微创穿刺碎吸术结合开颅术抢救急性巨大硬膜外(下)血肿并脑疝

目的 探讨微创穿刺碎吸术结合开颅术抢救急性巨大硬膜外（下）血肿并脑疝,以期提高急性巨大硬膜外血肿（下）并脑疝抢救的成功率。方法CT检查明确颅内情况后,定位并局部备皮、消毒,局麻下先用YL-I型一次性颅内血肿粉碎穿刺针穿刺血肿腔后粉碎抽吸、引流不凝血及血凝块,再完善术前准备,全麻下行标准大骨瓣开颅血肿清除加去骨瓣减压术。结果本组18例脑疝行血肿腔穿刺碎吸,一侧瞳孔散大4例缩小到正常,一侧瞳孔散大12例有所缩小,双侧瞳孔散大2例一侧瞳孔缩小,2例无效,再行开颅术后,2例由双侧脑疝缩至单侧脑疝后经抢救无效死亡,余16例瞳孔均缩至正常,均存活并恢复良好,存活率达88．8％。结论微创穿刺碎吸术结合开颅术抢救急性巨大硬膜外（下）血肿并脑疝成功率高。     

微创穿刺抽吸治疗高血压脑出血156例临床分析

目的 总结微创穿刺抽吸治疗高血压脑出血的治疗体会。方法 对我院经微创穿刺抽吸术治疗的156例高血压脑出血病人的临床资料进行回顾性分析。结果 死亡35例，术前瞳孔未散大者死亡率8．3％（9／108），出现瞳孔散大者死亡率54．2％（26／48）。结论 高血压脑出血致脑疝或濒临脑疝的病人应选择传统的骨瓣开颅血肿清除加去骨瓣减压术，以降低死亡率。     

微创穿刺抽吸引流术治疗脑出血合并脑疝的可行性探讨

目的探讨微创穿刺抽吸引流术治疗脑出血合并脑疝的可行性。方法回顾性研究9例合并血肿侧颞叶钩回疝的脑出血病例资料,均采用微创穿刺抽吸引流术治疗。结果术中血肿平均抽吸率为32%(10%~65%),9例病人抽吸前脑皮质均从切开的硬脑膜处疝出,8例抽吸后减压效果良好,脑皮质塌陷;1例抽吸后减压效果不明显,复查CT示血肿增大,行开颅术。术后发生再出血1例,肺部感染4例,癫疒间1例。术后6个月预后良好6例,预后不良3例。结论微创穿刺抽吸引流术治疗合并脑疝的脑出血病人可能仍是安全有效的,值得进一步扩大病例研究。     

颅内血肿微创穿刺粉碎清除术后再出血的临床分析

目的探讨颅内血肿微创穿刺粉碎清除术后再出血的原因及防治。方法对50例颅内血肿微创穿刺粉碎清除术后9例再出血进行分析。结果术中再出血5例，术后再出血4例。结论颅内血肿微创穿刺粉碎清除术后再出血与手术定位、手术时间、术前术后血压、抽吸量有关，需综合病人全面情况进行防治。     

颅内血肿微创穿刺粉碎清除术后再出血的临床分析

目的探讨颅内血肿微创穿刺粉碎清除术后再出血的原因及防治。方法对50例颅内血肿微创穿刺粉碎清除术后9例再出血进行分析。结果术中再出血5例,术后再出血4例。结论颅内血肿微创穿刺粉碎清除术后再出血与手术定位、手术时间、术前术后血压、抽吸量有关,需综合病人全面情况进行防治。     

脑微创引流针引流在颅内血肿合并脑疝中的运用

目的分析脑微创引流针引流在抢救颅内血肿合并脑疝中的运用价值。方法回顾36例颅内血肿合并脑疝患者使用脑微创引流针引流治疗的资料,我们使用YL-1型穿刺针(北京万特福公司生产)于常规开颅前在急诊室行血肿穿刺引流。结果本组27例通过脑微创引流针引流或加用尿激酶灌注达到去除颅内血肿的目的,引流后患者的症状均很快得到改善,其他9例后行开颅血肿清除减压术。结论脑微创引流针引流在颅内血肿合并脑疝急诊处理中有重要意义。     

快速钻颅减压抢救脑疝期颅内血肿的临床观察

目的 观察紧急钻颅减压在抢救特急性颅内血肿中的疗效.方法 将急症证实为脑疝期颅内血肿随机分为钻颅减压组20例,行紧急钻颅减压后再行开颅血肿清除术;常规手术组20例,行常规骨瓣开颅血肿清除术.结果 钻颅减压组有效降低颅内高压时间需15min,常规手术组需55min,钻颅减压组双侧瞳孔散大、病死率显著低于常规手术组,良好率显著高于常规手术组(P＜0.005).结论 快速钻颅减压抢救脑疝期颅内血肿,能有效降低病死率和致残率.     

微创颅内血肿清除术治疗颅内血肿48例分析

目的 探讨微创血肿清除术在治疗颅内血肿中的应用，并总结术前、术中及术后的经验体会。方法 利用CT片定位穿刺点。局麻下应用YL-1型颅内血肿粉碎穿刺针穿刺抽吸；中洗液化清除颅内血肿，并引流1～7d。结果 首次血肿清除率〉50％30例；拔管前清除率〉70％或基本清除18例；神志清楚、好转出院28例。结论 颅内血肿微创清除术适应证广、快速安全、创伤小、不易感染、疗效确切、操作简便，是目前治疗颅内血肿最有效的手术方法之一。     

快速钻颅减压抢救脑疝期颅内血肿40例分析

目的　评价脑疝期颅内血肿快速钻颅减压的临床效果。方法　对 78例脑疝期颅内血肿随机分为治疗组 40例 ,采用快速钻颅吸出部分积血和血凝块 ,迅速缓解颅内高压后再行开颅血肿清除术 ;对照组 3 8例 ,采用常规骨瓣开颅血肿清除术。结果　治疗组有效降低颅内高压时间需 15～ 2 8min(平均 18min) ;对照组 45～ 74min(平均 5 5min) ,经wilcoxon检验P <0 0 5 ,有显著性差异。治疗组总死亡率低于对照组 ,其中治疗组双侧瞳孔散大死亡率显著低于对照组 (P <0 0 5 )。治疗组良好率显著高于对照组 (P <0 0 5 )。结论　快速钻颅减压抢救脑疝期颅内血肿 ,能有效降低死亡率及致残率     

342例高血压脑内血肿分类治疗疗效分析

目的评价微创清除术、大骨瓣开颅血肿清除 去骨瓣减压术综合治疗高血压脑出血的临床疗效。方法大骨瓣开颅血肿清除 去骨瓣减压术86例,微创穿刺颅内血肿抽吸术195例,微创穿刺术 大骨瓣开颅血肿清除 去骨瓣减压术61例。结果342例高血压脑内血肿病人,恢复良好137例(40.06%),中残150例(43.57%),重残42例(12.28%),死亡13例(3.80%)。结论微创清除术结合大骨瓣开颅血肿清除 去骨瓣减压术可明显降低高血压脑内血肿的病死率和致残率。     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。