急性肾梗死的临床诊断(附3例报告并文献复习)

目的:总结急性肾梗死的临床特点,提高对急性肾梗死的诊断水平。方法:回顾性分析3例急性肾梗死患者的临床资料:男2例,女1例,临床表现为腰和(或)腹部疼痛4小时~2天;均采集病史并给予相关实验室、腹部彩超及上腹部CT增强检查。结果:3例患者血清乳酸脱氢酶(LDH)均有不同程度升高;双肾彩超均未见异常;腹部CT增强检查明确急性肾梗死。结论:急性肾梗死临床少见,因缺乏特异性而易延误诊治。基层医院超声检查对急性肾梗死诊断价值有限但有利于鉴别诊断,及时行CT增强检查有助于早期诊断和指导治疗。     

重型闭合性颅脑损伤合并颞叶沟回疝的显微减压手术治疗

颅内压增高和脑疝是重型颅脑损伤病人死亡与致残的主要原因,目前对于颅内压增高的手术治疗公认的方法首先考虑切除引起占位效应的病变,而关于去骨瓣减压尚存在争议;其他保守方法则包括过度换气、渗透性利尿剂、脑脊液引流和巴比妥冬眠疗法等.通过对颞叶直接的切除手术,能够使动眼神经减压,中脑、大脑后动脉、脉络膜前动脉得到充分减压,从而改善病人的预后.目前,此项手术国内开展的不多,且大都是在肉眼直视下开展.本研究应用显微手术技术施行选择性颞叶切除,力求挽救病人的生命、保留功能.     

外伤性大面积脑梗塞临床诊断与治疗

目的通过对外伤性大面积脑梗塞的研究，利用经颅多普勒超声(TCD)技术早期诊断，提高对外伤性脑梗塞患者的治疗效果。方法对48例大面积脑梗塞患者采取贴敷同侧颞肌去骨瓣减压术。利用经颅多普勒超声监测改善诊断和治疗手段。结果48例患者中20例死亡，其中17例患者为偏瘫进行性加重，3例患者出现失语。28例患者均有好转，生活自理8例。经TCD检查的7例患者，发现血流异常，给予干预，有5例患者生活可自理。结论去骨瓣减压颞肌贴敷术，可以使贴敷的颞肌给脑组织皮层供血，促进侧支循环建立，以增加脑血流量，并为侧支循环建立争取时间。脑外伤早期使用TCD监控颅内血管的流量，可以达到早期诊断的目的。     

神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.     

三氧化二砷诱导C6胶质瘤细胞凋亡实验研究

目的：研究三氧化二砷（As2O3）在体外是否具有抗鼠胶质瘤作用,并对其作用机制进行初步探讨。方法：应用不同浓度As2O3,且在不同时间点分别处理C6胶质瘤细胞株及原代培养的正常鼠神经胶质细胞,采用甲基噻唑基四唑（MTT）法,观察As2O3对C6胶质瘤细胞株及正常鼠神经胶质细胞生长的影响,以透射电镜、Hoechst33342和碘化丙啶（PI）双重荧光染色检测两种细胞凋亡的形态变化,并用异硫氰酸荧光素（FITC）标记的Annexin-V和PI双标记法通过流式细胞仪检测细胞凋亡率。结果：MTT法发现,As2O30.5～8.0μmol/L的浓度均可显著抑制C6胶质瘤细胞株的生长,而对正常原代神经胶质细胞株的抑制作用较弱。经As2O3作用后,透射电镜、Hoechst33342/PI双染荧光均观察到C6胶质瘤细胞发生了显著的凋亡形态改变;运用Annexin-V-FITC/PI双标记法在流式细胞仪检测显示,随As2O3浓度的增大和时间的延长,C6胶质瘤细胞株的凋亡率明显上升,而正常神经胶质细胞的凋亡率要明显小于C6胶质瘤细胞株。结论：As2O3在体外可显著抑制C6胶质瘤细胞株生长,其机制与诱导肿瘤细胞凋亡有关,且凋亡率随As2O3作用的时间和剂量的增加而增加。但As2O3对正常神经胶质细胞生长的抑制作用较弱,提示As2O3抑制细胞生长的作用具有一定的选择性。     

高龄病人三叉神经痛的微血管减压术治疗

目的目前对于药物难以控制的三叉神经痛,应用微血管减压术进行治疗已经得到普遍的认同,但是对于高龄病人,由于考虑到是否能耐受手术的原因,也经常选用其他的一些方法。本文拟对75岁以上的高龄三叉神经痛病人施行微血管减压术的安全性和有效性进行评价。方法作者对从2000年6月～2003年12月期间25例患有三叉神经痛的高龄病人进行了回顾性的分析并且对这些病人进行了电话随访。本组病人平均年龄为79.4岁（75～88岁）,所有病人都接受了三叉神经微血管减压术。对照组为平均年龄为42.3岁（17～50岁）的病人。结果在两组中初始疼痛有96%的病人得到缓解。没有手术死亡率。平均随访时间为44～52个月。老年组和对照组分别的疼痛缓解率为78%和72%,不再需要药物治疗（P=0.74）。结论微血管减压术对于老年三叉神经痛的患者是一种有效的治疗方法。作者的经验表明微血管减压术的死亡率和并发症发生率与年轻组无明显差异。     

应用神经导航系统辅助切除中央区附近动静脉畸形临床观察

目的 观察神经导航系统对中央区附近动静脉畸形手术定位的意义。方法 在神经导航下完成12例中央沟附近的动静脉畸形切除术。结果 导航系统对12例患者的定位误差为0．9～2．0mm，平均1．4mm。对全部血管畸形进行了全切。手术未对患者重要神经功能造成不良影响。结论 借助神经导航系统可明显提高手术的准确性和安全性。     

神经内镜辅助锁孔手术治疗前循环动脉瘤

目的 探讨神经内镜辅助锁孔手术治疗颅内动脉瘤的可行性及其意义。方法 对9例前循环动脉瘤病人,应用内窥镜辅助锁孔手术进行颅内动脉瘤夹闭术。经翼点锁孔开颅后,应用手术显微镜初步显露动脉瘤后,置入硬性神经内镜了解动脉瘤颈及周围结构的局部解剖,动脉瘤夹闭后再次用内镜了解夹闭情况。结果 术后9例全部治愈出院,结论 应用神经内镜辅助锁孔开颅进行颅内动脉瘤显微手术,可明显增加动脉瘤及其周围结构的可视范围,使颅内动脉瘤的手术效果明显提高,手术时间缩短,术后病人恢复快,且不影响美容。     

神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.