持续颅内压监测在自发性脑出血破入脑室治疗中的应用

目的探讨持续颅内压(ICP)监测在自发性脑出血破入脑室治疗中的意义。方法 100例自发性脑出血破入脑室患者,其中50例患者行侧脑室穿刺引流加持续性ICP监测(ICP监测组),另50例患者单纯行侧脑室穿刺引流(对照组)。比较两组患者的预后、并发症的发生率、脱水剂用量及再出血发生率。结果 ICP监测组与对照组患者的预后比较,差异无统计学意义(P0.05)。ICP监测组患者血电解质紊乱、肾功能损害的发生率及甘露醇使用量均明显少于对照组(P0.05~0.01)。两组其他并发症及再出血的发生率之间比较,差异均无统计学意义(均P0.05)。结论持续ICP监测并不能改善自发性脑出血破入脑室患者的预后,但可以减少甘露醇的使用量及部分并发症的发生率;并能及时预警患者病情的变化。     

颅内压监测下侧脑室外引流治疗丘脑出血破入脑室

目的探讨颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室的疗效。方法收集60例高血压性丘脑出血破入脑室患者的临床资料,无颅内压监测组32例,未应用颅内压监测,颅内压监测组28例,加用颅内压持续监测,比较两组的再出血率、并发症发生率及总体预后。结果颅内压监测组与无颅内压监测组相比,再出血率及并发症发生率明显降低,死亡率降低,恢复良好率提高,均有显著性差异。结论颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室可以更加直观、更准确地了解患者颅内压力的变化情况,根据颅内压控制引流速度、合理应用脱水剂及控制血压、保证有效满意的脑灌注压,进而降低了再出血率、减少了并发症,改善了患者的预后,安全性更高、疗效更好。     

Ommaya囊结合侧脑室外引流治疗重度脑室出血的临床研究

目的探讨Ommaya囊穿刺引流结合侧脑室外引流在重度脑室出血中的应用及意义。方法将我科2007年2月至2012年2月收治的46例重度脑室出血患者随机分为:Ommaya囊结合侧脑室外引流治疗组和单纯侧脑室外引流组,将两组患者疗效进行对比分析。结果 Ommaya囊治疗组的交通性脑积水及颅内感染发生率明显低于单纯脑室外引流组(P0.05),术后3个月GOS评分:Ommaya囊治疗组良好8例,中残10例,重残3例,死亡3例;单纯外引流组良好5例,中残4例,重残8例,死亡5例。Ommaya囊治疗组治疗有效率高于单纯外引流组(P0.05)。结论 Ommaya囊穿刺引流结合侧脑室外引流治疗重度脑室出血,可以降低颅内感染及脑积水发生率,改善患者预后,提高生存质量,是脑室出血安全、有效的治疗方法。     

储液囊联合脑室外引流治疗丘脑出血降低颅内感染的价值

目的分析储液囊联合脑室外引流治疗丘脑出血的临床效果,总结其在降低丘脑出血患者颅内感染发生率中的应用价值。方法选取我院收治的60例丘脑出血患者为观察对象,按随机数字表法分为对照组与观察组各30例。对照组仅给予脑室外引流处理,观察组给予储液囊联合穿刺引流联合脑室外引流,统计比较2组治疗效果、颅内感染发生率,记录脑室血肿清除时间,并于术后6个月采取GOS(格拉斯哥预后评分)量表评估2组术后恢复情况。结果治疗前,2组GCS及Graeb量表评分比较差异无统计学意义(P0.05);治疗后,观察组GCS量表评分提升至(12.33±2.67)分,Graeb量表评分上升至(21.34±3.59)分,与对照组相比差异有统计学意义(P0.05);观察组GOS评级为5级者7例,4级18例,预后良好25例,有效率为83.33%,明显高于对照组的53.33%,差异有统计学意义(P0.05);观察组脑室血肿清除时间为(7.03±1.02)d,对照组为(7.33±1.12)d,差异无统计学意义(P0.05);观察组术后颅内感染发生率为3.33%,交通性脑积水发生率为3.33%,均明显低于对照组(P0.05)。结论在常规脑室外引流的基础上联用储液囊反复穿刺引流,可明显降低丘脑出血患者术后颅内感染发生率,改善患者预后,且安全性高,值得推广。     

Ommaya囊联合侧脑室外引流治疗脑室内出血

目的探讨脑室内出血(IVH)的治疗方法并评价其临床疗效。方法 40例IVH病例随机分为改良组及传统组。改良组选择在出血相对较多的一侧常规行侧脑室额角穿刺外引流;而在出血相对较少的一侧额角置入Ommaya囊后行囊腔穿刺外引流。脑室外引流5~7 d后,改为仅Ommaya囊穿刺外引流。传统组则行双侧侧脑室普通外引流,5~7 d后结合腰大池置管持续引流血性脑脊液治疗。比较两组患者迟发性脑积水、颅内感染发生率及预后情况等。结果两组迟发性脑积水、颅内感染发生率及预后(ADL分级)比较差异有统计学意义(P0.05),表明改良组疗效明显优于传统组。结论该项改良技术安全可靠、损伤小、恢复快,能大大降低病死率和伤残率,减少并发症和后遗症,改善预后,优于传统方法。     

小骨窗经额入路显微镜下清除原发性重型脑室出血的临床分析

目的探讨小骨窗经额入路显微镜下清除原发性重型脑室出血的临床疗效。方法回顾性分析淮南市第一人民医院自2009年10月至2019年10月经手术治疗的成人原发性重型脑室出血患者的临床资料,根据手术方式分为经额入路组及脑室外引流组,对比分析两组患者在年龄、性别、术前GCS评分、Graeb评分、术后24h内血肿清除率、引流管留置时间、术后颅内感染率、晚期脑积水发生率、术后再出血发生率、预后评分等方面差异。结果纳入患者52例,经额入路者15例,脑室外引流者37例。两组患者在年龄、性别、术前GCS评分、Graeb评分、术后感染率、术后再出血发生率的差异上无统计学意义(P0.05);术后24 h血肿清除率、置管时间、晚期脑积水发生率及预后等方面,经额入路组明显优于脑室外引流组,差异具有统计学意义(P0.05)。结论与脑室外引流术相比,小骨窗经额入路显微镜下清除原发性重型脑室出血能有效提高疗效、降低远期并发症及改善预后等优势。     

综合护理措施在蛛网膜下腔出血(SAH)破入脑室行脑室外引流患者中的应用

目的分析综合护理措施在蛛网膜下腔出血(SAH)破入脑室行脑室外引流患者中的应用效果。方法 140例患者按照护理方案不同分为对照组和研究组,对照组68例采用常规护理,研究组72例在常规护理基础上实施综合护理,包括术前、术中和术后护理,在护理1个月后采用NIHSS评分及ADL分级法评价患者神经功能恢复情况,观察并比较2组并发症发生率,采用我院自行设计满意度调查表对患者家属进行调查。结果 2组在护理后神经功能恢复效果上差异无统计学意义(P0.05);对照组不良反应发生率为20.59%(14/68),研究组为5.56%(4/72),差异有统计学意义(P0.01);2组在家属护理满意度方面,差异有统计学意义(P0.01)。结论采用综合护理措施对蛛网膜下腔出血(SAH)破入脑室行脑室外引流患者能减少术后并发症的发生,值得推广应用。     

小骨窗微创治疗重症高血压脑室出血临床分析

目的探讨重症高血压脑室出血的手术方法。方法回顾性分析58例重症高血压脑室出血患者,根据手术方法的不同分为观察组和对照组。观察组25例,采用小骨窗开颅微创血肿清除术伴腰池脑脊液外引流治疗;对照组33例均采用脑室穿刺外引流术伴腰池脑脊液外引流治疗治疗。观察术后并发症、死亡率、脑积水等情况及术后3个月格拉斯哥预后评分(GOS)。结果术后3个月随访。观察组患者预后良好率(GOS评分4或5分)60%,显著高于对照组的30.3%,差异有统计学意义(P0.05);两组患者术后死亡率、脑积水发生率差异有统计学意义(P0.05),并发症发生率差异无统计学意义(P0.05)。结论采用小骨窗开颅血肿清除术伴腰池脑脊液外引流治疗能有效降低重症高血压脑室出血的死亡率、脑积水发生率,改善预后,值得临床推广运用。     

神经内镜在丘脑出血破入脑室手术中的应用

目的 探讨神经内镜下早期脑室内血肿清除联合第三脑室底造瘘术（ETV）治疗丘脑出血破入脑室的疗效。方法 回顾性分析2011年7月至2015年7月收治的68例丘脑出血破入脑室的临床资料。36例（观察组）行神经内镜血肿清除术联合ETV,术后留置脑室外引流管;32例（对照组）行脑室外引流术（EVD）并联合尿激酶血肿腔注入。术后随访12~26个月,平均（23±2.1）个月。结果 观察组有效率（86.1%,31/36）明显高于对照组（62.5%,20/32;P<0.05）。观察组留置脑室外引流管时间[（1.8±1.1） d]较对照组[（4.8±1.8） d]明显缩短（P<0.05）。观察组术后脑积水发生率（12.9%,5/36）明显低于对照组（37.5%,12/32;P<0.05）。观察组术后颅内感染发生率（0%）与对照组（6.3%）无统计学差异（P>0.05）。两组均未发生过度引流、脑疝、再次出血。结论 神经内镜下早期血肿清除联合ETV治疗丘脑出血破入脑室安全有效,可明显降低术后分流依赖性脑积水发生率,显著改善病人预后。     

神经内镜手术联合脑室外引流术治疗脑室出血的疗效

目的 探讨神经内镜手术联合脑室外引流术治疗脑室出血的效果。方法 回顾性分析2013年11月至2016年6月收治的93例脑室出血的临床资料,根据治疗方法分为内镜组（47例,神经内镜手术联合脑室外引流术）和单纯引流术组（46例,单纯脑室外引流术）。结果 内镜组引流时间、术后再出血率、住院时间均明显低于单纯引流组（P<0.05）,但两组甘露醇使用量、肺部感染发生率、颅内感染发生率、28 d内病死率均无统计学差异（P>0.05）。内镜组术后14、30 d纳维亚卒中量表评分均明显高于单纯引流术组（P<0.05）。两组术后3个月GOS评分无统计学差异（P>0.05）。结论 与单纯脑室外引流术相比,神经内镜手术联合脑室外引流术治疗脑室出血有利于缩短引流时间,促进神经功能恢复,降低再出血率。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]