脑外伤后脑震荡样症状早期药物治疗临床研究

目的:探讨脑外伤后脑震荡样症状早期药物治疗的有效性.方法:选择183例轻、中型脑外伤患者,分组后早期应用能量合剂(能量合剂组)、尼莫地平(尼莫地平组)、灯盏细辛(灯盏细辛组)治疗伤后脑震荡样症状,观察治疗后不同时间段脑震荡样症状恢复情况并进行比较.结果:治疗后7、14 d灯盏细辛组脑震荡样症状改善率(87.3%、94.4%)明显高于尼莫地平组(73.4%、82.8%)(均P＜0.05)及能量合剂组(64.6%、70.8%)(均P＜0.01).伤后1个月脑震荡样症状消失率能量合荆组(29.2%)明显低于尼莫地平组(48.4%)(P＜0.05)及灯盏细辛组(57.8%)(P＜0.01).伤后3个月脑震荡后遗症发生率能量合剂组(29.2%)明显高于尼莫地平组(12.5%)(P＜0.05)及灯盏细辛组(5.6%)(P＜0.01).结论:早期选择有效药物治疗可促进脑外伤后脑震荡样症状及时恢复,减少脑震荡后遗症的发生,可推广应用于临床.     

倒功训练致脑震荡伤发生机制分析

目的:探讨倒功训练致脑震荡伤特点、发生机制,提出预防脑震荡发生的建议。方法:对驻东北地区1999-05/2002-05不同兵种官兵13594人进行随机整群抽样填表,结合临床和基础研究进行分析、探讨。结果:军事训练致脑震荡伤377例,发生率为2.77％,其中,因倒功训练致脑震荡伤170例,占军事训练伤45.1％。入伍一年以内致伤达88.8％。结论:脑震荡伤后主要表现为脑血液循环障碍和脑实质神经细胞变性、点状出血、神经元缺血等病理、生理改变。预防和降低脑震荡发生建议包括抓好教育,重视场地建设和防震帽应用等。     

倒功训练致脑震荡伤发生机制分析

目的：探讨倒功训练致脑震荡伤特点、发生机制，提出预防脑震荡发生的建议。方法：对驻东北地区1999－05／2002－05不同兵种官兵13594人进行随机整群抽样填表，结合临床和基础研究进行分析、探讨。结果：军事训练致脑震荡伤377例，发生率为2．77％，其中，因倒功训练致脑震荡伤170例，占军事训练伤45．1％。入伍一年以内致伤达88．8％。结论：脑震荡伤后主要表现为脑血液循环障碍和脑实质神经细胞变性、点状出血、神经元缺血等病理、生理改变。预防和降低脑震荡发生建议包括抓好教育，重视场地建设和防震帽应用等。     

高压氧配合药物治疗轻度脑损伤后脑震荡样症状36例分析

轻度脑损伤在临床上较多见,包括脑震荡、外伤性蛛网膜下腔出血、脑挫裂伤等病症,患者一般神志清楚或有一过性意识障碍,有剧烈头痛、头晕、精神症状等脑震荡样症状。此类疾病不需要手术治疗,临床多采取保守治疗。本院近10a来共收治此类患者36例,现将治疗情况分析如下。     

通窍活血汤治疗脑震荡后遗症

脑震荡后遗症是因外界暴力打击,或从高处坠下,或跌扑等使头部受伤、脑干网状结构功能降低,并影响脊髓功能,出现意识、肌张力、脑反射降低的综合征象.     

养血清脑颗粒联合尼莫地平治疗脑外伤后脑震荡样症状

目的观察养血清脑颗粒联合尼莫地平治疗脑震荡样症状的治疗效果,探讨其可能的作用机制。方法 80例脑外伤后脑震荡样症状患者,按简单随机方法分为观察组(40例)和对照组(40例)。观察组采用养血清脑颗粒联合尼莫地平治疗,对照组采用尼莫地平治疗,用经颅多普勒对脑震荡样症状患者脑血流变化进行检测并比较其临床疗效。结果与对照组比较,观察组入院第1天脑血流平均峰流速度差异无统计学意义(P>0.05),入院后第7、14、20天脑血流平均峰流速度均明显增加(均P<0.05);治疗组治疗总有效率明显高于对照组,临床症状缓解率明显高于对照组(均P<0.05)。结论养血清脑颗粒联合尼莫地平治疗脑外伤后脑震荡样症状疗效显著,其作用机制可能为活血行气,祛风镇痛,解除脑血管痉挛,减轻脑血流速度。更多还原     

脑震荡患者伤后遗忘时间与脑震荡综合征出现的关系

目的:以脑震荡患者伤后遗忘时间的各时间段为判断标准,观察伤后遗忘时间与脑震荡综合征出现症状类型和症状出现时间的联系。方法:以1999-06/2003-12河南省鹤壁矿务局总医院脑外科收治闭合性脑损伤脑震荡患者165例为观察对象。使用Galveston定向遗忘实验(10个题目,满分为100分,达到75分为脱离伤后遗忘)判断患者伤后遗忘时间长短。根据伤后遗忘时间不同(<5min,5～25min,26～50min,51～60min)将患者分为4个不同时段组,观察出院时、出院后6,12,18个月时脑震荡综合征出现情况。结果:165例患者全部完成18个月随访,进入结果分析。①按伤后遗忘时间不同分组情况:<5min的45例,5～25min的67例,26～50min的35例,51～60min的18例。②脑震荡综合征发生率:所有患者出院时与出院后6个月比较无差异(P>0.05)。伤后遗忘时间<5min和26～50min的患者出院12个月时有降低(χ2=4.15,P<0.05)。出院18个月时伤后遗忘时间<5min的患者明显低于26～50min的患者(χ2=14.37,P<0.01)。所有患者出院时与出院后12个月的头疼症状发生率比较有差异(χ2=6.53～5.19,P<0.05),其他症状发生率比较无差异(P>0.05)。遗忘时间<5min的患者出院时与出院后18个月时头疼和睡眠障碍发生率比较有差异(P<0.01)。结论:脑震荡患者伤后遗忘时间与脑震荡综合征出现症状类型和症状出现时间有着密切的关系,伤后遗忘时间越短的患者在出院一年半以后脑震荡综合征出现概率越小。在各伤后遗忘时间段的脑震荡患者脑震荡综合征迁延时间较长,半年内无明显改善。     

老年期痴呆临床症状的调查及药物治疗

目的 了解门诊痴呆患者的主要临床症状与药物治疗的情况。方法 采用自制的调查表与简易智力状态检查（MMSE），对门诊164例痴呆患者进行调查。结果 不同类型的痴呆临床症状以认知功能障碍及精神行为症状为主。药物治疗中，抗精神病药物使用前三位依次为利培酮．奋乃静、奥氛平；益智药主要为双益平、尼莫地平、喜得镇；抗焦虑药主要为舒乐安定、佐匹克隆、氟硝安定。结论 门诊痴呆患者的临床症状无明显差异，药物治疗以非典型抗精神病药与胆碱能药物为主。     

分期辨症治疗重度脑震荡72例

将重度脑震荡分为昏迷期、初期和中后期辨症治疗72例，经7～23d治疗，症状全部消失，无死亡，随访6个月，无1例有后遗症状。     

基于阿尔茨海默病常见症状的非药物治疗

阿尔茨海默病(AD)是痴呆的最常见类型,其发病年龄群多为65岁以上,起病隐匿、发展缓慢。随着患病人群的不断扩增,AD已成为当今社会主要医疗卫生问题之一,亟待寻找有效治疗AD的方法。随着研究不断深入,目前尚未找到可以阻止或逆转AD病情的有效药物。早期识别AD的临床症状不仅是临床诊断的关键,对于AD的治疗也至关重要。因此,针对AD常见症状进行非药物治疗对于控制和延缓AD病情进展发挥重要作用。本文综述AD的症状与非药物治疗,为AD诊治提供新理念和新思路。     

Effects of CranioSacral therapy upon symptoms of post-acute concussion and Post-Concussion Syndrome: A pilot study

ObjectiveThe purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences.DesignTwo-part, longitudinal study conducted through a chart review of target group, followed by a Patient-reported Treatment Outcome Survey (PTOS).ParticipantsA convenience sample of 212 patients with a historical incidence of head trauma not requiring hospitalization was obtained through medical records department dating back ten years. Inclusion criteria for further chart review (n = 67) was determined by identifying patients with a confirmed concussion directly correlated with presenting symptoms and for which CST was specifically sought as a treatment option. Demographics and patient-determined treatment duration data were analyzed by comparison groups extensively suggested in existing literature: Recovery time since injury as either Post-acute concussion (<6 months) or Post-Concussion Syndrome (PCS) (≥6 months); Athletes (A) or Non-athletes (NA); and traditional gender. Final PTOS group criteria was determined by eliminating confounding issues reporting (n = 47): (A, n = 24 and NA, n = 23).ResultsQuantitative data was analyzed via Numerical Analysis, and qualitative data was analyzed via Inductive Content Analysis. Symptoms reported in all charts as well as in the PTOS were consistent with identified PCS subtypes. Utilization of CST revealed that most patients determined the treatment effect upon concussion symptoms within 1–3 sessions. Nearly twice as many sessions were attended in the PCS than post-acute groups. Referral sources, studied for a perspective on local concussion after-care discharge planning, ranged from professional to personal recommendation or self-discovery. A majority of patients met goals of reducing post-acute or PCS as reasons cited by self-determined change-in-status or discharge from service. Patients were asked to indicate on the PTOS which pre- and post-treatment symptoms were helped or not helped by this particular intervention.ConclusionsPatient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.     

轻度创伤性脑损伤评估及管理的研究进展

依据 GCS （Glasgow coma scale）评分,创伤性脑损伤（traumatic brain injury,TBI）可分三度,即轻度、中度、重度,其中轻度创伤性脑损伤（mild traumatic brain injury,mTBI）约占总TBI 的90％,且其发病率有逐年升高趋势,已成为一个严重的社会公共卫生问题。目前对 mTBI 缺乏统一的定义,临床上认为 mTBI 和脑震荡是可以互换的术语。近年来,随着脑成像、生物标志物和神经病理学的研究不断进展,mTBI 相关的知识不断修改、更新。鉴于 mTBI 在急诊和社区发病率高,而关于 mTBI 长期影响的研究数据又相对缺乏,因此如何减少 mTBI 的发病率和成本、减轻延迟性损伤,以及采取怎样的干预措施可减轻长期后遗症,仍需进一步研究。     

Subacute concussion-related symptoms in youth

Most athletes who experience a sports-related concussion recover from the acute effects within a few weeks. However, some children and adolescents with concussion experience symptoms for many weeks, or even months after the injury. Subacute and chronic symptoms related to concussion are particularly concerning in children, because cognitive deficits, headache or neck pain, sleep dysfunction, and emotional dysregulation can affect school performance and social function at a critical period of development and maturation. This article reviews the epidemiology of subacute symptoms after pediatric concussion and the current recommendations for the assessment and management of these symptoms in children and adolescents.     

Long-term consequences: effects on normal development profile after concussion

Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI), about 75% of which are classified as mild TBIs or concussions. Although symptoms typically resolve in a matter of weeks, both children and adults may suffer from postconcussion syndrome for months or longer. A progressive tauopathy, chronic traumatic encephalopathy, is believed to stem from repeated brain trauma. Alzheimer-like dementia, Parkinsonism, and motor neuron disease are also associated with repetitive brain trauma. Effective diagnoses, treatments, and education plans are required to reduce the future burden and incidence of long-term effects of head injuries.     

不同药物治疗压疮的效果观察及护理

目的：探讨采用两种不同的药物疗法治疗压疮的效果。方法：将130例压疮患者随机分为治疗组和对照组。对照组采用氟哌酸胶囊治疗,实验组采用康复新联合西瓜霜治疗。治疗结束后比较两组治疗效果。结果：实验组效果显著47例,总有效率93.9%,对照组28例,总有效率66.2%,实验组疗效显著优于对照组（P〈0.05）。结论：康复新联合西瓜霜治疗压疮效果显著,在治疗过程中可以通过加强营养和皮肤护理,解除压迫等措施可加强治疗效果,从而改善患者的生活质量,促进患者的早日康复。     

Epidemiology of youth sports concussion

The overall prevalence of concussion is high school sports is unknown. In general, concussions in this age range occur much more frequently in games than in practice. Also for sports in which both sexes participate, reported concussion rates are higher for female than male high school athletes. Recent data show that the time required for return to play and resolution of symptoms is similar for women and men. Very little is known about the epidemiology of concussions in middle school-aged athletes and younger children.     

低剂量雌激素替代疗法对围绝经期症状及激素水平的影响

目的探讨低剂量雌激素替代疗法对围绝经期症状及激素水平的影响。方法将120例围绝经期综合征患者随机分为2组,每组60例。治疗组给予低剂量雌激素治疗,对照组给予安宫黄体酮,观察2组患者雌二醇(E)、促卵泡素(FSH)、黄体生成素(LH)、骨密度值、更年期症评分、阴道评分、子宫内膜厚度以及并发症等指标。结果 2组患者治疗后E、FSH、LH、骨密度值、更年期症状评分、阴道评分均较治疗前显著改善,但2组之间无显著差异。治疗组不良反应发生率显著低于对照组。结论低剂量雌激素替代疗法治疗围绝经期症状具有显著疗效,能有效改善患者的更年期症状,不良反应少,适于临床推广应用。     

认知行为疗法在癌症病人身心症状护理中的应用进展

概述国内外认知行为疗法在癌症病人常见躯体症状(疼痛、疲乏、恶心呕吐等)以及心理症状(焦虑、抑郁)中的应用情况、效果,指出当前研究中存在的问题和面临的挑战,并提出相应建议,以推广认知行为疗法在临床癌症病人中的应用。