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神经内科危重症及监护监测

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神经内科危重症及监护监测

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神经内科危重症患者发病率高,死亡率、致残率极高,给个人、家庭、社会带来了沉重的负担,随着我国人群预期寿命的延长和人口老龄化速度的增快,该系统疾病的发病率和患病率还有逐渐增加的趋势,这一现象主要是与疾病本身的性质有很大关系。以往,临床上对某些神经系统疾病以诊断清楚为目的,对其治疗则多无良策。随着医疗水平迅速发展,目前临床上对神经内科危重症抢救都是争分夺秒,以期达到早期准确诊断,治疗上对症下药,达到预期目的。为了提高神经科医生的治疗水平,使病人得到及时合理的治疗,尽早康复,作者总结了从事神经内科工作多年的经验,参阅了国内外有关资料,编著了《神经内科危重症及监护监测》。《神经内科危重症及监护监测》共分为十七章,分别叙述了神经系统危重症及其监护监测的内容。
《神经内科危重症及监护监测》内容丰富、条理清楚,以治疗为主,力求简明扼要,通俗易懂,实用性强,实实在在地向读者介绍临床实用的理论和技术,提高危重患者抢救成功率,推动我国危重病相关医学事业的发展,造福于人。由于作者能力和水平有限,书中一定存在一些不尽如人意的地方和错误,真诚地希望得到读者及同道的批评指正。
Catalogue

第一章 脊髓疾病
第一节 急性脊髓炎
第二节 脊髓压迫症
第三节 脊髓血管病
第四节 脊髓蛛网膜炎
第五节 脊髓空洞症

第二章 颅内高压综合征

第三章 脑血管疾病
第一节 脑出血
第二节 脑梗死
第三节 脑栓塞
第四节 短暂脑缺血发作

第四章 颅内感染性疾病
第一节 化脓性脑膜炎
第二节 结核性脑膜炎
第三节 隐球菌性脑膜炎
第四节 单纯疱疹病毒性脑炎
第五节 神经性梅毒
第六节 脑囊虫病
第七节 艾滋病的神经系统病变
第八节 脑蛛网膜炎

第五章 癫痫持续状态

第六章 脱髓鞘疾病
第一节 视神经脊髓炎
第二节 多发性硬化
第三节 急性播散性脑脊髓炎
第四节 脑桥中央髓鞘溶解症
第五节 急性出血性脑白质炎

第七章 急性炎症性脱髓鞘性多发性神经病

第八章 神经一肌肉接头和肌肉疾病
第一节 重症肌无力危象
第二节 进行性肌营养不良症

第九章 周期性瘫痪

第十章 自主神经系统疾病
第一节 原发性体位性低血压
第二节 进行性脂肪营养不良
第三节 血管迷走性晕厥

第十一章 锥体外系疾病
第一节 帕金森病
第二节 迟发性运动障碍
第三节 肝豆状核变性

第十二章 神经系统中毒
第一节 中暑
第二节 一氧化碳中毒
第三节 药物中毒
第四节 农药中毒
第五节 食物中毒
第六节 乙醇中毒

第十三章 神经内科危重症监护简介

第十四章 神经系统脑检测
第一节 脑电图监测
第二节 诱发电位监测
第三节 自主神经功能监测
第四节 神经内分泌功能监测
第五节 脑血流监测
第六节 颅内压监测
第七节 脑组织氧监测

第十五章 神经重症监护病房中的发热和感染

第十六章 意识障碍

第十七章 神经系统危重病的并发症
Book Abstract

《神经内科危重症及监护监测》:
临床上,根据骨髓供应者的不同,可将骨髓移植分为以下三种:①同种同基因骨髓移植.同种即人与人之间,而同基因则必须是同卵双胎;②同种异基因骨髓移植,供髓者必须与患者HLA配型相一致的健康人,通常为患者的兄弟姐妹;③自身骨髓移植:骨髓来源取于患者本人,但必须在疾病的缓解期或造血功能未受累时采取骨髓,并在低温下冻藏备用。
(2)胸腺移植:感染HIV后,T淋巴细胞被大量破坏。T淋巴细胞是人体中最重要的免疫细胞,它可抗细菌、病毒、真菌等病原体的感染,可直接溶解和杀伤瘤细胞。
(3)淋巴细胞输注。
(四)处理机会性感染
针对不同的病因给予相应的抗病毒、抗结核或抗菌治疗。如脑弓形虫病用乙胺嘧啶和磺胺嘧啶,单纯疱疹病毒感染用阿昔洛韦,真菌感染用两性霉素B。巨细胞病毒所致的神经根病的进行性疼痛,早期可用阿昔洛韦及三环类抗抑郁药如阿米替林等治疗。
(五)治疗肿瘤
根据病情选用化学药物治疗、放射治疗、手术治疗及其他对症支持治疗。
第八节脑蛛网膜炎
脑蛛网膜炎是指脑蛛网膜在某些病因的作用下发生的一种组织反应,以蛛网膜的增厚、粘连和囊肿形成为主要特征。引起对脑和脑神经的压迫和供血障碍的一种疾患。急性、亚急性或慢性起病。症状常可自发缓解或复发加重。复发加重多与感冒、受凉和劳累有关。好发于青年和中年人,性别上无较大差异。
【救治流程】
1.主诉头痛、呕吐、眩晕,或耳聋、耳鸣、周围性面瘫、头痛和癫痫发作,或偏瘫、失语等。
2.病史病前可有发热、感染、颅脑外伤、蛛网膜下隙出血或椎管内药物注射史,或全身、头部有感染病灶等。
3.体征进行性视力减退、视盘水肿。
4.急救措施给予20%甘露醇快速静脉滴注,做好术前准备。
5.辅助检查急性期脑脊液细胞数多稍有增加(50×106/L以下),以淋巴细胞为主,慢性期可正常。蛋白定量可稍增高。
6.诊断根据临床表现及辅助检查即可确诊。
7.制订详细的治疗方案①非手术治疗;②手术治疗。
【救治关键】
(一)病情判断
1.主要症状可表现为急性,亚急性或慢性病程。患者出现程度不同的发热和全身症状由于脑蛛网膜炎主要侵犯的部位是颅后窝、视交叉和大脑半球凸面等处,有如下临床特点。
(1)视交叉部蛛网膜炎:是脑底部蛛网膜炎最常见的类型。最早期和主要的症状是慢性头痛和视力障碍。头痛多在额、颞部或眼眶部。常伴有一侧缓慢进行性视力减退,数月后波及对侧,少数两侧同时减退,仅累及一侧视神经者较少。视力减退大多早期出现并发展较快,往往有反复,经抗感染治疗后可好转,而在劳累、感冒、鼻窦炎发作、过量饮酒后又再发而逐渐加重,严重者1~2周内失明。视野缺损方面,由于粘连损害视神经的部位和程度不同,视野可出现多样化和不典型改变,其特点是早期出现中心暗点或旁中心暗点,周边视野不规则,如向心性视野缩小,两颞侧偏盲和鼻侧视野缩小等不典型改变。眼底检查早期可无改变,逐渐出现原发性或继发性视神经萎缩、视盘炎和一侧原发性视神经萎缩与另一侧视盘水肿等改变。较广泛的脑底部蛛网膜炎,还可出现工~Ⅵ脑神经损害的征象,少数下丘脑受累者可有尿崩症、嗜睡症、肥胖、性功能减退等症状。
(2)颅后窝蛛网膜炎:此区蛛网膜粘连很常见。大约占所有蛛网膜炎的1/3,与颅后窝肿瘤的比例大约为7:1。颅后窝蛛网膜炎容易致脑脊液循环障碍,引起颅内压增高症状。按病变的不同部位,又可分为三种类型。
①中线型:在颅后窝中最常见。主要粘连病变在正中孔、侧孔、枕大池和枕骨大孔区。最易引起梗阻性脑积水和早期颅内压增高症状。患者早期头痛显著,继而出现呕吐和视力减退等症状。神经系统检查除视盘水肿或继发性萎缩、展神经麻痹、颈强直等颅内压增高的症状和体征外,局限病征多不明显。但发病较快、病情较重,少有缓解。
②小脑凸面型:病程较缓慢,一般为1~3年。蛛网膜炎所形成的囊肿可压迫小脑半球出现一侧小脑共济失调和眼球震颤,但不如小脑肿瘤那样显著。
③小脑脑桥型:主要病变在脑干腹侧区。常有一侧不同程度的脑神经损害;包括三叉神经、面神经、听神经的不全麻痹和面肌痉挛。同侧小脑性共济失调和眼球震颤较轻或缺如,颅内压增高症状出现较晚。当炎症粘连波及颈静脉孔区时,则可有同侧舌咽、迷走和副神经损害的征象。此型病情发展较慢,症状持续时间较长,病程可长达数年。【救治方案】1.非手术治疗一般早期或急性期病例应先采用各种药物或措施进行综合治疗,其目的在于控制蛛网膜炎症、松解炎性粘连和降低颅内压力,并对原发感染病灶进行治疗。
(1)抗生素:对非特异性蛛网膜炎不是特效的,但在治疗可能存在于颅内或身体其他部位的隐性或显性细菌性感染;特别在蛛网膜炎活动期,可收到一定效果。
(2)肾上腺皮质激素:对防治蛛网膜粘连和炎症有较好的效果,初期应用效果较好。用药期间应注意补充氯化钾。如经过一个疗程有效,必要时可重复使用。
(3)降低颅内压力:可以采用20%的甘露醇、甘果糖(甘油果糖)、利尿药等。
(4)其他药物:如神经营养药和血管扩张剂等。
2.手术治疗
(1)颅后窝探查术:对小脑半球和桥小脑角的蛛网膜粘连和囊肿进行剥离和切除,可收到一定效果。对中线型第四脑室正中孔和小脑延髓池的粘连和囊肿可行剥离和切除,并使中孔开放。如枕大池广泛粘连影响脑脊液循环吸收,可先行枕肌下减压术,以后再考虑做脑室腹腔分流术。
(2)视交叉部探查术:视交叉部蛛网膜炎视力减退和视野缺损,经积极对症治疗不见好转甚至不断恶化时,可施行粘连与囊肿分离和切除。按常规垂体手术入路,最好在手术显微镜下小心地分离视神经和视神经交叉部的蛛网膜粘连,切除绞窄性的纤维带和压迫性的蛛网膜囊肿,使视神经和视交叉部得到缓解,但不可强行分离,以免增加损害。一般有效率为30%~40%,故术后仍应继续各种综合治疗。
……

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欣叶 御大福 芋头麻薯 180g

周销量 600+

$1.66 $1.99 83折

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