颅内动脉瘤破裂42例围手术期护理

颅内动脉瘤是引起自发性蛛网膜下腔出血(sSAH)的首位原因,其破裂出血后患者病情危重,病死率和致残率高[1],为提高破裂颅内动脉瘤的救治水平,笔者将破裂颅内动脉瘤围手术期护理进行分析.     

颅内动脉瘤破裂后再出血的相关因素分析与对策

颅内动脉瘤的危险性在于动脉瘤破裂,发生急性蛛网膜下腔出血或颅内血肿[1].文献报道,颅内动脉瘤破裂后再出血的发生率为19%～41%,再出血死亡率高达50%以上[2].分析我院1998年1月至1999年12月收治颅内动脉瘤破裂后再出血24例,探讨再出血的诱发因素与预防对策.     

水解脱弹簧圈填塞治疗急性期破裂颅内动脉瘤1例

摘要 背景：以往多采用电解脱弹簧圈填塞治疗颅内动脉瘤，但电解脱弹簧圈解脱时间较长，解脱区质地硬，并发症发生率较高，不利于微小动脉瘤的栓塞。 目的：观察水解脱弹簧圈填塞治疗急性期破裂颅内动脉瘤的效果。 方法：经头颅CT检查确认蛛网膜下腔出血并有脑叶出血1例，数字减影血管造影系统证实为颅内动脉瘤，采用水解脱弹簧圈栓塞动脉瘤。 结果与结论：经过治疗，患者破裂动脉瘤致密栓塞，填塞达99%，出血得到控制。提示水解脱弹簧圈的超柔软性及对瘤体壁的顺应性，操作方便，提高了动脉瘤的致密性栓塞的可能性，减少并发症的可能，应该为目前急性期颅内动脉瘤破裂较好的栓塞方法。 关键词：颅内动脉瘤；蛛网膜下腔出血；水解脱弹簧圈；介入治疗 doi:10.3969/j.issn.1673-8225.2011.12.040     

高血压对颅内动脉瘤发病机制影响的研究进展

人类对颅内动脉瘤的诊断和治疗虽取得了很大的进步,但蛛网膜下腔出血的病死率仍可达50％[1-2].高血压、吸烟、雌激素被认为是导致颅内动脉瘤发生的三个主要影响因素,其中高血压与颅内动脉瘤的发生相关性最强[3-4].本文回顾了高血压作用下颅内动脉瘤形成、发展机制的研究,探讨高血压患者颅内动脉瘤形成的可能机制,为进一步研究颅内动脉瘤,预防其发生、发展提供依据. 一、颅内动脉瘤的血流动力学改变     

栓塞治疗颅内动脉瘤36例护理体会

颅内动脉瘤是颅内动脉壁上的异常膨出,体积较小的在破裂之前多无症状,临床表现多以蛛网膜下腔出血(SAH)为主要表现,可合并脑血管痉挛,发病2周内再出血患者死亡率极高,宜尽早进行有效治疗.栓塞治疗颅内动脉瘤创伤小、安全、效果好.现在此技术已得到迅速发展.我们应用此技术治疗颅内动脉瘤36例,疗效满意,现将护理体会总结如下.     

Hunt Ⅳ、Ⅴ级颅内动脉瘤的显微外科治疗的经验

颅内动脉瘤是自发性蛛网膜下腔出血最常见的原因之一[1],好发年龄40～60岁.动脉瘤破裂出血后按Hunt分级属于Ⅳ、Ⅴ级者处理困难,死亡率及致残率很高.随着显微神经外科技术的发展,其死亡率明显降低.本组报告34例Hunt Ⅳ、Ⅴ级颅内动脉瘤的显微外科治疗经验.     

颅内动脉瘤弹簧圈栓塞术后并发症的预防及护理

颅内动脉瘤是一种严重的脑血管疾病,是引起自发性蛛网膜下腔出血最常见的原因,可占蛛网膜下腔出血病例的85%。颅内动脉瘤弹簧圈栓塞术是当前较先进的治疗手段,我科自2009-10-2010-06共完成56例颅内动脉瘤患者的介     

颅内动脉瘤介入栓塞术治疗蛛网膜下腔出血的护理

颅内动脉瘤是蛛网膜下腔出血(Subarchnoid hemorrhage,SAH)最常见的原因.动脉瘤一旦破裂,血管痉挛发生率为25%～30%[1],导致SAH患者病死率和致残率增高,严重影响预后.我科从2005-11-26～2006-11-26,应用微弹簧圈栓塞颅内动脉瘤治疗蛛网膜下腔出血27例.现将护理体会报告如下.     

颅内动脉瘤的家族性因素

颅内动脉瘤破裂出血是严重威胁人类生命的疾病,出血死亡率约50%(包括入院前死亡),而幸存者中约1/3不能生活自理,且有再次出血的可能.尽管神经影像学、显微神经外科及血管内治疗的发展使其疗效有一定程度的提高,但颅内动脉瘤的死亡率和致残率仍占脑血管病死亡患者的22%～25%[1].目前,对它的病因与发病机制仍不太了解,一般认为颅内动脉瘤的形成、生长与破裂是动脉管壁在长期血流应力作用下发生的退行性改变.但是,研究表明部分颅内动脉瘤患者具有明显的家族性.     

脑动脉瘤破裂致蛛网膜下腔出血诊治中的有关问题

蛛网膜下腔出血（SAH）是脑动脉瘤最常见的临床表现，非外伤性脑蛛网膜下腔出血源于动脉瘤破裂者约占50％～70％，其他病因见于颅内动静脉畸形、高血压、血液病、颅内血管炎及药源性等。本文对颅内动脉瘤破裂急性期诊断方法、手术时机和方式等问题进行讨论。     

Inhomogeneities in the propagation of the slow wave in the stomach

The propagation of the slow wave in the stomach and its role in inducing sweeping peristaltic contractions toward the pylorus, essential for a proper digestion and emptying, have been studied for many years. Irregularities in the timing or in the pattern of propagation of the slow wave have been known to induce various gastric malfunctions and, recently, several types of gastric dysrhythmias have been described which could lead to gastric contraction abnormalities. In this study, Du et al. have analyzed the disturbances caused by a simple transmural incision in a human stomach, performed to obtain a biopsy of the muscle, on the propagation pattern of the slow wave. In addition, they show that such an incision may by itself also induce new types of gastric dysrhythmias. These results are important in demonstrating that the function of the stomach can easily be disturbed by such procedures. This mini‐review describes several ways in which inhomogeneities in propagation may affect the conduction pattern of the slow wave, including the genesis of several dysrhythmias, and what is currently known about their impact on gastric contraction and digestion.     

Early stages in the formation of the cerebellum in the frog

The formation of the cerebellum was studied during the first 6 months of the tadpole stage of the bullfrog by using standard histological methods and reconstructions from serial horizontal sections. Three major developmental phases were noted in the formation of the cerebellum. (1) During the first 5 weeks of development, the neuroepithelium proliferated and the dorsal mesencephalic plates increased in size. (2) Starting in the sixth week, a patch of neuroepithelium began to differentiate and gave rise to a small population of Purkinje cells. In subsequent weeks, the area of differentiation continued to spread and a Purkinje cell layer became established along the dorsal margin of the cerebellar plate. (3) In the 12th week, the ventrolateral part of the cerebellar plate began to increase in size and generate two populations of small cells. The lateralmost part of the neuroepithelium in this area generated a group of cells that formed an external granular layer that was one cell deep. Cells of this external granular layer migrated inward into the primitive molecular layer, and by the 26th week only a remnant of an external granular layer remained in the cerebellum. The more medially situated part of the neuroepithelium gave rise to another population of small cells that formed a column, which appeared to be continuous with the Purkinje cells, but differed from them in size. It should be noted that full maturation of the cerebellum occurs during metamorphosis, which in this species remains some 2 years away.     

Asymmetry in the structural organization of the ganglion layer of the retina in the frog

Silver-impregnated retinal preparations were used to study the distribution density and topographic features of small and large ganglionic cells (GC) of Rana ridibunda and Rana temporaria. For both species the increased density of GC (a streak) stretched higher than the naso-temporal axis passing through the optic disk. Beyond the streak the density of small GC was maximal in the central zone of the retina and decreased towards its periphery. For the upper quadrants of the retina the density of small GC was higher than that for the lower ones by 26% on the average. On the contrary, the density of large GC was higher in the lower part of the retina as compared to the upper one, the difference being more pronounced for R. temporaria. The density of large GC was also asymmetric with respect to the dorso-ventral axis being higher in nasal quadrants than in temporal ones by 40-55%. The highest density of large GC was found in the middle zone of the retina. The found structural asymmetry in the retinal output raster may bear an adaptively ecological meaning and may condition the particularities of the formation of the visually guided prey-catching and avoidance reactions.     

Local nonuniformities in the syncytium of the horizontal cells of the retina in the turtle

Electrical coupling between horizontal cells of the turtle retina was investigated by means of two microelectrodes (current and recording ones) penetrating neighbouring cells at a fixed distance from each other. The morphological coupling was revealed by means of fluorescent dye Lucifer Yellow. The electrical coupling was confirmed between elements of similar type (L1--axonal terminals, or L2--cell bodies, or R/G type cells) and no coupling was found between elements of different types, though L1 and L2 are directly connected through thin axons. In the L1 syncytium the electrical coupling at small (less than or equal to 50 microns) but fixed distances between microelectrodes could differ several times depending on the minimal displacement of microelectrodes. This local nonuniformity of coupling can be explained on the basis of structural nonuniformities in the L1 (axon terminal) network. It is unlikely however that the structural nonuniformities can influence the functional properties of horizontal cell network when the retina is stimulated adequately (by light).     

Challenges in the Management of the HIV Patient in the Third Decade of AIDS

The epidemic of AIDS has been increasingly recognized as a major health and socioeconomic problem, not only in the United States or Africa, but also the rest of the world. The face of the epidemic has changed. The role that mental health providers play has also significantly grown as the epidemic continues on. Prior to the introduction of Highly Active Anti-Retroviral Therapy (HAART) and other advances in HIV care, the patients faced issues that related to death and dying. These advances brought with them renewed hope and resurrected lives. The patients fought with issues related to living new lives with HIV no longer an imminent death threat. In the third decade of AIDS, the struggles of the post-HAART era continue but bring with it more challenges. Mental health providers need to familiarize themselves with these issues so that they can better help HIV patients cope with this devastating disease.     

Role of the subthalamo-nigral input in the control of amygdala-kindled seizures in the rat

The substantia nigra pars reticulata (SNpr) is a critical site for the control of epileptic seizures. Potentiation of the inhibitory GABAergic input from the striatum to the SNpr suppresses primary or secondary generalized seizures in the rat. The purpose of this study was to examine the possible involvement of the excitatory glutamatergic input from the subthalamic nucleus to the SNpr in the control of both the electroencephalographic and the motor components of amygdala-kindled seizures in the rat. Microinjections of either an N-methyl- -aspartate (NMDA) antagonist in the substantia nigra or a GABA_A agonist in the subthalamic nucleus, significantly reduced motor seizures but did not modified the afterdischarges. These results provide evidence for the involvement of the subthalamo-nigral projection in the modulation and the propagation of the motor components of amygdala-kindled seizures.     

Patterning in the regeneration of electroreceptors in the fin of Kryptopterus

The influence of the target tissue on afferent nerve regeneration was studied in the adult glass catfish, Kryptopterus. In this fish, electroreceptors in the anal fin are distributed in a characteristic pattern in the proximal part of the fin and are absent in the distal portion of the fin. We tested whether axons were more likely to induce electroreceptors in certain regions of fin epidermis than in others. We rotated fin transplants so that the location of the degenerating electroreceptors was altered with respect to the regenerating axons in the host tissue dorsal to the fin. The effects of these rotations were observed in the living animal with differential interference contrast optics over a period of 10 weeks. When transplants were reversed rostrocaudally, new electroreceptors formed in the caudal half of the interradial zone, where degenerating electroreceptors were at the time of transplantation. When transplants were rotated so that the dorsoventral and rostrocaudal axes were reversed, some new receptors formed in the old target site regions that were located in the caudal interradial zones (in the distal half of the graft with respect to the host). Regenerating axons reached these regions of the transplant by taking unusual routes around the electroreceptor-free regions of fin. Very few electroreceptors formed in the distal/caudal or proximal/caudal interradial quadrants of grafts where the original orientation of the tissue was maintained. We suggest that old target sites have a neurotropic influence on the regenerating afferent axons and discuss the possibility that the distal fin epidermis is not as permissive to electroreceptor formation as proximal fin epidermis.     

Organization in the descending tracts of the dorsolateral funiculus in the cat

Organization of the fibers in the descending tracts of the dorsolateral funiculus of the cervical spinal cord was investigated in cats. The spinal cord was penetrated with microelectrodes at 400 mum intervals in the medio-lateral direction at the c5/c6 and c6/c7 segmental borders. Silicon substrate microelectrodes with a linear arrangement of activated iridium contacts were used. The stimulus consisted of a 20 ms train of charge balanced biphasic current pulses at 330 Hz. The evoked activities from selected forelimb muscles were acquired into computer. Only the data points with an activation threshold of less than 35 muA were considered in the analysis. Muscle contractions were mostly in the form of short twitches. In both spinal segments, an area of high threshold was found in the middle of the dorsolateral funiculus. Majority of the muscles studied had a dorsal or ventral concentration of activation points. The distal muscles were mostly activated in the ventro-lateral aspect of the funiculus, while the elbow muscle maps spread to both dorsal and ventral sides. These results show a functional organization in both cervical segments studied, with overlapping regions between the areas dedicated for each forelimb muscle.     

Pursuit of the origin of the large myelinated fibers of the anterolateral funiculus in the spinal cord in humans in relation to the pathomechanism in amyotrophic lateral sclerosis

To determine the origin of the large myelinated fibers in the anterolateral funiculus (ALF) in the spinal cord of humans, myelinated fibers in the ALF of the mid-cervical spinal cord were examined quantitatively. Five groups of subjects were examined, consisting of control subjects, patients with cerebral lesions and showing complete degeneration of the unilateral/bilateral pyramis of the medulla oblongata, those with lesions of the pontine tegmentum, those with lesions of the lower cervical spinal cord, and those with thoracic/lumbar lesions. The results indicate that the large myelinated fibers in the ALF of the mid-cervical spinal cord of humans originate from the tegmentum of the brain stem and the lower cervical spinal cord, and not from the cerebrum, or the thoracic or lumbar spinal cord. Thus, they are descending fibers from the brain stem tegmentum and ascending fibers from the lower cervical cord, and not corticospinal tracts or long-ascending fibers from the thoracic or lumbar spinal cord. The origin of the large myelinated fibers in the ALF of the spinal cord in humans, the number of which was severely decreased in patients with amyotrophic lateral sclerosis, is considered to be the long-descending neurons in the brain stem tegmentum and the propriospinal neurons in the spinal cord. Received: 23 December 1998 / Revised, accepted: 29 March 1999     

Selectivity between faces in the responses of a population of neurons in the cortex in the superior temporal sulcus of the monkey

There is a population of neurons in the cortex in the middle and anterior part of the superior temporal sulcus (STS) of the monkey with responses which are selective for faces. If, consistent with the effects of damage to the temporal lobe, these neurons are involved in face recognition or in making appropriate social responses to different individuals, then it might be expected that at least some of these neurons might respond differently to different faces. To investigate whether at least some of these neurons do respond differently to different faces, their responses were measured to a standard set of faces, presented in random sequence using a video framestore. It was found that a considerable proportion of the neurons with face selective responses tested (34/44 or 77%) responded differently to different faces, as shown by analyses of variance. An index of the discriminability of the most and least effective face stimulus (d') ranged between 0.2 and 5.0 for the different neurons. Although these neurons often responded differently to different faces, they did not usually respond to only one of the faces in the set, so that information that a particular face had been shown was present across an ensemble of neurons, rather than in the responses of an individual neuron. These findings indicate that the responses of these neurons would be useful in providing information on which different behavioral responses made to different faces could be based. These neurons could thus be filters, the output of which could be used for recognition of different individuals and in emotional responses made to different individuals.