术后化疗期乳腺癌患者心理痛苦及其心理僵化相关影响因素研究

目的明确术后化疗期乳腺癌患者心理痛苦现状及其心理僵化相关影响因素。方法采用心理痛苦温度计、认知融合问卷、接纳与行动问卷、正念注意觉知量表对204例术后化疗期乳腺癌患者进行调查。结果患者心理痛苦(4.80±1.04)分,阳性检出率97.1%。多元线性回归分析显示,经验性回避、认知融合、婚姻状况对患者的心理痛苦水平有影响(P0.05,P0.01)。结论术后化疗期的乳腺癌患者心理痛苦水平较高,经验性回避、认知融合、婚姻状况是术后化疗期乳腺癌患者心理痛苦的独立影响因素。帮助患者降低经验性回避和认知融合水平,有利于缓解其心理痛苦。     

肺癌化疗患者希望水平与自尊及领悟社会支持的相关性研究

目的探讨肺癌化疗患者希望水平及其与自尊、领悟社会支持的相关性,为临床护理干预提供理论依据。方法采用Herth希望量表、自尊量表和领悟社会支持量表对92例住院肺癌化疗患者进行问卷调查。结果肺癌化疗患者希望水平得分为(32.57±4.72)分,处于中等水平;自尊得分(29.49±3.26)分、领悟社会支持得分(55.76±8.34)分;肺癌化疗患者希望水平总分与自尊呈正相关(r=0.314,P<0.01),与领悟家庭内支持(r=0.293,P<0.01)、领悟家庭外支持(r=0.213,P<0.05)呈正相关。结论医务人员对患者希望进行干预时应将希望水平、自尊、领悟社会支持三者有机结合,重视自尊和领悟社会支持对希望水平的影响,增强患者的心理适应能力。     

口腔颌面部恶性肿瘤患者术后术区感染危险因素分析

目的:分析口腔颌面部恶性肿瘤患者术后术区感染的危险因素。方法:收集2005年1月-2014年12月在笔者科室进行口腔颌面部恶性肿瘤手术患者的临床资料,分析发生术后术区感染的可能因素,采用SPSS18.0进行数据统计。计量资料统计分析采用均数±标准差,计数资料采χ~2检验。结果:218例口腔颌面部恶性肿瘤患者,发生术后术区感染者24例(11.0%)。分析结果显示,术前白蛋白值、口腔卫生、术后置管时间、住院时间、手术时间、术中出血量、围手术期用药及手术方式是口腔颌面部恶性肿瘤患者发生术后术区感染的危险因素。结论:术前加强患者营养以改善患者术前白蛋白值,尽可能缩短手术时间,改善手术方式,减少术中出血,加强术后护理,减少患者术后住院时间,合理使用抗菌药物是降低口腔颌面部恶性肿瘤患者术后创口感染的重要措施。     

121例整形美容受术者心理状态初步分析

目的探讨整形美容手术对受术者心理状态的影响。方法采用焦虑自评量表、抑郁自评量表、自尊量表、体像障碍自评量表及艾森克人格问卷的方法,对121例受术者进行问卷调查,并进行结果分析。结果在121例整形美容受术者中,术前焦虑、抑郁状态者分别为57%和27%。受术者术后自尊量表分值较术前上升2.631(P<0.01),体像障碍及精神质量表、神经质量表和掩饰程度分值分别下降6.131(P<0.01)、1.966(P<0.05)、3.458(P<0.01)和2.829(P<0.01)。术前受术者体像障碍与抑郁状态相关性r=0.193(P<0.05),回归方程为y=0.125x+30.278。结论受术者的自尊和体像障碍状态在整形美容手术术后有明显的改善。     

基于应激系统理论的护理干预在口腔颌面部大面积损伤患者中的应用效果观察

目的：探讨基于应激系统理论的护理干预在口腔颌面部大面积损伤患者中的应用效果。方法：选取2019年1月-2021年10月在笔者医院口腔科收治的80例口腔颌面部损伤患者作为研究对象，采用1:1简单随机数表法将入组患者分为观察组和对照组，每组40例。两组患者均在急诊科抢救室进行口腔颌面部修复重建，并于修复完成后进急诊观察室观察病情。对照组予以急诊科常规护理，观察组行基于应激系统理论的护理干预，持续护理直至患者病情稳定后离开急诊。护理后比较两组疼痛水平、睡眠、心理状态、术后并发症、满意度评价情况。结果：术后第6 h、术后第3天疼痛视觉模拟评分(Visualanalogscoring,VAS)先升高后下降，且观察组均低于对照组（P<0.05）。术后第3天，两组患者匹茨堡睡眠质量(Pittsburgsleepqualityindex,PSQI)评分均明显降低，且观察组低于对照组（P<0.05），两组患者心理韧性评分(Chinese version of resilience scale,CD-RISC)均明显升高，且观察组高于对照组（P<0.05）。观察组术后病房环境、技术操作、...     

心理资本在乳腺癌患者知觉压力与癌症复发恐惧间的中介效应

目的 了解乳腺癌患者心理资本、知觉压力及癌症复发恐惧现状,探讨心理资本在乳腺癌患者知觉压力及癌症复发恐惧间的作用机制,为促进乳腺癌患者心理健康提供参考.方法 采用一般情况调查表、积极心理资本问卷、中文版知觉压力量表及恐惧疾病进展简化量表,对271例乳腺癌患者进行问卷调查.结果 乳腺癌患者心理资本总分(110.40±19.48)分,知觉压力总分(42.49士8.22)分,癌症复发恐惧总分(30.72±8.30)分.知觉压力、癌症复发恐惧与心理资本呈负相关,知觉压力与癌症复发恐惧呈正相关(均P＜0.01);心理资本在知觉压力与癌症复发恐惧间的中介效应为0.101,占总效应的15.51％.结论 乳腺癌患者的知觉压力较高,心理资本、癌症复发恐惧均处于中等水平,知觉压力可通过心理资本影响乳腺癌患者癌症复发恐惧.医护人员应对乳腺癌患者的心理资本进行评估,以采取干预措施减轻其心理压力,进而降低其癌症复发恐惧.     

恶性肿瘤患者术后化疗期创伤后成长状况调查

目的了解恶性肿瘤患者术后化疗期创伤后成长状况,为恶性肿瘤患者术后的心理干预提供依据。方法对230例恶性肿瘤术后化疗期患者进行一般情况和创伤后成长状况调查,并进行统计分析。结果恶性肿瘤术后化疗期患者创伤后成长总均分为67.33±14.17,欣赏生活维度条目均分最高,其次是精神改变、人际关系、个人增强,新的可能性均分最低。不同性别、年龄、婚姻状况、居住状况、月收入、病情、病程等患者的创伤后成长评分比较,差异有统计学意义(P<0.05,P<0.01)。结论恶性肿瘤术后化疗期患者呈中等程度的创伤后成长水平,性别、年龄、社会支持、病情等为其影响因素。肿瘤患者的护理过程中,要看到患者心理的积极改变,并针对患者的不同,护理措施有所区别。     

恶性肿瘤患者应对方式及其影响因素与身心症状关系的研究

目的探讨恶性肿瘤患者的应对方式及其影响因素与身心症状的关系。方法采用医学应对方式调查表(MC-MQ)、症状自评量表(SCL-90)和艾森克人格问卷(EPQ)对180例住院恶性肿瘤患者进行问卷调查评定。结果恶性肿瘤患者面对、屈服、回避3种应对方式的评分分别为(14.62±1.89、12.50±3.25、15.86±2.15)分;面对应对方式中,不同性别、文化程度、病程、经济状况差异有显著性意义(P<0.05,P<0.01),回避应对方式中,仅不同病程患者差异有显著性意义(P<0.01);屈服应对方式与EPQ中情绪稳定性维度呈显著正相关(P<0.01),与掩饰呈显著负相关(P<0.05);多元逐步回归分析示,病程、文化程度、经济状况为面对应对方式的主要影响因素(均P<0.01),情绪稳定性、文化程度为屈服应对方式的主要影响因素(均P<0.01),病程为回避应对方式的主要影响因素(P<0.01);3种应对方式的SCL-90总分及10个因子评分显著高于常模(P<0.05,P<0.01);对其身心症状相关分析示,面对和回避应对方式与SCL-90因子多呈负相关(P<0.05,P<0.01),屈服应对方式与SCL-90各项因子则多呈正相关(P<0.05,P<0.01)。结论恶性肿瘤患者的应对方式与其身心症状密切相关,在对恶性肿瘤患者进行生物学治疗的同时,应注重对患者进行心理干预。     

胃癌术后化疗期患者心理痛苦度及其影响因素的纵向研究

目的调查胃癌患者术后化疗期间心理痛苦变化情况及影响因素,为改善其负性心理提供参考。方法采用一般资料调查问卷、心理痛苦温度计及综合医院焦虑抑郁量表,分别于化疗前1 d(T1)及第1、3、6次化疗(T2、T3、T4)进行问卷调查。结果共212例完成研究。4个时间段中重度心理痛苦检出率分别为62.74%、70.28%、47.17%、31.60%;4个时间段心理痛苦、焦虑抑郁得分差异有统计学意义(均P0.01);其中心理痛苦得分T2最高(4.84±1.27)、T4最低(2.67±1.23)。多元回归分析结果显示:性别、年龄、文化程度、焦虑4个变量进入4个时间段、抑郁进入3个时间段(T2未能进入)、个人月收入进入T1、T3时间段、肿瘤分期进入T1时间段心理痛苦影响因素预测模型(调整R~2:T1为0.836,T2为0.512,T3为0.683,T4为0.605;P0.05,P0.01)。结论胃癌患者术后化疗期间心理痛苦发生率高,不同阶段心理痛苦呈动态变化趋势。应采取针对性措施干预,尤其对女性、高龄、文化程度偏低、个人月收入较少,以及焦虑、抑郁情绪较重患者应强化干预,以减轻患者心理痛苦水平,促其完成全程化疗和提高生活质量。     

家属培训对长期住院慢性精神分裂症患者康复的影响

目的探讨家属心理护理、生活技能培训在长期住院的慢性精神分裂症患者康复治疗中的作用。方法选取有家庭监护条件的长期住院的精神分裂症患者126例,将其随机分为干预组(66例)和对照组(60例)。干预组由心理咨询师对患者家属进行心理护理、生活技能培训,然后对患者实施假出院3个月。对照组患者仍住院治疗。实施前后采用护士用住院患者观察量表(NOS-IE)、自尊量表(SES)进行测试。结果干预后干预组NOSIE及SES评分显著优于对照组(P<0.01,P<0.05)。结论家属心理护理、生活技能培训用于长期住院的慢性精神分裂症患者,可使其社会能力、生活技能提高,激惹、抑郁等消极情绪减少;自尊水平提升。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.