颅脑损伤大骨瓣开颅硬脑膜减张修补40例

目的探讨颅脑损伤大骨瓣开颅硬脑膜修补的优缺点.方法回顾性分析40例颅脑损伤大骨瓣开颅硬脑膜减张修补患者的临床资料,通过对比,总结临床经验.结果经对23例人工硬膜修补、17例自体组织硬膜修补患者临床疗效比较,人工硬膜修补效果满意.结论颅脑损伤大骨瓣开颅人工硬脑膜减张修补效果好.     

颅脑手术后抗癫痫药物预防癫痫疗效分析

目的：分析抗癫痫药物在脑外科治疗中的使用情况,探讨抗癫痫药物在颅脑手术后癫痫的预防作用以及各种药物作用的强弱。方法：查阅2001～2007年医院神经外科住院患者的病例资料,利用spss软件分析术后使用抗癫痫药是否对术后癫痫的发生率产生影响,并比较4种常用抗癫痫药对术后癫痫的预防作用。结果：非癫痫患者有预防性用药的93例,术后无发作的89例,发作4例;未使用抗癫痫药物的38例,术后无发作的36例,发作2例。有预防性用药与无预防性用药的术后癫痫发生率分别为4．30％和5．26％（P〉0．05）,两组无统计学差异。苯妥英钠、苯巴比妥钠、丙戊酸钠、卡马西平4种抗癫痫药对非癫痫患者术后癫痫的预防作用无统计学差异。结论：对于非癫痫手术的患者,预防性使用抗癫痫药效果并不理想。外科中常用的四种抗癫痫药物在预防作用方面比较并无统计学差异。     

人工硬脑膜补片在大骨瓣减压术中的应用

目的观察人工硬脑膜补片在大骨瓣减压术中的应用效果。方法 60例颅脑损伤患者,随机分为对照组和观察组,各30例。对照组实施大骨瓣减压术,观察组在对照组的基础上采用人工硬脑膜补片行硬脑膜减张缝合修补处理。观察两组预后及并发症情况。结果观察组预后良好率为83.3%,明显高于对照组的66.7%,差异有统计学意义(P<0.05)。观察组并发症发生率为6.7%,显著低于对照组的26.7%,差异有统计学意义(P<0.05)。结论在常规大骨瓣减压术处理基础上采用人工硬脑膜补片修补创口有利于减少术后并发症,促进患者恢复并改善其生存质量,值得临床推广应用。     

人工硬脑膜在神经外科手术中应用的研究

目的观察并分析人工硬脑膜用于神经外科手术中修补硬脑膜缺损的临床资料,并评价其使用价值。方法对49例颅脑创伤手术中有硬脑膜缺损者使用人工硬脑膜进行修复,术后抗感染、降低颅内压及护胃等对症治疗,并对其术后出院患者随访。结果除在应用人工硬脑膜术后死亡6例外,其余未见明显感染、癫痫等并发症出现,术后头颅CT检查未见与人工脑膜有关的异常反应和表现。其中对21例患者术后4～6个月进行颅骨修补术手术,术后发现人工硬脑膜可以恢复原有的解剖层次,封闭、隔离以及保护脑组织的作用良好,炎症反应轻。结论颅脑创伤手术中应用人工硬脑膜使传统开颅减压术发生了新的变化,它能够较好地重塑原有解剖层次,保护脑皮层、显著降低各种并发症的发生,减少和避免了许多中枢神经系统的迟发性损害。     

颅骨修补术后癫痫的相关危险因素分析

目的分析颅骨修补术后癫痫发生的相关危险因素。方法 137例接受钛网片颅骨修补手术患者中,术后发生癫痫者34例。回顾患者的临床及影像学资料,分析颅骨修补术后癫痫的相关危险因素。结果钛网片颅骨修补术后癫痫的发生率为24.8%。预防性使用抗癫痫药物为颅骨修补术后癫痫的保护性因素(P<0.01),术后钛网板下积液和/或积血、颞部为主颅骨缺损、双侧颅骨缺损及颅骨缺损面积过大为术后癫痫发生的危险因素(P<0.05)。结论颅骨修补术后癫痫的发病率较高,预防性使用抗癫痫药物、防止术后钛网板下积液和/或积血有助于降低颅骨缺损修补术后癫痫的发生。     

神经外科病人预防癫痫发生的用药分析

目的 分析某医院收治的颅脑疾病病人预防癫痫发生的具体用药情况.方法 对某医院神经外科的出院病例进行回顾性调查,分析病人疾病种类、是否手术及具体手术类别,预防癫痫发作的药物使用情况.结果 所调查146例使用抗癫痫药物的病例中,以脑出血病人预防用抗癫痫药为多数;平均住院天数12.6 d;手术病例96例,平均手术时间是3.18 h;非手术病人50例.手术病人大多术后即刻或者术前1~3 d预防使用丙戊酸钠,住院期间预防用丙戊酸钠后无癫痫发作,术后无预防的癫痫发生率为6.8%.结论 该医院颅脑疾病病人预防癫痫发作以使用抗癫痫药丙戊酸钠为主,手术病人术后即刻或者术前预防用抗癫痫药术后癫痫的发生率明显降低.     

人工硬脑膜与自体筋膜用于后颅窝重建术后脑脊液漏的疗效观察

目的探讨人工硬脑膜及自体筋膜用于后颅窝硬脑膜修补能否减少术后脑脊液漏。方法回顾性分析165例后颅窝开颅术后病人的临床资料。结果脑脊液漏发生率传统术式组26．9％,人工硬脑膜组10．6％,自体筋膜组8．5％。早期传统术式组的脑脊液切口漏发生率与其他两组相比差异均有统计学意义（P〈0．05）,而人工硬脑膜组及自体筋膜组脑脊液切口漏发生率则无统计学差异（P〉0．05）。结论硬脑膜严密缝合及重建是降低脑脊液漏发生率的正确对策,人工硬脑膜及自体筋膜修补硬脑膜后脑脊液切口漏发生率相比无统计学差异（P〉0．05）。人工硬脑膜是可靠的硬脑膜修补替代物,疗效肯定。     

重度颅脑伤病人行去骨瓣减压术后硬脑膜减张缝合的疗效分析

目的 研究重度颅脑伤病人行去骨瓣减压术后硬脑膜减张缝合的临床疗效。方法 将重度颅脑伤(GCS<8分)行去骨瓣减压术后的病人行硬脑膜减张缝合与敞开硬脑膜两种术式,对比术后3月GCS评分及并发症进行临床分析。结果治疗组(行硬脑膜减张缝合术)术后3月GCS评分10.3±1.6,并发症6例;对照组(行敞开硬脑膜术)术后3月GCS评分8.6±1.2,并发症16例;治疗组明显优于对照组(P<0.05)。结论 重度颅脑伤病人行去骨瓣减压术后硬脑膜减张缝合具有明显的临床疗效。     

重型颅脑外伤运用不同手术方式治疗的临床效果比较

目的对重型颅脑外伤患者采取不同手术方式进行治疗,对比疗效。方法 120例重型颅脑外伤患者,随机分为治疗组和对照组,每组60例。治疗组患者采用改良标准大骨瓣开颅手术进行治疗,对照组患者采用常规标准外伤大骨瓣开颅手术进行治疗。比较两组的治疗效果。结果治疗组的远期生存率为86.7%,明显高于对照组的68.3%,差异具有统计学意义(P<0.05)。治疗组术后再出血、颅内感染、切口发生病变、癫痫等主要并发症发生率均低于对照组,差异具有统计学意义(P<0.05)。结论采用改良标准大骨瓣开颅手术进行重型颅脑外伤治疗的患者存活率远远高于采用常规方式进行治疗的患者,且并发症的发生率较低,值得应用推广。     

两种手术方式治疗重症颅脑损伤的临床效果比较

目的探讨常规性骨瓣开颅减压手术与标准大骨瓣开颅减压手术治疗重症颅脑损伤的临床效果。方法选取2012年5月-2013年5月本院收治的重症颅脑损伤患者43例,将其分为观察组和对照组,观察组23例采用标准大骨瓣开颅减压手术进行治疗,对照组20例采用常规性骨瓣开颅减压手术进行治疗,比较两组的临床疗效及术后并发症情况。结果治疗后观察组疗效优于对照组（P〈O．05）,观察组患者术后并发症发生率低于对照组（P〈O．05）。结论标准大骨瓣开颅减压手术治疗重症颅脑损伤有较好的疗效,优于常规性骨瓣开颅减压手术。     

单唾液酸四己糖神经节苷脂钠治疗脑外伤癫痫疗效分析

目的评价用单唾液酸四己糖神经节苷脂钠(神经节苷脂)联合高压氧及常规抗癫痫药物综合与单纯高压氧及常规抗癫痫药物治疗脑外伤癫痫的疗效。方法常规抗癫痫药物联合高压氧治疗脑外伤癫痫为对照组(73例),对照组基础上加用神经节苷脂静脉点滴为治疗组(77例),观察临床症状和脑电图。结果与对照组相比:试验组神经节苷脂给药越早,疗效指标改变越好。多个不同的发作类型,疗程结束的脑电图显示均有显著改善,其中以单纯部分性发作类型及全面性发作类型患者尤为明显。结论神经节苷脂联合高压氧综合治疗脑外伤癫痫是一种有效的治疗手段。     

The clinical pharmacology of antiepileptic agents

The correct choice of an antiepileptic drug, its individual dosage and schedule of administration at the beginning of treatment and then during the maintenance therapy promotes a complete control of seizures using one anticonvulsant in 60-90% of patients. The treatment should be initiated with administration of one drug which is adequate for the given type of seizures taking into consideration that different drugs can appear effective in different patients with the same form of epilepsy. One has to choose drugs by consecutively gradually changing them. The optimization of epilepsy treatment should be performed on the basis of the knowledge of the clinicopharmacological characteristic of the main antiepileptic drugs described in the lecture.     

Determination of risk factors associated with seizure relapse after antiepileptic drug withdrawal

There is no consensus regarding the time of antiepileptic drug withdrawal and the relevant risk factors for seizure relapse. In this study, we aimed to determine the seizure relapse rates and the associated risk factors for seizure relapse in childhood epilepsy. Two-hundred sixty-six epileptic patients who discontinued the antiepileptic drug therapy after a seizure-free period of at least two years, were enrolled into the study. The data of the patients regarding sex, febrile convulsion history, family history, age at onset, type of epilepsy, total number of seizures and antiepileptic drugs, seizures during treatment, mental status, first and last electroencephalography, brain imaging findings, etiological factors and seizure relapse in the first two years after antiepileptic drug withdrawal were obtained from the patients’ files. Univariate logistic regression analysis was performed for each variable. The variables which were found to be statistically significant in univariate analysis, were included in multivariate logistic regression analysis. The overall seizure relapse rate after antiepileptic drug withdrawal was 19.2%. There were no significant differences for seizure relapse rate after antiepileptic drug withdrawal between patient groups with respect to sex, family history, type of epilepsy, febrile convulsion history, seizures before treatment, first electroencephalography findings, brain imaging findings and etiology. However, there were statistically significant differences for seizure relapse rate among patient groups concerning age at onset of epilepsy, new seizure during treatment, the total number of antiepileptic drugs, mental status, and last electroencephalography findings. We imply that the clinical status of the patients should be considered before the cessation of drug therapy rather than the etiological factors or laboratory findings.     

Principles of treatment of epilepsy

Epilepsy is a common chronic neurological condition with a prevalence of 4-8 per 1000. The present classification of epilepsy is based on: 1) the etiology, which distinguishes symptomatic epilepsies from those that are idiopathic and cryptogenic, and 2) the localization of the disorder in the brain, separating the generalized seizures from epilepsies with partial or focal onset. The majority of patients with epilepsy will go into remission and two-thirds will remain so 2 years after drug withdrawal. The impact of epilepsy on individual patients varies. Employment, driving and learning may constitute major problems. There is a small but definite increase in mortality in patients suffering from epilepsy. Treatment of epilepsy usually involves long-term medical treatment, with the ultimate aim being no seizures and no drugs. Before starting treatment, the diagnosis of epilepsy should be assured. Initiation of antiepileptic drug therapy needs a full and adequate discussion with the patient and the choice of the minimum effective dose of an appropriate monotherapy. Nonpharmacological treatments may be necessary at a relatively early stage if pharmacologic treatment is ineffective. In choosing between different anti-epileptic drugs, consideration should be given to the efficacy of the drug for an individual patient and the tolerability of the drug. There is good evidence from many studies that the chief factor determining relative effectiveness is likely to be the spectrum and incidence of adverse effects of antiepileptic drugs. Some 20% of patients developing epilepsy have a chronic disorder uncontrolled by drugs. In patients receiving and complying with optimal doses of a single antiepileptic drug, the addition of further agents is likely to result in a significant improvement in seizure control in only about 10% of patients, but inevitably it increases the risks of dose-related, idiosyncratic and chronic toxicity due to both pharmacokinetic and pharmacodynamic drug interactions. For this group of patients an appropriate aim may not be complete remission of seizures but a compromise of reduced seizure frequency with less severe seizures, to be achieved with one or, at most, two drugs. The management of these patients with unremitting seizures constitutes a treatment challenge for epileptologists.     

不同生物型外科补片与自体帽状腱膜在硬脑膜缺损中的应用

目的 观察2种不同生物型外科补片(需缝合和免缝人工硬膜)与自体帽状腱膜修补硬膜缺损的安全性和有效性.方法 根据采用补片的差异将80例患者分为缝合组(采用需缝合的人工硬膜,32例)、免缝组(采用免缝合的人工硬膜,28例)和自体组(采用自体帽状腱膜,20例),术后给予常规药物治疗.比较2组生物型外科补片与自体帽状腱膜在手术时间、引流液量及术后并发症(发热、脑脊液漏、皮下积液及癫痫)等方面的差异.结果 缝合组、免缝组及自体组的手术时间分别为(3.1±0.6)、(2.5±0.5)和(3.0±0.5)h,缝合组手术耗时高于自体组,而免缝组手术耗时低于自体组,缝合组和免缝组分别与自体组比较,组间差异均有统计学意义(P＜0.05).缝合组、免缝组及自体组的引流量分别为(120±75)、( 178±68)和(131±66)ml,缝合组的引流量与自体组基本一致,组间比较差异无统计学意义(P＞0.05)；而免缝组高于自体组,组间比较差异有统计学意义(P＜0.05).缝合组与免缝组患者术后发热及脑脊液漏/皮下积液的发生率分别与自体组比较,组间差异均无统计学意义[发热:12.5％ (4/32)比5.0％ (1/20),7.1％ (2/28)比5.0％ (1/20)；脑脊液漏/皮下积液:6.2％ (2/32)比0％,25.0％(7/28)比0％,均P＞0.05].癫痫发生例数较少,仅缝合组为3.1％(1/31),余2组患者均无癫痫发生,组间差异均无统计学意义(P＞0.05).结论 在自体帽状腱膜取材受到一定限制时可采用生物型外科补片.免缝人工硬膜可相应减少手术时间,对难以缝合的部位不失为一种好材料.严密缝合生物型外科补片更具优势.     

A comparative study of vigabatrin vs. carbamazepine in monotherapy of newly diagnosed partial seizures in children

Carbamazepine (CBZ) is a drug of choice for the treatment of simple or complex partial seizures and secondary generalized seizures in adults and children. Vigabatrin (VGB) is a relatively new second line antiepileptic drug and was first registered for use in Poland more than ten years ago. Few reports have been published on the comparison of efficacy of VGB in children with epilepsy. The objective of this study is to evaluate the safety, efficacy and EEG effects of initial VGB monotherapy compared with initial CBZ monotherapy in children with newly diagnosed epilepsy. We present results of a prospective, outpatient and open study carried out in the University Hospital Center in Bia?ystok. Twenty-six children with partial epilepsy treated with VGB and 28 patients treated with CBZ were studied. The evaluation of the efficacy of the two drugs did not reveal any significant differences. Very good (reduction > 75%) seizure control was achieved in 22 out of 26 patients (84.6%) in the VGB group. One patient had a 50-75% decrease of seizures (good effect), similarly one child had a 25-50% reduction of seizures (mild effect). In two patients, we observed increased seizures (myoclonic jerks). Very good seizure control was achieved in 17 out of 28 patients (60.7%) in the CBZ group. Good seizure control was achieved in 5 out of 28 patients (17.8%) and mild control was seen in two children. No improvement was observed in 4 (14%) of the patients. The EEG background activity was improved in VGB-treated patients. No effect on the EEG background activity was observed in CBZ-treated children. VGB seems to be a safe and effective antiepileptic drug as primary monotherapy for epilepsy in children with similar proportion of side effects as CBZ.     

Medical treatment of epilepsy

The licensing of new antiepileptic drugs (AEDs) has led to a marked increase in the pharmaceutical armamentarium available for the treatment of epilepsy since 1990. The new drugs have now secured their place in the pharmacotherapy of epilepsy. The main reason for their success is their good general tolerability (especially with regard to cognitive function), the low rate of drug-drug interaction and the high anticonvulsant potency of some of the compounds. It is fortunate that many of the new AEDs have also proven effective in the treatment of generalised seizures, although they were originally developed for the treatment of focal seizures. However, the wide treatment choice has not solved the problems associated with the medical treatment of epilepsy. In monotherapy, none of the new AEDs have been shown to be superior in their potency to control seizures to older AEDs in comparative studies. Nonetheless, the greater choice of drugs allows treatment to be better tailored to the requirements of individual patients. Now there is a need to study patients whose seizures were not controlled by initial or alternative monotherapy to create an evidence-base for truly rational combination therapy in the future. Additional improvements in the medical treatment of epilepsy may come from AEDs currently in development, many of which use novel or unknown modes of action. So far, however, there is no evidence that any of these compounds will have radically different effects from the drugs currently available, or that they will have antiepileptic rather than purely anticonvulsant potential.     

脑血管病继发癫痫120例临床分析

目的回顾性分析120例脑血管病继发癫痫患者的临床资料,为相关的临床实践提供参考。方法所有患者的临床资料均录入Epidata3.0数据库,然后导入SPSS14.0进行频数分析。结果脑血管病后继发癫痫的发病率为9.15%,癫痫发生的时间主要集中在脑卒中发生后的6个月内;癫痫发作的类型主要为单纯部分性发作和全身强直阵挛发作;病变部位主要分布在脑叶区,其次为额顶基底节区;经治疗后116例患者的癫痫病情被控制。结论脑血管病后癫痫大多较易控制,抗癫痫药物在类别、剂量的选择原则上应强调个体化,不能千篇一律。     

左乙拉西坦治疗脑炎患儿早期癫痫发作的疗效观察

目的：观察左乙拉西坦在脑炎患儿早期癫痫发作中的疗效。方法：20例早期癫痫发作的脑炎患儿在常规抗癫痫治疗基础上,加用左乙拉西坦作为观察组,另20例脑炎有早期癫痫发作的患儿仅用常规抗癫痫治疗作为对照组。比较两组控制癫痫发作的时间,病死率和晚期癫痫发作的发生率。结果：观察组控制癫痫发作时间为（28.55±11.29）h,对照组为（94.56±29.97）h,两组比较差异有统计学意义（t=2.84,P<0.01）。但两组的病死率和晚期癫痫发作的发生率比较,差异无统计学意义。结论：左乙拉西坦能够快速、有效控制儿童脑炎早期癫痫发作。