刺激（C组和T组）。实验中,每隔2min记录一次齿状回反应,每隔5min检测一次齿状回细胞外DA和5-HT的水平。结果：齿状回反应：C组1、2阶段无改变（P〉0.05）,3阶段较1、2阶段增强（P=0.02）,产生长时程增强（LTP）;T组2阶段较1阶段增强（氯氮平增强）（P=0.004）,3阶段较2阶段进一步增强（P=0.02）,产生LTP;N组2阶段较1阶段增强（氯氮平增强）（P=0.004）,3阶段同2阶段（P〉0.05）。细胞外DA和5-HT的水平：C组的DA水平在3个阶段均无改变（P〉0.05）;T组2、3阶段DA水平较1阶段明显升高（P〈0.01）,但3阶段的DA水平却没有因LTP的产生而出现相应的改变;N组2、3阶段DA水平较1阶段明显升高（P〈0.01）;3组在全部实验中的5-HT水平均无改变（P〉0.05）。结论：氯氮平可在齿状回同步产生氯氮平增强和细胞外DA水平的增加。     

佐替平对家兔齿状回兴奋性突触反应和长时程增强的影响

Objective To observe the impact of zotepine on the excitatory synaptic response and long term potentiation (LTP) of dentate gyrus neurons.Methods Male rabbits ( n = 20) weighting about 2.5 ～ 3.5 kg were divided into four groups randomly ( n = 5 ): control, zotepine 1.0, zotepine 2.0 and zotepine 5.0.To each rabbit,there were 60 results during 120 min.Population spike(PS) amplitude and excitory postsynaptic potential (EPSP) slope were used to be the indexes of the excitatory synaptic response of dentate gyrus neurons.The sequence was base response ( at the beginning), intraperitoneal injection of 0.5ml dimethylsulfoxide or 0.5ml zotepine-dimethylsulfoxide solution ( 1.0,2.0,5.0 mg/kg of zotepine dosage) ( after 30 min) and titanic stimulation (after 90 min).Results To 4 groups,the PS amplitude and EPSP slope after single stimuli were not significantly different from those before single stimuli.In control group, the PS amplitude and EPSP slope after titanic stimulation[(0.68 ± 0.052)mV and(0.633 ± 0.024 )mV/ms] were significantly different from those before injection[(0.266 ±0.008) mV and(0.246 ±0.010) mV/ms] (P＜0.05 ～0.01 ) ,and LTP were induced.LTP were not induced after titanic stimulation in group zotepine 1.0,2.0 and 5.0.After titanic stimulation, the PS amplitude and EPSP slope in group zotepine 5.0[(0.277 ±0.008)mV and(0.296 ±0.007) mV/ms] were significantly different from those in group control(P＜ 0.05).Conclusion Zotepine had little effect on the excitatory synaptic response of dentate gyrus neurons after single stimuli in perforant path, while it blocked the induction of LTP in perforant path-dentate gyrus pathway.     

佐替平对家兔齿状回兴奋性突触反应和长时程增强的影响

目的 观察佐替平对家兔齿状回神经元兴奋性突触反应和长时程增强(LTP)的影响作用.方法 20只成年雄性家兔(体质量2.5～3.5 kg),按随机数字表法分为对照组和佐替平1.0组、佐替平2.0组、佐替平5.0组,每组各5只.每只家兔在120分钟里,共有60次记录结果.以群峰电位(PS)幅度和兴奋性突触后电位(EPSP)斜率作为齿状回神经元突触反应的观察指标.各组开始时记录基础反应,30min时分别腹腔注射二甲基亚砜0.5ml和佐替平-二甲基亚砜溶液0.5ml(佐替平的剂量依次为1.0mg/kg、2.0mg/kg、5.0mg/kg),90min时给予强直刺激,并记录相应的反应.结果 4组在单刺激前后的PS幅度和EPSP斜率均无显著性改变;对照组的PS幅度和EPSP斜率在强直刺激后[分别为(0.678±0.052)mV和(0.633±0.024)mV/ms]与注射前[分别为(0.266±0.008)mV和(0.246±0.010)mV/ms]相比有显著性差异(P＜0.05,P＜0.01),产生LTP;强直刺激后,佐替平1.0组、2.0组、5.0组均不产生LTP;佐替平5.0组强直刺激后的PS幅度和EPSP斜率[分别为(0.277±0.008)mV和(0.296±0.007)mV/ms]与对照组的同阶段结果相比有显著性差异(P＜0.05).结论 佐替平对单刺激家兔海马穿通纤维引起的兴奋性突触反应强度无影响作用,却能抑制家兔海马穿通纤维齿状回通路LTP的产生.     

参合精神病患者住院补偿政策之管见

本文对2007年1-12月在精神病专科医院住院治疗并出院的参加新型农村合作医疗的122例精神病患者住院医疗费用进行分析,结果显示,在现行的新型农村合作医疗补偿方法下,精神病患者得到的补偿较低,个人负担的住院医疗费用偏高。由此建议相关部门在制定、调整和改进新型农村合作医疗政策时,应充分考虑精神病患者这一特殊群体的实际困难,从政策上体现对精神病患者的特殊照顾。     

佐替平对家兔齿状回兴奋性突触反应和长时程增强的影响

Objective To observe the impact of zotepine on the excitatory synaptic response and long term potentiation (LTP) of dentate gyrus neurons.Methods Male rabbits ( n = 20) weighting about 2.5 ～ 3.5 kg were divided into four groups randomly ( n = 5 ): control, zotepine 1.0, zotepine 2.0 and zotepine 5.0.To each rabbit,there were 60 results during 120 min.Population spike(PS) amplitude and excitory postsynaptic potential (EPSP) slope were used to be the indexes of the excitatory synaptic response of dentate gyrus neurons.The sequence was base response ( at the beginning), intraperitoneal injection of 0.5ml dimethylsulfoxide or 0.5ml zotepine-dimethylsulfoxide solution ( 1.0,2.0,5.0 mg/kg of zotepine dosage) ( after 30 min) and titanic stimulation (after 90 min).Results To 4 groups,the PS amplitude and EPSP slope after single stimuli were not significantly different from those before single stimuli.In control group, the PS amplitude and EPSP slope after titanic stimulation[(0.68 ± 0.052)mV and(0.633 ± 0.024 )mV/ms] were significantly different from those before injection[(0.266 ±0.008) mV and(0.246 ±0.010) mV/ms] (P＜0.05 ～0.01 ) ,and LTP were induced.LTP were not induced after titanic stimulation in group zotepine 1.0,2.0 and 5.0.After titanic stimulation, the PS amplitude and EPSP slope in group zotepine 5.0[(0.277 ±0.008)mV and(0.296 ±0.007) mV/ms] were significantly different from those in group control(P＜ 0.05).Conclusion Zotepine had little effect on the excitatory synaptic response of dentate gyrus neurons after single stimuli in perforant path, while it blocked the induction of LTP in perforant path-dentate gyrus pathway.     

用指数分析法探讨出院者占用床日数的变动

指数分析法是用来综合说明复杂现象总体在数量上总变动程度及影响因素的一种特殊相对数,是一种常用的统计分析方法,也适用于医院质量管理多种指标的分析.本文试运用指数分析法对我院精神科出院者占用床日数这一统计指标的影响因素进行探讨.