疑病症的临床及认知功能特点研究

目的探讨疑病症患者的临床特征及认知功能特点。方法选取2015年1~12月间在浙江大学医学院附属第一医院就诊的疑病症患者(疑病症组)44例和健康对照者(对照组)42例,使用汉密尔顿抑郁量表(Hamilton's depression scale items,HAMD)、汉密尔顿焦虑量表(Hamilton's anxiety scale,HAMA)评定临床症状,使用精神分裂症认知功能成套测验共识版(MATRICS consensus cognitive battery,MCCB)评定疑病症患者的认知功能。结果疑病症组HAMD、HAMA评分显著高于对照组(tHAMD=18.61,P0.01;tHAMA=16.85,P0.01)。在MCCB测试中,疑病症组在注意/警觉性、工作记忆、词语学习、视觉学习、推理和问题解决、社会认知的分数及总体综合分数显著低于对照组(P均0.01)。控制了年龄、性别、受教育年限影响因素以后,疑病症组HAMD评分、HAMA评分与注意/警觉性、工作记忆、词语学习、视觉学习、推理和问题解决、社会认知领域及总体综合分数成负相关(P均0.05)。结论疑病症患者存在抑郁和焦虑情绪且有认知功能损害。     

情绪对焦虑症患者认知功能的影响

目的  探讨情绪对焦虑症患者认知功能的影响。方法  选取2013年1月-2015年5月海南省儋州市农垦那大医院收治的98例首发焦虑症患者为研究对象纳入观察组,并选择98名健康成人作为对照组,以汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）及蒙特利尔认知评估量表（MoCA）分别评估两组的焦虑、抑郁情绪及认知功能,比较两组的基线资料及HAMA、HAMD和MoCA评分,采用Pearson相关分析和多重线性回归分析探讨焦虑症患者发生认知功能损害的影响因素。结果  观察组的HAMA和HAMD评分显著高于对照组（P <0.05）。观察组MoCA的视空间与执行功能、注意力、抽象及定向等方面的评分及总分均显著低于对照组（P <0.05）。Pearson相关分析结果表明观察组患者的MoCA总分与HAMA评分呈负相关（r =-0.217,P =0.032）,与HAMD评分呈负相关（r=-0.228,P =0.024）。多重线性回归分析结果表明年龄、HAMA及HAMD评分进入最后的方程中,3者均与MoCA总分呈负相关（P <0.05）。结论  焦虑症患者的焦虑及抑郁情绪的严重程度与认知功能损害有关,且抑郁情绪可能是其主要因素。

     

重性抑郁障碍和广泛性焦虑障碍患者的色彩偏好及其对两者情绪水平的预测

【目的】探索重性抑郁障碍(MDD)、广泛性焦虑障碍(GAD)患者的色彩偏好及其对两者情绪水平的预测。【方法】对45例MDD患者和28例GAD患者以及41例健康志愿者进行色彩偏好测试,采用汉密尔顿抑郁量表HAMD)及汉密尔顿焦虑量表(HAMA)评估被试的抑郁和焦虑水平。【结果】MDD和GAD组比健康对照组更偏好于黑色,健康对照组比MDD和GAD组更偏好于黄色。在MDD组,黄色偏好顺序与HAMA得分呈负相关;紫色偏好顺序与HAMD得分呈负相关。在GAD组,红色偏好顺序与HAMA得分呈正相关,红色、黄色、白色偏好顺序与HAMD得分正相关。【结论】MDD和GAD患者存在不同的色彩偏好,这些偏好与各组的HAMA及HAMD得分相关联。这些发现或许为医疗环境色彩的合理布局提供参考。     

带状疱疹后遗神经痛患者的心理状态和认知功能的变化

目的探讨带状疱疹后遗神经痛（PHN）患者的心理状态和认知功能的变化。方法对26例PHN患者和31例健康者进行一般资料调查表、简式McGill疼痛问卷、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、彩色连线测验（TMT）、数字广度记忆、画钟测验以及词语流畅性测验,探讨PHN患者心理状态和认知功能的改变。结果PHN患者简式McGill疼痛问卷中疼痛分级指数（PRI）评分、视觉模拟量表（VAS）评分、现有痛觉强度（PPI）评分均明显高于对照组,差异均有统计学意义（均P＜0.01）。PHN患者HAMD总分明显高于对照组（P＜0.01）,HAMA总分也明显高于对照组（P＜0.01）;PHN患者TMT1完成时间较对照组长（P＜0.05）;而两组间在数字广度记忆、画钟测验和词语流畅性测验中均无统计学差异。结论PHN患者存在心理状态及认知功能改变,主要表现在抑郁、焦虑的分值增高,注意功能受损,信息处理速度减慢,而短时记忆、视空间功能、言语流畅性和言语表达功能无明显改变。     

临床护理路径在抑郁症患者健康教育中的效果评价

目的 探讨临床护理路径对住院抑郁症患者健康教育的作用.方法 70例首发抑郁症患者随机分为对照组和试验组,试验组应用临床护理路径实施健康教育;对照组只采用传统的方法进行健康教育（即无时间限制,随机进行教育）.于治疗前及治疗后2,4,10周末用汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）评定临床疗效.结果 治疗后2组HAMD和HAMA的评分均显著降低（P〈0.05）,以试验组疗效显著（P〈0.01）.结论 针对抑郁症患者的心理特点,应用临床护理路径对住院抑郁症患者实施健康教育可以提高健康教育的效果,满足患者的健康需求,对抑郁症的治疗、预防复发、降低自杀风险等具有重要意义.     

放松训练辅助治疗抑郁症疗效观察

目的：探讨放松训练对抑郁症的疗效。方法：将60例住院的抑郁症患者随机分成对照组和治疗组,每组30例患者。对照组给予常规治疗和护理措施,治疗组在对照组的基础上给予放松训练,疗程6周。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评定疗效。结果：治疗结束时治疗组HAMD、HAMA评分明显低于对照组。结论：放松训练对抑郁症有显著疗效。     

黄连温胆汤加减联合经颅磁刺激治疗对广泛性焦虑症伴失眠患者HAMA、HAMD、PSQI评分及血清神经递质的影响

目的：观察黄连温胆汤加减联合经颅磁刺激（TMS）治疗对广泛性焦虑症（GAD）伴失眠患者汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、匹兹堡睡眠质量指数（PSQI）评分及血清神经递质[5-羟色胺（5-HT）、去甲肾上腺素（NE）及γ-氨基丁酸（GABA）]的影响。方法：选取2020年9月-2022年3月上饶市人民医院收治的GAD伴失眠患者64例,以随机数字表法将患者分成联合组与对照组,各32例。对照组给予TMS治疗,联合组在对照组基础上予以黄连温胆汤加减治疗。比较两组临床疗效,治疗前后临床症候评分、HAMA、HAMD、PSQI评分及血清神经递质水平。结果：联合组总有效率为90.63%,显著高于对照组的68.75%(P<0.05);治疗后,联合组心悸失眠、神疲乏力、头晕目眩及少气懒言评分均显著低于对照组（P<0.05）;治疗后,联合组HAMA、HAMD、PSQI评分及血清NE水平均显著低于对照组,5-HT与GABA水平均显著高于对照组（P<0.05）。结论：黄连温胆汤加减联合TMS治疗GAD伴失眠患者的临床效果确切,可有效缓解相关临床症状,同时能有效改善患者...     

广泛性焦虑障碍及其共病抑郁障碍的心率变异性研究

背景　广泛性焦虑障碍（GAD）和抑郁障碍（MDD）均可导致心率变异性（HRV）降低,进而增加其共病心血管疾病的风险。然而,焦虑和抑郁情绪对HRV参数的影响及其潜在机制仍不清楚,也缺少GAD共病MDD对患者HRV影响的相关研究。目的　探讨GAD和MDD对HRV参数的影响,以及GAD共病MDD的HRV特点。方法　选取2015年1月—2016年12月于江西省精神病院住院或门诊治疗的90例患者,其中GAD患者（GAD组）、GAD共病MDD患者（GAD共病MDD组）和MDD患者（MDD组）各30例,另选取2015年1月—2016年12月在江西省精神病院门诊体检的健康体检者50例作为健康对照组。GAD组、GAD共病MDD组和MDD组患者在接受治疗前,健康对照组在入组后1周内由临床医生使用自制的人口学资料表收集人口学资料（年龄、性别、体质指数、收缩压、舒张压、每周运动时间）,并使用汉密尔顿焦虑量表（HAMA-17）和汉密尔顿抑郁量表（HAMD）分别评定焦虑、抑郁情况。GAD组、GAD共病MDD组和MDD组患者在开始治疗后1周内,健康对照组在入组后1周内完成HRV检查并进行分析,包括时域分析〔总的R-R间期标准差（SDNN）,相邻RR间期的均方根（RMSSD）〕和频域分析〔低频功率（LF）、高频功率（HF）〕。HAMA-17评分和HAMD评分与HRV的相关性使用Pearson相关分析。结果　四组年龄、性别、体质指数、收缩压、舒张压、每周运动时间比较,差异均无统计学意义（P>0.05）。GAD组和GAD共病MDD组HAMA-17评分高于MDD组、健康对照组（P<0.05）;GAD共病MDD组和MDD组HAMD评分高于GAD组、健康对照组（P<0.05）。GAD组和GAD共病MDD组LF低于MDD组、健康对照组,GAD共病MDD组LF低于GAD组（P<0.05）;GAD组和GAD共病MDD组HF低于MDD组、健康对照组,GAD共病MDD组HF低于GAD组（P<0.05）。MDD组HF、LF均低于健康对照组（P<0.05）。GAD共病MDD患者LF、HF、LF/HF与HAMA-17、HAMD评分呈负相关（P<0.05）。结论　GAD和MDD均可导致HRV降低,且与焦虑和抑郁的严重程度相关。GAD共病MDD可能导致更低的HRV,需要临床医生关注其发生心血管疾病风险。     

脑卒中后情感障碍和认知功能障碍的调查分析

目的:探讨脑卒中后情感障碍和认知功能障碍的的发生率及相互关系。方法:分别采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和蒙特利尔认知评估量表(MoCA)对120例脑卒中患者(观察组)和60例非脑血管病患者(对照组)的焦虑、抑郁症状的严重程度和认知功能进行评估。结果:观察组患者的情感障碍和认知功能障碍发生率明显高于对照组,差异有统计学意义,均P0.01。观察组患者的HAMA和HAMD评分明显高于对照组,而MoCA评分明显降低,差异有统计学意义,均P0.01。脑卒中患者的MoCA评分与HAMA评分和HAMD评分呈显著负相关,HAMA评分与HAMD评分呈显著正相关,均P0.05。结论:脑卒中患者情感障碍和认知功能障碍的发生率明显增高,且两者存在一定的相关性,应加强对脑卒中患者早期心理和情感障碍的护理干预,提高其认知功能,促进患者早日康复。     

高自杀意念与低自杀意念重性抑郁障碍患者情绪冲突及认知融合差异

目的:探讨高自杀意念抑郁症患者与低自杀意念抑郁症患者的情绪冲突效应及认知融合差异。方法:采用贝克自杀意念量表中文版(Beck scale for suicide ideation-Chinese version,BSI-CV)、17项汉密尔顿抑郁量表(Hamilton depression scale-17,HAMD-...     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.