侧方扩散反应电位监测在面神经显微血管减压术的意义

目的探讨面肌痉挛微血管减压(MVD)术中监测侧方扩散反应(LSR)的临床意义。方法回顾性分析35例面肌痉挛病人的临床资料,均行乙状窦后入路面神经MVD,术中电生理监测LSR。结果 35例病人术中均监测到LSR,LSR术中消失33例,术后病人症状完全消失者;2例术中LSR未消失,其中症状部分缓解1例,未缓解1例。结论 MVD术中监测LSR能够帮助术者判断责任血管,减少神经、血管牵拉时间,提高面肌痉挛MVD疗效。     

松果体区非肿瘤性囊肿性病变的外科治疗

目的总结松果体区非肿瘤性囊肿性病变的外科治疗经验。方法回顾性分析7例有症状的松果体区非肿瘤性囊肿病人的临床资料、手术方法和预后。采用显微手术切除4例，神经内镜囊肿部分切除1例，神经内镜三脑室底造瘘术2例。结果术后临床症状均改善或消失，术后随访6个月～3年。随访期间影像学复查松果体区囊肿性病变消失或显著缩小。结论松果体区非肿瘤性囊肿性病变的外科治疗。应根据囊肿的性质选择合理的手术方法；本病术后预后好。     

伴有颅底凹陷症的三叉神经痛3例

目的探讨颅底凹陷症引起的三叉神经痛的术前筛查及治疗方法。方法回顾性分析3例伴颅底凹陷症的三叉神经痛病人的临床资料,均采用乙状窦后锁孔入路,显微镜下行三叉神经包膜松解及神经梳理治疗。结果术后3例病人疼痛症状消失,术后均出现病侧面部轻度麻木。病人住院8～12d,出院时面部麻木感均不同程度缓解。术后2～8个月电话回访时病人面部麻木感均消失。结论颅底凹陷症引起的三叉神经痛伴桥小脑角区神经走行变异,由于三叉神经受压变薄,又无明显责任血管,且术中暴露欠理想,增大术中操作难度及术后并发症的发生率。     

显微血管减压术后面肌痉挛症状的演变特点

目的分析面肌痉挛行显微血管减压手术后症状的演变特点,探讨其可能机制。方法回顾性分析90例面肌痉挛病人的临床资料,均采用显微血管减压手术治疗。根据Cohen分级对病人术后1年内不同时间段的面肌痉挛程度进行评分,得到症状评分-时间曲线,分析面肌痉挛症状改善的演变特点。结果显微血管减压术后,将病人分为术后顷刻和出院时症状均消失组(A组)、术后顷刻症状消失而出院时又再现组(B组)、术后顷刻和出院时症状均减轻组(C组),3组病人长期随访症状消失比例分别为90.1%、83.3%、66.7%。术后症状评分-时间曲线表明:总体演变趋势先急剧下降,后低幅波动,并逐渐下降,术后9个月趋于稳定。结论显微血管减压术后,面肌痉挛症状有逐渐缓解趋势。根据术后即刻至出院前的症状恢复情况将病人分组,有助于预测显微血管减压手术的长期疗效。     

非交通性蛛网膜囊肿的诊断与神经内镜治疗

目的 探讨蛛网膜囊肿(intracranial arachnoid cyst，IAC)的影像学分类、手术适应证和神经内镜治疗。方法 对22例IAC病人行CT蛛网膜下腔脑池造影(computed tomographic cistemography，CTC)，选择非交通性蛛网膜囊肿(noncommunicating intracranial arachnoid cyst，NCIAC)病例，硬质内镜行NCIAC-脑池交通术或脑室广泛造瘘术治疗，术后进行随访。结果 经CTC检查，22例病人中15例确诊为NCIAC病人，有确切的神经系统症状体征，神经内镜手术后NCIAC病例临床症状改善或消失。本组病人无手术死亡，仅1例病人术后3个月并发慢性硬脑膜下血肿，行钻孔引流术治愈。9例NCIAC病人CT随访示囊腔明显缩小，脑组织复位。结论 (1)CTC对IAC病人具有诊断特异性，运用CTC可将IAC病人分为交通性蛛网膜囊肿(communicating intracranial arachnoid cyst，CIAC)和NCIAC。(2)症状性NCIAC具有神经外科手术指征。(3)神经内镜下NCIAC-脑池交通术，操作简便，微创，疗效肯定，术后并发症少。     

神经外科病人置胃管的护理探讨

神经外科病人常因病情重，昏迷时问长，或脑瘤压迫、术后等造成吞咽困难，常需留置胃管给予鼻饲饮食、给药。部分病人常伴有应激性溃疡，通过留置胃管可观察上消化道出血情况，对食物返流的病人还可行胃肠减压，以避免食物误吸引起窒息的危险。但由于病人的吞咽反射迟钝或消失，给插管带来一定难度。根据多年来我们在临床实践中对置胃管病人插管的护理体会，现介绍如下。     

18例罕见胚胎发育不良性神经上皮肿瘤的治疗

目的探讨胚胎发育不良性神经上皮肿瘤（dysembryoplastic neuroepithelial tumor，DNT）的临床治疗特点。方法对2001年至2007年治疗18例DNT病人的临床症状，影像学、电生理和病理资料进行回顾性分析。结果18例DNT病人表现癫痫发作，发作形式与部位有关，14例行脑电图描记，其中10例行术中皮层脑电图描记切除病灶，术后随访1月～6年，3例仍有癫痫发作，15例癫痫发作消失，无肿瘤复发。结论DNT属良性肿瘤，手术效果良好，行术中脑电图描记可有效切除癫痫灶。     

脑立体定向术前、后帕金森病患者的智能状况分析

本文通过对我院1997年1月~1998年11月住院的31例帕金森病患者的研究发现，帕金森病对患者的智能存在影响，年龄、病程和文化程度对此影响较突出。行脑立体定向术后（丘脑腹外侧核射频毁损术），病人在临床症状消失或明显改善的同时，智能状况也有明显的好转。     

脑内型海绵状血管瘤的手术治 疗简

目的探讨脑内型海绵状血管瘤（Cavemous angioma，CA）的诊治经验。方法回顾性分析19例脑内型CA的病例资料，均经手术切除和病理证实。结果19例病灶全切除。病人术后癫癎、头痛头晕、局灶神经功能障碍均有不同程度改善或消失。术后随访2周～6．9年，平均1．1年，2例病人术后仍需继续抗癫癎治疗。结论显微手术是治疗有症状脑内型CA的可靠方法，术前娩影材质（自制标记）定位及术中B超实时引导简便易行，临床可广泛应用。     

三叉神经痛诱发窦性停搏1例

目的探讨三叉神经痛诱发窦性停搏的临床特点、病因及治疗。方法回顾性分析行经皮穿刺微球囊压迫术(percutaneous micro-balloon compression,PBC)治疗的1例三叉神经痛诱发窦性停搏病人的临床资料,并结合文献进行分析。结果术后病人痛感消失,心电监测可见持续窦性心律,术后遗留面部麻木及咀嚼肌无力,3个月后逐渐恢复。结论三叉神经痛诱发窦性停搏病人少见,其与血管压迫间可能存在关联性。PBC手术可解除三叉神经痛,去除窦性停搏的诱因是有效的治疗方法。     

儿童良性癫Xian的随访研究

目的:探讨儿童良性癫癎的预后。方法:对１８３例儿童良性癫癎进行了２~１０年的随访观察。结果:１５６例(８５．２５%)脑电图恢复正常,其中１４３例经控制发作后已停药２~８年,均无临床发作。结论:良性癫癎患儿可无家族史。脑电图睡眠诱发试验可提高本病确诊率。经抗癫癎治疗控制发作１~２年后,脑电图恢复正常者可以停药。及早诊断及治疗者,预后较好。本病患儿可无明显心理障碍。     

帕罗西汀联合加味逍遥散治疗抑郁症的随机对照研究

目的观察帕罗西汀联合加味逍遥散治疗抑郁症的疗效和安全性。方法采用随机数字表法将60例符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的患者分为实验组和对照组各30例,两组均给予帕罗西汀20 mg/d治疗,实验组在此基础上加用加味逍遥散,对照组加用安慰剂治疗,于治疗前及治疗半月、1月、2月后采用汉密尔顿抑郁量表(HAMD)评定疗效,并于治疗前及治疗后2月抽血检验血清脑源性神经营养因子(BDNF)浓度,采用副反应量表(TESS)监测药物副反应。结果治疗半月、1月、2月后,实验组HAMD评分均较治疗前低,差异有统计学意义(P0.05)。治疗1月、2月后,对照组HAMD评分均低于治疗前,差异有统计学意义(P0.05)。治疗半月、1月、2月后,两组HAMD评分比较差异有统计学意义(P0.05)。治疗2月后,两组有效率比较差异有统计学意义(P0.05)。治疗1月、2月后,两组血清BDNF浓度均较治疗前高,差异有统计学意义(P0.05)。治疗2月后,实验组血清BDNF浓度高于对照组,差异有统计学意义(P0.05)。实验组不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论帕罗西汀联合加味逍遥散对抑郁症的疗效优于单独使用帕罗西汀,副作用更少。     

脑卒中后吞咽障碍的认知训练治疗

目的分析脑卒中后吞咽障碍的认知训练治疗效果。方法以2014-01—2017-03新乡市第一人民医院收治的82例脑卒中后吞咽障碍患者为研究对象,根据随机数字表法分为对照组和观察组,其中对照组仅应用常规康复训练治疗,而观察组在康复训练时增加认知训练治疗,经过3个月、6个月、9个月、12个月治疗后,评价2组MMSE、ADL评分情况。结果治疗后,观察组3个月、6个月、9个月、12个月的MMSE和ADL评分明显优于对照组,2组对比差异有统计学意义(P0.05)。结论脑卒中吞咽障碍患者常规康复训练过程中增加认知训练后,可以明显改善患者的认知功能,使患者病情进展得到有效控制,从而提高患者的生活质量,值得推广应用。     

巴曲酶对实验性糖尿病大鼠周围神经传导速度的影响

目的探讨巴曲酶对糖尿病大鼠周围神经传导速度的作用。方法用链脲佐菌素一次性腹腔注射诱导糖尿病大鼠模型,在造模后2月和3月时腹腔注射巴曲酶8Bu/(kg·d),10d后测定坐骨神经运动及感觉神经传导速度。结果糖尿病大鼠在造模后2月和3月时周围神经传导速度明显减慢;用巴曲酶治疗的糖尿病大鼠周围神经传导速度明显加快。结论巴曲酶治疗能纠正糖尿病大鼠周围神经传导速度的异常。     

巴曲酶对糖尿病周围神经病大鼠血液流变性的影响

目的探讨巴曲酶对糖尿病周围神经病大鼠血液流变性的作用。方法用链尿佐菌素一次性腹腔注射诱导糖尿病大鼠模型,在造模后2月和3月时腹腔注射巴曲酶8Bu/(kg·d),10d后测定坐骨神经运动及感觉神经传导速度;然后取血测定其血液流变学指标。结果糖尿病大鼠在造模后2月和3月时周围神经传导速度明显减慢,血液流变学指标明显增加,用巴曲酶治疗后均明显改善。结论巴曲酶治疗糖尿病周围神经病的机制之一可能为改善其血液流变学。     

Therapy of Infantile Spasms with Valproate: Results of a Prospective Study

In a prospective study, 22 children with recently manifested infantile spasms (18 patients with symptomatic and 4 with idiopathic infantile spasms) were treated with sodium valproate (VPA). Before VPA was instituted, a loading test was performed to exclude abnormal patterns of VPA metabolites by gas chromatography and mass spectroscopy of serum and urine. This test was repeated during VPA therapy; an abnormal pattern of VPA metabolites was not observed. VPA was started in increasing dosage until infantile spasms were controlled or a maximum dose of 100 mg/kg/day was reached. If VPA did not control seizures or at least reduce frequency significantly after a trial of 4-6 weeks, dexamathasone was added to VPA. If focal seizures occurred in association with localized epileptogenic EEG discharges, carbamazepine (CBZ) was added to VPA. After 4 weeks of VPA monotherapy, infantile spasms were controlled in 11 children. After 3 months of therapy, 16 children were free of seizures (14 patients VPA monotherapy), and 4 children had reduction of seizure frequency to less than 25%. VPA doses varied between 40 and 100 mg/kg/day (mean 74). The mean plasma concentration was 113 micrograms/ml (range 46-177). After 6 months of therapy, total seizure control was achieved in 20 of 22 patients (16 children VPA monotherapy). The mean observation time was 16 1/2 months (range 6-36 months). There were seven relapses in six children during the first 7 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term effects of partial denervation on sprouting and muscle fiber area in rat plantaris.

The long-term effects of partial denervation on the muscle fiber cross-sectional area, degree of axonal sprouting, and end-plate morphology were examined 1, 3, 6, 9, and 12 months postsurgery in rat plantaris muscle. After 1 month of partial denervation, mean cross-sectional areas of type I and type II myofibers were significantly lower than that of sham-operated controls; fiber atrophy and hypertrophy was observed. After 3 months, we found no statistical difference in the mean cross-sectional fiber area between the two experimental groups. After 6 months, the fiber areas were now significantly larger than controls, possibly the result of compensatory work hypertrophy, due to the overuse of remaining hyperexpanded motor units. Preterminal, intranodal, and intraterminal sprouting were found to significantly increase from 1 to 6 months following partial denervation. While sprouting was enhanced, the number of terminal branch points per end plate did not change. Following 9 months of partial denervation and overuse, the mean fiber areas significantly decreased as compared to controls. The former muscles were found to contain angulated fibers, group atrophy, and increased levels of axonal sprouting. The number of terminal branches per end plate was now significantly increased over control values, possibly a compensatory response to reduced synthesis of neurotrophic factor(s) and/or transmitter-related components. At 12 months, fiber areas, axonal sprouting, and the number of terminal branches per end plate have all decreased. Degenerating end plates, denervated myofibers, angulated fibers, and group atrophy were observed. It would appear that aging-like changes are occurring earlier in chronically stressed, partially denervated muscles.     

Recovery and loss of muscle force of rat plantaris after partial denervation

The isometric contractile characteristics of rat plantaris muscles were assessed 1, 3, 6, 9, and 12 months after resection of the L4 radicular nerve. After 1 month of partial denervation, twitch and tetanus were significantly lower (26.1 and 22.1%, respectively) than those of sham-operated rats. Plantaris muscle weight was reduced (22.5%), but twitch-to-tetanus ratio (TW/TT), time-to-peak, and one-half relaxation time were not changed significantly. At 3 months, average twitch force was normal but average tetanic force was significantly lower (27.1%) than control value. Muscle weight was reduced (28.9%), but TW/TT was increased by 31%. After 6 months, twitch, tetanus, and all other variables were similar to those of control rats. Normal twitch at 3 months indicates that all muscle fibers have been reinnervated by sprouting from L5 motor axons; however, the new synaptic contacts may not support the tetanic response. At 9 months, muscle force was again reduced and remained at about the same level at the 12-month interval. These results are consistent with the recovery and loss of function seen in poliomyelitis and the postpolio syndrome.     

Modifications in number and morphology of dendritic spines resulting from chronic ethanol consumption and withdrawal: a Golgi study in the mouse anterior and posterior hippocampus

Using Golgi-impregnated mice brains, the effects of 2.5, 6.5, and 9.5 months of chronic ethanol consumption were investigated with regard to morphology and number of dendritic spines of CA1 hippocampal pyramidal neurons. The posterior part of the hippocampus was more sensitive to the effects of ethanol consumption than the anterior one. In the posterior part of the structure, the number of dendritic spines was reduced by 25 and 33% after 6.5 and 9.5 months of treatment, respectively, as compared to age-matched controls. Moreover, the remaining spines appeared shorter than normal. After 9 months of ethanol treatment followed by 0.5, 1, and 2 months of withdrawal, the number of dendritic spines was reduced by 24, 19, and 7.5% in the posterior hippocampus, respectively. In the anterior part of the hippocampus, a significant loss of dendritic spines (-20.5%) was observed only after 9.5 months of ethanol consumption. After 1 month of withdrawal, both number and morphology of dendritic spines appeared normal in the anterior hippocampus. These results demonstrate that chronic alcohol consumption leads to morphological alterations and loss of dendritic spines in the hippocampus. However, both dendritic spine number and morphology progressively return to normal values after 2 months of withdrawal. This phenomenon is another example of neuronal plasticity in adult animal brain.     

氯氮平和氟哌啶醇对慢性精神分裂症患者糖、脂代谢及体重变化的比较分析

目的 比较氯氮平和氟哌啶醇对慢性精神分裂症患者的血糖、血脂代谢及体重变化情况。方法 采用氯氮平（89例）和氟哌啶醇（87例）对慢性精神分裂症患者进行治疗，并于治疗前后不同时段作血糖、胰岛素、血脂和体重的测定，同时比较其浓度变化和进行相关性分析。结果 ①氯氮平组在用药的第3和第6个月末，血糖浓度异常发生率分别为7．9％及23．6％，氟哌啶醇组为1．1％和2．3％。②氯氮平组在用药第3个月末，空腹及餐后2小时血糖浓度均较基线值升高，第6个月末继续升高；而在氟哌啶醇组上述两个治疗时段的变化则不明显。③氯氮平组在用药的第3个月末，体重平均增高为治疗前的5．5％，第6个月末增高为治疗前的9．1％，而氟哌啶醇组则变化不明显，④两组患者在用药第6个月末，胰岛素浓度均高于基线值；氯氮平组的胆固醇和甘油三酯浓度均高于基线值，而氟哌啶醇组则无明显变化。⑤在用药第6个月时，氯氮平组血糖、胰岛素、血脂浓度、体重变化和血药浓度之间均有一定相关性（r=0．21～0．99），差异均有统计学意义（P〈0．05或〈0．01）。结论氯氮平对慢性精神分裂症患者的糖、脂代谢和体重有影响，治疗期间需监测。