61例新型隐球菌脑膜炎临床分析

目的 探讨新型隐球菌脑膜炎的有效治疗方法.方法 回顾性分析61例新型隐球菌脑膜炎患者的临床资料.结果 61例患者均有颅内高压症状和发热,其中颈项强直51例.脑脊液检查显示压力均升高,病程短者脑脊液中细胞以中性粒细胞为主,蛋白质定量0.30～2.34 g/L.全部病例均行头颅MRI或CT检查,提示脑积水伴双侧脑室旁白质缺血性改变12例,脑膜异常强化35例,脑实质低密度灶9例.61例患者均经两性霉素B联合5-氟胞嘧啶(5-FC)治疗,其中行鞘内注射15例,行侧脑室引流术1例,反复隔天腰椎穿刺放脑脊液,随后用0.9％氯化钠行脑脊液置换30例.61例患者中治愈40例,好转16例,死亡5例.结论 两性霉素B联合5-FC仍是目前治疗新型隐球菌脑膜炎的较好方案;反复腰椎穿刺脑脊液检查是确诊新型隐球菌脑膜炎重要方法,积极行腰椎穿刺脑脊液引流或置换以控制颅内压,并行鞘内注射是降低病死率、赢得治疗时间的关键.     

双针腰椎穿刺置换脑脊液加鞘内注射治疗结核性脑膜炎的临床分析

目的 探讨双针腰椎穿刺置换脑脊液加鞘内注射治疗结核性脑膜炎的临床价值.方法 将32例结核性脑膜炎患者随机配对分为两组,对照组(17例)给予常规治疗,试验组(15例)在常规治疗的基础上应用双针腰椎穿刺置换脑脊液加鞘内注射,比较两组的临床疗效.结果 试验组总有效率为100.0%(15/15),显著高于对照组的64.7%(11/17)(P<0.01);试验组残障率显著低于对照组[6.7%(1/15)比41.2%(7/17),P<0.01].试验组住院时间明显短于对照组.结论 在系统常规治疗的基础上行双针腰椎穿刺置换脑脊液加鞘内注射治疗可明显提高结核性脑膜炎的疗效,改善其预后,缩短住院时间,节省住院费用.     

鞘内/脑室内注射多黏菌素B联合腰椎穿刺置管持续引流在颅内肿瘤术后并发颅内感染患者中的应用效果

目的探讨多黏菌素B联合腰椎穿刺置管持续引流治疗颅内感染的应用疗效。方法选取2017年1月-2019年6月因颅内肿瘤术后并发颅内感染转入我院神经外科ICU的患者40例,按入院顺序随机分为对照组和观察组,各20例,对照组给予静脉注射多黏菌素B联合腰椎穿刺置管持续引流,观察组在对照组基础上给予每12 h鞘内/脑室内注射多黏菌素B。记录两组患者临床症状改善时间、感染控制时间和住院时间,检测并比较两组患者治疗前后的体温、脑脊液中有核细胞、氯、葡萄糖、腺苷脱氢酶和蛋白质水平、疗效和不良反应。结果与对照组相比,观察组患者的临床症状改善时间、感染控制时间和住院时间均明显缩短(P0.05)。治疗前,两组患者体温、脑脊液的有核细胞、葡萄糖、腺苷脱氢酶和蛋白质水平无明显差异(P0.05);治疗后,两组患者体温、脑脊液的有核细胞、葡萄糖、腺苷脱氢酶和蛋白质均有不同程度的降低(P0.05),葡萄糖均有不同程度的增高(P0.05),且观察组变化更为明显(P0.05)。与对照组相比,观察组总有效率明显更高(P0.05)。结论鞘内/脑室内注射多黏菌素B联合腰椎穿刺置管持续引流治疗颅内感染患者疗效显著,可有效改善患者脑脊液标本的有核细胞、葡萄糖、腺苷脱氢酶和蛋白质水平。     

腰大池引流结合鞘内注射治疗脑出血侧脑室外引流术后颅内感染的效果观察

目的探讨腰大池引流结合鞘内注射治疗脑出血侧脑室外引流术颅内感染的效果。方法选取我院2010年7月至2016年7月收治的60例脑出血侧脑室外引流术后颅内感染患者,根据治疗方式不同分为引流组(n=30,腰大池引流结合鞘内注射)与腰穿组(n=30,腰椎穿刺结合鞘内注射)。观察两组的疗效、治疗时间及不良反应。结果引流组的总有效率高于腰穿组(P <0.05)。引流组的治疗时间短于腰穿组(P <0.05)。结论腰大池引流结合鞘内注射治疗脑出血侧脑室外引流术后颅内感染,疗效确切,能够缩短治疗时间,减少不良反应,具有推广价值。     

多药耐药及泛耐药鲍氏不动杆菌中枢感染5例诊治分析

目的 探讨脑室或鞘内注射敏感抗菌药物治疗多药耐药及泛耐药鲍氏不动杆菌中枢感染的疗效,为临床合理用药提供参考.方法 对5例鲍氏不动杆菌中枢感染病例严格按照脑脊液培养及药敏结果选择敏感抗菌药物,通过静脉联合脑室或鞘内给药;结合脑脊液细菌学结果及患者原发疾病选择抗菌药物及给药途径,同时监测患者感染相关指标及头颅CT、MRI等影像学检查;对感染并发脑积水通过脑室外或腰大池引流进行处理.结果 治疗后5例患者中3例脑脊液培养阴性,其中2例治愈,1例因家属放弃治疗带脑积水出院;2例仅多黏菌素敏感患者死亡.结论 早期脑室及鞘内注射敏感抗菌药物是治疗多药耐药鲍氏不动杆菌中枢感染的安全有效方法;脑积水发生率较高,脑室外引流优于腰大池引流,引流需早期进行并保持通畅.     

微创侧脑室引流联合腰椎穿刺脑脊液置换术治疗脑室出血的临床研究

【摘要】目的探讨微创侧脑室引流联合腰椎穿刺脑脊液置换术治疗脑室出血的临床疗效。方法82例脑室出血患者按随机数字表法分为治疗组和对照组,每组41例。治疗组患者采用微创侧脑室引流联合腰椎穿刺脑脊液置换术治疗脑室出血,对照组患者采用单纯微创侧脑室引流治疗脑室出血,观察两组患者的临床疗效。结果治疗组脑室通畅时间、脑脊液正常时间、意识苏醒时间、住院时间均比对照组短,差异有统计学意义（P〈0．05）。治疗组总有效率78．05％（32／41）,对照组56．10％（23／41）,两组比较差异有统计学意义（P〈0．05）。结论微创侧脑室引流联合腰椎穿刺脑脊液置换术治疗脑室出血疗效显著,优于单纯微创侧脑室引流治疗脑室出血,值得临床推广和应用。     

脑出血患者微创引流术后颅内感染的临床分析

目的探讨不同抗菌药物给药途径治疗脑出血患者微创钻颅置管外引流术后颅内感染的临床疗效。方法选择2009年1月-2013年6月72例脑出血行微创钻颅置管外引流术后颅内感染患者为研究对象,将36例行全身给药+腰穿后鞘内注射为A组,25例行全身给药+腰大池引流+鞘内注射为B组,11例行全身给药+脑脊液生理盐水置换为C组,比较3组患者治疗前后脑脊液常规指标差异,治疗期间不同时点脑脊液中的药物浓度以及患者的临床效果。结果 3组患者治疗后颅内压、脑脊液各项指标平均值恢复正常,颅内压值从高到低依次为C、A、B组,差异有统计学意义(F=12.341,P<0.05),C组氯化钠含量较A、B两组低,差异有统计学意义(F=4.621,P<0.05);B组患者治疗后不同时点脑脊液中药物浓度均为最高,C组明显低于A、B两组,差异有统计学意义(P<0.05);3组患者各项指标恢复时间中B组时间最短,C组最长,差异有统计学意义(P<0.05);3组均无明显不良反应发生。结论鞘内抗菌药物注射结合全身抗感染治疗能有效治疗颅内感染,其中腰大池置管引流比多次腰穿更能保证脑脊液中药物浓度,缩短治疗时间。     

微创穿刺治疗高血压脑出血术后颅内感染的高危因素及感染后防治

目的 分析微创穿刺治疗高血压脑出血术后颅内感染的高危因素及感染后防治,以控制颅内感染.方法 收集2004年1月-2012年6月鄞州第二医院及青海省人民医院共457例高m压脑出血微创穿刺术后,32例颅内感染后临床资料进行回顾性分析,其中2006年后15例患者加用腰大池持续引流并鞘内注射术为观察组,另17例患者常规静脉抗菌药物治疗为对照组.结果 32例颅内感染患者中,30例治愈,2例后期转他院治疗;患者头部引流管放置时间＞7 d、术后并发肺部感染、水盐电解质失衡、高血糖成为术后颅内感染的危险因素(P＜0.05);而发生颅内感染后及时采用腰大池持续引流鞘内注射可以取得较好的治疗效果:1周后除蛋白含量外体温、脑脊液压力、白细胞个数、含糖量、氯化物均明显改善(P＜0.05).结论 术后尽早拔除颅内引流管;及时控制肺部感染和纠正水盐电解质可能减少颅内感染,及早应用腰大池引流术并鞘内万古霉素的应用是治疗颅内感染的首选.     

腰大池持续引流并鞘内注射术治疗脑术后颅内感染的临床疗效分析

目的分析腰大池持续引流并鞘内注射术治疗脑术后颅内感染的临床疗效。方法资料随机选自2006年2月—2014年2月本院诊治的脑术后颅内感染患者60例,按照治疗方式分为两组,对照组30例患者行腰椎穿刺鞘内注射治疗,研究组30例患者行腰大池持续引流并鞘内注射术治疗,分析两组患者治疗效果及治疗时间情况。结果两组患者治疗后体温均有所下降,且脑脊液中的蛋白含量、白细胞数、葡萄糖含量比较差异无统计学意义（P〉0.05）;研究组临床治疗时间明显短于对照组,具有统计学意义（P〈0.05）。结论腰大池持续引流并鞘内注射术治疗脑术后颅内感染的临床疗效显著,值得临床推广。     

单、双侧侧脑室引流治疗脑室系统出血的疗效比较分析

目的探讨分析比较两种侧脑室引流治疗脑室系统出血问题的疗效。方法将2010—2012年因脑室系统出血患者就诊的符合入选标准的70例患者随机均分为A、B两组每组35例,两组个情况没有系统差异其中A组采用单侧侧脑室引流、脑室内尿激酶纤溶治疗联合腰椎穿刺放脑脊液置换术,B组采用双侧侧脑室引流、脑室内尿激酶纤溶治疗联合终池持续引流术。结果 B组总有效率为78%、病死率分别为8.57%,脑室系统内积血清除平均时间为6d;A组总有效率62.9%、总病死率17.15%脑室系统内积血清除平均时间为9d。双侧引流组总有效率、死亡率、脑室引流组脑室系统内积血清除时间与单侧引流组相比有明显差异。结论双侧侧脑室引流、脑室内尿激酶纤溶治疗联合终池持续引流术操作简便而且疗效好,适合在重度脑室出血病人的治疗中进行推广。     

Continuing low uptake of periconceptional folate warrants increased food fortification

Objective To assess whether the Health Education Authority's recent promotion of periconceptional folic acid has been successful in increasing uptake sufficient to prevent neural tube defects.
Design A retrospective questionnaire, completed by 162 patients in the early pregnancy clinic in Doncaster Royal Infirmary, an average-sized UK district general hospital. The study ran in February and March 1999.
Methods and main outcome measures Data were collected on: supplementation and dietary intake of folic acid, both preconceptionally and after confirmation of pregnancy; awareness of the benefits of folic acid; source of information on folic acid; the reasons for not taking folic acid (if this was so); planned or unplanned pregnancy; previous pregnancies; previous neural tube defect in a pregnancy; smoking habit; and age.
Results Eighty-one per cent of women were aware of the benefits of folic acid, but only 27% took it preconceptionally. Sixty-eight per cent took it after confirmation of pregnancy. A quarter of patients made an attempt to increase dietary folate. Unplanned pregnancy was a significant bar to uptake, with significant differences in awareness and consumption. Number of pregnancies had no effect. Older women were more likely to take postconceptional folate, but awareness and preconceptional use were the same as younger women.
Conclusion Despite an extensive campaign commissioned by the Department of Health and run by the Health Education Authority, use of periconceptional folate will probably only prevent one-sixth of affected pregnancies. The adverse effects of fortification discussed in the body of this paper are small. It is now time for increased fortification of all cereal-grain products to be instituted in the UK in a similar manner to the United States.     

舒血宁注射液联合叶酸片治疗冠心病心绞痛的临床疗效观察

目的：研究舒血宁注射液联合叶酸片治疗冠心病心绞痛的临床效率。方法选取2010年7月-2012年8月我院收治的冠心病心绞痛患者70例,随机分为研究组和对照组,每组35例,研究组给予舒血宁注射液联合叶酸片进行治疗,对照组给予常规硝酸甘油,比较两组临床疗效和心电图改善疗效。结果研究组总有效率显著高于对照组,两组比较差异具有统计学意义（P＜0.05）;研究组心电图改善总有效率显著高于对照组,两组比较差异具有统计学意义（P＜0.05）。结论舒血宁注射液联合叶酸片治疗冠心病心绞痛具有较好疗效,能改善微循环,缓解心绞痛。     

鞘内注射氨甲蝶呤和地塞米松治疗重症中枢神经狼疮初探

目的　探讨氨甲蝶呤联合地塞米松鞘内注射治疗系统性红斑狼疮 (SLE)中枢神经系统损害的效果。方法　对 2 0例鞘内注射的SLE中枢神经系统损害患者治疗前后的临床表现、脑脊液、头颅CT或MRI进行分析 ,并与 4 1例无鞘内注射者的死亡情况对比。结果　 2 0例中除 1例死亡外 ,其他均明显改善或完全缓解 ;脑脊液压力明显下降 ,蛋白降低 ,糖升高 ,但后二者无统计学差异 ;4例ANA阳性者全部转阴。结论　氨甲蝶呤联合地塞米松鞘内注射治疗SLE中枢神经系统损害有明显效果 ,尤其是有定位表现者 ,能提高抢救成功率 ,副作用轻且少 ,值得临床推荐使用。     

Which mothers take folic acid and folate containing foods?

This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of 587 mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors associated with the decision to take folic acid supplements or fortified foods were investigated using multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or during the first three months of their pregnancy. Of the 132 who did not take folate supplements only 35 (6% of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant factors independently associated with not taking folic acid supplements or fortified food were " years of education " (OR ' 10 years or less' 0.45 (0.23-0.88)), " family income " (OR < $ 25000 0.40(0.20-0.80)), and for taking folic acid "the timing of the pregnancy. "(OR'actively trying'2.01 (0.1.04-0.3.87)). There was a significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not taking folic were less educated, from lower socio-economic groups and were not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.     

Folic acid supplements modify the adverse effects of maternal smoking on fetal growth and neonatal complications

Maternal smoking during pregnancy leads to increased risks of neonatal complications. The use of folic acid supplements might reduce the adverse effects of smoking. We examined whether folic acid supplement use modifies the associations of maternal smoking with first trimester plasma homocysteine concentrations, fetal growth characteristics, and risks of neonatal complications. The associations were studied in 6294 mothers participating in a prospective population-based cohort study in The Netherlands. Main outcomes measurements were first trimester plasma homocysteine concentrations, fetal growth characteristics, and neonatal complications, including preterm birth, low birth weight, and small-size-for-gestational-age. Continued maternal smoking was associated with higher first trimester plasma homocysteine concentrations [difference 0.52 μmol/L (95% range = 0.20, 2.14)], lower third trimester fetal weight (difference -44 g (95% CI = -57, -31)], and birth weight [difference -148 g (95% CI = -179, -118)]. There were significant interactions between maternal smoking and folic acid supplements on all outcome measures (all P-interaction < 0.040). Among mothers who continued smoking during pregnancy, those who did not use folic acid supplements had the highest risk of delivering a child with low birth weight [OR = 3.45 (95% CI = 1.25, 9.54)] compared to those who did use periconceptional folic acid supplements. No significant effects were observed for the risks of preterm birth and small-size-for-gestational-age at birth. Our results suggest that some adverse effects of maternal smoking on fetal growth and neonatal outcomes might be reduced by the use of folic acid supplements. The observed interaction seems to be mainly driven by smoking in the first trimester only.     

孕妇服用叶酸行为影响因素研究

目的分析孕妇服用叶酸的影响因素,为提高叶酸干预效果提供基础数据。方法采用医院及入户调查方法,抽取甘肃省两个县内2094名孕后三个月至产后一年的妇女进行面对面匿名问卷调查。结果 2094名调查对象中,叶酸服用率为25.4%。叶酸认知水平、年龄、出生缺陷生育史及孕后去医院检查、文化程度、计划妊娠、流产史、孕前去医院检查等是影响孕妇叶酸服用行为的主要影响因素。结论孕妇生育史及对叶酸的认知水平是影响其叶酸服用的重要原因;对育龄人群广泛开展叶酸认知教育,倡导健康的计划生育观念应成为干预的重点措施;而如何找到提高孕前叶酸服用的有效途径还有待探讨。     

Prevalence of Anaemia, Deficiencies of Iron and Folic Acid and Their Determinants in Ethiopian Women

A cross-sectional community-based study with analytic component was conducted among Ethiopian women during June-July 2005 to assess the magnitude of anaemia and deficiencies of iron and folic acid and to compare the factors responsible for anaemia among anaemic and non-anaemic cases. In total, 970 women, aged 15-19 years, were selected systematically for haematological and other important parameters. The overall prevalence of anaemia, iron deficiency, iron-deficiency anaemia, deficiency of folic acid, and parasitic infestations was 30.4%, 50.1%, 18.1%, 31.3%, and 13.7% respectively. Women who had more children aged less than five years but above two years, open-field toilet habits, chronic illnesses, and having intestinal parasites were positively associated with anaemia. Women who had no formal education and who did not use contraceptives were negatively associated with anaemia. The major determinants identified for anaemia were chronic illnesses [adjusted odds ratio (AOR)=1.1, 95% confidence interval (CI) 1.15-1.55), deficiency of iron (AOR=0.4, 95% CI 0.35-0.64), and deficiency of folic acid (AOR=0.5, 95% CI 0.50-0.90). The odds for developing anaemia was 1.1 times more likely among women with chronic illnesses, 60% more likely in the iron-deficient and 40% more likely in the folic acid-deficient than their counterparts. One in every three women had anaemia and deficiency of folic acid while one in every two had iron deficiency, suggesting that deficiencies of both folic acid and iron constitute the major micronutrient deficiencies in Ethiopian women. The risk imposed by anaemia to the health of women ranging from impediment of daily activities and poor pregnancy outcome calls for effective public-health measures, such as improved nutrient supplementation, health education, and timely treatment of illnesses.Key words: Anaemia, Anaemia, Iron-deficiency, Community-based studies, Cross-sectional studies, Folic acid, Iron deficiency, Ethiopia     

颅脑手术后颅内感染的易感因素与防治措施

目的：探讨颅脑手术后颅内感染的易感因素与防治措施。方法：对1287例颅脑手术患者的有关临床资料进行分析。结果：颅内感染的发生与多种因素有关。诸如严格的无菌操作、缩短手术时间、减少和避免激素的术前应用、及时治疗并发症、适时拔去术中所置引流管和更换脑室外引流管以及正确处理脑脊液耳鼻和切口漏等。在全身使用大量有效抗生素的同时行鞘内或脑室注庆霉素或头孢噻肟钠收到良好疗效。结论：严格的无菌操作、针对不同的易感因素采取相应的预防措施可减少术后颅内感染的发生。     

颅脑手术后颅内感染临床分析

目的 探讨颅脑手术后颅内感染的易感与防治措施。方法 回顾性分析１２８７例颅脑手术虱的有关临床资料。结果 多种不同的易感与颅内感染的发生有关。诸如严格的无菌操作,缩短笔避免激素的术前应用,及时治疗并发症,适时拔去术中所置引流和和更换脑室外引流管以及正确处理脑脊液耳鼻和切口漏等,均为重要方面。     

依那普利叶酸治疗H型高血压的临床疗效观察

目的观察依那普利叶酸治疗H型高血压的临床疗效。方法选择某院2009年6月～2010年6月的186例H型高血压患者随机分为3组,采用依那普利片治疗的62例患者为对照组,采用依那普利叶酸片治疗的62例患者为复合组;采用依那普利片+叶酸联合方式治疗的62例患者为联合组,观察3组患者治疗效果。结果 3组治疗后血压较治疗前差异有统计学意义,复合组SBP下降较对照组差异有统计学意义(P﹤0.05)。3组DBP治疗后差异无统计学意义,对照组治疗前后Hcy比较差异无统计学意义(P﹥0.05)。复合组与联合组治疗前后Hcy差异有统计学意义,与对照组比较差异有统计学意义(P﹤0.05)。结论依那普利叶酸片固定复方制剂具有更好的控制H型高血压患者Hcy的疗效。