肋间神经阻滞镇痛在老年人小切口肺叶切除术后的临床观察

评价肋间神经阻滞镇痛在老年人小切口下开胸术后的临床效果。选取60例在胸腔镜辅助下小切口开胸的老年患者,随机分为三组,A、B组在关胸前以0．5％的ropivacain行肋间神经阻滞;B、C组术后均给予fentanyl（0．01mg／ml）静脉自控镇痛（PCIA）。结果直观模拟标度K（VAS）测定术后疼痛,三组患者均达到满意的效果,在血清皮质醇、血氧饱和度和不良反应方面A组与B组差异无显著（P〉O．05）,C组与A、B组差并存在显著性（P〈O．05）。三组患者平均术后住院天数,A、B两组扣C组差异存在显著性（P〈O．05）。肋间神经阻滞镇痛对老年人小切口开胸手术减少术后疼痛和改善预后有较好的临床效果。     

Drug effects: Agonistic and antagonistic processes

The research presented here has shown that tolerance to drugs can be accelerated by conditioning processes. Placebo effects may be considered the opposite of tolerance, and we have shown that placebo effects may be objectively recorded by physiological measures (electromyography, skin conductance responses, and event‐related potentials), as well as by behavioral and subjective methods. The placebo response, or more precisely, the expectation of drug effects, can add to the effect of the drug. Drug antagonistic expectations can also reverse the effect of the drug. There is some evidence that placebo effects are strongest when expectations are reinforced by administration of an active drug. Expectations have graded effects and may affect symptoms to a smaller or larger degree. Although drug effects can be considered stimuli, the investigation of the role of classical conditioning in drug use and drug effects involves special issues that must be carefully considered.     

重症患者的镇痛镇静治疗——理想与现实的渐近

重症患者的镇痛镇静治疗逐渐为广大重症医学医护人员所重视,开展亦日渐普及.首先在实践中发现问题,思考学习产生认识;并借鉴历史经验,少走弯路提高起点;再到实践中验证认识,逐渐发现问题不断改善进步.这一历程印证了在哲学认识论领域常说的＆quot;实践-认识-再实践-再认识,循环往复,以至无穷＆quot;这一规律,临床镇痛镇静治疗的现实与重症医学治病救命的理想逐渐趋近.     

条件位置范式在疼痛研究领域的应用

在疼痛领域,基础研究传统上主要关注疼痛的感觉维度和诱发痛的机制,对疼痛的情绪维度和临床上更常见的自发痛研究较少,这造成了基础研究和临床应用的脱节.条件位置范式的诞生在一定程度上解决了这一问题.条件位置范式是研究药物奖赏和成瘾的经典范式.近10年来,它开始被应用到疼痛研究领域.本文系统总结了目前条件位置范式在疼痛领域的研究进展,主要包括应用条件位置厌恶范式研究疼痛情绪、应用条件位置偏爱范式探索自发痛机制以及进行镇痛药物筛选.最后,结合已有的研究,提出了未来条件位置范式在疼痛领域的应用方向.     

Analyzing the role of culture in shaping American childhood: A twentieth-century case

Widespread beliefs about the nature and functions of children change over time, and affect actual treatment of children within and without the family. Significant changes in beliefs about children developed in the United States from the 1920s onward, with emphasis both on emotional value and on weakness or vulnerability. Increased consumption of expert advice played a key role in this shift, along with cultural translation of new issues concerning child labor and schooling. Key changes occurred in all industrial societies, but American culture generated some distinctive features that continue to show up in the anxieties many parents harbor about children and their effort to intervene on their children's behalf.     

Relation Between Emotional Labor and Organizational Citizenship Behavior: An Investigation Among Chinese Teaching Professionals

This study examined the association between emotional labor and organizational citizenship behavior (OCB) and the mediation of work engagement in this relationship. A total of 264 teachers in Mainland China were recruited for this study. Bivariate correlation showed that both deep acting and the expression of naturally felt emotion were positively related to the two dimensions of OCB, namely, OCB toward the individual (OCBI) and OCB toward the organization (OCBO), whereas surface acting was not related to the OCB dimensions. Work engagement was also positively associated with both OCB dimensions. Regression results showed that work engagement partially mediated the relation between deep acting and OCBO, and that between the expression of naturally felt emotion and OCBI. Work engagement also fully mediated the association between deep acting and OCBI, and that between the expression of naturally felt emotion and OCBO. In light of these findings, strategies that encourage employees to display emotions consistent with their inner experience were discussed.     

The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control

This study sought to track changes in intensity of fear of childbirth and locus of labor pain control in women attending an exercise program for pregnant women or traditional childbirth classes and to identify the predictors of these changes. The study was longitudinal/non-experimental in nature and run on 109 healthy primigravidae aged from 22 to 37, including 62 women participating in an exercise program for pregnant women and 47 women attending traditional childbirth classes. The following assessment tools were used: two scales developed by the present authors – the Fear of Childbirth Scale and the Control of Birth Pain Scale, three standardized psychological inventories for the big five personality traits (NEO Five Factors Inventory), trait anxiety (State–Trait Anxiety Inventory) and dispositional optimism (Life Oriented Test–Revised) and a questionnaire concerning socioeconomic status, health status, activities during pregnancy, relations with partners and expectations about childbirth. Fear of childbirth significantly decreased in women participating in the exercise program for pregnant women but not in women attending traditional childbirth classes. Several significant predictors of post-intervention fear of childbirth emerged: dispositional optimism and self-rated health (negative) and strength of the belief that childbirth pain depends on chance (positive).     

工作压力对中小学教师职业倦怠的影响：情绪劳动和工作满意度的链式中介作用

为探讨中小学教师的工作压力对职业倦怠的影响机制,采用中小学教师职业压力问卷、教师情绪劳动量表、工作满意度量表、教师职业倦怠量表对中小学教师进行调查,共回收有效问卷362份。结果发现,工作压力可以直接影响职业倦怠,也可以通过情绪劳动和工作满意度的链式中介作用影响职业倦怠。本研究揭示了中小学教师工作压力与职业倦怠的关系及其内在机制,研究结果扩展了资源保存理论和工作需求?资源模型,为中小学教师保持良好的工作状态提供了理论参考。     

Negative perfectionism increases the risk of fatigue following a period of stress

Abstract

There is a considerable amount of research concerning (he relationship between psychological variables and the postoperative outcome of surgery. However, little attention has been paid to the potential influence of psychological factors on infra-operative variables, most notably on anaesthetic requirement. The present study investigates the influence of surgery-related trail and slate anxiety as well as of dispositional and surgery-related actual coping on several indicators of intra- and postoperative adjustment. In addition, a possible mediating effect of stress-induced analgesia on the relationships between anxiety, coping, and intraoperative anaesthetic requirements was evaluated. Sixty-one patients undergoing elective lumbar iniclcotomy completed questionnaires regarding anxiety and coping variables one day before surgery. Intraoperative adjustment was assessed by measuring EEG-controlled anaesthetic requirements for induction and maintenance of anaesthesia, β-endorphin plasma concentration was collected preoperatively in the induction room. Postoperative outcome was assessed on the third day after surgery by questionnaires regarding pain experience, physical condition and emotional state. For preoperative anxiety as well as vigilant coping behaviour, there were opposite relationships with subjective measures of adjustment (e.g. self-reported postoperative pain experience), on the one side, and objective measures on the other (e.g., intraoperative anaesthetic requirement). Stress-induced analgesia was found for the subgroup of high-anxious patients. The results indicate that psychological programmes aimed at facilitating patients' perioperative adjustment should consider the different effects of anxiety and coping on subjective and objective measures.