选择2013年1月～2014年1月在我院ICU住院治疗的脓毒症患者60例,随机分为脓毒症组30例和严重脓毒症组30例.所有患者均在确诊为脓毒症的24h内抽取静脉血,分别进行血清PCT、WBC检测,同时记录入院24h内急性生理和慢性健康状况评分(APACHEⅡ评分系统).脓毒症组患者血清PCT、WBC水平及APACHEⅡ评分分别为3.80±1.32、12.11±1.95、8.10±2.06;严重脓毒症组患者血PCT、WBC水平及APACHEⅡ评分分别为37.02± 11.09、18.96±9.45、18.63±6.56.两组比较,差异均有统计学意义(P＜0.05).血清降钙素原对脓毒症患者早期病情诊断和评估具有一定的参考价值,值得在临床上应用和推广.

OBJECTIVE To assess bone mineral density in adult epileptics who have been treated with carbamazepine,and analysis correlation factors of the bone mineral density alteration.METHODS 32 adult epileptics who were treated with carbamazepine more than 6 months and 30 healthy adults as control were evaluated for bone mineral density,and measured the concentration of calcium,phosphorus concentration,drug concentration and alkaline phosphatase of patients.RESULTS The Z value of bone mineral density in carbamazepine group is lower than normal control group significantly(P=0.002),which L1 Z value lower than the L2-L4,and the values were-0.68±0.80 and-0.24±0.68,but there was no difference in the influence of carbamazepine on L1 and L2-L4.The Z value of patients' lumbar spine bone mineral density was positively correlated with body weight(B=0.06,P=0.012),and also related with gender.CONCLUSION Carbamazepine treatment could neduce the bone mineral density in adult patients with epilepsy,premenopausal women were affected less slightly than men by carbamazepine,the body weight is a protective factor.

<正>病例1,女,27岁,因烦渴、多饮、多尿6个月,行走不稳10d入院。患者于6个月前出现烦渴、多饮、多尿,在当地医院多次查血糖高于正常,2个月治疗中血糖一直未能控制。入院前10d出现双下肢乏力。入院查体:生命体征平稳,内科查体无特殊。神经科查体:神志淡漠,双

患者,女,87岁,因发作性晕厥1周,加重3 d于2008年12月27日人院.患者近1周来常于坐位或站立时出现晕厥,每次持续10～20 min,平卧数分钟后症状缓解,严重时伴有肢体抽搐及大小便失禁,至我院门诊,行脑电图检查提示额颞区不对称性尖波、尖慢波发放,拟"症状性癫痫"给予卡马西平(50 mg,3次/d),服药后上述症状未改善,仍有每天发作4～5次,为进一步明确诊断门诊拟"抽搐原因待查"收入我院神经科.

自杀而导致死亡被为是增加癫痫患者死亡率的最重要原因之一.国外许多研究报道都表明癫痫患者的自杀率比普通人群的自杀率高几倍到二十几倍.可能导致癫痫患者自杀的危险性因素是有多方面的,本文将从5-HT、抗癫痫药及癫痫手术治疗、精神病理等方面对癫痫患者可能存在自杀危险因素进行综述,并希望在癫痫的综合治疗中对这些危险因素能加以考虑.

Objective To explore the relationship of age of onset and duration of epilepsy with cerebral blood flow in interictal temporal lobe epilepsy(TLE).Methods Nineteen adult patients with temporal lobe epilepsy including nine TLE of right interictal discharges and ten TLE of bilateral interictal discharges according to video-electroencephalography(VEEG)underwent CT perfusion imaging.Perfusion parameter compassing cerebral blood flow(CBF)was measured for each patient and its asymmetry index(AI)was calculated.Results The CT scan indicated no abnormal findings from cranial structures of each patient.Correlations between imaging results and clinical variables were assessed with Spearman's correlation and there was no significant correlation between age of onset and AI in right temporal lobe epilepsy(r=-0.611,P=0.081).However,duration of epilepsy and AI suggest negative correlation(r=-0.780,P=0.013).In bilateral interictal discharges patients' group,there were no significant correlations between clinical variables and AI(r=0.354,P=0.316;r=-0.542,P=0.106).Conclusion In right interictal discharge patients' group,here is no significant correlation between age of epilepsy and degree of the hypoperfusion.However,positive correlation is found between duration of epilepsy and degree of the hypoperfusion.There are no significant correlations between clinical variables and hypoperfusion in bilateral interictal discharges patients' group.