脑血管病介入术后股动脉假性动脉瘤发生率及治疗分析

目的探究临床脑血管病患者行介入术后股动脉假性动脉瘤发生状况及治疗效果,为临床诊疗提供指导意见。方法回顾性选取自2009-02来我院就诊的全部脑血管病介入术患者451例为研究对象,其中合并股动脉假性动脉瘤患者7例,查阅患者的临床病例和影像学检测及治疗情况。结果在所有脑血管病介入术患者中,合并股动脉假性动脉瘤患者7例,发生率为1.55%,4例为全脑血管造影术患者,3例为支架植入术患者,均为医源性股动脉假性动脉瘤患者,2例患者过早下床活动,2例穿刺误入股浅动脉,3例假性动脉瘤患者伴原发性高血压病,均经过多普勒超声诊断,2例患者瘤体直径较小,<2cm,采用徒手局部压迫动脉瘤治疗,1例治愈,痊愈率为50%;6例患者瘤体直径2~3cm,直接采用超声指导下压迫治疗,痊愈率为83.33%;1例患者超声压迫无效,采用在超声引导下经动脉导管注射凝血酶治愈,痊愈率为100%。结论多种原因均可造成股动脉假性动脉瘤,且临床发病率较高,采用超声指导下局部压迫和注射促凝物质效果良好。     

脑血管病介入术后股动脉假性动脉瘤的临床分析及治疗

目的 探讨脑血管病介入术后股动脉假性动脉瘤发生率、发生原因和治疗效果.方法 分析395例脑血管病介入术后发生股动脉假性动脉瘤患者临床资料和治疗情况.结果 共有5例患者发生股动脉假性动脉瘤,发生率1.2%,均为单纯全脑血管造影术患者;1例患者过早下床活动;1例穿刺误入股浅动脉;3例假性动脉瘤患者伴原发性高血压病,其中1例患者术后血压仍然未得到有效控制.5例患者均经超声引导下徒手压迫,4例治愈,1例无效后改用在超声引导下假腔内注射凝血酶治愈.结论 肝素化、过早活动、高血压病、不规范的穿刺技术是脑血管病介入术后股动脉假性动脉瘤产生的危险因素,超声引导下局部压迫和假腔内注射凝血酶是治疗假性动脉瘤的有效措施.     

脑血管支架植入手术治疗缺血性脑血管病48例临床分析

目的探讨脑血管支架植入手术治疗缺血性脑血管病的疗效及并发症处理,以提高临床治疗水平。方法回顾性分析中国人民解放军第六十中心医院收治的48例缺血性脑血管病患者的脑血管病发生风险因素、脑血管病变、脑血管支架植入手术情况、术后并发症处理及预后等指标。结果 48例患者术后血管狭窄减少均在70%以上,术后并发症6例:应激性失明1例,继发性癫痫大发作2例,颈动脉窦反应2例,颅内出血2例;47例患者术后1个月回访均无明显不适症状,15例患者术后0.5~2a行DSA复查:12例支架形态、位置良好,3例出现支架内再狭窄。结论头颅影像学、颈部血管超声、DSA等检查可早期筛查发现脑血管病变,脑血管支架植入及球囊扩张手术可有效缓解脑血管狭窄恢复脑供血,全面的术前评估、严格的围手术期治疗护理以及术后定期复查DSA能有效降低术后并发症的发生。     

经血管内介入栓塞治疗脑动脉瘤破裂68例临床观察

目的观察血管内介入栓塞治疗脑动脉瘤破裂的临床疗效。方法 2013-01—2014-01对经全脑血管造影证实为脑动脉瘤破裂的68例患者行介入栓塞治疗,采用三维血管重建和旋转血管造影技术,用GDC或DCS(铂金弹簧圈)填塞动脉瘤。介入手术均在全麻状态下进行。结果 68例脑动脉瘤患者,血管内介入栓塞术成功65例,成功率达95.6%;3例失败,其中2例患者检查为宽颈动脉瘤。术后因压迫载瘤动脉造成3例偏瘫,占4.41%;死亡1例,占1.47%,为术中动脉瘤破裂大量出血,清除血肿后昏迷死亡。结论经血管内介入栓塞治疗脑动脉瘤破裂治疗成功率很高,临床观察术后创伤小、并发症少,是一种非常安全、有效的微创治疗方法。     

颅内动脉瘤开颅夹闭术后并发症的防治

目的探讨颅内动脉瘤开颅夹闭术后相关并发症的预防及处理。方法分析32例接受颅内动脉瘤夹闭术病人的临床资料和术后并发症,术中术后应用药物对并发症进行预防及处理。结果本组动脉瘤夹闭术后脑血管痉挛13例(40.63%),脑积水2例(6.25%),颅内血肿3例(9.38%),低钠血症11例(34.38%),高钠血症6例(18.75%),低钾血症11例(34.38%),颅内感染2例(6.25%)。结论颅内动脉瘤开颅夹闭术后的并发症主要有:脑血管痉挛、脑积水、颅内血肿、颅内感染、电解质紊乱等,术中操作及术后合理的治疗措施是减少并发症及其危害的关键。     

动脉瘤破裂致蛛网膜下腔出血患者死亡原因分析

目的 探讨动脉瘤破裂致蛛网膜下腔出血患者住院期间死亡的原因并提出相应的对策. 方法 回顾性分析江苏大学附属人民医院神经外科自2003年1月至2010年12月收治且住院期间死亡的24例颅内动脉瘤破裂致自发性蛛网膜下腔出血患者的临床资料和死亡原因.结果 死亡原因分别为:颅内再出血11例,其中术前再出血5例,介入栓塞术中出血3例,栓塞术后颅内再次出血3例;术后脑血管痉挛或脑梗死8例,其中早期(术后3d内)CT表现为脑梗死3例,晚期(术后3d后)脑血管痉挛或脑梗死5例;椎动脉瘤栓塞术后呼吸骤停1例;肺部感染3例;肾功能衰竭1例. 结论 颅内再次出血、脑梗死或脑血管痉挛、非神经系统并发症是动脉瘤性蛛网膜下腔出血患者住院期间主要的死亡原因.     

脑血管造影和介入术后可逆性神经功能障碍的临床分析

目的总结脑血管造影和介入术后可逆性神经功能障碍的诊疗经验。方法回顾性分析405例脑血管造影及介入治疗病人的临床资料。结果术后发生皮质盲2例,肢体肌力下降3例,颈部、头部疼痛5例。10例病人给予扩容、抗凝、脱水、激素和预防癫疒间治疗,症状在48 h内均消失。结论脑血管造影和介入术后的可逆性神经功能障碍预后好,但仍然需严密观察病情、提早预防,避免更严重的并发症发生。     

缺血性脑血管病脑血管造影及介入治疗术后并发症的分析与处理

目的：分析缺血性脑血管病单纯脑血管造影及介入治疗术后并发症原因与处理方法,探讨预防措施。方法2012‐01—2014‐09在郑州大学附属郑州中心医院神经内科完成的缺血性脑血管病全脑血管造影术316例,单纯脑血管造影156例,介入治疗160例,分析其术后并发症的发生情况及处理方法。结果单纯全脑血管造影术后共2例出现并发症,发生率为1.3％,分别为穿刺部位皮下血肿和迷走神经反射各1例;介入治疗组术后出现并发症7例,发生率为4.4％,分别是腹膜后血肿1例,脑血管痉挛1例,缺血性卒中4例（其中包括眼动脉栓塞1例）,皮质盲1例。结论在规范操作的基础上,单纯全脑血管造影术是安全的,并发症较低,但缺血性脑血管病的介入治疗,一定要严格掌握适应证,避免严重并发症的发生。     

手法压迫联合动脉压迫器治疗股动脉穿刺后股动脉假性动脉瘤

目的 探讨手法压迫联合动脉压迫器治疗股动脉穿刺后股动脉假性动脉瘤的效果。方法 回顾性分析21例介入诊疗术后股动脉假性动脉瘤的临床资料,均采用手法压迫联合动脉压迫器治疗。结果 所有病人均一次治疗成功,未发生并发症。21例均因脑血管病进行血管内治疗,术后均需长时间服用硫酸氢氯吡格雷（3个月）+阿司匹林肠溶片（1年）。随访3个月,假性动脉瘤均未复发,治愈率为100%,效果满意。结论 采用手法压迫联合动脉压迫器治疗股动脉穿刺后股动脉假性动脉瘤,操作简便,效果确定。     

颅内动脉瘤血管内栓塞治疗观察与护理

目的总结颅内动脉瘤血管内栓塞治疗观察与护理的经验。方法根据颅内动脉瘤的特点及术后可能出现的并发症,对30例患者完善术前检查,术后加强监护,重点注意股动脉穿刺点的处理,并发症观察与护理。结果30例病人均成功行介入栓塞术,术后2周左右出院,26例无神经功能障碍,3例轻度残疾,1例重度残疾。结论完善颅内动脉瘤血管内栓塞治疗的术前准备,术后加强监护,注意术中、术后并发症的观察与护理,能有效保证治疗效果及病人康复。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.