一氧化碳中毒迟发性脑病40例

急性一氧化碳(CO)中毒是一种常见病,部分中毒患者在意识障碍恢复后数天至数周正常的间歇期后,出现迟发的CO中毒性脑病(Delayed encephalopathy after acute carbon monox-ide poisoning,DEACMP),主要表现为意识障碍和锥体外系、锥体系功能障碍。我院于1994年~2004年收治DEACMP患者40例,现报告如下。1临床资料1.1一般资料本组40例,其中男30例,女10例,年龄13~74岁,平均45.3岁。否认有冠心病及脑血管病史,高血压病史1例。因失火中毒1例,煤气泄漏中毒5例,煤炉取暖中毒34例。中毒昏迷后苏醒时间1~72h不等,其中16例1~6h,11例7~12h,7例13~24…     

表观扩散系数值对急性一氧化碳中毒后迟发性脑病的诊断价值

目的 探讨ADC值对急性CO中毒后迟发性脑病(DEACMP)的诊断价值.方法 回顾件分析经临床确诊的32例DEACMP患者的临床和MR资料,同时选取头颅MRI表现正常的健康志愿者40名作为正常对照组.所有受试者均进行常规MR扫描及DWI,分别对称性测量苍白球、白质(侧脑室周围白质、半卵圆中心)、皮层(额叶、顶叶)的平均ADC值(ADCav).32例DEACMP患者根据常规MRI上有无异常信号分为有异常信号DEACMP组(20例)、无异常信号DEACMP组(12例),所有患者跟踪随访1年以上,13例患者无明显症状,3例偶有轻微头痛、头晕(预后较好组);15例有智能障碍、精神异常,1例反应迟钝、生活不能自理、大小便失禁(预后不良组).DEACMP组与正常对照组、异常信号与无异常信号DEACMP组、无异常信号DEACMP组与正常对照组、预后较好组与预后不良组间各个部位ADC值的比较采用独立样本t检验.结果 32例DEACMP患者20例有异常影像表现.MRI表现可分为3个类型:(1)脑白质受累型;(2)神经核团受累型;(3)皮层受累型.12例常规MRI上无肉眼所见异常信号.32例DEACMP患者ADCav值均下降,ADCav值[侧脑室周围白质(0.62±0.06)×10~(-3) mm~2/s、苍白球(0.67±0.05)×10~(-3)mm~2/s、半卵圆中心(0.57±0.07)×10~(-3)mm~2/s]较正常对照组[(0.74±0.03)×10~(-3)、(0.74±0.04)×10~(-3)、(0.73±0.05)×10~(-3)mm~2/s]降低(t值分别为2.82、2.89、2.98,P值均＜0.01);有异常信号DEACMP组的ADCav值[侧脑室周围白质(0.58±0.08)×10~(-3)mm~2/s、半卵圆中心(0.52±0.09)×10~(-3)mm~2/s]与无异常信号DEACMP组[(0.66±0.05)×10(-3)、(0.62±0.06)×10(-3)mm~2/s]比较,差异有统计学意义(t值分别为4.45、3.98,P值均＜0.01);无异常信号DEACMP组ADCav值[侧脑室周围白质(0.66±0.05)×10~(-3) mm~2/s,半卵圆中心(0.62±0.06)×10(-3) mm~2/s]与正常对照组[(0.74±0.03)×10(-3)、(0.73±0.05)×10~(-3)mm~2/s]比较,差异有统计学意义(t值分别为2.45、3.72,P值均＜0.05).预后不良组ADCav值[侧脑室周围白质(0.56±0.02)×10~(-3)mm~2/s、半卵圆中心(0.50±0.06)×10~(-3)mm~2/s]与预后较好组[(0.63±0.04)×10~(-3)、(0.58±0.05)×10~(-3) mm~2/s]比较,差异有统计学意义(t值分别为6.19、4.12,P值均＜0.01).结论 白质区(尤其是半卵圆中心)ADC值降低对DEACMP诊断具有重要价值,对常规MRI有异常信号的DEACMP患者,定量ADCav值可以量化中毒程度,作为DEACMP的发生、发展及预后评估的参考;对有临床症状而常规MRI上无异常信号患者,ADC值是诊断DEACMP较敏感指标.     

CO中毒及所致的DEACMP患者脑电图改变的临床意义

目的探讨一氧化碳(CO)中毒及所致的迟发性脑病(DEACMP)发生前后脑电图(EEG)相关变化及临床意义。方法对我院2008~2013年确诊的84例CO中毒患者EEG进行回顾性分析,其中56例出现CO中毒后迟发性脑病,对比其中毒期和迟发性脑病发生后的EEG变化。结果 CO中毒患者EEG异常率为85.7%,DEACMP患者EEG异常率为66.7%;EEG异常程度与患者中毒昏迷时间、年龄、有无并发症、发病前有无既往史、病情严重程度、首次行高压氧(HBO)治疗时间和HBO疗程长短高度相关,并且EEG异常程度越重,其预后越差。结论 EEG对CO中毒的早期诊断、预后判断、脑损伤程度及预测迟发性脑病的发生方面具有重要价值。     

1241例青少年运动员静息心电图特征

目的:分析青少年运动员心电图及其异常表现。方法:分析2005~2008年在北京市先农坛体校门诊部进行常规体检的1241名青少年运动员的静息心电图。受试对象年龄9~17岁,训练时间4~10年,其中男性719名,女性522名,均为国家二级及以上运动员,涉及26个运动项目。结果:(1)1241名青少年运动员中,752名存在心电图异常,占60.6%。窦性心动过缓、窦性心律不齐、左室高电压检出率分别为35.70%、35.13%和20.06%。房室交界性心律、不完全性右束支传导阻滞,II、III、avf导联ST-T改变和一度房室传导阻滞检出率分别为4.11%、1.40%、1.21%和1.13%。(2)青少年运动员平均心率为63.91±10.68次/分,其中男运动员为62.33±10.79次/分,女运动员为66.00±10.18次/分,有显著性差异(P<0.01);体能主导类项目运动员的平均心率为61.66±9.89次/分,技能主导类项目的为66.82±10.99次/分,其差异也具有统计学意义(P<0.05)。提示青少年运动员的心电图特点是长期、系统的训练所致的心脏适应性的改变。     

急性一氧化碳中毒迟发脑病的临床、影像与脑电图分析

目的探讨一氧化碳中毒迟发脑病(delayed encephalopathy after carbon monoxide poisoning,DEACMP)患者的临床、影像及脑电图改变特点。方法收集海军总医院2010年2月—2012年5月收治的42例DEACMP患者的临床资料,回顾性分析DEACMP发作期的临床资料。结果42例中男性24例,女性18例;发病年龄37~68岁,平均535岁;假愈期5~50 d,平均23 d。DEACMP的首发症状依次为反应迟钝（14例）、言语异常（12例）、傻笑（8例）、记忆力减退（5例）、情感异常（2例）和震颤（1例）。疾病达到高峰时表现为不同的临床症候群;其中,痴呆症候群（41例）表现为言语异常、反应迟钝、记忆力减退、情感异常及精神障碍,运动障碍症候群（38例）表现为肌张力异常、摸索、共济失调、小碎步、肢体瘫痪和震颤,其他症状（30例）表现为二便失禁、癫痫和失语。42例在DEACMP发生后1周内行头MRI检查;其中,脑白质受累型17例,主要表现为侧脑室旁和半卵圆中心的白质脱髓鞘;基底节受累型12例,表现为双侧豆状核及苍白球的弥漫性病变;多灶型13例,病灶弥漫和多部位受累。DEACMP发生后1周内脑电图检查示高度不正常11例,中度不正常13例,不正常9例,轻度不正常5例,正常4例。结论DEACMP常见的首发症状依次为反应迟钝、言语异常和傻笑;疾病高峰时主要表现为痴呆、精神症状、运动障碍和其他神经功能缺损。影像学主要表现为皮质下白质及基底节区累及,临床特点与颅内责任病灶相关。脑电图特点主要表现为α波频率减慢、节律减少或消失,θ波和δ波增多甚至大量出现。     

紧急锥颅引流抢救外伤性颅内血肿所致脑疝的临床观察

目的探讨紧急锥颅引流抢救外伤性颅内血肿所致脑疝的临床价值。方法将2005年1月—2009年1月收治的68例外伤性颅内血肿所致脑疝的患者采用开颅手术前床旁紧急锥颅引流减压方法进行抢救,将其与2001年1月—2004年12月直接行开颅手术治疗的52例患者进行回顾性疗效比较。结果伤后3个月时按GCS评分标准评估预后。紧急锥颅组治疗有效52例(占76.47%),无效16例(占23.53%),有效组觉醒天数为(14.38±4.76)d(n=52);对照组分别为31例(占59.62%)及21例(占40.38%),觉醒天数为(19.86±5.13)d(n=31)。两组比较差异均有统计学意义(P<0.05或P<0.01)。结论紧急锥颅引流抢救方法简便,有效。对外伤性颅内血肿所致脑疝的患者,一方面作好开颅手术准备,同时行床旁紧急锥颅引流减压,可为下一步治疗赢得宝贵时间,可明显提高临床疗效,缩短昏迷时间,值得临床推广应用。     

持续ST段抬高对直接经皮冠脉介入治疗疗效的影响

目的探讨心电图梗死相关导联持续ST段抬高对判断直接PCI治疗AMI疗效的应用价值。方法根据心电图梗死相关导联ST段抬高回落情况将229例直接PCI后TIMI血流3级的AMI患者分2组:ST段回落>50%组(甲组),147例;与ST段回落<50%组(乙组),82例,比较两组一般临床特征,随访心血管事件的发生率。结果甲乙两组:无复流(blush分级<2级)为14/147(9.5%)和21/82(25.6%);住院期间病死率5/147(3.40%)和9/82(11.0%);MACE 8/147(5.4%)和11/82(13.4%);心功能EF数值56.99±9.78和49.82±8.78比较,P<0.05,均有明显统计学差异。随访期间病死率2/147(1.34%)和3/82(3.7%);MACE 10/147(5.4%)和7/82(8.5%),P>0.05,均无统计学差异。结论心电图梗死相关导联ST段抬高回落情况可作为直接PCI后心肌组织水平再灌注及预后判断的指标。     

应用尿激酶动脉内溶栓治疗急性缺血性脑卒中105例临床观察

目的探讨应用尿激酶动脉内溶栓治疗急性缺血性脑卒中的安全性和有效性。方法对105例急性缺血性脑卒中患者在起病后2～24 h内进行超选择性动脉内尿激酶溶栓,尿激酶用量50～120万单位(平均85万单位)。结果 105例急性缺血性脑卒中中,颈内动脉系统血管闭塞69例,椎-基底动脉系统闭塞19例,脑血管造影未见明显异常17例;经动脉内溶栓治疗后,闭塞的颈内动脉系统再通率为63.8%(44/69),椎-基底动脉系统再通率为63.2%(12/19)。治疗后第7天和第14天神经功能评分分别为:(13.05±8.10)、(8.82±6.00)分,与治疗前的(18.86±8.20)分比较,差异均有统计学意义(t=2.87、2.39,P<0.01);治疗后ADL评分第7天和第14天分别为:(1.75±1.37)、(3.50±1.29)分,与治疗前的(4.82±1.37)分比较,差异均有统计学意义(t=2.52、2.44,P<0.01)。术后随访1年,临床症状完全缓解或明显好转为72.7%(64/88),并发脑出血为3.4%(3/88),消化道出血为11.4%(10/88)。结论应用尿激酶动脉内溶栓治疗急性缺血性脑卒中疗效好、见效快、并发症少。     

流行性出血热536例心电图分析

我们对流行出血热(肾综合征出血热,HFRS)536例,做了心电图观察,现分析报告如下。1　临床资料1.1　一般情况　本组男348例,女188例;年龄11～72岁,平均40.12±13.06岁。采用日本光电8110P型心电图机,常规做12个导联,入院时检查1次,如无异常,7d再复查1次,仍无异常者为正常心电图,异常心电图根据临床需要随时检查。1.2　结果　正常心电图205例,占38.25%;异常331例,占61.75%;心电图单项异常229例,两项以上异常102例,总的异常为471例次。异常心电图在发热期最多(181例,占38.4%),其次是少尿期、低血压期(附表)。附表　流行性出血热536例ECG异常…     

眼震电图诊断老年椎-基底动脉供血不足性眩晕的意义

目的探讨老年椎-基底动脉供血不足性眩晕患者眼震电图的改变及其临床意义.方法对60例老年椎-基底动脉供血不足性眩晕患者行眼震电图检测,观察视眼动系统反应、自发性眼震、冷热试验、位置性眼震,并以40例正常健康老年人为对照.结果老年椎-基底动脉供血不足性眩晕组中有自发性眼震11例(18.3%);引出位置性眼震46例(76.6%),位置性眼震强度7.76±6.05°/s,明显高于对照组(P<0.01).视眼动系统检查共48例(80%)出现1项或多项异常,表现为扫视试验37例(61.6%)异常,视跟踪试验Ⅲ型改变24例、Ⅳ型改变2例共26例(43.3%)异常,凝视试验有9例(15%)出现凝视性眼震,视动眼震减弱或双侧不对称18例(30%).冷热试验双侧不对称比值异常38例(63.3%),出现优势偏向者23例(38.3%).患者总慢相速度为34.68±5.66°/s,对照组中总慢相速度为46.57±6.34°/s(P<0.01).结论眼震电图检查对老年椎-基底动脉供血不足性眩晕的诊断是一种重要的检查手段.     

一氧化碳中毒迟发性脑病脑电图及磁共振成像影像学应用

目的 探讨急性一氧化碳中毒(ACMP)并发迟发性脑病(DEACMP)的脑电图(EEG)及磁共振成像(MRI)影像学的诊断价值.方法 选取2015年至2018年来三门峡市中心医院收治的符合纳入标准及排除标准的375例急性一氧化碳中毒患者为研究对象,收集研究对象的完整临床资料,对研究对象出院后进行3个月以上的随访,根据是否...     

低强度He-Ne激光血管内照射辅助治疗急性CO中毒后迟发性脑病

目的　观察低强度He Ne激光血管内照射 (ILLLI)治疗CO中毒后迟发性脑病 (DEACMP)的疗效。方法　 1 84例DEACMP患者随机分为常规组 (常规药物及高压氧治疗 ,98例 )及ILLLI组 (常规治疗 ILLLI治疗 ,86例 ) ,观察患者治疗前后的临床表现、智能、脑电图 (EEG)情况。结果　两组患者治疗后临床表现、智能、EEG较治疗前均有显著改善 ,ILLLI组较常规组改善更显著。结论　ILLLI对DEACMP的治疗有辅助作用。     

Reproducibility of serial peri-ictal single-photon emission tomography difference images in epilepsy patients undergoing surgical resection

Peri-ictal single-photon emission tomography (SPET) difference images co-registered to magnetic resonance imaging (MRI) visualize regional cerebral blood flow (rCBF) changes and help localize the epileptogenic area in medically refractory epilepsy. Few reports have examined the reproducibility of SPET difference image results. Epilepsy patients having two peri-ictal and at least one interictal SPET scan who later underwent surgical resection were studied. Localization accuracy of peri-ictal SPET difference images results, interictal electroencephalography (EEG), and ictal EEG from the first (seizure 1) and second (seizure 2) seizure, as well as MRI and positron emission tomography (PET) findings, were compared using surgical resection site as the standard. Thirteen patients underwent surgical resection (11 temporal lobe and 2 extratemporal). SPET results from seizure 1 were localized to the surgical site in 12/13 (92%) patients, while SPET results from seizure 2 were localized in 13/13 (100%) patients. All other modalities were less accurate than the SPET results [interictal EEG – seizure 1 6/13 (46%); ictal EEG – seizure 1 5/13 (38%); interictal intracranial EEG – seizure 2 4/9 (44%); ictal intracranial EEG – seizure 2 results 8/9 (89%); MRI 6/13 (46%); PET 9/13 (69%)].SPET results were reproducible in 12/13 (92%) patients.SPET difference images calculated from two independent peri-ictal scans appear to be reproducible and accurately localize the epileptogenic area. While SPET difference images visualize many areas of rCBF change, the quantification of these results along with consideration of injection time improves the diagnostic interpretation of the results. Received 17 July and in revised form 27 September 1999     

心肌灌注显像腺苷负荷试验致心电图改变分析

目的 评价腺苷负荷心肌灌注显像中患者的心电图变化.方法 回顾性分析2008年5月至12月完成腺苷负荷心肌灌注显像的641例患者腺苷药物负荷试验心电图变化和心肌灌注显像结果.统计学分析采用SAS 8.0软件,单因素分析采用t检验和χ2检验,多因素分析采用Logistic 回归分析.结果 腺苷注射前,641例患者中心电图正常436例(68.0%),心电图异常205例(32.0%).腺苷注射过程中新出现心律失常132例(20.6%,132/641),其中房性早搏39例(29.5%),室性早搏45例(34.1%),窦房阻滞8例(6.1%),一度房室传导阻滞7例(5.3%),二度Ⅰ型房室传导阻滞26例(19.7%),二度Ⅱ型房室传导阻滞6例(4.5%),三度房室传导阻滞1例(0.8%);需停药13例(9.8%).腺苷注射终止后新出现心律失常28例(4.4%,28/641),其中房性早搏16例(57.1%),室性早搏11例(39.3%),窦房阻滞1例(3.6%).641例患者腺负荷试验中共35例(5.5%)出现心电图ST段压低＞0.1 mV,39例(6.1%)予停药处理,无一例急性心肌梗死及猝死;心肌灌注显像结果:36例心肌缺血改变,8例心肌梗死改变.Logistic回归分析示,用腺苷药前、中、后心律失常并不增加出现心肌缺血及心肌梗死改变的风险[P=0.9613,比值比(OR)=0.982,95%可信区间(CI)0.471～2.046;P=0.9511,OR＜0.001,95%CI:＜0.001,＞999.999;P=0.9931,OR＜0.001,95%CI:＜0.001,＞999.999],并且腺苷注射过程中出现与未出现房室传导阻滞患者的阳性心肌灌注显像结果及ST段压低的发生率差异均无统计学意义(χ2=2.5298,0.5317,P均＞0.05).ST段压低＞0.1 mV的患者出现阳性心肌灌注显像结果的风险增加(P=0.0005,OR=5.608,95%CI2.110～14.905).结论 腺苷负荷试验过程中心电图异常发生率较高,但多为一过性,出现心律失常并不意味着有心肌缺血.     

SPET brain perfusion imaging in mild traumatic brain injury without loss of consciousness and normal computed tomography.

We present SPET brain perfusion findings in 32 patients who suffered mild traumatic brain injury without loss of consciousness and normal computed tomography. None of the patients had previous traumatic brain injury, CVA, HIV, psychiatric disorders or a history of alcohol or drug abuse. Their ages ranged from 11 to 61 years (mean = 42). The study was performed in 20 patients (62%) within 3 months of the date of injury and in 12 (38%) patients more than 3 months post-injury. Nineteen patients (60%) were involved in a motor vehicle accident, 10 patients (31%) sustained a fall and three patients (9%) received a blow to the head. The most common complaints were headaches in 26 patients (81%), memory deficits in 15 (47%), dizziness in 13 (41%) and sleep disorders in eight (25%). The studies were acquired approximately 2 h after an intravenous injection of 740 MBq (20.0 mCi) of 99Tcm-HMPAO. All images were acquired on a triple-headed gamma camera. The data were displayed on a 10-grade colour scale, with 2-pixel thickness (7.4 mm), and were reviewed blind to the patient's history of symptoms. The cerebellum was used as the reference site (100% maximum value). Any decrease in cerebral perfusion in the cortex or basal ganglia less than 70%, or less than 50% in the medial temporal lobe, compared to the cerebellar reference was considered abnormal. The results show that 13 (41%) had normal studies and 19 (59%) were abnormal (13 studies performed within 3 months of the date of injury and six studies performed more than 3 months post-injury). Analysis of the abnormal studies revealed that 17 showed 48 focal lesions and two showed diffuse supratentorial hypoperfusion (one from each of the early and delayed imaging groups). The 12 abnormal studies performed early had 37 focal lesions and averaged 3.1 lesions per patient, whereas there was a reduction to--an average of 2.2 lesions per patient in the five studies (total 11 lesions) performed more than 3 months post-injury. In the 17 abnormal studies with focal lesions, the following regions were involved in descending frequency: frontal lobes 58%, basal ganglia and thalami 47%, temporal lobes 26% and parietal lobes 16%. We conclude that: (1) SPET brain perfusion imaging is valuable and sensitive for the evaluation of cerebral perfusion changes following mild traumatic brain injury; (2) these changes can occur without loss of consciousness; (3) SPET brain perfusion imaging is more sensitive than computed tomography in detecting brain lesions; and (4) the changes may explain a neurological component of the patient's symptoms in the absence of morphological abnormalities using other imaging modalities.     

心肌灌注显像腺苷负荷试验致心电图改变分析

目的 评价腺苷负荷心肌灌注显像中患者的心电图变化.方法 回顾性分析2008年5月至12月完成腺苷负荷心肌灌注显像的641例患者腺苷药物负荷试验心电图变化和心肌灌注显像结果.统计学分析采用SAS 8.0软件,单因素分析采用t检验和χ2检验,多因素分析采用Logistic 回归分析.结果 腺苷注射前,641例患者中心电图正常436例（68.0%）,心电图异常205例（32.0%）.腺苷注射过程中新出现心律失常132例（20.6%,132/641）,其中房性早搏39例（29.5%）,室性早搏45例（34.1%）,窦房阻滞8例（6.1%）,一度房室传导阻滞7例（5.3%）,二度Ⅰ型房室传导阻滞26例（19.7%）,二度Ⅱ型房室传导阻滞6例（4.5%）,三度房室传导阻滞1例（0.8%）;需停药13例（9.8%）.腺苷注射终止后新出现心律失常28例（4.4%,28/641）,其中房性早搏16例（57.1%）,室性早搏11例（39.3%）,窦房阻滞1例（3.6%）.641例患者腺负荷试验中共35例（5.5%）出现心电图ST段压低＞0.1 mV,39例（6.1%）予停药处理,无一例急性心肌梗死及猝死;心肌灌注显像结果：36例心肌缺血改变,8例心肌梗死改变.Logistic回归分析示,用腺苷药前、中、后心律失常并不增加出现心肌缺血及心肌梗死改变的风险[P=0.9613,比值比（OR）=0.982,95%可信区间（CI）0.471～2.046;P=0.9511,OR＜0.001,95%CI：＜0.001,＞999.999;P=0.9931,OR＜0.001,95%CI：＜0.001,＞999.999],并且腺苷注射过程中出现与未出现房室传导阻滞患者的阳性心肌灌注显像结果及ST段压低的发生率差异均无统计学意义（χ2=2.5298,0.5317,P均＞0.05）.ST段压低＞0.1 mV的患者出现阳性心肌灌注显像结果的风险增加（P=0.0005,OR=5.608,95%CI2.110～14.905）.结论 腺苷负荷试验过程中心电图异常发生率较高,但多为一过性,出现心律失常并不意味着有心肌缺血.     

Clinical and MR correlates in children with extrapyramidal cerebral palsy.

PURPOSETo identify the characteristic MR findings in extrapyramidal cerebral palsy.METHODSix patients who had suffered intrapartum asphyxia and who subsequently developed extrapyramidal cerebral palsy were identified. Asphyxia was evidenced by severe neonatal systemic acidosis as documented by a venous cord pH of less than 7.0 whenever available, or acidosis in subsequent arterial blood gas samples, and clinical signs of an acute hypoxic-ischemic encephalopathy during the neonatal period. In addition, 1- and 5-minute Apgar scores were 3 or less, and there had been need for intubation or vigorous resuscitation in the delivery room. There were three boys and three girls, all born at term, with birth weight appropriate for gestational age, and without a history of bilirubin levels above 15 mg/dL. MR imaging at 1.5 T was performed between 1 and 19 years of age.RESULTSIn all subjects focal high signal abnormality was demonstrated in the posterior putamen and the anterior or posterior thalamus. There were no other findings in most cases.CONCLUSIONMR demonstrated lesions in the putamen and thalamus in all of our six patients with severe extrapyramidal cerebral palsy who had suffered intrapartum asphyxia.     

急性一氧化碳中毒危险分层与常压氧或高压氧综合治疗预后研究

目的 分析急性一氧化碳中毒(ACOP)患者的治疗方法与一氧化碳中毒迟发脑病(DEACMP)发病特点.方法 对我院高压氧科2007年1月至2009年2月经急诊首诊的201例有昏迷史的ACOP患者进行回顾性分析,根据ACOP中毒时间分组,A组患者昏迷时间<2 h,B组患者昏迷时间>2 h,B组根据昏迷时间及年龄再次分组.A组予高压氧(HBO)或常压氧(NBO)治疗,B组予HBO综合治疗,统计各组DEACMP的发病率.结果 有意识障碍的ACOP患者总的DEACMP发生率为3.5%,A组无DEACMP发生,B组DEACMP的发病率为10.3%.B组中昏迷时间>6 h的患者DEACMP发生率27.3%,与昏迷时间在2～6 h的患者DEACMP比较差异有统计学意义(P<0.01).B组不同年龄患者的DEACMP发生率差异无统计学意义(P>0.05).结论 ACOP患者中毒昏迷程度及时间为DEACMP的发病高危因素,根据发生DEACMP的危险程度分层后进行HBO综合治疗可使DEACMP发生率明显降低.     

Reproducibility of serial peri-ictal single-photon emission tomography difference images in epilepsy patients undergoing surgical resection

Peri-ictal single-photon emission tomography (SPET) difference images co-registered to magnetic resonance imaging (MRI) visualize regional cerebral blood flow (rCBF) changes and help localize the epileptogenic area in medically refractory epilepsy. Few reports have examined the reproducibility of SPET difference image results. Epilepsy patients having two peri-ictal and at least one interictal SPET scan who later underwent surgical resection were studied. Localization accuracy of peri-ictal SPET difference images results, interictal electroencephalography (EEG), and ictal EEG from the first (seizure 1) and second (seizure 2) seizure, as well as MRI and positron emission tomography (PET) findings, were compared using surgical resection site as the standard. Thirteen patients underwent surgical resection (11 temporal lobe and 2 extratemporal). SPET results from seizure 1 were localized to the surgical site in 12/13 (92%) patients, while SPET results from seizure 2 were localized in 13/13 (100%) patients. All other modalities were less accurate than the SPET results interictal EEG--seizure 1 6/13 (46%); ictal EEG--seizure 1 5/13 (38%); interictal intracranial EEG--seizure 2 4/9 (44%); ictal intracranial EEG--seizure 2 results 8/9 (89%); MRI 6/13 (46%); PET 9/13 (69%)[. SPET results were reproducible in 12/13 (92%) patients. SPET difference images calculated from two independent peri-ictal scans appear to be reproducible and accurately localize the epileptogenic area. While SPET difference images visualize many areas of rCBF change, the quantification of these results along with consideration of injection time improves the diagnostic interpretation of the results.     

创伤性膈肌破裂的表现及诊治中值得注意的问题

目的探讨创伤性膈肌破裂(TDR)的表现及诊治中值得注意问题。方法笔者回顾性分析1980年1月~2015年1月收治TDR 54例的临床资料,男性43例,女性11例;年龄7~68岁,平均(36±16.2)岁。左侧膈肌破裂48例,右侧6例。开放性、闭合性膈肌破裂膈疝发生率各为10.0%(1/10)和90.9%(40/44)(P0.01)。结果患者伤后或入院24h内未能确诊31例占57.4%,院内、外延误诊断率各为14.8(8/54)%和42.6%(23/54)(P0.01);X线、CT、B超对膈疝的检出率各为51.4%(19/37)、87.5%(28/32)和56.3%(9/16),其中23例经2种以上检查手段确诊,CT组与X线、B超组比较差异均有统计学意义(P0.05);41例膈疝术中证实均难自行还纳,其中29.3%与胸腔形成粘连,9例因疝入脏器破裂或绞窄、坏死行手术修补或切除。本组治愈51例(94.4%),因创伤性休克、重型颅脑损伤合并多器官功能衰竭死亡3例(5.6%),其ISS平均值为42.4分。结论伤后出现胸腹双腔症/症候群和膈疝影像学特征是诊断TDR的主要依据,早期诊断、合理选择手术方法、积极处理合并伤是临床关注的重点。