颅内破裂动脉瘤介入栓塞患者早期预后相关因素分析

目的分析影响血管内介入栓塞治疗颅内破裂动脉瘤患者早期预后的重要相关因素。 方法收集右江民族医学院附属医院神经内外科疾病治疗中心自2014年1月到2018年6月收治的180例行血管内介入栓塞治疗的颅内破裂动脉瘤患者的临床资料,根据患者发病后1个月的改良Rankin量表评分,分成预后良好组（0~2分）和预后不良组（3~6分）,通过单因素分析和多因素Logistic回归分析,筛选出影响患者预后不良的独立危险因素。 结果经单因素和多因素Logistic回归分析显示,入院时世界神经外科联盟分级（WFNSS）分型（OR=11.017,95%CI：4.153~29.229）、脑梗死（OR=10.325,95%CI：2.060~51.740）、手术中并发症（OR=6.917,95%CI：1.493~32.052）、急性梗阻性脑积水（OR=6.685,95%CI：2.171~20.587）是患者1个月预后不良的独立危险因素。受试者工作特征曲线的曲线下面积显示：急性梗阻性脑积水0.768（95%CI：0.689~0.846）、入院时WFNSS分型0.741（95%CI：0.661~0.821）、脑梗死0.658（95%CI：0.571~0.746）、手术中并发症0.609（95%CI：0.520~0.698）。 结论患者入院时的WFNSS在患者预后的因素中占主要地位,脑梗死是影响预后最主要的独立危险因素,临床治疗的关注点应该在如何减少栓塞术后再出血、脑梗死、脑积水等并发症,降低患者的死亡率和致残率,改善患者的预后。     

自制腹腔穿刺置管针在脑室-腹腔分流术中辅助应用临床研究

采用自制腹腔穿刺置管针对36例脑积水患者施行脑室-腹腔分流术,通过计算穿刺置管时间,评价腹腔穿刺置管成功率和安全性。结果显示,置管成功率达100%、平均穿刺置管时间5 min,术中无一例出现腹腔内出血或脏器损伤。表明腹腔穿刺置管针应用于脑室-腹腔分流术操作简单、安全、微创、手术成功率高、并发症少,易于推广。     

神经内镜手术和显微手术治疗幕上高血压性脑出血疗效的Meta分析

目的 比较神经内镜手术与显微手术治疗幕上高血压性脑出血的疗效及安全性。方法 计算机检索PubMed、Medline、EMbase、Cochrane等英文数据库及CNKI、万方、维普等中文数据库,搜集1997年1月至2017年6月关于对比神经内镜手术与显微手术治疗幕上高血压性脑出血的研究,使用Rev Man 5.1软件进行Meta分析。结果 共纳入3篇随机对照研究和10篇病例对照研究,1 163例中神经内镜组570例,显微手术组593例。Meta分析结果显示,神经内镜手术治疗幕上高血压性脑出血血肿清除率高,手术时间及住院时间短,术中失血少,病死率及并发症发生率低（P<0.05）。结论 神经内镜手术治疗幕上高血压性脑出血的安全性及有效性均高于显微手术。     

脑干听觉诱发电位分级对脑创伤长期意识障碍患者清醒预测的价值

目的 探讨脑干听觉诱发电位(BAEP)分级标准对脑创伤后长期意识障碍患者清醒预测的价值.方法 分析93例脑创伤后长期意识障碍患者的BAEP表现,将BAEP分为3级:Ⅰ级为各波均正常;Ⅲ级为双侧V波PL异常、双侧Ⅲ～Ⅴ波IPL异常、单侧或双侧V波消失;Ⅱ级为除Ⅲ级之外的任何异常BAEP表现.以脑创伤后6个月作为判断是否清醒的时间标准.结果 Ⅰ级、Ⅱ级、Ⅲ级的清醒率分别为:79％、18％和0％.分级与清醒差异有统计学意义(r=-0.662,P＜0.001),分级越高,清醒越困难.BAEP分级标准对清醒预测的ROC曲线下面积为0.859,95％可信区间为(0.781～0.937).结论 BAEP分级能客观、准确地反映脑功能损伤程度和预测清醒的概率.     

重型颅脑外伤后长期意识障碍患者清醒预测的体感诱发电位分级研究

目的 探讨体感诱发电位(SEP)对重型颅脑外伤(TBI)后长期意识障碍患者清醒预测的分级标准. 方法 记录46例重度TBI后意识障碍超过1周患者的SEP表现,根据SEP中N20-P25是否存在及中枢传导时间(CCT)是否正常,将SEP分为3级:Ⅰ级为双侧N20-P25都存在(Ⅰa:双侧CCT正常且对称,Ⅰb:双侧CCT正常,但不对称);Ⅱ级为一侧N20-P25存在,另一侧消失;Ⅲ级为双侧N20-P25都消失.预后以外伤后6个月患者是否清醒为标准. 结果 SEP分级与清醒的几率存在负相关关系(r=-0.591,P=0.000),分级越高,预后越差. 结论 SEP的分级可客观、准确地反映脑功能损伤程度和清醒的几率.     

脑创伤后长期意识障碍患者脑干听觉诱发电位表现与预后清醒的关系

目的 探讨重型创伤性颅脑损伤(TBI)后长期意识障碍患者脑干听觉诱发电位(BAEP)表现与预后清醒的关系.方法 分析63例重型TBI后意识障碍超过2周患者的BAEP表现,主要为BAEP中Ⅰ、Ⅲ、Ⅴ波各波峰潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ波峰间潜伏期(IPL)及Ⅰ波与Ⅴ波波幅比.预后以TBI后6个月患者是否清醒为标准,分为清醒组与未清醒组,组间运用两独立样本t检验以筛选出有意义的指标.结果 本组患者清醒率为34.9%(22/63),BAEP指标异常率为66.7%(42/63).双侧Ⅰ、Ⅲ、Ⅴ波PL,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波IPL及Ⅰ/Ⅴ波幅比均正常的21例中有16例清醒(清醒率为76.2%),双侧Ⅴ波PL异常的8例及双侧Ⅲ～Ⅴ波IPL异常的7例均未清醒,单侧Ⅴ波消失的2例未清醒.清醒组与未清醒组间比较发现双侧差异均有统计学意义的指标为Ⅴ波PL及Ⅲ～Ⅴ波IPL.结论 BAEP的Ⅴ波PL及Ⅲ～Ⅴ波IPL变化可客观、准确地反映脑损伤的程度及预测患者的预后.

Abstract：

Objective To explore the correlation between brainstem auditory evoked potential (BAEP) findings and outcome in long-term unconscious patients with severe traumatic brain injury (TBI).Methods BAEP findings were recorded and analyzed in 63 patients suffering from severe TBI with duration of disturbance of unconsciousness for more than 2 weeks. The peak latency (PL) of wave Ⅰ, Ⅲ and Ⅴ, the interpeak latency (IPL) of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ and the amplitude ratio of wave Ⅰ and Ⅴ were analyzed. Conscious or unconscious at 6 months after the injury was considered as the outcome criterion,and based on these, the patients were divided into conscious and unconscious groups; the significant indicators were chosen in the 2 groups using independent-sample t test. Results The probabilities of awakening in these patients were 34.9% (22/63) with abnormal index of BAEP indicators reaching 66.7%. Sixteen patients were sober at last in 21 patients with normal PL of wave Ⅰ, Ⅲ and Ⅴ, IPL of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ, and amplitude ratio of wave Ⅰ and Ⅴ in bilateral side (the probabilities of awakening were 76.2%); 8 patients having abnormal PL of wave Ⅴ in bilateral side and 7 having abnormal IPL of wave Ⅲ-Ⅴ in bilateral side were unconscious; 2 patients having disappeared wave Ⅴ in unilateral side were unconscious. PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side were significantly different between the conscious group and the unconscious group. (P＜0.05). Conclusion BAEP findings (PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side) can objectively and accurately demonstrate the cerebral dysfunction and predict the outcome of the patients.     

神经内镜高血压脑出血微创手术的三维重建手术定位

目的 探索神经内镜高血压脑出血(HICH)微创手术术前精确可靠的手术定位方法.方法南方医科大学珠江医院神经外科自2008年6月至2010年8月通过CT扫描及图像三维重建的方法定位脑内血肿、选择最佳内镜微创手术入路行神经内镜微创术治疗HICH患者18例,分析患者的临床资料和疗效.结果 根据CT三维重建结果,术者可以准确设计最佳内镜微创手术入路并实现颅骨钻孔部位的精确定位,减少手术前准备、麻醉及操作时间.本组患者平均手术时间仅1.5 h左右,手术失血量仅30～40mL,血肿清除率约为89.2%,且血肿清除后脑组织松弛,无需行去骨瓣减压.结论 HICH患者采用CT扫描、三维重建进行术前手术定位是一种快速、简便、可靠的神经内镜微创脑出血手术定位方法.

Abstract：

Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.     

p16和cyclin D1在膀胱癌中的表达及其相关性研究

目的研究ｐ１６和ｃｙｃｌｉｎＤ１在膀胱癌组织中的表达,探讨其与膀胱癌生物学行为的关系。方法应用免疫组化法观察５０例膀胱癌ｐ１６和ｃｙｃｌｉｎＤ１的表达情况。结果（１）膀胱癌组织中ｐ１６阳性率为４４％,明显低于正常膀胱粘膜（Ｐ＜０．０１）;ｃｙｃｌｉｎＤ１阳性率为６２％,明显高于正常膀胱粘膜（Ｐ＜０．０１）。随着肿瘤恶性程度的增高和临床分期的进展,ｐ１６阳性率下降,ｃｙｃｌｉｎＤ１阳性率升高。ｐ１６在未复发组、存活组的表达率显著高于复发组、死亡组（Ｐ＜０．０１）。ｃｙｃｌｉｎＤ１在存活组的表达率显著低于死亡组（Ｐ＜０．０５）。（２）ｐ１６与ｃｙｃｌｉｎＤ１的表达呈负相关。（３）有１５％的病例存在ｐ１６和ｃｙｃｌｉｎＤ１同时表达或失表达。结论ｐ１６与ｃｙｃｌｉｎＤ１异常表达在膀胱癌的发生、发展过程中起重要作用。     

Role of endothelin in the pathogenesis of cerebral vasospasm following subarachnoid hemorrhage

ＲｏｌｅｏｆｅｎｄｏｔｈｅｌｉｎｉｎｔｈｅｐａｔｈｏｇｅｎｅｓｉｓｏｆｃｅｒｅｂｒａｌｖａｓｏｓｐａｓｍｆｏｌｌｏｗｉｎｇｓｕｂａｒａｃｈｎｏｉｄｈｅｍｏｒｒｈａｇｅＷａｎｇＸｉａｎｇｙｕ（王向宇）；ＺｈｕＣｈｅｎｇ（朱诚）；ＣｈｅｎＣｈａｎｇｃａｉ...     

快速康复外科在颅脑手术中的应用现状

快速康复外科(enhanced recovery after surgery,ERAS)是指通过各种基于循证医学证据的围手术期处理措施以促进患者术后早期康复。经过20余年的发展,ERAS已经被广泛应用于胃肠道手术、肝胆外科手术、泌尿外科手术等领域,但其在颅脑手术领域尚未得到足够重视。为了促进ERAS在颅脑手术中的应用拓展,现就其在颅脑手术中的应用作一综述。