谵妄的治疗

谵妄的治疗包括三方面,一是对因治疗,二是对症治疗,三是护理工作。其中对因治疗针对的是震颤谵妄、疼痛、睡眠障碍、炎症和致谵妄药物;对症治疗主要使用抗精神病药,抗精神病药中又以氟哌啶醇最常用,利培酮和奥氮平次常用;护理工作主要是加强定向、控制感觉输入、激活认知和加强运动。     

Melatonin and sleep in aging population

The neurohormone melatonin is released from the pineal gland in close association with the light–dark cycle. There is a temporal relationship between the nocturnal rise in melatonin secretion and the ‘opening of the sleep gate’ at night. This association, as well as the sleep promoting effect of exogenous melatonin, implicates the pineal product in the physiological regulation of sleep. Aging is associated with a significant reduction in sleep continuity and quality. A decreased production of melatonin with age is documented in a majority of studies. Diminished nocturnal melatonin secretion with severe disturbances in sleep/wake rhythm has been consistently reported in Alzheimer's disease (AD). A recent survey on the effects of melatonin in sleep disturbances, including all age groups, failed to document significant and clinically meaningful effects of exogenous melatonin on sleep quality, efficiency and latency. However, in clinical trials involving elderly insomniacs and AD patients suffering from sleep disturbances exogenous melatonin has repeatedly been found to be effective in improving sleep. The results indicate that exogenous melatonin is more effective to promote sleep in the presence of a diminished production of endogenous melatonin. A MT₁/MT₂ receptor analog of melatonin (ramelteon) has recently been introduced as a new type of hypnotics with no evidence of abuse or dependence.     

Clinical Predictors of Alcohol Withdrawal Delirium

Up to now, clinical predictors for the course of the alcohol withdrawal syndrome, especially for the occurrence of a delirium, are lacking. Thus, this study was undertaken to examine whether clinical routine investigations at admission before the withdrawal syndrome can reveal factors indicating a higher risk for the development of a delirium. Our results showed that decreased serum electrolyte concentrations (i.e., chloride and potassium), elevated ALT, and γ-glutamyltransferase serum levels, as well as ataxia and polyneuropathy at the neurological examination, indicate a higher risk for the development of an alcohol withdrawal delirium.     

Melatonin modulates adiponectin expression on murine colitis with sleep deprivation

AIM To determine adiponectin expression in colonic tissue of murine colitis and systemic cytokine expression after melatonin treatments and sleep deprivation.METHODS The following five groups of C57BL/6 mice were used in this study:(1) group Ⅰ,control;(2) group Ⅱ,2% DSS induced colitis for 7 d;(3) group Ⅲ,2% DSS induced colitis and melatonin treatment;(4) group Ⅳ,2% DSS induced colitis with sleep deprivation(SD) using specially designed and modified multiple platform water baths; and(5) group V,2% DSS induced colitis with SD and melatonin treatment. Melatonin(10 mg/kg) or saline was intraperitoneally injected daily to mice for 4 d. The body weight was monitored daily. The degree of colitis was evaluated histologically after sacrificing the mice. Immunohistochemical staining and Western blot analysis was performed using anti-adiponectin antibody. After sampling by intracardiac punctures,levels of serum cytokines were measured by ELISA. RESULTS Sleep deprivation in water bath exacerbated DSS induced colitis and worsened weight loss. Melatonin injection not only alleviated the severity of mucosal injury,but also helped survival during stressful condition. The expression level of adiponectin in mucosa was decreased in colitis,with the lowest level observed in colitis combined with sleep deprivation. Melatonin injection significantly(P 0.05) recovered the expression of adiponectin. The expression levels of IL-6 and IL-17 were increased in the serum of mice with DSS colitis but decreased after melatonin injection. CONCLUSION This study suggested that melatonin modulated adiponectin expression in colonic tissue and melatonin and adiponectin synergistically potentiated antiinflammatory effects on colitis with sleep deprivation.     

Melatonin and its atheroprotective effects: A review

Atherosclerosis is a chronic vascular disease in which oxidative stress and inflammation are commonly implicated as major causative factors. Identification of novel strategies that contribute to plaque stabilization or inhibition represents a continuing challenge for the medical community.     

Melatonin for the treatment of irritable bowel syndrome

Irritable bowel syndrome(IBS)is a common disorder characterized by recurrent abdominal pain or discomfort,in combination with disturbed bowel habits in the absence of identifiable organic cause.Melatonin(Nacetyl-5-methoxytryptamine)is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa.Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility,local anti-inflammatory reaction as well as moderation of visceral sensation.Melatonin is commonly given orally.It is categorized by the United States Food and Drug Administration as a dietary supplement.Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects,such as headache,rash and nightmares.Melatonin was touted as a potential effective candidate for IBS treatment.Putative role of melatonin in IBS treatment include analgesic effects,regulator of gastrointestinal motility and sensation to sleep promoter.Placebo-controlled studies in melatonin suffered from heterogeneity in methodology.Most studies utilized 3 mg at bedtime as the standard dose of trial.However,all studies had consistently showed improvement in abdominal pain,some showed improvement in quality of life of IBS patients.Melatonin is a relatively safe drug that possesses potential in treating IBS.Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients.     

谵妄的诊断与治疗进展

谵妄是老年患者较常见的病症,但易被误诊。谵妄是意识、定向力、记忆力、思维、感知能力及行为等方面出现紊乱的一种精神障碍。其特点足急性发病及波动性病程。50％以上的住院患者可出现谵妄,临床表现为活动过度型、活动减退型及混合型三种类型。谵妄可发生于痴呆早期,其与功能性障碍、住院时间增加、长期护理时间延长、病死率及住院费用增长呈独立相关。尽管现在已认识到谵妄的重要性,并且实行护理筛选及危险因素评估等措施,以及已有的诊断及砰估方法,但谵妄在临床中仍存在漏诊及误诊的情况。虽然谵妄的病因、发病机制、诊断及治疗等方面进展有限,但谵妄的系统性诊断与治疗方法对老年患者治疗有益,其预防性措施对老年内科与外科住院患者亦有帮助。     

Stop Orders to Reduce Inappropriate Urinary Catheterization in Hospitalized Patients: A Randomized Controlled Trial

Background  Hospitalized patients frequently have urinary catheters inserted for inappropriate reasons. This can lead to urinary tract infections and other complications. Objective  To assess whether stop orders for indwelling urinary catheters reduces the duration of inappropriate urinary catheterization and the incidence of urinary tract infections. Design  A randomized controlled trial was conducted in three tertiary-care hospitals in Ontario, Canada. Patients with indwelling urinary catheters were randomized to prewritten orders for the removal of urinary catheters if specified criteria were not present or to usual care. Participants  Six hundred ninety-two hospitalized patients admitted to hospital with indwelling urinary catheters inserted for ≤48 h. Measurements  The main outcomes included days of inappropriate indwelling catheter use, total days of catheter use, frequency of urinary tract infection, and catheter reinsertions. Results  There were fewer days of inappropriate and total urinary catheter use in the stop-order group than in the usual care group (difference −1.69 [95% CI −1.23 to −2.15], P < 0.001 and −1.34 days, [95% CI, −0.64 to −2.05 days], P < 0.001, respectively). Urinary tract infections occurred in 19.0% of the stop-order group and 20.2% of the usual care group, relative risk 0.94 (95% CI, 0.66 to 1.33), P = 0.71. Catheter reinsertion occurred in 8.6% of the stop-order group and 7.0% in the usual care group, relative risk 1.23 (95% CI, 0.72 to 2.11), P = 0.45. Conclusions  Stop orders for urinary catheterization safely reduced duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections.     

Sleep and rheumatic diseases

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective.BackgroundA large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep.Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep.TherapySleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.