神经外科围手术期预防癫痫发作的丙戊酸钠血药浓度监测

目的探讨监测丙戊酸钠血药浓度在围手术期预防癫痫发作的意义及影响因素。方法回顾性分析2016-2017年郑州大学第二附属医院神经外科51例围手术期患者应用丙戊酸钠后的血药浓度,评估丙戊酸钠预防围手术期癫痫的疗效。结果丙戊酸钠血药浓度在正常治疗范围内(50～100μg·mL~(-1))36例,占70.6%,术后患者均未出现癫痫症状;高于正常治疗浓度范围(100μg·mL~(-1))9例,占17.8%;低于正常治疗浓度范围(50μg·mL~(-1)) 6例,占11.6%。结论丙戊酸钠在预防神经外科围手术期癫痫发作有良好的疗效,可通过血药浓度监测进行个体化给药,使丙戊酸钠维持在有效治疗浓度,对神经外科围手术期预防癫痫意义重大。     

神经外科术后早期癫痫的治疗及病因研究

目的探讨神经外科围手术期常规应用丙戊酸钠进行预防后仍出现术后早期癫痫的治疗方法及病因。方法对幕上开颅患者在术前、术中和术后应用丙戊酸钠进行癫痫预防。对预防后出现术后早期癫痫者立刻给予丙戊酸钠(15mg/kg)静脉注射,同时增加丙戊酸钠静脉维持剂量[1.5mg/(kg·h)],观察20min,无效者再次给予丙戊酸钠(18mg/kg)静脉注射。观察其疗效及副作用,并分析术后早期癫痫与疾病、手术损伤、颅内出血及抗癫痫药物血药浓度等关系。结果全组29例病人,丙戊酸钠治疗有效23例(79%),30min内控制癫痫发作,无复发;无效用其他药物6例(21%),测得最高丙戊酸钠血药浓度为150mg/L,无明显副作用。全组病例中20名患者在癫痫发生后首次丙戊酸钠静注(15mg/kg)后10min,所测丙戊酸钠血浓度低于70mg/L,全部应用丙戊酸钠针剂控制癫痫者血药浓度大于80mg/L。同时分析此29例病人,发现术后早期癫痫65%发生在术后6h内,平均手术时间为5.2h。72%早期癫痫患者为右侧额叶病变,72.4%早期癫痫患者在术中有侧裂静脉及额叶回流至矢状窦静脉损伤,31%术后早期癫痫患者术后复查头颅CT有蛛网膜下腔出血(SAH)或脑内血肿。结论丙戊酸钠在治疗术后早期癫痫中效果肯定,无明显副作用。预防后仍出现术后早期癫痫与疾病部位、术中静脉损伤、术后颅内出血、脑水肿、手术时间及丙戊酸钠血药浓度偏低有关。     

拉莫三嗪联合丙戊酸钠治疗脑卒中继发癫痫患者的疗效观察

目的 观察拉莫三嗪联合丙戊酸钠治疗脑卒中继发癫痫患者的临床疗效.方法 选取我院2011-01-2012-01收治的80例脑卒中继发癫痫患者为研究对象,将患者抽签速记分为观察组与对照组,每组40例.对照组给予丙戊酸钠治疗,观察组给予拉莫三嗪联合丙戊酸钠治疗,比较2组临床疗效,比较治疗前、治疗6个月、12个月后癫痫发作持续时间、生活质量评分及不良反应发生率.结果 观察组有效率95.00％,高于对照组的80.00％,差异有统计学意义(P＜0.05).2组治疗前癫痫发作持续时间、生活质量评分比较差异无统计学意义(P＞0.05);治疗6个月、12个月后癫痫发作持续时间(2.76±1.53)min/次、(2.25±1.23)min/次,低于对照组;生活质量评分(63.82±6.30)分、(78.95±6.71)分,高于对照组,差异均有统计学意义(P＜0.05).2组不良反应发生率比较差异无统计学意义(P＞0.05).结论 拉莫三嗪联合丙戊酸钠治疗脑卒中后继发性癫痫,可提高临床疗效,缩短癫痫发作持续时间,提高生活质量,且不增加不良反应发生率,具有较好的临床应用价值.     

托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性

目的探讨托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性。方法选取80例癫痫患儿,随机分为对照组和联合组各40例,对照组给予托吡酯单药治疗,联合组在对照组用药基础上加用丙戊酸钠治疗。观察2组疗效及不良反应发生情况。结果治疗3个月时联合组治疗总有效率95.00%高于对照组80.00%(P0.05),治疗6个月时2组治疗总有效率分别为97.50%、87.50%,差异无统计学意义(P0.05);治疗3、6个月时2组癫痫发作月均频率明显低于治疗前(P0.01),治疗6个月癫痫发作月均频率明显低于治疗3个月(P0.01),治疗3、6个月时联合组癫痫发作月均频率明显低于对照组(P0.01);对照组不良反应发生率10.00%,联合组为15.00%,差异无统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗儿童癫痫可在短期内减少癫痫发作频率,未明显增加不良反应发生率,耐受性较好。     

探讨咪达唑仑联合丙戊酸钠对癫痫持续状态的治疗效果及安全性

目的探讨咪达唑仑联合丙戊酸钠对癫痫持续状态的治疗效果及安全性。方法选择我院2013-08-2016-05收治的100例癫痫持续状态患者为研究对象,按照入院先后分为研究组和对照组各50例,对照组给予丙戊酸钠治疗,研究组给予咪达唑仑联合丙戊酸钠进行治疗,比较2组的疗效和不良反应情况。结果研究组和对照组的总有效率分别为94.00%和78.00%,组间比较差异有统计学意义(P0.05);研究组和对照组的不良发应发生率分别为16.00%和14.00%,组间比较差异无统计学意义(P0.05)。结论咪达唑仑与丙戊酸钠联合使用治疗癫痫持续状态具有明显的疗效,同时安全性较高,适合在临床推广应用。     

注射丙戊酸钠联合家庭干预对脑胶质瘤患者术后焦虑、抑郁情绪及围术期应激状态的影响

目的探讨家庭干预模式联合注射丙戊酸钠对脑胶质瘤患者围术期应激指标及术后焦虑抑郁情绪的影响。方法收集因脑胶质瘤在我院住院行手术治疗的93例患者,分为观察组与对照组,对照组有患者46例,在围术期行家庭干预模式,观察组47例在对照组基础上注射丙戊酸钠治疗。比较两组围术期应激指标及术后情绪状态改善情况。结果干预后观察组的焦虑评分(SAS)、抑郁评分(SDS)、舒张压(DBP)、收缩压(SBP)及心率(HR)水平均低于对照组(P0.05);观察组总有效率高于对照组(P0.05);两组不良反应对比差异无显著性(P0.05)。结论注射丙戊酸钠联合家庭干预可有效改善脑胶质瘤患者术后焦虑抑郁情绪,减轻围术期应激反应,具有较高的安全性。     

P300和MoCA评估丙戊酸钠治疗后癫痫患者认知功能的短期变化对比

目的应用P300和MoCA量表观察症状性癫痫患者接受单药丙戊酸钠治疗前后认知功能的改变。方法对30例首诊的拟行丙戊酸钠单药治疗的症状性癫痫患者(实验组)和30例正常健康体检者(对照组)分别进行事件相关电位P300、MoCA量表测定,并对实验组单药口服丙戊酸钠3个月后、6个月后再次进行P300、MoCA量表复查。结果治疗前实验组MoCA评分为(26.00±1.17)分,对照组为(28.60±1.33)分,实验组MoCA评分较对照组低,差异有统计学意义(P0.05)。治疗前实验组P300潜伏期(424.03±45.98)ms,对照组P300潜伏期(319.83±12.70)ms,实验组P300潜伏期较对照组长,差异有统计学意义(P0.05)。经丙戊酸钠单药治疗3个月后,实验组MoCA评分(26.40±1.17)分,与治疗前比较差异无统计学意义(P0.05);实验组P300潜伏期为(397.87±42.87)ms,与治疗前比较差异有统计学意义(P0.05)。经丙戊酸钠治疗6个月后,实验组MoCA评分为(27.33±1.03)分,与治疗前比较差异有统计学意义(P 0.01);实验组P300潜伏期为(367.50±33.80)ms,与治疗前比较差异有统计学意义(P0.01)。结论症状性癫痫患者存在认知功能障碍,口服丙戊酸钠可改善认知功能,且P300潜伏期较MoCA量表能更早反映癫痫患者短期认知功能变化。     

托吡酯抗癫痫治疗对糖代谢的影响

目的观察癫痫患者服用托吡酯后血糖、胰岛素、胰岛素抵抗指数等变化,评估托吡酯对于抗癫痫治疗的临床意义及局限性。方法回顾性分析2014-06—2016-05我院神经内科门诊及住院的78例癫痫患者临床资料,随机分成2组,托吡酯组40例给予托吡酯治疗,丙戊酸钠组38例给予常规的丙戊酸钠治疗,分别于治疗前和治疗后3个月、6个月检测2组糖代谢指标差异及不良反应发生情况。结果 2组治疗后体质量、胰岛素、IR、瘦素及脂联素比较差异有统计学意义(P0.05)。托吡酯不良反应发生率为12.5%,显著低于丙戊酸钠组的23.7%,差异有统计学意义(P0.05)。结论 (1)癫痫患者葡萄糖代谢存在异常,抗癫痫药物对癫痫患者糖代谢存在影响;(2)托吡酯与丙戌酸钠均会导致癫痫患者糖代谢指标出现不同程度的下降或升高,故两种药物是否可作为理想药物尚待进一步研究,建议临床合理选用抗癫痫药物,尽可能减少药物不良反应。     

大脑镰旁脑膜瘤术后丙戊酸钠中毒1例

正颅脑手术,特别是幕上开颅手术,为预防术后癫痫常预防性应用抗癫痫药物,而丙戊酸钠是临床上最常用的预防和控制癫痫的药物之一。本文报道大脑镰旁脑膜瘤术后丙戊酸钠严重中毒1例。1病例资料55岁女性,因头晕、左侧肢体乏力1个月入院。入院体格检查:左侧肢体肌力约4级,未发现其他神经系统阳性体征。入院后头部MRI检查示右侧大脑镰旁占位,大小约3cm×4 cm,位于右侧中央前回前方,且中央前回向后外侧受压明显,考虑脑膜瘤。常规预防癫痫治疗(口服丙戊酸钠缓释片,0.5 g,2次/d)。     

比较奥卡西平或拉莫三嗪联合丙戊酸钠治疗脑外伤术后癫疒间复发疗效

目的探讨丙戊酸钠治疗脑外伤术后癫疒间复发后,添加奥卡西平或拉莫三嗪联合治疗外伤性癫疒间效果。方法以治疗前3个月癫疒间发作频度为对照,对治疗12个月后的疗效、不良反应及安全性进行自身对比观察。结果应用奥卡西平或拉莫三嗪联合丙戊酸钠治疗12个月后,患者发作频率均较用药前明显减少;发作频率减少≥50%的患者分别为89.2%和89.7%,用药前后差异无统计学意义(P<0.05);奥卡西平或拉莫三嗪联合丙戊酸钠两组间差无明显统计学意义(P>0.05)。奥卡西平联合丙戊酸钠不良反应的发生率为19.3%,拉莫三嗪联合丙戊酸钠不良反应的发生率为9.1%,差异显著(P<0.05)。结论奥卡西平或拉莫三嗪联合丙戊酸钠治疗外伤性癫疒间复发疗效确切,副作用拉莫三嗪组明显低于奥卡西平组。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

奥氮平治疗精神分裂症对照研究的Meta分析

目的：探讨奥氮平治疗精神分裂症的疗效和不良反应。方法：应用M eta分析对17篇奥氮平与其他抗精神病药治疗精神分裂症对照研究的文章进行再分析。结果：奥氮平自身对照比较的治疗效应极大（χ^2=141.00，P〈0.05）。治疗2周和治疗结束，奥氮平与对照药疗效比较差异无显著性（P〉0.05）;阳性与阴性症状量表（PANSS）评分比较差异亦无显著性（P〉0.05）。与对照药相比，奥氮平的不良反应显著少于对照药组（P〈0.05或P〈0.01）。结论：奥氮平与对照药的临床疗效相仿，但不良反应明显较少。