目的 探讨体位指导干预在巨大侵袭性垂体腺瘤患者神经内镜下经蝶手术效果及对自我管理水平的影响.方法 选择2018年5月至2021年2月收治的巨大侵袭性垂体腺瘤患者68例,患者均行神经内镜下经蝶手术治疗,随机数字表法分为2组,每组34例.对照组采用常规护理,观察组联合体位指导干预,7 d后比较2组疼痛数字评分(NRS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、自我管理水平、知晓率及并发症发生率.结果 护理7 d后观察组NRS、SDS、SAS评分低于对照组(P<0.05),自我决策、自我减压、正性态度及总分均高于对照组(P<0.05);观察组护理7 d后发病机制、手术方法及并发症预防知晓率高于对照组(P<0.05),围术期反流性食管炎、感染、吻合口瘘发生率低于对照组(P<0.05).结论 体位指导干预用于巨大侵袭性垂体腺瘤患者神经内镜下经蝶手术中,有助于减轻患者疼痛及焦虑、抑郁,提高患者自我管理水平和知晓率,可降低术后并发症发生率.

目的 研究沙利度胺作为镇痛药发挥其镇痛效果的机制及TRPV-1通路在沙利度胺发挥其镇痛效果过程中的作用.方法 采用过表达HEK293细胞和背根神经节(DRG)神经元,予以辣椒素激活受体,沙利度胺孵育.通过离子荧光成像测量技术,观察不同细胞不同干预因素下TRPV1通道变化;通过TRPV1基因敲除小鼠和C57小鼠,结合TRPV1通道抑制剂应用,分别予以沙利度胺干预,通过观察试验小鼠行为学变化,测量动物模型的痛觉改变.监测在不同的动物模型中,沙利度胺的镇痛效果及TRPV1通道参与沙利度胺的镇痛作用的机制.结果 激动剂辣椒素激活细胞模型过程中,在300μmol/L沙利度胺预处理20 min,激活的TRPV1通道内的阳离子流入显著下降,RFU读数由320下降至150单位(P<0.01),而且,TRPV1活性的这种衰减呈沙利度胺剂量依赖性.KCl溶液处理下的DRG神经元均被激活,在没有沙利度胺预处理的情况下,对辣椒素溶液敏感的神经元占(62±11)％.在应用20～50μmol/L沙利度胺预处理的情况下,对辣椒素溶液敏感神经元为(41±9)％和(28±9)％.醋酸扭体试验,可见野生型小鼠经沙利度胺预处理后,平均扭体次数由原来的54次减少到28次.与对照组(野生型WT组)比较(P<0.01);热板试验中,野生型小鼠经沙利度胺预处理后15 min,平均热痛觉阈值由原来的26 s增加到49 s(15 min);52 s(30 min);46 s(60 min),正常对照组热痛觉阈值几乎无变化,与对照组比较差异有统计学意义(P<0.01);在TRPV1敲除小鼠和使用TRPV1通道抑制剂(A784168)的小鼠中,经沙利度胺干预后,与对照组比较,扭体数和热痛觉时间差异无统计学意义(P>0.05).结论 沙利度胺可通过TRPV1通道的调控,发挥其镇痛作用.

目的 探讨不同手术方式对危重高血压幕上脑出血患者术后转归的影响.方法 146例老年危重高血压幕上脑出血患者,采用随机数字表分配法,按照治疗方式不同,分为观察组(钻孔引流联合开颅血肿清除术组)和对照组(开颅血肿清除术组).通过院内、门诊或电话及家访方式,收集和记录2组患者术后1周、2周、3周的GCS评分,并计算其术后GCS评分增量.采用多元线性回归分析研究入院患者一般资料与术后GCS评分增量的关系.采用方差分析比较不同出血部位和不同手术方式对术后GCS评分增量的影响.结果 患者入院年龄、出血量和GCS评分对术后不同时间点GCS评分增量具有影响(P<0.05);不同出血部位的术后GCS评分增量差异无统计学意义(P>0.05);观察组术后第1周、第2周和第3周的GCS评分增量均高于对照组,差异均有统计学意义(P<0.05).结论 患者入院年龄、出血量和GCS评分对危重高血压幕上脑出血术后GCS评分变化具有影响,且钻孔引流术联合开颅血肿清除术可提升恢复速率,改善预后.

目的 探讨右美托咪定在危重高血压脑出血开颅术后的临床应用价值.方法 80例危重高血压基底节区脑出血患者随机单盲法分为试验组和对照组,每组40例.对照组在常规脑出血开颅术后给予常规治疗,试验组在常规治疗基础上给予右美托咪定以0.2μg·kg-1·h-1速度静脉泵入至术后24 h.比较2组患者术后相同时间点的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)、脑氧摄取率(CERO2)、脑动静脉血糖含量差(A-VDG)、颅内压增量(I-ICP)及脑脊液中GABA增量(I-GABA)和Glu增量(I-Glu).结果 试验组术后12 h、24 h、72 h的HR、MAP均低于对照组,差异有统计学意义(P<0.05);试验组的SpO2和对照组相比,差异无统计学意义(P>0.05);2组在术后即刻(0 h)的CERO2、A-VDG、ICP及脑脊液中GABA和Glu含量差异均无统计学意义(P>0.05);术后12 h、24 h、72 h试验组CERO2均小于对照组,A-VDG均大于对照组,差异均具有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-ICP均小于对照组,差异均有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-GABA高于对照组,I-Glu小于对照组,差异有统计学意义(P<0.05).结论 右美托咪定在危重症高血压脑出血开颅术后持续应用,能够减轻应激反应,稳定血流动力学,改善脑氧和脑糖代谢,缓解颅内高压,达到脑保护和促进功能恢复作用.

目的 观察Trevo支架取栓对缺血性脑卒中患者的疗效及对血清丝氨酸蛋白酶抑制剂(Vaspin)、神经元特异性烯醇化酶(NSE)、血液流变学、认知功能的影响.方法 2015年9月-2018年8月河北医科大学附属人民医院(石家庄市第一医院)神经外科收治急性缺血性脑卒中患者116例,按随机数字表法分为2组,每组58例.对照组采用人组织型纤溶酶原激活剂进行溶栓治疗,观察组采用Trevo支架取栓治疗.比较2组治疗前及治疗后24 h、72 h血清Vaspin、NSE水平、MoCA评分、NIHSS评分、血液流变学变化.结果 与治疗前比较,治疗后24h、72 h,2组血清Vaspin、MoCA评分均升高,且观察组优于对照组(t/P=2.378/0.019、2.693/0.008,8.321/＜0.001、7.699/＜0.001);治疗72 h,2组血浆黏度、全血黏度切变率、纤维蛋白原、NIHSS评分均降低,且观察优于对照组(t/P =3.210/0.002、3.106/0.002、3.185/0.002、5.483/＜0.001);2组治疗后24 h血清NSE均升高,治疗后72 h血清NSE均降低,观察组治疗后24h、72 h血清NSE均低于对照组(t/P=3.910/ ＜0.001、4.659/＜ 0.001);观察组预后良好率89.66％高于对照组70.69％(x2/P=6.562/0.011).结论 Trevo支架取栓可提高缺血性脑卒中患者血清Vaspin水平,降低NSE水平,改善神经缺损程度、血液流变学及认知功能,临床疗效满意,不良反应少,具有重要的临床应用价值.

目的 探讨神经内镜下经单侧鼻蝶窦入路垂体腺瘤切除术对垂体瘤病人术后并发症发生情况、疾病复发情况、血清胰岛素样生长因子-1(IGF-1)水平及手术切除效果的影响.方法 选取2015年1月—2017年3月我院60例垂体瘤病人,采用随机数字表法分为对照组与研究组,每组30例.研究组采用神经内镜下经单侧鼻蝶窦入路垂体腺瘤切除术,对照组采用显微镜下经单侧鼻蝶窦入路垂体腺瘤切除术.术后第1天对比两组手术情况、肿瘤切除效果、入院时及术后第1天血清IGF-1水平变化情况、术后1个月并发症发生率、术后6个月疾病复发率.结果 研究组手术用时、术中失血量、住院时间少于对照组,差异有统计学意义(P<0.05);研究组肿瘤完全切除率为90.00％,高于对照组的56.67％,差异有统计学意义(P<0.05);术后两组血清IGF-1水平较术前降低,且研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率、疾病复发率低于对照组,差异有统计学意义(P<0.05).结论 神经内镜下经单侧鼻蝶窦入路垂体腺瘤切除术治疗垂体瘤效果显著,创伤小,可改善血清IGF-1水平,提高肿瘤切除效果,且安全性较好,疾病复发率较低.

目的 探讨显微镜下单鼻孔扩大经蝶窦入路治疗巨大侵袭性垂体腺瘤的疗效.方法 选取2009年6月至2014年6月收治的巨大侵袭性垂体瘤患者83例,根据随机数字表分为对照组(n=43)和显微组(n=40).对照组采用传统开颅手术治疗,显微组采用微镜下单鼻孔扩大经蝶窦入路.观察2组手术情况(手术时间、术中出血量、术后住院时间)、肿瘤切除情况、日常生活能力分、并发症发生情况,患者随访至2018年7月,观察2组患者复发情况、生存时间、无瘤生存时间.结果 显微组手术时间、术中出血量和术后住院时间均显著低于对照组,差异有统计学意义(P<0.05).显微组肿瘤切除率高于对照组(P<0.05).2组术后6个月的日常生活能力评分均显著高于术前,且显微组术后6个月高于对照组(P<0.05).显微组并发症发生率显著低于对照组(P<0.05).显微组生存时间、无瘤生存时间显著高于对照组(P<0.05).显微组复发率低于对照组,但差异无统计学意义(P>0.05).显微组复发2例,其中1例行γ刀治疗,另1例再次行显微镜下单鼻孔扩大经蝶窦入路手术治疗.结论 显微镜下单鼻孔扩大经蝶窦入路治疗巨大侵袭性垂体腺瘤,手术暴露良好,全切率高、并发症发生率低,疗效确切.

Objective:To investigate the clinical effects of neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior approach. Methods:86 patients with hypertensive intracerebral hemorrhage (HICH) in our hospital from June 2015 to March 2017 were selected,and they were divided into two groups by random number table,43 cases in each. Control group was given routine stereotactic vacuation of hemato-ma,observation group was given neuroendoscopic evacuation of hematoma via CT-guided coronal suture ante-rior approach.The surgical indexes,surgical effects,rebleeding rate,fatality rate and the incidence of compli-cations of two groups were compared.Results:The surgical indexes of observation group were significantly bet-ter than those of control group,and the total surgical effective rate was significantly higher than control group, the rebleeding rate,fatality rate and the incidence of complications were significantly lower than control group (P<0.05). Conclusion:Neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior ap-proach can effectively shorten surgery time and recovery time of hemiplegia,protect normal brain tissues,de-crease surgical risks,reduce complications and death.

目的 研究神经内镜下经蝶手术治疗巨大侵袭性垂体腺瘤的临床效果.方法 选取2015年3月-2017年1月石家庄市第一医院收治的巨大侵袭性垂体腺瘤患者76例.根据随机数字表法分为观察组(n=39)与对照组(n=37).观察组采用神经内镜下经蝶手术治疗,对照组采用经颅显微镜手术治疗.对两组患者进行为期1年的随访观察,比较两组各项临床指标水平:全切率、术后症状缓解率、术后并发症发生率、肿瘤残留率以及复发率.结果 观察组手术时间、术后住院时间均短于对照组,术中失血量少于对照组,术后并发症发生率、肿瘤残留率及复发率均低于对照组,而全切率、术后症状缓解率均高于对照组,差异均有统计学意义(均P＜ 0.05).结论 神经内镜下经蝶手术治疗巨大侵袭性垂体腺瘤临床效果明显,可有效缩短手术时间,减少出血量,促进患者早日康复,同时有效降低术后并发症发生率以及肿瘤残留率、复发率,安全性较好,值得临床推广应用.

目的 对比单纯开颅血肿清除术与联合钻孔引流术治疗高血压脑出血(HICH)的临床疗效.方法 采用回顾性研究方法,选取石家庄市第一医院2014年12月至2017年8月收治的100例HICH患者作为研究对象,依据手术方式不同分为对照组40例,采用单纯开颅血肿清除术治疗;观察组60例,采用开颅血肿清除术联合钻孔引流治疗.比较两组患者术后首次血肿清除速率、并发症发生率、神经功能变化及近期疗效.结果 对照组患者术后首次血肿清除率为(52.6±6.0)％低于观察组的(79.9±7.8)％,差异有统计学意义(P＜0.01);术后对照组患者肺部感染、水电解质代谢平衡紊乱发生率均高于观察组(P＜0.05);术后两组患者再出血、颅内感染发生率比较,差异无统计学意义(P＞0.05);术后3个月对照组患者神经功能缺损评分为(13.1±1.4)分高于观察组的(8.8±1.2)分(P＜0.01);术后6个月对照组患者格拉斯哥预后评分(GOS=5分)预后良好率低于观察组(P＜0.05).结论 采用开颅血肿清除术联合钻孔引流治疗效果优于单纯开颅血肿清除术,能提高血肿清除率,减少并发症发生,改善患者神经功能和近期预后.

Objective:To investigate the relationship of expression of vascular endothelial growth factor (VEGF) and clinical features in patients with intracranial aneurysm and arteriovenous malformation (AVM).Methods:A total of 64 patients with AVM and intracranial aneurysm,who were treated in First Hospital of Shijiazhuang from February 2011 to November 2015,were chosen as research subjects,AVM were 32 cases and intracranial aneurysm were 32 cases.The samples were sectioned for VEGF immunohistochemical staining;the location and intensity of staining were recorded;the positive indexes were computed.The VEGF expression of different age and Hunt&Hess classification in patients with intracranial aneurysms were analysed;the VEGF expression of different diameters,ages,Spetzler classification in patients with AVM were analysed.Results:There were no statistical differences in the VEGF expression of different ages in patients with intracranial aneurysms (P＞0.05);the VEGF expression of different Hunt&Hess classification in patients with intracranial aneurysms was statistical difference (P＜0.05).The positive rate of VEGF in the artery of AVM was lower than that in the vein,the difference was statistically significant (P＜0.05).There were no statistical differences in the VEGF expression of the different Spetzler classification,different diameters and different ages in patients with AVM (P＞0.05).Conclusion:The expression of VEGF in the vein and the artery of patients with AVM is different,the expression of VEGF is not correlated with the age of intracranial aneurysm and the size and age of AVM.VEGF cannot be used as a predictor in the patients with intracranial aneurysms and AVM.

目的：探讨七氟醚与丙泊酚在小儿烟雾病患儿脑－硬膜－动脉贴敷术（encephalo-dura-artery sticking，EDAS）联合颅骨多点钻孔术中对脑氧代谢的影响。方法择期行 EDAS 联合颅骨多点钻孔术的儿童烟雾病患儿40例，采用随机数字表法分为七氟醚组和丙泊酚组各20例。分别记录麻醉诱导前（T1）、气管插管即刻（T2）、切皮即刻（T3）、硬膜开放即刻（T4）、硬膜开放后1 h（T5）、关闭硬膜即刻（T6）患儿的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）。测定 T3、T4、T5、T6时间点颈内静脉球血氧饱和度（jugular venous oxygen saturation，SjvO2）、脑动静脉血氧含量差（arteriovenous difference of oxygen content，AV-DO2）及脑氧摄取率（cerebral extraction rate of oxygen，CO2 ER）。结果2组术中 HR 和 MAP 组间、时点间、组间·时点间交互作用差异均无统计学意义（P ＞0.05）。2组 AV-DO2、CO2 ER、SjvO2值均逐渐降低，七氟醚组 AV-DO2、CO2 ER 值低于丙泊酚组，SjvO2值高于丙泊酚组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P ＜0.05或＜0.01）。结论七氟醚较丙泊酚在降低烟雾病患儿脑氧代谢方面更有优势，其术中降低脑氧代谢的程度要大于丙泊酚组，有一定的脑保护作用。

Objective To evaluate the security of application with stent assisted therapy combined with axiom detach-able coil on complicated basilar artery apex aneurysm. Method To review and analyze 27 complicated basilar artery apex aneurysm surgery cases, using the application of stent assisted therapy combined with detachable coil deal with the basilar artery apex aneurysm. Result The image of the 27 surgery cases showed that 19 cases were completed tamponed, and 7 cased were nearly completed tamponed, 1 loose tamponed. It also had three operation complica-tions:one hemorrhaged, one parent artery occlusion, one coil detached. 2 death cases: one was V-level, another had secondary hemorrhaged before surgery. Conclusion The application with stent assisted therapy on complicated basilar artery apex aneurysm is selectable, safe and effective.

高强度聚焦超声(high intensity focused ultrasound,HIFU)是应用高强度超声波的一种技术,可使目标组织温度升高产生凝固性坏死,从而达到治疗肿瘤的目的[1].目前有关HIFU手术麻醉特点及处理的报道不多,并且观点不同,现将石家庄市第一医院采用HIFU治疗肝癌患者的麻醉管理经验介绍如下.

【Objective】 To study the protective effects of Trimetazidine(TMZ)for myocardial injury resulted by acute hypobaric hypoxia in mice.【Methods】 60 healthy male mice were randomly divided into five groups(n = 12):normal control group;hypobaric hypoxia model group;high,middle and low dosage groups(TMZ 20 mg/kg、10 mg/kg、5 mg/kg).All of the groups,except the control group,were underwent hypobaric hypoxia at atmosphere of-0.06 Mpa(equivalent to 7 000 m) in hypobaric chamber for 12 hours.The myocardial injury degree resulted from hypobaric hypoxia was observed by HE staining.The activity of Lactate dehydrogenase(LDH) and the contents of endothelin-1(ET-1)and atrial natriuretic peptide(ANP)in serum were determined.【Results】 Compared with hypobaric hypoxia model group,each dose of TMZ could significantly decrease the LDH activity,ET-1 and ANP contents(P 0.01 or P 0.05).HE staining showed that TMZ could significantly attenuate the myocardial injury induced by acute hypobaric hypoxia in mice.【Conclusion】 TMZ showed a remarkable protective effect on acute hypobaric hypoxic injury in mice.

<正>近年来,随着神经介入技术的不断发展与完善,血管内栓塞已成为治疗颅内动脉瘤的主要方法之一,其效果已被普遍接受和认可。动脉瘤的颈/体比小于1/2被认为是微弹簧圈栓塞治疗的适应证之一~[1]。但临床研究发现,单纯使用微弹簧圈栓塞宽颈动脉瘤的完全栓塞率低、复发率高,一直是动脉瘤血管

一、资料与方法 1.一般资料:2004-2007年我们连续治疗了19例横窦-乙状窦区硬脑膜动静脉瘘(DAVF)患者,其中男13例,女6例;年龄29～60岁,平均43.4岁.18例行血管内栓塞治疗,1例自愈.临床症状:颅内杂音9例,头痛4例,视力下降4例,球结膜水肿1例.根据Cognard分型:Ⅰ型3例,Ⅱa型9例,Ⅱb型2例,Ⅲ型2例,Ⅳ型2例。

患者 女,54岁.因头外伤3 d伴头痛恶心入院.3 d前患者乘坐汽车,因道路颠簸,头顶碰在车顶上,当时受力局部头痛,2 d前出现持续性全头胀痛.入院查体:无明显阳性体征.患者既往体健,近来未服用任何药物,月经不规律,尚未绝经.凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间各项值均正常.头CT提示:窦汇、右侧横窦、部分矢状窦、直窦血栓形成.入院诊断:硬膜窦血栓.

目的 探讨应用球囊,支架及双微管辅助栓塞技术治疗颅内宽颈动脉瘤的效果和临床经验.方法 71例患者经DSA证实为宽颈动脉瘤.采用全身麻醉,经股动脉穿刺入路,在数字减影血管造影监视下,根据动脉瘤的形状、大小, 采用相应辅助技术, 选用合适的弹簧圈,逐步将瘤腔填塞满意.结果 71例患者共75个动脉瘤中,完全栓塞59个(78.8%), 大部分栓塞13个(14. 4%), 部分栓塞2个(2.5%),1例多发动脉瘤仅处理1枚动脉瘤.术后恢复良好57例;轻、中度神经功能障碍14例;死亡或植物生存3例.术后随访发现:1例再发蛛网膜下腔出血;5例动眼神经麻痹患者中4例恢复, 1例明显好转.结论 介入栓塞术适合大多数颅内动脉瘤的治疗,且疗效满意.使用球囊或支架辅助技术及双微管技术有利于颅内宽颈动脉瘤的介入治疗,扩大了介入技术治疗颅内动脉瘤的适用范围,提高了介入技术治疗颅内宽颈动脉瘤的安全性和可靠性,减少了并发症.提高了弹簧圈栓塞颅内宽颈动脉瘤的完全栓塞率.

Objective To investigate the major factors affecting the prognosis of ruptured intracranial aneurysms so as to provide theoretical foundation for the treatment of intracranial aneurysm.Methods The clinical data of 794 cases with ruptured intracranial aneurysms in seven hospitals in Shijiazhuang between 2003 and 2007 were studied retrospectively.Prognostic factors were analyzed according to sex,age,Hunt-Hess classification,location and amount of aneurysms,time and methods of operation,hypertension and smoking.Univariate analysis of variance by χ2 test and multivariate analysis by multiple Logistic regression model were carried out to screen risk factors related to the prognosis of ruptured intracranial aneurysms.Results Univariate analysis showed that there was statistical significance of difference in Hunt-Hess grade(P0.0001),age(P0.0001) and hypertension(P=0.0226);multivariate Logistic regression analysis showed that Hunt-Hess grade(P0.0001,OR=34.854),age(P0.0001,OR=1.779) and hypertension(P=0.0057,OR=1.413) were related to the prognosis of ruptured intracranial aneurysms.Conclusion Hunt-Hess grade,age and hypertension are independent risk factors for the prognosis of ruptured intracranial aneurysms.The prognosis of patients with hypertension,more Hunt-Hess scores and aging over 60 is poorer.