肌萎缩侧索硬化症患者机械通气11年以上的饮食护理

肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是运动神经元病的一个主要类型,选择性侵犯脊髓前角细胞、脑干运动神经元、皮质锥体细胞及锥体束的慢性进行性变性疾病,其病因、发病机制均不明确[1],一般以支持及对症疗法为主,生存期平均3～5年.最终因呼吸肌麻痹或并发呼吸道感染死亡.鼻饲是吞咽障碍患者补充营养的重要途径,且肠内营养较肠外营养更符合机体生理需要.严格的鼻饲管理能有效维持患者的生存达十余年.我科1998年2月至2010年11月30日收治了3例ALS患者,机械通气均超过11年,通过早期肠内营养,个体化的营养膳支持,严格的鼻饲管理预防反流、腹泻,使肠内营养顺利进行.本文将此3例ALS患者的饮食管理体会进行总结,现报道如下.     

1例运动神经元病合并2型糖尿病机械通气病人的护理

运动神经元病（motor neuron disease,MND）是一种病因未明,选择性侵犯脊髓、脑干及皮层运动神经元的进行性变性疾病.当前无实质性减缓疾病进展的治疗手段,从有症状开始,平均仅能存活3年～5年.主要见于老年人,年轻人偶发,其平均发病年龄为55岁.90％的病人为散发性,10％为家族性,通常呈常染色体显性遗传.因病变部位的不同可分为肌萎缩侧索硬化症,表现为上、下运动神经元的合并受累;进行性脊髓性肌萎缩症,仅脊髓下运动神经元受累;进行性延髓性麻痹,病变侵及脑桥和延髓的下运动神经核;原发性侧索硬化可选择性地损害锥体束.病情呈持续进行性发展,常因呼吸肌麻痹和（或）肺部感染导致死亡[1].2005年11月我科收治1例运动神经元病合并2型糖尿病病人,经7年精心治疗和个性化气道护理,病情稳定,人机配合良好,现报道如下.关键词：运动神经元病;2型糖尿病;机械通气;护理分类号：R473.74 文献标识码：C文章编号：1009-6493（2014）01B-0250-02     

1例气管切开接BIPAP通气的“渐冻人”医院-社区-居家护理实践

正运动神经元疾病(motorneurondisease,MND)是一系列以上、下运动神经元改变为突出表现的慢性进行性神经系统疾病,肌萎缩侧索硬化症(ALS)是最常见的类型。该病病人意识始终清醒,但全身肌肉包括咽喉肌、呼吸肌进行性萎缩、无力,逐渐丧失自理能力,身体好像被"冻"住一样,俗称"渐冻人",病人最终因呼     

肌萎缩侧索硬化的病因研究进展

肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是一种运动神经系统的退化性疾病,上运动神经元与下运动神经元均会受侵犯,临床上主要表现为肌肉逐渐地萎缩与无力,最后因呼吸衰竭而死亡。ALS的发生率约为1~2/100000,患者中男性较女性多,大部分的患者在50多岁发病。近20年     

1例水蛭粉治疗肌萎缩性侧索硬化症病人Ⅳ度压疮的观察及护理

正肌萎缩性侧索硬化症(amyotrpniclateral sclerosis,ALS),又称卢伽雷氏症(LouCehrigs disease),是一种不可逆的致死性运动神经元退化性疾病[1-3]。病变主要侵犯脊髓前角、脑干和额叶皮质运动神经元,导致其发生进行性改变而引起相应的上、下运动神经元损害,临床表现主要为肌肉逐渐萎缩与进行性肢体瘫痪。由于不能自主改变体位,压疮的防治是病人有限生命中     

1例肌萎缩侧索硬化症患者的护理体会

正肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是一种选择性累及上下运动神经元的神经系统变性疾病,是运动神经元病的最常见类型,由于上、下运动神经元变性导致延髓部、四肢、躯干、胸部及腹部肌肉逐渐无力和萎缩。该病分布呈全球性,发病率约为2~3/10万,80%~90%的患者多在3~5年死于肺部感染引起的呼吸衰竭[1],我院于2016年4月收治此病患者1例,通过良好的护理,患者病情好转后出院。现将该ALS患者的护理体会总结如下。     

1例肌萎缩侧索硬化症患者应用需要层次理论的护理

肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是选择性侵犯上、下运动神经元的慢性进行性变性疾病,主要表现为肌无力、肌萎缩、肌束震颤,呈进行性加重,最终因呼吸肌麻痹或并发呼吸道感染死亡[1-2].由于此病病因不明确,无特效治疗方法.患者病情重、并发症多、护理难度大,因此,寻找有效的、个性化的护理方法显得尤为重要.我科于2012年10月收治了1例肌萎缩侧索硬化症患者,在常规治疗、护理的基础上,运用马斯洛的人类基本需要层次理论,对患者进行了有针对性的、预见性的护理,取得了较好效果,现报道如下.     

肌萎缩侧索硬化症的诊断

肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)是一种主要累及大脑皮层、脑干和脊髓运动神经元的神经系统变性疾病。当代ALS的概念代表一组运动神经元进行性变性的疾病,涵盖了经典型的ALS(也称Charcot′s ALS)、进行性延髓麻痹、进行性肌萎缩、原发性侧索硬化等4种常见类型,也包括连枷臂综合征、连枷腿综合征和ALS-痴呆等特殊类型。Brain等[1]则用运动神经元病来统称此类疾病,两者的概念实际是等同的。ALS的年发病率约为     

1例肌萎缩侧索硬化病人的中医辨证施护

肌萎缩侧索硬化（amyotrophic lateral sclerosis,ALS）是一种累及脊髓前角细胞、脑干运动神经核及锥体束,具有上、下运动神经元损害并存的慢性进行性变性疾病,是慢性运动神经元病的最常见类型。     

针药结合治疗运动神经元病伴失眠1例报道

<正>运动神经元病是一系列以上、下运动神经元改变为突出表现的慢性进行性神经系统变性疾病。临床表现为上、下运动神经元损害的不同症状组合,特征表现以肌无力、肌萎缩、延髓麻痹及锥体束征为主。多中年发病,男性多于女性,年发病率约为1.5/10万~2.7/10万,患病率约为2.7/10万~7.4/10万~([1])。该病的病因及发病机制目前还不十分清楚,有遗传、氧化应激、兴奋性毒性、自身免疫、病毒感染及环境因素等多     

Patellar hypomobility and the flexibility of the iliotibial band and the femoral quadriceps

Background. The aim of our study was to determine whether or not the flexibility of the iliotibial band and femoral quadriceps have an impact on patellar hypomobility, due to their connections with the patellar stabilizers. Material and methods. We examined 62 patients (44 females, 18 males) with a median age of 15 years (range 9-19). All these patients had patellofemoral dysfunction in the tested knees (101). The medial and distal glide of the patella were tested with a manual test according to Kaltenborn's scale. Ober's test was performed to test the tightness of the iliotibial band. The flexibility of the quadriceps femoris was tested while the patient was lying prone with the tested leg on the couch and the other beside it. Results. Statistical analysis based on the c2 test (P=0.05) found no dependence between the flexibility parameters of the iliotibial band or the femoral quadriceps and the parameters of patellar hypomobility. Of the tested joints, 37.6% showed hypomobile patella and positive Ober's test, while 34.7% had hypomobile patella and a positive test for femoral quadriceps flexibility. Conclusions. The flexibility of the iliotibial band and femoral quadriceps has no direct influence on passive patellar hypomobility, but can affect the biomechanics of the patellofemoral joint and the location of the point of contact on articular surfaces during dynamic knee work. The flexibility of these muscles should be a diagnostic factor in patients with patellofemoral dysfunction.     

Berson, Yalow, and the JCI: the agony and the ecstasy

The isolation of insulin in 1921 by Banting, Best, Collip, and Macleod stands as one of the most dramatic stories in modern medical investigation. Only two years passed between the initial experiments in dogs to widespread human application to the awarding of the Nobel Prize in 1923. Insulin-related research has also served as a focus, at least in part, for the work of three other Nobel Prize recipients: determination of the chemical structure of insulin by Frederick Sanger in 1958; determination of the three-dimensional structures of insulin and vitamin B12 by Dorothy Hodgkin in 1964; and finally, the development of immunoassay by Solomon Berson and Rosalyn Yalow in 1959-1960, which led to a Nobel Prize for Yalow in 1977 (five years after the untimely death of Berson). The history of Yalow and Berson's discovery and its impact on the field is an illustration of the adage that every story has two sides.     

Tibetan Buddhism and the resolution of grief: the Bardo-thodol for the dying and the grieving

This article is a contribution to the cross-cultural study of grief. The Bardo thodol (sometimes translated the Tibetan Book of the Dead ) and the ritual associated with it provides a way to understand how Buddhism in Tibetan culture manages the issues associated with what is called grief in Western psychology. The resolution of grief in the survivors is intertwined with the journey to rebirth of the deceased. The present article describes (a) the progression of the deceased, (b) the rituals by which survivors separate from the physical incarnation of the deceased, (c) how, by channeling the feelings of grief to support the progress of the deceased, grief is brought to a positive resolution, and (d) the continuing bond survivors maintain with the dead even though the dead has moved on to the next life.