Objective To analyze the characteristics of tube infections related to nutrition therapy in patients with critical cerebrovascular disease. Methods A total of 110 patients with critical cerebrovascular disease who were treated in our hospital from January 2019 to June 2022 were selected for the research. They were divided into enteral nutrition group and parenteral nutrition group according to tolerance to enteral nutrition. The enteral nutrition group was divided into acid suppressive treatment and non-acid suppression treatment according to whether there was alimentary tract hemorrhage, and the bacterial infection spectrum was compared between the groups to see if there were differences. Results Bacterial cultures in the nutritional treatment pipeline of the enteral nutrition group were negative, and the difference in blood culture results between the parenteral nutrition treatment group and the enteral nutrition group was statistically significant, but it could not be directly confirmed that it related to nutritional treatment. Conclusions Enteral nutrition has high safety. We should pay more attention to the risk control of infection of parenteral nutrition.

目的 探讨云南彝族特发性震颤(essential tremor,ET)与LINGO基因多态性之间的相关性.方法 采用聚合酶链式反应-单链构象多态技术检测云南省86例彝族ET患者(ET组)和100例彝族健康人(对照组)的 LINGO1 基因 rs9652490、rs11856808,LINGO2 基因 rs7033345、rs10812774 等位点多态性情况.结果 云南彝族人群LINGO1基因的多态rs9652490存在A/A、A/G、G/G3种基因型,多态rs1 1856808 以及 LINGO2 基因 rs7033345、rs10812774 均存在 C/C、C/T、T/T 3 种基因型.两组 LINGO1-rs9652490、rs11856808 和 LINGO2-rs7033345,rs10812774 基因型频率分布和群体差异符合 Hardy-Wein-berg平衡;ET组患者rs9652490、rs1 1856808和rs10812774基因型频率、等位基因频率分布与对照组无显著差异(P＞0.05),而rs7033345基因型频率、等位基因频率分布与对照组存在显著差异(P＜0.05).rs7033345 的 C/C 基因型[OR=1.85(95％CI:1.192～2.384,P=0.031)]和 rs10812774 的 C/C 基因型[OR=1.62(95％CI:1.283～2.193,P=0.038)]患 ET 的风险较高.结论 LINGO1 基因 rs9652490 和rs11856808多态性不是云南彝族ET发生的危险因素,LINGO2基因rs7033345,rs10812774多态性可能与云南彝族人群ET发病相关.

目的 观察不同年龄健康成人大脑皮层厚度的差异.方法 对134名健康成人,包括青年组(18～44岁)54名、中年组(45～59岁)40名及老年组(≥60岁)40名采集脑结构MR T1WI.采用FreeSurfer 6.0软件对图像进行基于表面的形态测量学分析,观察左、右侧大脑皮层厚度与年龄的相关性;比较3组间左、右侧大脑皮层厚度的差异,并对组间皮层厚度存在差异的脑区进行图形可视化.结果 左、右侧大脑皮层厚度均随年龄增长而下降(r=-0.57、-0.52,P均＜0.01).3组间左、右侧大脑皮层厚度总体差异有统计学意义(F=70.20,P＜0.01),两两比较差异均有统计学意义(P均＜0.01).中年组20个脑区团簇皮层厚度较青年组变薄,老年组7个脑区团簇皮层厚度较中年组变薄,老年组29个脑区团簇皮层厚度较青年组变薄.结论 健康成人大脑皮层厚度随年龄增长而变薄.

目的 探讨磁共振弥散张量成像(DTI)定量测量在血管性帕金森综合征(VP)与帕金森病(PD)的鉴别诊断中的应用价值.方法 收集并评价15例VP及与之相匹配的16例PD患者的运动功能(UPDRS-Ⅲ),进行DTI成像扫描,并对感兴趣点进行定量测量后进行统计学分析.结果 VP组双侧红核、双侧黑质致密带、左侧苍白球、左侧壳核FA值均较PD组明显降低(P<0.05);VP组双侧红核、双侧黑质致密带、右侧黑质网状带、右侧扣带回ADC值较PD组明显升高(P<0.05).结论 利用DTI成像定量测量红核及黑质致密带FA及ADC值在VP及PD鉴别诊断中具有一定参考价值.

皮质层状坏死(cortical laminar necrosis,CLN),也被称为假层状坏死(pseudolaminar necrosis),由Sawada等于1990年最先报道,可发生在不同年龄,见于多种原因导致的中枢神经系统氧和(或)糖摄取障碍及脑能量代谢异常,随时间改变可出现影像学特征性变化[1].但目前国内许多临床医师和影像科医师因对CLN认识不足,常误诊为出血性疾病,进而影响治疗决策[2].

本文旨在综述持续脑电图监测在神经重症监护病房患者评估的应用进展.

目的 分析BiPAP呼吸机联合坎地沙坦酯对肺心病急性期合并呼吸衰竭老年患者心肺功能及血清内皮素(ET)-1、Clara细胞蛋白(CC)16、和肽素(Copeptin)水平的影响.方法 96例肺心病急性期合并呼吸衰竭老年患者随机分为两组各48例,对照组接受BiPAP无创呼吸机治疗,观察组接受BiPAP无创呼吸机联合坎地沙坦酯治疗.比较两组治疗2 w后的疗效、心肺功能指标及血清ET-1、CC16和Copeptin水平,并统计不良反应发生情况.结果 观察组总有效率较对照组显著高(P<0.05).治疗2个疗程后观察组肺动脉压(PASP)显著低于对照组,而每搏输出量(SV)、射血分数(EF)、舒张早期峰值速度与舒张晚期峰值速度比值(E/A)、1 s用力呼气容积(FEV1)/用力肺活量(FVC)、FEV1％、呼吸流量峰值(PEF)指标水平显著高于对照组(P<0.05).两组治疗后血清ET-1、CC16和Copeptin水平均显著下降,且观察组降低较多(P<0.05).主要不良反应为低血压、头痛、恶心、发热等,两组发生率无统计学差异(P=0.726).结论 BiPAP呼吸机联合坎地沙坦酯对老年患者肺心病急性期合并呼吸衰竭疗效显著.

As clinical research goes deep, new research evidence emerges continuously. In order to maintain the timeliness and advancement of the consensus, we have revised the Consensus on Nutritional Support for Neurological Diseases, issued in 2011, including 3 new evidences, 3 revised evidence levels according to the latest evidence level standards, 1 new recommendation and 1 revised recommendation. In addition, we have revised the Consensus on the Operational Standards of Nutritional Support for Neurological Diseases, issued in 2011, including 9 new evidences, 2 updated evidences, 7 revised evidence levels according to the latest evidence level standards, 4 new recommendations, 3 updated recommendations and 2 revised recommendations. In order to comprehensively and systematically reflect the management and regulation of nutritional support for neurological disease, we have merged the two consensuses.

随着医学水平的不断发展,对重症脑血管病的研究也越来越深入.重症脑血管病患者基础代谢率高、能量消耗大,机体应激强烈,内分泌严重紊乱,儿茶酚胺、肾上腺皮质激素及其他分解激素水平明显升高,易并发胃肠功能及代谢紊乱、蛋白质分解加速、免疫功能下降、应激性高血糖等状况[1].同时患者因内脏低灌注,交感神经激活,儿茶酚胺增多,胃黏膜血管强烈持续收缩,应激引起垂体-肾上腺轴释放大量糖皮质激素,使得胃运动减弱,胃酸排出延迟,影响胃黏膜愈合,从而易并发应激性溃疡[2].早期、充分的营养支持对提升重症脑血管病患者机体营养状况、增强免疫功能、有效避免感染具有重要作用.

目的 了解卒中相关性肺炎(SAP)患者的病原菌分布特点及耐药性,为临床合理用药提供依据,减少住院天数及住院费用.方法 采用回顾性研究方法,对2017年1月-2018年6月收住我科的诊断为SAP的患者,收集其痰培养及药物敏感试验结果数据并进行统计分析.结果 共检出病原菌276株,其中革兰阴性菌212株,占76.8％,以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌最为常见,其中鲍曼不动杆菌对常用抗生素均有一定纯度的耐药,而肺炎克雷伯菌、铜绿假单胞菌对常用的头孢西丁、头孢曲松、头孢吡肟等头孢菌素类耐药率大于20％;革兰阳性菌62株,占22.5％,以金黄色葡萄球菌、肺炎链球菌最为常见,未发现对万古霉素和替考拉宁耐药的肺炎链球菌菌株;真菌2株,占0.7％.结论 SAP的病原菌以革兰阴性菌为主,临床应及时送检痰培养,根据药敏结果及时调整抗生素用药方案,合理应用抗菌药物.

目的 探讨前列地尔对老年脓毒症急性肾损伤患者尿中性粒细胞明胶酶相关载脂蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)、肾损伤分子(KIM)-1水平的影响.方法 老年脓毒症急性肾损伤患者84例,随机分为观察组及对照组,对照组采用脓毒症常规治疗方案,观察组在对照组基础上加用前列地尔.观察两组尿NGAL、L-FABP、KIM-1水平、急性生理学与慢性健康状况(APACHE)Ⅱ评分及肾损伤程度的变化.结果 观察组及对照组尿NGAL、L-FABP、KIM-1水平在治疗前3 d内均呈上升趋势,差异无统计学意义(P>0.05);而治疗后5～7 d,两组尿NGAL、L-FABP、KIM-1水平差异有统计学意义(P<0.05).两组尿中KIM-1水平在治疗前3 d内均呈上升趋势,差异无统计学意义(P>0.05).而治疗后5 d至治疗后7 d,两组尿中KIM-1水平差异有统计学意义(P<0.05).观察组及对照组治疗前APACHEⅡ评分差异无统计学意义,治疗后观察组评分下降幅度较对照组明显增大(P<0.05).观察组及对照组肾损伤程度在治疗前3 d内均呈加重趋势,差异无统计学意义(P>0.05);而治疗后5～7 d,观察组肾损伤缓解程度明显优于对照组(P<0.05).结论 前列地尔可以降低尿NGAL、L-FABP、KIM-1水平,利于肾脏功能恢复.

目的 探讨帕金森病(PD)伴2型糖尿病(T2DM)患者的血糖水平、运动功能及左旋多巴等效剂量(LDE).方法 检测27例PD+T2DM患者空腹血糖(FPG)、果糖胺、糖化血红蛋白(HbA1c)水平,评定运动功能采用统一PD评分量表第三部分(UPDRS-Ⅲ),并计算LDE;与30例PD患者(对照组)进行比较.结果 PD+T2DM组FPG、HbA1c水平较对照组显著升高(P<0.05),两组果糖胺无统计学差异(P>0.05).PD+T2DM组较对照组运动症状(UPDRS-Ⅲ)评分显著升高(P<0.05),两组LDE无统计学差异(P>0.05).结论 PD伴有T2DM患者血糖水平可能影响运动功能,但对药物使用剂量无明显影响.

Objective To investigate the relationship between chronic cerebral hypoperfusion and low-perfusion quantification (VCI) in non-focal areas of patients with VCI and the value of different parts of brain CTP in the identification of VCI and early clinical diagnosis.Methods From April,2013 to August,2015,the patients with ischemic cerebrovascular disease diagnosed in Department of Neurology,First People's Hospital of Yunnan Province were collected.MMSE and MoCA were used to evaluate the cognitive function.And control group (n =18).40 patients were divided into VCI-ND group according to MoCA score 21 cases and 19 cases of VaD group.CBF,CBV and TTP values were obtained by CTP examination within 24 hours after the assessment of cognitive function.Normalized non-lesion areas were ROI in the cerebral cortex and thalamus.The CBF,CBV and TIP values of ROI were measured by mirror image method.Results There was significant difference between MMSE and MoCA (P＜0.05).The MoCA scale was more sensitive to VCI-ND.The levels of CBF,CBV and TTP in brain CTP were significantly correlated with MoCA scores.The values of CBF and CBV in non-lesion area decreased gradually with the degree of cognitive impairment increased,CBF was rnore obvious than CBV;TTP increased with the degree of cognitive impairment.There were significant differences in CTP perfusion parameters in different cerebral regions,CBF and TFP in thalamus,temporal lobe and parietal lobe,and there was significant difference between VCI-ND group and VaD group.In the lateral lobe,extra lateral lobe and occipital lobe,CBF was more sensitive and TTP had no significant difference,but CBV did not show any significant difference between VCI-ND group and VaD group.Conclusions The MoCA scale is sensitive to MMSE in detection of VCI and VCI-ND in low perfusion patients.The changes of cerebral blood perfusion parameters CBF,CBV,TTP in cerebral CT perfusion imaging were related to the cognitive dysfunction of VCI patients.The cerebral perfusion of cerebral cortex and thalamus in non-lesion area decreased,and the degree of cognitive dysfunction gradually decreased Which may reflect the pathophysiologic basis of VCI,especially VCI-ND.It is of potential clinical value in the early diagnosis of VCI.

神经重症患者除了本身病情危重、免疫力低下之外,还因为使用呼吸机、气管插管、气管切开以及留置深静脉导管、尿管、鼻胃管、鼻肠管等,使其暴露于众多感染危险因素之下.神经重症监护病房(NICU)感染增加了患者救治难度,必须高度重视.为了解我院NICU临床标本分离病原菌及耐药情况,完善感染控制措施,现报道如下.

Objective To evaluate the post-stroke penumbral areas using CT perfusion image matching technology. Methods Forty patients with ischemic stroke were completed the CTP exami-nation. Non variable tissue ( NVT) ,tissue at risk ( TAR) and relative ischemic tissue ( RIT) were matched and compared using cerebral blood volume ( CBV) , cerebral blood flow ( CBF) and time to peak (TTP). Results The threshold value of CBV, CBF and TTP is 1.7 mL/100 g, 30. 0 mL/(100 g?min) and 9.5 s respectively. For compound single infarction group, one case was saw in the type of RIT>NVT>TAR. For subcortical single infarction group, there are one case of RIT>NVT>TAR and four cases of the type RIT>TAR>NVT and one case of the NVT>RIT>TAR. For multiple infarc-tions group, the type of RIT>NVT>TAR has 16 cases and RIT>TAR>NVT has 10 cases and one case with the type of NVT>TAR>RIT. Conclusion CT perfusion image matching technology can confirm the different area of NVT, TAR, RIT accurately and quickly. The penumbralarea can be ob-served apparently. This technique can be used for clinical treatment of ischemic stroke as individual image assessment technology.

Objective:To discuss the capability of 3.0 T high resolution MRI to differentiate carotid atherosclerotic plaque composition and to predict plaque stability.Materials and Methods:Thirty-three consecutive patients with carotid atherosclerotic plaques were scanned using GE 3.0 T MRI. MRI protocols include three-dimensional time-of-flight (3D-TOF), double-inversion recovery T1 weighted image, T2 weighted image, proton density weighted image and carotid artery MRA. Plaque composition and its type were collected and analysed.Results:Total 63 carotid atherosclerotic plaques were found in 33 patients. According to American Heart Association classification, typeⅠ-Ⅱ plaques accounts for 12.7% of total plaques, typeⅢ accounts for 27% of total, typeⅣ-Ⅴ together occupies 19% of them, typeⅥ with number of 31.8% is the biggest in the group, and typeⅧ accounts for 9.5%. There was no statistically significant difference for plaque location (Fisher’s exact test:P=0.016). Thirty one stable plaques and 32 unstable plaques were detected of all 63 plaques. There was statistically signiifcant difference between stable plaque group and unstable plaque group in terms of the occurrence rate of lipid rich necrotic core, hemorrhage, thrombosis and integrity of fibrous cap (P<0.05). No significant differences were found for the number of calcification (P>0.05) between the two groups.Conclusion:3.0 T high resolution MRI has the capability to differentiate and identify plaque compositions between table plaque group and unstable plaque group. It can be an important guidance for treatment option and outcome evaluation.

Objective:To explore the psychological status of conscious patients in NICU.Methods:252 cases of conscious patients in NICU were selected from February 2013 to June 2014.Symptom checklist 90(SCL-90)were used to evaluate symptoms.Results:In the SCL-90 scale,force,interpersonal sensitivity,anxiety,depression and terror score results were significantly higher than the national norm,the difference was statistically significant(P<0.05).Somatization,hostility,paranoid and psychotic aspects were no significant differences.Conclusion:In NICU,Obsessive compulsive symptoms,interpersonal sensitivity,anxiety,depression and terror were serious.We should take targeted intervention measures.

目的：评估两种强化降脂方案对老年期极高危型脑梗死患者的安全性，一种是以1.8 mmol/L为低密度脂蛋白（ LDL）达标值或以降低LDL 50％为目标的强化降脂方案，另一种是以2.1 mmol/L为LDL达标值或以降低LDL 40％为目标的强化降脂方案。方法将老年期极高危型脑梗死患者分为两组，一组接受40 mg/晚的阿托伐他汀治疗，以达1.8 mmol/L为LDL达标值或以降低LDL 50％为目标，称为40 mg组（n＝30）；一组接受20 mg/晚的阿托伐他汀治疗，以2.1 mmol/L为LDL达标值或以降低LDL 40％为目标，称为20 mg组（ n＝49）。随访治疗3个月，治疗前后分别测定患者的LDL、门冬氨酸氨基转移酶（ AST）、丙氨酸转氨酶（ ALT）、肌酐（ Cr）、心肌肌酶（ CK）、血糖（ BG）、血小板（ PLT）；用 SWI检测患者的脑微出血的数量；用HAMD评价患者的抑郁程度；用ECG检测心脏情况；眼科会诊判断白内障情况；询问记录患者的心脏、消化道、呼吸系统、泌尿生殖系统、皮肤的主述。结果40 mg组降脂幅度大于20 mg组（P＜0.05）；治疗前后AST、ALT、Cr、CK、BG、PLT、脑微出血数量、HAMD评分、心肌缺血例数、心律失常例数、白内障例数、有心脏、消化道、呼吸系统、泌尿生殖系统、皮肤主述的例数40 mg组及20 mg组均无差异（ P＞0.05）。结论40 mg/晚的阿托伐他汀降脂效果优于20 mg/晚；两种强化降脂方案对老年期极高危型脑梗死患者均较安全。

临床思维能力是高层次医学人才必须具备的基本素质，也是医学生进入临床教学必须较早培养的一种基本能力。提高实习生的临床思维能力是搞好神经病学实习教学的关键，是帮助和指导实现实习生到临床医生的过渡与转变。我们逐步摸索并不断完善一套行之有效的提高实习医生神经病学临床思维能力的方法：首先掌握神经病学及相关医学基本知识是前提；采用启发式教学，充分调动学生的学习积极性；详细、正确的病史询问和系统的体征检查；不断总结临床经验，提高综合分析能力等几方面入手。同时采取相应积极对策：增强教师的教学意识和责任心，提高教师素质；充分利用好教学查房；组织学生参加病例分析及讨论；定期举行对实习生的临床小讲座；引导实习生直接接触患者，运用循证方法思考及解决问题。总之，通过关注在神经病学实习教学中临床思维能力的培养，使实习生具有探索新知识的能力，为培养全面素质教育的人才奠定基础。

Objective To investigate the role of cerebrospinal fluie( CSF)cytology on eiagnosis of meningeal cancer. Methods Retrospectively analyzee the clinical eata of 23 cases with meningeal cancer. Results (1)Of 23 patients,CSF eetection of 17 cases were showee with cancer cells at the first lumbar puncture,3 cases at the 2ne lumbar puncture,2 cases at the 3re eetection,ane 1 case at 4th eetection.(2)Of 23 cases with cerebrospinal fluie cytology positive patients,17 cases were carriee cranial MRI scan. The MRI showee that 9 were normal ane 8 cases were brain parenchyma ane meningeal image enhance. Ten cases were performee the enhancee MRI scan,5 cases were with extensive meningeal thickening,3 cases were showee meningeal extensive enhancement of brain surfer ane intracranial cerebral sulci,1 case was the circular shaeow strengthen at eifferent size at next to the eouble lateral parietal,occipital ane left cerebella hemisphere,ans 1 case was with tough brain surface ane abnormally long T1,long T2 signal at lateral ventricles,thire ventricle, fourth ventricle epeneymal.(3)The relationship between the primary tumor ane cancer eetection in cerebrospinal fluie:19 patients were foune with primary tumor lesions,inclueing 5 cases leukemia(3 cases with acute lymphoblastic leukemia,2 cases with acute non-lymphocytic leukemia),4 cases with lung cancer,3 cases with breast cancer,2 cases with brain lymphoma,1 case with melanoma,1 case with Hoegkin′s lymphoma,l case with nasopharyngeal carcinoma, 1 case with vaginal squamous cell carcinoma, 1 case with gastric carcinoma. Conclusion Multiple cerebrospinal fluie cytology eetection may improve meningeal cancer eetection rate. CSF cytology eetection can improve eiagnosis rate of meningeal cancer. No relationship between the eetection of cancer cells in cerebrospinal fluie ane brain MRI meningeal lesions,ane the further research neee to be eone with expaneing the sample size.