癌症患者焦虑抑郁情绪与性别、文化程度、医疗费支付方式的研究

目的对癌症患者焦虑、抑郁情绪状况的资料进行比较，探讨癌症患者焦虑、抑郁情绪的特点及其相关因素。方法采用Zung＇s自评焦虑量表（SAS）和Zung＇s自评抑郁量表（SDS），对97例癌症患者进行测定，然后，探讨癌症患者焦虑、抑郁情绪与不同性别、文化程度、经济状况的关系。结果本次调查中不同性别、医疗费支付方式与癌症患者焦虑、抑郁发生率之间无显著差异（P〉0.05），不同文化程度与焦虑发生率有显著差异（P〈0.05）与抑郁发生率无显著差异（P〉0.05）。结论癌症患者中焦虑、抑郁情绪发生率较高，不同性别、文化程度、经济状况与癌症患者焦虑、抑郁情绪的发生率有差别。且发生率明显高于一般人群。     

住院精神病患者焦虑抑郁情绪及影响因素评估

目的探讨住院精神病患者焦虑、抑郁情绪的发生率及其主要影响因素。方法采用焦虑自评量表、抑郁自评量表对153例住院精神病患者的焦虑、抑郁情绪进行评估，并应用自制调查表对其产生的原因进行逐步回归分析。结果住院精神病患者焦虑情绪发生率为30．72％，抑郁情绪发生率为45．09％，同时伴有焦虑抑郁情绪的发生率为28．76％。影响住院精神病焦虑情绪的主要因素为住院次数、病程、家庭经济状况；影响抑郁情绪的主要因素为病程、住院次数、病后家庭及单位和社会关心情况。结论住院精神病患者存在不同程度的焦虑、抑郁情绪，应重视产生这些情绪的影响因素，有针对性的进行干预。     

汶川地震伤员焦虑、抑郁情绪的影响因素及心理干预效果

目的探讨汶川地震伤员焦虑、抑郁情绪的影响因素以及心理干预的效果。方法采用SDS抑郁量表、SAS焦虑量表对46名汶川地震伤员的焦虑抑郁情绪进行评估,使用多元逐步回归分析筛选其影响因素,实施相应的心理干预,观察效果。结果46例地震伤员干预前后焦虑症状发生率分别为89．1％、32．6％,抑郁症状发生率为84．8％、30．4％。影响焦虑、抑郁情绪的因素为：个性特点、地震前家庭经济状况、病后家庭成员的关心程度、治疗期望值、担心出院存在残疾。结论制定针对性强的心理干预措施可明显缓解地震伤员焦虑、抑郁情绪,促进社会功能恢复。     

尊严疗法及人生回顾干预对晚期住院癌症患者尊严及心理状况的影响

目的 比较尊严疗法及人生回顾干预对晚期住院癌症患者尊严、心理状况的影响.方法 选取2家三级甲等医院肿瘤科收治的90例晚期住院癌症患者,按照患者就诊时间先后顺序将患者分为尊严疗法干预组、人生回顾干预组及对照组,每组30例.分别予尊严疗法干预、人生回顾干预及常规干预.干预1个月末,分别评价3组的焦虑、抑郁、尊严得分在组间的差异.结果 与对照组相比,尊严疗法及人生回顾组患者焦虑、抑郁、尊严得分差异有统计学意义(P<0.05);与人生回顾组相比,尊严疗法组尊严得分低于人生回顾组,差异具有统计学意义(P<0.05).结论 尊严疗法及人生回顾干预均可缓解住院晚期癌症患者焦虑、抑郁情绪,提高患者尊严水平,尊严疗法较人生回顾干预更能提高患者尊严水平.     

尊严疗法对住院晚期癌症患者生活满意度及心理状况的影响

目的:观察尊严疗法对住院晚期癌症患者生活满意度及心理状况的影响。方法:将122例肿瘤科住院晚期癌症患者随机分为实验组(n=62)和对照组(n=60),对照组接受常规照护,实验组在此基础上接受尊严疗法。采用重复测量方差分析对干预前、干预15天及30天时两组的生活满意度、焦虑、抑郁及尊严水平进行比较。结果:两组的生活满意度、焦虑、抑郁和尊严得分的组间效应具有统计学意义(P0.05);两组的焦虑、抑郁和尊严得分的时间效应具有统计学意义(P0.05);两组的生活满意度、焦虑、抑郁和尊严得分的干预与时间因素存在交互效应(P0.05)。结论:尊严疗法能有效提高住院晚期癌症患者生活满意度及尊严水平,改善其焦虑抑郁情绪。     

136例腹膜透析患者抑郁状况及影响因素分析

目的 了解腹膜透析患者的抑郁状况,并探讨其影响因素.方法 采用描述性研究设计,应用自编的一般资料调查表、抑郁自评量表、健康状况调查问卷、医学应对方式问卷对136例腹膜透析患者进行调查.结果 136例腹膜透析患者的抑郁发生率为31.6%,腹膜透析抑郁组患者的生活质量低于非抑郁组(P<0.01);非抑郁组的面对、应对方式总分高于抑郁组(P<0.01),非抑郁组在回避、屈服方面得分低于抑郁组(P<0.01);抑郁与生活质量各维度及面对应对方式呈负相关(P<0.01),与回避、屈服应对方式呈正相关(P<0.01).多元逐步回归分析显示,家庭人均月收入、躯体角色功能、情绪角色功能、面对、屈服是腹膜透析患者抑郁的主要影响因素(P<0.01或P<0.05).结论 136例腹膜透析患者抑郁发生率为31.6%,家庭经济收入、患者躯体角色功能及情绪角色功能和面对、屈服应对方式是抑郁的主要影响因素,提示护理人员应有针对性地对腹膜透析患者开展心理干预,以改善患者的心理状况.     

消化系统肿瘤患者术前焦虑及其影响因素分析

目的 了解消化系统肿瘤患者术前焦虑情绪并探讨其影响因素.方法 连续收集拟行消化系统肿瘤外科手术的患者451 例,调查患者一般资料,并施测焦虑自评量表、癌症患者生命质量测定量表中文版核心量表、艾森克人格问卷简式量表中国版及特质应对方式问卷.采用多元线性回归法分析焦虑影响因素.结果 本组的焦虑得分(44.33±8.64)分,阳性检出率32.2%;多元线性回归模型中,患者性别、文化程度、主要陪护者、情绪功能、认知功能、躯体功能、失眠、疲倦、应对方式是焦虑的影响因素(P＜0.05),其中积极应对方式是保护因素.结论 消化系统肿瘤患者术前焦虑较高发,其影响因素为性别、文化程度、主要陪护者、情绪功能、认知功能、躯体功能、失眠、疲倦及积极应对方式.     

地市级肿瘤医院癌症相关性抑郁焦虑情绪调查分析

目的通过调查某地市级肿瘤医院癌症患者的抑郁、焦虑情绪发生率,并分析相关影响因素,以期为临床干预提供借鉴。方法各科室由专人对住院患者进行抑郁、焦虑问卷调查,采用SPSS17.0软件包进行数据处理,分析癌症住院患者抑郁、焦虑的发病情况及各因子对癌症相关性抑郁的影响。结果本院癌症住院患者的抑郁、焦虑发病率分别为46.20%和16.60%,暂未发现并发重度抑郁、焦虑患者。癌症相关性抑郁与肿瘤部位、居住地无关(P0.05),经多元线性回归分析得出:性别、年龄、文化程度、经济负担及肿瘤分期为癌症相关性抑郁发生的主要影响因素(P0.05)。结论癌症相关性抑郁发病率较高,对家庭经济负担重、年轻、女性、晚期并转移等癌症患者,应多关注其心理状况,及时发现并早期干预,进一步提高患者生活质量和整体疗效。     

老年癌症晚期病人家庭照护者焦虑和抑郁状况的调查与对策

[目的]了解老年癌症晚期病人家庭照护者焦虑和抑郁状况,从而提出相应的对策。[方法]采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对39例老年癌症晚期病人家庭照护者的焦虑和抑郁情绪进行测评。[结果]老年癌症晚期病人家庭照护者焦虑、抑郁发生率分别为56.41%和48.72%。[结论]老年癌症晚期病人的家庭照护者大多存在焦虑和抑郁情绪,需给予心理支持、护理技术及生活护理服务和指导,以缓解家庭照护者的焦虑、抑郁情绪,提高照护水平。     

2型糖尿病合并肥胖患者焦虑、抑郁横断面调查与分析

目的：了解2型糖尿病合并肥胖患者焦虑、抑郁状况,分析其影响因素。方法：采用自行设计患者一般资料调查表和疾病相关资料调查表、焦虑自评量表（SAS）、抑郁自评量表（SDS）对128例门诊及住院2型糖尿病合并肥胖患者的焦虑、抑郁状况进行横断面调查及分析。结果：2型糖尿病合并肥胖患者焦虑、抑郁的发生率分别为58.6%和56.2%,焦虑、抑郁评分高于国内常模,差异有统计学意义（P<0.01）。多元逐步回归分析显示BMI、是否接受过糖尿病及肥胖健康教育是其焦虑情绪的主要影响因素;BMI、糖尿病并发症情况是其抑郁情绪的主要影响因素。结论：2型糖尿病合并肥胖患者存在焦虑、抑郁心理障碍,其焦虑情绪主要受BMI、是否接受过糖尿病及肥胖健康教育影响;抑郁情绪主要受BMI、糖尿病并发症情况影响。医务人员应着重关注2型糖尿病合并肥胖患者的心理状态,加强糖尿病及肥胖健康教育,尤其是运动和饮食教育,进行积极的心理疏导,减轻其焦虑、抑郁情绪。     

Status of microcirculation and rheological properties of blood in patients with cerebral circulatory disorders

Microcirculation and rheological properties of blood were investigated over time on the basis of the findings of biomicroscopy of the bulbar conjunctiva in 61 patients with different stages of circulatory encephalopathy in the presence of arterial hypertension and atherosclerosis. Rheological properties of blood were changed at all stages of disease. Correlations between the ability of erythrocytes to aggregation and the degree of their intravascular aggregation by the findings of biomicroscopy of the bulbar conjunctiva were not found. The importance of investigation of the intravascular aggregation of erythrocytes and theological properties of blood for assessment of the cerebral vascular microcirculation, control of therapy, and verification of some aspects of the mechanism of action of various drugs was shown.     

The pathology of the foot in the atherosclerotic damage of lower extremities vessels in patients with type 2 diabetes mellitus

The results of examination of 116 patients with atherosclerotic damage of lower extremities arteries caused by type 2 diabetes mellitus are presented. At the base of data of X-Ray examination the character, frequency and localization of damage of osteoarticular apparatus of the feet were been analyzed in disorders of main blood flow in cases with diabetes mellitus. Pathologic changes were recorded in 89.9% of cases with prevalence of isolated or combined hypertrophic processes. Destructive alterations, typical for osteoarticular apparatus of the feet in diabetes mellitus (diabetic osteoarthropathy), were absent. X-Ray signs of deformating osteoarthrosis of foot articulations were revealed in 48.4% of cases with maximal rate of damage of metatarsophalangeal joints. No relationship of osteoarticular apparatus lesions rate and a grade of circulation disorder in atherosclerotic vascular disturbances in type 2 diabetes mellitus was revealed (p > 0.05). The frequency of a set of X-Ray signs of osteoarthrosis--narrowing of joint space, subchondral osteosclerosis is associated with duration of diabetes mellitus more than 10 years. The relationship between frequency of development of atrophic processes (osteoporosis) of osteoarticular apparatus of the feet in cases with main vascular disorders and severity of course of diabetes mellitus (p < 0.01). Statistically confident prevalence of rate of osteoarticular apparatus of the foot was recorded in aggravation of metabolic disturbances.     

The activity of peroxidation of lipids in biologic samples of patients with recurrent diseases of upper respiratory tracts

The parameters of peroxidation of lipids in blood and saliva were analyzed on sampling of 60 patients with recurrent diseases of upper respiratory tracts during period of remission. It is established that the content of primary and secondary products of peroxidation of neutral lipids in blood plasma is lower as compared with healthy persons. The content of end products of peroxidation of neutral lipids and products of oxidation of phospholipids in blood plasma is higher as compared with healthy persons. The characteristics of alterations of intermediates of peroxidation of lipids in various biologic samples depend on the localization of inflammatory process.     

Bringing criteria for external assessment of the quality of biochemical studies within the framework of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, in conformity with requirements of the Order No. 45 of the Ministry of Health of Russia, 2/7/2000

Criteria for external assessment of the quality of evaluation of 23 biochemical parameters of the blood, meeting the standards of accuracy determined by the Order No. 45 of Ministry of Health of Russia of February 7, 2000 for intralaboratory quality control have been estimated. According to the data of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, the percentage of results of analyses of test sera meeting these criteria has been estimated. Introduction of new criteria for external assessment of the quality of biochemical tests into the practice of the Federal System will not notably modify the currently used criteria with regard to the majority of biochemical parameters, except introduction of more stringent criteria for albumin and magnesium and less stringent for creatine kinase.     

三种皮神经营养血管及筋膜蒂逆行岛状瓣的应用及康复

1MATERIALSANDMETHODS1.1Materials14malecaseslivedinourhospitalfromJanuary1999toMay2002,withagerange24-74,average35.8,inwhich3casesofcombiningcutaneousdeficiencywithboneexposureaftertrauma;1casesofcutaneousdeficiencyofinternalankle;1caseofcutaneousdeficiencyoflateralankle2casesofcombiningos-teomyelitisofcalcaneumboneandcutaneousdeficiency,1caseofboneexposureofcalcaneumboneaftertrauma,2casesofdegreeIIIburnofdorsumoffootcombiningwithexposureofdeeptissue,1caseoftuberculosisulcerofwristbacka…     

Classification of microangiopathy in systemic sclerosis

AIM: To classify main types of morphological changes of nailfold capillaries in systemic sclerosis (SSc). MATERIAL AND METHODS: Nailfold videocapillaroscopy (NCS) was performed in 103 patients with SSc (34 patients with dSSc and 69 patients with ISSc) with a median age of 47.9 +/- 13.3 years and mean disease duration of 8.1 +/- 7.1 years. The control group consisted of 35 healthy persons. RESULTS: On the basis of a quantitative estimation of changes the main capillaroscopic patterns of structural changes of capillaries in SSc were distinguished. The first (early) type is characterized by changes mainly of sizes of capillaries and a rather moderate decrease of their amount. In the second (transitive) type simultaneously with change of the sizes of capillaries an appreciable decrease of the amount of capillaries with formation of avascular sites is observed. The third (late) type of changes is characterized by marked reduction of capillaries and plenty of avascular sites in the absence or presence of few dilated capillaries. NCS enables to reveal destruction and new growth of capillaries. The statistical analysis has shown authentic distinctions of NCS parameters between main types of changes and close association of these types with activity of the disease. CONCLUSION: Definition of a type of capillaroscopic changes can serve a reliable and objective criterion of a stage and activity of microangiopathy in SSc which reflects duration of illness as a whole.     

Cytomegaloviral infection in patients with hemoblastoses

AIM: To estimate the incidence of cytomegaloviral (CMV) infection and CMV disease in patients with acute leukemia at different stages of chemotherapy and in patients after transplantation of hemopoietic cells. MATERIAL AND METHODS: The trial was carried out in 33 patients with acute leukemia at different stages of chemotherapy, 20 patients subjected to transplantation of autologic hemopoietic cells and 21 patients who had received transplantation of allogenic hemopoietic cells. To study the dynamics of the CMV infection markers, enzyme immunoassay of the titer of the specific immunoglobulins M and G was made, detection of the viral antigen in immunofluorescence reaction and cultivation with fibroblast cell culture and determination of the cytomegalovirus DNA by polymerase chain reaction (PCR). RESULTS: Before chemotherapy, up to 90% patients with acute leukemia were infected with cytomegalovirus (similar rate of infection was observed in healthy donors of hemopoietic cells). By the time of transplantation all the patients were infected with cytomegalovirus. During chemotherapy of acute leukemia, the primary infection and reactivation of latent infection occurred in 30% patients, whereas CMV disease developed in 18% patients. In case of transplantation of autologic hemopoietic cells the rate of reactivation of CMV infection (15%) was one-half of that value in patients with acute leukemia (30%). Similar trend was observed in case of development of CMV disease (5% and 18%, respectively). In case of transplantation of allogenic hemopoietic cells the incidence of reactivation of CMV infection was three times higher than in case of transplantation of autologic hemopoietic cells (47.6% and 15%, respectively, p = 0.02). The incidence of development of CMV disease in case of transplantation of allogenic hemopoietic cells was also significantly higher than in case of transplantation of autologic hemopoietic cells (28.6% and 5%, respectively, p = 0.05). CONCLUSION: Cytomegalovirus is an infection agent responsible for severe complications of chemotherapy of acute leukemia and transplantation of hemopoietic cells in patients with hemoblastoses. Among hematological patients, the group of the highest risk of development of this complication includes recipients of transplantation of allogenic hemopoietic cells, particularly from seronegative donors.     

The place of ultrasound diagnosis in obstetrics]

A review is presented of the diagnostic applications of the ultrasonic scan technique in obsterics. In the 1st trimester of pregnancy the demonstration of the gestational sac and of an embryo is most important. During the further course of pregnancy the growth of the gestational sac and motions of the fetus can be observed. A disturbance in the development of the pregnancy can be deduced from these parameters. The various types of abortion can be differentiated by means of the scan. In the 2nd trimester the biometry of the fetus is most important. The motion behaviour of the fetus seems to be a good indicator of its well-being. The location of the placenta and the evidence of twins are easily demonstrable. In the 3rd trimester the biometry of the fetus is a good parameter of its maturity. The diagnosis of the fetal position is important for the management of delivery. Apart from these applications of ultrasound in obstetrics, the procedure is of great value in the diagnosis of tumours and the measurement of the true pelvis in pregnancy.     

The alterations in fatty acids content of membranes of erythrocytes and insulin resistance syndrome under primary gout

The content of fatty acids of lipids of membranes of erythrocytes in patients with primary gout depending on presence of insulin resistance syndrome. The alterations of content of fatty acids in patients with gout and insulin resistance syndrome are characterized by increase of content of saturated fatty acids and decrease of unsaturated fatty acids. At that, in the pool of unsaturated fatty acids the content of monounsaturated acids is increased and the content of polyunsaturated acids is decreased. In the pool of polyunsaturated fatty acids the increase of content of gamma-linolenic and digomo-gamma-linolenic acids and significant decrease of arachidonic and docosapentaenic acids are noted. The shifts mentioned above can play a certain role in the formation of insulin resistance syndrome in patients with primary gout.     

Knonchenszintigraphische Darstellung bewegungsgestörter Wirbelsäulensegmente

One of the most important occupations of manual therapists is the treatment of hypomobilities of intervertebral joints. Such hypomobilities of the spine are treated with different kind of manipulations or mobilisations. The pathophysiological basis of hypomobilities is subject of discussion. Objective criteria for the diagnosis of disturbed spinal mobility are missing. They are not detectable in X-ray, computertomography or NMR. The aim of this study was to detect the evidence of a biomechanical alteration of hypomobile intervertebral joints with the help of SPECT (Single Photon Emission Computed Tomography). 13 healthy, outdoor patient of the Orthopaedic University Hospital of Marburg with back pain were examined by the means of manual medicine and demonstrated a hypomobility of a intervertebral joint. In addition the spine of this patients was examined by SPECT (bone scanning). The comparison of the results of physical examination and bone scanning demonstrated that the same localisation of hypomobility was found in 75% of all cases by both methods. In 83% the same site of hypomobility was identified.