目的 了解北京市某医院神经内科患者睡眠障碍、焦虑、抑郁的发生率及其现状,为临床早期干预及治疗提供依据.方法 采用横断面调查方法,对431例神经内科就诊患者使用匹兹堡睡眠质量量表(PSQI)、汉密尔顿焦虑量表14项(HAMA-14)、汉密尔顿抑郁量表24项(HAMD-24)进行他评式问卷调查.结果 被调查的431例患者睡眠障碍的发生率高达84.69％,68.91％ 的患者存在不同程度的焦虑或抑郁,其中32.2％ 的患者肯定有焦虑,30.6％的患者有明显抑郁,23.9％ 的患者焦虑抑郁共病.PSQI平均分为(12.12±4.17)分,HAMA-14的平均分为(10.97±6.95)分,HAMD-24的平均分为(15.29±10.15)分.女性睡眠质量较男性差,更容易患焦虑(P<0.05);住院患者睡眠效率明显低于门诊患者(P<0.05);有焦虑或抑郁的患者睡眠质量显著低于一般患者(P<0.01).结论 神经内科患者睡眠障碍与焦虑抑郁发生率较高,女性高于男性,住院患者睡眠效率更差,应引起医护人员的足够重视,并对患者进行早期预防及治疗.

目的 探讨腔隙性脑梗死患者睡眠与情感障碍及相关性.方法 回顾性研究2014年9月至2017年6月就诊于神经内科的腔隙性脑梗死患者64例,对照组选取同期非脑血管病患者50例.腔隙性脑梗死患者与对照组患者均于就诊1 d～2周内进行匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)测定,所有测试均一次完成.比较2组患者PSQI、HAMA、HAMD评分,并对腔隙性脑梗死患者PSQI评分与HAMA、HAMD评分进行相关性分析.结果 腔隙性脑梗死患者PSQI总分及各因子评分除"睡眠效率"外均高于对照组(P<0.05);HAMA总分及各因子评分明显高于对照组(P<0.01);HAMD总分及相关因子中"焦虑/躯体化"、"睡眠障碍"、"迟缓"等因子评分均高于对照组(P<0.05).腔隙性脑梗死合并焦虑抑郁的患者睡眠质量较无焦虑抑郁患者差(P<0.05),且腔隙性脑梗死患者眠障碍评分与情感障碍评分具有明显相关性(P<0.01);焦虑与抑郁评分之间也存在着相关性(P<0.05).结论 腔隙性脑梗死患者比一般患者更容易引起睡眠与情感障碍,且患者睡眠障碍与情感障碍具有明显相关性,应引起临床重视.

目的 探讨注射肉毒毒素中毒致神经系统损害的临床表现及电生理特征,以利于早期发现和治疗.方法选取2015年4月~2017年11月就诊于解放军307医院神经内科、因注射肉毒毒素中毒致神经系统损害的女性患者42例,选取40例年龄、性别相匹配的正常受试者为对照组,收集中毒患者的临床资料,并对两组周围神经电生理特征进行比较.结果 因注射肉毒毒素中毒致神经系统损害的临床表现主要为视物模糊、视物成双(重影)、四肢无力、部分伴有肢体麻木(全身乏力)、吞咽困难等.神经电生理检查发现,肉毒毒素中毒主要累及运动神经;运动神经检测的结果显示,与正常组相比,中毒组正中神经、腓总神经、胫神经传导速度减慢;正中神经、尺神经波幅降低;正中神经、腓总神经、胫神经潜伏期延长(P＜0.05或P＜0.01).感觉神经检测的结果显示,中毒组较正常组除正中神经、腓肠神经传导速度减慢(P＜0.05),其余无显著性差异.中毒组尺神经、胫神经F波较正常组潜伏期延长(P＜0.05).结论 注射A型肉毒毒素易引起中毒,分析其临床表现并结合神经电生理检查可有效反映周围神经损害的程度,并能与其他疾病进行鉴别,有助于临床的早期诊断及治疗.

Objective To investigate the clinical and electrophysiological features and treatments for thallium poisoning. Methods Twelve cases of thallium poisoning patients were from hospital 307 of PLA between June 2012 and October 2017 and their data were retrospectively analyzed. Twelve sex-and age-matched healthy subjects were selected as control group. Result The clinical manifestations of thallium poisoning were mainly symptoms of nervous and gastrointestinal systems as well as hair loss. Thallium poisoning compromised function of motor nerves including the prolonged distal latency of ulnar and common peroneal nerve, the decreased amplitude and slowed nerve conduction velocity of common peroneal nerve and tibial nerve, which were statistically different from control group (P<0.05). Thallium poisoning also impaired function of sensory nerve including the prolonged distal latency and decreased amplitude of median , ulnar and sural nerve, the slowed nerve conduction velocity of median , ulnar, radial and sural nerve which were statistically different from control group (P<0.05 or P<0.01 ). Electroencephalogram (EEG) of 7 cases revealed mild abnormality EEG in 6 cases and moderate abnormality EEG in one case. Patients received potassium supplementation, diuresis, oral Prussian blue, intramuscular injection of sodium dimercaptopropanesulfonate and other treatment. Severe cases had good outcome after hemoperfusion and plasma exchange. Conclusions Thallium poisoning is rare in clinic and typical clinical features and electrophysiological examination are helpful to the diagnosis and differential diagnosis of diseases. Timely increasing thallium excretion and symptomatic support treatment can effectively improve the prognosis of the patients.

Objective To evaluate the features of EEG spectrum and its clinical significance for patients with non-occupational chronic mercury poisoning. Methods Eighteen patients with chronic mercury poisoning were collected continuously as poisoning group at Affiliated Hospital of Academy of Military Medical Sciences from March 2012 to September 2013. At the same time, 12 age- and sex-matched healthy people were selected as control group. All patients underwent video EEG, and EEGLAB in Matlab 2013 software was used to analyze their EEG data. Relevant spectrum data of the 2 groups were compared and analyzed. Results The frequency-energy curves of 12 normal subjects were similar to sine curve, with obvious energy peak at α band. The frequency-energy curves of 18 patients showed as follows: 5 cases had the peak at slow δ wave, and the energy curve decreased since δ band appeared, with α band peak disappearing. The curve of 10 cases had 2 peaks respectively at α and δ band, and δ peak was higher than α peak. The spectrum in other 3 cases was normal. The quantitative analysis of EEG revealed the proportion of δ band for the total energy. The proportion of δ band for total energy of the poisoning group in right middle temporal (P = 0.018) and left posterior temporal (P = 0.039) channel was significantly higher than that of the normal group, while the proportion of δ band in middle frontal (P = 0.003), right frontal (P = 0.016) and right anterior temporal (P = 0.024), left middle temporal (P = 0.036) and right posterior temporal (P = 0.031) was lower than that of the normal group. Conclusions EEG examination plays an important role in assessing the severity of brain injury for patients with non-occupational chronic mercury poisoning. Spectrum analysis is an intuitive and simple method, and can provide some help for clinical diagnosis and treatment. DOI: 10.3969/j.issn.1672-6731.2015.02.013

目的 评价非职业性慢性汞中毒患者周围神经损害的临床表现及其神经电生理特征.方法 选取军事医学科学院附属医院神经内科2011年12月～2013年9月收治的慢性汞中毒患者31例为中毒组,选取年龄、性别匹配的31例健康体检者为对照组.收集两组的相关资料并进行比较分析.结果 慢性汞中毒患者周围神经损害的临床表现以肢体无力、疼痛、麻木为主.运动神经检测显示中毒组正中神经、尺神经、腓总神经远端潜伏期较对照组延长,正中神经、尺神经、腓总神经传导速度减慢,差异有统计学意义(P＜0.01或P＜0.05).感觉神经检测显示中毒组腓肠神经、正中神经潜伏期较对照组延长,尺神经、桡神经波幅降低,腓肠神经、正中神经、尺神经、桡神经传导速度减慢,差异有统计学意义(P＜0.01或P＜0.05).结论 非职业慢性汞中毒性周围神经损害起病隐匿,神经电生理检查能够无创、客观地反映患者的周围神经损害程度.

Shy-Drager syndrome(SDS) is a rare neurological disease involving autonomic nerves system.The patients with SDS are very often misdiagnosed because of complexity of symptoms.This study analyzes clinical data of 5 cases with SDS retrospectively.All patients have clinical manifestations of orthostatic hypotension.3 cases have impotence and 4 cases have extrapyramidal,cerebellar,or brain stem damage symptoms.MRI shows that 5 cases have cerebellar or brain stem atrophy.2 cases demonstrate unilateralⅠ-Ⅲ peak interval prolongation.2 cases of EAS-EMG show neurogenic changes.Lying orthostatic blood pressure measurement and careful examination are the most important for diagnosis.Combined treatment of traditional chinese medicine and western medicine maybe provide some help for treament,but the later prognosis is poor.

目的:探讨气管插管及气管切开患者行纤维支气管镜(纤支镜)诊疗术围术期护理方法。方法:回顾性分析42例气管插管及气管切开行纤支镜诊疗术患者的临床护理资料。结果:本组1例术中出现心律失常中断操作,给予退镜和对症处理后好转,其余均操作顺利,术后无并发症发生。结论:良好的围术期护理是提高治疗效果,降低纤支镜并发症的必要措施。