Wallenberg综合征的血管机制

Wallenberg综合征是一组因小脑后下动脉或椎动脉受累引起的临床综合征,其最常见病因为动脉粥样硬化,其血管形态学的多样性引起了临床表现和预后的可变性。文章对Wallenberg综合征的血管机制进行了综述。     

椎动脉异常与Wallenberg综合征发病机制的探讨

Wallenberg综合征（延髓背外侧综合征）又称小脑后下动脉梗死综合征，系由小脑后下动脉（posterior inferior cerevbellar arteries，PICA）供血障碍所致。随着磁共振技术的广泛应用，Wallenberg综合征的临床诊断已不再困难；特别是核磁共振血管成像（MRA）出现后，使人们开始注重导致小脑后下动脉梗塞综合征的原因的探讨，传统的单纯PICA的闭塞病因说受到质疑，椎动脉（vertebral artery，VA）异常导致PICA及延髓背外侧供血障碍开始受到关注。     

干燥综合征伴突发意识障碍1例

患者女性 ,30岁。因恶心、呕吐、头痛 4d于2 0 0 4年 2月 2 2日入院。既往有口、眼干燥症状 5年 ,经检查确诊为“干燥综合征” ,给予中药治疗后自觉症状减轻。2 0 0 4年 2月 2日患者因发热、咳嗽收住我院内分泌科。查ANA(+ )、RF(+ )、抗SSA(+ )、抗SSB(+ ) ,滤纸试验 5min左眼 3mm、右眼5mm ,角膜表面粗糙 ,泪膜破裂时间 <4秒 ;诊断为“干燥综合征、肺部感染”。经抗生素及泼尼松4 0mg/d治疗后 ,症状缓解出院。继续口服泼尼松4 0mg/d治疗。 4d前患者突然出现头痛 (呈持续性隐痛 ) ,伴恶心、呕吐 (呈非喷射状 ) ,5～ 8次 /d ,在当地医…     

延髓背外侧综合征二例临床分析

例1,男,33岁,于2007年2月12日入院.患者于入院23天前突然出现头晕、恶心、呕吐,伴有饮水呛咳反复呃逆、声音嘶哑、行走不稳.在外地医院治疗后症状无改善,转入我科,既往无高血压、冠心病、糖尿病等慢性病史.     

延髓背外侧综合征的临床特点及病因探讨

目的探讨延髓背外侧综合征(Wallenberg syndrome)的病因、临床特点。方法对28例延髓背外侧综合征患者的临床资料进行回顾性分析。结果主要危险因素是高血压、糖尿病、高脂血症。最主要的临床表现为眩晕(84％)，恶心、呕吐、吞咽困难(75％)，顽固性呃逆(32％)，Homer征(46％)，感觉障碍(46％)，共济失调(85％)，眼震(64％)。病变主要累及延髓背外侧、小脑。结论延髓背外侧综合征的主要病因为动脉硬化，临床特点复杂多变，诊断主要依据临床特征及MRI改变。     

肺源性心脏病患者合并意识障碍20例原因分析

慢性肺源性心脏病80%是由慢性阻塞性肺疾病发展而来,其合并症、并发症多,住院期间可能发生与医源性有关的并发症,危险性大,症状多样化,容易误诊和漏诊,本文回顾了2001~2005年4年间我科住院的肺心病患者发生意识障碍20例,分析其病因,以供临床医师参考。1临床资料1·1一般资料200     

COPD患者合并意识障碍的原因分析附50例报告

目的探讨引起慢性阻塞性肺疾病（C0PD）合并意识障碍的病因构成及防治。方法回顾性分析260例COPD患者的临床资料,通过体格检查、血气分析、电解质、头颅CT、MRI等检查综合判断意识障碍病因构成,分析其特征。结果 260例COPD患者出现不同程度的意识障碍50例,临床表现为失眠、烦躁、淡漠、兴奋,躁动不安、神志模糊,嗜睡、昏睡及昏迷等,其病因构成肺性脑病50.00%、低渗性脑病26.00%、脑血栓14.00%、药物不良反应10.00%。治疗意识障碍纠正46例,死亡4例：肺性脑病2例、低渗性脑病1例、脑梗死1例。结论 COPD合并意识障碍病因复杂,症状多样化,特异性不强,应实施针对性血气分析、血电解质、头颅CT等检查,提高诊断水平,及时采取相应的措施。     

延髓背外侧综合征8例误诊分析

延髓背外侧综合征,即Wallenberg syndrome,多由小脑后下动脉血栓形成或椎动脉闭塞,延髓背外侧部损害,使此处脑神经核团和传导束受损出现的一组临床表现的总称。因临床表现复杂,易误诊。我科收治的8例患者中6例首诊均被误诊。现对此进行回顾性分析,报告如下。1资料与方法1·1一般资料:8例中,男6例,女2例,年龄45岁~79岁,危险因素:既往有高血压病6例,糖尿病3例,心脏病1例,高血脂4例,吸烟5例,酗酒3例。1·2临床表现:8例患者中,6例起病急骤,起病时即出现眩晕、呕吐、声音嘶哑、吞咽困难及痛、温觉障碍,共济失调,2例呈逐渐加重,并于1周内达到高峰…     

Wallenberg综合征病变血管与梗死部位的相关性

目的探讨Wallenberg综合征病变血管与梗死部位的相关性。方法回顾性分析26例Wallenberg综合征患者影像资料。根据影像学方法,将Wallenberg综合征病变血管分为椎动脉病变及小脑后下动脉病变。根据磁共振,将延髓背外侧纵向分为上、中及下三部,横向分为A、B、C、D及E五个部位,分析病变血管与梗死部位的关系。结果 26例患者中,椎动脉病变14例,小脑后下动脉病变12例;椎动脉病变中动脉夹层3例,动脉瘤1例。Wallenberg综合征梗死病灶纵向分布最常见部位是延髓中部(84.62%),其次是延髓下部(34.62%),最后是延髓上部(23.08%);在延髓梗死灶的横向分布方面,Wallenberg综合征梗死灶最常见的部位是延髓背外侧的A部(84.16%),其他依次为B部(80.77%)、C部(46.15%)、E部(34.62%)及D部(26.92%)。椎动脉病变组与小脑后下动脉病变组比较,两组患者在出现延髓中段梗死(P=0.033)及延髓A部(P=0.003)和B部(P=0.012)梗死方面有统计学差异。结论椎动脉病变也是导致Wallenberg综合征的重要原因,动脉夹层是常见的血管病变;椎动脉病变导致的Wallenberg综合征梗死病灶更加容易累及延髓中段,延髓背外侧的A及B部位。     

精神科临床“意识”的含义和意识障碍（附常见的急性意识障碍综合征）

有关“意识”这一专门术语，在医学和哲学中都有自己的特定含义。因此，在认识和讨论“意识障碍”这一组精神病的症状时，首先需把“意识”的概念和“意识状态”的概念逐一简单的阐述，以免两者概念混淆，留意鉴别。然后结合临床，讨论“如何辨认意识障碍”、“意识障碍的分类”、“意识障碍的病理机制”以及“意识障碍的治疗和处理原则”。     

Pseudomeningocele induced transient loss of consciousness in Marfan syndrome

Anterior and posterior meningoceles are the severest clinical expression of dural ectasia in patients with Marfan syndrome. Meningoceles and pseudomeningoceles have been reported from either asymptomatic, to causing headache, back pain, leg pain, radiculopathy, constipation and/or urinary symptoms. This article includes a case report of a 31‐year‐old woman, who presented with recurrent transient loss of consciousness thought to be secondary to acute changes in intracranial pressure transmitted from a pseudomeningocele.     

Hyponatremia with consciousness disturbance caused by omeprazole administration

Summary A 68-year-old man developed severe consciousness disturbance after daily administration of 20 mg omeprazole for four days for the treatment of bleeding gastric ulcer. Systemic investigation revealed severe hyponatremia (111 meq/liter). Consciousness did not become clear until his sodium intake was increased to 480 meq/day, and his serum sodium concentrations reached 130 meq/liter. After the discontinuation of omeprazole, his serum sodium levels returned to the normal range with only minimum supplementation of sodium in the form of dietary sodium chloride intake of 10 g/day. Although the mechanism of hyponatremia induced by omeprazole is not clear, an excessive loss of urinary sodium appears to be more likely than water retention with an increase in fluid intake. The literature was also reviewed.     

Effects of STC on postoperative recovery of disturbance of consciousness in traumatic multiple intracranial hematoma patients

Objective:The study explored the therapeutic value of standard trauma craniectomy (STC) for the treatment of traumatic multiple intracranial hematoma.Methods:Clinical data of traumatic multiple intracranial hematoma patients who underwent surgical treatment in 2014 and 2015 were collected. The STC group and a control group according to the surgical mode, 48 and 30 cases were randomly selected from each group, respectively. Statistical analysis was performed on the change in the Glasgow coma scale (GCS) score from before the operation to 1 day, 1 week and 1 month postoperatively through repeated analysis of variance and Wilcoxon rank-sum analysis.Results:Significant differences in the GCS were observed at different time points for the two operative modes (P < .01), and an interaction was observed between time and treatment groups (P < .05). The rates of change of the GCS score for the two surgical modes were most obviously different at 3 days and 1 week postoperatively (P ≤ .001, P < .01). No statistically significant differences were observed in the rates of change of the GCS at 1 month postoperatively (P > .05).Conclusions:Compared to conventional craniotomy, STC has obvious effects on the recovery after disturbance of consciousness at 1 week postoperatively but does not result in a significant improvement in recovery at 1 month postoperatively.     

急性脑血管疾病并发意识障碍诊治分析

目的探讨急性脑血管疾病并发意识障碍的临床诊治措施及意义。方法选取我院2009年1月至2012年12月72例急性脑血管病并发意识障碍患者为观察研究对象,依据诊治措施的异同分为观察组(综合诊治护理组)和对照组(常规处置组)各36例,观察两组的临床治疗效果及患者症状改善情况,分析综合诊治护理的特点及意义,指导临床对急性脑血管疾病并发意识障碍的诊治实践。结果 4周后依据卒中量表(NIHSS)评分,格拉斯哥昏迷量表(GCS)评分及并发症发生情况对比,综合诊治护理组的患者在临床治愈效果、并发症等方面好于对照组,两组比较有明显差异(P0.05)。结论急性脑血管疾病并发意识障碍病情危急、凶险、多变,及时的观察诊断病情采取综合诊治护理措施可以最大程度的救治患者,促进脑功能的恢复,具有积极的临床价值。     

Development of disturbance of consciousness is associated with increased severity in acute pancreatitis

BackgroundDisturbance of consciousness (DOC) may develop in acute pancreatitis (AP). In clinical practice, it is known that DOC may worsen the patient’s condition, but we have no exact data on how DOC affects the outcome of AP.MethodsFrom the Hungarian Pancreatic Study Groups’ AP registry, 1220 prospectively collected cases were analyzed, which contained exact data on DOC, included patients with confusion, delirium, convulsion, and alcohol withdrawal, answering a post hoc defined research question. Patients were separated to Non-DOC and DOC, whereas DOC was further divided into non-alcohol related DOC (Non-ALC DOC) and ALC DOC groups. For statistical analysis, independent sample t-test, Mann-Whitney, Chi-squared, or Fisher exact test were used.ResultsFrom the 1220 patients, 47 (3.9%) developed DOC, 23 (48.9%) cases were ALC DOC vs. 24 (51.1%) Non-ALC DOC. Analysis between the DOC and Non-DOC groups showed a higher incidence of severe AP (19.2% vs. 5.3%, p < 0.001), higher mortality (14.9% vs. 1.7%, p < 0.001), and a longer length of hospitalization (LOH) (Me = 11; IQR: 8–17 days vs. Me = 9; IQR: 6–13 days, p = 0.049) respectively. Patients with ALC DOC developed more frequently moderate AP vs. Non-ALC DOC (43.5% vs. 12.5%), while the incidence of severe AP was higher in Non-ALC vs. ALC DOC group (33.3% vs. 4.4%) (p < 0.001). LOH showed a tendency to be longer in Non-ALC DOC compared to ALC DOC, respectively (Me:13; IQR:7–20 days vs. Me:9.5; IQR:8–15.5 days, p = 0.119).ConclusionDOC during AP is associated with a higher rate of moderate and severe AP and increases the risk of mortality.     

伴意识障碍的缺血性脑卒中患者营养支持的研究

目的探讨早期肠外-肠内营养支持对伴意识障碍的缺血性脑卒中患者的临床疗效。方法选择伴意识障碍的急性缺血性脑卒中患者56例,随机分为2组,接受肠外-肠内营养支持的26例作为研究组,单独接受肠内营养支持的30例作为对照组,检测入院第1、7、21天的血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞(Ly)和G1asgow评分,观察2组患者住院第21天感染发生率,90 d预后不良发生率。结果与第1天比较,2组患者第7、21天Alb、PA、Hb均明显下降,Ly升高(P0.05)。与对照组第7天比较,研究组Alb明显升高(P=0.048)。研究组总感染率虽较对照组低,但差异无统计学意义(57.7% vs 80.0%,P=0.07)。90 d时,2组预后不良发生率差异无统计学意义(P0.05)。结论早期肠外-肠内营养支持能改善伴意识障碍的缺血性脑卒中患者的营养,降低感染发生率和改善预后。     

Transcutaneous auricular vagus nerve stimulation in disorders of consciousness: A mini-narrative review

In this mini review, 6 studies that investigated the effects of transcutaneous auricular vagus nerve stimulation (taVNS) in patients with disorders of consciousness (DOC) were reviewed. Generally, the application of taVNS in patients with DOC appears to be effective (positive results in 5 of 6 studies) and safe. Furthermore, 4 studies that evaluated changes in the brain following taVNS reported positive results (2 studies, functional magnetic resonance imaging and 2 studies, electroencephalography). Based on our review of the 6 studies, we believe that research and clinical application of taVNS in DOC are in the initial stages and have the following limitations. First, there is a shortage of studies on this topic, with only 6 studies, 2 of which were case reports. Second, 5 studies were performed without control or sham groups. Third, there was no standardization of treatment schedules and electrical stimulation parameters. Therefore, further studies to overcome the above limitations should be encouraged; further original studies involving a larger number of patients in the control or sham groups are needed. However, studies on the optimal conditions (treatment schedule and electrical stimulation parameters) for taVNS in patients with DOC are necessary. Furthermore, neuroimaging studies should be undertaken to elucidate the neurological mechanisms for the recovery of impaired consciousness in DOC and the lasting effects of taVNS on the brain.     

超高场强磁共振扩散张量成像对脑白质疏松症的诊断价值

目的探讨超高场强磁共振扩散张量成像(DTI)对老年脑白质疏松症(LA)的诊断价值。方法单纯老年LA患者68例,应用超高场强3.0T磁共振行常规MRI及DTI检查,根据脑室周围高信号(PVH)分型,分别于侧脑室前角、后角周围脑白质及半卵圆中心测量脑白质病灶的平均扩散系数(ADC)和部分各向异性分数(FA)值,并进行统计分析。结果 68例老年中,PVH 1型42例,2型18例,3型6例,4型2例。随着PVH分型级别越高,ADC值越高,FA值越低(P<0.05,P<0.01),PVH与ADC值呈正相关(r=0.7328,P<0.01),与FA值呈负相关(r=-0.5816,P<0.01)。LA病灶在侧脑室前角、后角周围白质区和半卵圆中心区的ADC值逐渐升高,FA值则逐渐降低,差异有统计学意义(P<0.05)。结论应用超高场强DTI技术,可在特定脑白质病变区域通过更为准确的量化指标辅助临床对老年LA进行定性及定量的诊断。     

NIPPV治疗AECOPD患者合并意识障碍的临床效果

目的探讨无创机械通气(NIPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)患者合并意识障碍的临床效果。方法选取2014年1月至2016年10月我院收治的48例AECOPD合并意识障碍患者作为研究对象,按照随机数字表法将患者分为研究组和对照组,每组24例。研究组在常规治疗的基础上进行无创机械通气治疗,对照组在常规治疗的基础上进行有创机械通气(IPPV)治疗。比较两组患者治疗前及治疗后6、12 h呼吸频率、心率、氧分压(Pa O2)、二氧化碳分压(PCO2)、动脉血p H值,治疗前后两组SF-36评分及不良反应发生情况的差异。结果两组治疗前呼吸频率、心率、Pa O2、PCO2、动脉血p H值各参数比较均无统计学差异(P0.05),治疗后6 h,治疗后12 h,两组呼吸频率、心率、Pa O2、PCO2均持续改善,但研究组改善程度优于对照组(P0.05)。两组动脉血p H值改善不明显,组间比较无统计学差异(P0.05)。两组治疗后各项生活质量评分均比治疗前有显著提高(P0.05);研究组治疗后SF-36各维度评分优于对照组(P0.05)。两组不良反应发生率分别为8.3%、25.0%,组间比较无统计学差异(P0.05)。结论 NIPPV治疗AECOPD患者合并意识障碍效果好,可显著改善患者呼吸指标,提高生活质量,值得推广使用。     

Acute coronary syndrome induced by capecitabine therapy

Capecitabine, a new member of the fluoropyrimidine family, is an orally administered drug that delivers fluorouracil (5-FU) selectively to the tumour. Although the cardiotoxicity of 5-FU is well documented, there is little published data about cardiovascular adverse effects of Capecitabine. This case highlights the possible development of acute coronary syndrome as a side effect of Capecitabine therapy.