神经性厌食症伴重度营养不良1例临床护理

神经性厌食症是一种慢性的进食障碍性疾病,常由心理因素所致,多发于青少年女性,主要临床特点:过分担心发胖,常采取限制饮食、过度运动、引吐、导泻等方法减轻体重,并降至明显低于正常标准[1]。此病对患者的身心健康造成破坏性的影响,故心理和营养护理对疾病的康复有重要意义。2010年4月,我科收治1例神经性厌食症伴重度营养不良患者,给     

30例神经性厌食症的内分泌功能变化临床分析

目的：探讨神经性厌食症（anorexia nervosa,AN）的内分泌功能变化的特点。方法：对我院住院的30例资料完整的AN患者进行回顾性分析。结果：患者均为女性,最大年龄30岁,最小11岁,平均年龄（18．32±3．99）岁,平均体重（32．36±5．65）kg,体重指数（13．00±1．90）kg／m^2。垂体-性腺轴激素的变化：半数以上患者LH、FSH、E2和P水平降低（患者比例分别为70％、60％、53％和57％）;63％的患者PRL升高;97％患者T正常。11例患者接受LHRH兴奋试验,其中6例阴性占55％,5例正常占45％。垂体一甲状腺轴激素的变化：半数以上患者TT3、FT3、FT4降低（患者比例分别为97％、87％、60％）;54％患者rT3升高;77％患者TSH正常。半数以上患者（16例）有低T3综合症。垂体-肾上腺轴激素的变化：所有患者皮质醇生理波动均消失,其中半数及以上患者24hUFC和24：00点血皮质醇升高（患者比例分别为50％、82％）;16例行小剂量地塞米松抑制试验,9例可完全抑制。但是73％的患者ACTH和82％的患者清晨8：00点血皮质醇均正常。结论：AN多为青年女性患病,内分泌功能表现为多数患者LH、FSH、E2和P水平降低,PRL水平升高而T基本正常。多数患者TT3、FT3和FT4降低,rT3升高而TSH正常,表现为低T3综合症。所有患者皮质醇生理波动均消失,半数及以上患者24hUFC和24：00点血皮质醇升高,但多数患者ACTH正常。临床上遇到此类患者应注意排除器质性激素水平异常的各类疾病,并进行鉴别,避免漏诊、误诊。     

以腹痛、呕吐为首发症状的甲状腺功能亢进症误诊1例

1临床资料 患者男性,38岁,因脐周痛伴恶心、呕吐2周就诊。患者2周来无明显诱因出现脐周疼痛,呈持续性隐痛,阵发性加重,无放射痛,疼痛与进食与否无明显关系,伴反酸、恶心、呕吐,呕吐物为胃内容物及黄色胃液,每天10余次,呕吐量患者诉说不清,无咖啡样物,吐后腹痛无明显好转,     

Bulimia nervosa and anorexia nervosa

Anorexia and bulimia nervosa are aetiologically distinct diseases with different treatments. Though it was described more recently, bulimia nervosa occurs more commonly. Accurate diagnosis and early treatment should reduce the mortality of both conditions.     

Malnutrition from anorexia nervosa triggers severe complications of hereditary spherocytosis in an adolescent girl: A case report

Hemolytic crises and aplastic crises in hereditary spherocytosis (HS) are most commonly triggered by viral infections. We present the case of an adolescent girl with HS who developed unexpected and life‐threatening complications of her inherited hemolytic anemia as a consequence of anorexia nervosa and severe malnutrition.     

A cognitive-behavioral approach to anorexia nervosa

The initial section of this paper presents a rationale for describing the development of anorexia nervosa in cognitive-behavioral terms. The limitations of conceptualizing the disorder simply as a behavioral pattern maintained by environmental contingencies or negative reinforcement are discussed. The remainder of the paper outlines a basic cognitive-behavioral model for intervention that is based on Beck's cognitive therapy. Recommendations particularly relevant to the management of anorexic clients are presented, including techniques for developing motivation for psychotherapy and for monitoring weight gain and food intake. Common irrational beliefs and systematic cognitive distortions are described. Assessment procedures and behavioral strategies that complement the cognitive approach are presented. Detailed examples are provided to illustrate the specific cognitive strategies that are recommended for evoking and modifying the irrational beliefs and assumptions of anorexic clients.The order of authorship on the article is arbitrary. The authors wish to thank Steven D. Hollon, Aaron T. Beck, and Paul E. Garfinkel for their helpful comments. An abbreviated earlier draft of this paper was presented at the meeting of the Association for the Advancement of Behavior Therapy, San Francisco, December 1979.     

Medical complications of anorexia nervosa and bulimia nervosa

The internist plays a critical role in the care of eating disorder patients, especially in the management of the life-threatening medical complications of these conditions. In anorexia nervosa, the immediate danger is related to the effects of voluntary starvation, including hypophosphatemia, bone marrow failure, cardiac decompensation, and shock. Patients with bulimia nervosa more often experience severe fluid and electrolyte abnormalities resulting in hypovolemia, secondary hyperaldosteronism, depletion of total body potassium, and cardiac arrhythmias. Immediate management of medical complication and correction of nutritional deficits are necessary before patients can benefit from psychotherapy. The need for continued involvement of the internist in the ongoing care of the eating disorder patient is stressed. The high mortality and the likelihood of chronicity without early intervention underscore the need for early recognition and skilled management of eating disorders.     

局部浸润肾上腺素引起严重心血管反应事件1例

局部麻醉药中加入肾上腺素具有减少局麻药吸收速率及峰浓度,减少全身毒性反应,增强局部阻滞效果,延长麻醉作用时间,血管收缩和减少术野出血等作用,使得整形手术中局麻药中加入肾上腺素非常普遍.然而手术过程中肾上腺素吸收入血后可引起血流动力学变化,可导致严重高血压,心律失常,肺水肿,甚至心脏骤停.而我们在手术中也经历了1例局部浸...     

Heparin-induced platelet aggregation in anorexia nervosa and in severe peripheral vascular disease

Abstract. We have previously demonstrated that platelets obtained from patients with anorexia nervosa or severe peripheral vascular disease are hyperaggregable. Since conventional heparins are known to activate platelets in vitro and occasionally induce thrombosis and consumptive thrombocytopenia in vivo , we have investigated the direct effect of a conventional heparin on platelets obtained from patients with anorexia nervosa or severe peripheral vascular disease. Heparin at therapeutic concentrations was found to induce platelet aggregation of such platelets in vitro. In contrast, a recently developed low molecular weight heparinoid (Org 10172), at therapeutic concentrations, had no effect on these hyperaggregable platelets. We conclude that: (i) heparin may be potentially harmful to patients with hyperaggregable platelets; (ii) thrombocytopenia and thrombosis associated with heparin therapy may be mediated through a direct effect of heparin on platelets; (iii) it is unlikely that heparin induced thrombocytopenia is always mediated by classical immunological mechanisms, especially in patients with hyperaggregable platelets; and (iv) low molecular weight heparinoids may be safer anticoagulants in patients with platelet hyperaggregability.     

An introduction to anorexia nervosa and bulimia nervosa

Nurses may come into contact with patients who have anorexia nervosa and bulimia nervosa. The authors discuss the signs and symptoms of these illnesses and outline treatment options for patients with eating disorders.     

A case of severe reversible lung disease caused by sulphasalazine

Various lung problems have been reported in patients with inflammatory bowel disease. Some of these can be drug related. We report an unusual case of upper lobe infiltration which appeared to be caused by sulphasalazine.