激光辐照血液疗法治疗脑卒中180例

脑卒中是内科常见病,病情重、致残率高,常规药物治疗效果有限.近十余年来,激光辐照血液疗法治疗心脑血管疾病因疗效显著,而引起广泛的关注.我们采用激光辐照血液疗法治疗脑卒中患者180例,取得了较好的疗效,现报告如下.     

缺血性脑血管疾病脑水肿机理及治疗进展

脑水肿是急性脑血管疾病（CVD）最常见的共发症之一，又是急性CVD致死的主要原因。现就缺血性CVD脑水肿的分类、发病机理与治疗予以综述。一、脑水肿的分类脑水肿的原因很多，缺血性CVD脑水肿主要有血管源性和细胞毒性水肿两大类。1．血管源性脑水肿：血管源性脑水肿是由于急性CVD后，血脑屏障（BBB）功能的破坏，细胞外发生水肿。BBB受损后脑内毛细血管通透性增加，血浆中的水与电解质、蛋白分子外溢，导致脑细胞外水肿，以白质水肿与星形细胞改变为特征。由于缺血使血管内皮细胞机能完整性受到破坏，细胞膜上的致密结合处开放与…     

脑血管超声筛查缺血性脑血管疾病中的应用

目的：探讨脑血管超声筛查缺血性脑血管疾病中的应用价值。方法：对2009-06-2011-05的360例缺血性脑血管病患者TCD与DSA检查的临床资料样本进行回顾分析。结果：TCD检查360例缺血性脑血管病患者中188例患者检查结果正常,阳性者172例,占47.78%。TCD为阳性的172例住院患者经DSA检查30例（17.44%）为假阳性,阳性者为142例,符合率为82.56%。结论：TCD通过检测颅内外动脉的血流速度、血流方向、形态、频谱等,可较准确地反映脑动脉的狭窄、痉挛、闭塞等状态,可作为一线脑血管病的筛查项目。     

光量子血液疗法治疗脑血管病的研究

脑血管病是中老年人常见病、多发病,目前对脑血管病中的脑梗塞、颅内出血等尚无独特的治疗方法。一年来我院除应用一般常用的中西医治疗方法外,还采用了紫外线照射充氧自血回输疗法(简称光量子血疗UBI)治疗脑梗塞、脑出血及高粘滞血症共448例,并设计对照组50例,共498例,总结如下: 一、一般资料 1.病人来源所观察治疗病例均为本院住院病人,大多为本市县农民、城镇居民、机关工厂职     

浅析缺血性脑血管疾病的治疗

脑血管疾病是指各种病因使脑血管发生病变引起脑部疾病的总称,临床上可分为急性和慢性两种,急性最多见,包括缺血性的脑血栓形成、脑栓塞及短暂性脑缺血发作和出血性的脑出血及蛛网膜下腔出血[1].     

手术治疗缺血性脑血管疾病50例麻醉分析

开颅手术的麻醉不同于其他部位的手术麻醉,尤其是对于缺血性脑血管疾病手术,其术中血压的控制非常重要。笔者回顾性分析了我院2007—07至2010—04行缺血性脑血管疾病手术50例的麻醉记录,作为临床应用借鉴。     

缺血性脑血管疾病的DSA结果分析

缺血性脑血管疾病占脑血管疾病的比例不断上升。D SA仍是脑血管疾病诊断的“金标准”,为缺血性脑血管疾病的治疗提供充分的信息。1材料与方法1.1一般资料自2004年6月到2005年6月,来自2个中心临床诊断为缺血性脑血管疾病的72例患者,男47例,女25例,年龄为14～87岁,平均(60±13)岁     

复方丹参滴丸对缺血性脑血管疾病血液流变学及血脂观察

缺血性脑血管疾病是常见疾病之一,致残率高,复发率高,死亡率高.自2003年10月至2004年10月用复方丹参滴丸治疗32例缺血性脑血管疾病,取得良好效果.     

血管内支架植入术治疗缺血性脑血管疾病的临床研究

目的评价经皮穿刺血管腔内血管成形术与支架植入术(PTAS)治疗缺血性脑血管疾病的临床效果与安全性。方法对53例动脉狭窄致脑血管疾病患者从2006年5月至2008年5月在我院接受PTAS的临床资料进行了回顾性分析。53例患者共植入61枚支架,其中8例患者植入两枚支架。对PTAS的临床效果与安全性逐例进行了观察与记录。结果本组53例患者PTAS的成功率为100%。动脉狭窄的程度由术前的75.4%(65%～97%)下降到术后的15.7%(0%～27%)。所有患者脑缺血的临床症状与体征得到了有效控制或明显改善,未发生与操作本身有关的严重并发症。结论 PTAS是治疗缺血性脑血管疾病的一种安全、有效的方法,然而,为了尽可能地减少其并发症和提高其疗效,精心实施规范操作与严格选择适应证是至关重要的。     

金钠多治疗老年缺血性脑血管病疗效观察

我科于2 0 0 2年5月～2 0 0 3年9月应用德国威玛舒培制药公司生产的金钠多注射液治疗老年缺血性脑血管病患者并设对照组比较,治疗期为2～3个月,现将疗效及临床观察结果报告如下。1　临床资料1 1　一般资料　4 0例脑梗塞后遗症患者符合第二次全国脑血管病会议制订的脑梗塞诊断标准,均经过头颅CT明确梗塞部位,结合躯体功能受损等综合确诊,随机分为治疗组和对照组。4 0例患者中男2 6例,女14例,年龄自6 5岁至87岁,平均年龄76岁;其中脑大片梗塞4例,多发性腔隙梗塞10例,单个腔隙性梗塞7例,椎-基底动脉供血不足9例,血管性痴呆8例,其他4例(脑干梗塞…     

MR扩散加权成像与动脉自旋标记在缺血性脑血管病诊断中的临床应用

目的 探讨磁共振扩散加权成像(DWI)与动脉自旋标记(ASL)在缺血性脑血管病诊断中的价值.方法 对60例缺血性脑血管病患者(其中20例为临床高度怀疑或诊断为短暂性脑缺血发作)行常规MR、FLAIR、DWI及ASL(Q2TIPS)序列检查(其中32例行MRA检查,15例为TIA).分析DWI及ASL 2种技术显示病变的阳性率及面积大小.结果 病灶显示的阳性率:DWI对急性及亚急性脑梗死的检出率为100%,对TIA的检出率为0%;ASL对急性及亚急性脑梗死的检出率为100%(忽略因运动伪影较大致使图像无法观察的6例急性脑梗死患者),对TIA的检出率为70%.DWI与ASL对同一病例相同病变显示面积的大小:SDWI＜SASL,n=19;SDWI≈SASL,n=15;SDWI＞SASL,n=0;DWI阴性而ASL阳性,n=14(TIA);DWI和ASL均为阴性,n=6.结论 DWI及ASL均可用于急性脑梗死的早期诊断,联合应用2种技术能早期诊断TIA.     

DSA灌注造影在缺血性脑血管病介入检查及治疗中的应用

目的:探讨DSA灌注成像在缺血性脑血管病介入检查及治疗中的应用价值。方法:对4例健康志愿者及50例临床诊断为缺血性脑血管病的患者进行全脑血管造影及DSA灌注造影,对其中10例进行支架成形术的患者术后再次进行DSA脑灌注检查,评价支架成形术后的脑血流改变。结果:4例健康志愿者的DSA脑灌注造影显示实质期脑染色均匀,血供丰富。50例缺血性脑血管病患者的DSA脑灌注造影显示,47例患者实质期脑染色出现不同程度的改变,10例支架成形术后DSA脑灌注造影与术前相比脑实质染色有明显的增强。结论:DSA灌注成像在缺血性脑血管病介入检查及治疗中具有重要的作用,能够总体描绘脑部血供的分布、脑实质的染色及异常改变,客观评价支架置入术对缺血性脑血管病的治疗效果。     

脑血管疾病SPECT灌注显像的半定量方法探讨

目的：对脑血管病ＳＰＥＣＴ灌注显像中几种常用的半定量方法进行比较，以选择一种较适宜的定量方法。材料和方法：１２４例次脑血管疾病患者及１９名健康志愿者进行了ＳＰＥＣＴ脑血流灌注显像。对结果进行半定量分析，通过制作ＲＯＣ曲线对几种半定量方法进行比较。结果：以对侧相应部位作为参考区域，以Ｍｅａｎ－１．９６ＳＤ倍数的变化作为定量标准时，所得灵敏度（９５．９７％）及特异性（８４．２１％）高于另两种部位作为参考区域时对应的灵敏度及特异性。结论：本组病例以对侧相应部位作为参考区域，正常人相应部位比值的Ｍｅａｎ－１．９６ＳＤ作为定量标准，是一种较好的半定量方法     

Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases

BACKGROUND AND PURPOSE:There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children.MATERIALS AND METHODS:Retrospective review of children (17 years of age or younger) treated with flow diverters between May 2011 and July 2014 was performed. Clinical and laboratory data and angiographic findings were extracted. Seven patients (6 males, 1 female; mean age, 12.7 years; range, 3–16 years) were included. Two presented with posttraumatic fistulas. The remaining patients presented with traumatic aneurysms of the cavernous carotid artery or fusiform aneurysms of the distal vertebral artery, M1, or A2 segments. All patients were premedicated with clopidogrel (75 mg daily for patients with body weights of >45 kg, 37.5 mg daily for 1 small child with a body weight of <45 kg) and aspirin (300 mg daily for ≥45 kg, 100 mg daily for smaller children).RESULTS:VerifyNow and Multiplate Analyzer values were higher than expected. No clinical complications were noted. Imaging performed at 7–52 months after the procedure (mean/median, 22.3/14 months) revealed occlusions of all aneurysms and fistulas. One patient had an asymptomatic occlusion of the parent artery; otherwise, no hemodynamically significant parent artery restenosis was observed. There were no clinically significant neurologic events during follow-up.CONCLUSIONS:Although flow-diverter placement appears to be safe and effective on midterm follow-up in children, longer follow-up is critical. The current sizes of flow diverter devices and delivery systems cover the pediatric size range, obviating developing flow diverters specific to children.

The introduction of flow diverters into endovascular practice has been defined by some authors as a paradigm shift.¹ Currently, a significant proportion of intracranial aneurysms in adults are successfully treated with flow diverters. However, there are few case reports on the use of flow diverters in the pediatric population.^2–11 In this retrospective study, we report our experience with of flow diverters in 5 children with intracranial aneurysms and 2 children with carotid cavernous fistulas (CCFs). Through a review of our patient data and the relevant literature, we also summarize the current antiplatelet regimens used for children undergoing cerebrovascular interventions involving the placement of stents and flow diverters. There is a need for the development of a standardized antiplatelet therapy protocol for children undergoing cerebrovascular interventions involving the placement of permanent vascular scaffolds.     

纤维内镜Nd:YAG激光治疗咽喉疾病

随着激光器械、内镜、光敏剂研究和医疗技术的进步,激光在咽喉疾病治疗中的应用越来越受到重视,使许多过去传统疗法疗效不佳的问题得到解决.现结合我们多年来应用Nd:YAG激光结合光动力学疗法治疗放疗后复发或残留的鼻咽癌,在纤维内镜下应用Nd:YAG激光治疗早期声门癌、声带息肉、喉乳头状瘤、喉血管瘤、淀粉样瘤、喉狭窄等咽喉疾病的体会,谈一谈激光在治疗咽喉疾病中的作用,希望能有助于激光疗法在这一领域中的推广应用.     

Radiation Therapy for Nonmalignant Diseases in Germany

BACKGROUND: Radiotherapy (RT) of nonmalignant diseases has a long-standing tradition in Germany. Over the past decade significant theoretical and clinical progress has been made in this field to be internationally recognized as an important segment of clinical RT. This development is reflected in a national patterns-of-care study (PCS) conducted during the years 2001-2002. MATERIAL AND METHODS: In 2001 and 2002, a questionnaire was mailed to all RT facilities in Germany to assess equipment, patient accrual, RT indications, and treatment concepts. 146 of 180 institutions (81%) returned all requested data: 23 university hospitals (UNI), 95 community hospitals (COM), and 28 private institutions (PRIV). The specific diseases treated at each institution and the RT concepts were analyzed for frequencies and ratios between the different institution types. All data were compared to the first PCS in 1994-1996. RESULTS: In 137 institutions (94%) 415 megavoltage units (mean 1.7; range 1-4), and in 78 institutions (53%) 112 orthovoltage units (mean 1.1; range 0-2) were available. A mean of 37,410 patients were treated per year in all institutions: 503 (1.3%) for inflammatory disorders, 23,752 (63.5%) for degenerative, 1,252 (3.3%) for hypertrophic, and 11,051 (29.5%) for functional, other and unspecified disorders. In comparison to the first PCS there was a significant increase of patients per year (from 20,082 to 37,410; +86.3%) in most nonmalignant diseases during the past 7-8 years. Most disorders were treated in accordance with the national consensus guidelines: the prescribed dose concepts (single and total doses) varied much less during the period 2001-2002 in comparison with the previous PCS in 1994-1996. Only five institutions (3.4%) received recommendations to change single or total doses and/or treatment delivery. Univariate analysis detected significant institutional differences in the use of RT for various disorders. CONCLUSION: RT is increasingly accepted in Germany as a reasonable treatment option for many nonmalignant diseases. The long-term perspective and research plan will have to include various updates of PCS, re-writing of consensus guidelines, introduction of registries for rare nonmalignant disorders, and clinical controlled studies even for so-called established indications, as international acceptance is based on the criteria of evidence-based medicine.     

光动力学疗法治疗上消化道癌的临床研究

目的总结金蒸气激光和半导体激光光动力学疗法（PDT）治疗上消化道癌的近期疗效及不良反应。 方法上消化道癌症患者162例,分别应用金蒸气激光（67例）或半导体激光（95例）作为治疗光源,功率密度200～400mW/cm^2,能量密度100～300J/cm^2。光敏剂分别为血卟啉衍生物（5mg/kg给药）及卟吩姆钠（2mg/kg给药）,于照光前12～24h静脉滴注。 结果金蒸气激光组67例患者中,完全效应5例（7.5%）,明显效应40例（59.7%）,稍有效应16例（23.9%）,无效6例（9.0%）。半导体激光组95例患者中,完全效应9例（9.5%）,明显效应58例（61.1%）,稍有效应20例（21.1%）,无效8例（8.4%）。两组病例均未出现严重不良反应。 结论金蒸气激光器及半导体激光器PDT治疗临床各期上消化道癌疗效肯定,不良反应轻,耐受性好,是较好的姑息治疗手段。