目的:探讨脑室改良的Graeb评分(mGS评分)联合血清成纤维细胞生长因子受体-1(FGFR-1)、正五聚蛋白3(PTX3)对脑室出血(IVH)患者脑室外引流术后预后不良的预测价值.方法:选择河北医科大学第一医院2020年2月至2022年2月行脑室外引流治疗的109例IVH患者,出院后3个月采用格拉斯哥预后评分(GOS)评价患者预后,根据GOS评分将IVH患者分为预后不良组(51例)和预后良好组(58例).术前评估mGS评分,并检测血清FGFR-1、PTX3水平.多因素Logistic回归分析法分析影响IVH患者脑室外引流术后预后不良的因素.绘制受试者工作特征曲线(ROC)分析mGS评分联合血清FGFR-1、PTX3预测IVH患者脑室外引流术后预后不良的价值.结果:预后不良组术前mGS评分、血清PTX3水平高于预后良好组(P＜0.05),血清FGFR-1水平低于预后良好组(P＜0.05).并发脑疝、高mGS评分、高PTX3是IVH患者脑室外引流术后预后不良的危险因素(P＜0.05),高FGFR-1是保护因素(P＜0.05).联合mGS评分和血清FGFR-1、PTX3预测IVH患者脑室外引流术后预后不良的曲线下面积为0.894,高于以上各指标单独预测.结论:IVH脑室外引流术后预后不良患者mGS评分和血清PTX3水平增高,血清FGFR-1水平降低,联合mGS评分、血清FGFR-1和PTX3对IVH患者脑室外引流术后预后的预测价值较高.

目的 探讨颅内外高流量分流联合颈内动脉结扎术治疗巨大症状性颈内动脉海绵窦段动脉瘤的临床疗效.方法 回顾性分析2015年5月至2020年5月运用颅内外高流量分流联合颈内动脉结扎术治疗的4例颈内动脉海绵窦段巨大动脉瘤的临床资料.结果 术后症状明显改善.出院后随访1～4年,4例GOS评分均为5分.术后1年复查颅脑CT和CTA显示巨大动脉瘤完全消失3例,动脉瘤明显变小伴瘤内血栓形成1例.结论 颅内外高流量分流术联合颈内动脉结扎术是治疗巨大症状性海绵窦段动脉瘤的有效方法,尤其是缓慢结扎颈内动脉的方法是安全可靠的.

Objective:To explore the efficacy and influencing factors of stereotactic aspiration in the treatment of primary brain stem hemorrhage (PBH).Methods:The clinical data of 65 patients with PBH admitted to the Department of Neurosurgery of the First Hospital of Hebei Medical University from February 2019 to February 2020 were retrospectively analyzed. All patients were treated with stereotactic aspiration, and the patients with obstructive hydrocephalus were treated with occipital ventricle puncture and drainage at the same time. The survival status (mortality) of the patients was followed up 30 days after the operation, and the modified Rankin scale (mRS) was used to evaluate the 90-day neurological function recovery. Univariate and multivariate logistic regression analyses methods were used to explore the influencing factors of patients′ survival status and neurological function recovery.Results:Of the 65 patients, 15 patients (23.1%) died 30 days after the operation, and 21 patients (32.3%) reported good recovery of neurological function (mRS of 0 to 3 points). The results of multivariate logistic regression analysis showed that hematoma classification was an independent influencing factor of the survival of patients with PBH ( OR=0.255, 95% CI: 0.074-0.880, P=0.031) and the recovery of neurological function ( OR=0.029, 95% CI: 0.002-0.483, P=0.014). Conclusions:The death probability of patients with giant hematoma who underwent stereotatic aspiration is higher than that of patients with other hematoma types. The neurological function recovery of patients with unilateral tegmental hematoma is better than that of patients with other types. Stereotactic aspiration surgery is an effective treatment for PBH and has clinical promotion value.

儿童缺血性卒中的发病率低，年发病率约为1/10万，其发病原因多样，目前尚无规范的治疗方法。本文报道1例急诊采用机械取栓术治疗的因心脏黏液瘤引发的急性缺血性卒中患儿。术后24 h美国国立卫生研究院卒中量表评分为9分，术后第3天为0分；无手术相关并发症。因术前未行静脉溶栓治疗，术后第5天即行心房黏液瘤切除术。术后3个月随访，患儿恢复良好。

1 病历摘要(图1) 女,60岁;因"左侧下肢无力3个月余,加重1个月"于2015年7月入院.查体:左侧下肢肌力Ⅳ级,肌张力减低,深感觉障碍,位置觉异常.余神经系统查体正常.CT平扫:右侧顶叶近大脑镰旁见类圆形稍高密度影,其内可见多发高密度钙化影,呈结节状、沙粒状,大小约3.3 cm × 2.7 cm.MRI增强:呈不均匀明显强化,局部大脑镰亦明显强化.MRV:肿瘤表面可见多根引流静脉走行.

目的 探讨超早期神经介入栓塞治疗高龄破裂颅内动脉瘤患者的临床疗效.方法 2016年5月至2019年3月21例高龄颅内动脉瘤破裂蛛网膜下腔出血(SAH)的患者接受超早期神经介入栓塞治疗.男性8例,女性13例,年龄70～86岁,平均年龄(75.7±5.6)岁;Hunt-Hess分级:Ⅱ级6例,Ⅲ级7例,Ⅳ级6例,Ⅴ级2例.其中前交通动脉瘤3例,后交通动脉瘤13例,眼动脉瘤1例,大脑中动脉瘤1例,大脑前动脉瘤1例,基底动脉顶端动脉瘤2例.采用改良的Rankin分级量表(mRS)和Glasgow预后分级量表(GOS)评价患者的预后.结果 院内死亡2例(9.5％),迟发性血管痉挛3例(14.2％).19例出院患者中15例(71.4％)恢复良好(mRS 0～2分,GOS4～5),4例(19％)伴有神经功能障碍(mRS 3～5分,GOS2～3),2例(9.5％)出现轻度脑积水.结论 超早期神经介入手术综合治疗可以降低高龄颅内动脉瘤破裂患者的死亡率及致残率.

Objective To investigate the plasma miRNA155 level in patients with poor-grade aneurysmal subarachnoid hemorrhage(SAH)and predict the occurrence of neurogenic pulmonary edema(NPE).Methods Thirty patients with high grade aneurysmal subarachnoid hemorrhage were selected,including 1 1 cases of neurogenic pulmonary edema after subarachnoid hemorrhage,19 cases of subarachnoid hemorrhage without neurogenic pulmonary edema,and 20 cases of physical examinees at the same time as a control group,and the levels of plasma miRNA1 5 5 were detected in 3 groups.Results The level of plasma miRNA1 5 5 in patients with poor-grade subarachnoid hemorrhage with neurogenic pulmonary edema and non neurogenic pulmonary edema was higher than that in the control group.The level of plasma miRNA1 5 5 in patients with high grade subarachnoid hemorrhage with neurogenic pulmonary edema was higher than that of high grade subarachnoid hemorrhage without neurogenic pulmonary edema.There was a significant difference in the interaction between patients and between groups(P<0.05). Conclusion Plasma miRNA level is significantly higher in patients with subarachnoid hemorrhage with neurogenic pulmonary edema.Elevated miRNA can predict the occurrence of neurogenic pulmonary edema after poor-grade subarachnoid hemorrhage.

Objective To investigate the effect of end-expiratory positive pressure on intracranial pressure in patients with poor-grade aneurysmal subarachnoid hemorrhage and severe respiratory dysfunction.Methods Thrity cases of poor-grade aneurysmal subarachnoid hemorrhage combined with severe respiratory dysfunction were divided into 1 9 cases with neurogenic pulmonary edema and 1 1 cases without neurogenic pulmonary edema group.PEEP was set up to 0 cmH2O,6 cmH2O and 12 cmH2O to observe the changes of vital signs and intracranial pressure.Results When PEEP was 12 cmH2O,the intracranial pressure and central venous pressure were significantly higher than that of PEEP 0 cmH2O and PEEP 6 cmH2O. When PEEP was 12 cmH2O,the cerebral perfusion pressure was significantly lower than that of 0 cmH2O.There were statistically significant differences(P<0.05).There was no significant difference in intracranial pressure,cerebral perfusion pressure and central venous pressure between the two groups at different end expiratory pressure(P>0.05).Conclusion Poor-grade aneurysmal subarachnoid hemorrhage combined with severe respiratory dysfunction in patients with severe respiratory dysfunction can significantly increase intracranial pressure and decrease cerebral perfusion after>12 cmH2O,which is not related to the occurrence of neurogenic pulmonary edema.

Objective To investigate the correlation between the levels of myocardial biomarkers and incidence of neurogenic pulmonary edema ( NPE) in patients with aneurysmal subarachnoid hemorrhage ( SAH) . Methods A total of 207 patients with SAH who were admitted and treated in our hospital from June 2014 to June 2017 were enrolled in the study. The clinical data including clinical characteristics,electrocardiogram ( ECG) changes,and serum levels of cardiac and inflammatory biomarkers on admission and on the day of occurrence of NPE,were retrospectively analyzed to predict the occurrence of NPE. Results Among 207 patients, 15 patients (7. 25％) developed NPE. The female patients and the patients with hypertension or diabetes mellitus were more likely to suffer from NPE. Moreover the patients with NPE were more likely to occur myocardial damage and ECG changes,with obvious abnormalities of myohemoglobin, troponin, CPK and CPK-MB (P < 0. 01). Conclusion The myocardial biomarkers are obviously increased in patients with SAH complicated by NPE, with obvious abnormalities of ECG,therefor, the increase of myocardial biomarkers can predict the occurrence of NPE.

目的 评价机械开通治疗后循环基底动脉急性闭塞的效果及安全性.方法 对后循环基底动脉急性闭塞患者28例行单纯支架机械开通血管内治疗,观察血管再通情况及临床疗效. 结果 28例患者中血管恢复再通24例,再通率达85.7%,从发病到血管再通时间为(467.4±431.3) min.出院时恢复良好(mRS≤3分)6例(21.4%),3个月恢复良好(mRS≤3分)15例(53.6%),3个月时死亡9例(32.1%).恢复良好者术前美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分和血管再通率高于恢复不良者,差异有统计学意义(P<0.05).2组性别、年龄、危险因素、原发疾病、发病到股动脉穿刺时间、发病到血管再通时间差异均无统计学意义(P<0.05).结论 使用新一代支架取栓装置单纯机械开通基底动脉急性闭塞血管是安全有效的,其再通率高、并发症少.术前NIHSS评分及血管再通是临床预后的重要预测因素.

Objective To evaluate the efficacy and safety of mechanical thrombectomy in the treatment of acute cerebral infarction (4-6 hours).Methods From June 2015 to December 2016 in our hospital onset 4-6 hours within the time window of 187 cases of acute cerebral infarction patients were analyzed retrospectively.All patients underwent cerebral angiography to define the cause of vascular occlusion patients underwent stent thrombectomy,statistical analysis of vascular recanalization and clinical curative effect.Results After interventional therapy,M2 segment occlusion in 17 cases (12 cases recanalization),M1 segment occlusion in 58 cases (52 cases recanalization),carotid terminus occlusion (T) in 9 cases (4 cases recanalization),clinoid segment occlusion in 7 cases (1 case recanalization),complete occlusion of internal carotid artery in 15 cases (10 cases recanalization),vertebral basilar artery occlusion in 28 cases (24 cases recanalization).Occlusion of the M2 segment of patients after 1 week of treatment was significantly improved compared with preoperative (P<0.05),M1 occlusions in patients after 1 day showed a significant improvement (P<0.01),vertebral basilar artery occlusion in patients after first day showed a significant improvement (P<0.05).mRS score 1-3 after one month in patients with M2 segment occlusion accounted for 88%,M1 segment occlusion accounted for 60%,carotid terminus occlusion (T) accounted for 11%,clinoid segment of internal carotid artery occlusion accounting for 14%,complete occlusion of internal carotid artery accounted for 7%,vertebral basilar artery occlusion accounting for 39%.Conclusion It is safe and effective in the treatment of 4-6 hours time window for endovascular mechanical thrombectomy,and most of the patients can improve the clinical efficacy.

目的：评价双微管技术弹簧圈栓塞颅内宽颈动脉瘤的影像及临床疗效。方法选取2013年1月至2015年1月收治的颅内宽颈动脉瘤的患者，首先尝试应用双微管技术进行栓塞，如不能形成稳定的框架结构则改为支架或者球囊辅助栓塞。其中42例患者使用双微管技术成功栓塞。结果术后即时脑血管造影显示完全栓塞22例，近全栓塞14例，部分栓塞6例。出院时格拉斯哥预后评分5分20例，4分10例，3分7例，2分3例，1分（死亡）2例。术后35例随访3～12个月，无再出血病例，28例复查脑血管造影显示动脉瘤相对复发2例，使用支架辅助技术再次栓塞。结论双微管技术弹簧圈栓塞颅内宽颈动脉瘤是一种相对安全有效的治疗方法。

目的 观察巢蛋白(Nestin)与性别决定基因高迁移率组蛋白(SOX2)在快速老化小鼠SAMP8穹隆下器(SFO)中的表达.方法 成年8月龄SAMP8小鼠设为实验组,采用免疫组织化学和免疫组织化学荧光染色的方法观察Nestin及SOX2在穹隆下器中的表达,同时设正常老化小鼠SAMR1对照.结果 Nestin免疫组织化学染色发现,对照组免疫阳性细胞呈突起分布,放射丝状表达;实验组免疫阳性细胞染色深,丝状结构粗大,在血管周围密集分布,阳性细胞百分比(49.17±7.60)％较对照组阳性细胞百分比(16.33±4.41)％明显增多,差异有统计学意义(P＜0.01).SOX2免疫组织化学染色,对照组免疫阳性细胞散在分布,染色深浅不一;实验组大部分阳性细胞染色较深,在血管周围密集分布;阳性表达细胞百分比(62.17 ±20.27)％较对照组阳性表达细胞百分比(36.00±16.20)％明显增多,差异有统计学意义(P＜0.05).荧光双标染色,对照组SOX2散在分布,其间可见Nestin阳性表达,室管膜下区可见少量SOX2/Nestin双表达细胞.实验组阳性表达强烈,SOX2/Nestin双表达细胞增多.结论 Nestin及SOX2在快速老化小鼠SAMP8穹隆下器的表达明显增强,表明阿尔茨海默病(AD)在一定时期可能引起穹隆下器神经干细胞/祖细胞的增殖或分化增强,进而可能影响穹隆下器的神经生发功能.

颅内动脉瘤的血管内治疗日臻成熟,微导管安全进入动脉瘤腔并且位置稳定是介入治疗的前提,与载瘤动脉呈锐角的动脉瘤很难顺利置管,采用微导管成袢技术可以解决此类难题.一、资料与方法1.临床资料:男2例,女5例;年龄34 ～ 72岁,平均年龄58岁.未破裂动脉瘤1例,破裂动脉瘤6例.Hunt-Hess分级:0级1例,1级4例,2级1例,3级1例.大脑中动脉动脉瘤1个,后交通动脉动脉瘤3例,小脑后下动脉动脉瘤1例,眼动脉动脉瘤2例.动脉瘤颈与载瘤动脉(或载瘤动脉与主干)夹角在23°～56°,平均44.4°。

>脑血管疾病的血管内治疗技术日臻成熟[1-2],微导管安全顺利进入责任血管或动脉瘤腔并且位置稳定是介入治疗的前提,然而临床上经常遇到特殊角度的责任血管或动脉瘤,单纯微导管预塑形很难顺利置管,采用微导管成襻技术可以解决此类难题。2010年7月至2013年7月我科21例患者使用该技术栓塞颅内血管病变,效果良好,现报道如下。一、资料与方法 1.临床资料:回顾性分析21例使用微导管成襻技术患者资料,男9例、女12例;年龄17～78岁,平均(59±12)岁。

目的:观察巢蛋白(nestin)与性别决定基因高迁移率组蛋白(SOX2)阳性表达细胞在快速老化小鼠最后区的分布.方法:成年SAMP8小鼠,8月龄,采用免疫组织化学和免疫荧光显色的方法观察巢蛋白与SOX2在最后区的表达,同时设正常老化小鼠SAMR1作为对照.结果:巢蛋白免疫组织化学显色,SAMR1小鼠阳性细胞呈絮状或丝状表达,在背侧区分布稀疏;SAMP8小鼠免疫阳性细胞染色深,丝状结构粗大,在背侧区和外侧区分布密集,阳性细胞数目较SAMR1小鼠明显增多,差异具有统计学意义.SOX2免疫组织化学显色,SAMR1小鼠免疫阳性细胞染色深浅不一,散在分布;SAMP8小鼠大部分阳性细胞染色较深,在最后区的背侧区和外侧区分布密集,阳性细胞数目较SAMR1小鼠明显增多,差异具有统计学意义.荧光双标显色,SAMR1小鼠SOX2阳性细胞散在分布,其间可见巢蛋白阳性表达,内侧区可见少量SO X2/nestin双表达细胞.SAMP8小鼠阳性表达强烈,SOX2/nestin双表达细胞增多.结论:巢蛋白及SOX2在快速老化小鼠SAMP8最后区的表达明显增强,这表明阿尔茨海默病在一定时期时可能会影响最后区的神经生发功能,导致神经干细胞/祖细胞的增殖或分化增强.

目的 探讨微导管成袢技术超选颅内锐角血管或动脉瘤的安全有效性.方法 回顾性分析21例使用微导管成袢技术超选颅内锐角血管或动脉瘤病例临床资料.颅内动脉瘤19例(大脑中动脉瘤4例,后交通动脉瘤10例,小脑后下动脉瘤3例,眼动脉瘤2例),动静脉畸形1例,动静脉瘘1例.均采用微导管“α”型成袢超选责任血管或动脉瘤.结果 21例病人采用成袢技术均超选成功,除1例病人出现轻度血管痉挛外,无其他并发症.结论 采用微导管成袢技术可提高超选锐角血管或动脉瘤的成功率,且安全有效.

Objective To investigate the reliability and the validity of multi-model approach to diagnose(MMADD) in diagnosis of post stroke depression(PSD).Methods 100 stroke in-patients who reached the enrollment standards were admitted. These stroke patients were assessed with MMADD,DSI,HAMD,CCMD-3 and DSM-Ⅳby two neurologists,these patients were repeatedly assessed with MMADD by the first neurologist after three days.Results MMADD's reliability and interobservers' reliability were good.Cronbach's alpha coefficient of the first part was 0.845;Cronbach's alpha coefficient of the second part was 0.803.Internal consistency of MMADD was good.Content validity,criteria validity and construct validity of MMADD were good.Conclusion The reliability and the validity of MMADD was excellent.The diagnostic measurement table combined with clinical diagnosis standard was found to be reliable and valid as a diagnostic tool for assessing PSD.

目的 评估早期心理干预及黛力新治疗对急性脑卒中后抑郁患者神经功能损害康复的影响.方法 将112例脑卒中后抑郁患者随机分为研究组和对照组,每组56例.治疗组在常规治疗的基础上心理干预、服用黛力新,对照组进行常规治疗.2组患者在第2、4周均进行多模式方法诊断(MMADD)、日常生活活动能力(Banhel指数)、智能状况(MMSE评分)、神经功能缺损(NIHSs)评分.结果 治疗前及2周后2组患者NIHSS差异无统计学意义(P>0.05),治疗前MMADD及ADL评分差异无统计学意义(P>0.05),2周后MMADD及ADL差异有统计学意义(P<0.05),4周后治疗组MMADD评分和NJHSS评分明显减少(P<0.01),ADL评分明显增高(P<0.01).结论 脑卒中后抑郁的早期综合干预,能明显改善卒中后抑郁及神经功能缺损症状和日常生活活动能力.