老年出血性脑梗死患者146例临床疗效分析

目的探讨老年出血性脑梗塞患者临床表现和治疗效果。方法回顾性分析我院2008年1月至2012年12月收治的146例出血性脑梗塞患者的临床资料。患者均在发病后4 h内进行CT/MR检查,并于溶栓治疗后进行CT/MR扫描,以确定继发性出血现象,并进行止血、脱水和脑保护等对症支持治疗,有14例患者还进行了颅骨瓣减压手术。结果出血性脑梗塞146例患者中,症状明显缓解128例,病情恶化12例,死亡6例。随访4～12个月,完全康复120例,肢体功能障碍14例,语言障碍6例。出血性脑梗塞Ⅰ型86例,病变区域无占位效应,轮廓上存在点状密度;Ⅱ型60例,病变区域存在占位效应,存在较大融合点状密度。结论老年出血性脑梗塞血压不稳定、溶栓药物使用不合理等是老年出血性脑梗塞的主要诱因,掌握脑梗塞的发病过程,及时诊断和合理用药可以降低出血性脑梗塞死亡率。     

脑外伤后并发脑梗塞58例临床研究

目的 探讨脑外伤后并发脑梗塞患者的治疗效果及防治措施.方法 回顾分析58例脑外伤后并发脑梗塞患者的临床资料,总结治疗方法,并对GOS评分进行统计.结果 恢复良好者26例,占44.83%;中度残疾者20例,占34.48%;重残9例,占15.52%;持续性植物状态2例,占3.45%;死亡1例,占1.72%.结论 脑外伤后并发脑梗塞具有高死亡率、高残疾率的特点,应在临床上给予足够重视,给予及时且正确的治疗.     

急性脑梗塞的静脉溶栓治疗及护理效果观察

目的急性脑梗塞的静脉溶栓治疗及其护理措施,降低急性脑梗塞患者死亡率和预防并发症。方法选取2009年3月~2012年5月我院入院30例发病3h内确诊脑梗塞的临床资料进行回顾,总结急性脑梗塞的静脉溶栓治疗护理措施及预后情况。结果经过对30例急性脑梗塞患者的积极抢救及护理,仅5例患者死亡,2例患者转院,其余23例患者抢救存活,23例患者中有8例患者出现消化道出血,经治疗及有效护理后均有效控制。结论及时有效抢救和护理是急性脑梗塞治疗成功的重要因素。     

大面积脑梗塞32例治疗临床体会

目的 总结分析大面积脑梗塞的治疗,提高治疗效果.方法对32例患者临床治疗观察比较.结果 32例中20例好转但均伴有不同程度的功能障碍,12例死亡,死亡率为37.5%.结论 大面积脑梗死病情凶险,重在预防     

超早期显微手术治疗高血压性脑基底节出血

目的：探讨超早期显微镜下手术治疗高血压性脑基底节出血的疗效。方法：对36例高血压性脑基底节出血患者的临床资料进行回顾性分析。结果：本组36例,经手术治疗共存活34例;5例再次出血,其中2例死亡。随访3～6个月,ADL分级Ⅰ级6例、Ⅱ级12例、Ⅲ级12例、Ⅳ级2例、Ⅴ级2例。结论：超早期显微手术治疗高血压脑出血,可降低患者死亡率,改善患者生活质量。     

10例心脏大血管创伤的早期救治

目的探讨心脏大血管创伤的早期诊断及治疗经验。方法回顾急诊手术治疗10例心脏大血管创伤的临床资料,分析穿透性损伤和钝性损伤的临床特点,以及早期诊断及治疗特点。结果全组死亡1例,死亡率10%（1/10）。9例痊愈出院。结论心脏大血管创伤应早期准确诊断,加强对急性心脏压塞和休克的处理,紧急剖胸手术是救治成功的关键。     

肾衰竭合并毛霉菌病

目的 探讨肾衰竭合并毛霉菌病的临床特点、诊断、治疗及预后。方法 报道1例慢性肾衰竭合并肺毛霉菌病,并使用二性霉素B治疗成功的病例;结合该例的特点,复习肾衰竭合并毛霉菌病的文献资料,不包括存在明确易感因素如腹膜透析相关性的毛霉菌性腹膜炎及去铁胺治疗者。结果 共15例,平均年龄（49.9 15.8）岁。鼻脑型占46.7%,其次为肺型和弥漫型,分别占33.3%和20%。46.7%于死亡后尸检诊断,总死亡率为73.3%。7例接受治疗者,死亡率为42.9%。未接受治疗者,无1例存活。结论 毛霉菌病是肾衰竭患者致死性的感染性疾病,早期诊断、及时联合使用大剂量抗真菌药物、外科清创术或局部引流是改善预后的关键。     

原发性小肠肿瘤诊治的临床分析

目的探讨原发性小肠肿瘤的临床诊治措施;方法回顾性分析我院2008年1月至2010年2月治疗的原发性小肠肿瘤患者20例的临床资料;结果均实施手术治疗,术后有1例因肺心病、多脏器功能衰竭死亡,其余均未发生严重手术并发症。随访时间0.5～3a,良性肿瘤9例均存活,存活率达100%。恶性肿瘤11例存活5例,半年内死亡3例,1a内死亡2例,3a内死亡1例,存活率为45.45%;结论 ＂早发现早治疗＂是小肠肿瘤治疗时需要坚持的原则,若患者在诊断检查时未能得出准确的结论,且患者存在小肠肿瘤的可能性很大,应该及时采取腹腔镜或剖腹探查。     

原发性小肠肿瘤诊治的临床分析

目的 探讨原发性小肠肿瘤的临床诊治措施;方法回顾性分析我院2008年1月至2010年2月治疗的原发性小肠肿瘤患者20例的临床资料;结果均实施手术治疗,术后有1例因肺心病、多脏器功能衰竭死亡,其余均未发生严重手术并发症.随访时间0.5～3a,良性肿瘤9例均存活,存活率迭100%.恶性肿瘤11例存活5例,半年内死亡3例,1a内死亡2例.3a内死亡1例,存活率为45.45%;结论"早发现早治疗"是小肠肿瘤治疗时需要坚持的原则,若患者在诊断检查时未能得出准确的结论,且患者存在小肠肿瘤的可能性很大,应该及时采取腹腔镜或剖腹探查.     

妊娠急性脂肪肝10例及其相关资料临床分析

目的 探讨妊娠期急性脂肪肝（AFLP）的临床特点,以便早期诊断和及时治疗,降低孕产妇及围生儿的死亡率.方法 对近4年我院收治的10例妊娠期急性脂肪肝患者的临床资料进行回顾性分析.结果 9例患者为初产妇,平均发病孕周为36＋6周,单胎8例,双胎2例.4例存活孕妇均行剖宫产结束分娩,3例入院时出现凝血功能障碍行剖宫产加子宫全切.孕产妇共存活4例,死亡率为60%;围生儿死亡9例,死亡率为75%.结论 妊娠急性脂肪肝是发生在妊娠晚期的一种严重并发症,早期诊断、尽快终止妊娠是提高母儿预后的关键;对于AFLP患者的分娩方式选择我们主张以剖宫产尽快结束分娩为宜;对于出现凝血功能障碍者,就在剖宫产的同时行子宫全切,以挽救患者生命.     

Long-term remission,relapses and maintenance therapy in adult primary central nervous system vasculitis: A single-center 35-year experience

ObjectivesTo evaluate long-term treatment and outcomes of patients with primary central nervous system vasculitis (PCNSV).MethodsIn this cohort of 191 consecutive patients with PCNSV seen at Mayo Clinic, Rochester, MN, over 35 years with long-term follow-up we analyzed response to and duration of therapy, frequency of relapses, long-term remission, efficacy of maintenance therapy and initial intravenous glucocorticoid (GC) pulses, survival and degree of disability. We also compared the efficacy of initial IV and oral cyclophosphamide (CYC).ResultsA favorable initial response was observed in 83% of patients treated with prednisone (PDN) alone, 81% of those treated with PDN and CYC and 95% of those initially treated with PDN and an immunosuppressant other than CYC. One or more relapses were observed in 30% of patients, 35% had discontinued therapy by last follow-up, and 21.5% maintained remission for at least 12 months after discontinuing therapy. Maintenance therapy was prescribed in 19% of all patients and 34% of patients initially treated with CYC and PDN. High disability scores (Rankin 4–6) and deaths were less frequently observed in patients receiving maintenance therapy and more frequently in patients with Aβ-related angiitis. Large vessel involvement and cerebral infarction at diagnosis were associated with a poor treatment response. Aspirin use was positively associated with long-term remission and having gadolinium-enhanced cerebral lesions or meninges was negatively associated. A high disability score at last follow-up and higher mortality rate were associated with increasing age, cerebral infarction and cognitive dysfunction at diagnosis. Lymphocytic vasculitis on biopsy was associated with a more benign course with reduced disability and mortality. Patients initially treated with mycophenolate mofetil had better outcomes compared to those treated with CYC and PDN. No therapeutic advantages were observed in the patients initially treated with intravenous GC pulses. Intravenous and oral CYC were equally effective in inducing the remission.ConclusionsThe majority of patients with PCNSV responded to treatment. We found patient subsets with different outcomes. Mycophenolate mofetil may be an effective alternative to CYC.     

Curcumin attenuates vascular inflammation and cerebral vasospasm after subarachnoid hemorrhage in mice

Cerebral vasospasm is a major cause of death and disability after subarachnoid hemorrhage (SAH); however, clinical therapies to limit the development of cerebral vasospasm are lacking. Although the causative factors underlying the development of cerebral vasospasm are poorly understood, oxidative stress contributes to disease progression. In the present study, curcumin (150 or 300 mg/kg) protected against the development of cerebral vasospasm and limited secondary cerebral infarction after SAH in mice. The protective effect of curcumin was associated with a significant attenuation of inflammatory gene expression and lipid peroxidation within the cerebral cortex and the middle cerebral artery. Despite the ability of curcumin to limit the development of cerebral vasospasm and secondary infarction, behavioral outcome was not improved, indicating a dissociation between cerebral vasospasm and neurologic outcome. Together, these data indicate a novel role for curcumin as a possible adjunct therapy after SAH, both to prevent the development of cerebral vasospasm and to reduce oxidative brain injury after secondary infarction.     

急性脑梗死并发上消化道出血相关因素的临床分析

目的 分析急性脑梗死并发上消化道出血相关危险因子[尤其幽门螺杆菌(Helicobacter Pylori)]、发病特点、诊治要点、预后.方法 收集本院2014年6月至2015年7月收治的286例符合入选标准的急性脑梗死患者(其中56例合并上消化道出血)的临床信息,进行幽门螺杆菌及其他相关因素的全面分析、探讨.结果 脑梗死患者并发上消化道出血中检测幽门螺杆菌感染率65.8%,单纯脑梗死患者中幽门螺杆菌感染率30%,两者比较差异有统计学意义(P<0.05);上消化道出血多出现在该病发生7d内,且多见梗死部位位于脑干及基底核;合并上消化道出血的患者死亡率(57.1%)远高于未合并上消化道出血患者(16.9%),两者之间差异有统计学意义(P<0.05).结论 急性脑梗死并发上消化道出血患者幽门螺杆菌感染率高,需早日诊断,早日抗HP治疗.临床上急性脑梗死并发上消化道出血发病率不低,需格外重视脑梗死这种并发症,尽早积极有效防治.     

血浆和肽素浓度与脑梗死预后的相关性分析

目的:揭示脑梗死患者血浆和肽素浓度,分析其与预后的相关性。方法:对102例健康体检者和102例脑梗死患者,用ELISA检测血浆和肽素浓度,统计分析其水平改变及与预后的相关性。结果:脑梗死患者血浆和肽素浓度(448.1±158.4)pg/ml较健康体检者(57.7±20.6)pg/ml显著升高(P<0.01),与入院时美国国立卫生院神经功能缺损评分显著正相关(P<0.01),是脑梗死1年内预后不良(OR=1.216,95%CI=1.109～1.456,P<0.01)和死亡(OR=1.437,95%CI=1.274～1.783,P<0.01)的独立危险因素,可显著预测脑梗死1年内预后不良(曲线下面积=0.879,95%CI=0.849～0.924,P<0.01)和死亡(曲线下面积=0.884,95%CI=0.854～0.937,P<0.01)。结论:脑梗死后血浆和肽素含量显著升高,临床检测这些指标有助于早期判断脑梗死预后。     

开颅减压治疗猫急性脑梗塞的实验研究

目的：探索开颅减压术对大面积脑梗塞的治疗效果及实施手术的时机。方法：家猫５０只,均行经左侧眼眶阻断左大脑中动脉造成局灶性脑梗塞。４０只动物再行左侧开颅减压术,另外１０只动物不行手术,手术组动物又分为４组,分别于血管阻断后６ｈ、１２ｈ、２４ｈ及３６ｈ行脑梗塞侧开颅减压术。４８ｈ后观察脑梗塞范围的大小。结果：手术组梗塞范围小于对照组（Ｐ〈０．０１）。手术组动物无死亡,而对照组死亡率为２０％（Ｐ〈０．０     

标准大骨瓣开颅术治疗大面积脑梗塞的临床研究

目的探讨标准大骨瓣开颅（standard large craniotomy）去大骨瓣减压术与常规大骨瓣开颅去大骨瓣减压术对大面积脑梗塞的治疗效果。方法将60例大面积脑梗塞患者（脑梗塞面积〉4cm）随机分成研究组（标准大骨瓣开颅）和对照组（常规大骨瓣开颅）,在治疗前后对全部患者均进行GCS评分、头颅CT检查并测量脑梗塞灶范围和中线结构移位,TCD监测脑血流情况。根据两组的治疗结果比较其疗效。结果术后7d研究组较对照组的GCS评分、脑梗塞范围和中线结构移位有显著性差异（P〈0.05）;脑血流明显改善。14d后研究组的各项指标接近正常。研究组死亡率为3.33%,对照组为16.6%。结论标准大骨瓣开颅去大骨瓣减压术治疗大面积脑梗塞伴天幕裂孔疝能减少并发症,降低死亡率,是手术治疗大面积脑梗塞的有效方法。     

Therapeutic window for cycloheximide treatment after hypoxic-ischemic brain injury in neonatal rats

We have previously shown that cycloheximide significantly inhibited apoptosis, and reduced ensuing cerebral infarction in a newborn rat model of cerebral hypoxiaischemia. This study was performed to determine the therapeutic window for cycloheximide therapy. Seven day-old newborn rat pups were subjected to 100 min of 8% oxygen following a unilateral carotid artery ligation, and cycloheximide was given at 0, 6, 12 and 24 hr after hypoxia-ischemia (HI). Apoptosis or necrosis was identified by performing flow cytometry with a combination of fluorescinated annexin V and propidium iodide, and the extent of cerebral infarction was evaluated with triphenyl tetrazolium chloride (TTC) at 48 hr and 72 hr after HI, respectively. With cycloheximide treatment at 0 hr after HI, both apoptotic and necrotic cells by flow cytometry were significantly reduced, only necrotic cells were significantly reduced at 6 and 12 hr, and no protective effect was seen if administration was delayed until 24 hr after HI compared to the HI control group. Infarct volume, measured by TTC, was significantly reduced by 92% and 61% when cycloheximide was given at 0 or 6 hr after HI respectively; however, there was an insignificant trend in infarct reduction if cycloheximide was administered 12 hr after HI, and no protective effect was observed when administration was delayed until 24 hr after HI. In summary, cycloheximide was neuroprotective when given within 6 hr after HI in the developing newborn rat brain.     

迟发性外伤性颅内血肿临床分析

目的:探讨迟发性外伤性颅内血肿的临床特点、诊断及治疗。方法:收集我院1999年1月至2010年10月收治的迟发性外伤性颅内血肿病例193例进行回顾性分析。其中男性134例、女性59例,年龄4-71岁。结果:经治疗后,痊愈102例,轻残26例,重残22例,死亡43例,残亡占22%。结论:迟发性血肿多见于外伤的急性期,以枕部着力的对冲伤多见,意识变化是最重要的临床特点,致残率死亡率高,早期诊断及时处理是改善预后的关键。     

急性一氧化碳中毒并发脑梗死患者的护理分析

目的 总结对急性一氧化碳中毒并发脑梗死患者的护理方法。方法 通过对我院2014年1月~2016年12月收治的63例一氧化碳中毒并发脑梗死患者的护理,总结护理要点及方法。结果 63例患者在符合高压氧治疗条件下能配合进行高压氧治疗,53例患者痊愈,9例患者病情明显改善,遗留有轻度肢体功能障碍等症状体征,1例出现意识障碍加重,家属放弃治疗出院。结论 及时有效的治疗和护理在降低急性一氧化碳中毒并发脑梗死患者致残率和致死率中起着非常重要的作用。     

脑梗死患者血浆IL-11的检测及其临床意义

目的：揭示脑梗死患者血浆IL-11浓度,分析其与预后的相关性。方法：对102例健康体检者和102例脑梗死患者,用ELISA检测血浆IL-11浓度,统计分析其水平改变及与预后的相关性。结果：脑梗死患者血浆IL-11浓度（22．6±9．8）pg／ml较健康体检者（11．2±3．6）pg／ml显著升高（P〈0．01）,与人院时美国国立卫生院神经功能缺损评分呈显著正相关（t=8．749,P〈0．01）,是脑梗死1年内预后不良（OR=1．308,95％C1=1．114-1．569,P〈0．01）和死亡（OR=1．517,95％CI=1．218-1．881,P〈0．01）的独立危险因素,可显著预测脑梗死1年内预后不良（曲线下面积=0．864,95％CI=0．827-0．918,P〈0．01）和死亡（曲线下面积=0．889,95％CI=0．845-0．931,P〈0．01）。结论：脑梗死后血浆IL-11显著升高．其水平检测可作为临床宴用的标志物,有助于早期判断脑梗死预后。