影响重型和特重型颅脑伤合并颞叶钩回疝病人预后的因素分析（附129例报告）

通过129例重型和特重型颅脑伤合并颞叶钩回疝病人临床回顾性调查分析,发现患者的年龄、伤情、合并脑挫裂伤、高热、高糖血症、低氧血症、颅内高压等是影响病人预后的主要原因。有效地控制和纠正重型颅脑伤病人高热、高糖血症、低氧血症、颅内高压是提高重型颅脑伤病人疗效的关键。     

深低温对全脑缺血大鼠海马即早基因组表达的影响

目的筛选出深低温对全脑缺血大鼠海马影响的即早差异表达基因。方法建立大鼠体外循环模型，实验分成两组，常温缺血组（n=3）：常温条件下停循环全脑缺血5min；低温缺血组（n=3）：深低温条件下停循环全脑缺血5min。采用Affymetrix大鼠全基因组芯片检测两组动物海马基因表达的变化，获取差异表达基因。结果筛选出差异表达基因共有75个，其中39个基因表达有统计学意义（P〈0．01），上调33个，下调42个。结论深低温对全脑缺血大鼠海马即早基因表达有明显影响，这些差异表达基因可能与深低温脑保护作用相关。     

外伤性脑室内出血

外伤性脑室内出血(IVH)多伴有严重脑损伤,死亡率高。我院1984年4月至1992年5月收治10例,占同期重型颅脑外伤814例的1.2％。本文复习文献,对外伤性IVH的有关问题进行了讨论。     

282例颅脑伤病人死亡原因分析

目的:明确造成颅脑伤病人死亡原因,为提高颅脑伤病人治疗效果提供依据。方法:对282例颅脑伤死亡病人作回顾性调查分析。结果:282例中,车祸(49.6％)、坠落伤(24.8％)、跌伤(19.5％)是导致颅脑伤的最常见原因。严重脑挫裂伤、脑水肿、脑肿胀所致的颅内高压(41.5％)、脑干伤(28.4％)和肺部并发症(15.2％)是导致颅脑伤死亡的最常见因素。结论:寻找行之有效的控制创伤后颅内高压,防治肺部并发症是降低颅脑伤病人死亡率的关键。     

颅内表皮样囊肿19例报告

颅内表皮样囊肿１９例报告梁玉敏，卢亦成，张光霁，杨中坚朱诚，白如林，丁学华我院１９７８年１月一１９９５年１月手术治疗颅内表皮样囊肿１９例，现报告如下：临床资料本组男１４例，女５例，年龄：２３－５３岁，平均３９．６岁；发病至就诊时间：１个月一６年，平均...     

儿童外伤性后颅窝硬脑膜外血肿

目的 探讨儿童后颅窝硬脑膜外血肿的特点.方法 对28例儿童外伤性后颅窝硬脑膜外血肿进行回顾性总结.结果 28例均有枕骨骨折或者颅骨骨缝分离,头痛和频繁呕吐是突出的临床症状.22例手术治疗,6例非手术治疗,均痊愈出院.结论 早期诊断和及时处置,是救治儿童外伤性后颅窝硬脑膜外血肿的关键.     

人纤维蛋白黏合剂在显微神经外科手术中的应用

目的探讨人纤维蛋白黏合剂在显微神经外科手术中的实际应用方法,提高手术疗效及减少术后并发症.方法对2004年1～6月间我们在10例显微神经外科手术中应用人纤维蛋白黏合剂(HFG)进行回顾性研究.结果 (1)用于脑部手术创面止血效果好.(2)术中静脉窦出血,用明胶海绵或止血纱布压迫后加用HFG,止血效果佳.(3)开颅手术中用HFG覆盖硬脑膜,术后第1天,平均引流量明显减少,降低了术后脑脊液漏的发生.(4)用HFG加自体骨碎片作颅骨成形术,效果满意.(5)血管显微吻合术中使用HFG,可减少缝合针数,预防吻合口渗漏.(6)经蝶手术中使用HFG,可止血利于手术进行,另可行鞍底重建防治术后脑脊液漏.结论人纤维蛋白黏合剂在显微神经外科手术中应用广泛,其使用简便、安全、可靠,提高了手术疗效并减少了术后并发症.     

脑膜瘤卒中误诊为单纯脑出血1例

脑膜瘤以出血发病者非常少见,容易造成误诊.作者收治1例,结合文献报告如下.     

创伤性进展性后颅窝双侧硬脑膜外血肿一例报道

文章报道1例创伤性进展性后颅窝双侧硬脑膜外血肿病例.伤后1 h首次CT扫描示枕骨线形骨折伴薄层硬脑膜外血肿;于伤后14 h经再次CT检查确诊为后颅窝双侧跨幕上下进展性硬脑膜外血肿并引起梗阻性脑积水.病程中患者仅表现出头痛而无明显异常体征.急诊枕部旁正中切口入路手术清除血肿后,脑积水消失,患者恢复良好.文章结合文献,对该病例的相关问题进行探讨.     

脑室-腹腔分流术中分流管腹腔端无需特殊处理

Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial (V -A) shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method. The peritoneal catheter will located in pelvic cavity at the 1st day after shunt in vast majority. There is no special management for peritoneal catheter in V - P shunt in required.