{"nowTime30":1711714553778,"lyBarModerator":null,"metaSearch":{"description":"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。 \n\n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","keywords":"考生高考前被撞失忆 考试第一题1+1=?_洞医","title":"考生高考前被撞失忆 考试第一题1+1=?_洞医","channels":null},"identificate":{"id":"0300b4bddfaf11e6a61c00163e04584d","isDel":0,"createAt":1484985344390,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","realName":"赵玉","certifiedStatus":2,"phone":"111111111111","email":"2276635444@qq.com","hospitalId":"31c19c1b453011e69d4700163e005165","departmentId":"2000","illName":"","illId":"793a72a2bb5f11e6a61c00163e04584d","cardType":1,"cardImg":"http://01luntan.com/ly_img/1484985951761.jpg","idCardImg":"","identityType":2,"stop":0,"departmentName":"儿科","hospitalName":null},"canEdit":null,"adList":[],"lyBar":{"id":"1690","isDel":0,"createAt":1483439340281,"createBy":"system","createName":"system","updateAt":0,"updateBy":null,"updateName":null,"userId":null,"name":"北京协和医院神经外科","type":101,"twoCode":"http://zhao01.com/zly_img/zly_wx.jpg","image":null,"provinceId":"110000","cityId":"110101","illId":null,"hospitalId":"15009","keyWord":null,"totleTopic":0,"barDesc":null,"discussBarType":null,"metaSearch":"{\"description\":\"洞医为您提供:北京协和医院神经外科专家、北京协和神经外科专家、北京协和神经外科电话、病友的治疗经验等相关信息,让您在便捷的求医路上不花一分冤枉钱。\",\"keywords\":\"北京协和医院神经外科专家_北京协和神经外科专家_北京协和神经外科电话_洞医\",\"title\":\"北京协和医院神经外科专家_北京协和神经外科专家_北京协和神经外科电话_洞医\"}","adInfo":null},"isLikeThisTopic":null,"lastTopics":[{"id":"1899","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"颅裂的预防","content":"
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":"1169","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"帕金森病人有什么好的治疗方法","content":"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?
","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":2},{"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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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。
浙青网-青年时报消息,正在教室安静写作业,谁知一个“火影忍者”飞镖忽然飞来插入头顶。昨天下午,杭州某学校11岁女生雯雯被紧急送到浙江大学医学院附属儿童医院神经外科。
飞来横祸插入头顶飞来横祸插入头顶
昨天下午5点多,浙大儿院神经外科副主任医师沈志鹏接到急诊求助。赶来一看,一个女孩左侧头顶被插入一个飞镖。雯雯家长反映,雯雯下午课间时在教室里写作业,同班的同学在玩飞镖时不慎将她砸中。
“可以看得出,这个飞镖仿真度特别高,是金属制品,飞镖的一角像针刺一样牢牢插入头顶左侧。飞镖插入多深?是否伤及脑实质?这些都需要进一步探查。”沈志鹏告诉记者,当时,神经外科立马为雯雯做了CT,检查发现,飞镖一角穿透头皮2cm,但具体伤到什么程度,只能通过手术才能发现。
术前,雯雯的家长十分紧张。“当时有两个方案,一个是直接清创拔出,另一个则需要打开头皮颅骨进一步探查,但对雯雯的创伤无疑是非常大的。在经过反复研究讨论后,家长决定清创拔出。” 沈志鹏说,“昨天晚上10点,手术开始了,手术过程中,我们发现已经穿透整个颅骨,所幸的是被颅骨下一层黏膜挡住,没有损伤到脑实质。”
整个手术进行了一个小时。术后,雯雯的状态比较好。今天上午查房时,雯雯表示除了伤口处还有点疼,其他也都好。沈志鹏谈到,接下来还要观察伤口是否会继续感染,需要核磁共振再检查,如果没有其他问题,过3-5天就可以出院了。
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网上仿真玩具太多风险大
近几年,沈志鹏遇到形形色色的患儿,可被飞镖砸中插入颅骨的还没有遇到过。这样的玩具也让不少家长感到担忧。
对此相关网友如下表示:
\n秋风素意:强烈建议家长一定要看管好自己的小孩,不要孩子要什么就给,万一那天小孩说要把刀,难道家长真的去买吗?出了这样的事,家长先反省反省
你是绿色酿的酒:子不教 父之过 这家长也是有病 小孩子玩这样杀伤性玩具也不知道管管或者叮嘱不要在人多的地方玩
狙肉脯哈你切:所幸没有生命危险这让女孩子们对顽劣男同学的印象更加坏了
微梁平:学校的管理跟上了吗?这些东西根本应当严禁带入学校。
小小鸟小小人666:这样还怎么让我们放心的把孩子交给学校!还有这些没脑子的家长!什么都给!哪天说给毒药小孩自己吃,也给么!!!
宸睿小王子:幸好孩子没有生命危险!可是这也必然对她生活完成严重影响。严查管制刀具和利器。
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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。
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(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。
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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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