亚低温对急性重型颅脑损伤病人治疗机理及临床疗效研究

目的研究亚低温对急性重型颅脑损伤病人的治疗机理及临床效果.方法164例病人,随机分为亚低温治疗组和对照组.亚低温治疗组82例,均于伤后24小时内行亚低温治疗,直肠温度(RT)控制在32.0℃～35.0℃;脑温为32.5℃～35.0℃,持续1～7天,平均60.2±28.0小时.同时监测病人的生命体征、颅内压(ICP)、血糖、血乳酸、血气、血电解质以及脑组织氧分压(PbrO2)和脑组织温度(BT)、脑微循环血流(LDF血流值)和颈静脉血氧饱和度(SjvO2).对照组82例,直肠温度控制在36.5℃～37.0℃,其他治疗同亚低温组.两组病人均于伤后3个月时根据GOS评估法判定疗效.结果与对照组相比,亚低温治疗组病人伤后早期的高ICP、高血糖、高乳酸血症分别显著下降(P＜0.05);严重的低PbrO2迅速上升并维持在正常水平;脑血供得到改善;生命体征、血气及血电解质无显著差异;无严重并发症;死亡率降低,恢复良好率提高,预后显著改善.结论亚低温具有肯定的脑保护作用,临床上用于治疗急性重型颅脑损伤病人,安全有效,可降低死亡率,提高生存质量,无严重并发症.直接监测PbrO2、BT、LDF血流值和SjvO2,对亚低温治疗更有指导意义.     

亚低温治疗急性重型颅脑损伤的临床疗效

目的　研究亚低温对急性重型颅脑损伤病人的治疗作用及临床效果。方法　共 87例病人 ,随机分为亚低温治疗组和对照组。亚低温治疗组 43例 ,均于伤后 2 4小时内行亚低温治疗 ,直肠温度 (RT)控制在 31 5～ 34 9℃ ,脑温为 32 0～ 35 0℃ ,持续 1～ 7天 ,平均 5 7 7± 2 8 4小时。同时监测病人的生命体征、颅内压 (ICP)、血糖、血乳酸、血气、血电解质以及脑组织氧分压 (PbrO2 )和脑组织温度 (BT)。对照组　 44例 ,直肠温度控制在 36 5～ 37 5℃ ,其他治疗同亚低温组。两组病人均于伤后 3个月时根据GOS评估法判定疗效。结果　　与对照组相比 ,亚低温治疗组病人伤后早期的高ICP、高血糖、高乳酸血症分别显著下降 (P <0 0 5 ) ;严重的低PbrO2 迅速上升并维持在正常水平 ;生命体征、血气及血电解质无显著差异 ;无严重并发症 ,死亡率降低 ,恢复良好率提高 ,预后显著改善。结论　亚低温具有肯定的脑保护作用 ,临床上用于治疗急性重型颅脑损伤病人 ,安全有效 ,可降低死亡率 ,提高生存质量 ,无严重并发症。直接监测PbrO2 和BT ,对亚低温治疗更有指导意义     

早期应用亚低温治疗重型颅脑损伤并脑水肿的疗效分析

目的 研究早期应用亚低温疗法对急性重型颅脑损伤病人脑水肿的治疗价值和临床效果。方法 将116例重型颅脑损伤病人随机分为亚低温治疗组和对照组。亚低温组59例，均于伤后10h内行亚低温治疗，直肠温度控制在32-35℃，持续5-7d，同时监测颅内压、生命体征、血气分析、血氧饱和度、血电解质。定期头颅CT扫描。对照组57例，直肠温度控制在37℃，其它治疗两组相同。两组病人均于治疗半个月后评估脑水肿治疗效果及3个月后根据GOS评估治疗效果。结果 亚低温治疗组病人的生命体征变化、颅内压降低、脑水肿的CT改变及血糖改变明显优于对照组。3个月后亚低温组治愈31例，占53％，死亡15例，占25％。对照组治愈23例，占40％，死亡26例，占46％，两组具有显著的差异。结论 亚低温治疗明显减轻脑水肿，降低颅内压，具有脑保护作用，临床上治疗重型颅脑损伤脑水肿病人具有操作简便，安全可靠，可降低死亡率，提高治愈率。     

亚低温对重型颅脑创伤合并急性创伤性凝血病影响的临床研究

目的 研究亚低温对重型颅脑创伤(sTBI)合并急性创伤性凝血病(ATC)患者的影响及其临床意义.方法 83例sTBI合并AT℃患者随机分为亚低温治疗组42例、常规治疗组(对照组)41例.亚低温治疗组均于伤后24h内接受亚低温治疗.分别测量两组患者不同时间点的凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血时间(TT)、纤维蛋白原(FIB)及D-二聚体水平,同时监测患者颅内压(ICP)以及生命体征、血气、血电解质及动脉血氧饱和度等,并根据GOS评估法判断预后.结果 亚低温治疗组患者PT、APTT、TT、FIB及D-二聚体与对照组相比差异无统计学意义(P＞0.05),而颅内压明显降低(P＜0.01);生命体征、血气、血电解质、动脉血氧饱和度差异无统计学意义,无严重并发症,病死率低,预后改善明显.结论 亚低温治疗不会增加sTBI合并ATC患者出现凝血障碍及纤溶亢进的风险,并且能有效地降低颅内压,具有肯定的脑保护作用,是一项安全有效的治疗措施.     

亚低温治疗重型颅脑损伤的临床疗效观察

目的探讨亚低温疗法在颅脑损伤治疗中的作用。方法73例颅脑损伤患者分为①亚低温组：31例，均于伤后24h内接受亚低温治疗，直肠温度控制在32～34℃，维持3～7d；②常规治疗组：42例，其他治疗同亚低温组，根据GOS预后评估系统评估两组患者疗效。结果与常规治疗组相比，亚低温组患者伤后早期颅内压显著下降（P〈0．05）；生命体征、血气及电解质无显著性差异（P〈0．05）；无严重并发症，死亡率降低，恢复良好，预后显著改善。结论亚低温疗法能减轻颅脑损伤后脑水肿，降低颅内压，伤后24h内接受亚低温治疗，疗效确切，可降低颅脑损伤患者的死亡率，提高其生存质量。     

亚低温治疗重型颅脑损伤的临床分析

目的 探讨亚低温对重型颅脑损伤的脑保护作用及临床疗效.方法 回顾性分析我院收治的251例特重型颅脑损伤患者,常规治疗组182例和亚低温治疗组69例.亚低温治疗组均在受伤后24 h内行亚低温治疗,比较两组的手术疗效及对患者预后的影响.结果 与常温治疗组比较,亚低温治疗组恢复良好率显著提高,病死率显著降低,预后改善显著,且并发症无明显增加.结论 在常规治疗的基础上加用亚低温治疗特重型颅脑外伤,可以明显改善患者的预后;能显著降低特重型颅脑损伤的死残率.     

亚低温治疗重型颅脑损伤的疗效观察

目的探讨亚低温治疗重型颅脑损伤病人的方法、注意事项及治疗效果。方法将重型颅脑损伤病人（GCS≤8分）80例随机分成亚低温治疗组和对照组各40例,对照组按常规治疗,实验组常规治疗基础上于伤后24 h内接受亚低温治疗,直肠温度控制在32~35℃,维持亚低温7~14 d;2组病人均通过生命征监护,颅内压、电解质及血气分析监测。结果与对照组相比,亚低温治疗组病人伤后高颅压、高体温很快得到控制,而生命体征、血气及电解质2组变化不大。结论亚低温疗法能减轻颅脑损伤后脑水肿、降低颅内压和改善预后,疗效确切,安全有效,可降低病死率,提高生存质量。     

早期应用亚低温治疗重型颅脑损伤并脑水肿的疗效分析

目的 研究早期应用亚低温疗法对急性重型颅脑损伤病人脑水肿的治疗价值和临床效果。方法将116例重型颅脑损伤病人随机分为亚低温治疗组和对照组。亚低温组59例,均于伤后10h内行亚低温治疗,直肠温度控制在32～35℃,持续5～7d,同时监测颅内压、生命体征、血气分析、血氧饱和度、血电解质。定期头颅CT扫描。对照组57例,直肠温度控制在37℃,其它治疗两组相同。两组病人均于治疗半个月后评估脑水肿治疗效果及3个月后根据GOS评估治疗效果。结果 亚低温治疗组病人的生命体征变化、颅内压降低、脑水肿的CT改变及血糖改变明显优于对照组。3个月后亚低温组治愈31例,占53％,死亡15例,占25％。对照组治愈23例,占40％,死亡26例,占46％,两组具有显著的差异。结论 亚低温治疗明显减轻脑水肿,降低颅内压,具有脑保护作 用,临床上治疗重型颅脑损伤脑水肿病人具有操作简便,安全可靠,可降低死亡率,提高治愈率。     

亚低温对颅内巨大动脉瘤夹闭术临时阻断动脉血流及缺血-再灌注期的脑保护作用

目的观察亚低温对颅内巨大动脉瘤夹闭手术中临时阻断动脉血流及缺血-再灌注期的脑保护作用。方法1998年9月-2002年6月施行颅内巨大动脉瘤夹闭手术患者27例,其中13例于动脉瘤夹闭临时阻断动脉血流及缺血-再灌注期行亚低温处理(亚低温组),脑温为32.0℃～35.0℃,同时监测生命体征、脑组织温度和失血量;另14例常温下手术者(常温组)作为对照,其他均同亚低温组。两组均于术后3个月根据GOS进行预后评估。结果术中两组患者生命体征变化差异无显著性意义(P>0.05)。亚低温组,神经功能伤残评定等级为良好11例(84.62%),轻残1例(7.69%),死亡1例(7.69%);常温组,神经功能伤残评定等级为良好6例(42.86%),轻残4例(28.57%),重残2例(14.29%),死亡2例(14.29%),组间差异具有显著性意义(Z=2.083,P<0.05)。结论亚低温可降低颅内巨大动脉瘤夹闭术患者的病死率,提高患者生命质量,对脑缺血及再灌注性损伤具有良好的脑保护作用。     

亚低温在重型颅脑损伤中的临床应用体会

目的探讨亚低温在重型颅脑损伤救治过程中的价值。方法 2008年6月至2013年6月收治重型颅脑损伤(GCS≤8分)420例,分为亚低温组(185例)和常温组(235例);均进行标准大骨瓣减压术,亚低温组在常温组治疗的基础上,采用亚低温措施(直肠温度控制在32~34℃,治疗时间为4~7 d;同时监测病人的生命体征、颅内压等,预防并及时处理各种并发症)。结果治疗后6个月,亚低温组GOS评分明显优于常温组(P0.05)。治疗后12个月,亚低温组KPS评分明显优于常温组(P0.05)。结论在常规治疗的同时,采用亚低温措施对重型颅脑损伤病人的治疗有较好疗效,但应注意并发症等情况的预防和处理。     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Cultural Identity and Experiences of Prejudice and Discrimination of Afghan and Iranian Immigrant Youth

In culturally diverse and immigrant receiving societies, immigrant youth can be subject to prejudice and discrimination. Such experiences can impact on immigrant youth’s cultural identity and influence their psychosocial outcomes. This paper presents findings of a study that examined cultural identity and experiences of prejudice and discrimination among Afghan (N = 9) and Iranian (N = 17) immigrant youth in Canada. The study had a prospective, comparative, longitudinal qualitative design. Data was gathered through focus groups, interviews, journals and field logs. Four main themes emerged on participants’ experiences of prejudice and discrimination: (a) societal factors influencing prejudice; (b) personal experiences of discrimination; (c) fear of disclosure and silenced cultural identity; and (d) resiliency and strength of cultural identity. Drawing from Rosenberg’s (Conceiving the self, Basic Books, New York, 1979) self-concept framework and Romero and Roberts (J. Adolesc., 21:641–656, 1998) distinction between prejudice and discrimination, results indicated that youth’s extant and presenting cultural identity were affected. Inclusive policies and practices are needed to promote youth integration in multicultural and immigrant receiving settings.

发作性睡病与异态睡眠的诊治

本文目的是探讨发作性睡病与异态睡眠的诊断与治疗.发作性睡病被漏诊和误诊的几率较高,危害较大,共患异态睡眠比例高.文章从发作性睡病临床特征、REM睡眠的作用、发作性睡病与异态睡眠(睡眠瘫痪、睡眠幻觉、快眼动睡眠期行为障碍)共病特征及治疗这四个方面进行了讨论.     

Effects of Agonists and Antagonists of Cholecystokinin on Contractile and Myoelectric Activity of Isolated Muscle of Colon and Ileum in the Dog and Guinea Pig

This study evaluates the effects of agonists and antagonists of cholecystokinin (CCK) on contractile and myoelectrical activity in isolated longitudinal muscle strips from colon or ileum of guinea pigs or beagle dogs. Caerulein and CCK-8 caused a dose-dependent increase of contractile and myoelectrical spike activity in both species with maximal effects seen between 10⁻⁸ and 3 × 10⁻⁸ M. The dose responses were identical for both CCK agonists and species. The dose-related effects of CCK compounds on colonic muscle were slightly shifted to the right when compared to ileum in both species. All antagonists, the proglumide-derivatives CR1409, CR1392, and CR1505, as well as the nonpeptide substances asperlicin and L-364,718, caused a parallel rightward shift of CCK's dose-dependent motor activity response, indicating the competitive nature of inhibition. The antagonists displayed a rank order of potency in antagonizing CCK's action on intestinal motility similar to their ability to antagonize CCK's action on pancreas and gallbladder. L-364,718 was the most potent antagonist, followed by CR1409, CR1505, CR1392, asperlicin, and proglumide. The antagonists did not affect contractile or myoelectrical responses to acetylcholine, histamine, motilin, or substance P. Thus compounds that have been described as CCK antagonists for pancreas and gallbladder also act as specific and competitive antagonists of CCK's action on contractile and myoelectrical activity of Heal and colonie muscle.     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

小胶质细胞和少突胶质细胞前体的培养和鉴定

目的 探讨新生大鼠脑组织小胶质细胞(MG)和少突胶质细胞(OL)前体的分离和体外培养方法 . 方法 取新生2 d SD大鼠脑组织,体外原代培养混合胶质细胞7 d后,分别采用"改良振荡伴差速贴壁"法和"营养缺失伴振荡"法纯化培养MG和OL前体,并分别应用免疫荧光染色异凝集素-B4(IB4)和OL前体标记物(O4)进行鉴定.结果 混合胶质细胞培养7 d后呈明显三层增长,其中MG位于上层,星型胶质细胞位于底层,两者之间为2型少突星型(O2A)祖细胞.纯化培养后OL前体胞体呈小圆形,有双极或三极突起,MG则以阿米巴形、圆形居多,或边缘呈毛刺状.免疫荧光染色IB4显示绿色荧光,MG纯度达到90%以上.免疫荧光染色O4显示棕黄色荧光,OL前体纯度达到95%以上. 结论 采用"改良振荡伴差速贴壁"法以及"营养缺失伴振荡"法分别成功获取大量纯度高、活力好的MG和OL前体.     

Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents

OBJECTIVE: Using predetermined criteria for study quality and methods, a literature review and meta-analysis of seven reports about pediatric bipolar disorder (BPD) was conducted to determine if there is a consistent picture of the phenomenology and clinical characteristics of BPD in children and adolescents. METHODS: Searches were conducted in MedLine and PsycINFO using the terms mania, BPD, children and adolescents, and was limited to published articles in peer-reviewed journals. Seven reports were selected that met the following criteria: a systematic method for the elicitation and reporting of symptoms and clinical characteristics of subjects; subjects were interviewed by a trained researcher or clinician; ages 5-18 years; use of a diagnostic system, either DSM or RDC for categorization; a consensus method for the establishment of the diagnosis of BPD. RESULTS: Most DSM-IV symptoms of mania were common in the children and adolescents with BPD with the most common symptoms being increased energy, distractibility, and pressured speech. On average, four of five bipolar cases also showed threshold levels of irritable mood and grandiosity, and more than 70% of all cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features. CONCLUSIONS: The clinical picture that emerges is that of children or adolescents with periods of increased energy (mania or hypomania), accompanied by distractibility, pressured speech, irritability, grandiosity, racing thoughts, decreased need for sleep and euphoria/elation.