高血压丘脑出血的手术治疗

目的探讨高血压丘脑出血患者手术治疗的效果。方法高血压丘脑出血的患者58例,10例丘脑小血肿(10~30 m)l且有单侧或双侧脑室铸型者行脑室外引流及尿激酶纤溶治疗、17例丘脑出血未破入脑室且出血量31~40 ml者立体定向血肿穿刺碎吸术治疗,15例丘脑出血破入脑室且血肿量较大(>40 ml)者行血肿穿刺联合脑室外引流治疗及16例血肿量大且基本位于中心部位并破入脑室者经纵裂入路显微镜下丘脑血肿清除术治疗。结果术后6个月存活49例,死亡9例。存活者术后6个月按日常生活能力分级评估预后:1级15例,2级19例,3级10例,4级5例。结论高血压丘脑出血患者应根据出血量、有无破入脑室及其病情制定手术方案,经纵裂入路显微镜下丘脑血肿清除术对出血位于中线丘脑且出血量较大者有其可行性。     

脑室出血的临床、CT观察及其影响预后因素的探讨

本文报告继发性脑室出血４３例，原发性脑出血２例。我们观察到脑内血肿容积１０ｍｌ以内者，即使破入脑室也预后良好。大血肿破入脑室后、血凝块堵塞室间孔，第三、四脑室时，患者迅速死亡。部分脑室出血尚未形成凝血块者，并不完全是致命的。脑内血肿仅破入侧脑室者大多可治愈，病死率为１９．２３％，破入侧脑室及第三、四脑室者病死率达５２．６３％，伴有侧脑室或／和第三脑室扩大者预后不良。     

继发性脑室内出血（附48例分析）

报告继发性脑室内出血４８例临床资料。病因以高血压性脑出血为主占８３．３％，原发出血部位以基底节最多占６４．５％，破入脑室的脑实质内血肿量依次为脑叶、基底节、丘脑、小脑。根据脑实质内血肿量的多少及波及脑室程度的不同分别采用内科治疗、侧脑室穿刺引流、锥颅血肿抽吸、血肿抽吸加脑室引流，死亡率２９．１％。     

自发性脑出血破入脑室与否的预后比较分析

目的探讨自发性脑出血破入脑室与否对患者预后的影响及其相关危险因素。方法回顾性分析陆军军医大学第一附属医院2010年1月—2016年12月收治的1 342例s ICH患者的临床资料。根据出血是否破入脑室分为破入脑室组(455例,33. 9%)与未破入脑室组(887例,66. 1%),比较分析两组患者预后的差异及其影响因素。结果破入脑室组的平均住院时间为(25. 1±26. 7) d、出院时mRS评分4(3,5)分、死亡率14. 1%,未破入脑室组分别为(20. 9±21. 8) d、3(2,4)分及2. 5%,两组的差异均有统计学意义(均P 0. 05)。单因素Logistic回归分析结果显示,破入脑室(OR=2. 521,P=0. 000)为s ICH患者预后不良的独立危险因素。对未破入脑室组与破入脑室组预后相关影响因素分别进行多因素Logistic回归分析显示,病程 24 h(OR=0. 566,P=0. 001 vs OR=0. 547,P=0. 032)均为两组保护因素;入院格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分≤8分(OR=5. 146,P=0. 004 vs OR=11. 013,P=0. 000)、血肿形态不规则(OR=2. 053,P=0. 000 vs OR=3. 648,P=0. 000)、肺部感染(OR=2. 356,P=0. 000 vs OR=1. 994,P=0. 012)均为危险因素。对患者年龄、性别、血肿量、血肿部位、血肿形态、密度、入院GCS评分作森林图亚组分析,仅血肿部位亚组差异有统计学意义(P 0. 05)。结论自发性脑出血破入脑室患者预后总体差于未破入脑室者,破入脑室是影响自发性脑出血患者预后的独立危险因素。不同出血部位破入脑室与未破入脑室患者的预后有明显不同;病程 24 h为破入脑室和未破入脑室预后的保护因素,而入院GCS评分≤8分、肺部感染、血肿形态不规则为预后不良的危险因素。     

个体化治疗脑出血破入脑室的疗效评价

的探讨脑出血破入脑室的治疗方法与效果。方法根据头颅CT影像学特征采用个体化治疗方案：（1）A组血肿以脑室系统为主，脑室外血肿量小于30ml者行双侧脑室外引流术；（2）B组血肿以脑室系统为主，脑室外血肿量大于30m1者行血肿清除术＋对侧脑室外引流术；（3）C组血肿以脑实质内为主，为单侧脑室积血，第Ⅲ、Ⅳ脑室无铸造形，脑室外血肿量大于30ml者行血肿清除术。结果A组恢复良好率59．40％，不良率18．7％，病死率21．9％；B组恢复良好率58．40％，不良率20．8％，病死率20．8％；C组恢复良好率57．1％，不良率23．8％，病死率19．1％。结论对脑出血破入脑室者根据头颅CT影像学特征，并结合脑室内、外血肿情况综合分析，采用个体化治疗方案，可提高患者的生存质量和预后，减少并发症，降低致残率及病死率。     

150例脑出血破入脑室及其生命预后

本文综合分析了150例脑出血破入脑室及其生命预后,表明,脑出血破入脑室与出血部位密切相关,与血肿量、中线移位呈正相关;脑出血破入脑室生命预后尤与出血部位密切相关,但与血肿量,中线移位并不呈正相关;血肿侵入脑室系统的范围、血液量及其呈现的物理状态是影响生命预后的决定因素。清除脑室内积血,改善脑脊液循环是治疗脑出血破入脑室的关键。     

脑出血破入脑室的治疗体会

目的：探讨高血压脑出血破入脑室的治疗方法并降低死亡率。方法：该组40例高血压脑出血破入脑室的病人用开颅血肿清除，血肿内引流、脑室外引流等手术方法加术后脑室内尿激酶注入、腰穿等方法。结果：优9例占22．5％，良15例占37．5％，差6例占15％，朱醒1例占2．5％，死亡9例上22．5％。结论；根据病情选择适当的治疗方法是降低死亡率的有效方法。     

立体定向血肿清除术治疗高血压脑出血的疗效与死亡相关因素分析

目的评价立体定向血肿清除术治疗高血压脑出血的疗效并分析死亡相关因素。方法：1986年6月至1996年10月,用CT引导立体定向血肿清除术治疗高血压脑出血151例,男105例,女46例;年龄37-90岁,70岁以上者14例;意识3-5分者（Glasgow)68例;血肿体积大于100ml者35例;血肿破入脑室者33例。结果：术后一月内良好率及轻残率分别为25.2%和29.8%,手术死亡率为9.27%,术后并发症发生率为15.2%,其中术后再出血4%,122例随访2个月至10年,良好39.3%,轻残27.9%。结论：立体定向血肿排空术是治疗高血压脑出血的有效手术方法;高龄、血肿量大及术前血肿急性扩大仍是手术死亡的主要原因;虽然血肿破入脑室可明显加重病情,但适当处理可降低其死亡率;术后并发症的有效防治是降低手术死亡率的有效措施。     

双通道微创术治疗脑出血破入脑室系统临床观察

目的应用双通道微创术治疗脑出血破入脑室系统的临床观察。方法选择1999-07～2003-04我科住院病人28例，均经CT证实为脑出血破入脑室系统。结果微创术效果好，死亡率14.3％。结论双通道微创术治疗脑出血破入脑室系统，提高生存率，减少血肿对脑组织的继发性损害，减少并发症及后遗症。     

小骨窗开颅加脑外引流治疗破入脑室的高血压脑出血

高血压脑出血发病率高,破入脑室则病情危重,预后差。我们在总结以往治疗过程中的不足后,从1995年3月开始采用小骨窗血肿清除、脑室外引流结合尿激酶(UK)溶解血肿治疗基底节区出血破入脑室28例,取得良好效果。现报告如下。     

Endovascular Embolization of a Ruptured Distal Lenticulostriate Artery Aneurysm in Patients with Moyamoya Disease

A ruptured distal lenticulostriate artery (LSA) aneurysm is detected occasionally in moyamoya disease (MMD) patients presented with intracerebral hemorrhage. If the aneurysm is detected in hemorrhage site on angiographic evaluation, its obliteration could be considered, because it rebleeds frequently, and is associated with poorer outcome and mortality in MMD related hemorrhage. In this case report, the authors present two MMD cases with ruptured distal LSA aneurysm treated by endovascular embolization.     

颅内压监测下侧脑室外引流治疗丘脑出血破入脑室

目的探讨颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室的疗效。方法收集60例高血压性丘脑出血破入脑室患者的临床资料,无颅内压监测组32例,未应用颅内压监测,颅内压监测组28例,加用颅内压持续监测,比较两组的再出血率、并发症发生率及总体预后。结果颅内压监测组与无颅内压监测组相比,再出血率及并发症发生率明显降低,死亡率降低,恢复良好率提高,均有显著性差异。结论颅内压监测下侧脑室外引流治疗高血压性丘脑出血破入脑室可以更加直观、更准确地了解患者颅内压力的变化情况,根据颅内压控制引流速度、合理应用脱水剂及控制血压、保证有效满意的脑灌注压,进而降低了再出血率、减少了并发症,改善了患者的预后,安全性更高、疗效更好。     

Pathological and clinical features of primary ventricular hemorrhage due to moyamoya disease]

The clinical and pathological features of 20 cases of moyamoya disease complicated with primary intraventricular hemorrhage (PIVH) and verified by CT scanning, cerebral angiography and autopsy were reported. It seemed to the author that moyamoya disease appeared to be prone to cause PIVH, this hemorrhage being likely due to ischemic malacia in the ventricular wall. The tortuous, abnormal network vessels ruptured and bled as a result of infarction and damage of the walls of the miliary aneurysms. PIVH might be divided into two types: the panventricular hemorrhage and partial ventricular hemorrhage, according to the amount of blood that filled into the ventricles. 6 cases of the panventricular type were fatal. The symptoms were in conformity with the traditional concept of the most critical, intraventricular hemorrhage. The external ventricular drainage in combination with lumber puncture drainage would be the better way of treatment for these patients. 14 cases of the partial ventricular hemorrhage type showed the clinical features of acute subarachnoid hemorrhage (SAH). The treatment was similar to SAH too, and the prognosis was much better. It would be worth noting that moyamoya disease should be a factor not to be neglected in causing PIVH.     

Secondary brain stem hemorrhage in stroke

The occurrence of secondary brain stem hemorrhage was studied in 435 autopsies from patients with recent cerebral hemorrhage, infarction or ruptured cerebral aneurysms. The frequency of secondary brain stem hemorrhage was found to be 45% in cerebral hemorrhage, 15% in cerebral infarction, and 36% in ruptured aneurysms. In the majority of cases the secondary brain stem hemorrhage occurred a few days after the onset of cerebral hemorrhage or infarction. Ruptured aneurysms showed a more widespread temporal distribution of secondary brain stem hemorrhage. The median survival time was 2 days in cases of cerebral hemorrhage, 4 days in ruptured aneurysm and 4 days in cerebral infarction. The frequency of secondary brain stem hemorrhage was significantly lower in patients younger than 20 years. No significant difference was found in its distribution between the sexes. Secondary occipital lobe infarction was present in 3.5% of the patients. It is concluded that secondary brain stem hemorrhage is a common major contribution to the cause of death in stroke.     

动脉瘤破裂致蛛网膜下腔出血24 h内微弹簧圈栓塞干预的预后分析

目的分析动脉瘤破裂致蛛网膜下腔出血24 h内行微弹簧圈栓塞干预的预后。 方法纳入2014年1月至2017年6月黄冈市中心医院神经外科收治的127例动脉瘤破裂致蛛网膜下腔出血患者进行回顾性分析,将24 h内接受微弹簧圈栓塞患者纳为超早期组（71例）,将≥24 h患者纳为非超早期组（56例）。对比2组患者围手术期疗效及术后6个月的预后。 结果超早期组术前再出血、术后脑梗死及脑积水发生率均明显低于非超早期组,差异有统计学意义（P<0.05）。2组患者院内死亡率对比,差异无统计学意义（P>0.05）。2组患者术后6个月的改良Rankin量表评分比较,差异无统计学意义（P>0.05）。 结论对动脉瘤破裂致蛛网膜下腔出血患者在24 h内开展微弹簧圈栓塞术治疗,虽然能够减少术前再出血风险和术后并发症发生率,但对显著提升患者预后并无明显作用。     

蛛网膜下腔出血时玻璃膜下出血的发生机理及临床意义的探讨

我们五年间收治的609例SAH中有62例并发SHH,占10.2％,其中双眼SHH35例、单眼SHH27例。与无SHH的SAH患者相比,SHH组临床症状及体征重、颅内压更高,死亡率亦增加。说明SHH是重症SAH的体征之一。本组资料支持SHH是蛛网膜下腔的动脉血直接沿视神经鞘向眼底方向的扩延,条件是颅内压要在短时间内达到一定程度。单侧的SHH对SAH的病因具有定位和定性意义。     

Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase

The frequency and severity of cardiac arrhythmias were studied in 70 patients with spontaneous subarachnoid hemorrhage investigated prospectively with 24-hour Holter monitoring. Patients were less than 70 years old and without clinical and/or ECG signs of previous heart disease; Holter monitoring was initiated within 48 hours of subarachnoid hemorrhage. Arrhythmias were detected in 64 of the 70 patients (91%). Twenty-nine of the 70 patients (41%) showed serious cardiac arrhythmias; malignant ventricular arrhythmias, i.e., torsade de pointe and ventricular flutter or fibrillation, occurred in 3 cases. Serious ventricular arrhythmias were associated with QTc prolongation and hypokalemia. No correlation was found between the frequency and severity of cardiac arrhythmias and the neurologic condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation. The extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid hemorrhage and the absence of clinical and radiologic predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid hemorrhage, irrespective of early or delayed surgical treatment.     

重症脑室出血的临床救治

目的 探讨重症脑室出血的救治方法，以期降低重症脑室出血的死亡率。方法 早期采用双侧脑室交替或同时尿激酶灌注引流及早期改善脑血液循环等综合措施治疗。结果 本组救治50例重症脑室出血病人(GRAEB评分＞5分)，存活率72％(36／50)，死亡率28％(14／50)，36例存活患中5例因脑积水行脑室—腹腔分流术。结论 尽早疏通脑室梗阻，改善脑脊液循环与脑微循环是重症脑室出血救治成功的关键，脑室引流、尿激酶灌注治疗重症脑室出血是一种安全、可行、有效的方法。     

Treatment of subarachnoid hemorrhage from ruptured intracranial aneurysm with tranexamic acid: a double-blind clinical trial.

A double-blind clinical trial of tranexamic acid was carried out on 39 patients with fresh subarachnoid hemorrhage from a ruptured aneurysm. Twenty patients received tranexamic acid, 6 gm daily for 14 to 21 days, while 19 patients received conventional therapy of bedrest and dexamethasone when cerebral edema developed, plus isotonic saline. Rebleeding and mortality were reduced by one-fourth and one-fifth, respectively (p less than 0.001). No side-effects were observed. Tranexamic acid is valuable in the treatment of subarachnoid hemorrhage caused by ruptured intracranial aneurysms.     

Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. III. Subarachnoid hemorrhage of undetermined etiology

Among 6,638 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage were 477 cases in which the cause of hemorrhage could not be determined after carotid and vertebral angiography. These patients were followed up for up to 24 years after hemorrhage. Twenty patients were subsequently found to have an aneurysm or arteriovenous malformation missed by the first angiographic survey. After six-month survival, the rate of recurrent hemorrhage was a maximum 0.86% per year. Survival was significantly better than that of patients with verified ruptured aneurysms managed conservatively in this cooperative study. For normotensive patients who survived the first six months, the life expectancy for the next 20 years equaled that of an age- and sex-matched US population. Hypertensive patients had a higher mortality than normotensive patients.