![\"考生高考前被撞失忆](\"http://01luntan.com/ly_img/uimgs/1496984360480.jpg\" "\\"考生高考前被撞失忆")
本病是胎儿期神经管闭合不全后的一种常见畸形，其病因可能是与中枢神经系统在发育中对各种创伤、感染、放射性照射或化学性损害等因素的易感性有关，但具体某一因素致哪一种畸形，目前尚未清楚。孕妇在妊娠早期应避免上述因素的接触；一旦婴儿在生后发现头部膨出物时，不要用民间膏药外敷消肿，以免肿物溃破引起脑膜炎，宜到医院接受医生指导治疗。手术后患儿应避免过多哭闹、咳嗽，防止修补的脑膜破裂，颅内容再膨出。
一、原因分析
尿崩症的发生是由于下丘脑的视上核、室旁核、灰白结节、神经纤维束通路和脑垂体的损害，影响抗利尿激素 \n(adh)的分泌、释放和贮存减少，导致adh缺乏或肾小管对 \nadh失去反应，从而出现每天排出大量稀释性尿液。头部外伤后尿崩症系下丘脑或垂体柄损伤所致，垂体柄在颅底相对固定，颅底骨折由于外伤当时的旋转和剪力机制引起下丘脑或垂体柄的损伤而发生尿崩症。
二、 护理
1 病情观察
生命体征、神志、瞳孔的观察： 30 \nmin/次，准确记录，颅脑外伤患者首先应该着眼于颅内病情尤其是颅内压的变化的观察，如有血压、心率的变化，同时应及时准确计算出入量是否平衡。如有尿量突然增多并且排除利尿等因素的影响，应注意补充液体，纠正低血容量和电解质的紊乱，使生命体征恢复正常；尿量、烦渴的观察：对于清醒患者有烦渴症状要引起足够的重视，监测尿量和尿比重，有尿崩症表现应该及时处理。昏迷患者注意记录每小时尿量，观察尿的颜色， \n发现尿液增多，颜色逐渐变淡提示多尿或尿崩症的出现，每小时尿量>200 m，l比重<1. \n006，应该及时处理，我们的经验是，清醒患者嘱其多饮水；昏迷患者从胃管内补充所失去的体液，或者从静脉补充，但应注意防止补液过多造成脑水肿或心脏负担过重；水电解质平衡的监测：遵医嘱及时准确的监测血中k+、na+、cl-、ca2+、血糖、尿比重及血浆渗透压， \n4 h/次~ 6 \nh/次。观察患者有无面色的改变、全身乏力、肢体抽搐及意识淡漠等变化。通过血生化的监测了解机体水电解质平衡状态，合理的补充，保持机体内环境的平衡。清醒患者可以口服的尽量口服补充，有胃管的尽量从胃管鼻饲，急性失液经静脉补充。
2 药物治疗的监测
危重患者在尿崩症初期均采用垂体后叶素4 u~8 u皮下注射， 6 h/次~8 h/次，尿量控制后改为弥凝片口服，根据病情调整用药剂量。患者均在10 \nd左右尿量得到很好的控制，改为口服弥凝片。在用药的过程中要注意药物反应，出现过敏现象的及时停药，还应该注意尿量的变化，少尿时及时的调整用药剂量或停药。
3 加强基础护理，预防并发症
呼吸道管理：颅脑损伤患者宜尽早做气管切开，并且使用带气囊的气管导管，以防止口腔的分泌物和痰误吸入气管造成窒息，呼吸道管理不好容易造成脑缺氧加重病情，同时也增加了肺部感染的机会。在临床护理过程中，应及时的清理呼吸道的分泌物，颅底骨折的血液，呕吐物等，注意翻身、叩背以防止痰液堵塞气管支气管造成窒息或感染；口腔、皮肤护理：尿崩症的患者往往口腔黏膜、舌头及皮肤干燥，弹性差，注意口腔护理，同时保持皮肤润滑， \n适当使用护肤品，勤换衣裤，保持床单清洁、平整；饮食护理： \n危重患者应从鼻饲中补充水分及必要的营养，避免高蛋白，鼻饲不足的要经静脉补充，便秘者酌情运用导泻药。
于2006年发现有手指抖动症状。渐进出现活动僵硬症状。目前不能自理，运动困难。搀扶可以走路。睡觉不能自主翻身。想问问神经外科是否能做脑内深部电极植入？整个治疗过程需要多长时间？电池需要多久更换？电池能否充电？整个费用怎样？或者是否还有更好的治疗方案？谢谢
","barId":"1690","topicTypeId":null,"topicThemeId":"1020","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"2093","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"颅骨修补两边有点不对称","content":"男,26岁。因为脑外伤导致颅内压高去双侧额骨骨瓣减压，三个月左右实行ct三维塑型钛网修补术到现在已经九个月了，术后恢复正常，刀口已经愈合！现在就是从镜子中看出左侧钛网边缘跟右侧钛网边缘交汇的地方左侧钛网边缘微高于右侧，用手也能摸的到！因为这个自己心里压力很大，很担心左侧钛网边缘是不是螺钉破松动导致钛网边缘翘起来了！但是我又没有感觉有什么不适！又不痛，皮肤也不红！
钛网边缘凸出是钛网与骨窗没有贴合紧密还是钛钉松动引起钛网边缘翘起？
这是什么原因呢？是否正常？
","barId":"1690","topicTypeId":null,"topicThemeId":"1019","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":3},{"id":"2387","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"颅骨裂临床表现","content":"临床表现：
\n颅骨裂和有关畸形主要表现为囊性膨出统称为脑膨出(encephalocele或cephalocele)因膨出大小部位不同而表现各异 。
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","barId":"1690","topicTypeId":null,"topicThemeId":"1016","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"2692","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"什么是颅裂","content":"
颅裂为先天性颅骨缺损，分隐性和显性两类。隐性颅裂为单纯颅骨缺损，极少见。显性颅裂则有颅内容物自颅骨缺损处呈囊性膨出，又称为囊性颅裂，较常见。颅裂多发于颅骨中线。在颅盖者多见于枕部，少数见于额部、顶部。在颅底者多发于鼻根部，少数见于鼻腔、鼻咽腔或眼眶等处。根据膨出物不同，显性颅裂又分五类：①脑膜膨出(内容为脑膜、脑脊液)；②脑膨出(内容为脑膜、脑实质)；③脑膜脑膨出(内容为脑膜、脑实质、脑脊液)；④脑囊状膨出(内容为脑膜、脑实质、部分脑室)；⑤脑膜脑囊状膨出(内容为脑膜、脑实质、部分脑室及位于脑膜与实质之间的脑脊液)。
【诊断要点】
1．头部中线囊性肿物。多于出生时即存在，可逐渐增大。哭闹时触之可有冲动感。
2．透光试验可阳性或阴性，注意内容物之阴影。
3．肿物表面皮肤有否变薄、糜烂或形成溃疡。
4．头颅大小，特别测量乳突问顶半周，一般小于正常。
5．鼻根部囊性颅裂可有颜面畸形，如鼻根扁阔，眼距增宽，闭眼不全等。
6．身体及智力是否低于正常，有无神经症状。
7．颅骨x线片显示颅骨缺损。
8．ct或mri检查可予确诊。
【处理原则】
1．囊壁已溃破或有即将溃破可能者需急症处理。
2．无囊壁溃破可能者宜于出生后6个月至l岁间手术。目的是切除膨出物及其内容物，封闭颅裂缺口。
3．鼻腔或鼻咽腔部囊性颅裂堵塞呼吸道严重者应提早手术。
4．鼻根部囊性颅裂应于l岁后手术。先经颅内修补，3个月后再经颅外囊肿切除，可同时矫正鼻眼部畸形。亦可3岁一4岁后行第三期手术整容。鼻根部单纯脑膜膨出者可经颅外一次手术切除。但颅骨缺损较大者仍以先行颅内修补为宜。
5．顶盖部隐性颅裂，一般可不手术。
6．合并脑积水者应先做脑脊液分漉术，再做修补术。
【住院标准】
有手术指征者需住院治疗。
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6日下午，小杨骑电动车去认考场，满脸血的回到家，疑似被车撞。经诊断，小杨严重的脑震荡，问什么都不知道，我出去干嘛了？我被人撞了？我没事儿啊…第二天，小杨看手机才得知要高考，坚持前去考试。
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失忆症小知识：
\n原因有器官性原因或功能性原因。器官性原因包括大脑因创伤或疾病遭到损害，或使用某些（通常是镇静类）的药物而造成。功能性的原因是心理因素，如心理防卫机制。失忆症是由于脑部受创而产生的病症，主要分为心因性失忆症和解离性失忆症。
\n按失忆内容长短分为暂时失忆和永久失忆：
\n（1）暂时性失忆
\n①暂时性失忆是由于大脑受到外界的剧烈碰撞，造成脑积血，血块压住部分记忆神经导致失忆。等到手术后放出血后，就会恢复记忆。
\n②暂时性失忆通常人在遭受到重度社会心理压力之时，经由个人意识、认同或行为协调突然地暂时性地改变,容易造成身心崩溃,如果是意识发生改变,则记不起来重要的个人事件,便发生了心因性失忆症。如果紧张过度也会暂时失忆。例如上台表演忽然忘记歌词或是台词，这也是暂时失忆。
\n![\"考生高考前被撞失忆](\"http://01luntan.com/ly_img/uimgs/1496983829322.jpg\" "\\"考生高考前被撞失忆")
（2）永久失忆即是人类的记忆遗失、损失，有如电脑记忆体资料消失，找不到回来。
\n![\"考生高考前被撞失忆](\"http://01luntan.com/ly_img/uimgs/1496983716306.jpg\" "\\"考生高考前被撞失忆")
关于此事，且看网友如何评论：
\n锦鲤祈福：有些心酸
\n宇哥曾经的王：我是谁 我在哪 不重要 我要高考
\n橘子带你告别吃土o3o：高考可以唤醒记忆
\n我爱你：希望你警察叔叔尽快把肇事者找到，好给杨雪伟和家人赔偿好让爸孩子的病治好了。否则孩子这辈子就毁了。这孩子是家里唯一的希望。好不容易盼到孩子考大学了，结果…………希望平安无事。
\n吻替：原来真的有失忆这件事！我以为电视里都是骗人的呢
\n一只帅气阳：真的会有选择性失忆症，我女朋友去年骑车摔倒，打电话给我上来就哭说不知道在哪，最近发生的事全忘了，只记得以前的。好在没把我忘了
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我爱人09年得了帕金森，一直服美多芭，现在达到日服3片，出现剂末和剂峰现象，病人痛苦不堪。更不幸的是9月初得了肺癌，化疗五次，基本控制住。但是化疗中美多芭不起作用，结束后药效维持一个小时左右，病人生不如死。他这种情况有什么好的治疗办法和方案？能安装起搏器？
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