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91.
92.
颅脑损伤患者上消化道出血的预防和治疗(附625例报告) 总被引:7,自引:0,他引:7
目的探讨颅脑损伤后上消化道出血的预防措施及其治疗方法。方法回顾性分析625例颅脑损伤后上消化道出血的病例,在治疗原发伤病基础上,采用止血、制酸、保护胃黏膜等对症处理,同时应用阿托品治疗22例;胃镜下治疗8例;胃次全切除术5例。结果本组病例中,治愈572例,缓解36例,无效5例,死亡12例,其中阿托品治愈20例;胃镜下治愈6例;胃次全切除术治愈4例。结论预防和治疗的重点是消除颅脑损伤病灶和保护胃黏膜,常规处理方案效果满意,简单、经济且安全有效,但必要时应及时使用特殊治疗手段,以迅速控制出血病情。 相似文献
93.
目的探讨微创治疗高血压脑出血的临床效果。方法根据CT定位,使用YL-1型颅内血肿粉碎仪对颅内血肿碎吸引流。结果治疗36例,存活出院34例,死亡2例。结论微创治疗高血压脑出血,操作简便、安全,疗效好,费用低,是对高血压脑出血治疗的有效的治疗方法。 相似文献
94.
阿片肽及其受体系统在缺血性脑损伤的病理生理发展过程中具有非常重要的作用。其在缺血性脑损伤中的作用尚存争议,本文综述了阿片肽及其受体系统在缺血性脑损伤中的作用及其可能机制,有助于探索阿片肽在围术期的合理应用,为缺血性脑损伤防治研究提供新方向。 相似文献
95.
小脑后下动脉动脉瘤的诊断和治疗 总被引:1,自引:0,他引:1
目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。 相似文献
96.
97.
I. Y. Shvera A. M. Cherniavsky W. Yu. Ussov M. P. Plotnikov A. A. Sokolov V. M. Shipulin V. I. Chernov 《European journal of nuclear medicine and molecular imaging》1995,22(2):132-138
In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute obstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by99mTc-HMPAO SPET. The volume of nonperfused tissue (VS, cm3) was quantified using the Mountz technique. Hypoperfused volume (V
hypoperf, cm3) in the affected hemisphere was calculated as the total volume of voxels with99mTc-HMPAO uptake <90% of the contralateral symmetric voxels. Discriminant prognostic function was calculated by discriminant analysis as:PF = 0.072×VS + 29.46×(VS/V
hypoperf). Patients with preoperativePF values <8.20 demonstrated postoperative improvement in neurological status, while the group withPF>8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20–8.90 carried an indefinite prognosis. We conclude that the preoperative99mTc-HMPAO SPET can be used for the selection of patients in whom improvement in neurological status may be expected after urgent surgical correction of acute extracranial obstruction of the ICA. 相似文献
98.
99.
目的:观察偏瘫患者早期床上训练的效果。方法:对58例脑血管意外致偏瘫患者随机分成2组:观察组30例,护理中指导早期床上体操训练;对照组28例,按常规护理。以上、下肢肌力和日常生活活动能力(ADL)为评价指标,于训练开始时、训练4周、训练8周各评价1次。结果:观察组训练4周、8周时患侧上肢肌力以及ADL水平明显增加,与对照组比较有显著差异(P<001)。患侧下肢肌力训练4周及8周时均增加,与对照组比较,4周时无明显差异(P>005),8周时有显著性差异(P<001)。结论:对早期偏瘫患者实施床上功能训练,不仅可以提高患者的生命质量,而且可以减少、甚至解除患者及家属的经济和精神负担。 相似文献
100.
Effects of Ethanol in an Experimental Model of Combined Traumatic Brain Injury and Hemorrhagic Shock 总被引:3,自引:2,他引:1
Brian J. Zink MD Susan A. Stern MD Xu Wang MD Carl C. Chudnofsky MD 《Academic emergency medicine》1998,5(1):9-17
Objectives: Given that clinical and laboratory studies suggest that ethanol and hemorrhagic shock (HS) potentiate traumatic brain injury (TBI), the authors studied the effects of ethanol in a model of combined TBI and HS.
Methods: A controlled porcine model of combined TBI and HS was evaluated for the effect of ethanol on survival time, hemodynamic function, and cerebral tissue perfusion. Anesthetized swine (17–24 kg) were instrumented, splenectomized, and subjected to fluid percussion TBI with concurrent 25-mL/kg graded hemorrhage over 30 minutes. Two groups were studied: control ( n = 11) and ethanol ( n = 11). Ethanol, 3.5 g/kg intragastric, was given 100 minutes prior to TBI/HS. Systemic and cerebral physiologic and metabolic parameters were monitored for 2 hours without resuscitation. Regional cerebral blood flow (rCBF) and renal blood flow were measured with dye-labeled microspheres. Data were analyzed with 2-sample t-test and repeated-measures ANOVA.
Results: Ethanol levels at the time of injury were 162 ± 68 mg/dL. Average TBI was 2.65 ± 0.35 atm. Survival time was significantly shorter in the ethanol group (60 ± 27 min vs 94 ± 28 min, p = 0.011). The ethanol group had significantly lower mean arterial pressure, cerebral perfusion pressure, and cerebral venous
O2 saturation in the postinjury period. Cerebral O2 extraction ratios and cerebral venous lactate levels were significantly higher in the ethanol group. A trend toward lower postinjury rCBF in all brain regions was observed in the ethanol group.
Conclusion: In this TBI/HS model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion. 相似文献
Methods: A controlled porcine model of combined TBI and HS was evaluated for the effect of ethanol on survival time, hemodynamic function, and cerebral tissue perfusion. Anesthetized swine (17–24 kg) were instrumented, splenectomized, and subjected to fluid percussion TBI with concurrent 25-mL/kg graded hemorrhage over 30 minutes. Two groups were studied: control ( n = 11) and ethanol ( n = 11). Ethanol, 3.5 g/kg intragastric, was given 100 minutes prior to TBI/HS. Systemic and cerebral physiologic and metabolic parameters were monitored for 2 hours without resuscitation. Regional cerebral blood flow (rCBF) and renal blood flow were measured with dye-labeled microspheres. Data were analyzed with 2-sample t-test and repeated-measures ANOVA.
Results: Ethanol levels at the time of injury were 162 ± 68 mg/dL. Average TBI was 2.65 ± 0.35 atm. Survival time was significantly shorter in the ethanol group (60 ± 27 min vs 94 ± 28 min, p = 0.011). The ethanol group had significantly lower mean arterial pressure, cerebral perfusion pressure, and cerebral venous
O
Conclusion: In this TBI/HS model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion. 相似文献