目的:探讨颅内动脉瘤破裂出血患者早期显微夹闭术的手术时机.方法:选取从2016年12月—2020年1月漯河中心医院神经外科收治的55例颅内动脉瘤破裂患者,由电脑随机分配成对照组(出血后24～72 h接受手术治疗)和观察组(出血后24 h内接受手术治疗),对照组患者27例,观察组患者28例,记录两组术前、术中动脉瘤再次破裂次数和手术完全夹闭情况,根据恢复情况分为基本治愈、良好、轻残、重残和死亡5个等级,比较两组术后疗效.结果:术前再次破裂率观察组低于对照组(P<0.05);术中再次破裂率及手术安全夹闭率两组差异无统计学意义(P>0.05);术后并发症发生率观察组低于对照组(P<0.05);显效率观察组高于对照组(P<0.05).结论:颅内动脉瘤破裂出血患者早期显微夹闭术手术时机越早越好.

Abstract Context Cerebral ischaemia/reperfusion (I/R) injury has a high disability and fatality worldwide. Myrtenol has protective effects on myocardial I/R injury through antioxidant and anti-apoptotic effects. Objective This study investigated the effect of myrtenol on cerebral ischaemia/reperfusion (I/R) injury and the underlying mechanism. Materials and methods Cerebral I/R injury was induced in adult Sprague-Dawley rats by middle cerebral artery occlusion (MCAO) for 90 min. MCAO rats were treated with or without myrtenol (10, 30, or 50 mg/kg/day) or/and U0126 (10 μL) intraperitoneally for 7 days. Results In the present study, myrtenol had no toxicity at concentrations up to 1.3 g/kg. Myrtenol treatment improved neurological function of MCAO rats, with significantly (p < 0.05) improved neurological deficits (4.31 ± 1.29 vs. 0.00) and reduced brain edoema (78.95 ± 2.27% vs. 85.48 ± 1.24%). Myrtenol extenuated brain tissue injury and neuronal apoptosis, with increased Bcl-2 expression (0.48-fold) and decreased Bax expression (2.02-fold) and caspase-3 activity (1.36-fold). Myrtenol promoted angiogenesis in the brain tissues of MCAO rats, which was reflected by increased VEGF (0.86-fold) and FGF2 (0.51-fold). Myrtenol promoted the phosphorylation of MEK1/2 (0.80-fold) and ERK1/2 (0.97-fold) in MCAO rats. U0126, the inhibitor of ERK1/2 pathway, reversed the protective effects of myrtenol on brain tissue damage and angiogenesis in MCAO rats. Discussion and conclusions Myrtenol reduced brain damage and angiogenesis through activating the ERK1/2 signalling pathway, which may provide a novel alternative strategy for preventing cerebral I/R injury. Further in vitro work detailing its mechanism-of-action for improving ischaemic cerebral infarction is needed.

目的 探讨下调磷酸化应激诱导蛋白1(STIP1)表达对胶质瘤U251细胞增殖、侵袭和凋亡的影响,及其对JAK2/STAT3信号通路的调控作用.方法 免疫印迹法检测体外培养的正常胶质细胞(SVG)和人胶质瘤细胞(U251、U87和U37)STIP1蛋白表达水平.NC-siRNA或STIP1-siRNA质粒转染U251细胞,CCK-8法检测U251细胞增殖;Transwell实验检测U251细胞侵袭能力;流式细胞术检测U251细胞凋亡率;免疫印迹法检测JAK2/STAT3信号通路蛋白表达水平.结果 与正常胶质细胞SVG比较,胶质瘤细胞U251、U87和U373的STIP1蛋白表达水平均明显增高(P＜0.05).与NC-siRNA组比较,STIPl-siRNA组STIP1蛋白表达水平、细胞增殖活力和细胞侵袭力明显明显降低(P＜0.05),细胞凋亡率明显增高(P＜0.05),而且,p-JAK2和p-STAT3蛋白表达水平明显降低(P＜0.05).结论 STIP1在胶质瘤细胞中呈高表达,抑制STIP1表达可以抑制胶质瘤细胞的增殖和侵袭、促进凋亡,机制可能与抑制JAK2/STAT3信号通路有关.

目的 探讨早期颅骨成形术对重型颅脑损伤去骨瓣减压术病人预后的影响.方法 回顾性分析2017年7月～2019年6月收治的100例去骨瓣减压术治疗的重型脑损伤的临床资料.术后3～6个月行三维钛网颅骨成形术43例(对照组),术后5～8周行三维钛网颅骨成形术57例(观察组).术前、术后48 h进行CT灌注成像检查检测缺损侧顶叶皮质和缺损处皮质血流量.术后12个月采用GOS评分评估预后,4～5分为预后良好,1～3分为预后不良.术前、术后12个月采用美国卫生研究院卒中量表(NIHSS)评分评估神经功能,采用简易智力状况检查量表(MMSE)评估认知功能,采用Banhel指数评估日常生活能力.结果 术后48 h,两组顶叶皮质和缺损处皮质血流量均明显改善(P＜0.05),而且观察组明显优于对照组(P＜0.05).术后12个月,观察组预后良好率(85.96％,49/57)明显高于对照组(65.12％,28/43;P＜0.05),观察组NIHSS评分明显低于对照组(P＜0.05),MMSE评分和Barthel指数明显高于对照组(P＜0.05).结论 重型颅脑损伤去骨瓣减压术后病人,早期颅骨成形术有利于改善脑血流动力,促进神经功能恢复,改善病人预后.

目的 对比分析同期和分期行脑室-腹腔分流术(VPS)与颅骨成形术治疗颅脑损伤术后脑积水的效果.方法 回顾性分析2015年9月至2018年4月收治的79例颅脑损伤术后脑积水的临床资料.同期行VPS和颅骨成形术47例(同期组),分期行VPS和颅骨成形术32例(VPS后间隔至少3个月进行颅骨成形术;分期组).术前、术后7d采用功能独立性评价量表(FIM)、神经行为认知状况测试(NCSE)评价认知功能情况.术后3个月采用GCS评分、GOS评分评定病人意识及预后情况.结果 术后7d,两组FIM评分、NCSE评分均明显升高(P＜0.05),同期组明显高于分期组(P＜0.05).术后半年内,同期组术后并发症发生率(12.77％,6/47)明显低于分期组(31.25％,10/32;P＜0.05).术后3个月,同期组GCS评分[(12.02±2.87)分]明显高于分期组[(10.09±1.81)分;P＜0.05),但是GOS评分[(4.24±0.75)分]与分期组[(3.97±0.70)分]无统计学差异(P＞0.05).结论 对于颅脑损伤术后脑积水,同期和分期行VPS与颅骨成形术,均可有效改善病人认知功能和预后,而同期手术更具优势.

癫痫是由于大脑神经元异常放电引起的一种反复发作的神经系统疾病,我国有近900 万癫痫患者,其发病率呈逐年递增趋势[1]. 随着生物-心理-社会医学模式的发展,癫痫治疗在注重疾病本身的同时,更加关注患者的心境、社会支持和生活质量( QOL) [2]. 目前国内外关于癫痫患者QOL的调查分析多基于经济发达城市的癫痫专科门诊,农村癫痫患者的QOL状况报道较少. 为进一步了解农村癫痫患者治疗状况及QOL,我们应用癫痫患者生活质量评定量表-31 ( QOLIE-31 )对纳入患者进行分析,旨在为提高癫痫患者的QOL提供依据.

目的 旨在探讨脑胶质瘤在MRI动态增强扫描中的图像表现特征及临床应用价值.方法 选取我院2013年1月-2018年4月收治的脑胶质瘤患者39例,患者均进行了MRI检查,收集患者临床资料及影像学资料,由两名副主任级医师分析并总结39例脑胶质瘤患者MRI动态增强扫描图像表现特征,分析MRI动态增强扫描对脑胶质瘤的临床应用价值.结果 MRI平扫中胶质瘤实质部分主要表现为长T1、长T2信号;累及范围:累及范围2个脑叶者6例,累及范围≥3个脑叶者,39例患者中,21例患者主要累及颞叶、额叶.16例低级别胶质瘤患者T1WI呈现低信号,12例T2WI呈现高信号,9例患者为等信号,T1WI增强扫描中17例患者为结节强化;16例高级别胶质瘤T1WI表现为低信号,14例T2WI呈现高信号,T1WI增强扫描中13例患者为边缘强化;低级别胶质瘤ADC值为(1.23±0.26)s/mm2,明显低于高级别胶质瘤(0.86±0.14) s/mm2,差异具有统计学意义(t=5.397,P＜0.001).结论 MRI动态增强扫描可有效显示脑胶质瘤信号特点、强化特征,多序列扫描结合ADC值可提高临床评估脑胶质瘤分期的准确性,为临床制定治疗方案提供可靠资料.

颅内动脉瘤破裂导致病人死亡、残疾的主要原因是动脉瘤再破裂出血及脑血管痉挛(cerebral vasospasm,CVS).CVS可造成脑缺血或脑梗死.近几十年来,在动脉瘤手术技术和疗效提高的情况下,再出血问题已得到较好地解决,迟发性脑缺血是导致病人残疾和死亡的重要原因[1].本文就颅内动脉瘤破裂后迟发脑血管痉挛研究进展做一综述.

目的:探讨苍龟探穴针刺疗法联合拨穴通络推拿手法对肩周炎患者疼痛评分(VAS)及生活质量的影响.方法:肩周炎患者92例,抽签法分2组,各46例.对照组予以常规针刺与推拿手法治疗,观察组采取苍龟探穴针刺疗法联合拨穴通络推拿手法治疗,均持续治疗15d.比较2组临床效果及治疗前、治疗15d后VAS评分、肩关节功能评分(CMS)、与生活质量评分(SF-36).结果:治疗15d后观察组有效率89.13％(41/46)高于对照组的71.74％(33/46),差异有统计学意义(P＜0.05);治疗前2组VAS、CMS评分差异无统计学意义(P＞0.05),治疗15d后与对照组比较,观察组VAS评分降低,CMS评分提高,差异有统计学意义(P＜0.05);治疗15d后观察组SF-36评分较对照组提高,差异有统计学意义(P＜0.05).结论:肩周炎患者予以苍龟探穴针刺疗法联合拨穴通络推拿手法治疗效果确切,可明显降低患者VAS评分,减轻其疼痛感,提高其肩关节功能及生活质量.

目的 探讨CT与MRI检查在脑梗塞并脑出血诊断与疗效评价中的价值.方法 选取我院2015年2月-2016年12月我院经临床确诊的脑梗塞并脑出血患者56例,患者均行CT及MRI扫描,收集患者影像学资料及临床资料,对比患者MRI及CT检查对脑梗塞并脑出血的检出结果,并分析病人的出血部位、出血量以及对临床疗效进行评价.结果 56例患者经CT扫描共检出病灶46例,诊断准确符合率为82.14％,其中出血部位位于基底节41例,位于丘脑10例,位于小脑3例,位于脑干2例;MRI扫描共检出病灶51例,诊断准确符合率为91.07％,共检出72个出血灶,检出率为100％.MRI、CT均能清晰显示患者术后情况,对于术后复发的病灶显示为异常高信号且边界不清.结论 MRI对脑梗塞并脑出血检出率略高于CT,MRI、CT均能良好的监测患者的术后恢复情况,均能良好显示脑梗塞并脑出血的典型影像特征,具有一定的疗效评价价值.

目的:分析醒脑开窍针联合通脑汤治疗脑梗死后血管性痴呆的临床效果.方法:选取2014年12月至2016年12月漯河市中心医院收治的98例脑梗死后血管性痴呆患者,随机数字表法分为两组,各49例.对照组患者予以吡拉西坦片,观察组在对照组基础上予以醒脑开窍针+通脑汤,两组均持续治疗2个月.统计对比两组患者美国国立卫生研究院卒中量表(NIHSS)评分、生活质量评分[生活质量综合评定问卷(GQOL-74)]、认知功能评分[简易智能精神状态检查量表(MMSE)].结果:治疗后,观察组患者NIHSS评分低于对照组,MMSE评分高于对照组,差异具有统计学意义(P＜0.05);观察组患者心理功能、社会功能、躯体功能、物质生活状态评分均高于对照组,差异具有统计学意义(P＜0.05).结论:醒脑开窍针联合通脑汤可降低脑梗死后血管性痴呆患者NIHSS评分,提高MMSE评分,提升生活质量.

Objective To investigate the causes,EEG features and clinical manifestations in old patients with epileptic seizures.Methods The cause,clinical seizure types and therapeutic effects were analyzed in 86 patients with epileptic seizures.Results The causes of disease were determined in 84 patients,including 52 patients with cerebral vascular,13 patients with brain trauma,11 patients with brain metabolic disorder,4 patients with intracranial infection and 4 patients with brain tumor.The types of seizures included partial seizures in 51 patients,generalized seizures in 35 patients.Normal EEGs were found in 23 patients and abnormal in 63 patients,abnormal EEGs mainly showed increase of slow waves with low to middle amplitude,with diffuse of local distribution.Epileptiform discharges were found only in 15 patients of the 63 patients.The outcome of treatment were as follows:seizure free was found in 27 patients (31.4％),significant therapeutic effect was achieved in 30 patients (34.9％),no therapeutic effect was noted in 11 patients (12.8％),and death occurred in 5 patients (6.0％).Conclusions Most of old patients with epilepsy have definite cause of disease.Clinical manifestations mainly show partial seizures.Slow waves may be the background of EEGs,and EEGs showed low positive rate of epileptiform discharges.The elderly with epilepsy have a relatively good prognosis.

目的 探讨动态监测降钙素原(procalcitonin,PCT)在颅脑术后发生医院感染的临床意义.方法 对2013-01—2014-01行颅脑手术的176例患者的临床资料进行回顾性分析,其中术后发生医院感染的患者38例(感染组),未发生医院感染的患者138例(非感染组),分别在术后第1、3、5、7天采集静脉血标本检测血清PCT、C反应蛋白(CRP)、白细胞(WBC)数,同时选取同期健康体检者50例作为对照(对照组),以判断PCT水平变化对颅脑术后患者发生医院感染的预测价值.结果 颅脑手术后第1天的血清PCT水平明显高于对照组(P<0.05),而血清CRP水平、WBC计数和对照组比较差异无统计学意义(P>0.05).发生医院感染组和非医院感染组相比各时段血清PCT明显升高,差异有统计学意义(P<0.05);感染组血清CRP水平在术后第3、5天明显高于非感染组,差异有统计学意义(P<0.05),术后第1、7天和非感染组相比差异无统计学意义(P>0.05);感染组血清WBC计数和非感染组比较除第3天差异有统计学意义外,余差异均无统计学意义.结论 动态监测PCT水平可较早预测颅脑术后发生医院感染.

目的 对比微创钻孔引流术与开窗血肿清除术治疗高血压脑出血的临床效果.方法 抽取2013-04—2016-07在我院行外科手术治疗的110例高血压脑出血患者,根据不同术式分为微创组(n=55)与开窗组(n=55).微创组行微创钻孔引流术,开窗组行开窗血肿清除术.对比2组手术时间、住院时间、再出血发生率、预后情况及手术前后神经功能缺损程度(NIHSS)评分、C反应蛋白(CRP)、神经营养因子(NTF)、神经元特异性烯醇化酶(NSE)水平.结果 2组再出血率比较差异无统计学意义(P>0.05);微创组手术时间、住院时间均低于开窗组,且术后1周NTF水平高于开窗组,NIHSS评分、CRP、NSE水平低于开窗组,差异有统计学意义(P<0.05);微创组预后有效率92.73%,高于开窗组78.18%,差异有统计学意义(P<0.05).结论 微创钻孔引流术治疗高血压脑出血,可有效改善患者神经功能缺损程度及预后,且手术时间短,利于术后恢复,疗效显著优于开窗血肿清除术,值得推广.

Objective To observe the effect ofXing Nao Kai Qiao (awakening brain and opening orifice) needling method on the cognitive and motor function of patients in acute stage of cerebral infarction.Method Sixty-four patients in acute stage of cerebra infarction were recruited and randomized into a trial group and a control group, 32 cases in each group. The control group was intervened by Edaravone 30 mg plus Fibrinogenase injection 200 U mixed in 500 mL 0.9% NaCl via intravenous drip, once a day. The trial group was byXing Nao Kai Qiao needling method in addition to the intervention given to the control group, once a day, 5 times a week. The two groups were both given 2-week successive treatment. At the end of the intervention, clinical efficacy, cognitive function, motor function, nervous function, serum C-reactive protein and NO levels, and adverse reactions of the two groups were compared.Result After the treatment, the Chinese Stroke Scale (CSS) score dropped significantly, Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score, Barthel Index (BI) score and motor function score of both upper and lower limbs increased significantly in both groups (P<0.05); the total effective rate of the trial group was significantly higher than that of the control group (P<0.05); the CSS score was lower, and LOTCA score, BI score, and motor function scores of both upper and lower limbs were higher in the trial group compared with those in the control group, and the differences were statistically significant (P<0.05); on the 1st, 3rd, 7th and 14th day after the intervention, the serum CRP and NO levels were significantly lower in the trial group compared with those in the control group (P<0.05). There was no significant difference in comparing the adverse reaction incidence between the two groups (P>0.05).Conclusion Xing Nao Kai Qiao needling method can produce a significant efficacy in treating patients in acute stage of cerebral infarction, and it can improve the cognitive, motor and nervous functions with high security.

目的:对比果糖二磷酸钠和参麦注射液辅助治疗创伤性脑损伤的临床疗效.方法:选取在我院接受治疗的创伤性脑损伤患者88例作为研究对象,严格按照随机模式分为观察组和对照组,每组44例.在两组均接受常规开颅手术治疗后,给予对照组果糖二磷酸钠辅助治疗,给予观察组参麦注射液辅助治疗,观察并对比两组临床疗效.结果:观察组的总有效率和并发症发生率分别为93.18%和9.09%,对照组的总有效率和并发症发生率分别为77.27%和22.73%,观察组明显优于对照组,P<0.05,差异具有统计学意义.结论:采用参麦注射液对创伤性脑损伤进行辅助治疗的效果更好,有利于患者神经功能的恢复,值得在临床推广.

BACKGROUND:Titanium mesh has good clinical effect in repairing skul defects, but due to the lack of bone induction ability, the titanium mesh has a poor integration with the bone tissue. OBJECTIVE:To observe the biological properties of the gradient bioactive coating materials on the titanium surface in the skul repair. METHODS: Osteoblasts were co-cultured with the titanium mesh with or without gradient bioactive coatings for 14 days, and then cel proliferation was detected using MTT method. Seventy-one patients with skul defects were enroled, including 43 males and 28 females, aged 15-60 years, and were subjected to skul repair using the titanium mesh with (observation group, n=3) or without (control group, n=38) gradient bioactive coatings. During the postoperative folow-up of 12 months, the repairing effects and adverse reactions were observed in the two groups. RESULTS AND CONCLUSION:(1)In vitrocel culture: the cel proliferative ability was increased significantly in the observation group as compared with the control group at 8, 10, 12 and 14 days after cel culture. (2)In vivo repair: the hospital stay and wound healing time in the observation group were significantly lower than those in the control group (P< 0.05), and at the final folow-up, the postoperative recovery effect was significantly higher in the observation group than the control group (P < 0.05). The titanium meshes were fixed firmly in the two groups, with no floating, infection and exposure. These results show that the titanium mesh with gradient bioactive coating has good biocompatibility and osteoinduction capacity.

目的：探讨小骨窗开颅经侧裂-岛叶入路显微手术治疗基底节区脑出血的疗效及术中、术后对神经功能保护。方法回顾分析例了127例基底节区脑出血患者行血肿清除术的临床资料。结果115例患者经小骨窗开颅侧裂-岛叶入路显微手术，12例患者术中脑膨出明显改行大骨瓣经颞中回显微手术清除血肿，术后第ld行头颅CT检查，血肿清除量均在80％以上。住院期间死亡9例（7.1％）。6个月后随访97例患者，GOS评分Ⅴ分32例（34%）；Ⅳ分44例（45%）；Ⅲ分15例（15%）；Ⅱ分6例（6%）。结论小骨窗开颅经侧裂-岛叶入路显微手术，术中采取适当的血管及神经功能的保护措施是治疗基底节区脑出血是一种安全、高效的手术方式。

目的：对比观察治疗脑出血患者应用开颅术与锥颅术的临床疗效。方法116例脑出血患者,随机分为Ⅰ组和Ⅱ组,每组58例。Ⅰ组采用锥颅术进行治疗,Ⅱ组采用开颅术实施血肿清除治疗。对比两组治疗效果。结果Ⅰ组中恢复良好、轻度残疾的患者比例显著高于Ⅱ组,差异有统计学意义(P<0.05)。结论锥颅术对于脑出血患者的治疗效果优于开颅术,临床可积极实践应用。