用循证医学指导八年制阶段性神经病学教学

用循证医学指导临床医学八年制教学是一种新兴医学教育模式,循证医学的引入对神经病学的教学提出了新的要求。分阶段循序渐进的循证医学教学过程是可行的方法,最终使学生掌握学习的技巧和方法,成为一名终身的自我教育者。     

模拟教学与临床示范教学结合在NICU青年医师经口气管插管培训中的价值

目的:探讨模拟教学与临床示范教学结合在神经内科重症监护病房(NICU)青年医师经口气管插管培训中的价值。方法:将32名在NICU学习青年医生分成模拟教学与临床示范教学结合组(n=14)与单纯临床示范教学组(n=18),比较两组间首次临床气管插管成功人数及前5例气管插管成功率。结果:模拟教学组首次插管成功人数及前5例气管插管成功率明显高于单纯教学组(P=0.014,0.012)。结论:模拟教学与临床示范教学相结合提高了青年医师经口气管插管训练效果,是一种医学教育新模式。     

40 Hz听性稳态反应在脑干卒中患者中的近期预后价值

Objective To investigate the predictive value of the 40 Hz auditory steady state response (40-Hz ASSR) in the short-term prognosis of patients with brainstem stroke.Methods The 40-Hz ASSR and brainstem auditory evoked potentials (BAEP) examinations were recorded and graded from 36 patients with brainstem stroke admitted in the Neurological Intensive Care Unit (NICU). Tue end point of short-term prognostic evaluation was at the time of leaving the NICU. Tue patients with brainstem stroke were divided into the survival group (n =21) and the death group (including brain death,n = 15). The correlation between the grade of the 40-Hz ASSR or BAEP and the short-term prognosis was analyzed. Results The grade of the 40-Hz ASSR (r=0.571,P =0.000) or BAEP (r =0.441,P =0.001 ) was significantly correlated with the short-term prognosis in patients with brainstem stroke. The sensitivity,specificity and accuracy of the 40-Hz ASSR were 60.00％,100％ and 83.33％,respectively,and those for BAEP were 66. 67％,71.43％ and 69. 44％,respectively. Conclusions Tue 40-Hz ASSR has a certain short-term prognostic value in patients with brainstem stroke. The higher the grade of 40-Hz ASSR is,the more serious the illness,and the worse the prognosis.     

疏血通注射液治疗急性脑梗死疗效的汇总分析

目的 通过汇总分析评价疏血通注射液治疗急性脑梗死的疗效.方法 检索疏血通注射液治疗急性脑梗死疗效的随机对照研究,主要观察指标为治疗组与对照组神经功能改善(基本痊愈+显著改善)的比例,次要观察指标为治疗后神经功能评分.应用汇总分析软件包RevMan 4.2对各研究结果进行数据合并,并进行发表偏倚分析和敏感性分析评价结果的稳定性.结果 纳入相关文献28篇,总共包括1 654例急性脑梗死患者,其中疏血通组1 030例,对照组624例.疏血通组急性脑梗死患者在治疗后获得神经功能改善的可能性显著高于对照组(OR=3.30,95% CI 2.80～3.89;P<0.000 01),而神经功能评分显著低于对照组(WMD=-3.10,95% CI-4.33～-1.86;P<0.000 01).发表偏倚分析和敏感性分析显示汇总分析结果可靠.结论 疏血通注射液能显著改善急性脑梗死患者的神经功能,值得开展高质量的随机对照试验进一步验证.     

40 Hz听性稳态反应在脑干卒中患者中的近期预后价值

目的 探讨40 Hz听性稳态反应(40 Hz auditory steady state response,40-Hz ASSR)在脑干卒中患者近期预后评价中的价值.方法 分别对神经重症监护病房(Neurological Intensive Care Unit,NICU)收治的36例脑干卒中患者进行40-Hz ASSR和脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检查,并对两者进行分级.以转出NICU时为近期预后评价终点,将脑干卒中患者分为生存组(n=21)和死亡组(包括脑死亡,n=15),分析40-Hz ASSR和BAEP分级与近期预后的相关性.结果 40-Hz ASSR(r=0.571,P=0.000)、BAEP(r=0.441,P=0.001)分级与脑干卒中患者近期预后显著相关.40-Hz ASSR的敏感性、特异性和准确性分别为60.00%、100%和83.33%,而BAEP分级则分别为66.67%、7.43%和69.44%.结论 40-Hz ASSR对脑干卒中患者的近期预后有一定的预测价值;级别越高提示病情越严重,预后也越差.     

40Hz听性稳态反应在心肺复苏后昏迷中的预测价值——30例回顾性队列研究

目的 探讨40 Hz听性稳态反应(40 Hz auditory steady-state response,40 Hz ASSR)对心肺复苏(cardiopulmonary resuscitation,CPR)后昏迷患者早期预后的预测价值.方法 对神经重症监护病房(neurological intensive care unit,NICU)收治的30例CPR后昏迷患者进行40 Hz ASSR和短潜伏期体感诱发电位(short-latence somatosensory evoked potentials,SLSEP)检查,并对两者进行分级.以转出NICU时为近期预后评价终点,将CPR后昏迷患者分为存活组(n=21)和死亡组(包括脑死亡,n=9),分析40 Hz ASSR和SLSEP分级与预后的相关性.结果 40 Hz ASSR(r=0.722,P=0.000)和SLSEP(r=0.430,P=0.018)分级与近期预后显著相关.40 Hz ASSR预测近期预后的特异性为100%,敏感性为77.8%,准确性为93.3%;SLSEP的特异性为61.9%,敏感性为88.9%,准确性为70.0%.结论 40Hz ASSR对CPR后昏迷患者具有一定预后价值,40 Hz ASSR分级越高,近期死亡可能性越大.

Abstract：

Objective To investigate the predictive value of early prognosis of the 40 Hz auditory steady-state response (40 Hz ASSR) in patients with coma following cardiopulmonary resuscitation (CPR). Methods Thirty patients with coma following CPR admitted in the Neurological Intensive Care Unit (NICU) were examined with the 40 Hz ASSR and shortlatency somatosensory evoked potential (SLSEP), and both were graded. Using transferred out of NICU as the short-term outcome end point, the patients with coma following CPR were divided into a survival group (n =21) and a death group (n =9; including brain death). The correlation between the 40 Hz ASSR and SLSEP grading and prognosis was analyzed. Results The grades of the 40 Hz ASSR (r = 0. 722, P = 0.000) or SLSEP (r = 0. 430, P = 0.018) was significantly correlated with the short-term prognosis. The sensitivity, specificity and accuracy of the 40 Hz ASSR for predicting the short-term prognosis were 77. 8%, 100% and 93.3%, respectively; and those of SLSEP were 88. 9%, 61. 9% and 70. 0%, respectively. Conclusions The 40 Hz ASSR has a certain prognostic value in patients with coma following CPR. The higher the grade of the 40 Hz ASSR is, the greater the likelihood of the recent death.     

对氧磷酶2基因C311S多态性与2型糖尿病合并缺血性脑卒中的相关性

目的 探讨对氧磷酶2(paraoxonase 2，PON2)基因多态性与2型糖尿病(type 2 diabetes mellitus，T2DM)患者合并缺血性脑卒中(ischemic stroke，IS)的关系。方法 用聚合酶链反应—限制性片段长度多态性分析法探查PON2基因C311S多态性在T2DM合并IS组、T2DM无IS组以及正常对照组的基因频率。结果 发现中国人存在PON2基因C311S多态性，C／S等位基因频率为0．145／0．855。T2DM合并IS组患者PON2基因的C等位基因频率显著高于T2DM无IS组和正常对照组，差异有显著性(P＜0．05)。结论 中国人2型糖尿病患者PON2基因第311位密码子的多态性与并发缺血性脑卒中有关，C等位基因是2型糖尿病并发缺血性脑卒中的危险因素之一。     

线栓法大鼠缺血/再灌注脑损伤模型的改良

目的 研究一种线栓法大鼠缺血/再灌注脑损伤模型的改良术式。方法 结扎颈总动脉(CCA),不结扎颈外动脉和翼腭动脉,用头皮针于CCA结扎的远端穿刺导入3-0线栓造成缺血,通过拔出线栓形成再灌注。结果 栓线长度(20.0±1.8)mm,造模成功率近70%,造模动物临床表现及病理表现典型。结论 本术式简便,术者不需具备显微手术操作技巧,造模成功率较高。     

广东汉族人细胞色素C242T p22phox基因多态性观察

目的 调查广东汉族人是否存在细胞色素C242T p22phox基因多态性。方法 应用聚合酶链反应-限制性长度多态性法(PCR-RFLP)检测122名广东籍汉族人C242T p22phox基因多态性。结果 CC基因型频率为0．877，CT TT基因型频率为0．123，C等位基因频率为0．934，T等位基因频率为0．066。结论 广东汉族人存在C242T p22phox基因多态性，该基因多态性存在种族差异。     

广东汉族人细胞色素C242T p22phox基因多态性观察

目的调查广东汉族人是否存在细胞色素C242T p22phox基因多态性。方法应用聚合酶链反应-限制性长度多态性法(PCR-RFLP)检测122名广东籍汉族人C242T p22phox基因多态性。结果CC基因型频率为0.877,CT TT基因型频率为0.123,C等位基因频率为0.934,T等位基因频率为0.066。结论广东汉族人存在C242T p22phox基因多态性,该基因多态性存在种族差异。