脑脊液置换术治疗蛛网膜下腔出血疗效分析

目的 探讨蛛网膜下腔出血进行治疗。方法 采用脑脊液置换术对68例蛛网膜下腔出血的治疗。结果 蛛网膜下腔出血的患者经此方法治疗明显提高疗效，减少脑积水并发症，降低致残率及病死率。结论 脑脊液置换术是治疗蛛网膜下腔出血有效方法之一。     

脑脊液置换术治疗蛛网膜下腔出血20例的护理体会

<正>2007-0—2012-01,我科对20例经弹簧圈介入栓塞术治疗后的动脉瘤性蛛网膜下腔出血(SAH)患者实施脑脊液置换术,疗效满意,现将护理体会总结如下。1资料与方法1.1一般资料本组20例患者中男12例,女8例;年龄32～68岁,平均52岁。均以突发剧烈头痛、恶心和呕吐入院。经脑CT和DSA检查,确诊为动脉瘤性蛛网膜下腔出血。均施行弹簧圈致密栓塞破裂动脉瘤,并于术后次日行脑脊液置换术。     

脑脊液置换术治疗蛛网膜下腔出血的观察及护理

蛛网膜下腔出血的复发率及死亡率较高，应用脑脊液置换术治疗蛛网膜下腔出血取得较好的疗效，与对照组相比有显著差异（Ｐ〈０．０５），未发生肾衰及脑血管痉挛等并发症。护理要点是心理护理、病情观察、预防颅内感染、肾衰、脑血管痉挛、再出血。     

脑脊液置换术联合地塞米松鞘内注射治疗蛛网膜下腔出血的疗效观察

目的:观察脑脊液置换术联合地塞米松鞘内注射治疗蛛网膜下腔出血(SAH)患者头痛症状缓解及病情转归情况.方法:73例原发性蛛网膜下腔出血病例随机分为对照组和治疗组.所有病例给予脱水降颅压、镇痛、防止并发症等常规治疗,治疗组另行腰椎穿刺脑脊液置换术联合地塞米松鞘内注射.结果:两组病例治疗后头痛缓解情况比较以及治疗后总有效率比较差异均有统计学意义(P＜0.05).结论:腰椎穿刺脑脊液置换术联合地塞米松鞘内注射用于治疗SAH后头痛和并发症疗效显著,值得在临床上推广应用.     

不等量脑脊液置换治疗外伤性蛛网膜下腔出血

外伤性蛛网膜下腔出血是颅脑外科的常见病,在中重度颅脑损伤中．发病率达25％～45％。我院自1999年开展不等量脑脊液置换治疗外伤性蛛网膜下腔出血,显示其有效性和安全性,现报告如下。     

腰大池持续引流治疗重型颅脑损伤并蛛网膜下腔出血的应用体会

目的 探讨持续腰大池引流治疗重型颅脑损伤并蛛网膜下腔出血的临床疗效. 方法 回顾性分析74例重型颅脑损伤并蛛网膜下腔出血患者临床资料,随机分为对照组（50例）以及实验组（24例）.对照组患者采用单纯开颅血肿清除及去骨瓣减压术进行治疗,实验组患者采用开颅血肿清除及去骨瓣减压术后联合腰大池持续引流进行治疗.治疗后对两组患者进行长期随访,并对治疗效果进行总结评估.结果 治疗组并发症的发生（脑血管痉挛、脑梗死、脑积水、癫痫）低于对照组,但治疗组继发颅内感染高于对照组,其疗效、预后（死亡、植物生存、重残、轻残、良好）优于对照组,经统计学分析,P＜0.05或P＜0.01,差异有统计学意义. 结论 重型颅脑损伤并蛛网膜下腔出血早期行腰大池引流可有效降低病死率和致残率,减少并发症和后遗症,改善预后.但也面临继发性颅内感染的危险,应合理选用.     

椎管引流术治疗自发性蛛网膜下腔出血的临床研究

目的 探讨椎管引流术治疗自发性蛛网膜下腔出血(SAH)的疗效。方法 将第1次自发性SAH的患者随机分成治疗组(218例)和对照组(173例)，治疗组在常规治疗的同时，加作早期、大引流量椎管引流术治疗，而对照组只作常规治疗，根据GCS评级比较两组疗效。结果 椎管引流治疗组之恢复良好率(70．2％)较对照组(53．2％)明显增高，而致残率(18．3％)及病死率(10．1％)较对照组明显降低。结论 早期、大引流量椎管引流术能明显提高自发性SAH的恢复良好率，而明显降低致残率及病死率。     

脑脊液置换法治疗蛛网膜下腔出血的观察与护理

蛛网膜下腔出血（SAH）是神经内科急危重症之一。10％～50％死于首次发作［1］，80％发病年龄为30～69岁，但任何年龄均可发病。且易并发再出血、脑血管痉挛、脑积水、蛛网膜粘连等，直接影响治疗预后。我院于1996～1997年采用脑脊液置换法治疗9例，疗效满意。1一般资料本组病例均符合1986年中华医学会第二次全国脑血管病学术会议修订的关于SAH诊断标准。其中男6例，女3例，年龄30～73岁，平均52岁。病程1～48h。均经CT扫描确诊为原发性SAH。其中神志清醒7例，有2例在发病72h后意识逐渐转清。患者均有不同程度的头痛、呕吐、颈项强直。…     

脑脊液置换治疗蛛网膜下腔出血的观察及护理

目的:探讨腰穿脑脊液置换治疗蛛网膜下腔出血的观察及护理方法.方法:观察组(28例)采用内科常规治疗及腰穿脑脊液置换术治疗;对照组(30例)单用内科常规治疗方法治疗.观察两组病人用药的最大剂量及临床表现,并结合治疗采取有效的护理措施.结果:观察组用药剂量明显减少,头痛持续时间明显缩短,治愈率明星提高(P＜0.01).结论:脑脊液置换治疗蛛网膜下腔出血效果良好.术前做好降颅压,书后严密观察,加强心理护理及健康教育是护理要点.     

外伤性蛛网膜下腔出血对重型颅脑损伤患者Marshall CT分级预后的影响

目的研究外伤性蛛网膜下腔出血是否影响颅脑损伤患者Marshall CT分级的预后。方法收集本院2008年2月至2008年12月间共66例重型颅脑损伤患者,按照Marshall CT分级分为弥漫性损伤组和局灶性损伤组,分析外伤性蛛网膜下腔出血的发生率及对其预后的影响。结果66例重型颅脑损伤的患者中,合并外伤性蛛网膜下腔出血的发生率高达77．27％,并且预后较差。根据Marshall CT分级,弥漫性损伤组中,伤后6个月GOS评分合并蛛网膜下腔出血者平均为3．00,不合并者为4．25;局灶性损伤组中,伤后6个月GOS评分合并蛛网膜下腔出血者平均为1．91,不合并者为3．00,鼹者有统计学差异（P〈0．05）。结论外伤性蛛网膜下腔出血在重型颅脑损伤患者中极为常见,并且影响Marshall CT分级的预后。     

Should computed tomography scanning replace lumbar puncture in the diagnostic process in suspected subarachnoid hemorrhage?

The role of lumbar puncture and computed tomography scanning for initial diagnosis of subarachnoid hemorrhage has been evaluated in a retrospective survey of 283 consecutive cases. The material has been divided into early-and late-diagnosed cases with 72 hours after bleeding as the demarcation line between groups. The early-diagnosed cases have been further subdivided into patients exhibiting contraindications for lumbar puncture, patients with a typical history of apoplectic headache, and patients presenting with a diffuse noncharacteristic history. Four initially alert patients suffered neurological deterioration associated with the performance of lumbar puncture, which corresponds to a complication rate of 2.2%. It is concluded that all cases of suspected intracranial hemorrhage in the pediatric age group should be immediately investigated by computed tomography. In old age, individual factors determining the patient's operability overshadows all other aspects. In the intermediate age group lumbar puncture is preferable to diagnose subarachnoid hemorrhage in cases first seen in a late stage, due to both the high rate of falsely suspected cases as well as the poor visualization of degenerating blood in the cerebrospinal fluid by computed tomography. In patients suffering severe apoplectic headache with nuchal rigidity, lumbar puncture is without question superfluous. If neck stiffness is not considered, 4.68 computed tomography investigations per 100,000 individuals would be performed yearly in falsely suspected cases, a diminishingly small cost corresponding to < 1% of all cranial computed tomography scans performed in this region. Early-diagnosed patients with a diffuse atypical history constitute a small, low risk group for lumbar puncture. It may be acceptable in such patients to diagnose subarachnoid hemorrhage either by means of computed tomography or lumbar puncture, depending on the availability of local computed tomography resources.     

Different release of cytokines into the cerebrospinal fluid following surgery for intra- and extra-axial brain tumours

Summary To elucidate the role of cytokines in brain repair processes and in local inflammation after neurosurgical procedures, cerebrospinal fluid (CSF) samples from 8 patients with intra-axial tumours and 8 patients with extra-axial tumours were analysed for interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-6, IL-8, IL-10, and tumour necrosis factor (TNF)-alpha at the beginning and after surgery. Levels of IL-6 and IL-8 increased dramatically in all patients just hours after surgery and fell during subsequent days. IL-1beta was found only in low amounts in the CSF of both patient groups. Other cytokines demonstrated different courses. In patients with intra-axial tumours IL-1ra peaked two to four hours after surgery with a subsequent decrease. In patients with extra-axial tumours there was a continuous low-level IL-1ra release into the CSF without a peak. TNF-alpha was not present in detectable levels in the CSF after surgery for extra-axial tumours but was found to peak two to four hours after surgery for intra-axial tumours. IL-10 was detected in the CSF of both patient groups, but a higher peak was seen after surgery for extra-axial tumours. These results suggest different requirements for the cytokine response and an involvement of different cell types in cytokine release. However, the analysis of the CSF from both patient groups showed no differences in cell counts and populations, with a mild pleocytosis being present in both patient groups after surgery. Therefore, we conclude that after surgery for extra-axial tumours cytokines were predominately produced by non-immune cells stimulated through hypoxia or mechanical irritation. After surgery for intra-axial tumours with a significant brain injury immune cells — activated by necrotic material —seem to be involved in the process of cytokine synthesis. In these cases an additional IL-1ra and TNF-alpha peak was found and these cytokines may be markers for cerebral injury.     

Early change of plasma and cerebrospinal fluid arginine vasopressin in traumatic subarachnoid hemorrhage

Objective： To investigate the changes and effects of arginine vasopressin （AVP） in patients with acute traumatic subarachnoid hemorrhage （tSAH）. Methods： The plasma and cerebrospinal fluid （CSF） level of AVP, and intracranial pressure （ICP） were measured in a total of 21 patients within 24 hours after tSAH. The neurological status of the patients was evaluated by Glasgow Coma Scale （GCS）. Correlation between AVP and ICP, GCS was analyzed respectively. Meanwhile, 18 healthy volunteers were recruited as control group. Results： Compared with control group, the levels （pg/ml） of AVP in plasma and CSF （x±s） in tSAH group were significantly increased within 24 hours （38.72±24.71 vs 4.54±1.38 and 34.61±21.43 vs 4.13± 1.26, P〈0.01）, and was remarkably higher in GCS ≤8 group than GCS〉8 group （50.96±36.81 vs 25.26±12.87 and 44.68±31.72 vs 23.53±10.94, P〈0.05）. The CSF AVP level was correlated with ICP （r= 0.46, P〈0.05）, but no statistically significant correlation was found between plasma AVP, CSF AVP and initial GCS （r= -0.29, P〉0.05 and r= -0.32, P〉0.05, respectively）. The ICP （ram Hg） in tSAH patients was elevated and higher in GCS ≤ 8 group than in GCS〉8 group （25.9±9.7 vs 17.6±5.2, P〈0.05）. Conclusion： Our research suggests that AVP is correlated with the severity oftSAH, and may be involved in the pathophysiological process of brain damage in the early stage after tSAH. It seems that compared with the plasma AVP concentration, CSF AVP is more related to the severity oftSAH.     

重度颅脑损伤后继发脑积水的早期诊断和治疗

目的:探讨重度颅脑损伤后继发脑积水的早期诊疗方法及愈后。方法:对12例重度颅脑损伤后继发脑积水的患者均一期或二期行脑室—腹腔分流术,10例随访半年～3年。结果:12例术后2周～3月CT复查脑室大小恢复正常。随访10例,生活自理8例,意识及肢体活动好转2例。结论:重度颅脑损伤后继发脑积水是影响愈后的严重并发症,早期确诊和手术治疗是减少其死亡率及致残率的关键。     

Changes of endothelin concentration in cerebrospinal fluid and plasma of patients with aneurysmal subarachnoid hemorrhage

To investigate the clinical significance of endothelin (ET), a potent vasoconstrictor peptide, in subarachnoid hemorrhage (SAH) and SAH-related cerebral vasospasm, we measured the ET-like immunoreactivity (ETLI) in plasma and cerebrospinal fluid (CSF) obtained serially from patients with SAH due to ruptured cerebral aneurysm who underwent aneurysmal surgery. The normal ET–LI levels in plasma and CSF (n = 24) were 12.4±2.0 (mean±s.d.) and 9.1±1.2 pg·ml^-1, respectively. Plasma ET-LI levels in patients with SAH before surgery (16.8±7.8 pg·ml^-1, n = 8) were higher than the normal values ( P <0.05), and became further elevated after surgery (22.5±9.4 pg·ml^-1). ET-LI levels in plasma and CSF one day after surgery were 18.7±5.5 and 18.4±6.8 pg·ml^-1 ( P <0.01 vs. normal values), respectively, and declined thereafter. The plasma and CSF ET-LI levels in patients who showed symptomatic vasospasm became concomitantly elevated again. These results suggest that ET is involved in SAH-related vasospasm and raise the possibility that surgical stress influences the vasospasm.     

单唾液酸四己糖神经节苷脂钠注射液治疗重型颅脑损伤的疗效观察

目的观察单唾液酸四己糖神经节苷脂钠注射液对重型颅脑损伤患者血浆肌酸激酶同工酶BB（CreatinekinaseBB,CK-BB）的动态变化以及临床疗效。方法将60例重型颅脑损伤患者（GCS≤8分）分成两组,观察组30例在常规治疗的基础上加用单唾液酸四己糖神经节苷脂钠注射液治疗,对照组30例采用常规治疗。观察患者血浆CK-BB变化,并两组于伤后6个月按GOS预后评分评定预后,同时比较两组患者的意识好转率。结果观察组患者血浆CK-BB明显低于对照组。观察组恢复良好率（17/30）与对照组（8/30）比较,差异有统计学意义（P〈0.05）。观察组治疗后1个月清醒23例,而对照组l3例,两组清醒率比较,差异有统计学意义（P〈0.01）。两组清醒时间比较,观察组为（14.56±6.56）天,对照组为（20.85±10.92）天。结论单唾液酸四己糖神经节苷脂钠注射液能有效降低重型颅脑损伤患者血浆CK-BB的水平,并且不仅能加速重型颅脑损伤患者清醒,还能促进预后,提高生活质量。单唾液酸四己糖神经节苷脂钠注射液是治疗重型颅脑损伤安全有效的药物,可以广泛地应用于临床。     

Increased levels of nitrite/nitrate in the cerebrospinal fluid of patients with subarachnoid hemorrhage

The role of nitric oxide (NO) in the mechanism of delayed cerebral vasospasm (VS) after subarachnoid hemorrhage (SAH) was investigated by analyzing the stable metabolites of NO, nitrite and nitrate, by the Griess method in the cerebrospinal fluid (CSF) and venous blood of 29 patients with SAH, the CSF of 22 control patients, and venous blood from eight normal subjects. VS was defined as diffuse and severe angiographical vasospasm detected by angiography performed around days 7–9 after the onset. Six of the 29 patients had VS. The nitrite/nitrate levels in the blood of patients with SAH were almost within the range of those in normal subjects, but the levels in the CSF of patients with SAH were significantly higher than those of the control group. Patients with VS after SAH had significantly lower levels in the CSF than patients without VS on days 7–9, when VS is most likely to occur. These observations suggest that NO production in the CSF environment occurs following SAH, but possibly may not provoke VS. Received: 2 June 1998 / Accepted: 15 April 1999     

Urolithin A alleviates early brain injury after subarachnoid hemorrhage by regulating the AMPK/mTOR pathway-mediated autophagy

ObjectiveUnfavorable outcomes in patients with subarachnoid hemorrhage (SAH) are mainly attributed to early brain injury (EBI). Reduction of neuronal death can improve the prognosis in SAH patients. Autophagy and apoptosis are critical players in neuronal death. Urolithin A (UA) is a natural compound produced by gut bacteria from ingested ellagitannins and ellagic acid. Here, we detected the role of UA in EBI post-SAH.MethodsWe established an animal model of SAH in rats by endovascular perforation, with administration of UA, 3-methyladenine (3-MA) and Compound C. SAH grading, neurological function, brain water content, western blotting analysis of levels of proteins related to apoptosis, autophagy and pathways, blood-brain barrier (BBB) integrity, TUNEL staining, and immunofluorescence staining of LC3 were evaluated at 24 h after SAH.ResultsSAH induction led to neurological dysfunctions, BBB disruption, and cerebral edema at 24 h post-SAH in rats, which were relieved by UA. Additionally, cortical neuronal apoptosis in SAH rats was also attenuated by UA. Moreover, UA restored autophagy level in SAH rats. Mechanistically, UA activated the AMPK/mTOR pathway. Furthermore, inhibition of autophagy and AMPK limited UA-mediated protection against EBI post-SAHConclusionUA alleviates neurological deficits, BBB permeability, and cerebral edema by inhibiting cortical neuronal apoptosis through regulating the AMPK/mTOR pathway-dependent autophagy in rats following SAH.     

重型颅脑损伤后高血糖的临床意义分析

目的探讨重型颅脑损伤（SBI）后高血糖的临床意义。方法回顾性收集了128例重型闭合性颅脑损伤（GCS≤8分）患者的临床资料,应用统计学方法分析不同颅脑损伤损伤类型、入院时GCS水平、瞳孔光反应、近期预后与术后24小时内血糖水平的关系。颅脑损伤类型分为硬膜外血肿、硬膜下血肿、脑内血肿/脑挫裂伤3组;入院时GCS水平分成3-4分组、5-6分组、7-8分组;瞳孔对光反应情况分成双侧瞳孔光反应存在、单侧瞳孔光反应消失、双侧瞳孔光反应消失3组。近期预后分为预后良好和预后不良2组。结果重型颅脑损伤组血糖水平明显高于中型颅脑损伤组（P〈0.05）,3-4分组血糖水平（16.11±2.85）mmol/L明显高于7-8分组（12.33±2.23）mmol/L和5-6分组（14.11±2.85）mmol/L,而5-6分组血糖水平也明显高于7-8分组,各组间差异均有统计学意义（P〈0.05）;双侧瞳孔光反应消失组术后24小时内血糖水平（19.29±3.87）mmol/L,明显高于双侧瞳孔光反应存在组（15.69±2.83）mmol/L和单侧瞳孔光反应消失组（17.84±3.89）mmol/L,单侧瞳孔光反应消失组血糖水平明显高于双侧瞳孔光反应存在组,各组间差异均有统计学意义（P〈0.05）;预后不良组术后24小时内血糖水平明显高于预后良好组（P〈0.05）。血糖16.7mmol/L组的预后明显差于≤16.7mmol/L组（P〈0.05）。结论重型颅脑损伤后血糖水平明显增高。颅脑损伤伤情越重,血糖水平越高。高血糖是严重影响重型颅脑损伤预后的重要指标。