This study aimed to evaluate the predictive value of the combined Modified Early Warning Score (MEWS) and Modified Hematoma Expansion Prediction (MHEP) score for hematoma expansion(HE)in patients with intracerebral hemorrhage (ICH). The goal was to provide an accurate and practical tool for risk assessment in this patient population. Clinical data from patients with ICH admitted to Nanchuan Hospital Affiliated to Chongqing Medical University between January 2024 and June 2025 were prospectively collected. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with HE. Subsequently, the predictive performance of the combined MEWS and MHEP scores (termed MEWS-MHEP) was evaluated using receiver operating characteristic (ROC) curve analysis. A total of 421 patients were enrolled and categorized into the hematoma expansion group (n = 58) and the non-hematoma expansion group (n = 363). Significant differences (P < 0.05) were observed in smoking history, alcohol consumption, hematoma location, hematoma volume, island sign, and Glasgow Coma Scale (GCS) score, indicating their association with HE. The MEWS showed a moderate correlation with HE (P = 0.004). Both the MHEP score and the combined MEWS-MHEP score were significantly higher in the HE group (P < 0.001). The MEWS-MHEP score yielded an AUC of 0.813, which was significantly higher than that of the MEWS alone (0.616) and the MHEP score alone (0.699) (P < 0.001), with an overall prediction accuracy of 80.76%.The MEWS-MHEP score outperforms either the MEWS or MHEP score alone in predicting HE in patients with ICH. Thus, it represents a reliable tool for emergency risk stratification and may aid in optimizing medical resource allocation.

IntroductionDelayed cerebral ischemia (DCI) is one of the main causes of disability and death following surgical treatment of ruptured intracranial aneurysms. Many studies combine data from patients undergoing clipping and coiling; however, this approach may be inappropriate. The purpose of this study was to compare the incidence of DCI between the two surgical methods and to explore, separately for each method, the predictive factors of DCI.MethodsThis study systematically searched relevant articles on DCI after intracranial aneurysm surgery published in the PubMed, EMBASE, and Web of Science databases since their inception up to October 2025. After screening for inclusion criteria, RevMan software was used to perform a meta-analysis of the eligible studies.ResultsThis study included a total of 21 articles, including 5,358 patients. The results showed that there was a significant difference in the incidence of DCI after clipping and coiling. The combined OR value was 1.57 (95 % CI: 1.31–1.89), and the heterogeneity was within the acceptable range. The difference was statistically significant. In patients undergoing clipping, Fisher grade (OR 2. 11; 95 % CI: 1.57–2.84) and WFNS classification (OR 1.73; 95 % CI: 1.19–2.5) was a significant predictor of DCI, and the heterogeneity was low. Gender (OR 0.98; 95 % CI: 0.53–1.80), age (OR 1.34; 95 % CI: 0.13–2.55), hypertension (OR 0.97; 95 % CI: 0.75–1.25), diabetes (OR 1.48; 95 % CI: 0.77–2.83) and smoking history (OR 0.78; 95 % CI: 0.54–1.11) showed no statistical significance. In patients with interventional embolization, age (OR 3.34; 95 % CI: 1.27–5.41) and Fisher grade (OR 3.86; 95 % CI: 2.04–7.31) had a significant predictive effect on the occurrence of DCI.ConclusionThis study suggests that patients who have undergone clipping have a higher risk of DCI compared with patients undergoing coiling. Certain risk factors have shown a stronger predictive value in patients undergoing coiling. These conclusions require further validation by additional high quality studies.

Purpose:This study aimed to analyze the influence of volume during continuous lumbar drainage on the prognosis of patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) and to develop and validate a prognostic nomogram model. Patients and Methods:The clinical data of patients with acute hydrocephalus after aSAH at a single center were retrospectively collected. The modified Rankin Scale score at 6 months after discharge was used as the prognostic outcome. Clinical data were included in the univariate analysis. Significant variables were incorporated into a multivariate logistic regression analysis. On the basis of the independent factors identified, an individualized prognostic nomogram was developed and internally validated. Results:In total, 164 patients were included. Multivariate analysis revealed high World Federation of Neurological Surgeons scores (OR: 3.20), high modified Fisher grades (OR: 3.39), shunt dependence (OR: 8.05), and cerebral vasospasm (OR: 22.65) as independent risk factors for poor prognosis. Continuous lumbar drainage volume (OR: 0.61) was determined to be an independent protective factor. A nomogram model incorporating these independent factors was successfully constructed. The model demonstrated good predictive performance, with area under the receiver operating characteristic curve values greater than 0.86 in the training and test sets. Internal validation indicated high discriminative ability (C-index: 0.935) and good calibration. Conclusion:Increasing the volume of continuous lumbar drainage within the patient's tolerance range is an independent protective factor. The nomogram effectively integrates multiple independent factors and provides a potentially effective reference tool for individualized prognosis prediction in patients with acute hydrocephalus after aSAH.

ObjectivesTo investigate the influence of plaque distribution and vascular bifurcation angle on hemodynamics within the carotid artery bifurcation and to explore the role these factors play in the development of vulnerable carotid plaques. The study aims to provide a more comprehensive understanding of how complex hemodynamic patterns affect plaque formation, vulnerability, and progression.MethodsPatient-specific carotid bifurcation models were reconstructed using 3D rotational angiography and CT angiography, validated by digital subtraction angiography. Computational fluid dynamics (ANSYS Fluent) with non-Newtonian modeling simulated hemodynamics under patient-specific boundary conditions. Plaque morphology and hemodynamic parameters (TAWSS, OSI, ECAP) were quantified. Statistical analyses included Spearman’s correlations and non-parametric tests for bifurcation angles/plaque locations.ResultsNumerical simulations demonstrated that plaque subtypes and bifurcation angles critically modulate carotid hemodynamics. Elevated wall shear stress (WSS) upstream of plaques (sites M/N) increased rupture susceptibility, whereas low WSS at the outer bifurcation (site P) exacerbated atherogenesis. Larger bifurcation angles reduced peak velocities, expanded low-velocity zones, and diminished WSS, amplifying atherosclerosis risk. Vortex-driven low-shear regions prolonged platelet residence, enhancing thrombotic propensity. Fluid-structure interactions revealed arterial wall deformation near bifurcations, correlating with endothelial injury and plaque progression. These hemodynamic alterations underscore the biomechanical interplay driving plaque vulnerability and thrombosis in carotid atherosclerosis.ConclusionCarotid plaque vulnerability arises from bifurcation angle-dependent hemodynamic disturbances, where elevated upstream wall shear stress predisposes to rupture, while low-shear zones at the outer bifurcation accelerate atherogenesis. Vortex-driven platelet retention and fluid-structure interactions exacerbate endothelial dysfunction, underscoring hemodynamic targeting for clinical risk mitigation.

Phosphodiesterase 4 is a key enzyme involved in the regulation of cell signal transduction, but its role in subarachnoid hemorrhage remains unclear. Neuronal pyroptosis has been reported to be involved in early brain injury after subarachnoid hemorrhage. This study aimed to investigate whether phosphodiesterase 4 contributes to early brain injury after subarachnoid hemorrhage by mediating neuronal pyroptosis and its related mechanisms. Endovascular perforation of male C57BL/6J mice was performed to model subarachnoid hemorrhage in vivo , and oxyhemoglobin was added to the culture medium of primary neurons to model subarachnoid hemorrhage in vitro . A phosphodiesterase 4-specific inhibitor, etazolate, was intraperitoneally injected 30 minutes after subarachnoid hemorrhage induction. Small interfering RNA (siRNA) was administered intracerebroventricularly 72 hours before subarachnoid hemorrhage to achieve genetic knockdown of phosphodiesterase 4. To investigate the mechanism, a nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 (NLRP3)-specific agonist, nigericin, was intracerebroventricularly injected 60 minutes before subarachnoid hemorrhage. Neuronal phosphodiesterase 4 expression increased after subarachnoid hemorrhage and reached the highest point at 24 hours. Etazolate treatment reduced neurological deficits and brain edema in mice, alleviated neuronal pyroptosis and inflammatory response, and improved neuronal injury. Treatment with phosphodiesterase 4 siRNA had the same neuroprotective effects as etazolate. Mechanistically, phosphodiesterase 4 triggered the nuclear factor kappa-B pathway, and simultaneously caused lysosomal and mitochondrial dysfunction after subarachnoid hemorrhage, which promoted NLRP3 inflammasome activation and induced neuronal pyroptosis. Blocking of phosphodiesterase 4 inhibited the nuclear factor kappa-B pathway, and improved lysosome and mitochondrial function. Activation of NLRP3 reversed the neuroprotective effects of etazolate without affecting phosphodiesterase 4 expression. Together, the results indicate that phosphodiesterase 4 regulates NLRP3-mediated neuronal pyroptosis in early brain injury after subarachnoid hemorrhage. Phosphodiesterase 4 may be a potential therapeutic molecular target for subarachnoid hemorrhage.

Objective To analyze the influence of drainage volume on prognosis of acute hydrocephalus (AHC) after aneurysmal subarachnoid hemorrhage (aSAH) by continuous lumbar drainage. Methods A retrospective trial was conducted on 82 AHC patients after aSAH admitted to the First Affiliated Hospital of Chongqing Medical University between January 2017 and January 2022.In 6 months after discharge, modified Rankin Scale (mRS) score was used to evaluate the prognostic outcomes.Univariate and multivariate logistic regression analyses were performed on demographic factors, severity of subarachnoid hemorrhage (SAH) at admission, medical history, cerebral vasospasm, and lumbar drainage data.Then a nomogram prediction model was constructed. Results Univariate analysis found that World Federation of Neurosurgical Societies (WFNS) score, Hunt-Hess grade, modified Fisher grade, time for continuous lumbar drainage, shunt dependence, cerebral vasospasm, and drainage volume were factors affecting the prognosis of the patients.Then logistic regression analysis revealed that high WFNS score (OR: 3.25, 95%CI: 1.11~9.48), high modified Fisher grade (OR: 3.66, 95%CI: 1.08~12.35), shunt dependence (OR: 15.56, 95%CI: 1.22~198.57), and cerebral vasospasm (OR: 22.24, 95%CI: 3.08~160.68) were independent predictors for mRS score, while volume of continuous lumbar drainage (OR: 0.57, 95%CI: 0.40~0.82) was an independent protective factor.ROC curve analysis indicated a good predictive performance of the model (AUC=0.898, 95%CI: 0.935~0.861).Internal validation through Bootstrap method demonstrated excellent discriminatory ability of the model (C-index=0.950, 95%CI: 0.904~0.996;adjusted C-index: 0.934). Conclusion Increased volume of lumbar drainage is an independent protective factor for poor prognosis following aSAH and can improve the prognosis of SAH patients.

In the original publication [...].

BackgroundBlood blister-like aneurysm (BBA) is a rare and special type of intracranial aneurysm with extremely high rates of rupture, morbidity, mortality, and recurrence. Willis Covered Stent (WCS) is a new device that is specifically designed for the treatment of intracranial complex aneurysms. However, the efficacy and safety of WCS treatment for BBA remain controversial. Thus, a high level of evidence is required to prove the efficacy and safety of WCS treatment.MethodsA systematic literature review was performed using a comprehensive literary search in Medline, Embase, and Web of Science databases to identify studies related to WCS treatment for BBA. A meta-analysis was then conducted to incorporate the efficacy and safety outcomes, including intraoperative situation, post-operative situation, and follow-up data.ResultsEight non-comparative studies containing 104 patients with 106 BBAs met the inclusion criteria. In the intraoperative situation, the technical success rate was 99.5% [95% confidence interval (CI), 0.958, 1.000], the complete occlusion rate was 98.2% (95% CI, 0.925, 1.000), and the side branch occlusion rate was 4.1% (95% CI, 0.001, 0.114). Vasospasm and dissection occurred in 9.2% (95% CI, 0.000, 0.261) and 0.1% (95% CI, 0.000, 0.032) of the patients, respectively. In the post-operative situation, the rebleed and mortality rates were 2.2% (95% CI, 0.000, 0.074) and 1.5% (95% CI, 0.000, 0.062), respectively. In the follow-up data, recurrence and parent artery stenosis occurred in 0.3% (95% CI, 0.000, 0.042) and 9.1% (95% CI, 0.032, 0.168) of the patients, respectively. Ultimately, 95.7% (95% CI, 0.889, 0.997) of the patients had a good outcome.ConclusionsWillis Covered Stent could be effectively and safely applied for BBA treatment. The results provide a reference for clinical trials in the future. Well-designed prospective cohort studies must be conducted for verification.

Background: Pseudoaneurysm (PSA) of internal carotid artery is a rare but severe cerebrovascular disease and difficult to repair surgically. A novel medical device called Willis covered stent (WCS) has been created especially for the treatment of complex cerebrovascular diseases. However, the efficacy and safety of WCS therapy for PSA are still debatable. Additional substantial proof is needed. Methods: To find research pertaining to WCS treatment for PSA, a systematic review of literature was conducted in the Medline, Embase, Web of Science, CNKI, Wanfang, and CBM databases. The results comprising the data of intraoperative situation, postoperative situation, and follow-up were then included in a meta-analysis. Results: The criteria were met by 11 noncomparative studies with 152 patients and 157 PSAs. Technical success rate was nearly 100 % (>0.999 (95 % confidence interval (CI), 0.958, 1.000)), complete occlusion rate was 97.8 % (95 % CI, 0.932, 1.000), and side branch occlusion rate was 0.5 % (95 % CI, 0.001, 0.045). The rates of acute in-stent thrombosis (<0.001 (95 % CI, 0.000, 0.013)) and hemorrhage (<0.001 (95 % CI, 0.000, 0.005)) were both less than 0.1 %. In postoperative situation, surgery-related mortality rate was less than 0.1 % (<0.001 (95 % CI, 0.000, 0.005)). The rates of recurrence (<0.001 (95 % CI, 0.000, 0.002)) and parent artery stenosis (<0.001 (95 % CI, 0.000, 0.008)) were both less than 0.1 %, while late in-stent stenosis occurred in 1.3 % (95 % CI, 0.000, 0.053) of patients. In the end, 98.5 % (95 % CI, 0.943, 1.000) of patients had a good outcome. Conclusion: The application of WCS could be effective and safe for PSAs. The findings of this study could serve as a reference for upcoming clinical trials.

OBJECTIVE:A de novo intracranial aneurysm (IA) is a second, new IA that develops in patients with IAs distant from where the initial IA was detected. This study aimed to identify risk factors for de novo IA formation and establish and externally validate a multicenter risk prediction model for de novo IAs. METHODS:A systematic review and meta-analysis of existing de novo IA cohorts was conducted to form the derivation cohort. The risk ratios and 95% CIs of each risk factor were calculated. In addition, risk scores included in the model were calculated based on the statistically significant risk factors with their weightings. Then the model was validated in a multicenter external cohort of Chinese patients, and receiver operating characteristic and calibration curves, decision curve analysis, and Kaplan-Meier curves were used to evaluate the model. RESULTS:Nineteen studies with 9351 patients, of whom 304 patients (3.25%) developed de novo IAs, were included in the derivation cohort. These patients developed de novo IAs at 2.5-18.5 years during a total follow-up of 3.3-18.8 years. The statistically significant risk factors were age < 60 years, female sex, smoking history, family history of IAs, multiple IAs at initial diagnosis, and initial IAs in the middle cerebral artery, with risk scores of 4, 5, 2, 6, 3, and 3, respectively. Then, a multicenter external cohort comprising 776 patients, of whom 45 patients (5.80%) developed de novo IAs, was included in the validation cohort. De novo IAs formed in these patients at a mean of 5.25 years during a mean follow-up of 6.19 years. The area under the curve of the model was 0.804, with a sensitivity of 0.667 and specificity of 0.900, at a cutoff value of 13. The calibration curve, decision curve analysis, and Kaplan-Meier curves also indicated good performance of the model. CONCLUSIONS:This prediction model is a convenient and intuitive tool for identifying high-risk patients with de novo IAs. Reasonable use of the model can not only aid in clinical decision-making but also play a positive role in the prevention of aneurysmal subarachnoid hemorrhage to a certain extent.

Abstract Background: Several studies, including a randomized clinical trial, have demonstrated that atorvastatin may be an effective nonoperative treatment for chronic subdural hematoma (CSDH). Atorvastatin is mainly used to regulate lipid metabolism. However, few studies investigated the association between serum lipids level and risk of CSDH.Methods: We conducted a retrospective case-control study to assess the relationship between fasting lipids (total cholesterol, triglyceride, HDL-C and LDL-C), apolipoproteins (ApoA1, ApoB) and risk of CSDH. Using a one-to-three case–control ratio, 137 CSDH patients were included in our study. Conditional logistic regression was used to examine the relationship between lipids and apolipoproteins biomarkers and risk of CSDH.Result: In univariate analysis, baseline levels of total cholesterol (P<0.001), HDL-C (P<0.001) and ApoA1 were significantly lower among patients with CSDH, while levels of ApoB were higher. No significant difference for triglyceride (P=0.15) and LDL-C (P=0.47) were observed. In multivariable analysis, total cholesterol (OR for the highest vs lowest quartile 0.34, 05%CI 0.19-0.64, P<0,001), triglycerides (OR 1.98, 95%CI 1.05-3.71, p<0,05), HDL-C (OR 0.26, 95%CI 0.13-0.52, P<0,001), ApoA1 (OR 0.27, 95%CI 0.14-0.52, P<0,001) were significantly associated with CSDH, when conditioned on age and gender, and adjusted for head trauma and hypertension. Additional adjustment for all covariates of interest don’t substantially change the multivariable associations.Conclusion: Among a panel of lipids and apolipoproteins biomarkers, total cholesterol, triglycerides, HDL-C, ApoA1 were significantly associated with CSDH.

White matter damage (WMD), one of the research hotspots of subarachnoid hemorrhage (SAH), mainly manifests itself as myelin injury and oligodendrocyte differentiation disorder after SAH, although the specific mechanism remains unclear. Dexamethasone-induced Ras-related protein 1(Dexras1) has been reported to be involved in nervous system damage in autoimmune encephalitis and multiple sclerosis. However, whether Dexras1 participates in dysdifferentiation of oligodendrocytes and myelin injury after SAH has yet to be examined, which is the reason for creating the research content of this article. Here, intracerebroventricular lentiviral administration was used to modulate Dexras1 levels in order to determine its functional influence on neurological injury after SAH. Immunofluorescence, transmission electron microscopy, and Western blotting methods, were used to investigate the effects of Dexras1 on demyelination, glial cell activation, and differentiation of oligodendrocyte progenitor cells (OPCs) after SAH. Primary rat brain neurons were treated with oxyhemoglobin to verify the association between Dexras1 and cAMP-CREB. The results showed that Dexras1 levels were significantly increased upon in vivo SAH model, accompanied by OPC differentiation disturbances and myelin injury. Dexras1 overexpression significantly worsened OPC dysdifferentiation and myelin injury after SAH. In contrast, Dexras1 knockdown ameliorated myelin injury, OPC dysdifferentiation, and glial cell activation. Further research of the underlying mechanism discovered that the cAMP-CREB pathway was inhibited after Dexras1 overexpression in the in vitro model of SAH. This study is the first to confirm that Dexras1 induced oligodendrocyte dysdifferentiation and myelin injury after SAH by inhibiting the cAMP-CREB pathway. This present research may reveal novel therapeutic targets for the amelioration of brain injury and neurological dysfunction after SAH.

ObjectiveA nomogram was developed in this work to predict the probability of delayed cerebral infarction (DCI) after ruptured intracranial aneurysms (RIA) clipping.MethodsClinical data of patients with intracranial aneurysm were obtained from the neurosurgery department of the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2020. A total of 419 patients receiving surgery of ruptured intracranial aneurysm clipping were included and a total of 37 patients with DCI were set as the observation group. The control group consisted of 382 patients without DCI. Risk factors of DCI were screened by univariate and multivariate logistic regression analysis and included in the nomogram.ResultsUnivariate analysis showed that female (P = 0.009), small aneurysm (P = 0.031), intraoperative aneurysm rupture (P = 0.007) and cerebral vasospasm (P < 0.001) were risk factors for postoperative DCI while smoking history (P = 0.044) were protective factors for postoperative DCI. Multivariate Logistic regression analysis showed that small aneurysm (P = 0.002, OR = 3.332, 95%–7.104), intraoperative aneurysm rupture (P = 0.004, OR = 0.122, 95%-CI, 0.029–0.504)and cerebral vasospasm (P < 0.001, OR = 0.153, 95%-CI, 0.070–0.333) were independent risk factors of postoperative DCI. The calibration curve of the probability of occurrence showed that the nomogram was in good correspondence with the observed results with a C-index of 0.766 (95% CI, 0.684–0.848). Meanwhile, the Decision curve analysis (DCA) showed that the established predictive model had a good clinical net benefit.ConclusionThe well-established nomogram is expected to be an effective tool to predict the occurrence of DCI after intracranial ruptured aneurysm and can be used to assist clinicians to develop more effective treatment strategies and improve the prognosis of patients.

Objective To analyze the risk factors and clinical significance of delayed cerebral infarction (DCI) after intracranial aneurysm (IA) clipping. Methods A retrospective analysis was performed on the clinical data of IA patients admitted to the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019. A total of 480 patients undergoing aneurysm clipping were included. The patients with DCI were set as the observation group (n=42), and those without as the control group (n=438). The risk factors for DCI were screened by univariate and multivariate logistic regression analysis. Results Univariate analysis showed that female (P=0.029), small aneurysms (P=0.001), intraoperative aneurysm rupture (IAR) (P=0.007) and cerebral vasospasm (P < 0.001) were risk factors for DCI after IA clipping, while smoking history (P=0.020) was a protective factor. Multivariate logistic regression analysis indicated that small aneurysms (P=0.002, OR=2.951, 95%CI: 1.478~5.893), IAR (P=0.004, OR=7.829, 95%CI: 1.924~31.854) and cerebral vasospasm (P < 0.001, OR=5.919, 95%CI: 2.887~12.134) were postoperative independent risk factors for DCI. Conclusion Proper treatment of small aneurysms, proactive prevention of IAR and treatment of cerebral vasospasm can prevent the occurrence of DCI effectively, and thereby reduce the disability rate and improve the prognosis of patients.

目的 探讨神经内镜血肿清除术与微创血肿穿刺引流术治疗高血压脑出血患者的效果及其对手术相关指标的影响.方法 选取2019年5月至2020年5月该院收治的高血压脑出血患者50例.根据手术方式的不同分为对照组和观察组,各25例.对照组患者行微创血肿穿刺引流术,观察组患者行神经内镜血肿清除术,观察两组患者手术相关指标、Barthel指数评分、格拉斯哥结局评分(GOS评分)、美国国立卫生研究院卒中量表(NIHSS)评分、总有效率及并发症发生情况.结果 观察组患者手术时间、术中出血量、血肿清除率及住院时间等相关手术指标均显著优于对照组,差异均有统计学意义(P<0.05);术后1个月,两组患者Barthel指数、NIHSS评分及GOS评分均优于对照组,差异均有统计学意义(P<0.05);观察组总有效率显著高于对照组,并发症总发生率显著低于对照组,差异均有统计学意义(P<0.05).结论 高血压脑出血患者临床治疗选用神经内镜血肿清除术,可有效降低手术用时,减少术中出血量,临床疗效较好,且并发症发生率较低.

目的 探讨临床路径下硬通道穿刺引流术治疗慢性硬膜下血肿的临床价值.方法 选取2013年1月至2018年12月该院神经外科收治的126例慢性硬膜下血肿患者为研究对象,98例纳入试验组,采用临床路径下硬通道穿刺引流术治疗,28例纳入对照组,采用传统钻孔冲洗引流术治疗,比较两组的住院时间、住院费用、复发率、并发症发生率和患者满意度.结果 试验组的住院时间明显短于对照组,住院费用明显少于对照组,差异有统计学意义(P＜0.05);试验组的复发率和并发症发生率分别为4.08％和5.10％,明显低于对照组的17.86％和21.43％,差异有统计学意义(P＜0.05);试验组和对照组的满意度分别为91.84％和71.43％,差异有统计学意义(P＜0.05).结论 临床路径下硬通道穿刺引流术治疗慢性硬膜下血肿能够科学地规范治疗措施,减少了患者住院时间和住院费用,还能够降低复发和并发症发生风险,有利于提升患者满意度.

目的 观察盐酸纳洛酮对重度颅脑外伤患者的治疗效果,及对血清阿片肽的影响.方法 选取2016年3月--2018年6月在重庆市南川区人民医院接受治疗的重度颅脑外伤患者为研究对象,并随机分为对照组和观察组,两组患者均给予常规药物治疗,观察组在此基础上给予盐酸纳洛酮治疗.观察两组患者治疗前后血清阿片肽、认知功能、颅内压和清醒时间的差异.结果 两组患者治疗前血清阿片肽水平无差别,治疗后,观察组患者的阿片肽水平为135.67±13.11 ng/L,低于对照组患者的152.84±10.25 ng/L(t=6.525,P＜0.001);两组患者治疗前认知功能无差别,治疗后,观察组患者定向力、瞬时记忆和短时记忆等MMSE评分均高于对照组患者(P＜0.05);两组患者治疗前颅内压无差别,治疗后,观察组患者的颅内压为145.26±11.45 mmH20,低于对照组患者(t=20.004,P＜0.001);观察组中有1例患者死亡,其余患者的清醒时间为38.27±6.22 h,对照组中有3例患者死亡,其余患者的清醒时间为95.23±8.74 h,较观察组长(t=30.413,,P＜0.001).结论 盐酸纳洛酮对重度颅脑外伤患者有较好的治疗效果,可明显改善患者的认知功能和颅内压,具有良好的应用价值.

目的 探讨控制性减压术对重型颅脑损伤患者近远期转归效果影响.方法 选取自2015年12月到2017年2月重庆医科大学附属南川人民医院收治的96例重型颅脑损伤患者为研究对象.根据随机数字法将患者分为A组和B组,每组各48例.A组给予标准大骨瓣减压手术治疗,B组给予控制性减压术治疗,比较两组手术前后的颅内压、格拉斯哥昏迷量表(GCS)、神经行为认知状态检查表评分(NCSE)、日常生活活动能力评分(Barthel指数);记录两组术中、术后并发症的发生情况及术后6个月的预后质量.结果 术后即刻及术后6个月,两组患者的颅内压均低于术前,且B组患者的颅内压均低于A组,差异均有统计学意义(P<0.05).术后6个月,两组患者的GCS评分、NCSE评分及Barthel指数均高于术前,且B组均高于A组,差异有统计学意义(P<0.05).术中、术后B组并发症发生率为14.6(7/48),明显低于A组的47.9(23/48),两组间比较,差异有统计学意义(P<0.05).术后6个月,B组预后良好率为29.2％(14/48),明显高于A组的16.7％(8/48),两组间比较,差异有统计学意义(P<0.05).结论 控制性减压术能降低重型颅脑损伤患者术中、术后并发症的发生率,促进神经功能及生活质量的恢复.

目的 探讨高血压幕上脑出血手术方式和时机对预后的影响.方法 回顾性分析174例高血压幕上脑出血患者的临床资料,根据手术时机不同将患者分为A组(出血后≤24 h)和B组(出血后>24 h),A组113例患者根据手术方式的不同又分为A1组(骨瓣开颅血肿清除术)35例、A2组(小骨窗血肿清除术)38例、A3组(微创血肿穿刺引流术)40例,B组61例患者同样根据手术方式的不同分为B1组(骨瓣开颅血肿清除术)20例、B2组(小骨窗血肿清除术)20例、B3组(微创血肿穿刺引流术)21例.结果 A3组患者预后良好率(85.00%)较A1组(62.85%)、A2组(65.79%)、B3组(61.90%)显著增高(P<0.05);A1、2、3组ADL评分分别较B1、2、3组显著增高(P<0.05);A1组ADL评分较A2、3组显著降低,B1组ADL评分较B2、3组显著较低(P<0.05);A1、2、3组NIHSS评分分别较B1、2、3组显著降低(P<0.05);A1组NIHSS评分较A2、3组显著增高,B1组NIHSS评分较B2、3组显著增高(P<0.05);A3组并发症发生率(12.50%)较A1组(37.14%)、A2组(26.32%)显著降低(P<0.05);B3组并发症发生率(9.52%)较B1组(40.00%)、B2组(35.00%)显著降低(P<0.05).结论 超早期采用个性化手术方案治疗高血压幕上脑出血可改善疾病预后.

目的 探讨颅脑损伤后发生脑积水的危险因素.方法 回顾性分析2011年1月至2015年12月收治的380例颅脑损伤的临床资料,其中行去骨瓣减压术62例;采用多因素Logistic回归分析检验危险因素.结果 380例颅脑损伤中,继发脑积水63例,多因素Logistic回归分析显示术前GCS评分≤8分、蛛网膜下腔出血、硬脑膜下积液及去骨瓣减压术是发生脑积水的独立危险因素(P＜0.05).62例去骨瓣减压术中,发生脑积水20例,多因素Logistic回归分析显示双侧去骨瓣减压术、骨窗面积较大及二次手术是去骨板减压术后发生脑积水的独立危险因素(P＜0.05).结论 颅脑损伤后昏迷程度、蛛网膜下腔出血、双侧去骨瓣减压术、二次手术等均为发生脑积水的危险因素.