脑电双频指数在ICU机械通气患者镇静中的监测价值

目的:探讨脑电双频指数(BIS)在重症监护病房(ICU)患者镇静深度监测中的应用价值.方法:需机械通气的重症患者30例,根据病情予咪达唑仑或丙泊酚镇静,监测脑电BIS及Ramsay镇静评分,以Ramsay评分2～4分为合理镇静,分析BIS值与Ramsay评分的相关性及影响因素;同时监测心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、经皮饱和度(SpO2).结果:镇静后的生命体征较镇静前平稳,HR、RR、MAP在镇静后数值均较镇静前下降(P＜0.05);SpO2镇静前后比较无显著差异(P＞0.05);随着镇静程度的加深,BIS值明显下降,BIS与Ramsay分级评分相关性较好(r=- 0.891,P＜0.01).结论:在ICU机械通气患者中,BIS值与Ramsay评分有较好的相关性,BIS值不仅可量化监测镇静深度,还能减少护理量和对患者的不良刺激.     

耳带状疱疹(附27例分析)

目的：对耳带状疱疹的诊断、治疗方法及疗效进行探讨。方法：对我院1990年至2001收治的27例耳带状疱疹的诊断、治疗方法及疗效进行回顾性分析，其诊断主要根据耳周疱疹、耳痛、患侧面瘫及内耳神经症状，全部病例行扩张血管、抗病毒、营养神经及对症等治疗，21例行早期激素治疗。结果：治愈12例，有效10例，无效5例。结论：耳带状疱疹预后良好，早期诊断及治疗可提高治愈率。     

罗哌卡因复合芬太尼用于腹腔镜下胃癌根治术后硬膜外自控镇痛效果观察

目的 分析罗哌卡因复合芬太尼用于腹腔镜下胃癌根治术后硬膜外自控镇痛的效果.方法 收集2017年5月—2020年8月行腹腔镜下胃癌根治术109例的临床资料.按照不同术后镇痛用药分为A组57例和B组52例,A组给予罗哌卡因复合芬太尼硬膜外自控镇痛,B组给予罗哌卡因硬膜外自控镇痛.比较两组围术期指标、疼痛视觉模拟评分(VAS...     

Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale

Objective

The level of sedation in mechanically ventilated patients is most often assessed with the Ramsay Scale. Its reliability, however, has never been evaluated in a large group of professionals using the Ramsay Scale in daily clinical practice, while differences in interpretations among professionals have been indicated. We developed a written stepwise instruction to optimize the inter-observer reliability of the Ramsay Scale within a large group of Intensive Care (IC) nurses.

Design

Reliability study.

Setting

The Intensive Care Cardiology (ICC) and the Intensive Care Thoracic surgery (ICT) units of a university hospital.

Patients and participants

The study population comprises randomly selected mechanically ventilated patients and IC nurses with a bachelor's degree in Nursing and an IC certification. In total 2x105 Ramsay measures were performed in 45 patients by 24 nurses.

Measurement and results

Analysis of 105 paired Ramsay scores showed an almost perfect agreement between observers (weighted K (K_w) = 0.90). In both ICC patients and ICT patients, agreement between Ramsay scores was high (K_w = 0.95 and K_w = 0.86, respectively).

Conclusion

By using a written stepwise instruction with the Ramsay Scale, the inter-observer reliability of the level of sedation measurements, performed in daily clinical practice within a large team of IC nurses, proved to be almost perfect.     

鼠神经生长因子治疗Ramsay-Hunt综合征的疗效观察

摘要：目的观察鼠神经生长因子治疗Ramsay Hunt综合征的疗效。方法回顾性分析2010年1月~2013年12月收治的23例Ramsay Hunt综合征患者,随机分成两组,对照组（12例）予以常规抗病毒激素等支持对症处理,观察组（11例）在对照组治疗基础上予以鼠神经生长因子治疗。治疗前后分别对比两组患者H B面神经功能分级、起效时间、平均疗程,测定面神经传导速度。结果治疗后观察组较对照组在面神经功能分级、起效时间、平均疗程以及面神经传导速度上均有改善,差异具有统计学意义(P<0.05)。结论鼠神经生长因子治疗Ramsay Hunt综合征疗效好,临床上应尽早诊断及时治疗。

     

Contralateral facial palsy in a case of cervical zoster

Zusammenfassung Die Facialisparese beim Ramsay Hunt Syndrome und seinen Untergruppen wurde bisher stets ipsilateral zur Hauteruption beschrieben.Kelly berichtet von einer kontralateralen Facialisparese bei einem Zoster Oticus. Hier wird ein Fall von kontralateraler Facialisparese bei einem zervikalen Zoster dargestellt. Es handelt sich um eine 78jährige Patientin, die 2 Wochen nach linksseitigem Auftreten des Herpes Zoster im oberen Zervikalbereich eine periphere Facialisparese rechts entwickelte.Die möglichen pathogenetischen Zusammenhänge werden diskutiert.

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Research Fellow of the Alexander von Humboldt Foundation     

Ramsay Hunt Syndrome with Mental Disorder

Abstract: This is a case of Ramsay Hunt syndrome with mental disorder. The patient had action myoclonus, grand mal seizure and severe cerebellar ataxia. Schizophrenia-like symptoms including delusion of persecution and self-reference, auditory hallucination and incoherence were characteristically observed before the neurological disturbance became manifest. Subsequently, euphoria, disinhibition, moria and mild dementia appeared with neurological symptoms. The possibility of Ramsay Hunt syndrome to accompany organic mental syndromes and the relationship between cerebellar dysfunction and psychiatric symptoms are discussed.     

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

Objective

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell’s palsy (BP) or Ramsay Hunt syndrome (RHS).