蛛网膜下腔出血急性期的心电图改变分析

蛛网膜下腔出血 (ＳＡＨ)引起心电图改变首先由Ｂｙｅｒ于 1947年报道 ,其后ＳＡＨ与心电图改变的关系国内外亦有较多报道 ,且日益受到人们的重视。为了探讨蛛网膜下腔出血对心脏的影响 ,现对我院神经科 1991年 1月～ 2 0 0 0年6月收治的 72例蛛网膜下腔出血患者急性期心电图改变分析如下。1　资料与方法病例组 72例ＳＡＨ患者 (既往有心脏病史者除外 ) ,其中男 30例 ,女 42例 ,年龄 13～ 78岁 ,平均年龄 5 2 .11岁 ,所有病例均经临床病史和体检诊断和脑脊液检测或ＣＴ扫描证实。对照组 6 2例 ,为随机选择门诊健康体检者 ,其中男 2 8例 ,女 …     

90例蛛网膜下腔出血临床与心电图关系分析

本文报告９０例蛛网膜下腔出血病人心电图异常者６９例（７６．６％），其中６３例无心脏病史和体征。心电图异常以缺血性改变（４９例）和心律失常（３０例）为主，Ⅲ～Ⅴ度的病人均有心电图异常，死亡６例和病情恶化的３例均有心电图显著改变。提示大多数蛛网膜下腔出血病人有心电图异常改变，并与病型和预后有关。     

严重脑外伤患者心电图及心肌酶谱改变的临床意义

目的：分析严重颅脑外伤患者心电图及心肌酶谱改变的临床意义。方法将我院2011-08-2013-07收治的颅脑外伤患者86例纳入本研究,根据入院时GCS评分分组。其中GCS评分＞8分者为轻度颅脑损伤（A组）,GCS评分≤8分者为严重颅脑损伤（B组）。对比2组患者心电图、心肌酶谱等方面的差异。结果对比2组心电图检查结果,B组心电图异常率明显高于A组,差异有统计学意义（P＜0·05）。心肌酶谱检查结果B组AST、CK、CKMB、LDH、HBDH等指标明显高于A组,差异有统计学意义（P＜0·05）。结论颅脑外伤患者心电图及心肌酶谱异常改变,与创伤严重程度具有一定的相关性,早期检查心电图和血清心肌酶可辅助判断伤情和预后。     

心电图监测在判定动脉瘤性蛛网膜下腔出血预后中的价值

目的 探讨心电图(ECG)监测在动脉瘤性蛛网膜下腔出血(SAH)病程中的变化,并判定其在SAH预后中的预测价值.方法 同顾性分析108例住院期间做过ECG检查的动脉瘤性SAH患者资料,分析其改变特征与预后之间的关系.结果 108例患者开颅夹闭动脉瘤41例,血管内介入治疗67例.108例患者中初次ECG异常者89例,占82.4%;ST-T改变71例,心律异常13例,Q-T间期延长14例,T波改变37例,异常Q波9例,其他异变者7例;有2种以上波形改变者62例.心电图复查基本恢复正常者99例,好转5例,加重4例.结论 ECG改变与SAH预后之间无显著相关性,但在SAH病程中监测ECG前后变化对判定预后具有重要的临床参考价值.     

蛛网膜下腔出血患者的护理

蛛网膜下腔出血(SAH)是神经内科常见病,是指颅内血管破裂,血液流入蛛网膜下腔所致。发病原因有高血压、脑血管病、脑血管畸形和颅动脉瘤等多种因素,急性脑血管疾病占10%左右,颅内动脉瘤破裂约占50%[1]。现将在我院神经内科2009-07~2011-02住院30例蛛网膜下腔出血患     

蛛网膜下腔出血患者血浆内皮素水平变化

内皮素(Endothelin,ET)是一种血管活性肽。Yanagaisawa等从猪的主动脉内皮细胞培养液中分离出来。本文检测了23例蛛网膜下腔出血(SAH)急性期患者血浆ET水平的变化,现报告如下。     

急性脑血管病患者心电图及心肌酶改变分析

脑血管病为临床常见病,我们在临床发现很多脑血管病人合并心电图及心肌酶改变。笔者自2004-01～2004-06观察了160名急性脑血管病人的心电图及心肌酶,现分析报告如下。1资料与方法1.1观察对象所有观察对象均来自本院神经内科急性脑血管病住院病人,符合1995年全国第四届脑血管病学术会议制定的各类脑血管病诊断要点,并经CT或MRI证实。病程<3d,年龄41～80,平均(65.32±4.52)岁;男96人,女64人;缺血性脑血管病患者94人,出血性脑血管病66人(其中脑出血患者34人,蛛网膜下腔出血患者32人)。合并高血压病112人,合并糖尿病35人,排除既往有器质性心脏…     

蛛网膜下腔出血时脑脊液检查的意义

５２５例ＳＡＨ患者６８７次腰穿所得ＣＳＦ理化检查表明：ＳＡＨ后早期ＣＳＦ呈浓血性者死亡率达２０．９％压力高于１．９６ｋＰａ者死亡率达２８．４％；血性ＣＳＦ维持最长者到病后１８天，ＣＳＦ黄变的高峰是在病后２～３周。黄变延续时间最长可到病后５７天；ＣＳＦ中含噬铁颗粒的白细胞可存子病后的第十周。因此。ＳＡＨ急性期治疗以到病后３～４周为宜。ＣＳＦ检查对ＳＡＨ诊断、预后判断有价值。     

脑胶质瘤病人SII、血清Fib和AGR水平变化及意义

目的 探讨脑胶质瘤病人全身免疫炎症指数（SII）、血清纤维蛋白原（Fib）、血清白蛋白/球蛋白比值（AGR）水平变化及临床意义。方法 回顾性分析2012年12月至2017年7月收治的128例脑胶质瘤的临床资料，以同期健康体检者68例为对照组。SII为外周静脉血液中性粒细胞和血小板的乘积与淋巴细胞的比值。结果 脑胶质瘤病人SII、血清Fib水平明显高于对照组（P<0.05），而血清AGR明显低于对照组（P<0.05）。SII、血清Fib与胶质瘤病理级别呈明显正相关（P<0.05），而血清AGR胶质瘤病理级别呈明显负相关（P<0.05）。ROC曲线结果示，对判断胶质瘤恶性程度:SII曲线下面积为0.757，敏感度和特异度分别为0.844和0.789；血清Fib曲线下面积为0.706，敏感度和特异度分别为0.875和0.737；血清AGR曲线下面积为0.715，敏感度和特异度分别为0.813和0.632；三者联合检测曲线下面积为0.875，敏感度和特异度分别为0.906和0.842。结论 脑胶质瘤病人SII、血清Fib水平升高，而血清AGR水平降低；三者水平变化对脑胶质瘤恶性程度具有一定的诊断价值。     

Decreased serum sodium levels predict symptomatic vasospasm in patients with subarachnoid hemorrhage

Background: Symptomatic vasospasm is a major cause of morbidity and mortality in subarachnoid hemorrhage patients. Hyponatremia and dehydration due to natriuresis after subarachnoid hemorrhage are related to symptomatic vasospasm. Therefore, most institutions are currently targeting euvolemia and eunatremia in subarachnoid hemorrhage patients to avoid complications. We retrospectively investigated the predictors of symptomatic vasospasm with respect to water and sodium homeostasis, while maintaining euvolemia and eunatremia after subarachnoid hemorrhage. Methods: We monitored changes in serum sodium levels, serum osmolarity, daily sodium intake, daily urine volume, and daily water balance for 14 days after subarachnoid hemorrhage. Outcomes were assessed using the modified Rankin scale at 1 month after subarachnoid hemorrhage. Results: Among 97 patients, 27 (27.8%) had symptomatic vasospasm. Patients with symptomatic vasospasm were older than those without symptomatic vasospasm; the occurrence of symptomatic vasospasm affected outcomes. Serum sodium levels were sequentially significantly decreased, but within the normal range from 1 day before the occurrence of symptomatic vasospasm. Serum osmolarity of the spasm group was lower than that of the non-spasm group. Conclusions: Symptomatic vasospasm occurs more often in older patients and affects outcomes. A decrease in serum sodium levels occurs a day before symptomatic vasospasm. This observation may help predict symptomatic vasospasm.     

急性脑出血患者血清甲状腺激素水平的变化及其意义

目的探讨急性脑出血患者血清甲状腺激素水平的变化及其意义。方法 65例急性脑出血患者于入院第1 d、第3 d、第7 d、第15 d,52名正常对照者于体检日进行血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离T3(FT3)、游离T4(FT4)和促甲状腺激素(TSH)水平检测和比较。并对不同病情及预后的急性脑出血患者入院第3 d的血清甲状腺激素水平进行比较。结果与正常对照组比较,急性脑出血组入院第1 d、第3 d、第7 d时血清T3、FT3水平明显降低,血清T4、FT4水平明显增高(均P<0.05)。与急性脑出血轻度亚组比较,中度亚组及重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血中度亚组比较,重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。与急性脑出血显著进步亚组比较,进步亚组及死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血进步亚组比较,死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。结论急性脑出血...     

tSAH患者血清内皮素与神经元特异性烯醇化酶的动态检测

目的观察外伤性蛛网膜下腔出（tSAH）患者血清中内皮素-1（ET-1），神经元特异性烯醇化酶（NSE）水平的变化。方法用双抗体夹心酶标免疫分析法和放免法检测50例外伤性蛛网膜下腔出血患者发病24h内、第3、7、14d血清中ET、NSE的水平并与对照组比较。结果外伤性蛛网膜下腔出血患者血清中ET水平较正常对照组高（P〈0．01），第3、7d升高明显，第14d有降低但仍高于对照组，血清中NSE水平第7d达高峰。结论ET、NSE的变化可以反映蛛网膜下腔出后脑损伤程度。     

高血压脑出血患者血清CRP及IL-6变化及临床意义

目的探讨高血压脑出血患者血清C-反应蛋白（CRP）及白介素-6（IL-6）的水平变化及其临床意义。方法选取2013年2月至2013年9月收治的高血压脑出血患者75例,根据出血量分成3组：小出血量组（出血量〈30ml,25例）,中等量出血组（出血量为30-50ml,25例）,大量出血组（出血量〉50ml,25例）。选择同期正常体检者42例作为对照组,比较各组患者血清CRP、IL-6的水平。结果高血压脑出血患者血清CRP水平[（8．35±0．92）mg／L]及IL-6水平[（23．26±2．09）pg/ml]明显高于对照组[分别为（3．17±0．54）mg／L、（4．26±0．69）pg／ml;P〈0．05];随着脑出血量增多,CRP和IL-6血清水平均明显增高（P〈0．05）。出血后30d根据GOS评分评估患者预后,血清CRP和IL-6水平越低患者良好越好（P〈0．05）。结论高血压脑出血患者血清CRP及IL-6的水平明显升高,且它们血清浓度与脑出血量呈正相关。这提示血清CRP及IL-6的水平对脑出血患者的病情及预后的评估有一定的指导意义。     

脑出血并应激性溃疡患者血浆Ghrelin的变化及意义

目的探讨脑出血并应激性溃疡患者血浆Ghrelin水平的变化,并分析其意义。方法收集的急性脑出血病例97例作为观察组,将其分为单纯脑出血组53例,脑出血并溃疡组44例(其中基底节42例,小脑7例,脑干12例,丘脑2例,破入脑室18例,脑叶16例),同时取30例健康体格检查者作为对照组。分别取观察组患者入院后24h内血浆,检测Ghrelin含量,进一步分析血浆Ghrelin含量、脑出血及应激性溃疡的关系。结果单纯脑出血组血浆Ghrelin水平为(166.50±74.79)μg/L,脑出血并应激性溃疡组血浆Ghrelin水平为(322.50±22.53)μg/L,对照组为(68.64±16.28)μg/L,3组比较差异有统计学意义(P<0.05)。结论急性脑出血患者血浆Ghrelin水平对诊断应激性溃疡及估计病情预后有一定提示作用。     

Cerebrospinal fluid superoxide dismutase and serum malondialdehyde levels in patients with aneurysmal subarachnoid hemorrhage: preliminary results

OBJECTIVES: Experimental studies provide evidence that oxidative damage plays a role in the development of vasospasm after aneurysmal subarachnoid hemorrhage (SAH) but data from human studies is still limited. The purpose of this study was to investigate the time course of cerebrospinal fluid (CSF) superoxide dismutase (SOD) and serum malondialdehyde (MDA) changes in patients with aneurysmal SAH. METHODS: SOD in CSF and MDA in the serum were detected on days 1-3, 5 and 7 after aneurysmal SAH in 21 patients, and the results were compared with 15 patients with hydrocephalus. The results were also compared with those of clinical parameters including the patient's outcome at 6 months. RESULTS: The mean CSF SOD levels were lower and serum MDA levels were higher than the controls. Patients with a high amount of blood within the cisterns had a trend to decreased SOD while increasing MDA levels. CONCLUSION: These preliminary results suggest that the levels of antioxidants are decreased after the onset of SAH in the early period, possibly because of increased oxidative stress. Reactive oxygen-mediated oxidative damage may play an important role in inflammation after SAH.     

急性脑出血患者血清心肌酶谱血糖水平的变化及与预后的关系

目的：观察急性脑出血患者血清心肌酶谱、血糖水平的变化,探讨其与预后的相关性。方法收集急性脑出血患者120例作为观察组,纳入同时期健康志愿者60例作为对照组,比较2组患者间血清心肌酶谱、血糖水平;再将120例急性脑出血患者分别按心肌酶水平和血糖水平分为心肌酶正常组和心肌酶升高组、血糖正常组和血糖升高组,比较入组时和治疗3、6个月后组间神经功能缺损评分（NIHSS）。结果急性脑出血患者血清AST、LDH、CK及CK-MB水平显著高于正常人群,其空腹血糖水平也显著高于正常人群（ P＜0.05）。心肌酶升高和血糖升高的急性脑出血患者入组时和治疗3、6个月后NIHSS评分显著高于心肌酶和血糖正常者。结论急性脑出血患者血清心肌酶谱、血糖水平高于正常人群,其水平高低与预后呈正相关。     

Cerebrospinal fluid superoxide dismutase and serum malondialdehyde levels in patients with aneurysmal subarachnoid hemorrhage: preliminary results

Abstract

Objectives: Experimental studies provide evidence that oxidative damage plays a role in the development of vasospasm after aneurysmal subarachnoid hemorrhage (SAH) but data from human studies is still limited. The purpose of this study was to investigate the time course of cerebrospinal fluid (CSF) superoxide dismutase (SOD) and serum malondialdehyde (MDA) changes in patients with aneurysmal SAH.

Methods: SOD in CSF and MDA in the serum were detected on days 1–3, 5 and 7 after aneurysmal SAH in 21 patients, and the results were compared with 15 patients with hydrocephalus. The results were also compared with those of clinical parameters including the patient's outcome at 6 months.

Results: The mean CSF SOD levels were lower and serum MDA levels were higher than the controls. Patients with a high amount of blood within the cisterns had a trend to decreased SOD while increasing MDA levels.

Conclusion: These preliminary results suggest that the levels of antioxidants are decreased after the onset of SAH in the early period, possibly because of increased oxidative stress. Reactive oxygen-mediated oxidative damage may play an important role in inflammation after SAH.