脑干听觉诱发电位在椎-基底动脉供血不足性眩晕患者中的应用

目的:探讨听觉诱发电位(BAEP)检测在椎-基底动脉供血不足性眩晕(VBIV)定性诊断和定位诊断中的应用。方法:对21例伴耳鸣的VBIV患者和47例不伴耳鸣的VBIV患者分别进行BAEP检测,以50例健康志愿者作为对照。结果:3组BAEP的波潜伏期(PL)、波间期(IPL)比较差异有显著性(P<0.05)。病例组各波的PL及IPL均明显长于对照组;耳鸣组Ⅰ波PL明显长于非耳鸣组;耳鸣组Ⅰ、Ⅲ、Ⅴ波PL均显著长于对照组;非耳鸣组Ⅲ、Ⅴ波PL及Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL与对照组之间差异均有显著性。结论:BAEP可作为诊断VBIV的客观电生理指标;BAEP为VBIV的分类及定位诊断提供帮助。     

2型糖尿病患者脑干听觉诱发电位改变及其相关因素分析

[目的]探讨2型糖尿病患者听力损害的特点及与各临床因素之间的关系.[方法]测定132例2型糖尿病患者及40例健康人的脑干听觉诱发电位(BAEP).其中病例组按病程分为病程＜5年(A组)、5年≤病程＜10年(B组)、病程≥10年(C组),分析影响听力的危险因素.[结果]①B、C组的Ⅰ、Ⅲ波的潜伏期(PL),Ⅰ~Ⅲ波的峰间潜伏期(IPL)较对照组明显延长,C组的Ⅰ、Ⅲ波的PL,Ⅰ~Ⅲ波的IPL较A组明显延长( P <0.05),左右耳均无明显差异( P >0.05).②A组BAEP异常12例(26.67%),B组BAEP异常16例(35.56%),C组的BAEP异常28例(66.67%),组间差异有统计学意义( P <0.05).③周围神经病变严重组(病变神经数＞4条)的Ⅰ波的PL、Ⅰ~Ⅴ波的IPL较周围神经病变较轻组(病变神经数≤4条)明显延长( P ＜0.05).④病程、糖化血红蛋白是2型糖尿病患者听力损害的危险因素,病程与BAEP的Ⅰ、Ⅲ波的PL呈正的直线相关关系.[结论]BAEP是检测糖尿病患者听觉功能异常的有效方法,积极进行听力学检测有助于糖尿病患者听力损害的早期诊断和干预治疗.     

经颅多普勒超声和脑干听觉诱发电位在椎-基底动脉供血不足中的临床价值

目的 研究经颅多普勒超声(TCD)和脑干听觉诱发电位(BAEP)在椎-基底动脉供血不足(VBI)中的临床应用价值.方法 采用TCD和BAEP对80例VBI患者和60例健康者进行检查,探测椎动脉(VA)、基底动脉(BA)的血流频谱,通过计算机算出各动脉的收缩期速度(Vp)、平均速度(V m)及血管搏动指数(PI).应用BAEP测量Ⅰ、Ⅲ、Ⅴ波峰潜伏期(PL)和Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间潜伏期(IP L).结果 VBI组LVA、RVA、BA 3条血管Vp及Vm低于正常对照组(P＜0.05).PI值较正常对照组增高(P＜0.05).VBI组Ⅴ波潜伏期,Ⅲ～Ⅴ及Ⅱ～Ⅴ峰间期均较对照组延长(P＜0.05).80例VBI患者中TCD和BAEP均异常者34例,异常发生率为42.5%,与TCD或BAEP异常者比较差异有统计学意义(P＜0.01).对VBI组患者LVA、RVA、BA 3条血管的Vp分别与BAEP的V波潜伏期和Ⅰ～Ⅴ峰间期进行相关分析显示存在负相关(P＜0.05),即流速越低则潜伏期越长.结论 TCD和BAEP分别从血流动力学和电生理学两个方面反映了脑干的供血及神经传导情况,是诊断VBI的两种可靠的辅助检查,对VBI的诊断具有一定的临床应用价值.     

脑干听觉诱发电位在轻中型颅脑损伤患者评估中的应用

目的 :探讨脑干听觉诱发电位 (BAEP)对轻中型颅脑损伤患者脑干功能及预后的评估价值。方法 :对 36例轻中型颅脑损伤患者康复治疗前及治疗 1个月后行BAEP检测并行Fugl-Meyer运动功能评定。 3个月后随访 ,行脑外伤后综合征的临床测试。比较BAEP与CT检查结果 ,对照分析BAEP对脑干功能损伤的评估以及与预后的关系。结果 :36例轻中型颅脑损伤患者治疗前BAEP异常率为 77.8% ,高于CT异常率 4 4 .4 % (P <0 .0 5 )。BAEP异常表现主要为 :Ⅲ—Ⅴ /Ⅰ—Ⅲ >1、Ⅲ—Ⅴ及Ⅰ—Ⅴ峰间潜伏期 (IPL)的延长。与对照组相比 ,疾病组治疗前BAEP的Ⅴ波潜伏期 (PL)、Ⅲ—ⅤIPL、Ⅰ—ⅤIPL峰间潜伏期明显延长且Ⅲ—Ⅴ /Ⅰ—Ⅲ比值增大 (P <0 .0 5 ) ,治疗后有改善 ,但仍高于正常。治疗前BAEP异常患者的运动功能评分明显低于BAEP正常的患者 (P <0 .0 5 )。 3个月后的随访发现BAEP检测异常患者的脑外伤后综合征发生率高于BAEP正常的患者 (P <0 .0 5 )。结论 :BAEP能反映轻中型颅脑损伤患者脑干功能情况 ,可为预后判断及疗效评估提供依据。     

脑干听觉诱发电位在儿童脑外伤后综合征诊断中的应用

[目的]探讨脑干听觉诱发电位（BAEP）对儿童脑外伤后综合征（PTBS）诊断价值.[方法]对照分析24例PTBS患儿与24例正常儿童的BAEP的Ⅰ、Ⅲ、Ⅴ波峰潜伏期（PL）,Ⅰ~Ⅲ、Ⅲ~Ⅴ峰间潜伏期（IPL）的差异.[结果]PTBS患儿BAEPⅠ波PL与对照组相比差异无显著意义（P〉0.05）.BAEP其他波PL及IPL均延长,与对照组有显著差异（P＜0.05）.[结论]BAEP筛查有助于PTBS患儿的早期发现.     

脑干损伤病人的脑干反射和脑干听觉诱发电位研究

目的 :探讨脑干反射 (BSR)和脑干听觉诱发电位 (BAEP)在观察脑干损伤病人的病情变化、判断预后方面的价值。方法 :对 70例脑干损伤病人同时进行BSR、BAEP监测。分析BSR、BAEP与格拉斯哥昏迷计分 (GCS)、格拉斯哥预后分级 (GOS)之间的关系以及 2 5例临终状态时BSR、BAEP情况 ,同时研究早期脑疝病人的BAEP变化。结果 :BSR、BAEP与病人的GCS、GOS密切相关 ,BSR平面越低 ,病情越重 ,预后越差 ;BAEP异常程度与病情轻重基本一致 ,双侧或一侧Ⅰ、Ⅲ、Ⅴ波平坦 ,提示预后不佳。脑死亡者绝大多数BSR属Ⅵ平面 ,BAEP双侧各波呈电平坦。脑疝早期BAEP主要表现为一侧波Ⅴ消失或波Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜时 (IPL)延长。结论 :BSR、BAEP可用来观察病情、判断预后 ,可作为脑死亡的诊断标准之一 ,BAEP有助于早期发现脑疝 ,指导治疗     

脑出血患者的脑干听觉诱发电位与预后的关系

目的:探讨脑干听觉诱发电位(BAEP)在脑出血患者中的应用价值。方法:对50例脑出血患者在发病3d内行脑干听觉诱发电位检测,并行健、患侧Ⅰ、Ⅲ、Ⅴ波潜伏期及波间期比较,并观察其预后。结果:脑出血患者健患侧Ⅴ波潜伏期及Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期有明显差异。患者患侧V波潜伏期及Ⅲ～Ⅴ波间期与美国国立卫生研究院卒中量表(NIHSS)评分有相关性。结论:BAEP在脑干出血的定位及定侧上有一定临床参考意义,可用于脑出血患者病情严重程度及预后的判断。     

糖尿病脑干听觉诱发电位分析

目的探讨脑干听觉诱发电位(BAEP)对糖尿病患者脑干功能损害的评定价值。方法对30例临床诊断为2型糖尿病的患者进行BAEP检测,并与20例正常组进行对照分析。结果糖尿病患者BAEP的异常率为63.33%,并与其病程呈正相关,但与血糖浓度无相关性。其中Ⅲ、Ⅴ波潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间期(IPL)较正常组延长,Ⅲ、Ⅴ波波幅降低,均有显著性差异(P<0.05)。结论BAEP对糖尿病脑干亚临床功能异常的诊断有重要意义。     

基底动脉系统梗死3例早期静脉尿激酶溶栓治疗价值分析

早期溶栓治疗是近年来研究急性脑梗死的一个热点。基底动脉系统梗死具有病情重、进展快、早期即合并意识障碍、预后差的特点，尽管采用抗凝和抗血小板等治疗，但如果不能使梗死的血管再通，85％。95％的患者仍不能避免死亡，存活者中，植物状态的比例也相当高，一直是临床治疗的难点。以往脑梗死的溶栓中一直把意识障碍作为相对禁忌证，所以对基底动脉系统梗死较少采用溶栓治疗。近来很多学者尝试在基底动脉系统梗死急性期采用不同的方法进行血管再通治疗．降低了此病的死亡率。     

瞬目反射联合脑干听觉诱发电位检查在后循环缺血诊断中的应用

目的探讨瞬目反射(BR)联合脑干听觉诱发电位(BAEP)检查在后循环缺血(PCI)诊断中的应用价值。方法选取71例PCI患者为PCI组,包括后循环短暂性脑缺血发作(TIA)48例和后循环梗死23例。另选取同期健康体检者40例为对照组。2组均行BR和BAEP检查,对比2组相关电生理指标。结果 1 PCI组中,53例(74.6%)BR检测异常,后循环TIA和后循环梗死患者R1、R2、R2'波潜伏期均显著长于对照组(P0.01),但两者间各波潜伏期差异无统计学意义(P0.05)。2 PCI组中,50例(70.4%)BAEP异常,后循环TIA和后循环梗死患者Ⅰ、Ⅲ、Ⅴ波PL和Ⅰ~Ⅲ、Ⅲ~Ⅴ、Ⅰ~Ⅴ波IPL均较对照组显著延长(P0.01),但两者间差异无统计学意义(P0.05)。3联合检测异常61例(85.9%),高于BR或BAEP单独检测,但差异无统计学意义(P0.05)。结论 BR和BAEP均能反映PCI患者脑干供血情况,两者联合检测对PCI早期诊断和脑损伤区定位有重要的参考价值。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Voluntary breath-holding in the morning and in the evening

The aim of the present study was to determine whether or not voluntary breath-holding time (BHT) changes with the time of the day. BHT with airways closed at end-expiration was measured in six male subjects in the sitting position during the morning (08.00-12.00 hours, on days 1, 6, 7 and 8) and evening (20.00-24.00 hours, on days 2 and 4). BHT increased with the number of days of testing and, at day 8, the morning values averaged 160% of those on day 1. Also, Delta P ACO2 [the difference between end-tidal partial pressure of CO2 ( P CO2) and alveolar P CO2 ( P ACO2) at the breaking point] increased in proportion to BHT. Hence the BHT/Delta P ACO2 ratio remained nearly constant. Voluntary hyperventilation prolonged BHT and increased Delta P ACO2. Conversely, in hypoxia (13% O2 for 1-2 h), BHT and Delta P ACO2 were reduced proportionally. During the evening sessions, most of the BHT/Delta P ACO2 ratios in normoxia, hypoxia or after hyperventilation were higher than the corresponding morning values, with the group difference reaching statistical significance for the measurements in normoxia and hypoxia. In conclusion, voluntary BHT varies in both duration and its relationship with Delta P ACO2 between the morning and evening hours. The results should also imply that, with an interruption of breathing, changes in alveolar and arterial gases are not the same at different times of the day.     

On the Mechanism of the Splay in the Glucose Titration Curve in Advanced Experimental Renal Disease in the Rat

Glucose titration studies were performed in rats with unilateral chronic pyelonephritis before and after removal of the contralateral control kidneys. Identical studies were performed in animals with unilateral partial renal infarction in which the experimental kidneys had a marked reduction in nephron population but no anatomic deformation in the surviving nephrons. In the initial studies, both groups of animals were free of clinical and chemical abnormalities of uremia. In the follow-up studies uremic abnormalities were present. Minimal splay was observed in the titration curves in the initial studies; marked splay was present in the group data from the same kidneys in the subsequent studies. Thus a marked reduction in the nephron population was associated with the evolution of splay in both groups of animals. In association with the increase in splay, the mean values for maximal glucose transport increased; thus a defect in glucose transport can be excluded as the basis of the splay. Glomerular filtration rate increased proportionately more than the maximal transport of glucose; hence the ratios of glomerular filtration rate to maximal glucose transport increased consistently. The possibility of asymmetric hypertrophy of glomerular and tubular functions among the nephron population imposed by scar tissue or other anatomic deformities was considered, but the results in the animals with partially infarcted kidneys militate against this explanation. The splay also could reflect an asymmetric alteration in the distribution of glomerulotubular balance among the residual units initiated by functional adaptations. Finally, the splay could relate to an alteration in the kinetics of glucose transport without any change in the level of functional homogeneity. The possible nature of these has been considered in the text.