血肿清除加去骨瓣减压术治疗重症高血压基底节脑出血

目的探索血肿清除加去骨瓣减压及硬膜减张缝合在治疗高血压基底节脑出血的患者中的疗效。方法连续收集去骨瓣手术治疗的35例患者,记录的数据包括术前GCS评分,血肿大小,瞳孔反应,ICH评分等。随访指标有30d死亡率以及最近一次的ADL评分。结果 35例患者中27例(77%)30d内存活。27例存活者在平均13个月的随访中16例(62%)神经功能预后良好(ADL评分I-Ⅲ级)。结论高血压基底节脑出血患者施行血肿清除合并去骨瓣减压术有望降低死亡率,改善神经功能预后。     

高血压性脑干出血预后因素分析

目的探讨高血压性脑干出血预后相关的因素。方法回顾性分析57例高血压性脑干出血病人的临床资料,采用Kaplan—Meier法计算生存期及进行生存分析。以随访GOS评分为预后的判断指标,使用Fisher精确概率检验进行单因素分析,二分类Logistic回归作多冈素分析。结果单因素分析显示：入院时GCS评分、脑干血量及并发症是影响脑干出血预后的因素（P〈0．05）;其中人院时GCS评分13～15分,腑十出血量≤5ml及无并发症的病人预后较好。多因素分析显示：GCS评分和行发症是高血压性脑十出血预后相关的独立凶素（P〈0．05）。GCS评分越低,病人生存时间越短;有并发症者明显较无行发症者预后差。结论发病时GCS评分、出血量和并发症是影响病人预后的重要因素。     

首次全脑血管造影阴性的自发性蛛网膜下腔出血的临床及影像学分析

目的探讨首次全脑血管造影阴性的自发性蛛网膜下腔出血患者的病因和诊疗策略。方法回顾性分析43例经头颅CT或腰穿脑脊液检查确诊为自发性蛛网膜下腔出血,但首次全脑血管造影检查为阴性患者的临床及影像学资料。结果43例患者临床表现出现头痛43例,恶心呕吐36例,一过性意识障碍3例,局灶性神经功能障碍（肢体瘫痪）3例,癫痫发作2例,脑膜刺激征阳性39例。头颅CT显示为典型蛛网膜下腔出血者35例,其余8例通过腰穿发现血性脑脊液确诊。35例患者中符合中脑周围非动脉瘤性蛛网膜下腔出血（PNSH）者21例。其余14例为非PNSH。所有患者于发病后2～7d内行首次全脑血管造影检查,结果均为阴性。发病14-21d后全部复查全脑血管造影或CTA,41例仍为阴性;1例发现颅内动脉瘤,1例发现脊髓血管畸形,且均为非PNSH患者。经病因及对症治疗后,患者均预后良好。结论首次全脑血管造影阴性的自发性蛛网膜下腔出血患者临床症状较轻,并发症少,预后较好。对于临床症状和影像学表现符合PNSH的患者,应避免重复造影。但对于高度怀疑颅内动脉瘤或血管畸形可能的非PNSH患者,应积极复查DSA或高质量的CTA或MRA以免漏诊和误诊。     

中国云南纳西族脑血管病患者载脂蛋白E基因的多态性

Currently it is not well known whether apolipoprotein E(ApoE) is a genetic susceptibility factor for cerebrovascular diseases in the Chinese Naxi population.The present study detected and sequenced ApoE polymorphisms of 90 patients with cerebrovascular diseases(58 cases of cerebral infarction and 32 cases of intracerebral hemorrhage),and 50 normal people of Naxi nationality from Yunnan province,China.The populations were used to analyze the relationship of ApoE polymorphisms with cerebral infarction and intracerebral hemorrhage.Results showed an association between ApoE gene polymorphism and the onset of cerebral infarction,and a possibility that the ε4 allele is a susceptibility locus for the risk of cerebral infarction.However,there was no evidence of a relationship between the ApoE gene polymorphism and cerebral hemorrhage.     

卵巢动脉造影及栓塞在妇产科疾病介入治疗中的意义

经导管作髂内动脉栓塞术是目前治疗盆腔肿瘤所致阴道大出血和产科大出血的首选方法 ,近年选择性子宫动脉栓塞术(UAE)已成为替代外科手术治疗子宫肌瘤的有效方法 .文献报道,无论是治疗妇产科大出血还是栓塞子宫肌瘤,髂内动脉-子宫动脉栓塞术有一定失败率(4%～19%),后者与盆腔内存在丰富的侧支循环有重要关系,其中卵巢动脉(OA)是主要的侧支血管之一.另外,OA与子宫动脉之间的吻合支是UAE术中误栓塞卵巢、导致闭经的原因.OVA开口变异发生率为2%～10%.正常OA直径＜1.1 mm,多不为腹主动脉造影所显示,但当存在子宫或盆腔病变、对血液供应需求增加时,OA可增粗.OA参与盆腔疾病供血的高发因素有子宫底部巨大肌瘤、有盆腔手术史、曾做过子宫动脉栓塞术、一侧或两侧子宫动脉发育不良.当存在前述情况时,将猪尾导管插至肾动脉水平做腹主动脉造影和选择性OA插管造影是必要的.一旦确认有OA参与病变供血,应考虑作超选择栓塞术,一般认为用直径＞500 μm栓塞剂是安全的.做OA近侧栓塞,尤其是联合两侧UAE,可能导致医源性卵巢功能不全.对于绝经前患者、又确有必要做OA栓塞时,应尽可能做单侧、接近病变处栓塞,术前应签署知情同意书.     

他山之石 何以攻玉:从脑出血国际临床研究现状看我国的规范化治疗

自发性脑出血病死率和病残率较高,但缺乏有效的治疗策略.我国的脑出血相关研究与国际先进水平存在一定差距.近年国际上一系列临床研究从不同角度探讨脑出血的治疗方式,对我国脑出血研究和规范化治疗具有十分重要的参考价值.我国的脑出血临床治疗经验和研究成果要想走向世界,必须开展高质量的临床试验.四川大学华西医院神经外科正在开展IN...     

老年上消化道出血60例临床分析

目的 探讨老年上消化道出血的病因及治疗特点.方法 对2008年1月～ 2010年1月我院收治的老年上消化道出血病例进行分析.结果 胃溃疡出血26例(占43%),十二指肠球部溃疡出血8例(占13%),胃癌出血10例(占16%),食管静脉曲张破裂出血11例(占18%),Mallory-Weiss综合征2例(占3%),胆道出...     

脑脊液细胞学在蛛网膜下腔出血中的应用价值

目的：应用细胞玻片离心仪和50例蛛网膜下腔出血（SAH）患者进行了不同时期脑脊液细胞学检查。方法：常规抽取脑脊液,经FMU-5细胞玻片离心仪直接离心制片,进行MGG染色,进行细胞分类。结果：蛛网膜下腔出血后脑脊液中白细胞在不同时期的细胞特征是：急性期：大量红细胞及高比例的嗜中性粒细胞期,嗜中性粒细胞比率在70%以上,48～72 h达高峰,一周后逐渐消失。吸收期：激活单核细胞增多,可出现红细胞吞噬细胞及特征性细胞-含铁血黄素吞噬细胞,持续2～3周。恢复期：主要以激活单核细胞为主,持续数周或几月。结论：应用该法进行脑脊液细胞学检查,可给临床提供一个直观、准确的诊断依据。对蛛网膜下腔出血病人的病理学监测、鉴别诊断和治疗具有重要价值。     

A timeline of oligodendrocyte death and proliferation following experimental subarachnoid hemorrhage

AimsWhite matter (WM) injury is a critical factor associated with worse outcomes following subarachnoid hemorrhage (SAH). However, the detailed pathological changes are not completely understood. This study investigates temporal changes in the corpus callosum (CC), including WM edema and oligodendrocyte death after SAH, and the role of lipocalin‐2 (LCN2) in those changes.MethodsSubarachnoid hemorrhage was induced in adult wild‐type or LCN2 knockout mice via endovascular perforation. Magnetic resonance imaging was performed 4 hours, 1 day, and 8 days after SAH, and T2 hyperintensity changes within the CC were quantified to represent WM edema. Immunofluorescence staining was performed to evaluate oligodendrocyte death and proliferation.ResultsSubarachnoid hemorrhage induced significant CC T2 hyperintensity at 4 hours and 1 day that diminished significantly by 8 days post‐procedure. Comparing changes between the 4 hours and 1 day, each individual mouse had an increase in CC T2 hyperintensity volume. Oligodendrocyte death was observed at 4 hours, 1 day, and 8 days after SAH induction, and there was progressive loss of mature oligodendrocytes, while immature oligodendrocytes/oligodendrocyte precursor cells (OPCs) proliferated back to baseline by Day 8 after SAH. Moreover, LCN2 knockout attenuated WM edema and oligodendrocyte death at 24 hours after SAH.ConclusionsSubarachnoid hemorrhage leads to T2 hyperintensity change within the CC, which indicates WM edema. Oligodendrocyte death was observed in the CC within 1 day of SAH, with a partial recovery by Day 8. SAH‐induced WM injury was alleviated in an LCN2 knockout mouse model.     

Role of hydrogen sulfide in subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is a common acute and severe disease worldwide, which imposes a heavy burden on families and society. However, the current therapeutic strategies for SAH are unsatisfactory. Hydrogen sulfide (H₂S), as the third gas signaling molecule after carbon monoxide and nitric oxide, has been widely studied recently. There is growing evidence that H₂S has a promising future in the treatment of central nervous system diseases. In this review, we focus on the effects of H₂S in experimental SAH and elucidate the underlying mechanisms. We demonstrate that H₂S has neuroprotective effects and significantly reduces secondary damage caused by SAH via antioxidant, antiinflammatory, and antiapoptosis mechanisms, and by alleviating cerebral edema and vasospasm. Based on these findings, we believe that H₂S has great potential in the treatment of SAH and warrants further study to promote its early clinical application.