经皮气管切开术在神经外科急危重症病人中的应用体会

目的 总结经皮气管切开术在神经外科急危重症病人中的应用体会。方法 回顾性分析行皮气管切开术治疗的120例神经外科急危重症的临床资料，其中60例采用传统气管切开术（对照组），60例采用经皮气管切开术（观察组）。结果 与对照组相比，观察组手术时间、伤口愈合时间和伤口瘢痕长度均明显缩短（P<0.05），术中出血量明显减少（P<0.05）。观察组术后切口出血（0%）和切口渗痰（1.7%）发生率较对照组均明显减少（分别为11.7%、13.3%；P<0.05）。结论 在抢救神经外科急危重症病人时，经皮气管切开术时间短，并发症少，伤口小。     

神经外科急危重症患者家属心理需求及现状调查

目的调查神经外科急危重症患者家属的心理需求现状。方法选取2012-01—2012-12在我院神经外科治疗的178例急危重症患者家属作为研究对象,采用发放调查问卷的方式对神经外科急危重症患者家属的心理需求状况进行调查和分析。结果第1位保证患者的生命安全,分值为(4.98±0.01)分;第2位保证患者得到最佳救治,分值为(4.92±0.03)分;第3位了解患者治疗效果、预后,分值为(4.88±0.12)分。与小学及以下文化程度患者家属相比,大专及以上文化程度患者家属心理需求评分明显降低,差异有统计学意义(P0.05)。与年龄≥55岁患者家属相比,年龄≤35岁患者家属心理需求评分明显降低,差异有统计学意义(P0.05)。而不同性别患者家属心理需求评分差异无统计学意义(P0.05)。结论医护人员应根据神经外科急危重症患者家属的心理需求,积极采取针对性的护理干预方案,全面提升神经外科急危重症患者的临床救治水平。     

专科护理小组在神经外科护理管理中的应用及体会

目的为提高神经外科病区护理管理的质量和专科技能。方法四个专科护理小组（压疮护理小组、静脉输液护理小组、糖尿病护理小组、PICC护理小组）根据不同患者和疚病的需要分别在神经外科开展小组护理会诊活动。结果护理人员认识到专科护理小组重要性，解决了临床工作中遇到的难题，加崴了对危重、特殊和高要求患者的护理管理。结论专科护理小组可保证护理的质量，提高患者满意度，有利于护理人才梯队的培养。     

虚拟影像术前计划系统在神经外科的临床应用研究

目的探讨三维立体虚拟影像术前计划系统在神经外科常规手术中的应用价值。方法应用Radio Dexter虚拟影像术前计划系统对颅内肿瘤及椎管内肿瘤等15例神经外科常规手术病例进行术前计划操作。结果15例病例均成功进行了术的计划操作。该系统形成的三维立体虚拟影像清晰、逼真，并可进行多种模拟操作，能更清楚、准确地显示手术区域解剖结构及毗邻关系。本组无严重并发症．无死亡病例。结论三维立体虚拟影像术前计划系统能够提高神经外科手术的精确性．降低手术创伤及手术风险，值得推广应用。     

神经外科术前护理常见风险问题及应对措施

目的探讨神经外科术前护理常见风险问题及应对措施。方法本次研究观察组194例,均为我院神经外科2011-08—2012-08收治的手术患者,在术前针对风险问题进行分析,并制定应对措施。对照组为2010-07—2011-07收治的未采取风险管理的常规护理患者,共188例。回顾2组相关资料。结果观察组患者满意度、护理质量评分、记录合格率均高于对照组,护理缺陷发生率低于对照组,差异均有统计学意义(P<0.05)。结论针对神经外科术前护理常见风险问题进行分析,并制定应对措施,明显降低了护理缺陷发生率,提高了护理质量,为医疗安全提供了保障。     

混合现实电磁术中导航技术在神经外科手术中的应用

目的 探讨混合现实电磁导航技术在神经外科制定术前计划和术中导航的应用价值.方法运用混合现实电磁导航技术为4例神经外科患者进行术前影像资料的三维重建,生成可视化三维混合现实图像,明确病变位置及其周围解剖结构的毗邻关系,规划手术入路实施术中导航,同时应用博医来术中导航系统对混合现实导航结果进行验证.结果 应用混合现实术中神...     

神经导航在神经外科中的应用

目的:探讨和研究神经影像导航技术在神经外科领域的应用前景,尤其是位于重要功能区的颅内小病灶应用无框架立体定向影象导航技术,结合显微神经外科手术切除的经验和体会.方法:采用Stealth Station神经影象导航系统进行影象导航和显微手术切除的颅内病灶18例,男性11例,女性7例,年龄17～58岁.额叶6例(其中6例为于运动区),顶叶4例,枕叶2例,颞叶1例,桥小脑角2例,小脑半球3例.所有病例均常规应用影象导航下显微切除肿瘤或炎性肉芽肿.结果:影象导航总体误差1.8～3.7mm,平均2.68mm.手术病灶全切除14例,次全切4例,尤其位于运动区3例小病灶,手术全切除后无任何并发症.结论:影象导航系统定位准确,对病灶手术全切除、减少术后并发症具有重要价值,应用前景广阔.     

神经外科导航系统在癫痫外科中的应用

我院 1 998年 1 0月至 1 999年 4月运用德国博伊莱公司生产 Brain SCAN神经外科导航系统 ,完成癫痫外科手术治疗 8例 ,现报告如下。材料与方法一、临床资料一般资料 :本组 8例 ,男 5例。女 3例。年龄 1 4～ 39岁 ,平均 2 6.8岁。癫痫病史 3～ 1 8年 ,平均 1 0年。复杂局限性发作 5例 ,全身强直阵挛发作 1例 ,单纯失神性发作 1例 ,失张力性发作 1例。均严格服用抗癫痫药 2年以上 ,发作次数仍在每月一次以上 ,并已影响学习和工作者。神经心理学测试智商均在70以上。辅助检查 :8例均多次行常规 EEG(包括各种诱发试验 ,药物诱发 ,配合特殊电…     

异丙酚静脉麻醉在神经外科手术中的应用

旨在观察异丙酚在神经外科手术应用时诱导期和恢复期对心血管系统的影响及其恢复期特点。选择ＡＳＡＩ级的大脑半球占位，择期手术病人３０例，随机分为异丙酚诱导组和硫喷妥钠诱导组，记录插管前后及拔管前后的ＳＢＰ，ＤＢＰ，ＨＲ。两组诱导期ＳＢＰ，ＤＢＰ均明显下降，Ｐ组ＨＲ下降，Ｔ组ＨＲ升高。插管后Ｐ组ＳＢＰ，ＤＢＰ，ＨＲ与基础值相比无显著差异，Ｔ组ＳＢＰ，ＤＢＰ，ＨＲ显著升高。     

手术室风险管理在神经外科手术过程中的应用

目的探讨手术室风险管理在神经外科患者手术过程中的应用效果。方法将我院进行手术的神经外科患者70例随机分为观察组和对照组各35例,对照组给予传统的手术室常规护理,观察组对照组基础上给予手术室风险管理。观察对比2组护理安全事件的发生率、手术成功率及患者的满意度。结果观察组未发生护理安全事件,对照组8例发生相关护理安全事件;观察组护理满意度94.29%,明显优于对照组的68.57%。结论通过对神经外科患者实施手术室风险管理,全面评估手术过程中潜在的护理风险因素,制定有效的防范措施,为患者提供安全、优质的护理,确保手术顺利进行。     

Neuromuscular involvement in COVID-19 critically ill patients

ObjectiveCoronavirus disease 2019 (COVID-19) has a high incidence of intensive care admittance due to the severe acute respiratory syndrome (SARS). Intensive care unit (ICU)-acquired weakness (ICUAW) is a common complication of ICU patients consisting of symmetric and generalised weakness. The aim of this study was to determine the presence of myopathy, neuropathy or both in ICU patients affected by COVID-19 and whether ICUAW associated with COVID-19 differs from other aetiologies.MethodsTwelve SARS CoV-2 positive patients referred with the suspicion of critical illness myopathy (CIM) or polyneuropathy (CIP) were included between March and May 2020. Nerve conduction and concentric needle electromyography were performed in all patients while admitted to the hospital. Muscle biopsies were obtained in three patients.ResultsFour patients presented signs of a sensory-motor axonal polyneuropathy and seven patients showed signs of myopathy. One muscle biopsy showed scattered necrotic and regenerative fibres without inflammatory signs. The other two biopsies showed non-specific myopathic findings.ConclusionsWe have not found any distinctive features in the studies of the ICU patients affected by SARS-CoV-2 infection.SignificanceFurther studies are needed to determine whether COVID-19-related CIM/CIP has different features from other aetiologies. Neurophysiological studies are essential in the diagnosis of these patients.     

Seizures in the critically ill: the role of imipenem

PURPOSE: To determine the risk of seizures in critically ill patients receiving the antibiotic imipenem, a broad-spectrum antibiotic that has been associated with seizures. Reports generally have not considered other contributing factors such as dose, seizure history, and morbidity index of the underlying illness necessitating the antibiotic. METHODS: Charts of all patients in a 450-bed municipal hospital who received imipenem in a 6-month period, as determined by pharmacy records, were reviewed for dosage and duration of imipenem use, occurrence of seizures. and mortality outcome. Attention was paid to demographic features; pattern of seizure occurrence during, before, and after imipenem use; renal function; and correction for dosage based on size. RESULTS: Seventy-five charts were reviewed. Sixty-three patients had no seizures during the hospitalization, four had seizures while receiving imipenem, and eight had seizures during the hospitalization but before or after imipenem use. The incidence of seizures was 4/1,000 patient-days on, and 3.9/1,000 patient-days off imipenem (not significant). The risk of seizure in both groups was considerably higher in those patients with a history of seizures before hospitalization. The presence of other factors that could contribute to increased concentration of imipenem in the brain, such as renal failure or acute stroke, did not contribute to seizure incidence. Metabolic derangement, anoxia, and phenytoin discontinuation did contribute to seizure incidence. CONCLUSIONS: Seizure incidence is increased in all critically ill patients (16% of patients studied), but with no added risk during the period patients received imipenem. Determining the proper dose based on a patient's body mass, correction of dose in the presence of renal failure, and avoidance of excess of 2 g/day of imipenem removes any added risk for seizures from imipenem. Despite experimental data to suggest action of imipenem on the glutamate/N-methyl-d-aspartate receptor, or interference with binding to the gamma-aminobutyric acid receptor, and early clinical studies that warned against its use because of seizure risk, we found that careful use of this antibiotic is safe.     

Focal motor seizures induced by alerting stimuli in critically ill patients

Purpose: We have previously demonstrated that it is common for alerting stimuli to induce electrographic seizures and other periodic or rhythmic patterns in the critically ill; however, only 1 of the first 33 patients we reported with this phenomenon had a detectable clinical correlate.
Methods: Review of charts and video EEG findings in critically ill patients in a neurological ICU at a tertiary care medical center in Manhattan.
Results: We identified nine patients who had focal motor seizures repeatedly induced by alerting stimuli. All patients were comatose, and 8/9 had nonconvulsive status epilepticus at some point during their acute illness. Imaging abnormalities involved bilateral thalami in three patients, upper brainstem in one, and the perirolandic region in five.
Discussion: We hypothesize that in encephalopathic patients, alerting stimuli activate the arousal circuitry, and, when combined with hyperexcitable cortex, result in epileptiform activity or seizures. This activity can be focal or generalized, and is usually nonconvulsive, as is true of seizures in general in the critically ill. However, when the cortex is hyperexcitable in a specific region only, focal EEG findings arise. If the electrographic seizure activity is adequately synchronized and involves motor pathways, this can present as focal motor seizures, as seen in these nine patients.
Alerting can induce seizures in encephalopathic/comatose patients. The observation of clear focal clinical seizures removes the last remaining doubt that these stimulus-induced patterns are indeed seizures by any definition, not simply abnormal arousal patterns .     

神经外科昏迷患者输液治疗的安全护理

目的探讨对于神经外科昏迷患者在静脉输液治疗过程中的安全护理措施。 方法回顾性分析自2013年l月至2014年12月500例神经外科昏迷患者在南通大学第二附属医院神经外科接受输液治疗的情况,通过对患者输液治疗,总结出从输液前准备、血管的选择、输液速度的调节及输液的观察;严格执行查对制度等细节护理措施尤其适合神经外科昏迷患者。 结果输液过程中没有出现重大投诉与护理缺陷,患者满意度达到96.8%。 结论针对神经外科昏迷患者特点与静脉输液中主要存在的风险问题,采取相应护理措施,从而杜绝安全隐患,使神经外科昏迷患者在治疗过程中实现输液安全。     

皮肤吻合器在神经外科手术中的应用

目的探讨皮肤吻合器在神经外科手术切口缝合中的应用效果。方法我科自2010年9月至2014年1月对120例神经外科手术切口采用不同方法进行皮肤缝合,根据缝合方法分为吻合器组和传统组,各60例;吻合器组采用一次性皮肤吻合器缝合切口,传统组采用传统丝线缝合切口。观察记录两组手术缝合速度、术后脑脊液切口漏发生率、切口感染发生率、切口缘皮肤坏死发生率。结果吻合器组缝合速度为（9.5±0.7）cm/min,术后脑脊液切口漏发生率为1.7%（/60）,无切口感染及切口缘皮肤坏死病例;传统组缝合速度为（3.4±0.3）cm/min,术后脑脊液切口漏发生率为10%（6/60）,切口感染发生率为3.3%（2/60）,切口缘皮肤坏死发生率为13.3%（8/60）;两组切口吻合速度及术后切口缘皮肤坏死发生率均差异显著（P〈0.05）。结论对于神经外科手术切口,皮肤吻合器缝合皮肤切口较传统丝线缝合有明显的优势。     

术前预康复在脑胶质瘤手术病人中的应用

目的 探讨术前预康复在脑胶质瘤手术病人中的应用价值。方法 回顾性分析2015年12月至2018年12月手术治疗的80例脑胶质瘤的临床资料。40例进行常规术前准备（对照组）,40例在对照组基础上在进行术前预康复（观察组）。干预前、术前1 d及术后4周,使用Fugl-Meyer运动功能量表（FMA）评分评价运动能力,改良Barthel指数量表（MBI）评分评价日常生活能力,医院焦虑抑郁量表（HADS）评分评价心理状态,中国头颈癌生命质量测定量表（QLQCP-HN）评分评价生命质量。结果 术前1 d、术后4周,观察组FMA、MBI、QLQCP-HN评分均明显高于对照组（P<0.05）,而HADS评分明显低于对照组（P<0.05）。结论 术前预康复可改善脑胶质瘤病人术后运动能力、心理状态,提高日常生活能力及生命质量     

神经外科重症患者美罗培南迟发型过敏反应1例及处置经验

美罗培南是神经外科重症感染的常用药物,抗感染疗效确切,但有关不良反应报道的资料较少,特报道1例美罗培南迟发型过敏反应病例及处置经验,回顾并附以皮疹图片资料,以供临床参考.     

A meta-analysis of critically ill patients reveals several potential risk factors for delirium

Objective

To investigate potential risk factors for delirium in critically ill patients through a meta-analysis of clinical observational studies.

Method

A literature search was conducted of MEDLINE and Embase databases. Studies that reported risk factors for delirium in a critical care setting were included. Data were independently extracted by two reviewers and pooled using a fixed-effect or random effects model according to the result of a heterogeneity test.

Results

Twenty-five studies were included. The combined odds ratio (95% confidence interval) for each potential risk factor estimated by meta-analysis was as follows (univariate/multivariate): alcohol use, 1.47 (0.79–2.72)/2.34 (1.56–3.49); smoking, 1.01 (0.81–1.25)/1.61 (0.83–3.10); hypertension, 1.64 (1.30–2.06)/1.98 (1.44–2.72); age (per year), 1.03 (1.001–1.05)/1.04 (1.02–1.05); age > 65 years, 2.52 (1.55–4.10)/2.59 (1.93–3.47); mechanical ventilation, 3.09 (1.43–6.66)/4.51 (1.41–14.39); and Acute Physiology and Chronic Health Evaluation (APACHE) II score (per point), 1.13 (1.06–1.21) (multivariate only). There was no evidence of publication bias except for APACHE II score.

Conclusion

Age, history of hypertension, clinical use of mechanical ventilation and higher APACHE II score are associated with increased risk of delirium in critically ill patients.