经腰硬脊膜外腔颅内压监护仪的临床研究

经腰硬脊膜外腔颅内压监护仪的临床研究刘峥窦元元张锡增江艺陈宏颉林坚戴秋生张更生李萍李必军余英豪近年来国内外许多学者（１～７）开展了对硬脊膜外腔压力（ｉｎｔｒａｓｐｉｎａｌｅｐｉｄｕｒａｌｐｒｅｓｓｕｔｒｅ，ＩＳＥＤＰ）的研究，作者采用自制的ＬＮＰ－１...     

脑血管性痴呆局部脑血流的定量分析

目的探讨血管性痴呆的脑循环变化。方法采用单光子发射计算机断层显像（ＳＰＥＣＴ），９９ｍ－ＥＣＤ标记，定量测定血管性痴呆（ＶＤ）、多发性脑梗塞（ＭＩ）及正常老年人各１０例的局部脑血流量。结果ＶＤ组各脑叶及基底节区平均脑血流量均显著低于对照组（Ｐ＜０．０１）；ＶＤ组比ＭＩ组额颞叶皮质血流量明显减少（Ｐ＜０．０１，Ｐ＜０．０５）；ＶＤ额叶皮质脑血流量改变与神经心理测试ＭＭＳＥ呈正相关（ｒ＝０．６９２，Ｐ＜０．０５）。结论ＶＤ存在全脑广泛的脑血流灌注降低。额叶皮质血流灌注降低与痴呆的发生及痴呆的严重程度密切相关。ＳＰＥＣＴ局部脑血流定量测定对于ＶＤ的预测及早期发现有重要意义     

椎—基底动脉供血不足的SPECT与临床

本文对８０例椎－基底动脉供血不足（ＶＢＩ）患者及６０例健康对照组进行＾９９ｍＴｃ－ＥＣＤ－ＳＰＥＣＴ检查，ＳＰＥＣＴ诊断ＶＢＩ的灵敏性为７３．８％，特异性为７８．３％，总符合率为７５．７％，５９例ＳＰＥＣＴ阳性者，出现相应临床症状者４３例（７２．９％），ＶＢＩ组缺血灶的缺血程度较对照明显（Ｐ〈０．０１）。８０例ＶＢＩ患者均在距ＶＢＩ最后一次发作１６ｄ内进行ＳＰＥＣＴ检查，３ｄ以内与４ｄ后检查的两组     

高血压合并急性脑血管病的心率变异分析

目的：探讨急性脑组织损害对原发性高血压（ＥＨ）患者心率变异（ＨＲＶ）的影响。方法：对２６例ＥＨ并急性脑血管病（ＡＣＶＤ）患者进行２４ｈ动态心电图ＨＲＶ测定,并与２０例ＥＨ元ＡＣＶＤ患者进行对比。结果：ＥＨ并ＡＣＶＤ组最小心率及平均心率明显高于无ＡＣＶＤ组（Ｐ〈０．０１;Ｐ〈０．０１）;２４ｈ相邻Ｒ－Ｒ间期之差的均方根（ｒＭＳＳＤ）、相邻Ｒ－Ｒ间期之差大于５０ｍｓ的心搏数占心搏总数的百分比（ＰＮＮ５     

实验性颅内压增高的低温保护效应

一、实验材料与方法大耳白兔１０只，雌雄不限；体重２．５－３．ｏｋｇＺ随机分为两组，常温组（脑温控制在３７．５℃－３８．０℃）５只；亚低温组（脑温控制在３０．ｏｔ－３１．０℃）５只。置人颅内压探头于硬膜外间隙，颅内压监护仪为ＰｒｉｎｃｅｔｏｎＳＰ２０００，于右颈部钻孔，放人可膨胀性球囊，注液管经ｆａｌ：）Ｉ７ｌｌｅｋ３０３０输液泵控制，同时于球囊对测置脑温探头，持续监测脑温，肛温，心电图。监护仪为Ｍｉｎｉｍｏｎ７１３７Ｂ，所有骨孔用松香封闭，持续监测颅内压。亚低温设置采用北京产ＫＮ－ｏｆ冰毯机降温…     

椎－基底动脉供血不足的SPECT与临床

本文对８０例椎—基底动脉供血不足（ＶＢＩ）患者及６０例健康对照组进行￣（９９ｍ）Ｔｃ—ＥＣＤ—ＳＰＥＣＴ检查，ＳＰＥＣＴ诊断ＶＢＩ的灵敏性为７３，８％，特异性为７８．３％，总符合率为７５．７％。５９例ＳＰＥＣＴ阳性者，出现相应临床症状者４３例（７２．９％）。ＶＢＩ组缺血灶的缺血程度较对照组明显（Ｐ＜０．０１）。８０例ＶＢＩ患者均在距ＶＢＩ最后一次发作１６ｄ内进行ＳＰＥＣＴ检查，３ｄ以内与４ｄ后检查的两组阳性率相差不明显（Ｐ＞０．０５）。     

帕金森病病人的异常视网膜电图

目的探讨帕金森病（ＰＤ）病人视网膜的电生理改变，以期对ＰＤ诊断有所帮助。方法根据国际临床视觉电生理协会（ＩＳＣＥＶ）制定的标准化方案。对８２例帕金森病病人及４２名健康对照组进行视网膜电图（ｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ，ＥＲＧ）检查。结果（１）ＰＤ组的ＥＲＧ的ｂ波波幅比对照组低（Ｐ＜０．０１），且波形不规则。（２）ＰＤ病人ＥＲＧ的ｂ波波幅和统一帕金森病量表（ＵＰＤＲＳ）评分呈负相关（Ｐ＜０．０１）。（３）ＰＤ病人常规服药后和停药１天相比ＥＲＧ的ｂ波波幅差异不明显（Ｐ＞０．５），但ＵＰＤＲＳ评分两组差异有显著性意义（Ｐ＜０．０１）。结论ＥＲＧ作为一种眼电生理检查，可客观地反映ＰＤ病人由于视网膜内多巴胺（ＤＡ）变化所致的视网膜电生理改变，且具有较好的稳定性，对ＰＤ的诊断有一定的意义。     

高血压合并急性离出血管病的心率变异性改变

对原发性高血压（ＥＨ）合并急性脑血管病（ＡＣＶＤ）患者３０例进行２４小时动态心电图心率变异性（ＨＲＶ）测定，并与３０例无ＡＣＶＤ的ＥＨ患者进行对比。结果显示，合并ＡＣＶＤ组最小心率及平均心率明显高于对照组（Ｐ〈０．０１、〈０．００１）；ＳＤＮＮ、ｒＭＳＳＤ、ＰＮＮ５０比对照组明显减低（Ｐ〈０．００１、〈０．０１、〈０．００１）。提示合并ＡＣＶＤ的ＥＨ患者ＨＲＶ减低，其主要原因可能是自主神经中枢损害     

高血压合并急性脑血管病的心率变异性改变

对原发性高血压（ＥＨ）合并急性脑血管病（ＡＣＶＤ）患者３０例进行２４小时动态心电图心率变异性（ＨＲＶ）测定，并与３０例无ＡＣＶＤ的ＥＨ患者进行对比。结果显示，合并ＡＣＶＤ组最小心率及平均心率明显高于对照组（Ｐ＜０．０１、＜０．００１）；ＳＤＮＮ、ｒＭＳＳＤ、ＰＮＮ５０比对照组明显减低（Ｐ＜０．００１、＜０．０１、＜０．００１）。提示合并ＡＣＶＤ的ＥＨ患者ＨＲＶ减低，其主要原因可能是自主神经中枢损害。     

Wilson病患者血清氧化物和抗氧化物水平与内脏损伤的关系

目的 探讨Ｗｉｌｓｏｎ病（ＷＤ）患者血清氧化物和抗氧化物水平与内脏损伤的关系。方法 应用化学比色法和反相高效液相色谱法（ＲＰ－ＨＰＬＣ）测定２９例ＷＤ患者和２１名正常人血清丙二醛（ＭＤＡ）、谷胱甘肽过氧化物酶（ＧＳＨ－ＰＸ）、谷胱甘肽（ＧＳＨ）和维生素Ｅ（ＶｉｔＥ）的水平。结果 ＷＤ组与对照组相比ＭＤＡ显著增高（Ｐ〈０．０１）,ＧＳＨ－ＰＸ显著下降（Ｐ〈０．０１）。且两者呈负相关;血清ＶｉｔＥ和ＧＳＨ在肝型ＷＤ患者显著减少（分别Ｐ〈０．０１和Ｐ〈０．０５）。非肝型患者与对照组比,差别无显著性（Ｐ〉０．０５）。结论 ＷＤ患者轿清中存在着自由基系统的代谢紊乱,氧化物水平升高,抗氧化物水平下降,这可能是该病患者内脏损伤的重要原因之一。     

Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalus

Eide PK, Park E‐H, Madsen JR. Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalus.
Acta Neurol Scand: 2010: 122: 262–269.
© 2010 John Wiley & Sons A/S. Objective – To characterize the association between arterial blood pressure (ABP) and intracranial pressure (ICP) in idiopathic normal pressure hydrocephalus (iNPH) patients, and its impact on outcome of shunt surgery. Materials and methods – We analyzed all 35 iNPH patients whose ABP and ICP were recorded simultaneously during 6 years (2002–2007). The static and pulsatile pressures were averaged over consecutive 6‐s intervals; the moving correlations between ICP and ABP (static and pulsatile) were determined during consecutive 4‐min periods to explore time‐related variations. Results – Neither static nor pulsatile ABP were altered in iNPH shunt responders. Elevated pulsatile ICP, but normal static ICP, was seen in responders. The time‐varying correlations of static and of pulsatile pressures were generally low, and did not differ between shunt responders/non‐responders. Conclusions – In iNPH shunt responders, static or pulsatile ABP were not altered and only pulsatile ICP was elevated.     

颅高压时脑脊液脉动压与脑灌注压相互关系的实验研究

目的　研究颅高压时脑脊液脉动压与脑灌注压的相互变化关系。方法　 14条狗安置硬膜外球囊并注液制成颅高压模型。通过改变球囊内液体量改变颅高压程度和颅内容积。通过压力传感器持续记录脑室内压力、腰椎管内压力及体动脉压。结果　随着颅内压的持续增高 ,脑灌注压逐渐下降 ,脑脊液脉动压相应增高。脑脊液脉动压与颅内压的变化趋势呈现正性线性关系 (r=0 732 2 ,P <0 0 5 ) ,而与脑灌注压的变化趋势呈现负性线性关系 (r=- 0 6 879,P <0 0 5 )。结论　在实验性颅高压中 ,脑脊液脉动压随着脑灌注压的下降而增大 ,两者间呈现负性线性关系。在脑血管自动调节机制受损的情况下 ,脑脊液脉动压的变化可能提供脑血流量改变的信息。     

腔隙性脑梗死与脉压和脉压指数之间的关系

目的探讨腔隙性脑梗死与脉压和脉压指数之间的关系。方法回顾性分析我院2013-01—12收治的126例高血压患者的临床资料,根据头部CT和MRI检查结果或据MRI检查结果将62例腔隙性脑梗死患者作为观察组,将64例非腔隙性脑梗死组作为对照组,2组患者实施24h动态血压监测。结果观察组的脉压、脉压指数(PPI)和收缩压(SBP)均比对照组升高明显(P0.05)。结论腔隙性脑梗死与脉压、脉压指数及收缩压升高有关,控制血压可以预防腔隙性脑梗死的发生。     

Intracranial pressure B-waves precede corresponding arterial blood pressure oscillations in patients with suspected normal pressure hydrocephalus

Abstract

B-waves are rhythmic oscillations of intracranial pressure (ICP) with a wavelength of 0.5-2 min. These oscillations are accompanied by corresponding fluctuations of arterial blood pressure (BP). There is controversy in the literature whether the ICP oscillations precede or follow the BP oscillations. This relationship, however, is important for the understanding of the origin and the interactions of ICP B-waves with other parameters. ICP and BP were monitored continuously for one night in nine patients with suspected symptomatic normal pressure hydrocephalus (NPH). Forty-five B-waves were identified and the time delays between the peaks and the onsets of B-waves and their BP-equivalents were measured. The mean (± standard deviation) of the time delays between the peaks of ICP B-waves and corresponding BP-oscillations was 4.2 ±2.4 sec and between the onsets of the oscillations 7 0.3 ±6.6 sec. In all but two B-waves, the ICP peak preceded the BP peak, in all the 45 B-waves the onset of the ICP increase preceded the BP increase (p < 0.004). Our study demonstrates that ICP B-waves precede concomitant changes in BP by several seconds. [Neurol Res 1999; 21: 627-630]     

Morphological quantitative analysis of intracranial pressure waves in normal pressure hydrocephalus

Abstract

This work presents a prospective morphological and quantitative analysis of 43 intracranial pressure recordings performed on normal pressure hydrocephalic patients. This analysis led us to separate Lundberg's B waves into different subtypes and to refine the definition of the ‘Plateau’ wave. Two B wave subtypes named Great Symmetrical wave and Intermediate wave appeared correlated with the surgical improvement. In additioni, the degree of post-operative improvement was correlated with the frequency of Intermediate wave. An extended quantitative classification of intracranial pressure waves is proposed that can be used alone to determine which patients should undergo a shunting procedure and which one should the most improve.     

颅脑损伤患者眼内压对颅内压的预测效果

目的探索一种可间接监测颅脑损伤患者颅内压(ICP)变化趋势的无创性方法。方法腰穿测量ICP,同时采用无创性压陷式眼压计测量眼内压(IOP),统计学分析ICP与IOP之间的关系。结果IOP与ICP呈显著正相关关系,相关系数r=0.871(P<0.001)。结论连续监测IOP可间接判断ICP的变化,因此,连续监测IOP可作为一种无创性监测颅内压的简单方法。     

脑组织氧分压脑灌注压及颅内压对重型颅脑创伤患者预后的影响

目的探讨脑组织氧分压、脑灌注压及颅内压对重型颅脑创伤患者预后的影响。方法观察112例重型颅脑损伤病人脑灌注压（CCP）、颅内压（ICP）、脑组织氧分压（PbtO2）的变化,比较CCP、ICP、PbtO2与预后的相互关系。结果 PbtO2（24h及72h）与预后有显著性相关,随着PbtO2的升高,预后良好的比例明显升高。ICP（24h及72h）与预后显著相关,随着ICP的升高,预后良好的比例明显下降。CCP（24h及72h）与预后有显著性相关,随着CCP的升高,预后良好的比例明显升高。结论 PbtO2、ICP、CPP与预后均有显著相关性,24h及72h的CCP、ICP对预后有显著影响。     

Evaluation of the auto continuous positive airway pressure efficacy by upper airway pressure measurement

The efficacy of auto continuous positive airway pressure (CPAP) was prospectively evaluated in 11 obstructive sleep apnea cases by the upper airway pressure measurement. Their apnea plus hypopnea index decreased from 68.3+/-20.2/h to 0.5+/-0.9/h during manually adjusted and 9.6+/-14.5/h during auto CPAP The intraesophageal pressure decreased from -88.0+/-34.0 cm H2O to 11.9+/-7.2 cm H2O during manually adjusted and -26.0+/-13.7 cm H2O during auto CPAP. The manually adjusted CPAP level was 9.1+/-1.7 cm H2O and the maximum pressure of the auto CPAP was 9.4+/-2.0 cm H2O. Auto CPAP could automatically detect the optimal CPAP level. However, the efficacy of the auto CPAP was less than that of the manually adjusted CPAP.     

尼卡地平对气管拔管心血管反应、颅内压以及脑灌注压的影响

目的观察拔管前单次静脉注射两种剂量的尼卡地平(0.01,0.02 mg*kg-1)对拔管心血管反应、颅内压(ICP)、脑灌注压(CPP)的影响.方法选择30例择期行经蝶垂体腺瘤切除术患者,于术毕患者清醒,拔管前2 min随机分为静注尼卡地平0.01 mg·kg-1组(N1),0.02 mg·kg-1组(N2组)组以及对照组注射生理盐水(N0组),观察拔管后1～10 min心率,动脉血氧饱和度(SaO2),平均动脉压(MAP),颅内压(ICP)以及脑灌注压(CPP)的变化及副反应.结果拔管后N0组患者MAP显著高于N1组(P<0.05),N2组(P<0.05).N0组患者高血压发生率为60%,N1组为30%,N2组为20%;3组心动过速发生率相似为70%;N1、N2组低血压发生率分别为20%、30%,N0组无一例发生.N1、N2组ICP、CPP与N0组比较无明显变化(P>0.05).结论单次静脉注射尼卡地平0.01～0.02 mg*kg-1可预防全麻患者清醒后气管拔管心血管反应,安全有效,且对ICP、CPP影响较轻.     

The relationship of intracranial venous pressure to hydrocephalus

Little is known about intracranial venous pressure in hydrocephalus. Recently, we reported that naturally occurring hydrocephalus in Beagle dogs was associated with an elevation in cortical venous pressure. We proposed that the normal pathway for cerebrospinal fluid (CSF) absorption includes transcapillary or transvenular absorption of CSF from the interstitial space and that the increase in cortical venous pressure is an initial event resulting in decreased absorption and subsequent hydrocephalus. Further analysis, however, suggests that increased cortical venous pressure reflects the effect of the failure of transvillus absorption with increase in CSF pressure on the venous pressure gradient between ventricle and cortex. Normally, the cortical venous pressure is maintained above CSF pressure by the Starling resistor effect of the lateral lacunae. A similar mechanism is absent in the deep venous system, and thus the pressure in the deep veins is similar to that in the dural sinuses. Decreased CSF absorption causes an increase in CSF pressure followed by an increase in cortical venous pressure without a similar increase in periventricular venous pressure. The periventricular CSF to venous (transparenchymal) pressure (TPP) gradient increases. In contrast, cortical vein pressure remains greater than CSF pressure (negative TPP). The elevated periventricular TPP gradient causes ventricular dilatation and decreased periventricular cerebral blood flow (CBF), a condition that persists even if the CSF pressure returns to normal, particularly if tissue elastance is lessened by tissue damage. If deep CBF is to be maintained, periventricular venous pressure must increase. Since the veins are in a continuum, cortical venous pressure will further increase above the CSF pressure. Understanding these principles related to intracranial venous pressure helps in the selection of shunt characteristics that best match the pathologic condition.Presented at the Consensus Conference: Hydrocephalus '92, Assisi, Italy, 26–30 April 1992