尿激酶应用于高血压脑出血破入脑室的治疗(附24例临床分析)

本文报告24例高血压脑出血破入脑室行脑室引流及尿激酶灌注的治疗结果。24例中原发脑室出血3例，脑干血肿破入脑室1例，壳核及丘脑区血肿破入脑室20例。24例中1例后改行血肿清除术，1例行双侧脑室引流，2例行血肿腔置管及尿激酶灌注，20例行单侧脑室引流加尿激酶注入。尿激酶总量3～12万单位，引流不超过7天。治疗有效率71％，病死率29％。作者认为脑内血肿量＞50ml，壳核丘脑区闭塞型出血及合并严重并发症者预后不良。该方法简便易行，创伤小，特别适用于高危患者。     

原发性桥脑出血64例的预后相关因素分析

目的 :探讨原发性桥脑出血的预后相关因素。方法 :用回顾法分析64例原发性桥脑出血的临床、CT所见与预后的关系。结果 :高热、意识障碍、出血量≥4ml、血肿占据全桥脑或被盖两侧巨块型、破入脑室系统者预后差 ;无高热、无或轻度意识障碍、出血量≥4ml、血肿位于被盖一侧或被盖基底型、未破入脑室系统者预后好。结论 :从临床、CT所见能较前面认识原发性桥脑出血病人的预后     

丘脑出血123例临床分析

目的：观察丘脑出血的临床特点，探讨早期判定预后及病死率的相关因素。方法：对123例经CT确诊丘脑出血患者的临床特征及其预后进行分析。结果：123例患者平均年龄62．7岁，既往有高血压病史82例，入院时血压高于正常91例，意识障碍38例，眼球运动障碍57例，瞳孔变化17例，感觉障碍79例，运动障碍95例，血肿破入脑室32例。存活104例，死亡19例，病死率15．4％。结论：丘脑出血临床表现严重而复杂，病死率以及严重并发症的产生与年龄、血肿大小、是否破入脑室、下丘脑及脑干是否受累有关。     

高血压脑出血并发消化道出血临床分析

目的探讨高血压性脑出血破入脑室与并发上消化道出血发生率、意识障碍程度和病死率之间的关系。方法对142例高血压性脑出血患者按出血破入脑室与否分为2组,分别比较其并发上消化道出血发生率、病死率以及入院时格拉斯哥昏迷评分（GCS）分布情况。结果出血破入脑室组并发上消化道出血11例（23．40％）,GCS≤8分25例（53．19％）,死亡22例（46．81％）;出血未破入脑室组并发上消化道出血9例（9．47％）,GCS≤8分24例（25．26％）,死亡16例（16．84％）,组间比较差异均有统计学意义（P〈0．05或0．01）。结论高血压性脑出血破入脑室患者并发上消化道出血发生率和入院时意识障碍程度、病死率均高于未破入脑室患者,高血压脑出血破入脑室是病情严重的标志。     

130例脑出血并发应激性溃疡的临床分析

目的探讨脑出血后应激性溃疡发生与脑出血部位、是否破入脑室以及脑出血量的关系。方法连续性收集2007年10月至2010年5月期间入住我科的脑出血患者,据出血部位、血肿是否破入脑室以及出血量将患者分成不同组别,比较组间应激性溃疡发生有无差别。结果共纳入脑出血患者130例,其中应激性溃疡31例,溃疡发生率为23.8%。分析显示,各不同出血部位间应激性溃疡发生率无明显差别;血肿破入脑室与未破入脑室相比,大量脑出血与小量脑出血相比,溃疡发生率显著增加。结论血肿破入脑室及大量脑出血量是脑出血后应激性溃疡发生的重要危险因素,应采取积极防治措施。     

高血压脑出血破入脑室的生命预后评价

报告经CT证实的高血压脑出血破入脑室者56例,其中死亡者者18例(32.1％)。死亡因素与原发出血部位、破入脑室部位、脑实质内血肿量、中线结构移位程度有关。积极地、针对性地治疗可明显降低死亡率。     

影响老年人脑出血预后的因素分析

目的：了解老年人脑出血预后与某些因素的关系。方法：对78例老年人脑出血病例根据出血部位，出血量及主要并发症分生死组进行回顾性分析。结果：脑室出血，基底节区出血破入脑室，跨叶，多灶，脑干出血，出血量在30ml以上，中线结构明显位移，肺部感染、昏迷高热、过高血压与预后有明显关系，结论：老年人脑出血预后较差，导致死亡的直接原因为多器官功能衰竭及脑疝。     

高血压性脑出血的磁共振表现与预后(附103例分析)

对103例高血压性脑出血患者经MR检查。观察其出血部位,血肿量,血肿分期,脑中线结构移位程度及脑室、脑池的改变,认为出血部位在幕上者以深部型、混合型预后差,出血部位在幕下者以中间型、混合型预后差,出血量以幕上>50ml、幕下>10ml预后差,血肿分期以急性期内病死率高,脑中线结构移位程度及脑室、脑池改变以中线移位>10mm或一侧脑室消失则预后差,特别是环池、四叠体池明显受压则病死率明显增高。     

老年脑出血患者CT影像学特征与预后的相关性探讨

目的分析探讨老年脑出血患者CT影像学特征与患者预后的相关性。方法收集2011年~2013年我院共计168例老年脑出血患者的CT影像学资料和临床资料进行回顾性分析,包括中线移位情况、血肿量、破入脑室情况等,分析CT影像学特征和病死率的相关性。结果中线移位0、1~5、6~10、>10 mm组的病死率分别为9.8%、19.3%、26.5%、46.2%;患者病死率随血肿量的增加而呈上升趋势;出血破入脑室的患者病死率明显高于未破入脑室者;上述差异均具有统计学意义(P<0.05)。结论老年脑出血患者CT中线移位距离大、血肿量大、血肿破入脑室者病死率明显升高,预后不佳。     

高血压性脑出血的CT影象分析及预后评估

目的　分析高血压性脑出血的 CT表现及预后情况。方法　对本组 98例高血压性脑出血 CT检查结果进行回顾性分析及预后评估。结果　本组 98例高血压性脑出血病例中 :(1 )出血部位 :基底节区脑出血 6 2例 ,伴血肿破入脑室 1 5例 ;丘脑出血 1 0例 ,伴血肿破入脑室 4例 ;脑叶出血 1 0例 ,伴血肿破入脑室 3例 ;脑干出血 7例 ;原发性脑室出血 5例 ;小脑出血 4例。本组死亡 2 0例中 ,基底节区及丘脑出血共有 1 2例 ,占 6 0 %。血肿进入脑室系统者共死亡 1 3例 ,占 6 5 %。 (2 )形态边缘 :基底节区脑出血多表现为肾形、类圆形 ,其它部位为类圆形、梭形和不规则形。新鲜血肿表现为边缘清楚、密度均匀的高密度影 ,周边环绕低密度水肿带 ;陈旧性出血灶表现为低密度影 ,边缘清楚。 (3) CT值测量 :1～ 9d 86～ 5 5 Hu 93例 ;1 0～ 2 9d 6 5～ 4 0 Hu 1 5例 ;30～ 5 9d 4 5～ 1 5 Hu3例 ;6 0 d以上 1 5～ 3Hu7例。 (4 )出血量 :本组脑出血病例中 ,最多出血量为 1 5 6 ml,最小出血量为 1 ml。其中 30～ 80 ml出血量为 6 5例 ,本组有 7例出血量大于 1 0 0 ml,死亡 5例 ,死亡率为 71 .4 %。 (5 )占位效应 :83例脑出血出现侧脑室、脑池受压变形 ,9例室间孔或中脑导水管受压或阻塞使幕上脑室扩大 ,2 0例环池、纵裂池、四叠体     

Cerebral haemorrhage induced by warfarin - the influence of drug-drug interactions

PURPOSE: To evaluate the frequency, severity and preventability of warfarin-induced cerebral haemorrhages due to warfarin and warfarin-drug interactions in patients living in the county of Osterg?tland, Sweden. METHODS: All patients with a diagnosed cerebral haemorrhage at three hospitals during the period 2000-2002 were identified. Medical records were studied retrospectively to evaluate whether warfarin and warfarin-drug interactions could have caused the cerebral haemorrhage. The proportion of possibly avoidable cases due to drug interactions was estimated. RESULTS: Among 593 patients with cerebral haemorrhage, 59 (10%) were assessed as related to warfarin treatment. This imply an incidence of 1.7/100,000 treatment years. Of the 59 cases, 26 (44%) had a fatal outcome, compared to 136 (25%) among the non-warfarin patients (p < 0.01). A warfarin-drug interaction could have contributed to the haemorrhage in 24 (41%) of the warfarin patients and in 7 of these (12%) the bleeding complication was considered being possible to avoid. CONCLUSIONS: Warfarin-induced cerebral haemorrhages are a major clinical problem with a high fatality rate. Almost half of the cases was related to a warfarin-drug interaction. A significant proportion of warfarin-related cerebral haemorrhages might have been prevented if greater caution had been taken when prescribing drugs known to interact with warfarin.     

脑卒中与上消化道出血的相关性研究

目的探讨急性脑卒中并发上消化道出血的相关关系及其对病死率的影响,以及脑卒中合并高血压、糖尿病时与上消化道出血的相关关系。方法将1992例急性脑卒中患者和上消化道出血之间的关系进行相关性分析,并分析其和病死率的关系,同时将106例脑卒中合并上消化道出血的患者分别和高血压、糖尿病之间的关系也进行相关性分析。结果急性脑卒中和上消化道出血有相关性,且出血性卒中更易合并上消化道出血,合并上消化道出血更易导致脑卒中患者的死亡,且出血性卒中合并上消化道出血比缺血性卒中更易导致患者的死亡;脑卒中合并高血压、糖尿病和上消化道出血也相关,且合并有高血压比糖尿病更易在此类患者中出现。结论对于急性脑卒中患者,尤其是合并高血压、糖尿病的患者,应在卒中早期积极防治上消化道出血,从而改善预后。     

缓激肽预处理对大鼠局灶性脑缺血的影响

目的研究缓激肽预处理对大鼠局灶性脑缺血/再灌注损伤的影响。方法线栓法制备大鼠大脑中动脉缺血/再灌注模型,在缺血前由颈外动脉泵入缓激肽,对照组给予等量生理盐水,缺血2 h再灌注24 h后,观察脑梗死体积、脑含水量、血脑屏障通透性及组织病理学的变化。结果缺血前15 m in给予缓激肽组与对照组相比,梗死体积减小、水肿程度减轻、血脑屏障通透性降低、相关脑区神经元损伤程度减轻。结论预先给予缓激肽可对脑缺血损伤起保护作用,这可能是通过保护脑血管、减少梗死体积来起作用的。     

Congenital afibrinogenemia complicated by spontaneous cerebral hemorrhages: a case report

Congenital afibrinogenemia is a rare autosomal recessive disease caused by markedly reduced or absent synthesis of fibrinogen. Consanguinity is common in affected family. Clinical manifestations range to minimal or moderate bleeding to catastrophic haemorrhage. Bleedings are often post-traumatic, sometimes spontaneous. Diagnosis is established by laboratory tests presenting trace or absence of fibrinogen. Substitutive treatment with fibrinogen concentrates or fresh frozen plasma is used. The authors reported the case of a 41-year-old male with congenital afibrinogenemia with fatal spontaneous cerebral haemorrhage. Diagnosis was made upon history, bleeding history, clinical examination, blood coagulation tests and radiography. Cerebral haemorrhage must be suspected in any patient presenting blood coagulation disorders with bleeding history. Drug therapy must be installed immediately and continued before obtention of specific radiology images which are often late in relation to clinical signs.     

姜黄素对大鼠缺血性脑损伤炎症反应和血脑屏障通透性的影响

目的研究姜黄素对大鼠脑缺血/再灌注损伤炎症反应和血脑屏障通透性的作用,并进一步探讨其潜在的机制。方法利用线栓法制备大鼠脑缺血/再灌注损伤模型,随机分为对照组、模型组和姜黄素治疗组。检测大鼠神经功能损伤评分和脑梗死体积;通过检测脑组织髓过氧物酶的含量说明中性粒细胞浸润和炎症反应的程度;检测脑组织伊文思蓝的含量说明血脑屏障的破坏程度;ELISA检测脑组织肿瘤坏死因子-α(TNF-α)的含量;免疫印记法检测基质金属蛋白酶-9(MMP-9)的表达变化。结果姜黄素治疗组减轻神经功能损伤、脑梗死体积,并减轻中性粒细胞在脑组织的浸润程度、改善血脑屏障完整性。同时姜黄素还可以降低脑组织TNF-α的含量以及MMP-9的表达水平。结论姜黄素通过减轻炎症反应和血脑屏障破坏对大鼠脑缺血/再灌注损伤起脑保护作用。姜黄素的脑保护作用可能与其降低TNF-α含量和MMP-9的表达有关。     

高血压脑出血术后再出血的危险因素探讨

目的 探讨高血压脑出血术后再出血的相关危险因素.方法 选择行手术治疗的270例高血压脑出血患者为临床研究病例,对其临床资料进行回顾性分析,探讨术后再出血发生的危险因素.结果 高血压脑出血术后再出血发生率为9.63％,经CT检查均为原出血部位再出血,且患者病死率61.54％.高血压脑出血患者术后再出血与患者发病至手术时间、凝血机制、术前血肿量、术后收缩压及术后躁动等有关(P＜0.05);而与患者年龄、性别、入院时格拉斯哥昏迷(GCS)评分、手术方式、出血部位无关(P＞0.05).将单因素分析有统计学意义的变量引入Logistic回归方程,分析得出发病至手术时间、凝血机制、术前血肿量、术后收缩压及术后躁动是高血压脑出血术后再出血的独立危险因素(P＜0.05).结论 高血压脑出血术后再出血与发病至手术之间时间、术前血肿量、血肿形态、术后血压控制、凝血功能及术后躁动情况有显著相关性,临床应给予高度重视并积极处理,以降低术后再出血发生率,提高手术疗效,改善预后.     

Cerebral kinetics of oxycodone in conscious sheep

Oxycodone is an opioid analgesic that is administered orally or parenterally. The time-course of opioid action is a function of the systemic kinetics of the opioid, and the rate and extent of its entry into the brain and central nervous system. The latter is incompletely understood for oxycodone. Therefore, the cerebral kinetics of oxycodone was quantified using a conscious chronically instrumented sheep preparation. Five sheep were administered oxycodone as intravenous infusions (30 mg over 4 min). Using hybrid physiologically based kinetic models, cerebral kinetics was estimated from arterio-sagittal sinus concentration gradients and cerebral blood flow (CBF). A two-compartment membrane-limited model best described the data. The volume of the first brain compartment was 35.4 mL with a half-life of equilibrium of 0.6 min. The brain:blood equilibration of oxycodone was relatively slow (half-life of 7.2 min), with a large deep cerebral distribution volume (222.8 mL) for the second compartment and a moderate membrane permeability of 54.8 mL/min, which exceeded the nominal CBF (40 mL/min). Drug retention in the brain was 1.3% after 45 min. In conclusion, pharmacokinetic modelling of oxycodone showed a delayed equilibration between brain and blood of a nature that would be affected by changes in both CBF and blood brain barrier permeability.     

高血压脑出血采用不同外科手术方式治疗的疗效对比

目的:探讨高血压脑出血采用不同外科手术治疗的临床疗效。方法:随机将2015年1月~2018年1月收治的86例高血压脑出血患者分为两组。A组采用小骨窗血肿清除术(SWC)治疗,B组采用微创穿刺血肿引流术(MIPHD)治疗,比较两组的手术疗效。结果:两组术前出血量、NIHSS评分、GCS评分比较无明显差异(P>0.05);B组术后出血量、NIHSS评分明显少于A组,GCS评分、治疗优良率明显高于甲组,差异有统计学意义(P<0.05)。结论:高血压脑出血采用微创穿刺血肿引流术治疗,有助于减少手术出血量,改善患者神经功能与预后,适合用于临床推广。     

急性脑出血病人血糖增高对近期预后影响的探讨

目的 通过观察急性脑出血非糖尿病病人血糖增高对近期预后的影响，提出积极处理并发症的重要性，提高抢救脑出血的成功率。方法 对确诊急性脑出血病人进行常规检测空腹血糖，观察急性脑出血并血糖增高和血糖正常的病人近期预后的好坏。结果 有58．9％的急性脑出血病人血糖增高，此类病人并发症多、预后差、死亡率高。结论 急性脑出血病人出现高血糖，并发症多、预后差、死亡率高，控制血糖，积极处理并发症可提高抢救成功率，减少死亡率。     

Barriers to Drug Distribution into the Perinatal and Postnatal Brain

Drug bioavailability to the developing brain is a major concern in the treatment of neonates and infants as well as pregnant and breast-feeding women. Central adverse drug reactions can have dramatic consequences for brain development, leading to major neurological impairment. Factors setting the cerebral bioavailability of drugs include protein-unbound drug concentration in plasma, local cerebral blood flow, permeability across blood-brain interfaces, binding to neural cells, volume of cerebral fluid compartments, and cerebrospinal fluid secretion rate. Most of these factors change during development, which will affect cerebral drug concentrations. Regarding the impact of blood-brain interfaces, the blood-brain barrier located at the cerebral endothelium and the blood-cerebrospinal fluid barrier located at the choroid plexus epithelium both display a tight phenotype early on in embryos. However, the developmental regulation of some multispecific efflux transporters that also limit the entry of numerous drugs into the brain through barrier cells is expected to favor drug penetration in the neonatal brain. Finally, drug cerebral bioavailability is likely to be affected following perinatal injuries that alter blood-brain interface properties. A thorough investigation of these mechanisms is mandatory for a better risk assessment of drug treatments in pregnant or breast-feeding women, and in neonate and pediatric patients.