肝血管瘤外科治疗方案的选择

肝海绵状血管瘤是肝脏最常见的良性肿瘤,一直以来,手术切除是其治疗的首选方法,但手术指征存在着很大争议,近年来,腹腔镜的广泛使用使手术指征有放宽的趋势。而介入治疗的发展为肝海绵状血管瘤的治疗提供了新的、更具有优势的选择。通过运用治疗方法决策的利弊论,站在使患者利益最大化的角度分析两种方法的利弊,选择合适的治疗方法对,临床工作具有重要意义,通过对比,笔者认为介入治疗应成为肝海绵状血管瘤的首选治疗方法。但对于每一个患者个体必须充分考虑其生理、心理、社会方面的特殊性,运用矛盾的普遍性和特殊性原理,选择恰当的方法。     

临床指征优先谨慎使用抗菌药物

抗菌药物是临床广泛应用的一类药物。根据卫生部全国医院感染监测网监测结果,我国临床抗菌药物使用率较高。抗菌药物压力是细菌产生耐药性最重要的原因。对于临床谨慎使用抗菌药物来说,知晓和掌握使用指征是非常重要的,在任何情况任何时候,指征是优先考虑的。抗茵药物使用指征包括治疗性用药指征和预防性用药指征,尤其是预防用药方面。本文讨论抗菌药物应用指征,包括感染诊断与治疗性用药的关系、手术前预防性使用抗菌药物预防手术部位、内科患者预防性使用抗菌药物指征与药物选择等。     

自然分娩与剖宫产的比较研究

剖宫产不是一种分娩方式,而是解决难产的手段.日益增高的剖宫产率成为人们关注的热点话题,自然分娩和剖宫产对母婴的健康和卫生资源的影响,有很多的研究和争议,对于没有医学指征要求剖宫产目前倾向于在知情同意的情况下尊重患者的自主权和选择权,但控制剖宫产率在一个理性的范围之内,是一个系统工程,值得全社会的关注.     

自然分娩与剖宫产的比较研究

剖宫产不是一种分娩方式,而是解决难产的手段。日益增高的剖宫产率成为人们关注的热点话题,自然分娩和剖宫产对母婴的健康和卫生资源的影响,有很多的研究和争议,对于没有医学指征要求剖宫产目前倾向于在知情同意的情况下尊重患者的自主权和选择权,但控制剖宫产率在一个理性的范围之内,是一个系统工程,值得全社会的关注。     

子宫切除对患者身心健康的影响

子宫不但是重要的生殖器官，同时也被认为是一个内分泌器官。切除子宫虽是治疗子宫肌瘤的有效手段，但对患者的精神心理、性生活质量有无影响也是一个非常敏感的问题。本文将重点探讨子宫切除术对患者精神心理、性生活及内分泌的影响。     

室间隔缺损合并重度肺动脉高压的外科手术治疗策略

探讨室间隔缺损伴重度肺动脉高压患者手术指征的判断标准和围术期的治疗策略。11例室间隔缺损伴重度肺动脉高压患者,在体外循环下行室间隔缺损修补术,围术期给予吸氧、前列腺素E1等降低肺动脉压力的综合治疗。结果11例手术患者全部治愈出院,经随访肺动脉压力有着不同程度的下降。术前全面检查、综合分析以明确手术指征是室间隔缺损合并重度肺动脉高压患者获得满意疗效的根本,其中肺血管纹理是一个最重要的判断指标。     

室间隔缺损合并重度肺动脉高压的外科手术治疗策略

探讨室间隔缺损伴重度肺动脉高压患者手术指征的判断标准和围术期的治疗策略.11例室间隔缺损伴重度肺动脉高压患者,在体外循环下行室间隔缺损修补术,围术期给予吸氧、前列腺素E1等降低肺动脉压力的综合治疗.结果11例手术患者全部治愈出院,经随访肺动脉压力有着不同程度的下降.术前全面检查、综合分析以明确手术指征是室间隔缺损合并重度肺动脉高压患者获得满意疗效的根本,其中肺血管纹理是一个最重要的判断指标.     

破解无手术指征剖宫产困局

女性生育事涉国家、社会、个人,中国的高剖宫产率一直为世人诟病。法学界对于高剖宫产率鲜有论述,尹口博士从司法实证角度切入探讨医生应对无手术指征剖宫产的要求,论点虽新颖,但是其从患者自主权以及功利主义角度等方面论述医生应对策略,这对于降低高剖宫产率及根本上维护患者利益并无益处。本文以伦理、法律、政策作为切入点,认为放任无手术指征剖宫产有违最小损害原则、滥用患者自主权、导致卫生资源浪费,并从医学、政策、司法实践角度提出破解无手术指征剖宫产困局对策,以此文与尹口博士商榷。     

个体化降压的临床意义

高血压是由多种病因和发病机制引起的一种慢性疾病,可以导致多种靶器官功能损害,并最终导致严重的心、脑血管并发症,危及人类的健康和生命。如何做到有效的预防和治疗是目前面,临的问题。本文分析了高血压控制的现状,以矛盾的特殊性原理为指导,从高血压的病因和发病机制、临床特点以及药物对个体的敏感性等诸多方面出发,阐述了高血压患者个体差异性。高血压患者个体差异性决定每一个个体综合控制策略的不同,运用“具体问题具体分析”的方法,为每一个个体制定个体化的血压控制方案,以期达到理想的高血压整体控制水平。     

个体化降压的临床意义

高血压是由多种病因和发病机制引起的一种慢性疾病,可以导致多种靶器官功能损害,并最终导致严重的心、脑血管并发症,危及人类的健康和生命.如何做到有效的预防和治疗是目前面临的问题.本文分析了高血压控制的现状,以矛盾的特殊性原理为指导,从高血压的病因和发病机制、临床特点以及药物对个体的敏感性等诸多方面出发,阐述了高血压患者个体差异性.高血压患者个体差异性决定每一个个体综合控制策略的不同,运用"具体问题具体分析"的方法,为每一个个体制定个体化的血压控制方案,以期达到理想的高血压整体控制水平.     

产褥期抑郁症的高危因素及防治措施的分析

产褥期抑郁症是指产妇在产褥期内出现抑郁症状,是产褥期精神综合征中最常见的一种类型.国外报道发生率达30%,国内资料较少,防治措施亦少.通常在产后6周内发病,产后2周出现症状,表现为易激惹、恐怖、焦虑、沮丧等,有时还会陷入错乱或嗜睡状态.既往无精神病史,包括抑郁症在内的抑郁症史.现对我院2004年6月～2005年6月分娩产妇中随机抽取有随访条件的1824例产妇进行调查,有产后抑郁症状者达289例,发生率15.84%.     

Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

The termination phase of combined therapy

Three different kinds of termination are described and discussed. In combined therapy the group can help to resolve and clarify the meanings of moves to terminate therapy. The role of the therapist's countertransferences in this stage of the work is important to consider, and here, too, the group is an important part of the work. The author sees termination as an important part of the treatment process. In combined therapy it may be more complex but it also allows for a fuller exploration of the relevant issues.     

'Limits to therapy and counselling': Deconstructing a professional ideology

The rapidity with which therapy, as discourse and as clinical—professional practice, has become established in contemporary culture is subjected to a searching deconstructive critique. Specifically, it is argued that therapy's pretensions to being a legitimate professional, clinical practice are not only highly questionable, but actually constitute a self-serving and ethically questionable ideology. The 'scientific' status of therapy as a modernist enterprise is argued to be fundamentally undermined by new-paradigm epistemologies. It is further argued that, in its professionalised, commodified form, therapy can become routinely and intrinsically abusive to the extent that it self—fulfillingly constructs a framework which then serves to guarantee its own legitimacy within a discursive 'regime of truth'. Parker's important work on discourse and power is drawn upon to illustrate these radical arguments, and to make the case for an approach to therapy which is ongoingly and processually deconstructive of its 'professional' ideologies and clinical practices, if the kinds of dangers outlined are to be avoided. Such deconstruction would also include an ongoing and explicit interrogation of 'therapy' as an historically specific, evolving and, it is submitted, transitory cultural practice. Deep and honest ethical reflection is needed on the nature of therapy, and on the possibility of developing more healthily appropriate socio-cultural forms for helping people with their 'difficulties of living'.     

大学生亲密恐惧的图式干预研究

为研究图式治疗对大学生亲密恐惧的临床疗效,以54名有亲密恐惧问题的大学生为被试,采用支持咨询和图式治疗对比的实验研究,对疗效评估的各项指标进行了重复测量(前测、后测和追踪测量)的方差分析。结果表明干预后图式组亲密恐惧以及情感剥夺、缺陷/羞耻、伤害/疾病的易感性、情感抑制等四个适应不良图式都显著低于支持组,而且干预后图式组人际功能和适应功能等两项心理治疗效果评估指标都显著高于支持组。结论:图式治疗比支持支持咨询能更有效地减轻大学生亲密恐惧。     

Kunsttherapie

Art therapy uses all kinds of art media for psychotherapeutic purposes, such as painting, drawing, moulding, constructing, sculpturing and building. Therapeutically driven art therapies are aimed at the enhancement of personal resources, motivational and intentional improvement, coping and more adaptive interpersonal functioning. Every psychotherapeutic and psychiatric setting can integrate art therapy, and its use in different types of mental disorder has been extensively described. Neurobiological aspects of creativity and effects of the therapeutic relationship are discussed as being involved in the effectiveness of art therapy. There is growing evidence for its effectiveness. Art therapy can contribute to diagnostic and therapeutic procedures. A comprehensive table of art therapy interventions which can be applied within a psychotherapeutic setting is presented.     

序贯疗法根除幽门螺杆菌

幽门螺旋杆菌（HP）感染是胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织淋巴瘤的主要病因,根除HP具有重大的临床意义。随着抗生素耐药株HP逐年增加,HP根除率日益下降,因此出现了一种新的HP根除方案——10天或14天序贯疗法。此疗法指前5天或7天的诱导期中应用质子泵抑制剂（PPI）加一种抗生素的二联治疗,随后5天或7天应用PPI和两种抗生素的三联治疗。目前除少数研究外,绝大多数临床研究表明序贯疗法能够获得比传统的7天或10天三联疗法更高的HP根除率,其具体机制尚不明确。目前大部分相关的研究为单中心、样本量少,缺乏双盲对照,未能评估抗生素耐药性,尚待大样本、多中心、随机双盲对照的临床研究来进一步证实该疗法的有效性和安全性。     

原发性三叉神经痛两种治疗方法的比较

原发性三叉神经痛的治疗方法以神经毁损术最为常用。通过对经皮射频热凝毁损术和阿霉素化学毁损术的疗效、安全性、复发率、并发症及费用等方面的比较,揭示两种方法的利弊。用比较治疗学的理念及方法来指导三叉神经痛治疗的临床决策,以期能在目前条件下提高患者的治疗效果、降低医疗费用及提高生活质量。     

Patients’ Tests and Clinicians’ Emotions: A Clinical Illustration

Journal of Contemporary Psychotherapy - Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These...     

Stages in the Family Therapy of Adolescents

Family therapy is considered from the systems point of view as a process with a series of stages including definitive beginning and end points. The stages are identified as crisis points in family therapy - i.e., moments in the therapy process when the equilibrium of the family is upset and when stress reactions among family members are most likely to be intense. Since times of crisis also provide special opportunities for growth and change, they can be utilized therapeutically provided the therapist is knowledgeable about the kinds of upheavals that a family may experience and the time sequence in which they may occur. Eight such crisis points and their relation to therapeutic intervention are presented. The purpose of this paper is to outline the role of the crisis as therapeutic opportunity in the course of family therapy.