结合医学与中西医结合神经病学

中西医结合医学的概念产生于中国的20世纪50年代,最初是以利用现代医学技术与手段来研究与发展中医为目标而提出的。在发展过程中,此概念逐渐扩展,由中医结合西医逐步转变为结合所有有益于健康及诊治疾病的医学,即概念转变为结合医学(integrative medicine)或整合医学或综合医学。中西医结合神经病学涉及的疾病种类与中国传统医学文献记载的病种存在较大差异。尽管疾病的名称无法一一对应,但是在治疗疾病时,却可利用中医学的症状治疗及辨证施治的特色及优势,结合现代医学治疗手段,提高神经科部分重大难治性疾病的疗效。     

神经内科护士失禁性皮炎知信行的访谈分析

目的：探讨神经内科护士对失禁性皮炎(IAD)的知识、态度、信念及行为现状,为 IAD 的培训、教育及规范管理提供参考依据。方法采用随机抽样,运用半结构式访谈法,对50名神经内科护理人员进行一对一深入访谈,记录、整理并分析资料,归纳主题。结果被访者对于 IAD 知识缺乏,态度积极,护理行为有待提高。结论降低 IAD 发生率、减少 IAD 患者痛苦需多部门合作,护理人员需进行相关知识培训,对家属行健康指导,管理部门需制定相关处理策略,从而提高 IAD 护理质量。     

神经内科呼吸机撤离失败相关因素分析

目的:分析神经内科机械通气患者呼吸机撤离失败率及失败的相关因素.方法:回顾分析我院2008 年1月至2011 年1月神经内科重症监护室收治的机械通气患者70 例,统计撤机失败率,分析撤机失败的相关因素.结果:70 例患者按计划撤机,58 例撤机成功,12 例撤机失败,撤机失败率为17.1%.60 岁以上老年人撤机失败率高于60 岁以下患者,但差异无显著性,机械通气时间对撤机成功与否差异无显著性,心理障碍对撤机成功与否无影响,但应给予高度重视.合并肺部感染患者撤机成功率最高,合并呼吸中枢损伤患者是撤机失败的高危因素.结论:神经内科机械通气患者的撤机评估主要依赖于患者的生命指标监测及临床医生的经验判定,适时的撤机和去除导致撤机失败的因素是提高撤机成功的关键.     

多媒体视频技术联合以问题为中心教学法在神经病学理论课教学中的应用

目的探讨多媒体视频技术联合以问题为中心教学法(PBL)在神经病学教学中的应用效果。方法在神经病学理论教学中,应用多媒体视频技术联合PBL对学生授课,并对学生进行评估和问卷调查。结果问卷调查显示,多数学生赞成以多媒体视频技术联合PBL教学,教学整体情况、课堂教学表现及学生学习兴趣均显著优于传统教学组(P<0.01);而且联合教学组考试成绩明显高于传统教学组,差异具有统计学意义(P<0.01)。结论在神经病学理论课教学中,多媒体视频技术联合PBL教学方法更有助于提高学生学习兴趣,便于掌握与理解重点和难点,更加适应现代医学教育的发展。     

Abnormalities on the Neurological Examination and EEG in Young Children with Pervasive Developmental Disorders

This study examined the nature and frequency of neurological and EEG abnormalities in 60 young children (ages 2–6 years) with pervasive developmental disorders. A number of standard neurological functions could not be adequately assessed due to the young age of the children and/or limited comprehension and cooperation. The most common neurological deficits were hyporeflexia, stereotypies, and hypotonia. EEG abnormalities were identified in 32% of the children while only two children were known to have clinical seizures. The frequency of cases with hypotonia or hyporeflexia was more common than in older children with this diagnosis. Results also indicate that EEG abnormalities are common in this young population but clinical seizures are rare, confirming other studies.     

Neurological soft signs and their relationship to 1-year outcome in first-episode schizophrenia

OBJECTIVES: To examine the relationship between the severity of neurological soft signs at onset and at the 1-year follow-up of patients with schizophrenia, and to investigate temporal stability of neurological soft signs within 1year from the onset of the first episode schizophrenia. METHODS: The study included 92 first-episode male schizophrenic patients. Neurological soft signs were assessed on the Neurological Evaluation Scale (NES) during index hospitalization and at a 1-year follow-up. The patients were divided into remitters and non-remitters according to their psychiatric status assessed at the 1-year follow-up, using the Positive and Negative Syndrome Scale (PANSS). RESULTS: A trend for a lower score for the NES item "others" in late remitters versus non-remitters at baseline was found during index hospitalization. At the 1-year follow-up, the overall severity of the neurological soft signs was statistically significantly higher in non-remitters than in remitters. Within 1year after index hospitalization, a significant reduction of neurological soft signs, with the exception of sensory integration, occurred in remitters. Within 1year after index hospitalization, the non-remitters reported a significant reduction of the overall NES score. CONCLUSION: These findings in a population of patients with first episode schizophrenia are in accord with the findings of previous studies which found an association between neurological soft signs, treatment response and outcome. This association may characterize a subgroup of patients with a poor course of illness and outcome. Neurological soft signs might be regarded as one of the indicators of treatment outcome in patients suffering from their first episode of schizophrenia.     

北京市区县二级医院神经内科医疗资源现况调查与对策

目的对北京二级医院神经内科的医疗服务进行现况调查。方法对北京市66家二级医院进行定性与定量结合的普查。结果收治的病种以脑血管病为主（84％）。城区二级与三级医院的比例为58：60;而远郊区县为48：6。远郊区县中,能提供尿激酶和组织纤溶酶原激活剂（t-PA）溶栓治疗的医院仅占64．7％和26．5％。结论担负脑血管病救治重任的远郊二级医院尚不能满足需求。应加强培训、建立远程医疗模式。