840例颅脑损伤引发精神障碍的病例组分析
发布时间：2018-08-27 07:25
【摘要】：研究目的:了解颅脑损伤引发精神障碍的临床特征和相关影响因素,分析高压氧治疗颅脑损伤并发狂躁型精神障碍患者的效果,为更加全面的认识该病的特征和探索有效的治疗方法提供依据。研究方法:1.采用回顾性方法,收集2005年-2014年清远市人民医院神经外科及精神康复中心治疗的颅脑损伤并发精神障碍患者的临床资料,分析其流行病学特征和临床特征。2.从入选患者中选择颅脑损伤并发狂躁型精神障碍患者26例,根据患者的临床治疗方法分为高压氧治疗组(n=13)和常规治疗组(n=13)。常规治疗组采用常规方法治疗,高压氧治疗组在常规治疗的基础上增加高压氧治疗。两组治疗前、后分别采用格拉斯哥昏迷评分(Glasgow Coma Scale GCS)来评价患者的昏迷情况,采用格拉斯哥预后评分(Glasgow Outcome Scale GOS)评价患者的精神障碍症状,采用MRI影像学资料分析患者的颅脑损伤情况,比较两组患者并发症的情况和临床疗效。3.采用SPSS17.0软件进行统计学分析,计数资料采用n(%)表示,组间比较采用χ2检验。检验水准α取0.05,当P0.05,认为差异有统计学意义。研究结果:1.年龄和性别分布:共840例符合纳入标准,患者年龄为3-79岁,平均年龄(41.3±17.9)岁,以男性居多,占 82.6%(694/840)。25 岁以下为 42.9%(360/840),25-54 岁组为 42.9%(360/840),大于 55 岁组为 14.3%(120/840)。2.临床特点:840例患者中,躁狂性精神障碍217例(25.8%),痴呆95例(11.3%),遗忘220例(26.2%),人格改变103例(12.3%),神经症样综合症120例(14.3%)。重型颅脑损伤患者的狂躁性精神障碍、痴呆、遗忘、人格改变、情感障碍及神经症样综合征发生率显著高于中型颅脑损伤患者(p0.001);中型颅脑损伤的狂躁性精神障碍、痴呆、遗忘、人格改变、情感障碍及神经症样综合征发生率显著高于轻型患者(p0.001)。左侧额叶损伤、左侧颞叶损伤及多叶合并损伤的躁狂性精神障碍、痴呆、人格改变、情感障碍及神经症样综合征发生率显著高于右侧额叶损伤及右侧颞叶损伤(P0.001);多叶合并损伤的躁狂性精神障碍、痴呆、人格改变、情感障碍及神经症样综合征发生率明显高于左额叶损伤及左颞叶损伤(P0.001)。右额叶损伤的遗忘发生率显著高于左额叶损伤、左颞叶损伤及右颞叶损伤(P0.001)。3.高压氧治疗颅脑损伤并发狂躁型精神障碍患者效果:高压氧治疗组13例中,男性7例,女性6例,年龄(35-67)岁;对照组的13例中,男性8例,女性5例,年龄(36-69)岁。两组治疗前神经功能缺损评分、水肿面积、GCS及GOS评分差异无统计学意义(P0.05)。治疗组恢复良好率为69.23%,显著高于常规治疗组(38.46%);高压氧治疗组植物生存率(15.38%)及死亡率(7.69%),低于常规治疗组(分别为30.77%和15.38%),但差异没有统计学意义;高压氧治疗组治疗后神经功能缺损评分和水肿面积,显著低于常规治疗组(P0.05);高压氧治疗组治疗后GCS评分和GOS评分,显著高于常规治疗组(P0.05)。结论:1、颅脑引发精神障碍以遗忘最多见,其次为躁狂性精神障碍。2、颅脑损伤引发的精神障碍与颅脑损伤的程度与部位相关。3、高压氧治疗可明显改善颅脑损伤合并狂躁性精神障碍患者的临床症状,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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.12
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.12
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