原发性脑干出血患者预后的影响因素分析

目的探讨影响原发性脑干出血患者预后的危险因素。方法回顾性分析41例原发性脑干出血患者的临床资料,发病30d根据GOS评分评估患者预后,1-3分为预后不良（21例）,4—5分为预后良好（20例）。采用COx比例风险模型分析影响患者预后的因素,对有意义的连续性变量进行受试者工作特征（ROC）曲线分析,判定其截断值。结果单因素分析显示饮酒、出血量、出血部位（单/双侧）、急性脑积水、入院时GCS评分、瞳孔变化与预后有关,COX比例风险模型分析显示,年龄、出血量和入院时GCS评分是影响患者预后的独立因子。ROC曲线分析显示,年龄、出血量和入院时GCS评分的截断值分别为51．5岁、7．7ml和5．5分。结论影响原发性脑干出血病人预后的因素很多,年龄、出血量和入院时GCS评分可作为评估预后的独立指标,年龄〉51．5岁、出血量〉7．7ml、入院时GCS评分〈5．5分的患者提示30d预后不良。     

非手术治疗自发性基底节区脑出血预后因素分析

目的 探讨非手术治疗自发性基底节区出血预后相关的因素.方法 回顾性分析贵阳市第二人民医院神经外科2005年4月至2012年6月收治的109例随访资料完整的患者,采用Kaplan-Meier法进行单因素分析.Log-rank法进行生存率显著性检验,Cox比例风险回归模型作多因素分析.结果 单因素分析显示入院时GOS评分、GCS评分、高血压、出血量、出血破入脑室、肺部感染及血糖与预后有关联.多因素分析显示GCS评分、出血量和血糖是自发性基底节区出血预后相关的独立危险因素.结论 发病时GCS评分、出血量和血糖水平是影响患者预后的重要因素.     

高血压性脑干出血预后因素分析

目的探讨高血压性脑干出血预后相关的因素。方法回顾性分析57例高血压性脑干出血病人的临床资料,采用Kaplan—Meier法计算生存期及进行生存分析。以随访GOS评分为预后的判断指标,使用Fisher精确概率检验进行单因素分析,二分类Logistic回归作多冈素分析。结果单因素分析显示：入院时GCS评分、脑干血量及并发症是影响脑干出血预后的因素（P〈0．05）;其中人院时GCS评分13～15分,腑十出血量≤5ml及无并发症的病人预后较好。多因素分析显示：GCS评分和行发症是高血压性脑十出血预后相关的独立凶素（P〈0．05）。GCS评分越低,病人生存时间越短;有并发症者明显较无行发症者预后差。结论发病时GCS评分、出血量和并发症是影响病人预后的重要因素。     

80例原发性脑干出血的临床与预后分析

目的 探讨原发性脑干出血的临床特点及影响预后的相关因素.方法回顾性调查80例原发性脑干出血患者的临床资料,对其临床表现、诊治及预后进行分析.结果 80例原发性脑干出血患者死亡49例,病死率为61.3%.入院时血压高、血糖高、出血量＞5 ml、GCS评分≤8分、瞳孔异常、早期并发消化道出血患者病死率更高.结论 高血压动脉硬化是原发性脑干出血的主要病因,意识障碍、出血量、GCS评分和早期并发消化道出血是评估脑干出血预后的重要指标.     

高血压性脑干出血的临床特点和预后分析

目的探讨高血压性脑干出血的临床特点和预后。方法对103例高血压性脑干出血患者的临床资料进行回顾性分析,以治疗或随访3个月后的日常生活活动能力(ADL)分级作为预后评价指标。采用卡方检验对可能影响患者预后的因素(包括性别、年龄、出血量、出血部位、出血破入脑室、GCS评分、瞳孔变化、并发症及收缩压和舒张压)进行单因素分析,对其中差异有统计学意义(P0.05)者采用有序多分类Logistic回归方法进行多因素分析,寻找影响患者预后的主要因素;并对出血量因素进行受试者工作特征曲线(ROC)分析。结果 103例患者预后为ADLⅠ级14例、ADLⅡ级10例、ADLⅢ级11例、ADLⅣ级15例、ADL V级7例、ADLⅥ级46例。单因素分析结果显示出血量、出血部位、出血破入脑室、GCS评分、瞳孔变化、并发症及入院时收缩压等因素差异有统计学意义(P0.05),进一步多因素分析显示出血量、出血部位和并发症是影响患者预后的重要因素(均P0.05)。ROC曲线分析显示死亡风险的出血量阈值为≤6 mL。结论高血压性脑干出血的预后较差,其预后主要取决于出血量、出血部位和并发症。     

高血压性基底节区脑出血的三种不同治疗方案预后分析

目的通过对高血压性基底节区脑出血患者不同治疗方案预后分析,探讨微创术治疗本病的最佳治疗方案。方法收集119例高血压性基底节区脑出血住院患者的出血量和GCS评分等临床资料,根据其治疗方案分为保守、开颅、微创3组,以第30天SSS评分为预后指标。采用SPSS10.0软件,分析不同出血量、GCS评分水平的患者预后与3种治疗方案的关系。结果多因素分析显示,出血量、GCS评分和保守治疗为患者预后的独立影响因素。出血量25.0~39.9mL各组患者预后差异无统计学意义,出血量40.0mL~90.0mL微创组和开颅组患者预后优于保守组。出血量25.0~90.0mL、GCS评分≤7分开颅组患者预后优于保守组,微创组与保守组患者预后比较差异无统计学意义;GCS评分≥8分者微创组患者预后优于保守组,开颅组和保守组比较差异无统计学意义。结论高血压性基底节区脑出血,出血量40.0~90.0mL、GCS评分≥8分的患者最适合于行微创术,GCS评分≤7分患者适合开颅手术。     

影响基底节出血患者手术治疗预后的因素

目的 探讨影响基底节出血患者手术治疗预后的相关因素.方法 对157例经手术治疗的基底节出血患者的临床资料[性别、年龄、术前格拉斯哥昏迷量表(GCS)评分、血糖、C-反应蛋白(CRP)水平、出血量、中线移位、脑室出血]与其预后进行相关性分析.结果 单因素分析显示,患者的年龄、GCS评分、血糖、血肿量中线移位及脑室出血与预后显著相关(P＜0.05 ～0.005).多因素Logistic回归分析显示,年龄、GCS评分、血肿量及脑室出血为影响患者预后的独立相关因素(P ＜0.05 ～0.005).结论 影响基底节出血患者手术治疗预后的相关因素有年龄、GCS评分、出血量及脑室出血.     

高血压脑出血短期预后相关因素研究

目的分析影响高血压脑出血短期预后的相关因素。方法选择高血压脑出血患者304例,比较预后不良组及预后良好组在性别、年龄、HICH知识知晓、高血压病程、心脏病史、家族性脑出血史、糖尿病、出血部位、血肿量、破入脑室、入院GCS评分、就诊时间、肺部感染间的差异,并对预后影响因素进行Logistic多因素分析。结果 304例患者中,预后良好184例,预后不良120例,其中死亡31例。预后良好组与预后不良组在性别、高血压(≥10a)、血糖(8mmol/L)、HICH知识知晓、血肿量、破入脑室、入院GCS评分、就诊时间及肺部感染方面比较差异有统计学意义(P0.05)。多因素Logistic分析显示,性别、血肿量及入院GCS评分为高血压脑出血短期预后的独立影响因素。结论性别、血肿量及入院GCS评分是影响高血压脑出血的独立危险因素,应引起临床重视。     

脑干出血的预后分析

目的研究脑干出血患者预后相关因素.方法回顾分析我院81例脑干出血患者.结果脑干出血患者死亡率与患者血压、体温、白细胞计数、血糖的升高、意识障碍重、GCS评分低、出血量大、脑干变形、血肿破入脑室有关.结论对脑干出血预后判断非常重要,经采取积极措施可降低死亡率.     

高血压脑出血手术治疗近期预后的影响因素

目的分析高血压脑出血手术治疗近期预后的影响因素。方法以我院收治的100例高血压脑出血患者为研究对象,患者出院时行ADL(日常生活能力)评分分级,根据评分结果分为预后良好组(1~3级)与预后不良组(4~6级),统计并比较2组临床资料,包括年龄、术前GCS评分、出血部位、手术时机、术后是否再出血等,对影响近期预后指标行单因素及多因素Logistic分析。结果预后良好组术前GCS评分明显高于预后不良组,手术时机明显长于预后不良组、脑实质内出血量明显少于预后不良组(P0.005);预后良好组瞳孔异常率、幕上出血率、术后再出血率分别为1.7%、98.3%、0.0%,较预后良好组的50.0%、70.0%、20.0%差异有统计学意义(P0.001)。多因素Logistic分析影响手术治疗近期预后的独立危险因素包括术前GCS评分及术后再出血。结论高血压脑出血手术近期预后影响因素较多,其中术前GCS评分及术后再出血为其独立危险因素。     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.