针灸治疗小儿脑瘫临床取穴配伍规律研究

目的:分析探讨近20年针灸治疗脑瘫取穴配伍特点及规律。方法:检索近20年CNKI、万方及维普数据库收录的针灸治疗脑瘫的相关文献,运用Excel及中医传承辅助平台软件分析数据。结果:研究共纳入文献311篇,取穴应用频次最多的为足三里、百会、四神聪、合谷、曲池、三阴交和阳陵泉,使用频次居前三位的经脉是督脉、足少阳胆经、手阳明大肠经,且取穴所在位置集中在下肢部、头颈部、上肢部,所选腧穴中特定穴以交会穴、五输穴、下合穴数量居多。穴位配伍百会和四神聪,合谷和足三里,曲池和合谷是针灸治疗脑瘫所取用的使用频次较高的腧穴配伍。结论:针灸治疗脑瘫具有注重四肢及头部选穴、侧重阳经取穴、注重特定穴的使用、重视上下配穴法的规律特点。     

脑小血管病

目的探讨伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,CADASIL)患者脑微出血(cerebral microbleeds,CMBs)的分布特征及临床意义。方法回顾性纳入2017年6月-2019年12月北京协和医院基因确诊的连续CADASIL患者21例(CADASIL组),以及性别匹配的高血压动脉硬化性脑小血管病患者21例(高血压脑小血管病组)。所有患者均行头MRI检查(含T2^*/SWI序列),盲法读片并记录CMBs的数量和部位,分析两组CMBs分布的差异。结果CADASIL组年龄和常见血管病危险因素比例均低于高血压脑小血管病组。CADASIL组47.6%患者检出CMBs(共计115个),而高血压脑小血管病组高达95.2%(共计218个)。CADASIL组CMBs分布以丘脑最常受累(45.2%),其次是脑叶(皮层/皮层下,35.7%)、基底节(11.3%)。高血压脑小血管病组则以丘脑以外的基底节CMBs最多见(35.3%),其次是脑叶(26.6%)、丘脑(19.2%)、脑干(16.1%)。CADASIL患者丘脑CMBs/总CMBs比例、丘脑CMBs/(基底节CMBs+脑干CMBs)比例均高于高血压脑小血管病组(均P<0.001)。结论CADASIL患者CMBs分布以丘脑最常见,其次是皮层/皮层下区域,而高血压脑小血管病患者则以丘脑以外的基底节、脑干更常见。     

Have outcomes following extremely preterm birth improved over time?

Increased survival of infants born preterm, especially those born extremely preterm (<28 weeks’ gestation), has meant that more are reaching later childhood and adulthood. As preterm birth is associated with a higher risk of neurodevelopmental deficits, the aim of this review was to determine whether or not the advances in perinatal care that led to improved survival have also had a positive impact on long-term neurodevelopment. Studies examining temporal changes in neurodevelopment are limited, and only from high-income countries. However, based on available published data, there is no definite trend of improved neurodevelopment at school age for neurosensory, cognitive, academic achievement, motor or executive function with time. Cerebral palsy rates, however, may be decreasing. More research is needed into the potential contributors for the trends observed, and also for other outcomes such as mental health and behavior.     

不同护理路径在脑出血护理中的应用效果分析

目的比较不同护理路径在脑出血患者护理中的应用效果。方法选取我院收治的48例脑出血患者,随机均分为对照组(常规护理)和观察组(临床护理路径),使用日常生活活动量表(Barthel指数)对患者日常生活活动能力进行评定,比较2组患者护理前后Barthel指数、疾病知晓情况和护理满意度。结果护理后观察组Barthel指数和疾病知晓情况均显著优于对照组(P<0.05);观察组护理满意度95.8%,高于对照组的70.8%,2组比较差异有统计学意义(P<0.05)。结论临床护理路径应用于脑出血患者效果确切,可有效提高患者对疾病的认知程度和生活自理能力,值得临床推广使用。     

Éveil visuel à l’image chez de jeunes enfants cérébrolésés : étude pilote d’un accompagnement pluridisciplinaire pour une intégration multimodale

To arouse the visual interest for image, the essential support for the prerequired school learnings, we proposed a work on shadows to five brain-damaged children presenting an important delay of psychomotor development and cerebral visual impairment. In a first part, the visual perceptions are stimulated by colors and elementary geometrical forms then by simple shadow figures thrown onto a screen. In a second part, the spatial and temporal structuralizations, the proprioception and the body image are worked by creating shadows with the body on the screen. We observed different types of visual and behavioral improvements: increase of the interest for image both by its creation and by its observation, increase of visual attention, more obvious social relationships. This therapeutic and educational experiment conducted over one year testifies of the importance of a multi-field coverage both by pooling the knowledge and by confronting objectives of the therapists and educator team for a holistic support of the young brain-damaged child in the understanding of image processing.     

临床护理路径对脑出血偏瘫患者康复效果的影响

目的 探究与分析临床护理路径对脑出血偏瘫患者康复效果的影响.方法 选取本院自2013年7月至2015年7月收治的90例脑出血偏瘫患者,按照就诊时间顺序分为常规护理组与临床护理路径组,每组45例.常规护理组给予基础护理对策,包括入院时宣教、介绍病情、观察病情变化等;临床护理路径组指派至少由1名护士长及3名以上护理人员建立临床护理路径小组,由护士长组织组内人员系统性的学习并加强脑出血偏瘫后康复护理的相关知识,根据每位患者的个体情况给予评估,并对每个阶段后的康复护理效果给予评价.对比两组患者康复护理效果、活动能力、肢体功能及负面情绪评分.结果 临床护理路径组的护理效果总有效率明显高于常规护理组,差异具有统计学意义(P＜0.05).两组患者治疗后较治疗前相比Barthel评分及Harris评分均明显升高,临床护理路径组较常规护理组相比Barthel评分及Harris评分升高更加明显,差异具有统计学意义(P＜0.05).两组患者治疗后较治疗前相比HAMA评分及HAMD评分评分均明显降低,临床护理路径组较常规护理组相比HAMA评分及HAMD评分降低更加明显,差异具有统计学意义(P＜0.05).结论 临床护理路径可有效提高脑出血偏瘫患者的护理效果,促进改善日常活动能力及肢体功能,降低负面情绪.     

Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report

BACKGROUNDSudden hearing loss (SHL) is associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury. Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke. It is important to distinguish stroke from benign disease. CASE SUMMARYA 48-year-old male patient presented with SHL and vertigo as first symptoms. Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm, confirming that the patient had cerebral infarction. Treatment with antiplatelet drugs, steroid anti-inflammatory drugs, and neurotrophic nerve therapy promoted blood circulation and removed blood stasis, and the symptoms of the patient were significantly improved. CONCLUSIONSHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke.     

脑状态指数联合中枢神经系统感染评分表在重型脑外伤并发颅内感染患者中的应用

目的探讨脑状态指数(CSI)联合中枢神经系统(CNS)感染评分表在重型脑外伤并发颅内感染患者病情监测中的应用。方法选取2018年6月至2019年6月开封市中心医院神经外科收治的重型脑外伤患者78例,采用CSI评分及CNS评分对患者病情进行评估。结果CSI评分10~30分组、31~50分组、51~80分组、CNS评分0~13分组、14~26分组、27~39分组在性别、年龄、脑挫裂伤、颅内血肿等方面比较差异均无统计学意义(均P>0.05),而CSI评分10~30分组、31~50分组、51~80分组在颅内感染发生率、死亡率、格拉斯哥预后评分(GOS)、Barthel指数差异均有统计学意义(均P<0.05)。CNS评分0~13分组、14~26分组、27~39分组颅内感染发生率及死亡率差异均有统计学意义(均P<0.05)。经Pearson单因素分析可知,CSI评分与CNS评分呈负相关(P<0.05)。结论CSI评分联合CNS评分对重型脑外伤并发颅内感染患者病情判断及预后有重要的价值,可为患者实施预见性护理提供指导,从而降低重型脑外伤患者颅内感染率及死亡率,提高患者临床治疗效果。     

Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review

BackgroundThe use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed.Research QuestionThe purpose of the current work was to perform a scoping review to describe and categorize the range of existing literature about IGA as applied to the clinical management of children with CP related gait disorders.MethodA health sciences librarian developed a search strategy to include four key inclusion criteria of original research study, population included children with CP, study employed IGA, available in English. The available literature was organized into six study categories: reliability and validity, documentation of subgroups or model development, IGA for clinical decision making, effectiveness of treatments that depend on IGA, cost effectiveness, IGA used to evaluate the outcome of surgical, medical or rehabilitation treatment.Results909 studies met the inclusion criteria and were placed into the six study categories. 14 % of studies were in reliability and validity, 33 % in subgroups or modeling, 2% in IGA for clinical decision making, 2% in treatments that depend on IGA, 1% in cost effectiveness, and 49 % of studies had IGA used as an outcome measure for treatment.SignificanceThis scoping review has documented the wide range, diversity and extent of original research studies investigating the use of IGA for the clinical management of children with CP related gait disorders. The large volume of studies provides a basis for future work to develop a CPG about the use of IGA for the clinical management of children with CP related gait disorders.