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:分析颈动脉溶栓桥接血管内技术在急性脑梗死中的治疗效果.方法:对我院2015-11-2017-12期间进行颈动脉溶栓桥接血管内技术治疗的143例急性脑梗死患者临床资料进行回顾性分析,分析治疗前后NIHSS评分变化、手术一般情况、临床疗效、并发症及预后情况.结果:治疗后2h、1d、7 d NIHSS评分较治疗前有显著降低,差异有统计学意义(P＜0.05),且随着时间的延长不断降低;就诊到颈动脉穿刺溶栓所用时间平均为(3.14±0.58)h,颈动脉穿刺注药平均时长(98.26±15.23) min,血管内治疗平均时长(85.17±15.16) min;神经功能缺损评分评价临床疗效显示:术后1个月,治愈75例,有效41例,无效27例,恶化0例,总有效率为81.12％;mRS量表评价预后显示:术后3个月,143例患者中97例mRS评分≤2分,46例mRS评分＞2分,有效率为67.83％;Gonner评分评价血管再通情况显示,0级0例,1级0例,2级42例,3级101例,血管再通率为100.00％.结论:颈动脉溶栓桥接血管内技术确实兼具溶栓治疗简单便捷以及血管内技术成功率高、预后好的优点,值得进一步探索.

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 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 观察Trevo支架取栓对缺血性脑卒中患者的疗效及对血清丝氨酸蛋白酶抑制剂(Vaspin)、神经元特异性烯醇化酶(NSE)、血液流变学、认知功能的影响.方法 2015年9月-2018年8月河北医科大学附属人民医院(石家庄市第一医院)神经外科收治急性缺血性脑卒中患者116例,按随机数字表法分为2组,每组58例.对照组采用人组织型纤溶酶原激活剂进行溶栓治疗,观察组采用Trevo支架取栓治疗.比较2组治疗前及治疗后24 h、72 h血清Vaspin、NSE水平、MoCA评分、NIHSS评分、血液流变学变化.结果 与治疗前比较,治疗后24h、72 h,2组血清Vaspin、MoCA评分均升高,且观察组优于对照组(t/P=2.378/0.019、2.693/0.008,8.321/＜0.001、7.699/＜0.001);治疗72 h,2组血浆黏度、全血黏度切变率、纤维蛋白原、NIHSS评分均降低,且观察优于对照组(t/P =3.210/0.002、3.106/0.002、3.185/0.002、5.483/＜0.001);2组治疗后24 h血清NSE均升高,治疗后72 h血清NSE均降低,观察组治疗后24h、72 h血清NSE均低于对照组(t/P=3.910/ ＜0.001、4.659/＜ 0.001);观察组预后良好率89.66％高于对照组70.69％(x2/P=6.562/0.011).结论 Trevo支架取栓可提高缺血性脑卒中患者血清Vaspin水平,降低NSE水平,改善神经缺损程度、血液流变学及认知功能,临床疗效满意,不良反应少,具有重要的临床应用价值.

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 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>在中国,脑卒中的发病率约为150/1000000,脑出血占所有脑卒中患者的17.1%～39.4%[1],随着经济发展,中国人生活方式迅速西方化,包括脂肪的过度摄入、吸烟、饮酒、缺少体育锻炼等,而且中国逐渐步入老龄化社会,年龄做为脑出血的高危因素,脑出血的发病率呈现上升趋势[2]。我院中等量高血压脑出血患者45例分别采用脑室镜辅助手术(21例)、常规开颅手术(24例),2种手术的手术效果报告如下。

Objective To investigate the expression of PRDX Ⅲ in human gliomas and cell apoptosis of U251 gliomas cells induced by RNAi silencing PRDX Ⅲ gene.Methods The specific PRDX Ⅲ siRNAs were designed and transfected into U251 gliomas cells by liposome.The expression levels of PRDX Ⅲ mRNA and protein were detected by RT-PCR and Western Blotting 24 hours and 48 hours after the transfection,respectively.The apoptotic state 48 hours after the transfection was detected by flow cytometry(FCM),DNA ladder and PI staining,respectively,and the inhibition rate of U251 cell growth was determined by MTT 48 hours after transfection.Results The results of RT-PCR and Western Blotting showed that the expression of PRDX Ⅲ mRNA had no obvious changes in blank control group,empty carrier group and independent subsequence group,however,to interfere sequence 1,3 reduced significantly the expression of PRDXⅢ mRNA.The results of DNA ladder suggested that there appeared obvious ladder-shaped electrophoresis strip in interference group,but no obvious ladder-shaped electrophoresis strip was found in blank control group,empty carrier group and independent subsequence group.The results of PI staining showed that no obvious cell apoptotic changes were observed in blank control group,empty carrier group and independent subsequence group,however,some cellular nucleus were stained thickly and some of them were split into broken bits in interference group,which was in coincidence with apoptotic morphological changes.The results of FCM indicated that the cell apoptosis rate in interference group was significantly higher than that in blank control group,empty carrier group and independent subsequence group,respectively(P<0.01).The inhibition rate of U251 cell growth detected by MTT was 44.4% in interference group,which slowed down the cell growth(P<0.01).Conclusion RNAi technique can effectively inhibit the expression of PRDX Ⅲ gene in U251cells,and can induce cell apoptosis of U251,which suggests that PRDX Ⅲ gene is correlated with apoptosis of gliomas,and PRDX Ⅲ gene is possible to become the target gene in gene therapy for gliomas.

显微外科手术是目前治疗肠源性囊肿的主要手段,但因大部分属囊性且与延髓、颈髓、后组颅神经、椎动脉紧密粘连而影响治疗效果.回顾分析河北省石家庄市第一医院2003年3月至2010年12月收治的16例枕骨大孔区肠源性囊肿的临床资料,总结其临床特征与显微手术效果,报告如下.

<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

<正>20世纪60年代由于guiot和Hardy的不懈努力,经鼻蝶窦入路显微外科切除垂体瘤的方式又逐渐为人所接受。目前对于95%的垂体腺瘤和其他鞍内病变而言,经蝶窦显微外科手术是其治疗方法之首选。经蝶窦手术入路有很多优势,安全性高、并发症少是其中最重要的。本文回顾我院96例与其他医院2例垂体瘤患者临床资料,就该术式常见并发症及其防治报告如下。1临床资料1.1一般资料自2003年3月至2011年3月共对96例垂体

一、资料与方法 1.一般资料:2004-2007年我们连续治疗了19例横窦-乙状窦区硬脑膜动静脉瘘(DAVF)患者,其中男13例,女6例;年龄29～60岁,平均43.4岁.18例行血管内栓塞治疗,1例自愈.临床症状:颅内杂音9例,头痛4例,视力下降4例,球结膜水肿1例.根据Cognard分型:Ⅰ型3例,Ⅱa型9例,Ⅱb型2例,Ⅲ型2例,Ⅳ型2例。

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.

用免疫组化、TUNEL法检测过氧化物酶Ⅲ(PRDXⅢ)在胶质瘤的表达与凋亡,利用RT-PCR法测定PRDXⅢmRNA表达水平。结果胶质瘤与正常脑组织中PRDXⅢ的蛋白表达有明显差异;随胶质瘤病理级别的增高,PRDXⅢmRNA表达也逐渐增强,Ⅲ、Ⅳ级胶质瘤PRDXⅢmRNA的表达明显高于正常脑组织和Ⅱ级胶质瘤。认为PRDXⅢ可能与肿瘤的生长和恶性表型有关,具有抑制胶质瘤细胞凋亡的作用,从而使其生长加快。

自1927年Monis发明脑血管造影以来,在20世纪一直是诊断神经系统疾病最主要的检查手段,由于脑血管造影的直观性,现已经成为诊断脑血管病的金标准,目前最常用的方法是SINGLIN法,因为其有一定的创伤性,因此常有并发症发生,严重的会导致患者重残或死亡.我科自2001年开展脑血管造影及介入手术以来,有5例患者发生严重并发症,报告如下.