【摘要】：研究目的:了解顱腦損傷引發(fā)精神障礙的臨床特征和相關(guān)影響因素,分析高壓氧治療顱腦損傷并發(fā)狂躁型精神障礙患者的效果,為更加全面的認(rèn)識(shí)該病的特征和探索有效的治療方法提供依據(jù)。研究方法:1.采用回顧性方法,收集2005年-2014年清遠(yuǎn)市人民醫(yī)院神經(jīng)外科及精神康復(fù)中心治療的顱腦損傷并發(fā)精神障礙患者的臨床資料,分析其流行病學(xué)特征和臨床特征。2.從入選患者中選擇顱腦損傷并發(fā)狂躁型精神障礙患者26例,根據(jù)患者的臨床治療方法分為高壓氧治療組(n=13)和常規(guī)治療組(n=13)。常規(guī)治療組采用常規(guī)方法治療,高壓氧治療組在常規(guī)治療的基礎(chǔ)上增加高壓氧治療。兩組治療前、后分別采用格拉斯哥昏迷評(píng)分(Glasgow Coma Scale GCS)來(lái)評(píng)價(jià)患者的昏迷情況,采用格拉斯哥預(yù)后評(píng)分(Glasgow Outcome Scale GOS)評(píng)價(jià)患者的精神障礙癥狀,采用MRI影像學(xué)資料分析患者的顱腦損傷情況,比較兩組患者并發(fā)癥的情況和臨床療效。3.采用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)數(shù)資料采用n(%)表示,組間比較采用χ2檢驗(yàn)。檢驗(yàn)水準(zhǔn)α取0.05,當(dāng)P0.05,認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果:1.年齡和性別分布:共840例符合納入標(biāo)準(zhǔn),患者年齡為3-79歲,平均年齡(41.3±17.9)歲,以男性居多,占 82.6%(694/840)。25 歲以下為 42.9%(360/840),25-54 歲組為 42.9%(360/840),大于 55 歲組為 14.3%(120/840)。2.臨床特點(diǎn):840例患者中,躁狂性精神障礙217例(25.8%),癡呆95例(11.3%),遺忘220例(26.2%),人格改變103例(12.3%),神經(jīng)癥樣綜合癥120例(14.3%)。重型顱腦損傷患者的狂躁性精神障礙、癡呆、遺忘、人格改變、情感障礙及神經(jīng)癥樣綜合征發(fā)生率顯著高于中型顱腦損傷患者(p0.001);中型顱腦損傷的狂躁性精神障礙、癡呆、遺忘、人格改變、情感障礙及神經(jīng)癥樣綜合征發(fā)生率顯著高于輕型患者(p0.001)。左側(cè)額葉損傷、左側(cè)顳葉損傷及多葉合并損傷的躁狂性精神障礙、癡呆、人格改變、情感障礙及神經(jīng)癥樣綜合征發(fā)生率顯著高于右側(cè)額葉損傷及右側(cè)顳葉損傷(P0.001);多葉合并損傷的躁狂性精神障礙、癡呆、人格改變、情感障礙及神經(jīng)癥樣綜合征發(fā)生率明顯高于左額葉損傷及左顳葉損傷(P0.001)。右額葉損傷的遺忘發(fā)生率顯著高于左額葉損傷、左顳葉損傷及右顳葉損傷(P0.001)。3.高壓氧治療顱腦損傷并發(fā)狂躁型精神障礙患者效果:高壓氧治療組13例中,男性7例,女性6例,年齡(35-67)歲;對(duì)照組的13例中,男性8例,女性5例,年齡(36-69)歲。兩組治療前神經(jīng)功能缺損評(píng)分、水腫面積、GCS及GOS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療組恢復(fù)良好率為69.23%,顯著高于常規(guī)治療組(38.46%);高壓氧治療組植物生存率(15.38%)及死亡率(7.69%),低于常規(guī)治療組(分別為30.77%和15.38%),但差異沒(méi)有統(tǒng)計(jì)學(xué)意義;高壓氧治療組治療后神經(jīng)功能缺損評(píng)分和水腫面積,顯著低于常規(guī)治療組(P0.05);高壓氧治療組治療后GCS評(píng)分和GOS評(píng)分,顯著高于常規(guī)治療組(P0.05)。結(jié)論:1、顱腦引發(fā)精神障礙以遺忘最多見,其次為躁狂性精神障礙。2、顱腦損傷引發(fā)的精神障礙與顱腦損傷的程度與部位相關(guān)。3、高壓氧治療可明顯改善顱腦損傷合并狂躁性精神障礙患者的臨床癥狀,且有良好的安全性。
[Abstract]:Objective: To understand the clinical characteristics and related factors of craniocerebral injury-induced mental disorders, and to analyze the effect of hyperbaric oxygen therapy on craniocerebral injury patients with manic mental disorders, so as to provide evidence for a more comprehensive understanding of the characteristics of the disease and explore effective treatment methods. Methods: 1. Retrospective methods were used to collect data from 2005 to 2014. The clinical data of 26 patients with craniocerebral injury complicated with manic mental disorder were analyzed. 2. 26 patients with craniocerebral injury complicated with manic mental disorder were selected from the selected patients and divided into hyperbaric oxygen treatment group according to the clinical treatment method (n = 1). 3) and routine treatment group (n = 13). Routine treatment group was given routine treatment, and hyperbaric oxygen treatment group was given hyperbaric oxygen treatment on the basis of routine treatment. The patients'coma was evaluated by Glasgow Coma Scale GCS before and after treatment, and Glasgow Outcome Scale GO was used. S) Evaluate the symptoms of mental disorders, using MRI imaging data analysis of patients with brain injury, compare the two groups of patients with complications and clinical efficacy. Results: 1. Age and gender distribution: A total of 840 patients met the inclusion criteria, the age of patients was 3-79 years, the average age was (41.3 217 cases (25.8%), 95 cases (11.3%) of dementia, 220 cases (26.2%) of amnesia, 103 cases (12.3%) of personality changes, 120 cases (14.3%) of neurosis-like syndrome. The incidence of manic mental disorder, dementia, forgetting, personality change, affective disorder and neurosis-like syndrome was significantly higher in craniocerebral injury than in mild patients (p0.001). The incidence of manic mental disorder, dementia, personality change, affective disorder and neurosis-like syndrome was significantly higher in left frontal lobe injury, left temporal lobe injury and Multilobe injury. The incidence of manic mental disorder, dementia, personality change, affective disorder and neurosis-like syndrome was significantly higher than that of left frontal lobe injury and left temporal lobe injury (P 0.001). The forgetting rate of right frontal lobe injury was significantly higher than that of left frontal lobe injury, left temporal lobe injury and right temporal lobe injury. The effect of hyperbaric oxygen treatment on craniocerebral injury complicated with manic mental disorder: in the hyperbaric oxygen treatment group, there were 7 males, 6 females, age (35-67) years; in the control group, there were 8 males, 5 females, age (36-69) years. There was no significant difference in the neurological deficit score, edema area, GCS and GOS scores between the two groups before treatment. The recovery rate of the treatment group was 69.23%, significantly higher than that of the conventional treatment group (38.46%); the plant survival rate (15.38%) and mortality rate (7.69%) of the hyperbaric oxygen treatment group were lower than that of the conventional treatment group (30.77% and 15.38% respectively), but the difference was not statistically significant; the neurological deficit score and edema area of the hyperbaric oxygen treatment group were significant after treatment. The scores of GCS and GOS in the hyperbaric oxygen treatment group were significantly higher than those in the conventional treatment group (P 0.05). Conclusion: 1. Forgetting was the most common cause of mental disorders, followed by manic mental disorders. Improve the clinical symptoms of patients with craniocerebral injury combined with manic mental disorder, and have good safety.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.12

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張慶原;彭偉;李建東;;高壓氧綜合治療顱腦損傷并發(fā)精神障礙的臨床觀察[J];甘肅科技;2015年17期

2 Yang Wang;Shuquan Zhang;Min Luo;Yajun Li;;Hyperbaric oxygen therapy improves local microenvironment after spinal cord injury[J];Neural Regeneration Research;2014年24期

3 張溢華;邱俊;周繼紅;徐倫山;許民輝;;159242例顱腦交通傷流行病學(xué)分析[J];中華創(chuàng)傷雜志;2014年12期

4 Wei Wang;Jun Gao;Lei Na;Hongtao Jiang;Jingfeng Xue;Zhenjun Yang;Pei Wang;;Craniocerebral injury promotes the repair of peripheral nerve injury[J];Neural Regeneration Research;2014年18期

5 金建烽;王志偉;孫劍;丁睿鷹;嚴(yán)清章;徐樂(lè)平;;晚發(fā)性精神分裂癥患者雙側(cè)額葉指數(shù)的對(duì)照研究[J];中國(guó)健康心理學(xué)雜志;2014年08期

6 楊昌美;;護(hù)理干預(yù)對(duì)重型顱腦損傷并發(fā)急性精神障礙患者預(yù)后的影響[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2014年13期

7 張志華;郭榜虎;郝文光;許信龍;;老年顱腦損傷后并發(fā)精神障礙的臨床分析及治療[J];中國(guó)現(xiàn)代醫(yī)生;2014年10期

8 于越;;顱腦損傷并發(fā)精神障礙臨床觀察與護(hù)理[J];環(huán)球中醫(yī)藥;2013年S2期

9 戴云飛;肖澤萍;;中國(guó)精神障礙分類與診斷標(biāo)準(zhǔn)第3版與國(guó)際疾病分類第10版的比較[J];臨床精神醫(yī)學(xué)雜志;2013年06期

10 Su Liu;Guangyu Shen;Shukun Deng;Xiubin Wang;Qinfeng Wu;Aisong Guo;;Hyperbaric oxygen therapy improves cognitive functioning after brain injury[J];Neural Regeneration Research;2013年35期

相關(guān)博士學(xué)位論文 前1條

1 祁伯祥;高壓氧治療新生大鼠缺氧缺血性腦損傷毒副作用的實(shí)驗(yàn)研究[D];中南大學(xué);2006年

相關(guān)碩士學(xué)位論文 前10條

1 李建波;顱腦損傷患者高壓氧治療后腦血流動(dòng)力學(xué)變化的臨床研究[D];延安大學(xué);2014年

2 姜泱;顱腦損傷合并肺部感染中醫(yī)證型與病原學(xué)特點(diǎn)的臨床研究[D];廣西醫(yī)科大學(xué);2014年

3 江s，

本文編號(hào)：2206544