目的 探讨磷酸化tau蛋白(P-tau)及其与总tau蛋白(P-tau/T-tau)比对预测创伤性脑损伤(traumatic brain injury,TBI)病人6个月内死亡和预后情况的诊断效能.方法 2017年6月～2019年6月收治的TBI病人90例.采用格拉斯哥预后评分(GOS)记录病人随访6个月后死亡和预后情况,由此将病人分为死亡组、存活组、预后良好组、预后不良组,采用Logistic回归分析死亡相关因素,分析伤后6小时内P-tau、P-tau/T-tau与GOS评分相关性,绘制ROC曲线评估前二者对死亡和预后的预测效能.结果 最终纳入86例,死亡组发病至入院时间、P-tau、P-tau/T-tau均高于存活组,格拉斯哥昏迷评分(GCS)低于存活组,差异有统计学意义(P<0.05);P-tau和P-tau/T-tau为死亡危险因素(P<0.05);预后良好组GOS评分高于预后不良组,P-tau和P-tau/T-tau低于预后不良组,差异有统计学意义(P<0.05);P-tau和P-tau/T-tau均与GOS评分呈负相关(r=-0.773、-0.745,均P=0.000);P-tau和P-tau/T-tau预测病人死亡的AUC分别为0.767与0.873、0.968与0.961,两者预测死亡(91.30％和91.34％)和预后(94.11％和91.24％)的敏感性无明显差异(P>0.05).结论 P-tau水平和P-tau/T-tau值可有效预测TBI病人6个月内死亡和预后情况.

Objective To study the effect of Encephalo-Duro-Arterio-Myo-Synangiosis(EDAMS) method for the treatment of moyamoya disease.Methods 11 cases of moyamoya patients diagnosed with digital subtraction cerebral angiography(DSA) were chosen and treated with EDAMS method.All the patients were followed up after operation and their DSA reviewed.The clinical efficacy was observed.Results Follow-up(3~24 months) revealed all the 11 patients recovered well.Smog-like vessels decreased in three cases by DSA review two years after operation.External carotid artery blood was apparently supplied to the cortex.DSA retests were not conducted on other cases.Conclusion EDAMS is an indirect vascular fusion surgery for the treatment of moyamoya disease,which is relatively simple and has certain curative effect on some patients.

目的探讨法舒地尔联合脑脊液置换在治疗蛛网膜下腔出血(SAH)脑血管痉挛(CVS)中的临床疗效。方法观察比较应用法舒地尔加脑脊液置换与尼莫地平常规治疗治疗CVS患者2周前后脑CT、脑TCD及不良反应的变化。结果治疗7d后,法舒地尔联合脑脊液置换组和尼莫地平组患者CVS均有很大程度的缓解。两组患者CT变化和TCD变化均很明显,但法舒地尔联合脑脊液置换组患者的缓解程度优于尼莫地平治疗组(P<0.05)。结论法舒地尔联合脑脊液置换能有效的缓解SAH后的CVS。

Objective To investigate time and method of interventional therapy by observing the therapeutic effect of intracranial aneurysm treatment.Methods Retrospectively analyze the cerebral angiography diagnosis,interventional treatment process and its effect of 22 cases.Results After embolization among 22 patients,20 patients recovered well,1 case of sequelae,and 1 case died.Conclusion Endovascular embolization of aneurysms is a method with minimally invasive,low risk of operation,wide indications,few sequelae and reliable effect.

Objective To Investigate the clinical diagnostic value on DSA aortocranial angiography in cerebrovascular disease.Methods 164 cerebrovascular disease patients(hemorrhagic/ischemic) with aortocranial angiography indicatio were put into aortocranial angiography;analyzed the opacification consequence,and follow-up visited on the treatment condition.Results Ahout diagnose,in 99 ischemic disease patients,abnormal in 44cases,masculine rate was 44.44%(44/99);in 65 hemorrhagic diseasepatients,①50 SAH patients:abnormal in 36 cases,masculine rate was72.00%(36/50).②15 spontaneouscerebral hemorrhage(including cerebroventricular haemorrhage) patients,abnormal in 10 cases,masculine rate was 66.67%(10/15);the total masculine rate was 54.88%(44+36+10/164).About treatment in ischemic disease,in internal carotid artery narrow patients,10 were act on stent implantation,1 patient was act on endarterectomy of the internal carotidartery,and others were act on expectant treatment;in intracalvarium arterial stenosis patients,1patients was act on stent implantation,otherd were act on expectant treatment;2 Moyamoya disease patients were treated bytemporal musclesticking and covering therapy.About treatment in hemorrhagic disease,20 patients were act on interventional embolic therapy with AN,5 patients were act on occlusion operation(base-court),others gave up further treatment;in AVMpatients,2 were put into operation(basecourt),2 were act on γ-knife therapy(base-court),DAVF patient gave up further treatment,ccf patient were treated by interventional embolic therapy ;CA patient were treated by operation;Moyamoya disease patients were treated bytemporal muscle sticking and covering therapy.Conclusion DSA aortocranial angiography is the golden dignose standard for cerebrovascular disease,and can put forward more evidence for treatment.

Objective To discuss the clinical effect of treatment on hypertensive cerebral hemorrhage with minimally invasive draining treatment by soft passageway.Methods According to the hematoma position,shape,and magnitude displayed on CT,to decide the furfuraceous puncture position,direction,angle and depth,then insert soft passageway into haematoma cave.By sucking and draining with urokinase colliquation to eliminate the haematoma.Results In 56 cerebral hemorrhage patients,48 patients (85.71%) survived after surgery,no death in duration of hospital stay,8 patients left hospital voluntarily,according to death case data,fatality rate ≦14.29%(8/56).According to grading standard for daily living activities at discharge time,67.86%(38/56)patients reached superiority rating.Conclusion The soft passageway draining treatment can eliminate the Haematoma as soon as possible and also it can release the compression of the brain promptly.Soft passageway draining treatment is minimally invasive,safe,and the therapeutic effect is reliable.