高血压脑出血微侵袭外科治疗的临床研究

目的比较分析高血压脑出血微侵袭血肿引流术与传统开颅血肿清除术的疗效。方法对37例高血压脑出血行血肿粉碎清除术或经皮钻颅血肿粉碎引流术,33例采用传统开颅血肿清除术。结果微创手术治疗组平均住院(19 ±4)d,昏迷(5 ±3)d,而传统手术组分别为(28 ±11)d、(13 ±3)d,均有显著性差异(P <0.05)。微创手术组并发症发生率、病死率分别为2.62%、8.10%,而传统手术组分别为29.4%、30.3%,均有显著性差异(P<0.01)。头颅CT动态检查发现微创手术组9~19d大部分血肿消失,水肿明显消退,而传统手术术后水肿期较长,恢复缓慢。结论微创手术治疗高血压脑出血具有创伤小、恢复快、简便易行、并发症少、病死率低等优点。     

微创血肿碎吸术治疗少量高血压脑出血的临床效果

目的探讨微创血肿碎吸术治疗少量高血压脑出血的临床疗效。方法选择2013-01-2014-12在我院治疗的高血压脑出血患者74例的临床资料进行回顾性分析。其中34例采用微创血肿碎吸术治疗为研究组,40例采用保守治疗为对照组。比较2组的临床疗效。结果研究组血肿吸收时间(10.3±3.1)d,对照组(25.8±4.6)d,2组比较差异有统计学意义(P0.01)。对照组住院费用显著高于研究组,差异有统计学意义(P0.01)。治疗后3个月及9个月,研究组ADL评分显著高于对照组,神经功能缺损评分显著低于对照组,差异有统计学意义(P0.01)。研究组临床疗效显著优于对照组,总有效率显著高于对照组,差异有统计学意义(P0.05)。结论微创血肿碎吸术治疗少量高血压脑出血能够显著改善患者预后,值得临床推广。     

微创治疗高血压脑出血的临床研究

目的 比较高血压脑出血不同治疗方法的疗效,寻找理想的治疗方法。方法将 1995年1月至2003年6月在我院治疗的高血压脑出血患者分为微创引流组、内科治疗组和开颅手术 组,根据配对条件对278例患者按照1:1配对研究,分别行微创引流和内科治疗,微创引流组中10例患者同时另与10例开颅手术患者对比。微创引流组根据脑CT显示血肿的不同情况进行穿刺抽吸引流,壳核、脑室出血选择额部入路,保留引流至CT显示血肿消失。内科治疗组以药物治疗为主。开颅手术组则于全麻下进行手术清除血肿。结果微创引流组与内科治疗组患者治疗后临床神经功能缺损程度评分分别为19.91±13.55与34.55±10.93,差异有非常显著意义(P<0.01);微创引流组和开颅手术组患者治疗后临床神经功能缺损程度评分分别为13.60±11.93与31.20±17.04,差异有显著意义(P<0.05)。随访存活患者微创引流组ADL1-2级与内科治疗组间差异有非常显著意义(P<0.01),随访病死率两组间差异有非常显著意义(P<0.01)。结论 临床观察和随访表明,微创引流治疗效果明显优于内科治疗及开颅手术治疗。     

脑出血微创碎吸术与内科治疗的对照研究

目的:比较高血压性脑出血微创碎吸术与内科治疗的疗效与安全性的差别。方法:利用南京市第一医院脑卒中登记数据库,登记微创碎吸术脑出血患者33例,同期登记内科治疗的脑出血患者33例作为对照组,收集其临床、影像学等资料并前瞻性随访其预后。运用SPSS10.0对微创碎吸术与患者预后进行logistic回归分析。结果:(1)微创碎吸术并未显著增加脑出血患者的死亡率,并且可降低脑出血患者第3月末死亡/残疾率。(2)手术治疗组一例患者并发气颅症。结论:(1)微创碎吸术治疗脑出血是有效的,可以降低患者3个月末的残疾/死亡率。(2)微创碎吸术是安全可行的,其未增加脑出血患者的死亡率。     

微创穿刺引流术治疗幕上自发性脑出血的临床效果分析

目的对比分析微创穿刺引流术与内科保守法在治疗幕上自发性脑出血疗效的差异。 方法回顾性分析北京市顺义区医院神经外科自2014年1月至2017年6月收治的幕上自发性脑出血患者173例（出血量20~40 mL）的临床资料,分为微创穿刺引流术组和内科保守治疗组,分别统计2组的入院时出血量、入院时GCS评分、7 d后残余血肿量、7 d后GCS评分及3个月后GOS评分。 结果2组均出现死亡病例,但短期死亡率差异无统计学意义;治疗7 d后微创穿刺引流术组较内科保守治疗组残余血肿量、GCS评分差异有统计学意义（P<0.05）,3个月后微创穿刺引流术组GOS评分较内科保守治疗组差异有统计学意义（P<0.05）。 结论微创穿刺引流术在治疗中等量幕上自发性脑出血中较保守治疗存在优势,可以改善患者的神经功能,改善患者预后。     

锥颅碎吸引流治疗高血压脑出血（附58例临床分析）

目的 探讨锥颅碎吸引流治疗高血压脑出血的经验体会.方法 对56例高血压脑出血患者,通过锥颅碎吸引流术并辅以尿激酶反复灌洗治疗.结果 按ADL(日常生活能力)分级法,I级24例,II级19例,III级7例,IV级 5例,V级1例.结论 锥颅碎吸引流术辅以尿激酶血肿腔反复灌洗可以降低病死率,提高生活质量,是一种简单、经济、有效、微创的治疗方法.     

脑出血患者治疗中动态经颅多普勒超声监测的临床意义

目的　探讨脑出血患者急性期降血压治疗的利弊和经颅多普勒超声 (TCD)监测对脑出血治疗的指导作用。方法　动态监测 6 8例 12h内入院的脑出血患者的血压 ,其中 4 0例入院 2 4h内接受血肿碎吸引流术 ,2 0例内科对症支持治疗 ,并于入院时和第 1、3、7及 14天监测TCD ;8例未手术者 (降压组 )在接受降血压治疗前、后监测TCD ,并与 2 4例单纯高血压患者 (对照组 )降血压治疗前后的TCD参数进行比较。结果　对照组降血压前后TCD参数差值无显著性 ,而降压组降压后双侧大脑中动脉 (MCA)流速降低 ,脉动指数 (PI)值升高。脑出血患者治疗过程中血压逐渐下降 ,双侧MCA流速呈先降后升 ,双侧PI值呈先升后降 ;保守治疗组MCA流速发病 1周内下降 ,第 2周开始升高 ,PI值改变与其相反 ;手术组第 7天MCA流速即开始升高 ,PI值降低 ,且在第 14天两组间差异有显著性意义 ;手术组血压下降幅度较保守组大 ,第 14天收缩压差异有显著性意义 (前者为 - 12 6± 6 8、后者为- 7 5± 4 8)。结论　微创血肿引流术可显著性改善脑出血患者的脑灌注 ,而急性期的降血压治疗不利于脑灌注 ,动态TCD监测可评估患者脑灌注状态 ,指导治疗     

超早期微创穿刺引流术治疗基底节区脑出血的疗效观察

目的观察超早期微创穿刺引流术治疗基底节区脑出血的疗效。方法将84例基底节区脑出血患者随机分为2组,对照组(n=40)给予内科保守治疗,观察组(n=40)行超早期微创穿刺引流术;比较2组患者术后血肿接近完全吸收时间以及治疗4周后的神经功能缺失评分(NDS)、日常生活能力评分(ADL)。结果观察组术后血肿接近完全吸收时间显著短于对照组(P0.05);观察组治疗4周后的NDS评分和ADL评分均明显优于对照组(P0.05)。结论超早期微创穿刺引流术治疗基底节区脑出血有利于血肿的快速清除,可以显著促进患者神经功能的恢复,改善日常生活能力,疗效肯定,建议临床推广。     

微创穿刺术与简易碎吸术治疗高血压基底节出血临床分析

目的 探讨简易碎吸术与微创穿刺术治疗高血压脑出血的临床效果.方法 将281例基底节压出血分为2组,简易碎吸组92例,采用直径5mm槽型手锥锥透颅骨,LXS-1型颅内血肿碎吸机负压吸引,硅胶管引流加尿激酶溶解血肿;微创穿刺组189例,采用YL-1型颅内血肿粉碎穿刺针正压冲洗引流加尿激酶溶解血肿.结果 脑卒中临床神经功能缺损(FAM)评分,简易碎吸组术前(38.7±8.1),术后28d为(19.6±7.4);微创穿刺组术前(39.1±8.3),术后28d(11.48±5.4),2组对比有显著差异(P<0.05).术后6个月ADL优良率,简易碎吸组54.3%,微创穿刺组77.8%(P<0.005).病死率简易碎吸组42.4%,微创穿刺组21.2%(P<0.05).结论 微创穿刺术治疗脑出血近期、远期疗效均好,病死率低.     

微创治疗高血压脑出血的疗效观察

目的探讨微创手术治疗高血压脑出血的临床治疗效果。方法 82例高血压脑出血患者随机分为微创治疗组42例和开颅治疗组40例,微创治疗组采用微创血肿清除术治疗,开颅治疗组采用传统的开颅血肿清除术治疗;比较2组的治疗有效率和日常生活能力状态(ADL)。结果手术治疗后对2组患者随访6个月观察疗效。微创治疗组42例,死亡5例,病死率11.9%;开颅治疗组40例,死亡15例,病死率37.5%。微创治疗组手术时间短于开颅治疗组,血肿清除率和总有效率高于开颅治疗组,ADL优于开颅治疗组,差异具有统计学意义(P<0.05)。结论微创手术清除高血压脑出血患者颅内血肿,治疗创伤小,手术恢复情况好,提高了患者的生存质量,是治疗高血压脑出血的有效手术方法。     

脑血管病临床研究设计的方法简介和实例分析

在脑血管病临床研究过程中,根据临床问题选择适宜的临床研究设计方法是保证得到正 确研究结果的基础。本文就脑血管病常见的临床研究类型,如横断面研究、病例对照研究、队列研究、 临床登记研究和临床试验,简要介绍其基本方法、适用研究问题和应用注意事项等内容,并辅以案 例加以分析,以期为不同脑血管病临床研究设计方法的合理选择提供参考意见。     

The role and interpretation of pilot studies in clinical research

Pilot studies represent a fundamental phase of the research process. The purpose of conducting a pilot study is to examine the feasibility of an approach that is intended to be used in a larger scale study. The roles and limitations of pilot studies are described here using a clinical trial as an example. A pilot study can be used to evaluate the feasibility of recruitment, randomization, retention, assessment procedures, new methods, and implementation of the novel intervention.A pilot study is not a hypothesis testing study. Safety, efficacy and effectiveness are not evaluated in a pilot. Contrary to tradition, a pilot study does not provide a meaningful effect size estimate for planning subsequent studies due to the imprecision inherent in data from small samples. Feasibility results do not necessarily generalize beyond the inclusion and exclusion criteria of the pilot design.A pilot study is a requisite initial step in exploring a novel intervention or an innovative application of an intervention. Pilot results can inform feasibility and identify modifications needed in the design of a larger, ensuing hypothesis testing study. Investigators should be forthright in stating these objectives of a pilot study. Grant reviewers and other stakeholders should expect no more.     

Does it make sense to do repeated surveys? – the Lundby Study, 1947–1997

OBJECTIVE: To describe the Lundby Study and the difficulties in doing repeated surveys. METHOD: Best-estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997. RESULTS: The Lundby population consisting of 3563 probands was investigated in 1947, 1957 and 1972. Sufficient information was available for 98-99%. In 1997-2000 a fourth field investigation was carried out. Attrition rate for the interviews was 13% (238/1797). About 36% (1030/2827) had died between 1972 and 1997, but data from registers, case notes and key-informants for the period 1972 and 1997 completed the information for 94% (2659/2827). The population has followed the same pattern of development as many rural populations in Sweden since the 1940s. Multiple sources of information are preferable in longitudinal studies in order to tackle the problem of changing diagnostic systems. CONCLUSION: Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.     

Association between PDE4D gene and ischemic stroke: recent advancements

Stroke is a severe complication and a leading cause of death worldwide and genetic studies among different ethnicities has provided the basis for involvement of phosphodiesterase 4D (PDE4D) gene in cerebrovascular diseases. Recent advancements have evaluated the role of this gene in stroke and these studies have provided a stronger support for the involvement of this gene in stroke development and few studies also suggest that it may influence outcome. Furthermore, case-control studies and meta-analysis studies have provided strong evidence for certain variants in PDE4D to predispose to stroke only among certain ethnicities. Thus, this review focuses on recent progress made in PDE4D gene research involving genetic, molecular and pharmacological aspect. A strong conclusion has emerged that clearly indicates a pivotal role played by this gene in ischemic stroke globally. Studies have also noticeably highlighted that PDE4D gene/pathway can be a suitable drug target for managing stroke; however, a more comprehensive research is still required to understand the molecular and cellular intricacies this gene plays in stroke development, progression and its outcome.     

A repetition–prediction study of European parasuicide populations: a summary of the first report from Part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC Concerted Action on Attempted Suicide

One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33–45 years and that for women was 29–45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.     

Component studies of psychological treatments of adult depression: A systematic review and meta-analysis

Objectives: A recent report from the US Institute of Medicine indicated that identifying core elements of psychosocial interventions is a key step in successfully bringing evidence-based psychosocial interventions into clinical practice. Component studies have the best design to examine these core elements. Earlier reviews resulted in heterogeneous sets of studies and probably missed many studies. Methods: We conducted a comprehensive search of component studies on psychotherapies for adult depression and included 16 studies with 22 comparisons. Results: Fifteen components were examined of which four were examined in more than one comparison. The pooled difference between the full treatments and treatments with one component removed was g?=?0.21 (95% CI: 0.03～0.39). One study had sufficient statistical power to detect a small effect size and found that adding emotion regulation skills increased the effects of CBT. None of the other studies had enough power to detect an effect size smaller than g?=?0.55. Only one study had low risk of bias. Conclusions: The currently available component studies do not have the statistical power nor the quality to draw any meaningful conclusion about key ingredients of psychotherapies for adult depression.     

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

OBJECTIVE: To compare the prevalence of dementia in two different time periods and two different studies. METHOD: Representative, random samples of the elderly (>65 years) in the Zaragoza Study or ZARADEMP-0 (n = 1080) completed the previous decade, and now in Wave I of the ZARADEMP Project or ZARADEMP-I (n = 3715) were interviewed. Standardized measures included the Geriatric Mental State and the History and Aetiology schedule. Cases of dementia were diagnosed according to DSM-IV criteria. RESULTS: Adjusted, global prevalence of dementia has not varied significantly: it was 5.2% (95% CI = 3.9-6.6) in ZARADEMP-0 and 3.9% (95% CI = 3.3-4.5) in ZARADEMP-I (prevalence ratio = 0.75; 95% CI = 0.56-1.02). However, the prevalence in ZARADEMP-I was significantly lower among men, particularly in all age groups between 70 and 84 years. CONCLUSION: Stability of the global prevalence of dementia in the elderly population has been documented. However, the decreased prevalence found in elderly men stimulated environmental hypotheses.     

Outcome of neurotic disorders in African patients

Among 130 patients who attended the neurotic diseases clinic in Benin 1963–1965, it was possible to follow-up 60 patients 8–9 years later. Thirty-four patients were diagnosed as anxiety cases and of these 21 had recovered and a further five were considerably improved. Nineteen patients were considered cases of neurotic depression and of these only three had recovered whereas 14 had residual symptoms, although five showed considerable improvement. Two of the depressive patients had died, one during the civil war, the other presumably committed suicide. Of five patients with hysteria, one had recovered and one had become worse, one patient with hypochondriasis had also recovered whereas one patient with obsessional neurosis did not recover. The results are in line with similar European and American follow-up studies of neurotic disorder except that the depressive patients showed a less satisfactory outcome.     

Increased risk for dementia both before and after stroke: A population-based study in women followed over 44 years

Introduction

Longitudinal studies are needed to understand the long-term associations between stroke and dementia.