单纯性急性外伤性硬膜下血肿63例治疗分析

目的探讨单纯性急性外伤性硬膜下血肿的治疗特点。方法本组共63例,急诊手术25例,保守治疗38例(其中有9例保守治疗失败后中转手术)。手术方式:小骨窗开颅24例,颞肌下减压7例,标准外伤大骨瓣开颅3例;术前根据受伤机制、临床表现、CT资料等初步确定出血位置及性质。结果按3月后GOS评分,良好46例(73.02%),中残8例(12.70%),重残0例(0%),植物生存1例(1.59%),死亡2例(3.17%)。结论单纯性硬膜下血肿保守治疗指征可适当放宽,手术方式首选小骨窗开颅,可减少创伤,加快病人康复。     

Tumor necrosis factor α in the pathogenesis of cerebral malaria

Physiologically in the brain, cytokines such as tumor necrosis factor-alpha (TN) are released by the immune system and can modulate neurological responses. Conversely, the central nervous system (CNS) is also able to modulate cytokine production. In the case of CNS disorders, cytokine release may be modified. Cerebral malaria (CM) is a complication of Plasmodium falciparum infection in humans and is characterized by a reversible encephalopathy with seizures and loss of consciousness. Central clinical signs are partly due to sequestration of parasitized red blood cells in the brain microvasculature due to interactions between parasite proteins and adhesion molecules. TNF is produced and released by host cells following exposure to various malarial antigens. The increase of TNF release is responsible for the overexpression of adhesion molecules. This article reviews the involvement of TNF in cerebral malaria and the relation with all the processes involved in this pathology. It shows that (i) TNF levels are increased in plasma and brain but with no clear correlation between TNF levels and occurrence and severity of CM; (ii) TNF is responsible for intercellular adhesion molecule-1 upregulation in CM, the relation being less clear for other adhesion molecules; (iii) TNF receptors are upregulated in CM, with TNF receptor 2 (TNFR2) showing a higher upregulation than TNFR1 in vivo; (iv) in murine CM, low doses of TNF seem to protect from CM, whereas excess TNF induces CM and anti-TNF therapies (antibodies, pentoxifylline) did not show any efficiency in protection from CM. Moreover, the involvement of lymphotoxin a, which shares with TNF the same receptors with similar affinity, appears to be an interesting target for further investigation.Received 4 December 2002; received after revision 7 February 2003; accepted 14 February 2003     

纵裂池偏密征在外伤性蛛网膜下腔出血中的诊断价值

目的:提高对纵裂池偏密征的认识,评价该征对外伤性蛛网膜下腔出血(TSAH)首次CT确诊的价值。方法:回顾性分析TSAH300例CT资料中有纵裂池偏密征者136例的CT表现;分甲乙两组医生对疑诊或漏诊TSAH的43例行盲法复阅CT片,并统计学处理其测试结果。结果:TSAH以纵裂池少量积血最多见(212例);纵裂池偏密征136例,其中出现前纵裂池偏密征109例次,后纵裂池偏密征52例次,以前者更多见;疑诊或漏诊TSAH的43例复阅CT结果:甲组医生确诊TSAH19例,疑漏诊24例;乙组确诊TSAH34例,疑漏诊9例;两组比较有统计学意义(χ2=11 06,P<0 005)。本组136例均有其它颅脑内损伤,首次CT发现病变154个,迟发病变57个,其中首发病变111个和迟发病变51个均在纵裂池偏密征同一侧发病。结论:纵裂池偏密征是CT诊断外伤性蛛网膜下腔少量积血的一个可靠征象,是否认识此征象,直接影响TSAH的首次CT确诊率;纵裂池偏密征也是迟发性外伤性颅脑内病变的早期征象之一。     

颈内动脉注射尿激酶治疗急性脑梗死的疗效观察

应用颈内动脉注射尿激酶治疗30例急性脑梗死患者,并与对照组（静脉滴注尿激酶）30例比较。结果显示治疗组疗效明显优于对照组（P＜0．01）,且无1例发生颅内出血。提示颈内动脉注射尿激酶治疗急性脑梗死,疗效显著而安全。     

去甲肾上腺素治疗上消化道出血20例临床观察

用去甲明上腺素治疗上消化道出血20例,治疗时间1－2天,有效率100％。     

钩藤散对麻醉犬脑血流量的影响

目的观察钩藤散对脑血流量的影响。方法选择家犬20只,随机分为5组,麻醉后股动脉插管、经压力换能器连接RM-6000型多导生理记录仪,颈总动脉和椎动脉连接MFV-3200型电磁血流量计;打开腹腔寻找十二指肠,3个实验组经十二指肠注入高、中、低剂量的钩藤散浸膏,阴性对照组注入生理盐水,阳性对照组注入尼莫地平(2 mL/kg),分别测定给药前、后脑血流量、收缩压、舒张压、平均动脉压、心率等变化,计算脑血管阻力。结果实验各剂量组及阳性药组,在给药后150 min时脑血流量显著高于(P<0.05)、脑血管阻力显著低于(P<0.05)正常对照组,180 min时有极显著差异(P<0.01或P<0.001),210 min时仍有效。结论钩藤散可明显增加脑部的供血,减少脑血管阻力,从而改善脑部营养,防治老年痴呆。     

线栓法制备大鼠局灶性脑缺血模型的失败原因探悉

目的　对大鼠局灶性脑缺血模型制备中的失败因素进行研究。方法　采用健康Wistar大鼠 ,线栓法制备MCAO(middlecerebralocclusion)模型 ,利用神经功能缺陷评分和TTC染色判定梗死是否成功。结果　夏季的大鼠梗死成活明显高于冬春季 (P <0 0 5 ) ;体重在 2 70～ 2 80g的成活率明显高于其它体重的 (P <0 0 5 ) ;雌雄之间没有明显差别 (P >0 0 5 ) ;插入长度小于 1 8cm的成活率明显高于插入长度为大于 1 8cm的 (P <0 0 5 ) ;而麻醉也影响模型成功与否 ;还未发现有明显原因而死亡的大鼠。结论　最理想大鼠脑梗死模型制备是在夏季 ,体重 2 70～ 2 80g ,插线长度小于 1 8cm。     

高血压脑出血手术时机与适应证的探讨

根据对118例高血压性脑出血立体定向外科手术治疗的总结，强调高血压性脑出血一经诊断，且具有手术指征时，手术越早越好；且认为患者的意识障碍严重程度、出血量、出血部位、发病时血压以及病人的年龄等因素对选择手术时机和手术适应证具有重要价值，并提出了具体的手术指征．     

Atrial natriuretic factor in hypovolemic tachycardia

Summary Atrial natriuretic factor (ANF) is released in response to many stimuli which increase right atrial pressure. Following hemorrhage pigs lowered their atrial pressures, developed a tachycardia and increased ANF levels. Electrical pacing increased heart rate and ANF levels. There is a stimulus to ANF release other than atrial stretch, probably heart rate.     

脑卒中运动性失语的护理

目的：探讨脑卒中运动性失语护理作用，方法：对15例失语患者采取心理疏导、语言训练，结果：语言完全恢复5人，不完全性失语6人，完全性失语4人，但能用手势等与对方沟通，结论：护理干预后失语患者生活质量明显改善。