以脑静脉血栓形成为首发表现的原发性血小板增多症1例

原发性血小板增多症(ET)主要表现为骨髓中巨核细胞和粒细胞显著增生伴反应性纤维结缔组织沉积以及髓外造血,属于慢性骨髓增殖性肿瘤。其主要并发症为出血和血栓形成,合并脑静脉血栓较为罕见,且起病隐匿,容易误诊和漏诊。现报告1例以颅内静脉系统血栓形成(CVST)为首发表现,最终诊断为JAK2/V617F基因阳性的ET如下。1病例患者女性,31岁,因"反复头痛1年余,加重半月"于2019年1月入住我院神经内科。     

成年烟雾病患者脑微出血的初步研究

Objective To investigate the incidence,distribution patterns,and influencing factors of cerebral microbleed (CMB) in Chinese adult patients with moyamoya disease.Methods Thirty consecutive patients with moyamoya disease confirmed by digital subtraction angiography from the Nanking Stroke Registry Program were included.All patients performed conventional MRI sequences (3.0 T) and susceptibility-weighted imaging.The clinical data,such as medical history,systolic blood pressure,diastolic blood pressure,mean arterial pressure,and white matter lesions were collected.Their fasting blood glucose levels and fibrinogen levels were detected.The numbers of CMB lesion,distribution information,and their relationship with various clinical parameters in patients with moyamoya disease were analyzed.Results Among the 30 subjects included,14 CMBs were detected in 10 patients from 11 hemispheres.The distribution of the lesions was mainly in deep brains (71.4%),especially in the periventricular white matter (50.0%).There was no statistical difference in age,gender,hemorrhage symptoms,blood pressure,white mater lesions,and plasma fibrinogen levels between the CMB positive group and CMB negative group.However,the fasting blood glucose levels in the former was significantly higher than those in the latter (8.0 ± 4.1 mmol/Lvs.4.8 ± 0.4 mmol/L;P =0.035).Multivariate regression analysis showed that the increased fasting blood glucose level was an independent risk factor for the occurrence of CMBs in adult patients with moyamoya disease (OR = 10.992,95% CI 1.325-91.218;P=0.026).Conclusions The CMB lesions are susceptible to Chinese adult patients with moyamoya disease in deep brains,especially in the periventricular white matter.The fasting blood glucose level may influence the incidence of CMBs in patients with moyamoya disease.     

动脉粥样硬化性椎动脉狭窄介入治疗的实践与指南

椎动脉血管成形及支架置入术(vertebral artery angioplasty and stenting,VAS)是目前症状性椎动脉开口狭窄患者药物治疗无效的一种治疗选择,文中从动脉粥样硬化性椎动脉狭窄的自然病史及相关病理特点、VAS的临床研究及指南与临床实施3方面进行综述。     

颈动脉球囊扩张支架置入术后持续性低血压危险因素分析

目的探讨颈动脉球囊扩张支架置入(CAAS)术后发生持续性低血压的危险因素。方法收集CAAS术患者177例资料,分析术后发生持续性低血压的危险因素。结果 177例中,出现持续性低血压92例。单因素分析提示,球囊直径、球囊长度、扩张次数、扩张持续时间、扩张压力、双侧颈动脉支架与术后发生持续性低血压有关(P<0.05)。Logistic回归Forward LR法分析提示,双侧颈动脉支架、球囊扩张持续时间≥5s、球囊扩张压力>8atm是发生术后持续性低血压的独立危险因素。结论双侧颈动脉支架置入、球囊扩张压力>8atm、扩张持续时间≥5s的患者术后易出现持续性低血压。     

缺血性脑血管病患者颈内动脉颅外段血管折曲的影响因素分析

目的 探讨缺血性脑血管病患者颈内动脉颅外段血管折曲的影响因素. 方法 选择行DSA检查的334例缺血性脑血管病患者,根据颈内动脉颅外段血管走行分为血管折曲组(血管成角小于90°定义为血管折曲,110例)和血管无折曲组(血管成角大于90°或盘曲成环状定义为血管无折曲,224例),根据患者年龄分为青年组(18～45岁)、中年组(46～64岁)和老年组(≥65岁).对于可能影响患者颈内动脉颅外段血管折曲的影响因素,如性别、年龄、身高、颈动脉狭窄程度和脑血管病危险因素等进行统计学分析. 结果 单因素分析发现,患者年龄、高血压病史、吸烟史、酗酒史、身高、性别比例在血管折曲组和血管无折曲组中差异有统计学意义(P＜0.05);logistic回归分析显示,高血压病史(OR=2.546,95%CI:1.376～4.712,P=0.003)、年龄(以18～45岁为参照组,46～64岁组OR=2.610,95%CI:1.056～6.452,P=0.038;≥65岁组OR=2.929,95%CI:1.159～7.401,P=0.023)与患者颈内动脉颅外段血管折曲有明显相关性. 结论 高血压病史和年龄是缺血性脑血管病患者颈内动脉颅外段血管折曲的重要影响因素.

Abstract：

Objective To investigate the influencing factors of kinking of extracranial internal carotid artery (EICA) in patients with transient ischemic attack. Methods Three hundred and thirty-four patients with ischemic cerebrovascular disease performed digital subtraction angiography (DSA) were chosen; they were divided into 2 groups according to vascular morphology through DSA detection: kinking group (angulation smaller than 90°, n=110) and non-kinking group (angulation larger than 90°, n=224). According to the age, the patients were divided into youth group (18-45 years old),middle age group (46-64 years old) and elderly group (older than 65 years old). The influencing factors which may be related to the kinking of EICA, including gender, age, height and stenosis degree, and the risk factors for cerebrovascular diseases were statistically analyzed. Results Univariate analysis found that the kinking group and non-kinking group on the ratio of age, gender, height, and histories of hypertension, smoking and drinking were significantly different (P＜0.05). Multiple logistic regression analysis showed that the kinking of EICA was obviously correlated to the history of hypertension (OR=2.546, 95% CI: 1.376-4.712, P=0.003) and age (taking youth group as reference group, middle age group:OR=2.610, 95% CI: 1.056-6.452, P=0.038, elderly group: OR=2.929, 95% CI: 1.159-7.401, P=0.023).Conclusion The history of hypertension and age are identified as independent predictors for kinking of EICA in patients with ischemic cerebrovascular diseases.     

前循环短暂性脑缺血发作患者脑血管狭窄特点与ABCD2评分

目的探讨动脉粥样硬化性前循环短暂性脑缺血发作(TIA)患者中,动脉狭窄位置和狭窄程度与ABCD2评分的相关性。方法选择南京卒中注册系统中,接受数字减影血管造影(DSA)检查的前循环动脉粥样硬化性TIA患者1 51例进行ABCD2评分,根据ABCD2评分分值分为3组:低危组60例,中危组64例,高危组27例。分析患者脑血管形态学特点与各组的关系。结果 DSA显示,151例患者中,25例为正常血管,126例血管狭窄的患者检出216处狭窄或闭塞性病变。3组患者血管狭窄位置的分布差异无统计学意义(P>0.05);在症状相关侧大血管中,低危组患者正常血管的比例明显高于高危组,轻度狭窄的比例明显高于中危组和高危组,重度狭窄及闭塞的比例明显低于中危组和高危组,差异有统计学意义(P<0.05);在非症状相关侧大血管中,低危组患者正常血管的比例明显高于中危组和高危组,高危组患者中度狭窄的比例明显高于低危组和中危组,差异有统计学意义(P<0.05)。有症状和无症状侧血管的管腔狭窄程度随ABCD2评分的增高而表现出升高趋势(P<0.01)。结论前循环TIA患者的ABCD2评分能够反映患者前循环血管的狭窄程度。ABCD2评分高的前循环TIA患者应重视血管形态学检查。     

基层医院病理科防范医疗事故浅见

病理科是一个高技术、高风险的科室,而基层医院病理科又有其特殊性:①医师大多非病理专业毕业,先天不足;②设备条件差,待遇低,所见病例数量少,积累的工作经验也就较少,后天不足;③人员少,有的医院病理科甚至只有1人,遇到问题无法讨论。总之,基层医院病理科需要克服的困难很多,本文就基层医院病理科如何防范医疗事故谈一些粗浅的见解。     

对广西实行医疗事故保险的调查与评价

本文介绍了广西壮族自治区实行医疗事故和意外保险的具体做法。两年来,通过对玉林地区实施的现状调查和意向调查,从社会效应及解决问题的能力的角度,对其可行性及发展前景进行了分析评价。为解决医疗事故补偿经费的来源问题,1988年,广西壮族自治区卫生厅与中国人民保险公司广西分公司共同协商,决定由该公司在广西全区开办医疗事故责任保险,保险条款和保险费率报经保险管理机关——中国人民银行广西分行批准后,由上述两个单位联合发文施行。     

中华护理学会玉林地区分会举行年会

我会于1980年4月26～30日在玉林举行1979年学术年会。参加这次年会的代表有地、县、公社等各级医院的护理工作者88人。交流了护理论文23篇。