双针腰椎穿刺置换脑脊液加鞘内注射治疗结核性脑膜炎的临床分析

目的 探讨双针腰椎穿刺置换脑脊液加鞘内注射治疗结核性脑膜炎的临床价值.方法 将32例结核性脑膜炎患者随机配对分为两组,对照组(17例)给予常规治疗,试验组(15例)在常规治疗的基础上应用双针腰椎穿刺置换脑脊液加鞘内注射,比较两组的临床疗效.结果 试验组总有效率为100.0%(15/15),显著高于对照组的64.7%(11/17)(P<0.01);试验组残障率显著低于对照组[6.7%(1/15)比41.2%(7/17),P<0.01].试验组住院时间明显短于对照组.结论 在系统常规治疗的基础上行双针腰椎穿刺置换脑脊液加鞘内注射治疗可明显提高结核性脑膜炎的疗效,改善其预后,缩短住院时间,节省住院费用.     

脑脊液置换联合鞘内注药对结核性脑膜炎患者疗效的观察

目的观察脑脊液置换联合鞘内注药对结核性脑膜炎患者脑脊液生化及腺苷脱氨酶（adenosine deainase,ADA）的影响,并探讨其疗效。方法55例结脑患者随机分为治疗组和对照组,对照组常规治疗,治疗组在常规治疗的基础上采用脑脊液置换联合鞘内注药,两个月后对两组疗效进行比较分析。结果治疗组在改善脑脊液生化指标方面均优于对照组（P〈0.05）。治疗组总有效率为96.67%,治愈率为56.67%;对照组总有效率为64%,治愈率为32%,差异有统计学意义（P〈0.01）。结论脑脊液置换联合鞘内注药治疗结核性脑膜炎疗效显著。     

等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎疗效观察

目的探讨等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎的方法和疗效。方法将44例重症结核性脑膜炎患者随机分为治疗组和对照组,对照组给予常规治疗,治疗组在常规治疗的基础上采用等容等压脑脊液置换联合鞘内注药,2个月后对两组疗效进行比较分析。结果治疗组总有效率为95.65%,治愈率为56.52%;对照组总有效率为61.9%,治愈率为28.57%,两组比较差异有统计学意义(P<0.01)。治疗组脑脊液蛋白、白细胞数及脑脊液压力下降速度快于对照组(P<0.05)。结论等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎疗效显著。     

脑脊液置换联合鞘内注药治疗结核性脑膜炎的临床疗效观察

目的探讨脑髓液置换联合鞘内注药治疗结核性脑膜炎的临床疗效。方法选择2008年9月-2010年9月,收治的结核性脑膜炎患者86例,随机将患者分为观察组和对照组,每组43例,2组患者均给予抗结核和保肝以及激素和脱水剂等常规药物治疗,观察组在此基础上加用脑脊液置换与鞘内给药的联合治疗,对2组患者的临床疗效等相关指标进行比较分析。结果与对照组相比,观察组的治愈率和总有效率均显著提高,分别高达72.09%和90.70%;而无效率则显著降低,仅为9.30%,差异均有统计学意义(P<0.05);与此同时,观察组的发热、头痛、脑膜刺激征消失时间;压力、脑脊液细胞和脑脊液蛋白恢复时间;住院时间均显著降低,差异均有统计学意义(P<0.05)。结论脑髓液置换联合鞘内注药治疗结核性脑膜炎,其疗效确切,效果显著,是结核性脑膜炎患者较为理想的综合治疗方法,值得临床推广和应用。     

腰大池置管持续引流联合鞘内注射给药治疗结核性脑膜炎患者疗效观察

目的:探讨腰大池置管持续引流联合鞘内注射治疗结核性脑膜炎的临床疗效。方法:回顾性分析我院收治结核性脑膜炎患者105例,分为观察组和对照组。对照组按常规药物进行治疗,观察组在对照组治疗的基础上,行腰大池置管持续引流联合鞘内注射地塞米松、异烟肼。综合患者临床症状、体征和脑脊液的转归情况对治疗效果进行评估。结果:观察组临床症状和体征恢复时间显著少于对照组(均P0.05),脑脊液生化检测指标恢复时间也显著少于对照组(均P0.05);经过治疗后,观察组的总有效率高于对照组,死亡率低于对照组(均P0.05)。结论:腰大池置管持续引流联合鞘内注射给药可提高结核性脑膜炎的临床疗效,提高患者治愈率值得临床推广。     

等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎疗效观察

目的探讨等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎的方法和疗效。方法将44例重症结核性脑膜炎患者随机分为治疗组和对照组。对照组给予常规治疗，治疗组在常规治疗的基础上采用等容等压脑脊液置换联合鞘内注药，2个月后对两组疗效进行比较分析。结果治疗组总有效率为95．65％，治愈率为56．52％；对照组总有效率为61．9％，治愈率为28．57％，两组比较差异有统计学意义（P〈0．01）。治疗组脑脊液蛋白、自细胞数及脑脊液压力下降速度快于对照组（P〈0．05）。结论等容等压脑脊液置换联合鞘内注药治疗重症结核性脑膜炎疗效显著。     

腰穿放液并鞘内注射异烟肼加地塞米松治结核性脑膜炎临床疗效观察

目的:观察腰穿放液联合鞘内注射给药治疗结核性脑膜炎的临床疗效.方法:将40例成年结核性脑膜炎患者随机分为治疗组与观察组各20例,两组在常规三联抗结核治疗基础上,治疗组给予腰穿放液联合鞘内注射异烟肼加地塞米松治疗.结果:治疗组比观察组临床症状消失和脑脊液恢复正常时间明显缩短,疗效差异有显著性.结论:腰穿放液联合鞘内注射异烟肼加地塞米松是治疗结核性脑膜炎的一种比效经济实用和安全有效的方法.     

“负流量脑脊液置换＋鞘内注药”在结核性脑膜炎治疗中的应用

目的探讨“负流量脑脊液置换＋鞘内注药”模式治疗结核性脑膜炎的临床疗效。方法采用脑脊液置换联合鞘内注药治疗结核性脑膜炎75例（治疗组）和常规抗结核药物及激素、脱水剂等治疗60例（对照组）。对两组的疗效和脑脊液压力、蛋白、糖、氯化物及细胞数进行比较。结果治疗1周和8周后,两组脑脊液蛋白、白细胞数和脑脊液压力下降速度比较差异有统计学意义（P〈0．05）,治疗8周时治疗组总有效率为92％,对照组总有效率为70％。治疗组未发现与脑脊液负流量置换加鞘内注药相关的并发症。结论“负流量脑脊液置换＋鞘内注药”模式是治疗结核性脑膜炎的一种简单、有效、安全的方法,可显著缓解结核性脑膜炎的症状,可缩短治疗疗程。     

脑脊液负流量置换联合鞘内注药治疗中晚期结核性脑膜炎的疗效观察

目的 探讨脑脊液负流量置换联合鞘内注药治疗中晚期结核性脑膜炎(结脑)的临床疗效.方法 92例中晚期结脑患者随机分为治疗组(47例)和对照组(45例),所有患者均采用3HRZE(s)/9HRE方案抗结核治疗,治疗组同时采用脑脊液负流量置换联合鞘内注药治疗,对比两组疗效.结果 治疗第2周末和第8周末,治疗组患者脑脊液蛋白质水平、白细胞数和脑脊液压力均明显低于对照组(P<0.01).治疗第8周末治疗组总有效率为87.23%(41/47).对照组总有效率为60.00%(27/45),两组总有效率比较差异有统计学意义(P<0.01).未发现与脑脊液负流量置换联合鞘内注药相关的并发症.结论 脑脊液负流量置换联合鞘内注药治疗中晚期结脑安全有效,值得在临床中推广使用.     

脑脊液置换联合鞘内注射治疗结核性脑膜炎的临床疗效分析

目的探讨结核性脑膜炎(TBM)应用脑脊液(CSF)置换联合鞘内注射治疗的临床疗效。方法选取我院2012年1月至2015年4月收治的78例TBM患者,随机平均分为对照组和观察组。对照组给予常规治疗;观察组在对照组基础上,采取CSF置换联合鞘内注射治疗。记录和比较两组治疗过程中CSF指标及体征、症状恢复时间和治疗2个月后的疗效。结果观察组的CSF指标(CSF压力、白细胞、糖及氯化物)以及体征和症状(脑膜刺激征、发热、头痛)的恢复时间均显著短于对照组(P<0.01)。观察组总有效率为94.87%,显著高于对照组的76.92%(P<0.05)。结论 TBM应用CSF置换联合鞘内注射疗法的疗程短,疗效显著,具有较高临床应用价值。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.