目的 探讨依达拉奉右莰醇(ED)对大鼠液压冲击脑损伤的影响及机制.方法 取96只SD大鼠随机分为假手术组、模型组、ED组和ED+脂多糖(LPS,TLR4激活剂)组,每组24只;采用液压冲击法制备脑损伤大鼠模型.ED组腹腔注射(ip)给予5.6 mg·kg-1依达拉奉+1.4 mg·kg-1右莰醇,ED+LPS组ip给予5.6 mg·kg-1依达拉奉+1.4 mg·kg-1右莰醇+0.4 mg·kg-1 LPS,假手术组和模型组ip给予生理盐水,均1次·d-1连续14d.通过mNSS评分评价大鼠神经功能缺损状况,干湿重法检测脑组织含水量(BWC),苏木精-伊红染色法、TUNEL染色法观察脑组织病理变化和神经元凋亡状况,ELISA法检测炎症因子水平,Western blot检测Toll样受体4(TLR4)/核因子-κ B p65(NF-κ B p65)通路相关蛋白表达.结果 治疗后,ED组大鼠mNSS评分和BWC均明显低于模型组(P＜0.05);模型组脑组织呈现结构疏松、神经元间隙增大、空泡变性、炎细胞浸润等病理变化及大量神经元凋亡,ED组脑组织病理学变化及神经元凋亡状况较模型组明显改善、凋亡指数明显降低(P＜0.05);ED组脑组织肿瘤坏死因子-a(TNF-a)、白细胞介素-1 β(IL-1 β)水平和TLR4表达量及p-NF-κ B p65/NF-κ B p65、p-I κ B a/I κ B a表达比值较模型组均明显降低(P＜0.05).LPS能够明显逆转ED对液压冲击脑损伤大鼠上述各指标的调控作用(P＜0.05).结论 ED可抑制液压冲击脑损伤大鼠炎症反应、减轻脑损伤,其作用机制可能与抑制TLR4/NF-KB通路活化有关.

Purpose The main aim of this study was to investigate the risk factors of traumatic subdural effusion (TSE) development in traumatic brain injury (TBI) patients who did not undergo decompressive craniectomy (DC). Methods This is a retrospective study based on a database of patients treated in a single institution from January 2020 to January 2022. The clinical and demographic characteristics of the enrolled patients, including gender, age, Glasgow Coma Scale score at admission, characteristics of the initial CT scan on admission, mechanism of injury and the mannitol treatment were recorded retrospectively. Results Two hundred fifty-four patients with TBI who did not receive DC were enrolled in this study. Among them, 78 (30.71%) patients were assigned to the TSE group, while 176 patients (69.29%) without TSE were assigned to the control group. Univariate analysis showed that patients in the TSE group were more likely to be male ( p = 0.019), older ( p < 0.001), have a subarachnoid haemorrhage ( p = 0.016) and have a basal cistern haemorrhage ( p = 0.014). Logistic regression analysis identified that older age (odds ratio [OR] = 1.056, p < 0.001), presence of subarachnoid haemorrhage (OR = 2.022, p = 0.018) and presence of basal cistern haemorrhage (OR = 2.861, p = 0.027) were risk factors independently associated with the development of TSE. Conclusion Our results showed that older age, presence of subarachnoid haemorrhage and presence of basal cistern haemorrhage were risk factors independently associated with the development of TSE for TBI patients without DC.

The medical and health industry has successively experienced three stages of digital medical treatment, local area network medical treatment, and internet medical treatment. With the rapid development of technologies such as the Internet of Things, big data, and artificial intelligence, emerging applications and service models have gradually penetrated into all aspects of the medical and health field. At this point, the informatization development process of the medical industry has entered the stage of smart medical treatment. (Smart medical system is a new medical system that improves users’ medical experience and provides users with better services. Due to the cumbersome, complicated, and mechanically rigid environment of the past medical service, there was no uniform standard. In order to create a reliable and open medical service environment, an intelligent medical system came into being.). A diversified technical foundation and smart medical protection, conducive to providing patients with high-quality medical services, are established. This article mainly introduces the analysis of the therapeutic effect of smart medical electronic endoscopic hematoma removal on hypertensive basal ganglia cerebral hemorrhage and aims to inject advanced technology and vitality of smart medical treatment into the treatment of hypertensive basal ganglia cerebral hemorrhage by hematoma removal and help the doctor to treat the patient. This article proposes the research methods of smart medical application in the treatment of hypertensive basal ganglia cerebral hemorrhage with electronic endoscopic hematoma removal, including smart medical overview, intracranial hematoma removal for hypertensive basal ganglia cerebral hemorrhage, and smart medical bioelectric signal classification. The recognition algorithm is used to realize the smart medical application of the electronic endoscopic hematoma removal in the treatment of hypertensive cerebral hemorrhage in the basal ganglia area. The experimental results show that the removal of intracranial hematoma based on smart medicine can effectively improve the removal rate of intracranial hematoma, with a recovery rate of 26.73% and a significant efficiency of 36.49%.

目的 研究3D Slicer辅助下微创手术与开颅显微手术对高血压基底节区脑出血患者手术后脑脊液生化指标及凝血功能的影响.方法 选取2017年9月至2019年9月该院收治的142例高血压脑出血患者,采用随机数字表法将患者分为试验组(70例)和对照组(72例).试验组采用3D Slicer辅助下微创手术治疗,对照组采用开颅显微手术治疗.比较2组患者手术指标,手术后第1、7天的血肿清除率和格拉斯哥昏迷量表(GCS)评分,手术前及手术后第1、7天的脑脊液生化指标、凝血功能及日常生活活动能力量表(ADL)评分.结果 试验组手术时间和手术后清醒时间短于对照组(P<0.05),手术后再出血率低于对照组(P<0.05);试验组手术后第1、7天血肿清除率及GCS评分均高于对照组(P<0.05),脑脊液葡萄糖、乳酸脱氢酶、乳酸水平均低于对照组(P<0.05),凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均短于对照组(P<0.05),手术后第7天ADL评分高于对照组(P<0.05).结论 3D Slicer辅助下微创手术治疗高血压基底节区脑出血,可缩短手术时间和手术后清醒时间,提高血肿清除率,有效改善患者脑脊液生化指标水平和日常生活活动能力,对凝血功能的影响更小,值得临床推广.

目的 研究高血压性脑出血(HICH)微创手术治疗中3D Slicer的应用效果.方法 150例高血压性脑出血患者按采用的手术治疗方法不同,分为3D Slicer软件辅助神经内镜微创手术组(内镜微创组)和传统开颅手术组(对照组),每组各75例.对比两组患者的手术时间、血肿清除率等手术相关指标,以及术后清醒时间、再出血及预后状况.结果 内镜微创组患者的血肿清除率明显高于对照组、手术时间和再出血率低于对照组(P ＜0.05 ～0.005);术后清醒时间和改良Rankin量表(mRS)评分明显低于对照组,格拉斯哥昏迷量表(GCS)评分显著高于对照组,术后并发症发生率明显低于对照组,格拉斯哥预后量表(GOS)评分显著优于对照组(P ＜0.05 ～0.001).结论 应用3D Slicer软件辅助内镜微创手术治疗高血压性脑出血,能够显著发挥微创手术治疗和软件定位的优势,能使手术相关指标和血肿清除效果得到显著提高;同时还有助于降低手术创伤,改善患者的预后.

背景 神经内镜下血肿清除术、显微镜下小骨窗开颅血肿清除术是目前临床治疗基底核区出血的常用手术方式,而3D-Slicer软件可利用患者术前颅脑CT或MRI扫描图像原始数据,在短时间内对头皮、颅骨、血肿进行三维重建,便于术者更清楚地了解术区的解剖关系.目的 比较3D-Slicer三维重建技术辅助神经内镜下血肿清除术与显微镜下小骨窗开颅血肿清除术治疗高血压基底核区出血的临床效果.方法 选取邯郸市中心医院神经外4科2018年3月—2019年10月收治的高血压基底核区出血患者109例,按照随机数字表法分为治疗组59例和对照组50例.治疗组患者采用3D-Slicer三维重建技术辅助神经内镜下血肿清除术治疗,对照组患者采用显微镜下小骨窗开颅血肿清除术治疗.比较两组患者手术时长、术前血肿量、术后残留血肿量、血肿清除率、再出血发生率及并发症发生率.术后随访3个月,比较两组患者日常生活活动能力量表(ADL)评分、格拉斯哥预后量表(GOS)评分及生活能力恢复良好率、神经功能恢复良好率.结果 两组患者术前血肿量比较,差异无统计学意义(P>0.05);治疗组患者手术时长短于对照组,术后残留血肿量少于对照组,血肿清除率大于对照组(P<0.05).治疗组患者术后再出血发生率、并发症发生率低于对照组(P<0.05).术后3个月,治疗组患者ADL评分、GOS评分高于对照组(P<0.05).治疗组患者生活能力恢复良好率、神经功能恢复良好率高于对照组(P<0.05).结论 与显微镜下小骨窗开颅血肿清除术相比,3D-Slicer三维重建技术辅助神经内镜下血肿清除术治疗高血压基底核区出血患者可更有效地缩短手术时长,提高血肿清除率,降低再出血发生率,提高患者日常生活能力,改善患者预后,且安全性高.

目的 探讨神经生长因子用于高血压脑出血微创软通道引流术后的疗效,以及对患者神经功能的影响.方法 选取医院2018年9月至2019年9月收治的高血压脑出血患者106例,按盲法随机分为观察组和对照组,各53例.两组均予微创软通道引流术治疗,观察组术后加用神经生长因子,两组均治疗4周.结果 观察组总有效率为90.57％,显著高于对照组的75.47％(P<0.05).与对照组比较,治疗后观察组患者的美国国立卫生研究院卒中量表评分显著降低,格拉斯哥昏迷指数评分、蒙特利尔认知功能评分均显著升高;神经元特异性烯醇化酶、胶质纤维酸性蛋白、血浆内皮素1水平均显著降低,巴塞尔指数评定量表、日常生活活动能力评定量表评分均显著升高(P<0.05).观察组与对照组不良反应发生率相当(15.09％比9.43％,P>0.05).结论 神经生长因子用于高血压脑出血微创软通道引流术后疗效较好,可改善患者的神经功能缺损评分,降低脑损伤标志物水平,提高预后生活质量,且安全性较好.

目的 观察脑外伤去骨瓣减压术联合早期颅骨成形术的临床效果,并分析术后硬膜下积液的危险因素.方法 选取脑外伤行去骨瓣减压术患者120例为研究对象,根据术后行颅骨成形术的时间分为对照组(n=80)与研究组(n=40).比较2组患者颅骨成形术后神经功能、运动功能、日常功能及术后并发症发生情况,并分析术后硬膜下积液的危险因素.结果 术后2个月,研究组美国国立卫生研究院卒中量表(NIHSS)评分低于术前、术后15 d及对照组,Fugl-Meyer评分、生活质量(Barthel)评分高于术前、术后15 d与对照组,差异有统计学意义(P＜0.05);研究组硬膜下积液、颅脑缺损综合征发生率低于对照组,差异有统计学意义(P＜0.05).中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素(P＜0.05).结论 脑外伤去骨瓣减压术联合早期颅骨成形术能有效改善患者神经功能、运动功能与日常生活功能,降低术后并发症发生率.中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素.

目的 将3D-Slicer软件应用于高血压基底节区脑出血患者的血肿清除术中,探讨本病手术治疗的优化方案.方法 选择邯郸市中心医院2018年9月至2019年9月收治的高血压脑出血患者178例,按照随机数字表法分为观察组86例和对照组92例,两组均采取微创血肿穿刺抽吸术并术后引流,观察组采取术前3D-Slicer辅助定位,对照组采取CT检查定位法.比较两组穿刺部位准确性、血肿清除率、拔管时间、手术时间、术后并发症、手术预后.结果 观察组引流管置管准确率、术后第3天时血肿清除率均高于对照组,手术时间、引流管拔管时间短于对照组,差异有统计学意义(P＜0.01).观察组并发症总发生率显著低于对照组,差异有统计学意义(8.14％ vs 27.17％,x2=10.921,P＜0.01).术后3个月,两组NIHSS评分均低于术前,且观察组低于对照组,差异有统计学意义(P＜0.01).术后3个月,观察组ADL分级优于对照组,差异有统计学意义(P＜0.01).结论 3D-Slicer为高血压基底节区脑出血手术提供精确的穿刺部位,对提高血肿清除效率,改善手术预后具有积极意义.

目的:探讨高血压基底节区血肿清除术中3D-Slicer软件辅助神经内镜的应用.方法:选取医院收治的106例高血压基底节区出血患者,按照随机数表法将其分为治疗组(56例)和对照组(50例).治疗组采取3D-Slicer软件辅助神经内镜血肿清除术,对照组采取显微镜血肿清除术.比较两组的穿刺达到预计位置的成功率、术后并发症发生率、血肿清除率及大脑中动脉血流,以及美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力巴氏指数(BI)量表和简易智能量表(MMSE)的评分情况.结果:治疗组穿刺成功率为100％,对照组为92％,差异有统计学意义(x2=4.656,P<0.05);治疗组术后并发症发生率为1.79％,对照组为10％;差异有统计学意义(x2=4.468,P<0.05);治疗组血肿清除率在术后第1 d、第3 d均高于对照组,组间差异有统计学意义(t=4.02、t=4.35;P<0.05).两组患者术前大脑中动脉血流情况比较,差异无统计学意义;治疗组大脑中动脉血流速度在术后3个月高于对照组,组间差异有统计学意义(t=6.75,P<0.05);治疗组术后3个月NIHSS评分低于对照组,而BI及MMSE评分均高于对照组,差异有统计学意义(t=11.13,t=3.95,t=4.09;P<0.05).结论:3D-Slicer软件辅助神经内镜血肿清除术,能够提高高血压基底节区出血患者临床效果,促进患者康复,改善手术预后.