不同治疗护理方法对脑栓塞后抑郁、运动功能及血液相关指标的影响

目的探讨护理干预对脑栓塞后抑郁患者神经及运动功能康复的影响。方法脑栓塞后抑郁患者108例,随机分为两组,对照组47例,观察组61例。对照组实施常规护理措施,观察组在常规护理的基础上给予护理干预。入院后第1天及治疗护理后90天抽晨起静脉血检测血流变学、血黏度、体液免疫和细胞免疫;采用运动功能量表、神经功能缺损评分表、汉密顿抑郁量表评分评价抑郁、神经和运动功能。应用SPSS20.0软件,所获数据采用方差分析、t检验和2检验。结果对照组NFA、HAMD评分比较,P均<0.0005;FMA评分比较,P<0.01;观察组NFA、HAMD、FMA评分比较,P均<0.0005。两组治疗后NFA、HAMD、FMA评分情况比较,P均<0.0005。对照组治疗前后血流变学指标比较,P均<0.0005;观察组治疗前后血流变学指标比较,P均<0.0005。两组治疗后血流变学指标比较,P<0.0005。两组治疗前炎性因子比较,P均>0.05;同组治疗前后炎性因子水平变化比较:对照组治疗后IL-6、IL-8、CRP比较,P均>0.05;TNF-α比较,P<0.05;观察组治疗前后IL-6比较,P>0.05;IL-8、CRP、TNF-α比较,P<0.05。两组治疗前后IL-6、IL-8、CRP、TNF-α比较,P>0.05。对照组显效率82.98%。观察组显效率95.08%。两组比较,P<0.05。结论不同治疗护理方法对脑栓塞后抑郁、神经功能、运动功能的恢复和血流变学、炎性因子均有显著性影响。

静舒氧治疗急性脑血管意外40例疗效观察

目的:观察静舒氧治疗急性脑血管意外的临床疗效。方法:对40例急性脑血管意外患者采用静舒氧治疗,10d为1个疗程。观察患者治疗前后的血气分析和临床症状改善情况。结果:采用静舒氧治疗2h后,患者的PaO2和SaO2均有明显改善,与治疗前比较,差异有显著性意义(P<0.01)。患者的临床症状明显改善,总有效率均达90.0%。结论:静舒氧治疗可明显改善急性脑血管意外患者的血氧饱和度,明显提高患者的日常生活活动能力,值得临床推广应用。

高压氧治疗过程中诱发脑梗死的危险因素6例分析(英文)

背景:传统观点认为高压氧可以防治脑梗死,但在高压氧治疗中有诱发脑梗死的病例报告。目的:分析高压氧过程中诱发脑梗死的危险因素。设计:以患者为观察对象的病例分析。单位:广州军区广州总医院高压氧科。对象:观察对象为1996-12/1998-03广州军区广州总医院行高压氧治疗的的192例住院患者,男127例,女65例;年龄9～78岁。接受高压氧治疗中发生脑梗死的患者共6例,男女各3例;年龄51～76岁。方法:对192例行高压氧治疗患者及其中发生的6例脑梗死患者的背景因素进行分析。主要观察指标:患者的症状、体征以及头颅CT 或M RI变化。结果:按意向处理分析,192例患者进入结果分析。①高压氧治疗过程中脑梗死发生率为0.3%(6/192)。②发现高压氧诱发脑梗死以年龄≥60岁、高血压病、高脂血症、原有脑梗死(或脑出血)、高黏血症及糖尿病等基础疾病为危险因子,危险因子簇集4个以下者不发病,4个或4个以上者发病率大为增加。结论:危险因子的簇集性水平与高压氧诱发脑梗死发生概率有密切关系。

高压氧治疗过程中诱发脑梗死的危险因子:水平分析(英文)

背景:既往认为高压氧可以防治脑梗死,但有报道高压氧也可诱发其发生,其发生原因尚不甚清楚。目的:探讨高压氧诱发脑梗死的原因。设计:病例分析。单位:解放军广州军区广州总医院高压氧科。对象:选择1996-12/1998-03在广州军区广州总医院高压氧科行高压氧治疗的192例住院患者。男127例,女65例,年龄9～78岁。纳入标准:①因缺氧、缺血性疾病,或由于缺氧、缺血引起的一系列疾病且无高压氧治疗的禁忌证在高压氧科住院治疗的患者。②年龄、性别不限。③患者及家属知情同意。不符合上述标准或虽符合上述标准但未做高压氧治疗的住院患者为排除标准。脑梗死诊断及治愈标准:按照《临床疾病诊断依据治愈好转标准》,治疗中发生脑梗死的患者共6例,男女各3例,年龄51～76岁。方法:高压氧治疗:采用多人空气加压舱,治疗压力为0.2MPa(2.0ATA),面罩吸纯氧40min2次,中间间歇吸空气10min,1次/d,每10次为1个疗程。对6例发生脑梗死患者、186例未发生脑梗死患者的背景因素及其危险因子水平进行分析。主要观察指标:高压氧治疗诱发脑梗死患者危险因子分布及未发生脑梗死患者危险因子水平分析。结果:①6例患者均有高脂血症,5例有高血压,5例原有脑梗死或脑出血,4例年龄≥60岁或有高黏血症,有糖尿病者1例。6例患者的危险因子数在4个以上,存在危险因子簇集性。②6例发生脑梗死患者中含4个危险因子的有5例,含5个危险因子的1例。186例未发生脑梗死患者中含4个危险因子的有25例,含5个危险因子的0例,其危险因子蔟集性相对较小(χ2=54.37,P<0.005)。结论:发生脑梗死患者均存在危险因子簇集性,危险因子的簇集性水平与高压氧诱发脑梗死概率有密切关系。

Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS)was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.

Rare pulmonary and cerebral complications after transarterial chemoembolisation for hepatocellular carcinoma:A case report

We report a rare case of acute pulmonary and cerebral complication after transarterial chemoembolisation (TACE) for inoperable hepatocellular carcinoma. The case involved a large tumor and hepatic vein invasion. Nonspecific pulmonary and cerebral symptoms such as acute dyspnoea and transient consciousness loss developed in the patient, a 49-year-old woman, following the TACE due to pulmonary and cerebral oil embolism. The chest and brain conditions of this patient improved after some supportive therapies and nursing interventions. She also subsequently completed the other three procedures of TACE.

Transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes

Objective：To evaluate the safety and efficiency of transvenous embolization of dural arteriovenous fistula of cavernous region by multiple venous routes. Methods： Twenty seven patients with dural arteriovenous fistula of cavernous region were treated by transvenous embolization with micro-coils. The transvenous routes included inferior petrosal sinus, superior ophthalmic vein and facial vein. Results： Clinical cure was achieved in 23 cases and significant improvement of symptoms in 4 cases. Complete anglographic obliteration was documented in 22 patients （82%）. Residual shunting were left in 2 patients via pterygoid drainage and 1 case via inter-cavernous sinus, 2 cases via inferior petrosal sinus, disappeared one month later by manual compression carotid artery. Headache and vomiting were the most common symptoms after embolization. Three patients had diplopia and relieved within two months after embolization. There was no permanent procedure-related morbidity. The clinic follow up ranged from 5 months to 6 years, and there was not recurrence case. Conclusion： Transvenous embolization via different venous routes is a safe and efficient method for dural arteriovenous fistula of cavernous region treatment.

ENDOVASCULAR EMBOLIZATION TREATMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS（REPORT OF 54 CASES）

For further reaseach on endovascular embolization treatment of AVMs, 54 patients with AVMs treated with embolization were observed. It was found that embolization was an effective procedure for the treatment of AVMs. Combined treatment of AVMs with presurgical embolization and direct surgery could reduce the comphcations resulting from large and high flow AVMs with lone surgical removal.