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。     

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.     

Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-CompassTM

Background

Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic “Rehab-Compass,” a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

NF-κB、ICAM-1在实验性SAH后基底动脉壁上的表达变化

目的 探讨免疫炎症反应在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)发病机制中的作用.方法 应用新西兰家兔经枕大池二次注血制成SAH动物模型.在各相应时间点运用数字减影血管造影(digital subtraction angiography,DSA)、HE染色和免疫组化等方法 ,观察兔基底动脉管壁形态以及核转录因子kappaB(nuclear factor-kappaB,NF-κB)、细胞间粘附因子-1(intercellular adhesion molecule,ICAM-1)在管壁上表达的动态变化.结果 在SAH后第3天基底动脉血管腔已开始狭窄,第7天达到高峰,之后狭窄渐减轻,14d时基本接近正常.SAH后3d NF-κB表达增加,5～7d表达持续在一个较高的水平,随后开始下降;ICAM-1表达变化趋势与NF-κB相似,但在表达高峰时相上稍迟于后者.结论 NF-κB、ICAM-1在血管壁上的表达变化与CVS的发生时相密切相关,提示由其参与介导的血管壁炎症反应可能在CVS的发生和发展过程中起了重要的作用.

Abstract：

Objective To evaluate the possible effect of inflammatory reaction in the pathogenesis of CVS after SAH.Methods The "double-hemorrhage" model of vasospasm Was performed by two injections of autologous aterial blood into the cisterna magna of Newzealand rabbits.We oberserved morphological changes and the rule of expression and activity of NF-κB and ICAM-1 in basilar artery(BA)walls by DSA,light microscope and immunohistochemistry.Results The "double-hemorrhage"model of vasospasm was succeeded to be made.The BA vasospasm Was obvious on 3d after autologous aterial blood wa8 first injected into the cisterna magna,and peaked on 7d,and then relieved.On 14d,there was almost no abnormality in the arterial wall.Upregulation of NF-κB expression started on 3d,became stronger on 5d to 7d,and then decreased.The upregulation of ICAM-1 expression in the BA walls Was similar with NF-κB,but was a bit later to tively correlated with the vasospasm.Inflammatory reaction in arterial walls mediated by NF-8κB may play a key mle in the process of CVS after SAH.     

法舒地尔动、静脉给药治疗颅内动脉瘤栓塞后脑血管痉挛的对比研究

目的探讨法舒地尔动脉推注(IAF)与静脉给药对脑动脉瘤栓塞后脑血管痉挛(CVS)的疗效对比并评估其安全性。方法介入栓塞治疗后出现脑血管痉挛39名患者,随机分成A、B二组。A组,改用静脉法舒地尔治疗,30 mg,3次/d;B组立即行动脉内注射盐酸法舒地尔(60 mg+生理盐水100 ml,60 min缓慢推注治疗),连续3 d,3 d后予常规静脉法舒地尔治疗。结果 B组IAF治疗后血管痉挛程度明显改善,第3 d、7 d、14 d的GCS评分均高于A组,3月后GOS评分明显高于A组。结论 IAF能安全有效地缓解蛛网膜下腔出血后脑血管痉挛的临床症状并改善预后。     

Microsurgical clipping of previously coiled intracranial aneurysms

Objective

Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation.

Methods

From June 2006 to August 2011, 15 patients underwent surgical clipping of residual or recurrent aneurysms after previous endovascular treatment. The mean age of the patients was 50.6 years (range, 27–85 years). The mean interval between coiling and clipping was 76.5 weeks (range, 0–288 weeks).

Results

Thirteen patients revealed a regrowth of coiled aneurysms, and in 5 patients compaction of coils was present. Coil extrusion was observed in 9 patients intraoperatively. In case of coil obstruction at the aneurysmal neck during surgery, coils were partially or completely removed. In all cases complete occlusion of the aneurysms was surgically achieved.

Conclusion

Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.     

6186例脑卒中患者发病时间的季节性分析

目的探讨青岛市区脑出血(CH)、脑梗死(CI)、蛛网膜下腔出血(SAH)发病时间的季节规律。方法收集青岛市1998年～2002年脑卒中患者6186例,其中CH1179人,CI4821人,SAH186人。圆分布分析探讨脑卒中患者发病时间的季节规律。结果CH冬季高发,平均角在1月份(P<0.05),男性患者的平均角在2月份(P<0.05),女性患者的平均角在1月份(P<0.05);CI秋季高发,男、女间无差别,平均角在10月份(P<0.05);SAH秋季高发,平均角在10月份(P<0.05),男性患者的平均角在9月份(P<0.05),女性患者的平均角在10月份(P<0.05)。结论青岛市的脑卒中发病具有季节性,在脑卒中预防工作中要充分考虑其发病的季节特点,并采取相应的措施。     

蛛网膜下腔出血对ICP、rCBF及死亡率影响的实验研究

目的 :研究不同严重程度SAH对颅内压 (ICP) ,脑灌注压 (CPP) ,局部脑血流量 (rCBF)及死亡率的影响。方法 :建立一种新的大鼠颈总动脉 视交叉前池体外转流蛛网膜下腔可控制性出血动物模型 ,比较出血 3 0 ,60 ,90s及重复 3 0s 3次出血后上述指标的变化。结果 :SAH后ICP急剧上升至接近平均动脉压水平 ,当ICP超过 6kPa(80mmHg)即可引起部分动物呼吸抑制而死亡 ;60s和 90s出血组ICP水平相差未具显著性 ,提示在此期间内出血可能趋向停止 ;SAH后rCBF立即受到大幅抑制 ,其后恢复程度与SAH严重程度呈反比。结论 :SAH后ICP剧升引起呼吸功能衰竭是死亡的主要原因 ;SAH后普遍存在脑微循环障碍 ,故应及早开始脑缺血的治疗     

老年人蛛网膜下腔出血的临床特点与DSA研究

目的 探讨老年人蛛网膜下腔出血(SAH)的临床特征与DSA之间的关系,以提高诊治水平.方法 回顾分析1995年9月～2004年3月北京医院神经外科收治的60岁以上的SAH 152例的临床资料与DSA结果对比分析.结果 老年人SAH仍以动脉瘤破裂出血为主,152例中行DSA133例(87.5%),动脉瘤患者119例(89.5%),发现动脉瘤129个,其中多发性动脉瘤7例,动脉瘤多分布在前、后交通动脉(61.2%),DSA阴性者10例(7.5%),动静脉畸形(AVM)3例,moyamoya病1例.头痛、脑膜刺激征发生率低,程度也较轻,意识障碍及并发症多见.结论 了解和重视老年人SAH的临床特征,尽早行DSA检查,对颅内动脉瘤及时行血管内栓塞治疗,可避免再出血,减少并发症,降低死亡率.     

Psychosocial impact of finding small aneurysms that are left untreated in patients previously operated on for ruptured aneurysms

Objectives

In patients with previous subarachnoid haemorrhage (SAH) undergoing follow up screening, the authors assessed the impact of finding but not treating very small aneurysms by comparing quality of life (QOL), anxiety, and depression between patients with a newly detected aneurysm that was left untreated (cases) and patients with a negative screening (controls) as this should be incorporated in the evaluation of effectiveness of screening.

Methods

In patients with previous SAH undergoing screening for new aneurysms the authors compared QOL (SF‐36, EURO‐QOL, and a screening related questionnaire), anxiety, and depression (Hospital Anxiety and Depression Scale (HADS)) between cases and controls. Differences in scores on the SF‐36, EURO‐QOL, and HADS were assessed with Student''s t test and differences in proportions of patients with HADS scores in the pathological range and screening related changes with χ² analysis. The authors powered the study to detect a moderate, clinically relevant difference.

Results

Thirty five cases and 34 controls were included. Trends for health related QOL, anxiety, depression, and consequences in daily life pointed in the same direction of a less favourable situation for cases but all effects were small, and did not reach statistical significance. On the screenings specific questionnaire, cases more often (but not statistically significant) reported changes in daily life.

Conclusions

The authors found no major or moderate impact on QOL, anxiety, and depression of the awareness of having an untreated aneurysm, which was detected at screening, although most items showed a trend towards more negative effects for cases. Minor effects on individual level cannot be excluded by this study.