目的 探讨精神分裂症患者载脂蛋白E基因多态性与血清ApoE浓度、血脂、心血管疾病发生风险的相关性。方法 收集住院精神分裂症患者116例,记录一般资料和测定患者载脂蛋白E基因(APOE)、载脂蛋白E(ApoE)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、心血管疾病发生风险评分(Framingham risk score,FRS)等指标。结果 ①APOEε2、ε3、ε4不同等位基因组精神分裂症患者TC、载脂蛋白E、FRS评分差异有统计学意义(P=0.01,P=0.005,P=0.012)。②载脂蛋白E与TC、FRS评分存在负相关关系(r_s=-0.48,P=0.02;r_s=-0.52,P=0.04),APOE ε4等位基因组载脂蛋白E与TC、FRS评分存在更高的相关关系(r_s=-0.55,P<0.001;r_s=-0.63,P=0.04)。结论 精神分裂症患者ApoE基因多态性与载脂蛋白E、胆固醇、FRS评分存在关联,ApoE基因-载脂蛋白E-胆固醇代谢通路可能是精神分裂症患者心血管疾病的致病机制之一。

目的 探讨医院-社区-家庭一体化管理在精神分裂症患者中的应用效果。方法 选择我院2018年6月—2019年6月期间收治的精神分裂症患者86例,按随机数字表法分为两组,每组43例。对照组采取常规护理管理,研究组实施医院-社区-家庭一体化管理,观察6个月。比较两组精神症状、生活质量及肇事肇祸率。结果 两组管理前阳性与阴性症状量表(PANSS)评分、WHOQOL-100评分比较,差异无统计学意义(P＞0.05);两组管理后PANSS评分均低于管理前,生存质量测定量表简表(QOL-BREF)评分高于管理前,差异有统计学意义(P＜0.05);研究组管理后PANSS评分为(43.23±8.11)分,低于对照组的(49.48±8.26)分,WHOQOL-100评分为(83.69±8.87)分,高于对照组的(77.25±8.54)分,差异有统计学意义(P＜0.05);研究组肇事肇祸率为9.30%,低于对照组的25.58%,差异有统计学意义(P＜0.05)。结论 医院-社区-家庭一体化管理的实施能够减轻精神分裂症患者精神症状,提升生活质量,降低肇事肇祸率。

Objective To explore the applications of hospital community family integrated management on the quality of life and accident rate of schizophrenics. Methods 86 schizophrenics admitted to our hospital from June 2018 to June 2019 were divided into two groups according to the method of random number table, 43 cases in each group. Routine nursing management was adopted in the control group and hospital community family integrated management was implemented in the study group for 6 months. The mental symptoms, quality of life and accident rate were compared between the two groups. ResultsThere was no statistical significance in PANSS score and WHOQOL-100 score between the two groups before management (P>0.05); PANSS score of the two groups after management was lower than that before management, QOL-BREF score was higher than that before management, and the difference was statistically significant (P<0.05); PANSS score of the study group after management was (43.23±8.11), lower than that of the control group (49.48±8.26), WHOQOL-100 score was (83.69±8.87), higher than the control group (77.25±8.54), the difference was statistically significant (P<0.05); the study groupls accident rate was 9.30%, lower than that of the control group 25.58%, the difference was statistically significant (P<0.05). Conclusion The implementation of hospital community family integrated management reduces the mental symptoms of schizophrenics, improve the quality of life, and reduce the accident rate.

目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。

目的 对江门市新会区会城街道的严重精神障碍患者监护人进行守护APP干预并评价干预效果影响。方法 以会城街道辖区内登记在国家精神障碍信息系统1 488在册精神障碍患者作为研究对象,随机抽取分为安装守护APP组1 084例和无安装守护APP组404例。安装组通过监护人使用守护APP实现责任医生对患者进行动态监护和实时监护,提供免费咨询、心理干预、服药指导及随访管理服务;无安装组采用常规随访康复管理措施干预。干预满一年后对比分析两组患者康复措施落实情况、服药依从性（治疗率）、病情及社交改善情况、复发住院率、肇事肇祸率及家属疾病知识知晓情况等指标。结果 安装守护App组患者服药依从性（治疗率）及康复措施落实率高于无安装组,家属对精神疾病知识知晓良好率较高;干预后安装组患者的SCL-90评分及心理社交功能评估表评分改善情况优于无安装组,复发住院率和肇事肇祸率明显较低,以上差异均有统计学意义。结论 守护APP平台帮助医生与监护人把严重精神障碍患者的监护工作真正落到实处,康复效果优于传统的康复方法,值得进一步推广应用。

Objective Guardianship APP intervention was conducted for the guardians of severe mental disorders in Huicheng,Xinhui district,Jiangmen city and the effect of intervention was evaluated. Methods 1 488 psychiatric patients in the unit area were taken as the research objects,which were randomly divided into the guardian APP installation group of 1084 cases and the non - installation group of 404 cases. The installation group uses guardian APP to realize the dynamic guardianship and real-time monitoring of the patients,and we provided free charge consultation,psychological intervention,medication guide,case tracking and follow-up management services. The non installation group adopted the routine rehabilitation management measures after discharge. After a year the implementation of rehabilitation measures,compliance,condition and social improvement,relapse rate of hospitalization,accident rate and knowledge of family disease between the two groups of patients were compared and analyzed. Results The compliance and rehabilitation measures of the patients in the App group were higher than those in the non installation group. The rate of knowledge about mental illness was higher in family members,and the improvement of SCL-90 score and psychosocial function assessment score after intervention was better than that of non installation group. The rate of relapse hospitalization and cause trouble were lower. The differences above were statistically significant. Conclusion The guardian APP platform helps doctors and guardians to make the monitoring work of patients with severe mental disorder really practical,and the rehabilitation effect is better than the traditional rehabilitation method,which is worthy of further promotion and application.

目的 观察轻性精神疾病患者对不同躯体疾病患者病情的影响,为临床轻性精神疾病合并躯体疾病患者的诊治提供参考。方法 选择我院门诊于2015年3月—2016年3月期间诊治的124例轻性精神疾病合并躯体疾病患者作为研究对象,设为观察组。选择同期诊治的124例不伴有精神疾病的躯体疾病患者设为对照组。两组患者分别根据患者实际情况采用精神疾病和合并躯体疾病临床诊疗指南进行治疗,并按照孙传兴编著的临床疾病诊断依据治愈好转标准(第二版)判断治疗预后。比较两组患者中不同躯体疾病患者的治愈率、好转率、复发率。结果 对照组和观察组患者的年龄、性别、文化背景、躯体疾病类型比较差异无统计学意义(P>0.05)。两组患者经过临床规范治疗后,观察组患者不同躯体疾病治愈率和好转率与对照组相同躯体疾病患者比较,差异无统计学意义(P>0.05),但观察组患者所有类型躯体疾病患者的复发率均明显高于对照组同类躯体疾病患者,组间比较差异有统计学意义(P<0.05)。治疗结束后至随访期间,观察组患者完全遵医率明显低于对照组,组间比较差异有统计学意义(P＜0.05)。结论 轻性精神疾病患者的躯体疾病病情进展和单纯躯体疾病患者之间存在差异,临床医护人员在诊治轻性精神疾病合并躯体疾病患者时,应重视精神疾病对躯体疾病的影响,酌情调整治疗方案,确保患者预后良好。

Objective To observe the effect of mild mental illness on the condition of patients with physical diseases, to provide reference for clinical diagnosis and treatment. Methods We selected 124 cases of patients with mild mental illness combined with physical diseases in our hospital from March 2015 to March 2016 as the research objects, and set up as the observation group. 124 patients with physical diseases but without mental illness were selected as the control group. Based on the actual situation of patients in the two groups, clinical guidelines of mental disorders and physical diseases were adopted to the treatment, and according to the clinical disease diagnosis based on cure and improvement standard edited by Sun Chuanxing (Second Edition), we judged the prognosis conditions. And then the cure rate, improvement rate and recurrence rate were compared between the two groups of patients with physical diseases. Results There were no significant differences in age, sex, culture background, and physical disease types in the control group and the observation group (P>0.05). After the clinical standard treatment, compared with patients with the same physical diseases in the control groups, it had no statistically differences in cure rate and improvement rate of the patients with different physical diseases (P>0.05), but all types of physical disease recurrence rate of patients in the observation group was significantly higher than that of the control group, there was statistically difference between the two groups(P<0.05). After the end of treatment to the follow-up period, the rate of patients' completely following the medical treatment in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P< 0.05). Conclusion There is progressive difference between patients with mild mental illness combined with physical diseases and patients with only physical diseases. When the clinical medical personnel are faced with the diagnosis and treatment of patients with mild mental illness combined with physical diseases, they should pay attention to the impact of mental illness on the physical diseases, and adjust the treatment plan appropriately in order to ensure a good prognosis of patients.

目的 探讨精神科急救培训用护士作为标准化病人的培养方法。方法 2013年9月挑选了4名精神科护士参加标准化病人系统培训,考核合格后成为护士标准化病人在2013年10月—11月对30名新护士自缢、噎食急救培训和考核中使用。结果 对急救培训中使用护士标准化病人,30名新护士中认为“新颖,第一次接触”19人(63%)、“满意”的26人(87%);4名作为标准化病人的护士都认为“非常有意义”。结论 精神科急救培训应用护士标准化病人丰富了培训的形式和内涵,得到了绝大部分参与人员的肯定。

Objective To explore the methods of training nurses as standardized patients for psychiatric first aid. Methods 4 nurses were selected to participate in the psychiatric standardized patient training program and all passed the examination. Using these nurse standardized patients to train the 30 new nurses for psychiatric first aid. Results After the first aid training, 19 of the 30 new nurses(63%) felt that it was “novelty and interesting”. 26 nurses(87%) felt “being satisfied”. And those 4 standardized patients felt “very meaningful”. Conclusion Training and application of nurses as standardized patients for psychiatric first aid may enrich the form and content of training program, and gains most of the participants affirmation.

目的 探索利伯曼康复治疗对慢性精神分裂症患者社会功能的影响。方法 选取长期住院的慢性精神分裂症患者130例,随机分为研究组65例和对照组65例,研究组实施利伯曼康复治疗,在康复训练前与训练后的第1、3月末分别采用护士用住院病人观察量表(NOSIE)和住院精神病人康复疗效评定量表(IPROS)对患者进行评价。结果 患者通过利伯曼康复治疗后,NOSIE量表总积极分、社会能力、社会兴趣、个人整洁等得分有明显提高;IPROS量表的工疗情况生活能力社交能力讲究卫生能力都有较明显的提高(T、P<0.01)。结论 利伯曼康复治疗对患者的社会功能的改善有积极的意义。

Objective To explore the impacts of Lieberman rehabilitation technique on chronic schizophrenic patient's quality of life. Methods 130 patients diagnosed with chronic schizophrenia with over 5-year long hospitalization were divided into two groups randomly, with 65 samples at either study group or control group. Team to implement a lieberman rehabilitation. NOSIE and IPROS were used by nurse to assess the performance of all samples in one month after the beginning of the study and three months after the beginning study. Results After intervention, the performance of samples in study group indicated that patients had significantly higher score in NOSIE total score, social ability, social interest, individual tidiness. Patient's total negative points including irritability, mental performance, retardation and depression were decreased. IPROS living ability and social ability has improved significantly(P≤0.01). Conclusion Lieberman rehabilitation technique can improve patients'social function.

目的 探讨改良型音乐治疗对慢性精神分裂症患者临床康复效果的影响。方法 选取2010年4月—10月在我院住院的病情稳定的慢性精神分裂症患者76例,随机分为研究组和对照组各38例,两组患者在同等环境下维持原来的药物治疗和护理,研究组同时予以改良型音乐治疗,观察6个月,采用护士用住院病人观察量表(NOSIE)对两组进行评估。结果 两组经过治疗后,NOSIE各项因子分均较前有明显提高,差异有统计学意义;研究组 NOSIE总积极分、社会能力、社会兴趣、个人整洁等得分较对照组有明显提高,差异有统计学意义;总消极分激惹、精神病表现、迟缓、抑郁较对照组有较明显降低,差异统计学意义。结论 改良型音乐治疗,对慢性精神分裂症患者的临床康复有积极的促进作用。

Objective To explore the effect of modified music therapy on the rehabilitation of patients with chronic schizophrenia. Methods 76 patients with chronic schizophrenia who were hospitalized in our hospital from October to April of 2010 were randomly divided into study group and control group (38 cases). The patients in the two groups were treated with the same environment. The research group was treated with modified music. The two groups were evaluated by using the observation scale (NOSIE). Results Two groups after treatment, the NOSIE of the factors were significantly improved, the difference was statistically significant; the study group NOSIE total score, social ability, social interest, personal cleanliness, etc, compared with the control group were significantly improved. The difference was statistically significant; the total negative score, mental disease, depression, and the control group were significantly lower than the control group, the difference was statistically significant. Conclusion Modified music therapy has a positive effect on the rehabilitation of patients with chronic schizophrenia.

目的 探索协助式农疗对慢性精神分裂症患者社会功能的影响。方法 选取住院5年以上的慢性精神分裂症患者64例,随机分为研究组32例和对照组32例,实施室外农艺园艺方面的职业康复训练,并实行协助式管理新模式,康复训练前与训练后的第1、3、6月末分别采用护士用住院病人观察量表(NOSIE)对患者进行评价。结果 患者通过协助式农疗后,NOSIE总积极分、社会能力、社会兴趣、个人整洁等得分有明显提高,有统计学意义;总消极分激惹、精神病表现、迟缓、抑郁出现降低,有统计学意义。结论 慢性精神病患者在工作人员协助下参加农艺和园艺技术培训治疗,其症状和社会功能有较显著的改善。

Objective To explore the impact of assisted farming and gardening therapy on social function of patients with chronic schizophrenia. Methods 64 patients with chronic schizophrenia were randomly and equally divided into research group and control group, with 32 cases implemented outdoor farming and gardening vocational rehabilitation training in new management mode. Observe scale evaluation (NOSIE) was applied to assess the patients at the time before the training, one month after the training, three month after the training, and six month after the training. Results Patients received assisted farming therapy scored higher in total positive points, social ability, social interest, individual tidy. The difference was statistically significant. The scores of total negative points irritability, mental performance, slow, depression had reduced with statistical significance. Conclusion Assisted farming and gardening therapy can relieve patients' symptoms and improve patients' function.