术野灌注CO2气体在体外循环心脏直视术中脑保护作用的研究

目的:探讨术野灌注CO2气体在体外循环心脏直视术患者中的脑保护作用?方法:2012年6月~2013年3月行体外循环心脏直视术患者97例,随机分为CO2灌注组(Ⅰ组,50例)和对照组(Ⅱ组,47例)?分别于麻醉诱导后5 min(T0)以及主动脉开放后5 min(T1)?1 h(T2)?4 h(T3)和24 h(T4)检测血浆S-100β和神经元特异性烯醇化酶(neuron specific enolase,NSE)水平?两组患者均于手术前及术后第7天采用简易智能状态检查量表(mini-mental state examination,MMSE)评估认知功能?术后认知功能障碍(postoperative cognitive dysfunction,POCD)的诊断以术前测试值为对照,等于或超过1个标准差诊断为POCD?结果:Ⅰ组患者T1~T3时间点的S-100β和T1~T4时间点的NSE水平较T0明显升高(P < 0.05);Ⅱ组患者T1~T4时间点S-100β和NSE水平均较T0明显升高(P < 0.05)?与Ⅱ组比较,Ⅰ组S-100β水平在T1~T4时间点显著降低(P < 0.05),NSE水平在T2~T4时间点也明显降低(P < 0.05)?两组患者中各有2例因病情危重术后第7天无法行MMSE检测,其余患者术后MMSE评分均较术前明显降低(P < 0.05),且Ⅱ组的评分较Ⅰ组降低更明显(P < 0.05)?Ⅰ组术后出现POCD 16例,Ⅱ组为25例,差异有统计学意义(P < 0.05)?结论:术野灌注CO2气体可降低心脏直视术患者术后S-100β和NSE升高的水平,并改善术后早期认知功能,具有脑保护作用,有临床推广价值?     

Object relations couple therapy for a married Korean man with sexual dysfunction

This study uses James Donovan's object relations couple therapy to examine the triangle of focus (conflict style, couple characteristics, and family of origin) and triangle of conflict (anxiety, defence mechanisms, and hidden emotions) of a married Korean man with sexual dysfunction (reduced sexual desire, premature ejaculation, and erectile dysfunction). This qualitative study uses thematic analysis to identify, describe, and analyse a family therapy case study. The aim of this study is to examine the couple's interaction patterns and experiences of conflicts related to the husband's erectile dysfunction. The researchers induced patterns or topics by repeatedly reading and comparing the data. Then, they textualised and analysed the relevant data. To ensure the reliability and validity of the data analysis, the researchers conducted shared coding sessions to review and discuss the initial codes and the generated main themes and subthemes, triangulating the qualitative data. Findings show that a newlywed husband's sexual dysfunction is associated with his emotional resistance towards his wife's unilateral pursuit over their sexual relationship and the negative emotions triggered by their dysfunctional interactions. Further, couple characteristics, conflict style (dysfunctional interactions), and family-of-origin factors (transference and patrilocality) influenced their sexual relationship. Therefore, therapists who counsel Korean couples with sexual issues may pay attention to the sociocultural factors, interactional patterns, and psychological factors associated with unresolved issues with their families of origin.