脑血管动脉瘤

脑血管动脉瘤王立１７６１年Ｍｏｒｇａｇｎｉ首先对脑血管动脉瘤进行了叙述。１９２７年Ｍｏｎｉｚ在尸检时发现颅内动脉瘤。在人群中由颅内动脉瘤破裂发生蛛网膜下腔出血（ＳＡＨ）的患病率为７．２～１５．７／１０万［１，２］。通常将脑血管动脉瘤分为５种：囊状动脉...     

脑血管重建术辅助治疗颅内复杂动脉瘤的研究进展

脑血管重建术是指采用手术方法重新建立脑的侧支循环通路,包括颅外-颅内动脉吻合术(extracranial-intracranial bypass,EC-IC)等直接血管吻合术,或头皮动脉-硬脑膜动脉-颞肌-脑皮质血管粘连成形术等间接建立脑血流等方法.     

尿失禁与脑血管意外

尿失禁是脑血管意外的重要后遗症,其发生率为37％～58％。尿动力学研究有助于了解膀胱逼尿肌和尿道外括约肌的功能状态,指导治疗;另外尿失禁的发生及恢复受多方面因素的影响,同时又是判断远期预后的重要指标。     

脑血管意外康复期的护理

脑血管意外起病急、发病率高、死亡率高、致残率高、再发率高，机体功能恢复慢。由于恢复期长，病人常产生焦虑、悲观、恐惧等不良情绪，使病人的心理活动失去平衡，导致神经功能失调，影响疾病的恢复。为此，做好病人康复期的护理至关重要。     

脑血管意外后的抑郁状态调查分析

本文对住院脑血管意外患者的病后抑郁症进行了调查，结果发现在脑血管意外后的一个月之内，患者出现抑郁性障碍者达５３．４９％，以女性及肌力受损严重明显；而在年龄，病程及病灶等指标上，６０岁以下，２周以内，左侧病灶平衡总分是有高的趋势，但统计上差异无显著性，作者认为，在发生脑卒中后的早期，抑郁情绪的发生较为普遍，且与性及瘫痪程度等社会因素有关，而与病程，病灶部位等脑卒中对大脑功能影响的因素相对较小。     

急性心肌梗死并发脑血管意外23例临床分析

近年来,AMI并发脑血管意外的情况有逐渐增高的趋势,由于AMI并发脑血管意外时,有些患者特别是老年人AMI的表现并不典型,仅有脑血意外的表现。为引起重视,现将近9年来,我院ALMI并发脑血管意外的病例资料进行总结。1方法AMI并发脑血管意外的诊断标准主要根据在AMI的基础上突然发生神经系统局灶性功能障碍［门,并经头颅O证实。2结果856例AMI中力例发生脑血管意外,发生率2．ho％。并发脑血管意外患者年龄在43－82岁,平均62．5岁。男（17例）,多于女（7例）。AMI后二周内发生20例（86％％）,其中7例（30．43％）在AMI后24…     

妊娠期高血压疾病并发脑血管疾病的护理体会

目的 探讨妊娠期高血压疾病并发脑血管疾病患者的护理措施,抢救病人生命,提高护理质量.方法 回顾分析我院2003-01～2010-02收治妊娠期高血压产妇中并发脑血管疾病患者的护理措施、经验.结果 本组3例患者及时终止妊娠,痊愈出院.结论 针对性心理疏导,避免诱因,及时发现脑出血先兆,加强产前、产中监护,注意药物疗效,多科协作,有效保证了病人安全.     

高血压合并急性脑血管病的心率变异分析

目的：探讨急性脑组织损害对原发性高血压（EH）患者心率变异（HRV）的影响。方法：对26例EH并急性脑血管病（ACVD）患者进行24h动态心电图HRV测定,并与20例EH元ACVD患者进行对比。结果:EH并ACVD组最小心率及平均心率明显高于无ACVD组（P＜0．01;P＜0．01）;24h相邻R-R间期之差的均方根（rMSSD)、相邻R-R间期之差大于50ms的心搏数占心搏总数的百分比（PNN50）较无ACVD组明显减低（P＜0．01;P＜0．001）。结论：EH合并ACVD患者HRV低于EH无ACVD患者,与其自主神经中枢损害有关。     

Comparative bioinformatics analysis between proteomes of rabbit aneurysm model and human intracranial aneurysm with label-free quantitative proteomics

AimsThis study aimed to find critical proteins involved in the development of intracranial aneurysm by comparing proteomes of rabbit aneurysm model and human aneurysms.MethodsFive human intracranial aneurysm samples and 5 superficial temporal artery samples, and 4 rabbit aneurysm samples and 4 control samples were collected for protein mass spectrometry. Four human intracranial aneurysm samples and 4 superficial temporal artery samples, and 6 rabbit aneurysm samples and 6 control samples were used for immunochemistry.ResultsProteomic analysis revealed 180 significantly differentially expressed proteins in human intracranial aneurysms and 716 significantly differentially expressed proteins in rabbit aneurysms. Among them, 57 proteins were differentially expressed in both species, in which 24 were increased and 33 were decreased in aneurysms compared to the control groups. Proteins were involved in focal adhesion and extracellular matrix‐receptor interaction pathways. We found that COL4A2, MYLK, VCL, and TAGLN may be related to aneurysm development.ConclusionProteomics analysis provided fundamental insights into the pathogenesis of aneurysm. Proteins related to focal adhesion and extracellular matrix‐receptor interaction pathways play an important role in the occurrence and development of intracranial aneurysm.     

Pathology of a dissecting intracranial aneurysm

The pathological findings of six autopsy cases of dissecting intracranial aneurysm are studied. Clinically, all cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited rupture of the vertebral artery and subarachnoid hemorrhage. Two types of lesion were present. First, all cases showed the formation of a dilatated pseudoaneurysm with widespread disruption of the entire arterial wall, which was composed of thin adventitia. Second, a medial disruption of the arterial wall and subadventitial dissecting hemorrhage, which formed a false lumen and stenosis of the ‘true’ lumen of the artery, was also found. However, these lesions were found to be connected to the site of rupture. The autopsy cases within 1 day of onset of intracranial dissecting aneurysm showed the formation of fibrin thrombus, a marked degree of leukocyte infiltration and necrosis of the arterial wall at the site of the lesion. The cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration. No arteriosclerosis was found in any lesion studied. These data suggest that the disruption of the entire arterial wall might initially occur and cause medial disruption and subadventitial hemorrhage. Hypertension and arteriosclerosis might function as causal and protective factors in the pathogenesis of dissecting intracranial aneurysms, respectively.     

实验性肾性高血压大鼠脑动脉瘤模型的建立及发生机制探讨

目的 探讨高血压大鼠脑血管早期病理改变与脑微动脉瘤形成的关系。方法 建立肾性高血压大鼠模型,应用光镜及电镜观察脑血管组织学改变。结果 实验组发现2个肉眼可见的动脉瘤及10个镜下早期动脉瘤。动脉分叉部内膜垫的变化与动脉瘤的病理改变程度有密切关系,动脉瘤形成早期即有内皮细胞损伤。结论 持续高血压引起的内弹力膜与平滑肌的破坏导致了动脉瘤的发生。     

Blink reflex in patients with hemispheric cerebrovascular accident (CVA). Blink reflex in CVA

A blink reflex consists of an early unilateral component, R1, and a late bilateral component, R2. During an acute phase of hemispheric cerebrovascular accident, R1 and R2 were abnormal in 30 and 50 of 66 patients, respectively. Paired stimuli usually corrected R1 but not R2, which was profoundly suppressed. The discrepancy between polysynaptic R2 and oligosynaptic R1 indicates a greater disfacilitation at the level of interneurons than at the motoneuron, which serves as the final common path. Abnormality of R2 occurred bilaterally with stimulation on the affected side of face and contralaterally after stimulation on the normal side in 31 patients. This finding suggests a diffuse loss of internuncial excitability, contralateral to the hemispheric lesion. Changes of R2 implicated the brainstem pathways forming the afferent and efferent arc of the reflex in 7 and 8 patients, respectively. The remaining 4 comatose patients had no R2 irrespective of stimulus sites. Clinical localization of the hemispheric lesion showed no consistent correlation with the type of blink reflex abnormalities. The CT scans revealed widely scattered changes in 29 patients with abnormal blink reflex but with a tendency to overlap in the inferior Rolandic area. This contrasted with conspicuous sparing of the inferior post-central region in 10 patients with normal blink reflex. These findings suggest the presence of crossed facilitation to this reflex from wide areas of the cortex but most prominently from the sensory representation of the face.     

血清Caspase-3水平与颅内动脉瘤的相关性研究

目的探讨人血清天冬氨酸特异性半胱氨酸蛋白酶-3（Caspase-3）与人颅内动脉瘤的关系,为临床早期诊断和筛选提供一种简易检验方法。方法用双抗体夹心免疫酶联吸附试验测定50例住院颅内动脉瘤患者（动脉瘤组）与50例健康成人（健康组）血清中Caspase-3水平。结果健康组血清Caspase-3水平为（84.6±17.6）ng/ml,未破裂颅内动脉瘤患者血清Caspase-3为（111.7±22.6）ng/ml,较对照组明显升高（P〈0.05）;破裂颅内动脉瘤患者血清Caspase-3水平为（1013.8±34.7）ng/ml,较未破裂颅内动脉瘤患者和对照组均明显升高（P〈0.05）。结论血清中Caspase-3水平升高可能与颅内动脉瘤形成以及破裂相关。     

颅内动脉瘤术后并发颅内感染的临床因素分析

目的分析颅内动脉瘤术后并发颅内感染的临床危险因素,探究脑脊液（CSF）指标与血清学指标在颅内感染的临床应用价值。 方法回顾性研究河北省黄骅市人民医院神经外科自2014年8月至2016年3月收治的213例颅内动脉瘤手术患者,按照感染与否分为颅内感染组28例、非颅内感染组185例。对比2组患者的临床基线资料,多因素Logistic回归分析法分析颅内感染的危险因素;对比2组患者的CSF指标、血清学指标并分析其与颅内感染的相关性。 结果多因素Logistic回归分析显示,糖尿病、术中动脉瘤破裂、术中CSF漏、术中出血量和手术时间>4 h为颅内感染的独立危险因素。颅内感染组的CSF水平、血清学指标水平均高于非颅内感染组,且患者的CSF指标、血清学指标与颅内感染呈现正相关。 结论患者的糖尿病、术中动脉瘤破裂、术中CSF漏、术中出血量100 mL以上、手术时间>4 h均为术后颅内感染的危险因素,对患者的CSF指标与血清学指标的检测可协助颅内动脉瘤术后并发颅内感染的诊断。     

血浆同型半胱氨酸与颅内动脉瘤的关系

目的 探讨血浆同型半胱氨酸(Hcy)、血清叶酸、维生素B12水平与颅内动脉瘤的关系.方法 采用化学发光法检测80例颅内动脉瘤患者和60例对照者血浆Hcy、血清叶酸、维生素B12水平,相关危险因索用logistic回归分析.结果 颅内动脉瘤组平均血浆Hcy水平明显高于对照组(P=0.005),两组中血浆Hcy升高分别有38例(48%)和9例(15%)(X2=16.239,P＜0.001);颅内动脉瘤组平均血清叶酸、维生素B12水平明显低于对照组(P=0.01;P=0.005);颅内动脉瘤患者血浆Hcy水平与血清叶酸、维生素B12水平呈负相关(P＜0.05).多因素logistic回归分析显示:血浆Hcy是颅内动脉瘤发病的独立危险因素,比值比(OR)=3.961[P=0.019,95%可信区间(CI):1.255～12.500].结论 高Hcy血症与颅内动脉瘤发病有密切关系,可能是颅内动脉瘤发病的一个独立危险因素;血浆Hcy水平升高可能与血清叶酸、维生素B12水平降低有关.     

合并眼部症状的颅内动脉瘤临床分析

目的：探讨合并眼部症状的颅内动脉瘤的临床特点和治疗效果。方法回顾性分析我科近四年间收治的73例合并眼部症状的颅内动脉瘤病例。所有患者均经DSA或CTA检查明确诊断后施行动脉瘤瘤颈夹闭手术或介入栓塞治疗,重点分析动脉瘤的位置、大小及瘤顶指向与眼部症状的关系,随访观察术后眼部症状改善情况。结果73例合并眼部症状的动脉瘤患者中表现为颅神经麻痹58例,视力下降37例,眼痛34例,视野改变9例,眼底改变11例。43例经动脉瘤颈夹闭手术治疗的患者,术后症状消失或有较大程度改善的24例,占55．8％。30例经介入栓塞治疗的患者,术后症状消失或有较大程度改善8例,占26．7％。动脉瘤瘤颈夹闭手术治疗组眼部症状疗效优于介入栓塞治疗组（ P＜0．01）。结论近半数颅内动脉瘤伴有眼部临床表现,其中以颈内动脉海绵窦段、眼动脉段和后交通动脉段动脉瘤最多见。眼部症状以动眼神经麻痹最为常见,及时发现以眼部表现为首发症状的动脉瘤,对改善患者预后意义重大。就眼部症状治疗效果而言,动脉瘤瘤颈夹闭手术优于介入栓塞治疗。