目的:分析阅读式疗法在创伤后应激障碍患者心理治疗中的应用效果.方法:选87例创伤后应激障碍患者作为研究对象,分两组.对照组(43例)采用常规治疗,观察组(44例)联合使用阅读式疗法,比较应激障碍状况及心理状况.结果:观察组PCL-C评分低于对照组(P＜0.05),HAMD、HAMA评分均低于对照组(P＜0.05).结论:创伤后应激障碍患者心理治疗中的应用阅读式疗法,能有效降低患者创伤后心理应激障碍,且能缓解患者抑郁、焦虑不良心理.

目的:评价帕罗西汀辅助治疗精神分裂症改善阴性症状的效果.方法:64例精神分裂患者随机分组:对照组用氨磺必利治疗,观察组用帕罗西汀联合氨磺必利治疗.比较两组疗效.结果:观察组患者阴性症状改善好于对照组,治疗有效率高于对照组,不良反应相近.结论:帕罗西汀辅助治疗精神分裂症阴性症状效果良好.

目的:评价维持性精神分裂症患者使用奥氮平治疗的效果.方法:将76例精神分裂症患者平均分为两组:对照组使用氯氮平治疗,观察组使用奥氮平治疗,对比两组疗效.结果:观察组患者PANSS平均显著下降,治疗有效率高于对照组,不良反应少于对照组,两组对比P<0.05,有统计学意义.结论:奥氮平维持性治疗精神分裂症有效率高,不良反应少.

Objective To investigate the cerebral blood flow in migraine without aura with three-dimensional arterial spin labeling technology .Methods From January 2013 to February 2016, magnetic resonance perfusion imaging was operated in 20 migraine patients without aura and 20 healthy controls by using arterial spin labeling, to determine their regional cerebral blood flow (rCBF) during migraine attacks and attack-free period.The significant difference was analyzed in rCBF between the two groups .Results The rCBF was significantly lower at the headache side during migraine period ( ( 52.77 ±5.97 ) ml? 100 g-1? min-1 ) than symmetrical side in the migraine patients without aura ((62.72 ±6.65) ml? 100 g-1?min-1 , t=3.780,P<0.01).The rCBF of temporosphenoid lobe in headache side in the migraine patients without aura ((53.97 ±5.87) ml? 100 g-1? min-1) was significantly lower than corresponding region in the control group ((59.21 ±2.35) ml? 100 g-1? min-1, t=4.449, P=0.001).And no significant difference in rCBF was found in migraine patients without aura under attack-free period. Conclusions Three-dimensional arterial spin labeling could quantitatively analyze the cerebral blood flow .Monitoring the perfusion difference in migraine patients could provide some references in the pathogenesis research and therapy.

[Objective]To investigate the clinical value of noninvasive intracranial pressure monitoring in the treatment of posttraumatic acute diffuse brain swelling (PADBS) and to evaluate its significance to the prognosis.[Methods]A retrospective analysis of the clinical data of 69 patients with PADBS treated by neurosurgery from January 2009 to December 2014 in the 163 Hospital of People's Liberation Army was performed.All patients were in ICU ward within 2~24 hours after injury and were monitored by noninvasive intracranial pressure monitor (MICP-1A, flash visual evoked potential noninvasive intracranial pressure detection analyzer).Patients were divided into mild, moderate, and severe intracranial hypertension according to the value of noninvasive intracranial pressure monitoring and were treated accordingly based on their symptoms and brain CT examination.The Glasgow prognosis scores were evaluated for patients' prognosis among different types of PADBS.[Results]The overall accurate prognosis rate was 43.5% (30/69) and poor prognosis rate was 56.5% (39/69).The mortality rate was 31.8% (22/69).The accurate prognosis rates of mild, moderate, and severe intracranial hypertension patients were 90.1% (10 / 11), 65.22% (15/23), and 14.29% (5/35), respectively.The accurate prognosis of patients with mild intracranial hypertension was significantly higher than that of moderate and severe intracranial hypertension.The difference was statistically significant (P<0.05).The proportion of death in patients with severe intracranial hypertension was significantly higher than that in patients with mild to moderate intracranial hypertension;the difference was statistically significant (P<0.05).[Conclusion]The value of noninvasive intracranial pressure monitor was closely related to the prognosis of PADBS patients.Continuous monitoring can provide an important indicator for the treatment of posttraumatic acute diffuse brain swelling.

Objective To investigate the effect of flash visual evoked potential(FVEP)noninvasive in-tracranial pressure (ICP)monitoring combined with simple invasive ICP monitoring in the treatment of acute traumatic brain swelling. Methods A lot of 39 cases suffered acute traumatic brain swelling carried out non-invasive and simple invasive ICP monitoring admitted from January 2010 to December 2014 were analyzed retro-spectively. The GCS scored 3 to 5 in 8 cases,6 to 8 in 17 cases and 9 to 12 in 14 cases. CT scanning showed midline shift <5 mm in 11,5 to 10 mm in 10,>10 mm in 6 and bilateral diffuse cerebral swelling in 12 ca-ses. According to initial ICP,all cases were divided into three types:11 of mild intracranial hypertension type (ICP l5~25 mmHg),13 of mid intracranial hypertension type (ICP 25~35 mmHg)and 15 of severe intracra-nial hypertension type (ICP>35 mmHg). Results The eusemia rate of mild,mid and severe intracranial hypertension patients was 90. 1%(10/11),61. 5%(8/13)and 20%(3/15),the unfavourable prognosis rate was 9. 1%(1/11),38. 5%(5/13)and 80%(12/15);there was statistic differences between two groups (P<0. 05). Conclusions The initial ICP is correlated to prognosis in the acute traumatic brain swelling pa-tients. The technique of FVEP noninvasive combined with simple invasive ICP monitoring is manipulative and practical,and can be popularized in basic hospital. The ICP monitoring combined with external ventricular drainage can play an important role in the treatment of acute traumatic brain swelling.

Objective To study the application of the annular drilling in the operation of traumatic intracra-nial hematoma.Methods The clinical data of 31 cases of posterior cranial fossa hematoma were analyzed retrospec-tively.Results In 31 patients,the operation was successful and the hematoma was satisfactory.After the injury,the GOS score,22 cases recovered,8 cases of mild disability,1 case of severe disability,no case of plant survival and death.Conclusion It has high hematoma removal rate and a satisfactory recovery after surgery for traumatic posterior cranial fossa hematoma.The size and scope of the posterior fossa craniotomy are restricted by bone window, so we should have a good knowledge of the surgical indications and contraindications.

目的：探讨3.0T磁共振M RA诊断颅内动脉成窗畸形的临床价值，了解颅内动脉成窗畸形的M RA表现、好发部位。方法回顾性分析2012-04-2013-02我院22例颅内动脉成窗畸形患者的影像学特点、畸形好发部位、类型及合并其他颅内血管性病变。22例均行颅脑磁共振血管成像（magnetic resonance angiography ，MRA）扫描，再将原始图像经 AW4.5工作站采用M IP及V R两种方法进行血管重组，并对血管图像进行后处理。结果22例颅内动脉成窗畸形患者中，单发19例，多发3例，共25处。其中19例单发病例中位于基底动脉6例，位于前交通动脉区3例，位于大脑前动脉10例；3例多发病例中，位于基底动脉及左大脑前动脉1例，位于左椎动脉颅内段及左大脑前动脉1例，位于基底动脉及前交通动脉1例。22例中合并其他颅内血管性病变者20例（90.9％），双侧动脉对比一侧优势者16例，伴AVM1例，永存三叉动脉1例，大脑前动脉A1段缺失8例，血管狭窄2例。结论3.0T磁共振M RA能清楚显示颅内动脉成窗畸形的位置、形态及合并颅内其他血管病变，是诊断颅内动脉成窗畸形首选、有效、无创的影像检查方法。

Objective: Explore 3.0 T MRA diagnosis of intracranial artery into the window deformity clinical value, understanding of intracranial artery into window deformity the MRA performance, the predilection sites, as wel as the value of clinical application. Methods:A retrospective analysis of the April 2012 to February 2013, a total of 22 cases of intracranial arteries into window deformity in patients with the imaging features, deformity predilection sites, type its combined with other intracranial vascular lesions. 22 cases underwent brain MRA scan, then the original image AW4.5 workstation using two methods of MIP and VR vascular reorganization, and vascular image processing. Results:22 cases of intracranial arteries window deformity patients, single 19 cases, multiple three cases, a total of 25. 19 patients with single cases in the basilar artery in six cases, three cases located in the anterior communicating artery, located in the anterior cerebral artery 10 cases. Three cases frequently occurring example, in the basilar artery and left anterior cerebral artery in 1 case, in the left vertebral artery intracranial segment of the left anterior cerebral artery in 1 case, in the basilar artery and the anterior communicating artery in 1 case. 20 patients with other vascular lesions in 22 cases, 90.9%, contrast side of the advantages of bilateral artery in 16 patients, with AVM 1 case, trigeminal artery in 1 case, A1 segment of anterior cerebral artery deletion in 8 cases,vascular stenosis in 2 patients. Concluson:3.0 T MRA can clearly show the intracranial arteries window demformity position, morphology and other intracranial vascular lesions, the diagnosis of intracranial into windows deformity preferred, effective, non-invasive imaging method.

Objective To analyze the clinical features and surgical treatment of traumatic brain injury in children.Methods The clinical data of 257 children with traumatic head injury admitted to our hospital from January 2003 to December 2010 were analyzed retrospectively.The patients aged from 1 to 14 years with an average of 6.3 years,including 52 cases aged less than 3 years,98 cases aged from 3 to 6 years,107 cases aged from 7 to 14 years.Among them,there was closed craniocerebral injury in 217 cases and open craniocerebral injury in 40 cases.The Glasgow coma score revealed 13 to 15 score in 92 cases,9 to 12 score in 62 cases,6 to 8 score in 87 cases and 3 to 5 score in 16 cases.The craniocerebral injury was mild in 90,moderate in 57,severe in 89 and extra-severe in 21.Surgical interference was performed in 97 cases,including 62 cases of evacuation of intracranial hematoma with skull retain(trephine craniotomy in 14 cases),11 cases of evacuation of intracranial hematoma with the decompressive craniectomy,18 cases of evacuation of intracranial hematoma with the depression fracture reduction surgery,and 6 cases of open debridement of head injury or intracranial foreign body removal surgery.21 patients were carried out tracheotomy.Non-surgical interference was performed in 160 cases.Results According to GOS standard,the prognostic outcome showed good recovery in 212 cases(82.5%),moderate disability in 18 cases(7.0%),severe disability in 8 cases(3.1%),plant survival in 2 cases(0.8%) and died in17 patients(6.6%).The hospital stay duration was ranged from 11 to 195 days with an average of 11 days.95 children were followed up for 6 months to 2 years.Traumatic epilepsy was appeared in 26 children,subdural effusion in 20 children and communicating hydrocephalus in 11 children.Conclusions The serious primary damage,severe symptom and fast pathogenetic condition development were the clinical features of craniocerebral trauma in children.The individual and standardized treatment should be emphasized in the treatment including active postoperative complication prevention and timely and appropriate combined modality therapy to reduce the mortality and morbidity.The good prognosis was easier to achieve in children because of better restoration ability in their nervous system.

Objective To analyze the clinical features of cerebral arteriovenous malformation in insular cortex and microsurgical techniques.Methods The clinical manifestation,microsurgical techniques,results of surgery and postoperative management of cerebral arteriovenous malformation were analyzed retrospectively according to the results of surgery in 17 cases.Results Seventeen cases of cerebral arteriovenous malformation were treated with microsurgical,total focus removal was achieved in 14 cases,3 cases with not completely were received postoperative management about γ-ray.According to GOS score,11 patents got good recovery,4 moderately disabled,2 severely disabled,0 plant survival and 0 died.Conclusion Microsurgical for cerebral arteriovenous malformation in insular cortex can remove focus completely and get satisfactory effect with few complications,the results were satisfactory.

目的 分析重型颅脑伤继发急性呼吸窘迫综合征(ARDS)的高危因素,根据高危因素采取综合治疗措施.方法 对我科近5 年来28 例重性颅脑损伤合并ARDS 的病人资料进行回顾性分析,对患者发病的高危因素及治疗方法 进行讨论.结果 28 例患者均诊断明确,16 例抢救成功,12 例死亡.结论 重型性颅脑损伤后并发ARDS 病死率较高.预防高危因素的发生,早期诊断、早期气管切开以及正确使用呼吸机是其抢救成功的关键.

Objective Analysis of risk factors of ARDS caused by severe traumatic brain injury,adopt effective precautions and nursing interventions according to risk factors.Methods The datas of 28 patients with severe traumatic brain injury caused ARDS during last five years were retrospectively analyzed and the incidence of patient risk factors and treatment methods were discussed.Resul 28 patients were diagnosed clearly,16 patients were successfully rescued and 12 patients died.The achievement ratio of rescue is up to 57.1%.Conclusion Severe craniocerebral injury complicated by ARDS caused a high mortality.To prevent the occurrence of risk factors,early diagnosis,early tracheotomy and the correct use of breathing machine as well as high qualified basic nursing are the key to the success of their rescue.

目的 探讨边缘系统胶质瘤的临床特点和显微外科治疗的手术技巧及术中注意事项.方法 回顾性分析我院35例边缘系统脑胶质瘤患者临床资料.所有病例均采用显微手术, 在保护重要结构的前提下最大限度地切除肿瘤.结果 显微镜下全切除肿瘤26例,次全切除5例,部分切除4例.术后1例死亡.结论 熟悉边缘系统的局部解剖和熟练掌握显微神经外科技术是手术成功的关键.术中注意对侧裂区动静脉血管及肿瘤周围重要功能区的保护, 能够提高边缘系统胶质瘤的手术治疗效果.

目的 研究重型特重型颅脑损伤并侧裂血管损伤的临床特点、手术体会及术后处理.方法 对我科60例重型特重型颅脑损伤伴有侧裂区血管损伤患者的临床资料进行回顾性分析.结果 根据COS预后标准:死亡15例,植物生存2例,重残10例,中残14例,良好19例.结论 术中注意对外侧裂区血管的保护,采用标准外伤去大骨瓣减压手术,能提高手术疗效.

目的 探讨显微外科手术治疗外侧裂区脑动静脉畸形的预后.方法 对1995年2月至2008年2月收治的15例侧裂区脑动静脉畸形患者行显微外科手术切除治疗.结果 显微外科治疗外侧裂区脑血管畸形15例,12例完全切除病灶,3例未完全切除,术后行γ刀辅助治疗.手术效果按格拉斯哥预后评分:恢复良好8例,中度残废5例,严重残废2例,无植物生存和死亡.结论 显微镜下外科治疗侧裂区脑动静脉畸形,切除病灶彻底,手术并发症少,疗效满意。

Objective To investigate the clinical features and microsurgical resection techniques of cerebellopontine angle cholesteatoma. Methods Clinical features, surgical approach and techniques, results and complications were analyzed in 30 cases of cerebellopontine angle cholesteatoma. Results Total resection in 26 cases, subtotal resection in 4 cases ,no operative mortality. Post-operative complications was aseptic encephalitis which was most common after treatment, and all recovered. Conclusion Cerebellopontine angle cholesteatoma was a third category of common tumors, CT, MRI examination can provide diagnosis. According to cholesteatoma involving the site ,selecting a good surgical approach and making good use of microsurgical technique could improve surgical total removal rate and reduce postoperative complications.

Objective To investigate the anatomical characteristics,imaging features and microsurgical techniques of the glioma located in lateral fissure area.Method The clinical data of 46 patients suffered the lateral fissure gliomas were reviewed,including 30 of total resection 13 of subtotal resection and 3 of partial resection.Results Postoperative pathological results revealed that astrocytoma was in 29 cases,multiform glioblastoma in 7 cases and oligodendrogliomas in 10 cases.The myodynamia of contralateral limb improved in 15 and aggravation in 4 after operation.8 patients were found cerebral vasospasm,of which 6 combined with severe encephaledema.Out of the 8 patients,good prognosis was achieved in 7 cases after symptomatic treatment and severe disability associated with large area cerebral infarction in 1 case.There was transient alogia and hypomnesia in 4 cases.No one died during the perioperative period.41 cases were followed up for 3 to 36 months with an average of 18 months.35 patients survived,5 died of tumor relapse and 1 died of pulmonary infection.Among the 6 deaths,5 were multiform glioblastoma and 1 was astrocytoma with grade ⅠtoⅡ.12 cases relapsed in 10 to 18 months after operation.Conclusions Microsurgery can improve the total removal rate,reduce the complication incidence of neurological deficits and avoid short-term tumor recurrence in the treatment of the glioma located in lateral fissure area.The measures of proper selection of surgical approaches and precise identification and protection of the blood vessels are the keys to improve the operative effect.

目的 探讨颅底胆脂瘤显微外科治疗的临床疗效.方法 回顾性分析以三叉神经痛为首发症状的26例后颅窝胆脂瘤患者的临床资料,根据肿瘤的不同生长部位及大小,采取不同的手术入路予以显微切除.结果 术后三叉神经痛症状均消失.手术全切除22例,次全切除4例,无手术死亡.术后并发症以无菌性脑炎最多见,治疗后痊愈.结论 胆脂瘤导致的三叉神经痛临床表现多不很典型,CT、MRI检查可提供诊断依据.根据胆脂瘤累及的部位,选择好手术入路和运用好显微外科技术可提高手术的全切率,降低并发症.肿瘤切除后三叉神经痛即停止,无需特殊处理.

目的 探讨后颅窝肿瘤术后皮下积液的原因、预防对策及治疗.方法 回顾性分析后颅窝肿瘤术后并发皮下积液21例患者的临床资料.21例中局部穿刺抽吸+局部加压包扎7例(仅限于骨窗区皮瓣下),局部头皮穿刺引流2例,腰椎穿刺持续引流脑脊液辅以局部积液穿刺后加压包扎6例,行分流术3例,再次开颅手术清除积液3例.结果 19例患者获得随访,随访3个月至2.5年,行分流术者1例因堵管予以再次手术调整;腰椎穿刺持续引流者1例复发,再次行开颅手术治疗.其余病例预后良好.结论 后颅窝开颅术后皮下积液是可以预防和治疗的.术中严密缝合硬脑膜及逐层肌肉组织,局部长时间多次加压包扎,拔除引流管后严密缝合引流口等防治措施可预防术后皮下积液.对于并发皮下积液者,应强调综合性治疗.