标准大骨瓣开颅术治疗重型颅脑损伤效果观察

目的探讨标准大骨瓣开颅术治疗重型颅脑损伤的效果。方法随机将84例重型颅脑损伤患者分为2组,每组42例。对照组实施常规骨瓣开颅术,观察组行标准大骨瓣开颅术。比较分析2组手术前后颅内压水平、并发症发生率及预后效果。结果 2组术后7 d颅内压水平较术前均有明显改善。观察组改善情况优于对照组,差异有统计学意义(P0.05)。观察组并发症发生率、病死率、植物生存率低于对照组,预后良好率高于对照组,差异均有统计学意义(P0.05)。结论标准大骨瓣开颅术治疗重型颅脑损伤,可有效改善患者的颅内高压,并发症少,病死率低和生活质量高。     

标准大骨瓣开颅术对重型颅脑损伤患者颅内压及脑代谢指标的影响

目的探讨重型颅脑损伤患者采用标准外伤大骨瓣开颅术对其颅内压及脑代谢指标的影响。方法选择2015-05—2017-09间卢氏县人民医院收治的98例重型颅脑损伤患者,按照手术方式不同分为2组,各49例。对照组行常规骨瓣开颅手术,观察组采用标准大骨瓣开颅术。术后随访6个月,比较2组预后情况、颅内压和脑代谢指标及并发症发生率。结果观察组总良好率较对照组高,并发症发生率较对照组低,差异有统计学意义(P0.05);术后第5天后,观察组颅内压较对照组低,CEO_2、CCP及SVO_2水平均较对照组高,差异有统计学意义(P0.05)。结论重型颅脑损伤采用标准外伤大骨瓣开颅术治疗,颅内压水平控制好,能有效改善脑代谢指标,降低并发症发生率,提高预后良好率。     

改良标准大骨瓣开颅术治疗重型颅脑外伤效果分析

目的研究重型颅脑外伤患者应用改良标准外伤大骨瓣开颅术的治疗效果。方法本次纳入2017年8月至2019年6月收治的90例重型颅脑外伤患者展开研究,根据手术方式的不同进行分组,对照组45例实施标准外伤大骨瓣开颅术治疗,观察组45例实施改良标准外伤大骨瓣开颅术治疗。将两组的颅内压、并发症发生情况、预后情况进行比对。结果观察组患者术后1、7、14天的颅内压以及并发症发生情况低于对照组,预后情况优于对照组,差异具有统计学意义(P0.05)。结论改良标准外伤大骨瓣开颅术应用于重型颅脑外伤患者治疗中安全有效,可改善预后。     

标准大骨瓣减压术治疗重型颅脑创伤临床分析

目的探讨标准大骨瓣与常规颞顶瓣开颅术治疗重型颅脑创伤的效果。方法选取2016-01—2016-12间收治的60例重型颅脑损伤患者,随机分为2组,各30例。对照组采用常规颞顶瓣或联合开颅手术,观察组采用标准大骨瓣开颅手术。比较2组的临床效果。结果观察组患者预后良好率高于对照组,差异具有统计学意义(P0.05)。结论标准大骨瓣减压术可提高颅脑损伤患者的治疗效果。     

标准大骨瓣开颅减压术治疗重型颅脑损效果观察

目的分析标准大骨瓣开颅减压术治疗重型颅脑损伤的临床效果。方法将64例重型颅脑损伤患者随机分为2组,各32例。对照组实施常规骨瓣开颅减压手术,观察组给予标准大骨瓣开颅减压手术。观察2组的治疗临床效果及术后并发症情况。结果观察组治愈率高于常规组,并发症发生率明显低于常规组,差异均具有统计学意义(P0.05)。结论与常规骨瓣开颅减压手术相比,对重型颅脑损伤患者实施标准大骨瓣开颅减压术,治愈率高、术后并发症发生率低,可明显改善预后。     

双侧去骨瓣减压开颅术治疗重型对冲性颅脑损伤效果观察

目的分析双侧去骨瓣减压开颅术治疗重型对冲性颅脑损伤的效果。方法随机将73例重型对冲性颅脑损伤患者分为2组。观察组(37例)采用双侧去骨瓣减压开颅术,对照组(36例)采用单侧去骨瓣减压开颅术。比较2组的治疗效果。结果观察组总有效率、术后GCS评分及并发症发生率均优于对照组,差异均有统计学意义(P0.05)。结论双侧去骨瓣减压开颅术治疗重型对冲性颅脑损伤,能有效改善患者的意识状态,并发症发生率低,效果显著。     

标准大骨瓣减压术联合亚低温治疗重型颅脑损伤效果观察

目的观察标准大骨瓣减压术联合亚低温治疗重型颅脑损伤的效果。方法随机将接受标准大骨瓣减压术的56例重型颅脑损伤患者分为2组,各28例。观察组联合亚低温治疗,对照组仅在体温38℃时实施常规方法降温。比较2组的治疗效果。结果治疗后观察组患者的颅内压及NIHSS评分均优于对照组,差异有统计学意义(P0.05)。随访1~3个月,末次随访,观察组的并发症发生率及恢复优良率均优于对照组,差异均有统计学意义(P0.05)。结论对重型颅脑损伤患者实施标准大骨瓣减压术联合亚低温,能有效保护脑组织,降低颅内压及并发症发生率,有利于改善患者预后。     

改良标准大骨瓣开颅术治疗重型颅脑外伤临床观察

目的观察改良标准外伤大骨瓣开颅术对重症颅脑外伤的治疗效果。方法将41例重型颅脑外伤患者分为2组,对照组20例给予标准外伤大骨瓣开颅术治疗,改良组21例接受改良标准外伤大骨瓣开颅术治疗。观察2组患者术后基本指标改善情况和预后情况。结果改良组心电图异常患者明显少于对照组,颅内压明显下降患者多于对照组(P0.05)。改良组患者恢复良好率明显高于对照组,且病死率明显低于对照组(P0.05)。结论改良标准大骨瓣开颅术治疗重型颅脑外伤疗效确切,改善患者生存质量较好。     

标准外伤大骨瓣开颅术治疗重型颅脑损伤效果观察

目的探讨标准外伤大骨瓣开颅术治疗重型颅脑损伤患者的效果。方法选取2016-05—2018-10间登封市人民医院收治的90例重型颅脑损伤患者,按照手术方案不同分为2组,各45例。常规组采用常规骨瓣开颅术,标准组采用标准外伤大骨瓣开颅术。比较2组的疗效。结果标准组术后第3天、7天的颅内压、并发症总发生率低于常规组,术后随访6个月的预后良好率高于常规组,差异均有统计学意义(P0.05)。结论标准外伤大骨瓣开颅术治疗重型颅脑损伤,能有效降低颅内压,减少并发症发生率,预后效果显著。     

标准大骨瓣减压术对重型颅脑损伤患者脑代谢指标的影响

目的探讨标准大骨瓣减压术对重型颅脑损伤患者脑代谢指标的影响。方法随机将60例重型颅脑损伤患者分为2组,各30例。对照组采用传统骨瓣开颅术,观察组采用标准大骨瓣减压术。比较2组患者的脑氧摄取率(CEO_2)、脑灌注压(CCP)、静脉血氧饱和度(SVO_2)等脑代谢指标及格拉斯哥(GCS)评分。结果观察组患者的CEO_2、CCP、SVO_2水平及GCS评分均优于对照组,差异有统计学意义(P0.05)。结论与传统骨瓣开颅术比较,标准大骨瓣减压术治疗重型颅脑损伤,可有效改善患者的脑代谢指标和预后。     

Alfentanil increases intracranial pressure when intracranial compliance is low

Intracranial pressure increases following the administration of alfentanil 1 mg are reported in five patients with suspected normal pressure hydrocephalus who were undergoing infusion of saline into a lateral ventricle to measure cerebrospinal fluid outflow resistance. The increase in intracranial pressure was accompanied by a fall in mean arterial pressure. These observations show that, when the intracranial compliance is reduced, alfentanil can cause considerable increases in intracranial pressure and decreases in cerebral perfusion pressure.     

支架辅助栓塞未破裂颅内动脉瘤术后颅内微缺血危险因素

目的分析支架辅助栓塞(SAE)治疗未破裂颅内动脉瘤后发生颅内微缺血(IMI)的危险因素。方法回顾性分析236例接受SAE治疗的未破裂颅内动脉瘤患者,根据术后3天内头部MR弥散加权成像(DWI)检查结果判断是否发生IMI;采用单因素分析和多因素Logistic回归分析筛选IMI危险因素。结果 236例中,97例(97/236, 41.10%)发生IMI(IMI组),139例未发生IMI(非IMI组,n=139)。2组间合并糖尿病、缺血性卒中病史、血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊差异有统计学意义(P均0.05)。多因素Logistic回归分析结果显示,血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊是IMI的独立危险因素(P均0.05)。结论 SAE治疗未破裂颅内动脉瘤后可发生IMI;血小板抑制不足、前交通动脉瘤、伴瘤内附壁血栓、支架贴壁不良及微弹簧圈襻疝出瘤囊促进IMI发生。     

Genetics of intracranial aneurysms

Despite advances in the treatment of intracranial aneurysms (IA) in recent years, the overall outcome of patients with aneurysmal subarachnoid hemorrhage has shown only modest improvement. Given this poor prognosis, diagnosis of IA before rupture is of paramount importance. Currently, there are no reliable methods other than screening imaging studies of high-risk individuals to diagnose asymptomatic patients. Multiple levels of evidence suggest that environmental factors acting in concert with genetic susceptibilities lead to the formation, growth, and rupture of aneurysms in these patients. Epidemiological studies have already identified aneurysm-specific risk factors such as size and location, as well as patient-specific risk factors, such as age, sex, and presence of medical comorbidities, such as hypertension. In addition, exposure to certain environmental factors such as smoking have been shown to be important in the formation of IA. Furthermore, substantial evidence proves that certain loci contribute genetically to IA pathogenesis. Genome-wide linkage studies using relative pairs or rare families that are affected with the Mendelian forms of IA have already shown genetic heterogeneity of IA, suggesting that multiple genes, alone or in combination, are important in the disease pathophysiology. The linkage results, along with association studies, will ultimately lead to the identification of IA susceptibility genes. Identification of the genes important in IA pathogenesis will not only provide novel insights into the primary determinants of IA, but will also result in new opportunities for early diagnosis in the preclinical setting. Ultimately, novel therapeutic strategies based on biology will be developed, which will target these newly elucidated genetic susceptibilities.     

Monitoring of intracranial pressure

A very small fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. 13 patients with intracranial hypertension have been studied with this probe. The clinical experience confirmed the safety, accuracy and reliability of the device. The monitor has functioned very well, and there have been no complications except for two breakages of optic fiber as a result of nursing manoeuvres. This new device can be placed into the ventricular, subdural and epidural space. Camino System appears to offer advantages over other monitors presently in use.