12例开颅术后应用丙戊酸钠引起丙戊酸钠脑病患者的护理

总结12例开颅术后应用丙戊酸钠引起丙戊酸钠中毒性脑病患者的护理。丙戊酸钠脑病的临床表现与颅脑术后颅压增高的临床表现很相似,护士密切观察病情变化,早期识别丙戊酸钠脑病,还需要早期配合医师进行肝功能、血氨、血气分析等各项监测,做好用药护理及心理护理,并落实各项安全措施。本组1例患者因病情较重,转至重症监护病房治疗后自动出院,其余11例于停药后1~3d意识逐步恢复至正常,直至康复出院。     

丙戊酸钠致脑损伤一例

患儿男,5年8个月大。家族中无癫痫病史：因间断抽搐2个月,症状加重4d后入院。2个月前开始出现阵发性抽搐,发作时意识不清,口吐白沫,四肢强直,持续约5～15min。在我院行脑电图检查确诊为癫痫,给予门服丙戊酸钠片(VPA)0．2g,3次／d,5d后症状得到控制,此后坚持服药,未再抽搐。4d前患儿突然出现共济失调,意识障碍,癫痫发作频繁。     

大脑中动脉瘤夹闭术后症状性脑梗死的原因分析

目的 分析大脑中动脉分叉处动脉瘤夹闭术后形成脑梗死的原因。方法 本研究纳入2018年3月—2020年11月湖北省第三人民医院收治的行动脉瘤夹闭手术的大脑中动脉瘤患者31例,比较术前与术后24～48 h内患者的头颅CT或弥散加权成像(DWI)的影像资料,判断是否存在新发脑梗死,并结合影像与手术实际情况判断梗死原因。结果 31例患者中,术后有脑梗死的患者5例(脑梗死组),无脑梗死的患者26例(无梗死组)。2组年龄、性别、基础疾病与术中阻断时间比较,差异无统计学意义(P>0.05)。5例患者发生术后脑梗死,包括阻断后侧支代偿不足相关梗死1例,继发载瘤动脉狭窄相关脑梗死1例,穿支损伤相关脑梗死1例和穿支动脉粥样硬化性疾病2例。结论 大脑中动脉分叉处动脉瘤夹闭术后脑梗死的原因多样,其中缺乏侧支代偿、继发载瘤动脉狭窄、穿支动脉损伤及穿支动脉粥样硬化性疾病是引起术后脑梗死的主要原因。     

1例顽固性癫痫患儿开颅术后应用丙戊酸钠引起丙戊酸脑病的护理

<正>丙戊酸钠(sodium valproate,VPA)是治疗癫痫的一线药物~([1])。尽管有很好的耐受性,但仍可能引发不良反应。丙戊酸脑病是一种少见且严重,又可逆的不良反应,通常伴有血氨升高而不伴有肝功能损害~([2])。故又被称为丙戊酸钠相关的高血氨脑病(valproate-induced hyperammonemic encephalopathy,VHE)。VHE通常发生在VPA开始治疗或VPA再联用其他抗癫痫药后     

顽固性癫痫术后丙戊酸钠脑病1例临床护理

<正>丙戊酸盐类抗癫痫药物是治疗癫痫的常用药物,目前临床发现该药可诱发脑病,常发生在服药早期,停药可使症状消失[1]。若临床医护人员不能正确认识,常误认为是不同发作形式的癫痫发作,而加大剂量继续使用。其典型临床表现为癫痫发作加重、意识障碍、共济失调、扑翼样震颤[2]。2014年4月,我科收治1例顽固性癫痫术后应用丙戊酸钠引起丙戊酸钠脑病的患儿,通过早期识别,配合医生做好用药护理,实施     

口服丙戊酸钠引起药物性黄疸一例

1病例资料患者,男,46岁,于2009年2月19日行脑膜瘤切除术。术后第3天,为预防癫痫,常规给予丙戊酸钠口服,0．5g（1片）／次,20（／d。服药2d后,患者自觉周身无力,厌食,尿液颜色加深;服药10d后患者上述症状加重,将丙戊酸钠减量,0．5g（1片）／次,1次／d;术后1月余,患者自觉上述症状未见减轻,且尿液呈浓茶水色,食欲急剧下降,     

颅内动脉瘤夹闭术42例术后预见性护理

颅内动脉瘤是一种病死率、致残率较高的脑血管疾病[1].自2000年至今,我们为42例颅内动脉瘤患者行夹闭术治疗,术后给予预防性护理,效果满意.现报告如下. 1 临床资料 本组颅内动脉瘤患者42例,男24例,女18例;年龄31～67岁,平均43岁.首发症状:蛛网膜下腔出血38例,动眼神经麻痹3例,一过性视力障碍1例.均由DSA和/或CTA和/或MRI确诊,其中前交通动脉瘤25例,后交通动脉瘤8例,大脑中动脉瘤6例,眼动脉瘤2例,基底动脉顶端动脉瘤1例.均行颅内动脉瘤夹闭术治疗.     

1例开颅动脉瘤夹闭术后患者并发丙酸钠脑病的护理

正在神经外科中丙戊酸钠是一种常用于癫痫预防和治疗的药物,虽然安全性较好,但仍可出现一种罕见而严重的可逆性不良反应,多伴有血氨增高,故又称为丙戊酸钠相关性高血氨性脑病(VHE)~([1])。VHE通常发生在应用丙戊酸钠数天或数周后~([2]),大多伴有血氨升高,但无肝损害~([3,4])。临床表现多为急性或亚急性意识障碍,可进行性发展,严重时昏迷,同时可伴有局灶性神经功能缺损,认知功能减退,恶心呕吐等胃肠道症状,癫痫发     

调整丙戊酸钠给药时间一例报告

临床上口服药物的常规给药时间多安排在白天,每日两次为8-4(或8-6),每日三次为8-12-4(或8-12-6)。此种给药时间对要求血药浓度恒定的药物,常可影响疗效。因此,为了维持有效的血药浓度,需按一定间隔时间给药。我科对一例应用丙戊酸钠治疗的癫痫患者,根据血药浓度对服药时间进行调整,收效较好。现报道如下。病例介绍患者男,11岁。因外伤后发作性四肢抽搐三年,诊断外伤性癫痫入院。给予苯妥因钠0.1每日三次,疗效不佳。后改用丙戊酸钠治疗,服药后同时监测血药浓度。开始给予丙戊酸钠0.2口服,每日二次,患者间隔2～3日仍有四肢小抽搐,测血药浓度为20μg/     

丙戊酸钠和苯巴比妥钠预防开颅术后癫痫的对照研究

幕上开颅手术可引起脑的代谢、血流和内环境等方面的一系列变化。开颅术后癫痫的发作,是开颅术后严重并发症之一,其发生率为4％～20％。多发生在术后1周内,常加重脑水肿而影响患者的预后,甚至危及患者生命。虽然开颅术后易发生癫痫已得到肯定,但对围手术期预防性应用抗癫痫药物的价值尚有争议,     

Ischemic middle cerebral artery stroke: a case study

Stroke is the third leading cause of death, ranking lower only to cardiac disease and cancer. Patients with stroke involving large vessels, including the middle cerebral artery, account for almost half of all patients with ischemic strokes and have an increased risk for poor outcomes and mortality at 6 months. Despite the availability and use of published guidelines for the early management of ischemic stroke, evidence to support treatment modalities for cerebral edema is still lacking. This case presentation will include the pathophysiology of an ischemic stroke and outline the established management guidelines. Literature related to the management of cerebral edema will also be discussed.     

Iatrogenic pseudoaneurysm of femoral artery: case report and literature review

The case of a patient who developed a femoral artery pseudoaneurysm (FAP) following cardiac catheterization is described. It is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to ooze into the surrounding tissues and form a pulsatile hematoma. The FAP occurs in 0.8% to 2.2% after interventional procedures. This problem has become more significant due to the exponential growth of interventional cardiology. Doppler flow mapping has been the mainstay of diagnosis. Diagnostic criteria include: swirling color flow in a mass separate from the affected artery, and a typical "to-and-fro" Doppler waveform in the pseudoaneurysm neck. Ultrasound-guided compression repair has replaced the need for surgical repair of FAP. It has been shown to be a safe and cost-effective method for achieving pseudoaneurysm thrombosis. However, it carries considerable drawbacks including long procedure times, discomfort to patients, high recurrence rate in patients receiving anticoagulant therapy and an overall 3.6% complication rate. Recently, percutaneous thrombin injection in the FAP has gained popularity despite complications associated with the initial use of high dose thrombin (average dose of 1,100 IU). The technique was refined when low-dose thrombin injections were studied and proved to have the same efficacy and consistently high success rates (average dose used 192 IU). However, there is a theoretical risk of developing type I IgE-mediated allergic reaction to bovine thrombin. The indications, advantages, disadvantages, and complications of the various treatment modalities are discussed in this report and review of the literature. Other treatments with collagen injection are also discussed in detail.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

大脑中动脉囊性动脉瘤临床特征及显微手术策略

目的探讨大脑中动脉囊性动脉瘤(MCAA)的临床特点和显微手术治疗策略。方法回顾性分析2005年1~12月手术治疗37例MCAA患者的病历资料。结果37例患者共发现MCAA38个,位于大脑中动脉近端(M1As)11个、大脑中动脉分叉部(MbifAs)25个、大脑中动脉远端(MdistAs)2个;MCAA发生破裂者32例,脑内血肿发生率37&#183;5%;入院时Hunt-Hess0级3例、Ⅰ级3例、Ⅱ级9例、Ⅲ级15例、Ⅳ级5例、Ⅴ级2例;所有患者均在电生理检测下,经翼点或改良翼点入路,显微镜下顺行或逆性循大脑中动脉打开侧裂,分离并夹闭动脉瘤颈;术中微血管多普勒检测夹闭前后MCAA及其重要分支的血流状况,确保瘤夹放置满意;38个动脉瘤均以一枚或多枚动脉瘤夹夹闭;术后恢复良好25例;22例获随访6月,GOS4~5分16例、GOS2~3分5例、GOS1分1例、死亡1例。结论联合多种影像学检查手段,术前充分做好手术计划,并在电生理检测和微血管多普勒的辅助下,显微手术治疗大脑中动脉动脉瘤可获得满意疗效。     

Common carotid artery thrombosis and malignant middle cerebral artery infarction following ovarian hyperstimulation syndrome: A case report

BACKGROUNDArterial thrombosis is a serious and rare complication of ovarian hyperstimulation syndrome (OHSS). Herein, we describe a case of OHSS complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction after egg retrieval and before embryo transfer. CASE SUMMARYA 32-year-old female with a family history of thrombosis who was undergoing in vitro fertilization due to unexplained infertility, was admitted due to abdominal distension for 3 d and coma for 2 h. She received egg retrieval 7 d ago and embryo transfer had not yet been performed. Blood biochemical analysis showed estrogen of 15781 pmol/L. Gynecological examination showed palpable masses on both sides of the adnexal areas. Ultrasound observed enlarged ovaries and abdominal ascites. Imaging examination of the head and neck revealed fresh malignant middle cerebral artery infarction in the left side of brain and internal carotid artery as well as occlusion in the left carotid artery, internal carotid artery, and middle cerebral artery. The patient was finally diagnosed with severe OHSS, complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction. Liquid replacement, anticoagulation, vascular endothelium protection, brain protection and decompressive craniectomy were carried out. Rehabilitation training was then performed for 6 mo. At present, she has poor speaking ability and decreased muscle strength on the right side. CONCLUSIONThere is a risk of thrombosis during any period of OHSS. During in vitro assisted reproduction, for cases with a family history of thrombosis, hyperlipidemia and other high-risk factors, serum lipid levels should be controlled as soon as possible to improve metabolic dysfunction. When thrombosis occurs, timely and effective treatment should be performed to improve the prognosis.     

Azadirachtin poisoning: a case report

The use of neem-based products is widespread in the Indian Subcontinent. Neem-based pesticides obtained from neem kernels are considered natural and safe. The toxic effects of ingestion and overdose of this pesticide in adults have not been described in this literature. We report the case of a 35-year-old lady who had consumed Azadirachtin in an attempt of deliberate self-harm. The patient had features of neurotoxicity because of Azadirachtin requiring intensive medical care with mechanical ventilation. The patient survived the overdose with no long-lasting side effects of the toxin.     

Open surgical approach for two coincidental splenic artery aneurysms: a case report

<正>Several factors can contribute to the formation of aneurysms,including hemodynamic changes, polyarteritis nodosa, bacterial endocarditis, vasculitis, fibromuscular dysplasia, vascular malformation, and cystic medial necrosis.^[1,2] Surgery is recommended for splenic artery aneurysms (SAAs) greater than 25 mm in diameter, and several surgical approaches are used, including open surgery, laparoscopic surgery, and percutaneous embolization. Laparoscopic surgery might be associate...     

Imidacloprid poisoning: a case report

Imidacloprid is a systemic, chloronicotinyl insecticide. It is generally considered nontoxic to humans based on available literature. Its effects are mediated through acetylcholine receptor blockade. We report a patient with such poisoning who had respiratory arrest, for which he had to be mechanically ventilated, and who subsequently recovered. This is only the second such case report.