对脑出血周边组织存在缺血性损害的再认识

脑出血后 ,在周围组织的继发性损伤中是否存在脑缺血是近年来研究的热点 ,文章就脑出血后局部是否存在脑缺血、局部脑血流和代谢的变化及其可能机制进行了综述 ,希望能为进一步的研究和临床治疗提供依据。     

对脑出血周边组织存在缺血性损害的再认识

脑出血后,在周围组织的继发性损伤中是否存在脑缺血是近年来研究的热点。文章就脑出血后局部是否存在脑缺血、局部脑血流和代谢的变化及其可能机制进行了综述。希望能为进一步的研究和临床治疗提供依据。     

出血性脑梗塞的发生及其机制研究进展

随着脑梗塞溶栓治疗的广泛开展,出血性脑梗塞(HI)再次受到重视。文章对其自然发生率、抗凝和溶栓治疗引起的HI发生率及其发生机制予以综述。     

临床-弥散加权成像不匹配在急性大脑中动脉闭塞患者动脉溶栓中的应用

目的 研究临床-弥散加权不匹配(clinical-diffusion mismatch,CDM)机制在急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)患者动脉溶栓治疗中的作用,分析CDM机制预测缺血半暗带的可行性.方法 选择发病在6h内经磁共振血管成像(magnetic resonance angiography,MRA)检查证实为MCAO的急性脑梗死患者106例,其中动脉溶栓组36例,常规治疗组70例,依据CDM定义:美国国立卫生研究院卒中量表评分(NIHSS)≥8分,弥散加权成像(DWI)病灶体积≤25 ml,再将两组各分为CDM亚组和非CDM亚组,对各亚组发病14 d后T2加权成像(T2weighted imaging,T2WI)梗死体积、30 d及3个月NIHSS评分进行对比观察.结果 动脉溶栓组中,CDM亚组(n=15) NIHSS评分在病程30 d、3个月均低于非CDM亚组(n=21,3.20±2.40与6.76±4.00,t=-3.330,P=0.002;2.20±1.70与6.05±4.06,t=3.895,P=0.001);非动脉溶栓组中,CDM亚组(n=23) NIHSS评分在病程30 d、3个月与非CDM亚组(n=47)比较差异均无统计学意义(5.22±2.95与5.66±3.21,t=- 1.756,P =0.084;4.34±2.53与5.34±3.42,t=1.234,P=0.353);虽然存在CDM,接受溶栓者与不接受溶栓者的NIHSS评分在30 d、3个月差异均有统计学意义(3.20±2.40与5.22±2.95,t=-2.210,P=0.034;2.20±1.70与4.34 ±2.53,t=-3.128,P=0.003),反之,不符合CDM的患者接受与不接受溶栓治疗,NIHSS评分在30 d与3个月时差异均无统计学意义.入院14d后CDM患者中溶栓组T2WI显示的梗死体积明显小于非溶栓组[(6.29±4.41) ml与(60.25±49.23) ml,Z=-4.848,P=0.001].结论 CDM机制对于确定急性MCAO脑梗死缺血半暗带的存在有一定意义,对指导急性MCAO脑梗死的动脉溶栓治疗可能有一定价值.     

症状性大脑中动脉狭窄率与组织灌注的相关性

目的 应用单一症状性M1段狭窄模型定量分析症状性大脑中动脉狭窄率与组织灌注的相关性.方法 从连续203例症状性颅内动脉狭窄选择性支架成形术患者中严格筛选所有单一M1段狭窄患者.所有患者均进行头颅CT、CT灌注(CTP)和DSA检查.根据CTP检查结果,测量两侧从前往后包括额叶、前分水岭、岛盖、颞叶、后分水岭和枕叶的各脑区CTP各参数.CTP参数包括平均通过时间(MTT)、脑血流量(CBF)和脑血容量(CBV).以健侧作为正常对照,计算患侧各脑区CTP参数相对值和判定患侧各脑区CTP各参数变化.根据DSA造影结果,肓法手工测量M1段狭窄率和判断侧支代偿动脉来源及侧支血流分级.对M1段狭窄率与患侧各脑区CTP各参数绝对值、相对值进行相关性分析.结果 20例患者入组,患侧M1段狭窄率平均为70.5%±10.6%(53%～91%).以对侧为对照,患侧额叶MTT正常,CBF正常,CBV升高;前分水岭MTT延长,CBF正常,CBV升高;岛盖MTT延长,CBF正常,CBV升高;颞叶MTT延长,CBF正常,CBV正常;后分水岭MTT延长,CBF下降,CBV正常;枕叶MTT正常,CBF正常,CBV正常.狭窄M1段供血相关脑区,从前往后各脑区血流灌注逐渐减低;而后分水岭是惟一处于血流失代偿期的脑区.所有患者DSA显示侧支代偿均主要来自大脑前动脉软脑膜支.M1段狭窄率与后分水岭区相对CBV正相关(r=0.66,P=0.002);与其余各脑区各CTP灌注参数均没有相关性.结论 症状性大脑中动脉狭窄患侧各脑区组织灌注水平受侧支代偿动脉的影响有明显空间分布效应;M1段狭窄率与血流失代偿期脑区相对CBV呈正相关,与血流代偿期脑区组织灌注没有相关性.

Abstract：

Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.     

右侧胸腔巨大神经纤维瘤囊性变一例报告

我院遇到右侧胸腔巨大神经纤维瘤囊性变一例,报导如下: 患者女性,45岁,已婚,职业家务。自诉右侧胸背部、右肩关节及前臂疼痛,右臂活动受限伴胸闷,气急惑4月余而就诊,患者否认有既往相似病史。体检:病人一般情况尚好。体温、血压、心率正     

主动脉弓上MRA检查对缺血性脑血管病的意义

目的 评价主动脉弓上TOF MRA检查对缺血性脑血管病的诊断、治疗及预防的价值.方法 回顾性分析该科诊治的缺血性脑血管病200例患者的头颈MRI+MRA加主动脉弓MRA联合扫描(以下简称主动脉弓上MRA)资料.结果 61例患者血管未见异常,7例仅发现一侧椎动脉细小,其余132例患者发现299处血管狭窄闭塞.颅外血管狭窄占33.4%(100/299),颅内血管狭窄占66.6%(199/299);发现颈动脉系统病变占67.6%(202/299),椎基底动脉系统病变占32.4%(97/299);血管闭塞或重度狭窄率高,约43.1%(129/299);发现无症状动脉瘤3例.结论 主动脉弓上MRA可以及时发现脑血管狭窄,特别是及时发现颅外段严重病变,为诊断治疗及预防提供指导.     

MRI在脑出血研究中的应用

传统观点认为,MRI不能对超早期脑出血做出正确的诊断,因此不适于脑出血的临床和实验研究。文章对近年来发展较快的功能性MRI和快速成像技术对超早期脑出血的诊断价值、血肿周围组织损伤机制等方面的研究进行了综述。     

医院药房柜台式服务浅探

随着社会的发展，传统的医院药房服务模式正在发生变化。患者希望能更多的了解所用药品的情况，有更多的机会选择所使用的药物和得到更多的咨询服务。我院作为一所综合性的二级甲等医院，有350张床位，在医院管理年中为了将“以病人为中心”的服务理念落到实处，建立了集门诊药房、住院药房和中药房为一体的占地400平方米的开放柜台式便民大药房。[第一段]