目的:探讨焦虑障碍患者脑电图的量化分析及光驱动反应的特点.方法:选取焦虑障碍患者60例和性别年龄相仿的正常人30例进行常规脑电图(EEG)检查,记录EEG检查结果,并计算全脑、额、颞、中央、顶、枕、左额、右额、左中央、右中央、左顶、右顶、左枕、右枕、左颞、右颞区各频段的相对功率比值DTABR=(δ+θ)/(α+β).同时分析2组脑电图光驱动反应的出现率.结果:EEG量化分析结果,焦虑障碍组与正常对照组相比,DTABR值在额、颞、左中央、左枕、右中央、左顶、右枕的差异有统计学意义(P＜0.01,P＜0.05).EEG显示光驱动反应的出现率焦虑障碍组(81.67％)高于对照组(66.67％),两组间差异有统计学意义(P＜0.01).结论:定量脑电图有可能反映焦虑障碍患者脑功能变化,为理解焦虑障碍的电生理学机制提供客观量化分析方法,有助于焦虑障碍患者鉴别诊断.

压力也被称为应激,包括两个要素,即压力源和人体对压力源反应.应激反应是压力源与对压力源反应的组合. 压力都是不好的吗? 压力源可以来源于境遇、挫折、心理冲突和对自我不合理的认知.也就是说,压力源有来自外在的,也有来自我们自身的.当压力源来自外在的境遇或挫折时,压力是被环境要求做出选择和改变时的个体感受;当压力源来自内在的心理冲突和对自我不合理的认知时,压力就是个体对已知或未知事件悲观的解释.

Objective The aim of the study was to investigate the clinical, neuropsychological, and regional cerebral blood flow (rCBF) perfusion changes in patients with neuropsychiatric symptoms caused by nitrous oxide (N2O) abuse. Methods A total of 16 patients with neuropsychiatric symptoms caused by nitrous oxide abuse were recruited for this study. The study was carried out in the withdrawal phase of N2O abuse. A 925–1110 MBq 99mTc-ECD was administered intravenously. SPECT/CT images were collected with a low-energy and high-resolution collimator. The region uptake statistics of different brain regions of interest between patients with N2O abuse and normal people of the databases for younger subjects from the Scenium DB Comparison software were calculated automatically. Results The clinical manifestations of the 16 patients with neuropsychiatric symptoms were mood lability, anxiety, hallucination, delusion, agitation, confusion, and other psychiatric symptoms. In addition, 15 of the patients also complained of memory decline; 14 patients manifested numbness or paresthesia; 14 patients developed limb weakness, and their motor impairments were more severe in the lower limbs than in the upper limbs; and eight patients had urinary and defecation disturbances. In the neuropsychological examination, the BPRS score was 54.69 ± 11.48, the HAMD score was 30.00 ± 11.06, the HAMA score was 18.06 ± 5.77, the MMSE score was 28.06 ± 2.29, and the MoCA score was 25.06 ± 3.40. SPECT showed hypoperfusion in the frontal and temporal lobes, which is consistent with the clinical findings. Conclusion This was the first study to demonstrate the obvious effect of N2O abuse on CBF in patients with neuropsychiatric symptoms. CBF perfusion imaging is helpful to detect the changes in the local brain functional activity in patients with N2O abuse.

您好!我女儿正在上大学三年级,她半年前被诊断患有抑郁症,严重到经常失眠、情绪忧郁,不能坚持上课,在医生建议下开始服用治疗抑郁症的药物.服药两个月后,她感觉情绪有明显的好转,并逐步恢复学习.现在服药已经6个月了,看起来和正常的时候没什么不同,我担心她长期服用治疗抑郁症的药会上瘾,能停药吗?

您好!我妻子退休七年了,最近半年我发现她的脾气秉性发生了很大的变化,最大的特点就是"经不住事儿".其实我们的生活还算安逸,有退休金,住房也宽裕,孩子已经成家,按说没有什么负担和压力,但是她每天总是忧心忡忡的.她经常莫名其妙地紧张、担心,问她因为什么,她自己也说不明白.最近还加重了,有时候急得直哭,我的一位老同事提醒我,这该不是得了抑郁症吧?她到底是怎么了?

您好!我丈夫已临近退休,工作也比较清闲.他性格开朗,朋友也多,但是兴趣爱好太过简单了,就是喜欢打牌、饮酒.现在业余时间多了,孩子也成年了,他就拿这些爱好打发时间,经常约朋友出去吃饭、打牌,有时深夜才回家.我担心这些嗜好会影响他的身体健康,眼看快退休了,老年生活也不能靠这些习惯来消遣呀.能否提些建议,中老年人应当培养一些什么样的兴趣爱好呢?

您好!我丈夫是一名刚退休的公司职员,最近两三个月来情绪出现很大变化,总是唉声叹气,打不起精神,对什么事情都没有兴趣,还丢三落四.他的生活起居也变得没有规律,夜里失眠,凌晨就醒了,再也睡不着觉,食欲减退,面容憔悴.我在网络上查阅很多资料,感觉他像是得了"抑郁症".但是我又有些犹豫,他到底是一般的心情不好、不开心,还是病了?不开心和抑郁症怎么区分呢?我是否应该带他到医院检查一下?

目的:分析一氧化二氮滥用导致肺栓塞患者的临床和影像学特点,探讨可能的发病机制.方法:对2019年1月～2020年12月在中日友好医院和清华大学第一附属医院神经内科就诊的4例一氧化二氮滥用致神经系统损害病程中合并肺栓塞患者的临床特点、实验室检测、影像学检查结果等进行回顾性分析.结果:4例患者均为男性,平均年龄24.75±3.50岁,平均一氧化二氮接触时间13.50±9.04个月.患者先后出现神经系统及呼吸道症状,伴有下肢肿胀,存在血同型半胱氨酸、D-二聚体升高,肺动脉CTA均发现双侧肺动脉栓塞.其中3例患者颈胸椎磁共振脊髓后索可见"倒V"征.结论:长期滥用一氧化二氮可能会增加肺栓塞的风险,血浆D-二聚体升高、呼吸道症状或下肢肿胀可作为此类患者的预警指标之一,必要时尽快完善肺动脉CTA,减少误诊.

Pressure injury is a common problem faced by global health care institutions, which seriously threatens the lives and health of patients. The treatment and care of pressure injuries need people in multiple professional fields to work together. This article interprets the assessment and planning part of the clinical practice guideline for the third edition of " Assessment and Management of Pressure Injuries for the Interprofessional Team" developed by the Registered Nurses' Association of Ontario, Canada. This article aims at helping the interprofessional team conduct accurate, comprehensive, and full-process assessments of patients with pressure injuries, formulate a reasonable diagnosis and treatment plan, and providing a basis for the implementation of correct treatment measures, so as to promote the improvement and healing of pressure injuries.

Objective:To explore the changes of cerebral blood flow (CBF) perfusion caused by N 2O (laughing gas) abuse. Methods:From December 2017 to October 2018, the CBF perfusion images of 24 patients with laughing gas abuse (9 males, 15 females; age: 18-32(24.0±8.9) years) from China-Japan Friendship Hospital were analyzed retrospectively. The region uptake statistics of different brain regions of interest (ROI) (basal ganglia, central region, cerebellum, cingulate gyrus, frontal lobe, medial temporal lobe, occipital lobe, parietal lobe, temporal lobe) between patients with laughing gas abuse and normal people of the same age group from background software database were calculated automatically. Statistic>1.68 indicated the increase of local CBF perfusion, while statistic < -1.68 indicated the decrease of local CBF perfusion. The correlation between the statistics of bilateral brain regions and the correlation between statistical values and clinical indicators were analyzed by Pearson and Spearman correlation analyses.Results:The correlation of the statistics between bilateral regions of each brain area was significant( r values: 0.503-0.892, all P<0.05). The decreased CBF proportions of frontal and temporal lobes were 62.5%(15/24) and 70.8%(17/24), respectively. The highest proportion of increased CBF was cingulate gyrus (33.3%, 8/24). There were significant correlations between frontal lobe, central brain area and duration of laughing gas abuse ( rs values: 0.375, 0.305, both P<0.05). Conclusion:CBF perfusion imaging is helpful for understanding the changes of CBF in patients with laughing gas abuse.

您好!我母亲今年76岁,长期失眠,入睡困难,每晚需要服用一片到两片镇静催眠药艾司唑仑才能入睡.有时候看见她上午昏昏沉沉的,走路不稳,请问是否和前一天晚上服用安眠药有关?她这样长期吃安眠药是不是成瘾了?老年人服用安眠药应该注意什么?这些药物是否能够长期服用?

您好!我丈夫60岁出头,是刚刚退休不久的一个国企中层干部.他原先在单位里兢兢业业,吃苦耐劳,业务能力强,为人也随和,领导、群众对他评价都很高.眼下退休了,辛苦几十年,是该歇一歇了,可是他却高兴不起来,似乎离开工作岗位就不知道该做什么.他整天拉着脸,家务事也不管,还时常心烦意乱、唉声叹气、发呆发愣,要不就是看哪儿都不顺眼.老朋友、老同事聚会请他,他一概回绝.其实在他临近退休的时候就已经有一些苗头了,总是紧张、担心,觉得自己没有价值了,怕别人嫌弃他多余.当时我觉得他就是有些多虑,静下心来就好了,没想到退休后心事越来越重.为此我和孩子都很着急,希望能够帮助他把心态调整好,快快乐乐地享受生活.您可以给我提些建议吗?

您好!我父亲是一位退休教师,七十多岁了.近半年来性格变化很大,原先内向稳重,但是现在稍不顺心就发脾气.尤其是对家里亲近的人,说出的话非常刻薄,一点儿也不顾及妈妈和我们的感受.其实,我们都照顾和迁就他,但是他这样让人很难接受,这到底是怎么回事呀?

您好!我是一名已经退休四五年的干部,将近七十岁了.本来,退休后的生活应当是相当惬意的,在退休前也有很多计划和憧憬,但是不知为什么,我这几年总是被一些不良的情绪困扰,烦躁、失落、疲劳、孤独感接踵而至,终日无所事事,还容易发脾气.我不愿意把这些不开心的情绪告诉老伴儿和孩子,怕影响他们的生活,但是有时候又忍不住闹情绪,过后冷静了自己也后悔.我应该怎么办呢?

Objective:To investigate the clinical, neuropsychological and regional cerebral blood flow (rCBF) characteristics in patients with psychiatric symptoms caused by nitrous oxide abuse.Methods:Twelve patients with psychiatric symptoms caused by nitrous oxide abuse were enrolled from February 2018 to February 2020 in the Department of Neurology, China-Japan Friendship Hospital and the First Hospital of Tsinghua University.All patients were scored with the brief psychiatric rating scale (BPRS), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). The SPECT/CT images were collected with low-energy and high-resolution collimator.After the pictures were reconstructed, 18 brain regions were automatically sketched and calculated by Database Comparison software.The statistical value of the difference between the general mean value of each brain region and that of the corresponding region of interest in the same age group was estimated.Results:(1)The clinical manifestations of 12 patients were anxiety, depression, hallucination, delusion, and 7 patients were accompanied by cognitive decline.(2)Neuropsychological examination: BPRS score was 57.83±11.15 (anxiety depression factor was 3.94±0.47; lacking active factor was 3.25±0.85; thinking disturbance factor was 3.21±1.27; activity factor was 2.28±0.56; hostility factor was 3.14±1.24). The score of self-knowledge impairment was 2.92±1.08, the score of inability to work was 4.50±1.17, the score of HAMD was 32.75±10.13, the score of HAMA was 18.67±5.80, the score of MMSE was 27.67±2.50, and the score of MoCA was 24.58±3.78.(3)SPECT showed that compared with the general mean value of the corresponding regions of interest of normal people, the patients showed hypoperfusion in the frontal lobe (7 patients, 58.30%) and the temporal lobe (8 patients, 66.70%).Conclusion:Nitrous oxide abuse has an obvious effect on rCBF.The psychiatric symptoms include anxiety, depression, hallucination, delusion and so on, which affect the ability to work and learn.SPECT has important value in the diagnosis of nitrous oxide abuse, and indicates changes in local brain functional activity.

您好!我孙子上初一.这孩子很聪明,成绩还过得去,就是有一点特别让人头疼,他从上小学起就不爱写作业,每天作业都拖拖拉拉到晚上12点还写不完.老师批评他也无济于事.他总是很浮躁,容易冲动,静不下来,做事情没头绪.他时常在课堂上出怪样儿,所以老师和同学都嫌弃他.现在上初中,课业负担重了,他每天都完不成作业,甚至就不写了,这可怎么办呀?

您好!我今年62岁,是—名事业单位的退休职工.前不久,我的一位亲属因为情绪忧郁、失眠多梦去医院就诊,结果被诊断患有抑郁症.他就诊的全过程都是我陪同的,我看到医生给他做了很多问卷调查,请问凭借这些问卷能诊断抑郁症吗?有没有一些简单的工具,在我们感到情绪不好的时候,在家里就能自己检查,判断自己是否患有抑郁症?

您好!我的孙子10岁,上小学四年级.最近3个月来,他经常失眠,夜里睡不着觉,导致白天没精神,上课犯困,听讲时注意力总是不集中,学习成绩也下降了.他的爸爸妈妈急得一筹莫展,我们做爷爷奶奶的也很担心,小孩子怎么就失眠了呢?我们家长应该怎么做才对?

您好!我母亲今年不到七十岁.年轻时注意锻炼,退休后每年体检也都没发现什么问题,按说身体挺好的,没有严重疾病,可是最近这半年她时常去医院“看病”.母亲几乎天天都会说自己难受,还经常后背疼、出虚汗、疲劳、乏力、坐立不安,所以她就怀疑自己是不是脑血管出问题了?心绞痛了?肾虚了?必须得上医院看大夫,做检查.看了好几个科室,神经科、心脏科、肾内科、内分泌科都看了,做了好多化验检查,什么病也没查出来,母亲终日心烦意乱,您能帮我分析一下这是怎么回事吗?

您好!我儿子、儿媳都是医务工作者,今年新冠疫情期间工作特别忙,上小学五年级的孙女停课了,就放在我家里照看.上半年的假期特别长,我发现孩子总是自己待在房间里,闷闷不乐.4月份开始上网课之后,她每天对学习漫不经心,十分松懈,有时候拿着手机没听网课,而是在玩游戏,生活一点儿规律都没有,晚睡晚起,暴饮暴食,有时还会烦躁、闹脾气.疫情减轻之后,她也不愿出门,状态也没恢复过来,没有以前活泼了,不爱写作业,对父母的要求也听不进去.如今又开始放暑假了,我真不知道该怎么帮助她了. 重庆武先生