顽固性头皮下积液1例

1 临床资料 患者,男,38岁.因1个月前颅内复发肿瘤切除术后,术区头皮下出现积液,经局部穿刺引流、加压包扎、腰穿持续引流后,积液消失出院.4个月前又出现头皮下积液,无头痛、呕吐及畏寒、发热,无行走不稳等症,未予处理.     

卒中后焦虑患者早期白介素-6及皮质醇变化

目的:探讨白介素-6(IL-6)以及皮质醇水平与卒中后焦虑(PSA)发生的相关性。方法:选取卒中患者132例,在发病后第1周采用ELISA法检测血清IL-6水平和化学发光免疫分析法检测皮质醇波动变化(8:00与16:00)。另选择健康体检者50例为正常对照组,同样检测IL-6及皮质醇水平(8:00)。发病3周后根据是否发生PSA,将卒中患者分为PSA组32例和非PSA组100例。结果:PSA组的IL-6水平与非PSA组及正常对照组相比均升高,差异有统计学意义(P0.05)。与正常对照组相比,PSA组和非PSA组的皮质醇均升高(P0.05),PSA组的皮质醇生物学节律消失。结论:IL-6和皮质醇水平检测可能有助于PSA的早期筛查。     

术前备皮时间与颅内感染相关性分析

目的 分析我院颅脑手术患者一段时间内连续出现颅内感染的高危因素,提出干预对策.方法 对2015年4—9月颅脑手术后连续出现颅内感染的7例病例进行发病因素调查与分析.结果 2015年4-9月间行42例手术,发生颅内感染7例,感染率为16.67％.主要分布于颅内肿瘤、高血压脑出血及脑外伤手术,病例数依次为5例、1例和1例.术前备皮时间＜1小时手术病人29例,感染1例,感染率3.45％,备皮时间＞1小时手术病人13例,感染6例,感染率46.15％.排除其他因素外,考虑备皮时间与颅内感染具有相关性,采取相应措施干预后,效果良好.结论 术前备皮时间＞1小时以上不排除系颅内感染独立危险因素之一,临床医生应高度重视.     

颈部外伤异物存留漏诊1例

颈部外伤异物存留漏诊１例沐川县人民医院（６１４５００）邹为患者，男，２５岁。因放炮飞石击伤后颈部，疼痛，出血１小时入院。查：右侧颈部肿胀明显，后颈部正中偏右１ｃｍ处有５ｃｍ长纵行裂口，伤口内有少许细小碎石，手术时未发现明显肌肉断裂及假性通道。术后抗炎...     

术中超声在颅内占位病灶切除中的应用探讨

目的：探讨术中超声在颅内占位病灶切除术中的应用效果。方法对23例颅内占位手术患者进行术中超声定位,选择手术路径,并判定病灶完整切除程度。结果23例颅内占位切除术中,22例术中超声定位准确,准确率达95.65﹪,仅1例误判行了再次手术;23例颅内占位病灶均完整切除,无死亡及严重并发症病例。结论术中超声能准确显示病灶的位置和范围,有助于术中病灶定位,减少正常脑组织的损伤,并判断病灶完整切除程度,对＜3cm的深部病灶尤具优势;高分辨率的超声探头及有经验的医师操作在术中至关重要。     

小骨瓣开颅和小骨窗开颅手术治疗高血压脑出血78例临床对比研究

目的：探讨小骨瓣开颅和小骨窗开颅手术治疗高血压脑出血的外科治疗方法及相关性问题,比较其优缺点,以期获得最佳治疗效果,最大限度地减少死亡率和致残率。方法：分析78例高血压脑出血患者的临床资料,分析手术适应证、手术时机、手术方案及并发症处理等,采取骨瓣开颅和小骨窗开颅两种手术方法,比对治疗效果。结果：78例高血压脑出血患者中,骨瓣开颅48例,治愈42例,占87.5%,死亡1例,占2.08%,自动离院5例,占10.42%。;小骨窗开颅30例,治愈27例,占90%,死亡1例,占3.33%自动离院2例,占6.67%。结论：高血压脑出血外科手术效果良好,合理掌握手术适应证、把握手术时机,尤其超早期手术效果明显。采用小骨瓣开颅和小骨窗开颅手术,效果各具优缺点,而小骨瓣开颅更具灵活性。     

外伤性迟发性颅内血肿36例诊治体会

目的探讨外伤性迟发性颅内血肿(DTICH)的临床特点、机制、治疗及预防措施,提高对DTICH发病机制及临床特点的认识,为早期诊断和及时治疗创造有利条件。方法回顾性分析36例DTICH的临床资料,病例均通过严密观察病情并CT复查确诊为DTICH,其中手术治疗22例,保守治疗14例。结果恢复良好25例,轻残7例,重残2例,死亡2例。结论DTICH多于急性期72h内发病。伤后24h尤高,是颅脑损伤致死、致残的主要原因之一,早期的诊断和治疗对影响预后极为重要。     

成年男性先天性巨结肠1例

患者，男，２６岁，农民，未婚，小学文化。因肛门未挑气、便，伴腹胀３天以急性肠梗阻入院。入院前无外伤、腹泻、呕吐及畏寒发热史。体查：扶入病房，表情忧郁，自动位。发育正常，营养中等，全身皮肤粘膜无黄染，浅表淋巴结不大。Ｔ：３６８℃，Ｒ：２２次／分，Ｐ：...     

Effects of IL-6 and cortisol fluctuations in post-stroke depression

Depression is an important post-stroke sequela with negative impact on mortality, functional outcome and quality of life. Changes in cytokines have been hypothesized to be associated with the etiology of post-stroke depression (PSD). The altere dhypothalamic-pituitary-adrenal (HPA) functioning is associated with the onset of depression. The activity of HPA could induce the fluctuations of cortisol levels. In this study, we prospectively checked interleukin 6 (IL-6) and cortisol levels in patients with early ischemic stroke. It was hypothesized that early serum IL-6 and cortisol fluctuations in stroke patients were the predictions of PSD. Totally, 100 participants were selected from stroke inpatients consecutively admitted to the Department of Neurology, Tongji Hospital from July 2014 to December 2015. Fifty health people served as the controls. The serum of all the patients was collected at 8:00 am and 4:00 pm respectively one week after stroke. The serum of controls was collected only at 8:00 am. The levels of IL-6 were analyzed by enzyme-linked immunosorbent assay kit, and those of cortisol were detected by chemiluminescence immunoassay. On the 3rd week after stroke, the patients were enrolled to the PSD group and non-PSD group based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and The Hamilton Depression Rating Scale (HAMD-21, score>7). The IL-6 level (13.24±2.89 ng/L) was elevated significantly in PSD groups as compared with that in non-PSD group and control group respectively (P<0.05 for both), but there was no significant difference in the IL-6 level between non-PSD group and control group. The patients in both PSD group and non-PSD group had significantly elevated morning cortisol levels in comparison with those in the control group (P<0.05; for PSD, non-PSD and control: 508.86±119.51, 420.83±70.04 and 340.40±76.30 nmol/L respectively). Moreover, afternoon cortisol levels in PSD group were significantly higher than those in non-PSD group, and the morning baseline cortisol levels in these two groups were similar (P>0.05). It was suggested that PSD generally runs a chronic course and is related to a variety of adverse health outcomes including increased disability, morbidity and mortality. This study will help the screening of potential PSD in the early stage.     

开颅术后顽固性头皮下积液的治疗探讨

目的总结开颅术后顽固性头皮下积液的治疗经验。方法对12例临床上开颅术后由于不同原因导致的顽固性头皮下积液所采取的不同治疗方法及其疗效进行分析。结果 11例顺利治愈,有1例并发颅内感染,经抗感染治疗后治愈。结论 顽固性头皮下积液不可小视,应根据不同原因,采取个体化治疗方案,制定周密计划,方能奏效。