缺血缺氧性脑病91例康复治疗临床分析

目的 探讨成人缺血缺氧性脑病的病因、功能障碍特点及康复治疗效果和预后相关因素.方法 回顾性分析2012年8月至2016年12月中国康复研究中心北京博爱医院神经康复科收治的91例缺血缺氧性脑病患者的临床资料,总结患者病因、功能障碍表现,比较综合康复治疗前后功能障碍的改善情况.结果 病因:一氧化碳中毒21例,突发呼吸心跳骤停13例,手术中发生13例,呼吸循环衰竭9例,窒息8例,脑血管意外8例,脑外伤6例,电击伤4例,中毒3例,过敏性休克3例,高血糖酮症酸中毒昏迷1例,羊水栓塞1例,热射病l例.其中实施心肺复苏58例(63.7％),气管插管21例(23.1％),气管切开29例(31.9％).功能障碍中,合并症状性癫痫21例(23.1％),认知功能障碍81例(89.0％);运动功能障碍患者75例(82.4％):单纯锥体束损伤42例(46.2％),单纯锥体外系损伤11例(12.1％),共存22例(24.2％).康复治疗前的简易精神状态检查(MMSE)评分为13.09±10.87,康复治疗后的评分为16.21±11.13,差异有统计学意义(t=3.741,P=0.001).康复治疗前日常生活活动能力(ADL)评分为13.09±10.87,康复治疗后为16.21±11.13,差异有统计学意义(t=5.287,P＜ 0.001).康复治疗前步行能力评分为1.36±1.76,治疗后为1.66±1.83,差异有统计学意义(t=3.466,P=0.001).康复治疗前平衡障碍评分为5.30±4.97,治疗后为6.26±4.96,差异有统计学意义(t=-5.91,P＜0.01).结论 缺血缺氧性脑病患者往往出现皮层、锥体系统、锥体外系统、小脑系统损害,表现为认知、运动、构音障碍,情绪障碍.经综合康复治疗后,患者的认知功能、步行能力、平衡功能、日常生活能力均可得到改善.     

七叶神安片与艾司唑仑治疗原发性失眠症近期疗效比较

目的 观察和比较七叶神安片与艾司唑仑治疗失眠症的临床疗效和不良反应。方法 将200例原发性失眠症患者随机分为七叶神安片组和艾司唑仑组,每组100例,两组患者分别采用七叶神安片和艾司唑仑治疗,疗程均为4周。观察和比较两组患者的匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）,并以PSQI总分减分率作为疗效判定标准。在治疗过程中随时记录患者出现的药物不良反应,治疗结束后比较两种药物的不良反应发生率。结果 艾司唑仑组临床疗效优于七叶神安片组（P＜0.05）;治疗后两组患者PSQI评分较治疗前均显著降低（P＜0.05）,七叶神安片组患者PSQI评分降低值显著小于艾司唑仑组（P＜0.05）;七叶神安片组的不良反应发生率显著低于艾司唑仑组（P＜0.05）。结论 七叶神安片和艾司唑仑均可有效治疗失眠症,艾司唑仑临床疗效更佳,有效性更高,而七叶神安片的不良反应少而轻微,安全性高。     

高压氧治疗新生儿缺氧缺血性脑病

目的　了解高压氧对新生儿缺氧缺血性脑病 (HIE)的近期疗效及远期预后。方法　对 189例HIE患儿随机分为对照组和观察组 ,采用 2 0项新生儿行为神经测定 (NBNA) ,对治疗前、后进行评分 ,满分为 4 0分 ,<35分为异常。应用Gesell发育量表测出发育商 (DQ)值 ,对 16周、8个月评出的DQ值分布情况进行比较 ,判断标准为正常≥ 86 ,可疑 76～ 85 ,异常≤ 75。结果　治疗后轻度HIE观察组和对照组NBNA值分别为(38 5 6分± 1 4 6分 ,37 83分± 1 32分 ) ,2组之间无显著性差异 ;中、重度HIE观察组NBNA值为 (35 4 7分±1 15分 ,30 4 2分± 2 18分 ) ,对照组NBNA值为 (2 9 5 7分± 2 2 1分 ,2 5 2 8分± 1 96分 ) ,2组之间差异有显著意义 (P <0 0 1)。随访观察组DQ正常例数明显高于对照组 (χ2 =6 38,6 93,P <0 0 5 )。结论　高压氧治疗HIE具有显著疗效 ,又能明显改善预后。     

Natural history of asymptomatic bile duct stones at time of cholecystectomy

OBJECTIVES: There is little data on the natural history of asymptomatic bile duct stones and hence there is uncertainty on the management of asymptomatic bile duct stones discovered incidentally at the time of laparoscopic cholecystectomy. We retrospectively reviewed a group of patients who had previously underwent laparoscopic cholecystectomy, but who did not have a pre-operative suspicion of intra-ductal stones, to determine if any biliary complications had subsequently developed. A group of patients who had no pre-operative suspicion of intra-ductal stones, but routinely underwent intraoperative cholangiogram (IOC) at time of cholecystectomy, served as the control group. METHODS: A telephone questionnaire was completed by each patient''s family practitioner in 59 of 79 (75%) patients who underwent laparoscopic cholecystectomy. In the remaining 20 patients additional information was obtained from hospital records and from the central services agency (CSA). These patients had no pre-operative suspicion of bile duct stones and therefore did not undergo an IOC or ERCP. The control group (73 patients) had no pre-operative suspicion of bile duct stones but had a routine IOC performed to define the biliary anatomy. RESULTS: 59 patients were followed up for an average of 57 months (range 30-78 months) after laparoscopic cholecystectomy. None of these patients developed pancreatitis, jaundice, deranged liver function tests (LFT''s), or required ERCP or other biliary intervention. In the additional 20 patients where no information was available from the family practitioner, 11 patients had follow up appointments with no documentation of biliary complications or abnormal LFT''s. 19 of 20 patients were traceable through the CSA and were all alive. Only 1 patient was untraceable and therefore unknown if biliary complications had developed. In the control group, 4 of 73 (6%) patients had intraductal stones detected and extracted. Thus the prevalence of asymptomatic bile duct stones during the time of cholecystectomy in our population was 6%. CONCLUSIONS: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed.     

人恶性实体瘤患者外周血淋巴细胞亚群计数分析

目的：探讨CD3,CD4,CD8,CD4／CD8,CD19诸项免疫指标与恶性实体瘤发生,发展及受化疗影响的关系。方法：用常规免疫荧光流式细胞仪技术测定受试外周血T,B淋巴细胞亚群百分数,恶性实体瘤患才各项指标分析与正常人群比较,并按接受和未接受化疗与否进行异种人群比较,按化疗前后进行同种人群比较,按化疗后一般状况P,S,得分进行分组比较。结果：恶性实体瘤患者CD3,CD4,CD3／CD4／CD19均值低于正常,CD8高于正常,不同人群比较,接受化疗者CD3测得值低于正常值的百分率较之未接受化疗者或高,其他各项指标差异无显著性,同一患者群化疗前后比较,化疗后CD3,CD4的测得值低于正常值的在分率较之化疗前显著升高,其他各基指标差异无显著性,化疗后按P．S．得分分组,P．S．得分分组,P．S．得分大于等于3组群CD3,CD4测得值低于正常值的百分率较之P．S．得分小于等于2组群显著升高,其他各项指标差异无显著性,结论：恶性实体瘤患者免疫功能可能与发病和病情进展有关,化疗可以同时杀灭免疫细胞,但个体的免疫反应可能与人体特征有关。     

Ability to learn inhaler technique in relation to cognitive scores and tests of praxis in old age

Clinical observations have shown that some older patients are unable to learn to use a metered dose inhaler (MDI) despite having a normal abbreviated mental test (AMT) score, possibly because of dyspraxia or unrecognised cognitive impairment. Thirty inhaler-naive inpatients (age 76–94) with an AMT score of 8–10 (normal) were studied. Standard MDI training was given and the level of competence reached was scored (inhalation score). A separate observer performed the minimental test (MMT), Barthel index, geriatric depression score (GDS), ideational dyspraxia test (IDT), and ideomotor dyspraxia test (IMD). No correlative or threshold relationship was found between inhalation score and Barthel index, GDS, or IDT. However, a significant correlation was found between inhalation score and IMD (r = 0.45, p = 0.039) and MMT (r = 0.48, p = 0.032) and threshold effects emerged in that no subject with a MMT score of less than 23/30 had an inhalation score of 5/10 or more (adequate technique requires 6/10 or more), and all 17/18 with an inhalation score of 6/10 or more had an IMD of 14/20 or more. The three patients with a MMT >22 and inhalation score <6 had abnormal IMD scores. Inability to learn an adequate inhaler technique in subjects with a normal AMT score appears to be due to unrecognised cognitive impairment or dyspraxia. The MMT is probably a more useful screening test than the AMT score in this context.     

高压氧对缺血缺氧性脑病所致抑郁状态患者的临床疗效及其对血液流变学的影响研究

目的观察高压氧对因缺血缺氧性脑病所致抑郁状态患者的临床疗效及其对血液流变学的影响。方法将40 例诊断明确的因缺血缺氧性脑病所致抑郁状态入院治疗的患者,按入院先后顺序,采用随机数字表法分为治疗组和等待治疗组（对照组）各20 例。治疗组予高压氧结合常规对症药物处理法治疗,对照组仅予以常规对症药物处理,其中治疗组患者的高压氧治疗隔天1 次,1 周为1 个小疗程,4 个小疗程为1 个总疗程。总疗程前后采用汉密尔顿抑郁量表（HAMD）的减分率评判两组患者的总体临床疗效,简易智能精神状态检查量表（MMSE）评价患者的认知功能,Barthel指数评分评估患者的日常生活能力,同时检测两组患者的血液流变学变化情况。结果两组患者在总疗程治疗后均有效,认知功能、日常生活能力和血液流变学情况与治疗前比较,差异有统计学意义（P <0.05）,但治疗组患者总有效率更高,各指标改善较对照组更优。结论应用高压氧结合常规对症药物处理法对缺血缺氧性脑病所致抑郁状态患者的综合临床疗效确切,该法能改善患者的血液流变学指标,促进被受损脑细胞尽可能地恢复,值得临床进一步深入研究并加以推广。     

脑卒中患者家庭康复综合状况调查研究

目的 通过横断面调查研究,了解脑卒中患者家庭康复状况,比较不同特征下卒中患者的康复效果。方法 采用便利抽样,选取某三甲医院康复医学中心已出院的卒中患者共计234例为研究对象,采用自制的《患者一般资料调查表》及Barthel指数评定（BI）量表、工具性日常生活活动能力(IADL)量表、移动能力评定(MRMI)量表、患者自我感受负担(SPBS)量表、照顾者负担(ZBI)量表对患者进行问卷调查。结果 患者BI得分（61.77±22.83）分,61.11%的患者日常生活轻度依赖;IADL得分（7.25±6.26）分,处于低水平;MRMI得分（28.90±10.22）分;SPBS得分（29.26±7.07）分,超过90%的患者有疾病自我负担感;ZBI得分（43.97±12.28）分。脑梗塞、男性患者各量表得分均优于脑出血、女性患者;年龄<60岁、家庭康复时间超过1年、由亲属照顾、女性照顾的脑卒中患者其家庭康复躯体功能总体优于老年、家庭康复时间少于1年、由非亲属、男性照顾的患者,但患者自我感受负担、照顾者负担无明显差异。结论 我国脑卒中患者家庭康复效果差。卒中类型、性别、年龄和家庭康复时间等对脑卒中患者家庭康复效果产生影响。     

支持性心理干预对脑卒中抑郁患者认知功能和日常生活能力的影响

【摘要】目的 探讨支持性心理干预对脑卒中后抑郁患者（post-strok depression,PSD）抑郁状态和认知功能及日常生活能力的影响。方法 选取2019年1月至2019年12月在浙江省人民医院康复科住院治疗的脑卒中后抑郁患者50例作为研究对象,随机将50例PSD患者分为干预组（n=25）和对照组（n=25）。对照组接受常规治疗、护理和康复训练。干预组在对照组治疗基础上给予支持性心理治疗干预。两组分别在治疗前、治疗8周后、16周后（治疗结束后8周）随访,分别采用汉密尔顿抑郁量表（HAMD）评定患者的抑郁状态;采用洛文斯顿作业疗法认知评定成套测验 (LOTCA)和蒙特利尔认知功能评估量表(MoCA)评定患者的认知功能;采用Barthel指数（BI）评定日常生活活动能力。结果 治疗8周后,两组患者的HAMD评分较治疗前均显著下降（P0.05）且干预组显著低于对照组（P0.05）。两组的LOTCA和MoCA各项评分及Barthel指数评分较治疗前有显著提高（P0.05）,且干预组显著高于对照组（P<0.05）。16周后随访,干预组HAMD评分显著低于对照组（P0.001）。干预组LOTCA总分、MoCA总分及Barthel指数评分显著高于对照组（P<0.05）。结论 在常规治疗的基础上增加支持性心理干预可以显著改善脑卒中后抑郁患者抑郁状态,促进认知功能障碍的恢复,提高日常生活活动能力并且有持续影响作用。     

胃食管反流病相关非心源性胸痛诊断的探讨

目的 评价内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测和质子泵抑制剂(PPI)试验等方法对胃食管反流病(GERD)相关非心源性胸痛(NCCP)的诊断价值.方法 因胸痛而接受冠状动脉造影的连续病例共255例中,符合本研究标准的NCCP患者27例纳入研究,对这些患者行问卷调查、内镜、24 h食管pH和胆汁监测后,予埃索美拉唑20 mg,2次/d,试验14 d.结果 27例NCCP中,若仅以存在糜烂性食管炎和(或)病理性酸反流诊断GERD相关NCCP有9例(33%);若以存在糜烂性食管炎和(或)病理性酸反流、症状指数阳性、病理性胆汁反流之其中1项诊断为GERD相关NCCP则有20例(74%).以后者为GERD相关NCCP的诊断标准,PPI试验的诊断敏感性75%、特异性86%,反流性疾病问卷(RDQ)敏感性35%、特异性86%.结论 结合内镜、24 h食管pH监测、症状指数、24 h食管胆汁监测等检查可提高GERD相关NCCP的诊断,PPI试验是临床上诊断GERD相关NCCP的首选方法.     

持续脑电双频指数监测在脓毒症脑病患者中的应用价值

目的  探讨持续性脑电双频指数（BIS）监测在脓毒症脑病（SAE）患者中的临床应用价值。方法  采取随机区组法，将山东省胜利油田中心医院2011年4月-2014月4月收治的116例脓毒症患者按是否为脑病患者分为脓毒症脑病组（SAE）及非脓毒症脑病组（非SAE），比较两组BIS、PCT、S100β蛋白、GCS分数及APACHE-II分数差异，并就BIS与GCS分数及APACHE-II分数进行Pearson相关性分析，同时对以上指标在患者的差异进行比较。结果  SAE组PCT值（8.453±3.442）μg/L及S100β蛋白值（0.775±0.356）μg/L均高于非SAE组（4.775±2.874）μg/L、（0.146±0.096）μg/L，差异具有统计学意义（P <0.05）；同时，脓毒症脑病患者BIS与GCS及APACHE-II具有明显的相关性，相关系数分别为0.754及-0.657，而脓毒症患者则无明显相关性，此外，两组患者不同治疗结局下各项指数差异均具有统计学意义（P <0.05）。结论  对脓毒症患者实施持续BIS监测有利于早期确诊患者是否并发脓毒症脑病，并对治疗预后起到一定的预判作用，同时BIS与GCS及APACHE-II具有较好的相关性，若配合PCT及S100β表达水平，则有助于准确评估患者病情。

     

Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG

CONTEXT: Both attenuated heart rate recovery following exercise and the Duke treadmill exercise score have been demonstrated to be independent predictors of mortality, but their prognostic value relative to each other has not been studied. OBJECTIVE: To assess the associations among abnormal heart rate recovery, treadmill exercise score, and death in patients referred specifically for exercise electrocardiography. DESIGN AND SETTING: Prospective cohort study conducted in an academic medical center between September 1990 and December 1997, with a median follow-up of 5.2 years. PATIENTS: A total of 9454 consecutive patients (mean [SD] age, 53 [11] years; 78% male) who underwent symptom-limited exercise electrocardiographic testing. Exclusion criteria included age younger than 30 years, history of heart failure or valvular disease, pacemaker implantation, and uninterpretable electrocardiograms. MAIN OUTCOME MEASURES: All-cause mortality, as predicted by abnormal heart rate recovery, defined as failure of heart rate to decrease by more than 12/min during the first minute after peak exercise, and by treadmill exercise score, defined as (exercise time) - (5 x maximum ST-segment deviation) - (4 x treadmill angina index). RESULTS: Three hundred twelve deaths occurred in the cohort. Abnormal heart rate recovery and intermediate- or high-risk treadmill exercise score were present in 20% (n = 1852) and 21% (n = 1996) of patients, respectively. In univariate analyses, death was predicted by both abnormal heart rate recovery (8% vs 2% in patients with normal heart rate recovery; hazard ratio [HR], 4.16; 95% confidence interval [CI], 3.33-5.19; chi(2) = 158; P<.001) and intermediate- or high-risk treadmill exercise score (8% vs 2% in patients with low-risk scores; HR, 4.28; 95% CI, 3.43-5.35; chi(2) = 164; P<.001). After adjusting for age, sex, standard cardiovascular risk factors, medication use, and other potential confounders, abnormal heart rate recovery remained predictive of death (among the 8549 patients not taking beta-blockers, adjusted HR, 2.13; 95% CI, 1.63-2.78; P<.001), as did intermediate- or high-risk treadmill exercise score (adjusted HR, 1. 49; 95% CI, 1.15-1.92; P =.002). There was no interaction between these 2 predictors. CONCLUSIONS: In this cohort of patients referred specifically for exercise electrocardiography, both abnormal heart rate recovery and treadmill exercise score were independent predictors of mortality. Heart rate recovery appears to provide additional prognostic information to the established treadmill exercise score and should be considered for routine incorporation into exercise test interpretation. JAMA. 2000;284:1392-1398.     

绳带疗法对脑卒中后偏瘫患者异常步态和下肢功能改善作用

目的 探讨绳带疗法对脑卒中后偏瘫患者异常步态和下肢功能的改善作用。方法 选择2018年4月～2019年4月期间我院康复科进行康复治疗的脑卒中后偏瘫患者90例,采用抛银币法分为康复组与对照组,各45例。两组患者均酌情予控制颅内压、血压、血糖和血脂,营养神经细胞及预防并发症等常规治疗。对照组患者予以常规康复训练方法,康复组患者在对照组基础上加用绳带疗法。两组均干预8周。评估两组患者干预前后步态参数(步长、步宽和步速)、下肢运动功能及日常生活能力的变化。结果 干预8周后,两组患者平均步长、步宽和步速较前明显升高(P0.05或P0.01),且康复组升高幅度较对照组更明显(P0.05);两组患者FMA-L评分和改良MBI评分较前明显升高(P0.05或P0.01),且康复组升高幅度较对照组更明显(P0.05)。结论 绳带疗法用于脑卒中后偏瘫患者不仅可有效改善患者异常步态,而且可明显改善患者下肢功能,提高其日常生活能力。     

强迫症与抑郁障碍、焦虑障碍地塞米松抑制试验对照研究

目的研究地塞米松抑制试验(DST)在强迫症发病机制中的作用及其对强迫症诊断的价值。方法采用放射免疫测定法测定了29例强迫症(OCD)、27例正常对照(NC)、20例抑郁障碍对照(DD)和17例焦虑障碍对照者(AD)DST皮质醇含量结果OCD患者DST阳性率为24.1%,与各对照组比较无显著性差异(P>0.05);OCD患者8:00血浆基础皮质醇浓度显著高于正常对照组(P<0.01);DST阳性的7例OCD患者中6例(85.7%)为男性。结论OCD中存在一组患者DST脱抑制、下丘脑垂体-肾上腺轴活动过度,该结果独立于抑郁;DST对OCD的诊断作用较小。     

间充质干细胞治疗强直性脊柱炎的临床疗效

目的:分析探讨间充质干细胞对强直性脊柱炎(AS)患者的临床治疗效果.方法:对2016年5月至2017年5月收治的82例AS患者进行回顾性研究,其中42例患者采用间充质干细胞进行治疗为观察组,40例患者采用抗风湿药物治疗为对照组,分析两组患者治疗前后血常规变化、肝功能水平变化、血沉指数、夜间疼痛VAS评分、Bath强直性脊柱炎功能指数(BASFI)评分和Bath强直性脊柱炎疾病活动性指数(BASDAI)评分变化.结果:经治疗后,观察组患者血常规红细胞计数(RBC)、白细胞计数(WBC)、血小板计数(PLT)、血红蛋白(HB)分别为[(3.20±0.24)×1012/L]、[(893.65±121.85)×109/L]、[(192.64±7.68)×109/L]、[(106.84±12.35)g/L],与治疗前相比差异具有统计学意义(t=9.40,30.14,7.08,5.34;P<0.05),且治疗后显著优于对照组(P<0.05);观察组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)以及总胆红素(TBIL)水平分别为[(17.24±4.96)U/L]、[(28.03±4.96)U/L]、[(10.07±1.42)μmoL/L],与治疗前相比差异显著(t=3.44,3.74,3.02;P<0.05);观察组患者治疗后VAS评分、BASFI评分以及BASDAI评分均显著优于治疗前(P<0.05),与对照组相比差异也具有统计学意义(P<0.05).结论:AS患者采用间充质干细胞治疗可以有效的改善患者的血常规和肝功能水平,且可以有效的缓解患者的临床症状,改善脊柱功能,效果显著,值得临床推广.     

左炔诺孕酮宫内节育系统治疗子宫腺肌病患者的疗效和不良反应观察

目的: 探讨左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的疗效和不良反应。方法: 回顾性分析2013年9至12月于浙江大学医学院附属妇产科医院因子宫腺肌病就诊并放置曼月乐的患者75例,共随访39个月,观察曼月乐的疗效和不良反应。结果: 月经量增多和月经量正常的患者放置曼月乐后月经量评分均降低（118±13和29±33,82±15和14±13,均P < 0.01）,月经量增多者比月经量正常者的月经量评分降低更明显（90±35和69±19,P < 0.01）。放置曼月乐后患者痛经评分降低[7（6,7）和1（0,2）,P < 0.01]。患者发生曼月乐脱落18例（24.0%）,放置曼月乐无效9例（12.0%）,发生月经模式改变28例（37.3%）。多因素Cox回归分析未发现治疗后痛经评分、治疗前后月经量评分和月经稳定时间与曼月乐环脱落相关（均P>0.05）。结论: 曼月乐在子宫腺肌病的长期保守治疗中总体安全有效,约1/3的患者可能因曼月乐脱落或治疗无效接受进一步治疗。     

The effect of reduction of door-to-needle times on the administration of thrombolytic therapy for acute myocardial infarction

Optimal management of acute myocardial infarction requires rapid administration of thrombolytic therapy. However, only patients who fulfill the following specific criteria are likely to benefit from this treatment: admission within 12 hours of the onset of symptoms, no contraindications, ST elevation or possible new-onset left bundle branch block on the admission electrocardiogram. We employed an aggressive policy to reduce the delay between admission to hospital and the administration of thrombolysis (the ''door-to-needle time''), and investigated whether this approach affected the accuracy of administration of thrombolysis. Patients admitted to the cardiac care unit with acute myocardial infarction, or who were thrombolysed, were identified retrospectively over two equivalent 4-month periods before and after implementation of our policy. Patients were considered eligible for thrombolysis if they fulfilled the criteria mentioned above. The mean (SD) door-to-needle time for all patients who received thrombolysis on admission decreased from 61(70) to 19(20) minutes (p = 0.0004). The proportion of patients eligible for thrombolysis who received treatment increased from 24/38 to 30/30 (p = 0.0002). However, the proportion of patients receiving thrombolysis who did not fulfill our criteria also increased, from 3/27 to 11/41 (p = 0.1). There were no complications of thrombolysis in the first study period, but two cerebrovascular accidents in the second period; both patients fulfiled our criteria for treatment. We conclude that simple educational measures greatly reduced door-to-needle times and led to a higher proportion of eligible patients receiving thrombolysis. However, greater pressure on medical staff to make rapid management decisions increased the proportion of patients being thrombolysed inappropriately.     

老年人急性重型颅脑损伤的临床特征与预后分析

目的总结老年人急性重型颅脑损伤的临床特征及影响预后的因素。方法对我院2001年1月至2009年10月收住的106例老年急性重型颅脑损伤患者的临床资料进行回顾性分析。结果存活45例,其中20例恢复良好,轻残8例,中残11例,重残6例。死亡61例,其中格拉斯哥昏迷评分3～5分者死亡24例,6～8分者死亡37例。结论老年重型颅脑损伤患者病死率高,预后相对较差。早期诊断与积极的综合治疗措施是救治老年重型颅脑损伤的重要方法。     

无张力尿道中段悬吊术治疗女性混合性尿失禁的疗效分析

目的：评估无张力尿道中段悬吊术治疗女性混合性尿失禁的中远期疗效。方法：随访分析2010年4月至2016年9月共26例无张力尿道中段悬吊术治疗女性混合性尿失禁患者的临床资料。26例随访到的患者中,4例采用经耻骨后无张力尿道中段悬吊术（retropubic tension free mid-urethral sling, TVT）, 22例采用经闭孔无张力尿道中段悬吊术（transurethral middle obturator sling,TOT）。术后中远期电话随访尿失禁严重程度评分（urinary incontinence severity score,UISS）、逼尿肌不稳定评分（detrusor instability score,DIS）、尿失禁生活质量量表评价（incontinence quality of life scale evaluation,I-QOL）、泌尿生殖障碍量表简版（Urogenital Distress Inventory short form,UDI 6）,与术前评分进行比较分析。结果：26例患者年龄42~80岁,平均62岁。体重指数（body mass index, BMI）21.48~31.14 kg/m2,平均26.82 kg/m2。随访时间8~69个月,平均26个月,14例患者手术前曾服用M受体阻滞剂,但未超过2周。术中无膀胱损伤、尿道损伤、闭孔血管及神经损伤等并发症,术后拔除尿管时,患者均无局部疼痛或排尿困难。压力性尿失禁治愈25例,达96.15%,急迫性尿失禁治愈20例,达76.92%。26例随访患者生活质量较手术前显著改善（P<0.05）。结论：无张力尿道中段悬吊术治疗女性混合性尿失禁总体有效率高,即使未长期服用M受体阻滞剂等药物,手术本身对急迫性尿失禁的治愈率达76.92%。手术的远期疗效稳定,患者生活质量能得到显著改善。     

前庭性偏头痛与梅尼埃病患者的听力及前庭功能比较

目的 比较前庭性偏头痛(VM)与梅尼埃病(MD)患者的听力及前庭功能特点,为两者的鉴别诊断提供帮助.方法 回顾性分析2016年1月1日至12月31日在上海市静安区闸北中心医院神经内科就诊的VM和MD患者的临床资料,全部患者均在发病2周内行纯音测听、视频头脉冲试验(VHIT)以及眼震视图(VNG)检查并对检查结果进行比较分析.结果 VM患者共31例,男7例、女24例,平均年龄(53.52±13.80)岁.其中,纯音测听异常17例(54.8％),均为感音神经性聋,其中13例为双侧对称性高频听力轻中度下降.VHIT异常5例(16.1％).VNG中,VM患者均未见自发眼震,变位试验见4例(12.9％)位置性眼震.扫视试验异常10例(32.3％),平稳跟踪试验异常8例(25.8％),视动性眼震异常13例(41.9％),VM患者凝视试验均未见异常.变温试验异常12例(38.7％).MD患者共计31例,男17例、女14例,平均年龄(55.48±12.32)岁.纯音测听均为单侧低、中频感音神经性聋.VHIT异常9例(29.0％).VNG中,自发眼震1例(3.2％).MD患者变位试验均无位置性眼震.扫视试验异常6例(19.4％),平稳跟踪试验异常8例(25.8％),视动性眼震异常6例(19.4％),MD患者均未见凝视试验异常.变温试验异常13例(41.9％).VM与MD患者的的纯音测听、变位试验、视动性眼震异常率差异均有统计学意义(P均＜0.05).结论 VM患者听力异常较MD少见,且多表现为双侧对称性高频感音神经性聋.而VM患者变位试验及视动性眼震异常率高于MD.纯音测听、变位试验和视动性眼震检查可为二者鉴别提供辅助参考.