循证护理对高血压性脑出血患者术后意识障碍的影响

目的分析实施循证护理对改善高血压性脑出血患者术后意识障碍的临床意义。方法将128例高血压性脑出血术后意识障碍患者平均分成两组,对照组实施神经内科常规护理模式,观察组实施循证护理模式。结果经由护理干预后,观察组的各项MPOC-56维度得分、GCS评分与临床总有效率均明显高于对照组(P0.01),NIHSS评分明显低于对照组(P0.01)。结论循证护理能提高护理工作的质量,对于改善高血压性脑出血患者术后意识障碍具有积极的临床意义。     

首发精神分裂症患者于出院后实施延续性护理对其康复影响分析

目的观察延续性护理对首发精神分裂症患者出院后康复影响。方法 82例首发精神分裂症患者按照随机数字表法分组为对照组和干预组,各41例。对照组实施常规护理;干预组于对照组常规护理基础上实施延续性护理干预。观察2组患者出院时、干预6个月后日常生活能力、生活质量及社会支持、6个月复发率、治疗依从性情况。结果经护理干预6个月后,2组患者日常生活能力和生活质量及社会支持评分均较出院时明显改善,但干预组优于对照组,具有统计学意义,P<0.05。干预组治疗依从率为90.2%明显高于对照组78.1%,P<0.05;干预组6个月复发率为2.4%明显低于对照组195%,P<0.05。结论实施延续性护理干预可提高其治疗依从性和生活质量,改善社会功能,降低复发几率。     

心理辅导护理对行微创颅内血肿穿刺引流术的高血压脑出血患者的疗效

目的探究心理辅导护理措施在高血压脑出血患者经微创颅内血肿穿刺引流术治疗后的临床效果。方法选取我院2015年1月~2016年1月收治的高血压脑出血行微创颅内血肿穿刺术的患者100例,根据随机数字法分为观察组(50例)和对照组(50例)。对照组患者采取常规护理手段,观察组患者在常规护理的基础上予以心理辅导护理;观察并比较两组患者术后护理方式满意度、临床疗效、并发症发生率以及出院时Herth希望评分。结果两组患者护理前Herth希望评分组间无明显差异(P0.05)。观察组的护理模式满意度、治疗疗效均高于对照组(P0.05);观察组术后的并发症的发生情况低于对照组(P0.05),;观察组患者在出院时的Herth希望评分显著高于对照组患者(P0.05)。结论心理辅导护理有利于高血压脑出血患者经微创颅内血肿穿刺引流术的术后恢复,降低了术后并发症的发生率,并有效提高了患者的希望水平和护理满意度,值得临床推广。     

脑出血患者综合护理体会

目的总结脑出血稳定期患者采取综合护理措施的临床体会,为今后提高脑出血患者护理质量提供一定的依据。方法将符合条件的160例脑出血患者随机分为综合护理组和对照组,综合护理组给予全程康复护理,出院后继续给予康复指导;对照组仅给予常规护理措施。比较住院期间并发症发生率、患者满意度及纠纷发生次数、运用SIS 3.0比较2组患者出院后6个月的生活质量。结果综合护理组并发症发生率少于对照组(P<0.05);满意度及发生纠纷次数与对照组比较差异均有统计学意义(P<0.05);出院后6个月SIS比较,除记忆与思维一项2组差异无统计学意义(P>0.05)外,其他各项比较综合护理的改善均明显优于对照组(P<0.05)。结论对脑出血患者采取综合护理措施可以减少并发症及纠纷发生,提高患者满意度,提高患者生活质量。     

立体定向抽吸术与小骨窗开颅术治疗高血压脑出血的疗效观察

目的 探讨立体定向抽吸术与小骨窗开颅术治疗高血压脑出血的效。方法 我院2010年7月至2013年5月收治高血压脑出血患者137例,采用立体定向抽吸术治疗75例（立体定向组）,采用小骨窗开颅术治疗62例（小骨窗组）。结果 ①手术前两组GCS评分无显著差异（P>0.05）;术后3 d和术后7 d,立体定向组GCS评分均显著高于小骨窗组（P<0.05）。②两组患者术后肺部感染、上消化道出血、肾功能衰竭、迟发再出血等并发症发生率无统计学差异（P>0.05）,两组患者死亡率也无统计学差异（P>0.05）。③术后3个月,立体定向组GOS评分明显高于小骨窗组（P<0.05）;术后6个月,立体定向组日常生活能力评分显著高于小骨窗组（P<0.05）。结论 与小骨窗开颅术相比,立体定向抽吸术治疗高血压脑出血具有术后恢复快、并发症发生率低、近期疗效与远期疗效良好等优点。     

改良Kronlein定位神经内镜术治疗高血压脑出血的疗效

目的 观察改良Kronlein定位神经内镜术治疗高血压脑出血的临床疗效。方法 选取2018-12—2022-08在亳州市人民医院接受神经内镜术治疗的76例高血压脑出血患者为研究对象,观察组32例采取改良Kronlein定位神经内镜术治疗,对照组44例采取常规神经内镜术治疗。比较2组患者的手术情况、术后残余血肿量及格拉斯哥昏迷量表（GCS）评分变化、并发症发生情况。结果 观察组患者的手术时间、出血量、住院时间、并发症率、术后第1天及第7天复查颅脑CT残余血肿量均低于对照组,术后第3天及第7天GCS评分皆高于对照组,差异均有统计学意义（P<0.05）。结论 改良Kronlein定位神经内镜术治疗高血压脑出血有利于降低手术损伤,减少术后残余血肿量,促进患者术后康复,改善预后,降低并发症发生风险。     

不同手术方式治疗高血压性脑出血的疗效比较及术后再出血影响因素分析

目的探讨神经导航辅助微创穿刺血肿引流术（NAMIEH）、小骨窗开颅血肿清除术（SWCEH）与大骨瓣开颅血肿清除术（LBFEH）治疗高血压性脑出血的疗效及术后再出血影响因素Logistic回归分析。 方法回顾性分析自2016年9月至2019年3月解放军联勤保障部队第九一医院神经外科收治的134例高血压性脑出血患者的临床资料,根据手术治疗方式的不同将其分为NAMIEH组38例、SWCEH组45例与LBFEH组51例。记录2组患者术前及术后7、14 d出血量、GCS评分、NIHSS评分、Barthel指数以及治疗后临床疗效并进行比较,并将高血压性脑出血患者术后再出血影响因素采用Logistic回归分析。 结果3组患者术前出血量、GCS评分、NIHSS评分及Barthel指数比较,差异无统计学意义（P>0.05）;3组患者术后7、14 d出血量、GCS评分、NIHSS评分及Barthel指数比较,差异均有统计学意义（P<0.05）;3组患者术前及术后7、14 d出血量及NIHSS评分均依次明显降低,GCS评分及Barthel指数均依次明显升高,且组内任意两时间点比较差异均有统计学意义（P<0.05）。NAMIEH组、SWCEH组再出血、血肿残留及并发症发生率均分别明显低于LBFEH组,NAMIEH组再出血发生率（10.53%）、血肿残留发生率（5.26%）及术后并发症发生率（15.79%）均明显低于SWCEH组（P<0.05）。以高血压性脑出血患者术后再出血为因变量,对单因素分析中的可能术后再出血影响因素进行Logistic回归分析,结果显示合并糖尿病、术前收缩压、发病至手术时间、血肿形状、破入脑室、术前出血量、术前GCS评分、术前NIHSS评分、术前Barthel指数、凝血功能异常、术后并发症及总住院时间为高血压性脑出血患者术后再出血的独立影响因素（均P<0.05）。 结论NAMIEH治疗高血压性脑出血的临床效果明显优于SWCEH及LBFEH,可有效促进神经功能的恢复,明显降低再出血及术后并发症的发生率,且合并糖尿病、术前收缩压、发病至手术时间等为高血压性脑出血患者术后再出血的独立影响因素。     

程序化护理联合认知行为干预对脑出血患者护理效果及对其神经功能的影响

目的 探讨程序化护理联合认知行为干预对脑出血患者护理效果及神经功能的影响。方法 2020年6月～2023年3月收治的脑出血患者共96例,根据护理方法分为观察组48例,对照组48例,比较护理前后两组患者的认知功能、神经功能以及生活质量。结果 护理后,两组运动功能量表和巴塞尔指数均升高,观察组得分均高于对照组（P<0.05）。护理后美国国立卫生研究院卒中量表评分下降,格拉斯哥预后评分升高,两组间比较差异有统计学意义（P<0.05）。护理后,观察组总有效率（91.7%）显著高于对照组（77.1%）,差异有统计学意义（P<0.05）。护理后,观察组得分高于对照组（P<0.05）。结论 程序化护理结合认知行为干预可以提高脑出血患者的临床疗效,改善其肢体运动能力,减少神经功能缺损。     

细节护理对蛛网膜下腔出血病人肺部感染及预后的影响

目的探讨细节护理对蛛网膜下腔出血病人肺部感染以及预后的影响。方法回顾性分析2015年2月至2017年2月收治的104例蛛网膜下腔出血的临床资料。52例采用常规护理(对照组),52例在常规护理基础上加用细节化护理方案(观察组)。出院后随访6个月,比较两组肺部感染情况;以日常生活活动能力(ADL)评分评估生活能力,以KPS评分评估身体状态,以GCS评分评估意识状态。结果观察组肺部感染发生率明显低于对照组(P<0.05),观察组机械通气时间较对照组明显缩短(P<0.05),重症监护室住院时间也较对照组明显缩短(P<0.05)。入院时两组GCS评分、ADL评分以及KPS评分均无明显差异(P>0.05)。出院后6个月,两组GCS评分、ADL评分以及KPS评分较入院时均明显增高(P<0.05),而且观察组均明显高于对照组(P<0.05)。结论细节护理能明显降低蛛网膜下腔出血病人肺部感染发生率,改善病人预后。     

优质护理模式在高血压脑出血患者术后再出血中的应用效果

目的探讨优质护理模式在高血压脑出血术后再出血患者中的构建及应用效果。方法选取56例高血压脑出血术后再出血患者,利用随机综合序贯法将所有患者分为优质组和对照组。对照组接受常规护理干预,优质组接受优质护理干预。对比干预前后2组心理状态、生活质量变化及预后成效。结果护理前2组心理状态评分及各维度生活质量评分差异均无显著性(P0.05),护理后2组心理状态评分均较护理前显著降低(P0.05),而2组各维度生活质量评分均较护理前显著升高(P0.05),且护理后2组间心理状态及各维度生活质量评分差异均有显著性(P0.05);优质组预后评分远高于对照组(P0.05)。结论在高血压脑出血患者术后再出血中实施优质护理模式对心理状态、生活质量及预后状况的改善作用均较为显著。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.