抗精神病药物所致急性肠麻痹22例报告

目的:了解精神科住院病人在服用抗精神药物过程中出现急性肠麻痹特点,以便及早采取措施,避免突然死亡.方法:对1990～2004年住院病人中因服用抗精神药物所致22例急性肠麻痹作临床回顾性分析.结果:14年间我院急性肠麻痹病人22例(4例死亡)全部为几种不同抗精神病药物合并应用和抗震颤麻痹症药物所引起的.结论:用抗精神病药物治疗过程中应密切观察便秘、腹胀等早期症状,一旦出现肠麻痹症状应作急症处理.     

抗精神病药物引起月经周期紊乱的临床观察

目的 了解抗精神病药物与女性患者月经周期紊乱的关系。方法 观察住院病人129例，分别服用氯丙嗪34例，氯氮平29例。维思通18例，合并用药48例，服药后对月经周期影响的评定，对有月经同期紊乱的患者矛减药观察。以证明月经周期紊乱与抗精神病药物的关系。结果 129例患者的387个月经周期中144个发生紊乱，主要表现为经期延长，尤以氮丙嗪及合并用药所致经期延长更明显。结论 抗精神病药物可引起月经周期紊乱，在临床应用时应予以注意。     

氯氮平致白细胞减少一例报告

氯氮平是抗精神病的常用药物之一。如若有大量服用引起中毒者,即可出现：意识模糊、昏迷、高热、腹胀、肠麻痹,甚至造成癫痫样发作,特别是对骨髓功能的抑制,可引起严重的粒细胞减少,最终导致死亡。我院用大量葡萄糖醛内酯及对症处理抢救氯氮平中毒一例获得成功。现报道如下。     

浅谈急腹症伴精神病围手术期的处理

精神病是一种慢性终生性疾病,有时不可避免地出现需迅速处理的外科急腹症,多数需要手术治疗.精神患者由于长期服用抗精神病药物均有不同程度的肥胖,糖尿病,转氨酶升高,过度镇静反应迟缓,肠蠕动缓慢便秘及肠麻痹,心动过速及心律失常.因此给围手术期处理提出了一定的要求.由于抗精神病药物的作用机制所致脏器毒性反应及不良受体反应.     

精神病患者服用抗精神病药物后的行为观察及心理护理

目的:给精神病患者服用抗精神病药物之后的行为观察和心理护理方法。方法:选择我院从2014年2月-2016年1月期间收治的,诊断为精神疾病的患者245例,根据患者不同的疾病类型和病情的严重程度,给予不同的抗精神类疾病的药物进行口服,观察患者在口服药物之后的行为并做好记录,同时对患者进行必要的心理护理,并根据患者的药物反应实施干预。结果:在用药治疗的245例精神类疾病患者当中,有精神分裂症120例,躁狂症5例,精神障碍120例。给患者进行药物治疗之后,有34例患者发生了行为异常,5例患者发生了嗜睡,7例患者出现情绪抑郁,13例患者发生焦虑症状,9例患者出现缄默、呆滞的症状,对患者进行心理护理干预之后,患者的的大部分症状得到了改善。结论:精神病患者进行抗精神类疾病的药物治疗是必要的,但是有部分的患者特别是长期服用药物进行治疗或者年老体弱的患者如果出现药物的不良反应并发行为异常,因此需要对神病患者服用抗精神病药物后的行为进行观察以及做出心理护理干预。     

急性胰腺炎肠麻痹中药保留灌肠的护理

目的了解中药保留灌肠对胰腺炎肠麻痹的影响.方法对45例合并肠麻痹的急性胰腺炎患者行中药保留灌肠护理.结果45例急性胰腺炎合并肠麻痹患者恢复肛门自主排气、排便平均时间为11.4h,平均住院天数12d.结论中药保留灌肠能促进急性胰腺炎合并肠麻痹患者的肠蠕动尽早恢复,帮助患者排除肠道积气积便,缓解腹部症状及体征,缩短平均住院时间.     

急性胰腺炎肠麻痹中药保留灌肠的护理

目的了解中药保留灌肠对胰腺炎肠麻痹的影响。方法对45例合并肠麻痹的急性胰腺炎患者行中药保留灌肠护理.结果45例急性胰腺炎合并肠麻痹患者恢复肛门自主排气、排便平均时间为11．4h，平均住院天数12d。结论中药保留灌肠能促进急性胰腺炎合并肠麻痹患者的肠蠕动尽早恢复，帮助患者排除肠道积气积便，缓解腹部症状及体征，缩短平均住院时间：     

抗精神病药物对心电图影响及相关因素

目的探讨抗精神病药物对心电图的影响。方法回顾性分析本院636例服用抗精神病药物的住院患者的心电图变化及影响因素。结果在636例服用抗精神病药物的患者中有295例出现心电图异常。服用典型和非典型抗精神病药物、用药时间长短对心电图的影响无统计学意义（P〉0．05）。不同性别对心电图的影响差异有统计学意义（P〈0．05）。不同年龄、剂量对心电图的影响差异有统计学意义（P〈0．01）。结论服用典型抗精神病药物和服用非典型抗精神病药物及用药时间的长短对心电图无影响,而性别、年龄、剂量对心电图有影响。故无论服用哪类抗精神病药物都有必要监测心电图,并针对性地使用抗精神病药物。     

氟西汀合并抗精神病药物治疗精神分裂症的效果研究

目的:探讨氟西汀合并抗精神病药物治疗精神分裂症的效果.方法:选择2015年7月-2017年7月期间我院收治的精神分裂症患者54例为研究对象,均分为两组,对照组患者应用抗精神病药物,观察组患者在对照组的基础上联合氟西汀,对比两组患者治疗情况.结果:两组患者的总有效率为96.30％和77.78％,观察组明显更高,统计学有意义(P<0.05).结论:氟西汀合并抗精神病药物治疗精神分裂症的效果显著,症状和生活质量得到改善,提高了治疗效果,值得应用.     

抗精神病药物致女性患者闭经的临床研究与干预策略

目的了解女性患者服用抗精神病药物后出现闭经的频率和换用阿立哌唑治疗的有效性。方法对女性精神病患者120例进行观察,对服用抗精神病药物后出现闭经的发生率和换用阿立哌唑后闭经患者恢复月经情况进行统计分析。结果出现闭经17例,发生率14．17％。换用阿立哌唑治疗后恢复月经患者13例。结论女性患者服用典型抗精神病药物及非典型抗精神病药物均有可能出现闭经。阿立哌唑可有效降低女性患者闭经发生率。     

Treatment of acute porphyrias. The importance of follow-up of patients and carriers

Acute porphyrias are caused by the inherited decreased activity of the enzymes of the heme biosynthesis pathway. Depending on the affected enzyme there are 4 types of them: acute intermittent porphyria, porphyria variegata, coproporphyria and delta-aminolevulinic acid dehydratase deficient porphyria, listed in order of their frequency. Basically the clinical picture is the same in the four types of acute porphyria. The most frequent complaints and symptoms are: cramping abdominal pain, nausea, vomiting, muscle weakness of the limbs then, in the advanced phase, there is a red-colored urine, hyponatremia, subileus, acute psychosis and Landry-type paralysis. Without proper treatment death is caused by respiratory paralysis or serious arrhythmia. In case of suspicion of acute porphyria it is mandatory to identify the type of the acute porphyria and the actual status of the patient. The later indicates what kind of treatment should be used. In the acute phase the early therapy with heme arginate is the treatment of choice. Since the clinical symptoms are precipitated by endogenous or exogenous inducing factors--most often by drugs-, the drugs negatively affecting the heme biosynthesis should be omitted at once even in the suspicion of acute porphyria. The role of the inducing factors in the manifestation of the clinical symptoms makes possible the prevention. It is possible to avoid the inducing factors and this way to prevent the acute attack if the acute porphyrias are recognized in time and the patients and the carriers are under regular control. The patients receive special identification card and the up-to-date list of safe drugs. They can use only these drugs in any kind of illness. Other drugs should be considered as porphyrinogenic since it is impossible to predict based on their chemical structure if they negatively affect the heme biosynthesis.     

Tick toxicosis in North America.

This is a case presentation and review of an uncommon disorder, tick toxicosis. The history, epidemiology, pathophysiology, and treatment are discussed. This disorder was mentioned in diaries from the early 1800s and has been reported in 18 states and the District of Columbia. A review of 70 cases reveals that the typical patient is a female child who develops leg weakness, irritability, or clumsiness. The exact site at which the toxin induces the paralysis is unknown. Removal of the tick usually reverses the paralysis within hours. Confusing tick toxicosis with other disorders may occur, and death has resulted. This article will remind physicians to consider tick toxicosis when seeing patients with acute ataxia or ascending paralysis and to, perhaps, prevent death from an easily treatable disorder.     

妊娠期急性脂肪肝26例临床分析

目的:探讨妊娠期急性脂肪肝(AFLP)的临床特点、诊断及治疗方法,以降低孕产妇和围产儿死亡率。方法:回顾性分析因妊娠期急性脂肪肝住院的26例患者临床表现、实验室检查、诊治情况和母婴结局。结果:26例病例中,早期出现厌食、乏力、恶心等症状21例,皮肤黄染19例,肝酶增高和凝血功能异常26例,胆红素升高21例,急性肾功能不全19例,弥漫性血管内凝血(DIC)16例,产后出血18例,肝性脑病6例,宫缩乏力5例;术中均尽早行Blynch缝合,无1例子宫切除;产妇死亡1例,死胎3例,新生儿轻度窒息4例,重度窒息1例,均抢救成功。结论:加强产检,重视孕妇妊娠晚期消化道症状和实验室检查异常,对AFLP尽早诊断、尽快终止妊娠、加强多学科的综合治疗可有效降低母婴死亡率。     

187例老年肺结核临床分析

目的对187例老年肺结核患者进行临床分析,探讨老年肺结核的临床特点及治疗方法。方法对2009年1月1日～2011年12月31日我院收治的187例65岁以上的老年肺结核患者的临床症状、胸片、痰检情况、耐药情况、并发症和合并症、疗效及预后、药物不良反应等方面进行分析。结果老年肺结核临床症状不典型,耐药率高,合并症多,病程长,疗效差,药物不良反应多,治疗依从性差。结论应重视老年肺结核,加强老年肺结核的研究,提高早期诊断和治疗效果,有效遏制结核病流行。     

Predisposing and precipitating factors for falls among older people in residential care

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.     

Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy

Glucocorticoids are commonly used in the treatment of patients with thyroid disorders, in particular Graves' ophthalmopathy. Thyrotoxic hypokalemic periodic paralysis (TPP) is an infrequent but potentially serious condition characterised by recurrent episodes of weakness associated with hypokalemia. We describe the development of acute hypokalemic paralysis in a middle-aged Caucasian man with recently diagnosed thyrotoxicosis and severe, active Graves' opthalmopathy who developed progressive flaccid paralysis 12 hours following intravenous administration of methylprednisolone. Rechallenge with the same dose after the patient had been rendered euthyroid did not provoke TPP. Clinicians should exercise caution when administering high-dose glucocorticoids during thyrotoxicosis as there is a risk of provoking hypokalemic paralysis in susceptible patients.     

急性有机磷农药中毒致呼吸肌麻痹的特点及其相关因素

目的探讨急性有机磷中毒致呼吸肌麻痹（respiratory muscle paralysis，RMP）的发病特点及其相关因素。方法以山东省内4家县级医院10年来首诊收治的急性有机磷中毒病人为研究对象，重点观察并收集呼吸肌麻痹病例的发生情况、用药情况及实验室指标测定情况等。结果轻度有机磷中毒病例中无RMP发生，中度中毒病例RMP发病率为5．1％，重度中毒病例RMP发病率为16．3％。有机磷中毒12h后可发生RMP，RMP组乙酰胆碱酯酶活力重度降低者占74．6％，高于非RMP组的34．3％，二者相比，差异有统计学意义。电解质紊乱与与否在2组间差异亦有统计学意义。结论急性有机磷中毒后应合理府用特效解毒药。并密切关注病情变化，以便更好地防治呼吸肌麻痹。     

Vaccine-associated paralytic poliomyelitis: a retrospective cohort study of acute flaccid paralyses in Brazil

BACKGROUND: At the present time, in Brazil and other countries in the Americas, the only cases of paralytic poliomyelitis due to poliovirus are caused by vaccine strains. The recognition of possible determinants of vaccine-associated paralytic poliomyelitis (VAPP) by public health surveillance and immunization programmes is relevant to inform the debate on criteria for case definition and vaccination strategies. METHODS: A retrospective cohort study based on the cases of acute flaccid paralysis (AFP) reported to the Ministry of Health (MoH) was designed, with the objective of studying cases of VAPP in Brazil between 1989 and 1995. Clinical, laboratory and epidemiological data from 3656 acute flaccid paralysis (AFP) cases, 30 of them diagnosed as VAPP, were analysed. RESULTS: An 8.88 risk ratio of VAPP (95% CI : 4.37-18.03) was found when comparing individuals who received oral poliovirus vaccine (OPV) between 4 and 40 days before the onset of paralysis and individuals who did not receive the vaccine within this period. A risk of 1 case/2.39 million first doses and 1 case/13.03 million OPV doses administered was estimated for the general population. CONCLUSIONS: Cases of AFP who received OPV between 4 and 40 days before the onset of paralysis and had fever, a prodrome of gastrointestinal symptoms, history of first dose of OPV, isolation of vaccine poliovirus type 2, and young age deserve careful investigation, since they are at increased risk for the condition studied.     

河北省2009年残留麻痹的急性弛缓性麻痹病例疾病谱监测分析

目的对河北省2009年非脊髓灰质炎(脊灰)急性弛缓性麻痹(AFP)病例中残留麻痹病例的疾病谱进行分析。方法对2009年河北省AFP监测系统监测资料采用EPI-info和SPSS软件进行统计分析。结果河北省2009年非脊灰AFP病例疾病谱的顺位为格林巴利综合征(GBS)、非脊灰肠道病毒(NPEV)感染、脊髓炎、偏瘫和单瘫、神经根炎、周围神经损伤、脑瘤、手足口合并症、皮肌炎等。发病年龄以0～4岁为主,男性多于女性;在7、8月份发病较多;临床表现以下肢麻痹、腱反射减弱或消失为主。结论进一步掌握河北省导致AFP病例残留麻痹的主要因素,采取有效措施防治残留麻痹的AFP病例。