下丘脑损伤与血钠紊乱的动物实验研究

目的探讨下丘脑损伤与血钠紊乱的关系及血浆脑钠尿肽(BNP)在血钠紊乱发生中的作用。方法采用立体定位电解毁损大鼠下丘脑不同区域复制下丘脑损伤的动物模型,检测血钠、尿钠及血浆BNP含量,记录饮水量和尿量,计算水平衡。结果下丘脑前部毁损组术后1~3d血钠均较术前显著升高,下丘脑后部毁损组术后2d血钠较术前显著降低;下丘脑后部毁损组术后1d血浆BNP含量较术前及术后3d显著升高。术后1d下丘脑后部毁损组血浆BNP含量较其它组显著升高。结论下丘脑前部损伤引起高血钠,下丘脑后部损伤导致低血钠。下丘脑后部毁损组血钠降低伴有血浆中BNP含量升高,提示血浆BNP含量的升高可能是下丘脑损伤致低血钠的原因之一。     

颅咽管瘤MRI表现与术后水钠代谢紊乱关系分析

目的分析MRI上颅咽管瘤与第三脑室底的关系及对估计术后水钠代谢紊乱的意义.方法回顾性分析64例颅咽管瘤,根据术前MRI上颅咽管瘤与第三脑室底的关系将其分为4级,术后钠代谢情况分为正常、低钠、高钠及混合4组,尿量分为正常、轻度尿崩及严重尿崩3组,分别进行统计学分析.结果各级颅咽管瘤与钠代谢情况、尿量之间均有统计学差异.结论颅咽管瘤对第三脑室底侵袭越多,术后水钠代谢紊乱程度越重.分析MRI上颅咽管瘤与第三脑室底的关系,可以在一定程度上预测术后部分下丘脑反应的严重程度.     

下丘脑区手术后水钠紊乱的研究进展

水钠紊乱是神经外科领域既常见又棘手的问题。许多中枢神经系统疾病 ,尤其是下丘脑区域 (鞍区、三脑室 )病变手术后常常并发水钠紊乱 ,若得不到及时纠正 ,不仅影响原发病的治疗和预后 ,而且会引起严重后果 ,甚至危及生命。本文就下丘脑区术后水钠紊乱的常见类型、发病机制及其诊断治疗原则及相关最新进展作以综述 ,以期加深神经外科医师对水钠紊乱的正确认识。一、机体水钠平衡的生理调控机制生理条件下机体通过复杂的神经 内分泌调节实现水和血钠平衡 (以后简称水钠平衡 )。在渴觉中枢、抗利尿激素 (antidiuretichormone ,ADH)、肾素 血…     

脑肿瘤切除术后脑性耗盐综合征的临床研究

目的　探讨脑肿瘤切除术后脑性耗盐综合征 (CSWS)的病因、类型、诊断及处理方案。方法　分析 2 3 4例脑肿瘤术后出现 2 1例脑性耗盐综合征的病例资料及诊疗情况 ,患者多在术后第 4～ 9天出现血钠下降 ,血钠均低于 13 0mmol/L ,2 4h尿钠排泄均超过 10 0mmol,CVP <6cmH2 O。结果　 18例一过性低钠血症 ,经充分补钠、补液治疗 4～ 9d后恢复正常 ;1例颅咽管瘤患者术后第 10天死亡 ;2例持续性低钠血症患者病情明显恶化 ,但补钠效果不佳。结论　鞍区肿瘤术后CSWS发生率较高 ,常伴有尿崩症 ;颅咽管瘤术后CSWS发生率较垂体瘤术后高 ,血钠降幅更显著。CSWS存在一过性和持续性两种类型。     

儿童颅咽管瘤术后血钠水平的波动及其与癫痫发作的关系

目的探讨儿童颅咽管瘤患者术后7 d内血钠水平的波动及其与癫痫发作的关系。方法回顾性分析74例颅咽管瘤手术患儿的临床资料。其中术后发生癫痫者6例(8.1%)。检测患儿术后当日、术后1~7 d及发生癫痫时的血钠浓度,血钠值正常范围为135~145 mmol/L。依据各时间点的血钠值将患儿分为4组,均在正常范围者为血钠正常组,持续性低钠血症者为低钠血症组,持续性高钠血症者为高钠血症组,既有高钠血症也存在低钠血症者为交替异常组。分析患儿术后7 d血钠波动状况及各组患儿的癫痫发生率。结果本组74例患儿术后1~3 d的平均血钠值均在正常范围;术后4~6 d的平均血钠值均低于正常,第4 d为低钠血症的高发时间点;术后第7 d平均血钠值恢复至正常水平。74例患儿中,交替异常组26例(35.1%),其中发生癫痫者5例(19.2%);低钠血症组9例(12.2%),发生癫痫者1例(11.1%);血钠正常组22例(29.7%),高钠血症组17例(23.0%),均无发生癫痫者。结论术后第4 d为颅咽管瘤患儿低钠血症的高发时间点;颅咽管瘤患儿术后血钠水平降低,更有可能导致癫痫发作。     

鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析

目的探讨鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析。方法选取在我院就诊的48例鞍区肿瘤术后或重度颅脑损伤合并中枢性尿崩症患者,按照诊断类型分为短暂性尿崩症组(A组),持续性尿崩症组(B组),三相性尿崩症组(C组),检测患者治疗前后实验室指标,同时分析患者预后情况。结果 1治疗结束后,A组、C组在血钠、血渗透压、24尿钠及24h尿量均降低,同治疗时比较,差异具有显著性意义(P0.05或P0.01);治疗后A组、C组血渗透压,24 h尿钠均低于B、C组(P0.05);2治疗后经GOS评分,B组、C组4分及以下患者所占比例明显高于A组(P0.05),而5分者均低于A组(P0.05);3患者随访1年,A组患者生存状况良好,与B组死亡3例、C组死亡3例相比较,差异有统计学差异(P0.05);4B、C组ADH术后先下降后上升,但未能达到正常水平,A组先升高后下降,后恢复至正常水平。结论鞍区肿瘤术后、重度颅脑损伤合并CDI患者的预后与血ADH水平、24小时尿量有一定的相关性,不同类型CDI预后生存状况存在一定差异。     

免疫应答期间大鼠部分脑区内乙酰胆碱酯酶活性的变化

用绵羊红细胞（ＳＲＢＣ）免疫大鼠，在免疫后第３天至第６天，分别检测大鼠下丘脑、丘脑、中脑和脑桥内乙酰胆碱酯酶（ＡＣｈＥ）活性的变化。其中丘脑、中脑和脑桥在免疫后第３至６天，ＡＣｈＥ活性与对照组比较均无显著差异。而下丘脑内ＣＡｈＥ活性从第３天开始下降，至第６天均明显降低．本实验说明，在免疫应答期间，下丘脑中ＡＣｈＥ活性降低，由此提示体液免疫应答可影响下丘脑中乙酰胆碱（ＡＣｈ）的含量。我们以往的实验表明，中枢ＡＣｈ可调控体液免疫功能。综合两者结果，可以推断中枢ＡＣｈ与免疫之间存在相互作用。     

不同剂量神经生长因子对神经源性疼痛大鼠脊髓Fos蛋白的影响

背景：神经生长因子对神经元的存活、生长发育、分化、再生和功能维持起到调控作用。 目的：进一步验证不同剂量神经生长因子对神经源性痛大鼠的治疗作用以及对脊髓中Fos蛋白的影响。 设计、地点：随机对照动物实验，在上海第九人民医院完成。 材料：健康成年雄性Wistar大鼠72只,体质量180~200 g，随机分为4组，模型组及腹腔注射神经生长因子4， 8，16 μg组，每组18只。 方法：72只大鼠结扎左侧坐骨神经制备坐骨神经慢性缩窄性损伤模型；腹腔注射神经生长因子4， 8，16 μg组，造模后分别腹腔注射神经生长因子4，8，16 μg/(kg•d)。 主要观察指标：①于术前和术后第1，2，3，5，7，10，14天进行行为学观察和机械性痛阈测定。②于术后第2，7，14天各组分别处死大鼠各6只，取脊髓，应用免疫组织化学方法和图像分析系统检测脊髓中Fos蛋白的表达。 结果：模型组大鼠术后出现自发抬足、舔足等自发痛表现，术后第3天起开始出现痛阈下降，第14天达最低值，而注射神经生长因子组大鼠没有自发痛表现，没有出现机械性痛阈的低常期，第10，14天模型组大鼠痛阈与其余各组比较差异有显著性意义(P < 0.05)。4组大鼠术后第1天机械性痛阈普遍升高；注射神经生长因子16 μg组大鼠术后第1天机械性痛阈比其他各组低(P < 0.01)，第2天机械性痛阈恢复至术前水平，低于注射神经生长因子4 μg组(P < 0.05)。术后模型组大鼠脊髓Fos蛋白表达进行性升高，而其他各组大鼠脊髓中仅有少量Fos阳性神经元，模型组与其余各组比较差异显著(P < 0.01)。术后第2天注射神经生长因子16 μg组大鼠脊髓Fos蛋白表达最低，与模型组和注射神经生长因子4 μg组比较，差异有显著性意义(P < 0.01)。 结论：神经生长因子对大鼠神经源性痛有治疗作用，且大剂量较小剂量作用更为明显，其机制可能与抑制脊髓中Fos蛋白表达有关。     

50例多发性额叶挫裂伤术后水钠代谢紊乱的分析

目的分析额叶挫裂伤术后水钠代谢紊乱的病理生理、诊断及处理。方法额叶挫裂伤50例,术后每4h取标本测定血钠、尿钠、渗透压以及中心静脉压等连续7d,测定水钠值,分析水钠代谢紊乱类型,进行治疗处理。结果本组发生低钠血症28例(56%),高血钠10例(20%),高钠及低钠交替出现12例(24%),高钠及低钠血症平均发生时间为术后24～36h和72～86h,ICU综合治疗,钠代谢紊乱均获得纠正,平均住院28d。2例死于严重下丘脑反应。结论水钠代谢紊乱是额叶多发性挫裂伤术后常见表现。高血钠与尿崩有密切关系,低钠血症则为脑性耗盐综合征和抗利尿激素分泌不适当相关。二者的临床处理方法:高钠血症应在颅内压监测指导下补足液体和高钠盐液,而低钠血症则应在补盐的基础上要适当限水和利尿。     

颅脑外伤后低钠血症与血清脑钠素抗利尿激素醛固酮的关系

目的探讨颅脑外伤后低钠血症与脑钠素、抗利尿激素和醛固酮的关系及其发病机制。方法测定42例颅脑损伤患者伤后第1、5、7、10天不同时间点血钠、尿钠、脑钠素、抗利尿激素和醛固酮的浓度。结果 15例患者(44.1%)出现低钠血症,较无低钠血症者血醛固酮浓度显著降低,抗利尿激素浓度显著升高。结论低钠血症的发生与醛固酮分泌减少、抗利尿激素分泌增加有关。     

Coagulation-fibrinolytic abnormality and symptomatic vasospasm in the acute stage of ruptured cerebral aneurysms--analysis of alpha 2 PI, alpha 2 PIC, FDP and D.dimer]

In this study, alpha 2 plasmin inhibitor (alpha 2 PI), alpha 2 PI-plasmin complex (alpha 2 PIC), FDP (Fibrinogen/Fibrin Degradation Product) and D.Dimer were analyzed to confirm their clinical usefulness for estimation of symptomatic vasospasm and outcome. That included 34 patients operated on by clipping of aneurysm within 48 hours after onset. The patients were divided into two or three groups for each of the following items: Subarachnoid hemorrhage; Group A1 (Fisher's classification 1 and 2) and Group A2(3) and Group A3(4), Preoperative grade; Group B1 (Hunt and Kosnik I and II) and Group B2 (III and IV), Symptomatic vasospasm; Group C1 (present) and Group C2 (absent), Outcome; Group D1 (good recovery, moderate disability) and Group D2 (severe disability, vegetable). Peripheral venous blood was collected on the day before operation (Day 0) and first, second, 5th, 7th, 10th, 14th, 21st day after operation. Results are following. alpha 2 PI was found to change without significant intergroup or intragroup difference. alpha 2 PIC was significantly higher in A2 group than A1 group at 0 and 2nd day (p less than 0.05), in B2 group than B1 group at 0 day (p less than 0.05) and in C1 group than C2 group at 0 day and 5th day (p less than 0.05). Namely, alpha 2 PIC was already high before operation in patients with severe subarachnoid hemorrhage, poorer grade and/or symptomatic vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS)     

重型颅脑损伤患者血钠水平的变化及与预后关系的探讨

目的观察重型颅脑损伤（STBI）患者血钠水平的变化并探讨STBI患者血钠水平与预后的关系。方法选择38例STBI患者,根据患者入院时格拉斯哥昏迷评分（GCS）分为A组、B组和C组,观察以上各组患者住院后第1d、第3d、第5d和第7d血钠水平的变化;并依据患者就诊时血钠水平将以上患者分为正常组,轻度组,中度组和重度组,根据格拉斯哥预后评分（GOS）,探讨STBI患者的血钠水平与预后的关系。结果入院后第1d各组患者血钠水平与GCS评分呈负相关性,不同GCS评分患者间血钠水平差异具有统计学意义;就诊时患者血钠水平与病死率呈正相关性,不同血钠水平患者间病死率比较,差异差异具有统计学意义。结论就诊时STBI患者血钠水平与其病程进展和预后密切相关,应重视患者血钠水平的纠正。     

脑外伤合并四肢骨折患者血清生长激素水平变化对骨折愈合的影响

目的 通过动态检测重度颅脑外伤合并四肢骨折及单纯四肢骨折患者血清生长激素(GH)水平的变化,结合骨折愈合时间的改变,探讨内源性生长激素(GH)对骨折愈合的相关性及其影响,为重度颅脑外伤合并四肢骨折患者手术时机的选择和外源性生长激素(rhGH)辅助治疗骨折提供依据.方法 2010-03-2012-03选择重度颅外伤(GCS评分5～8分)合并四肢骨折患者和单纯四肢骨折患者各22例,分别于创伤后1 d、3 d、7 d、9 d、14 d测定血清GH水平.对2组各时间点GH水平变化进行统计学分析.结果 重度脑外伤合并四肢骨折组生长激素水平升高从第3天开始,7 d达高峰,9 d后开始下降,14 d 2组水平接近.而单纯四肢骨折各时间点GH水平基本与正常人指标一致.2组在3、7、9 d GH水平具有统计学意义(P＜0.05).结论 重度颅脑创伤合并四肢骨折患者2周内GH水平升高较对照组明显;与骨痂机化形成期时间一致.因此,对有手术指征的四肢骨折患者在脑部情况稳定后应尽早行骨折手术,依据GH升高时间,骨折手术应尽量在2周内进行.同时,我们推断重组人生长激素(rhGH)的小剂量、短时间应用可能对骨折愈合有促进作用.     

蛛网膜下腔出血后大鼠血清PDGF与脑血管痉挛关系的研究

目的探讨大鼠SAH(subarachnoid hemorrhage,SAH)后血清血小板源性生长因子(platelet-derivedgrowth factor,PDGF)与脑血管痉挛的关系,为临床治疗SAH后CVS(脑血管痉挛cerebral vasospasm)提供实验依据。方法 55只Sprague-Dawley大鼠随机分为三组:正常组,对照组(即SOR组,假手术组,Shamoperated rats,枕大池注入等量生理盐水)和SAH模型组。采用ELISA法测定血液中PDGF的水平;同时保存对应标本,观测大鼠基底动脉的形态学改变,测定血管壁厚度及血管内径。比较血清PDGF含量的变化与脑血管痉挛之间的关系。结果模型组基底动脉痉挛于第1 d就出现,第3d表现最为明显,第5,7d以后明显减轻,但仍比SOR组明显,第14 d基本正常。大鼠SAH后血清PDGF浓度于第1 d就明显升高,至第3 d达到顶峰,至第7天时仍高于SOR组,第14 d时基本正常。SAH后血清PDGF水平的变化与脑血管痉挛的变化是一致的。结论二次枕大池注血后,基底动脉发生了明显的细胞形态改变、管壁的增厚以及管腔的狭窄,提示SAH后有CVS的存在。SAH后血清PDGF水平的变化与脑血管痉挛的变化是一致的,呈正相关。提示PDGF可能参与了CVS的病理过程。     

Progressive ventricular enlargement in the absence of high ventricular pressure in an experimental neonatal rat model

OBJECT: In the present study, we compared ventricular pressures (VP) and the progression of ventricular enlargement in a new experimental neonatal hydrocephalus model, to gain an understanding of how communicating hydrocephalus progresses. METHODS: Kaolin was injected into the subarachnoid space at the cranial convexity of neonatal rats. Gross examination was performed on the 3rd, 5th and 7th days, and ultrasonographic examination on the 15th day, and at the end of the 1st and 2nd months following the kaolin application. Ventricular size indexes (VSI) were calculated in the case of a large ventricular dilatation. VPs were assessed on the 15th day, and at the end of the 1st and 2nd months, with a computerized data acquisition system. CONCLUSIONS: In the 1st and 2nd months VSIs were significantly higher than in control rats on the 15th day after kaolin administration. VP on the 15th day was significantly increased compared with that in control rats. VP in the 1st month was still high, but had subsided. In the 2nd month VP was not increased over control. In the late stages, the progression of infantile communicating hydrocephalus is not related to VP levels.     

急性液化石油气中毒大鼠血清S100B和髓鞘碱性蛋白的检测及意义

目的 研究急性液化石油气(LPG)中毒大鼠血清S100B和髓鞘碱性蛋白(MBP)的变化.方法 健康雄性成年SD大鼠54只按随机数字表法分为正常对照组(n=6)、20%LPG中毒组(n=24)和50%LPG中毒组(n=24).后2组大鼠分别吸入20%、50%LPG,对照组吸入等体积的空气.在中毒1、2、3、7 d时每组取6只大鼠进行神经功能缺损评分(NSS),ELISA法检测血清样本S100B和MBP的含量.结果 与正常对照组比较,20%LPG组中毒1 d、50%LPG组中毒1 d和2 d时NSS评分均较高,差异有统计学意义(P＜0.05);在1 d和2 d时,20%LPG组和50%LPG组大鼠血清S100B、MBP均高于正常对照组,且50%LPG组高于20%LPG组,差异有统计学意义(P＜0.05);3 d时50%LPG组血清S100B、MBP高于正常对照组和20%LPG组,差异有统计学意义(P＜0.05);大鼠LPG中毒1 d时NSS评分、血清S100B、MBP浓度最高,与其它时间点比较差异均有统计学意义(P＜0.05),后随时间延长逐渐恢复.结论 LPG中毒大鼠血清S100B和MBP同时升高,提示胶质细胞参与LPG中毒对神经系统的损害.

Abstract：

Objective To observe the changes of serum S100B and MBP in rats with liquid petroleum gas poisoning. Methods Fifty-four healthy adult male SD rats were randomized into normal control group (n=6), 20% LPG poisoning group (n=24) and 50% LPG poisoning group (n=24). Rat models of liquid petroleum gas poisoning were established in the later 2 groups, and controls were given the same volume of air. The rats of each group(n=6) were scored with neurological severity scale (NSS) and the blood serum was collected on the 1st, 2nd, 3nd and 7th d of poisoning, respectively. The levels of S100B and MBP were detected by euzymelinked immunosorbent assay (ELISA).Results As compared with the scores of NSS in the normal control group, those on the 1st d of poisoning in the 20% LPG poisoning group and those on the 1st and 2nd d of poisoning in the 50% LPG poisoning group were significantly higher (P＜0.05). The levels of Sl00B and MBP in 20% and 50% LPG poisoning groups were higher than those in the control group on the 1st and 2nd d of poisoning (P＜0.05); the levels of S100B and MBP in 50% LPG poisoning group were higher than those in 20% LPG poisoning group on the 1st and 2nd d of poisoning (P＜0.05). The levels of S 100B and MBP in 50% LPG poisoning group were higher than those in 20% LPG poisoning group and normal control group on the 3rd of poisoning (P＜0.05). The NSS scores and the levels of S100B and MBP in rats with LPG poisoning enjoyed the highest scores or levels on the 1st d of poisoning and those decreased after that. Conclusion The levels of S100B and MBP of rats with LPG poisoning increase, indicating that gliocytes participate in the mechanism of nervous system injury in rats with liquid petroleum gas poisoning.     

巴曲酶治疗超早期急性脑梗死的临床观察

目的观察不同剂量巴曲酶治疗急性脑梗塞不同疗程的疗效。方法急性脑梗塞患者51例,随机分为巴曲酶常规剂量治疗组(24例)和大剂量延长疗程组(27例),观察两组治疗后7天及14天的神经功能缺损评分及纤维蛋白原含量。结果大剂量延长疗程组患者治疗后7天及14天ESS评分与常规剂量组相比,有显著改善。但两组血浆纤维蛋白原水平无明显差别。各组治疗后7天血浆纤维蛋白原水平较治疗前显著降低,治疗后14天血浆纤维蛋白原水平与治疗前相比无显著变化。结论巴曲酶能够改善急性脑梗死患者的预后,提高患者的生活质量,是治疗急性脑梗死有效药物之一。     

新生小鼠缺血缺氧性脑损伤中TLR4-TRIF信号通路的表达

目的 建立新生小鼠缺血缺氧模型,探讨TLR4-TRIF信号通路中TLR4、IRF3的表达.方法 将60只7日龄C57BL/6小鼠分为假手术组、缺血缺氧1 d、2 d、3 d、4 d、7 d、建立新生小鼠缺血缺氧性脑病模型,比较鼠脑左右半球的质量,确定模型是否建立成功.以逆转录-聚合酶链反应（RT -PCR）检测大脑皮质和海马中TLR4 mRNA、IRF3m RNA的表达.结果 缺血缺氧1 d组右侧的脑质量明显重于左侧,说明缺氧缺血1 d后,右脑水肿明显.缺氧缺血组的TLR4m RNA、IRF3m RNA的表达水平均明显高于假手术组.结论 脑缺氧缺血损伤可激活TLR4,引起IRF3表达量增加.     

Changes in brain temperature and thermoregulation produced by destruction of medial septal neurons in rats

Brain temperatures (Tbr) of male Wistar rats were recorded at every 15 min interval for 24 h, prior to the destruction of the medial septal (MS) neurons with N-methyl-D-aspartic acid, and on the 7th, 14th and 21st days after the destruction. The capacity of the rats to regulate their body temperature under severe cold and heat was assessed by recording their Tbr when they were exposed to 5+/-1 and 37+/-1 degrees C for 2 h, before lesion and on 8th, 9th, 15th, 16th, 22nd and 23rd days after the lesion. The Tbr was decreased and its circadian variation increased after the MS lesion. On exposure to an ambient temperature of 5+/-1 degrees C the Tbr was decreased on 9th and 16th days after the lesion, when compared with the sham lesion group on identical days, though the fall in temperature was not significant on the 23rd day. The change in Tbr (compared with the sham lesion group) was not significantly different on all days of exposure to 37+/-1 degrees C. The decrease in Tbr after the MS lesion is in contrast to the hyperthermia produced by lesion of the adjoining thermoregulatory areas. The present findings suggest that the MS lesions caused an alteration in the set point of body temperature, without drastic changes in thermoregulatory ability.     

法舒地尔动、静脉给药治疗颅内动脉瘤栓塞后脑血管痉挛的对比研究

目的探讨法舒地尔动脉推注(IAF)与静脉给药对脑动脉瘤栓塞后脑血管痉挛(CVS)的疗效对比并评估其安全性。方法介入栓塞治疗后出现脑血管痉挛39名患者,随机分成A、B二组。A组,改用静脉法舒地尔治疗,30 mg,3次/d;B组立即行动脉内注射盐酸法舒地尔(60 mg+生理盐水100 ml,60 min缓慢推注治疗),连续3 d,3 d后予常规静脉法舒地尔治疗。结果 B组IAF治疗后血管痉挛程度明显改善,第3 d、7 d、14 d的GCS评分均高于A组,3月后GOS评分明显高于A组。结论 IAF能安全有效地缓解蛛网膜下腔出血后脑血管痉挛的临床症状并改善预后。