心理护理对妊娠高血压综合征孕妇母婴结局的影响

目的探讨心理护理对妊娠高血压综合征孕妇母婴结局的影响。方法以我院2013-03—2014-12就诊的100例妊娠高血压综合征孕妇为研究对象,随机双盲法将其分为2组各50例,对照组采取对症治疗及常规护理,观察组在对照组基础上给予心理护理干预,比较2组并发症发生率、新生儿结局。结果观察组胎盘早剥、HELLP综合征、剖宫产率分别为2.0%、4.0%、52.0%,对照组为16.0%、16.0%、76.0%,差异有统计学意义(P0.05)。观察组新生儿窒息发生率6.0%,胎儿早产率12.0%,与对照组的20.0%、28.0%比较差异有统计学意义(P0.05)。结论给予妊娠高血压综合征心理护理干预能明显降低剖宫产率,改善母婴结局,值得临床推广。     

脑梗死患者伴脑白质疏松症相关危险性因素Logistic分析

目的研究脑梗死患者伴脑白质疏松症相关危险性因素。方法收集2011-01-2014-12在我院神经内科初步诊断为脑梗死并接受治疗患者的临床资料,把脑梗死伴脑白质疏松症患者设为观察组,脑梗死不伴脑白质疏松症患者作为对照组。结果 2组年龄(t=2.089,P=0.04)、是否患有高血压(χ2=3.919,P=0.048)因素比较差异具有统计学意义(P0.05);2组血脂指标差异无统计学意义(P0.05);观察组炎症因子hs-CRP、Lp-PLA2水平明显高于对照组,差异具有统计学意义(P0.05);Logistic多因素模型分析发现,年龄、高血压、Lp-PLA2水平升高是脑梗死伴脑白质疏松症独立的危险因素。结论临床上可通过控制患者血压和体内Lp-PLA2水平减少脑梗死伴LA的发病风险,具有较高的应用价值。     

硫酸镁联合小剂量阿司匹林治疗妊娠高血压综合征的疗效及护理

目的探讨硫酸镁联合小剂量阿司匹林治疗妊娠高血压综合征的效果。方法以2012-02—2013-01我院收治的64例妊娠高血压综合征患者为研究对象,随机分为2组,分别进行硫酸镁+阿司匹林治疗(治疗组)和单纯硫酸镁治疗(对照组)。比较2组临床疗效、高血压、水肿、蛋白尿、肾功能衰竭、脑出血情况及血细胞积压、血黏度、24h尿蛋白、尿素氮水平。结果治疗组总有效率93.75%,对照组为71.88%,差异具有统计学意义(P0.05)。2组预后情况比较,差异具有统计学意义(P0.05)。治疗结束后,2组患者的血细胞压积、血黏度、24h尿蛋白、尿素氮水平均明显降低,且组间差异具有统计学意义(P0.05)。结论硫酸镁联合小剂量阿司匹林治疗妊娠高血压综合征疗效显著,安全性高。     

硫酸镁联合硝苯地平及酚妥拉明治疗妊娠高血压综合征的疗效

目的分析酚妥拉明、硝苯地平和硫酸镁联合治疗妊娠高血压综合征的临床效果。方法对照组采用硫酸镁治疗,研究组采用施酚妥拉明、硝苯地平和硫酸镁联合治疗。结果对照组与研究组的临床效果分别为72.09%与90.70%,差异有统计学意义(P0.05);2组产后出血和胎儿宫内窘迫、新生儿窒息和宫缩乏力等母婴并发症情况比较,差异有统计学意义(P0.05);治疗后2组平均动脉压与血尿氮素、血尿氮素与尿酸等比较,研究组明显低于对照组,差异有统计学意义(P0.05)。结论针对妊娠高血压综合征患者予以酚妥拉明、硝苯地平和硫酸镁联合治疗,其临床疗效显著,能使患者的并发症有效降低,具有较高的安全性。     

硫酸镁联合川芎嗪治疗妊娠高血压综合征的临床疗效观察

目的 探讨硫酸镁联合盐酸川芎嗪注射液治疗妊娠高血压综合征的临床疗效.方法 将我院2009-10-2012-10收治的确诊为妊娠高血压综合征患者86例,随机分为观察组与对照组,每组各43例.对照组采用常规处理与硫酸镁注射液治疗,观察组在对照组治疗基础上加用盐酸川芎嗪注射液静滴.对2组患者治疗后的总有效率及对母婴情况的影响进行观察分析.结果 观察组治疗的总有效率为90.7%,对照组为79.1%,2组比较差异有统计学意义（P＆lt;0.05）.观察组治疗后在发生胎儿宫内窘迫、新生儿窒息、产后出血等情况与对照组相比,疗效差异有统计学意义（P＆lt;0.05）.结论 硫酸镁联合盐酸川芎嗪治疗妊娠高血压综合征能明显提高治疗有效率,用药安全可靠,值得临床推广应用.     

左乙拉西坦治疗妊娠期癫痫的疗效及对母婴结局的影响

目的 分析左乙拉西坦治疗妊娠期癫痫的临床效果以及对母婴结局的影响。方法 选取河南高等医学专科学校附属医院2018-01―2019-01收治的妊娠期癫痫患者124例作为研究对象,随机分成实验组(左乙拉西坦治疗)和对照组(丙戊酸钠治疗),每组62例,对比2组临床疗效以及妊娠期癫痫发作频率,分析2组产妇妊娠期并发症发作情况,统计胎儿结局和子代喂养情况。结果 实验组总有效率91.94%,对照组为54.84%,组间比较差异有统计学意义(P0.05);实验组发作、单纯发作、复杂发作、全面发作分别为82.26%、8.06%、6.45%、3.23%,对照组分别为56.45%、17.74%、14.52%、11.29%,组间比较差异有统计学意义(P0.05);实验组产妇妊娠期抑郁、妊娠高血压综合征以及围生期癫痫发作发生率分别为11.29%、12.90%、16.13%,对照组分别为29.03%、27.42%、46.77%,组间比较差异有统计学意义(P0.05);实验组新生儿畸形、低体质量儿发生率低于对照组,组间比较差异有统计学意义(P0.05)。结论 左乙拉西坦治疗妊娠期癫痫能够控制患者癫痫发作,降低新生儿异常结局。     

应用头部亚低温治疗高血压脑出血临床效果分析

目的对使用头部亚低温治疗高血压脑出血患者的临床效果进行观察和分析。方法选取2015-06—2016-06收治的60例高血压脑出血患者为研究对象,按照治疗方法的差别将患者分成采取常规治疗的对照组30例和采取头部亚低温治疗的观察组30例,分析2组治疗的效果。结果治疗前,2组颅内压水平差异无统计学意义,治疗后观察组颅内压降低程度较对照组明显,差异有统计学意义(P0.05)。观察组并发症发生率13.99%,明显低于对照组33.33%,2组差异具有统计学意义(P0.05)。治疗前,2组GCS评分差别不大,治疗后观察组提高幅度更大;治疗前,2组NIHSS评分差异不大,治疗后观察组降低幅度优于对照组,差异有统计学意义(P0.05);2组患者治疗后半年的ADL对比发现,观察组总有效率92.7%,优于对照组76.4%,差异有统计学意义(P0.05)。结论头部亚低温治疗高血压脑出血能够有效降低患者的颅内压,并降低并发症发生率,因此该治疗方式适合作为高血压脑出血患者治疗的优选方案,值得推广使用。     

小骨窗开颅术与大骨瓣开颅术治疗高血压脑出血的疗效比较

目的比较高血压脑出血应用小骨窗开颅术与大骨瓣开颅术临床疗效。方法选择2011-01—2014-01我院接诊的82例高血压脑出血患者进行研究,随机分为观察组和对照组。观察组41例采用小骨窗开颅手术治疗;对照组41例采用大骨瓣开颅术治疗。比较2组患者的手术时间、术中出血量、切口长度、住院时间、术后并发症发生率等指标。结果观察组的淋巴结清扫数量与对照组相比差异无统计学意义(P0.05);观察组的手术时间和住院时间均短于对照组,2组比较差异有统计学意义(P0.000 1);观察组的术中出血量少于对照组,2组比较差异有统计学意义(t=5.075 6,P0.000 1);观察组的切口长度也比对照组短,2组比较差异有统计学意义(P0.000 1);观察组总有效率(92.68%)明显高于对照组(70.73%),2组疗效比较差异有统计学意义(u=6.609 0,P=0.010 1);观察组并发症发生率为14.63%,对照组并发症发生率为39.02%,2组比较差异有统计学意义(P0.05)。结论采用小骨窗开颅手术治疗高血压脑出血的疗效优于大骨瓣开颅术,创伤小,并发症少,值得临床推广。     

超声检测在急性脑血管病中的作用

目的分析超声检测在急性脑血管病中的作用。方法以2015-01-2016-01在我院接受救治的急性脑血管病患者80例为观察组,同期体检的健康对象80例为对照组,2组均给予超声检测颈动脉内-中膜厚度,计算2组颈动脉粥样硬化斑块积分并统计斑块检出率,对比斑块严重程度。结果观察组颈动脉内-中膜厚度及斑块积分明显高于对照组,差异均有统计学意义(P0.05)。观察组斑块检出率(77.5%)明显高于对照组(31.3%),差异有统计学意义(P0.05)。观察组斑块等级为2级占51.3%、3级占18.8%与对照组的2.5%、0相比,差异均有统计学意义(P0.05)。结论超声检测在判定急性脑血管病患者病情严重程度上有良好效果。     

单纯舒张期高血压对新发心脑血管事件的影响

目的评价单纯舒张期高血压对新发心脑血管事件的影响。方法将常规体检中1 200例既往无心脑血管病史的单纯舒张期高血压患者为观察组,另选择同时期常规体检的1 200例血压正常者为对照组,随访1~5a,比较2组随访期间新发心脑血管事件情况。结果 2组心肌梗死发生率差异无统计学意义(P0.05);观察组脑梗死、脑出血及总心脑血管事件发生率均明显高于对照组(P0.05);经Cox回归模型分析,观察组脑梗死、脑出血及总心脑血管事件的发生风险均高于对照组(P0.05),观察组中≥60周岁患者的脑梗死、脑出血及总心脑血管事件的发生风险均高于组内60周岁患者(P0.05)。结论单纯舒张期高血压是新发心脑血管事件的独立危险因素,≥60周岁患者的发生风险更高,临床上应给予重视并采取适当的治疗措施以改善预后。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.