引流术及尿激酶灌洗治疗脑室出血56例临床护理

为56例脑室出血患者行双侧侧脑室额角穿刺引流、腰穿置管引流及尿激酶灌洗治疗，积极进行术前准备，做好脑室引流及腰穿置管期间的护理，并积极预防和护理并发症。结果治疗总有效率为87．93％，6例呈植物生存状态，3例死亡。认为对脑室出血患者行双侧侧脑室额角穿刺引流、腰穿置管引流及尿激酶灌洗治疗疗效满意。积极的临床护理是治疗成功的保证。     

引流术及尿激酶灌洗治疗脑室出血56例临床护理

为56例脑室出血患者行双侧侧脑室额角穿刺引流、腰穿置管引流及尿激酶灌洗治疗,积极进行术前准备,做好脑室引流及腰穿置管期间的护理,并积极预防和护理并发症.结果治疗总有效率为87.93%,6例呈植物生存状态,3例死亡.认为对脑室出血患者行双侧侧脑室额角穿刺引流、腰穿置管引流及尿激酶灌洗治疗疗效满意,积极的临床护理是治疗成功的保证.     

颈椎侧方穿刺早期诊断出血性脑血管病的临床研究

目的 探讨出血性脑血管疾病颈、腰穿脑脊液（csf）对比检查的意义。方法 对100例出血性脑血管病病人同时进行颈穿和腰穿取脊液作对比检查,检测脑脊液的压力色泽、RBC计数、并作统计分析。结果 颈穿抽取的脑脊液同腰穿抽取的脑脊液和对比压力、色泽、RBC计数方面均有明显差异。结论 颈穿抽取脑脊液检查对小量脑内出血,蛛网膜下腔出血及对颅内病变的早期诊断比腰穿检查更具优越性。     

腰穿放液治疗脑室出血临床疗效观察

原发性或继发脑室出血是神经科急诊之一,预后较凶险,我院开展腰穿放液治疗脑室出血,取得良好疗效,现分析如下: 1 临床资料 我院自1995年5月～1999年5月收治高血压脑出血破入脑室及原发性脑室出血共80例,全部经CT或MRI证实,随机分为腰穿放液组和保守治疗组,腰     

侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血临床分析

目的探讨采用侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血的效果。方法单侧或双侧脑室穿刺引流，术后第2d开始行腰穿脑脊液置换。结果40例高血压脑室出血患者采用侧脑室外引流并腰穿脑脊液置换治疗的病例，存活31例（77．5％），死亡9例（22．5％）。结论应用侧脑室外引流并腰穿脑脊液置换治疗高血压脑室出血，能明显降低死亡率，提高生存率。     

微创引流结合腰穿脑脊液置换术治疗脑室出血12例分析

目的探讨应用微创引流结合腰穿脑脊液置换术治疗脑室出血的疗效。方法对全部病例采用YL-1型颅内血肿粉碎穿刺针微创引流治疗脑室出血,根据脑室出血的部位、脑积水的情况决定一侧或双侧进针,清除脑室积血,微创术后第2天每日进行1次腰穿脑脊液置换术。结果全部病例手术获得成功,术后存活11例,无手术并发症。结论微创引流结合腰穿脑脊液置换术治疗脑室出血是一种安全有效的治疗方法,可降低脑室出血的死亡率。     

置管置换脑脊液治疗蛛网膜下腔出血引致之头痛

蛛网膜下腔出血是一种严重威胁患者生命的急性脑血管病。最主要的症状是剧烈头痛，死亡率及致残率高。常规治疗方法等待血性脑脊液自行缓慢吸收，效果不尽理想。近年来有经腰穿多次置换脑脊液治疗蛛网膜下腔出血的报道，疗效可靠。但需反复、多次作腰穿，病人有一定的痛苦...     

蛛网膜下腔出血再出血23例临床分析

一般资料 本组23例中，男14例．女9例，年龄最小12岁．最大72岁，平均50.38岁。发生2次出血23例．3次出血2例。首次出血23例均做腰穿证实．再次出血15例被腰穿证实．其它被CT证实。     

不同治疗方式在创伤性蛛网膜下腔出血的临床疗效分析

目的对创伤性蛛网膜下腔出血的不同治疗方式临床效果进行了分析研究。方法将我院收治的蛛网膜下腔出血患者随机分为两组,一组接受腰大池脑脊液引流治疗,一组接受腰穿放去脑脊液方法治疗,比较两组患者的治疗效果。结果接受引流治疗的患者组其并发症发生率明显低于接受腰穿的患者组,但颅内感染率明显高于腰穿患者组(P<0.05);引流治疗的患者组其预后情况明显优于腰穿治疗的患者组(P<0.05)。结论腰大池脑脊液引流治疗方法能够有效改善蛛网膜下腔出血患者的预后情况,减少并发症的发生,降低患者死亡率,值得在临床进行推广。     

储液囊埋植引流在早产儿脑室出血中的应用与护理

脑室内出血(IVH)是早产儿颅内出血的常见类型,重度IVH死亡率高达50％,其后遗脑积水发生率达80％。近年来,主张对出血后脑积水患儿进行连续腰穿放液治疗,达到阻止脑室进行性增大、避免手术治疗的目的,但存在腰穿损伤、腰穿不成功     

急性脑血管病患者血浆N端脑钠肽前体的检测及意义

【目的】探讨血浆N端脑钠肽前体（NT—proBNP）浓度与急性脑血管病之间的关系。【方法】选择脑出血组20例（CH组）、脑梗死组61例（CI组）、蛛网膜下腔出血组9例（SAH组）,及同期住院的非心脑血管病及肝肾功能正常者38例（ControI组）,用固相免疫层析法检测血浆NT—proBNP浓度。【结果】CH组、CI组、SAH组NT—proBNP水平均显著高于Control组（P〈0．01）。CH组和CI组组间无统计学差异（P〉0．05）,SAH组较CH、CI组显著增高（P〈0．01）;且病情中、重型组显著高于轻型组（P〈0．01）。脑出血和脑梗死大灶组高于小灶组（P〈0．05）。【结论】NT-proBNP异常分泌参与了脑出血、脑梗死、蛛网膜下腔出血的病理、生理过程,急性脑血管病患者血浆NT—proBNP升高对病情评价具有一定的临床价值。     

Measurement of plasma and intracellular S-adenosylmethionine and S-adenosylhomocysteine utilizing coulometric electrochemical detection: alterations with plasma homocysteine and pyridoxal 5'-phosphate concentrations

BACKGROUND: The relative changes in plasma and intracellular concentrations of S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) may be important predictors of cellular methylation potential and metabolic alterations associated with specific genetic polymorphisms and/or nutritional deficiencies. Because these metabolites are present in nanomolar concentrations in plasma, methods of detection generally require time-consuming precolumn processing or metabolite derivatization. METHODS: We used HPLC with coulometric electrochemical detection for the simultaneous measurement of SAM and SAH in 200 microL of plasma, 10(6) lymphocytes, or 10 mg of tissue. Filtered trichloroacetic acid extracts were injected directly into the HPLC system without additional processing and were eluted isocratically. RESULTS: The limits of detection were 200 fmol/L for SAM and 40 fmol/L SAH. In plasma extracts, the interassay CV was 3.4-5.5% and the intraassay CV was 2.8-5.6%. The analytical recoveries were 96.8% and 97.3% for SAM and SAH, respectively. In a cohort of healthy adult women with mean total homocysteine concentrations of 7.3 micromol/L, the mean plasma value was 156 nmol/L for SAM and 20 nmol/L for SAH. In women with increased homocysteine concentrations (mean, 12.1 micromol/L), plasma SAH, but not SAM, was increased (P <0.001), and plasma pyridoxal 5'-phosphate concentrations were reduced (P <0.001). Plasma SAM/SAH ratios were inversely correlated with homocysteine concentrations (r = 0.73; P <0.01), and the SAM/SAH ratio in plasma was directly correlated with the intracellular SAM/SAH ratio in lymphocytes (r = 0.70; P <0.01). CONCLUSIONS: Increased homocysteine in serum is associated with an increase in SAH and a decrease in the SAM/SAH ratio that could negatively affect cellular methylation potential. Accurate and sensitive detection of these essential metabolites in plasma and in specific tissues should provide new insights into the regulation of one-carbon metabolism under different nutritional and pathologic conditions.     

动脉瘤性蛛网膜下腔出血患者脑脊液IL-1β、IL-6及TNFα检测及意义

【目的】探讨动脉瘤性蛛网膜下腔出血（SAH）患者脑脊液白介素-1β（IL-1β）、白介素-6（IL-6）和肿瘤坏死因子d（TNFa）水平及其与脑血管痉挛的关系。【方法】选用双抗体夹心酶联免疫吸附试验（ELISA）检测动脉瘤性SAH患者脑脊液IL-1β、IL-6和TNFa浓度,并将其结果与经颅多普勒（TCD）检查判别的脑血管痉挛与否进行相关分析。【结果】动脉瘤性SAH患者脑脊液中IL-1β、IL-6和TNFa水平均明显升高（P〈0．05）,IL-1β、IL-6水平与脑血管痉挛显著相关（P〈0．05）,TNFa水平与脑血管痉挛无统计学相关（P〉O．05）。【结论】动脉瘤性SAH患者脑脊液IL-1β和IL-6水平增高可能与脑血管痉挛发病有关,检测其患者脑脊液中IL-1β和IL-6有助于脑血管痉挛的预测及治疗。     

Beneficial effects of a new 20-hydroxyeicosatetraenoic acid synthesis inhibitor, TS-011 [N-(3-chloro-4-morpholin-4-yl) phenyl-N'-hydroxyimido formamide], on hemorrhagic and ischemic stroke

The present study characterized the effects of TS-011 [N-(3-chloro-4-morpholin-4-yl) phenyl-N'-hydroxyimido formamide], a new selective inhibitor of the synthesis of 20-hydroxyeicosatetraenoic acid (20-HETE), on the metabolism of arachidonic acid by human and rat renal microsomes and the inhibitory effects of this compound on hepatic cytochrome P450 enzymes involved in drug metabolism. The effects of TS-011 on the fall in cerebral blood flow following subarachnoid hemorrhage (SAH) and in reducing infarct size in ischemic stroke models were also examined since 20-HETE may contribute to the development of cerebral vasospasm. TS-011 inhibited the synthesis of 20-HETE by human renal microsomes and recombinant CYP4A11 and 4F2, 4F3A, and 4F3B enzymes with IC50 values around 10 to 50 nM. It had no effect on the activities of CYP1A, 2C9, 2C19, 2D6, or 3A4 enzymes. TS-011 inhibited the synthesis of 20-HETE by rat renal microsomes with an IC50 of 9.19 nM, and it had no effect on epoxygenase activity at a concentration of 100 microM. TS-011 (0.01-1 mg/kg i.v.) reversed the fall in cerebral blood flow and the increase in 20-HETE levels in the cerebrospinal fluid of rats after SAH. TS-011 also reduced the infarct volume by 35% following transient ischemic stroke and in intracerebral hemorrhage in rats. Injection of 20-HETE (8 or 12 mg/kg) into the carotid artery produced an infarct similar to that seen in the ischemic stroke model. These studies indicate that blockade of the synthesis of 20-HETE with TS-011 opposes cerebral vasospasm following SAH and reduces infarct size in ischemic models of stroke.     

蛛网膜下腔出血的CT研究

目的研究蛛网膜下腔出血(SAH)的CT分型、伴随改变和不典型表现的鉴别诊断。方法对123例SAH患者(外伤性81例,自发性42例)头颅CT进行回顾性研究。结果 SAH分为单纯型和复合型,多累及2个脑池以上;自发性SAH多伴随脑室积血、脑积水和脑组织血肿,外伤性SAH颅内其他改变以硬膜下血肿、脑组织血肿和脑挫裂伤为主。结论认识SAH的CT表现和分型,有助于临床治疗。     

Subarachnoid haemorrhage induces an inflammatory response followed by a delayed persisting increase in asymmetric dimethylarginine

Abstract Objective. Subarachnoid haemorrhage (SAH) is associated with an inflammatory systemic response and cardiovascular complications. Asymmetric dimethyl arginine (ADMA), an endogenous inhibitor of nitric oxide synthase, mediates vasoconstriction and might contribute to cerebral vasoconstriction and cardiovascular complications after SAH. ADMA is also involved in inflammation and induces endothelial dysfunction. The aim of this study was to evaluate whether and how CRP (marker for systemic inflammation) and ADMA increased in patients during the acute phase (first week) after SAH. The ADMA level was also assessed in the patients in a non-acute phase (three months), and in healthy controls. Methods. A prospective study of 20 patients with aneurysmal SAH. ADMA and CRP were followed daily during the first week after SAH and a follow up sample for ADMA was obtained 3 months later. A single blood sample for ADMA was collected from age- and sex-matched healthy controls (n = 40, two for each case). Results. CRP increased significantly from day 2; 16 (Confidence interval (CI) 10-23) mg/L to day 4; 84 (CI 47-120) mg/L, (p < 0.01). ADMA increased significantly from day 2; 0.22 (CI 0.17-0.27) μmol/L, to day 7; 0.37 (CI 0.21-0.54) μmol/L, p < 0.01. ADMA remained elevated at a 3-month follow-up: 0.36 (CI 0.31-0.42) μmol/L. ADMA in the first sample from the patients (day 1-3); 0.25 (CI 0.19-0.30) μmol/L, was not different from ADMA in matched healthy controls; 0.25 (CI 0.20-0.31), p > 0.05. Conclusion. After SAH, CRP and ADMA in serum increased significantly during the first week and ADMA remained elevated 3 months later.     

L精氨酸枕大池注射对兔脑血管痉挛的影响及作用机制

目的 研究 L 精氨酸枕大池注射对兔蛛网膜下腔出血后血管痉挛的影响及作用机制. 方法 采用双侧颈动脉结扎及枕大池二次注血法制造兔蛛网膜下腔出血模型.在蛛网膜下腔出血后第 4天,以比色法测定血清及脑脊液中一氧化氮及脑组织的浓度.光镜下测定基底动脉的动脉壁厚度和基底动脉的内径,以其比值作为脑血管痉挛的指标.治疗组分为 300 μ mol/L及 500 μ mol/L组,在蛛网膜下腔出血后第 4天,枕大池持续微泵滴注 L 精氨酸,在滴注后再分别研究上述指标. 结果 蛛网膜下腔出血后第 4天,基底动脉的动脉壁厚度和内径的比值 (0.085± 0.007)明显升高 (t=20.26,P< 0.05);血清一氧化氮 [(24.34± 7.36) μ mol/L,t=6.72 ,P < 0.05]及脑脊液中一氧化氮 [(10.68± 3.43) μ mol/L,t=4.25,P < 0.05]及脑组织 NOS[(0.007± 0.001) nmol/(s@ g),t=6.14,P < 0.05].的浓度降低.在 L 精氨酸滴注后,脑血管痉挛缓解.血清一氧化氮 [(37.38± 6.42) μ mol/L,t=3.27,P < 0.05]、脑脊液中一氧化氮 [(14.16± 3.36) μ mol/L, t=1.98,P < 0.05]脑组织一氧化氮合酶 (nitric oxygenase, NOS)[(0.011± 0.002) nmol/(s@ g ),t=3.10,P < 0.05]的浓度较对照组明显升高. 结论 L-精氨酸枕大池注射对兔蛛网膜下腔出血后的血管痉挛具有治疗作用. L-精氨酸可能通过影响一氧化氮及 NOS而起作用.     

螺旋CT脑血管成像在自发性蛛网膜下腔出血病因诊断中的应用

目的 探讨螺旋CT脑血管成像(spiral computed tomograplic angiography，SCTA)、三维重建(three-dimensional，3D)在不明原因的自发性蛛网膜下腔出血(spontameous subarachnoid hemorrhage，SAH)的病因诊断中的临床应用价值。方法 对39例原因不明的自发性SAH患者行螺旋CT扫描获得原始图像，增强扫描，用表面阴影成像和最大强度投影技术进行三维重建，血管成像。结果 动脉瘤20例，脑动静脉畸形11例，脑血管畸形3例，烟雾病2例，肿瘤卒中l例，未见异常2例。无并发症发生。结论 3D-SCTA能清晰显示颅内动脉瘤和脑动静脉畸形的部位、形状、大小及与周围结构的关系，可用于临床诊断。     

3D-CTA检查在基层医院诊断自发性蛛网膜下腔出血患者的临床实用性分析

目的探讨3D—CTA在基层医院诊断自发性蛛网膜下腔出血（SAH）患者的临床实用性。方法通过3D—CTA检查自发性SAH患者36例,结合DSA,开颅手术、介入栓塞术、保守治疗结果证实3D—CTA检查结果及临床实用性。结果通过3D-CTA技术检查SAH患者36例,4例为非动脉瘤性SAH。32例动脉瘤阳性患者共发现34个动脉瘤。13例行介入栓塞治疗。5例开颅动脉瘤夹闭。6例放弃手术,要求保守治疗。8例要求转上级医疗中心。结论3D-CTA较DSA具备快速、便捷、微创、安全、敏感性高、家属认同度高、基层临床医生易于掌握和开展等优点,在基层医院具有很强的临床实用性。患者可在第一时间得到准确合理的救治。     

蛛网膜下腔出血的CT漏诊情况分析

目的 探讨各级医院蛛网膜下腔出血（subaraehnoid hemorrhage,SAH）的CT漏诊情况及可能原因.方法 回顾性分析近10年国内文献发表的各医院CT检查漏诊的143例SAH的临床资料.结果 Hunt-Hess Ⅰ、Ⅱ级的SAH患者漏诊率较高（92.4％）.高龄组SAH漏诊率明显高于中年龄段组,差异有统计学意义（P＜0.05）.伴有高血压病、脑卒中病史的SAH患者漏诊率明显低于无此类并发症的患者,差异有统计学意义（P＜0.05）.三级医院漏诊率明显低于一级、二级医院,差异有统计学意义（P均＜0.05）;一级医院相对漏诊风险（odds ratio,OR）是三级医院的2.748倍,差异有统计学意义（OR=2.748）.结论 Hunt-Hess分级较低、非SAH高发年龄段的SAH患者易漏诊,一级医院漏诊率较高,漏诊风险较大,临床应提高警惕.