老年胸痛患者的心理状态及其临床意义

目的观察老年冠心病和非典型胸痛患者冠状动脉造影术前心理状态及其临床意义。方法采用横断面研究,整群抽样法,对在我院进行冠状动脉选影术(CAG)检查的59例老年胸痛患者术前使用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表-17项(HAMD-17)进行心理状态评估,观察老年冠心病和非典型胸痛患者CAG术前焦虑抑郁等情绪改变;同时,结合CAG结果,比较CAG阳性与阴性老年患者在一般情况和心血管危险因素方面的差异。结果59例老年患者中术前有焦虑症状者26例,占44.1%;有抑郁症状者10例,占16.9%;既有焦虑又有抑郁者8例,占14.2%。CAG检查阳性者43例,阴性者16例,CAG阴性率27.59%。CAG阳性组焦虑症状较CAG阴性组更明显(HAMA平均分:16.1±7.2比11.1±6.6,P<0.05)。结论老年冠心病和非典型胸痛患者的焦虑、抑郁症状发生率均较高。     

对消化性溃疡伴抑郁焦虑症患者进行针对性护理干预的效果观察

目的:探讨对消化性溃疡伴抑郁焦虑症患者针对性护理干预的效果。方法:选取148例消化性溃疡伴抑郁焦虑患者,随机分为对照组和观察组各74例;对照组给予常规治疗消化性溃疡,观察组则在常规治疗基础上给予针对性护理干预;两组均观察8周后,对患者的溃疡愈合和幽门螺旋杆菌清除率进行综合评估,并应用焦虑自评量表(SAS)和抑郁自评量表(SDS)评分对患者精神、心理状态进行评价。结果:经基础治疗及有针对性的护理后,观察组的总有效率93.24%,对照组的总有效率67.57%,两组结果相比,差异具有统计学意义(P<0.05);两组治疗后的抑郁焦虑评分均低于治疗前(P<0.05),干预组治疗后的抑郁焦虑评分显著低于对照组(P<0.05)。结论:针对性护理干预应用于消化性溃疡伴焦虑患者的治疗能提高治疗效果,且能有效缓解焦虑症状,值得推广应用。     

维持性血液透析患者应用团体人际心理治疗改善抑郁状态的效果观察

目的探讨维持性血液透析患者应用团体人际心理治疗改善抑郁状态的效果。方法选取维持性血液透析患者46例分为心理干预组和对照组,应用Zung氏抑郁自评量表(SDS)为测量工具,调查患者在透析治疗过程中加入团体人际心理治疗对抑郁状态的改善情况。结果 加入团体人际心理治疗的透析患者SDS标准分治疗后较治疗前,以及治疗后与对照组比较均显著降低(P均<0.01)。结论 IPT-G治疗可改善维持性血液透析患者抑郁状态。     

CCU急性心肌梗死患者心理状况调查研究

目的探讨冠心病监护病房(CCU)急性心肌梗死患者(AMI)的心理状况,为临床心理康复提供科学依据。方法采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和A型行为问卷调查。结果38例AMI患者发生焦虑29%,抑郁13%,A型性格占92%。AMI抑郁发生人数比不稳定心绞痛(UA)少(P<0.01);焦虑两者无显著差异(P>0.05)。结论部分AMI患者存在焦虑、抑郁情绪,因此临床治疗应充分考虑患者心理因素。     

截肢患者治疗期间适应行为模式的护理研究

目的探讨适应行为模式在截肢患者治疗期间的护理应用效果。方法收集60例截肢患者,随机分成试验组和对照组,每组各30例。治疗期间试验组采用适应行为模式,对照组采用常规护理,比较两组患者的心理状态和生活质量。结果 60例患者焦虑、抑郁的发生率分布为18.3%(11/60)、23.3%(14/60),试验组焦虑、抑郁的发生率均显著低于对照组(P<0.05),生活质量多项评分显著高于对照组(P<0.01)。结论适应行为模式可明显改善截肢患者的生活质量和心理状态,促进患者更快适应社会生活。     

肠易激综合征137例临床特点分析

目的 通过137例肠易激综合征(IBS)分析,总结其主要临床特点及治疗,并探讨其可能的发病因素.方法 收集门诊137例IBS患者临床资料,分析其临床资料.结果 137例IBS病人临床表现为腹泻,腹痛,便后缓解115例(83.9%),腹泻92例(62.7%),腹泻便秘交替23例(16.9%),腹胀便秘33例(24.1%),伴明显焦虑,紧张,抑郁等精神心理障碍89例(65.7%).137例病例分别给予抗胆碱能药,钙拮抗剂,止泻,胃肠动力药,抗焦虑,抑郁及心理治疗,症状消失或明显减轻121例,无效16例,有效率88.1%.结论 IBS临床特点以腹痛,腹泻,腹胀便秘交替为主,并多伴有紧张,焦虑,抑郁等症状,精神心理在其发病中起较为重要作用,对症治疗辅以精神心理治疗有效.     

不稳定心绞痛患者心理状况分析

目的探讨冠心病不稳定心绞痛(UA)患者的心理状况,为临床心理康复提供客观依据。方法采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和A型行为问卷,对56例住院冠心病不稳定心绞痛患者进行调查。结果冠心病不稳定心绞痛患者SAS标准分>38分21例,焦虑发生率37%;SDS标准分≥43分25例,抑郁发生率43%;A型行为评分28～50分48例,A型行为占89%。不稳定心绞痛与急性心肌梗死患者比较发生抑郁的人数显著增多(t=2.936,P<0.01),但二者出现焦虑情绪无显著差异(t=1.045,P>0.05)。结论冠心病不稳定心绞痛患者常出现焦虑、抑郁情绪,其抑郁情绪的发生率较急性心肌梗死明显增高,临床在治疗基础疾病的同时应积极采取心理康复措施。     

不同护理模式对病毒性肝炎焦虑、抑郁状态的影响效果比较

目的 了解不同护理模式对病毒性肝炎焦虑、抑郁状态的影响,为防治病毒性肝炎焦虑、抑郁提供理论依据.方法 将100例病毒性肝炎患者随机分为观察组和对照组,每组50例.观察组实施以患者为中心的护理模式,对照组给予常规护理服务.采用医院焦虑-抑郁情绪自评量表(HAD)测试.比较两组患者焦虑、抑郁状态的变化情况.结果 病毒性肝炎患者的焦虑情绪发生率为66%,抑郁情绪发生率为57%.实施不同护理模式后,观察组焦虑情绪发生率为33%,抑郁情绪发生率为24%;对照组焦虑情绪发生率为58%,抑郁情绪发生率为49%.与护理前相比,护理后两组患者的焦虑、抑郁发生率均显著降低(P＜0.05),护理后观察组焦虑、抑郁发生率明显低于对照组(P＜0.05).结论 病毒性肝炎患者产生焦虑抑郁情绪较普遍,以患者为中心的护理模式能明显降低其焦虑、抑郁的发生率,有利于患者的康复.     

扁平苔藓患者心理健康状况研究

目的:探讨扁平苔藓患者有无异常的心理健康状态。方法:对122例口腔粘膜扁平苔藓患者进行汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)测量。结果:89例(72.9%)口腔粘膜扁平苔藓患者有焦虑倾向,27例(22.1%)有抑郁倾向,两者与对照组均有统计学上的显著差异。结论:口腔粘膜扁平苔藓患者多伴有焦虑和抑郁,其中焦虑的表现更为突出。临床治疗中应更加注重扁平苔藓患者的心理疏导。     

焦虑抑郁状态对智齿冠周炎复发的影响

 目的 探讨焦虑抑郁状态对非外科手术治疗的智齿冠周炎复发的影响。方法 选择就诊于中日友好医院口腔医学中心的首发非外科治疗的智齿冠周炎患者,通过发放电子问卷收集如下信息:人口学信息、焦虑量表(GAD-7)和抑郁量表(PHQ-9)。半年后对随访患者的复发情况进行统计,采用多因素logistic回归分析智齿冠周炎复发与患者发病时情绪状态的关系。结果 共收集568份有效问卷,其中7.0%患者存在焦虑状态(GAD-7≥10),13.7%存在抑郁状态(PHQ-9≥10),半年后随访智齿冠周炎的复发率为11.4%。分析智齿冠周炎6个月后复发情况发现,男性的风险低于女性(OR=0.416,P＜0.05),焦虑增加了智齿冠周炎的复发风险(OR=1.124,P＜0.05)。结论 口腔医师应关注患者焦虑抑郁情绪状态,有助于智齿冠周炎的预防和治疗。     

Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI

OBJECTIVE: The purpose of this study was to determine the accuracy of MRI for discrimination between tuberculous spondylitis and pyogenic spondylitis. MATERIALS AND METHODS: MR images of 52 patients who had MRI of the spine and confirmed spondylitis were retrospectively reviewed. After review of medical records, we compared MRI findings in 20 patients with tuberculous spondylitis and 20 patients with pyogenic spondylitis. Statistical analysis was performed with the chi-square test. RESULTS: The reviewer identified tuberculous spondylitis with sensitivity, specificity, and accuracy of 100% (20/20), 80% (16/20), and 90% (36/40), and pyogenic spondylitis with sensitivity, specificity, and accuracy of 80% (16/20), 100% (20/20), and 90% (36/40), respectively. The patients with tuberculous spondylitis had a significantly higher incidence of MRI findings as follows (p < 0.05): a well-defined paraspinal abnormal signal (95% [19/20] in tuberculous vs 25% [5/20] in pyogenic), a thin and smooth abscess wall (95% [19/20] vs 15% [3/20]), combination of both findings (90% [18/20] vs 0% [0/20]), presence of paraspinal or intraosseous abscess (95% [19/20] vs 50% [10/20]), subligamentous spread to three or more vertebral levels (85% [17/20] vs 40% [8/20]), involvement of multiple vertebral bodies (60% [12/20] vs 25% [5/20]), thoracic spine involvement (40% [8/20] vs 10% [2/20]), and hyperintense signal on T2-weighted images (95% [19/20] vs 65% [13/20]). CONCLUSION: MRI was accurate for differentiation of tuberculous spondylitis from pyogenic spondylitis.     

Utility of follow-up studies using meta-[123 I]iodobenzylguanidine scintigraphy for detecting recurrent neuroblastoma

Neuroblastomas sometimes recur after the initial disappearance of the tumour. We evaluated the utility of meta-[123I]iodobenzylguanidine (123I-MIBG) scintigraphy for the detection of recurrent neuroblastomas by comparing with the measurement of biochemical markers and clinical findings. Forty patients who had received treatment for neuroblastomas were included in the study. After the disappearance of the initial tumours, periodic measurements of urinary vanillyl mandelic acid, homovanillic acid and serum neuron specific enolase values, and an 123I-MIBG scintigraphy were performed. Whenever an abnormal finding was observed, other appropriate examinations and/or follow-up examinations were performed to elucidate the true state of the patient. Eleven recurrent episodes in eight patients were observed. Most of them occurred in the bone marrow or bone. Corresponding symptoms were observed in only two episodes; the other episodes were asymptomatic, and discovered by the periodic examinations. 123I-MIBG scintigrams visualized the recurrent tumours in 10 (91%) episodes. Elevated tumour markers were observed in only three episodes. 123I-MIBG scintigrams visualized most of the recurrent tumours, unless they were accompanied by any symptoms or elevations in biochemical tumour markers. Periodic examinations with 123I-MIBG scintigraphy appears to be a useful technique for the detection of the recurrences.     

结核性渗出性胸膜炎86例临床分析

目的进一步探讨结核性渗出性胸膜炎的临床特点以及与肺实质结核的关系。方法回顾性分析2006年1月-2008年12月收治的86例结核性渗出性胸膜炎住院患者的临床特点、治疗及转归。结果结核性胸膜炎好发于青少年及老年人,最常见症状为发热、胸痛及咳嗽,以单侧淋巴细胞为主型渗出性胸膜炎为主。86例患者中经CT检查观察到合并肺实质损害的有69例,占80．2％,其中42例表现为活动性肺结核影像学特点,占48．8％;最常见为渗出及增殖性病灶,病灶位于上叶者42例,占60．9％。肺内病灶与胸水在同一侧59例,双侧都有病灶8例,二者之和远高于肺内病灶在胸水对侧的2．9％（2／69）（P〈0．05）。经统计学处理对比继发性结核性胸膜炎组与单纯性结核性胸膜炎组发病年龄、PPD阳性率、血清结核抗体阳性率、胸水蛋白含量、胸水细胞数及淋巴细胞数比例无显著性差异（P〉0．05）,两组胸水PCR—TB—DNA检出阳性率分别为81_3％和16．7％,经统计学处理对比差异具有显著性（P〈0．05）。本组病例89．5％采用短程化疗方案2HRZE／4HR、2HRE／4HR抗结核治疗,近期疗效显著。继发性结核性胸膜炎组与单纯性结核性胸膜炎组疗效无明显差异。结论结核性胸膜炎与肺结核关系密切,将其与肺结核一并列入结核病归口管理对象,对控制结核病疫情具有重要意义。     

Improvement of cardiac sympathetic innervation by renal transplantation.

Chronic renal failure (CRF) patients on dialysis frequently show reduced heart rate variability (HRV), which has been reported to be corrected by renal transplantation. Recently, (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy has been used to evaluate cardiac sympathetic innervation, and uremic patients often show marked abnormalities of cardiac (123)I-MIBG uptake. We investigated whether renal transplantation can improve cardiac (123)I-MIBG uptake in patients with CRF on dialysis. METHODS: We analyzed time- and frequency-domain measures of 24-h HRV and cardiac (123)I-MIBG scintigraphy before and 1-3 mo after renal transplantation in 13 CRF patients on dialysis and in 10 control subjects. RESULTS: Both 24-h HRV and cardiac (123)I-MIBG uptake were significantly abnormal in the patients before transplantation compared with the control subjects. After transplantation, (123)I-MIBG washout rate from the myocardium significantly decreased from 46% +/- 21% to 20% +/- 22% (P = 0.006), and the heart-to-mediastinum ratio of (123)I-MIBG uptake in the late image significantly increased from 1.74 +/- 0.39 to 2.06 +/- 0.39 (P = 0.006). On the other hand, HRV measures tended to increase after transplantation but the changes did not reach statistical significance (P > 0.05). CONCLUSION: Renal transplantation provides the improvement of uremic cardiac sympathetic neuropathy assessed by (123)I-MIBG imaging, which may be a more sensitive or at least an earlier marker than HRV.     

急性一氧化碳中毒后迟发性脑病46例临床分析

目的总结急性一氧化碳中毒后迟发性脑病(DEACMP)的有关临床特征。方法对本院2003年1月—2006年1月收治的46例DEACMP患者临床表现、影像学、脑电图、心电图、治疗及预后等进行回顾分析。结果46例均有意识障碍(主要表现为意识内容改变,少数表现为意识水平受损)持续时间(12.5±5.8)h,假愈期(10.5±6.2)d;36例有锥体外系功能障碍,部分病例有锥体系功能障碍,心电图检查异常率为43.5%(20/46),脑电图异常率为100%(32/32),CT异常率为69.6%(32/46),MR I 92%(23/25)。全组痊愈32例,好转13例,死亡1例。结论DEACMP主要表现为意识障碍、锥体外系和锥体系功能障碍,一经发生治疗较困难,致残率高。     

131I全身显像及血清甲状腺球蛋白测定在分化型甲状腺癌治疗随访中的作用

目的 评价131I全身显像联合血清甲状腺球蛋白(Tg)测定在分化型甲状腺癌(DTC)131I治疗随访中的临床应用价值。 方法 153例经手术病理确诊为DTC的患者,均在术后接受了1次以上的131I治疗,每次剂量为1.85~9.25 GBq,131I治疗前测定血清Tg,治疗5 d后进行131I全身显像。 结果 153例行131I治疗的DTC患者共行血清Tg和131I全身显像检查各为262次,其中55.6%(85/153)的患者的血清Tg水平与131I全身显像均异常,13.7%(21/153)的患者两者均为正常,30.7%(47/153)的患者两者结果不一致,不一致的47例患者经其他影像学检查证实19例131I全身显像异常的患者中有13例异常,28例血清Tg异常的患者中有25例异常。血清Tg诊断DTC转移的灵敏度和特异度分别为89%(110/123)和90%(27/30),而131I全身显像的灵敏度和特异度分别为79.6%(98/123)和80%(24/30)。 结论 DTC手术及131I治疗后,常规进行血清Tg测定和131I全身显像检查,对术后判定复发转移灶及制定最佳131I诊疗计划、评价131I疗效具有重要的临床应用价值。     

急性肠梗阻354例回顾分析

目的 :提高对急性肠梗阻 (AO)的诊断治疗水平。方法 :回顾分析我院连续 10年AO住院患者 35 4例。其中少儿组、成年组、老年组分别为 33、198、12 3例。结果 :粘连性AO占 5 2 .5 % (186 /35 4) ,其中少儿组占 42 .4% ,成年组占 6 4.6 % ,老年组占35 .8% ,差异有非常显著意义 (P <0 .0 1) ;肿瘤所致AO占 2 5 .4% (90 /35 4) ,其中少儿组 9% ,成年组占 2 1.7% ,老年组占 35 .8% ,差异有非常显著意义 (P <0 .0 1) ;腹外疝所致AO占 13.8% (4 9/35 4) ,其中少儿组占 2 7.2 % ,成年组占 7.5 % ,老年组占 2 0 .3% ,差异有非常显著意义 (P <0 .0 1)。术后并发症发生率 2 1.1% (4 9/2 32 )、病死率 11.3% (2 6 /2 32 )。结论 :AO的主要病因为粘连 ,肿瘤 ,腹外疝。肿瘤的早期诊治和积极手术治疗在AO的诊治中具有重要意义     

Clinical significance of I-123 IMP brain SPECT in children with brain diseases

Single photon emission computed tomography (SPECT) of the brain using N-isopropyl p-I-123-iodoamphetamine (I-123 IMP) was performed in 43 children with suspected brain diseases. Forty-three children (25 males and 18 females), with an age range of 24 days-15 years (mean: 6.6 years), were included in the study. Six patients were subsequently diagnosed as normal. Early SPECT of the brain was performed 30 minutes after intravenous administration of 74-111 MBq (2-3 mCi) I-123 IMP using a rotating gamma camera equipped with a 30-degree slant hole and medium energy collimator. Transverse images were reconstructed by Shepp-Logan filtered back projection method with attenuation correction after spatial filtering using an 8th order Butterworth-Wiener filter. Findings of I-123 IMP SPECT were compared with those of X-ray computed tomography (CT) and electroencephalography (EEG). The results showed that 1) In I-123 IMP SPECT, abnormality was found in 30 out of 37 children with brain diseases. The incidence of abnormal findings in the 37 patients was 81% in I-123 IMP SPECT, 61% in X-ray CT, and 78% in EEG., 2) In both cryptogenic and secondary epilepsy, the incidence of abnormality was higher in I-123 IMP SPECT than in X-ray CT. (70% and 94% vs 50% and 81% respectively). Epileptic foci detected by EEG did not correspond with defects found using I-123 IMP SPECT in 27% of the patients., 3) In asphyxiated infants, a high incidence of abnormality was observed on both I-123 IMP SPECT (86%) and X-ray CT (86%).(ABSTRACT TRUNCATED AT 250 WORDS)     

ω-123I-Hexadecanoic acid metabolic probe of cardiomypathy

The utility of -¹²³I-hexadecanoic acid myocardial scintigraphy as a metabolic probe of cardiomyopathies was investigated. Sixteen patients with a variety of cardiomyopathies and myopathies that involve cardiac muscle and ten volunteers were imaged in the postabsorptive state in a 40° LAO projection after a standard dose of -¹²³I-hexadecanoic acid. An elimination T_1/2 was calculated from the left ventricular myocardial time-activity curve. An uptake index, corrected for chest wall attenuation, was also computed in 7 of 10 volunteers and 8 of 16 patients.Of the 16 patients, only 2 had distinctly abnormal -¹²³I-hexadecanoic acid myocardial tracer kinetics. The first patient had a metabolic disorder of which cartine deficiency was one component. The second patient had endocardial fibroelastosis, a process which has been linked to disorders which deprive the myocardium of oxygen and energy. Therefore, the cardiomyopathy may have been caused by some abnormality of cardiac metabolism other than carnitine deficiency. Although of limited utility in the overall cardiomyopathic population, -¹²³I-hexadecanoic acid myocardial scintigraphy should be further investigated as a screening test for carnitine deficiency and related metabolic abnormalities in patients at risk.Supported by a Canadian Heart Foundation Research FellowshipSupported by an Australian Heart Foundation Travel Grant     

Thyroid imaging agents: a comparison of I-123 and Tc-99m pertechnetate

Tc-99m pertechnetate and I-123 were used to perform thyroid scanning in 122 patients with history or clinical evidence of thyroid disease. Thyroid scans were abnormal in all patients, while thyroid palpation was abnormal in all but 19. The quality of thyroid imaging was similar with both agents in 42%, better with I-123 in 18%, and better with Tc-99m in 7%. In the remaining 33% (40 cases), there were discrepancies between Tc-99m and I-123 images. The most frequent discrepancies were "hot" or "warm" lesions on Tc-99m scans that were "cold" or normal on I-123 scans. Results from this study indicate that neither Tc-99m nor I-123 is always superior to the other as a thyroid imaging agent.