不同丙戊酸负荷量对癫痫持续状态的治疗效果分析

目的了解不同丙戊酸负荷量对癫痫持续状态患儿的治疗效果。方法收集2013年1月1日至2017年12月31日在浙江大学医学院附属儿童医院重症监护室住院治疗的癫痫持续状态患儿的病例资料,根据丙戊酸负荷量进行分组,了解各组患儿癫痫持续状态的控制情况。结果(1)66例癫痫持续状态患儿,包括癫痫36例(54.5%),颅内感染16例(24.2%),缺氧窒息3例(4.5%),颅内肿瘤2例(3.0%),脑发育异常2例(3.0%),颅内出血2例(3.0%),病因不明确5例(7.6%)。(2)所有癫痫持续状态患儿根据不同的丙戊酸负荷量(0 mg/kg,10~15 mg/kg,16~39 mg/kg,40 mg/kg)分为4组,各组间的性别、年龄差异无统计学意义,癫痫持续状态控制时间和癫痫控制情况差异无统计学意义(P=0.402、0.340)。(3)所有患儿予丙戊酸钠应用后都有监测肝功能,无一例患儿出现肝功能损害的表现。结论不同丙戊酸负荷量对于癫痫持续状态患儿的治疗效果无明显差异,并且接受负荷量为40 mg/kg治疗的癫痫持续状态患儿未出现相关不良反应。     

中西医一体化防治增生性瘢痕的研究现状

皮肤瘢痕是一个巨大的医学问题,每年约有1亿患者产生瘢痕。瘢痕的预防/治疗在很大程度上还没有得到满足的临床需求。瘢痕的形成通常是皮肤创伤的病理结果。而增生性瘢痕(hypertrophic scar,HTS)常发生在人深部损伤后。HTS通常被认为是组织收缩和过度的细胞外基质沉积的结果。肌成纤维细胞作为主要由成纤维细胞分化而来的效应细胞,在HTS的病理生理中起着至关重要的作用。多种生长因子、炎症因子参与了HTS发生的过程。目前,随着对HTS的深入探索和临床研究,各种创造性和有效的治疗方法正在萌芽。本文就HTS中西医形成机制研究进展进行综述,并针对其病理生理特点,对现有的中西医综合治疗方法进行综述。此外,我们进一步展望更适合的HTS中西医综合治疗的特色与方法。     

基于岗位管理的基层医院专科护士使用及考核的现状调查研究

目的调查四川省基层医院专科护士使用和考核现状,对其使用和考核体系进行探索。方法于2017年9月7-15日,采用问卷调查法对四川省38所二级及三级乙等医疗单位专科护士的使用和发展现状进行调查。结果共有38所医院参与网络问卷调查,其中34.21%的医院未针对专科护士设置岗位,岗位职责不清晰。有73.68%的专科护士未进行资质再认证,60.53%的专科护士学成后未进行专科资质再考核。结论我国对专科护士能力的评价认证体系尚未形成统一标准,对专科护士的培养条件也未形成统一标准。护士岗位管理中设置专科护士岗位能促进专科护士的职业发展规划,有利于专科护士使用和考核。     

丹参对持续癫痫幼鼠脑损伤保护作用的实验研究

目的 探讨丹参对持续癫痫发作诱发幼鼠脑神经元损伤是否具有保护作用。方法 皮下及腹腔注射贝美格针诱发健康幼龄鼠癫痫持续状态发作。光镜下观察神经元病变情况；电镜观察海马神经元超微结构的改变。结果 持续癫痴组幼鼠脑组织光镜下可见明显的神经元病变。电镜下可见海马区神经元的超微结构病变。丹参治疗组神经元病变均轻于持续癫痴组；而正常对照组未见类似病变。结论 丹参在组织、细胞和亚细胞水平对持续癫病幼鼠脑神经元损伤具有一定的保护作用，为临床有效防治小儿惊厥性脑损伤提供了可靠的实验依据。     

181例离退休干部抑郁状况及影响因素的研究

目的 了解离退休干部抑郁状况及有关影响因素。方法对181例离退休干部进行GDS量表评定，并进行相关分析和逐步回归分析。结果离退休干部抑郁症状患病率为25．4％，对其影响的最主要因素为身体状况、生活感觉、性别、家庭关系，标准化回归系数分别为-0．294、0．260、-0．163、-0．169。结论必须从多方面采取综合干预措施，才能改善离退休干部的抑郁状况，从而达到心理健康水平。     

妥泰对海人酸致癎大鼠海马神经元线粒体损伤的保护作用

目的观察海人酸（KA）诱导的癫痫持续状态（SE）、大鼠海马CA3区神经元线粒体超微结构的损伤及妥泰（TPM）的保护作用。方法用TPM干预。用KA诱导大鼠SE2h，并于癫痫终止后3h制作脑切片，用光镜观察神经元的大体损伤，并用电镜进一步观察线粒体的超微结构。结果KA组和TPM组大鼠均出现了线粒体超微结构的损伤，TPM组大鼠的损伤明显减轻。结论KA诱导的SE可导致海马神经元线粒体损伤，妥泰对此具有保护作用。     

Generalized Convulsive Status Epilepticus in the Adult

Summary: Status epilepticus (SE) is denned as recurrent epileptic seizures without full recovery of consciousness before the next seizure begins, or more-or-less continuous clinical and/or electrical seizure activity lasting for more than 30 min whether or not consciousness is impaired. Three presentations of SE are now recognized: recurrent generalized tonic and/or clonic seizures without full recovery of consciousness between attacks, nonconvulsive status where the patient appears to be in a prolonged "epileptic twilight state," and continuous/repetitive focal seizure activity without alteration of consciousness. Generalized convulsive status epilepticus (GCSE) encompasses a broad spectrum of clinical presentations from repeated overt generalized tonic-clonic seizures to subtle convulsive movements in a profoundly comatose patient. Thus, GCSE is a dynamic state that is characterized by paroxysmal or continuous tonic and/or clonic motor activity, which may be symmetrical or asymmetrical and overt or subtle but which is associated with a marked impairment of consciousness and with bilateral (although frequently asymmetrical) ictal discharges on the EEG. Just as there is a progression from overt to increasingly subtle clinical manifestations of GCSE, there is also a predictable sequence of progressive EEG changes during untreated GCSE. A sequence of five patterns of ictal discharges has been observed: discrete electrographic seizures, waxing and waning, continuous, continuous with flat periods, and periodic epileptiform discharges on a relatively flat background. A patient actively having seizures or comatose who exhibits any of these patterns on EEG should be considered to be in GCSE and should be treated aggressively to stop all clinical and electrical seizure activity to prevent further neurological morbidity and mortality.     

Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Summary: The effect of gestational age on neonatal ictal and interictal durations has not been investigated. Sixty-eight neonates with 644 electrographic seizures were identified retrospectively. Thirty-five full-term (FT) neonates were compared with 33 preterm (PT) neonates. Eighteen older preterm infants (OPT) [>31 weeks estimated gestational age (EGA)] were also compared with 15 young preterm infants (YPT) of ≤31 weeks EGA. Ictal/ interictal durations were calculated for the total cohort with and without status epilepticus (SE). Statistical analyses were two-tailed t tests, chi-square calculations, and one-way analysis of variance (ANOVA) with Duncan's multiple-range test. Eleven of 35 (33%) FT had SE as compared with 3 of 33 (9%) PT (chi-square = 7.8, p < 0.05). The mean ictal duration was 14.2 min for FT infants as compared with 3.1 min for PT infants (p < 0.01); only borderline differences were noted after those with SE were excluded. Interictal durations were longer for OPT than YPT (p < 0.05). By ANOVA and Duncan's multiple-range tests, group differences included longer mean ictal durations for FT infants as compared with OPT infants (p = 0.06, ANOVA; p < 0.05, Duncan's), and longer mean interictal durations for FT infants versus OPT and OPT versus YPT (p = 0.02, ANOVA; p < 0.05, Duncan's). More developed neuronal networks result in longer ictal durations in FT than in PT neonates, including FT infants with SE. Inhibitory networks responsible for longer interictal periods are more dominant in OPT infants than in YPT infants, reflecting maturational changes that suppress seizure activity during the latter part of the third trimester before the infant reaches an FT corrected age.     

Therapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation

Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when 'conventional therapies' fail in the intubated patient with status asthmaticus.     

Substantia nigra lesions in mercaptopropionic acid induced status epilepticus: a light and electron microscopic study

Summary Light microscopic and ultrastructural changes of substantia nigra were studied in paralyzed ventilated rats with status epilepticus induced by mercaptopropionic acid. Some rats were killed at the end of seizure activity and others were examined in varying intervals after the arrest of seizure. The earliest changes were reduction in the size of the neuronal nuclei and chromatin clumping followed by simultaneous distention of axons and dendrites. There was also enlargement of the neuronal perikarya associated with microvacuolation. This neuronal microvacuolation corresponded ultrastructurally to swollen mitochondria with disrupted cristae. These changes were followed by progressive neuronal shrinkage and astrocytic swelling. The swollen astrocytic processes together with swollen neurites gave a spongy appearance to the involved area. The lesion thereafter progressively enlarged and evolved into an area of frank necrosis containing abundant macrophages. This lesion is morphologically different from that produced in cortex and hippocampus by seizure activity or due to the direct effect of excitotoxins. The significance of substantia nigra pars reticularis changes and their pathogenesis are discussed.