单唾液酸四己糖神经节苷脂治疗急性脑梗死疗效观察

目的探讨单唾液酸四己糖神经节苷脂（GM-1,商品名澳甘）治疗急性脑梗死的疗效。方法 257例急性脑梗死患者随机分为治疗组129例及对照组128例,治疗组除常规治疗外给予神经节苷脂注射液100mg,加入0.9%氯化钠注射液250mL,1次/d,连续治疗2周。2组分别在治疗前、后28d进行NIHSS评分。结果治疗组好转率为90.6%,明显高于对照组（70.7%）,2组比较差异有统计学意义（P〈0.05）;治疗过程中未发现明显不良反应。结论 GM-1治疗急性脑梗死疗效显著,能促进神经功能早期恢复,提高患者生活质量。     

单唾液酸四己糖神经节苷脂（GM1）治疗急性脑梗死的多中心临床疗效观察

目的观察GM1治疗急性脑梗死的临床疗效及安全性.方法选择96例发病72 h内的急性脑梗死患者,随机分为两组,采用中国卒中程度评分(Chinese stroke scale,CSS)、Barthel指数及Rankin残疾评分评价神经功能恢复状况.结果治疗组显效率52.08%,有效率31.25%; 对照组显效率25.00%,有效率52.08%.治疗组Barthel指数变化较对照组明显(P＜0.05).Rankin指数(3个月后)治疗组明显小于对照组,无不良反应发生.结论GM1治疗急性脑梗死是安全、有效的.     

单唾液酸四己糖神经节苷脂钠治疗糖尿病周围神经病变临床疗效观察

目的探讨单唾液酸四己糖神经节苷脂钠(GM1)治疗糖尿病周围神经病变临床应用前景。方法将56例糖尿病周围神经病变患者随机分为GM1治疗组和甲钴胺治疗组,两组均给予常规降糖、改善循环等治疗,3个月后观察治疗前后临床症状改善情况并测定治疗前后患者血清一氧化氮(NO)水平。结果①GM1组治疗有效率高于甲钴胺组,但差异无统计学意义,(P>0.05);②治疗前两组NO水平差异无统计学意义,治疗后两组自身比较,差异有统计学意义(P<0.001),且治疗后GM1组明显高于甲钴胺组(P<0.001)。结论 GM1治疗糖尿病周围神经病变有良好前景,待进一步观察。     

单唾液酸四己糖神经节苷脂治疗急性脑梗死的临床观察

目的 探讨单唾液酸四己糖神经节苷脂治疗急性脑梗死的疗效变化.方法 56例急性脑梗死患者随机分为治疗组和对照组,每组各28例,对照组用常规治疗方法,治疗组在常规治疗的基础上加用单唾液酸四己糖神经节苷脂60mg静滴, 1次/d,7～14d为1个疗程,进行疗效评定.结果 1周后治疗组、对照组ESS评分、BI分别为64.56±19.78、59.32±21.78、49.22±28.55、42.11±24.35.2周后治疗组、对照组ESS评分、BI分别为82.12±19.76、68.85±21.32,60.79±25.89、55.13±24.42.2组对比差异均有统计学意义,前者P<0.05,后者P<0.01.结论 单唾液酸四己糖神经节苷脂能有效改善急性脑梗死的神经功能缺失和日常生活能力,对急性期脑梗死有明显的疗效.     

脑缺血后大鼠大脑新皮质的nestin表达与神经节苷脂GM1的关系

目的观察大鼠缺血脑损伤后,外源性单唾液酸四己糖神经节苷脂(GM1)与大脑新皮质巢蛋白(nestin)的表达的关系。方法Wistar成年大鼠随机分配到GM1组、对照组和假手术组;建立大脑中动脉永久梗死性模型,腹腔注射GM1后,利用免疫组织化学染色方法,观察模型大鼠大脑新皮质的巢蛋白表达。结果(1)GM1组表达nestin的细胞数明显比对照组和假手术组多,对照组又明显比假手术组多;(2)对照组表达nestin的细胞数是在干预后7d达最高,干预后10d与3d相比,无差别;GM1组则是干预后7d达高峰,10d后下降,但仍比3d的高。结论GM1能促进缺血脑组织的nestin表达的增加。     

观察神经节苷脂联合醒脑静对急性脑卒中患者预后的影响

目的观察单唾液酸四己糖神经节苷脂联合醒脑静对急性脑卒中患者预后的改善作用。方法研究对象为2013-01—2014-07我院收治的急性脑卒中患者124例,随机法分为联合组(n=62)和对照组(n=62),对照组静滴醒脑静,联合组在此基础上加用单唾液酸四己糖神经节苷脂治疗,持续治疗6周。比较用药前后2组患者神经功能缺损评分、认知水平、不良反应率及疗效。结果联合组总有效率85.5%高于对照组66.1%,差异有统计学意义(P0.05)。2组患者用药后NIHSS评分均降低,MMSE、WMS评分均明显上升,与用药前比较差异有统计学意义(P0.05);联合组用药后NIHSS评分显著低于对照组,MMSE、WMS评分高于对照组,差异有统计学意义(P0.05)。联合组不良反应率9.7%低于对照组14.5%,差异无统计学意义(P0.05)。结论单唾液酸四己糖神经节苷脂联合醒脑静治疗急性脑卒中,能显著改善患者神经功能和认知水平,疗效显著,且不增加不良反应,预后好。     

单唾液酸四已糖神经节苷脂联合康复治疗对老年脑梗死患者的疗效

目的观察单唾液酸四己糖神经节苷脂联合康复治疗对老年脑梗死的临床效果。方法 118例老年脑梗死患者随机分为对照组和观察组,2组均给予常规对症支持治疗+康复治疗。对照组在常规治疗的基础上加用胞二磷胆碱治疗,观察组在常规治疗的基础上加用单唾液酸四己糖神经节苷脂治疗。观察2组治疗前后肢体功能恢复情况,生活质量改善情况及TNF-α、IL-6、CRP改善情况。结果 2组治疗后FMA积分均显著优于治疗前,观察组改善效果更显著。2组治疗后ADL评分均显著优于治疗前,观察组改善效果更显著。2组治疗后TNF-α、IL-6、CRP水平均较治疗前下降,观察组降低更显著。结论单唾液酸四己糖神经节苷脂联合康复治疗脑梗死疗效显著,值得临床推广应用。     

单唾液酸四己糖神经节苷脂治疗重度窒息新生儿脑损伤临床观察

目的观察单唾液酸四己糖神经节苷脂治疗重度窒息新生儿脑损伤的临床疗效。方法回顾性分析我院收治的84例重度窒息新生儿脑损伤患儿的临床资料,根据治疗方法不同分为治疗组和对照组各42例,其中对照组给予常规治疗,治疗组在对照组基础上加用单唾液酸四己糖神经节苷脂治疗,比较2组临床疗效、出生后不同时段NBNA评分以及治疗前后血清MBP、S-100水平。结果治疗组的总有效率92.56%,显著高于对照组的78.57%(P<0.05);出生后第7天2组NBNA评分差异无统计学意义(P>0.05),出生后第14、21天治疗组NBNA评分均显著高于对照组(P<0.05);治疗前2组血清MBP、S-100比较差异无统计学意义(P>0.05),治疗后治疗组血清MBP、S-100显著低于对照组(P<0.05)。结论单唾液酸四己糖神经节苷脂治疗重度窒息新生儿脑损伤临床效果显著。     

神经节苷脂GM1治疗神经系统损伤

神经节苷脂ＧＭ_１治疗神经系统损伤陈嘉峰，秦震近年来，许多研究表明，神经节苷脂在神经细胞的分化、发育、神经组织的损伤修复、神经元的可塑性、突触的传递等方面起着极为重要的作用。在神经节苷脂治疗神经系统损伤中研究最多的是单唾液酸神经节苷脂ＧＭ１。ＧＭ１的?..     

国产及进口单唾液酸四己糖神经节苷脂治疗新生儿缺氧缺血性脑病疗效比较

目的 观察国产及进口单唾液酸四己糖神经节苷脂(GM1)治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 将104例新生儿HIE随机分为申捷组(国产GM1,53例)和施捷因组(进口GM1,51例),两组在常规治疗的同时,分别给予申捷或施捷因20 mg/d静脉滴注持续7～28 d,观察两组的疗效及不良反应.结果 两组总有效率分别为98.11%及88.24%,两组间差异无统计学意义;两组均未见明显的不良反应.结论 国产及进口GM1治疗新生儿HIE均具有良好的疗效和安全性.     

脑弥漫性轴索损伤的诊断与救治（附27例报告）

目的探讨脑弥漫性轴索损伤的临床表现及其诊断与处理方法，以提高治愈率，减少致残、致死率。方法回顾性总结27例脑弥漫性轴索损伤的损伤原因、救治措施和预后情况。结果27例脑弥漫性轴索损伤多为车祸伤及坠落伤，治愈好转11例、重残5例、植物生存状态3例、死亡8例。结论脑弥漫性轴索损伤的死亡率高，早期诊断治疗是其抢救成功的关键。     

弥漫性轴索损伤的CT影像分析

目的探讨CT对弥漫性轴索损伤（DAI）的诊断价值。方法回顾性分析临床确诊的56例DAI患者的CT特点及临床表现。结果CT表现：①脑灰白质交界区、胼胝体及其周围、脑干、基底节区多发或单发小出血灶；②弥漫性白质密度减低，灰白质界线不清，双侧脑室和脑池受压、变窄或消失；③合并硬膜下血肿、脑室及蛛网膜下腔出血、骨折等。临床表达为深昏迷，GCS评分≤6～7分，生命指征紊乱，瞳孔散大，光反射消失。结论CT影像结合临床表现对DAI有较高的诊断价值。     

64例弥漫性轴索损伤的临床特点与预后分析

目的 分析脑弥漫性轴索损伤(diffuse axonal injury,DAI)的临床特征及其预后因素。方法 按Levi分级法依据入院时GCS和瞳孔情况,将我科1997年1月至2000年7月收治的64例DAI病人分为Ⅰ～Ⅳ级,分析各级临床特点、入院时GCS和瞳孔变化与预后(GOS)的关系。结果 Ⅰ级2例(1/64),Ⅱ级8例(2/64),Ⅲ级18例(18/64),Ⅳ级36例(36/64)。Ⅲ、Ⅳ级的入院时GCS均明显低于Ⅱ级(P<0.05),其昏迷时间明显长于Ⅱ级(P<0.01)。预后按GOS分5级:恢复良好组、中残组、重残组、植物状态组及死亡组。死亡组年龄分别大于中、重残组(P<0.05)。死亡组GCS分别低于中、重残组(P<0.05),植物状态组GCS低于中残组(P<0.05)。死亡组瞳孔改变发生率分别高于中、重残组(P<0.05)。结论 入院时GCS和瞳孔情况有助于对DAI病情判断及预后估计。     

Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

Objective

This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury.

Methods

From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients'' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem.

Result

Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days).

Conclusion

Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.     

Locations and Clinical Significance of Non-Hemorrhagic Brain Lesions in Diffuse Axonal Injuries

Objective

Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance.

Methods

Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted.

Results

Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes.

Conclusion

NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.     

直线加速度所致的猫弥漫性轴突损伤

目的：为了解直线加速度在颅脑损伤特别是在弥漫性轴突损伤（ＤＡＩ）中的作用。方法：用一套撞击装置对２６只猫进行实验。结果：直线加速度可以导致几乎所有类型的颅脑损伤，包括颅骨骨折、蛛网膜下腔出血、硬膜下血肿、硬膜外血肿、脑挫伤、脑干损伤，特别是ＤＡＩ。ＤＡＩ的特征性改变－轴突回缩球在２４小时内死亡的动物脑标本中看不到，２４小时后可见到，７２小时则多而典型，７天时仍然存在。结论：凡能使脑的神经纤维受到广泛剪力和（或）张力的任何形式的外部作用均可产生ＤＡＩ。     

Freeze-fracture studies of reactive myelinated nerve fibres after diffuse axonal injury

Summary We have studied the axonal and myelin sheath response in diffuse axonal injury after angular acceleration using the freeze-fracture and thin section techniques. It was found that the glial-axonal junction was intact until 1 h after injury. But upon loss of the nodal axolemma specialisations, after 3 to 4h, the dimeric particles of the glial-axonal junction (GAJ) were lost and, by 6h, the myelin lamellae became separated from the axonal remnant. There was a correlated loss of glial membrane specialisations of the GAJ during this separation. In the internodal region a suggestion of membrane damage occurred after 20 min but discrete myelin dislocations (particle-free areas) were not found until 1-h survival and were extensive by 6 h. Areas of loosely organised myelin occurred between intact axons at 7–28 days after injury. No evidence for growth cone formation was obtained.Part of this work was presented at the Xth International Congress of Neuropathology, Stockholm, 7–12th September, 1986. Attendance at this meeting (WLM) was supported by the Wellcome Trust     

弥漫性轴索损伤280例临床分析

目的 探讨弥漫性轴索损伤(DAI)患者的临床特点、治疗及预后.方法 广东省揭阳市人民医院神经外科自1999年1月至2009年12月共收治280例DDI患者,其中76例予以双侧开颅减压术治疗,204例保守治疗,回顾性分析患者的临床资料及治疗效果.结果 本组患者恢复良好122例(43.6%),轻残或遗留部分并发症86例(30.7%),重残37例(13.2%),植物性生存2例(0.7%),死亡33例(11.8%).结论 脑肿胀,一侧或双侧瞳孔散大DAI患者应及早行开颅去骨瓣减压术,昏迷时间长者及早行气管切开保持呼吸道通畅,早期脱水治疗选用20%甘露醇+速尿+白蛋白模式,辅助甲强龙冲击及亚低温治疗.

Abstract：

Objective To discuss the clinical features and pathological changes of diffuse axonal injury (DAI), and explore the treatment and prognosis of patients with DAI. Methods Two hundred and eighty patients with DAI, admitted to our hospital from January 1999 to December 2009,were enrolled in our study; bilateral decompressive craniotomy was performed in 76 patients and conservative treatment in 204 patients; the clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Good recovery was achieved in 122 patients (43.6%), mild disability in 86 (30.7%), severe disability in 37 (13.2%), persistent vegetative state in 2 (0.7%) and death in 33 (11.8%). Conclusion Decompressive craniotomy is needed as early as possible for patients with brain swelling, unilateral or bilateral mydriasis; early tracheotomy should be performed for patients in coma for a long time to maintain airway smooth; 20% mannitol plus furosemide plus albumin, together with methylprednisolone and mild hypothermia therapy, can be employed to treat patients with early dehydration.     

连续应用7．5％高渗盐水治疗重型颅脑损伤的临床观察

目的 探讨7．5％高渗盐水治疗重型颅脑损伤的效果及副作用。方法 将50例颅脑损伤患者随机分为高渗盐水治疗组（HTS组，26例）和甘露醇治疗组（M组，24例）。HTS组静脉滴注7．5％高渗盐水2ml／kg，M组静脉滴注甘露醇250ml，均为q8h，连续7d。用药前及用药后第1、3、7天测患者血电解质、渗透压和肾功能，用药前及用药后2周对患者进行GCS评分。结果 与用药前相比，用药后6h两组患者的平均动脉压、心率、呼吸均无统计学差异（P〉0．05），而HTS组患者中心静脉压在用药后明显升高（P〈0．05）。用药后第1、3、7天HTS组患者血K^＋、Na^＋、Cl^-、尿素氮、肌酐及血浆渗透压均无显著改变；M组血K^＋、Na^＋、Cl^-、肌酐及血浆渗透压无显著改变（P〉0．05），但用药后第7天尿素氮值较同期HTS组明显升高（P〈0．05）。用药2周后，两组患者GCS评分均有明显改善（P〈0．05）。结论 7．5％高渗盐水降低颅脑损伤引起的高颅内压是安全、有效的，连续使用效果好、副作用少。     

CPG15在大鼠脑弥漫性轴索损伤中的表达及意义

目的探讨大鼠脑弥漫性轴索损伤（diffuse axonal injury，DAI）中不同时间点脑额叶皮层组织中候选可塑性相关基因15（candidate plasticity related gene 15，CPG15）的表达及意义。方法雄性SD大鼠54只，随机分为正常对照组18只和DAI组36只；采用头颅侧向旋转致伤方法制作DAI模型，并按伤后大鼠处死时间分为第1d、4d、7d、10d、14d、21d组，每组6只。用免疫组化方法检测大鼠脑额叶皮层CPG15的表达，并分析其表达变化特点。CPG阳性结果判断标准以细胞浆内出现棕黄染色颗粒为阳性，反之为阴性。结果正常对照大鼠额叶皮质中无CPG15的表达；DAI后，CPG15表达于神经元细胞的胞浆内。DAI后1d，大鼠大脑皮层仅见少量CPG15表达；DAI后4d、7d、10dCPG15表达逐渐增强，至14d达到峰值；损伤后第21d仍维持在较高水平。DAI后不同时间，神经元数量逐渐增多。结论DAI后，随着脑内CPG15表达增强，神经元数量也逐渐增多，提示二者存在正相关；本文对有关机理进行了讨论。