BACKGROUNDThe present study aimed to explore the relationship between surgical methods, hemorrhage position, hemorrhage volume, surgical timing and treatment outcome of hypertensive intracerebral hemorrhage (HICH).METHODSA total of 1 310 patients, who had been admitted to six hospitals from January 2004 to January 2008, were divided into six groups according to different surgical methods: craniotomy through bone flap (group A), craniotomy through a small bone window (group B), stereotactic drilling drainage (group C1 and group C2), neuron-endoscopy operation (group D) and external ventricular drainage (group E) in consideration of hemorrhage position, hemorrhage volume and clinical practice. A retrospective analysis was made of surgical timing and curative effect of the surgical methods.RESULTSThe effectiveness rate of the methods was 74.12% for 1 310 patients after one-month follow-up. In this series, the disability rate was 44.82% 3-6 months after the operation. Among the 1 310 patients, 241 (18.40%) patients died after the operation. If hematoma volume was >80 mL and the operation was performed within 3 hours, the mortality rate of group A was significantly lower than that of groups B, C, D, and E (P<0.05). If hematoma volume was 50-80 mL and the operation was performed within 6-12 hours, the mortality rate of groups B and D was lower than that of groups A, C and E (P<0.05). If hematoma volume was 20-50 mL and the operation was performed within 6-24 hours, the mortality rate of group C was lower than that of groups A, B and D (P<0.05).CONCLUSIONSCraniotomy through a bone flap is suitable for patients with a large hematoma and hernia of the brain. Stereotactic drilling drainage is suggested for patients with hematoma volume less than 80 mL. The curative effect of HICH individualized treatment would be improved via the suitable selection of operation time and surgical method according to the position and volume of hemorrhage.

Objective To explore the relationship between different hemorrhage position,hemorrhage volume,surgical time and outcome of treatment with surgical methods of HICH.Methods A total of 1310 patients were admitted from six hospitals from January 2004 to January 2008,the 1310 patients were divided into six groups according to different operation:craniotomy through bone flap (group A),craniotomy through small bone window (group B),stereotactic drilling drainage (group C1 and group C2),neuron-endoscopy operation (group D) and external ventricular drainage (group E),considering hemorrhage position,hemorrhage volume,surgical time and result of surgical methods were reviewed and analyzed.Results ①Craniotomy through bone flap should be selected with the case of superficial or deep hematoma volume (＞ 80 mL),median line structure distinct motion,metaphase or advanced stage of hernia of brain.②Craniotomy through small bone window and neuron-endoscopy should be selected with the case of moderate hematoma volume (50-80 mL) ③Drilling drainage should be selected with the case of small hematoma volume in superficial or deep hematoma volume (20-50 mL) ④Extemal drainage should be selected in dealing with ventricular hemorrhage.Small bone window or neuron-endoscopy should be selected in ventricular casting mould.⑤The appropriate operation time for patients with hematoma volume less than 80 mL should be 6-12 hours and large hematoma should be immediately operated to save lives.The operation time should depend on patients detail condition.Conclusions Craniotomy through bone flap was suitable for large hematoma and hernia of brain; Stereotactic drilling drainage should be selected in patients with hematoma volume less than 80mL; and the operation results in dealing with HICH would be improved via suitable operation time and surgical methods and adividual according to Hemorrhage position and Hemorrhage volume.

目的探讨重度高血压脑出血的显微外科治疗方法及疗效。方法根据CT检查确定出血部位和血量,29例均采用去大骨瓣开颅,捷径进入血肿腔的显微手术方法清除血肿。结果术后12h内死亡3例;术后1个月,按ADL分级,Ⅰ～Ⅱ级4例,Ⅲ～Ⅳ级17例,Ⅴ级2例,死亡6例(20.7%)。结论超早期去大骨瓣显微手术治疗重症高血压脑出血能够降低病死率,是有效的治疗方法。

目的 探讨齐齐哈尔市道路交通伤的流行病学特点.方法 收集齐齐哈尔市2006-2008年交通事故及交通伤的资料,采用流行病学描述性研究方法,并应用SPSS13.0统计软件包进行统计学分析,卡方检验,P＜0.05为差异,有统计学意义.结果 齐齐哈尔市道路交通事故发生率呈逐年下降的趋势,交通伤的发生率、死亡率及直接经济损失也呈稳中有降的趋势,但齐齐哈尔市道路交通事故的高发期在夏季,道路交通伤的死亡率较高.结论 齐齐哈尔市道路交通伤不同于其它城市的特点是夏季高发和死亡率高,应加强夏季交通安全工作,提高道路交通伤的急救水平.

目的 探讨尼莫同、苯妥英钠联合应用预防重度颅脑损伤后癫痫发作的疗效.方法 88例重度颅脑损伤患者随机分成治疗组和对照组,在相同的治疗方案,治疗组给予苯妥英钠和尼莫同预防癫痫发作.结果 治疗组(45例)早期癫痫发作3例,晚期发作1例:对照组(43例)早期癫痫发作10例,晚期发作6例,具有统计学差异.结论 尼莫同、苯妥英钠联合应用预防重型颅脑损伤后癫痫发作取得了满意的疗效,是一种安全、有效、可行的治疗方案.

目的探讨齐齐哈尔市颅脑交通伤的流行病学特点。方法收集齐齐哈尔市2006～2008年交通事故资料,并收集相应年份的人口资料,建立数据库,采用流行病学描述性研究方法,并应用SPSS13.0统计软件包进行统计学分析,P<0.05为差异有统计学意义。结果3年共发生事故6496起,呈逐年下降趋势,伤者多分布在20～50岁,以30～40岁为高峰,男性多于女性,第三季度为高发期,占33.82%,周六、周日高于平时,多发时段在10:00～12:00,14:00～16:00,19:00～21:00,凌晨0:00～1:00。驾驶摩托车者、行人和乘非机动车使用者占绝大多数(72.41%)。结论齐齐哈尔市第三季度为颅脑交通伤高发期,应加强交通意外伤害的防控,制定有力的干预措施。

目的探索纵裂胼胝体入路治疗高血压脑出血的适应症,方法及优缺点.方法回顾分析我院神经外科1999年1月～2004年12月经纵裂胼胝体入路治疗高血压脑出血14例.结果正常生活4例,生活自理4例,需人帮助2例,卧床1例,死亡3例.结论纵裂胼胝体入路是治疗高血压脑出血的一种有效的方法,手术在直视下操作,盲区小,便于保留重要结构,使病人生存质量提高.

目的研究老年重度颅脑损伤患者发生多器官功能衰竭的预防和治疗.方法总结我院2001年7月～2004年11月大于60岁老人重度颅脑损伤并发多器官功能衰竭56例的防治措施.结果主要诱因是重度颅脑损伤老人免疫功能低下易发生肺感染、颅内压力升高、药物治疗不当、心肾功能不全导致多器官低灌注.结论防治措施在于预防重度颅脑损伤诱发MOF的各种因素,如控制感染、密切监测各器官功能、改善微循环、保证器官正常灌注压及水电解质平衡、加强全身管理、合理营养支持等.

目的初步分析脑出血术后早期消化道出血的发生机制.方法回顾我院70例脑出血术后发生早期消化道出血患者的发生情况,测定基础胃酸和血清胃泌素水平,观察血凝功能和血浆去甲肾上腺素(NE).结果上消化道早期出血患者,胃酸和血清胃泌素、血浆NE明显增高,血凝功能下降.结论早期上消化道出血与胃酸分泌增加,血凝机制异常,上消化道粘膜局部血液循环改变有关.

丘脑是高血压性脑出血的常见部位,占脑出血患者的12%～24%.积极的救治脑出血患者,对于降低脑出血的病死率,提高患者的生活质量具有重要意义.作者自2000年1月～2005年4月应用穿刺血肿清除术治疗高血压性脑出血患者84例,与同期手术治疗35例比较取得较好的疗效,现报道如下.

目的探讨重型颅脑损伤病人早期癫痫持续状态的诊断及治疗.方法反瞻性分析我院1986年1月～2001年12月收治24例重型颅脑伤病人早期癫痫持续状态的临床资料.结果 24例患者中,2例癫痫未控制住患者均死亡,22例癫痫被控制住,其中临床治愈4例,轻残及生活自理各5例,重残4例,植物生存1例,死亡2例.结论重型颅脑损伤后的癫痫持续状态是非常严重的并发症,直接影响病人的康复及转归,积极稳妥的治疗对愈后有重要意义.

目的评价超早期微创手术救治脑出血的疗效.方法对132例脑出血病人超早期(发病后6小时内)行微创手术治疗.结果存活113例,死亡19例.按ADL分级评定,I级36例,II级37例,III级25例,IV级9例,V级5例.结论超早期微创手术治疗脑出血,创伤小,止血可靠,并发症少,功能恢复快,是临床较理想的治疗方法.

目的分析总结枕下乙状窦后入路显微外科手术切除听神经瘤的经验和技巧,以提高肿瘤全切率和面神经的保留率,预防并发症.方法对32例枕下乙状窦后入路显微手术治疗的听神经瘤的手术资料进行分析.结果肿瘤的全切率为93.3% (30), 面神经解剖保留为90.7% (29),无死亡病例.结论枕下乙状窦后入路是切除听神经瘤的安全有效入路;熟练的显微外科技术和局部显微解剖学基础知识是术中面神经保留的关键.

目的探讨P53家族新成员P 73及P63在脑星形细胞瘤中的表达和在不同恶性程度中的表达变化.方法采用免疫组化方法检测61例不同恶性程度的星形细胞瘤P73及P63基因的表达情况,与置换一抗的空白对照组比较,并同时进行组间对照.结果P73与P63总的阳性表达率为31.15%和40. 98%.组间对照:P73组3～4级与1～2级比较P＜0.05,2～3级与1～2级比较P＞0. 05;P63组3～4级与1～2级比较P＜0.01.,2～3级与1～2级比较P＜0.05.结论P73及P6.3作为P53家族的新成员可能是候选的抑癌基因,且随着恶性程度的增加其表达越明显.

本文总结10年来特重型颅脑损伤患者374例,未手术122例,死亡102例,手术252例,死亡161例,与国内外文献报道死亡率相仿,现将本组病人救治及预后情况进行分析报道如下.

鼻衄是临床常见的一种并发症,一般通过前后鼻孔填塞后都可以得到有效治疗,但对于一些顽固性鼻衄,有时则不能奏效.我们对9例顽固性鼻衄在填塞失败后进行超选择性颈外动脉造影栓塞治疗,随访5个月～3年,效果满意.现总结如下.