慢性阻塞性肺疾病急性加重期意识障碍的原因分析

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）意识障碍的原因。方法对2004年1月至2008年6月AECOPD患者的临床资料进行回顾性分析。结果5年来收治AECOPD患者310例，发生意识障碍16．8％（52／310）：肺性脑病29例、低渗性脑病12例、脑梗死7例、药物引起4例；临床上症状常表现多样化，可无特征性，但是由其引起死亡达死亡总数的55．6％（10／18）。结论AECOPD意识障碍发生率较高，且很难完全避免；应注意鉴别，可先要行头颅CT或MRI检查以排除颅内器质性病变，再根据动脉血气分析、血电解质等检查进一步明确病因。     

对护士实施格拉斯哥昏迷评分的评价

目的 为了解护士对意识障碍病人格拉斯哥昏迷评分(Glasgow Coma Scale，GCS)掌握的情况。方法 护士在神经外科ICU对意识障碍病人进行200次Clasgow昏迷评分，并对结果进行分析，组织护士学习前后的评分结果进行对比。结果 组织护士学习前GCS评分的正确率为62％，学习后的正确率为96％。结论 通过不断地学习和实践，对护士评分的正确性有很大帮助。建议ICU护士应不断加强学习，以期得出正确的结论，为病人的护理提供准确的依据。     

Human bedside evaluation versus automatic responsiveness testing in epilepsy (ARTiE)

Evaluation of behavioral impairment during epileptic seizures is critical for medical decision making, including accurate diagnosis, recommendations for driving, and presurgical evaluation. We investigated the quality of behavioral testing during inpatient video–electroencephalography (EEG) monitoring at an established epilepsy center, and introduce a technical innovation that may improve clinical care. We retrospectively reviewed video‐EEG data from 152 seizures in 33 adult or pediatric patients admitted for video‐EEG monitoring. Behavioral testing with questions or commands was performed in only 50% of seizures ictally, 73% of seizures postictally, and 80% with either ictal or postictal testing combined. Furthermore, the questions or commands were highly inconsistent and were performed by nonmedical personnel in about one fourth of cases. In an effort to improve this situation we developed and here introduce Automatic Responsiveness Testing in Epilepsy (ARTiE), a series of video‐recorded behavioral tasks automatically triggered to play in the patient's room by computerized seizure detection. In initial technical testing using prerecorded or live video‐EEG data we found that ARTiE is initiated reliably by automatic seizure detection. With additional clinical testing we hope that ARTiE will succeed in providing comprehensive and reliable behavioral evaluation during seizures for people with epilepsy to greatly improve their clinical care.     

一起蘑菇致急性中毒事件的现场调查与鉴定

目的 调查分析云南省南华县一起蘑菇中毒事件的处置过程,鉴定引起中毒的毒蘑菇种类,为做好此类中毒事件的处置提供借鉴.方法 收集事件病例资料、流行病学调查、对蘑菇样品进行形态学和分子生物学鉴定并对中毒事件进行分析.结果 流行病学调查发现患者均食用自行采摘并炒制的蘑菇,食量不等,潜伏期2h,出现呕吐、抽搐、意识不清等神经精神型中毒症状,经形态学和分子生物学鉴定为假褐云斑鹅膏和小豹斑鹅膏.结论 本事件是因误食名为假褐云斑鹅膏和小豹斑鹅膏引起的急性中毒.结合流行病学特点和患者临床表现,证实了通过形态学及分子生物学方法对假褐云斑鹅膏和小豹斑鹅膏的物种鉴定具有适用性.     

Very Long-Term Outcomes in Children Admitted in a Disorder of Consciousness After Severe Traumatic Brain Injury

ObjectivesTo investigate functional outcomes and state of consciousness at 1 year and ≥2 years postinjury in children who sustained a traumatic brain injury and were in a disorder of consciousness (DOC), either vegetative state (VS) or minimally conscious state (MCS), upon admission to inpatient rehabilitation.DesignRetrospective chart review.SettingPediatric inpatient rehabilitation unit.ParticipantsChildren aged 2-18 years (N=37) who were admitted to inpatient rehabilitation with admission scores <30 on the Cognitive and Linguistic Scale (CALS).InterventionsNot applicable.Main Outcome MeasuresGlasgow Outcome Scale- Extended, Pediatric Revision (GOS-E Peds), and state of consciousness based on previously established guidelines.ResultsAt admission, 16 children were in VS (43.2%) and 21 (56.8%) were in MCS. Children admitted in VS had a significantly longer time from injury to inpatient rehabilitation admission, lower CALS admission scores, were more likely to be in a DOC ≥28 days, and had greater disability at both follow-up time points. At the 1-year follow-up, 3 patients were in VS, 7 were in MCS, and 27 had emerged from MCS. By the time of the most recent follow-up (≥2y), 2 more patients had emerged from MCS. Across the cohort, GOS-E Peds scores at 1 year ranged from VS (GOS-E Peds, 7) to upper moderate disability (GOS-E Peds, 3). Most patients were functioning in the lower severe disability category (GOS-E Peds, 6) at 1 year (43.2%) and at the time of the most recent follow-up (43.2%). Twenty-seven patients (73.0%) showed stable GOS-E Peds scores between the 2 time points, 6 (16.2%) improved, and 4 (10.8%) were deceased.ConclusionsAlthough a majority of patients emerged from a DOC by 1 year postinjury, most continued to demonstrate notable functional impairment at the 1-year follow-up that persisted to the most recent follow-up. A small subset demonstrated important improvements between 1 year and the most recent follow-up (2 patients emerged, 6 patients showed improvement in GOS-E Peds scores).     

经济全球化背景下医学生的道德构建

毋庸置疑,地球村将是人类社会发展的一个必然趋势,在这一趋势中起决定作用的当然是经济的全球化。经济全球化影响到世界各国、各民族方方面面的发展,其中包括民族道德。所以,在经济全球化的进程中,我们不得不重视意识领城的反作用。尤其是现在的中国,在经历了30年改革开放之后,于一片繁荣之中,我们发现了许多问题。对于这些问题,我们都做了很多有益的探索与研究,如经济全球化与市场经济的发展,与国际政治的关系,与对外开放的关系等等。但是,在经济全球化与民族道德的关系上的探讨,无论是广度还是深度方面,都还不够。     

Consciousness and speech evaluation of 96 patients with craniocerebral injury

Objective: To explore the effective methods for evaluating the consciousness and speech status of patients with special types of cerebral injuries.Methods: Atotal of 96 patients with injury in the language center and in coma were treated with operative and correlated conventional therapies. Then their recovery status of consciousness and speech was observed.Results: All the patients were recovered to consciousness. Sixty-nine patients with aphasia were cured completely, but 7 patients were complicated with incomplete ataxic aphasia, 15 with incomplete sensory aphasia,and 5 with incomplete mixed aphasia.Conclusions: For the patients with injury in the language center, evaluation of the conscious state with GCS scoring system has certain limitations and conscious behaviours are advantageous evidences to evaluate the consciousness recovery of the patients. The patients with conscious disturbance and injury in the language center should be considered to have aphasia.     

护理安全隐患原因分析与防范措施

目的探讨护理安全隐患的原因与防范措施。方法结合商丘市第一人民医院护理部的实际情况,对存在的安全隐患进行整改。结果通过加强法律知识的学习,提高了自我保护意识,端正了行为规范,增强了服务意识。结论随着人们自身利益保护观念的不断增强和法律意识的迅速提高,提高护理安全和患者的生命息息相关,任何疏匆大意都可酿成严重后果,而带来终生的遗憾,只有建立一套完整、系统、科学、有效的安全护理管理措施,才能使护理人员自觉的用法律意识来保护自己。     

Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

Objective

This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury.

Methods

From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients'' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem.

Result

Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days).

Conclusion

Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.     

通腑泄毒法加针刺治疗痰热腑实型脑卒中意识障碍的临床研究

目的：观察通腑泄毒法加针刺治疗痰热腑实型脑卒中意识障碍的临床疗效。方法：将90例脑卒中意识障碍患者随机分为3组各30例。对照组给予基础治疗及相应对症处理（包括控制脑水肿、稳定血压、维持水电解质平衡、控制感染、控制血糖）等西医常规治疗,中西药组加用通腑泄毒剂加减治疗,针灸中西药组在中西药组基础上加用人中、丰隆针刺治疗。疗程均为2周。治疗前后行格拉斯哥-庇斯布赫昏迷分度表（G—Pcs）评分及临床神经功能缺损评分,并检测血清β-内啡肽（β—Ep）。结果：治疗后3组G—Pcs评分和临床神经功能缺损评分均有改善且血清β—EP明显降低（P〈0．05,P〈0．01）;与对照组治疗后比较,中西药组、针灸中西药组改善更明显（P〈0．05,P〈0．01）;而针灸中西药组G—Pcs评分改善及降低血清β—EP均优于中西药组（P〈0．05）。结论：通腑泄毒法加针刺治疗痰热腑实型脑卒中意识障碍在改善G—Pcs和临床神经功能缺损评分及降低血清β-EP方面疗效优于中西药或西药基础治疗。