强化胰岛素治疗对重型颅脑损伤患者预后的影响

目的探讨胰岛素强化治疗对重型颅脑损伤预后的影响。方法回顾性分析2006～2008年间我院收治的重型颅脑损伤伴血糖升高患者62例,其中32例进行强化胰岛素治疗,使血糖控制在4．4～6．1mmol／L,传统胰岛素治疗组30例患者血糖控制在11．1～14．0mmol／L。观察3个月后患者的格拉斯哥预后评分（GOS）。结果比较两组的GOS,强化胰岛素治疗组的恢复良好率高于传统胰岛素治疗组,而病死率低于后者,两组之间有显著差异（P〈0．05）。结论强化胰岛素治疗能改善重型颅脑损伤患者预后。     

重型颅脑外伤患者亚低温治疗后血糖及胰岛素变化的动态观察

目的探讨亚低温治疗对重型颅脑外伤患者血糖代谢的影响及临床意义.方法把重型颅脑外伤65例随机分为亚低温治疗组(32例)和常规治疗组(33例).前组于入院或急诊手术后即用亚低温治疗,将直肠温度控制于33～35℃,持续3～5 d;后组行常规治疗.并按Glasgow预后分级评定患者的预后.两组分别于入院后及治疗后第1、3、5、7 d检测血糖和胰岛素含量,观察其动态变化,并分析与预后的关系.结果重型颅脑外伤后血糖及胰岛素水平均升高.亚低温组治疗5～7 d后血糖水平较治疗后1 d及常规组治疗同一时期显著下降,两组观察期内胰岛素水平则无显著差异.亚低温组病死率为28.1%,常规组病死率为54.5%.入院时血糖≥11mmol/L者预后较差.结论亚低温治疗有可能通过缓解机体强烈的应激反应,导致血糖水平下降,从而减轻颅脑损伤患者糖代谢紊乱,并改善预后.     

胰岛素强化治疗重型颅脑损伤合并糖尿病

目的探讨胰岛素强化治疗对重型颅脑损伤(STBI)合并糖尿病患者的临床疗效及预后的影响。方法选择入住重症监护病房(ICU)既往有糖尿病史的重型颅脑损伤患者80例,随机分为治疗组和对照组,每组40例,治疗组给予7 d胰岛素强化治疗,随后给予常规血糖控制,对照组全程常规血糖控制。强化胰岛素治疗组血糖控制目标为4.4~8.3 mmol/L,常规血糖控制目标为4.4~11.1 mmol/L。结果伤后随访6月按(GOS)评分评价疗效,治疗组恢复良好率较对照组组提高15%,死亡率下降17%(P0.05),ICU住院时间、机械通气时间、院内感染发生率均低于对照组(P0.05)。结论短期胰岛素强化治疗能有效改善重型颅脑损伤合并糖尿病患者的预后,降低ICU内并发症的发生率。     

重型颅脑损伤急性期高血糖、伤情和预后的临床分析

目的 探讨重型颅脑损伤后高血糖形成机制与伤情和预后的关系.方法 48例重型颅脑损伤患者于入院当时、第3d和第7d检测空腹血糖,根据预后将患者分为死亡组和存活组,同时与对照组(轻、中型颅脑损伤者)进行对比分析.结果 重型颅脑损伤患者血糖均有不同程度增高,死亡组血糖明显高于存活组(P＜0.01);重型颅脑损伤组血糖显著高于对照组(P＜0.01);入院时血糖与 GCS 和预后显著相关(P＜0.01),且入院时血糖≥10mmol/L者,病死率显著增高.结论 重型颅脑损伤患者急性期血糖均有不同程度升高,血糖升高程度越明显,脑损伤程度越重、预后越差;动态检测重型颅脑损伤患者血糖对了解病情、判断预后具有重要的意义.     

重型颅脑损伤并高血糖高渗非酮症昏迷救治体会

目的探讨重型颅脑损伤并高血糖高渗非酮症昏迷的发病机制、临床特点及治疗方法。方法回顾性分析24例重型颅脑损伤并高血糖高渗非酮症昏迷患者的临床资料。结果 24例患者均以脱水、意识障碍加重为主要临床表现,血糖、血钠、血浆渗透压均明显增高,确诊后给予补液、应用胰岛素等综合治疗,死亡11例,重残及植物生存状态6例,中残及恢复良好7例。结论重型颅脑损伤并高血糖高渗非酮症昏迷预后差、早期诊治有助于改善预后。     

重型颅脑损伤患者的预后因素分析

目的 探讨交通伤所致重型颅脑损伤患者预后的临床影响因素. 方法回顾性分析南方医科大学珠江医院神经外科自1998年2月至2008年2月收治的652例交通伤所致重型颅脑损伤患者的临床资料,伤后3个月根据患者格拉斯哥预后评分(GOS)分为预后良好组和预后不良组,比较患者性别、年龄、入院时间、瞳孔、血氧饱和度、收缩压、血糖、损伤严重度评分(ISS)、格拉斯哥昏迷评分(GCS)及脑损伤类型等10项指标在2组间的差异.结果 与预后良好组相比,预后不良组患者入院时间长、血糖和ISS评分较高,而瞳孔评分、血氧饱和度、收缩压、GCS分值较低,差异有统计学意义(P<0.05);脑挫裂伤、颅内多发血肿和颅内血肿患者预后较差;血糖、血氧、GCS评分和ISS评分为影响患者预后的独立因素.结论血糖、血氧、GCS评分和ISS评分可有效判断交通伤所致重型颅脑损伤患者的预后.     

重型颅脑损伤患者ICU早期监护对预后的影响

目的探讨重型颅脑损伤患者ICU期监护对预后的影响。方法收集2011-01-2011-08我院收治的重型颅脑损伤患者60例,将其随机分为治疗组与对照组各30例,治疗组患者是使用常规护理联合早期护理监护干预,对照组患者使用常规护理进行治疗。统计分析2组患者的治疗效果,总结其ICU早期监护对患者预后影响的作用。结果治疗组效果明显优于对照组,2组患者差异有统计学意义,P〈0.05。结论重型颅脑损伤患者在治疗过程中使用ICU早期监护可以有效的帮助患者进行预后恢复,治疗效果明显优于常规治疗,值得在临床过程中进行推广使用,提高患者的治疗效果。     

强化胰岛素治疗在重型颅脑创伤患者中的应用

强化胰岛素治疗是一种将ICU重症患者的系统血糖严格控制在4.4～6.1mmol/L的胰岛素冲击疗法。该疗法在有效降低部分重症患者死亡率的同时,也增加了低血糖症的发生几率。重型颅脑创伤后出现系统循环血糖应激性升高并不意味大脑糖供给充足。在患者高血糖症出现的同时伴有相同程度的应激性颅内糖代谢率升高,脑组织供能需求增大。若此时使用强化胰岛素治疗将系统循环血糖控制在较低范围,将导致大脑摄糖不足,严重时则造成持续的大脑缺能量性代谢不良,影响患者预后。因此,治疗重型颅脑创伤患者时应慎重使用胰岛素控制血糖,将其波动范围更宽的定位在6.0～10.0mmol/L之间。     

肠内肠外复合营养对重型颅脑损伤患者预后的影响

目的探讨重型颅脑损伤肠内肠外复合营养支持的临床意义及对预后的影响。方法选择重型颅脑损伤40例,随机分为治疗组20例和对照组20例。治疗组采用肠内肠外复合营养,对照组常规治疗。观察治疗后病人的前白蛋白、血糖、血红蛋白、血清白蛋白、淋巴细胞计数、并发症发生率及预后。结果治疗组病例营养状态明显好于对照组(P<0.01),并发症减少,预后良好。结论重型颅脑损伤病人早期肠内肠外复合营养支持有利于颅脑损伤病人尽早恢复。     

颅脑损伤后血糖、胰岛素紊乱的相互关系及意义

目的：探讨颅脑损伤病人的血糖及胰岛素浓度及相互关系。方法：测定了71例颅脑损伤病人的血糖及胰岛素浓度部份病人进行糖耐量试验。结果：轻型组血糖及胰岛素含量均低于重型组（P＜0．01），血糖浓度与胰岛素浓度呈正相关（γ=0．784，P＜0．001）。糖耐量试验：1小时末，两组血糖与胰岛素含量均升高，但轻型组血糖低于重型组（P．＜0．001），胰岛素却高于重型组（P＜0．05）；2小时末，轻型组血糖及胰岛素均显著下降，而重型组则变化不大。结论：脑外伤后升高血糖因素虽是多方面的，但胰岛素含量的相对不足和绝对不足是高血糖的主要因素，为脑外伤后高血糖胰岛素治疗提供了理论依据。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -