无脑部外伤与骨科相关的意识障碍分析与处理

目的 探讨无脑部外伤与骨科相关的意识障碍原因、鉴别诊断和治疗方法.方法 回顾性分析自2003-01-2014-01诊治的77例无脑部外伤骨科患者出现意识障碍的临床资料.结果 本组68例获得随访6～128个月,平均67.6个月.其中脂肪栓塞综合征(FES)33例中死亡2例,植物状态1例,13例昏迷2～10周,17例表现为较轻的意识障碍,24例目前意识均恢复正常.肺栓塞(PE)21例中死亡9例,植物状态2例,4例昏迷2～5 d,6例出现短暂的意识丧失,8例目前意识恢复正常.脑梗死(CI)9例中死亡3例,植物状态1例,4例遗留部分后遗症.重度低钠血症(SHN)7例,意识均恢复正常.重症肺炎(SP)5例中死亡4例,1例意识恢复正常.颅内感染(ICI)2例,均死亡.结论 无脑部外伤的骨科患者出现的意识障碍要充分认识,辨明病因,积极防治,减少死亡率和病残率.     

Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage.

AIMS: To evaluate the prevalence and the characteristics of secondary trauma among patients referred to the emergency department (ED) for a transient loss of consciousness (TLOC). METHODS AND RESULTS: Over a 24 months period, all the patients referred to our ED for a TLOC were evaluated according to the ESC Guidelines on Syncope and enrolled in the study. Among 1253 consecutive patients with TLOC (1114 with a true syncope and 139 with a non-syncopal condition) 365 (29.1%) reported a trauma, in 59 cases (4.7%) severe. The frequency and the characteristics of trauma did not differ among the two main categories of TLOC. Out of 54 patients with syncope and a severe trauma, 20 (37%) had a definite diagnosis after a guidelines-based initial evaluation, and further 17 (31.5%) during the hospital course. Among these latter, carotid sinus syndrome was by far the most common diagnosis. CONCLUSION: Among patients referred to the ED for a TLOC secondary trauma is a common complication, whose characteristics are of little utility to discover the specific cause of the symptom. For older patients with syncope complicated by a severe trauma carotid sinus massage should be the first diagnostic manoeuvre to be undertaken after a non-diagnostic initial evaluation.     

北京郊区医务人员艾滋病职业暴露与防护现况

目的了解北京郊区医务人员艾滋病职业暴露及防护情况。方法采取现况调查的方法,按多阶整群抽样的原则,于2005年12月-2006年1月抽取北京郊区的医务人员进行问卷调查。结果2 021名医务人员中有21.8%参与过艾滋病诊疗服务,5.6%一年内接触过HIV阳性病人,38.9%一年内曾被医疗器械(皿)刺破皮肤,52.0%一年内经常接触引起血液、体液飞溅的操作;职业暴露防护不规范率为12.3%~62.1%;职业暴露后局部处理、预防性用药知识知晓率分别为4.6%、15.3%。结论北京郊区医务人员普遍存在艾滋病职业暴露危险,防护相关行为有待进一步培训、规范,推广普遍性防护原则势在必行。     

高功率和微波辐照致家兔视网膜损伤的防护研究

目的 以定量组织病理学的重要指标节细胞层和内核细胞层的厚度和细胞计数为指标,探讨三七总皂甙和480目铜丝网对高功率微波所致的视网膜损伤进行药物防护和物理防护的效果.方法 将青紫蓝兔分为假辐射对照组、辐射组、三七总皂甙防护组和480目铜丝屏蔽组.观察各实验组视网膜组织的病理形态变化.结果 三七总皂甙预处理能显著减轻高功率微波辐照所致的视网膜组织的病理形态学损伤;480目铜丝网屏蔽防护,能完全屏蔽该频率高功率微波辐射,使视网膜组织结构维持正常,表现出良好的屏蔽防护效果.结论 三七总皂甙和480目铜丝网对高功率微波致视网膜损伤具有药物和物理防护作用,为探讨可供实用的高功率微波眼损伤防护措施提供实验依据.     

急性脑血管疾病并发意识障碍诊治分析

目的探讨急性脑血管疾病并发意识障碍的临床诊治措施及意义。方法选取我院2009年1月至2012年12月72例急性脑血管病并发意识障碍患者为观察研究对象,依据诊治措施的异同分为观察组(综合诊治护理组)和对照组(常规处置组)各36例,观察两组的临床治疗效果及患者症状改善情况,分析综合诊治护理的特点及意义,指导临床对急性脑血管疾病并发意识障碍的诊治实践。结果 4周后依据卒中量表(NIHSS)评分,格拉斯哥昏迷量表(GCS)评分及并发症发生情况对比,综合诊治护理组的患者在临床治愈效果、并发症等方面好于对照组,两组比较有明显差异(P0.05)。结论急性脑血管疾病并发意识障碍病情危急、凶险、多变,及时的观察诊断病情采取综合诊治护理措施可以最大程度的救治患者,促进脑功能的恢复,具有积极的临床价值。     

Training and Education in Clinical Psychology in the Context of the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act of 2010 (ACA) is revamping the access, quality, and financing of the health and mental health systems. However, its impact on training and education in clinical psychology is unclear. This article aims to identify specific components of the ACA, in particular the Mental and Behavioral Health Education and Training Grants, that are expected to affect training and education in the field. The article further connects the ACA with four paradigm shifts in clinical psychology that have broad implications for training and education—evidence‐based practices, research methodology, interprofessionalism, and the quality indicator movement. The overarching goal of this article is to begin timely discussions on the future directions of the field under the current healthcare reform.     

昏迷恢复量表与ICU病房DOC患者预后关系

目的 探讨行为量表与ICU病房意识障碍(Disorders of consiousness,DOC)患者预后的关系。方法 选择2018年1～12月在我院ICU治疗的意识障碍患者为研究对象,根据随访GOS评分分为预后良好组39例与预后不良组29例。比较两组一般资料及临床资料、CRS-R评分以及EEG结果。多因素分析影响患者预后的相关因素。分析GRS-R评分与GOS评分的相关性。结果 (1)随访3个月,其中39例恢复良好,占57.35%,29例恢复不良,占42.65%。(2)预后良好组患者CRS-R评分显著高于预后不良组的患者,EEGⅠ～Ⅱ的比例显著高于预后不良组的患者,差异有统计学意义(P0.05)。(3)多因素分析结果显示,CRS-R评分、EEG是ICU病房DOC患者预后的相关影响因素(OR=8.712、5.709,P0.05)。(4)CRS-R评分与GOS评分呈显著正相关关系(r=0.903)。结论 ICU病房DOC患者的预后与入院时CRS-R评分以及EEG检查结果有密切的关系,临床上患者入院时通过CRS-R评分以及EEG检查可对患者病情以及预后进行初步判断。