重型颅脑损伤的救护重点

重型颅脑损伤经格拉斯哥昏迷量表评分（GCS）3～8分。由于其伤情重、病情发展迅速，随时会危及患者生命，如何做到争分夺秒、有效的救护显得尤为重要。本文将从护理的角度对重型颅脑损伤的救护重点进行简要综述，以帮助护理人员提高紧急救护能力。     

大剂量纳洛酮治疗急性重型颅脑损伤临床疗效观察

目的观察大剂量纳洛酮对重型颅脑损伤的临床治疗效果。方法选择格拉斯哥昏迷评分法（GCS）评分3～8分患者共60例,分为纳洛酮治疗的治疗组和常规治疗的对照组,各30例。对照组根据病情给予常规综合治疗．治疗组在常规综合治疗基础上采用纳洛酮静脉滴注治疗。观察比较两组患者意识觉醒、血液流变学及临床征象改善情况。结果治疗组患者经纳洛酮治疗后,觉醒时间缩短,患者神经功能恢复、格拉斯哥预后评分（GOS）、语言功能及运动功能评分显著高于对照组,病死率显著低于对照组,差异均有统计学意义（P〈0．05）。结论纳洛酮对于内源性阿片肽引起的生理功能应激性疾病起效快、作用可靠,使用中未见不良反应。     

依达拉奉治疗重型颅脑损伤的临床疗效

目的:探讨早期应用依达拉奉对重型颅脑损伤的疗效。方法:48例重型颅脑损伤患者随机均分为依达拉奉治疗组(n=24)和对照组(n=24)。对照组给予常规治疗(手术和脱水、神经营养、高压氧治疗等),治疗组在常规治疗基础上加用依达拉奉注射液30mg静脉滴注,bid,共14d。两组病例于治疗前、治疗后14d和3个月进行格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)和预后比较。结果:治疗后14d治疗组GCS增分率明显高于对照组[(130．9±28．4)%,(90．8±21．6)%,P＜0．05];3个月后治疗组GOS评分明显高于对照组[(4．52±2．68)分, (3．78±2．24)分,P＜0．05];治疗组与对照组的治愈率分别为29．2%,16．7%,总有效率为87．5%,79．2%,植物状态或死亡率为12．5%,20．8%,均有显著性差异(P＜0．05)。治疗组无明显不良反应。结论:早期应用依达拉奉可减轻继发性颅脑损伤的损害,有利于重型颅脑损伤患者的神经功能康复。     

对经颅磁刺激治疗患者的心理护理

目的 探讨经颅磁刺激治疗患者的心理状态及护理.方法 对225例做经颅磁刺激治疗患者的心理状态及护理进行回顾性分析.结果 通过对不同患者的心理状态进行分析,运用语言沟通,微笑服务,耐心细致等建立起良好护患关系.结论 通过了解患者的心理状态有针对性的进行心理干预,实行人性化护理,使患者情绪稳定,增强勇气和信心,主动配合,使患者能够以良好的心态接受经颅磁刺激治疗,提高护理质量.     

重复经颅磁刺激治疗腓总神经损伤的临床效果

目的 探讨重复经颅磁刺激治疗腓总神经损伤的疗效.方法 从佛山市中医院2019年1—12月诊治的腓总神经损伤患者中针对性抽取采用常规静滴和口服西药治疗的40例患者作为对照组,针对性抽取在对照组治疗基础上采用重复经颅磁刺激治疗的40例患者作为观察组,比较两组患者临床疗效,观察重复经颅磁刺激治疗的临床应用价值.结果 观察组临...     

帕金森病康复治疗中低频重复经颅磁刺激的应用探讨

目的 探讨帕金森病康复治疗中低频重复经颅磁刺激的应用.方法 选取2018年8月～2020年3月惠州市第一人民医院收治的帕金森病患者86例,应用随机数字法分为两组,对照组应用常规药物及常规康复训练治疗,研究组在对照组基础上应用低频重复经颅磁刺激治疗.结果 研究组UPDRS评分低于对照组(P<0.05);研究组HAMD评分...     

经颅磁刺激治疗精神分裂症幻听的疗效观察

目的齐拉西酮胶囊联合低频重复经颅磁刺激（rTMS）治疗精神分裂症幻听的疗效观察。方法68例伴有幻听症状的精神分裂症患者,随机分为研究组和对照组,对照组给予齐拉西酮胶囊口服联合假性rTMS治疗,研究组给予齐拉西酮胶囊口服联合真性rTMS治疗,治疗初期、治疗2周末、治疗4周末给予PANSS阳性症状量表评分,评定疗效。不良反应采用TESS量表进行评定。结果两组疗效差异有统计学意义（P＜0.05）。两组不良反应分析差异无统计学意义（P＞0.05）。结论 rTMS治疗在治疗精神分裂症阳性症状方面有较好的增效作用,疗效可靠,安全性高。     

重复经颅磁刺激对抑郁症的研究进展

重复经颅磁刺激在精神科领域的使用已趋于成熟,其对抑郁症的治疗作用也收到国内外学者的关注,本文就重复经颅磁刺激的基本原理,对抑郁症治疗的有关研究结果及作用机制、安全性等作一一综述。     

经颅磁刺激治疗偏头痛急性发作期的疗效观察

目的：比较经颅磁刺激在治疗偏头痛急性发作期方面的疗效。方法48例偏头痛急性发作期患者随机分为治疗组和对照组,各24例。两组均给予常规药物治疗,治疗组加用经颅磁刺激治疗。观察两组患者治疗后10 d及30 d的头痛程度及头痛次数方面的变化。结果治疗后10 d两组患者头痛程度均减轻,治疗组头痛程度明显低于对照组,差异有统计学意义(t=-3.275, P=0.002<0.05);治疗后30 d,两组患者头痛程度及头痛次数较治疗前减少,差异均有统计学意义(t=-3.66, P=0.01<0.05;t=-2.038, P=0.047<0.05)。结论经颅磁刺激治疗偏头痛急性发作期安全有效,值得临床推广应用。     

经颅磁刺激运动诱发电位评估脑梗塞预后的研究

目的探讨经颅磁刺激运动诱发电位（MEP）检测在脑梗塞患者运动功能预后评估中的价值。方法对我院神经内科2005年4月～2007年6月收治的40例门诊或住院脑梗塞患者于发病72h及半年后进行改良SSS评分。并对40例患者在72h内进行瘫痪侧肢体或一侧肢体的MEP检测。结果急性期MEP正常者预后较MEP异常者好。MEP波形消失或运动传导时间延长者．瘫痪程度重．SSS评分高。结论经颅磁刺激运动诱发电位无痛、无创、安全、操作简便,对脑梗塞病情判断和在运动功能恢复方面具有较高的临床预测价值,可作为判断陆梗塞预后的常规检测手段。     

Application of transcranial magnetic stimulation in treatment of drug-resistant major depression—a report of two cases

We report the cases of two drug-resistant major depressed psychotic patients, who were treated with 10 sessions of transcranial magnetic stimulations (TMS) and afterwards with 10 sessions of electroconvulsive therapy (ECT) without changing the concomitant neuroleptic and antidepressive medication. TMS did not exert a therapeutic effect in one patient and only a slight one in the other. However, there was a clear beneficial effect for ECT in the patient not responding to TMS and a slight therapeutic effect in the other. In summary, there was no clear-cut evidence for effectiveness of TMS as a treatment for patients with psychotic, therapy resistant depression. However, since there was a slight therapeutic effect of TMS in one patient it seems worthwhile to explore its therapeutic efficacy in a larger group of depressed patients.     

A transcranial magnetic stimulation study of the effects of olanzapine and risperidone on motor cortical excitability in patients with schizophrenia

RATIONALE: There has been a progressive increase in interest in the functioning of the main inhibitory and excitatory neurotransmitters in the pathophysiology of schizophrenia. Limited information is available as to how these neurotransmitters are affected by commonly prescribed antipsychotic agents. OBJECTIVES: We investigated whether the atypical antipsychotics olanzapine and risperidone differ in their effects on inhibitory and excitatory cortical markers measured with transcranial magnetic stimulation. METHODS: Electromyographic recordings from the abductor pollicis brevis muscle were made during focal transcranial magnetic stimulation to the contralateral motor cortex and during bilateral cortical stimulation. Twenty patients on each drug and 22 controls were studied with measures of the resting motor threshold, motor evoked potential size, post-excitatory silent period duration, cortical inhibition and facilitation to paired-pulse transcranial magnetic stimulation and transcallosal inhibition. RESULTS: The patient groups differed from the controls in the silent period and transcallosal inhibition measures, both of which assess cortical inhibitory activity. The two medication groups differed in the magnitude of the resting motor threshold and several measures of transcallosal inhibition that reflect the spread of inhibitory activity between hemispheres. CONCLUSIONS: These findings suggest that olanzapine and risperidone differ subtly in their effects on cortical inhibitory mechanisms. Further evaluation is required to establish whether these differences may reflect or underlie differences seen between these medications in their clinical profiles, including their effects on cognitive symptoms of schizophrenia.     

Brain-derived neurotrophic factor serum concentrations in depressive patients during vagus nerve stimulation and repetitive transcranial magnetic stimulation

Background Vagus nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex are brain stimulation techniques used as therapeutic interventions in major depression.Methods In this study, we report the impact of these stimulation techniques on serum concentrations of brain-derived neurotrophic factor (BDNF) in treatment-resistant patients with a diagnosis of major depression.Results We found no changes of BDNF serum concentrations and no association of neurotrophin concentrations in serum with clinical parameters in our sample.Conclusion Our preliminary results suggest that brain stimulation techniques—in contrast to several antidepressant medications—do not change BDNF serum concentrations.     

经颅磁刺激对脑缺血再灌注大鼠皮层单胺类递质的影响

目的 探索经颅磁刺激(TMS)干预对大鼠大脑中动脉阻塞/再灌注(MCAO/R)急性期梗死灶周围皮层单胺类神经递质及其代谢物、脑梗死体积的影响.方法 TMS组与假刺激组大鼠各30只,于MCAO90min后R1h和12h给予2次TMS(每次200脉冲)和假刺激.检测两组大鼠梗死灶周围皮层单胺类神经递质及其代谢产物含量及脑梗死体积.结果 MCAO/R 24h,去甲肾上腺素(NE)、肾上腺素(E)含量显著低于假刺激组(P＜0.01),P＜0.05),多巴胺(DA)、5-羟色胺(5-HT)含量显著高于假刺激组(P＜0.01).TMS组大鼠脑梗死体积[(297.34±17.49)mm3]明显小于假刺激组[(327.27±20.87)mm3](P＜0.05).结论 TMS对大鼠MCAO/R急性期具有调节梗死灶周围皮层单胺类神经递质水平,减小梗死体积的作用,提示TMS对大鼠MCAO/R急性期具有保护作用.     

持续颅内压监测在重度颅脑外伤治疗中的应用

目的探讨持续颅内压监测在颅脑外伤治疗中的临床价值。方法将60例重度颅脑外伤患者随机分为观察组30例（常规诊治＋持续颅内压监测）、对照组30例（常规诊治）,比较两组应用甘露醇后肾功能、失治率及疗效。结果观察组失治率（13％）低于对照组（33％）,治愈率（20％）高于对照组（10％）,差异均有统计学意义（均P〈0．05）。结论在重度颅脑外伤患者中实施有效的颅内压监测可以减少肾功能损害,降低失治率,提高疗效。     

Low frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex transiently increases cue-induced craving for methamphetamine: A preliminary study

Background

Repetitive transcranial magnetic stimulation (rTMS) can temporarily interrupt or facilitate activity in a focal brain region. Several lines of evidence suggest that rTMS of the dorsolateral prefrontal cortex (DLPFC) can affect processes involved in drug addiction. We hypothesized that a single session of low-frequency rTMS of the left DLPFC would modulate cue-induced craving for methamphetamine (MA) when compared to a sham rTMS session.

Methods

In this single-blind, sham-controlled crossover study, 10 non-treatment seeking MA-dependent users and 8 healthy controls were randomized to receive 15 min of sham and real (1 Hz) DLPFC rTMS in two experimental sessions separated by 1 h. During each rTMS session, participants were exposed to blocks of neutral cues and MA-associated cues. Participants rated their craving after each cue block.

Results

In MA users, real rTMS over the left DLPFC increased self-reported craving as compared to sham stimulation (17.86 ± 1.46 vs. 24.85 ± 1.57, p = 0.001). rTMS had no effect on craving in healthy controls. One Hertz rTMS of the left DLPFC was safe and tolerable for all participants.

Conclusions

Low frequency rTMS of the left DLPFC transiently increased cue-induced craving in MA participants. These preliminary results suggest that 1 Hz rTMS of the left DLPFC may increase craving by inhibiting the prefrontal cortex or indirectly activating subcortical regions involved in craving.     

重复经颅磁刺激联合米氮平治疗首发抑郁症的临床观察

目的探讨重复经颅磁刺激联合米氮平治疗首发抑郁症的疗效及安全性。方法将63例首发抑郁症的患者随机分为治疗组和对照组,治疗组33例,对照组30例。两组均应用米氮平片30mg／d治疗,治疗组在应用米氮平治疗的基础上联合重复经颅磁刺激治疗,刺激左额叶前部背外侧,每周5次,共治疗20次;对照组应用伪刺激线圈,刺激部位、次数、频率同治疗组,有振动声音,但不产生磁场效应。分别于治疗前及治疗后第1、2、4周末应用汉密尔顿抑郁量表（HAMD）、副反应量表（TESS）评价临床疗效和副反应。结果两组均完成治疗,治疗后第2周末两组患者的HAMD评分与治疗前比较,差异有统计学意义（P〈0．05或P〈0．01）;治疗组在治疗第1周末即显示出明显疗效,与对照组比较差异有统计学意义（P〈0．05）。治疗组总有效率（97％）与对照组总有效率（90％）比较,差异有统计学意义（P〈0．05）。两组均未出现明显的副反应。结论重复经颅磁刺激联合米氮平治疗首发抑郁症起效快,能增强抗抑郁效果,耐受性好。     

颅脑损伤GCS评分与CT像计分对临床预后的相关性研究

目的 探讨GCS得分与CT图像之间的关系.方法 511例颅脑损伤患者连续进行10 mm厚度和区间CT切片扫描,根据CT图像得分和临床GCS标准,CT图像计分理想总分为15分,依据积分情况分为轻型(≤5分)33例,中型(6～10分)247例和重型(≥11分)231例.GCS评分为:轻型(13～15分)61例,中型(9～12分)311例,重型(3～10分)139例.结果 两种评分之间比较差异无统计学意义.结论 CT图像计分与GCS评分在颅脑损伤病情分级存在相关性,随着GCS评分病情的加重而CT图像计分呈增高的趋势.