脑功能、生活质量与神经外科手术策略

进入21世纪以来，专家和学者对神经外科手术后病人生存质量问题的研究逐渐增多，仅Medline检索近5年有关脑功能、生活质量和神经外科相关文献即达130余篇。这说明随着社会的进步、科学的发展，人们对生活质量的要求在不断提高。脑作为人类高级生存活动的最重要器官，其功能状态决定人的生存质量。20世纪神经外科的重要进步是显微外科和计算机技术等带来的颅底外科和脑血管外科手术的发展与完善，使临床医师可以驾轻就熟地在这些领域开展积极治疗，且多可获得比较好的疗效。     

《中国临床神经外科杂志》2000年至2007年载文与作者分析

目的了解《中国临床神经外科杂志》2002—2007年载文与作者等情况，为该刊的进一步发展和期刊评价提供参考。方法用文献计量学方法对《中国临床神经外科杂志》2000～2007年1929篇论文的栏目设置、作者、地区及机构分布、出版时滞和被引情况等进行统计学分析。结果该刊载文量逐年上升；栏目设置稳定；论文的高产作者和高产单位相对集中，并形成了自己的核心作者群；科研合作率高；2006年后出版时滞大为缩短，论文质量进一步提高；引用该刊文献的期刊有382种，其中引用频次≥15次的有19种。结论《中国临床神经外科杂志》论文质量逐年提高，学术水平逐渐增强，能将国内外最新的神经外科进展传递给临床工作者。     

2007/中医药治疗帕金森病研究文献的系统评价

摘要 目的：在严格的质量评价方法的基础上,对中医药治疗帕金森病的临床治疗性文献进行系统评价,以期对中医药治疗帕金森病的疗效作出客观的评价。方法：采用《中医药治疗性文献系统性评价质量及信息评价表》,对2001-2008年7月国内发表的、研究中医药及中西医结合治疗帕金森病的临床对照试验文献进行评价。结果：所评价的44篇文献中均未进行样本估算,随机对照的文献有34篇,占77.3%,但大多缺乏对随机方法的描述;4篇文献提到有关退出、失访病例的情况,仅占9.1%;诊断标准、疗效标准的选择、结论推导等重要环节亦存在着一些问题,影响着随机对照试验的质量及其可信度。结论：中医药治疗帕金森病的方法学运用有待进一步加强。     

精神科护士对身体约束的知_信_行现状及培训需求调查

目的了解精神科护士对身体约束的知信行现状及培训需求,为护理管理者制定干预措施提供依据。方法采取便利抽样的方法,采用自行设计的身体约束知、信、行问卷及身体约束培训需求问卷对深圳市康宁医院110名精神科护士进行横断面现况调查。结果精神科护士身体约束知识、态度和行为得分分别为(15.82±1.75)分、(38.14±4.69)分、(68.16±5.01)分,身体约束知识与态度呈负相关(r=-0.42,P<0.01)、知识与行为呈正相关(r=0.38,P<0.01),态度与行为呈负相关(r=-0.26,P<0.05)。培训需求前3位依次为暴力管理技能培训、攻击风险评估及约束替代性措施。结论精神科护士身体约束知识掌握较好,对身体约束呈中性态度,有恰当的约束行为。对精神科护士应加强暴力管理技能、攻击风险评估及约束替代性措施的培训。     

强迫症与立体定向神经外科治疗的全球文献计量分析趋势

目的 分析1991—2022年全球强迫症与立体定向神经外科治疗相关文献，了解强迫症立体定向神经外科治疗的相关科研现状和变化态势，为未来相关领域学术发展提供参考和建议。方法 通过检索Web of Science数据库获得强迫症的立体定向神经外科治疗在1991—2022年发表的相关文献，采用文献计量学的方法对文献的发文量变化情况和高频关键词进行可视化分析。结果 1991—2022年共发表相关论文141篇，且发文量呈增长趋势。在这141篇出版物中，超过半数的出版物为美国发表，远超其他国家。且在该研究中最多产的机构，前3名分别为美国的布朗大学、哈佛大学、佛罗里达大学。该领域研究热点集中在难治性强迫症、深部脑刺激、立体定向外科、囊切开术、抑郁、扣带回毁损术、特发性震颤、丘脑切割术、伏膈核。结论 未来该领域的研究可更多基于强迫症患者的实际需求，在保证治疗效果的同时，加强对治疗副作用及患者康复等方面的协同优化，防止患者因治疗后的人格改变等与社会剥离，帮助强迫症患者回归社会。     

关于脑卒中康复治疗随机对照试验论文的质量评价

目的：评价关于脑卒中随机对照试验研究的中文文献质量,找出这一领域随机对照试验研究的优势和不足,为今后开展研究提供依据。方法以“脑卒中”、“随机对照”和“康复”作为检索词,在CNKI数据库中检索关于脑卒中随机对照试验研究的中文文献,从纳入标准、样本含量估计、随机方法、盲法、意向性治疗分析等角度加以评价。结果共查到2008-2012年关于脑卒中随机对照试验研究的文献113篇,排除不符合评价标准文献13篇,共参与评价文献100篇。此类论文发表数量呈逐年增加趋势,纳入标准的文献占99.0％（95％CI94.6％～100.0％）,描述随机方法的文献占61.0％（95％CI50.8％～70.6％）,有盲法的文献占25.0％（95％CI16.9％～34.6％）,有意向性治疗分析的文献23.0％（95％CI15.2％～32.5％）。结论关于脑卒中随机对照试验研究的论文发表数量呈逐年增加趋势,中文文献的质量逐年改善,但在样本含量估计、盲法、意向性治疗分析仍有待加强。     

牛胚胎干细胞建系方法及其影响因素*☆

学术背景：小鼠胚胎干细胞的建系方法已基本成熟，对于建立牛胚胎干细胞无限系的相关报道较少。 目的：就牛胚胎干细胞的研究概况、建系方法及影响因素等问题进行概括性论述。 检索策略：由该论文的研究人员应用计算机检索Pubmed数据库1980-01/2007-06的相关文献，检索词“bovine，Embryonic Stem Cells，Embryonic Germ Cells”，并限定文章语言种类为English。同时计算机检索中国期刊全文数据库1998-01/2007-06的相关文献，检索词“牛，胚胎干细胞，胚胎生殖细胞”，并限定文章语言种类为中文。共检索到70篇文献，对资料进行初审，纳入标准：①文章所述内容应与牛胚胎干细胞密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准：①重复性研究。②Meta分析。 文献评价：文献的来源主要是通过对牛胚胎干细胞的研究概况、建系方法及影响因素等方面内容进行汇总分析。所选用的30篇文献中，6篇为综述，其余均为临床或基础实验研究。 资料综合：①已有报道从牛鲜胚内细胞团、原始生殖细胞、体外受精胚胎和核移植胚胎中成功分离获得牛类胚胎干细胞。②影响牛胚胎干细胞建系的因素包括胚胎日龄、培养方法、饲养层、细胞因子、传代方法等。③传统的从牛囊胚内细胞团和原始生殖细胞中分离培养胚胎干细胞时会遇到诸多瓶颈，不少学者尝试通过卵母细胞的孤雌生殖和体外成熟、受精来拓宽胚胎干细胞的来源。牛原始生殖细胞的分离过程中，易造成大量原始生殖细胞损失和凋亡，若使用密度梯度离心或特异性荧光抗体标记后通过流式细胞仪进行分离筛选，可能会起到较好的效果。如果使用转白血病抑制因子或干细胞生长因子基因的同源牛胎儿成纤维细胞作饲养层，既可克服外源蛋白污染及动物种间病原交叉感染等问题，同时又提供了培养牛胚胎干细胞所需的外源因子，提高了饲养层的质量。对胚胎干细胞集落进行转基因，通过荧光显微镜可以很清楚地知道所需传代的集落及传代时机。不同学者报道的牛胚胎干细胞碱性磷酸酶的表达有差异，可能与不同的染色程序和细胞分化程度、表型有关，因此碱性磷酸酶活性能否作为牛多能干细胞的特异标记还有待进一步研究。 结论：尽管目前有关牛胚胎干细胞的培养与应用技术已取得一定进展，但如何维持牛胚胎干细胞自我复制及多潜能分化的 调控机制、如何确定不同的细胞因子联合使用时对牛胚胎干细胞的剂量效应、不同胚胎干细胞系在分化能力上是否存在差异、如何提高利用牛胚胎干细胞制作嵌合体的成功率等诸多问题还有待深入研究。     

《中国微侵袭神经外科杂志》退稿原因分析及建议

目的了解本刊作者稿件的退稿情况,分析退稿原因,科学指导作者投稿和写作,提高稿件刊用率。方法分析抽取的314篇《中国微侵袭神经外科杂志》退稿稿件,其中非神经外科专业稿件114篇;神经外科专业相关稿件183篇,作者撤稿17篇。统计所有退稿稿件的退稿阶段和退稿周期,及183篇神经外科专业相关稿件的退稿原因、地区分布及基金项目支持情况。结果初审退稿136篇(43.3%),外审退稿178篇(56.7%);退稿周期0~248 d。183篇神经外科专业相关退稿中,来自北京、广东、四川、江苏、新疆、上海、安徽、湖南、陕西、福建10个省市的退稿稿件占60.7%,退稿稿件中有基金项目支持者12篇。退稿原因概括为5类:(1)研究设计缺乏创新性和合理性。(2)数据资料不完整或缺乏可信度。(3)统计学问题。(4)论文学术不端问题。(5)论文写作方面的问题。结论作者应明确投稿期刊的刊发范围,科学选题,夯实数据资料,做好统计分析,规范论文写作格式,严肃学术研究,提高写作水平。     

神经外科护士的心理压力原因分析

目的：探讨神经外科护士产生心理压力的原因,采取缓解方法,从而提高护理质量。方法分析神经外科护士产生心理压力的原因,有针对性的提出防护措施。结果导致神经外科护士产生心理压力的原因是多方面的,而复杂,除了人们对护理工作的过高要求外,护士职业的性质,不良的工作环境,工作的高风险性,紧张的护患关系及自身的职业素质均对神经外科的护士造成了很大压力。结论通过对神经外科护士产生心理压力的原因分析,探讨其应对措施,使神经外科护士提高了应对心理压力的能力并能正确释放压力,从而提高护理质量。     

儿童惊厥持续状态预后不良相关因素的预后研究质量分析

目的采用预后研究质量(Quality in prognosis studies,QUIPS)分析,对影响儿童惊厥持续状态(Convulsive status epilepticus,CSE)预后不良因素进行文献质量评估。方法通过对PUBMED、EMBASE、COCHRANE数据库进行检索,查找关于CSE患儿发生死亡及后遗症等预后评价的纵向队列研究相关文献。检索时间为2008年1月—2019年11月,由3名系统评价员进行文献资料提取和质量评价。根据QUIPS分析方法对纳入文献进行评分,划分质量等级,并选择中/高质量文献具有统计学意义的分析变量得出结论。结果共纳入17篇中/高质量文献,选择在≥2篇中/高质量文献中至少被提及2次或以上的具有统计学意义(P<0.05)的因素,被认为是影响预后的重要危险因素。因素包括:病因、年龄、惊厥持续时间、难治性惊厥持续状态、神经影像学异常。结论总结出5项提示CSE患儿预后不良的危险因素。但因各文献研究的异质性,尚未完善Meta分析,具有一定的局限性。     

Thrombosis associated with physical restraints

OBJECTIVE: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. METHOD: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. RESULTS: To our knowledge, we are the first to report thrombosis associated with physical restraint. CONCLUSION: Immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.     

Physical restraints in the emergency department and attendance at subsequent outpatient psychiatric treatment

While an estimated 8.5% of psychiatric patients treated in emergency departments require physical restraint, the impact of restraint on attendance at post-discharge outpatient psychiatric appointments has not been investigated. This study evaluated two groups of patients aged 18 or over: 1) 67 individuals who presented voluntarily or involuntarily (being brought in by the police) to the emergency department and who were physically restrained in the course of clinical care, and 2) a comparative group of 84 individuals who presented involuntarily but were not restrained. Perception of quality of care, recollection of the restraint episode, and attendance at follow-up outpatient appointments were compared between these two groups. Of the 151 patients, 33% were from minorities, 45% were female, and the median age was 36 years (range of 18 to 77 years). Both minority race and use of physical restraints were related to less frequent attendance at the prescribed outpatient psychiatric appointment, based on multivariate logistic regression (odds ratios of 0.40 and 0.38, respectively). Although physical restraint may sometimes be necessary to manage aggression and agitation in the emergency department, being restrained appears to be associated with decreased likelihood of attending prescribed outpatient follow-up mental health treatment. Clinicians should consider alternatives to physical restraints whenever possible to minimize impact on treatment compliance after discharge from the emergency department.     

Characteristics of patients in restraint: six year analysis of the Assaulted Staff Action Program (ASAP)

Emergency service providers, including mental health care providers, are often called upon to impose restraint procedures. These procedures may result in physical injury and psychological distress and provide a unique opportunity for emergency mental health personnel to be of assistance. Reviews of the literature on restrained patients have suggested that clinical variables studied need to be added to demographic factors in order to better clarify those at high risk for restraint procedures. This study compared restrained and non-restrained subjects on basic demographic variables and the clinical variables of histories of violence toward others, personal victimization and substance use disorder. The clinical variables did not enhance the prediction of the use of restraints. The implications for reducing the use of restraints, for needed emergency mental health services and future research directions are explored.     

The use of physical restraint in patients with cerebral contusion

Behavioral problems resulting in the use of physical restraint is a clinical problem seen in the acute phase of recovery from cerebral contusion. However, little is known about the frequency of physical restraint, factors that might predispose to its use, the pattern of adjunctive psychotropic drugs used or the outcome for patients needing this form of management. In order to examine these issues, a retrospective study of all patients (N = 34) admitted with cerebral contusion to a neurosurgical service over a one-year period was undertaken. Physical restraint was used in twelve patients (35%) for an average length of 4.3 days. The use of physical restraint was associated with presumptive evidence of alcohol abuse or dependence but not with level of consciousness on admission. Restrained patients were frequently prescribed psychotropic drugs during hospitalization. Patients requiring physical restraint stayed in hospital nearly twice as long as those not needing restraint. Close attention to the identification and treatment of alcohol problems and their complications in this population may reduce the need for physical restraint and shorten length of hospital stay.     

Beyond emergencies: the use of physical restraints in medical and psychiatric settings

Physical restraints, such as locked-door seclusion and two- or four-point leather restraints, are frequently used in both the medical and psychiatric settings. Efforts are currently under way to reduce the use of physical restraints in psychiatric settings; various institutional, state, and federal policies are place. However, using these same restraints in the context of providing medical care for psychiatric patients is more complicated, as it is uncertain which principles and regulations apply in a particular setting. For example, is the restraint governed by the policies that regulate the psychiatric application of restraints, by those that regulate the medical application of restraints, or by both? This article reviews the principles and regulations governing the use of restraints on psychiatric patients, with specific attention to the use of restraints in providing medical treatment to that patient population. Also addressed are general principles of risk management to help avoid negative outcomes and to reduce the risk of litigation for unauthorized or unlawful restraint. A case example is used to illustrate these concepts.     

神经外科复合手术后感染分析及防范措施

目的 探讨神经外科复合手术后感染的发生率及危险因素。方法 选择2017年8月至2019年1月我院复合手术室进行的101台开放性手术，回顾性分析病例资料、实验室检查、影像学检查等资料，采用多因素logistic回归分析检验危险因素。结果 101例中，38例术后出现感染，发生率为37.6%，其中颅内感染4例。单因素分析结果显示，年龄、存在呼吸系统基础疾病、术后出血、术后脑梗死与术后感染有关（P<0.05），多因素logistic回归分析结果显示术后脑出血是术后发生感染的独立危险因素（OR=17.315；95% CI 1.931~155.292；P=0.011）。结论 神经外科复合手术后感染发生率较高，肺部仍是术后感染的主要部位，术后脑出血是独立危险因素，应采取预防措施以降低感染率。     

神经外科病人血流感染危险因素分析

目的 探讨神经外科病人发生血流感染的危险因素。方法 回顾性分析2014年6月至2018年1月神经外科收治的1 573例病人的临床资料,采用多因素Logistic回归分析检验危险因素。结果 1 573例中,发生血流感染126例,感染率为8.01%。126例血培养标本检出142株致病菌,其中革兰阳性菌68株（47.89%）,革兰阴性菌72株（50.70%）,真菌2株（1.41%）。多因素Logistic分析显示,深静脉置管、气管切开机械通气、留置导尿、使用糖皮质激素、血清降钙素原>0.5 ng/ml、血溏>11.1 mmol/L是神经外科病人发生血流感染的独立危险因素（P<0.05）。结论 做好评估,减少不必要的侵入性诊疗;合理使用糖皮质激素,控制血糖;监测降钙素原早期预测与干预可能是减少神经外科血流感染的有效措施。     

Precipitants of violence in a psychiatric inpatient setting

Data gathered from the medical record and in interviews with staff and patients in an inpatient psychiatric setting at a Veterans Affairs medical center were used to examine events preceding 73 episodes in which patients were placed in four-point restraints. The behaviors leading to restraint included physical aggression, verbal threats, and threats with an object as a weapon. These behaviors were more likely to relate to external situations than to the patient's internal psychiatric symptoms. Staff were most frequently the target of patients' aggression, and patients were more likely to view the events leading to restraint as conflict with staff. No differences in the subsequent number of restraint episodes or hours in restraints were found between patients with positive and negative responses to the index restraint episode.     

The development of pediatric neurosurgery in Paris How to create something out of nothing: reflexions on the methodology

Up to 1960, children in need of neurosurgical treatment in France were treated either in neurosurgical departments where anesthetists, nurses and neurosurgeons had no specialized training in pediatrics or in departments of pediatric surgery in which the specific aspect of neurosurgery was ignored. Clearly a mutation was needed before any progress could be made: the development of pediatric neurosurgery services. This essay tells the story of the creation of the first pediatric neurosurgery service in France, of the difficulties encountered and of the strategies applied to overcome them. It also recalls the discussions about what size such a service should be and whether it should be located in a general hospital or in a pediatric hospital. During the second half of the twentieth century, progress in neurosurgery, and more specifically in pediatric neurosurgery, has been tremendous. The contribution of the pediatric neurosurgery service at Les Enfants Malades in Paris is briefly summarized.     

Mechanical Restraint—Which Interventions Prevent Episodes of Mechanical Restraint?—A Systematic Review

PURPOSE: To identify interventions preventing mechanical restraints. DESIGN AND METHODS: Systematic review of international research papers dealing with mechanical restraint. The review combines qualitative and quantitative research in a new way, describing the quality of evidence and the effect of intervention. FINDINGS: Implementation of cognitive milieu therapy, combined interventions, and patient‐centered care were the three interventions most likely to reduce the number of mechanical restraints. PRACTICE IMPLICATIONS: There is a lack of high‐quality and effective intervention studies. This leaves patients and metal health professionals with uncertainty when choosing interventions in an attempt to prevent mechanical restraints.