夹闭术与血管内治疗破裂性宽颈动脉瘤的比较

Objective To analyze the clinical efficacy of clipping and endovascular treatment for ruptured wide-necked aneurysm Methods 143 patients with ruptured wide- necked aneurysm were treated by clipping ( n =83) or endovascular treatment ( n =60). Their complication rates、recurrence rates and modified Rankin scale scores at six months after leaving hospital were evaluated. Results The complication rate in endovasular treatment group was less than that in clipping group( P ＜ 0.05) significantly. The recurrence rate in clipping group was less than that in endovasular treatment group( P ＜ 0. 05) significantly. The modified Rankin scale in endovasular embolization group was less than that in clipping group( P ＜ 0. 05) significantly. Higher recurrence rate and lower complication rate were observed in endovasular treatment group. Patients with endovascular treatment had better prognosis. Conclusion Endovascular treatment for ruptured wide - necked aneurysm is efficient and safe. Better quality of life could be achieved.     

夹闭术与血管内治疗破裂性宽颈动脉瘤的比较

目的 回顾性分析破裂性宽颈动脉瘤夹闭术及血管内治疗的疗效.方法 确诊的143例破裂性宽颈动脉瘤患者分别采用夹闭术(83例)和血管内治疗(60例),对两组患者并发症发生率、复发率及出院后6个月改良Rankin评分进行比较.结果 两组的并发症发生率、复发率及改良Rankin评分差异有统计学意义(P＜0.05),血管内治疗组较夹闭术组复发率高,但并发症少,患者预后好.结论 血管内治疗破裂性宽颈动脉瘤安全、有效,患者有着更好的生存质量.

Abstract：

Objective To analyze the clinical efficacy of clipping and endovascular treatment for ruptured wide-necked aneurysm Methods 143 patients with ruptured wide- necked aneurysm were treated by clipping ( n =83) or endovascular treatment ( n =60). Their complication rates、recurrence rates and modified Rankin scale scores at six months after leaving hospital were evaluated. Results The complication rate in endovasular treatment group was less than that in clipping group( P ＜ 0.05) significantly. The recurrence rate in clipping group was less than that in endovasular treatment group( P ＜ 0. 05) significantly. The modified Rankin scale in endovasular embolization group was less than that in clipping group( P ＜ 0. 05) significantly. Higher recurrence rate and lower complication rate were observed in endovasular treatment group. Patients with endovascular treatment had better prognosis. Conclusion Endovascular treatment for ruptured wide - necked aneurysm is efficient and safe. Better quality of life could be achieved.     

血管内栓塞治疗颅内动脉瘤时间窗的临床评价

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods To respectively analyse the clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment. The patients were divided into 3 groups accrodding to the time of treatment, endovascular reatments were stated within 24 h in group A, 3 d in group B and after 3 d in group C. The outcomes and complications including rebleeding, vasospasm and hydrocephala of 3 groups were compared. Results The incidence of rebleeding, vasospasm and hydrocephala in group A and B were lower than that in group C ( P ＜ 0. 01 ). Vasospasm in group C was most severe. The GOS score was highest in group A and lowest in group C. Conclusion Endovascular embolization treatment is a safe and effective method for treatment of intracranial aneurysm. The timing of treatment is a major factor for technical success.     

血管内栓塞治疗颅内动脉瘤时间窗的临床评价

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods To respectively analyse the clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment. The patients were divided into 3 groups accrodding to the time of treatment, endovascular reatments were stated within 24 h in group A, 3 d in group B and after 3 d in group C. The outcomes and complications including rebleeding, vasospasm and hydrocephala of 3 groups were compared. Results The incidence of rebleeding, vasospasm and hydrocephala in group A and B were lower than that in group C ( P ＜ 0. 01 ). Vasospasm in group C was most severe. The GOS score was highest in group A and lowest in group C. Conclusion Endovascular embolization treatment is a safe and effective method for treatment of intracranial aneurysm. The timing of treatment is a major factor for technical success.     

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1,Hunt and Hess grade≤II and surgical clipping;Group 2,Hunt and Hess grade≤II and endovascular embolization;Group 3,Hunt and Hess grade≥III and surgical clipping;Group 4,Hunt and Hess grade≥III and endovascular embolization.Level of consciousness was evaluated using the Glasgow Coma Scale,functional status using the Glasgow Outcome Scale,level of the mobility using the Mobility Scale for acute stroke patients,and independence in activities of daily living using the Barthel Index.After early physiotherapy,the level of consciousness and functional status improved significantly in Groups 1,3,and 4;mobility improved significantly in all groups;and independence in activities of daily living improved significantly in Groups 1 and 3.At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4.Level of consciousness,functional status,mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients with a worse clinical status at presentation had a poorer functional status at discharge.The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.     

颈内动脉分叉部动脉瘤的手术及血管内治疗 （英文）

BACKGROUND Aneurysms of the internal carotid artery(ICA)bifurcation are rare,and no studies have compared patient outcomes after endovascular vs surgical treatment.OBJECTIVE To report the safety,efficacy,and follow-up outcome of these 2treatment options for patients with ICA bifurcation aneurysms.METHODS Patient and aneurysm characteristics,treatment results,and follow-up outcomes(at 30 months)were analyzed from patient records and review of imaging findings.RESULTS A total of 58 patients with ICA bifurcation aneurysms were treated.By interdisciplinary consensus,30 aneurysms were assigned for coiling and 28 for clipping.Patients who underwent surgical clipping were younger and had larger aneurysms.More patients were assigned to coiling if their aneurysms originated only from the ICA bifurcation or projected superiorly.For the combined angiographic endpoint,complete and nearly complete occlusion(Raymond-Roy I+II),similar rates of 96%(coiling)or 100%(clipping)could be achieved.Raymond-Roy I occlusion occurred more often after clipping(79%vs 41%coiling).Follow-up of the endovascular group showed minor recanalization of the aneurysm neck(Raymond-Roy II)in 42%.One patient(4%)showed a major recanalization(Raymond-Roy III)and needed retreatment.For incidental findings,no bleeding complications or new persistent neurological deficits occurred during follow-up.CONCLUSION Treatment of ICA bifurcation aneurysms after interdisciplinary assignment to clipping or coiling is effective and safe.Despite significantly more minor recanalizations after coiling,the re-treatment rate was very low,and no bleeding was observed during follow-up.Multivariate analysis revealed that origin only from the ICA bifurcation was an independent predictor of aneurysm recanalization after endovascular treatment.     

Mild hypothermia for treatment of diffuse axonal injury: a quantitative analysis of diffusion tensor imaging简

Fractional anisotropy values in diffusion tensor imaging can quantitatively reflect the consistency of nerve fibers after brain damage, where higher values generally indicate less damage to nerve fibers. Therefore, we hypothesized that diffusion tensor imaging could be used to evaluate the effect of mild hypothermia on diffuse axonal injury. A total of 102 patients with diffuse axonal injury were randomly divided into two groups: normothermic and mild hypothermic treatment groups. Patient's modified Rankin scale scores 2 months after mild hypothermia were significantly lower than those for the normothermia group. The difference in average fractional anisotropy value for each region of interest before and after mild hypothermia was 1.32–1.36 times higher than the value in the normothermia group. Quantitative assessment of diffusion tensor imaging indicates that mild hypothermia therapy may be beneficial for patients with diffuse axonal injury.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.     

Effect of electro-acupuncture combined with early rehabilitation on motor function and expressions of CD11b/CD18 and tumor necrosis factor-α in patients with acute cerebral infarction

Objective To observe the effect of electro-acupuncture combined with early rehabilitation on the motor function and expressions of the adhesion molecules CD11b and CD18 in the polymorphonuclear leucocytes (PMN) and monocytes and serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction (ACI). Methods A total of 165 ACI patients were randomly divided into control group (group A, n=50), conventional rehabilitation group (group B, n=50) and comprehensive rehabilitation group (group C, n=65). The expressions of CD11b and CD18 in the PMN and monocytes and serum TNF-α levels were determined before and at 1, 2, and 4 weeks after the treatment. Thirty-two healthy subjects were also recruited as the normal control group (group N). The neurological function of the subjects was evaluated by modified Edinburgh-Scandinavia stroke scale (MESSS) and Fugi-Meyer Assessment (FMA), and their activity of daily living (ADL) was assessed using Barthel index (BI). Results The CD11b/CD18 expression in the PMN and MN and serum TNF-α level in groups A, B and C were significantly higher than those in group N before and 1 week after the treatment (P<0.05). CD11b/CD18 expression and serum TNF-α level were significantly lower in groups B and C than in the group A at 1 week after the treatment, and significantly lower in group C than in group B (P<0.05). At 2 weeks of treatment, CD11b/CD18 and TNF-α were significantly lower in groups B and C than in the group A, being the lowest in group C (P<0.05). The scores of mESSS in both groups B and C were lower than that in group A, and the scores were lower in group C than in group B. Group C showed higher FMA scores than group B, both having higher scores than group A. At 4 weeks of treatment, the mESSS scores were significantly lower, hut the FMA and ADL score significantly higher in groups B and C than in the control group (P<0.05), and the differences were more obvious in group C. Groups B and C had greater effective rate than group A (P<0.05), and the rate was the highest in group C (P<0.05). Conclusion Electro-acupuncture combined with early rehabilitation promotes the recovery of motor function in ACI patients probably by regulating the expressions of the adhesion molecules CD11b and CD18 on the PMN and monocytes and the serum levels of TNF-α.