Belgian General Practitioners' Perspectives on the Use of Palliative Sedation in End-of-Life Home Care: A Qualitative Study

ContextPalliative sedation (PS) is a far-reaching palliative measure with a life-shortening potential. Guidelines provide only for a restricted use of PS and as a last resort.ObjectivesTo explore PS practice in end-of-life (EoL) home care.MethodsThis was a qualitative analysis of semi-structured interviews with 52 general practitioners (GPs) of Flanders, Belgium.ResultsApart from GPs who adhere to the existing prerequisites for PS, opinions diverge among GPs on the indication area for PS and on possible life-shortening intentions. The key to GPs' broadened view on “which suffering merits PS” is the fragile context of EoL home care, and the key to GPs' possible life-shortening intentions is their need to facilitate the dying process, when trying or lengthy. When honoring a terminally ill patient's request for euthanasia, several GPs prefer slow euthanasia using PS to a lethal injection.ConclusionPS home practice deviates from the PS guidelines' recommendations. In addition to the GPs' shortage of knowledge, the guidelines' recommendations do not always meet the particular needs of EoL home care. If one consideration of EoL home care is to respect a patient's wish to die at home, then the pre-emptive use of PS to avoid a futile transfer to the hospital in the case of an undesirable turn of events deserves more attention in the PS debate.     

针药结合治疗缺血性脑卒中40例

目的:观察针药结合治疗缺血性脑卒中的疗效。方法:将缺血性脑卒中患者80例分为"醒脑开窍"法针刺组40例,并设"醒脑开窍"法针刺并加服中药化痰通络汤对照组40例。治疗30天分别统计两组的临床有效率、愈显率,症状积分及日常生活能力,并进行比较。结果:治疗后针药组总有效率、愈显率均显著高于针刺组,症状积分显著低于针刺组。结论:针刺结合中药治疗在改善临床症状方面优于针刺组,能提高日常生活能力。     

脑电近似熵与双频指数在意识消失时预测概率的比较

目的比较脑电非线性参数近似熵(ApEn)和双频指数(BIS)在异丙酚靶控输注(TCI)镇静时意识消失的预测概率(Pk).方法随机选择20例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行择期下肢手术患者,硬膜外麻醉完善后,异丙酚TCI起始血药浓度为0.5μg/ml,然后以0.3～0.5μg/ml的梯度递增直至意识消失,再递减至意识恢复.每个靶浓度维持12min,双盲记录患者意识清醒·消失时的EEG非线性参数ApEn值和BIS值.计算ApEn和BIS对意识消失的Pk值,并进行比较.结果意识清醒和消失阶段,ApEn值分别为0.84±0.05,0.71±0.06,BIS值分别为80.2±6.2,67.3±7.9.ApEn、BIS对意识消失的Pk值分别为0.97±0.06、0.91±0.11,无显著性差异(P＞0.05).结论ApEn与BIS一样可有效地用于异丙酚TCI时意识反复消失-清醒的预测.     

反复下体负压致脑缺血对大鼠脑组织离子含量、ATP酶活性及神经元形态的影响

为阐明多次发生＋Ｇｚ致意识丧失对脑的影响及其机制，观察了反复下体负压（ＬＢＮＰ）致脑缺血对大鼠脑组织离子含量、ＡＴＰ酶活性及神经元形态的影响。雄性ＳＤ大鼠３０只，随机分为３组。将动物麻醉后置于－４．０ｋＰａ的下体负压舱内（下降速率为０．６７ｋＰａ／ｓ），至脑电波消失２ｍｉｎ后恢复常压。分别于一次和三次ＬＢＮＰ作用后１ｈ测定脑组织Ｎａ＋－Ｋ＋－ＡＴＰ酶活性、Ｋ＋、Ｎａ＋及水含量等。结果表明，一次ＬＢＮＰ作用后１ｈ，大鼠脑组织Ｎａ＋－Ｋ＋－ＡＴＰ酶活性较对照组显著降低（Ｐ＜０．０５），Ｋ＋、Ｎａ＋及水含量有升高趋势，但均未达到显著水平，顶叶皮层和海马区神经元与对照组基本相似。三次ＬＢＮＰ作用后１ｈ，脑组织Ｎａ＋－Ｋ＋－ＡＴＰ酶活性显著降低（Ｐ＜０．０１），Ｋ＋、Ｎａ＋及水含量均显著升高（Ｐ＜０．０５），顶叶皮层和海马区多数神经元表现为缺血性改变。结果提示，反复三次ＬＢＮＰ致脑缺血可引起大鼠脑组织离子平衡紊乱及神经元损害     

以“抽搐、意识丧失”为首发症状的有机氟中毒与癫痫患者的脑电图对照研究

本研究表明:有机氟中毒与癫痫患者的首发临床症状虽相同,但脑电图的改变有显著的差别。前者的背景节律较同龄人明显慢而波幅高,波形为单形性,同时伴有大量的特征性病理波即2.5～3.5Hz的节律性、复合性波呈段状爆发。而癫痫组患者的脑电图背景活动多为正常,主要出现与临床发作相对应的爆发性异常波,其特征是突然出现、突然消失。两者间的差异有一定的神经电生理意义,也是临床上首诊时进行鉴别诊断手段之一。     

Dynamics of the spatial organization of cortical electrical activity during the formation and actualization of a cognitive set to facial expression

The coherence functions of cortical electrical potentials were studied in 35 healthy adults in the alpha (8–13 Hz) and beta (14–25 Hz) ranges, recorded at the stages of formation and testing of a visual set to images of faces bearing different emotional expressions. At the set actualization stage, the frontal area showed significant increases in intra-and interhemisphere coherence of potentials in the alpha range and coherence of potentials between the frontal and temporal areas of the cortex in the right hemisphere. These analytical results support the suggestion that the formation and actualization of a set to emotional facial expression are predominantly associated with activity in the frontal areas of the cortex. This conclusion is based on the view that the extent of spatial synchronization of electrical potentials is a measure of the functional relationships between corresponding cortical areas and their cooperativity, and thus reflects the state of their activity. __________ Translated from Zhurnal Vysshei Nervnoi Deyatel’nosti imeni I. P. Pavlova, Vol. 57, No. 1, pp. 33–42, January–February, 2007.     

A new index of the autonomic nervous balance and its clinical usefulness; a power law 1/<Emphasis Type="Italic">f</Emphasis> like scale of a spectral analysis of the heart rate variability

OBJECTIVE: This study was undertaken to develop a new autonomic scoring scale distinct from the conventional sympathetic or parasympathetic parameters cardiac autonomic response. METHODS: The parameters were obtained from a log-log scale of frequency (f ) vs. power spectral (P) amplitude of heart rate variability (HRV). A gradient value in which the graph decreases towards a high frequencies on the X-axis, while showing an absolute value beta itself based on the formula 'P = f (-beta)' was newly named the 'Balance index' by implying a balanced state in the living body. The index was categorized into four bands based on the appearance of the whole frequency ranges (T-Balance Index). Therefore, we compared the responses of the following groups: the patient test group (Group PT), the normal test group (Group NT), and the normal non-test group (group NN). RESULTS: Significant differences in parameters were observed among the three groups. In addition, the difference between the 'High-side Balance Index' and the 'Low-side Balance Index' was 0.75 +/- 0.12 vs. 0.07 +/- 0.04 (p < 0.005) for groups NT vs. PT. This novel analyzing method was useful for evaluating the subtle changes in a living body to regulate the living-power (strength of vitality). Moreover, the difference between the 'T-Balance Index' and 'SV-Balance Index' was 0.18 +/- 0.12 vs. -0.21 +/- 0.15 (p < 0.01) for groups NT vs. PT. CONCLUSIONS: One application of new parameters 'Balance Index' is its ability to evaluate the vital or emotional functions of unconscious patients in a critical condition undergoing a sense challenge test. This method assists in improving our ability to measure the early stage of conscious recovery with greater accuracy by using our novel analysis method for performing senses challenge test, with the aid of media such as music.     

“醒脑开窍”针刺法对局灶性脑缺血大鼠海马蛋白质组学影响的研究

[目的]寻找与脑缺血相关及针刺起效的靶蛋白,从蛋白质组学层面探讨脑缺血的病理机制及针刺治疗脑缺血性损伤的作用机制。[方法]将Wistar大鼠随机分为正常组、假手术6h组,模型6h组和针刺6h组,采用改进的线栓法制备动物模型。在规定时间快速断头取脑,剥离缺血侧海马,提取脑组织总蛋白进行双向电泳,以Image Master 2DV3.01 Elite软件进行图像分析。选取差异蛋白质点进行胶内酶解,以基质辅助激光解析电离飞行时间质谱(MAL-DI-TOF-MS)测肽质量指纹图,检索Swiss-Port数据库,对蛋白质进行鉴定。[结果]共鉴定出30个差异蛋白质。正常组与假手术组比较无差异蛋白表达;模型组与正常组比较鉴定出差异蛋白质点29个,其中在模型6h组新出现1个,在模型6h表达上调的11个,表达下调的17个;针刺组与模型组比较鉴定出差异蛋白质点21个,其中在针刺组上调有16个,下调的有5个。[结论]以双向电泳联合质谱技术,初步发现与脑缺血相关以及针刺治疗脑缺血的部分靶蛋白质,有助于深入研究脑缺血性损伤病理机制及针刺治疗脑缺血性损伤的作用机制。     

复方麝香注射液治疗意识障碍63例疗效观察

目的：探索复方麝香注射液治疗中枢意识障碍的临床疗效。方法：将104例意识障碍患者随机分为复方麝香组（治疗组）63例，清开灵组（对照组）41例，进行疗效对比分析。结果：治疗组治愈28例，显效22例，有效6例，总有效率88．89％；对照组治愈10例，显效8例，有效12例，总有效率73．17％，两组疗效差异有显著性（P〈0．05）。治疗组的起效时间和达最大效应时间也明显快于对照组（P〈0．05），从证效关系分析，复方麝香注射液对痰热内闭型的疗效优于痰浊内盛型（P〈0．025）；同时提示复方麝香注射液的治疗效果与剂量呈正相关。结论：复方麝香注射液具有醒脑止痉、清热凉血、行气活血和解毒止痛等功效，是防治意识障碍的安全、有效药物。