Wallenberg 综合征 15 例临床分析

目的探讨Wallenberg综合征临床特点、治疗方法及预后。方法回顾性分析15例Wallenberg综合征患者的临床资料。结果本组患者以急性或亚急性起病,以眩晕(66.7%)、构音障碍(60%)、吞咽困难(47%)、Horner征(73.3%)、共济失调(53.3%)及交叉性感觉障碍(53.3%)为常见临床表现。15例行MRI检查均显示延髓背外侧梗死,11例采用抗凝、抗血小板、活血化瘀治疗,4例采用东菱抗栓酶治疗,其中10例于7～10d后症状缓解,1～2个月后症状基本消失,4例遗留不同程度的感觉障碍和共济失调,1例死亡。经治疗眩晕、恶心、呕吐、声音嘶哑及吞咽困难恢复较快,感觉障碍和共济失调恢复最慢。结论动脉粥样硬化致椎基底动脉血栓形成是Wallenberg综合征的主要病因,但不是唯一原因,本病积极治疗后预后较好。     

老年脑出血患者颅内血肿微创伤治疗的临床研究

目的探讨微创清除术对老年脑出血患者的治疗效果。方法选择经头颅CT证实为脑出血患者450例,随机分为颅内血肿微创清除术组(微创组,236例)和内科保守治疗组(保守组,214例)。微创组采用双侧头皮相应部位安放标记物,螺旋CT导向定位,YL-1型颅内血肿穿刺针对脑出血患者进行穿刺治疗,并对两组患者治疗前后神经功能缺损评分、日常生活能力Barthel指数(BI)评分、病死率、并发症发生率以及血肿的清除吸收情况进行比较。结果微创组总有效率为91.1%,保守组为67.8%,两组疗效比较差异显著(P<0.01)。微创组、保守组治疗前血肿体积为(50.47±9.23)ml和(51.88±10.33)ml;治疗7天后,微创组、保守组血肿体积为(14.65±5.36)ml和(29.52±4.38)ml,微创组血肿吸收速率明显快于保守组(P<0.01)。治疗3天后,微创组神经功能缺损评分低于保守组,BI评分明显高于保守组。结论颅内血肿微创清除术是一种安全、适用于老年患者颅内中等量和大量出血且疗效较好的一种方法。     

老年人慢性充血性心力衰竭稳定期的睡眠呼吸障碍

目的　了解稳定期、已得到良好治疗的老年慢性充血性心力衰竭患者睡眠呼吸障碍的发生情况及其对心力衰竭的影响。　方法　应用多导睡眠监护仪对 42例老年稳定期充血性心力衰竭患者进行监测。以呼吸紊乱指数 (AHI) 15作为界值 ,AHI >15者为睡眠呼吸障碍组 ,19例 ;AHI≤ 15者为对照组 ,2 3例。　结果　睡眠呼吸障碍组AHI为 18 3～ 84 1,平均 48 6± 16 3,其中阻塞性者AHI为 10 7± 9 2 ,而中枢性者AHI为 37 9± 10 5。与对照组比较 ,睡眠呼吸障碍组有着显著高的醒觉指数 (分别为 17 6± 12 1和 37 3± 2 2 4 )。同时 ,有着更低的睡眠中最低血氧饱和度〔分别为(81 2± 6 8) %和 (6 7 8± 8 2 ) %〕、更低的左心室射血分数〔(32 4± 10 3) %和 (2 4 5± 8 6 ) %〕。　结论　老年稳定期慢性充血性心力衰竭患者有着很高的睡眠呼吸障碍的发生率 ,主要为伴中枢性睡眠呼吸暂停的周期性呼吸 (陈 施呼吸 )。睡眠呼吸障碍的发生与严重的夜间氧合血红蛋白的脱饱和过多的醒觉有关。严重的未经治疗的睡眠呼吸障碍可能影响左心室功能 ,并能加剧老年充血性心力衰竭患者的死亡。     

稳定期慢性充血性心力衰竭患者睡眠呼吸障碍

目的了解稳定期、已得到良好治疗的慢性充血性心力衰竭(心衰)患者的睡眠呼吸障碍的发生情况及睡眠呼吸障碍对心衰的影响.方法应用多导睡眠监护仪(Polywin1000,RespironicsInc.)对稳定期充血性心衰患者进行监测.结果病人分为两组,Ⅰ组(21例)A-H指数≤15,Ⅱ组(15例,占41.7%)A-H指数》15.Ⅱ组A-H指数为16.8～78.8,平均42.6±15.5,其中阻塞性AHI为11.1±8.4,而中枢性AHI为31.5±9.6.同时,Ⅱ组有着显著多的醒觉指数,为36.8±21.3(Ⅰ组为19.4±11.2),这直接与呼吸暂停及低通气指数有关,并与睡眠中最低血氧饱和度[Ⅱ组(76.7±4.6)%,Ⅰ组(86.5±2.8)%、更低的左心室射血分数[Ⅱ组(24.2±8.8)%,Ⅰ组(31.5±10.6)%]有关.结论稳定期慢性充血性心衰患者有着很高的严重的睡眠呼吸障碍的发生率,主要为伴中枢性睡眠呼吸暂停的周期性呼吸.睡眠呼吸障碍的发生与严重的夜间氧合血红蛋白饱和度的下降及过多的觉醒有关.严重的未经治疗的睡眠呼吸障碍可能影响左心室功能,并能加剧充血性心衰患者的死亡.     

鼻面罩通气治疗高龄患者急性呼吸衰竭的经验

用损伤性较小的方法代替气管插管(ETV)治疗高危患者有着特殊意义。研究旨在评价鼻面罩通气(NMV)作为急性呼吸衰竭(ARF)的一线疗法及当ETV禁忌时NMV作为最后治疗手段的价值。患者和方法受试者为有严重呼吸困难(呼吸频率26.68±7.72次/min)、明显低氧血症(PaO_2 5.85±1.62kPa)伴重度高碳酸血症(PaCO_2 9.27±1.89kPa,pH7.28±0.08)和(或)意识障碍(24/30例)而确诊为ARF的30(男14,女16)例患者,平均76(59～93)岁。每例均用塑料面罩以容量型呼吸机通气,其参数根据血气结果调定。前12h及夜间持续通气,白天按照患者情况行间断通气。17例患者用NMV作为最后治疗手段(组1),13例作为一线治疗以避免ETV(组2)。结果 21例患者应用NMV 1h PaO_2迅速改善,数小时后PaCO_2降低,酸中毒、临床表现特别是意识状态亦见好转,而9例立即恶化包括5例死亡(其中4     

经鼻持续气道正压在慢性阻塞性肺病并急性呼吸衰竭治疗中的作用

本研究旨在观察经鼻持续性气道正压(nCPAP)对未行机械通气的慢性阻塞性肺病(COPD)急性发作期合并急性呼吸衰竭患者的治疗作用。 材料与方法 对15例确诊为COPD发生急性呼衰而入院的勿须立即行气管插管的男性患者进行了实验.其平均年龄64±7(47～74)岁,FEV_125±8％,最大呼气流量(PEF)36±13％。受试者均符合下列条件:①入院时 PaCO_2>55mmHg或入院后1小时内下降>5mmHg;②严重的气道阻塞(FEV-1低于预计值的40％,FEV_1/FVC低于预计值的60％);③意识状态良好。除外睡眠呼吸暂停综合征、胸膜或胸壁病理异常伴     

持续气道正压通气治疗老年人阻塞性睡眠呼吸暂停低通气综合征合并高血压的疗效

目的探讨老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压之间的关系,以及经鼻持续气道正压通气(nCPAP)治疗老年人OSAHS合并高血压的远期效果。方法104例确诊为OSAHS合并高血压的门诊或住院患者,其中52例患者经过6个月的nCPAP治疗作为治疗组,于行nCPAP治疗前及治疗后6个月,进行多导睡眠图(PSG)及24h动态血压测定,另52例患者未行nCPAP治疗或治疗失败作为对照组,6个月后对两组重复上述各项指标的监测并进行统计学处理。结果治疗组治疗前最长呼吸暂停时间、睡眠呼吸暂停低通气指数(AHI)、最低氧分压(SpO2)、收缩压/舒张压分别为(63.5±22.4)s、(46.8±19.2)次/h、(62.4±18.5)%、(146.2±9.5/90.4±8.5)mmHg,经过nCPAP治疗6个月后,上述各项指标分别为(10.5±11.4)s(、4.6±4.0)次/h(、89.81±8.2)%、(134.7±8.3/82.6±9.1)mmHg,均有显著改善(P<0.01),平均血压明显好转,治疗组降压有效率为96%,与对照组比较差异有统计学意义(P<0.01),部分患者停用降压药。结论反复低氧血症、呼吸暂停可能是部分老年OSAHS伴发高血压的发病原因,nCPAP治疗有助于此类患者血压的恢复。     

经桡动脉冠状动脉腔内成形术治疗急性冠状动脉综合征

目的　评价急性冠状动脉综合征的患者采用经桡动脉冠状动脉腔内成形术的可行性。方法　急性冠状动脉综合征的患者 96例 ,经桡动脉穿刺冠状动脉成形术 (TRCA)组 5 3例 ;经股动脉穿刺冠状动脉成形术 (TFCA)组 4 3例。观察两组手术的成功率、并发症等。结果　两组手术过程中均无死亡和心肌梗死并发症发生。两组插管成功率分别为 96 2 %与 97 7% ,两组冠状动脉成形术成功率分别为 94 3%与 95 4 % ;两组间差异无显著性。但出血并发症TRCA组为 0 ,而TFCA组为 7 2 % ,两组间差异有显著性 (P <0 0 1)。术后持续卧床时间两组分别为 0与 (12 8± 5 6 )h ;住院天数两组分别为 (2 5± 0 4 )d与 (3 8± 0 6 )d ;两组比较差异均有显著性 (P <0 0 1)。结论　经桡动脉冠状动脉成形术治疗急性冠状动脉综合征安全有效 ,出血并发症少 ,住院时间短 ,且不影响术后患者活动。     

谷氨酰胺双肽在异基因造血干细胞移植中的应用

目的:探讨谷氨酰胺双肽(DPT)对异基因造血干细胞移植患者并发症及恢复的影响。方法:40例异基因造血干细胞移植患者随机分为应用DPT加全肠外营养液组(DPT组,20例)和单用全肠外营养液组(对照组,20例),检测应用DPT前1天、第7天及第28天的血清白蛋白、总蛋白、肌酐、总胆红素、白细胞及淋巴细胞计数,并分析两组患者中性粒细胞恢复时间、体重下降程度、出层流室时间以及关于感染、急性移植物抗宿主病(aGVHD)等情况。结果:两组血清白蛋白于第7天均明显下降,第28天DPT组能恢复至原水平,而对照组无恢复,两组差异有统计学意义;两组总胆红素均无异常波动。DPT组淋巴细胞恢复较对照组迅速,两组差异有统计学意义。移植后DPT组和对照组发生临床感染例数分别为10例和16例,细菌培养阳性结果分别为11例次和17例次,总抗生素应用天数分别为(16.5±10.6)d和(25.4±16.3)d,差异均有统计学意义;两组肠炎持续时间分别是(4.7±4.5)d和(8.2±6.0)d,体重下降分别是(2.0±2.0)kg和(3.3±1.6)kg,出层流室时间分别是(49.2±18.8)d和(58.0±20.2)d,差异有统计学意义;而两组aGVHD发生率差异无统计学意义。结论:添加DPT的全肠外营养可改善异基因造血干细胞移植患者的营养状态,减少感染及肠、肝损害,不增加aGVHD的发生,有利于异基因移植     

普伐他汀早期应用对急性冠状动脉综合征血管炎症反应及内皮功能的影响

目的观察普伐他汀在急性冠状动脉综合征患者早期(发病48h以内)应用对患者血浆一氧化氮、内皮素及C反应蛋白的影响。方法60例急性冠状动脉综合征患者随机分为两组。普伐他汀组30例,常规治疗组(未服用他汀类调脂药物)30例,疗程2周,分别于治疗前后测定血浆一氧化氮、内皮素及C反应蛋白水平。结果普伐他汀组血浆C反应蛋白(32.7±10.8μg/L)及内皮素(50.3±17.2μg/L)水平明显下降、血浆一氧化氮(50.3±10.2μmol/L)水平明显上升,与常规治疗组血浆C反应蛋白(44.3±9.7μg/L)、内皮素(72.4±16.4μg/L)及血浆一氧化氮(42.8±8.7μmol/L)水平比较有显著性差异(P<0.01)。结论普伐他汀在急性冠状动脉综合征患者中早期应用能够抑制血管内皮的炎症反应,稳定粥样斑块,改善血管内皮功能,解除冠状动脉痉挛。     

Neurofibromatosis type 1 with basilar artery fusiform aneurysm manifesting Wallenberg's syndrome

A case of neurofibromatosis type 1 (NF1) manifesting Wallenberg's syndrome and fusiform aneurysm of the basilar artery is reported. The patient suddenly developed dysarthria, walking difficulty and sensory disturbance. Neurological examination suggested Wallenberg's syndrome and MR imaging confirmed an ischemic lesion at the left lateral medulla oblongata. Cerebral angiography revealed a fusiform aneurysm at the middle portion of the basilar artery. However, there was no occlusive change in either the posterior inferior cerebellar artery or the vertebral artery. The clinical and radiological features are discussed together with a review of NF1 cases with intracranial aneurysms in the literature.     

脑脊液置换术治疗蛛网膜下腔出血临床研究

目的探讨脑脊液置换术治疗蛛网膜下腔出血的临床效果。方法将80例蛛网膜下腔出血患者随机分治疗组及对照组,各40例,治疗组在常规治疗的基础上进行脑脊液置换术治疗,对照组使用单纯的常规治疗。结果治疗组治疗的有效例数与对照组比较差异有统计学意义。治疗组中有头痛颈强者21例,持续时间6～12.5d,对照组头痛颈强持续时间14～21d,两组比较差异有统计学意义。治疗组中表现不同意识障碍者6例,经置换2～3次最短在4d内意识恢复正常,对照组意识障碍11例,意识障碍恢复时间6～14d,两组比较有显著差异。蛛网膜下腔出血3大并发症脑血管痉挛、脑积水、脑梗死,治疗组与对照组比较,均有显著差异。结论脑脊液置换术治疗蛛网膜下腔出血,能减少脑血管痉挛、脑积水、脑梗死等并发症,有利于患者恢复,操作简单易行、安全,疗效显著,值得临床推广应用。     

Cortical petechial hemorrhage, subarachnoid hemorrhage and corticosteroid-responsive leukoencephalopathy in a patient with cerebral amyloid angiopathy.

We describe a 69-year-old woman who developed subacute onset cognitive decline after hitting the left side of her head. Cerebral spinal fluid showed yellowish discoloration with highly elevated protein content. FLAIR MRI revealed diffuse high signal intensity in all cortical sulci, and leptomeningeal enhancement in the left cerebral hemisphere was seen in the T1 image after contrast administration. She was treated with a corticosteroid. Consciousness disturbance was temporarily relieved but again worsened, resulting in an apathetic state due to communicating hydrocephalus. A shunt tube was placed in her right lateral ventricle. A brain biopsy disclosed multiple cortical microbleeds and heavy deposition of Abeta-immuoreactive amyloid on vascular walls. Inflammatory mononuclear cells surrounded a few leptomeningeal vessels. After the operation her condition further deteriorated and she fell into a coma. MRI showed diffuse swelling of the right cerebral white matter. She again received high-dose corticosteroid and gradually recovered during the following 2 months. On MRI the vast majority of abnormal signals in the right cerebral white matter disappeared. An initial manifestation of this patient was possibly caused by multiple microhemorrhages from fragile cortical and subarachnoid vessels with Abeta-amyloid deposition, which was triggered by head trauma. CAA-related inflammation possibly worsened this condition. Additionally, surgical intervention for communicating hydrocephalus might have induced cerebral amyloid angiopathy (CAA)-related leukoencephalopathy in her right cerebral hemisphere. These CAA-derived manifestations are unusual and high-dose corticosteroids seems to be useful for vascular events in CAA patients.     

Cortical petechial hemorrhage,subarachnoid hemorrhage and corticosteroid-responsive leukoencephalopathy in a patient with cerebral amyloid angiopathy

We describe a 69-year-old woman who developed subacute onset cognitive decline after hitting the left side of her head. Cerebral spinal fluid showed yellowish discoloration with highly elevated protein content. FLAIR MRI revealed diffuse high signal intensity in all cortical sulci, and leptomeningeal enhancement in the left cerebral hemisphere was seen in the T1 image after contrast administration. She was treated with a corticosteroid. Consciousness disturbance was temporarily relieved but again worsened, resulting in an apathetic state due to communicating hydrocephalus. A shunt tube was placed in her right lateral ventricle. A brain biopsy disclosed multiple cortical microbleeds and heavy deposition of Aβ-immuoreactive amyloid on vascular walls. Inflammatory mononuclear cells surrounded a few leptomeningeal vessels. After the operation her condition further deteriorated and she fell into a coma. MRI showed diffuse swelling of the right cerebral white matter. She again received high-dose corticosteroid and gradually recovered during the following 2 months. On MRI the vast majority of abnormal signals in the right cerebral white matter disappeared. An initial manifestation of this patient was possibly caused by multiple microhemorrhages from fragile cortical and subarachnoid vessels with Aβ-amyloid deposition, which was triggered by head trauma. CAA-related inflammation possibly worsened this condition. Additionally, surgical intervention for communicating hydrocephalus might have induced cerebral amyloid angiopathy (CAA)-related leukoencephalopathy in her right cerebral hemisphere. These CAA-derived manifestations are unusual and high-dose corticosteroids seems to be useful for vascular events in CAA patients.     

经眶上外侧入路与经翼点入路治疗前循环动脉瘤破裂的疗效分析

目的探讨经眶上外侧入路治疗前循环颅内动脉瘤（IA）破裂急性期患者的疗效分析。 方法选取自2016年2月至2019年6月于爱德堡医院神经外科进行治疗的前循环IA急性期患者60例,根据随机分组的原则分为经翼点入路组（WA组）和眶上外侧入路组（UA组）,每组30例。WA组患者采用经翼点入路的手术方法进行治疗,UA组采用经眶上外侧入路的手术方法进行治疗。分析2组患者的临床指标、治疗效果。 结果手术过程中,WA组患者术中出血量[（164.81±24.13）mL]、切口长度[（18.59±2.04）cm]、手术时间[（182.35±21.75）min]均高于UA组[（101.25±25.76）mL、（9.89±1.12）cm、（131.08±17.58）min],差异具有统计学意义（P<0.05）。WA组患者22例恢复良好,UA组患者23例恢复良好,2组均未出现死亡,UA组恢复良好率优于WA组（P>0.05）。WA组8例患者出现并发症,UA组2例患者出现并发症,UA组并发症发生率低于WA组（P<0.05）。 结论经眶上外侧入路手术方法与传统手术方法相比较,前者治疗前循环IA效果更佳、预后良好、并发症发生率较低。     

123I-metaiodobenzylguanidine scintigraphy in the detection of irregular regional sympathetic innervation in long QT syndrome

Twelve patients with the long QT syndrome were studied to determinethe usefulness of ¹²³I-metaiodobenzylguanidine (MIBG) single-photonemission tomography (SPECT) at 2 h and 6 h after injection;the results were compared to 10 healthy volunteers (controls).Uptake of MIBG in the left ventricle at 2 h after injectionwas significantly reduced in patients with the long QT syndrome(1.43±0.13) vs 1.66±0.15 in controls, heart-to-mediastinumratio, P <0.002) and washout after 6 h was faster on a planarview image. Decreased MIBG uptake could be observed preferentiallyin the anterior and lateral walls near the apex. The half-timevalues of MIBG washout from the left ventricle were significantlyreduced in the long QT syndrome (6.4±1.5 h) comparedto controls (16.7±15.3 h, P <0.002). In three cases,the same pattern of disturbed activity distribution was maintainedeven after surgical left cardiac sympathetic denervation. Thepresent results strongly support the hypothesis that an inhomogenousregional distribution of sympathetic nerve terminals accompaniedby an overall reduction in their absolute number may play animportant role in the pathogenesis of the long QT syndrome.Additional functional disturbances, possibly related to theuptake of catecholamines in the left ventricle may coexist withregional inhomogeneity of nerve terminals. The differences observedfrom one case to the other may be related to the variation inseverity of the disease. MIBG SPECT imaging seems an interestingnew tool for the quantitative assessment of presynaptic sympatheticnerve terminal disturbances in the left ventricle of patientswith the long QT syndrome.     

侧脑室穿刺持续引流在婴幼儿重度脑室出血中的应用研究

目的探讨侧脑室穿刺持续引流治疗婴幼儿重度脑室出血的临床疗效。方法选取53例重度脑室出血的婴幼儿作为研究对象,并将所有患儿分为侧脑室持续引流治疗组和连续腰穿治疗组,比较两组患者的住院时间及Barley婴幼儿发育量表评分。结果侧脑室穿刺引流组的脑室通畅、意识转清、脑脊液转清、平均住院时间都少于连续腰穿治疗组,差异具有统计学意义(均P0.05),而术后感染率、四肢运动障碍、再发性脑出血发生率都少于传统连续腰穿治疗组,差异具有统计学意义(均P0.05),两组婴幼儿在Barley婴幼儿发育量表评分上的智力评分上无统计学意义,但侧脑室穿刺引流组的运动评分总体显著优于传统连续腰穿治疗组(P0.05)。结论侧脑室穿刺引流治疗住院时间短,术后并发症发生率较低,且对婴幼儿运动功能的影响较小。     

Tuberculous meningitis with hydrocephalus: a clinical and CT study

Fourteen cases of tuberculous meningitis complicated by moderate or severe hydrocephalus identified by CT are reported. The accumulation and blockage of tuberculous exudate in the basic cisterns and ependymitis in the cerebrospinal drainage pathway are the important pathological features of this disease. There may be a correlation of hydrocephalus with hyponatraemia. Headache, vomiting, and impaired consciousness are common symptoms, although a few cases did not show obvious symptoms of raised intracranial tension. The study suggests a relation between the degree of hydrocephalus and the pressure on lumber puncture. If patients with impaired consciousness, especially in the chronic stage show no improvement during medical treatment, ventricular shunt may bring about remarkable improvement.     

侧脑室钻孔引流术结合LCFD术治疗老年脑室出血的临床研究

目的 探讨侧脑室钻孔引流术结合腰大池持续引流术(lumbar cistern countinue drainage,LCFD)治疗老年脑室出血的有效性,并分析术后并发颅内感染的Logistic的危险因素.方法 前瞻性选取本院2015年9月至2020年3月接诊的老年脑室出血患者88例,按照随机数字表法将患者分为对照组和研...     

Clinical studies on diabetic myocardial disease using exercise testing with myocardial scintigraphy and endomyocardial biopsy

Nine diabetics without significant coronary stenosis participated in an exercise testing protocol with thallium-201 myocardial scintigraphy. Endomyocardial biopsy of right ventricle was also obtained. There were 4 patients with abnormal perfusion (positive group) and 5 patients with normal perfusion (negative group). All cases of the positive group were familial diabetics and there was only one case of dietary treatment, whereas in the negative group, there were only 2 cases of familial diabetics and 3 cases receiving dietary treatment. No statistical differences between the positive and negative groups were observed for the data of exercise performance and hemodynamic parameters in cardiac catheterization at rest. However, the mean ejection fraction in the positive group (62 ± 13%) was significantly lower than in the negative group (77±4%). In both groups, the mean diameter of myocardial cells and the mean percent fibrosis of biopsy specimens showed significant increases compared with the control group. The mean percent fibrosis in the positive group (24.1±8.5%) compared with that in the negative group (16.5±5.9%) showed a tendency to increase. It is suggested that the abnormal perfusion of thallium-201 in the positive group indicates subclinically a pathological change of microcirculation caused by diabetes mellitus.