高分辨磁共振管壁成像技术在颅内动脉瘤破裂风险评估中的可行性

目的探讨分析高分辨磁共振(HR-MRI)管壁成像技术在颅内动脉瘤破裂风险评估中的可行性。方法将该院60例经三维数字减影血管造影(DSA)技术诊断为颅内动脉瘤破裂患者分为瘤壁强化组(24例)和瘤壁未强化组(36例),所有研究对象在术前行HR-MRI管壁成像检查,观察瘤壁强化与颅内动脉瘤破裂的关系,进而探究HR-MRI成像技术在颅内动脉瘤破裂风险评估中的可行性。结果所有研究对象HR-MRI管壁成像检查显示颅内动脉瘤破裂的有41例,准确率为68.33%;瘤壁未强化组中瘤体破裂的比例(9.80%)明显低于瘤壁强化组(18.42%),差异有统计学意义(χ~2=1.39,P0.05);2组患者中有子囊与无子囊患者例数,SR2与SR≥2患者例数比较,差异均有统计学意义(χ~2=5.62、9.26,P0.05)。结论 HR-MRI成像技术对颅内动脉瘤破裂有少许的漏诊率,但成像结果显示瘤体破裂的风险与瘤壁强化有明显关系,影响瘤壁强化的因素包括瘤体有无子囊及瘤体体率等动脉瘤形态学特征。     

高分辨MRI成像对基底动脉狭窄患者斑块分布、成分及相关特征分析

目的采用高分辨MRI成像分析有症状和无症状基底动脉狭窄患者斑块分布、成分及相关特征。方法回顾性分析2018年3月~2021年3月我院收治的106例行高分辨MRI检查的基底动脉狭窄患者,根据是否存在后循环卒中分为症状性组（n=45）和无症状组（n=61）,收集所有纳入对象影像学资料,分析两组斑块分布、成分、重构等相关特征。结果症状性组斑块主要分布在背侧壁,无症状组斑块主要分布在腹侧壁,两组斑块分布差异存在统计学意义（P < 0.05）;症状性组合并斑块内出血、纤维帽断裂概率高于无症状组（P < 0.05）;症状性组患者最狭窄层的血管面积、管壁面积、管腔面积、最大管壁厚度、狭窄率、血管重构指数（RI）均高于无症状组（P < 0.05）,两组斑块负荷差异无统计学意义（P > 0.05）;两组斑块强化等级分布存在明显差异,其中症状性组斑块2级强化率高于无症状组（P < 0.05）。结论有症状和无症状基底动脉狭窄患者斑块分布、成分、重构等特征存在一定差异,而高分辨MRI成像能为识别斑块特征和及早干预提供可靠影像学参考。     

多排螺旋CT对乏脂性肾血管平滑肌脂肪瘤的诊断价值

目的探讨多排螺旋CT（MDCT）在乏脂性肾血管平滑肌脂肪瘤诊断中的应用价值。方法选取2012年1月~2020年2月在我院治疗的乏脂性肾血管平滑肌脂肪瘤患者作为观察组（n=117）,将肾透明细胞癌患者作为对照组（n=210）,两组均给予MDCT检查,分析两组CT征象、CT值等差异,采用受试者工作特征（ROC）曲线分析CT值判断乏脂性肾血管平滑肌脂肪瘤的价值。结果观察组女性比例高于对照组（P < 0.05）,年龄低于对照组（P < 0.05）;观察组密度均匀、边界清楚、瘤内血管影比例分别为80.34%、100.00%和16.24%,明显高于对照组（P < 0.05）;观察组假包膜比例低于对照组（P < 0.05）;CT征象中,形态、强化方式在观察组和对照组中差异无统计学意义（P>0.05）;观察组病灶CT值和病灶/肾实质CT比值分别为46.10±7.82 Hu和1.37±0.32,明显高于对照组（P < 0.05）;观察组和对照组肾实质CT值比较差异无统计学意义（P>0.05）;病灶CT值、病灶/肾实质CT比值诊断乏脂性肾血管平滑肌脂肪瘤的ROC曲线下面积分别为0.872和0.862,截断值分别为41.50 Hu和1.20时,敏感度分别为78.80%和76.50%,特异性分别为75.50%和74.40%。结论MDCT在乏脂性肾血管平滑肌脂肪瘤诊断中有较好的应用价值,值得临床使用。     

头颈部CT血管成像对颅内动脉瘤的诊断价值更高

目的  探究头颈部CT血管成像（CTA）在颅内动脉瘤中的诊断效果及在手术指导中的应用价值。方法  选择2018年6月~ 2021年9月本院收治的129例颅内动脉瘤疑似患者纳入研究对象,均行头颈部CTA诊断和磁共振血管成像（MRA）诊断,以数字减影血管造影（DSA）作为金标准,比较头颈部CTA诊断和MRA诊断对颅内动脉瘤的诊断及手术应用价值。结果  以DSA诊断为“金标准”,129例颅内动脉瘤疑似患者经DSA诊断证实有80例确诊为颅内动脉瘤,头颈部CTA诊断准确度为92.24%,敏感度为95.06%,特异性为87.50%,阳性预测值为92.77%,阴性预测值为91.30%;MRA诊断准确度为88.37%,敏感度为91.46%,特异性为82.97%,阳性预测值为90.36%,阴性预测值为84.78%。头颈部CTA诊断和MRA诊断的病灶检出部位差异无统计学意义（P>0.05）。头颈部CTA诊断检出 < 3 mm直径的瘤体数量多于MRA诊断（P < 0.05）。头颈部CTA诊断Kappa值为0.850,MRA诊断的Kappa值为0.747,头颈部CTA诊断与DSA诊断一致性更高。结论  头颈部CT血管成像对颅内动脉瘤的诊断价值更高,对手术治疗具有更好的指导作用。     

瑞芬太尼静脉自控分娩镇痛对产后抑郁的影响

目的研究瑞芬太尼静脉自控分娩镇痛对产后抑郁的影响。方法选取2014年3月~2017年3月入我院妇产科进行分娩的单胎头位足月初产妇 66例作为研究对象。采用随机数字表法将产妇分为瑞芬太尼组（n=22）、硬膜外组（n=22）和对照组（n=22）。瑞芬太尼组采用瑞芬太尼静脉自控分娩镇痛,硬膜外组行硬膜外分娩镇痛,对照组为自然分娩。记录3组产妇组产妇产程、出血量和新生儿体质量等一般情况指标,采用视觉模拟评分量表（VAS）评价产妇分娩各时点的疼痛指数,医院焦虑-抑郁情绪自评量表（HAD）评定产妇产前情绪状况,爱丁堡产后抑郁量表（EPDS）评价产妇产后抑郁状态,并对3组调查资料进行对比分析。结果瑞芬太尼组、硬膜外组和对照组患者年龄、体质量指数、孕周、产程、出血量和新生儿体质量等资料的差异无统计学意义（P>0.05）。3组产妇娩出后的VAS评分较分娩时均有所降低。瑞芬太尼组和硬膜外组分娩时、娩出后的VAS评分均比对照组低（P<0.05）。与硬膜外比较,瑞芬太尼组分娩时、娩出后的VAS评分稍高,差异有统计学意义（P<0.05）。3组产妇生产前的HAD评分及产前抑郁率差异无统计学意义（P>0.05）。生产后瑞芬太尼组EPDS评分和产后抑郁发生率低于对照组和硬膜外组（P<0.05）。对照组和硬膜外组EPDS评分差异无统计学意义（P>0.05）。硬膜外组产后抑郁发生率低于对照组（P<0.05）。结论瑞芬太尼静脉自控分娩镇痛较硬膜外镇痛效果差,但可以减少产妇产后抑郁现象的发生,对产前有抑郁倾向的产妇可选用瑞芬太尼静脉镇痛。     

实时剪切波弹性成像可评价下肢深静脉血栓的分期及溶栓疗效

目的  探讨实时剪切波弹性成像技术在评价下肢深静脉血栓（DVT）分期及溶栓疗效中的应用价值。方法  选取212例DVT患者为研究对象,结合发病时间长短与彩色多普勒超声检查结果将其分为急性期组（n=97）、亚急性期组（n=68）、慢性期组（n=47）,全部患者均接受溶栓治疗,根据治疗结果将其分为治愈组（n=83）、有效组（n=97）、无效组（n=32）,采用剪切波弹性成像技术测定不同分期、不同疗效患者杨氏模量值,通过绘制ROC曲线评估治疗后血栓杨氏模量对DVT患者溶栓疗效的诊断效能。结果  治疗前,不同分期DVT患者血栓杨氏模量的差异有统计学意义（P<0.05）,其中急性期组<亚急性期组<慢性期组（P<0.001）;治疗后,各组血栓杨氏模量低于治疗前（P<0.05）,且各组治疗后血栓杨氏模量差异有统计学意义（P<0.05）,其中急性期<亚急性期<慢性期（P<0.001）。治疗后,不同预后DVT患者血栓杨氏模量差异有统计学意义（P<0.05）,其中治愈组<有效组<无效组（P<0.001）。ROC分析结果显示,当Youden指数取最大值0.632时,血栓杨氏模量截断值为6.825 kPa,此时诊断DVT患者溶栓治疗无效的敏感度为93.8%,特异性为69.4%,曲线下面积为0.885。结论  实时剪切波弹性成像技术测定杨氏模量,可作为评价DVT分期及溶栓疗效的辅助手段。     

基于CT图像的气管支气管异物性质分析

目的探讨CT图像在气管支气管异物性质鉴别中的价值。方法收集2014年8月~2019年4月诊断为气管支气管异物的患者69例,并将其根据异物种类分为花生组（n=36）与非花生组（n=33）。花生组男25例,女11例;非花生组男21例,女12例。分析两组间在临床（异物呛咳史、年龄、性别及居住地）,纤维支气管镜下（异物部位、肉芽形成）,胸部CT图像上（异物CT值、异物边界清晰度、支气管闭塞、异物长径、异物宽径、肺气肿、支气管狭窄、肺炎、纵隔偏移、纵隔气肿、肺不张及支气管扩张）的特征差异。结果花生组的异物呛咳史较非花生组多见,两组间的异物呛咳史差异有统计学意义（P=0.044）;两组年龄、性别、居住地差异无统计学意义（P>0.05）;纤维支气管镜下,两组间的异物部位（P=0.361）和肉芽形成（P=0.543）差异均无统计学意义;胸部CT图像下,花生组CT值较非花生组低（P < 0.001）,异物边界更模糊（P=0.005）,支气管闭塞（P < 0.001）更多见,其余CT图像上的特征差异均无统计学意义（P>0.05）。结论结合临床异物呛咳史,胸部CT图像可鉴别气管支气管异物的性质。     

彩色多普勒超声在评估乳腺癌手术前辅助性化疗效果的价值

目的探讨彩色多普勒超声检查在评估乳腺癌手术前辅助性化疗效果的价值。方法选取2015年1月~2021年1月安徽省肿瘤医院术前采取辅助化疗方式治疗的88例乳腺癌患者作为研究对象,根据化疗效果将患者分为有效组（n=60）和无效组（n= 28）,对比两组化疗前后的原发病灶大小、病灶内血流分级特征、超声声像特征差异。结果化疗前,有效组和无效组患者的病灶长、宽、厚、病灶面积、病灶体积测定值差异无统计学意义（P>0.05）;化疗后,有效组患者的病灶长、宽、厚、病灶面积、病灶体积测定值均低于无效组（P < 0.05）,两组患者的病灶长、宽、厚、病灶面积、病灶体积测定值较化疗前均降低（P < 0.05）;化疗前,有效组和无效组患者的病灶形态、边界、强回声带、后方回声构成情况差异无统计学意义（P>0.05）;化疗后,有效组患者肿瘤病灶规则形态、边界清晰、后方回声无异常的占比均高于化疗无效组,差异具有统计学意义（P < 0.05）;化疗前,有效组和无效组患者的肿瘤病灶血流分级构成情况差异无统计学意义（P>0.05）;化疗后,有效组患者肿瘤病灶血流分级达到（0级+Ⅰ级）占比高于无效组,差异具有统计学意义（P < 0.05）。结论彩色多普勒超声可以从病灶大小、血流分级、声像特征变化3个方面评估乳腺癌术前辅助性化疗效果,对于指导临床治疗及手术具有重要价值。     

个性化扫描与常规扫描对≤1 cm肺小结节的CT成像价值比较

目的  比较个性化和常规两种扫描方案对≤1 cm肺小结节的CT成像效果,探索最佳扫描方案。方法  按照纳入及排除标准,选择2020年1月~2022年6月在我院行肺小结节CT成像的患者,按随机对照表以平衡对照法随机分为个性化组（n=67）和常规组（n=70）,个性化组进行严格的过度吸气训练、个性化体位、个性化扫描方向制定,获得的图像与常规扫描组进行图像质量比较。结果  个性化组的CT平扫、肺动脉期、肺静脉期图像质量均优于常规扫描组,差异有统计学意义（χ²=8.204,P=0.017;χ²= 6.625,P=0.036;χ²=7.139,P=0.028）;两组组内CT平扫、肺动脉期、肺静脉期图像质量比较,常规组组内CT平扫和肺静脉期图像质量差异有统计学意义（χ²=9.188,P=0.010）,常规组其余各期、个性化组组内比较图像质量差异均无统计学意义（P > 0.05）。结论  个性化扫描方案成像质量稳定,能提高≤1cm肺小结节CT成像的图像质量。     

弥散加权成像在CT引导下肺肿块穿刺活检的临床应用

目的  探讨磁共振弥散加权成像（DWI）在CT引导下肺肿块穿刺活检术的应用价值。方法  回顾性分析2022年10月~2023年10月在陕西中医药大学附属医院行CT引导下肺肿块穿刺的152例患者,根据术前有无胸部DWI检查分为A组（无DWI检查,n=85）,B组（有DWI检查,n=67）。比较两组患者的一般资料、病理阳性率、调针次数、靶皮距、套管针在肺内长度和并发症。结果  A组病理诊断为恶性肿瘤65例,良性病变9例,未明确诊断11例;B组病理诊断为恶性肿瘤57例,良性病变8例,未明确诊断2例;A组和B组病理阳性率分别为87.06%和97.01%,差异有统计学意义（P=0.029）。2组总体并发症发生率及气胸发生率的差异无统计学意义（P>0.05）,但A、B组出血发生率分别为30.59%、13.43%,差异有统计学意义（P < 0.05）。结论  CT引导下肺肿块穿刺活检前行胸部DWI检查,有助于指导穿刺靶点的选择,提高病理诊断阳性率,减少穿刺相关出血事件发生,具有较好临床实用价值。     

CTA与高分辨磁共振血管壁成像评估颅内动脉瘤破裂风险的临床价值

目的 探讨CT血管造影(CTA)与高分辨磁共振血管壁成像(HR-MRI)评估颅内动脉瘤破裂风险的临床价值.方法 选取2019年1月至2020年12月我院收治的189例颅内动脉瘤患者作为研究对象,入院后均行数字减影血管造影(DSA)、CTA、HR-MRI检查,检测患者动脉瘤破裂情况,并根据诊断结果将患者分为破裂组(n=5...     

Endovascular treatment of unruptured intracranial aneurysms

We report the clinical and angiographic results of endovascular treatment of unruptured intracranial aneurysms. Over a three-year period, 80 unruptured aneurysms in 74 patients were electively treated with endovascular management. One aneurysm was diagnosed during investigations for a second ruptured aneurysm, 54 aneurysms were incidentally discovered, 18 aneurysms presented with symptoms of mass effect and seven aneurysms presented with symptoms of brain stem ischemia. Mean size of the 80 unruptured aneurysms was 12.5±8.0 mm (range, 2-39 mm). Thirty-six aneurysms (45%) were small (<10 mm), 38 aneurysms (47.5%) were large (10-25 mm), and six aneurysms (7.5%) were giant (25-39 mm). Forty-eight wide-necked aneurysms (60%) were coiled with the aid of a supporting device. The mortality rate was 1.25%, and the overall morbidity was 1.25%. Of these, one of the patients suffered a stroke, leading to severe disability (1.25%). In one patient, the aneurysm ruptured during treatment, resulting in death. Initial aneurysm occlusion was complete (100%) in 76.25% aneurysms, nearly complete (90%-98%) in 10% aneurysms and incomplete (60%-85%) in 13.75% aneurysms. Follow-up angiography was available in 67 patients with 73 treated aneurysms (91.25%) from one to 36 months (mean 9.3 months); partial reopening occurred in 7.5%, mainly large and giant aneurysms (5.5%). Additional coiling was performed in four aneurysms. There were no complications in additional treatments. At 14.1-month clinical follow-up (range, 2 to 36 months), mRS score was 0 in 78.75% patients, 1 in 10% patients, 2 in 8.75% and 3 in 1.25%. There was no aneurysmal rupture during the follow-up period. Endovascular treatment of unruptured intracranial aneurysms has low procedural mortality and morbidity rates.     

影响颅内动脉瘤破裂的危险因素分析

【目的】探讨与颅内动脉瘤（IA）破裂相关的危险因素。【方法】回顾性分析167例经数字减影血管造影（DSA）确诊的IA患者资料,分为破裂IA（A组）和未破裂IA（B组）,比较两组动脉瘤的位置、大小以及患者的血压、血糖、颅内血管粥样硬化情况。【结果】位于大脑前、后交通动脉以及左侧椎动脉的动脉瘤在B组所占比例大;两组动脉瘤的平均直径无显著性差异;高血压、颅内血管粥样硬化可能为动脉瘤破裂的高危因素,而血糖对动脉瘤的破裂无明显影响。【结论】IA的破裂可能与动脉瘤的位置及患者的血压、颅内血管粥样硬化有关。     

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

BackgroundAneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems.ObjectiveWe observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed.Materials and methodsClinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location.ResultsA total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured.ConclusionsMethamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.     

前交通支动脉瘤CTA形态学特征与破裂风险的量化分析

目的通过量化分析前交通支动脉瘤形态学特征,并预测其破裂风险。方法本研究回顾性地分析了2015年1月~2019年12月收治的246例前交通支动脉瘤患者的头部CT血管造影资料,记录下动脉瘤的形态学特征,再对其形态学特征进行赋值量化(1、2、3分),寻找动脉瘤破裂风险界值。结果(1)发生于偏侧的前交通支动脉瘤共计186个(破裂151个,81.18%),中间位置动脉瘤89个(破裂38个,42.70%)。(2)已破裂动脉瘤的瘤体长径、瘤体长径/瘤颈宽径(AR)、瘤体宽径/瘤颈宽径(BN)与未破裂动脉瘤相比,均具有统计学差异(均P<0.05)。(3)有子囊结构者破裂率(89.26%)高于无子囊者(44.16%)。(4)前交通支动脉瘤总分越高,其破裂率亦越高;总分为11分或以上破裂风险高(P<0.01)。结论CTA形态学特征量化分析可评估前交通支动脉瘤破裂风险。     

HR-MRI、MRA与DSA在颅内动脉瘤瘤径测量中的对比研究

目的研究高分辨率磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)在颅内动脉瘤测量中的应用价值,并与三维数字减影血管造影(three-dimensional DSA,3D-DSA)、三维时间飞跃法磁共振血管成像(threedimensional time of fl ight MRA,3D-TOF MRA)作对比。材料与方法选取2013年10月至2015年3月我院神经外科诊断为颅内动脉瘤的患者25例。患者首先行3D-TOF MRA及HR-MRI扫描,并于1周内行DSA检查。分别在3D-TOF MRA、HR-MRI和3D-DSA图像上测量动脉瘤的宽径,采用配对t检验两两比较3D-TOF MRA、HR-MRI与3D-DSA在测量颅内动脉瘤宽径方面的差异。P0.05为差异有统计学意义。结果 HR-MRI与3D-DSA、HR-MRI与3D-TOF MRA在测量颅内动脉瘤宽径方面的差异[平均差值分别为(3.16±2.66)mm、(5.15±4.89)mm]均有统计学意义(P10.05,P20.05),3D-DSA与3D-TOF MRA在测量颅内动脉瘤宽径方面的差异[平均差值为(2.53±5.18)mm]无统计学意义(P30.05)。结论 HRMRI与3D-DSA、HR-MRI与3D-TOF MRA在显示颅内动脉瘤宽径方面有差异,可能HR-MRI能更准确地显示颅内动脉瘤实际大小,具有较高的临床应用价值。     

Levels of MMP-9 in patients with intracranial aneurysm: Relation with risk factors,size and clinical presentation

BackgroundIntracranial aneurysms are arterial anomalies affecting 2% to 3% of the general population in the world and these ruptures are associated with a high mortality. Some risk factors, such as age, gender, smoking, alcohol, hypertension and familial history are associated with the number of aneurysms and their size. In addition, inflammatory processes within the blood vessels of the brain can activate matrix metalloproteinase-9 (MMP-9), which degrades various components of the extracellular matrix, such as elastin. Thereby, this work has aimed at evaluating the relationship between plasma MMP-9 levels and the risk factors that are associated with intracranial aneurysm, as well as investigating the aneurysm statuses (ruptured and unruptured) and comparing them with the control volunteers.MethodsBetween August 2014 to June 2016, blood samples were collected from 282 patients (204 ruptured and 78 unruptured saccular intracranial aneurysms) and 286 control volunteers. The MMP-9 plasma levels were measured by ELISA. Statistical analyzes were performed with SPSS software when using parametric or nonparametric tests, after the normality tests.ResultsHigher levels of MMP-9 were found in the aneurysm groups as a whole and when they were stratified by rupture status, then compared with the control group (p < 0.0001). When stratifying them by diameter, those smaller than 7 mm presented high levels of MMP-9 (p < 0.0001), especially in the ruptured ones. As for risk factors, hypertension and smoking were the most important. However, hypertension was mostly associated with the ruptured aneurysms (p < 0.0001).ConclusionsHigh levels of MMP-9 were found in smaller ruptured and unruptured intracranial aneurysms (<7 mm) with strongest statistical associations than other sizes, especially when associated with smoking and hypertension.     

颅内动脉瘤破裂的危险因素分析

目的 探讨未破裂颅内动脉瘤发生破裂的危险因素.方法 回顾性分析承德医学院附属医院2008年1月至2010年5月确诊为颅内动脉瘤的患者,依据动脉瘤是否破裂分为破裂组(n=326)和未破裂组(n=90),收集患者临床资料及动脉瘤特征相关资料.结果 对两组临床资料和颅内动脉瘤特征的各变量单因素分析筛选后进行logistic回归分析,结果显示,吸烟史[优势比(OR)=18.226,95%可信区间(CI)=4.427～75.033]、动脉瘤家族史(OR=14.334,95%CI=3.171～64.786)、后交通动脉瘸(OR=4.265,95%CI=1.643～11.072)、中等动脉瘤(OR=5.641,95%CI=2.332～13.641)发生动脉瘤破裂风险高.结论 吸烟史、动脉瘤家族史、中等动脉瘤、后交通动脉瘤均是未破裂颅内动脉瘤发生破裂的危险因素.     

血清胱抑素C、纤维蛋白原和C-反应蛋白水平与颅内动脉瘤发生及破裂的关系

目的 探讨血清胱抑素C(serum cystatin C, CysC)、纤维蛋白原(fibrinogen, FBG)和C 反应蛋白(C reactive protein, CRP)水平与颅内动脉瘤发生及破裂的关系。方法 选取颅内动脉瘤患者100例分为破裂组(n=54)和未破裂组(n=46),50例健康体检者为对照组。收集患者血液和脑脊液并检测血清CysC、FBG和CRP的含量。结果 颅内动脉瘤患者中饮酒、吸烟、高血压和动脉粥样硬化比例明显高于对照组,且破裂组年龄≥60岁、男性、饮酒、吸烟、糖尿病、高血压及动脉粥样硬化占比更高,差异具有统计学意义 (p<0.05)。与对照组相比,颅内动脉瘤患者血液和脑脊液内CysC、FBG和CRP 含量显著升高(P<0.05)。结论 颅内动脉瘤患者血液和脑脊液内CysC、FBG和CRP 含量异常升高,且CysC、FBG和CRP 含量与颅内动脉瘤破裂有关。     

Unruptured intracranial aneurysms: using evidence and outcomes to guide patient teaching

It is estimated that approximately 10 to 15 million Americans have intracranial aneurysms. Intracranial aneurysms are classified as either unruptured or ruptured. Advances in knowledge and technology are enhancing diagnosis, management, and outcomes associated with unruptured intracranial aneurysms. Optimal outcomes are achieved when aneurysms are treated before they rupture. If the aneurysm ruptures, the mortality rate ranges from 30% to 60%. A review of evidence regarding aneurysms, including the pathogenesis, risk factors, treatment options, and outcomes, is presented. Treatment options addressed include surgical clipping, endovascular coiling, or watchful waiting. Current evidence supports aggressive treatment for patients with previously ruptured aneurysms, large or symptomatic aneurysms, a family history of aneurysm rupture, a long life expectancy, and aneurysms demonstrating growth. Factors that favor watchful waiting include aneurysms that are small or located in the anterior circulation and in patients with a short life expectancy or comorbid medical conditions. Nurses are in an ideal position to use evidence and outcomes to provide accurate and current information on how to reduce the risks for rupture and evaluate treatment options.