北京市居民2型糖尿病现况调查和危险因素研究

目的 揭示北京市居民2型糖尿病的流行趋势及探索相关危险因素.方法 采用多因素logistic回归模型分析北京市居民2型糖尿病的相关危险因素.结果 共调查22301人,其中男性9836人,女性12465人,60岁以上2658人,占11.92%.男性(OR=1.453)、有糖尿病遗传史(OR=2.751)、中老年人(OR=1.584)、高血压(OR=1.338)、腹型肥胖(OR=1.741)、超重或肥胖(OR=1.098)、水果摄入量少(OR=1.430)、血清高甘油三酯(OR=1.767)和高胆固醇水平(OR=1.315)是影响2型糖尿病发生的危险因素.结论 控制血压在正常范围、控制体重、增加水果摄入量和降低血清甘油三酯及胆固醇水平,对于北京市居民预防和控制2型糖尿病发生具有重要意义.

Abstract：

Objective To disclose the epidemiological status of type 2 diabetes mellitus and its related risk factors in adults in Beijing.Methods Logistic model was applied to analyze the relationship between the risk factors and type 2 diabetes mellitus.Results A total of 22301 people were studied,of whom 9836 were males,12465 females,and 2658 of them aged over 60(accounting for 11.92%).The risk factors,which might cause diabetes,would include being male(OR=1.453),with genetic history(OR=2.751),people older than 40(OR=1.584),with hypertension(OR=1.338),with larger waist circumference(OR=1.741),overweight or obesity(OR=1.098),low consumption of fruits(OR=1.430),hypertriglyceridemia(OR=1.767)and hypercholesterolemia (OR=1.315).Conclusion It is of great importance to carry out prevention and controI of type 2 diabetes mellitus programs to eliminate the risk factors among adults in Beijing,with contents as:keeping the blood pressure and weight within the normal range,increasing fruit intake,decreasing the triglyceride and cholesterol levels.     

广东省佛山市社区中老年人群无症状颅内动脉狭窄的横断面研究

目的 研究广东省佛山市社区中老年人群颅内动脉狭窄的患病率和危险因素.方法 以居委会为单位随机整群抽样.采集相关资料和临床指标,经颅多普勒超声(TCD)检测双侧颅内大动脉的狭窄情况.用SPSS 18.0软件进行数据统计分析.结果 在1405名研究对象中,163例(11.6%)存在颅内动脉狭窄,104例(7.4%)存在单一颅内动脉狭窄,59例(4.2%)存在2条及以上动脉狭窄,标化患病率为10.3%.颈内动脉虹吸段狭窄率最高(9.89%),其余依次为基底动脉(3.05%)、大脑中动脉(2.29%)、大脑前动脉(1.59%)、椎动脉(1.38%)、大脑后动脉(0.89%).年龄分层分析显示,70岁以上年龄组标化患病率(27.8%)显著高于70岁以下组(7.5%)(P=0.000).单因素分析显示,糖尿病史在狭窄组(8.6%)显著高于非狭窄组(2.7%)(P=0.000);平均收缩压在狭窄组显著高于非狭窄组(P=0.000).logistic回归分析证实糖尿病史和收缩压升高是无症状颅内动脉狭窄的独立危险因素(糖尿病史OR=2.362,95%CI:1.194～4.674,收缩压升高OR=1.024,95%CI:1.016-1.031).结论 无症状颅内动脉狭窄在中国南方地区中老年人群中有较高的患病率,尤其是70岁以上人群,累及颈内动脉虹吸段、基底动脉、大脑中动脉为多.糖尿病史和收缩压升高是无症状颅内动脉狭窄的独立危险因素.

Abstract：

Objective To investigate the prevalence and risk factors of asymptomatic intracranial artery stenosis in middle-aged and elderly population in the community of Foshan city,Guangdong province. Methods Subjects from residential communities were chosen through Cluster sampling method. Physical data and history were collected. Serum fasting glucose, total cholesterol and triglycerides concentrations were tested with venous blood samples. Intracranial artery stenosis was diagnosed by transcranial Doppler(TCD). Data was analyzed by the software SPSS 18.0.Results 1405 subjects met the inclusive criteria, among which 163(11.6%)were found one(7.4%)or more(4.2%)stenotic arteries, and the standardized rate was 10.3%. 9.89% of the SICA, and 3.05%, 2.29%, 1.59%, 1.38%, 0.89% of basilar artery, middle cerebral artery, anterior lerebral artery,vertebral artery, posterior cerebral artery were found stenotic respectively. Data from the age-stratified analysis showed that the prevalence in these above 70(27.8%)was significantly higher than that under age 70(7.5%)(P=0.000). Single factor and logistic regression analysis demonstrated the history of diabetes mellitus and elevated systolic pressure present were significantly different between stenofic group and the non-stenotic group(P=0.000, P=0.000), which were the independent risk factors of asymptomatic stenosis of intracranial arteries(OR= 2.362,95%CI:1.194-4.674; OR= 1.024,95%CI:1.016-1.031). Conclusion Comparatively high prevalence of asymptomatic intracranial artery stenosis in middle-aged and aged community population was found in the Southern part of China,especially among the age group above 70. History of diabetes and elevated systolic pressure seemed to be the independent risk factors of asymptomatic stenosis of intracranial arteries.     

颅内动脉瘤大小与介入栓塞术中破裂关系的临床研究

目的探讨颅内动脉瘤大小与介入栓塞术中破裂关系。方法选取2013年6月至2015年6月本院收治的105例介入栓塞治疗颅内动脉瘤患者中,6例患者动脉瘤发生破裂,通过对颅内动脉瘤栓塞过程中破裂的检查和处理,分析患者颅内动脉瘤大小与介入栓塞术中破裂的关系。结果破裂动脉瘤大小在3.5~5.8 mm,平均动脉瘤大小为(4.0±0.4)mm,瘤体与瘤颈比为1.2:1。结论动脉瘤大小与栓塞术中破裂具有较为密切的联系,颅内动脉瘤直径在5 mm以下是导致术中破裂的危险因素,动脉瘤越小,在栓塞术中破裂的可能性越大。     

颅内破裂动脉瘤栓塞术后早期破裂再出血的危险因素分析

目的 探讨颅内破裂动脉瘤栓塞术后早期破裂再出血的相关危险因素.方法 共纳入42例颅内破裂动脉瘤栓塞术后早期破裂再出血患者(研究组),同期随机抽取行颅内破裂动脉瘤栓塞术后早期未破裂再出血患者40例作为对照组.采用非条件Logistic回归模型进行单因素及多因素分析.结果 单因素分析结果表明:研究组年龄≥50岁、高血压病史、糖尿病病史、破裂次数≥2次、合并脑血管痉挛、术后抗凝治疗、术后血压波动≥30mm Hg(l mm Hg=0.133 kPa)、假性动脉瘤、致命栓塞及大部分栓塞[81.0％(34/42)、76.2％( 32/42)、66.7％( 28/42)、76.2％(32/42)、81.0％( 34/42)、76.2％( 32/42)、66.7％( 28/42)、66.7％( 28/42)、66.7％( 28/42)]与对照组[57.5％( 23/40)、50.0％(20/40)、37.5％( 15/40)、50.0％ (20/40)、57.5％ (23/40)、47.5％ (19/40)、37.5％( 15/40)、37.5％ (15/40)、37.5％(15/40)]比较差异有统计学意义(P＜0.05).进一步行多因素分析结果表明:年龄≥50岁、高血压病史、破裂次数≥2次、合并脑血管痉挛、术后抗凝治疗、术后血压波动≥30 mm Hg是颅内破裂动脉瘤栓塞术后早期破裂再出血的独立危险因素(P＜0.05).结论 年龄≥50岁、高血压病史、破裂次数≥2次、合并脑血管痉挛、术后抗凝治疗、术后血压波动≥30 mm Hg是颅内破裂动脉瘤栓塞术后早期破裂再出血的独立危险因素,对该类人群的危险因素进行必要的干预具有重要意义,可以降低颅内破裂动脉瘤栓塞术后早期破裂再出血的发生率并改善预后.     

硝酸甘油复合艾司洛尔在经DSA行颅内动脉瘤栓塞术中控制性降压的研究

目的 观察硝酸甘油复合艾司洛尔用于经数字减影血管造影(DSA)行颅内动脉瘤栓塞术中控制性降压的可行性.方法 选择32例颅内动脉瘤行电解可脱性弹簧圈(GDC)栓塞术的患者,随机分为两组:A组为硝酸甘油组;B组为硝酸甘油复合艾司洛尔组.每组各16例.结果 B组术中心率(HR)及心肌耗氧量(RPP)值明显低于A组(P＜0.01);B组术中硝酸甘油的用药量明显低于A组(P＜0.01);A组术中有2例动脉瘤破裂改行开颅手术,而两组术后均未见明显的心脑栓塞、苏醒延迟等并发症.结论 硝酸甘油复合艾司洛尔可安全有效地应用于经DSA行颅内动脉瘤GDC栓塞术中控制性降压.     

某汽车公司铸造厂工人腰背痛的危险因素分析

目的 通过横断面流行病学记查,寻找汽车铸造厂作业工人腰背痛的主要危险因素,为此类疾患的预防提供科学依据.方法 在某汽车公司铸造厂对1340名工人进行腰背痛和劳动负荷问卷调查,利用logistic回归进行危险因素分析.结果 铸造厂工人的腰背痛年患病率为58.9%,其中铸造、物流和造型工种工人腰背痛年患病率较高,分别为64.6%、64.6%和62.5%.以不适体位搬举、大幅度弯腰、弯腰与转身并存及搬运重物这些负荷因素导致患腰背痛危险性最高,其OR值分别为2.085、1.961、1.967和1.956.各个危险因素在不同工种中的分布不同.多元logistic同归分析表明,搬运重物、不适体位搬举、大幅度弯腰、弯腰与转身并存及工龄和性别均被选人模型.结论 手工搬运重物、不良劳动姿势或二者同时存在是导致腰背痛的首要危险因素,应从这方面入手,加强工效学干预研究,减少此类疾患.

Abstract：

Objective To study the main risk factors of low back pain of workers in a foundry factory of the automobile company using cross sectional epidemiological investigation, and to provide scientific base for preventing the disorder. Methods The low back pain and work loads of 1340 workers in a foundry factory of the automobile company were investigated using questionnaire, and logistic regression analysis was used to analyze the risk factors. Results The one-year morbidity of low back pain in workers was 58.9%the morbidities of low back pain in workers engaged in foundry, transportation and modeling were 64.6 %, 64.6 % and 62.5 %, respectively. The lifting with squat postures, bending trunk heavily, bending trunk with twisting and moving the heave objects were found to be the most dominant risk factors for low-back pain, the OR values were 2.085, 1.961, 1.967 and 1.956, respectively. The distributions of risk factors were different among the different jobs. The logistic regression analysis showed that moving the heave objects, lifting with squat postures, bending trunk heavily, bending trunk with twisting existed simultaneously, also the work years and gender were the risk factors. Conclusion The manual moving heave objects, awkward working posture or both were the most important risk factors for low-back pain. The intervene ergonomic study should be performed in future to reduce the morbidity of low-back pain.     

影响病毒性脑炎近期预后的相关危险因素分析

目的 探讨影响病毒性脑炎近期预后的相关危险因素.方法 回顾性分析124例病毒性脑炎患者的临床资料,应用格拉斯哥预后量表(COS)分级将患者分为预后良好组(89例)和预后不良组(35例).并选取14个危险因素进行Logistic回归分析.结果 单因素分析表明,抽搐持续时间、意识障碍、局灶性神经功能缺损,头颅MRI异常、脑电图重度异常与病毒性脑炎近期预后有显著相关性(P＜0.05);而年龄、性别、精神行为异常、脑膜刺激征、脑脊液(CSF)压力、CSF白细胞数、CSF蛋白、外周血白细胞计数、头颅CT异常与病毒性脑炎近期预后无显著相关性(P＞0.05).多因素分析表明,抽搐持续时间(OR=2.877,P=0.005)和头颅MRI异常(OR=16.582,P=0.008)为影响病毒性脑炎近期预后的独立危险因素.结论 病毒性脑炎的预后是多因素共同作用的结果,头颅MRI异常和抽搐持续时间是影响病毒性脑炎近期预后的独立危险因素.

Abstract：

Objective To investigate the risk factors of short-term prognosis in patients with viral encephalitis. Methods Clinical data of 124 patients with viral encephalitis were analyzed retrospectively. All patients were divided into good prognosis group and poor prognosis group according to the Glasgow outcome scale. Fourteen related risk factors were chosen and multifactor Logistic regression analysis was made. Results Univariate analysis showed, the duration of seizure, consciousness disorder, deficiency of cranial nerves, severe abnormal electroencephalogram and abnormal cranial MRI had significant correlation with short-term prognosis (P＜0.05), but age, sex,behavior disorder, meningeal irritation sign, pressure of cerebrospinal fluid (CSF), leukocyte number of CSF, protein level of CSF, peripheral white blood cell, and abnormal cranial CT had no correlation with short-term prognosis (P ＞0.05). Multivariate analysis showed that the abnormal of cranial MRI and the duration of seizure were the independent risk factors of short-term prognosis. Conclusions The short-term prognosis of viral encephalitis relates with many factors. The abnormal cranial MRI and the duration of seizure are the important related risk factors.     

孕母叶酸摄入与MTHFR基因C677T多态性对子代先天性心脏病发病风险研究

目的 分析孕母孕早期环境高危因素,探讨叶酸摄入与MTHFR基因多态性间交互作用对子代先天性心脏病(简称先心病)发病的影响.方法 通过病例对照研究回顾性分析98例12岁以下先心病患者母亲和101例正常婴儿的母亲(对照组)孕期危险因素暴露水平以及叶酸摄入情况,进一步应用变性液相高效色谱(DHPLC)检测MTHFR基因C677T多态性,并分析其与叶酸摄入的交互作用.结果 经Logistic回归分析,6项因素纳入先心病风险模型,孕母教育程度、没有定期产检、精神紧张、接触化学物质是子代先心病的高危因素,服用叶酸和复合维生素是先心病的保护因素.叶酸补充充足情况下,MTHFR基因各基因型比较,病例组与对照组无统计学差异.将间断服用及未服用叶酸者合并作为叶酸补充不足者,其孕母基因型为CT与CC时发病无统计学意义(P=0.066,OR=2.018,95%CI:0.95～4.285).结论 提高孕母的自我保健意识是减少先心病危险因素暴露的重要措施.怀孕早期孕母叶酸的补充不足可能是导致子代先心病发病风险增高的独立因素,孕母MTHFR基因C677T基因型合并叶酸补充不足可能增加先心病风险.

Abstract：

Objective To explore the environmental risk factors,periconceptional folate intake and methylenetetrahydrofolate reduetase (MTHFR)gene C667T polymorphism of pregnant women on congenital heart diseases (CHD)in offspring.Methods Retrospective case-control study was carried out to investigate periconceptional folate supplementation and environmental factors in 98 parents with CHD offsprings and 101 parents with normal offsprings.The mothers'MTHFR gene C667T mutation was also identified.The possible risk factors were analyzed by simple and multiple factors Logistic regression methods.Results Six factors were related to the occurrence of CHD in the offspring:education of gestation mother,no prenatal examination,under depressed or nervous condition during pregnancy and maternal exposures to harmful substance;periconceptional folate and compound vitamin supplementation were protection factors.There were significant difference between case and control group in folate supplement(P<0.05).The maternal MTHFR 677genotypes CC and TT in combination with daily folate supplements were associated with no increased risk for CHD in offspring,however in combination with not use of folate a two-fold(P=0.066,OR=2.018,95%CI 0.95-4.285)increased risk.Conclusion Improving self health care of gestational mother is the most important protection measures to avoid the risk factors exposure.Periconceptional folate deficiency may be the independence risk factor for CHD.Periconceptional mother carrying MTHER heterozygote's(CT)genotype in combination with deficiency may increase risk for CHD.     

新生儿低血糖的危险因素及预防

目的 分析非糖尿病母亲分娩的新生儿发生低血糖的危险因素及预后,为临床诊治提供依据,避免发生脑损伤.方法 采用病例对照的方法,选取诊断明确的非糖尿病母亲分娩的低血糖新生儿111例为病例组,以同期血糖正常的新生儿111例为对照组,分析新生儿低血糖的危险因素及低血糖后神经发育情况.结果 新生儿低血糖的危险因素为低出生体重儿(X2=4.066,P=0.044)、小于胎龄儿(X2=21.125,P=0.000)、先天性心脏病(X2=5.869,P=0.015)、日龄≤3d(X2=6.876,P=0.032)、母亲患有妊娠期高血压疾病(X2=6.618,P=0.010)或年龄<25岁(X2=6.311,P=0.044).足月儿比早产儿可能更易出现低血糖性脑损伤;低血糖性脑损伤的发生与血糖水平及低血糖持续时间相关.结论 对存在引起低血糖高危因素的新生儿要严密监测血糖,及时发现及时治疗,避免低血糖引起脑损伤.

Abstract：

Objective To analyze the risk factors and prevention of non-diabetic mother neonatal hypoglycemia,in order to provide evidences for clinical diagnosis and avoid hypoglycemic brain injuries.Methods This was retrospective study using the method of case control.One hundred and eleven cases of non-diabetic mother neonatal hypoglycemia were enrolled in patients group,and 111 controls of normal blood glucose neonate at the same period were enrolled in control group.The risk factors of neonatal hypoglycemia and the results of neural development after hypoglycemia were analyzed.Results The risk factors of neonatal hypoglycemia were low-birth-weight infant(X2=4.066,P=0.044),small for gestation age infant (X2=21.125,P=0.000),congenital heart disease(X2=5.869,P=0.015),day-age≤3 days(X2=6.876,P=0.032),mother with pregnancy-induced hypertension(X2=6.618,P=0.010)or age<25 years old (X2=6.311,P=0.044).Full-term infants might be easier to show up hypogtycemic brain injuries than pre-term infants;the occurrence of hypoglycemic brain injuries correlated with the level of blood glucose and the lasting time of hypoglycemia.Conclusion Monitor blood glucose closely to the infant has risk factors of hypoglycemia,and discover and cure it on time,in order to avoid hypoglycemic brain injuries.     

The Relationship between Gastric Cancer and the Unhealthy Habits and the Gastric Diseases

Objective To explore the relationship between gastric cancer and smoking, drinking spirits and the history of chronic gastric disease s. Method A case-control study was conducted on 361 cases and 1 525 population-controls to interview the history of exposure. The contact stre ngth of each factor with gastric cancer was estimated by Logistic regression mod el. The data were adjusted for confounders. Results The risk of gastric cancer increased 48% for smokers, the longer the year of smoking was,the more the numbe r of smoking per day was, and the younger the age of beginning smoking was, the greater the risk of gastric cance r was.82% of the risk increased for drinkers, the affects of white wine was most obvious(OR=3.14，95% CI=2.23～4.42). The risk rose markedly (OR=7 .87,95% CI=5.72～10.83)for the persons who had chronic gastric diseases, and t he relation of duration-effect was presented, which the risk rose with the exte nsion of having chronic gastric diseases. Smoking, drinking spirits and the hist ory of chronic gastric diseases were the strong independent factors, and they al so had obvious interaction affects. Conclusion Smoking, drinkin g spirits and chronic gastric diseases are the major factors of gastric cancer. Giving up unhealthy habits and radically curing chronic gastric diseases in grai n and in the early stage is the one of major measures to reduce the incidence of gastric cancer.     

电解可脱弹簧圈栓塞治疗颅内动脉瘤

目的:分析应用电解可脱卸弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床效果。方法:6例因蛛网膜下腔出血或其他神经系统症状的病人。经CT或(和)MR以及DSA检查证实为颅内动脉瘤。其中左侧后交通动脉3例,右侧后交通动脉1例,前交通动脉1例,C2段1例。瘤体直径在5～20mm之间。在神经安定+局麻下行动脉瘤栓塞术。先作载瘤动脉造影,明确动脉瘤的大小、形状、体/颈比以及与载瘤动脉的关系。再将微导管和微导丝塑形为相应的形状后经指引导管送至动脉瘤腔中部,选择合适的GDC进行填塞,直至致密填塞。结果:全部病人均一次性栓塞治疗成功,技术成功率为100%。栓塞后即刻行脑血管造影显示动脉瘤腔填塞满意,填充程度均在95%以上。全部病人均无再次出血和并发症产生。结论:经皮穿刺GDC栓塞术是颅内动脉瘤安全、有效和微创的治疗手段。     

动脉瘤性蛛网膜下隙出血后脑血管痉挛的治疗及临床分析

目的 总结动脉瘤性蛛网膜下隙出血(SAH)后脑血管痉挛的防治经验及体会.方法 选择住院治疗的58例颅内动脉瘤性SAH患者作为研究对象,对其临床资料进行回顾性分析.所有患者均行可脱性弹簧圈栓塞术血管内栓塞治疗颅内动脉瘤,术后采取腰大池持续引流、尼莫地平经深静脉持续泵入以及升高血压、增加血容量、稀释血液(3H)治疗等综合措施.结果 58例患者中术后有8例患者发生脑血管痉挛,发生率为13.8%(8/58),主要表现为短暂性偏瘫4例,意识障碍加深2例,短暂性失语2例,经积极治疗,运动功能、意识障碍及语言功能均完全恢复,无植物生存和死亡病例.结论 尽早行动脉瘤可脱性弹簧圈栓塞术,术后予脑脊液引流、尼莫地平静脉泵入、3H治疗等是治疗和预防动脉瘤性SAH后脑血管痉挛的有效方法.     

Improved risk counselling possible for patients with unruptured intracranial aneurysms

The 'International Study of Unruptured Intracranial Aneurysms' (ISUIA) investigators have recently published the results of a large prospective, observational study on risks of rupture and risks of treatment in patients with unruptured intracranial aneurysms. In patients with aneurysms smaller than 7 mm no rupture of the carotid, middle cerebral and anterior communicating arteries occurred during follow up (mean 4.1 years) if there was no history of subarachnoid haemorrhage from a separate aneurysm. Risks were higher in aneurysms of the posterior circulation (2.5% in 5 years), and in patients with a previous episode of subarachnoid haemorrhage from another aneurysm (1.5 to 3.4% in 5 years for aneurysms < 7 mm). Size was the most important risk factor for rupture, and aneurysms of the posterior circulation > 25 mm had a 50% cumulative risk of rupture over 5 years. The absence of rupture in some subgroups, such as small aneurysms of the anterior communicating artery, is probably explained by the small numbers in these subgroups. Similarly, the lack of identification of risk factors other than size is probably explained by insufficient power of the study. The overall risk (defined as death or dependence) of surgical treatment was 13%, with patient age and size and site of the aneurysm as the most important risk factors. Endovascular treatment carried a 7 to 10% risk in most subgroups; only patients with aneurysms > 25 mm had increased risks. Age was not a risk factor for endovascular treatment. By making use of these results, patients can now be given sound advice regarding the benefits of preventive treatment in each individual case.     

64层螺旋CT血管成像在脑动脉瘤术前评价中的临床应用

目的：探讨64层螺旋CT血管成像在脑动脉瘤术前评价中的临床应用价值。方法：对52例患者行64层螺旋CT血管成像检查。运用容积再现、最大密度投影及多平面重组评价动脉瘤的大小、形态和位置。结果：52例患者共发现动脉瘤59个,其中6例患者为多发;后交通动脉瘤31个,前交通动脉瘤16个,基底动脉瘤9个,前动脉动脉瘤3个。59个动脉瘤呈囊状41个,梭形5个,不规则形13个。动脉瘤平均直径为7.2 mm,瘤体大小平均为6.5 mm,瘤颈平均宽度为4.1 mm。29例患者伴有蛛网膜下腔出血。结论：64层螺旋CT血管成像能能准确提供关于脑动脉瘤的信息,指导外科手术夹闭及栓塞治疗,降低治疗风险,提高治疗成功率。     

174例蛛网膜下腔出血患者生存率及死亡的相关危险因素历史性队列研究

目的 描述蛛网膜下腔出血(SAH)患者生存状况,探讨死亡的相关危险因素.方法 对174例患者的年龄、既往史、出血累及脑区、实验室检查指标、治疗方式、并发症与预后等进行随访调查,通过Kaplan-Meier生存分析和Cox比例风险模型分析,明确患者生存状况及死亡的相关危险因素.结果 共164例患者完成随访调查[失访10例(5.75%)],其中死亡66例,最长随访时间为5.64年;患者28天生存率70.60%,1年生存率63.40%,3～5年生存率57.20%;应用尼膜同、行动脉瘤夹闭和栓塞治疗可以显著降低患者的死亡风险;而高龄、长期吸烟、低钠血症、急性期白细胞增高、再出血和脑血管痉挛等将显著增加患者的死亡风险.结论 高龄、急性期白细胞增高、并发低钠血症、消化道出血、再出血和脑血管痉挛的SAH患者预后不良;给予尼膜同、行动脉瘤夹闭或栓塞治疗可以降低动脉瘤性SAH患者的死亡风险.     

Intracranial aneurysms. A review

Intracranial aneurysms are common, and their rupture carries a grave prognosis. There is no effective way of preventing the development of intracranial aneurysms, but noninvasive means of detection are becoming increasingly practical and, at present, should be used routinely--at least in populations at high risk. SAH is frequently preceded by warning signs that, when recognized by the primary care or the emergency room physician, can lead to prompt and safe surgical intervention. About half the patients who suffer a major rupture either die or remain in poor condition as a result of the hemorrhage. In the rest, surgical intervention has become safer and very effective in preventing subsequent hemorrhage, which occurs in about 50% of patients if the aneurysm is left untreated. Since early surgery should be at least considered in the majority of these patients and since the early treatment of a patient after SAH is so specialized, it appears prudent to manage patients with SAH in units where the necessary neurological and neurosurgical specialized intensive care is available.     

Surgical treatment for a ruptured true posterior communicating artery aneurysm arising on the fetal-type posterior communicating artery--two case reports and review of the literature

Only a small number of aneurysms arising on the posterior communicating artery itself (true Pcom aneurysm) have been reported. We report two cases of ruptured true Pcom aneurysms with some characteristic features of true Pcom aneurysm. A 43 year old man suffering from subarachnoid hemorrhage (SAH) had an aneurysm arising on the fetal-type Pcom artery itself, and underwent surgery for clipping. Most of the aneurysm was buried in the temporal lobe, so retraction of the temporal lobe was mandatory. During the retraction, premature rupture was encountered. After tentative dome clipping and the control of bleeding, complete clipping was achieved. Another patient, a 71 year old woman presenting with consciousness disturbance due to SAH, had an aneurysm on the fetal-type Pcom artery itself, and underwent surgery for clipping. It has been generally considered that hemodynamic factor plays an important role in the formation, the growth, and the rupture of the cerebral aneurysm. This factor is especially significant in true Pcom aneurysm formation and rupture. According to the literature, a combination of fetal type Pcom and formation of the true Pcom aneurysm has been reported in most cases (81.8%). Most of the aneurysm can be buried in the temporal lobe, and the retraction of the temporal lobe during the dissection of the neck would be necessary, which causes premature rupture of the true Pcom aneurysm. In the surgery for a true Pcom aneurysm, we should be aware of possible premature rupture when temporal lobe retraction is necessary.     

Subarachnoid hemorrhage without aneurysm on the angiogram: the value of repeat angiography

OBJECTIVE: To determine the yield of repeated angiography in patients with a non-perimesencephalic subarachnoid haemorrhage (SAH) and a negative first cerebral angiogram. DESIGN: Retrospective. METHOD: All diagnostic data of patients with a spontaneous SAH admitted to the Department of Neurology, St. Elisabeth Hospital, Tilburg, the Netherlands, in the period 1 January 1992-30 June 2000 were analysed. Patients with a perimesencephalic haemorrhage on a CT-scan were excluded and follow-up was completed. A negative angiogram was considered false-negative, if an aneurysm was shown on a repeat angiogram or after a rebleed. These angiograms were reviewed. RESULTS: A total of 333 patients with a spontaneous SAH were registered. Of these, 249 patients had one or more angiograms made, which resulted in 59 first angiograms being negative (24%). A total of 36 patients had a non-perimesencephalic SAH (26 women and 10 men; mean age: 54 years (range: 25-77)). In 25 of these 36 patients, angiography was repeated revealing 9 aneurysms. Four patients suffered from a rebleed after a previous negative angiogram. Altogether, in 13 of these 36 patients the first negative angiogram was false-negative (36%). In 5 of the 9 patients with a positive repeat angiogram, the first angiogram had been incorrectly assessed as negative. CONCLUSION: Of the 36 patients with a non-perimesencephalic subarachnoid haemorrhage and a negative angiogram, 13 were revealed to have an aneurysm. Nine of these 13 aneurysms were demonstrated on a repeat angiogram. Technical and interpretation factors appeared to play an important role in missing an aneurysm on a cerebral angiogram.     

可脱性微弹簧圈血管内栓塞治疗颅内动脉瘤的临床价值

目的:评价可脱性微弹簧圈血管内栓塞治疗颅内动脉瘤的临床价值及操作技术。方法:选择并回顾性总结分析56例颅内动脉瘤患者病例,共发现动脉瘤63例,前交通动脉瘤28例,后交通动脉瘤25例,颈内动脉岩段动脉瘤3例,在全麻下将可脱性微弹簧圈经微导管送入动脉瘤内,诱发血栓形成并最终使动脉瘤闭塞,并保持载瘤动脉通畅。结果:1例因术中过度栓塞造成载瘤动脉血流略显受阻,1例略有神经功能障碍,经治疗后均恢复正常;1例术中动脉瘤破裂,经继续栓塞止血成功;其余53例患者中动脉瘤栓塞后无再出血,临床症状消失。结论:可脱性弹簧圈可有效     

脑动脉瘤术后腰大池置管引流患者颅内感染及影响因素

目的了解Hunt-Hess高分级颅内动脉瘤破裂术后腰大池置管引流患者颅内感染情况及其影响因素。方法收集某院2017年3月—2018年5月脑血管病诊疗中心收治的Hunt-Hess高分级颅内动脉瘤破裂手术患者的临床资料,分析患者社会人口学情况、病情、治疗过程、术后颅内感染情况及其危险因素。结果共有72例Hunt-Hess高分级颅内动脉瘤破裂手术后腰大池置管引流患者,发生颅内感染30例,感染率为41.67%。单因素分析结果显示,不同年龄、入院mRS评分、术前抗菌药物使用情况、脑脊液漏情况、引流管污染情况的患者颅内感染率比较,差异均有统计学意义(均P0.05)。logistic回归分析结果显示,影响其感染的主要因素为:有脑脊液漏(OR=3.68)、术前未预防性使用抗菌药物(OR=3.18)、引流管污染(OR=2.82)、入院mRS评分≥4分(OR=2.51)、年龄≥61岁(OR=1.06)。结论 Hunt-Hess高分级颅内动脉瘤破裂术后腰大池置管引流患者颅内感染率较高,控制脑脊液漏、预防性使用抗菌药物、引流管使用时加强无菌操作均可有效减少术后腰大池置管引流患者颅内感染的发生。