目的 探讨高气压下吸氧对患者动脉血气指标的改变及对其葡萄糖代谢的影响.方法 选取2019年2月至8月在南京紫金医院接受高压氧治疗的14例患者进行回顾性分析,对比在空气加压氧舱内2.0个绝对大气压(ATA)压力下的两个吸氧治疗时间段和氧舱外1.0 ATA压力下鼻导管吸氧时间段动脉血的pH值、血氧分压(PO2)、血二氧化碳分压(PCO2)、血糖(GLU)、血乳酸(LAC)水平,以及舱内不同氧分压组GLU和LAC水平.结果 患者于氧舱内2.0 ATA下第1吸氧时间段PO2平均值和舱内第2吸氧时间段PO2平均值均明显高于舱外,GLU水平明显低于舱外,差异有统计学意义(P<0.01);患者两个时间段的PCO2均有轻度下降,但较氧舱外,以及两个时间段之间的差异均无统计学意义(均P>0.05);患者第2阶段血LAC水平低于氧舱外,血pH值高于氧舱外(P<0.05),但与第1阶段相比差异无统计学意义(P>0.05).进一步对比氧舱内不同PO2组的指标,发现与氧舱外比较,舱内PO2较低组患者的LAC水平降低更加明显,而舱内PO2较高组的GLU降低更加明显(P<0.05).结论 高压氧治疗可促进机体组织葡萄糖的有氧代谢,抑制无氧酵解,可改善代谢性酸中毒;推测高压氧治疗有助于损伤组织的修复,是康复治疗的重要手段.

目前高压氧治疗已经成为脑损伤后意识恢复的重要辅助手段，如何精准对比高压氧治疗前后患者的意识改变，神经行为学评分量表成为量化评估患者意识状态的有力工具。患者因脑损伤的部位和程度不同表现为昏迷、植物状态、微小意识和保持清醒等不同的意识状态；由于临床和基础研究对于意识障碍认识的不断深入，相应的评估量表也在发生变化。国内外应用频率较高的量表有欧洲的格拉斯哥昏迷量表和美国的昏迷恢复量表修订版，我国学者编制的中国南京持续性植物状态量表经多中心对照研究显示与美国的昏迷恢复量表功效相当且有一定优势，比格拉斯哥昏迷量表更加精准。本综述介绍了昏迷和其他意识障碍评估量表的发展史，并对我国学者编制量表的工作进行介绍与展望，以期为相关基础及临床学科的研究提供帮助。

Objective:To investigate the effects of minimally invasive aspiration and drainage combined with hyperbaric oxygen (HBO) therapy on inflammatory factors and cerebrovascular dynamic indicators in patients with hypertensive intracerebral hemorrhage.Methods:A total of 74 patients with hypertensive intracerebral hemorrhage treated in 454 Hospital and Nanjing Zijin Hospital from January 2019 to January 2021 were selected and randomly divided into treatment group ( n=37) given minimally invasive aspiration and drainage combined with HBO therapy and control group ( n=37) given minimally invasive aspiration and drainage only. The levels of serum inflammatory factors, cerebrovascular dynamic indicators, arterial blood gas (ABG) levels, and the neurologic function scores in the two groups before and after treatment were compared. Results:Before treatment, there was no significant difference between the two groups in the levels of serum inflammatory factors, cerebrovascular dynamic indicators, ABG levels, and the neurological function scores ( P>0.05); after 30 days of treatment, the levels of inflammatory factors such as tumor necrosis factor-α (TNF-α), interleukin-1(IL-1), and IL-8 in the treatment group were lower than those in the control group, the National Institute of Health Stroke Scale (NIHSS) scores, the values of peripheral resistance (PR) and dynamic resistance (DR) in the treatment group were lower than those in the control group, while the Mini-mental State Examination (MMSE) scores, the mean blood flow velocities (Vm), mean blood flow quantities (Qm), the arterial partial pressures of CO 2 (PaCO 2) and the arterial partial pressures of oxygen (PaO 2), and the blood pH values in the treatment group were higher than those in the control group ( P<0.05), and all the differences were statistically significant ( P<0.05). Conclusion:Minimally invasive aspiration and drainage combined with HBO therapy in the treatment of hypertensive intracerebral hemorrhage can effectively reduce the patients’ inflammatory response and promote the recovery of cerebral vascular dynamics and nerve function.

目的探讨磁敏感成像(SWI)在帕金森病DBS手术术前针道及靶点设计中的应用价值.方法10例丘脑底核脑深部电刺激术(STN-DBS)治疗的原发性帕金森病患者,术前行3.0T磁共振3D T1平扫和增强扫描、T2轴位和冠位扫描及SWI扫描.每例患者针道设计:单侧分中央、前方、后方、内侧及外侧共5个针道,双侧共10个针道.本研究10例患者总计100个针道,比较每个针道在T2像、T1增强像及SWI上血管分布情况.测量每个针道在SWI及T2轴位上STN的宽度.结果T2像上12％的针道有血管分布,主要是硬脑膜及脑表面血管.T1增强像上22％针道有血管,主要分布在脑表面及脑组织内,以动脉性血管为主.SWI上62％针道有血管分布,相对于T1增强像与T2像能更多显示额外的脑组织内小血管,特别是小的静脉血管.轴位上SWI显示的STN的宽度明显小于T2像.结论SWI与T1增强像及T2像结合可优化DBS术前针道设计,减少术中穿刺损伤血管导致颅内出血的风险.SWI与T2像结合可科学确定STN的边界.

目的 探讨同型半胱氨酸(Hcy),脂蛋白(a)[Lp(a)]和血浆纤维蛋白原(Fg)联合检测在急性脑梗死(ACI)诊断中的意义.方法 选择急性脑梗死患者63例,正常对照组43例,分别检测Hcy,Lp(a)和Fg的浓度,并进行比较,分析其与急性脑梗死的关系.结果 急性脑梗死组Hey,Lp(a)和Fg的浓度分别为19.48±8.42 μmol/L,373±182 mg/L和3.7±1.2 g/L,正常对照组三者的浓度分别为10.66±2.61 μmol/L,181±106 mg/L和2.4±1.0 g/L.急性脑梗死组明显高于正常对照组,差异有统计学显著性意义(P<0.01);急性脑梗死组中各项阳性检出率为Hcy 60.3%,Lp(a) 42.9%和Fg 30.0%,而正常对照组三者的阳性率只有6.9%,11.6%和6.9%,急性脑梗死组明显高于正常对照组,差异有统计学意义(P<0.05);三者联合检测阳性率为89%,高于三者任何一个单项阳性率.结论 Hcy,Lp(a)和Fg联合检测有利于急性脑梗死患者的预测、诊断及预后.