动脉瘤性蛛网膜下腔出血后低钠血症发生率的分析及治疗

目的研究颅内动脉瘤破裂出血后低钠血症的发生率同Fisher分级和脑血管痉挛的关系。方法2003年1月至2005年12月动脉瘤性蛛网膜下腔出血（SAH）患者320例。按解剖部位分成大脑前及前交通（ACA＆ACoA）、后交通（PCoA）和大脑中动脉（MCA）三组。分析其低钠血症的发生率。结果动脉瘤性SAH低钠血症总的发生率约为29．7％,ACA＆ACoA、PCoA、MCA三组低钠血症的发生率分别约为47．9％、15．2％和16．2％。重度低钠血症的发生率分别为35．0％、7．1％和7．4％。ACA＆ACoA组中Fisher分级Ⅲ～Ⅳ级和Ⅰ～Ⅱ级低钠血症的发生率分别为66．7％和14．0％;有脑血管痉挛和无脑血管痉挛者低钠血症的发生率分别为73．1％和16．1％。结论ACA＆ACoA组低钠血症与重度低钠血症的发生率明显高于PCoA组和MCA组,ACA＆AcoA组中Fisher分级Ⅲ～Ⅳ级或并发脑血管痉挛的患者低钠血症的发生率明显增高,临床应注意监测并及时纠正。     

实验性SAH脑脊液TGF-β1检测与慢性脑积水形成机制的研究

目的:探讨在大鼠蛛网膜下腔出血(SAH)发病过程中脑脊液转化生长因子-β1(TGF-β1)的动态变化及与慢性脑积水形成的相关性。方法:采用ELISA方法检测正常大鼠组、生理盐水组、SAH组脑脊液TGF-β1的浓度,应用多媒体彩色图文分析系统对软脑膜胶原纤维进行定量分析。结果:SAH组大鼠脑脊液TGF-β1第1天都明显升高(P<0.05),第6天下降,第10天又开始上升并持续到第20天(P<0.05),而不同时间点生理盐水组与正常组无明显变化(P>0.05),且SAH后脑脊液TGF-β1的升高与软脑膜胶原纤维增生呈同步性。结论:SAH大鼠脑脊液中TFG-β1的表达呈双时相,第一时相与外周血小板进入脑脊液有关,对损伤脑组织的早期修复起促进作用;第二时相与被激活的巨噬细胞、血管内皮细胞、脉络膜细胞释放TGF-β1有关,且持续高水平表达与SAH后慢性脑积水的发生密切相关。     

实验性犬SAH后CVS血浆、CSF中NPY、ANP含量动态变化及巴曲酶的保护作用研究

目的探讨蛛网膜下腔出血（ＳＡＨ）后脑血管痉挛（ＣＶＳ）的发病机理和防治方法。方法采用放免法动态观察了犬ＳＡＨ后血浆、ＣＳＦ中神经肽Ｙ（ＮＰＹ）、心钠素（ＡＮＰ）含量动态变化及巴曲酶的保护作用。结果单纯注血组及巴曲酶治疗组血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ含量较注血前及同期正常对照组明显增高（Ｐ＜０．０１）；单纯注血组在注血后３０ｍｉｎ血浆、ＣＳＦ中ＮＰＹ含量开始升高，ＣＳＦ中ＡＮＰ含量亦在注血后３０ｍｉｎ升高，血浆ＡＮＰ含量则在第２ｄ开始升高，至第７ｄ最高。蛛网膜下腔给药组和静脉注入巴曲酶０．４ＢＵｋｇ－１ｄ－１组血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ含量均明显低于同期单纯注血组（Ｐ＜０．０１）。结论血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ的异常增高是ＳＡＨ后ＣＶＳ的原因之一，巴曲酶可以防止ＮＰＹ和ＡＮＰ的异常增高。     

蛛网膜下腔出血患者脑脊液垂体激素含量的动态变化

目的研究蛛网膜下腔出血(SAH)患者脑脊液(CSF)促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、生长激素(GH)含量的动态变化规律。方法对35例SAH患者发病后1～3d、7～9d、13～15d脑脊液中的ACTH、TSH、FSM、LH、PRL、GH含量进行动态观察，用TCD检测大脑中动脉血流速度(VMCA)。结果SAH患者脑脊液ACTH、TSH、FSH、LH、PRL、GH含量在发病后1～3d、7～9d明显高于对照组，尤以发病后7～9d变化最明显；脑血管痉挛(CVS)组和非CVS组也有明显差异。结论SAH患者脑脊液ACTH、TSH、FSH、LH、GH、PRL含量与病情演变、CVS程度有关，并可判断预后。     

蛛网膜下腔出血并发症的预见性护理

回顾分析51例蛛网膜下腔出血急性期CT表现以及出血在颅内的分布情况，总结出其并发症的发生与CT显示的积血阳性及分布区域不同有关。临床上根据其急性期CT表现预测并发症的发生，进行预见性的治疗和护理。     

脑脊液置换术治疗蛛网膜下腔出血临床研究

目的：降低蛛网膜下腔出血（SAH）病人的临床复发率及死亡率.方法： 对38例蛛网膜下腔出血病人,随机分为两组,通过不同次数脑脊液置换治疗观察临床表现.结果：两组病人在缓解剧烈头痛,降低复发率、死亡率、并发症等方面具有十分显著的差异,应用脑脊液置换治疗者明显优于不使用者.结论：脑脊液置换治疗蛛网膜下腔出血具有极高的临床应用价值,并值得广泛推广应用.     

小儿自发性蛛网膜下腔出血病因及治疗方法探讨

目的：研究小儿自发性蛛网膜下腔出血（ＳＡＨ）的病因与治疗。方法：多数病人行凝血因子，ＣＳＦ，血管造影，ＣＴ，ＤＳＡ，ＭＲＩ和ＭＲＡ检查以明确该病的病因诊断和手术治疗的临床意义。结果：６３例小儿自发性ＳＡＨ中，有１３例出血性血液病，３３例血管性疾病，８例颅内肿瘤，１例炎症，８例病因不明。结论：脑血管病和颅内肿瘤病人应手术治疗，采用手术治疗对血液病所致的严重ＳＡＨ病人有一定的帮助。     

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 ± 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3–0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 ± 0.12 cm vs 1.09 ± 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients. Received 15 July 1997; Revision received 30 September 1997; Accepted 5 November 1997     

Increased levels of somatomedins in human lumbar and central cerebrospinal fluid after subarachnoid haemorrhage

Summary The somatomedins, multitargit growth-promoting peptide hormones, were measured with radio receptor assay in cerebrospinal fluid (CSF) after subarachnoid haemorrhage (SAH) in 21 patients and after head injury in 2 patients.In the first group of 10 patients, lumbar (n=8) or central (n=2) CSF was collected on days three, six and nine after SAH. 6 of the 8 patients with SAH showed an increase in somatomedin concentrations ranging between 0.52–1.26 U/ml while 2 patients fell within the normal range between 0.19–0.48 U/ml. In the 2 patients with head injury, the somatomedin concentrations were scarcely detectable.In the second group of 13 patients with SAH, CSF was collected peroperatively during surgical clipping of an aneurysm. These patients fell into two groups: 6 patients who had CSF somatomedin levels within the normal range and 7 patients with pathologically increased somatomedin concentrations ranging between 0.38–1.26 U/ml. Neither the neurological condition nor the cerebral vascular diameter correlated with the somatomedin concentrations. It is suggested that the increased somatomedin levels in CSF after SAH could be a compensatory response in order to stimulate cerebral anabolism after injury.This work was supported by grants from Karolinska Institutet, the Swedish Medical Research Council, Sävstaholmsföreningen, and Loo and Hans Osterman Research Fund.     

Acute non-communicating hydrocephalus after spontaneous subarachnoid haemorrhage

Summary Five patients, who developed progressive neurological deterioration within hours due to subarachnoid haemorrhage (SAH) are reported. The computertomographic (CT) appearance of a noncommunicating hydrocephalus (n.c.h.) was a unique feature in 4 cases.CT during the early phase of neurological deterioration after SAH permits the differentiation between an ischaemic, an oedematous, a haemorrhagic-compressive lesion and an increase in intracranial pressure (ICP) due to n.c.h.