神经精神性狼疮的诊断与鉴别

系统性红斑狼疮(systemic lupus erythematosus，SLE)是一慢性、特发性自身免疫病，累及多脏器。SLE的神经累及称为“神经精神性狼疮”(neuropsychiatric LE，NPLE)，包括中枢神经系统(CNS)、周围神经系统(PNS)、自主神经系统综合征和精神症状。1875年Hebra等最早报道在SLE患中发生的昏迷，之后，SLE中有多种神经精神综合征被报道。这些症     

儿童神经精神狼疮的临床特征及脑外表现

目的 探讨儿童神经精神狼疮(NPSLE)患者的临床特点、实验室检查特点、影像学表现及预后.方法 回顾性分析45例系统性红斑狼疮(SLE)患儿中15例NPSLE患儿的临床资料,行脑电图检查12例,脑CT检查8例,脑MRI检查3例,脑脊液检查6例.结果 15例NPSLE患儿中80%(12/15)在确诊SLE第1年内出现神经系统受损表现,20%(3/15)以神经系统损害为首发症状,头痛8例、癫痫发作2例、记忆力减退2例、昏迷1例、情绪失调1例、舞蹈样动作1例.脑外表现:15例患儿均有发热,占100%;皮肤、黏膜损害13例,占87%;肾损害11例,占73%.脑脊液检查:3例正常,3例压力升高,但脑脊液常规、生化正常.8例头部CT检查:6例异常;12例脑电图检查:8例异常;3例头部MRI检查均异常.随诊中死亡2例.结论 儿童NPSLE可有多种临床表现,影像学和脑电图检查有助于NPSLE的诊断,有效的治疗可获得良好的预后.     

神经精神性狼疮的观察及护理

目的 探讨神经精神性狼疮（NPSLE）的临床特点和护理措施.方法 对25例NPSLE患者的临床观察和护理进行回顾性总结.结果 23例好转出院,2例死亡.结论 观察细致、掌握特点及操作熟练是护理NPSLE患者的关键;加强基础护理及消毒隔离能有效预防各种并发症,降低死亡率;健康教育能够提高患者治疗依从性,降低复发率.     

45例系统性红斑狼疮合并神经精神狼疮病人急性期的安全护理

[目的]总结系统性红斑狼疮合并神经精神狼疮病人的临床症状及个体特点,探讨其相应的护理对策,对临床护理工作提供指导,保证神经精神狼疮病人的安全。[方法]收集临床资料,结合临床经验,对神经精神狼疮病人进行安全护理。[结果]通过对45例神经精神狼疮病人急性期的临床症状分析,并对其进行针对性的安全护理,消除安全隐患,提高治疗的有效性,保证病人的安全,促进疾病早日康复。[结论]应对神经精神狼疮病人进行多方位的安全护理。     

精神神经性狼疮患者精神神经症状的护理分析

精神神经性狼疮(NPLE)是由于系统性红斑狼疮(SLE)累及中枢神经系统，其表现除一般SLE的症状外，还有中枢神经症状和精神症状。其临床表现呈多样性、复杂性，且病情凶险，易造成临床误诊和漏诊，从而延误治疗的最佳时机和及时有效的护理措施。     

神经精神性狼疮病人的护理

对42例神经精神性狼疮病人进行充分评估,确定护理重点,对病人进行病情观察、避免诱因、预防并发症、"三防"护理、药物护理、心理护理及健康教育等护理措施,结果39例病情好转出院,1例死亡,2例病情无明显好转自动出院.     

狼疮脑的临床观察与抢救护理

狼疮脑作为系统性红斑狼疮的危现症,近几年来已获得很好的治疗效果,既归功于临床有效的治疗,又得益于充分的临床护理。本文通过对９例狼疮脑的成功抢救,着重阐述在护理过程中,如何进行系统的临床观察及抢救护理。     

神经精神性狼疮40例临床分析

国外报道近半数的系统性红斑狼疮（SLE）患者在病程中可出现神经系统损害，被称为神经精神性狼疮（NPLE），占SLE死亡原因的7．0％～19．0％[1]。本文将我院收治的40例NPLE临床资料报道如下。1材料与方法1．1一般资料我院近10年来共收治SLE患者173例，其中NPLE40例（23．1％）。男2例，女38例；年龄16～54岁，平均28．5岁，病程1～14年，平均3．6年。从SLE起病至出现神经系统损害的时间小于1年10例，1～3年12例．4、5年3例，5年以上15例。1．2方法SLE诊断标准参照1982年美国风湿病学会通过的新标准［2］。NPLE诊断标准参照1987…     

神经精神性狼疮病人的护理

对42例神经精神性狼疮病人进行充分评估,确定护理重点,对病人进行病情观察、避免诱因、预防并发症、＂三防＂护理、药物护理、心理护理及健康教育等护理措施,结果39例病情好转出院,1例死亡,2例病情无明显好转自动出院。     

神经精神性狼疮的观察及护理

目的探讨神经精神性狼疮(NPSLE)的临床特点和护理措施.方法对25例NPSLE患者的临床观察和护理进行回顾性总结.结果23例好转出院,2例死亡.结论观察细致、掌握特点及操作熟练是护理NPSLE患者的关键;加强基础护理及消毒隔离能有效预防各种并发症,降低死亡率;健康教育能够提高患者治疗依从性,降低复发率.     

狼疮性肾炎治疗的临床研究进展

本文综述了狼疮性肾炎的治疗进展。药物治疗包括传统的免疫抑制剂环磷酰胺,新型免疫抑制剂吗替麦考酚酯、硫唑嘌呤、来氟米特,和近年来研究较多的生物制剂;同时也对非药物治疗,如免疫净化、干细胞移植以及肾移植的治疗现状做了概述。     

临床中毒学研究进展

本文复习了2009年美国国立卫生研究院(Pub Med)和万方数据系统中关于中毒的文献,同时也参考了2009年北京第8届亚太临床中毒学大会的会议纪要.这些文献包括了罕见病例报告、系列病例研究、荟萃分析及多中心中毒流行病学研究.以此达到为中国的急诊医师提供临床中毒学新进展的目的 ,同时为该领域临床实践、住院医师培训及科研工作提供信息(中国在这些领域还远远落后于其他亚太国家).     

他汀类药物临床应用研究进展

<正>自1976年第一个他汀类药物美伐他汀问世以来,他汀类药物已发展至第3代,目前常用于临床的有:洛伐他汀、辛伐他汀、普伐他汀、氟伐他汀、阿托伐他汀,较新的     

Subdural hematoma presenting as headache in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) affects the nervous system in 75% of cases (1). A female with several neurological manifestations in the case history presented with severe headache, psychiatric disturbances, and increasing paraparesis. She was found to have bilateral subdural hematomas, and after evacuation her neuropsychiatric symptoms, including headache, disappeared. It is speculated that the reported low incidence of subdural hematomas in SLE may be more apparent than real. On the basis of our case, we recommend repeated neuroradiological investigations to uncover this important, treatable and otherwise potentially fatal cause of headache.     

Pain perception studies in tension-type headache

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders.     

Electrophysiological studies on headache: the contingent negative variation

The contingent negative variation (CNV) is a slow cortical potential recorded from the scalp. This method allows the pathophysiology of chronic headaches to be elucidated. When assessed during the pain-free interval patients suffering from migraine without aura show significantly more negative amplitudes than healthy controls. This negativity reflects the activity of cerebral noradrenergic systems. Some studies using repeated recordings of the CNV show a periodicity in amplitude change. When migraine patients are assessed a few days before a migraine attack occurs, they show pronounced negativity, which normalized during the attack. Despite these interesting findings that are based on group comparisons, evaluating the CNV on an individual basis does not allow specific conclusions. Thus, assessment of the CNV is an important tool to examine pathophysiological aspects of chronic headaches, but is not suitable as a diagnostic procedure.     

Translating instruments for cross-cultural studies in headache research

OBJECTIVE: To describe translation methods, to outline current recommendations for translation and to give an overview of translation procedures used in headache. BACKGROUND: In health-care research, particularly in the domain of health-related quality of life, an increasing number of questionnaires are translated for cross- cultural comparison. A number of headache-related questionnaires have also been translated. To ensure true cross-cultural comparison, it is important to use rigorous translation methods to ensure a high quality translated version of the instruments. METHODS: Literature relevant to cross-cultural translations was reviewed, as well as literature concerning translation of headache-related instruments. CONCLUSION: More information on the translation process for headache-related instruments is essential to carry out high quality cross-cultural research. Recommendation are given to encourage good translation practices.