外伤性后颅窝血肿117例临床分析

目的 分析总结外伤性后颅窝血肿的诊断和治疗特点。方法 对1990年1月至2002年12月117例外伤性后颅窝血肿的病因学、影像学、诊断和治疗特点进行分析。结果 本组117例外伤性后颅窝血肿中硬膜外血肿76.06％(89例),其中跨幕上下者60.67％(54例),硬膜下血肿4.27％(5例),小脑脑内血肿19.66％(23例)。合并幕上对冲性脑损伤52例,合并原发脑干伤9例。本组95例行血肿清除术及综合治疗,22例采用保守治疗,其中18例小脑脑内血肿,3例后颅窝硬膜外血肿和1例硬膜下血肿(出血量<10 mL)。伤后6个月行GOS评估,死亡12例,重残2例,其余预后良好。结论单纯后颅窝血肿应及时诊断并手术,预后良好,即使合并幕上血肿,只要及时治疗,也能取得满意效果。     

外伤性迟发性后颅窝血肿28例的诊治分析

目的探讨外伤性迟发性后颅窝血肿的诊断、治疗及预后。方法对28例外伤性迟发性后颅窝血肿患者的临床资料进行回顾性分析。结果常规复查或急诊复查CT发现迟发性血肿患者23例,其中后颅窝硬膜外血肿17例,硬膜下血肿6例;血肿跨横窦6例。先行幕上血肿清除的5例患者,术中发现小脑内血肿并硬膜下血肿1例;术后4例复查CT示,后颅窝硬膜外血肿3例,硬膜下血肿1例;血肿跨横窦1例。8例患者行保守治疗,20例行手术治疗,术后死亡1例。伤后6个月,27例患者预后按GOS分级：2分1例;3分7例;4分9例;5分10例。结论外伤性迟发性后颅窝血肿病情隐匿、危重,早期诊断并根据临床症状和血肿类型及时治疗是挽救患者生命、改善预后的关键。     

儿童外伤性迟发性后颅窝血肿的手术治疗体会

目的探讨儿童外伤性迟发性后颅窝血肿的诊断、手术治疗及预后。方法对2002年1月至2011年12月18例行手术治疗的外伤性迟发性后颅窝血肿患儿的临床资料进行回顾性分析。结果经复查头颅CT发现的15例后颅窝迟发性血肿患儿中,后颅窝硬膜外血肿11例,硬膜下血肿4例。先行幕上血肿清除的3例患儿,1例术中发现硬膜下血肿并小脑内血肿;2例术后复查CT示,后颅窝硬膜外血肿1例,硬膜下血肿1例。术后死亡1例,术后6个月患者预后按GOS分级：2分1例,3分2例,4分5例,5分9例。结论儿童外伤性迟发性后颅窝血肿病情危重,早期诊断、对达到手术指征的患儿行及时有效的手术治疗是挽救患儿生命、改善预后的关键。     

外伤性后颅窝血肿的诊治体会(附26例报告)

目的探讨外伤性后颅窝血肿的诊断和治疗。方法对26例外伤性后颅窝血肿根据血肿量和GCS评分情况选择手术或保守治疗。结果本组11例血肿量<10 ml,GCS评分>12分,无脑室、脑干受压移位(环池清晰),在严密观察、对症治疗及颅内压监测、CT动态监控下行保守治疗。15例血肿量>10ml,出现意识状态突然变化,烦燥、剧烈头痛、频繁呕吐,而且靠近枕骨大孔区,积极手术治疗。预后18例恢复良好,3例重残,死亡5例。保守治疗无一例死亡。结论外伤性后颅窝血肿缺乏特有的临床征象,但可以形成枕骨大孔疝而导致死亡。早期诊断比较困难,主要依靠头颅CT或MRI检查。根据出血量和GCS评分而选择手术或保守治疗。     

改良颅骨钻孔引流治疗慢性硬膜下血肿术后肺部感染及预后不良相关因素分析

目的探讨改良颅骨钻孔血肿引流术治疗慢性硬膜下血肿的安全性和有效性,分析术后病人肺部感染及预后不良的相关因素。方法回顾性分析202例采用改良颅骨钻孔引流术治疗慢性硬膜下血肿病人的临床及影像学资料。结果住院期间发生术后并发症17例(8.4%),其中肺部感染12例,尿路感染2例,切口感染2例,急性无症状脑内点状出血1例。入院时GCS评分(15分)是住院期间发生术后肺部感染的危险预测因素(P=0.003,OR=9.368)。术后3个月随访197例(97.5%),预后良好177例(89.8%),预后不良20例(10.2%)。血肿复发6例(3.0%),死亡2例(1.0%)。年龄≥75岁(P=0.007,OR=6.264)及出院时mRS评分≥3分(P0.001,OR=19.029)是病人预后不良的预测因素。结论改良颅骨钻孔引流术是一种安全、有效的慢性硬膜下血肿手术方式。术前病人GCS评分低(15分)是住院期间发生术后肺部感染的危险预测因素。年龄大(≥75岁)及出院时mR S评分高(mRS≥3分)是病人预后不良的预测因素。     

急性外伤性硬膜下血肿45例救治体会

急性外伤性硬膜下血肿占颅脑损伤的15%～40%,其病死率为40%～85%。本文对我院自2001-09～2004-05收治的45例急性外伤性硬膜下血肿的有关临床资料,手术及预后回顾性总结如下。1临床资料1.1一般资料45例中男29例,女16例;年龄3～75岁,平均35岁。车祸37例,跌伤4例,打击伤4例。伤后20min～38h入院,平均7h。血肿单纯位于额叶8例,颞叶12例,顶叶5例,枕叶1例,血肿波及2个或2个以上脑叶者19例。合并颅骨骨折16例,颅底骨折15例,脑挫裂伤10例,硬膜外血肿3例,脑内血肿2例,全身多发伤10例。1.2相关因素(1)GCS评分:根据病人入院时GCS评分分为3组:GCS3～…     

外伤性后颅窝硬膜外血肿87例临床分析

总结外伤性后颅窝硬膜外血肿的临床和预后。对87例外伤性后颅窝硬膜外血肿进行回顾性总结。本组87例手术治疗63例（72.4）,1例术中呼吸暂停者抢救成功,保守治疗20例（23％）,本组共死亡12例,死亡率为13．8％。外伤性后颅窝硬股外血肿的治疗关键在于早期诊断,CT扫描是可靠的确诊手段,可根据CT和临床表现选择不同的治疗方法,对已发生脑病的患者也不应放弃手术治疗。     

影响早期开颅去骨瓣减压术治疗急性颅脑损伤致半球脑肿胀预后的因素分析

目的探讨急性外伤性半球脑肿胀的临床特点,并分析影响其早期行开颅减压术疗效的因素。方法本组199例急性外伤性半球脑肿胀患者均早期(伤后24h内)行开颅减压术,选取年龄、性别、受伤距手术时间、术前GCS评分、瞳孔变化、病理反射、头颅CT显示硬膜下血肿厚度及中线结构移位程度等8个临床指标作为影响因素,采用有序Logistic回归,分析各影响因素与急性外伤性半球脑肿胀患者术后半年GOS评分的关系。结果术后随访6～24月,根据GOS评分,恢复良好73例,中度残疾45例,重度残疾36例,植物生存14例,死亡31例。术后发生癫痫34例,脑积水23例,切口感染2例。术前GCS评分、CT显示血肿厚度和瞳孔变化三个因素对急性外伤性半球脑肿胀患者预后有显著影响(P<0.05)。结论急性外伤性半球脑肿胀早期行开颅减压术是积极、有效的治疗措施,术前GCS评分、CT显示血肿厚度和瞳孔变化是影响患者预后的重要因素。     

外伤性颅内血肿术后不良预后的危险因素

目的 探讨外伤性颅内血肿术后预后不良的危险因素。方法 回顾性分析2016年4月至2019年3月手术治疗的228例外伤性颅内血肿的临床资料。伤后6个月采用GOS评分评估预后，4~5分为预后良好，1~3分为预后不良。采用多因素logistic回归分析检验预后不良危险因素；采用受试者工作特征（ROC）曲线分析分析影响因素的评估效能。结果 228例中，158例预后良好，70例预后不良。多因素logistic回归分析示，术前GCS评分低、血肿量大、改良CT评分高、部分活化凝血活酶时间（APTT）延长是预后不良的独立影响因素（P<0.05）。ROC曲线分析显示，术前GCS评分、血肿量、改良CT评分、APTT评估预后不良的曲线下面积（AUC）分别为0.790、0.824、0.826、0.617，四个指标联合评估预后不良的AUC为0.954。结论 术前GCS评分、血肿量、改良CT评分、APTT对外伤性颅内血肿术后预后不良有一定的评估价值，联合评估效果更好     

Glasgow昏迷量表在高血压性脑出血急救策略选择中的作用

目的探讨入院时Glasgow昏迷量表(GCS)评分对高血压性脑出血患者急救策略的影响。方法共286例高血压性脑出血患者中186例接受手术治疗,包括GCS评分5~8分94例、9~11分71例和12~14分21例,分别予血肿清除术联合去骨瓣减压术(63例,22.03%)、单纯血肿清除术(21例,7.34%)和血肿钻孔引流术或脑室外引流术(102例,35.66%);100例接受保守治疗,包括GCS评分5~8分25例、9~11分27例、12~14分25例和15分23例。随访3~6个月,采用Glasgow预后分级(GOS)评价疗效。结果 GCS评分5~8分组失访6例(5.04%),GOS分级1级14例(11.76%)、2级21例(17.65%)、3级39例(32.77%)、4级22例(18.49%)、5级17例(14.29%);GCS评分9~11分组失访2例(2.04%),GOS分级1级6例(6.12%)、2级2例(2.04%)、3级6例(6.12%)、4级48例(48.98%)、5级34例(34.69%);GCS评分12~14组GOS分级4级15例(32.61%)、5级31例(67.39%);GCS评分15分组GOS分级4级1例(4.35%)、5级22例(95.65%),组间差异具有统计学意义(χ~2=142.966,P=0.000)。结论高血压性脑出血患者入院时GCS评分与其预后呈正相关,GCS评分越高、GOS分级越高。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。