目的 探究血管内介入疗法治疗急性缺血性脑卒中的疗效及其对纤维蛋白原(fibrinogen,FIB)、同型半胱氨酸(homocysteine,HCY)水平和预后的影响.方法 选取行血管内介入疗法治疗的急性缺血性脑卒中患者60例为观察组,接受药物静脉溶栓治疗的急性缺血性脑卒中患者60例为对照组.于溶栓前、溶栓后即刻、溶栓10 d后比较2组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分和血管再通评分,FIB和HCY水平,格拉斯哥预后(Glasgow Outcome Scale,GOS)评分.结果 2组NIHSS评分、FIB和HCY水平呈降低趋势,血管再通评分、GOS评分呈升高趋势,观察组NIHSS评分、FIB和HCY水平降低幅度大于对照组,血管再通评分、GOS评分升高幅度大于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05或P<0.01).结论 血管内介入治疗可改善急性缺血性脑卒中患者的神经功能缺损症状,提升血管再通率,降低FIB、HCY水平,有利于改善预后.

OBJECTIVE: To evaluate the effects of dexmedetomidine in treatment of patients with severe craniocerebral injury, so as to provide references for the selection of sedation therapy. METHODS: 160 patients with moderate/severe craniocerebral injury admitted into ICU in the First Hospital of Shijiazhuang from Apr. 2017 to Apr. 2018 were selected and divided into control group and observation group according to the admission sequences, with 80 cases in each group. The control group was treated with midazolam for sedation and analgesia, while the observation group was given dexmedetomidine. Differences in heart rates (HR), respiratory rates (RR), mean arterial pressure (MAP), partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), dosage of mannitol, wake-up time after stopping the infusion of sedatives (the time when the Richmond sedation score was restored to 0 point) and Glasgow coma scale (GCS) before and after wake-up at 24 h, 48 h and 72 h after ICU admission between two groups were compared; during follow-up for 3-6 months, the recovery rates of two groups were compared. RESULTS: At 24 h, 48 h and 72 h after ICU admission, the HR, RR, MAP, PaO2 and PaCO2 of both groups had been significantly improved than those of right after admission, and those of observation group were significantly better than the control group, with statistically significant differences (P＜0.05); the dosages of mannitol of observation group at 24 h, 48 h and 72 h after ICU admission were significantly lower than those of the control group, with statistically significant differences (P＜0.05); the wake-up time of observation group was significantly shorter than that of the control group, with significantly lower difference value of GCS between before and after wake-up, with statistically significant differences (P＜0.05); during follow-up for 3-6 months, the recovery rate of observation group was significantly higher than that of the control group, with statistically significant difference (P＜0.05). CONCLUSIONS: The sedative effect of dexmedetomidine for sedation and analgesia in patients with severe craniocerebral injury is significantly better than that of midazolam, which can effectively improve short-term prognosis and safety.

目的 探讨米氮平联合文拉法辛治疗伴有失眠的老年抑郁症患者的临床效果及对睡眠质量、血清5-羟色胺(5-HT)的影响.方法 选取2016年10月—2018年2月石家庄市第一医院收治的伴有失眠的老年抑郁症患者88例为研究对象,根据治疗方法的不同分为观察组和对照组各44例.对照组患者接受米氮平治疗,观察组患者接受米氮平联合文拉法辛治疗,两组患者均连续治疗8周.治疗结束后观察两组患者的临床疗效、治疗前后汉密尔顿抑郁量表(Hamilton depression rating scale for depression,HAMD)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分及血清5-HT水平,以及治疗期间不良反应发生情况.结果 ①治疗8周后,观察组治疗总有效率为93.18％明显高于对照组的77.27％,差异有统计学意义(χ2=38.210,P<0.001);②两组患者治疗后HAMD和PSQI评分均较治疗前降低,且治疗后观察组HAMD和PSQI评分降低程度明显大于对照组,差异均有统计学意义(P<0.01);③两组患者治疗后血清5-HT水平较治疗前明显升高,且治疗后观察组血清5-HT升高幅度明显大于对照组,差异均有统计学意义(P<0.01);④两组治疗期间不良反应总发生率比较差异无统计学意义(χ2=0.948,P=0.257).结论 米氮平联合文拉法辛治疗在改善伴有失眠的老年抑郁症患者睡眠质量方面效果显著,且能有效减轻患者的抑郁症状,调节神经内分泌功能,应用安全性较好.

目的 探究血管内介入疗法对急性缺血性脑卒中患者的临床疗效及对血液流变学和炎性因子的影响.方法 选取2017年8月至2019年1月收治的行血管内介入治疗的急性缺血性脑卒中患者50例为试验组,另选取同期接受药物静脉溶栓治疗的急性缺血性脑卒中患者50例为对照组.比较2组临床疗效和高切黏度、低切黏度、血浆比黏度、红细胞比容等血液流变学指标水平及C-反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)等炎性因子指标水平.结果 对照组临床治疗总有效率为84.00％(42/50),试验组临床治疗总有效率为96.00％(48/50),试验组高于对照组,差异有统计学意义(P<0.05).溶栓前,2组高切黏度、低切黏度、血浆比黏度、红细胞比容水平比较,差异无统计学意义(P>0.05);溶栓1周后,2组高切黏度、低切黏度、血浆比黏度和红细胞比容水平均低于溶栓前,并且试验组低于对照组,差异有统计学意义(P<0.05).溶栓前,2组CRP、IL-6和TNF-α水平比较,差异无统计学意义(P>0.05);溶栓1周后,2组CRP、IL-6和TNF-α水平均低于溶栓前,同时试验组低于对照组,差异有统计学意义(P<0.05).结论 血管内介入疗法应用在急性缺血性脑卒中患者治疗中疗效确切,有利于改善患者血液流变学状态,抑制炎性介质反应,值得临床推广应用.

目的 观察艾司西酞普兰治疗老年抑郁症的临床效果及安全性.方法 选择2017年10月—2018年5月收治的老年抑郁症患者73例,根据治疗方法分为观察组38例及对照组35例.观察组给予艾司西酞普兰,对照组给予米氮平.2组均治疗6周,观察临床疗效、汉密尔顿抑郁量表(HAMD)评分及药物不良反应.结果 2组治疗后HAMD评分均较治疗前降低(P<0.05),但2组间比较差异无统计学意义(P>0.05).2组总有效率比较差异无统计学意义(P>0.05).观察组不良反应发生率低于对照组(P<0.05).结论 艾司西酞普兰治疗老年抑郁症效果好,且安全性较高.

目的 探讨经导管选择性脑动脉内介入溶栓术在急性脑梗死中的应用价值.方法 选取2017年10月至2018年10月急性脑梗死患者80例的临床资料进行回顾性分析,根据治疗方法分为对照组(n=40)和研究组(n=40).对照组采取常规药物治疗,研究组在对照组基础上采取经导管选择性脑动脉内介入溶栓术.比较2组治疗前后神经功能(NIHSS)及临床症状(mRS)分值、临床疗效、血管再通情况.结果 治疗后2组NIHSS分值及mRS分值较治疗前降低,且研究组低于对照组(P<0.05);研究组总有效率为92.5％高于对照组的75.0％(P<0.05);研究组血管完全再通率为65.0％高于对照组的42.5％(P<0.05);随访3个月,研究组患者恢复优良率为87.5％明显高于对照组的65.0％(P<0.05).结论 采取经导管选择性脑动脉内介入溶栓术治疗急性脑梗死可有效缓解患者临床症状,提高治疗效果及血管再通率,促使患者神经功能及早恢复.

目的 研究重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)联合盐酸舍曲林片治疗老年抑郁症的临床疗效及对患者认知功能的影响.方法 回顾性分析石家庄市第一医院2016年4月—2017年10月收治的84例老年抑郁症患者的临床资料,根据不同的治疗方式将其分为对照组(42例)与观察组(42例),对照组患者给予假刺激结合盐酸舍曲林片治疗,观察组患者给予rTMS结合盐酸舍曲林片治疗,2组均治疗5周,分别采用汉密尔顿抑郁量表(HAMD)对抑郁症进行评分和威斯康星卡片分类测验(WCST)对认知功能进行评估,观察2组治疗中的不良反应发生率和临床疗效情况.结果 治疗前,2组患者HAMD评分比较差异均无统计学意义(P>0.05);治疗后,观察组第1、3、5周末HAMD评分低于对照组(P<0.05).治疗后,观察组患者的总应答数及错误应答数、持续错误应答数均低于治疗前(P<0.05),其正确应答数及完成分类数高于治疗前(P<0.05);对照组治疗后总应答数、错误应答数及持续错误数低于治疗前(P<0.05),其正确应答数高于治疗前(P<0.05),2组患者的WCST评分治疗后比较差异有统计学意义(P<0.05);观察组患者治疗有效率(95.24％)与对照组(90.48％)比较,差异无统计学意义(P>0.05);观察组患者不良反应发生率(11.90％)与对照组(9.52％)比较,差异无统计学意义(P>0.05).结论 rTMS联合盐酸舍曲林片和单纯采用盐酸舍曲林片治疗老年抑郁症临床效果相似,均无明显不良反应,然而前者联合治疗更能有效地改善老年抑郁症患者认知功能.

Objective To investigate the neuroprotective effects of Gastrodia elata extract on SH-SY5Y cell injury induced by H2O2 in vitro,and to explore its molecular biological mechanism.Methods The SH-SY5Y cells were treated by H2O2 in vitro to induce SH-SY5Y cell injury model,then the Gastrodia elata extract was added into the medium at the concentration of 0,0.1,1,10,100μg/ml,respectively.The cell morphological changes were observed by microscopy,and cell proliferation was detected by MTT,moreover,the expression levels of related genes with nerve cells growth including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were detected by qPCR method.Results After 24-hour induction by H2O2,the obvious morphological changes were found in SH-SY5Y cells,with cell synapse length being decreased significantly (P ＜ 0.05),and cell proliferation was obviously decreased (P ＜ 0.05),however,after H2O2 cells were treated by Gastrodia data extracts,the cytotoxicity caused by H2O2 was obviously inhibited,moreover,with the increase of Gastrodia elata extract concentration,the cell synapse length and cell proliferation were gradually improved,furthermore,there were significant differences among different concentrations of Gastrodia elata extracts (P ＜ 0.05).In addition the expression levels of NGF and BDNF in SH-SYSY cells with injury induced by H2O2 were significantly decreased (P ＜ 0.05),however,after the cells were treated by different concentrations of Gastrodia elata extract,the expression levels of NGF and BDNF were significantly upregulated (P ＜0.05).Conclusion Gastrodia elata extract has protective effects on SH-SY5Y cells with injury induced by H2O2,and its action mechanism may be correlated with its regulative effects on the expressions of NGF and BDNF.

Objective:To investigate the clinical effects of neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior approach. Methods:86 patients with hypertensive intracerebral hemorrhage (HICH) in our hospital from June 2015 to March 2017 were selected,and they were divided into two groups by random number table,43 cases in each. Control group was given routine stereotactic vacuation of hemato-ma,observation group was given neuroendoscopic evacuation of hematoma via CT-guided coronal suture ante-rior approach.The surgical indexes,surgical effects,rebleeding rate,fatality rate and the incidence of compli-cations of two groups were compared.Results:The surgical indexes of observation group were significantly bet-ter than those of control group,and the total surgical effective rate was significantly higher than control group, the rebleeding rate,fatality rate and the incidence of complications were significantly lower than control group (P<0.05). Conclusion:Neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior ap-proach can effectively shorten surgery time and recovery time of hemiplegia,protect normal brain tissues,de-crease surgical risks,reduce complications and death.

目的 分析血管内支架机械取栓术在缺血性脑卒中急性期患者中的应用效果.方法 选取2016年12月—2018年1月石家庄市第一医院收治的缺血性脑卒中急性期患者124例,采用随机数字表法分为对照组和研究组,每组62例.在常规治疗基础上,对照组患者采用静脉溶栓治疗,研究组患者采用血管内支架机械取栓术治疗.两组患者均随访3～6个月,比较两组患者溶栓/取栓前、溶栓/取栓后即刻、溶栓/取栓后10 d美国国立卫生研究院卒中量表(NIHSS)评分,溶栓/取栓后即刻、溶栓/取栓后10 d及随访结束后血管再通率,随访结束后格拉斯哥预后量表(GOS)评分;并观察两组患者溶栓/取栓后10 d内不良反应/并发症发生情况.结果 两组患者溶栓/取栓前NIHSS评分比较,差异无统计学意义(P>0.05);研究组患者溶栓/取栓后即刻、溶栓/取栓后10 d NIHSS评分低于对照组(P<0.05).研究组患者溶栓/取栓后即刻、溶栓/取栓后10 d及随访结束后血管再通率高于对照组(P<0.05).研究组患者随访结束后GOS评分低于对照组(P<0.05).研究组患者溶栓/取栓后10 d内不良反应/并发症发生率低于对照组(P<0.05).结论 与静脉溶栓治疗相比,血管内支架机械取栓术能有效减轻缺血性脑卒中急性期患者神经功能损伤程度,提高血管再通率,改善患者短期预后,且安全性较高.

Objective:To investigate the relationship of expression of vascular endothelial growth factor (VEGF) and clinical features in patients with intracranial aneurysm and arteriovenous malformation (AVM).Methods:A total of 64 patients with AVM and intracranial aneurysm,who were treated in First Hospital of Shijiazhuang from February 2011 to November 2015,were chosen as research subjects,AVM were 32 cases and intracranial aneurysm were 32 cases.The samples were sectioned for VEGF immunohistochemical staining;the location and intensity of staining were recorded;the positive indexes were computed.The VEGF expression of different age and Hunt&Hess classification in patients with intracranial aneurysms were analysed;the VEGF expression of different diameters,ages,Spetzler classification in patients with AVM were analysed.Results:There were no statistical differences in the VEGF expression of different ages in patients with intracranial aneurysms (P＞0.05);the VEGF expression of different Hunt&Hess classification in patients with intracranial aneurysms was statistical difference (P＜0.05).The positive rate of VEGF in the artery of AVM was lower than that in the vein,the difference was statistically significant (P＜0.05).There were no statistical differences in the VEGF expression of the different Spetzler classification,different diameters and different ages in patients with AVM (P＞0.05).Conclusion:The expression of VEGF in the vein and the artery of patients with AVM is different,the expression of VEGF is not correlated with the age of intracranial aneurysm and the size and age of AVM.VEGF cannot be used as a predictor in the patients with intracranial aneurysms and AVM.

目的 探讨颅脑损伤并发2型糖尿病患者胰岛素泵临床应用的必要性.方法 将颅脑损伤并发2型糖尿病患者83例随机分为胰岛素泵(continuous subcutaneousinsulin infusion,CSII)组43例,普通胰岛素多次皮下注射(multiple subcutaneous insulin injection,MSII) 40例,观察2组治疗后血糖达标时间、每日胰岛素用量、低血糖发生率、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、住院时间、住院费用.结果 CSII组血糖达标时间短于MSII组,每日胰岛素用量少于MSII组,低血糖发生率低于MSII组,预后GCS＞8分的比例高于MSII组,住院时间和住院费用少于MSII组(P＜0.05或＜0.01).结论 胰岛素泵治疗颅脑损伤并发2型糖尿病患者,血糖达标快速平稳,可明显改善患者的预后.

Objective To evaluate the security of application with stent assisted therapy combined with axiom detach-able coil on complicated basilar artery apex aneurysm. Method To review and analyze 27 complicated basilar artery apex aneurysm surgery cases, using the application of stent assisted therapy combined with detachable coil deal with the basilar artery apex aneurysm. Result The image of the 27 surgery cases showed that 19 cases were completed tamponed, and 7 cased were nearly completed tamponed, 1 loose tamponed. It also had three operation complica-tions:one hemorrhaged, one parent artery occlusion, one coil detached. 2 death cases: one was V-level, another had secondary hemorrhaged before surgery. Conclusion The application with stent assisted therapy on complicated basilar artery apex aneurysm is selectable, safe and effective.

<正>基底动脉顶端动脉瘤占椎-基底动脉系统动脉瘤50%左右[1],因其与脑干比邻,多为宽颈及大动脉瘤,长期随访如果破裂基底动脉顶端动脉瘤不予治疗,几乎所有病例在3～6年内因再出血死亡或重残,再出血几率较前循环动脉瘤比高2～3倍[2],一旦破裂病死率极高,保守治疗预后极差。开颅手术治疗的手术难度和手术风险都很大,病死率及致残率极高。本文回顾2008年3月至2012年3月我院应用双微管技术血管内栓

目的 评价双微管技术与支架技术辅助弹簧圈栓塞基底动脉顶端宽颈动脉瘤的可行性.方法 选择基底动脉宽颈动脉瘤患者28例,随机分为双微管组(C组)15例和支架辅助组(D组)13例,全身麻醉下行血管内治疗.结果 C组完全致密栓塞(栓塞程度100%)7例,近全栓塞(栓塞程度95%)4例,大部栓塞(栓塞程度90%)4例,2例术后出现明显脑积水者行侧脑室额角钻孔外引流术,8例接受间断腰椎穿刺或腰大池持续外引流术;材料费用5~14.5万元,平均(7.8±2.5)万元;出院前格拉斯哥预后评分(Glasgow outcome score,GOS)5分9例,4分3例,3分2例,2分1例,1分(死亡)0例.D组完全致密栓塞(栓塞程度100%)6例,近全栓塞(栓塞程度95%)4例,大部栓塞(栓塞程度90%)3例,3例术后出现明显脑积水者行侧脑室额角钻孔外引流术,5例接受腰椎穿刺或腰大池持续外引流术;材料费用为8~19万元,平均(10.5±2.3)万元;GOS 5分6例,4分3例,3分3例,2分0例,1分(死亡)1例.2组动脉瘤栓塞率和GOS差异无统计学意义;但C组材料费用低于D组,差异有统计学意义(P＜0.05).结论 虽然双微管技术较支架辅助不能提高动脉瘤栓塞率和改善患者预后,但可避免患者长期服药带来的不便,降低患者血管内治疗材料费用.

<正>颅内宽颈动脉瘤(颈宽≥4 mm,或者瘤颈体比≥1∶2)一直以来被认为是介入治疗的弱项。基底动脉顶端动脉瘤占椎-基底动脉系统动脉瘤50%左右,GDC使得血管内治疗颅内动脉瘤的安全性以及疗效都有很大的提高[1]。基底动脉宽颈动脉瘤的治疗方法是利用三维弹簧圈的"成篮性"或应用辅助技术如球囊、双微导管、支架等,将宽颈动脉瘤变为相对窄颈的囊状动脉瘤,使得复杂动脉瘤的治疗简单化,治疗难度降低。本文综述近年来弹簧圈血管内治疗基底动脉顶端宽颈动脉瘤的研究进展。1三维成篮技术三维弹簧圈的二级螺旋为一系列形如"Ω"的环状结构。在自然盘曲时,由多个大圈和小圈依次成90度构成一个"篮

<正>近年来,随着神经介入技术的不断发展与完善,血管内栓塞已成为治疗颅内动脉瘤的主要方法之一,其效果已被普遍接受和认可。动脉瘤的颈/体比小于1/2被认为是微弹簧圈栓塞治疗的适应证之一~[1]。但临床研究发现,单纯使用微弹簧圈栓塞宽颈动脉瘤的完全栓塞率低、复发率高,一直是动脉瘤血管

患者 女,54岁.因头外伤3 d伴头痛恶心入院.3 d前患者乘坐汽车,因道路颠簸,头顶碰在车顶上,当时受力局部头痛,2 d前出现持续性全头胀痛.入院查体:无明显阳性体征.患者既往体健,近来未服用任何药物,月经不规律,尚未绝经.凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间各项值均正常.头CT提示:窦汇、右侧横窦、部分矢状窦、直窦血栓形成.入院诊断:硬膜窦血栓.

目的 探讨应用球囊,支架及双微管辅助栓塞技术治疗颅内宽颈动脉瘤的效果和临床经验.方法 71例患者经DSA证实为宽颈动脉瘤.采用全身麻醉,经股动脉穿刺入路,在数字减影血管造影监视下,根据动脉瘤的形状、大小, 采用相应辅助技术, 选用合适的弹簧圈,逐步将瘤腔填塞满意.结果 71例患者共75个动脉瘤中,完全栓塞59个(78.8%), 大部分栓塞13个(14. 4%), 部分栓塞2个(2.5%),1例多发动脉瘤仅处理1枚动脉瘤.术后恢复良好57例;轻、中度神经功能障碍14例;死亡或植物生存3例.术后随访发现:1例再发蛛网膜下腔出血;5例动眼神经麻痹患者中4例恢复, 1例明显好转.结论 介入栓塞术适合大多数颅内动脉瘤的治疗,且疗效满意.使用球囊或支架辅助技术及双微管技术有利于颅内宽颈动脉瘤的介入治疗,扩大了介入技术治疗颅内动脉瘤的适用范围,提高了介入技术治疗颅内宽颈动脉瘤的安全性和可靠性,减少了并发症.提高了弹簧圈栓塞颅内宽颈动脉瘤的完全栓塞率.

Objective:To offer anatomical data for transcallosal-interforniceal approach in neuroendoscopic surgery.Methods:The relative anatomical structures were observed and recorded in 25 adult antiseptic cadaveric head specimens imitating transcallosal-interforniceal approach by operating microscope and neuroendoscopic.Results:The thickness of callosum was about(7.22±0.32)mm under bregma.The distance was about(8.65±1.64)mm from fornix to inferior margin of callosum.Camera septi pellucidi was found in 19 cadaveric heads(76%).Adhesio interthalamica was absent in 6 heads(24%).The anatomic features of the third ventricle were observed by interforniceal approach.The important "road mark" in the third ventricle included choroid plexus,anterior and posterior commissure,infundibular recess,interthalamic adhesion,the opening of aqueductus mesencephali and so on.Conclusions:The structures of the third ventricle and pineal area could be shown clearly by using neuroendoscop.The normal anatomic structures can be protected by transcallosal-interforniceal approach under neuroendoscope.