延伸护理服务对脑卒中患者遵医行为和改善护患关系的影响

目的探讨延伸护理服务对脑卒中患者遵医行为和改善护患关系的影响。方法选择80例脑卒中患者按出院时间顺序随机分为2组,每组各40例,2组患者均在出院前给予出院指导,观察组实施延伸护理服务,时间为3月。比较2组脑卒中患者遵医行为及对改善护患关系的差异。结果观察组遵医行为及护患关系改善方面明显优于对照组,2组比较,差异具有统计学意义（均P〈0．01）。结论延伸护理服务能提高脑卒中患者的遵医行为,并明显改善护患关系。     

脑卒中后抑郁与脑底动脉TCD检测的相关性研究

目的 评价卒中后抑郁 (PSD)表现者脑底动脉供血情况和经颅超声彩色多普勒 (TCD)技术检测的意义。方法 用 2mHz探头经颞窗搜索脑底动脉血流信号进行统计学比较。结果 卒中后抑郁者脑底动脉检出率低,平均血流速度 (MS)缓慢和阻力指数 (RI)增高均以大脑中动脉 (MCA)和大脑前动脉 (ACA)明显,与对照组比较 (P     

Independent predictors of neuronal adaptation in human primary visual cortex measured with high-gamma activity

Neuronal adaptation is defined as a reduced neural response to a repeated stimulus and can be demonstrated by reduced augmentation of event-related gamma activity. Several studies reported that variance in the degree of gamma augmentation could be explained by pre-stimulus low-frequency oscillations. Here, we measured the spatio-temporal characteristics of visually-driven amplitude modulations in human primary visual cortex using intracranial electrocorticography. We determined if inter-stimulus intervals or pre-stimulus oscillations independently predicted local neuronal adaptation measured with amplitude changes of high-gamma activity at 80-150 Hz. Participants were given repetitive photic stimuli with a flash duration of 20 μs in each block; the inter-stimulus interval was set constant within each block but different (0.2, 0.5, 1.0 or 2.0 s) across blocks. Stimuli elicited augmentation of high-gamma activity in the occipital cortex at about 30 to 90 ms, and high-gamma augmentation was most prominent in the medial occipital region. High-gamma augmentation was subsequently followed by lingering beta augmentation at 20-30 Hz and high-gamma attenuation. Neuronal adaptation was demonstrated as a gradual reduction of high-gamma augmentation over trials. Multivariate analysis demonstrated that a larger number of prior stimuli, shorter inter-stimulus interval, and pre-stimulus high-gamma attenuation independently predicted a reduced high-gamma augmentation in a given trial, while pre-stimulus beta amplitude or delta phase had no significant predictive value. Association between pre-stimulus high-gamma attenuation and a reduced neural response suggests that high-gamma attenuation represents a refractory period. The local effects of pre-stimulus beta augmentation and delta phase on neuronal adaptation may be modest in primary visual cortex.     

不同构型高血压患者左室长轴收缩功能的应变率评价

目的:探讨左心室收缩期应变率与射血分数的关系,评价不同左室构型的原发性高血压患者左室长轴收缩功能的临床价值。方法:研究对象为55例高血压患者和25例健康人,应用常规二维及M型超声心动图计算左室重量指数(LVMI)和相对室壁厚度(RWT)。根据LVMI和RWT将高血压病分为左室正常构型(LVN)和左室重构(LVR)两组。每例病人采用应变率成像法测量各室壁中间段和基底段的收缩期应变率,Simpson’s法计算射血分数。结果:不同构型组各室壁收缩期应变率的平均值与射血分数相关性良好(相关系数分别为r1=-0.82,r2=-0.84和r3=-0.94,P<0.001)。收缩期应变率在3组之间均有显著性差异(P值均<0.05)。射血分数在高血压LVR与正常组和高血压LVN组之间有显著性差异(P值均<0.05)?熏 而在正常人组和高血压LVN组之间没有显著性差异(P>0.05)。结论:应变率成像为临床提供了一个敏感、简便而可靠的描述原发性高血压患者心肌收缩功能的指标。     

血清、脑脊液中S-100B、NSE水平与缺血性脑卒中的研究

目的探讨血清、脑脊液中S-100B、神经元特异性烯醇化酶(NSE)与缺血性脑卒中的关系。方法将无特定病原体(SPF)级48只SD大鼠随机编号分为8组,每组6只,手术后8 h做行为学评价。按照不同时间段,术后8 h、12 h、1 d、3 d、5 d、7 d、21 d腹腔取血及抽取脑脊液,检测S-100B蛋白及NSE水平;进行2,3,5-氯化三苯基四氮唑(TTC)大脑染色及行为学功能评价并分析其相关性。结果SD大鼠血清及脑脊液中S-100B及NSE在不同时间段呈趋势性变化;脑脊液中S-100B、NSE水平增高时间均早于血清中S-100B、NSE水平增高时间;脑损伤后12 h,脑脊液中NSE水平即可达到峰值,血清中S-100B、NSE水平增加,3 d后达到峰值,7 d后S-100B、NSE水平与对照组比较,差异无统计学意义(P>0.05);血清和脑脊液中S-100B、NSE水平与梗死面积、神经功能评分均呈正相关(P<0.05)。结论脑脊液及血清中S-100B及NSE均能反应脑损伤程度,作为缺血性脑卒中的生物学指标,可进一步为临床患者提供血液及脑脊液标本采集的时间窗口。     

NREM Arousal Parasomnias and Their Distinction from Nocturnal Frontal Lobe Epilepsy: A Video EEG Analysis

Study Objectives.

To describe the semiological features of NREM arousal parasomnias in detail and identify features that can be used to reliably distinguish parasomnias from nocturnal frontal lobe epilepsy (NFLE).

Design.

Systematic semiologial evaluation of parasomnias and NFLE seizures recorded on video-EEG monitoring.

Patients.

120 events (57 parasomnias, 63 NFLE seizures) from 44 subjects (14 males).

Interventions.

The presence or absence of 68 elemental clinical features was determined in parasomnias and NFLE seizures. Qualitative analysis of behavior patterns and ictal EEG was undertaken. Statistical analysis was undertaken using established techniques.

Results.

Elemental clinical features strongly favoring parasomnias included: interactive behavior, failure to wake after event, and indistinct offset (all P < 0.001). Cluster analysis confirmed differences in both the frequency and combination of elemental features in parasomnias and NFLE. A diagnostic decision tree generated from these data correctly classified 94% of events. While sleep stage at onset was discriminatory (82% of seizures occurred during stage 1 or 2 sleep, with 100% of parasomnias occurring from stage 3 or 4 sleep), ictal EEG features were less useful. Video analysis of parasomnias identified three principal behavioral patterns: arousal behavior (92% of events); non-agitated motor behavior (72%); distressed emotional behavior (51%).

Conclusions

Our results broadly support the concept of confusion arousals, somnambulism and night terrors as prototypical behavior patterns of NREM parasomnias, but as a hierarchical continuum rather than distinct entities. Our observations provide an evidence base to assist in the clinical diagnosis of NREM parasomnias, and their distinction from NFLE seizures, on semiological grounds.

Citation:

Derry CP; Harvey AS; Walker MC; Duncan JS; Berkovic SF. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. SLEEP 2009;32(12):1637-1644.     

“邵氏五针法”辅助治疗卒中相关性肺炎疗效观察

目的:比较"邵氏五针法"配合常规西医治疗与单纯常规西医治疗卒中相关性肺炎的疗效。方法:将80例患者随机分为观察组和对照组,每组40例。对照组予抗感染等常规西药治疗配合康复吞咽训练。在对照组治疗的基础上,观察组采用"邵氏五针法"治疗,穴取肺俞、大椎、风门等,每日1次。两组均治疗10 d。比较两组患者治疗前后外周血炎性指标[白细胞(WBC)、C-反应蛋白(CRP)、中性粒细胞百分比(N%)],主要临床症状、体征消失时间,美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力(ADL)评分,并评定两组临床疗效。结果:治疗后,两组患者WBC、CRP、N%、NIHSS评分均较治疗前降低(P<0.05),ADL评分升高(P<0.05),且观察组以上指标较对照组改善更显著(P<0.05);观察组体温复常、咳嗽持续时间、啰音消失时间均短于对照组(P<0.05)。观察组有效率为97.5%(39/40),高于对照组的85.0%(34/40,P<0.05)。结论:"邵氏五针法"配合常规西医治疗能有效改善卒中相关性肺炎患者临床症状,降低炎性指标及提高患者生活质量,疗效优于单纯常规西医治疗。     

对学生标准化病人实施预防压疮的护理研究

目的:将推拿技术应用于学生标准化病人预防压疮的舒适护理中,以探讨优质护理服务内涵建设。方法:选择平凉医学高等专科学校(以下简称平凉医专)2009级护理专业1班为试验组共46名学生,2班为对照组共45名学生,15名学生标准化病人(SSP)和6名考评教师参与实践技能的考核。对学生标准化病人实施推拿治疗;对2组学生和学生标准化病人进行满意度问卷调查。结果:护理学生对护理技术、学生标准化病人对护理效果均满意。结论:应围绕优质护理服务的内涵建设,树立护理服务科研性、内涵性、开放性的理念,综合多学科理论与技术开展预防压疮的舒适护理。