基层医院特急性外伤性颅内血肿78例救治体会

目的　探讨基层医院特急性 (伤后 3h内 )外伤性颅内血肿的救治体会。方法　将近 9年来收治特急性外伤性颅内血肿 78例作临床分析。结果　手术治疗 66例 ,死亡 1 8例 (2 7.2 7% )。出院时格拉斯哥预后评分 (glasgowoutcomescaleo ,GOS)恢复良好 37例 ,预后不良 2 9例 ,其中脑疝早期 7例均手术治疗 ,恢复良好 6例 ,预后不良 1例。脑疝中期 2 9例均手术治疗 ,恢复良好 2 2例 ,预后不良 7例。脑疝晚期 42例中手术 30例 ,恢复良好 9例 ,预后不良 2 1例 ,非手术 1 2例全部死亡。结论　特急性外伤性颅内血肿在脑疝早期及中期及时手术效果良好 ,脑疝晚期手术效果不佳 ,死亡率及致残率极高 ,及时手术及术后包括亚低温治疗在内的综合治疗是抢救成功的关键     

特急性中颅窝硬脑膜外血肿21例临床特点及救治体会

目的 总结特急性中颅窝硬脑膜外血肿的临床特点及诊断救治体会.方法 对2002年1月至2010年7月收治的特急性中颅窝硬脑膜外血肿21例患者的临床资料进行回顾性分析,根据格拉斯哥预后量表(GOS)评分标准对治疗效果进行评估.结果 术前未形成脑疝者3例,术后均恢复良好.术前脑疝一侧瞳孔散大7例患者中,恢复良好5例,轻残2例;双侧瞳孔散大11例患者中,5例术后未出现大面积脑梗死,恢复良好2例,轻残2例,重残1例;6例出现大面积脑梗死,重残1例,植物生存2例,死亡3例.其中3例合并脑干梗死患者均死亡.结论 特急性中颅窝硬脑膜外血肿病情发展急速,很快出现脑疝,且早期临床症状较轻,缺少硬脑膜外血肿的典型临床表现,CT易误诊或漏诊.细致观察、准确诊断、及时手术是提高疗效的关键.     

改良翼点入路治疗急性外伤性脑疝60例临床分析

脑疝是颅脑损伤后一种严重临床危象。必须立即处理才能使脑干损害成为可逆性。手术是治疗脑疝的重要手段。作者对2 0 0 0 -0 6～2 0 0 3 -0 6我科60例颅脑损伤后发生小脑幕切迹疝采用改良翼点入路治疗,疗效较为满意,现报告如下。1　资料与方法1·1　资料　本组60例,男性43例,女性17例。年龄16～68岁。车祸伤42例,坠落伤14例,钝器伤4例。手术前GCS 3～5分18例,6～8分42例。单例瞳孔散大46例,双例瞳孔散大14例。呼吸暂停3例。头颅CT :颞顶部急性硬脑膜外血肿12例,额颞顶部急性硬脑膜下血肿2 6例,其中继发对侧颞部急性硬脑膜外血肿10例,同侧…     

特急性颅内血肿手术时机的选择

目的总结特急性颅内血肿的发展规律、临床特点及诊治经验,选择正确的手术时机。方法回顾性分析笔者所在科近6年121例特急性颅内血肿患者的临床资料。通过对其临床表现、影像学特征的分析研究,找出特急性颅内血肿的发展规律,发现最佳手术时机。结果根据COS评分判断预后,非手术治疗43例,恢复良好21例（48．8％）,中残7例（16．3％）,重残3例（7．0％）,植物生存4例（9．3％）,死亡8例（18．6％）。手术治疗78例：恢复良好38例（48．7％）,中残10例（12．8％）,重残9例（11．5％）,植物生存9例（t1．5％）,死亡12例（15．4％）。结论对入院有误吸、低血压、缺氧情况存在及颅内多发血肿早期尽量保守治疗,改善供氧,动态CT观察,选择好手术时机可避免或减少脑膨出发生。对迟发血肿导致脑膨出,根据头颅CT和临床表现分析脑膨出原因,采取正确方案。     

手术室绿色通道在抢救急性外伤性颅内巨大血肿的价值

目的探讨手术室建立绿色通道对抢救急性外伤性颅内巨大血肿病人的价值。方法统计94例急性外伤性颅内巨大血肿、脑疝进行手术过程的情况。结果94例急性外伤性颅内巨大血肿手术全部顺利完成,手术效果满意。结论急性外伤性颅内血肿一旦确诊,血肿较大应及早手术,如延误治疗常可导致不良后果。尽快解除颅内压增高和脑受压,有利于病人恢复。     

急性硬脑膜下血肿早期快速自然消散13例分析

急性硬脑膜下血肿占外伤性颅内血肿的比例很高,约占40％,随着CT的进一步普及,伴随着急救半径的缩小和颅内血肿的超早期发现,急性硬脑膜下血肿有早期快速自然消散的病例,该病例在神经外科鲜见[1].我院2005年5月至2012年8月共发现急性硬脑膜下血肿早期快速自然消散患者13例,由于早期识别,采用了积极的保守治疗,避免了开颅手术给患者带来的巨大创伤及经济负担,现报道如下.     

开放性前额底粉碎性骨折伴颅内血肿合并脑疝的手术治疗

目的探讨开放性前额底粉碎性骨折伴颅内血肿合并脑疝的手术治疗方法。方法回顾性分析我院2008年1月～2012年6月56例开放性前额底粉碎性骨折伴颅内血肿合并脑疝患者的临床资料,术中均不干扰颅底处颅骨,实施硬脑膜紧密悬吊、硬脑膜严密修补、血肿清除及额颞部去骨瓣减压的手术方法,术后定期随访及行CT检查。结果 56例患者术后随访5个月～1年,53例预后良好,术后无血肿新生,无出现脑脊液漏及颅内感染,3例均死亡于严重消化道出血合并肺部感染。结论开放性前额底粉碎性骨折伴颅内血肿合并脑疝时,采用不干扰颅底处颅骨、硬脑膜紧密悬吊、硬脑膜严密修补、血肿清除及额颞部去骨瓣减压的手术方法,手术效果好,值得临床推广使用。     

急性硬膜外血肿外科治疗60例临床分析

目的：研究硬膜外血肿的外科治疗方法及临床疗效。方法：选取我院神经外科收治的急性硬膜外血肿患者60例,全部患者均采取手术治疗,针对患者不同情况采取不同术式,手术后,进行随访,观察患者的存活率、恢复良好率、轻度致残率、重度致残率及死亡率。结果：①60例手术患者中8例术后出现对侧迟发性硬膜下血肿,5例合并颅底骨折患者术后出现动眼神经损伤,9例重度脑疝及5例原发脑干损伤患者死亡。②所有出院患者电话随访或门诊复查随访3-9个月恢复良好37例,轻度致残13例,重度残疾9例,死亡5例,患者的存活率91．67％、恢复良好率61．67％、轻度致残率21．67％、重度致残率15．00％及死亡率8．33％。结论：对于急性硬膜外血肿,在治疗过程中,应该及早诊断,严格遵守医疗技术操作原则,根据病情选择术式,才能取得了满意的治疗效果。     

急性颅内血肿清除术中术后迟发性颅内血肿的诊治（附27例报告）

目的探讨开颅术中、术后出现迟发性颅内血肿的原因、诊断方法及治疗技巧。方法分析；27例患者在手术中出现急性脑膨胀采取术中B超扫查或术后出现病情变化及时复查头颅CT的方法，及早发现迟发性颅内血肿尽快行手术治疗。结果；27例迟发性颅内血肿病人，预后良好11例，中残5例，重残6例、死亡5例，植物生存0例，死亡率18．5％。结论术中清除急性外伤性颅内血肿时发生急性脑膨胀应考虑迟发性颅内血肿的存在并行术中B超扫查，术后的观察过程出现意识变化及一侧瞳孔散大时即复查头CT，能迅速确定诊断及血肿的部位，及时手术治疗可以改善预后。     

钻孔引流治疗稳定型硬脑膜下血肿

目的 探讨稳定型硬脑膜下血肿的有效治疗方法.方法 对行钻孔引流治疗的68例稳定型硬脑膜下血肿患者的临床资料进行回顾性分析.结果 术后第2天68例患者症状均改善,复查头部CT,42例血肿清除约80％,其中26例血肿清除约60％；余下血肿予以尿激酶注入法,拔管前复查头部CT,59例血肿清除80％以上,9例血肿清除60％以上,中线系统和脑室系统均恢复正常,意识状况和症状均明显改善,预后良好.结论 钻孔引流术操作简单,并发症少；只要选择合适的患者,规范化的术中操作和术后管理,对于治疗符合手术指征的稳定型硬脑膜下血肿是可行的.     

Decompressive craniectomy in the management of sylvian infarction

Space-occupying middle cerebral artery infarction represents about 10 to 15% of supratentorial ischemic strokes. This syndrome carries a high rate of mortality and requires aggressive surgical decompression. The authors present 6 patients with signs of trans-tentorial herniation operated on between February 2001 and August 2003. Neurological preoperative status was evaluated with Glasgow coma scale score and postoperatively with Barthel index. Three patients had excellent recovery (Barthel Index up to 70), one remained dependant and two died. Younger patients had better prognosis. Decompressive surgery, when done early, should improve mortality rate and even functional outcome. Optimal selection of patients, with the help of Diffusion-Weighted imaging, could vouch good results.     

微创手术治疗腰椎间盘突出症的临床研究

目的探讨微创手术治疗腰椎间盘突出症的临床疗效及应用。方法对在本院治疗的80例腰椎间盘突出症患者随机分为两组,治疗组40例接受微创手术治疗,对照组40例采用传统手术治疗,对两组患者的疗效进行观察并随访。结果本组80例患者切口均I期愈合,随访时间6个月～3年,平均18个月。治疗组优良率67．5％,对照组优良率37．5％,两组进行统计学分析,有显著性差异（P〈0．05）。结论微创手术具有创伤小、并发症少、恢复快、疗效好等优点,可成为治疗腰椎间盘突出症的一种疗效满意、值得进一步探讨应用的治疗方法。     

外伤后弥漫性脑肿胀致脑疝的围手术期治疗

目的总结与探讨外伤后弥漫性脑肿胀致脑疝的围手术期治疗方法，进一步提高本病的治疗效果。方法回顾分析70例外伤后弥漫性脑损伤致脑疝的围手术期相关治疗和预后。结果根据GOS评估，70例患者中44例预后较好，其中良好37例，中度致残7例；26例预后较差，重度致残6例，植物生存5例，死亡15例。结论对外伤后弥漫性脑肿胀致脑疝患者采用围手术期的综合治疗，提高了治疗效果，是值得推广应用的较好方法。     

经颞去骨瓣减压治疗高血压脑出血脑疝的临床分析

目的:探讨经颞叶入路去骨瓣减压术治疗高血压脑出血脑疝形成的应用优劣和注意事项以及影响预后的相关因素.方法:回顾性分析41例经颞叶入路去骨瓣减压术治疗高血压脑出血脑疝形成的病例资料.结果:41例患者存活31例(75.6%),死亡和自动出院10例(24.4%).存活者中(ADL1)2例;(ADL2)12例;(ADL3)11例;(ADL4)4例;(ADL5)2例."预后良好"25例(61.0%),"预后不良"16例(39.0%).结论:经颞叶入路去骨瓣减压术治疗高血压脑出血脑疝形成能明显地降低"预后不良"率,防治术后各种并发症是提高救治成功率的重要环节.     

推拿牵引加中药治疗腰椎间盘突出症60例临床分析

目的评价推拿牵引加中药治疗腰间盘突出症的临床效果，与单纯的牵引加中药治疗相比较。方法对120例腰椎间盘突出症患者随机分为推拿牵引加中药治疗组60例（治疗组），单纯牵引中药治疗组60例（对照组），观察比较两组疗效。结果治疗组治愈42例，占70％；显效15例，占25％；有效3例，占5％；无效0例，总有效率为100％；对照组治愈21例，占35％；显效16例，占26．67％；有效10例，占16．67％；无效13例，占21．67％，总有效率为78．3％。结论推拿牵引加中药治疗腰椎间盘突出症优于单纯牵引加中药治疗。     

北京地区3 139例首发脑出血患者流行特征及预后情况分析

目的 分析北京地区首发脑出血患者流行特征及对预后的影响,为脑出血防治工作提供科学依据。方法 通过医院病案管理系统检索获取2018—2020年某医院脑出血患者资料,并对患者出院后6个月时采用格拉斯哥结局量表（GOS评分）进行跟踪随访评估其预后,采用描述流行病学分析方法对脑出血患者病例特征及预后情况进行分析,对不同特征的脑出血患者预后情况进行比较分析。结果 本研究共纳入3 139例脑出血患者资料进行分析,2018、2019、2020年分别纳入927、1 019、1 193例,病例数逐年增加。男女性别比例为1∶0.98,年龄34~87岁,以60~<70岁年龄段所占比例最大,为38.8%,3年间不同年龄患者分布差异有统计学意义（P<0.01）,且年龄较低患者所占比例有增加趋势。发病季节以秋冬季所占比例较高,为60.7%,发病原因均显示高血压脑出血为主,占44.4%,以基底核区出血为主,占60.2%。3年间不同年份、性别、发病季节、发病原因、出血部位分布差异无统计学意义（均P>0.05）。共完成脑出血患者出院后6个月随访2 279例,预后良好的病例1 277例,良好率为56.0%。性别、年龄、发病原因、出血部位情况不同的脑出血患者预后良好率差异均有统计学意义（均P<0.01）,不同年份及发病季节的脑出血患者预后良好率差异无统计学意义（均P>0.05）。结论 近3年北京地区首发脑出血患者具有较明显的性别、年龄、发病季节分布特征,发病原因以高血压脑出血为主,出血部位以基底核区出血多见,不同特征的患者预后存在差异,可结合医院脑出血患者流行特征积极采取有效的防治措施,减少脑出血带来的健康危害,获取良好预后。     

小细胞肺癌治疗62例分析

目的 比较小细胞肺癌的治疗模式及治疗效果.方法 1、2期小细胞细胞肺癌患者62例A组（32例）行手术治疗,术后给予放化疗,B组（30例）单纯给予放化疗.结果 A组中位生存时间为50个月,1、2、3年生存率分别为96%、70%、52%,B组总中位生存时间为48个月,1、2、3年生存率分别为93%、71%、48%;A组术后治疗中或治疗后出现转移病灶的情况依次为：失败原因包括局部复发（12%）、远处转移（32%）、局部复发加远处转移（8%）和脑转移（19%）,B组失败原因包括局部复发（14%）、远处转移（30%）、局部复发加远处转移（9%）和脑转移（29%）.手术＋化疗＋放疗组与放化疗组的生存率差异无统计学意义（P〉0.05）.结论 手术＋化疗＋放疗和放化疗对临床Ⅰ、Ⅱ期小细胞肺癌的治疗均有较好的疗效.     

Breast liver metastases--incidence, diagnosis and outcome.

Breast liver metastases are uncommon and have not been well reported. We studied the clinical outcome of 47 patients who developed liver metastases out of 912 breast cancer patients treated between 1982 and 1987, an incidence of 5.2%. The median disease free interval prior to clinical liver metastases was 20.2 months (range 4-192 months). The most frequent clinical presentations were hepatomegaly (70%) and abdominal pain (34%). The diagnosis was confirmed on ultrasound scan in 72.7% patients. Thirty-one patients (70.5%) received specific treatment with both hormone and chemotherapy but only six showed any evidence of objective response, the majority of whom had metastases only in the liver. The median survival of treated patients was 4 months and absence of jaundice, response to treatment and liver metastases only were associated with significantly better survival. In conclusion breast liver metastases usually present as a manifestation of disseminated disease and have an appalling prognosis. When they occur as an initial site the prognosis is better but very few patients overall respond to conventional treatment.     

Life expectancy in Down syndrome infants and children with congenital heart defects, 1974-1997

Authors analysed 359 cases with Down's syndrome and congenital heart defects registered between 1974-1997 in Hungary. The total death rate was 19.9% (70 cases). Mortality in the operated group (85 cases) was 10.5% (9 patients), in the non-operated group (274 cases) 22.2% (61 patients). The death rate was lower in the group with early primary reconstruction (2.3%) than in the group with palliation + reconstruction (15.3%), or in the group with only palliative procedure (20%). These results indicate that the life expectancy of infants and children with Down's syndrome and congenital heart disease after early primary reconstructive procedure is the same as in Down syndrome patients without cardiac defects. The prognosis depends on the patient's social circumstances. The results after correct surgical procedure in patients with the same cardiac defect are similar to that of the patients with or without Down's syndrome.     

Trends for stroke incidence, severity, and prognosis in a rural community with a long-term stroke prevention program

OBJECTIVE: To examine the benefit of a long-term community-based stroke prevention program, we explored 35 years of surveillance data of stroke incidence for residents in a rural area in Japan. METHOD: The surveyed community was Ikawa town (population in 2000 was 6,116) in Akita prefecture, where a community-based stroke prevention program has been conducted since 1963. Incidence rates and numbers of stroke episodes, proportions for loss of consciousness and motor paralysis at onset, proportions for each seriousness category (A: death within one day after onset, B: death during 2-7 days after onset, C: survival more than 8 days after onset with complete hemiparesis, D: survival more than 8 days after onset with incomplete or no hemiparesis), and one-year survival rates and activity of daily living were investigated for 1964-69, 1970-79, 1980-89 and 1990-98. RESULTS: Stroke incidence declined 66% and 64% among the 30-69 years age group and 70 years over age group, respectively between 1964-69 and 1990-98. Incident numbers of stroke episodes declined 41% among those aged 30-69 years and, while it increased 100% in the 70 years over age group, this was much less than the increase rate of 271% rated for the corresponding aged population growth over time. In the 30-69 years age group, the proportion of patients with no loss of consciousness at onset increased from 53-64% during the former three periods to 79% in 1990-98. The proportion of patients with no motor paralysis also increased progressively over the study periods and the proportions for A or B categories in the seriousness classification decreased between 1964-69 and 1990-98 while the proportion in the D category increased between 1980-89 and 1990-98. One-year survival rates increased from 71% and 36% in 1964 to 86% and 61% in 1990-98 among the 30-69 years age group and 70 years over age group, respectively. With both, the numbers of totally dependent patients at one-year after onset, did not change significantly over time, despite the marked increase in the population of risk. CONCLUSION: The present study showed that a long-term community-based stroke prevention program can not only decrease stroke incidence and number of episodes, but also reduce the likelihood of severe stroke attack and improve prognosis, thereby suppressing the increase of totally dependent patients expected from growth of the old population in the community.