85例流行性乙型脑炎的临床分析

流行性乙型脑炎(简称乙脑)是由流行性乙型脑炎病毒引起的中枢系统的传染病。本病流行于夏秋季,主要集中在7、8、9月份。临床表现以急性发热、头痛起病,迅速出现意识障碍、惊厥、脑膜刺激征等中枢神经系统症状,重者病死率高,幸存者也往往留有后遗症。发病年龄多在2~10岁。现将我     

流行性乙型脑炎253例临床分析

流行性乙型脑炎（乙脑）是由乙脑病毒引起的以急性中枢神经系统病变为主的传染病，流行于夏秋季，临床以急性发热、头痛起病，迅速出现中枢神经系统症状，重症者死亡率高，存活者多留有后遗症。其发病年龄绝大多数在2～10岁。现将我院2000—06-2004—06收治的253例乙脑患者进行临床分析，报告如下。     

流行性乙型脑炎的影像学特点

目的：分析流行性乙型脑炎的MRI表现特征，探讨MRI对流行性乙型脑炎诊断价值。方法：回顾分析经临床和血清学证实的4例流行性乙型脑炎不同发病时期的MRI资料，其中成人1例，儿童3例。MRI均采用常规横轴位T1WI和T2WI，冠状面FLAIR及DWI。成年患者还经钆喷酸葡胺（GD2DTPA）增强检查。结果：4例患者MRI都有双侧丘脑、中脑病变，其中2例还有大脑皮质病变。增强扫描病灶未见强化。结论：流行性乙型脑炎的MRI特征是双侧丘脑和中脑异常信号。     

幼儿流行性乙型脑炎的护理要点

目的探讨幼儿乙型脑炎（乙脑）的临床护理经验。方法对52例幼儿乙脑在高热、抽搐、呼吸衰竭及基础护理等方面的重要性进行总结。结果治愈或好转88．5％,无效和死亡11．5％,并发症15．4％,后遗症7．7％。结论幼儿乙脑护理难度较大,要认真履行护理计划,及时处理高热、抽搐、呼吸衰竭,可减少并发症,降低病死率。     

47例流行性乙型脑炎的临床分析

流行性乙型脑炎(简称乙脑)是由流行性乙型脑炎病毒引起的,以脑实质炎症为主要病变的中枢系统急性传染病,常流行于夏秋季,临床以发热、头痛起病,迅速出现意识障碍、抽搐、病理反射、脑膜刺激征等中枢神经系统症状,病死率高,部分病人留有后遗症,发病年龄多在2～10岁.现将我院2003-2008年收治的47例患者报告如下.     

流行性乙型脑炎112例临床分析

目的分析流行性乙型脑炎(乙脑)的临床表现与临床流行病学规律,明确该病有效预防措施。方法2003年5月至2007年12月治的112例乙脑的临床资料,观察其临床流行病学特点及临床特征。结果本组112例患者均为儿童,男63例,女49例,年龄4岁～12岁,平均年龄为4.65±0.75岁,其中89(79.46%)例为爆发流行病例,23(20.53%)例为散发流行病例,103(91.96%)例没有乙脑疫苗接种史。以急性起病,高热,头痛、多数患者有意识障碍(96例,85.71%)及癫痫发作(61例,54.46%),发病第二周血清或脑脊液乙脑IgM阳性。本组患者81(72.32%)例临床治愈,18(16.07%)例住院期间死亡。结论本病的临床特征主要为儿童罹患,发热、头痛为常见的临床表现,发病第二周血清或脑脊液乙脑IgM阳性,重症患者死亡率高,而夏秋季发病为其主要临床流行病学特点。乙脑疫苗注射仍是目前主要行之有效的预防措施。     

流行性乙型脑炎603例流行病学分析

近年发现流行性乙型脑炎（乙脑）的流行病学规律发生了一些变化,本文对我院传染科1990-06～2001-06收治的603例乙脑病人进行临床流行病学分析,现将结果报告如下.     

60例流行性乙型脑炎的脑脊液细胞学观察

目的：研究流行性乙型脑炎的脑脊液细胞学特点。方法：采用FMU－5微型脑脊液细胞玻片离心沉淀器收集细胞,迈一格一姬氏法染色,光学油镜观片。结果：60例乙脑病人脑脊液细胞学均有异常,各病期有不同的细胞学变化。结论：脑脊液细胞学检查,为乙脑的诊断及鉴别诊断提供了更有价值的实验室依据。     

干扰素治疗流行性乙型脑炎157例临床观察

我们自1990～1999年短疗程应用干扰素治疗流行性乙型脑炎（乙脑）157例,现将结果报告如下。     

复方丹参注射液治疗流行性乙型脑炎疗效分析

目的探讨复方丹参注射液对各期流行性乙型脑炎（乙脑）的治疗作用。方法 124例乙脑患者随机分为2组,对照组62例采用综合治疗,观察组62例在综合治疗基础上加用复方丹参注射液治疗。结果观察组在临床症状、体征改善方面优于对照组,2组总有效率分别为100%（62/62）、83.8%（52/62）,差异有统计学意义（P〈0.05）。且不同发病时期乙脑患者采用复方丹参注射液治疗,在减少并发症及后遗症发生率方面,均具有一定优势。结论复方丹参注射液可用于各期乙脑的治疗,可迅速改善乙脑的症状和体征,提高成活率并降低病死率及致残率,为乙脑开辟一条新的治疗途径。     

流行性乙型脑炎后残疾的回顾性研究

目的 :研究乙脑后残疾。方法 :为有对照的历史性队列研究 ,首先以血清学检查阳性者 (165例 )为乙脑组 ,阴性者 (175例 )为非乙脑组 ,比较其在性别、年龄、地域、诊断、预后、疫苗接种和住院天数等方面的差别。其次远期随访了其中的 66例 (3 0∶3 6) ,另设正常健康人对照组 (65例 ) ,以双盲法进行神经系统检查和神经心理测验 ,比较其在后遗症方面的区别。结果 :乙脑组病例来自郊区较多 ,病情程度和早期后遗症重于非乙脑组。后遗症中中枢神经系统症状体征和神经心理测验异常以乙脑组为多 ,而两个对照组则无。结论 :乙脑的后遗症尤其是认知功能损害相当严重     

Patients with epilepsy are at an increased risk of subsequent stroke: A population-based cohort study

PurposeEpilepsy is well known as a disorder in poststroke patients. However, studies that have investigated the association between epilepsy and the risk of subsequent stroke are limited. This population-based study investigated the incidence and risk of stroke in patients with epilepsy by using the Taiwan National Health Insurance claims data.MethodsWe identified 3812 patients newly diagnosed with epilepsy in 2000–2008 and 15,248 nonepilepsy comparisons frequency matched according to sex, age, and index year. We searched for subsequent stroke diagnoses in both cohorts until the end of 2009. The incidence rates and hazard ratios of stroke were estimated based on sex, age, the average defined daily doses (DDDs) of antiepilepsy drugs, and comorbidity.ResultsThe stroke incidence of the epilepsy cohort was 3-fold higher than that of the comparison cohort. The age-specific results indicated that in the epilepsy cohort and the comparison cohort, the risk was the highest for the youngest group (20–39 years).ConclusionThe patients with epilepsy exhibited a higher incidence of cerebral stroke than the general population did. In addition, younger patients with epilepsy and patients who took a high doses of antiepileptic drugs exhibited a high risk of stroke.     

The incidence of first provoked and unprovoked seizure in pediatric patients with and without psychiatric diagnoses

PURPOSE: To estimate the rate of new-onset afebrile provoked and unprovoked seizure in a general pediatric population and subgroups of patients with and without psychiatric diagnoses other than attention deficit hyperactivity disorder (ADHD). METHODS: A retrospective cohort study of 133,440 pediatric patients, between the ages of 6 and 17 years, and without history of seizure or prior use of anticonvulsant medications, with follow-up during 2003. The data source for this study was Ingenix's research database containing pharmacy and medical claims for members of a large US-based managed care organization. The main outcome measure was new-onset nonfebrile seizure. Incidence rates of seizure and 95% confidence intervals (CI) were calculated and expressed as rates per 100,000 person-years. RESULTS: There were 132 new-onset provoked and unprovoked seizures in 78,423 person-years of follow-up among the general pediatric population sample. The incidence rate of seizure among the general pediatric population was 168 per 100,000 p-y (95% CI 141-200). The incidence rate of seizure among patients without psychiatric diagnoses was 149 per 100,000 p-y (95% CI 122-180). The incidence rate of seizure among patients with psychiatric diagnoses other than ADHD was 513 per 100,000 p-y (95% CI 273-878). There were increases in the incidence rates of seizure in all of the seizure risk factor groups, but this was more pronounced among males ages 6-12 with psychiatric diagnoses. CONCLUSIONS: The results of this study are consistent with previous reports showing that pediatric patients with psychiatric disorders have a higher incidence rate of seizure than the general pediatric population.     

经蝶窦显微外科手术治疗垂体腺瘤的长期疗效观察

目的：研究经蝶窦显微外科手术治疗垂体腺瘤的长期治疗效果。方法：对经蝶窦显微外科治疗的２４９例垂体腺瘤，从临床、血清激素水平测定及影像学检查进行３～１２年，平均４．６年的随访，以判断手术疗效。结果：随访期肿瘤控制率为７９％，复发率为３．６％。结论：经蝶窦手术能控制大多数垂体腺瘤。肿瘤大小、术前激素水平、以及术中肿瘤切除程度是影响远期疗效的重要因素。大型向鞍外生长的肿瘤，术前血清激素水平过高及术中肿瘤切除不完全者，肿瘤常不能控制，术后复发率可达５．９％～２０％，为防止肿瘤复发，这些病例应给予放射治疗。     

来氟米特用于肾移植患者长期维持治疗20例

背景：来氟米特作为一种新型免疫抑制剂广泛应用于治疗自身免疫性疾病,它兼有免疫抑制作用和抗病毒活性,初步临床观察提示它可用于器官移植抗排斥治疗,但长期疗效尚不清楚。 目的：评价来氟米特+环孢霉素(或他克莫司)+泼尼松三联药物对肾移植受者维持治疗的长期效果。 设计、时间及地点：回顾性病例分析,2002-12/2007-03在解放军第四五五医院,解放军南京军区肾脏专科中心完成。 对象：选取肾移植术后超过1个月且肾功能正常者。来氟米特治疗组：用氟米特替换霉酚酸酯或硫唑嘌呤患者20例,移植时年龄16~47岁,平均(32.6±8.7)岁,其他免疫抑制剂与对照组相同。对照组：同期肾移植患者41例,年龄17~57岁,使用霉酚酸酯+环孢素A/他克莫司+泼尼松为维持治疗。 方法：来氟米特起始剂量为50 mg/d,应用3~5 d后给予20 mg/d 维持;泼尼松维持剂量为10 mg/d;环孢素A或他克莫司剂量根据其血药浓度进行调整。前3个月每月复查肝功能、肾功能和血常规,以后根据患者情况1~3个月复查1次。 主要观察指标：来氟米特治疗组和对照组移植肾和患者生存率,及来氟米特不良反应。 结果：来氟米特组观察时间平均(27.7±21.6)个月。继续维持来氟米特治疗肾功能稳定7例,血肌酐翻倍或肾功能丢失2例,失访1例,退出10例。来氟米特组人、肾生存率分别为1年100%和100%,3年100%和94%,5年79%和78%。对照组人、肾生存率分别为1年95%和95%,3年90%和88%,5年90%和77%。死亡原因：来氟米特组2例移植肾失功后放弃透析治疗;霉酚酸酯组2例带功死于肺部感染,2例于移植肾失功后因经济困难放弃治疗。来氟米特不良反应：早期脱发3例,皮疹2例,恶心3例,贫血2例。 结论：用来氟米特+钙调素抑制剂+泼尼松三联治疗和霉酚酸酯+钙调素抑制剂+泼尼松三联治疗的肾移植受者5年的临床结果无明显差别。     

Effects of oxytocin used during delivery on development: A retrospective cohort study

Objective: The objective was to evaluate the potential influence of oxytocin administered during delivery on children’s development at the age of 5. Method: This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression). Results: Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79–2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46–824.86]). When delivery was instrumental or through cesarean section in mothers aged 28–35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04–0.66]). Conclusion: Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.     

数据库匹配方法提高卒中队列死亡结局准确性的研究

目的 探索大型多中心卒中队列研究数据与行政管理数据匹配的情况,为同类临床研究数据质量控 制提供新的思路与方法。 方法 本研究选取2015-2017年入组并完成90 d随访的12 112例缺血性卒中队列患者为研究对象, 将研究对象与2015-2017年全国疾病监测系统死因监测数据库中所有死亡个案进行匹配,比较卒中 队列中未匹配到死亡信息而死因监测数据库显示死亡的队列患者与死亡信息正确匹配的队列患者在 地区、医院分布及患者特征等方面的差异。 结果 两组患者在地区、医院分布及患者特征等方面的差异均无统计学意义,但从数据趋势来 看,入院时NIHSS评分≤3分患者未成功匹配到死亡信息的比率明显高于入院时NIHSS评分＞3分患者 （11.36% vs 6.56%）;单独居住患者未成功匹配到死亡信息的比率明显高于与家人同住患者（13.16% vs 7.65%）。 结论 通过数据分析提示入院时神经功能缺损程度轻的患者、独居的患者随访调查时获得准确死 亡结局信息更不易。数据库匹配研究方法在一定程度上可弥补大型多中心队列研究随访信息缺失的 现象,通过两种不同来源死亡结局信息的互补,可获得更为准确的卒中死亡结局信息。