从心血管疾病的美国模式看肿瘤的中国模式

近年来,心脑血管疾病和癌症的死亡率在世界范围内已上升至前三位。自从美国通过改变生活方式,以控制心血管疾病的方针以来,心血管疾病的患病率减少了５０％,死亡率降低了２５％,人们称之为心血管疾病的美国模式。与此相应的是上海市癌症俱乐部提出了“群体抗癌”的新模式,倡导了“第四医学”和“第三人生”的新理论,１０年努力的结果,使癌症患者的５年生存率延长了３倍,１０年生存率延长了２－３倍,创造了癌症康复的中国模     

抑郁和焦虑与心血管疾病

抑郁焦虑与心血管疾病的关系最能体现身与心两者相互影响、不可分割的特点。但临床上,心血管疾病患者抑郁焦虑的诊疗率不足1％。这说明现有的诊疗理念和方式没有将心血管疾病和精神障碍联系起来,给患者全面全程的干预和管理。这样的缺陷不仅增加患者的痛苦和功能障碍,也增加心血管疾病的发病率和病死率,还增加患者及社会的医疗负担。本文结合临床经验,从心身一体的诊疗理念,谈谈抑郁焦虑与心血管疾病。     

心血管疾病患者心理评估及干预措施

本文概述了常见心血管疾病的患者合并心理障碍的发生率、发病机理以及心理障碍对心血管疾病发生、发展及预后的影响,分析了心血管疾病患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别心血管疾病患者出现心理障碍的重要性,探讨对心血管专科治疗效果不明显的心血管疾病患者合并心理障碍的鉴别诊断,并以"双心医学"方式对其进行心理干预及药物治疗,减少不必要的检查和治疗,以便有利于心血管疾病患者的康复和预后。     

导言：情感障碍对心血管疾病的影响不容忽视

随着我国人民生活水平的不断提高,心血管疾病发病人数,尤其是冠心病及高血压病逐年增加,人们的健康意识也越来越强,就诊患者症状表现的多种多样。心血管疾病中常伴有的社会及心理因素使心血管疾病的诊断与治疗更加复杂和多样化。20世纪80年代及21世纪初以来,心血管疾病的治疗手段也越来越多。在基本药物治疗的基础上,心血管疾病的介入治疗及外科手术治疗的病例数也迅速增加,并取得了良好的临床效果,改善了患者的预后,提高了患者的生活质量。但越来越多的心血管病患者同时患有心理障碍,两种疾病互为因果,互相影响,导致疾病恶化。二者共病率高,已成为严重的健康问题之一,并形成了一门新兴的学科即心理心脏病学（psychocardiology）或称双心医学。     

从整合医学视角看心血管学科未来发展

心血管疾病已经成为威胁国人健康的首位疾病.现代医学的发展使药物、介入和外科手术成为治疗心血管疾病的三大基石,但专科的进一步细化也带来相当多的弊端.因此,需要以患者为核心,摒弃学科的分野,将各种医学知识和防治手段有机融合,构建一个新的整合医学体系去培养年轻医师,切实控制心血管疾病.     

矛盾分析法在心血管疾病心理治疗中的应用

随着我国人口老龄化趋势的加快,心血管疾病患病率、病死率不断上升,并往往伴随异常的心理状态,在传统治疗基础上辅以心理干预,将会改善患者的生活质量和预后。矛盾分析法是运用对立统一规律,观察、分析社会现象,应贯穿于心血管疾病心理治疗的全部过程。     

哲学视野下脑卒中后心理障碍的辩证康复

脑卒中后的心理障碍不但影响患者的心理健康,还严重阻碍整个康复治疗的进程。心理疗法作为一种重要的心理障碍康复手段,其有效性已得到相关临床研究的证实。但如何根据临床具体情况选择适宜的心理疗法加速患者功能的康复,提高其生活质量和日常生活活动能力,最终帮助患者重返家庭和社会一直是临床关注的热点。为了更好地提高对卒中患者心理障碍的认识和干预,本文试从哲学的角度出发,结合各期心理障碍的特点,对脑卒中后心理障碍的康复作一论述。     

基于虚拟现实的康复医学模式

康复医疗传统模式是康复中心一对一的指导训练,但远无法满足患者的需求。虚拟现实康复技术的出现,是传统康复模式的一场变革。虚拟现实康复是直接以家庭和患者为中心,为康复的患者提供一个虚拟环境,一个生动的康复训练平台,实现患者与该虚拟环境直接进行自然对接,以自然方式在虚拟环境中与具有感官刺激的对象进行交互,使得单调枯燥的康复训练在虚拟环境中,更加轻松、容易、高效、趣味及依从,能使患者障碍的功能最大限度地恢复。     

“三联预康复”:ERAS的术前优化

快速康复外科(ERAS)是指依据一系列有循证医学证据的围术期优化措施,多学科协作,减少患者的围术期应激反应,加速患者术后康复。术前"三联预康复"基于ERAS优化理念,在术前对患者进行运动、营养、心理干预,旨在改善患者功能状态和预后。本文主要就术前"三联预康复"这一新兴概念的临床进展进行综述,为践行ERAS提供新的思路。     

循证医学在心血管危险控制中的应用

1　“心血管危险控制”的定位心血管疾病占全世界所有死亡原因的 2 5 % ,是各种原因死亡中比例最高者 ,因此有“第一杀手”(ｋｉｌｌｅｒｎｕｍｂｅｒｏｎｅ)之称。在发达国家 ,心血管疾病约占全部死亡病因的一半[1] 。根据 1995年我国卫生部公布的统计资料表明 ,我国的心血管疾病 (包括脑卒中 )死亡已居全部死因的首位 ,占总死亡的4 0 7% ,据此推算全国每年有 2 0 0多万人死于心血管疾病。就高血压病而言 ,全国有高血压患者 1亿多人 ,每年新增患者 32 0万 ,患病率每 10年递增5 0 % ;每年新发脑卒中病例高达 15 0万人 ,死亡 10 0万人 ,生存…     

人文关怀在喉癌治疗和康复中的重要意义

临床医生在治疗疾病的过程中,需要医学人文精神。这种精神提倡对人的理解和关怀,以人为中心的医学人文理念。这一精神尤其体现在喉癌的治疗中。在提高生存率的同时,改善患者的生活质量显得尤其重要。人文精神要求医生有针对性地做好喉癌患者的健康指导,让患者从医生的言谈举止中感受到人道主义的关怀。     

正确认识高血压患者应用阿司匹林的出血问题

高血压作为一种全球性的心脑血管疾病,会导致多器官损害,其患者发生心肌梗死、心绞痛、脑卒中等血栓栓塞性事件的几率远远高于血压正常者,因此防止心脑血管事件的发生是高血压治疗中的一个重要目标。多项大型临床研究证明,阿司匹林可以有效预防高血压患者心脑血管事件发生,同时也增加了出血的危险。本文将探讨如何正确认识高血压患者应用阿司匹林的出血问题,并如何将出血的危险降低到最小。     

华生关怀理论在慢性病患者护理中的应用探索

随着我国经济的发展,人群中疾病谱和死因谱发生了重大变化。以心脑血管疾病、恶性肿瘤为代表的慢性病已成为严重威胁人们健康的公共卫生问题。慢性病的主要特点是病程长,迁延不愈,反复发作,它对人的共同影响有：身体功能、心理、社会生活等的影响。护理理论家华生提出关怀护理理论,关怀必须是护理人员结合科学与人文知识在与患者的互动关系中按照关怀的10个要素来完成,目标是帮助患者达到身体、心理及心灵更高程度的协调。本文介绍了关怀理论的主要内容、慢性病的特点,并通过实际病例应用阐述了关怀理论在慢性病患者临床护理中的应用。     

Relationship of Illness Severity with Health and Life Satisfaction in Patients with Cardiovascular Disease: The Mediating Role of Self-efficacy Beliefs and Illness Perceptions

Guidelines for cardiovascular rehabilitation from different countries underline the importance of psychological factors in the achievement of improved clinical conditions and quality of life in patients with cardiovascular disease (CVD). Nevertheless, little research has been performed to identify the specific factors that greatly affect or foster patients’ quality of life. The aim of the current study was to investigate the contribution of illness perceptions (IP) and self-efficacy beliefs (SE) on the impact exerted by illness severity on health and life satisfaction in patients with CVD undergoing a rehabilitation program. The study had a cross-sectional design and involved 116 patients (mean age = 65.6 years; SD = 10.0 years; 79.3 % men). Illness severity was measured in terms of left ventricular ejection fraction (LVEF) at the discharge from the cardiology department, whereas psychological factors were assessed one week later. The results showed no relationships among LVEF and the two indicators of health and life satisfaction; moreover, these two variables are differently influenced by IP and cardiac risk factors SE (χ²(1) = 0.96, p = n.s.). Findings provide important suggestions for the implementation of interventions aimed at bettering patients’ quality of life, underlying the importance of working on IP and SE to improve levels of health and life satisfaction in patients with CVD.     

Healing the Heart: A Qualitative Study of Challenges and Motivations to Cardiac Rehabilitation Attendance and Completion among Women and Men

Heart disease is the leading cause of death in the United States. Given that cardiovascular rehabilitation (CR) participation is the best secondary prevention of cardiac mortality, it is important to understand the challenges and motivations people experience while taking part in rehabilitation. The present qualitative study explored the treatment experiences of 20 women and 20 men at urban and rural rehabilitation clinics in Minnesota. Participants were equally divided based on the number of CR session completed (less than or equal to 18 vs. more than 18). The study’s primary aim was to articulate similarities and differences in the CR treatment experiences by gender. Data were gathered from individual interviews and analyzed using an inductive content analysis. Findings revealed that both women and men view CR as a means to move forward from their cardiac incident and achieve good health. Women were more likely than were men to be motivated by a perceived obligation to CR staff and improved quality of life. Men, in comparison, identified their commitment to CR as a need to complete a task. The study findings can help inform the design of rehabilitation programs and strengthen patient-centered interventions to enhance participation in treatment.     

精神疾病患者遭受社会歧视的现状及其原因与对策分析

社会对精神疾病患者的歧视由来已久,这种歧视广泛存在于不同的阶层与民族当中,且各有其特点。其对精神病患者及其家属带来的负面影响是显而易见而且是深刻的,这种影响涉及到了患者生活的各个方面。本文对各种歧视的特点及其深层次原因进行了初步分析和探讨,并对如何减少这种歧视进行了探讨。     

急性心理应激对多囊卵巢综合征患者的影响

为了了解PCOS患者易患抑郁症、肥胖、代谢综合征、心血管疾病、糖尿病的原因。通过对28例PCOS患者和28例体重指数、年龄匹配的健康对照组回应公众演讲压力进行分析,在回应公众演讲压力时,PCOS组和对照组均有比较显著的焦虑程度、ACTH、皮质醇、心率和血压升高（P均〈0．01）;但PCOS患者焦虑程度、ACTH、皮质醇...     

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (? = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (? = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.     

浅谈肝移植术后患者长期随诊的临床意义

回顾性分析肝移植术后随访中的临床与非临床因素对移植物和受体长期存活的影响。选择术后3年以上病例,在并发症的诊断处理、患者各种非医疗不良因素（依从性）方面调查分析和总结。结果多数术后患者均能有良好的依从性,配合移植医师的术后治疗、随访及心理健康指导,但有些患者因为个人、医院等原因不能很好地得到随访,发生并发症及不能及时处...