无蛛网膜下腔出血的破裂脑动脉瘤

目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床表现、影像学检查结果 、治疗方法 和预后进行回顾性分析.结果 本组首次CT或MRI检查表现为ICH者3例、IVH合并ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混合密度者1例.其中动脉瘤位于大脑中动脉6例、前交通动脉4例、后交通动脉3例、大脑前动脉1例和小脑后下动脉1例.开颅手术夹闭动脉瘤13例,血管内栓塞2例.出院时GOS评分:恢复良好8例、中残3例、重残3例和植物生存1例.本组15例占同期破裂脑动脉瘤的3.8%.结论 破裂脑动脉瘤首次CT扫描可表现为单纯ICH,和(或)IVH、SDH、IMH而无SAH,与CT扫描时间、动脉瘤的部位和指向以及出血量有关.早期控制颅内高压、及时诊断和有效处理破裂动脉瘤,是改善预后的关键.     

淀粉样脑血管病相关性脑出血与高血压脑出血的临床研究

目的 探讨淀粉样脑血管病相关性脑出血(CAAH)与高血压脑出血(HICH)的临床、影像、手术预后的特点.方法 收集3年来6家三级甲等医院经手术治疗的101例自发性脑出血患者的临床资料,所有标本经送我院病理科诊断后分为CAAH组11例,HICH组90例.对两组临床表现、影像学特点、术后病死率进行统计分析.结果 CAAH组发病平均年龄高于HICH组,而术前偏瘫的发生率低于HICH组.CAAH组出血部位多在脑叶,而HICH组以基底节区最常见.CAAH组年龄≥70岁患者术后病死率高于HICH组.随访期内CAAH组2例再次出血,其中1例死亡,4例出院后因长期卧床并发肺部感染,1例出现左眼视力颞侧偏盲,生活基本自理.结论 CAAH在临床和影像学上具有一定的特征,年龄较大者预后较差.外科手术干预近期有较好的效果,术后肺部感染是导致预后不良的常见并发症.     

高血压脑出血的外科治疗

目的 探讨高血压脑出血病人外科治疗手段,提高此类病人的生存率和改善生存质量。方法根据病人高血压脑出血的部位、血肿量及血肿形态,采取不同的手术方法。围手术期的血压管理,并加强静脉营养。结果本组治疗127例不同类型的高血压脑出血病人,良好15例（11．8％）,中残44例（34．6％）,重残36例（28．3％）,植物生存9例（7．1％）,死亡23例（18．1％）。结论依据病人情况,治疗以清除血肿、减轻手术副损伤,内减压或内外减压,严格适度地控制血压．加强并发症的防治,高血压脑出血的外科治疗效果是令人满意的。     

Hematoma enlargement-related factors in hypertensive cerebral hemorrhage☆

BACKGROUND：Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE： To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING： A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS： Fifty-eight males and thirty-one females aged （52.7 ± 5.23） years （range, 28-73 years）. METHODS： Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group （n = 30）, and those with no obvious hematoma changes served as the control group （n = 60）. Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES： Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS： There were no significant differences in hemorrhage sites between the two groups （χ2 = 2.262, P 〉 0.05）. The percent of intemperance patients in the observation group was significantly larger than the control group （χ2 = 6.923, P 〈 0.01）. No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups （χ2 = 0.03, 0.08, P 〉 0.05）. The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group （χ2 = 25.57, P 〈 0.01）. CONCLUSION： Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patien     

Hematoma enlargement-related factors in hypertensive cerebral hemorrhage

BACKGROUND:Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE: To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING: A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Scie...     

高血压性脑出血头痛与血压

目的：探讨脑出血头痛与血压的关系。方法：脑出血147例,按有无头病症状分为头痛组和无头痛组,并对有高血压病史、病后血压升高、两者皆有、两者皆无等四个类型给予对照分析。结果：高血压性脑出血发生后约1／3无头痛。脑出血后血压升高与病后头痛无关,与临床表现有关,临床表现越重,血压升高越显著。结论：脑出血后头痛与血压升高是高血压性脑出血的早期症状,但不能作为确诊依据,仅供临床参考。     

高血压脑出血昏迷患者的分期及治疗

我科于1995年2月至2005年5月收治高血压性脑出血昏迷患者323例，通过对临床特点及治疗过程进行分析。总结其在医学干预下病程演变过程，以指导治疗，降低死亡率和致残率。现报告如下。     

Location of cerebral aneurysms and arteriospasm after subarachnoid hemorrhage

On the basis of an analysis of 314 patients with aneurysms situated supratentorially the authors tried to establish a possible correlation between the location of the aneurysm and the frequency, intensity and extent of this spasm. Similarly as in the reports of other authors it was not possible to find a correlation between the location of the aneurysm and arteriospasm. Only the group of 28 patients with multiple aneurysms showed the highest percent of most intense and most extensive arteriospasm, which was particularly evident within the first three days after haemorrhage. In the period from the 4th to the 6th days after the last subarachnoid haemorrhage the lowest proportion of angiograms with arteriospasm was noted in patients with aneurysms of the anterior communicating artery. In this group diffuse bilateral arteriospasm was significantly more frequent than in the remaining groups.     

青年高血压脑出血的临床分析

目的 探讨青年高血压脑出血患者的病因、临床特点及预后.方法 回顾性分析46 例45 岁以下青年高血压脑出血患者病因、临床特点、CT表现及预后.结果 青年高血压患者发病前均未进行有效的血压检测及控制,临床以突然发病,临床出现头痛、呕吐、意识障碍及偏瘫为主.CT表现主要为基底节区出血,死亡6例,病死率13.04%.结论 加强对青年高血压患者的健康教育,提高对高血压的认识,进行血压定期监测是降低该病发生率及病死率的关键.     

尿激酶辅助立体定向术治疗高血压脑出血

目的探讨尿激酶辅助立体定向术治疗高血压脑出血的临床应用价值。方法对30例高血压脑出血患者(定向组)采取立体定向血肿次全排空术,术中血肿腔置管,术后残留血肿采取尿激酶溶解。以拔管时间及日常生活能力(ADL)评分作为评价疗效的指标,与同期采取CT定位下钻孔抽吸血肿及尿激酶溶解术(抽吸组)的30例患者进行比较。结果定向组拔管时间明显短于抽吸组,疗效明显好于抽吸组。结论尿激酶辅助立体定向术治疗高血压脑出血具有创伤小、操作简便、清除血肿较彻底等优点,是治疗高血压脑出血的一种有效方法。     

神经内镜辅助手术治疗高血压脑出血

目的应用神经内镜辅助手术治疗高血压脑出血，探讨微创血肿清除方法与最大程度的神经功能保护。方法63例高血压脑出血病人在神经内镜引导下清除血肿，血肿腔壁粘附止血纱后引流，辅助全面正规治疗。结果术后按日常生活能力（ADL）分级为Ⅰ级21例，Ⅱ级22例，Ⅲ级12例，Ⅳ级6例，Ⅴ级0例，死亡2例。结论神经内镜辅助微创手术是治疗高血压脑出血的安全有效方法，可显著改善脑出血后神经功能缺损程度。     

亚低温脑保护在高血压脑出血治疗中的应用

目的 探索亚低温脑保护在高血压脑出血治疗中应用的可行性及疗效。方法 85例高血压脑出血患者分为(1)亚低温治疗组:31例,其中脑出血分级Ⅱ级者1例,Ⅲ级9例,Ⅳ～Ⅴ级21例,于伤后24h内接受轻度低温治疗,直肠温度维持在33℃～35℃,颅内压在20mmHg以下者,治疗时间为24h;颅内压高于20mmHg者治疗72h;而颅内压持续在30mmHg以上或在短时间内迅速增高者行CT检查,以确定是否有颅内血肿形成。(2)常规治疗组:54例,脑出血分级Ⅱ级者2例,Ⅲ级16例,Ⅳ～Ⅴ级36例,于伤后24h内以常规药物治疗。根据GOS预后评估系统评价两组患者疗效。结果 经治疗后,亚低温组轻残8例、中残11例、重残4例、植物生存3例,死亡5例,恢复良好率为25.81％(8/31),与常规治疗组比较差异有显著性意义(P<0.05)。结论 亚低温具有减轻高血压脑出血患者脑水肿、降低颅内压、防止神经细胞凋亡的作用。可提高高血压脑出血患者的生存率及生存质量。     

Diagnosis of cerebral arterial aneurysms in acute and subacute subarachnoid hemorrhage

The paper pools experience in using computed tomographic and magnetic resonance angiographies in patients with intracranial berry aneurysms in different periods following subarachnoid hemorrhage. The new low-invasive techniques for visualization of arterial vessels have been found to detect the aneurysm and to define its topographic and anatomic location in most cases (as high as 90%) by being on a par with direct cerebral angiography and to compare favourably with the latter. Based on the analysis of complex studies (angiography, CT- and MR-angiographies), the authors have developed algorithms for diagnosing intracranial aneurysms by the stage of subarachnoid hemorrhage.     

Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms.

BACKGROUND AND PURPOSE: Recent progress in noninvasive imaging techniques has resulted in increased detection of unruptured aneurysms. Although many neurosurgeons advocate surgical intervention for such unruptured aneurysms, the long-term results of surgery for unruptured aneurysms have not been carefully investigated. METHODS: We analyzed 173 consecutive patients who had unruptured intracranial saccular aneurysm(s) detected by angiography that was performed for reasons other than subarachnoid hemorrhage (SAH). Of those, 115 cases were surgically treated and studied. All patients were followed up for either SAH, repeat treatment of aneurysms, or death. The median follow-up period was 8.8 years. RESULTS: Four of the 115 patients suffered SAH either from a de novo aneurysm (2) or from regrowth of clipped aneurysm (1), or from regrowth after wrapping (1). Additionally, 1 patient also suffered SAH from an unstudied basilar aneurysm. One patient was incidentally found to have de novo aneurysm and underwent reoperation 14 years after the first operation. The cumulative risk for SAH for the 114 cases excluding the basilar aneurysm case was 1.4% in 10 years and 12.4% in 20 years. CONCLUSIONS: Although this study confirmed the long-term efficacy of clipping unruptured aneurysms, the risk of SAH was high compared with that in the general population, even after treatment. Considering the high mortality rate of SAH, long-term follow-up by angiography may be warranted for patients with surgically treated unruptured aneurysms.     

Grading of intracerebral hemorrhage in ruptured middle cerebral artery aneurysms

Objective

To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately.

Methods

From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author''s clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm.

Results

According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome.

Conclusion

The ICH grading system composed of above three variables was helpful in predicting the patient''s outcome more accurately.     

尼卡地平和乌拉地尔对高血压脑出血术后的疗效比较

目的对比尼卡地平和乌拉地尔在高血压脑出血术后控制血压效果。方法高血压脑出血术后血压高于165／95mmHg的60例病人在常规治疗基础上,分别用尼卡地平（30例）及乌拉地尔（30例）注射液微泵静脉注射降压,均7d后改为口服或鼻给药。观察用药后降压效果及心率变化,定期CT复查观察颅内血肿＋水肿面积大小并随访3个月。结果两药均有明显的降压效果;在降压过程中,尼卡地平组轻微增加心率,乌拉地尔对心率影响不大。CT示2组患者颅内血肿＋水肿面积均减小,但尼卡地平组减小幅度大于乌拉地尔组,随访3个月按CCS评分和API,评分尼卡地平组均优于乌拉地尔组。结论两药均能有效控制高血压脑出血术后高血压,改善局部脑血流量,提高疗效,但尼卡地平临床效果优于乌拉地尔。     

年轻人高血压脑出血临床特点

目的通过探讨年轻人高血压脑出血的临床特点,唤起人们对年轻人高血压病防治知识的重视。方法对157例开颅治疗的40mL以上高血压脑基底节区出血病人进行回顾性分析,比较年轻人与中老年人血肿量、发病后即刻意识障碍率、术前意识障碍率、瞳孔变化率、手术时机、血肿清除量及预后,并进行统计学处理。结果两组病人出血量、手术清除血肿量均相当,但年轻人发病后即刻意识障碍率、术前意识障碍率、瞳孔变化率高,GCS评分低,手术时机较早,但预后与中老年人无显著性差异。结论40mL以上年轻人高血压脑出血与中老年人相比,发病急、进展快、病情重,及时手术后预后同中老年人。要降低年轻人高血压脑出血的危害,重在防治年轻人高血压病。