重型颅脑损伤患者的健康教育

我科2003年4月-2006年6月共收治重型颅脑损伤患者392例，年龄最大79岁，最小3．5岁。通过实施健康教育，指导家属正确有效地配合护理，对减少伤后伤残率、提高患者生存率与生存质量、减少护患纠纷有着重要的意义。     

肝气郁结证诊断的必备症状以及与抑郁状态的关系探讨

作者在进行肝气郁结证的脑功能成像研究中，采用金益强等制定的肝气郁结证临床诊断标准，其标准可分为两类症状：情绪障碍和躯体症状。肝气郁结证的情绪障碍以情绪低落为主。指“抑郁太息、闷闷不乐、忧郁、沉闷思虑无穷。流泪”等症状。是本证的核心症状，同时是躯体症状的基础。躯体症状可分“胸胁、乳房、少度胀痛”等肝经循行部位症状的必备症状，     

阻塞性睡眠呼吸暂停低通气综合征流行病学研究方法和意义

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是对人类健康有重要影响的临床疾病之一，越来越受到人们的重视；但从流行病学角度认识这个疾病还存在一些问题。疾病的相关研究通常是要兼顾宏观和微观的；虽然近年来微观研究已进入分子生物学时代，宏观的流行病学研究仍不容忽视。     

倾斜实验诊断血管性晕厥36例临床观察

目的：倾斜实验诊断血管性晕厥的意义。方法：检查前要求：①检查时间统一在上午9～12时；②空腹12h；③停用影响自主神经功能药物3d，④停用心血管活性药物至少5个半衰期。行倾斜实验，先平卧位监测基础心率、血压等数据，取70°倾斜角度行基础倾斜观察45min。如未发作，再行异丙肾药物倾斜试验，以1μg／min的滴数，使心率增快20％～30％，撤下异丙肾，并排除输液管中残留药物，换上生理盐水维持静脉通道，再次直立倾斜70°，观察15min；如未发作，再乎卧，以40μ／min静滴异丙肾，心率较基础心率增快50％～60％后，重复倾斜操作，如未诱发，即终止试验。结论：显示倾斜实验是血管性晕厥简便、有效的诊断措施，但本组患者结果阳性组血压最低为0，最慢心率为40次／min，说明此项检查并非绝对安全，需要注意。     

中药多途径用药治疗股骨头骨骺坏死的回归性研究

目的：探讨中药多途径用药治疗股骨头骨骺坏死的临床方法、适应症和疗效，为临床提供一种治疗股骨头骨骺坏死的有效方法。方法：回归性采集2004—2008年中国中医科学院望京医院住院股骨头骨骺坏死病例30例（31髋）。其中男性22例，女性8例。最小年龄3岁，最大年龄14岁，平均7岁。采用中药多途径用药治疗，随访内容包括病人的基本情况，治疗前、后髋关节影像学资料及髋关节功能。结果：随访病例中，患儿的头骺高度明显增加，有的恢复同心圆，优良率85．7％。结论：中药多途径用药治疗股骨头骨骺坏死能改善患者疼痛，跛行，恢复髋关节功能以及X线表现，该疗法具有创伤小、恢复快等特点，临床疗效确切。值得临床借鏊。     

88例刀损伤患者的院前急救与途中护送

珠江三角洲地区，随着经济的发展，人们的生活越来越丰富多彩，打架、醉酒闹事的人也随之增多，以周末居多，其中刀损伤的患者有上升的趋势。因此，除加强各方面的管理外，一旦发生严重损伤，应争分夺秒地抢救。现将2008年1月～2009年6月，我科出诊抢救88例刀损伤患者护理体会介绍如下。     

重症颅脑损伤手术患者出院后生活质量调查

目的 了解重症颅脑损伤手术患者出院1年后的生活质量,为探讨重症颅脑损伤手术患者持续护理提供依据.方法 选取笔者所在医院神经外科重症颅脑损伤手术患者82例,随机分为亚低温治疗组和常规治疗组,各41例,固定护士2名上门随访.根据ADL生活质量评价表及KPS生活质量评价表进行生活质量调查.结果 62例出院患者1年后的ADL评价及KPS评价与出院时比较差异有统计学意义(P<0.05),亚低温治疗组与常规治疗组比较差异有统计学意义(P<0.05),两组患者分别出现不同程度的并发症及意外,但亚低温治疗组发生率稍低于常规治疗组.结论 亚低温能降低重症颅脑损伤患者出院后并发症及意外发生率,对这类患者在出院后给予持续专科护理和康复性指导,可以提高他们的生活质量和自理能力,帮助他们回归社会,减轻家庭和社会负担.     

经络能量健康检测系统对十二经脉表里关系的研究

目的:探讨人体十二经脉脏腑表里相合关系及其态势.方法:用中医经络脏腑理论与西医生物能量检测、量化表达技术结合,以ETS检测报告单上自动给出的相应经脉能量区是否相同或相邻作为相合判定标准并计数比较.结果:在2594例受检男女中,肺与大肠、脾与胃、心与小肠、肾与膀胱、心包与三焦、肝与胆的表里关系符合率诊次为74.67%、54.05%、65.69%、57.79%、54.47%、58.17%,显示古医书所记述的脏腑表里相合关系是有客观科学依据的,但各经脉相合的程度不尽相同.结论:ETS作为一种人体身心健康状态客观、整体的全新评测手段,在揭示人体的健康-亚健康-疾病中,有良好的应用前景.     

胰岛素抵抗综合征的护理进展

体温是临床医护人员采集病史和资料过程中最重要的客观指标之一，其准确性和精确性直接影响到疾病的诊断和治疗。近年来，有关体温的测量及其与临床的研究日渐增多，现将其测量方法与临床疾病的关系等进行综述，现介绍如下。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.