早期针刺治疗对高血压脑出血微创术后患者意识状态影响临床观察

[目的]观察针刺治疗对高血压脑出血微创术后患者意识状态的影响。[方法]将研究对象随机分为微创术后常规治疗加针刺组(命名为治疗组,下同)患者20例、微创术后常规治疗组(命名为对照组,下同)患者20例。分别评定两组入院时、入院第4天、第10天、第20天、第30天的格拉斯哥昏迷量表(GCS)积分情况。[结果]治疗组与对照组GCS评分第30天时比较差异有统计学意义(P<0.01),两组间第30天时间相点与第4天时间相点GCS积分差值比较差异有统计学意义(P<0.01)。[结论]早期针刺治疗对高血压脑出血微创术后患者具有较好的促醒作用。     

Changes in concentration of cerebrospinal fluid components in patients with traumatic brain injury

Brain injury, like other central nervous system pathologies, causes changes in the composition of the cerebrospinal fluid (CSF). In this study, changes in the concentration of small molecules of the CSF, which are in the minimal micromolar concentration, were observed and monitored using high-resolution proton (NMR) spectroscopy. Twenty-two patients with isolated traumatic brain injuries (TBI) and 15 patients making up the control group were recruited for the study. CSF samples were collected by lumbar puncture from the lumbar subarachnoid space in the patients just before commencement of therapy and on the first, third, seventh and fourteenth days of therapy at the ICU. Forty-four signals of the NMR spectra and NO concentration of the CSF samples were analyzed. The analysis shows that the amino acid and organic acid concentrations change during the therapy and mostly are higher than in the control group. Significant differences in concentration of the analyzed CSF components between the TBI patients and the control group have been noted. The rate of the lactate to pyruvate conversion increased because the L/P ratio showed no significant differences between the TBI group and the control group, while the concentrations of both components were significantly higher in the TBI patients than in the control group. Citrulline, arginine and nitric oxide concentrations were the focus of the analysis. Citrulline concentration changes overlapped NO changes from 0 until 3rd day of therapy, while for the remaining days of observation the NO concentration stabilized at the control level, whereas citrulline concentration significantly decreased.     

Can diffusion tensor imaging predict motor power affection after moderate traumatic brain injury?

Objective

To determine whether commissural and projection fibers fractional anisotropy (FA) abnormalities can help in the prediction of long-term outcome of motor power affection after moderately severe traumatic brain injury (TBI).

Methods

MRI protocol included diffusion tensor imaging (DTI) and was performed for 32 patients with moderate TBI and 32 matched control subjects. Regions of interests were applied in the FA maps in the corpus callosum, internal capsules posterior limb, and cerebral peduncles. Results were compared in patients with motor power affection and patients without motor power affection to the control group.

Results

All patients had FA values lower than the control group with significance differences in the corpus callosum. Patient group with weakness had FA values lower than the control groups with significance differences in the posterior limb of the left internal capsules (p = 0.001) and left cerebral peduncles (p < 0.001). Significant differences were found when comparing the posterior limb of the left internal capsule (p = 0.002) and left cerebral peduncle (p = 0.022) to the right side in the weakness group.

Conclusion

FA values measured in the acute stage provided information about associated and projectional fibers disruptions, which have a prognostic value about motor power affection.     

颅脑损伤后脑脊液与血清中IL—6含量变化研究

２８ 例急性颅脑损伤以 Ｇ Ｃ Ｓ评分分组, Ａ 组 Ｇ Ｃ Ｓ≤８ 分, Ｂ 组 Ｇ Ｃ Ｓ＞ ８ 分,结果显示,脑脊液及血清 Ｉ Ｌ－ ６均在伤后第１ 天达峰值,其中脑脊液 Ｉ Ｌ－ ６ 两组峰值无显著差异,血清 Ｉ Ｌ－ ６ 两组差异显著,且其下降速度亦有显著差异。说明颅脑损伤后 Ｉ Ｌ－ ６ 主要由 Ｃ Ｎ Ｓ产生,且血清 Ｉ Ｌ－ ６ 水平与临床病情和炎症反应变化呈平行关系, Ｉ Ｌ－ ６ 可作为判定机体免疫状态和临床判定疗效和预后指标之一。     

Effects of thyrotropin-releasing hormone on severe head injury:A preliminary clinical trial

Overthepastdecades,ithasbeenclearthatneurologicdeficitsresultingfromtraumaticbraininjuriesarecaused,onlyinpart,bydirecttraumaticdisruptionofneuronsandneuralfibers,whereasindirectorsecondarymechanismsoftheinjurymayalsoplayimportantpathogeneticrolesInsuchneurologicdeficits[]j.Suchdelayedinjuryappearstoinvolvethereleaseofendogenousfactorsincludingfree--radicals,monoaminesubstances.arachidonicacidsmetabolites,endogenousopioids.excitatoryaminoacids,energymetabolismdisturbanceandalterationofcalciumf…     

依达拉奉联合醒脑静对急性脑出血患者GCS及NIHSS评分的影响

目的 研究依达拉奉联合醒脑静对急性脑出血(ACH)的治疗疗效及对患者神经功能的影响.方法 将2013年9月至2016年9月在榆林市第一医院住院治疗的ACH患者178例纳入研究,依照随机数表法分为观察组和对照组各89例.两组患者均给予常规治疗,对照组另给予依达拉奉静滴,观察组基于对照组的用药方案另增加醒脑静.比较两组患者治疗2周后的疗效、治疗前后GCS评分及神经功能缺损NIHSS评分、血肿量及C反应蛋白(CRP)水平以及不良反应.结果 观察组患者的治疗总有效率为97.75%,明显高于对照组的89.89%,差异有统计学意义(P<0.05);治疗后观察组患者的GCS评分为(15.62±6.57)分,明显高于对照组的(12.45±4.38)分,NIHSS评分为(10.15±3.06)分,明显低于对照组的(17.52±6.35)分,差异均有统计学意义(P<0.05);治疗后观察组的血肿量和CRP水平分别为(3.47±0.82)mL和(6.24±1.13)ng/L,均明显低于对照组的(8.52±1.26)mL和(12.68±1.59)ng/L,差异均有统计学意义(P<0.05);观察组不良反应总发生率为2.25%,与对照组的6.74%比较,差异无统计学意义(P>0.05).结论 依达拉奉与醒脑静联合治疗ACH患者可有效提升疗效,改善神经功能,安全性较好,值得临床推广.     

立体定向指导下经颅磁刺激对重型颅脑损伤的治疗价值

目的 探讨立体定向指导下的经颅磁刺激方案对重型颅脑损伤昏迷病人的治疗价值.方法 选取2017年9月至2019年9月西安交通大学医学院附属三二〇一医院收治的重型颅脑损伤病人90例.采用随机数字表法分为常规治疗组、普通经颅磁刺激(TMS)组与立体定向指导下的经颅磁刺激(sTMS)组,每组各30例.观察三组治疗7 d后的有效率,格拉斯哥昏迷评分量表(GCS)评分变化、神经科重症监护室(NICU)住院时间、平均住院时间、癫痫、脑疝发生率及肺部感染等并发症的发生率.结果 sTMS组治疗有效率(96.7％)明显高于TMS组(80.0％)与常规治疗组(50.0％)(P<0.05);sTMS组病人NICU住院时间(9.23±2.69)d与平均住院时间(53.70±10.00)d较常规治疗组(27.23±6.63)、(94.40±7.78)d均明显减少(P<0.05);sTMS组癫痫发生率明显低于TMS组的与常规治疗组(3.3％比40.0％、40.0％,P<0.05),而脑疝、肺感染等发生率三组间差异无统计学意义(P>0.05).结论 立体定向指导下的经颅磁刺激治疗方案有助于促进重型颅脑损伤病人的觉醒,减少了住院时间,并降低了癫痫的发生率,优于普通经颅磁刺激治疗.     

重度颅脑损伤患者临床格拉斯哥评分、颅内压变化与脑干听觉诱发电位的关系

本文对78例重度颅脑损伤患者行临床格拉斯哥评分(GCS)、颅内压(ICP)及脑干听觉诱发电位(BAEP)检查.以研究创伤性脑水肿时的GCS、ICP与BAEP间的关系.结果发现,CCS 8分上下组的ICP在4 kPa上下的比率显然不同(P<0.05),ICP在 4 kPa上下的BAEP异常率分别为39.53％和 82.86％(P<0.05),当ICP≥4 kPa时,BAEP异常率显著增加,提示创伤性脑水肿时,GCS、ICP、BAEP是同步变化,说明神经生理BAEP的变化与生物物理改变有内在关系.