金尔伦治疗急性重型脑外伤的临床研究

目的　探讨金尔伦治疗急性重型颅脑损伤患者的疗效和安全性。方法　 13 1名急性重型颅脑伤病人随机分成金尔伦治疗组 (n =62 )和对照组 (n =69) ,观察治疗早期病人GCS评分变化和远期疗效。结果　金尔伦组患者GCS评分在用药后第 5d开始明显优于对照组 (P <0 0 5 ) ;金尔伦组病死率 2 4 2 % ,对照组病死率 5 0 7% ,两组相比有显著性差异 (P <0 0 1)。结论　金尔伦可以降低急性重型颅脑外伤病人颅内压的升高幅度 ,缩短昏迷时间 ,降低伤残率 ,促进病人神经功能恢复 ,改善预后。     

依达拉奉治疗重型颅脑外伤的疗效观察

目的观察依达拉奉对重型颅脑外伤的治疗效果。方法60名急性重型颅脑损伤病人随机分成依达拉奉治疗组（n=30）和对照组（n=30），观察病人颅内压、头颅CT变化和远期疗效。结果依达拉奉治疗组伤后10d内颅内压显著升高和重度脑水肿者均较对照组明显减少；依迭拉奉组10d后格拉斯哥计分及伤后3个月恢复良好率显著高于对照组。结论依达拉奉可以降低急性重型颅脑外伤病人颅内压的升高幅度，缩短昏迷时间，降低伤残率，促进病人神经功能恢复，改善预后。     

早期应用纳络酮治疗急性重型颅脑外伤对照观察

目的　探讨早期应用纳络酮对急性重型颅脑外伤的影响。方法　对 95例重型颅脑损伤病人随机分成纳络酮 (NLX)治疗组 (n =48)和对照组 (n =47) ,观察治疗早期病人生命体征、颅内压、头颅CT征变化和远期疗效 ,进行统计学分析。结果　纳络酮治疗组病人呼吸循环较快恢复稳定 ,呼吸异常 ( 2 9 2 % )和心律异常 ( 3 1 3 % )明显减少 (P <0 0 1)。伤后 1周内NLX组病人颅内压显著升高和重度脑水肿者较对照组明显减少 (P <0 0 1)。NLX组治疗 1周后意识转清醒率( 5 4 2 % )高于对照组的 40 4% (P <0 0 5 ) ,伤后 3个月恢复良好率显著高于对照组 ,重残率明显减少 (P <0 0 5 )。结论　早期大剂量运用纳络酮可以降低重型颅脑外伤病人颅内压的升高幅度 ,缩短昏迷时间 ,降低伤残率 ,促进病人神经功能恢复。     

金尔伦(盐酸纳洛酮)治疗急性颅脑损伤病人随机双盲多中心前瞻性临床研究

背景：本试验是由中华医学会神经外科学会和中华神经外科杂志部组织，国内18家医院实施，完成金尔伦（盐酸纳洛酮）对受试患者的疗效和用药安全性观察，目的，证明金尔伦在治疗急性中，重型颅脑损伤患者的治疗和安全性，方法：设计并实施了随机双盲前瞻性临床对照试验计划，比较大剂量金尔伦和生理盐水安慰剂的疗效差异，每位受试得接受为期10天随机分组治疗和3个月随访，分析对比治疗前后和治疗过程中患者的病情和重要辅助检查指标的变化,趋势并同时对比随访结束时患者神经功能恢复情况和生活质量状况，全部试验结束后进行揭盲并对结果进行统计学分析,结果，实际完成530例，有效病例511例，其中金尔伦组256例，安慰剂组255例，金尔伦组和安慰剂组死亡率分别为治疗组12．5％，有效病例12．5％，安慰剂组17．3％（P＜0．05），金尔伦组患者GCS评分在用药后第5天开始明显优于安慰剂组（P＜0．05），治疗结束后金尔伦组患者GOS评分明显优于安慰剂组（P＜0．05），金尔伦组患者语言功能评分和生活质量状况评分也明显优于安慰剂组（P＜0．05），另外，过程中未发现因用药造成的毒副反应，结论：早期应用大剂量金尔伦能明显降低急性颅脑损伤患者死亡率，促进脑神经功能恢复，改善远期生活质量状况，并且具有相当可靠的安全性。     

金尔伦(盐酸纳洛酮)治疗急性中、重型脑外伤的神经电生理研究

目的：通过诱发电位（EP）监测,探讨金尔伦（盐酸纳洛酮）治疗急性中,重型脑外伤的疗效,方法：对40例急性中,重型脑外伤患者者随机,双盲治疗,前3天剂量为每日0．3mg/kg,后7天剂量为4.8mg/日,于用药前,用药后30分钟,24小时,72小时,120小时监测正中神经短潜伏期体感诱发电位（SLSEP）和脑干听觉诱发电位（BAEP）,揭盲后分为金尔伦治疗组和对照组,对金氽伦治疗组与对照组诱发电位进行统计学分析,结果：金尔伦治疗级SLSEP的N13－N20峰间潜伏期（N13－N20IPL）及BAEP的I－V波峰间潜伏期（I－VIPL）在用药手均较对组缩短且有显著性差异,P＜0．05,结论,诱发电位监测结果表明,金尔伦能有效改善急性脑外伤患者异常的神经网络生理指标,对于急性中,重型脑外伤有明显的治疗作用。     

金尔伦(盐酸纳洛酮)治疗急性重症脑外伤的临床观察

目的：针对重度颅脑外伤后血浆,脑脊液和脑区内源性阿片肽,特别是β－内啡肽明显升高,应用金尔伦（盐酸纳洛酮）探讨对重症颅脑外伤的临床疗效,方法选择GCS5－8分患者30例每天应用金尔伦4．8毫克,随机以30例同等伤情未用金尔伦药物治疗病例为对照组,观察意识觉醒,血液流变学及临床征象,结果,觉醒天数缩短,外伤后脑血管痉 发生率,血液粘滞度降低,致残率减少,结论：金尔伦对于内源性阿片肽引起的生理功能的应激性疾病起效快,作用可靠,其使用安全,治疗过程中未见有毒副作用。     

纳美芬对急性重型颅脑损伤疗效的临床观察

目的探讨纳美芬对急性重型颅脑损伤的治疗效果。方法重型颅脑损伤患者134例,入院后随机分为纳美芬治疗组和对照组,观察并比较两组患者治疗前后的生命体征、颅内压变化、觉醒时间,治疗后第7天的GCS及伤后90d的GOS等。结果与对照组比较,纳美芬组患者的心律异常和呼吸异常者的比例明显减少（P〈0．05）,出现高颅内压的比例明显减少（P〈0．05）;纳美芬组觉醒时间为（10．1±1．45）d,对照组为（12．4±2．58）d,两者差异显著（P〈0．01）;两组患者治疗后第7天的GCS及伤后90d的GOS比较也差异显著（P〈O．05）。结论纳美芬可有效改善急性重型颅脑损伤患者的预后。     

纳洛酮治疗急性脑梗死48例临床分析

目的 观察急性脑梗死患者血浆β－内啡肽变化和纳洛酮的治疗效果。方法 将我院1999年6月－2000年12月住院的98例急性脑梗死患者分成两组，治疗前后分别采取空腹静脉血2ml，用放免法检测β－EP的含量，同时对患者的神经系统功能缺失进行评分，评价临床疗效。结果 （1）治疗组总有效率89．58％，对照组总有效率58％，治疗组的疗效明显高于对照组（P＜0．01）。（2）急性期2组患者血浆β-内啡肽均升高，随着临床症状的好转，β－EP含量均有明显下降，治疗组下降更为明显（P＜0．01）。结论 纳洛酮应早期应用，其作用迅速、疗效好，价格低廉，且无不良反应。     

亚低温治疗高温高湿环境下重型颅脑损伤的临床护理

目的 探讨亚低温治疗高温高湿环境下重型颅脑损伤的护理方法。方法 高温高湿环境下的重型颅脑损伤患者60例，随机分为亚低温治疗组和对照组。规范护理程序，严密观察病人生命体征变化，采取积极护理措施，减少并发症。结果 亚低温治疗24h后颅内压逐渐下降，脑组织PO2逐渐上升，伤后3个月亚低温治疗组的良好率明显高于对照组（P〈0.05），而死亡率明显低于对照组（P〈0．01）。结论 精心护理有助于改善亚低温治疗的高温高湿环境下重型颅脑损伤病人的预后。     

亚低温治疗重型颅脑损伤的效果观察

目的观察亚低温对重型颅脑损伤（sTBI）患者的治疗效果。方法36例sTBI患者（Gcs≤8分）随机分为对照组和亚低温组,每组18例。伤后0、1、3、7、14、21d各行一次头颅CT检查,手术后病人均持续监测颅内压7d。对照组维持正常体温,亚低温组人院后在4．8h内将肛温降至33℃左右,并维持3～5d。比较两组颅内压、伤灶脑水肿体积变化和预后不良（GOS〈3分）率。结果在伤后第7天,对照组和亚低温组颅内压分别为（3．15±0．24）kPa和（1．78±0．24）kPa;在伤后第14天,对照组和亚低温组伤灶脑水肿体积分别为（140．90±22．95）cm^3和（81．72±15．95）cm^3;伤后1周内患者清醒率对照组和亚低温组分别为22．2％（4／18）和55．6％（10／18）;伤后3年随防时,预后不良率对照组为55．6％（10／18）,亚低温组为22．2％（4／18）。上述指标两组比较均相差显著（P〈0．05）。结论亚低温治疗法能减轻颅脑损伤患者的脑水肿,稳定其颅内压、缩短其昏迷时间,从而改善其远期预后。     

Proton magnetic resonance spectroscopy and intracranial tumours: Clinical perspectives

Proton magnetic resonance spectroscopy (1H-MRS) was applied to characterize intracranial tumours of different hystological types. Seventy patients with intracranial neoplasms were studied before receiving surgery, radiotherapy or chemotherapy. All tumours were characterized by reduced or absentN-acetylaspartate and increased signal from choline-containing compounds. Distinctive patterns were observed only for primitive brain neoplasms; high-grade gliomas were differentiated from low-grade ones by higher levels of choline-containing compounds. The metabolic aspects of metastatic lesions were similar to high-grade gliomas. These results, together with the limitations of¹HMRS and future applications are reviewed.     

脑梗死患者脑白质病变及其危险因素

目的 探讨脑梗死患者脑白质病变(white matter lesions,WML)患病情况及其危险因素.方法 采用多中心横断面研究和病例-病例对照研究.收集全国12家医院2004年5月至12月连续就诊的1～6个月内脑梗死患者720例的临床资料.分别对头MRI显示的脑梗死部位、大小、血管分布、血管类型做出判断,用年龄相关性白质改变评分法(Age-Related White Matter Changes Scales,ARWMC)测量脑白质病变,阅片者不了解患者的临床资料.采用Logistic回归检验独立危险因素.结果 MRI图像质量完好700例[平均年龄(59.93±9.86)岁,男/女为481/219],WML患病率77.4%,随年龄增长患病率和病变严重程度增加.额叶病变最多,程度最重.Logistic回归显示高龄(OR 1.09,95% CI 1.067～1.114)、舒张压升高(OR 1.039,95% CI 1.018～1.06)、基底节梗死(OR2.244,95% CI 1.609～3.708)与WML存在独立相关.结论 脑梗死患者WML普遍存在.病变以额叶最明显.高龄、舒张压升高、基底节梗死是发生WML的独立危险因素.     

The distribution of normal brain water content in Wistar rats and its increase due to ischemia

The aim of this study was to describe the normal distribution of the water content in several regions of the rat brain and furthermore to determine if global ischemia results in a variable increase in water content in these regions. Water content was determined in 40 regions: in 8 unaffected brains by gravimetry and in 9 unaffected brains by estimation of the wet/dry weight ratio. In addition, 6 rats underwent 6 h of moderate global brain ischemia in order to evaluate the sensitivity of the investigated brain areas to develop a cytotoxic brain edema. The impermeability of the blood-brain barriers to proteins was evaluated by staining with Evans blue. Physiological differences in water content between the several brain regions ranged from 72.57 ±0.77% (mean ± S.D.) in the medulla oblongata to 84.83 ± 0.52% in the hypothalamus. Generally, the water content of the grey matter was higher than that of the white matter and increased from the frontal to the occipital and from the parietal to the basal cortex. Even adjacent cortical regions showed differences in the amount of brain water of up to 3.41%. In the ischemic animals, the impermeability of the blood-brain barrier to proteins was not compromised, but an increase in the amount of brain water was found in the frontoparietal cortex of 1.17 ± 0.37% and hippocampus of 1.49 ± 0.39% (P < 0.05). This ischemic increase in the brain water content was small in comparison to the normal variance in regional brain water content. Similar results were obtained by determining the wet/dry weight ratio and by gravimetry. Gravimetry led to more consistent results. In conclusion, the study shows great differences in normal water content between the several brain areas in comparison to an only slight increase of water content due to the development of cytotoxic brain edema. The determination of an early state of an increased brain water content requires an adequate and differentiated measurement of different brain areas. The gravimetry fulfills this demand.     

Alterations in cat cerebrocortical capillary morphometrical parameters following K+-induced cerebrocortical swelling

Summary Histochemical, electron microscopic, and morphometrical techniques were employed in the determination of the effects attributed to K⁺-induced cerebrocortical swelling on cat cerebrocortical capillary diameter, length, surface area, volume, and minimal intercapillary distance.Bilaterally exposed and intact temporoparietal cerebral cortices of 4 conditioned adult cats were simultaneously superfused with isotonic, artificial CSF containing 3.5 mM K⁺ (control) and 54 mM K⁺ (experimental) for 1 h at 37°C with monitoring of systemic vital function, hematocrit, arterial blood gases, and determination of cerebrocortical tissue water content.The mean values for cerebrocapillary diameter were 5% (P<0.05) greater in swollen tissues when compared with comparable mean values determined for controls. The values for minimal intercapillary distance determined from control and experimental animals plotted as relative frequency histograms represented two distinct populations (P<0.0005). The significance of altered capillary morphometric parameters are discussed in relation to K⁺-induced cerebrocortical swelling.     

颅脑损伤术后并发脑梗死的临床分析

目的探讨颅脑损伤术后脑梗死的发生机制及治疗方法。方法回顾分析24例颅脑损伤术后病人发生脑梗死的临床资料。结果保守治疗19例,开颅减压5例,死亡7例。结论颅脑损伤后如手术指征明确则须及时手术。术后注意病情变化采取综合治疗措施。应积极保持脑灌注压、维持血压及血氧,降低颅内压,改善脑血管痉挛,早期扩管改善微循环,有利于降低死残率,改善预后。     

Delayed cerebral pseudo-tumoral radionecrosis following scalp-tumour irradiation. Case report and review of literature

Summary A case of delayed radionecrosis of the brain is reported, following irradiation of a scalp dermatofibrosarcoma. Signs and symptoms were those of an intracranial neoplasm and appeared 5 years after an irradiation dosage of 1890 rets. Twenty-seven similar cases were gathered from a survey of the literature. Surgical excision was the treatment of choice and led to cure or improvement in 20 cases. Analysis of doses and fractionation revealed excessive irradiation in all but one of the cases.     

免疫组化法观察兔脑缺血灶内移植神经元的变化

以兔大脑中动脉阻断型(MCAo)局灶脑缺血模型为对象,把含胎免脑干中缝核血清素(5—HT)能性神经元的细胞悬液用脑立体定向术移植到缺血灶内。对术后存活一、二、三个月的兔进行脑5—HT的免疫组化研究。结果表明植入的5—HT阳性细胞能够在脑缺血灶内存活、生长并成熟,同时发出细胞突起与宿主细胞形成联系;移植神经元最初集聚成簇,逐渐向周围脑实质内迁移并与宿主脑整合起来。     

深低温对全脑缺血性损伤的保护作用

国际上把低温划分为轻度低温(33～35℃),中度低温 (28～32℃),深度低温(17～27℃)和超深度低温(2～16℃)。低温已经被大量动物试验和临床实践证实具有脑保护作用,但同时也存在心律失常,凝血功能障碍,免疫抑制等全身多系统副作用,产且温度越低,副作用越明显。日前国内外已经有大量的试验证实深低温对全脑缺血的脑保护作用,它能明显增加脑组织对缺血的耐受性,本文将就深低温对全脑缺血性损     

慢性精神分裂症与脑肿瘤患者认知状况比较分析

目的　探讨慢性精神分裂症患者脑功能缺陷与不同脑叶损伤间的关系。方法　运用威斯康星卡片分类测验、词汇流畅性测验、Stroop测验,对30名正常人、39例精神分裂症及88例脑肿瘤患者(其中左、右额叶各2 4例、颞叶2 0例、顶枕叶2 0例)进行测试。结果　精神分裂症患者与脑肿瘤患者均存在不同程度、不同特征的认知损伤,其中阴性症状为主的精神分裂症与右额叶脑肿瘤患者损伤类似,除完成分类数、总词汇数外,本研究所采用的测查其余指标差异无显著性(P >0 . 0 5)。结论　阴性症状为主的慢性精神分裂症患者右侧额叶功能受损明显,精神分裂症起病的器质性因素可能涉及右额叶。