植物状态患者中央丘脑颅内电刺激促醒

1病例报告患者,女,28岁。主诉:电击伤后昏迷1.5年。现病史:患者1年半前,电击导致呼吸心跳骤停,具体时间不详,被人发现后给予心肺复苏,后送至当地医院,给予生命体征支持,气管切开,留置胃管,鼻饲营养,保留尿管及抗炎及神经营养治疗,病情平稳后转入普通病房,但仍持续昏迷。在1.5年的病程中,患者逐渐能够非自主睁闭眼,存在睡眠觉醒周期,逐     

星形胶质细胞转分化为神经元的研究进展

近年来, 转分化技术在干细胞和再生学领域迅速发展, 具有较大的研究价值。研究发现, 随着转分化诱导条件的成熟, 可以改变其他细胞的谱系来获得神经元。并且, 星形胶质细胞 （As） 广泛分布于中枢神经系统的灰质和白质中, 其过度增生会形成胶质纤维瘢痕, 是阻碍神经功能恢复的关键。因此, As 转分化为神经元成为目前研究的热点。As 的转分化既可以阻止胶质瘢痕的形成, 又能获得新的神经元。本文就 As 的功能及其转分化为神经元的相关研究进行综述。     

阿伐曲泊帕联合重组人血小板生成素和阿伐曲泊帕单药治疗慢性肝病相关重度血小板减少症的临床疗效

目的:探讨阿伐曲泊帕联合重组人血小板生成素（rhTPO）和阿伐曲泊帕单药治疗慢性肝病相关重度血小板减少症（TCP）的临床疗效。方法:采用回顾性队列研究方法。收集2020年5月至2021年10月中国科学技术大学附属第一医院收治的56例慢性肝病相关重度TCP患者的临床资料;男36例,女20例;中位年龄54岁,年龄范围为33...     

疏肝养心汤治疗郁病56例

郁病是临床常见病、多发病,多见神经衰弱、癔病、焦虑症、抑郁症和更年期综合征等。笔者自1999～2003年以来,应用疏肝养心汤治疗本病56例,疗效满意,并与单用盐酸多塞平治疗的48例进行对比观察,现报告如下。     

早期亚低温结合后期高压氧治疗重度颅脑创伤的疗效分析

目的:评估早期亚低温结合后期高压氧治疗重度颅脑创伤的疗效。方法:157例急性重度颅脑创伤患者,按住院先后顺序随机分为早期亚低温治疗组(亚低温组,54例)、早期亚低温结合后期高压氧组(亚低温加高压氧组,48例)和常规治疗组(55例)。治疗后3个月根据格拉斯哥预后评分(GOS)标准判定疗效。对于除植物生存和死亡以外的患者,采用Borthel评估患者的日常生活活动能力(ADL)。结果:亚低温加高压氧组的病死率低于常规治疗组,差异有统计学意义(P<0.05)。3组的恢复良好率差异均有统计学意义(P<0.05),亚低温加高压氧组良好率最高。亚低温组和亚低温加高压氧组的ADL评分高于常规治疗组,亚低温加高压氧组的ADL评分高于亚低温组,差异均有统计学意义(P<0.001)。结论:早期应用亚低温治疗急性重型颅脑创伤可降低患者病死率,同时后期给予高压氧治疗可以提高患者恢复良好率,二者结合的疗法是一种较好的颅脑外伤综合治疗措施。     

外伤性癫痫危险因素分析

目的 调查颅脑创伤(TBI)患者外伤性癫痫(PTE)的发生率、发作类型、危险因素及其认知功能等.方法 对我院脑系科中心2004年9月至2007年9月之间好转出院的TBI病例进行回顾性调查和电话随访及回访.纳入资料完整及能随访的患者共2023例.结果 (1)2 023例TBI患者中有98例出现PTE,其发生率为4.84%,高发年龄段为51～70岁和10岁以下.65例(66.32%)患者的PTE发生于外伤后1年以内;(2)TBI病情重、高龄、皮层损伤、蛛网膜下腔出血、多次手术治疗及受伤早期痫性发作均可增加PTE的发病率;(3)PTE 患者认知障碍和性格发生变化的发生率高于非PTE患者(P＜0.05).结论 癫痫发生与TBI严重程度、受伤年龄、损伤部位、影像学表现、治疗方法和伤后临床表现等有关.

Abstract：

Objective The purpose of this study was to investigate the incidence of posttraumatic seizure and epilepsy,the seizure type of epilepsy,risk factors of epilepsy and Recognition function.Methods The TBI cases discharged after the improvement from September 2004 to Septemher 2007 were retrospectively investigated and visited by telephone and 2023 cases was brought into study.Results (1)98 cases suffered PTE and the incidence of PTE was 4.84%;the age of high incidence was 51～70 years old and less than 10 years old. 65 cases(66.32%)occurred in less than one year after trauma.(2)Serious injury,old age,cortical injury,subarachnoid hemorrhage,many surgical treatment and early epileptic seizure after injury would increase the incidence of PTE(P＜0.05).(3)The incidence of cognitive impairment was higher in patients with PTE than non-PTE patients(P＜0.05).Conclusion The risk of posttranmatic seizure and epilepsy is correlation with the severity of TBI,age,injury location,imaging findings,treatment methods and clinical manifestations after injury.     

亚低温对重型颅脑创伤患者血清抗脑抗体含量的影响

目的 研究重型颅脑创伤(sTBI)后患者血清抗脑抗体(ABAb)浓度变化及亚低温治疗对血清ABAb浓度的影响,探讨亚低温脑保护机制.方法 选择80例sTBI住院患者,随机分成常温治疗(NT)组和亚低温治疗(HT)组各40例,分别予以常温治疗和亚低温治疗,于伤后第1、3、5、7、14天采血.用酶联免疫吸附(ELISA)法测定血清ABAb浓度,观察各时间点血清ABAb浓度的变化,分析各时间点两组血清ABAb浓度与格拉斯哥预后评分(GOS)的相关性.另取20例健康体检者作为对照组.结果 (1)所有sTBI患者在伤后各时间点血清ABAb浓度高于正常对照组(P＜0.01).(2)HT组于伤后各时间点血清ABAb浓度低于NT组,且差异有统计学意义(P＜0.01).(3)NT组于伤后各时间点血清ABAb浓度与GOS评分呈负相关,出院时HT组预后也较NT组为佳.结论 HT能够降低sTBI患者血清ABAb含量,具有脑保护作用,其脑保护机制可能与HT能减轻血清ABAb介导的损伤性脑细胞炎性反应有关.

Abstract：

Objective To disclose the Probably protective mechanism of mild hypothermia protecting brain through investigating the contents charges of Antibrain-Antibody(ABAb)in serum in patients with severe traumatic brain injury(sTBI) and the influence of mild hypothermia on serum levels of ABAb.Methods A total of 80 cases with sTBI were treated with normothennia - treated (NT) (NT group, re =40)and mild hypothermia( HT) (HT group, n =40) respectively. ELISA was used to measure serum levels of ABAb. Groups at 1、3、5、7 and 14 days after injury to observe the contents changes of ABAb in serum and the influence of mild hypothermia. Simultaneous analysis two groups at each time point of serum ABAb concentration and Glasgow outcome scale (GOS) of relevance was performed Contrast analysis of clinical prognosis for patients in the two groups was carried out to reveal the protective mechanism of mild hypothermia protecting on patients with sTBL 20 serum specimens of normal persons were used as control group. Results (1) All sTBI patients at each time point after injury, serum ABAb levels were higher than the normal control group ( P ＜0.01). (2) Concentration of antibodies in the serum ABAb levels in HT group at each time point was lower than in NT group( P＜0.01). (3) Concentration of serum ABAb levels in NT group at each time point of injury was negatively correlated with the GOS score; prognosis at discharge in HT group was better than in NT group. Conclusions HT can reduce the serum ABAb levels in sTBI patients, improve the prognosis, have brain protective effect The brain protective mechanisms may be related to the mild hypothermia which reduce the serum ABAb - mediated inflammatory damage on brain cells.     

RAUMDIC双腔脑室外引流管治疗蛛网膜下腔出血的应用研究

目的：探讨RAUMDIC双腔脑室外引流管治疗蛛网膜下腔出血的临床应用研究。方法：入选临床蛛网膜下腔出血患者396例,分为对照组198例,治疗组199例。对照组予以常规药物及单腔脑室外引流管治疗;治疗组给予常规药物及RAUMDIC双腔脑室外引流管治疗,分别观测比较2组患者治疗后1、3、5、7d的脑脊液红细胞计数。统计比较术后14d内患者手术并发症的发生率和颅内感染率;术后7、14d的体温及GCS评分变化。结果：治疗组患者术后脑脊液检验红细胞数较对照组降低明显（P〈0.05）,术后感染率小于对照组（P〈0.05）,手术并发症发生较对照组无差异（P〉0.05）,治疗后患者体温恢复快（P〈0.05）,治疗后14d的GCS昏迷评分较对照组高（P〈0.05）。结论：RAUMDIC双腔脑室引流管较传统单腔脑室引流管提供了更为准确真实的颅内压监测,减少了颅内感染,提高了SAH患者的临床治疗效果。     

MRI-三维重建动态测量颅脑创伤模型大鼠的空腔变化

BACKGROUND: Currently, morphological observations of brain cavity after traumatic brain injury (TBI) via cadavers or animal specimen are difficult to obtain dynamic changes.