高血压脑室型丘脑出血的微创治疗

目的 探讨高血压脑室型丘脑出血微创治疗的疗效。方法 2002年7月～2006年5月采用丘脑穿刺、丘脑穿刺联合脑室穿刺、脑室穿刺及联合腰穿引流治疗31例脑室型丘脑出血。结果 术后存活26例,死亡5例。5例在穿刺术后12 h内清醒,2例在并发成人呼吸窘迫综合征危急情况下,采用双针微创穿刺治疗最终获救。术后日常生活能力（activities of daily living,ADL）分级：1级5例,2级9例,3级8例,4级4例,死亡5例。26例术后3个月随访病情稳定,无复发;1例术后随访3年,已完全康复。结论 局麻下微创穿刺治疗高血压脑室型丘脑出血创伤小,操作简便,疗效满意。     

纵裂入路外科治疗脑室型丘脑出血方法及护理体会

目的:探讨经纵裂入路手术治疗脑室型丘脑出血的方法及术后护理要点.方法:回顾分析11例继发性全脑室型丘脑出血患者经纵裂入路手术清除脑室和丘脑血肿.结果:患者住院期间死亡2例,2例行脑室外引流手术,4例术后2用清醒,其中2例高热,4例呼吸道感染,1例消化道出血,1例尿崩症.结论:经纵裂入路手术迅速清除丘脑血肿和脑室特别是三脑室、导水管内血肿是打通脑脊液循环通路,降低病死率关键,术后严密观察护理保证了疾病预后.     

1例丘脑出血破入全脑室病人的护理

我院于 2 0 0 0年 1月收治 1例高血压病 3期并左侧丘脑出血破入全脑室病人 ,经行侧脑室引流及脑室腹腔分流术治疗 ,痊愈出院。现将护理报告如下。1　病例简介男 ,5 8岁。因无明显诱因突然头晕、头痛、失语、右侧肢体无力 3ｈ ,于 1月 6日 2 1时急诊入院。既往有 2 0余年高血压病史、10余年胃病和慢性支气管炎病史。入院时查体 :神志不清 ,双侧瞳孔等圆等大 ,对光反射存在 ;Ｔ 37 3℃ ,Ｐ 10 8次 /ｍｉｎ ,Ｒ 2 2次 /ｍｉｎ ,ＢＰ 173/ 112ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ;右侧肢体功能障碍。经ＣＴ检查结合临床确诊为 3期高血压 ,左侧丘…     

丘脑出血破入脑室手术治疗分析

目的分析微创手术治疗丘脑出血破入脑室的疗效。方法对86例丘脑出血破入脑室患者的临床资料进行回顾性分析。结果治愈31例,好转36例。本组死亡11例,自动出院8例。6个月后随访,采用日常生活活动能力(ADL)量表评定:Ⅰ级31例,Ⅱ级14例,Ⅲ级10例,Ⅳ级8例,Ⅴ级4例。结论对丘脑出血破入脑室患者,准确把握手术适应证,恰当选择手术方式,及早进行手术治疗,对提高治愈率、改善预后至关重要。     

双侧脑室引流治疗重度脑室出血

重度脑室出血多继发于高血压脑出血,临床表现险恶,愈后差,死亡率高。自1999年8月至今,我院应用双侧脑室引流并尿激酶冲洗的方法共治疗重度脑室出血21例,疗效满意,现报告如下。     

穿刺抽吸引流术治疗高血压丘脑出血

丘脑解剖位置深在，出血后易破入第三脑室并经室间孔和中脑导水管向侧脑室、第四脑室扩张，易产生中心疝和脑积水，迅速对生命构成威胁。常规开颅术既加重了丘脑损害，又不易解除脑积水，中心疝所致丘脑移位难以复位。我院采用血肿腔穿刺引流及双侧侧脑室额角引流治疗高血压丘脑出血，取得良好效果，报告如下。     

丘脑出血破入脑室并脑积水的治疗体会

目的丘脑出血破入脑室合并脑积水的治疗方法的选择。方法回顾性分析我科近5年来收治的45例丘脑出血破入脑室合并脑积水患者治疗方案的临床资料。结果45例患者经过保守治疗、血肿穿刺（颅骨钻孔血肿穿刺引流术）、脑室外引流、V—P分流术（侧脑室腹腔分流术）等方法治愈37例,占82．22％,自动出院5例,死亡3例。结论无论是血肿穿刺、脑室外引流还是V-P分流,都应尽早清除脑室内外积血,恢复脑脊液的循环通畅,改善脑的微循环,这是降低病残率及死亡率,成功治疗的关键。     

穿刺置管全脑室冲洗术治疗脑室出血

目的探讨穿刺置管全脑室冲洗术治疗原发性高血压丘脑出血破入脑室、积血铸型的价值.方法 1999年3月～2002年4月我们在积血侧侧脑室额角置硅胶管,第3、4腰椎间隙穿刺,蛛网膜下腔置硬膜外麻醉管,脑室端生理盐水冲洗引流治疗17例脑室出血. 结果 17例均一次手术成功,术后3～12 h神志清醒,无一例发生颅内感染.术后第1天复查CT,发病6 h以内手术者,脑室积血全部消失;发病6 h以上手术者,侧脑室血肿减少,第三、四脑室血肿明显变小或消失. 结论穿刺置管全脑室冲洗引流术简便,创伤小,效果良好.     

第四脑室出血扩张与预后关系的探讨

作者报道１９８８～１９９５年经ＣＴ扫描证实的成人第四脑室出血（ＩＶＨ）５２例临床治疗资料。其中２８例有第四脑室出血并第四脑室扩张，尽管采取积极的综合治疗，所有患者均死亡。另２４例第四脑室出血非扩张者，有１０例死亡，１４例生存，质量良好。第四脑室出血扩张患者的死亡率明显高于非扩张组患者。两组ＧＣＳ评分存在较大差异。多因素分析提示，第四脑室出血扩张是预测预后的一项最有意义的指标，其次是ＧＣＳ评分，居第三位的是弥漫性脑室出血。     

老年人自发性脑室出血的脑室外引流治疗

老年人自发性脑室出血是神经外科中常见的危重疾病，其病死率高。脑室外引流是治疗脑室出血的有效方法，但若长时间引流，则易发生脑室感染。自2003年3月至2009年3月．本院采用Ommaya囊联合侧脑室外引流治疗老年人自发性脑室出血56例，获得满意疗效，现报告如下。     

Subarachnoid hemorrhage,midbrain hemorrhage and thalamic infarction following transsphenoidal removal of a pituitary adenoma. A case report

We report a rare case of complication following transsphenoidal resection of a nonfunctioning pituitary adenoma in which subarachnoid hemorrhage, midbrain hemorrhage and thalamic infarction occurred. Possible pathologic mechanisms are discussed and the need for clinical awareness of this rare complication is stressed.     

Challenges in management of a giant left ventricular pseudoaneurysm complicated by intracerebral hemorrhage

Urgent surgery is generally indicated for left ventricular (LV) pseudoaneurysms, especially for large or expanding lesions. However, management of pseudoaneurysms complicated by acute intracerebral hemorrhage is controversial. This case of a giant LV pseudoaneurysm followed a successful postoperative course after 4 weeks of conservative management followed by surgical repair and may suggest a safe and efficient management.     

治疗牙本质过敏症的两种方法比较

目的:比较Green Or和Single Bond光固粘结剂两种方法对牙本质过敏症的疗效。方法:针对临床中2度和2度以上的牙本质过敏症患者187例(357颗患牙),采用随机分组对照实验,以Single Bond为对照组,Green Or为实验组,分别观察两组的即时、1个月、6个月有效率,并进行统计学分析。结果:实验组和对照组即时有效率分别为95.2%和73.1%,1个月有效率分别为91.5%和68.1%,6个月有效率分别为86.9%和51.0%,统计学分析有明显显著性(P0.01)。结论:以Green Or来治疗牙本质过敏症有较好的疗效,值得临床推广。     

Massive intercostal hemorrhage after implantation of an intrapericardial ventricular assist device: A case report

Left ventricular assist devices (LVADs) have become integral to the treatment of advanced heart failure. Surgical bleeding is a known complication of LVAD placement but is most associated with intraperitoneal pump locations. Here we describe a case of massive postoperative hemorrhage secondary to erosion of an intrapericardial LVAD into an intercostal artery with an associated rib fracture.     

Pulmonary alveolar hemorrhage in a patient with a temporary external ventricular assist device and extracorporeal membrane oxygenation

Mechanical circulatory support is increasingly used and may bring about unique challenges. Most support systems require systemic anticoagulation and the need for anticoagulation must be balanced against the increased risk for bleeding. We report the case of a young man awaiting heart retransplantation, who was supported with a temporary extracorporeal ventricular assist device with the addition of an oxygenator. He developed hemoptysis that forced the cessation of anticoagulation exposing to increased thromboembolic risk. We discuss this distinct clinical scenario with no clearly defined solution and explore the risks and benefits of the different treatment options.     

高血压脑出血136例外科治疗分析

目的探讨高血压脑出血外科治疗的适应证、手术方法和疗效。方法对我院136例高血压脑出血住院手术患者的临床资料进行了回顾性分析。结果采用骨瓣开颅加用去骨瓣减压及小骨窗开颅术,治愈83例,残障13例,植物生存14例,死亡26例。结论正确运用微创技术和个体化治疗原则,可有效提高外科手术高血压脑出血的治愈率,降低死亡率、致残率。     

Review of the literature regarding the relationship of rebleeding and external ventricular drainage in patients with subarachnoid hemorrhage of aneurysmal origin

Acute hydrocephalus is a well-documented complication of subarachnoid hemorrhage. The insertion of external ventricular drainage (EVD) has been the standard of care in the management of this complication, aiming primarily at immediate improvement of the clinical condition of these patients, making them more suitable candidates for surgical or endovascular intervention. In our current communication, we review the pertinent literature regarding the relationship of rebleeding and EVD. Several studies have implicated a significantly increased risk of rebleeding in patients with EVD, compared with patients without it. Abrupt lowering of the intracranial pressure could lead to rebleeding due to decreased transmural pressure or removal of the clot sealing the previously ruptured aneurysm. However, a variety of parameters that could affect the rebleeding rate, such as the timing of surgery, the timing and duration of drainage, the size of the aneurysm, as well as the severity of the initial hemorrhage, do not seem to have been adequately explored in the majority of these studies. In addition, a number of clinical trials have failed to provide evidence for the negative role of EVD in the development of rebleeding. Conclusively, further long-term multi-center studies are required in order to establish the exact nature of the relationship between EVD and rebleeding after aneurysmal subarachnoid hemorrhage.A commentary on this paper is available at     

侧脑室外引流联合尿激酶灌注治疗高血压基底节区出血破入脑室

目的　总结应用侧脑室外引流联合尿激酶灌注治疗高血压基底节区出血破入脑室的经验 ,并与单纯侧脑室外引流的疗效进行对比。方法　对 5 9例高血压基底节区出血破入脑室患者中 3 2例行侧脑室外引流加尿激酶灌注 (A组 ) ,2 7例单纯采用脑室外引流 (B组 )。结果　A组重残6例 ,死亡 4例 ,持续引流时间 (7± 3 .1)d ;B组重残 5例 ,死亡 10例 ,持续引流时间 (12± 4.2 )d。两组死亡率和持续引流时间比较差异有显著性 (分别 P <0 .0 5和 <0 .0 1) ,生存质量方面两组重残构成比差异无显著性 (P >0 .0 5 )。结论　脑室外引流联合尿激酶灌注较单纯行脑室外引流虽不能明显改善存活患者神经功能 ,但可明显缩短引流时间 ,降低死亡率。