脑卒中患者认知功能障碍的发生率及其影响因素的探讨

目的　了解脑卒中患者认知功能障碍的发生率并探讨其影响因素。方法　采用神经行为认知状态测试 (NCSE)量表对在康复医学科住院的脑卒中患者 2 16例进行认知功能评估 ,发现存在的问题 ,并用统计学分析认知功能障碍与各影响因素间的关系。结果　 2 16例脑卒中患者中有认知功能障碍的患者为94例 ,占 43.5 % ,尤以记忆力、空间结构能力、计算能力容易受累 ,多数患者的认知能力为轻度～中度受损 ,一般涉及 2～ 3个左右的认知项目 ;脑卒中患者认知功能障碍的发生与患者的性别、卒中类型无关 (P >0 .0 5 ) ,但与患者的年龄、文化程度、病程、病变部位、病灶大小和数量、卒中次数及有无合并疾病等密切相关 (P <0 .0 5或P <0 .0 1)。结论　脑卒中患者认知功能障碍的发生率较高 ,NCSE量表可以作为认知功能障碍常规检查量表 ,以便早期发现脑卒中后认知障碍的问题并及时予以干预 ,临床上尤为重要     

脑损害认知障碍与功能恢复的相关研究

目的　探讨脑损害后肢体运动功能和综合功能障碍的恢复是否与认知障碍的程度有关 ,以寻求最佳的认知和运动功能康复方法。方法　采用中文版NCSE评定量表 ,分别评测正常人 2 5例、脑损害患者 2 5例。比较两组分测验得分情况 ,并将NCSE分测验结果与患肢运动功能Brunnstrom分级、综合功能ADL(Barthel指数 )的入、出院得分进行相关分析。结果　 2 5例脑损害患者均有不同程度的认知障碍 ,分测验结果与正常人均有显著差异 (P <0 .0 1)。ADL恢复与MEM、NAM、CALC、JUD相关 (P <0 .0 5或 0 .0 1) ,功能恢复与COMP、NAM、CONST、MEM、CALC、SIM和总分相关 (P <0 .0 5或 0 .0 1)。结论　NCSE是筛查脑损害认知功能障碍的实用方法 ,其结果与脑损害功能恢复相关 ,可以作为估计预后的指标。     

14例儿童非惊厥性癫痫持续状态的护理

目的 本文通过对非惊厥性癫痫持续状态的患儿进行急救护理,总结了非惊厥性癫痫持续状态的护理体会.方法 对10年间14例非惊厥性癫痫持续状态的患儿实施全面的护理,并对护理结果进行评估.结果 系统性整体护理下非惊厥性癫痫持续状态患儿的抢救成功率95%以上,无1例发展为惊厥性癫痫持续状态.结论 系统全面的有效护理可以提高病人的抢救成功率及患儿康复效果,提高患儿生存质量.     

“Paradoxical” EEG response to propofol may differentiate post‐cardiac arrest non‐convulsive status epilepticus from diffuse irreversible cerebral anoxia

Current EEG criteria for the diagnosis of non‐convulsive status epilepticus in critically ill patients with repetitive generalised or focal epileptiform discharges primarily rely on a widely accepted low cut‐off frequency limit of 2.5–3 Hz for non‐evolving patterns, or on discharge evolution of frequency, location or mophology. The secondary criterion is a significant clinical or EEG improvement following acute administration of a rapidly acting antiepileptic drug, such as lorazepam. We describe a comatose patient after out‐of‐hospital cardiac arrest, in whom very slow (1‐Hz), non‐evolving generalised periodic epileptiform discharges against an almost completely depressed background would suggest substantial anoxic damage and poor neurological outcome. Yet, reloading with propofol for diagnostic purposes completely dispersed generalised periodic epileptiform discharges and revealed previously absent biological activity, raising the possibility of non‐convulsive status epilepticus that was subsequently confirmed. Brain MRI showed no significant anoxic brain damage and EEG improved, but the patient died from severe cardiopulmonary complications. These observations suggest that in rare cases, slow, non‐evolving generalised periodic epileptiform discharges may reflect non‐convulsive status epilepticus rather than diffuse irreversible cerebral anoxia, while reloading with propofol can be used as an additional secondary diagnostic criterion.     

认知障碍与脑损害部位的相关研究

目的　明确认知障碍与脑损害部位是否有必然的联系 ,探索不同的认知障碍在脑部相应区域的定位。方法　采用中文版神经行为认知测试 (NCSE)量表测试脑部损害后有认知障碍的患者 30例 ,将其脑部损害的CT定位与NCSE的 10个分项目 (ORI、ATT、COMP、REP、NAM、CONST、MEM、CALC、SIM、JUD )进行相关分析。结果　左、右侧均与COMP相关 (P <0 .0 5 ) ;额叶与CALC、JUD、MEM相关 (P值分别为 <0 .0 5及 <0 .0 1) ;顶叶与NAM、JUD相关 (P <0 .0 5 ) ,与REP、CALC明显相关 (P <0 .0 1) ;颞叶和基底节与各项分测验均不相关 (P >0 .0 5 )。结论　认知障碍与脑病损部位有关 ,以额、顶叶损害较为明显     

Nonconvulsive status epilepticus in terminally ill patients-a diagnostic and therapeutic challenge

Nonconvulsive status epilepticus (NCSE) is rarely considered as a cause of confusion in terminally ill patients. The clinical presentation varies from altered mental status to coma, without visible convulsions. Electroencephalogram is the most important diagnostic tool to identify epileptiform activity. Treatment should be initiated following a stepwise model, avoiding intubation and transfer to the intensive care unit. Although mortality rates are high, in some patients NCSE can be reversed by treatment. NCSE should be considered in a differential diagnosis of all terminally ill patients with sudden mental status changes. We present two cases and discuss treatment options and the borders of therapy.     

"智能实验室"一种有效提升滥药青少年戒药动机的工作方法

在香港有不少药物滥用习惯的青少年对传统的预防教育漠不关心,刻意忽视滥用药物对身体的影响。香港明爱南区青少年外展社会工作队在2006年推行了一项名为智能实验室计划,目的是提升药物滥用青少年戒药动机。在推行期间,我们发现部份认知行为状况测试能提升青少年对身体状况的了解并更能具体反映药物滥用行为对青少年的影响。这些测试操作简单,只要能配合上具体及图像化的测试报告,一方面能提升他们的戒药动机,另一方面又轻巧易用,令工作员能在更短时内推动青少年投入戒药服务。     

Clinical utility of EEG in diagnosing and monitoring epilepsy in adults

Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.