颅内静脉窦血栓形成的临床特点和护理

目的:探讨颅内静脉窦血栓形成(CVST)的发病诱因和临床特点,针对病因和症状进行护理干预,促进康复和预防复发。方法:对21例颅内静脉窦血栓形成患者进行临床分析,并实施护理干预措施。结果:21例CVST患者有诱发因素的15例,占71.4%,未找到诱因的6例,占28.6%。最常见的发病诱因是妊娠和分娩,占42.8%;最多发生血栓的部位是上矢状窦,占41.4%;最常见的症状是头痛,占71.4%;经综合治疗和护理干预,治愈出院11例,好转5例,未愈自动出院2例,死亡3例。结论:颅内静脉窦血栓的发生多种原因可促发,各种引起血液高凝状态的原因均可导致颅内静脉窦血栓,通过护理干预,排除不良因素,促进病人的康复。     

体视学法在颅内血肿体积测量的应用

目的介绍改进后的体视学法测量颅内血肿体积,并验证其准确性。方法在92例颅内出血的CT图像上,同时运用体视法、CT定量法测量颅内血肿体积,以CT定量法的结果为标准验证体视法的准确性。结果按血肿体积大小分为5组,各组CT定量法、体视学法所测得体积采用配对样本的t检验分析P值皆大于0.05,即CT定量法、体视学法所测血肿体积无统计学差异。结论体视学法测量颅内血肿准确可靠,在CT工作站对颅内血肿病例行胶片打印排版时,在图像上加上合适的网格,可方便临床医生快速运用体视法准确测量颅内血肿体积。     

磁共振血管造影在颅内动脉瘤诊断中的应用价值分析

颅内动脉瘤是蛛网膜下腔出血的重要病因,是在脑动脉腔内压力增高或先天性缺陷基础上发生的内腔局限性的异常扩大,进而导致动脉壁的瘤状突出[1]。该疾病会导致患者出现呕吐、剧烈头痛、视力障碍等临床症状,如不及时治疗,会导致动脉瘤破裂,引发大出血,引发脑水肿、蛛网膜下腔出血等疾病,甚至危及患者的生命安全。临床上,常用数字减影血管造影(DSA)、磁共振血管造影(MRA)等进行诊断颅内动脉瘤。作为诊断该疾病的金标准,DSA检查不仅可以动态展示血管的充盈情况,还可以对血液循环时间进行计算,从而开展血管内的治疗性操作[2]。     

D-ACT与3D-DSA技术对颅内动脉瘤诊断价值探讨

目的早诊断、早治疗是改善颅内动脉瘤(intracranial aneurysm,LAN)患者预后关键,但临床检查及诊断方法较多,当前尚未明确各方法在LAN中诊断价值。本研究探讨LAN患者实施三维CT血管造影术(three dimensional computerized tomography angiography,3D-CTA)与三维数字减影血管造影术(three dimensional digital subtraction angiography,3D-DSA)临床诊断价值。方法选取河南省儿童医院2015-10-01-2018-10-01收治的80例LAN患者作为研究对象,以检验方法分为研究组和对照组,各40例。研究组实施3D-DSA检查,对照组实施3D-CTA检查,以全脑血管造影为金标准,对两组检出情况、敏感性、特异性、准确性、阳性预测值及阴性预测值进行评估。结果以全脑血管造影为金标准,研究组阳性检出率及阴性检出率分别为62.50%和37.50%,对照组分别为52.50%和47.50%,两组比较差异无统计学意义,χ~2=0.818 4,P=0.365 6。瘤体检出率两组比较,差异无统计学意义,P>0.05。研究组检出准确率为92.50%,与对照组的90.00%比较,差异无统计学意义,χ~2=0.058 2,P=0.809 4;灵敏度为92.00%,与对照组的90.48%比较,差异无统计学意义,χ~2=0.053 2,P=0.817 6;特异性为93.33%,与对照组的89.47%比较,差异无统计学意义,χ~2=0.082 1,P=0.956 3;阳性预测值为92.00%,与对照组的90.48%比较,差异无统计学意义,χ~2=0.520 8,P=0.470 7;阴性预测值为93.33%,与对照组的89.47%比较,差异无统计学意义,χ~2=0.965 1,P=0.325 9。结论 LAN患者实施3D-CTA和3D-DSA技术诊断均有显著价值,临床可根据患者病情、治疗需求及实际需求选择合适诊断方法。     

运用介入法检查治疗颅内宽颈动脉瘤的分析

目的：研究探讨血管内水解可脱卸弹簧圈结合球囊封堵治疗颅内宽颈动脉瘤的技术操作要点，适应症及临床应用前景。方法：本组共10例患者采用水解可脱卸弹簧圈结合封堵球囊栓塞治疗颅内宽颈动脉瘤，直径在5mm-10mm。先用大弹簧圈使其在瘤内成篮，然后再用小弹簧圈进行填塞，根据瘤体的大小，可用数个由大到小的水解可脱弹簧圈直至把瘤体腔填塞完全，结果：10例颅内动脉瘤获得完全致密栓塞均获得成功，术后不定期随访，载瘤动脉保持通畅，无再出血及脑缺血性事件发生，动脉瘤无复发，效果良好。结论：水解可脱卸弹簧圈结合球囊封堵法栓塞治疗颅内宽颈动脉瘤效果良好，是首选的治疗颅内宽颈动脉瘤的完全、有效的方法，在临床上有广阔的应用前景。     

心源性脑栓塞

随着诊断技术水平的提高,愈来愈多的证据表明心源性栓子是缺血性脑卒中患者发病的重要原因,据估计,约15%～20%的脑梗死患者是由心源性栓塞引起。因缺乏金标准,临床常推测诊断,如果患者有全身性栓塞的病史和表现,又有心脏     

“微创颅内血肿清除术”专题高研班将举办

由中国医院协会（原中华医院管理学会）主办的全国神经内科主任（微创颅内血肿清除术）临床适宜技术高研班，拟定于2006年9月10日至15日在安徽省黄山市举办，培训费980元，食宿统一安排，费用自理。学习期满授予学员Ⅰ类继续教育学分。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.