预见性护理在降低ICU非计划拔管中的效果观察

非计划拔管（unplanned extubation，UEX）是指为病人治疗需要留置在病人体内的各种导管无意被拔除。Christie等根据始动者的不同将UEX分为自主拔管和事故拔管。而气管插管的非计划拔管是重症监护病房（ICU）机械通气病人较为常见的严重并发症之一，占所有气管插管病人的5．4％～15．5％，     

盐酸舍曲林治疗冠心病患者伴焦虑抑郁状态的疗效

目的 探讨盐酸舍曲林对冠心病患者焦虑、抑郁状态的影响.方法对179例冠心病伴焦虑、抑郁患者随机分为对照组87例和治疗组92例,给予冠心病常规治疗和心理治疗,治疗组同时给予盐酸舍曲林口服,25 mg起服,qd,早餐后服药,第3天加量至50 mg.疗程为8周.分别在治疗2周和治疗8周进行患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、症状自评量表(SCL-90)评分和冠心病临床症状(心电图ST段改变级胸痛等)缓解情况比较.结果治疗8周后,盐酸舍曲林治疗组临床症状好转率(96.7%)较对照组(86.2%)高(P<0.05).治疗2周后和8周后治疗组和对照组SAS、SDS评分均较首次评定显著下降 (P<0.01);且治疗8周盐酸舍曲林治疗组较对照组SAS、SDS评分下降更为明显(P<0.05).SCL-90量表显示患者躯体化、抑郁和焦虑状态在治疗2周和8周均较入院时症状改善明显.结论盐酸舍曲林能明显改善冠心病患者焦虑、抑郁症状,并明显缓解冠心病患者急性期临床症状.     

城市儿童急性血吸虫病57例报告

城市儿童急性血吸虫病５７例报告钟锡娥，龚连春，熊荣红（湖南省寄生虫病防治研究所附属医院４１４０００）我院１９８７～１９９１年共收治急性血吸虫病２０７例，其中城市儿童５７例，占２７．５％，感染方式主要随父母游泳，戏水，少数为捕鱼捞虾。现将资料报告如下。...     

进展性脑梗死患者血清C反应蛋白和D-二聚体的动态改变

目的探讨动态观察血C反应蛋白(CRP)、纤维蛋白原(FIB)和D-二聚体的变化对进展性脑梗死的早期识别和及时处理的意义。方法选择73例颈内动脉系统进展性脑梗死患者为进展组,184例非进展性脑梗死患者为非进展组,分别检测患者入院次日(第1天)、第3天、第7天和第14天血CRP、FIB和D-二聚体含量动态改变,颈部血管超声检查及神经功能缺损评分(NIHSS)。结果进展组患者入院时颈动脉狭窄的比例高于非进展组(43.8%vs 30.9%,P<0.01);非进展组CRP在第3天、第7天和第14天下降,进展组CRP在第3天明显增加、随后在第7天和第14天下降,但明显高于非进展组(P<0.01)。FIB和D-二聚体的含量在进展组明显增加,高于非进展组(P<0.01或P<0.05)。进展组患者NIHSS评分在入院后进行性增高,而非进展组患者NIHSS评分呈下降趋势,两组比较差异有统计学意义(P<0.01)。结论动态观察FIB和D-二聚体的变化可能有助于进展性脑梗死的早期识别和及时处理。     

痴呆患者家庭照料者心理应激，家庭功能与社会支持的研究

背景与目的：随着人口的老龄化,痴呆的发病率在逐年增加。中国作为一个人口大国,痴呆患者增长的比例也引起政府相关部门的广泛关注,针对痴呆的诊断、治疗和预防开展了大量的研究工作。尽管如此,目前痴呆没有特效药,只有对症治疗,虽在一定程度上减少或延缓疾病的进展,但这些药物价格昂贵;在中国,痴呆尚未被列入重症医保的范畴,国内没有专门的医疗机构可以长期收治痴呆患者;对痴呆患者的照料不可避免的落在患者的家庭身上,给患者家属带来沉重的经济负担和心理压力。目前有关国内痴呆家庭照料者的心理健康和社会支持的研究报道较少。因此,本研究通过研究国内痴呆家庭照料者的心理状态和社会支持的改变,希望政府相关部门采取措施,在诊治痴呆患者的同时,关注痴呆家庭照料者的心理健康。 材料与方法：试验组（家庭照料者组）选取58例痴呆家庭照料者,心理应激测试采用症状自评量表（The Symptom Checklist 90,SCL-90）,家庭功能测试采用家庭功能量表评分（The Family Assessment Device,FAD）,社会支持测试采用社会支持量表（Multi-dimensional Scale of Perceived Social Support,MSPSS）。同时,选取58例年龄、性别相匹配的正常志愿者为对照组。组间差别的显著性采用t检验,社会支持与家庭功能间的相关性采用Pearson相关分析。 结果：试验组SCL-90评分中除恐怖因子分外,其他因子分均显著高于对照组(P<0.05)。试验组FAD评分中除情感卷入维度外,其他维度评分均在不健康家庭功能的范围之内;对照组除行为控制维度外,其他维度评分及总体功能评分均在正常家庭功能范围内。试验组FAD总体功能评分及问题解决、交流、角色、情感反应、行为控制维度评分和MSPSS总分均显著高于对照组(P〈0.01)。试验组MSPSS与FAD的问题解决、交流、角色、情感反应、行为控制和总体功能呈显著正相关(P〈0.05 或 0.01)。 结论：痴呆对家庭照料者的心理健康有负性影响,痴呆家庭照料者体验到家庭功能有缺陷和社会支持程度较低。因此,在治疗痴呆患者的同时,有必要动员政府、相关医疗机构和各种社会团体对痴呆家庭照料者积极地开展有针对性的心理干预,同时给予良好的社会支持;既有助于缓解压力,改善心理健康状况,又有助于帮助患者及其家属恢复家庭功能。     

Psychological Distress,Social Support and Medication Adherence in Patients with Ischemic Stroke in the Mainland of China

Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction(stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers(control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90(SCL-90), the social support by the Social Support Rating Scale(SSRS), and medication adherence by Morisky’s self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group(P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions(including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group(P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group(P<0.05, or P<0.01). Those in the “SCL-90 total scores >150 group” were significantly higher than in the “SCL-90 total scores <100 group” and the “SCL-90 total scores between 100 to 150 group”(P<0.05, or P<0.01). Those in the “SCL-90 total scores between 100 to 150 group” were significantly higher than in the “SCL-90 total scores <100 group”(P<0.05). In 90 patients with ischemic stroke, 26(28.89%) patients obtained high medication adherence, 47(52.22%) patients medium medication adherence, and 17(18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17(50.00%) patients with high medication adherence in the “SCL-90 total scores >150 group”, 28(75.67%) patients with medium medication adherence in the “SCL-90 total scores between 100 to 150 group”, and 12(61.16%) patients with low medication adherence in the “SCL-90 total scores <100 group”, respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients(P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.     

案例教学法在硕士研究生临床神经病学教学中的应用

针对目前多数入学研究生有理论知识,但临床实践不足的状况,我院神经精神病学教研室对神经病学硕士研究生的临床神经病学课程采取案例教学法。经过两年来应用取得了较好的教学效果,这说明案例教学法是培养实用型医学人才的有效方法。本文就案例教学法在硕士研究生临床神经病学教学中应用的必要性、可行性、现实意义以及存在的问题进行探讨。     

《神经病学》教学改革初探

我院神经病学教研室根据自己多年的教学经验,在遵循现代临床发展需求是教学改革源泉的原则基础上,结合本校的实际,针对神经病学传统教学方法存在的问题进行了改革探索,取得了较好的教学效果。     

预见性护理在降低ICU非计划拔管中的效果观察

非计划拔管(unplanned extubation,UEX)是指为病人治疗需要留置在病人体内的各种导管无意被拔除.Christie等[1]根据始动者的不同将UEX分为自主拔管和事故拔管.