个性化愉悦元素积极刺激护理在颅脑外伤致慢性头痛病人中的应用分析

[目的]观察个性化愉悦元素积极刺激护理在颅脑外伤致慢性头痛病人中的应用效果。[方法]选择收住于我院的颅脑外伤后慢性头痛病人80例为研究样本,以随机数字表法分为对照组和试验组各40例,对照组接受常规镇痛用药护理,试验组在镇痛用药护理基础上加用个性化愉悦元素积极刺激护理,对两组干预后疼痛与睡眠质量评分进行比较。[结果]试验组干预后NRS评分和匹兹堡睡眠质量量表(PSQI)评分显著低于对照组(P0.05)。[结论]将个性化愉悦元素积极刺激护理应用于颅脑外伤致慢性头痛病人之中,对于该类病人头痛症状的缓解与睡眠质量的改善均具有积极有效性。     

愉快因子刺激疗法对老年高血压患者的影响

目的:探讨愉快因子刺激疗法对老年高血压患者的影响。方法:将60例老年高血压患者随机分为实验组和对照组各30例,对照组给予常规治疗及护理,实验组在此基础上给予愉快因子刺激疗法,观察比较1个疗程后两组血压变化情况。结果:实验组收缩压、舒张压下降程度及降压有效率均明显高于对照组(P<0.05)。结论:愉快因子刺激疗法可有效降低老年高血压患者的血压,提高降压有效率。     

耳部放血疗法在颅脑外伤性头痛患者中应用的效果观察

目的观察耳部放血疗法对缓解颅脑外伤性头痛的效果。方法将60例颅脑外伤性头痛患者按随机数字表分为对照组和观察组各30例,对照组采用常规对症止痛治疗,观察组采用耳部放血疗法,观察治疗前后患者头痛程度变化、两组使用止痛剂频次的变化。结果耳部放血疗法后患者头痛程度明显减轻,治疗后30min、1h、3h、6hNRS评分与治疗前比较明显改善,使用止痛剂的频率明显低于对照组,差异有统计学意义。结论耳部放血疗法可缓解颅脑外伤患者头痛的程度。     

对高龄病人实施"愉快因子刺激疗法"的护理与评价

目的　探讨心理护理新方法 ,提高高龄病人生活质量。方法　以本院神经科 80岁及以上的高龄住院病人 6 0例为观察对象 ,收集其人生经历中值得自豪和愉快的业绩 ,作为“愉快因子” ,通过交谈的方式将愉快因子反复刺激病人 ,观察其接受刺激前后生理、心理反应和评估生活质量。结果　 6 0例病人经愉快因子刺激治疗后 ,生理、心理有明显反应 ,生活质量明显改善(t=3.74 ,P <0 .0 5 )。结论　愉快因子刺激治疗是一项简单、有效的护理新方法 ,对提高高龄病人生活质量有显著疗效。     

神经阻滞治疗急性颅脑外伤后重度颈源性头痛的效果研究

目的:观察神经阻滞治疗急性颅腩外伤后重度颈源性头痛的效果.方法:对14例急性轻度颅脑外伤后重度头痛患者进行研究,所有患者按照国际诊断颈源性头痛(CEH)的标准确定为CEH.根据体征行枕大、枕小、耳大神经或颈2横突阻滞,应用曲安萘得10mg配成利多卡因浓度为0.4%的消炎镇痛液,每个穿刺点注射3ml.结果:治疗后第1天、第3天和第5天的随访中,疼痛程度数字评分、颈部活动度较治疗前明显改善(p＜0.01).疼痛消除12例,疼痛程度明显减轻(视觉模拟评分＜3)2例,疗效满意.结论:神经阻滞对于缓解急性颅脑损伤后的CEH的疼痛程度有显著的疗效.可明显缩短住院日、降低医疗费用、提高患者满意度.     

颅脑外伤性头痛的护理分析

选择我院2012年5月~2013年5月收治的90例颅脑外伤性头痛患者作为研究对象,随机分为常规方案护理组(对照组)与整体、全面的针地性护理干预(观察组),对其预后加以比较。结果观察组临床护理满意度及镇痛有效率显著高于对照组,差异均有统计学意义(P0.05)。加强颅脑外伤性头痛的护理干预,可显著提高护理质量,消除头痛症状,促进患者康复。     

首发精神分裂症后抑郁患者愉快因子刺激疗法干预的效果观察

目的观察愉快因子刺激疗法对首发精神分裂症后抑郁患者疗效的影响。方法按随机数字表将68例患者分为观察组和对照组各34例,两组均给予精神科常规治疗和一般护理,持续12周。观察组在此基础上实施愉快因子刺激疗法。于入组时及干预第12周末采用汉密尔顿抑郁量表、抑郁自评量表及精神分裂症患者生活质量量表评定干预效果。结果干预后第12周末观察组汉密尔顿抑郁量表、抑郁自评量表及精神分裂症患者生活质量量表评分均明显低于对照组,差异有统计学意义(P0.01)。结论愉快因子刺激疗法对首发精神分裂症后抑郁患者的情绪和生活质量有改善作用。     

颅脑外伤后头痛相关因素分析及护理

痛觉是感觉神经系统的功能,是机体自我保护的一种反射机制,影响着机体局部或整体的功能,给患者带来痛苦,甚至危及生命[1,2].目前,疼痛已成为继体温、脉搏、呼吸、血压四大生命体征之后的第五生命体征[3].颅脑外伤后24~48 h,患者通常都会出现头痛,不仅仅引起患者不适,还可能导致严重的并发症,甚至死亡.2009年10月以来,我们对102例颅脑外伤患者的头痛进行了因素分析,并给予规范化护理,取得满意效果.现报告如下.     

生物反馈疗法预防慢性每日头痛患者头痛发作的效果

目的探讨生物反馈疗法预防慢性每日头痛（CDH）患者头痛发作的效果。 方法选取100例CDH患者按随机数字表法分为生物反馈组和药物治疗组,每组50例。生物反馈组接受脑电生物反馈治疗,每次训练时间为30min,每周2次,连续治疗8周,疗程结束后每个月强化治疗1次,至12个月随访期末;药物治疗组根据预防性用药原则选择及使用药物。分别于治疗后3、6和12个月随访时,记录各组患者的头痛发作频率、头痛持续时间、月急性止痛药使用情况及不良事件发生情况,并进行统计学分析比较。 结果2组患者在性别、年龄、VAS评分、头痛发作频率、汉密尔顿焦虑量表评分（HAMA）、汉密尔顿抑郁量表评分（HAMD）、匹兹堡睡眠质量指数（PSQI）等一般临床资料方面差异均无统计学意义（P>0.05）。生物反馈组患者3、6和12个月随访时的头痛发作频率分别为（3.54±1.64）、(2.48±1.55)和（3.10±1.26）天/月,与药物治疗组［（4.46±1.59）、（3.44±1.59）和（3.86±1.03）天/月］相比,显著降低,且组间同时间点比较,差异均有统计学意义（P<0.01）;3、6和12个月随访时,生物反馈组各随访时间点的头痛发作持续时间评分［（1.52±0.76）、(1.40±0.72)和（1.42±0.70）分］均低于药物治疗组［（2.28±0.88）、（1.86±0.92）和（1.76±0.89）分］;3、6和12个月随访时,生物反馈组各随访时间点的月急性止痛药服用天数［（1.74±1.02）、(1.32±1.31)和（1.26±1.00）天/月］均低于药物治疗组［（2.64±0.92）、(2.06±1.36)和（1.92 ±0.80）天/月］,且组间差异均有统计学意义（P<0.05）。 结论与药物治疗相比,生物反馈治疗能够更加有效地预防CDH发作,且安全性更好。     

康复训练对颅脑外伤患者认知障碍的效果观察

目的:分析康复训练对颅脑外伤后患者认知障碍的干预效果;方法:选择2015年1月至2016年2月在我院康复科治疗的轻中度颅脑外伤后认知障碍患者60例,其中男,40例,女20例,平均年龄为41.5岁.康复组在采用综合治疗法,给予神经营养剂、改善循环、脱水及防止并发症等处理的基础上进行针对性认知障碍康复综合训练.对照组仅采用综合治疗法,给予神经营养剂、改善循环、脱水及防止并发症等处理.结果:康复训练后,比较两组多个指标差异显著,特别是在联想学习、触摸测验、视觉再生、图片回忆、视觉再认、理解认知方面等方面,差异尤为明显.结论:根据患者的个体情况制定个性化的训练方法,采用常规药物治疗并结合康复训练,能够有效地促进患者认知恢复,特别是短时认知恢复.     

Possible predictive factors in the evolution of episodic to chronic cluster headache

The purpose of our study was to identify general factors and distinctive clinical features differentiating patients with chronic cluster headache (CH) evolved from episodic CH and patients with episodic CH. Our study sample included 28 patients suffering from chronic CH evolved from episodic CH and 258 patients with episodic CH; all were referred to the Headache Center of Parma between December 1975 and June 1998. Patients with episodic CH were selected from all episodic CH referrals (n = 485) and selection was based on the duration of the disorder, which was to exceed the average period needed for an episodic form to turn into a chronic form (4.5 years for females and 7.0 years for males). At CH onset, the mean age for patients with chronic CH evolved from episodic CH was older than for those with episodic CH. Among patients with chronic CH, more were smokers or heavy drinkers, and had suffered a head injury. Clinically, episodic CH evolving into chronic CH was characterized by a high frequency of cluster periods, a larger proportion of patients with attacks not occurring strictly within cluster periods, and remission periods lasting less than 6 months. Possible predictive factors in the development of chronic CH appear to be CH onset from the third decade of life onward, the occurrence of more than one cluster period a year, and the short-lived duration of remission periods. The role played by head injury and cigarette smoking in the evolution of the disorder still cannot be established with certainty.     

Risk factors for headache chronification

About 4% of the adult population and about 1% to 2% of children experience chronic attacks on a daily or near daily basis. While there is uncertainty about the biological mechanisms that lead to headache "chronification," the epidemiologic literature has provided some insight into modifiable and nonmodifiable factors that appear to influence risk of headache progression. This review summarizes the evidence from population-based studies related to the chronic daily headache phenotype, natural history, and risk factors that may influence incidence, prevalence, or prognosis.     

Prevalence of head trauma in patients with difficult headache: the North Norway Headache Study

OBJECTIVE: To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma. METHOD: We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self-reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma. RESULTS: One hundred eighty-nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P =.18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity. CONCLUSION: Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity.     

Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache

OBJECTIVES: To investigate the efficacy and long-term outcome of intravenous prochlorperazine for the treatment of refractory chronic daily headache. BACKGROUND: Unlike dihydroergotamine, the treatment results of intravenous neuroleptics as first-line agents for refractory chronic daily headache have rarely been reported. METHODS: We retrospectively analyzed the data of inpatients with refractory chronic daily headache who received intravenous repetitive prochlorperazine treatment from November 1996 to March 1999. A semistructured telephone follow-up interview was done in September 1999. RESULTS: A total of 135 patients (44 men, 91 women) were recruited, including 95 (70%) with analgesic overuse. After intravenous prochlorperazine treatment, 121 (90%) achieved a 50% or greater reduction of headache intensity, including 85 (63%) who became headache-free. The mean hospital stay was 6.2 +/- 2.7 days, and mean total prochlorperazine used was 98 +/- 48 mg. Acute extrapyramidal symptoms occurred in 21 patients (16%). One hundred twenty-four patients (92%) were successfully followed up, with a mean duration of 14.3 +/- 7.5 months. Compared with pretreatment status, 93 patients (75%) considered their headache intensity decreased, and 86 patients (69%) considered their headache frequency decreased, although 40 (32%) still had a daily headache. Of the 87 patients with analgesic overuse who could be followed, 61 (70%) no longer overused analgesics. Poor response to prochlorperazine treatment (relative risk, 1.8) and presence of major depression (relative risk, 1.8) were predictors of persistent chronic daily headache at follow-up. CONCLUSIONS: Prochlorperazine was effective and safe in the treatment of patients with refractory chronic daily headache with or without analgesic overuse. Compared with dihydroergotamine, prochlorperazine seemed less effective at achieving "freedom from headache" during hospitalization, but had a similar outcome at follow-up.     

认知行为疗法对脑外伤病人康复效果的影响

[目的]探讨认知行为疗法对脑外伤病人日常自理和社会参与能力的影响。[方法]将符合入组条件的56例脑外伤病人随机分为实验组和对照组,两组均接受一般的康复训练,实验组还同时接受认知行为治疗。受伤后1个月和3个月时分别予Barthel指数、自评抑郁量表（SDS）和简明健康调查量表（SF-36）测量。[结果]两组病人的Barthel指数、SDS和SF-36测量结果比较,差异有统计学意义（P〈0.01）。[结论]护理人员运用认知行为疗法能提高脑外伤病人的康复效果。     

认知行为疗法对脑外伤病人康复效果的影响

[目的]探讨认知行为疗法对脑外伤病人日常自理和社会参与能力的影响.[方法]将符合入组条件的56例脑外伤病人随机分为实验组和对照组,两组均接受一般的康复训练,实验组还同时接受认知行为治疗.受伤后1个月和3个月时分别予Barthel指数、自评抑郁量表(SDS)和简明健康调查量表(SF-36)测量.[结果]两组病人的Barthel指数、SDS和SF-36测量结果比较,差异有统计学意义(P＜0.01).[结论]护理人员运用认知行为疗法能提高脑外伤病人的康复效果.     

Withdrawal therapy improves chronic daily headache associated with long-term misuse of headache medication: a retrospective study

Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1-3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9+/-4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month (n = 41), group II, those who had 11-20 days (n = 37), and group III, those who had 21-30 days (n = 23). The mean headache frequencies in groups I, II and III were 5.6+/-2.8 days, 15.7+/-2.5 days and 28.7+/-2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (> or = 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only.     

Relief of posttraumatic headache by intravenous chlorpromazine

We report the case of an 18-year-old male with a vascular-type headache occurring 3 days after a minor closed-head injury. The headache resolved completely, without recurrence, with a single dose of intravenous chlorpromazine. This case and the few others reported in the literature illustrate that the response of a headache to anti-migraine therapy cannot be relied upon to diagnose or confirm a diagnosis of migraine headache, or to rule out other intracranial pathology.     

Nimodipine in the treatment of headache in chronic cerebral ischemia

The aim of this study was to evaluate the influence of nimodipine on non-migrainous vascular headache in patients with chronic cerebral ischemia. Eighty-six patients were examined in a double-blind trial for 16 weeks (12 weeks of nimodipine or placebo, followed by a 4-week placebo period). Fifty-six patients were studied in an open trial for 12 months. In the total material of the double-blind study there was no difference as far as improvement of headache was concerned when comparing the patients treated with nimodipine with those receiving placebo. However, in a group of 38 patients with a higher degree of headache intensity, selected in accordance with the Sandoz Clinical Assessment Geriatric scale, a statistically significant difference was found in favor of nimodipine. The results obtained in the long-term open trial seem to confirm the effect of nimodipine on headache. The underlying mechanisms of the beneficial effect of the drug have been discussed.