目的 探讨Ⅰ类切口开颅术后颅内感染的危险因素,为预防感染提供依据.方法 回顾性分析2019年1月至2023年3月在我院接受Ⅰ类切口开颅手术治疗的329例患者的临床资料,采用单因素分析(卡方检验、秩和检验)、Logistic多元线性回归分析术后颅内感染的影响因素.结果 329例患者术后发生颅内感染18例,感染发生率为5.47％(18/329),单因素分析结果提示是否急诊手术、是否规范预防性使用抗生素、术者有无很强无菌意识、术后是否有脑脊液切口漏、疾病类型、术中使用的手术辅助工具与开颅术后发生颅内感染相关(P＜0.05),Logistic多元线性回归分析结果提示术者无很强无菌意识、术后有脑脊液切口漏、术中使用手术辅助工具是术后颅内感染的独立危险因素(P＜0.05).结论 手术医师要加强无菌意识,提高无菌技术,落实无菌管理,避免术中污染,严密修补好硬脑膜,规范使用抗生素,尽量避免术后颅内感染.

目的 探讨自发性脑出血患者术后肺部感染危险因素并构建其列线图预测模型.方法 选取2014年6月-2019年6月宜宾市第一人民医院行手术治疗自发性脑出血患者768例,根据术后肺部感染情况分为感染组和未感染组,分析患者临床资料、感染病原菌分布情况,向前法多因素Logistic回归、R语言分别分析和构建术后肺部感染危险因素、列线图风险预测模型,受试者工作特征曲线(ROC)验证预测模型效能.结果 患者术后肺部感染198例,分离革兰阴性菌142株,革兰阳性菌56株,真菌7株.感染组年龄≥60岁、吸烟、饮酒、高血压、糖尿病、气管插管、呼吸机使用时间≥3 d、格拉斯哥昏迷量表(GCS)评分≤8分、低蛋白血症患者占比和外周血白细胞(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)、一氧化氮(NO)、内皮素-1(ET-1)水平高于未感染组(P<0.05).年龄≥60岁、吸烟、糖尿病、呼吸机使用时间≥3 d、GCS评分≤8分、低蛋白血症是自发性脑出血患者术后肺部感染的独立危险因素(P<0.05),列线图风险预测模型ROC曲线下面积(AUC)为0.920.结论 自发性脑出血患者术后肺部感染病原菌以革兰阴性菌为主,列线图风险预测模型预测效能良好.

目的 探讨基于全球营养领导人营养不良倡议(GLIM)标准营养评定后的序贯营养治疗在颅内动脉瘤患者围术期中的应用效果.方法 选取2020年1月至2021年12月于我院采用介入栓塞术治疗的颅内动脉瘤患者68例,随机分为对照组(36例)和观察组(32例),分别按常规围术期健康教育及加速康复外科理念下的序贯营养治疗策略进行营养管理,观察患者主观感受、一般住院指标和营养状况指标.结果 患者术前、术后饥饿感和口渴评分观察组低于对照组,术后3 d疼痛VAS评分对照组高于观察组(P<0.05).观察组患者术后肛门排气时间、首次排便时间、首次下床活动时间、术后住院时间、总住院时间及总住院费用显著低于对照组(P<0.05),恶心呕吐发生率观察组低于对照组(46.9％vs.75.0％,P<0.05).两组患者入院时体质指数(BMI)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)及C反应蛋白(CRP)差异无统计学意义(P>0.05),观察组体质量下降率均低于对照组[(1.79±0.39)％vs.(3.48±0.44)％,P<0.05],两组患者术后3 d的ALB、PA、CRP观察组优于对照组,差异有统计学意义(P<0.05).结论 术前基于GLIM标准的营养评估及围术期序贯营养治疗策略符合加速康复外科营养管理理念,有利于改善患者术前和术后主观感受,缩短住院时间和费用,改善患者营养相关指标,促进患者快速康复.

目的 探究不同时机显微夹闭手术治疗颅内动脉瘤(LA)的疗效并分析影响预后的因素.方法 选择2017年1月至2019年1月于宜宾市第一人民医院神经外科接受显微夹闭手术治疗IA的102例患者,其中男性49例,女性53例;年龄33～72岁,平均年龄56.54岁.比较不同时机(24h内、48 h内、72 h内)显微夹闭手术患者的一般资料、术后动脉瘤夹闭情况、术后并发症发生情况、治疗效果及患者预后情况;单因素及多因素Logisitic回归分析影响IA患者预后的因素;根据筛选出的独立危险因素构建列线图预测模型并验证.结果 不同时机显微夹闭手术患者的一般资料差异无统计学意义(P＞ 0.05);24 h内手术的患者动脉瘤完全夹闭率、恢复良好率、预后良好率显著高于48 h内和72 h内手术的患者(95.24％vs 72.22 vs 40.74％、85.71％vs 74.07％vs 59.26％、95.23％vs 87.04％vs 74.07 ％;P＜ 0.05);根据出院时格拉斯哥预后量表(GOS)评分,将患者分为预后良好组(87例)和预后不良组(15例).预后良好组和预后不良组两组患者的年龄、高血压史、术前颅内血肿量、动脉瘤大小、术前Hunt-Hess分级、手术时机、术后并发症、美国国立卫生研究院卒中量表(NIHSS)评分差异均具有统计学意义(P＜0.05),均是影响IA患者术后预后的独立危险因素;列线图模型预测患者预后不良率为14.71％,模型评价的实际C-index为0.815,内部验证C-index为0.809,外部验证C-index为0.805,模型符合度较好.结论 IA患者动脉瘤破裂后越早(24 h内)进行显微夹闭手术疗效越好,患者年龄、高血压史、术前颅内血肿量、动脉瘤大小、术前Hunt-Hess分级、手术时机、术后并发症、NIHSS评分均是影响IA患者预后不良的独立危险因素.

目的 研究长链非编码RNA Pvt1致癌基因(PVT1)在胶质瘤细胞增殖和上皮-间充质转化(EMT)过程中的作用.方法 收集不同级别胶质瘤临床样本,定量逆转录聚合酶链反应(qRT-PCR)检测PVT1表达水平;U87MG和U251细胞系分别转染siRNA-PVT1及siNC后,CCK-8检测细胞增殖活性,Transwell法检测细胞侵袭能力,蛋白质印迹(Western blot)法检测EMT相关蛋白E-cadherin、N-cadherin和Vimentin的表达情况.结果 与正常脑组织相比,随着胶质瘤分级的增加,PVT1表达水平逐渐升高(P﹤0.05).胶质母细胞系U87MG和U251的PVT1表达水平均明显高于正常HEB细胞系(P﹤0.01).培养2、3天后,siRNA-PVT1组U87MG和U251细胞光密度值均低于siNC组.与siNC组相比,siRNA-PVT1组U87MG和U251细胞侵袭细胞数量均减少.siRNA-PVT1组U87MG和U251细胞系中E-cadherin蛋白相对表达量均高于siNC组,N-cadherin和Vimentin蛋白相对表达量均低于siNC组,差异均有统计学意义(P﹤0.05).结论 长链非编码RNA PVT1在胶质瘤中高表达,其表达水平与胶质瘤恶性程度有关;沉默PVT1可抑制胶质瘤细胞的增殖、侵袭和EMT过程,为胶质瘤的基因疗法提供了一个新的潜在靶点.

Objective To investigate whether miR-92a and miR-362-3p is involved in the protective effects of mild hypothermia on severe traumatic brain injury via TOB2. Methods 84 patients with severe traumatic brain injury(STBI)were selected in this study from March 2015 to April 2017 and randomly divided into conventional treatment group(42 cases)and mild hypothermia+ conventional treatment group(42 cases). The patients from conventional treatment group were given conventional treatment of dehydration,hemostatic and anti-inflammatory and neuro-trophic drugs,the patients from mild hypothermia + conventional treatment group were given conventional treatment,based on hypother-mia treatment. 5 ml of elbow vein bloods were collected before treatment,at first,seventh and fourteenth days after treatment,the serum levels of miR-92a and miR-362-3p were detected by qRT-PCR,the TOB2 protein was detected by western blotting,the luciferase reporter assay was used to verify TOB2 is target gene of miR-92a and miR-362-3p,the Glasgow outcome classification(GOS)was recorded at 6 months after in-jury. Results Before treatment,there was no significant difference in serum miR-92a and miR-362-3p between the two groups(P >0.05). At the first,seventh and fourteenth days after treatment,compared with the conventional treatment group,the levels of serum miR-92a and miR-362-3p were decreased in mild hypothermia + conventional treatment group(P <0.05),in addition,during the treatment,the TOB2 pro-tein was gradually increased. The luciferase reporter assay confirmed that TOB2 was the target gene of miR-92a and miR-362-3p. At sixth months after injury,compared with the conventional treatment group,mild hypothermia + conventional treatment group had good prognosis and moderate residual rate,while severe disability rate,plant survival rate and mortality rate decreased(P <0.05). Conclusion After traumatic brain injury,miR-92a and miR-362-3p is involved in the protective effects of mild hypothermia on severe traumatic brain injury via TOB2.

Objective:To study the effect of Claudin6 (CLDN6) gene on cell proliferation and invasion-related gene expression in meningioma tissue.Methods:Patients with meningioma and patients with brain trauma who received surgical treatment in Yibin First People's Hospital between May 2014 and March 2017 were selected,the meningioma and normal meninges tissue were collected,the positive protein rate of CLDN6 was determined by immunohistochemical kit,and the protein expression of CLDN6,invasion genes and proliferation genes were determined by the enzyme-linked immunosorbent assay kit.Results:The protein content and positive protein rate of CLDN6 in meningioma tissue were significantly lower than those in normal meninges tissue;PHH3,MCM2,E2F3,MMP2,MMP9,N-cadherin and Vimentin protein contents in meningioma tissue were significantly higher than those in normal meninges tissue while BAG-1 and Caspase-3 protein contents were significantly lower than those in normal meninges tissue;PHH3,MCM2,E2F3,MMP2,MMP9,N-cadherin and Vimentin protein contents in CLDN6-positive meningioma tissue were significantly lower than those in CLDN6-negative meningioma tissue while BAG-1 and Caspase-3 protein contents were significantly higher than those in CLDN6-negative meningioma tissue.Conclusion:The low expression of CLDN6 gene in meningioma tissue is closely related to the abnormal proliferation and invasion of cells.

Objective To investigate the risk factors of neurological deficits in patients with cerebral arteriovenous malformation (CAVM) after microsurgical resection.Methods 213 patients with CAVM treated with microsurgical resection in our hospital from January 2007 to January 2017 were enrolled. Before and 7 days after surgery, their neurological function was classified by modified Rankin scale (mRS), recurrent neurological dysfunction was defined as that the postoperative mRS score was more than preoperative. Their general information, laboratory and pathological detection indexes were observed, and the risk factors of recurrent neurological dysfunction were analyzed with single factor andLogistic regression analysis.Results 43 patients developed recurrent neurological dysfunction. Single factor analysis and multivariateLogistic regression analysis showed that preoperative intracranial hemorrhage, high expression of Angiogenin-1(Ang-1) were protective factor for recurrent neurological dysfunction (P<0.05). drainage through deep venous, lesion located in functional areas, larger size, Spetzler-Martin(Ⅲ-Ⅴgrade), aneurysm accompanying AVM, lower resistance index of feeding artery, higher expression of vascular endothelial growth factor (VEGF) and Ang-2 were risk factors (P<0.05).Conclusion Neurological dysfunction is easy to reoccur in patients with CAVM after microsurgical CAVM resection. Preoperative intracranial hemorrhage and high expression of Ang-1 were protective factor. Drainage through deep venous, lesion located in functional area, larger size, Spetzler-Martin(Ⅲ-Ⅴgrade), aneurysm accompanying CAVM, lower resistance index of feeding artery, higher expression of vascular endothelial growth factor (VEGF) and Ang-2 were risk factors.

目的探讨快速立体定位固定系统在开颅手术中的应用价值.方法应用快速立体定位固定系统辅助开颅手术治疗颅内病变15例,并对应用快速立体定位固定系统术中定位的准确性、使用的安全性和术后治疗效果进行评估.结果定位平均误差(2±0.76)mm,术中均能准确定位病灶,系统无安全隐患.病变全切10例,脑内血肿穿刺引流4例,脑脓肿穿刺引流1例.术后均无神经功能障碍,无手术并发症及死亡.结论使用快速立体定位固定系统辅助开颅手术,能大幅度提高手术的精准度,减少手术创伤及术后并发症,降低手术死亡率和致残率.

Objective:To study the correlation of Claudins6 (CLDN6)gene expression in meningioma tissue with the expressions of matrix metalloproteinases (MMPs)/tissue inhibitors of matrix metalloproteinase (TIMPs)and epithelial-mesen-chymal transition (EMT)genes.Methods:Meningioma tissue samples that were surgically removed in Yibin First People's Hospital between April 2014 and May 2017 were selected,and normal arachnoid tissue samples that were collected from de-compressive craniectomy in this hospital during the same period were selected.The expressions of CLDN6,MMPs/TIMPs and EMT genes in tissues were determined.Results:CLDN6 protein expression in meningioma tissue was significantly lower than that in normal arachnoid tissue;EMMPRIN,MMP2,MMP9,Vimentin and N-cadherin protein expressions in meningioma tissue were significantly higher than those in normal arachnoid tissue while TIMP1,TIMP2,E-cadherin and α-catenin protein expressions were significantly lower than those in normal arachnoid tissue;EMMPRIN,MMP2,MMP9,Vimentin and N-cad-herin protein expressions in meningioma tissue with higher CLDN6 expression were significantly lower than those in meningio-ma tissue with lower CLDN6 expression while TIMP1,TIMP2,E-cadherin andα-catenin protein expressions were significantly higher than those in meningioma tissue with lower CLDN6 expression.Conclusions:Lowly expressed CLDN6 gene in meningio-ma tissue can increase the hydrolysis activity of MMPs,induce epithelial-mesenchymal transition and thus promote the invasive growth of meningioma.

NT-proBNP是BNP的前体。具有灵敏度高,易检测的临床特点,广泛的应用到临床的诊断中去 [1] 。笔者根据目前急性脑梗死的治疗现状,选取2015年6月-2016年6月来我院治疗的急性脑梗死患者100例作为此次报告的研究对象。分析和探究急性脑梗死患者血浆NT-proBNP的检测及其临床意义,详细见以下报道。1资料和方法1.1一般资料选取我院于2015年6月-2016年6月收治的100例急

Objective To investigate the effect of surgical treatment and the points for attention of primary intraventricular hemorrhage with casting of the whole ventricle.Methods 48 cases of primary intraventricular hemorrhage and casting of the whole ventricle in department of neurosurgery in our hospital were randomly selected.Among them,29 cases underwent craniotomy with right frontal cortex fistula,and the lateral ventricle hematoma decompression was performed under microscope(group A);19 cases were treated with bilateral lateral ventricle drilling and drainage of hemorrhagic cerebrospinal fluid(group B);The two groups were treated with intraventricular drainage and intraventricular injection of urokinase,followed up for 3 months,and the curative effect and prognosis were observed.Results In group A,15 cases had good postoperative recovery,10 casesimproved,4 casesdied;There were 3 cases of intracranial infection,3 cases of epilepsy and 0 case of hydrocephalus;GOS score:5 points in 2 cases,4 points in 13 cases,3 points in 7 cases,2 points in 3 cases,1 point in 4 cases;The success rate of treatment was 86％.While in group B,1 case had good postoperative recovery,10 cases improved,8 cases died;There were 4 cases of intracranial infection,2 cases of epilepsy and 5 cases of hydrocephalus;GOS score:5 points in 0 case,4 points in 1 case,3 points in 5 cases,2 points in 5 cases,1 point in 8 cases;The success rate of treatment was57.8％.SPSS 24 was used to analyze the data,and the difference was statistically significant(P ＜ 0.05).Conclusion It is a powerful way to rescue the acute intraventricular hemorrhage and cast the whole ventricular cavity by frontal lobe ostomy,hematoma evacuation and postoperative drainage.

目的:探讨CT灌注成像(CTPI)、CT血管造影(CTA)和数字减影血管造影(DSA)在诊断早期外伤性脑梗死(PTI)中的应用价值.方法:选取2012年3月-2016年12月收治的78例外伤性脑梗死患者临床资料,回顾性分析CTPI和CTA,DSA检查结果,与手术结果对照,比较3种诊断方法的符合率.结果:78例外伤性脑梗死患者中,74例发现灌注异常,4未见异常,敏感度为94.87％(74/78).74例患者脑梗区表现为局部脑血容量(CBV)、获得局部脑血容量(CBF)明显降低,平均通过时间(MTT)、峰值时间(TTP)明显延长;缺血半暗带区表现为CBV、CBF轻微降低,MTT、TTP有所延长.74例患者脑梗区与对侧镜像区CBV、CBF比值分别为:(0.43±0.09)、(0.19±0.05);脑梗区与对侧镜像区CBV、CBF比值分别为:(0.47±0.12)、(0.21±0.06).CTA诊断结果显示72例头颈部动脉主干或分支狭窄、闭塞,其中大脑中动脉主干狭窄19例,大脑中动脉主干闭塞18例,颈动脉狭窄12例,颈动脉闭塞6例,大脑中动脉远端狭窄5例,大脑后动脉狭窄2例.DSA诊断结果显示71例出现动脉狭窄或闭塞145支,颅内、外动脉狭窄或闭塞分别为86支、59支.单纯颅内或颅外动脉狭窄或闭塞分别为26例、30例,颅内、颅外动脉多发狭窄或闭塞15例.结论:多层螺旋CT灌注成像结合头颈部CT血管造影,能够发现早期缺血脑组织及其血流异常灌注情况,并区分脑梗死区及缺血半暗带区,同时直观显示供血动脉形态,明确狭窄的部位和程度.DSA是诊断血管狭窄与闭塞的金指标,可检查颅外及颅内主要分支血管的狭窄与闭塞程度、范围、侧枝供应情况及粥样硬化斑块存在情况,3种方法为急性缺血性脑病的诊断和研究提供新的方法,对指导临床选择最佳治疗方案及观察疗效亦具有非常重要的意义.

Objective To study clinical efficacy of microsurgery through lateral fissure and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage.Methods 84 patients with hypertensive cerebral hemorrhage were divided into control group and research group, 42 people of each. The patients of control group were given small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage, and the research group of 42 people were given lateral fissure microsurgery in the treatment. Then compared the curative effect of the two groups.Results The total effective rate of the research group was 97.6%, which was significantly higher than that of the control group 76.2%(P<0.05), and the postoperative complications rate of the research group was 4.8%, which was significantly lower than that of the control group(23.8%)(P<0.05).Conclusion The patients with hypertensive cerebral hemorrhage treated by lateral fissure microsurgery can get better clinical effect.

目的：探讨开颅蛛网膜造瘘术治疗外伤性硬膜下积液的手术方法及疗效。方法回顾性分析2010年6月至2013年4月接受开颅蛛网膜造瘘术治疗的45例外伤性硬膜下积液患者的临床资料。结果45例患者术后随访3个月~2年，32例患者的积液全部消失，13例患者的积液量有明显减少；45例患者的临床症状均有不同程度改善。结论开颅蛛网膜造瘘术是治疗外伤性硬膜下积液的一种可行的方法。

objective:To discuss the applied value of pneumoperitoneum puncturation in ventriculoperito-neal shunt(VPS)surgery.Methods :Retrospective statistic analysed the cases of traditional surgery group and pneu-moperitoneum puncturation technology group in June 201 1 to June 2013 in the scientific research and compared two groups of patients with postoperative imaging results and complications for confirming the applied value of pneumo-peritoneum puncturation in ventriculoperitoneal shunt surgery.Results:In 65 completed statistic cases,there were no obvious differences about postoperative 4 weeks imaging results in the two groups,but as to the postoperative com-plications in half year pneumoperitoneum puncturation technology group was superior to the traditional surgery group.Conclusion:The application of pneumoperitoneum puncturation technology not only obtain the equal effect of traditional surgery,but also have the advantages that the operation is simple,safe,minimally invasive,high success rate and little scar.

目的 收集我院12例儿童弥漫性轴索损伤患者的临床资料,比较颅内压监护与未应用颅内压监护患者的再出血率及预后.方法 收集12例儿童弥漫性轴索损伤患者的临床资料,比较应用颅内压监测组与未应用颅内压监测组患者的再出血率及预后.结果 颅内压监护组患者在病死率、预后均优于无颅内压监测患者,重度残疾率和再出血率均低于无颅内压监测患者.结论 持续性颅内压监护,弥漫性轴索损伤患儿可以降低颅内压同时保证脑灌注,能够及早把握手术时机,降低病死率和致残率,改善患儿的预后.

目的：讨论冠状截颅去骨瓣减压手术治疗伴有双侧额颞叶脑损伤型特重型颅脑损伤的应用价值。方法回顾分析我院2010年9月~2013年12月收治的采用冠状截颅去骨瓣减压手术（以下简称冠截）治疗的36例特重型颅脑损伤患者的病例资料。结果恢复良好8例，中残11例，重残7例，死亡10例。结论冠截手术可以提高双侧额颞叶损伤型特重型颅脑损伤的救治成功率，是一种行之有效的手术方法。

目的 探讨分析颅内血管外皮瘤的诊断、治疗及预后.方法 经外科手术后再联合伽马刀放射治疗2例颅内血管外皮细胞瘤,结合文献复习,对颅内血管外皮细胞瘤的诊断,治疗及预后进行讨论.结果 颅内血管外皮细胞瘤的术前诊断主要依靠影像检查,预后不理想,且受较多因素影响.结论 颅内血管外皮细胞瘤的术前确诊困难,治疗仍以外科手术联合伽马刀放射治疗为主要治疗方法.终生随访是必要的.

目的:分析单纯内减压治疗儿童重型颅脑损伤的方法及预后。方法:回顾分析我院收治的11例儿童重型颅脑损伤患儿采用单纯内减压治疗的方法及预后。结果:11例患儿全部存活,其中康复5例,轻度伤残3例,中残2例,1例因再次脑疝而再次手术去除骨瓣,术后中度伤残。结论:单纯内减压治疗儿童重型颅脑损伤在临床上具有一定可行性及特有的优越性。