颅脑损伤后促红细胞生成素的变化和意义

目的通过制作大鼠急性重型颅脑损伤模型,探讨急性颅脑损伤后促红细胞生成素动态变化的规律及意义,为今后外源性促红细胞生成素治疗颅脑损伤提供理论依据和参考。方法将120只SD大鼠随机分为对照组和颅脑损伤组,每组60只,检测时点为改良Feeney法颅脑损伤模型制作后5h、12h、24h、3d、5d、7d六个时点,在每个时点处死对照组及颅脑损伤组各10只大鼠进行标本制作。采用RT-PCR检测EPO mRNA量,采用免疫荧光法检测阳性细胞数。结果脑损伤组在颅脑损伤后5h开始出现EPO,mRNA及免疫荧光蛋白染色阳性细胞数均在损伤后5d持续升高,在伤后24h至3d达到高峰,5d后出现下降,7d时降至刚损伤后的水平,对照组在各时点mRNA及免疫荧光蛋白染色阳性细胞数均持续表达,无明显的变化趋势。经重复测量方差分析的结果表明,两组EPO mRNA表达量随时间变化的趋势有差异(F=22.368,P<0.01),两组免疫荧光蛋白染色阳性细胞表达量随时间变化的趋势有差异(F=19.324,P<0.01)。结论大鼠急性颅脑损伤后皮质内EPO可出现短暂性的升高,可能对神经系统可以起到保护作用。     

深圳市“无名氏”患者的救治管理

目的分析"无名氏"患者的特点,总结其救治管理经验。方法统计2007年1月～2011年9月深圳市龙岗区六家医院520例"无名氏"患者资料,分析在救治过程中所面临的法律、经费、人员、伦理困境,提出相应的解决策略。结果 "无名氏"患者多因交通意外、治安事件、突发心脑血管病入院,绝大多数为外来农民工,病死率15.23%,残疾率36.18%。结论早期积极的治疗是降低这类患者病死率的关键环节,我们呼吁社会、政府高度重视这一问题。     

脑动静脉畸形出血的诊断和治疗——附26例报告

我科自1995年9月～1999年6月共收治脑动静脉畸形(AVM)出血患者26例,全部行手术治疗,并经病理检查及CT、磁共振血管成像(MRA)、数字减影血管造影(DSA)检查证实AVM及出血.现报告如下.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

微创引流术与开颅术治疗老年高血压脑出血病人疗效及对相关蛋白因子水平的影响

目的比较微创引流术与开颅术治疗老年高血压脑出血病人的疗效及对相关蛋白因子水平的影响。方法选取2015年3月至2017年3月我院收治的年龄60岁的老年高血压脑出血病人100例,随机分为对照组与观察组,每组50例。对照组实施开颅术,观察组实施微创引流术。观察并比较2组病人术后疗效、格拉斯哥预后评分(GOS)、术后血肿残余量及治疗前后Tau蛋白、胶质纤维酸性蛋白(GFAP)、N末端脑钠肽前体(NTpro BNP)水平的变化。结果手术后,对照组治疗总有效率为72. 00%,观察组为92. 00%,2组比较差异有统计学意义(P0. 05)。2组术后GOS评分与术前比较显著升高,术后血肿残余量、Tau蛋白、GFAP及NT-proBNP水平显著降低,差异均有统计学意义(P0. 05);且观察组较对照组改变更明显,组间比较差异有统计学意义(P0. 05)。结论微创引流术治疗老年高血压脑出血,可改善病人生活质量及再出血情况,降低相关蛋白因子水平,显著提高临床疗效。     

内窥镜辅助眶上锁孔入路的技术特点与并发症预防

目的：通过开展的内窥镜辅助下，眶上锁孔入路的手术体会，总结其手术特点及预防并发症的有效措施，促进该技术的广泛开展。方法：10例鞍上区肿瘤，通过该方法肿瘤切除：其中脑膜瘤4例，垂体腺瘤3例，颅咽管瘤2例，生殖细胞瘤1例，肿瘤最大径25-45mm，平均35mm，5例动脉瘤通过该技术行动脉瘤夹闭术，手术切口位于眉部中、外侧，骨穿直径2cm。采用内窥镜铺助的显微外科技术。结果：10例肿瘤均行显微全切除，5例动脉瘤夹闭成功，除1例输血200ml外，余均术中未输血，术后恢复快，只1例术后出现短暂的偏瘫，7例肿瘤，4例动脉瘤近期影像学检查无肿瘤残余；动脉瘤消失。结论：该技术有以下特点：1、皮肤切口小，藏于眉毛中间。2、骨穿直径仅2cm，手术创伤小。3、内窥镜辅助下提高手术准确率。4、以最直接径路达病变，对额部牵拉损伤小，5、手术恢复快，住院期短。6、手术中基本上不输血。     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.