肝性脑病并发电解质和酸碱失衡的探讨

目的　探讨肝性脑病时电解质和酸碱平衡紊乱的发生规律。方法　对 80例肝性脑病患者的动脉血气、电解质和血浆渗透压等检测结果进行回顾性分析。结果　肝性脑病患者中单纯酸碱失衡占 35 0 % ,二重酸碱失衡占 37 5 % ,三重酸碱失衡占 2 5 0 %。电解质紊乱一般多表现为低钠血症 (4 3 75 % )、低钾血症 (30 0 0 % )、低氯血症 (2 6 2 5 % ) ,血浆渗透压降低亦很常见。结论　肝性脑病患者经常出现电解质和酸碱平衡紊乱 ,并且使其病情更趋复杂化 ,应该及时给予纠正     

出血性疾病的诊断思维

出血性疾病是以自发性出血或轻度外伤后过度出血为特征的一组疾病,包括血管因素、血小板、凝血以及纤溶等异常.对于出血性疾病的诊断,除了依赖病史和临床出血特征外,实验室检查至关重要.其实验室检查分为初筛试验和确诊试验.初筛试验包括血小板计数(PLT)、凝血酶原时间(PT)和活化的部分凝血活酶时间(APTT),根据PLT、PT和APTT初筛结果,对出血性疾病进行分类诊断和初步诊断,然后在此基础上再进行相应的确诊试验,最后完成对出血性疾病的明确诊断.     

精神病患者首次求治途径及其影响因素调查分析

[目的]探讨精神病患者首次求治途径及其影响因素.[方法]采用自制《精神病患者首次求治途径调查表》,调查入住于本院精神科的病人715例.[结果]精神病患者首次求治选择迷信、宗教方式的占42%,选择普通诊所的占13%,选择综合医院非精神专科的占18%,选择精神专科的占27%.70.48%的精神分裂症首治于非精神专科,80.7%的抑郁症首治于综合医院非精神专科,61.54%的躁狂症首治于非精神科.有近47.78%的精神分裂症患者、5.26%的抑郁症患者、12.82%的躁狂症患者、36.36%的其他精神病患者首次求治选择了迷信、宗教活动方式.[结论]精神病患者患病后首次求治多数不能到精神专科,既延误了治疗时机,又加重了患者的家庭经济负担.因此加强心理卫生知识及精神医学科普知识的宣传教育工作十分重要.     

Comparison of Sequential Swallowing in Patients With Acute Stroke and Healthy Adults

Murguia M, Corey DM, Daniels SK. Comparison of sequential swallowing in patients with acute stroke and healthy adults.

Objectives

To compare hyolaryngeal complex (HLC) movement and leading-edge-of-the-bolus location patterns of sequential swallowing in patients with stroke and healthy adults, and to determine whether these patterns affect swallowing safety.

Design

Between-groups comparison.

Setting

Veterans hospital.

Participants

Consecutively admitted patients with acute unilateral supratentorial stroke (right hemisphere damage, n=13; left hemisphere damage, n=16) and age-matched healthy participants (n=25).

Interventions

Not applicable.

Main Outcome Measures

HLC movement pattern, bolus location, Penetration-Aspiration (P-A) Scale score.

Results

No significant group differences were observed for HLC movement pattern, bolus location, and P-A Scale score. Specific HLC movement patterns and bolus location were not associated with a higher P-A Scale score. A significant correlation between HLC movement pattern and bolus location was observed. Bolus location was typically inferior to the valleculae between swallows when the HLC was partially elevated. Across all groups, P-A Scale scores were significantly higher during sequential swallowing than single swallows.

Conclusions

HLC movement pattern and bolus location do not appear related to airway invasion, at least in persons without significant dysphagia. Given higher P-A Scale scores during sequential swallowing as compared with single swallows, sequential swallowing should always be evaluated in all patients.     

急性脑卒中后睡眠障碍及相关因素研究

【目的】探讨急性脑卒中患者的睡眠障碍情况及其影响因素。【方法】采用匹兹堡睡眠质量指数问卷（PSQI）、神经功能缺损程度评分（NDS）、汉密尔顿抑郁量表（HAMD）对298例急性脑卒中住院患者进行调查【结果】脑卒中急性期睡眠障碍发生率为45．97％;对患者不同性别、年龄、卒中部位、NDS和HAMD评分等方面进行比较,睡眠障碍发生率的差异均具有统计学意义（P〈0．01或P〈0．05）。【结论】急性脑卒中后患者睡眠障碍的发生率较高,与患者年龄、性别、卒中部位、神经功能缺损程度及抑郁状态等因素相关。临床工作中应积极改善睡眠以提高患者生活质量。     

脑心卒中与心脑卒中的临床特征分析

[目的]探讨脑心卒中及心脑卒中的临床差异.[方法]将60例患者分为脑卒中与心卒同时发生A组,脑心卒中B组及心脑卒中C组,并对其临床特征,病变部位,转归等进行分析比较.[结果]脑卒中与心卒中同时发生愈后最差.[结论]通过对脑心卒中与心脑卒中的临床分析比较,可总结其预后及治疗最佳方案等.     

脑卒中后语言障碍

失语症是脑卒中后的主要语言障碍。它通常是由于左侧大脑损害造成理解和运用语言符号系统表达的能力受损,并伴有右侧运动机能减弱或偏瘫。它不属于智能减弱、知觉丧失或运动机能障碍。在Framingham研究中,分别有18%和16%的长期脑卒中存活者被发现有失语症和呐吃。失语症严重影响了患者的生活。一个多世纪以来,学者们对失语症进行了各方面的研究与发展。介绍失语症的分类、评估及治疗。     

Avoidance and early diagnosis of erroneous permanent pacemaker placement into the left ventricle: A case report

Diagnosis of a pacemaker inserted through the subclavian artery is essential due to risk of thromboembolism. Fluoroscopy, ECG, and other imaging techniques must be used to diagnose the condition, and appropriate treatment path must be administered.     

伏立康唑致精神障碍的临床特征和危险因素分析

目的 探讨伏立康唑引起精神障碍的临床特征和危险因素.方法 回顾性分析使用伏立康唑而导致精神障碍24 例患者临床资料,并随机收集同期使用伏立康唑未引起精神障碍96 例患者为对照组,采用单因素分析(t检验,χ2检验)及多因素非条件Logistic 回归模型分析导致精神障碍的危险因素.结果 24 例精神障碍患者临床表现以意识障碍(谵妄状态)的发生率最高(50.0% ),次之为感知觉障碍(幻视、幻听),占25.0%.精神障碍发生于用药后(3±2)d,停药(2±1)d症状消失.单因素分析表明,年龄、用药阶段、每日单位体重维持剂量、应用质子泵抑制剂、血清ALT 水平与出现精神障碍有关,但经多因素Logistic 回归分析发现年龄(OR=1.136;95% CI=1.044~1.238;P=0.003 )及每日单位体重维持剂量(OR=1.546;95% CI=1.062~2.251;P=0.023 )为发生精神障碍的独立危险因素.结论 在应用伏立康唑的患者中,年龄及每日单位体重维持剂量是导致精神障碍的独立危险因素.     

Case study of a young man with tremor

PURPOSE: To provide the clinician with an opportunity to review the most common causes of tremor in young adults. DATA SOURCES: Extensive review of international scientific literature on tremors and other movement disorders, supplemented by a recent case study. CONCLUSIONS: Essential tremor (ET) is the most common tremor disorder in the world. In contrast to common expectations, the 2nd decade of life represents a period of peak incidence. The early presentation may be so mild that the tremor goes unnoticed by patients and clinicians for many years. The most important movement disorder to rule out in the workup of patients with tremors is Parkinson's disease. IMPLICATIONS FOR PRACTICE: The diagnosis of ET is generally made on clinical grounds. A comprehensive history and careful physical examination that rules out cerebellar or extrapyramidal disease is required. The clinician must distinguish between resting tremors and action tremors. If the appropriate diagnosis is unclear, a tremor recording (electromyogram) may assist in this distinction. Referral to a neurologist may be warranted.     

Opioid dependence and addiction during opioid treatment of chronic pain

Throughout the long history of opioid drug use by humans, it has been known that opioids are powerful analgesics, but they can cause addiction. It has also been observed, and is now substantiated by multiple reports and studies, that during opioid treatment of severe and short-term pain, addiction arises only rarely. However, when opioids are extended to patients with chronic pain, and therapeutic opioid use is not confined to patients with severe and short-lived pain, compulsive opioid seeking and addiction arising directly from opioid treatment of pain become more visible. Although the epidemiological evidence base currently available is rudimentary, it appears that problematic opioid use arises in some fraction of opioid-treated chronic pain patients, and that problematic behaviors and addiction are problems that need to be addressed. Since the potentially devastating effects of addiction can substantially offset the benefits of opioid pain relief, it seems timely to reexamine addiction mechanisms and their relevance to the practice of long-term opioid treatment for pain. This article reviews the neurobiological and genetic basis of addiction, its terminology and diagnosis, the evidence on addiction rates during opioid treatment of chronic pain and the implications of biological mechanisms in formulating rational opioid treatment regimes.     

Early and late onset groups of substance misusers: Differences in primary and secondary psychiatric disorders

Aim: To identify clinical differences between early onset (EO; at age <18 years) and late onset (LO; at age 18 years or older) groups of patients with substance use disorders (SUD).

Sample: A naturalistic, consecutive sample of DSM‐IV alcohol‐dependent (n=156) and polysubstance‐dependent patients (n=131) from three outpatient and six inpatient public programmes in two neighbouring counties in Norway.

Methods: Primary axis I disorders (occurring at least 1 year before any SUD) and secondary axis I disorders (occurring at least 1 year after any SUD) were assessed with the Composite International Diagnostic Interview (CIDI); axis II disorders were assessed with Millon Clinical Multiaxial Inventory (MCMI)‐II.

Results: In the EO group, significantly more clients had primary anxiety disorders, (especially social phobia and post‐traumatic stress disorder (PTSD)) and antisocial, borderline and passive‐aggressive personality disorders (PDs), and fewer had dependent and compulsive PDs. EO strongly predicted polysubstance misusers (vs. pure alcoholism) and had more frequent secondary PTSD. Results were generally identical when a cut‐off point of 25 years was used. The average EO patient's SUD manifested 6 years before psychiatric treatment, whereas the LO patients had been in psychiatric treatment for 2 years before the SUD.

Conclusion: EO/LO allowed the delineation of two clinical subgroups and provided information about possible prevention strategies, early interventions and treatment.     

Pharmacologic Advances in Residential Treatment

The author has worked as a child psychiatry consultant to several residential treatment centers from 1965 to the present. Prior to the last 5 or 10 years, the psychiatric consultant role was mainly one of providing diagnoses, assisting with the formulation of psychodynarnics, consulting with residential staff, providing psychotherapy, etc. However, there is a remarkable revolution in psychiatry in the areas of neuroscience and psychopharmacology. These advances, especially in psychopharmacology, offer a great deal of potential for children and youth in residential care, especially those whose problems of mood and behavioral control interfere with the standard, non-pharmacologic approaches. This paper will mention the older drugs (Ritalin , Thorazine , Haldol), but will focus on the use of the newer drugs (the SSRI antidepressants, clonidine, lithium carbonate, valproic acid, betablockers and carbamazepine) in diagnosing and ameliorating behavioral pathology.     

Psychiatric aspects of chronic renal disease

Abstract

Recognition of the prevalence of mood disorders and increased availability of medication options have led to calls for treating bipolar disorders in the primary care setting. Second-generation antipsychotic medications (SGAs) were initially lauded for treating bipolar disorders because of their efficacy and perceived safety relative to first-generation antipsychotic medications. Metabolic syndrome is a constellation of risk factors for cardiovascular disease and type 2 diabetes mellitus, which may emerge when treating bipolar disorders with SGAs. We conducted a search of the research literature examining the association between different SGAs and metabolic syndrome. Based on our review, we offer guidelines for monitoring patient status regarding metabolic syndrome and for providing interventions to promote healthy diet and exercise.     

炎性肌病合并甲状腺功能异常的临床分析

目的研究炎性肌病合并甲状腺功能异常的临床特点。方法两家教学医院2007~2009年期间确诊的2例多发性肌炎合并甲状腺功能异常患者及结合文献报道进行分析。结果 2例炎性肌病患者为女性,在发现甲状腺疾病之前,常规治疗效果不佳,后检查确诊伴有甲状腺功能异常,经过相应内分泌方面治疗后,病情恢复加快。结论炎性肌病正规治疗效果不佳时,注意筛查甲状腺功能。     

丹参多酚酸对急性脑梗死患者运动和认知功能影响的临床研究

目的研究丹参多酚酸对急性脑梗死患者运动和认知功能恢复的作用。方法按随机数字表法将研究对象分为常规治疗组和研究组,运用相关量表分别于治疗前后对两组患者行运动和认知功能评定,并对两组患者行安全性评定。结果治疗前两组间各评分比较差异均无统计学意义;治疗后两组间美国国立卫生研究院卒中量表、日常生活活动能力、蒙特利尔认知评估、简易精神状态检查量表评分差异有统计学意义（P ＜0．05）,残疾程度组间比较差异无统计学意义（P ＞0．05）。结论丹参多酚酸可促进急性脑梗死患者认知功能的恢复。     

Comparison of inpatients with comorbid mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW,Australia

Aim: To explore the association of mental health disorders and alcohol- and other-substance-use disorders within general hospitals and psychiatric hospitals in NSW.

Method: The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period from 1 July 2006 to 30 June 2007. Statistical analyses were performed using Statistical Analysis System.

Results: Of the 1,814,830 admissions, 1,808,095 were in general hospitals (45.7% males, 54.3% females) and 6716 in psychiatric hospitals (60.8% males, 39.2% females). Most admissions were within age groups 20–29 and 30–39 years. Comorbidity rates in psychiatric hospitals were double those of general hospitals (9.5% in general hospitals, 19.7% in psychiatric hospitals). The highest comorbidity rate for males was in age group 30–39 (18.8% in general hospitals, 25.1% in psychiatric hospitals). For females the highest comorbidity rate was in 40–49 years age group in general hospitals (13.3%) and 30–39 years age group in psychiatric hospitals (20.9%).

Conclusion: Addressing comorbidity of mental health disorders and alcohol- and other-substance-use disorders in both general hospitals and psychiatric hospitals has important clinical implications for both prevention and treatment. This first investigation of its kind provides important information for policymakers to plan adequate policies and interventions targeting these comorbid patients.     

脑卒中合并吞咽困难患者上食管括约肌动力特征

【目的】探讨脑卒中吞咽困难患者上食管括约肌（UEs）动力特征。【方法】急性脑卒中伴吞咽困难的患者20例（卒中组）,健康志愿者19名（对照组）,行高分辨率食管测压检查,测量两组对象的UES的静息压、残余压、松弛持续时间、恢复时间、松弛前峰压及松弛后峰压。【结果】卒中组患者UES静息压力、UES松弛持续时间、UES松弛后峰压、UES松弛恢复时间均明显低于对照组（P〈0．05）,UES松弛时残余压明显高于对照组（P〈0．05）,两组患者UES松弛前峰压比较无明显差别（P〉0．05）。【结论】脑卒中合并吞咽困难患者存在UES异常动力功能,异常的UES动力功能对吞咽困难患者气道保护不利,可能增加并发症的风险。     

精神病患者恢复期的焦虑情绪和应对方式分析

目的 :探讨恢复期精神病患者的焦虑情绪和应对方式及相互关系 ,为临床心理干预提供依据。方法 :对 80例恢复期精神病患者应用焦虑自评量表 (SAS)及简易应对方式问卷进行调查。结果 :患者SAS均分明显高于国内常模 ,焦虑发生率为 4 8 75 % ,女性及文化程度较低者发生率高 ;多为消极应对 ,积极应对不足 ;积极的应对方式与焦虑程度呈负相关 ,消极的应对方式与焦虑程度呈正相关。结论 :应对方式与焦虑程度之间显著相关 ,积极应对能降低焦虑程度。应用社会认识疗法有助于调整患者认识结构 ,改善应对方式 ,减轻其焦虑程度