心理行为护理干预对剖宫产初产妇产后焦虑、抑郁及疼痛状态的影响

目的探讨心理行为护理干预对于剖宫产初产妇产后焦虑、抑郁及疼痛状态的影响。方法将102例择期剖宫产初产妇随机分为观察组与对照组各51例。对照组给予常规护理,观察组给予常规护理联合心理行为护理干预。干预前后评价两组Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,比较术后72h疼痛程度及术后并发症发生率。结果护理后两组的SAS、SDS评分均较护理前显著降低,且观察组显著低于对照组(P0.05);术后72h,观察组的疼痛程度显著轻于对照组(P0.05);观察组术后并发症发生率为5.88%,显著低于对照组的19.61%(P0.05)。结论心理行为干预能够有效缓解初产妇剖宫产术后焦虑、抑郁情绪,减轻术后疼痛程度并降低并发症发生率。     

综合护理干预在微创颅内血肿清除术的应用效果分析

目的探讨综合护理干预在微创颅内血肿清除术的应用效果。方法选择2013-11—2015-02我院收治的行微创颅内血肿清除术治疗的颅内血肿患者106例,随机分为观察组和对照组各53例。对照组给予常规护理,观察组给予综合护理干预。对比分析2组患者运动功能、术后生活自理能力及并发症的发生率。结果护理干预后,2组患者的Fugl-Meyer评分均较护理干预前明显提高,观察组Fugl-Meyer评分和生活自理能力明显高于对照组;观察组护理干预后并发症的发生率22.64%(12/53)明显低于对照组47.17%(25/53),差异具有统计学意义(P0.05)。结论综合护理干预在颅内微创血肿清除术中的合理应用可有效改善患者的运动功能和生活自理能力,降低并发症的发生率,值得临床推广应用。     

护理干预在胸腰椎爆裂骨折神经损伤患者术后康复期中的应用

目的 探讨护理干预在胸腰椎爆裂骨折神经损伤患者术后康复期中的应用效果.方法 选择2013-05-2016-05我院收治的88例胸腰椎爆裂骨折神经损伤择期需行手术治疗的患者,入院后编号,按照随机数字表法分为对照组(n=44)和观察组(n=44),对照组给予常规护理,观察组给予专项护理干预,护理时间6周,观察2组患者术后康复期情况.结果 护理结束后,观察组VAS评分显著低于对照组(P<0.05),观察组日常生活能力评分明显高于对照组(P<0.05);观察组并发症总发生率9.09%,显著低于对照组的25.00%,差异有统计学意义(P<0.05).结论 护理干预可减少胸腰椎爆裂骨折神经损伤患者术后并发症发生率,减轻患者疼痛,提高护理人员专业知识和沟通技巧,值得临床推广使用.     

强化健康教育对术后肠内营养治疗患者心理状态及肠内营养并发症的影响

目的探讨强化健康教育对术后肠内营养治疗患者心理状态及肠内营养并发症的影响。方法将86例术后肠内营养治疗患者随机分为观察组与对照组,每组43例。对照组实施常规护理,观察组在常规护理基础上实施强化健康教育,干预前后使用焦虑自评量表(SAS)、抑郁自评量表(SDS)对两组患者焦虑、抑郁程度进行评价,观察两组患者肠内营养并发症发生率。结果两组患者护理干预前,SAS、SDS评分组间无明显差异(P0.05)。干预后SAS、SDS评分均较干预前显著减少(P0.01),且观察组SAS、SDS评分明显低于对照组,两组比较差异具有统计学意义(P0.05);观察组肠内营养并发症发生率(6.98%)明显低于对照组(25.58%)(P0.05)。结论对术后肠内营养治疗患者实施强化健康教育,有助于缓解患者不良情绪,提高肠内营养耐受性及依从性,减少并发症的发生。     

早期康复护理对急性脑梗死患者动脉内接触性溶栓术后的影响

目的探讨早期康复护理对急性脑梗死行动脉内接触性溶栓术后的影响。方法采用随机数字表法将105例急性脑梗死行动脉内接触性溶栓术患者分为2组,对照组给予常规护理干预,观察组给予内科配合早期康复护理干预,对比2组患者的临床疗效和并发症发生情况。结果观察组总有效率92.31%明显高于对照组75.47%(P<0.05);观察组并发症发生率1.92%明显低于对照组并发症发生率15.09%(P<0.05)。结论早期康复护理干预措施能够提高急性脑梗死行动脉内接触性溶栓术的手术疗效和降低并发症发生率,从而提高患者的生存质量和改善预后,值得临床探讨。     

质量控制理论在急性脑血管疾病介入治疗患者护理中的应用价值

目的探讨质量控制理论在急性脑血管疾病行介入治疗患者护理中的应用价值。方法选取我院收治的急性脑血管疾病行介入治疗患者64例,按随机数字表法分为对照组与观察组。对照组采用围术期常规护理,观察组在质量控制理论指导下开展护理干预,比较2组并发症发生情况及护理满意度。结果观察组并发症发生率为12.50%(4/32),低于对照组的31.25%(10/32),2组比较差异有统计学意义(P0.05);观察组护理满意度为93.75%(30/32),低于对照组的78.13%(25/32),差异有统计学意义(P0.05)。结论质量控制理论在急性脑血管疾病介入治疗患者中的应用效果显著,临床推广价值高。     

临床护理路径预防颅内多发动脉瘤围手术期并发症的临床效果

目的探讨临床护理路径预防颅内多发动脉瘤围手术期并发症的效果。方法选择颅内多发动脉瘤患者100例,随机分为观察组和对照组各50例。对照组给予常规护理,观察组给予临床护理路径,比较护理干预后2组并发症发生率及护理满意度,并采用生活质量综合评估问卷(GQOL-74)评估患者生活质量。结果干预后观察组并发症的总发生率(10.0%)明显低于对照组(30.0%)(P0.05),GQOL-74评分明显优于对照组(P0.05),护理满意度(96.0%)明显高于对照组(80.0%)(P0.05)。结论临床护理路径可有效地减少颅内多发动脉瘤患者围手术期并发症的发生率,改善患者的生活质量,提高患者的护理满意度,值得临床推广与应用。     

全程护理对三叉神经痛行微血管减压术患者的效果分析

目的观察全程护理对三叉神经痛微血管减压术患者并发症、负性情绪及生活质量的影响。方法以2016-05—2018-04收治的100例原发性三叉神经痛患者为观察对象,行微血管减压术治疗,通过随机数字表法分成观察组和对照组各50例。对照组实行常规护理,观察组实行全程护理。对比2组并发症发生率及护理前后负性情绪、生活质量。结果观察组并发症发生率6%,明显低于对照组的22%(P0.05);2组护理前负性情绪得分及生活质量得分差异均无统计学意义(P0.05),观察组护理后负性情绪得分及生活质量得分均明显低于对照组(P0.05)。结论全程护理能有效降低三叉神经痛经微血管减压术治疗患者并发症,并改善负性情绪,提高生活质量。     

心理护理对腹腔镜下胆囊切除术患者的焦虑抑郁及治疗依从性的影响

目的探讨心理护理干预对腹腔镜下胆囊切除手术患者的焦虑抑郁情绪及治疗依从性的影响。方法将我院2018年3月～2019年3月收治的腹腔镜下胆囊切除手术患者100例,随机分组,分别给与常规围手术期护理(对照组,n=50)和围手术期重视心理护理干预的实施(观察组n=50),观察两组患者的胃肠功能恢复指标、疼痛程度、焦虑抑郁情绪、自我效能感、治疗依从性的差异。结果观察组患者术后肠鸣音恢复时间、肛门首次排气时间、排便时间经观察均慢于于对照组(P0.05);两组术后6h疼痛评分无差异(P0.05),术后24h、48h、72h疼痛评分均有降低,且观察组降低程度较对照组更为显著(P0.05);两组干预前,焦虑、抑郁心理状态评分经评测无差异(P0.05);干预后评测分值较前均有程度不等下降,但观察组下降程度较对照组更为显著(P0.05);两组干预前,自我效能感评分无差异(P0.05),干预后评分较前均有升高,但观察组升高程度较对照组更为显著(P0.05);观察组干预后治疗依从性各维度即遵守院内制度、积极乐观、合理饮食、适宜锻炼比例均高于对照组(P0.05);观察组术后并发症率低于对照组(P0.05)。结论在围手术期对腹腔镜下胆囊切除手术患者积极开展心理护理干预,可促进胃肠功能恢复,缓解疼痛,改善焦虑抑郁状态,提高自我效能感及治疗依从。     

人性化护理干预在老年结肠癌合并肠梗阻患者中的效果分析

目的探讨人性化护理干预在老年结肠癌合并肠梗阻患者中的护理效果。方法选择我院2009-11—2012-11结肠癌合并肠梗阻患者60例,随机分为观察组和对照组。观察组在常规护理基础上给予人性化护理干预,对照组给予常规护理。观察2组患者术后并发症情况及护理满意度。结果观察组切口感染发生率1.0%,肺部感染发生率3.3%,无下肢静脉血栓发生,粘连性肠梗阻发生率3.3%。对照组切口感染发生率为40.0%,肺部感染发生率33.3%,下肢静脉血栓发生率20.0%,粘连性肠梗阻发生率为30.0%。观察组发生率均低于对照组,差异有统计学意义(P0.05)。观察组患者对护理满意度为93.4%,对照组为63.3%,观察组护理满意度高于对照组,差异有统计学意义(P0.05)。结论人性化护理干预能够降低老年结肠癌合并肠梗阻患者术后并发症的发生率,提高患者对护理的满意度,护理效果显著。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.