目的:探讨一氧化碳中毒迟发型脑病的治疗方法.方法:随机抽取我院2016年1月—2019年1月收治确诊为一氧化碳中毒迟发型脑病患者80例,采用随机数字法将所有患者随机分为两组:治疗组采用甲强龙+高压氧治疗(n=40);对照组采用高压氧治疗(n=40).分别记录两组患者治疗前及治疗1个月时神经功能(N I H S S)评分、认知功能(MoCA)评分及日常生活能力量表(ADL评分).对比分析两组的疗效及安全性.结果:两组患者治疗前NIHSS评分、MoCA评分及ADL评分对比无显著差异(P>0.05);治疗后,观察组NIHSS评分、MoCA评分及ADL分值改善情况优于对照组(P<0.05);治疗组治疗总有效率显著高于对照组(P<0.05),两组不良反应无显著差异.结论:甲强龙联合高压氧治疗一氧化碳中毒迟发型脑病安全有效,可促进患者神经修复,提高患者的认知功能,改善患者日常生活能力,值得临床应用.

目的 探讨皮质下缺血性血管病(SIVD)患者血清可溶性细胞间黏附分子1(sICAM-1)、超敏C反应蛋白(hs-CRP)、胰岛素样生长因子1(IGF-1)、可溶性CD40配体(sCD40L)、白细胞介素6(IL-6)水平变化及其与认知功能损害的关系.方法 将83例SIVD患者根据认知能力分为血管性痴呆组(VaD组)41例和血管性认知障碍非痴呆组(VCIND组)42例,另取25例认知功能正常者作为对照组(NC组).比较3组血清sICAM-1、hs-CRP、IGF-1、sCD40 L、IL-6水平变化,分析SIVD患者认知功能与上述指标的相关性.结果 3组的高血压病史、教育年限、蒙特利尔认知评估量表和临床痴呆评定量表得分差异有统计学意义(P<0.05).VaD组、VCIND组sICAM-1、sCD40 L、IL-6水平高于NC组,IGF-1水平低于NC组(均P<0.05).SIVD患者血清IGF-1与认知功能评分相关(P<0.05).结论 SIVD患者血清sICAM-1、sCD40L、IL-6水平升高,IGF-1水平降低,其中血清IGF-1水平对患者认知功能有一定影响.

Objective To analyse the clinical manifestation and prognosis of hemichorea with non-ketotic.Method we collected the clinical data of 16 hemichorea patients with non-ketotic diabetes, including general information,admission, clinical symptoms and signs, laboratory tests, imaging results, treatment and prognosis. Results All the 16 patients, 12 cases had an acute onset (75%) and 12 cases with the side of the body disorder, non-autonomous action like the dance(75%); blood glucose level at the onset of disease was 13.8-26.3mmol·L-1, and the average was 21.3±4.6mmol·L-1. Results of CT examination in the 16 patients were: 6 cases of putamen high density(37.5%), 4 cases of caudate nucleus high density(25.0%), 3 cases of bilateral striatum high density (17.58%);MRI tests results: 7 cases of putamen uneven high signal (43.5%), 6 cases of putamen uneven high signal (37.5%), 3 cases of putamen uneven high signal (18.75%). All patients were given conventional insulin to control blood glucose 7.7-11.0 mmol·L-1, haloperidol and fluphenazine for symptomatic treatment. The treatment time is 22-41 days, and the average is (28.61±5.14) days.14 patients improved and symptoms disappeared (87.50%), and 2 cases were with different degrees of hemichorea (13.50%).Conclusion The patients with non-ketotic diabetic and hemichorea featured disorder ,non-autonomous action like the dance unilaterally, and got good prognosis when treated with haloperidol and fluphenazine after controling the blood glucose.

目的回顾分析17例椎基底动脉延长扩张症(Vertebrobasilar dilichoectasia,VBD)的临床表现及影像学特征,提高对该病诊断的认识。方法对我院2009年9月~2013年9月确诊的17例椎基动脉延长扩张症患者分析其临床表现、影像特点及治疗方法。结果椎基动脉延长扩张症是一种少见的血管异常性疾病。临床表现复杂、多样,主要症状有头晕、肢体麻木、乏力,还可表现为面肌痉挛、三叉神经痛,甚至可表现为视野缺损,主要导致的疾病为脑梗死、脑室或蛛网膜下腔出血、脑干的神经压迫症状及脑积水等,无特异性治疗方法对症治疗为主。结论椎基动脉延长扩张症是一种易复发,致残率、致死率高的疾病,应引起临床工作的重视,采取合理的治疗方法。

Objective:To investigate the etiology,clinical features,imaging charateristics,management and prognosis of hemorrhagic infarction(HI) in acute cerebaral infarction.Methods:Retrospective analysis was performed in 28(male,17;female,11)acute hemorrhagic infarction patients admitted in our hospital between Jan 2009 and Jan 2012.This analysis reviewed regarding the etiology,clinical featutes,CT classification and treatment.Results:Risk factors of HI included massive cerebral infarction,long term diabetes,poorly controlled hypertension and hyperlipidemia.HI patients treatment should be timely review of CT;Based on CT classifaction antiplatelet drugs can be stoped in HI-I,HI-II patients,and this treatment does not lead to disease progression.Conclusion:The pstients with massive cerebral infarction,long term diabetes,poorly controlled hypertension and hyperlipidemia are susceptible to HI.HI patients treatment should be combined with CT clsssification and timely adjustment of the threapy plan.

Objective:To observe effects of edaravone and hetastarch on treatment to the progressive stroke.Methods:94 patients with progressive stroke from our hospital were divided ramdomizationally into treatment group of 49 patients and control of 45 patients.In the treatment group,edaravone and hetastarch were administered,and edaravone and saline were used in control group.The neurological deficit scores and curative effects were compared between two groups pre-and pro-treatment.Results:There is a significant difference(p<0.01) in NDS between two groups;A total effective rate is 89.3% in the treatment group and 69.9% in the control group,which is significantly different(p<0.05).Untoward effect was not found in the treatment group.Conclusion:Edaravone and hetastarch can be administered together to treat the progressive stroke,which is proved to be safe and effective.

Objective To investigate the changes of thrombelastogram(TEG) in patients with acute cerebral infarction pre-and post-treatment,and in patients with hemorrhage after treatment.Methods 156 patients with acute cerebral infarction were examined by TEG using whole blood calcium-recovery.After treatment,the examination were taken both in patients with and without secondary hemorrhage.Data of the three groups were analyzed.Results After treatment,the hypercoagulation in patients with acute cerebral infarction changed to hypocoagulation,which was statistically more significant in the group with secondary hemorrhage than those without hemorrhage.Conclusion It suggests that TEG is a good approach for supervision of blood coagulation status in patients with acute cerebral infarction and can be used to guide the treatment and prevention of secondary hemorrhage.

目的 探讨肝豆状核变性((hepatolenticular degeneration,HLD)的早期临床表现及早期诊断,旨在提高临床医生对本病的认识,减少误诊.方法 回顾性分析48例HLD病的早期临床表现、实验室及特殊检查、首次误诊情况.结果 48例患者中,神经、精神异常者33例,伴肝炎、肝硬化13例,关节痛2例,消化道出血2例,其他3例.裂隙灯下角膜K-F环阳性47例.血清铜蓝蛋白、血清铜均降低.误诊最常见的依次为各种类型肝炎、肝硬化、精神疾患、关节炎、脱髓鞘脑病、胶质瘤、肌营养不良、肾炎、癫痫、贫血、消化道大出血和Leigh、脊髓病等,误诊率达34.5%.结论 肝豆状核变性多见于青少年,神经系统及肝损害为主要临床表现,常伴有肾脏损害,K-F角膜环是重要阳性体征,头颅CT或MRI可作为辅助诊断手段.本病易被长期误诊或诊断不明,早期治疗对预后至关重要.建议对具有上述易被误诊疾病症状的患者常规行角膜K-F环及铜代谢检查,以免误诊、误治.

目的探讨自发性脑叶出血的临床特点、发病机制、诊断治疗与预后。方法分析了2005年至2007年在我院住院经CT证实脑叶出血23例的临床资料。结果发现自发性脑叶出血有以下特点:①脑叶出血发生率仅次于基底节出血。②高血压是常见病因。③意识障碍、肢体瘫痪轻或无。④头疼仍是常见症状。⑤大量出血,病情危重可手术治疗。结论本病诊断不难,尽早CT检查是诊断自发性脑叶出血的重要依据,及时抢救,合理治疗是减少死亡、降低致残的关键。

Objective To explore the diagnostic of TCD,DSA and MRA in Moyamoya disease by retrospectively analyzing the clinical and image.Methods 20 Patients who were diagnosed Moyamoya were investigated.The clinical representation,TCD,DSA and MRA changes were observed.Results MRA in 20 cases and DSA in 9 cases showed stenosis or occlusion at the distal bifurcation of internal carotid arteries and proximal portion of the middle or anterior cerebral artery,companied by the apparently abnormal vascular network like puff of smoke.The collateral circulation and anastomotic vessels were showed more clearly on DSA.TCD in 7 cases showed increased velocity of blood flow.Conclusion MRA are helpful to the diagnosis of Moyamoya disease with the non-invasive and feasible advantage.DSA is better than MRA in showing the details such as smoke-like vessels and collateral circulation.TCD can be a alternative tool for detecting abnormal vessels.DSA must be done if the patients need an operation.