气管切开术与插管术在重症脑外伤中应用的比较

目的比较气管切开术与插管术在重症脑外伤患者治疗中,住院时间、应用呼吸机辅助呼吸时间、术后肺炎发病率及病死率的差异。方法回顾性分析2000-05~2006-11我院住院治疗的符合以下标准的脑外伤患者:单纯脑外伤,在伤后第1d及第3d Glasgow昏迷评分(GCS)≤8,CT显示脑损伤。随机分为气管切开组(n=27)及气管插管组(n=31),比较2组患者住院时间、应用呼吸机时间、术后肺炎发病率及病死率的差异。结果气管切开组应用呼吸机时间平均为(9±4.6)d,气管插管组平均为(13±3.6)d,2组间有显著差异。而总住院时间、术后肺炎发病率及病死率2组间均无明显差异。结论气管切开术可以明显减少应用呼吸机辅助呼吸时间,但在减少患者住院时间、术后肺炎发病率及病死率方面无明显差异,表明脑外伤昏迷患者早期进行气管切开术有利于患者自主呼吸功能的恢复。     

持续加温湿化吸氧疗法在重型颅脑损伤患者气管切开术后的应用

目的观察持续加温湿化吸氧疗法在重型颅脑损伤患者气管切开术后的疗效。方法选取2002-01—2004-01我院收治的重型颅脑损伤气管切开非机械通气患者42例,随机分为观察组和对照组。观察组采用持续加温湿化加氧对气道湿化给氧,对照组采用传统的吸氧装置给氧,对比2组患者治疗前后呼吸情况、痰液黏稠度及感染发生率。结果 2组患者PaO2、PaCO2、SpO2和呼吸频率治疗后7d比较差异均有统计学意义(P0.05);2组痰液黏稠度治疗后3d、5d、7d差异均有统计学意义(P0.05);观察组肺部感染率低于对照组,差异有统计学意义(P0.05)。结论与传统的吸氧装置气道给氧相比,持续加温湿化吸氧疗效显著,是明确治疗重型颅脑损伤患者气管切开术的最佳选择。     

院前骨髓腔输液及院内经皮气管切开术在重型颅脑损伤患者中应用

目的 探讨院前骨髓腔穿刺输液及院内经皮气管切开术在重型颅脑损伤患者中治疗效果。方法 选取郑州大学第二附属医院收治的76例重型颅脑损伤患者,其中院前骨髓腔穿刺输液及院内经皮气管切开术治疗组38例,院前骨髓腔穿刺输液及院内气管插管术治疗组38例,分析比较2组患者的肺部感染率、呼吸机使用时间、带管时间、EICU住院时间、抗生素使用时间、感染控制时间、病死率。结果 院前骨髓腔穿刺输液及院内经皮气管切开术治疗组患者的肺部感染率、呼吸机使用时间、带管时间、EICU住院时间、抗生素使用时间、感染控制时间均少于院前骨髓腔穿刺输液及院内气管插管术治疗组,差异有统计学意义(P0.05);2组患者病死率比较,差异无统计学意义(P0.05)。结论 院前骨髓腔穿刺输液及院内经皮气管切开术在重型颅脑损伤患者治疗中效果较好,值得推广和应用。     

高流量氧气湿化在重症脑卒中气管插管合并Ⅱ型呼吸衰竭患者中的应用

目的探讨高流量氧气湿化在重症脑卒中气管插管合并Ⅱ型呼吸衰竭患者中的应用效果。方法将46例重症脑卒中行气管插管合并Ⅱ型呼吸衰竭患者随机分为对照组和观察组各23例,对照组给予常规氧气吸入及气道湿化,观察组应用高流量氧气湿化进行气道吸氧及湿化处理,比较2组临床效果。结果观察组的气道湿化效果明显优于对照组(P0.05),观察组的痰液黏稠度和并发症发生率均低于对照组(P0.05);观察组的PaO_2、PaCO_2、心率和呼吸频率均优于对照组(P0.05)。结论高流量氧气湿化可提高重症脑卒中气管插管合并Ⅱ型呼吸衰竭患者的气道湿化效果,且可降低痰液黏稠度、减少气道湿化并发症,并改善缺氧状态。     

重症颅脑损伤气管切开术并发症的原因分析

目的探讨重症颅脑损伤患者气管切开术并发症的常见原因。方法将1997-02～2006-12我科发生的气管切开术并发症47例分成全麻气管切开组和局麻气管切开组进行分析比较。结果全麻气管切开组并发症明显少于局麻气管切开组(P<0.01)。躁动、体位改变与手术操作困难有一定关系。结论重症颅脑损伤致严重呼吸道功能障碍患者有条件时尽量在全麻气管插管后行气管切开术[1],对减少并发症的发生有积极意义。     

气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响

目的研究气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响。方法回顾2011-04—2015-04我院收治的大量高血压脑出血患者80例,按照气管切开的时机分为早期气管切开组35例,晚期气管切开组45例。对于早期气管切开组患者,急诊手术同时行气管切开。患者进入手术室行术前准备后,由手术医师快速行经皮微创气管切开术(PDT)。晚期气管切开组根据病情于术后2~14d内行气管切开术,操作同上。结果 35例早期气管切开组患者好转32例(91.4%),死亡3例(8.6%);45例晚期气管切开组好转出院35例(77.8%),死亡10例(22.2%);早期气管切开组肺部感染23例(65.7%),晚期气管切开组肺部感染45例(100%)。早期气管切开组肺部感染率明显低于晚期气管切开组,差异有统计学意义(P0.05);早期气管切开组术后2个月日常生活能力(ADL)Ⅱ~Ⅲ级25例(71.4%),ADLⅣ级7例(20%)。晚期组术后2个月ADLⅡ~Ⅲ级20例(44.4%),ADLⅣ级15例(33.3%)。术后2个月后早期组日常生活能力明显高于晚期组;早期气管切开组平均住院时间(34.13±6.51)d,晚期气管切开组为(43.45±10.72)d,早期组平均住院时间少于晚期组,早期组再出血2例(5.71%),晚期组再出血5例(11.11%),差异有统计学意义(P0.05)。结论早期气管切开可有效提高患者的好转出院率,减轻肺部感染,提高日常生活能力,且可以缩短住院时间,降低再出血风险。     

一次性气管导管与金属导管联用在吸入性损伤患者应用中的

背景：目前用于气管切开后的气管导管主要有一次性气管导管和金属导管2种，临床中发现各有优势与不足。 目的：对比观察单用金属导管、单用一次性气管导管及联用一次性气管导管与金属导管在气管切开患者中应用的生物相容性反应。 设计、时间及地点：回顾性分析，对照观察，于2008-12/2009-01在宜春市人民医院、南昌大学第一附属医院完成。 对象：选择宜春市人民医院、南昌大学第一附属医院烧伤中心伴有吸入性损伤、作气管切开并行呼吸机支持的患者203例。其中1990/1997用金属导管患者85例为金属导管组，1998/2002用一次性气管导管患者62例为一次性气管导管组，2003-01/2008-11在应用呼吸机时用一次性气管导管而撤机后用金属导管患者56例为联用组。各组患者在性别、年龄、烧伤面积及吸入性损伤分型、治疗及呼吸机应用时间等方面差异无显著性意义(P > 0.05)。 方法：金属导管组患者一直采用金属导管外套气囊，一次性气管导管组患者应用一次性气管导管，联用组患者在应用呼吸机时采用一次性气管导管而撤机后用金属导管，应用金属导管时可每日拔出内导管清洗消毒4次。 主要观察指标：观察各组患者在用管期间导管气囊破裂、脱落情况，计算各组患者气道出血例数、气管导管堵塞例数、撤机至拔管时间。 结果：一次性气管导管组、联用组患者气囊破裂、脱落例数与出血例数少于金属导管组(P < 0.05)；金属导管组、联用组导管堵塞例数少于一次性气管导管组(P < 0.05)，拔管时间也较一次性气管导管组短，但差异无显著性意义(P > 0.05)。 结论：一次性气管导管与金属导管联用在吸入性损伤行气管切开患者中应用效果较单用效果好。     

早期高压氧对重症脑卒中气管切开患者护理效果的影响

目的探讨重症脑卒中昏迷患者气管切开后早期行高压氧舱内治疗时的最佳供氧方式和护理,保证患者的治疗安全,提高治疗效果。方法选取2018-02—2019-03焦作市第二人民医院治疗的96例重症脑卒中患者,随机分数表法分为对照组和观察组各48例,2组均给予常规内科治疗及气管切开护理,对照组给予管道氧气吸入,观察组实施高压氧舱,采用烟台宏远16人空气加压舱,重症脑卒中气管切开重症昏迷患者早期行高压氧治疗过程中选择合适的供氧方式,保持呼吸道通畅。结果治疗前2组GCS评分、呼吸道感染、住院时间、生活质量评分、认知功能比较差异无统计学意义(P0.05);治疗后,观察组GCS评分、生活质量评分、认知功能评分均明显高于对照组,住院时间少于对照组,呼吸道感染发生率低于对照组,差异均有统计学意义(P0.05)。结论重症脑卒中气管切开患者早期接受高压氧治疗,可提高治疗效果,做好各个阶段的护理是确保高压氧治疗效果的根本。     

神经外科术后气管切开术的并发症与手术时机的选择

目的 探讨神经外科术后气管切开术并发症发生率及气管切开时机的选择。方法 回顾性分析2012年8月至2013年8月收治的266例神经外科术后建立人工气道的临床资料。结果 266例中,单纯气管插管209例（18例出院随访数据缺失）,其中气管插管时间<7 d 148例,7~14 d 24例,>14 d 19例;行气管切开术57例[3例出院随访数据缺失,余54例中,早期气管切开术（气管插管时间≤7 d）38例,晚期气管切开术（气管插管时间>7 d）16例]。单纯气管插管病人肺部感染发生率及院内病死率均明显低于气管切开术病人（P<0.05）,入住ICU时间较气管切开术病人明显缩短（P<0.05）。住院期间,早期与晚期气管切开术病人肺部感染发生率、机械通气时间、入住ICU时间、GCS评分均无统计学差异（P>0.05）;出院后,早期与晚期气管切开术病人严重出血、皮下气肿、气胸、肺部感染、气管狭窄等发生率以及病死率均无统计学差异（P>0.05）。结论 神经外科术后病人是否需要早期气管切开术或晚期气管切开术,需要综合考虑病人情况及利弊得失,做出对病人最有利的决策。     

重症脑血管病患者早期气管切开的临床价值

目的 &#8197;探讨重症脑血管病患者早期气管切开的临床价值。方法 回顾性分析102例重症脑血管病患者。所有患者入院48&#8197;h内进行了气管插管，气管插管后5&#8197;d内进行了气管切开者55例（早期气管切开组）；气管插管5&#8197;d后进行了气管切开者47例（延迟气管切开组）。比较两组间病死率、镇静药物的用量、院内获得性肺炎（HAP）的发生率、机械通气的时间、ICU住院时间等指标。结果 早期气管切开组机械通气的时间、ICU住院时间、抗生素使用天数和镇静剂的用量均低于延迟气管切开组，差异有统计学意义[（177±94）h&#8197;vs（266±162）h，P=0.03；（10±5）d&#8197;vs（13±4）d，P=0.006；（9±4）d&#8197;vs（12±4）d，P=0.03；（139±39）mg&#8197;vs（186±48）mg，P=0.001）]。两组病死率和HAP的发生率差异无统计学意义（29.1%&#8197;vs&#8197;36.2%，P=0.45；49.1%&#8197;vs&#8197;63.8%，P=0.13）。结论 重症脑血管病患者早期气管切开可获得较大的收益，提倡早期气管切开以改善预后。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。