脑室出血持续外引流的护理

脑室出血在急性出血性脑血管疾病中较常见，以往治疗此病多经外手术治疗或直接手术治疗，效果较差。自1991年互月～1993年1月共收治脑室出血34例，均经脑室持续外引流治疗，效果较满意。现将术后护理介绍如下：1临床资料1．1一般资料原发性脑室出血5例，脑实质出血破入脑室29例，男23例，女11例，年龄22～69岁，34例均经CT扫描证实。临床表现暖陇2例，浅昏迷9例，中昏迷15例，深昏迷巴例。一侧脑室出血者吕例累及2个以上脑室出血者26例，其中第三脑室积血12例，第三、四脑室积血14例，并脑积水25例。1．2手术方法手术常规于一例，若累及双…     

新生儿缺氧缺血性脑病的CT诊断

目的：了解新生儿缺氧缺血性脑病（HIE）的CT表现特点及其预后。方法：对110例经临床诊断为HIE的患儿进行CT检查，分析其CT表现特点。结果：本组110例中有88例CT表现异常，占80％；轻度CT表现41例．占46．6％，中度CT表现45例，占51．1％．重度CT表现2例，占2．3％；蛛网膜下腔出血5例，占5．7％，脑室内出血2例，占2．3％；12例随访复查3例表现正常，6例表现外部性脑积水，2例表现为脑萎缩，1例表现为交通性脑积水。结论：HIE的CT诊断为：（1）脑水肿，表现为脑质低密区，CT值〈16Hu；（2）脑室系统受压变窄；（3）脑出血表现为蛛网膜下腔出血、脑实质出血和脑室内出血；（4）脑梗塞很少见。轻、中度HIE患儿临床预后较好，重度HIE患儿预后较差。     

侧脑室—矢状窦分流治疗脑积水18例

1990年以来，我们采用侧脑室一矢状窦分流的方法治疗各种脑积水18例，经临床观察，疗效满意，现报告如下。目临床资料1．至一般情况本组男12例，女6例；年龄7～51岁，平均27岁。儿童先天性脑积水5例，成人单纯性脑积水11例（其中外伤性脑积水4例，蛛网膜下腔出血后脑积水3例，脑膜炎后脑积水2例，不明原因2例），后颅窝占位病变合并重度脑积水2例。头颅CT检查：5例儿童均示脑室系统扩大，皮层变薄。其余患者脑室系统轻度扩大2例，中、重度扩大11例；小脑蚓部巨大肿瘤1例，脑干肿物回例。除2倒后颅窝占位病变外，其余患者均于术前行腰穿检查…     

彩色多普勒超声和多层螺旋CT 检查急性胰腺炎的诊断价值

目的：探讨彩超和多层螺旋C T检查急性胰腺炎的诊断价值。方法急性胰腺炎86例患者分别采用彩超、CT进行检查,比较诊断结果符合情况。结果86例患者经彩超、CT平扫及CT增强扫描后进行各项影像学检查阳性率比较可以发现C T平扫和增强扫描的阳性率均明显高于彩超,且差异具有统计学意义（礸2=7．22、18．15、3．97、9．31, P ＜0．05）。CT平扫与CT增强扫描在诊断急性胰腺炎方面的阳性率比较无明显差异（礸2＝0．85,P ＞0．05）;而CT增强扫描在诊断急性重症胰腺炎方面的阳性率明显高于CT平扫,且差异具有统计学意义（礸2=3．95,P ＜0．05）。彩超、CT 平扫、C T增强扫描检查发现86例患者中并发胆囊炎、胆囊和胆管结石者20例、11例、12例,经统计学分析彩超在诊断胆源性胰腺炎的检出率明显高于CT平扫和CT增强扫描,且差异具有统计学意义（礸2=4．11、3．99,P ＜0．05）。结论彩超、CT 平扫和CT增强检查对急性胰腺炎的检出率有显著差异,各具优点,如联合应用可以相互弥补缺陷,发挥各自优势。     

双源双能量CT肺动脉成像辐射剂量与图像质量的比较研究

_目的：比较第一代双源双能量 CT（DECT）与第二代双源双能量 CT 肺动脉成像（CTPA）的辐射剂量和图像质量。方法：120例疑似肺栓塞患者行 DE-CTPA 检查,其中40例患者行第二代双源 DECT 80/Sn140 kV 检查（第一组）,40例患者行第二代双源 DECT 100/Sn140 kV 检查（第二组）,40例患者行第一代双源 DECT 140/80 kV 检查（第三组）。测量每例患者肺动脉主干、肺动脉段、空气及背部脂肪的 CT 值及标准差,对肺动脉图像进行主观评分,计算图像信噪比（SNR）、对比噪声比（CNR）及每例患者的有效剂量（ED）。结果：第一组肺动脉平均 CT 值[（354．1±73．4）HU]明显高于第二组[（290．1±73．1）HU,P＜0．001]和第三组[（303．9±73．3）HU,P＜0．001],但第二组与第三组差异无统计学意义（P＝0．399）;第三组平均 SNR（24．8±8．4）低于第一组（40．4±12．9,P＜0．001）和第二组（44．6±12．9,P＜0．001）,但第一组与第二组差异无统计学意义（P＝0．115）。第一组平均 CNR（435．3±77．7）明显高于第二组（355．8±77．8,P＜0．001）和第三组（384．8±79．0,P＝0．005）,但第二组与第三组差异无统计学意义（P＝0．100）。三组图像主观质量评分差异无统计学意义（P＞0．05）。第一组的 ED[（1．2±0．3）mSv]明显低于第二组[（2．4±0．7）mSv]和第三组[（3．0±0．7）mSv],差异均有统计学意义（P＜0．05）。结论：第二代双源 DECT 80/Sn140 kV 扫描方案可在大幅度降低辐射剂量的同时获得满足诊断需求的图像。     

中脑出血:临床和CT的相互关系

作者报告6例CT证实的中脑出血。CT显示中脑卵圆形高密度血肿,均未累及桥脑。2例向丘脑后部延伸。4例血肿使四迭体池消失。5例破入三脑室,3例并有侧脑室积血。脑室均扩大。随访CT显示脑室积血在7天内消失,血肿在3周内吸     

高原低氧与C型利钠肽的关系探讨

目的：探讨进驻高原不同海拔高度不同居住时间健康青年血浆C型利钠肽（C－type natriuretic peptide CNP)和心房利钠肽（Atrial natriuretic peptide ANP)的变化。方法：对从平原进驻海拔3700m和5380m高原第7d及6个月的40名边防某部官兵，应用放射免疫分析法检测其血浆CNP、ANP含量，并与20名平原健康青年作对照。结果：进驻海拔3700m和5380m的第7天及5380m6个月较平原CNP、ANP均增高显著（P＜0．05或P＜0．01），3700m居住6个月时较平原ANP增高显著（P＜0．01），CNP无统计学差异（P＞0．05）。且随海拔高度的升高而增高（P＜0．05或P＜0．01），初入高原时明显高于在高原居住6个月者（P＜0．01）。结论：CNP和ANP对急、慢性高原缺氧环境下的心血管系统功能调节具有重要意义。     

高原地区速发型哮喘发作特点及吸入大剂量β激动剂治疗的研究

目的：探讨高原地区速发型哮喘发作（ROAA）和迟发型哮喘发作（SOAA）在成人急性重症哮喘患者中各占的比例，两者的临床和肺功能是否存 差异以及对β激动剂的治疗反应。方法：对ROAA（16例）和SOAA（76例）患者，采用经定量型雾化吸入器（MDI）和贮雾瓶吸入沙丁胺醇治疗。每隔10min300ug，共持续3h，在给药前，后30，60，90，180min即刻检查肺功能，辅助呼吸肌活动，并观察呼吸困难和哮鸣音变化，后3项依据严重程度计分，平均值为临床指数，结果：ROAA发生率和上呼吸道感染诱发者（分别为17．4％，12．5％）显著低于SOAA（分别为82．6％，43．4％），P均＜0．01，ROAA组FEV1占预计值％和PEF占预计值％降低较SOAA组更显著（P均＜0．05），给药后30，60，90，180min ROAA组和SOAA组FEV1占预计值％，PEF占预计SOAA值％较给药前均显著升高（P均＜0．01），临床指数显著降低（P均＜0．01），给药后60，80，180min ROAA组三项指标改善较SOAA组更显著（P＜0．01或＜0．05），结论：高原地区ROAA是一组少见的哮喘急性发,同情发展快，经MDI和贮雾瓶吸入大剂量沙丁胺醇是治疗高原急性哮喘的有效方法，与SOAA比较，ROAA对治疗的反应更好。     

能谱CT在预测肝硬化门脉高压食管静脉曲张出血风险的应用

＿目的：通过能谱CT探讨肝硬化门脉高压血流动力学改变来预测食管静脉曲张出血风险。方法：41名肝硬化患者行能谱CT扫描,分别记录肝左叶、肝右叶、肝尾状叶、脾脏、门静脉、胃左静脉碘基值,门静脉主干及脾静脉主干内径,比较门脉高压组（门静脉内径≥15 mm或脾静脉内径≥10 mm）与非门脉高压组（门静脉内径＜15 mm或脾静脉内径＜10 mm）、CT下食管静脉曲张组与未曲张组、出血组与未出血组之间能谱参数差异。将出血组与未出血组的能谱参数绘制ROC曲线,选取截点,确定能谱参数对出血风险的诊断价值。结果：胃左静脉指数 GLI （胃左静脉碘基值／门静脉碘基值）与脾静脉主干内径呈正相关（r＝0．358,P＝0．035）。CT下食管静脉曲张组GLI（0．99±0．26）较未曲张组高（0．78±0．22）,P＝0．02。出血组GLI （1．01±0．21）较未出血组高（0．83±0．28）,P＝0．037。GLI临界值为0．87时曲线下面积为0．71,诊断出血风险的敏感性82．4％,特异性65％。结论：胃左静脉指数可以作为预测食管静脉曲张出血风险指标。     

MRI与CT影像检查在老年多发性脑梗死诊断中的应用分析

目的：比较M RI与C T影像检查在老年多发性脑梗死诊断中的应用。方法：方法选取218例多发性脑梗死患者进行常规的CT检查和MRI检查,比较分析CT检查和MRI检查在老年多发性脑梗死诊断和成像功能中的临床价值。结果218例患者C T检查总检出率为56．88％,M RI检查总检出率为95．87％,两组比较分析表明差异具有统计学意义（x2＝6．795,P ＝0．008）;24h以内组共有患者85例,患者 CT 检查检出率为37．65％,MRI检查检出率为94.12％,两组比较分析表明差异具有统计学意义（x2＝6．357, P ＝0．006）;24～72 h组共有患者70例,患者C T检查检出率为48．57％,MRI检查检出率为97．14％,两组比较分析表明差异具有统计学意义（x2＝5．315,P ＝0．026）;＞72h共有患者63例,患者CT检查和MRI检查检出率两组比较分析表明差异无统计学意义（ P ＞0．05）。提示梗死24h以内组和24～72h组MRI脑梗死的检出率明显高于CT的检出率,而7h组患者CT和MRI检出梗死率无明显差异。患者MRI检查脑梗死病灶数量明显高于CT 检查（ P ＜0．01）;患者 MRI检查脑梗死微小病灶的能力明显强于CT 检查（ P ＜0.05）。结论 M RI比C T诊断老年多发性脑梗死中具备显著优势。     

Posterior fossa intracranial hemorrhage in infants treated with extracorporeal membrane oxygenation: sonographic findings

Posterior fossa hemorrhage was documented by autopsy in five infants who had been treated with extracorporeal membrane oxygenation over a 5-year-period. In all five cases, the diagnosis was made prospectively by cranial sonography. Sonographic findings were compared with those in a control group of 15 infants with normal posterior fossae at autopsy. The following sonographic abnormalities were exhibited in neonates with posterior fossae hemorrhage: loss of definition of the cerebellum and fourth ventricle on midline sagittal images, heterogeneous cerebellar parenchyma, focal hypoechoic lesions, ventricular dilatation, and tentorial abnormalities. Bright foci inferior to the third ventricle were seen in four neonates in the normal control group. These foci measured 5-10 mm in diameter. One cranial sonogram was falsely interpreted as showing a posterior fossa hemorrhage because of prominent echoes in the interpeduncular cistern. Infants treated with extracorporeal membrane oxygenation are at risk for developing posterior fossa hemorrhage. Awareness of sonographic signs and potential pitfalls in the interpretation of posterior fossa hemorrhage is important for early and accurate recognition of these unusual and sometimes treatable hemorrhages.     

先天性四脑室中、侧孔闭锁(Dandy—Walker Syndrome)的CT诊断

本文报告20例先天性四脑室中侧孔闭锁的CT诊断,男性13例,女性7例,年龄45d～8岁.CT表现:第四脑室囊状扩大9例;第四脑室囊状扩大通过小脑溪与后颅窝小囊腔相通4例,或大囊腔相连3例;第四脑室与两侧小脑半球大小不等的两囊腔相连1例;扩大的第四脑室向天幕上延伸7例;枕大池、脑沟、脑裂消失20例;第三脑室及两侧侧脑室对称性重度积水扩大20例.合并右额顶区硬膜下积液1例.本病需与后颅窝蛛网膜囊肿、囊性新生物和变异的巨大枕大池以及重度小脑发育不全鉴别.     

Computed tomography of the trapped fourth ventricle.

A dilated fourth ventricle due to outlet obstruction is a clinical-radiologic entity with symptoms similar to those of a posterior fossa space-occupying lesion. Computed tomography reveals cystic dilatation of the fourth ventricle and hydrocephalus supratentorially. Frequently the symptoms resolve completely and the fourth ventricle returns to normal following lateral ventricular shunting. If there is actual obliteration of the aqueduct, the fourth ventricle must be shunted directly. While the exact mechanism by which the fourth ventricle becomes trapped is not fully known, outlet obstruction must be present. It is most frequently related to previous episodes of meningitis or subarachnoid hemorrhage. In a review of 48 cases of an abnormally enlarged fourth ventricle demonstrated on CT, six were found to have a trapped fourth ventricle. Careful attention to densities and configurations on CT allows its differentiation from other lesions such as cystic tumors and cysts.     

跨中后颅窝肿瘤的CT诊断

报告30例跨中后颅窝肿瘤的CT 表现。所有肿瘤都紧邻颅底骨结构。86.6%有颅底骨质破坏,发生的部位为岩尖,斜坡,中颅窝底,鞍旁和内听道。12例瘤周无水肿,18例有轻度水肿。29例肿瘤有清楚边界。肿瘤占位表现为相邻脑组织的受压移位,脑底池变形闭塞,三、四脑室移位及脑积水。本组资料表明,岩尖和相邻的斜坡是跨中后颅窝肿瘤易侵犯的部位,破坏多见。CT 能清楚显示跨中后窝肿瘤的大小、形态和累及范围,定位准确。跨中后颅窝肿瘤多属脑外肿瘤,常见的有脑膜瘤,三叉神经瘤,听神经瘤和胆脂瘤。作者讨论了它们的CT 定性诊断和鉴别。     

Fluid-attenuated inversion-recovery MR imaging in acute and subacute cerebral intraventricular hemorrhage.

BACKGROUND AND PURPOSE: Fluid-attenuated inversion-recovery (FLAIR) MR imaging may show subarachnoid hemorrhage (SAH) with high sensitivity. We hypothesized that the FLAIR technique is effective and reliable in the diagnosis of cerebral intraventricular hemorrhage (IVH). METHODS: Two observers evaluated the 1.5-T MR fast spin-echo FLAIR images, T1- and T2-weighted MR images, and CT scans of 13 patients with IVH and the FLAIR images of 40 control subjects. RESULTS: IVH appeared bright on the FLAIR images obtained during the first 48 hours and was of variable appearance at later stages. FLAIR MR imaging detected 12 of 13 cases of IVH; no control subjects were falsely thought to have IVH (92% sensitivity, 100% specificity). However, IVH could not be fully excluded in the third ventricle (20%, n = 8) or in the fourth ventricle (28%, n = 11) on some control images because of CSF pulsation artifacts. Two cases had CT-negative IVH seen on FLAIR images. One case had FLAIR-negative IVH seen by CT. Although the sensitivities of conventional MR imaging (92%) and CT (85%) were also high, FLAIR imaging showed IVH more conspicuously than did standard MR imaging and CT in 62% of the cases (n = 8). FLAIR was as good as or better than CT in showing IVH in 10 cases (77%). FLAIR images showed all coexisting SAH. CONCLUSION: FLAIR MR imaging identifies acute and subacute IVH in the lateral ventricles with high sensitivity and specificity. In cases of subacute IVH, conventional MR imaging complements FLAIR in detecting IVH. The usefulness of the FLAIR technique for detecting third and fourth ventricular IVH may be compromised by artifacts. Blood hemoglobin degradation most likely causes the variable FLAIR appearance of IVH after the first 48 hours.     

颅内非典型海绵状血管瘤的CT和MRI分析

目的提高颅内非典型海绵状血管瘤的CT和MRI正确诊断。方法回顾分析12例颅内非典型海绵状血管瘤的CT和MRI,并与手术病理进行对照。在12例病人中,11例作CT检查,10例作MRI检查,CT和MRI同时检查9例。结果本组12例中,1例位于鞍内,1例位于四脑室内,5例位于脑内,4例位于中颅窝,1例位于后颅窝。出现脑水肿3例、囊变1例,伴脑出血4例。本组定位诊断100%,定性诊断,11例错误,1例未作定性诊断。结论非典型海绵状血管瘤定性诊断较困难,应强调影像学与临床综合分析。     

Evidence for transventricular absorption in the hydrocephalic dog.

Hydrocephalus was induced in 10 mongrel dogs by injection of a silastic mixture into the basal cisterns. The posterior part of the left lateral ventricle was isolated from the remainder of the ventricular system by introducing Pantopaque into both lateral ventricles and the third ventricle with the animals in prone positions. Labeled albumin injected into the posterior part of the left lateral ventricle was shown to enter the blood stream before it was shown in the fourth ventricle or vallecula. This provides qualitative evidence of transventricular absorption.     

Dandy-Walker综合征的MRI诊断(附6例报告)

目的:探讨Dandy-Walker综合征(DWS)的临床及MRI表现特征。方法:对6例经MRI诊断为DWS进行回顾性分析。结果:MRI主要表现为小脑蚓部缺如,小脑半球部分发育不全伴分离、移位;第四脑室囊状扩大与后颅窝囊腔相通;后颅窝扩张伴有横窦、窦汇和小脑幕上移;常伴有幕上不同程度梗阻性脑积水及其他颅内畸形。结论:DWS的MRI表现具有特征性,MRI是诊断DWS的最理想的影像学方法。     

外伤性脑室内出血的CT临床分析

目的：分析外伤性脑室内出血的发生机理、临床特点、ＣＴ表现、并发症及预后。材料与方法：回顾性分析外伤性脑室内出血患者３６例。结果：原发性外伤性脑室内出血２４例，继发性外伤性脑室内出血１２例；单侧侧脑室出血１０例，双侧侧脑室出血７例，双侧侧脑室及三脑室出血４例，单纯四脑室出血２例，全脑室出血１３例。２９例有颅内合并症。结论：ＣＴ检查是诊断该病的首选和必查项目。     

Cranial CT findings in patients with meningomyelocele.

The association between meningomyelocele and various cranial abnormalities, particularly Chiari II malformation is well established. Cranial CT scans in 47 patients with meningomyelocele proved to be a safe and effective method of elucidating the type and extent of anatomic abnormalities associated with this disorder, and evaluating and following the degree of hydrocephalus seen in these patients. Of the 47 patients, 43 (92%) showed CT findings indicative of an abnormally low fourth ventricle, the hallmark finding in Chiari II malformation. In 67% the fourth ventricle was not visualized, and in 25% it was directly visualized in an abnormally caudal position. Other findings included hydrocephalus (85%), a striking and possibly unique heart-shaped psuedomass in the posterior fossa (58%), and abnormal configuration of the lateral ventricles ("vampire bat" configuration). Calvarial abnormalities, in particular lacunar skull, were also noted at CT.