恶性综合征临床特征与护理干预

恶性综合征是1960年法国医生Delay首次报道,临床主要表现为应用抗精神病药物后出现的持续高热、肌肉僵硬、意识障碍、植物神经紊乱和心血管系统等症状,是精神科、急诊科遇到的一种罕见的并发症,死亡率高达20%-30%[1].早期识别、早期治疗是减少恶性综合征死亡率的关键,为提高诊治和护理水平,现将我们收治的12例恶性综合征的情况报导如下.     

恶性综合征临床误诊分析

目的探讨恶性综合征误诊原因及防范措施。方法在中国知网中国期刊全文数据库、中国科技期刊全文数据库及万方数据库检索并搜集恶性综合征55例,加上我科收治的1例,回顾性分析其临床资料。结果典型及非典型抗精神病药物均有引起恶性综合征的风险,最常见药物为奥氮平、利培酮,其次为氯氮平。13例无药物变动,43例存在药物调整。43例调整药物后出现恶性综合征时间为1 d～6个月,13例无药物变动出现恶性综合征时间为6.5个月～3年。临床常见表现为发热、肌强直和意识障碍,分别占89.29%、71.43%及60.07%。30例首诊误诊,误诊时间为3 d～1个月,平均8.5 d,误诊为感染性疾病15例,误诊为精神疾病加重6例,误诊为脑血管病3例,误诊为药物性肝损伤、横纹肌溶解、癫痫发作各2例,误诊率53.57%。所有患者均依据Levenson恶性综合征诊断标准确诊为恶性综合征,52例停用当前抗精神病药物,4例停用多巴丝肼再度加用多巴丝肼,12例给予溴隐亭,6例给予左旋多巴,5例进行血液透析,6例进行有创机械通气,同时给予抗感染治疗29例。6例死亡,病死率10.71%。结论恶性综合征临床罕见且病死率高,涉及药物广泛,临床表现无特异性,误漏诊率高,早期诊断并及时干预是改善预后的关键。     

4例恶性综合征的观察与护理

恶性综合征常在应用高效价抗精神病药物尤其是联合用药过程中发生,以高热、意识障碍、肌肉强直、植物神经功能紊乱等为主要临床表现.对恶性综合征重视高热、意识障碍、肌肉强直等针对性护理及必要的基础护理,尤其要加强病情观察,早期识别是治疗恶性综合征的关键.通过治疗和护理,本组4例患者均康复出院.     

抗精神病药物所致恶性症状群的早期发现及护理

抗精神病药物所致的恶性综合征(NMS)是抗精神病药物最严重的不良反应。这种不良反应死亡率高,严重威胁着患者的生命安全。因此,早期发现NMS的危险因素及做好NMS患者的护理,成为一个迫切解决的问题。为了早期发现NMS的患者,1998年5月-2003年5月本研究对住院患者中发生NMS的8例患     

神经病与精神病护理

的1947恶性综合征的观察与护理:附3例报告/李洪 荣…//黑龙江护理杂志一1999,5(8)一22 恶性综合征(MNs)是指抗精神病药物所致的一种少见而又危险的并发症。由于病人不能主诉,反应迟钝,应及时观察生命体征并详细记录,为临床医生及时准确地判断病情提供依据。发热是MNS主要症状之     

抗精神病药物致恶性综合征的临床分析及护理

恶性综合征是由抗精神病药物所致的一种少见、严重而危险的并发症。最早由法国医生Delay在1960年报道，无特效治疗方法，如不及时处理可导致死亡。死亡原因是高热性脑水肿、抽搐持续状态、缺氧、继发感染、心功能紊乱等。有效的治疗与护理对防止并发症，患者是否完全康复，起着决定性的作用。为了提高护理质量，对1998年12月-2002年12月在本院住院的32例使用抗精神病药物所致恶性综合征患者进行了临床分析，针对其临床特征，给予了针对性的精心护理，从而大大促进了治疗效果，现报告如下。     

尿毒症伴恶性抗精神病药综合征1例临床护理

恶性抗精神病药综合征是因服用抗精神病药诱发的致命性综合征,临床以高热、肌肉强直、意识障碍、椎体外症状和自主神经功能紊乱为特征[1].2010年4月,我们收治1例尿毒症伴恶性抗精神病药综合征患者,给予腹膜透析及精心护理,效果满意.现报告如下.     

抗精神病药物致恶性综合征的临床分析及护理

恶性综合征是由抗精神病药物所致的一种少见、严重而危险的并发症。最早由法国医生Delay在1960年报道,无特效治疗方法,如不及时处理可导致死亡[1]。死亡原因是高热性脑水肿、抽搐持续状态、缺氧、继发感染、心功能紊乱等。有效的治疗与护理对防止并发症,患者是否完全康复,起着决定性的作用。为了提高护理质量,对1998年12月~2002年12月在本院住院的32例使用抗精神病药物所致恶性综合征患者进行了临床分析,针对其临床特征,给予了针对性的精心护理,从而大大促进了治疗效果,现报告如下。临床资料一、一般资料1998年12月~2002年12月,在本院住院…     

抗精神障碍药物致恶性综合征患者1例护理

恶性综合征（Neuroleptie Malignant Syndrome，NMS）是一种罕见但可致命的不良反应，几乎所有的抗精神病药物都可引起。通常由服用抗精神病药诱发，临床以高热、肌肉强直、意识障碍、椎体外症状和自主神经功能紊乱为特征，实验室检查结果是血肌酸激酶升高和白细胞增多。如未及时处理，会导致死亡。我科于2009年9月29日收治1例恶性综合征患者。经积极治疗和护理，病情好转，现将护理及体会报道如下。     

1例恶性综合征患者的护理

正恶性综合征是精神病患者服用抗精神病药物引起的严重并发症。于1968年由法国医生Delay首先提出,临床表现以高热、意识障碍、肌强直、木僵、缄默同时伴有多种自主神经障碍(出汗、心动过速)为主要特征的一组综合征。通常辅助检查无特异性,主要表现为白细胞升高、血清肌酸磷酸肌酶升高。其疾病特点为来势凶险、漏诊误诊率高、潜在死亡率高。现就本科对1例恶性综合征患者进行的治疗及护理报道如下:     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.