目的 通过对比分析评价利用智能手机简化增强现实(AR)技术辅助定位引流术治疗老年幕上脑出血的应用价值.方法 回顾性分析221例引流手术治疗的老年幕上脑出血患者(出血量20～ 40 mL)的临床资料,其中行简化AR技术辅助定位引流术(观察组)108例,行立体定向引流术(对照组)113例.对比两组患者手术时间,置管位置准确率,血肿清除率,术后患肢肌力改善明显率,预后良好率的差异,评价利用智能手机简化AR技术辅助定位引流术治疗老年幕上脑出血的应用价值.结果 观察组手术时间平均为(32.8 ±7.5)min,对照组手术时间平均(97.3±11.4)min,两组比较差异有统计学意义(P＜0.05).观察组置管准确率,血肿清除率,术后肺部感染率,术后下肢静脉血栓发生率,术后患肢肌力改善明显率,预后良好率分别为94.4％,85.4％±7.9％,18.5％,12.0％,76.8％,72.2％;对照组为94.7％,90.1％±6.5％,21.2％,15.0％,82.3％,78.8％;两组比较差异无统计学意义(均P＞0.05).结论 利用智能手机简化AR技术辅助定位引流术治疗老年幕上脑出血,与立体定向引流术比较,可明显缩短手术时间,操作过程更简便,无需专业设备辅助,但手术的安全性和可靠性无明显差别.

目的 通过分析重症高血压脑出血(HICH)患者行有创颅内压监测术后发生颅内感染的相关危险因素,建立并评估个体化预测重症HICH患者行有创颅内压监测术后发生颅内感染风险的列线图模型.方法 选取2013年8月至2020年11月在本院确诊并住院行有创颅内压监测术治疗的重症HICH患者230例为研究对象,并根据患者术后颅内感染的发生与否将研究对象分为感染组(39例)和未感染组(191例).采用Logistic回归模型分析重症HICH患者行有创颅内压监测术后发生颅内感染的独立危险因素,应用列线图在线网站绘制预测重症HICH患者行有创颅内压监测术后发生颅内感染风险的列线图模型,采用研究对象工作特征曲线(ROC)、校准曲线及Hosmer-Lemeshow拟合优度检验评估列线图模型进行验证.结果 多因素Logistic回归模型显示,糖尿病、探头留置时间＞7d、术后间断开放脑室型外引流管、脑脊液漏及有创颅内压监测时行开颅手术是重症HICH患者行有创颅内压监测术后发生颅内感染风险发生的独立危险因素(P＜0.05).ROC结果显示,预测重症HICH患者行有创颅内压监测术后发生颅内感染风险的曲线下面积(AUC)为0.806.校准曲线为斜率接近1的直线,Hosmer-Lemeshow拟合优度检验x2=6.465,P=0.595.结论 本研究基于糖尿病、探头留置时间＞7d、术后间断开放脑室型外引流管、脑脊液漏及有创颅内压监测时行开颅手术这5项重症HICH患者行有创颅内压监测术后发生颅内感染的独立影响因素构建的列线图模型,具有良好的区分度及较高的准确度.

Objective:To evaluate the application value of simplified augmented reality (AR) technique in the location of puncture point before drainage of supratentorial hemorrhage in the elderly.Methods:One hundred and sixty-three senile patients with supratentorial cerebral hemorrhage (amount of bleeding: 30-60 mL) treated by hematoma drainage from February 2018 to February 2020 were chosen in our study; 85 patients (observation group) were treated with AR technique assisted drainage, and 78 patients (control group) accepted drainage assisted by virtual reality (VR) technique (3D slicer software) combined with AR technique (Sina software). The differences of preoperative location time, accuracy rate of catheter placement, sufficient drainage rate of hematoma within 72 h of surgery, postoperative pulmonary infection rate, postoperative Intensive Care Unit staying time, and favorable prognosis rate were compared between the two groups.Results:The accuracy of the catheter placement (95.3% vs. 94.9%), sufficient drainage rate of hematoma within 72 h of surgery (96.5% vs. 96.2%), postoperative pulmonary infection rate (21.2% vs. 19.2%), postoperative Intensive Care Unit staying time ([75.5±16.7] h vs. [81.5±19.5] h), favorable prognosis rate (75.3% vs. 70.5%) between the observation group and control group showed no significant differences ( P>0.05), but the preoperative location time in the observation group was significantly shorter than that in the control group ([12.2±6.5] min vs. [37.5±11.3] min, P<0.05). Conclusion:On the basis of no significant difference in the accuracy and therapeutic effect of catheter placement, drainage assisted by simplified AR technique is more convenient and faster than that by VR combined with AR technique.

目的 评价智能手机增强现实(augmented reality,AR)技术辅助定位引流术在幕上脑出血治疗中的应用价值.方法 回顾性分析166例行引流手术的幕上脑出血(出血量30～60 ml)病人的临床资料,92例应用智能手机AR功能辅助简化立体定位作为观察组,74例应用传统立体定向定位作为对照组.对比两组手术时间及疗效指标差异.结果 观察组手术时间较对照组显著减少(P<0.05),而两组置管准确率、血肿清除率、术后并发症发生率、术后1个月肌力增加情况、术后1、3个月预后良好率、术后3个月GOS评分等差异均无统计学意义(P>0.05).两组各发生术后再次脑出血1例,经治疗后好转.两组均无死亡病例.结论 利用智能手机AR功能辅助定位引流术治疗幕上脑出血,可明显缩短手术时间,无需专业设备支持,值得临床推广.

目的 ：研究对脑卒中偏瘫患者实施针灸和生物反馈治疗对恢复和预后的影响。方法 ：于我院脑卒中偏瘫患者随机抽取 74 例，对照组给予针灸治疗，观察组联合给予生物反馈治疗，对比两组恢复和预后效果。结果 ：观察组 BI 指数（68.29±6.45）分，FMA（68.62±8.49）分，明显高于对照组。观察组 SDSS（7.14±1.12）分，SF-36（70.45±4.72）分，均优于对照组。2 组对比，差异显著（P ＜ 0.05）。结论 ：对脑卒中偏瘫患者给予生物反馈治疗联合针灸治疗有利于恢复患者肢体功能和生活能力，从而恢复社会功能以及生活质量，回归正常生活，改善预后效果。

目的 对比利用智能手机增强现实(augmented reality,AR)技术进行幕上脑出血引流术与传统立体定向引流术的手术时间与效果.方法 回顾性收集我院2018年2月至2020年2月我院老年幕上脑出血(出血量30～60 mL)引流手术治疗166例.其中研究组92例,为利用智能手机简化AR技术辅助立体定位血肿引流手术患者.对照组74例,为传统立体定向血肿引流手术患者.对比研究组与对照组患者手术时间、引流管位置准确率、血肿清除率、术后改良Rankin评分(modified Rankin scale,mRS)的差异,评价利用简化AR技术辅助定位引流术在幕上脑出血治疗中的应用价值.结果 研究组手术时间(42.5±7.7)min,对照组(109.4±7.3)min,两组比较差异有统计学意义(P<0.05).研究组和对照组置管准确率(94.6％vs.97.3％)、血肿清除率(87.3％±8.3％vs.89.5％±9.1％)、术后4周mRS(2.3±1.2 vs.2.2±1.3)、术后90 d随访Barthel(Barthel index,BI)明显改善率(76.1％vs.68.9％),两组比较差异无统计学意义(P>0.05).结论 利用智能手机简化AR技术辅助定位引流术治疗幕上脑出血,可明显缩短手术时间,无需专业设备、操作简便,并可取得与传统立体定向手术相同的疗效.

目的 探讨应用CT血管成像(CTA)点征选择老年基底节中等量脑出血超早期钻孔引流,或开颅手术治疗的手术方式.方法 选择2015年4月～2019年1月入住我院适合手术的老年中等量基底节脑出血(出血量30～60 ml)且家属同意超早期手术治疗患者216例,根据入院后患者是否同意行头颅CTA检查分为应用组(同意行CTA者)112例,对照组(不同意行CTA者)104例,应用组CTA点征阳性者,进入开颅亚组45例,CTA点征阴性者进入引流亚组67例.对照组根据患者家属选择的手术方式,分为开颅亚组46例,引流亚组58例.2组引流手术亚组超早期均给予微创血肿软通道引流术,并给予血肿内纤溶药物治疗.2组开颅亚组患者均给予超早期开颅血肿清除术治疗.对比应用组与对照组引流亚组及开颅亚组患者治疗效果的差异,评估应用CTA点征选择老年基底节中等量脑出血超早期手术方式的价值.结果 与对照组比较,应用组总有效率显著增高,差异有统计学意义(72.3％ vs 53.8％,P＜0.05).术后应用组血肿增大、死亡、颅内感染显著低于对照组(2.7％ vs 13.5％,3.6％vs 15.4％,1.8％ vs 7.7％,P＜0.05);术后对照组肺部感染与应用组比较差异无统计学意义(25.0％ vs 17.9％,P＞0.05).结论 通过CTA点征选择引流或开颅手术,可明显改善患者预后,CTA点征可作为客观指标是选择中等量基底节脑出血超早期手术方式.

Objective:To investigate the value of CT angiography (CTA) point sign in the treatment of patients with moderate amount basal ganglia hemorrhage at ultra-early stage by trephination and drainage or craniotomy, and its influence in the prognoses.Methods:One hundred and twenty-six patients with moderate amount basal ganglia hemorrhage (30-60 mL) admitted to our hospital from March 2017 to March 2019 were chosen in our study; these patients were evaluated and conformed to have the same tolerance of craniotomy or drainage; and their families agreed to the ultra-early surgical treatments; their clinical data were retrospectively collected. They all accepted CTA before operation. Among them, 68 were into the craniotomy group, including 38 into CTA spot sign negative sub-group and 30 into positive sub-group; 58 were into the trephination and drainage group, including 39 into CTA spot sign negative sub-group and 19 into positive sub-group. The differences of favorable prognosis rate and postoperative re-hemorrhage rate were compared between the craniotomy group and trephination and drainage group, as well as each two sub-groups.Results:The favorable prognosis rate and postoperative re-hemorrhage rate of patients in the craniotomy group (61.8% and 2.9%) were significantly lower as compared with those in the trephination and drainage group (82.8% and 15.5%, P<0.05). In the craniotomy group, the favorable prognosis rate and postoperative re-hemorrhage rate in the CTA spot sign positive sub-group (60.0% and 4.8%) were higher than those in the negative sub-group (63.2% and 2.1%), without significant differences ( P>0.05); in the trephination and drainage group, the favorable prognosis rate and postoperative re-hemorrhage rate in the CTA spot sign positive sub-group (63.2% and 36.8%) were significantly different as compared with those in the negative sub-group (92.3% and 5.1%, P<0.05). Conclusion:Among patients with moderate amount basal ganglia hemorrhage, prognoses can be effectively improved in the following treatments: if the patients have negative CTA spot sign, are evaluated to have low risk of postoperative re-hemorrhage after craniotomy or drainage, and are considered that the prognosis by drainage is better than that by craniotomy, trephination and drainage should be selected; if the patients have positive CTA spot sign, and are evaluated to have lower risk of postoperative re-hemorrhage by craniotomy than that by drainage, craniotomy should be selected.

目的 探讨CT血管成像(CTA)和CT灌注成像(CTP)点征在中等量(出血量30～60 ml)高血压性基底节区出血超早期手术方式选择中的应用价值.方法 回顾性分析2016年2月至2019年7月收治的242例中等量高血压性基底节区出血的临床资料.118例完成颅脑CTA、CTP检查(观察组),124例未完成颅脑CTA、CTP检查(对照组).观察组病人根据CTA、CTP检查结果选择手术方式:1项点征阳性采用开颅手术,2项点征均为阴性采用钻孔引流术.对照组病人根据对全麻手术的耐受性及知情同意情况选择手术方式:耐受性差或不同意开颅手术的病人采用钻孔引流术,耐受性尚可且不同意引流术的病人病人采用开颅手术.结果 观察组引流术治疗有效率明显高于对照组(P＜0.05),而观察组引流术后血肿增大率、病死率、颅内感染发生率较对照组均明显降低(P＜0.05).观察组开颅手术治疗有效率、术后血肿增大率、病死率、颅内感染发生率与对照组均无统计学差异(P＞0.05).结论 联合应用CTA、CTP点征作为客观依据选择中等量脑出血超早期手术方式,可提高治疗有效率,降低术后血肿扩大、死亡及颅内感染的风险,改善病人预后.

目的 探讨3D-slicer辅助神经内镜微创手术在老年性中等量丘脑出血中的应用.方法 回顾性分析我院老年性中等量丘脑出血患者118例,根据家属意愿分为手术组和对照组.手术组60例,对照组58例.手术组应用3D-slicer辅助神经内镜清除颅内血肿,对照组给予保守治疗.对比两组住院时间,术后并发症及临床预后.结果 手术组平均住院时间为(12.61±3.61)天,对照组为(17.36±4.22)天,两组对比P＜0.05;两组术后并发症相比手术组肺炎、下肢静脉血栓、电解质紊乱、应激性溃疡发生的人数均少于对照组,两组对比P＜0.05;手术组预后良好人数为45例,对照组为28例,两组治疗有效率相比x2=9.093,两组对比P＜0.05,差异有统计学意义.结论 在3D-slicer辅助下神经内镜治疗老年性中等量丘脑出血能有效的降低老年性少量丘脑出血患者的并发症,改善预后,提高老年患者的生活质量.

目的 探讨不同时期基底节区脑出血应用3D-slicer辅助神经内镜的治疗效果.方法 回顾性分析邢台市第三医院神经外科自2017年1月至2019年1月收治的96例高血压基底节区脑出血患者.根据手术时机不同将患者分为超早期组(发病时间<6 h,50例)和早期组(发病时间6～24 h,46例).2组患者均在3D-slicer辅助下行神经内镜手术,对比其并发症、临床预后及脑脊液中神经元特异性烯醇化酶(NSE)的变化.结果 超早期组患者的再出血、颅内感染与早期组比较差异无统计学意义(P>0.05),而肺炎、应激性溃疡发生人数少于早期组,差异有统计学意义(P<0.05).超早期组的GOS评分中轻度残疾多于早期组,重度残疾少于早期组,差异有统计学意义(P<0.05);超早期组在术后第7、14天脑脊液中NSE的含量低于早期组,差异有统计学意义(P<0.05).结论 超早期应用3D-slicer辅助神经内镜治疗能有效地改善基底节区脑出血患者的临床预后,减少脑出血后相关并发症的发生,但不增加再出血率.

目的 探讨联合应用CT血管成像(CTA)、CT灌注(CTP)点征在基底节中等量脑出血超早期抽吸术或开颅手术的手术方式选择中的应用价值.方法 选择中等量基底节脑出血(出血量30～ 60ml)且家属同意超早期手术治疗221例,根据入院后患者是否同意行颅脑CTA及CTP检查,分为研究组(同意检查者)105例,对照组(不同意检查者)116例,研究组CTA或CTP点征阳性者,入开颅手术亚组32例,CTA和CTP点征阴性者入抽吸亚组73例.对照组根据患者家属知情同意后选择的手术方式,分为开颅亚组39例,抽吸亚组77例.对比研究组与对照组患者治疗效果的差异,评估联合应用CTA、CTP点征在基底节中等量脑出血超早期手术方式选择中的应用价值.结果 研究组有效率、术后血肿增大率、病死率、颅内感染率分别为77.1％、3.8％、3.8％、2.9％,对照组分别为52.6％、18.1％、15.6％、12.1％,2组比较差异有统计学意义.(P＜0.05).结论 联合应用CTA、CTP点征选择基底节中等量脑出血手术方式,可明显改善患者预后.

目的 探讨鸦胆子油乳联合尼莫斯汀治疗复发胶质瘤的情况.方法 选取我院108例复发胶质瘤患者,按照就诊先后顺序随机分为实验组和对照组,每组54例.实验组给予尼莫斯汀联合鸦胆子油乳,对照组单纯应用尼莫斯汀.所有患者均进行4个周期化疗,观察治疗效果和不良反应的变化.结果 两组治疗效果相比,实验组总有效率为53.7％,对照组总有效率为24.1％,实验组优于对照组,差异有统计学意义(P<0.05);两组副作用相比,治疗组和对照组未见明显差别,P>0.05.结论 鸦胆子油乳注射液联合尼莫斯汀更能有效抑制复发胶质瘤的生长,且不增加患者的副作用.

Objective To analyze of cause of nasal feeding complications in patients with spontaneous intracerebral hemorrhage and efficacy of cluster nursing intervention.Methods A total of 60 spontaneous intracerebral hemorrhage patients with aspiration during nasal feeding were randomly divided into control group and observation group,clinical nursing effect were compared.Results The causes of nasal feeding complications of patients with spontaneous intracerebral hemorrhage were gastrointestinal dysfunction in 48 cases (80％),improper position in 12 (20％) cases.Nursing satisfaction of the observation group was 93.3％,and was 80％ in the control group,the difference was statistically significant(P ＜ 0.05);Gastrointestinal motility and gastrointestinal hormone level of two groups showed a significant difference (P ＜ 0.05).Conclusion Cluster nursing intervention can significantly improve the clinical nursing effect and nursing satisfaction,is conductive to harmonious relationship between nurses and patients,so it is worth popularizing.

Objective:To research the inhibition effects of brucea javanica oil on the expression of vascular endothelial growth factor ( VEGF) in U251 glioma cells. Methods:The human U251 glioma cell was cultivated in vitro,set control group and three drug groups (the final concentration of Brucea javanica oil emulsion is 5 g/L,2. 5 g/L,1. 25 g/L). The content of VEGF in the supernatant of culture cells was measured using ELISA, and the change of VEGF protein in U251 glioma cell was measured using the immunocytochemistry. Results:The VEGF level in the supernatant of culture cells showed that the significant decreasing of the VEGF level was identified with the increasing of drug concentration(P<0. 01). The immunocytochemistry showed that the expression of VEGF protein decreased with the dose increasing of brucea javanica oil. Conclusions:Brucea javanica oil emulsion can inhibit the expression of VEGF protein in U251 glioma cells.

Objective To study the value of CT perfusion (CTP) in treatment of small hemorrhage volume from basal ganglia in elderly patients.Methods One hundred and eighty-eight elderly patients with small hemorrhage volume from basal ganglia admitted to our hospital from April 2011 to March 2016 were divided into mild hypoperfusion group (n =102) and severe hypoperfusion group (n=86) according to their regional cerebral blood flow (rCBF).The patients in mild hypoperfusion group were further divided into operation group (n =55) and non-operation group (n=47) and those in severe hypoperfusion group were divided into operation group (n=46) and non-operation group (n=40).CTP was performed for the patients at admission and on day 7 after admission respectively.The curative effect was compared between the two groups on day 28 after admission.Results No significant difference was found in the rCBF in mild hypoperfusion group at admission and on day 7 after admission.The rCBF was significantly slower in severe hypoperfusion group on day 7 after admission than at admission (8.87±1.72 ml · 100 g-1 · min-1 vs 17.25±1.62 ml · 100 g-1 · min-1,P=0.000).No significant difference was found in the rCBF and in the effective rate in severe hypoperfusion group at admission and on day 7 after admission (P＞0.05).The effective rate was significantly higher in operation group than in non-operation group derived from severe hypoperfusion group (60.9 ％ vs 30.0 ％,P =0.004).Conclusion CTP can provide data of cerebral blood flow in hemorrhagic cerebral tissue and guidance for surgery of small hemorrhage volume from basal ganglia in elderly patients.

Objective To explore the application of CT perfusion (CTP) in assessing the surgical indications for a small amount of cerebral hemorrhage in basal ganglia region.Methods According to the regional cerebral blood flow (rCBF) around the hematoma obtained by CTP at admission to hospital,236 patients with a small amount of cerebral hemorrhage in the basal ganglia region were divided into mild low perfusion (MLP) group [n =142,rCBF ≥ 15 ml/(100 g· min)] and severe low perfusion (SLP) group [n =94,rCBF ＜15 ml/(100g·min)].Then according to whether the patients agreed with operation,the two groups were redivided into operation group and non-operation group respectively.The two operation groups were immediately treated by the minimally invasive drainage with soft channel after admission to hospital,while the two non-operation groups were given conservative treatment.The patients' quality of life was assessed by using Rankin classification.The response rate and rCBF between different groups were compared respectively.Results There was no statistical difference in the response rate between the operation group and non-operation group (P ＞ 0.05),and no statistically differences were found in the rCBF between at admission to hospital and 7 d after admission in operation group and non-operation group respectively in the MLP group (P ＞ 0.05).There was statistical difference in the response rate between the operation group and non-operation group in the SLP group (P ＜ 0.05).And statistical difference was also found in the rCBF between at admission to hospital and 7 d after admission in operation group (P ＜ 0.05),however,no significant differences was found in non-operation group (P ＞ 0.05).Conclusions CTP is an objective index for assessing the surgical indication for small amount of cerebral hemorrhage in the basal ganglia region.Surgery can obviously improve the prognosis of SLP patients with a small amount of cerebral hemorrhage in the basal ganglia region.

目的 研究替莫唑胺联合尼莫地平对胶质瘤SKMG-4细胞的抑制作用.方法 实验分为空白对照组、替莫唑胺组、尼莫地平组、替莫唑胺联合尼莫地平组(联合用药组).应用四甲基偶氮唑盐(MTT)比色法检测各组胶质瘤SKMG-4细胞的增殖情况,应用流式细胞仪分析各组细胞周期,应用实时荧光定量聚合酶链反应(RT-PCR)方法检测各组细胞内bcl-2基因表达.结果 尼莫地平组、替莫唑胺组、联合用药组SKMG-4细胞的增殖抑制率逐渐增高,差异有显著意义(F=41.554,P＜0.05).联合用药组胶质瘤细胞处于G1期的比例高于其他组,处于S期的比例低于其他组,差异有显著意义(F=67.622、88.253,P＜0.05).联合用药组细胞bcl-2 mRNA的表达量最低,与其他组比较差异有显著意义(F=87.221,P＜0.05).结论 尼莫地平可增强替莫唑胺对胶质瘤细胞的抑制作用.