目的 探讨动态颅内压监测下阶梯式减压策略在老年外伤性颅脑损伤患者去骨瓣减压术中的应用效果.方法 选取2019-03-2022-03石家庄市人民医院收治的102例老年外伤性颅脑损伤患者,对照组50例,观察组52例.对照组患者行常规去骨瓣减压术治疗,观察组患者采取动态颅内压监测下阶梯式减压策略的去骨瓣减压术,比较2组认知功能、神经功能、意识障碍程度、颅内压、血清指标及预后.结果 术后1 d、3 d、7 d,观察组颅内压水平均明显低于对照组(P＜0.05).术后1、3个月观察组神经行为认知状态检查量表(NCSE)、格拉斯哥昏迷量表(GCS)评分明显高于同期对照组,美国国立卫生研究院卒中量表(NIHSS)评分明显低于同期对照组(P＜0.05);术后1、3个月观察组血清胶质纤维酸性蛋白(GFAP)、S100B蛋白(S100B)、神经元特异性烯醇化酶(NSE)水平明显低于同期对照组(P＜0.05);术后1、3个月观察组C反应蛋白(CRP)、白细胞计数(WBC)及降钙素原(PCT)明显低于同期对照组(P＜0.05).观察组预后良好率明显高于对照组(P＜0.05).结论 在老年外伤性颅脑损伤患者中行动态颅内压监测下阶梯式减压策略的去骨瓣减压术,可有效降低其颅内压水平,加速神经功能恢复,改善预后.

OBJECTIVE:To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH).METHODS:Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared.RESULTS:The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001).CONCLUSIONS:The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.

目的 探讨血清降钙素原(PCT)+C反应蛋白(CRP)+白细胞介素6(IL-6)联合检测用于鲍曼不动杆菌肺炎的临床诊断效能.方法 以2018年1—12月在我院进行治疗的218例肺炎为研究对象,其中以74例鲍曼不动杆菌肺炎为研究组,以144例非微生物感染肺炎为对照组.收集研究对象的临床资料,并比较PCT、CRP、IL-6、CD3+、CD4+、CD4+/CD8+水平.采用Logistic回归分析拟合PCT+CRP+IL-6联合诊断模型并绘制受试者工作特征曲线,分析研究组PCT、CRP、IL-6、CD3+、CD4+、CD4+/CD8+检测及PCT+CRP+IL-6联合检测对鲍曼不动杆菌肺炎的诊断效能,并分析鲍曼不动杆菌肺炎与PCT、CRP、IL-6、CD3+、CD4+、CD4+/CD8+的相关性.结果 研究组PCT、CRP及IL-6水平均高于对照组,CD3+、CD4+、CD4+/CD8+水平均低于对照组,差异均有统计学意义(P<0.01).多因素Logistic回归分析显示,PCT、CRP、IL-6升高是鲍曼不动杆菌肺炎的危险因素,CD3+、CD4+、CD4+/CD8+升高是其保护因素.PCT+CRP+IL-6联合诊断鲍曼不动杆菌肺炎的曲线下面积高于PCT(Z=2.151,P=0.031)、CRP(Z=3.175,P=0.001)、IL-6(Z=4.255,P<0.001)分别单独诊断.Spearman相关分析结果显示,鲍曼不动杆菌肺炎与PCT、CRP、IL-6呈正相关,与CD3+、CD4+、CD4+/CD8+呈负相关.结论 PCT+CRP+IL-6联合检测能够提高鲍曼不动杆菌肺炎的诊断灵敏度,具有较高的临床预测价值.

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.

目的 探讨物理疗法配合常规药物对高血压脑出血(HICH)术后肺部感染的治疗效果.方法 选取2018年2月至2019年7月于石家庄市第一医院行HICH手术并发肺部感染的病人106例,按随机数表法分为观察组54例,对照组52例,对照组接受常规药物治疗(抗感染+氨溴索等),观察组在对照组基础上接受物理疗法(机械辅助排痰、雾化治疗、有效咳嗽训练、缩唇呼吸训练、呼吸训练器治疗和肺活量训练),均连续治疗12 d.对比两组治疗后咳嗽、肺部啰音、呼吸困难症状消失时间,比较两组治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、FEV1占预测值百分比(FEV1％pred)、FEV1占用力肺活量百分比(FEV1/FVC％)]、两组抗肺部感染的临床疗效.结果 因死亡剔除、终止3例,最终观察组53例,对照组50例.观察组咳嗽、肺部啰音、呼吸困难症状消失时间均短于对照组(P<0.001);两组治疗后FEV1、FEV1％pred、FEV1/FVC％均升高(P<0.05),且观察组均更高(P<0.05);两组抗肺部感染临床疗效等级分布差异有统计学意义(P<0.05),观察组总有效率94.34％(50/53)高于对照组72.00％(36/50)(P<0.05).结论 物理疗法配合常规药物治疗可有效缩短HICH术后肺部感染病人咳嗽、肺部啰音、呼吸困难症状的恢复时间,促进病情恢复,提高病人肺功能,具有较好的抗肺部感染临床疗效.

目的 探讨血清中性粒细胞与淋巴细胞比值(NLR)、可溶性髓系细胞触发受体-1(sTREM-1)、降钙素原(PCT)对老年卒中相关性肺炎(SAP)的诊断价值.方法 选取2017年12月—2019年6月收治的脑出血165例,根据其是否发生相关性肺炎,分为SAP组86例和非SAP组79例.记录2组一般情况与临床资料,分别于入院第1、3、7天检测血清PCT、sTREM-1水平及NLR值,并分析其对SAP的诊断价值.结果 SAP组PCT、sTREM-1、NLR在入院第3天达到峰值,第7天逐渐下降,均高于入院第1天,入院第7天低于入院第3天(P<0.05).SAP组入院第1、3、7天血清PCT、sTREM-1、NLR水平均高于非SAP组(P<0.01).入院第3天,血清PCT、sTREM-1、NLR对SAP诊断价值最大,曲线下面积分别为0.920、0.922、0.894.结论 血清PCT、sTREM-1、NLR可能成为SAP早期临床诊断的可靠生物学标记物,入院第3天时均达到峰值,因此上述指标在入院第3天对SAP的诊断价值最大.

目的 探讨不同手术方式对危重高血压幕上脑出血患者术后转归的影响.方法 146例老年危重高血压幕上脑出血患者,采用随机数字表分配法,按照治疗方式不同,分为观察组(钻孔引流联合开颅血肿清除术组)和对照组(开颅血肿清除术组).通过院内、门诊或电话及家访方式,收集和记录2组患者术后1周、2周、3周的GCS评分,并计算其术后GCS评分增量.采用多元线性回归分析研究入院患者一般资料与术后GCS评分增量的关系.采用方差分析比较不同出血部位和不同手术方式对术后GCS评分增量的影响.结果 患者入院年龄、出血量和GCS评分对术后不同时间点GCS评分增量具有影响(P<0.05);不同出血部位的术后GCS评分增量差异无统计学意义(P>0.05);观察组术后第1周、第2周和第3周的GCS评分增量均高于对照组,差异均有统计学意义(P<0.05).结论 患者入院年龄、出血量和GCS评分对危重高血压幕上脑出血术后GCS评分变化具有影响,且钻孔引流术联合开颅血肿清除术可提升恢复速率,改善预后.

目的 探讨右美托咪定在危重高血压脑出血开颅术后的临床应用价值.方法 80例危重高血压基底节区脑出血患者随机单盲法分为试验组和对照组,每组40例.对照组在常规脑出血开颅术后给予常规治疗,试验组在常规治疗基础上给予右美托咪定以0.2μg·kg-1·h-1速度静脉泵入至术后24 h.比较2组患者术后相同时间点的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)、脑氧摄取率(CERO2)、脑动静脉血糖含量差(A-VDG)、颅内压增量(I-ICP)及脑脊液中GABA增量(I-GABA)和Glu增量(I-Glu).结果 试验组术后12 h、24 h、72 h的HR、MAP均低于对照组,差异有统计学意义(P<0.05);试验组的SpO2和对照组相比,差异无统计学意义(P>0.05);2组在术后即刻(0 h)的CERO2、A-VDG、ICP及脑脊液中GABA和Glu含量差异均无统计学意义(P>0.05);术后12 h、24 h、72 h试验组CERO2均小于对照组,A-VDG均大于对照组,差异均具有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-ICP均小于对照组,差异均有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-GABA高于对照组,I-Glu小于对照组,差异有统计学意义(P<0.05).结论 右美托咪定在危重症高血压脑出血开颅术后持续应用,能够减轻应激反应,稳定血流动力学,改善脑氧和脑糖代谢,缓解颅内高压,达到脑保护和促进功能恢复作用.

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 分析右美托咪定对重症颅脑损伤患者镇静、生命体征及脑氧代谢的影响.方法 100例重症颅脑损伤患者,采用随机数字法分为对照组与观察组,每组50例.对照组术后给予常规综合治疗,观察组在常规治疗基础上加用右美托咪定静脉泵注.分析2组患者的术后镇静、免疫功能及脑氧代谢各项指征的变化.结果 观察组在术后12 h、24 h、48 h、72 h的内的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)均明显低于对照组(P<0.05);与术后0 h比较,2组患者在术后12 h、24 h、48 h、72 h的Ramsay评分、动脉-颈内静脉血氧含量差(AVDO2)、脑氧摄取率(CERO2)均明显下降,格拉斯哥昏迷量表(GCS)评分、颈静脉球部血氧饱和度(SjvO2)均明显增加,但观察组的以上指标明显优于对照组(P<0.05).结论 重症颅脑损伤患者在术后加用右美托咪定可明显改善术后镇静的效果,同时稳定患者生命体征及意识状态,增强脑氧代谢,安全性高.

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:评价右美托咪定对重症颅脑损伤患者围术期脑组织的保护作用,并探讨其对血清炎性因子的影响.方法:选取2017年5月至2018年11月拟行颅脑手术的重症颅脑损伤患者120例,按随机数字表法分为对照组和观察组,每组60例.对照组患者给予丙泊酚+罗库溴铵+咪达唑仑+芬太尼常规麻醉诱导,观察组患者在对照组基础上加用右美托咪定.比较两组患者的镇静情况,手术前后脑氧代谢指标、血清炎性因子水平及预后良好率的差异.结果:观察组患者镇静所需时间、机械通气时间明显短于对照组,芬太尼用量明显少于对照组,差异均有统计学意义(P<0.05).术后72 h,两组患者的颈内静脉血氧饱和度明显高于术前,颈内动静脉血氧含量差、脑组织氧摄取率明显低于术前,且观察组患者上述指标水平均明显优于对照组,差异均有统计学意义(P<0.05);两组患者的血清C反应蛋白、肿瘤坏死因子α、白细胞介素6及白细胞介素8水平均明显高于术前,但观察组患者上述指标水平均明显低于对照组,差异均有统计学意义(P<0.05).观察组的预后良好率明显高于对照组,差异有统计学意义(P<0.05).结论:右美托咪定用于重症颅脑损伤患者手术,可提高麻醉效率,减少麻醉药用量,降低脑耗氧量,改善脑代谢紊乱状态,降低炎性因子水平,抑制炎症反应,改善患者预后.

目的 评价高血压脑出血患者入住神经ICU后,使用右美托咪定达到目标镇静后的效果、一般生命体征、动脉血气指标及预后的影响.方法 140例高血压性脑出血并采取非手术干预的患者作为研究对象,采用随机数字法分为对照组和观察组,每组70例.对照组给予常规综合治疗,观察组在观察组治疗方案的基础上泵点右美托咪定静脉行镇痛镇静治疗.比较2组患者入住神经ICU后相同时间点的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、唤醒后的昏迷评分(GCS),随访3～6个月,比较2组患者的预后(GOS评分).结果 观察组在入住神经ICU后12、24、48、72 h的内的HR、RR、MAP均低于对照组(P<0.05);观察组(PaO2、PaCO2与对照组比较,差异无统计学意义(P>0.05);唤醒后GCS评分、随访3～6个月GOS评分,观察组的明显优于对照组(P<0.05).结论 高血压脑出血患者在发病入住神经ICU后使用右美托咪定镇痛镇静,效果明显,可稳定生命体征,对意识状态评估无显著影响,安全性高,无呼吸抑制,促进恢复,改善预后.

目的 探讨右美托咪定不同给药剂量对重症颅脑损伤患者镇静镇痛、血流动力学及脑氧代谢的影响.方法 选择颅脑损伤患者180例,随机分为A组、B组、C组各60例.A组给予0.3 μg·kg-1·h-1右美托咪定静脉维持,B组给予0.5 μg·kg-1·h-1右美托咪定静脉维持,C组给予0.7 μg·kg-1·h-1右美托咪定静脉维持.比较3组手术时间、麻醉时间、术中舒芬太尼用量.术后0h、12 h、24 h、72 h比较3组血流动力学[心率(heart rate,HR)、呼吸频率(respiration rate,RR)、平均动脉压(mean arterial pressure,MAP)、脉搏血氧饱和度(pulse oxygensaturation,SpO2)]及脑氧代谢[颈静脉球部血氧饱和度(blood oxygen saturation of jugular vein bulb,SjvO2)、颈内静脉血氧分压(jugular venous oxygen pressure,PjvO2)、动脉—颈内静脉血氧含量差(arteriovenous oxygen contentdiference,AVDO2)、脑氧摄取率(cerebral O2 extraction rate,CERO2)]指标.比较3组不良反应发生情况.结果 B组、C组术中舒芬太尼用量明显低于A组,C组术中芬太尼用量明显低于B组(P＜0.0S).3组手术时间、麻醉时间差异无统计学意义(P＜0.05).3组HR、RR、MAP均呈先降低再升高的趋势,B组、C组HR、RR、MAP水平低于A组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P＜0.05),3组SpOz水平组间、时点间、组间·时点间交互作用差异均无统计学意义(P＞0.05).3组Ramsay评分呈降低趋势,VAS评分和GCS评分呈升高趋势,B组和C组Ramsay评分、VAS评分低于A组,GCS评分高于A组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P＜0.05).3组SjvO2呈明显升高趋势,AVDO2、CERO2呈明显降低趋势,B组和C组SjvO2明显高于A组,AVDO2、CERO2明显低于A组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P＜0.05).3组不良反应发生率差异无统计学意义(P＞0.05).结论 重症颅脑损伤患者术中给予0.5 μg·kg-1·h-1右美托咪定静脉维持可明显发挥术后镇静镇痛效果,有效稳定血流动力学,增强脑氧代谢.

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 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.

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 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.