53例儿童中枢神经系统感染血清及脑脊液降钙素原检测的临床意义探讨

目的探讨钙素原(PCT)检测在儿童中枢神经系统(CNS)感染中的临床应用价值。方法采用半定量固相免疫测定法测定53例CNS感染患儿血清和脑脊液(CSF)PCT,20例非感染性疾病作为对照。结果化脑组血清PCT阳性率(100%)明显高于病脑组(8.0%)、结脑组(0),差异有统计学意义;化脑组脑脊液PCT阳性率76.9%,病脑组及结脑组阳性率均为0;化脑组血清PCT与脑脊液PCT之间的直线相关关系有统计学意义,且呈正向变化关系。血清PCT检测诊断化脑的敏感性、特异性、阳性预测值、阴性预测值均达到100%(以PCT≥2.0ng/ml为阈值),脑脊液PCT检测以上各值分别为76.9%、100%、100%、95.2%(以PCT≥0.5ng/ml为阈值)。结论血清及脑脊液PCT检测可作为化脑鉴别于病脑及结脑的一项灵敏指标,可用于辅助指导儿童CNS感染性疾病的早期诊治。     

儿童肠道病毒性脑炎的临床特点及脑脊液病毒检测结果分析

目的 探讨肠道病毒性脑炎(EVE)儿童的临床特点及脑脊液病毒检测结果。方法 回顾性分析河南省儿童医院2015年1月至2017年12月收治的216例EVE病儿病例资料。结果 临床特点:发热症状占69.44%,头痛占64.35%,呕吐占75.00%;6[KG-*3]～8月发病占39.35%,9[KG-*3]～11月占31.48%;白细胞(WBC)总数＞10×10⁹/L占68.98%,C反应蛋白(CRP)升高占57.87%;脑电图轻中度异常检出率21.76%。脑脊液病毒检测:肠道病毒(EV)通用核酸检测阳性率55.56%,其中埃柯病毒30(ECHO30)型占79.17%;特异性IgM抗体阳性95例;不同年龄段、不同发病时间段病儿脑脊液EV通用核酸阳性检出率、特异性IgM抗体阳性检出率比较均差异有统计学意义(P均＜0.05)。预后:均治愈出院。结论 儿童EVE主要症状为发热、头痛及呕吐,好发于夏、秋季;脑脊液病毒检测以ECHO30为主且特异性IgM抗体检出率较高,经综合治疗后病儿预后良好。     

Slow elimination of mannitol from human cerebrospinal fluid

Objective: The rise of intracranial pressure above the pre-treatment level (rebound phenomenon) is considered, in part, a consequence of osmotherapeutics penetrating into the intracranial compartments. Methods: The kinetics of mannitol in the ventricular CSF were studied in 10 patients with cerebrovascular stroke after a single i.v. infusion of 37.5 g over 15 min. Results: Maximum mannitol CSF concentrations (mean = 51.1 mg · l⁻¹) were reached 2–12 h after termination of the infusion. Mean t_1/2CSF (18.3 h) by far exceeded t_1/2S (3.71 h). AUC_CSF/AUC_S, as a measure of mannitol CSF penetration, ranged from 0.037 to 0.390. Conclusion: The slow elimination of mannitol from CSF implies a high risk of accumulation in the central nervous compartments after repeated dosing. Received: 20 January 1997 / Accepted in revised form: 12 June 1997     

病毒性脑炎患儿脑脊液和血清S100B蛋白变化的意义

目的 观察病毒性脑炎（VE）患儿急性期和恢复期脑脊液和血清S100B蛋白浓度变化,探讨S100B蛋白对VE患儿脑损害的评估价值.方法 40例病毒性脑炎（昏迷组16例,无昏迷组24例）住院患儿为观察组,30例无神经系统疾病、无肿瘤的外科腰麻患儿为对照组.采用酶联免疫吸附试验双抗体夹心法（ELISA）,检测其急性期和恢复期脑脊液和血清S100B蛋白 水平,并应用SPSS15.0统计软件包进行统计学分析.结果 病毒性脑炎患儿急性期脑脊液和血清S100B蛋白水平显著高于恢复期患儿和对照组（均P〈0.001）;VE昏迷组的脑脊液和血清S100B蛋白含量显著高于无昏迷组和对照组（均P〈0.001）,无昏迷组脑脊液和血清S100B旦白含量与对照组也有差异（p〈0.001）;脑脊液S-100B蛋白含量与其血清含量呈正相关.结论 脑脊液和血清S100B蛋白作为病毒性脑炎患儿脑损害的标志物,有助于判定脑组织受损的严重程度及评估患儿的预后.     

病毒性脑炎患儿脑脊液IL-6和血清CRP的动态变化与意义

目的研究病毒性脑炎患儿脑脊液白细胞介素石（IL-6）和血清C反应蛋白（CRP）的变化及其临床意义。方法用双抗体夹心酶标免疫分析法测定病毒性脑炎脑脊液（CSF）IL-6和血清CRP的水平，并分析IL-6和CRP的相关性。结果轻重度病毒性脑炎脑脊液（CSF）IL-6和血清CRP水平均有升高，其水平与病毒性脑炎的严重程度显著相关（P〈0．01），并且病毒性脑炎脑脊液（CSF）IL-6和血清CRP含量之间呈正相关（P〈0．05）。结论脑脊液（CSF）IL-6和血清CRP是评价病毒性脑炎早期炎症损伤程度的重要生化指标，其含量变化与伤情严重程度密切相关，通过对其动态观察可及时判断病毒性脑炎的严重程度及预后。     

Effects of carbamazepine on cerebrospinal fluid somatostatin

This paper reports the reduction of the concentration of the neuropeptide somatostatin in the CSF of patients with affective illness during treatment with the anticovulsant carbamazepine. None of the other psychotropic agents used in this study similarly affected CSF somatostatin, although zimelidine appeared to increase CSF somatostatin in a small number of patients. The potential mechanism and significance of the effects of carbamazepine on CSF somatostatin are discussed in relation to the psychotropic, anticonvulsant, and analgesic properties of carbamazepine.     

Concentration of ondansetron in cerebrospinal fluid following oral dosing in volunteers

This study measured the concentrations of ondansetron in plasma and cerebrospinal fluid (CSF) in six volunteers after oral dosing to steady state. Ondansetron concentrations ranged from 39.5–147 ng ml^–1 in plasma and from 2.6–15.4 ng ml^–1 in CSF. There was good correlation between plasma and CSF concentrations (r=0.89,p=0.017). CSF concentrations were less than 15% of plasma concentrations in all cases, indicating that the rate of penetration of the blood brain barrier by ondansetron is low.     

手足口病患儿脑脊液及外周血白细胞检测结果分析

目的 通过对手足口病患儿脑脊液及外周血白细胞的检测,探究其对患儿病情以及预后价值的判断价值.方法 对我院于2012年2月至2013年2月收治的162例手足口病患儿的脑脊液进行外周血白细胞计数、蛋白质以及葡萄糖检测以及白细胞检测(为观察组),另外对162例进行体检检测(对照组),比较两组患者经过检测后的检测结果.结果 观察组患儿脑脊液白细胞数升高所占比例较高(67.9％),而且白细胞升高者以单细胞核升高为主,经过对比其外周血白细胞的检测结果要高于对照组(P＜0.05),此外,外周血白细胞与脑脊液白细胞水平并无相关性.结论 对手足口患儿进行脑脊液白细胞计数、蛋白质以及葡萄糖检测以及外周血白细胞计数检测有利于判断并且治疗手足口病患儿并发脑炎病情程度,这对患儿的预后判断具有极大的意义.     

原发性颅内肿瘤患者的临床及脑脊液细胞学检查

目的探讨原发性颅内肿瘤患者的临床和脑脊液细胞学检查在肿瘤定性诊断中的应用价值。方法对13例原发性颅内肿瘤患者的脑室、腰椎穿刺引流的脑脊液进行细胞学检查。结果手术前由脑室、腰椎穿刺引流行脑脊液检查确诊的颅内肿瘤患者分别占44．4％和50．0％。结论脑脊液细胞学检查可作为术前颅内肿瘤影像学定性诊断的重要补充，亦可作为病理学诊断的手段之一。     

病毒性脑炎患儿脑脊液钙、镁、铁水平的变化及临床意义

目的探讨病毒性脑炎(VE)患儿脑脊液钙、镁、铁水平的变化及临床意义。方法测定30例VE患儿(VE组)和10例非VE患儿(对照组)脑脊液钙、镁、铁水平。结果与对照组比较,VE组脑脊液钙、镁水平降低(P<0.05),铁水平升高(P<0.05);VE组脑脊液钙水平与镁水平呈正相关(r=0.428,P<0.05),钙水平与铁水平呈负相关(r=-0.532,P<0.01)。结论 VE患儿脑脊液钙、镁水平降低,铁水平增高可能参与了VE的病理生理过程。     

不同置换量对蛛网膜下腔出血脑脊液置换疗效的影响

目的 观察不同置换量对蛛网膜下腔出血脑脊液置换疗效的影响。方法 将60例患者随机分为A组（大量脑脊液置换组）30例、B组（小量脑脊液置换组）30例。对A、B组腰椎穿刺用三通管行脑脊液置换，置换总量A组50～70ml做，B组10～30ml／次。结果头痛缓解时间A组〈B组（P〈0．01）；继发脑血管痉挛、脑积水的发生率A组〈B组（P〈0．05），但再出血的发生率两组差异无显著意义（P〉0．05）；总有效率A组〉B组（P〈0．05）。结论 早期大量脑脊液置换治疗蛛网膜下腔出血的效果优于小量脑脊液置换，但都不能减少再出血的发生。     

Alterations in cerebrospinal fluid dopamine metabolites following physostigmine infusion

The effect of IV physostigmine administration on the cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) and dihydroxyphenylacetic acid (DOPAC) in normal subjects was determined. After an adjustment for differing CSF concentrations of probenecid, physostigmine was found to elevate CSF HVA and DOPAC concentrations. The authors discuss these changes in CSF HVA and DOPAC and their possible relationship to the ability of physostigmine to decrease the symptoms of some patients with tardive dyskinesia.     

外伤性脑脊液鼻漏的治疗体会

目的探讨外伤性脑脊液鼻漏的治疗方法和临床疗效。方法回顾性分析87例外伤性脑脊液鼻漏患者的临床资料、治疗方法和效果。结果72例患者经一般保守治疗后2—7d自愈;15例1周内未自愈,后行持续性腰大池放液,9例3～10d停止漏液愈合,6例最后行手术治疗。所有患者出院后随访3～6个月无复发。结论保守治疗是外伤性脑脊液鼻漏的主要治疗方法,而手术治疗要抓住术前准确定位、术中选择合适的颅骨钻孔位置、骨瓣形成后充分暴露漏口、硬脑膜破口与颅骨缺损处仔细分离、术后防止脑水肿等关键点才能要做到修补确切,安全可靠。     

持续蛛网膜下腔引流脑脊液治疗脑外科术后切口脑脊液漏分析

目的 探究持续蛛网膜下腔引流脑脊液治疗脑外科术后切口脑脊液漏的临床效果.方法 采用回顾性分析的方法,分析了我院在2013年1月1日至2013年12月31日间收治的108例经脑外科治疗术后切口发生脑脊液漏的患者的临床资料,根据治疗方法的不同,将108例患者分为实验组和对照组,实验组采用持续蛛网膜下腔引流术,对照组采用漏口旁头皮下引流术.结果 实验组的治疗有效率与对照组相当（P＞0.05）,实验组治疗时间明显少于对照组（P＜0.05）,实验组治疗过程中不良反应的发生率明显低于对照组（P＜0.05）.结论 持续蛛网膜下腔引流脑脊液治疗脑外科术后切口脑脊液漏的临床治愈率高,治疗时间短,病人痛苦小,且不良反应少,安全可靠,值得临床推广使用.     

Tryptophan levels in human cerebrospinal fluid after acute and chronic ethanol consumption

The essential amino acid tryptophan was measured in human cerebrospinal fluid by a fluorometric high-performance liquid chromatographic method. Acute ethanol consumption (80 g) by healthy volunteers lead to a decrease in tryptophan levels during intoxication. After intoxication no difference from base levels was evident. Following ingestion of a higher dose (120 g) the mean levels of tryptophan remained unchanged. Alcoholics were found to have elevated tryptophan levels in the cerebrospinal fluid as compared to healthy subjects even after abstention from ethanol for several weeks.     

Endorphin levels in human cerebrospinal fluid during alcohol intoxication and withdrawal

Levels of endorphins were determined in CSF from alcoholics while intoxicated or after 1 day, 1 week, and 3 weeks of abstinence, respectively, and from healthy volunteers. The level of endorphins was determined by a radioreceptor assay and two fractions were analyzed. With fraction 1, there were no significant differences between the groups, but the level was negatively correlated with the blood-alcohol level. The mean level of endorphin fraction 2 during the early withdrawal phase was significantly lower than those of the other groups. With respect to clinical conditions and monoamine metabolites, fraction 2 in early withdrawal correlated significantly to duration of abuse and age. During late withdrawal, fraction 1 level correlated to depressive symptoms and, after 3 weeks of abstinence, fraction 2 correlated to MOPEG levels. This study suggests that endorphin systems are affected during alcohol intoxication and withdrawal in alcoholics.     

Effects of alcohol on cerebrospinal fluid norepinephrine in rhesus monkeys

Alcohol (1–3 g/kg) significantly increased the concentration of cerebrospinal fluid (CSF) norepinephrine (NE) in rhesus monkeys. This effect is consistent with the previously demonstrated activational and possible antidepressant effect of low doses of alcohol. The greatest increase was observed in subjects with low baseline levels of CSF NE. Individual differences in activation or euphoria could be related to differential increases in CSF NE following alcohol consumption.     

鼻内镜下脑脊液鼻漏修补的临床疗效观察

目的 观察鼻内镜下脑脊液鼻漏修补手术的临床疗效.方法 将本院耳鼻咽喉头颈外科及神经外科收治的26例脑脊液鼻漏患者按随机数字表法分为试验组与对照组,每组13例;对照组采用传统的颅内修补手术治疗,试验组采用鼻内镜下修补手术治疗,比较两组的治疗效果.结果 试验组一次手术后漏口修补成功的患者有12例,占92.3％;对照组一次手术后漏口修补成功的患者有9例,占69.2％;试验组一次手术后漏口修补成功率明显高于对照组,差异有统计学意义（P＜0.05）.试验组术后发生并发症的患者为1例,占7.7％,明显低于对照组的23.1％（3/13）,差异有统计学意义（P＜0.05）.试验组平均住院时间为（13.5±3.0）d,明显短于对照组的（24.0±4.1）d,差异有统计学意义（P＜0.05）.结论 对脑脊液鼻漏患者采用鼻内镜下修补手术治疗,有效地提高了手术的成功率,改善了患者的症状,并且术后产生的并发症少,值得临床推广应用.     

Toxicokinetics of soman in cerebrospinal fluid and blood of anaesthetized pigs

The toxicokinetics of the four stereoisomers of the nerve agent C(±)P(±)-soman was analysed in cerebrospinal fluid (CSF) and blood in anaesthetized, spontaneously breathing pigs during a 90-min period after injection of soman. The pigs were challenged with different intravenous (i.v.) doses of C(±)P(±)-soman corresponding to 0.75–3.0 LD₅₀ (4.5, 9.0 and 18 μg/kg in a bolus injection and 0.45 μg/kg per min as a slow infusion). Artificial ventilatory assistance was given if, after soman intoxication, the respiratory rate decreased below 19 breaths/min. Blood samples were taken from a femoral artery and CSF samples from an intrathecal catheter. The concentrations of the soman isomers were determined by gas chromatography coupled with high resolution mass spectrometry. All four isomers of soman were detected in both blood and CSF samples. The relatively non-toxic C(±)P(+) isomers disappeared from the blood stream and CSF within the first minute, whereas the levels of the highly toxic C(±)P(−) isomers could be followed for longer, depending on the dose. Concurrently with the soman analyses in blood and CSF, cholinesterase (ChE) activity and cardiopulmonary parameters were measured. C(±)P(−) isomers showed approx. 100% bioavailability in CSF when C(±)P(±)-soman was given i.v. as a bolus injection. In contrast, C(±)P(−) isomers displayed only 30% bioavailability in CSF after slow i.v. infusion of soman. The ChE activity in blood decreased below 20% of baseline in all groups of pigs irrespective of the soman dose. The effect of soman intoxication on the respiratory rate, however, seems to be dose-dependent and the reason for ventilatory failure and death. Artificial ventilation resulted in survival of the pigs for the time-period studied. Received: 3 March 1998 / Accepted: 5 May 1998     

围手术期护理干预在自发性蛛网膜下腔出血的脑脊液置换术中体会

目的 探讨护理干预对自发性蛛网膜下腔出血的脑脊液置换术患者的疗效分析.方法 对我院收治的87例患者随机分为实验组以及对照组,并对实验组行护理干预.结果 实验组患者的预后以及相关并发症明显低于对照组.结论 对自发性蛛网膜下腔出血的脑脊液置换术患者实施护理干预可提高患者预后.