事件相关电位P300评估阿尔茨海默病患者认知功能障碍程度以及对老年精神分裂症的鉴别作用

目的：探讨阿尔茨海默病与老年精神分裂症患者P300的差异及P300在阿尔茨海默病患者认知功能障碍严重程度判断中的价值。方法：采用电生理技术检测2000-12／2003-12山东省精神卫生中心住院及门诊阿尔茨海默病患者38例及老年精神分裂症患者40例的P300。应用简明精神状态量表评定阿尔茨海默病患者的认知功能。结果：阿尔茨海默病患者P300检测结果中在Fz[(402．50&;#177;3．77)ms]、Cz[(425．81&;#177;1．90)ms]和Pz[(366．31&;#177;1．61)ms]3点P300潜伏期与老年精神分裂症患者相比均明显延长，差异有显著性(t=4．23，2．79．4．56；P均&;lt;0．01)；在Fz[(5．05&;#177;0．65)μV]、Cz[(3．93&;#177;0．56μV]和Pz[(7．97&;#177;0．73)μV]3点波幅明显减低，与老年精神分裂症患者比较，差异有显著性(t=4．02，3．75，2．85；P均&;lt;0．01)。阿尔茨海默病患者P300在Fz，Cz及Pz3点潜伏期与简明精神状态量表分数显著负相关(r=-0．78，-0．76，-0．77．P均&;lt;0．01)；在Fz，Cz及Pz3点波幅与简明精神状态量表分数显著正相关(r=0．77，0．78，0．75；P均&;lt;0．01)。结论：阿尔茨海默病患者P300在Fz、Cz与Pz3点潜伏期延长及波峰减低的现象与老年精神分裂症患者的差异以及与简明精神状态量表分数的关系，有助于对阿尔茨海默病患者认知功能受损程度的判断。     

事件相关电位对短暂性脑缺血发作患者认知功能的评估

目的:对短暂性脑缺血发作患者的事件相关电位进行研究,以发现短暂性脑缺血发作是否对患者的认知功能有影响。方法:2002-12/2003-12解放军北京军区总医院干部病房收治短暂性脑缺血发作患者28例,年龄42～81岁;年龄、性别及受教育程度匹配的对照组28例。应用经典的Oddball刺激模式,对所有受试者进行P300的测试。结果:病例组P300的潜伏期较对照组延长犤Fz:(363.6±39.2)ms,Cz:(355.0±41.5)ms,Pz:(357.0±42.0)ms,P<0.01犦,波幅降低犤Fz:(3.0±1.7)μV,Cz:(2.8±1.6)μV,Pz:(3.3±1.5)μV,P<0.05犦。结论:短暂性脑缺血发作对患者的认知功能是有一定影响的。     

军人创伤后应激障碍患者脑诱发电位的3种变异

目的:探讨军人创伤后应激障碍(post-traumaticstressdisorder,PTSD)患者3种脑诱发电位(brainevokedpotential,BEP)的变异。方法:应用美国NicoletBravo型脑诱发电位仪,采用光、声刺激和Click短声刺激,检测75例PTSD患者(研究组)和46名健康军人(对照组)的视觉诱发电位(visualevokedpotential,VEP)、听觉诱发电位(auditoryevokedpotential,AEP)和脑干听觉反应(auditorybrainstemresponse,ABR)。结果:①VEP:Cz脑区的P2波幅研究组低于对照组犤(4.4±4.1)和(9.0±5.2)μV,t=5.40,P<0.01犦,Pz脑区的P3波幅研究组低于对照组犤(5.1±4.0)和(8.1±4.5)μV,t=3.82,P<0.01犦。②AEP:Oz脑区的P3潜伏期研究组长于对照组犤(330.2±30.7)和(298.1±27.4)ms,t=5.81,P<0.01犦,Cz脑区的P2波幅研究组低于对照组犤(2.8±1.7)和(4.5±1.8)μV,t=5.22,P<0.01犦,Cz脑区的P3波幅研究组高于对照组犤(4.2±2.1)和(2.2±1.0)μV,t=6.05,P<0.01犦。③ABR:Pz脑区的波Ⅴ绝对潜伏期研究组长于对照组犤(5.8±0.3)和(5.4±0.2)ms,t=8.01,P<0.01犦,Oz脑区的波Ⅴ绝对潜伏期研究组短于对照组犤(6.4±0.3)和(6.9±0.3)ms,t=8.90,P<0.01犦。Pz脑区的波Ⅳ绝对波幅研究组低于对照组犤(0.24±0.12)和(0.40±0.10)μV,t=7.57,P<0.01犦,Oz脑区的波Ⅱ绝     

老年期抑郁症患者认知功能损害与听觉诱发电位P300的特征变化

目的:探讨反映老年期抑郁症患者认知功能损害的客观指标听觉诱发电位P300的特征。方法:应用配对设计,对2002-02/2003-12河南省精神病医院经老年认知功能量表筛查的58例老年期抑郁症患者(实验组)及58例正常老年人(对照组)采用意大利产安培MK-15诱发电位系统完成听觉P300检测。针状电极产自丹麦ECI公司。电极位置参照国际脑电图学会10/20标准,记录电极置于中央中线Cz点,参考电极置于右耳M2点,前额FPz点接地,电极间阻抗小于5kΩ,分析时间为1000ms。被检者接受双耳的短音刺激,刺激频率为1次/s,刺激持续时间10ms,灵敏度为5μV,带通低频滤波0.1Hz,高频滤波50Hz,叠加200次。采用两套触发和刺激系统、两个完全独立的时间窗口来进行听觉诱发电位P300检测。非靶刺激(NT)强度为85dB,频率为1000Hz,占80%。靶刺激(T)频率为2000Hz,强度为95dB,随机出现,串插在非靶刺激中,占20%。两者次序关系的范例如下:NTNTNTTNTNTNTNTTTNTNTNTNTNTTNTNTNT。受试者对靶刺激作按键反应,每例重复2次,取平均值。在听觉诱发电位P300检查的当日,采用汉密顿抑郁量表及老年认知功能量表分别评价抑郁情绪及认知功能。主要观察靶刺激时听觉诱发电位P300的成分N1,P2,N2,P3潜伏期及波幅和反应时间。N2,P2为内源性成分,N1,P2为外源性成分,N2,P3为潜伏期及反应时间代表大脑皮质的觉醒态度,大脑激活水平或兴奋性水平。P2,P3的波幅与注意、记忆有关,即与认知资源容量及对认知资源容量的分配能力有关。应用配对样本t检验及直线相关分析进行数据处理。结果:两组各58例均进入结果分析。①靶刺激实验组P2,N2,P3潜伏期比对照组明显延长犤P2(205±32),(184±29)ms,t=3.266,P<0.01;N2(281±26),(230±24)ms,t=4.054,P<0.01;P3(358±19),(321±17)ms,t=9.767,P<0.01犦。P2,P3波幅比对照组明显降低犤P2(2.51±1.49),(3.39±2.09)μV,t=3.101,P<0.01;P3(2.03±1.53),(8.09±1.28)μV,t=3.496,P<0.01犦。实验组反应时间比对照组明显延长犤(475±62),(330±45)ms,t=12.878,P<0.01犦。②女性抑郁组P3潜伏期及反应时间比男性抑郁组明显延长(P<0.01)。③实验组老年认知功能量表总分与N2,P2,P3潜伏期呈显著负相关,相关系数分别为P<0.05,而汉密顿抑郁量表总分与听觉诱发电位P300无相关性(P>0.05)。结论:听觉诱发电位P300能客观的反映出老年期抑郁症患者大脑皮层的觉醒状态降低、认知资源容量减少以及对认知资源的分配能力降低。听觉诱发电位P300的改变与老年认知功能量表认知功能损害严重程度的文化合作具有一致性。     

P300评估帕金森病患者的抑郁情绪及其认知功能

目的:探讨P300电位在评价帕金森病患者的抑郁情绪及认知功能中的作用及其临床价值。方法:1999-11/2003-08河南省人民医院和河南省精神病院神经内科60例帕金森病患者和59例健康者分别进行了P300电位测定和抑郁量表评定,并将两组结果加以比较。结果:帕金森病组的潜伏期和波幅犤N2(260.9±23.1)ms,P3(364.0±26.2)ms,(3.1±1.7)μV犦与健康对照组犤N2(243.3±23.4)ms,P3(341.6±25.5)ms,(5.9±2.0)μV犦比较,差异有显著性意义犤t=2.06,P<0.05;t=2.97和4.23,P<0.01)。结论:帕金森病患者存在抑郁情绪和认知功能障碍,P300电位可作为评价其认知功能的指标应用于临床。     

轻度认知功能障碍老年患者事件相关电位P300和脑电图的临床研究

目的 探讨轻度认知障碍(MCI)老年患者的事件相关电位(ERP) P300和脑电图(EEG)的特点,并将神经心理学测试(MMSE)与P300进行相关性分析,探讨对老年MCI进行综合评价的有效方法.方法 对115例MCI患者(MCI组)、105例阿尔茨海默病(AD)患者(AD组)进行P300、EEG检查和MMSE测试,并与80例健康老年人(对照组)作比较.结果 与对照组比较,MCI组与AD组患者ERP改变是P300潜伏期的逐渐异常延长,AD组较MCI组的变化更为明显.MCI组与AD组只在P300潜伏期的顶部(Pz)点差异有统计学意义(P＜0.05);MCI组P300潜伏期在中央(Cz)点与对照组比较差异有统计学意义(P＜0.05).AD组额部(Fz)、Cz、Pz点潜伏期与对照组比较,差异有统计学意义(P ＜0.01),波幅的Cz点的差异有统计学意义(P＜0.05).EEG异常率MCI组为52.2％(60/115),AD组为94.3％(99/105),对照组为30.0％(24/80),3组间差异有统计学意义(P＜0.01).MCI组和AD组的MMSE总分与对照组比较,差异有统计学意义(P＜0.05或＜0.01).MCI组Cz的P300的潜伏期与MMSE评分呈负相关(r =-0.75,P＜0.05),P300波幅与MMSE评分呈正相关(r=0.65,P＜0.05).结论 P300潜伏期的Pz点的改变可能有助于区分MCI和AD,EEG中θ波相关功率谱及平均频率增加是预测MCI转为AD的早期信号,利用EEG和P300并结合MMSE量表可能有助于对老年性痴呆患者的临床评价,是早期发现MCI的有效手段之一.     

焦虑症患者的听觉事件相关电位P300研究

目的探讨焦虑症听觉事件相关电位P300的特点.方法收集符合中国精神病分类方案第2版(CCMD-2-R)焦虑症诊断标准的30例患者(焦虑症组)以及30名正常人(正常对照组),应用美国Nicolet Spirit脑诱发电位仪,采用"听觉靶-非靶刺激序列"为诱发事件,完成听觉P300检测.结果焦虑症组与正常对照组的P300波形均清晰可辨.(1)靶刺激在Fz、Cz 2个电极位置,焦虑症组靶N2潜伏期[分别为(282.7±34.6)ms和(277.9±22.6)ms]较正常对照组[分别为(263.3±18.9)ms和(259.5±13.8)ms]明显延长(P<0.01);焦虑症组靶P3波幅[分别为(3.1±1.2)μV和(3.1±1.4)μV]较正常对照组[分别为(6.4±2.4)μV和(6.2±2.0)μV]明显降低(P<0.01);在Fz、Cz 2个电极位置,尽管焦虑症组靶P3潜伏期也较正常对照组延长,但差异无统计学意义(P>0.05).(2)非靶刺激在Fz点,焦虑症组非靶P2波幅[(2.3±1.3)μV]较正常对照组[(3.4± 1.0)μV]明显降低(P<0.01).结论 P300为反映焦虑症认知功能障碍的客观生理指标,P300中靶N2潜伏期、靶P3波幅有可能成为焦虑症诊断的一个辅助指标,值得进一步跟踪观察.     

载脂蛋白Eε4等位基因对阿尔茨海默病患者认知功能和P300的影响

目的:研究载脂蛋白E(ApoE)ε4等位基因对阿尔茨海默病(Alzheimer'sdisease,AD)患者总体认知功能和P300的影响。方法:选取做过P300检查和ApoE基因分析的所有轻中度AD患者20例作为研究对象,根据是否携带ApoEε4等位基因分为携带组8例,非携带组12例。对两组间简明精神状态检查(MMSE)成绩和P300潜伏期(P300peaklatency,P3PL)的差异进行分析,并进一步分析了年龄、MMSE成绩和P3PL之间的相关性。结果:ApoEε4等位基因携带组平均年龄高于非携带组犤(81±4)比(77±4)岁,t=2.19,P=0.0419犦,MMSE成绩低于非携带组犤(19.5±2.2)比(21.6±1.8)分,t=2.34,P=0.0309犦,P3PL表现出延长的趋势犤(386±21)比(360±30)ms,t=2.12,P=0.0481犦。但年龄与MMSE之间(r=-0.4013,P=0.0795)以及年龄和P3PL之间(r=0.3861,P=0.0927)均无相关性,MMSE对P3PL也无显著性影响(r=-0.0484,P=0.8396)。结论:AD患者中,ApoEε4等位基因携带者认知功能衰退更明显,并且其P3PL也明显延长,说明不同的ApoEε4表现型可能具有不同的认知和P300表现模式。     

阴性、阳性精神分裂症事件相关电位P300的比较及其与临床症状关系的探讨

目的 探讨事件相关电位P300与阴性、阳性精神分裂症异质性的关系。方法对首次发作未用药或复发但停药半年以上的36例阴性精神分裂症、35例阳性精神分裂症进行阳性、阴性临床症状量表（PANSS）评定和Fz、Cz、Pz位点事件相关电位P300各指标检测，对36例正常对照也同样进行P300各指标的检测。结果 （1）与正常对照组相比，阴性精神分裂症组Fz、Cz、Pz三点靶刺激P3波幅降低（P〈0．01），Cz、Pz位点靶刺激P3潜伏期延长（P〈0．01），P2-N2峰间潜伏期延长（P〈0．05～0．01），P2点P2-N2峰间波幅增高（P〈0．05），Cz点N2-P3峰间波幅降低（P〈0．01），非靶刺激P2波幅降低（P〈0．01），而阳性精神分裂症组Fz、Cz、Pz三点靶刺激P3波幅降低（P〈0．05～0．01），P2-N2峰间波幅增高（P〈0．05～0．01），F，、C。位点靶刺激P，潜伏期延长（P〈0．05），P2-N2峰间潜伏期延长（P〈0．05～0．01），N2-P3峰间波幅降低（P〈0．05），阴性与阳性精神分裂症组相比，F2点P3波幅有降低趋势（P=0．05）。（2）阴性精神分裂症组内Fz、Cz、Pz三点P2-N2峰间潜伏期与抑郁分成正相关（r=0．500，0．370，0．429，P〈0．05～0．01），C2点非靶刺激P2波幅与抑郁分成负相关（r=-0．361，P〈0．05）；阳性精神分裂症组内Fz点靶刺激P3潜伏期、非靶刺激P2潜伏期与偏执分成正相关（r=0．344，0．381，P〈0．05）。结论提示两组患者脑电异常有不同的脑功能异常基础。     

纯词聋患者的事件相关电位特征

目的:探讨纯词聋病态语言产生的可能机制,为失语的康复提供必要的理论依据。方法:采用视、听两种模式下事件相关电位(event-relatedpotentials,ERPs)和汉字形状音义分类的ERPs对2003-10北京大学第一医院神经科的1例纯词聋患者和46例健康对照进行了研究。结果:与对照组相比,患者听觉模式下的ERPs波形分化欠佳,早成分P80潜伏期正常,N200,P300潜伏期延长P300∶Cz:患者为498ms,对犤照组为(378±19)ms犦,波幅降低犤P300∶Cz:患者为6.5μV,对照组为(17.8±6.6)μV犦;而视觉模式下的图形分辨ERPs其N200,P300成分和汉字形音义分类的N400成分潜伏期、波幅均正常。结论:纯词聋发生的层级可能始于一般的听觉加工缺陷,在听理解的路径上可能定位于初级听皮质以后的结构。     

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.     

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.     

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.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.     

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.