原发性脑室出血并脑积水的治疗

目的探讨原发性脑室出血并脑积水的治疗方法。方法报告96例原发性脑室出血,38例采用单纯侧脑室外引流、早期注射尿激酶(1组),58例采用侧脑室外引流、早期注射尿激酶加腰大池置管持续引流术(2组)。结果两组死亡分别为10例(26.3%)、5例(8.6%);颅内感染分别为3例(7.9%)、1例(1.7%);脑积水分别为9例(23.7%)、2例(3.4%)。在死亡率、颅内感染率、交通性脑积水发生率,差异均有统计学意义(P分别为<0.01,<0.01,<0.01)。结论侧脑室外引流、早期注射尿激酶加腰大池置管持续引流术是治疗原发性脑室出血并阻塞性脑积水的有效方法。     

早期双侧脑室外引流并尿激酶灌洗治疗脑室内出血疗效分析

目的探讨侧脑室外引流联合尿激酶灌注治疗脑室出血的疗效及相关问题。方法对脑室出血患者早期行双侧脑室外引流加尿激酶灌注进行纤溶治疗的32例病例进行回顾性分析。结果本组恢复良好20例,中残8例,重残3例,死亡1例。结论早期双侧脑室外引流及尿激酶治疗脑室出血效果良好。     

血肿腔钻孔引流联合脑室外引流治疗高血压脑出血破入脑室

目的探讨高血压脑出血破入脑室的外科治疗方法。方法30例高血压脑出血破入脑室患者行血肿腔钻孔引流、脑室外引流及尿激酶灌注治疗。结果30例患者存活21例（70％），死亡9例（30％），死亡率低于文献报道的33．75％。结论钻孔引流联合脑室外引流及尿激酶灌注的手术方法操作简单、创伤小，并能提高存活率。     

双侧脑室外引流联合尿激酶治疗23例重型高血压脑室出血的临床分析

目的探讨侧脑室额角穿刺脑室外引流同时尿激酶注入脑室治疗重型高血压脑室出血的临床疗效。方法选取46例重型高血压脑室出血患者,根据不同的治疗方法分为治疗组与对照组两组,每组各23例。治疗组为双侧脑室额角穿刺脑室外引流同时脑室注射尿激酶,对照组为单纯侧脑室额角穿刺脑室外引流治疗,观察和比较两组病例的临床治疗效果。结果术后随访3个月时治疗组的ADL评分明显高于对照组(P0.05)。结论对脑室内出血患者采用双侧脑室外引流与尿激酶冲洗联合进行治疗具有良好的临床疗效,有效提高患者的生存质量,值得推广应用。     

单纯脑室外引流和结合尿激酶灌注治疗高血压脑出血破入脑室的疗效观察

目的探究脑室外引流联合尿激酶灌注治疗高血压脑出血破入脑室的临床治疗效果。方法采用回顾性分析的方法 ,将2011年2月至2017年1月在本院接受治疗的60例高血压脑出血破入脑室患者的临床资料进行研究分析,并给予这60例患者有效的分组,对照组30例,给予单纯的脑室外引流治疗;干预组30例,在对照组治疗的基础上给予尿激酶灌注治疗,对这两组手术情况、并发症发生情况以及临床治疗效果进行综合评价。结果干预组患者引流时间、住院之间、手术时间等方面的指标明显低于对照组(P0.05),有统计学意义;干预组患者出现术后并发症为2例,并发症发生率为6.7%,对照组出现并发症为11例,并发症发生率为36.7%,两组差异较大,统计学有意义。且干预组共有28例有效,治疗总有效率为93.3%,对照组仅有18例有效,治疗总有效率为60.0%,差异较大(P0.05),有一定的统计学价值。结论对高血压脑出血破入脑室患者给予脑室外引流联合尿激酶灌注治疗,能够有效改善患者的病情,缩短住院时间与引流时间,具有一定的安全性与有效性,临床治疗效果显著,可以在临床医学中得以广泛地推广应用。     

双侧侧脑室引流联合腰池置管持续引流术治疗重度脑室出血39例

目的双侧侧脑室引流联合腰池置管持续引流术治疗重度脑室出血的疗效。方法对39例侧重度脑室出血患者采用双侧侧脑室引流加腰池置管持续引流术;同时交替行脑室内尿激酶灌注术进行治疗。结果本组39例,存活34例,死亡5例。结论双侧侧脑室引流加腰池置管持续引流术治疗重度脑室出血疗效显著,简单实用。     

不同部位高血压性脑出血不同术式的探讨

目的探讨不同部位高血压性脑出血的有效术式. 方法 2001年1月～2003年8月,对85例不同部位高血压性脑出血采取不同手术方式.40例皮层下、基底节区外侧型未出现脑疝者,采用局麻加强化麻醉下小骨窗开颅血肿清除术;26例基底节区内侧型未出现脑疝者,采用局麻加强化麻醉下头皮小切口颅骨钻孔血肿穿刺抽吸术;11例术前脑疝及6例小脑半球出血者采用静脉全麻,开颅清除血肿;2例脑干出血破入第四脑室者采取侧脑室外引流术,其他部位出血破入脑室加用侧脑室外引流. 结果 85例病死率12.9%(11/85),其中皮层下、小脑、脑干、基底节区外侧型未出现脑疝的病例无死亡;基底节区内侧型病死率29.0%(9/31);11例术前脑疝的病死率45.5%(5/11). 结论皮层下、基底节区外侧型未出现脑疝的病人经局麻小骨窗开颅清除血肿效果显著,小脑出血经积极手术预后良好,基底节区内侧型出血经局麻小切口钻孔抽吸效果较差.     

高血压脑基底节出血并破入脑室外科手术治疗

目的探讨高血压脑出血并破入脑室的外科治疗方法和疗效。方法回顾性分析2005年4月～2010年10月内蒙古医学院第三附属医院神经外科收治的182例高血压脑基底节出血并破入脑室患者的临床资料,根据患者的不同情况,采用开颅血肿清除并置入侧脑室引流管、侧脑室穿刺引流、腰大池引流为主要手段的综合治疗。结果 182例患者生存109例,死亡34例,39例手术后放弃治疗。结论高血压脑基底节出血并破入脑室死亡率和致残率较高,手术清除血肿同时引流脑室才能提高疗效。     

侧脑室体外引流结合腰大池持续引流治疗脑室出血临床研究

目的评价早期腰大池引流结合侧脑室体外引流治疗脑室出血疗效。方法随机将48例脑室出血患者分成2组。治疗组28采用单侧或双侧侧脑室置管引流,同时或脑室外引流术后3 d内行腰大池引流。对照组20例单纯延长脑室外引流时间或停止脑室外引流后再行腰大池引流。结果治疗组积血完全清除、脑脊液循环通畅时间均低于对照组,脑积水发生率均低于对照组,GOS评定优于对照组。结论早期持续腰大池引流结合侧脑室体外引流可缩短脑室出血积血时间,降低患者的脑积水发生率。     

Ommaya储液囊联合脑室外引流治疗脑室内出血

目的探讨脑室内出血的治疗方法并评价其临床疗效。方法对30例高血压脑室出血患者采用Ommaya囊联合侧脑室外引流治疗。结果随访时间6-8月,其中恢复良好17例,中残6例,重残4例,植物生存2例,死亡1例。结论Ommaya囊联合侧脑室外引流治疗脑室出血具有操作简单、并发症相对较少的优点,是治疗脑室出血的一种新的有效方法。     

无蛛网膜下腔出血的大脑中动脉动脉瘤破裂

目的总结无蛛网膜下腔出血（SAH）的大脑中动脉（MCA）动脉瘤破裂的临床特点。方法对6例在首次CT扫描上表现为脑内出血（ICH），或壁内出血（IMH）而无SAH的MCA动脉瘤破裂患者的临床表现、影像学检查、治疗方法和预后进行回顾性总结。结果本组首次CT扫描时间为起病后0—2d，表现为单纯ICH者4例，IMH者2例。DSA和手术证实为MCA动脉瘤破裂。开颅动脉瘤切除1例，夹闭5例，其中4例同时行血肿清除术。术后无死亡。结论MCA动脉瘤破裂首次CT扫描可仅表现为ICH或IMH而无SAH，与动脉瘤的部位、出血量以及CT扫描时间相关。     

Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm

This study was performed to analyze the effect of intraventricular hemorrhage (IVH) on 14-day mortality, outcome at 6 months, and the occurrence of chronic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Clinical grade of subarachnoid hemorrhage and the distribution of extravasated blood were evaluated in 219 patients with ruptured aneurysms. Computed tomographic scans performed within 72 h of hemorrhage were analyzed to determine the severity of intraventricular and subarachnoid hemorrhage and the volume of intracerebral hematomas. Outcome at 6 months was assessed using the Glasgow Outcome Scale. Intraventricular hemorrhage extension occurred in 109 of the 219 patients studied. Fourteen-day mortality increased from 7.3% in patients without IVH to 14.1% in those with moderate IVH (IVH score 1–6) and to 41.7% in those with more severe IVH (IVH score >6). The corresponding figures for unfavorable outcome at 6 months are 19.8%, 30.5%, and 66.7%, respectively. According to logistic regression analyses, the severity of IVH was an independent predictor of mortality and functional outcome. The clinical outcome after aneurysm rupture is at least in part determined by the severity of IVH. Knowledge of the effect of IVH may help guide physicians in the care of patients with aneurysmal bleeding. Electronic Publication     

Spontaneous subperiosteal hematoma of the orbit

Spontaneous subperiosteal hematoma of the orbit is extremely rare. This is a case of an 81-year-old woman. The presenting symptom was protrusion of the right eye with severe intraorbital pain. Computed tomography scanning showed a high-density area in the upper part of the right orbit, which, at operation, was found to be a subperiosteal hematoma of the orbit.     

Unusual case of hypertonic hemorrhage

Hemorrhage arose simultaneously in the leftside putamen and the brain stem region in a 45-year-old hypertonic woman. The cause of death, which occured on the seventh day after the incident, was the recurrence of hemorrhage into the brain stem, which was disclosed at autopsy. Possible causes of recurrent brain stem hemorrhage are discussed.     

Bi-manual proximal external aortic compression after major abdominal-pelvic trauma and during ambulance transfer: A simulation study

BackgroundApplying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion.MethodsWe developed a simulated central vessel compression model utilizing a digital scale and Malbrain intra-abdominal pressure monitor inside a cardiopulmonary resuscitation mannequin. Twenty prehospital health care professionals (HCPs) performed simulated bimanual PEAC i) while stationary and ii) inside an 80 km/h ambulance on a closed driving-track. Participants compressed at “the maximal effort they could maintain for 20 min”. Results were measured in mmHg applied-pressure and kilograms compressive-weight. The Borg scale of perceived-exertion was used to assess sustainability, with <16 regarded as acceptable.ResultsWhile stationary all participants could maintain 20 min of compressive pressure/weight: within five-percent of their starting effort, and with a Borg-score <16. Participants applied 88–300 mmHg compression pressure; (mean 180 mmHg), 14–55 kg compression-weight (mean 33 kg), and 37–66% of their bodyweight (mean 43%). In contrast, participants could not apply consistent or sustained compression in a moving ambulance: Borg Score exceeded 16 in all cases.ConclusionsSurvival following major abdominal-pelvic hemorrhage requires expedited operative/interventional rescue. Firstly, however, we must temporize pre-hospital exsanguination both on scene and during transfer. Despite limitations, our work suggests PEAC is feasible while waiting for, but not during, ambulance-transfer. Accordingly, we propose a chain-of-survival that cautions against over-reliance on manual PEAC, while supporting pre-hospital devices, endovascular occlusion, and expeditious but safe hospital-transfer.     

Tentorial meningioma on follow-up presenting with sudden deterioration due to intra- and peritumoral hemorrhage

Summary Almost all meningiomas presenting with intracranial hemorrhage in the literature were admitted with symptoms relating to the hemorrhage and there were no prehemorrhage scans which demonstrated the actual size and apperance of the meningioma. This is a very rare report of a case with a tentorial meningioma documented with pre- and posthemorrhage scans.     

CTA辅助下经侧裂入路高血压壳核出血的显微外科治疗

目的 探讨CTA辅助下经侧裂入路显微外科治疗高血压壳核出血的方法及预后.方法 2004年5月～ 2008年5月间共收治符合显微外科治疗标准的高血压壳核出血病例81例,分为CTA辅助下经侧裂入路血肿清除术组(侧裂组,58例)及经传统的颞上回入路治疗组(颞上回组,23例).通过对CTA辅助下经侧裂入路特点及预后的分析,总结临床经验. 结果 采用KPS评分判定预后,随访半年.侧裂组58例,KPS评分60 ～ 80者15例(25.9％),40～ 50者20例(34.5％),10～ 30者20例(34.5％),评分为0者3例(5.1％).颞上回组23例,KPS评分60～80者1例(4.4％),40～ 50者5例(21.7％),10～30者15例(65.2％),评分为0者2例(8.7％).两组比较差异显著(P＜0.01). 结论 CTA辅助下经侧裂入路显微外科治疗高血压壳核出血安全、有效,预后优于传统的经颞上回入路手术.     

心脏手术后消化道出血44例临床分析

目的探讨心脏手术后并发消化道出血的诊断、处理和相关危险因素。方法回顾性分析1991年1月至2003年10月间8317例成人心脏手术后的44例消化道出血患者的临床资料,采用多因素logistic回归分析方法分析死亡相关危险因素。结果消化道出血发生于术后2～11d,平均(6±3)d,病死率为23%(10/44)。上消化道出血者38例,其中保守治疗26例,死亡4例,与心脏手术后引起其他重要脏器损伤或心脏本身有关;行剖腹探查手术6例,死亡4例,其中1例死于败血症、3例死于多器官功能衰竭;胃镜下电灼或夹闭出血点止血6例,均存活。下消化道出血6例,其中2例行剖腹探查术中未发现出血点,后死于多器官功能衰竭。术后呼吸机依赖、急性肾功能不全、使用主动脉内球囊反搏和剖腹手术为消化道出血死亡危险因素。结论心脏手术后消化道出血病死率较高,对高危病例有必要采取预防措施;早期进行内窥镜下诊断、微创介入止血处理可取得较好的效果。