Analysis of the Effect of the Comprehensive Nursing Model on Patients with Moyamoya Disease Undergoing Intracranial and Extracranial Revascularization Surgery

Objective:To explore the effect of a comprehensive nursing model on patients with Moyamoya disease who underwent intracranial and extracranial revascularization surgery.Methods:110 cases were divided into control and observation groups with 55 cases each.The control group received routine perioperative care,and the observation group received perioperative care along with comprehensive nursing care.The two groups’disease cognition levels,anxiety,symptoms,daily living ability scores,and postoperative complication rates were compared.Results:The anxiety score and total postoperative complications of the observation group upon discharge were lower than that of the control group,and the disease cognition level and daily living ability upon discharge were higher than that of the control group(P<0.05).Conclusion:Applying the comprehensive nursing model in conjunction with perioperative care for patients undergoing surgery can effectively improve their anxiety,strengthen activities of daily living,and reduce the risk of postoperative complications.

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage after spinal surgery.METHODS A retrospective cohort study was conducted from January 1,2015,to December 31,2022.Patients aged≥18 years,who had undergone spinal surgery were included.Intracranial hemorrhage patients were selected after spinal surgery during hospitalization.Based on the type of spinal surgery,patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage.The patients'pre-,intra-,and post-operative data and clinical manifestations were recorded.RESULTS A total of 24472 patients underwent spinal surgery.Six patients(3 males and 3 females,average age 71.3 years)developed intracranial hemorrhage after posterior spinal fusion procedures,with an incidence of 0.025%(6/24472).The prevailing type of intracranial hemorrhage was cerebellar hemorrhage.Two patients had a poor clinical outcome.Based on the type of surgery,30 control patients were randomly matched in 1:5 ratio.The intracranial hemorrhage group showed significant differences compared with the control group with regard to age(71.33±7.45 years vs 58.39±8.07 years,P=0.001),previous history of cerebrovascular disease(50%vs 6.7%,P=0.024),spinal dura mater injury(50%vs 3.3%,P=0.010),hospital expenses(RMB 242119.1±87610.0 vs RMB 96290.7±32029.9,P=0.009),and discharge activity daily living score(40.00±25.88 vs 75.40±18.29,P=0.019).CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low,with poor clinical outcomes.Patient age,previous stroke history,and dura mater damage were possible risk factors.It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients:A single-center retrospective study

BACKGROUND At present,many studies have reported the risk factors for postoperative intracranial reinfection,including age,sex,time to surgery,duration of postoperative catheterization,emergency procedures,type of disease and cerebrospinal fluid leakage,but the academic community has not reached a unified conclusion.AIM To find factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients.METHODS Ninety-four patients who underwent elective craniotomy from January 1,2015 to December 31,2022 in the Department of Neurosurgery,First Hospital of Jilin University,were included in this study.Of those,45 patients were enrolled in the infection group,and 49 were enrolled in the control group.The clinical data of the patients were collected and divided into three categories,including preoperative baseline conditions,intraoperative characteristics and postoperative infection prevention.The data were analyzed using SPSS 26.0 software.RESULTS There were 23 males and 22 females in the infection group with a mean age of 52.8±15.1 years and 17 males and 32 females in the control group with a mean age of 48.9±15.2 years.The univariate analysis showed that the infection group had higher systolic blood pressures and postoperative temperatures,fewer patients who underwent a supratentorial craniotomy,more patients with a history of hypertension and higher initial postoperative white blood cell counts than the control group,with statistically significant differences(P<0.05).The multifactorial logistic regression analysis showed that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative infection in neurosurgical patients.CONCLUSION The results obtained in this study indicated that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative neurological symptoms.

Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery

BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.

Contribution of Surgery in the Care of Intracranial Hematomas in Developing Countries: Case Series of 30 Patients in Abidjan

Intracranial hematomas, whatever its causes, represent an important disabling, and dreaded adult’s lesion. This brain’s condition has not well been studied in developing countries. The aim of our study is to overview the management of intracaranial hematomas in Abidjan. It is a retrospective analytical and descriptive study, involving patients who had been admitted and monitored by neurosurgeons for intracranial hematomas, documented in brain CT scan and had been operated on from 1 January 2007 to December 31, 2009 in Abidjan. These 30 patients were 23 men and 7 women. The average age was 58.6 years old. 90% of the patients were admitted with wakefulness issues. Half had a Glasgow score of less than 8. The brain scanner allowed identification of an intraparenchymal hematoma associated or not with a cerebral ventricle contamination in 28 patients. There were 18 external ventricle derivations with or without decompressive craniectomy and 12 independent decompressive craniectomy. The evolution was marked by 20 deaths. 10 patients (33.3%) survived. Among the survivors, the first attack and arterial hypertension were the only illness before the attack. None had blood in the membranes and all had Glasgow scores greater than or equal to 9 at admission. Around 7 out of 10 patients were operated on during the first 48 hours. The operative indications of intracranial hematomas are still the subject of controversy. By basing itself on criteria and rigorous clinical and neuroimaging selection, surgery could eventually contribute to the management of this pathology which has become very frequent in Africa.

Primary intracranial extraskeletal myxoid chondrosarcoma:A case report and review of literature

BACKGROUND Primary intracranial extraskeletal myxoid chondrosarcoma(EMC)is an extremely rare low-to intermediate-grade malignant soft tissue sarcoma,and only 15 cases have been reported in the literature.Due to its rarity,clinical data and research on this tumor type are extremely limited,the pathogenesis and histological origin are still unclear,and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.CASE SUMMARY We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo,and his health status deteriorated during the last week.CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus.Brain magnetic resonance imaging(MRI)showed a 3.4 cm×3.0 cm sized,well-defined,round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus.The entire lesion was removed via supratentorial craniotomy and microsurgery.Postoperative pathological diagnosis indicated primary intracranial EMC.Subsequently,the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge.At present,it is 12 mo after surgery,with regular postoperative follow-up and regular MRI examinations,that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor,and the patient has returned to normal life.CONCLUSION Currently,the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy.Long-term follow-up is also necessary for patients.

Clinical Analysis of Lumbar Pool Drainage Combined with Antibiotics in the Treatment of Intracranial Infection

Objective: To explore the clinical effect of lumbar pool drainage combined with antibiotics in the treatment of patients with intracranial infections, and to provide a reference basis for clinical treatment. Methods: To collect and select patients admitted to the First People’s Hospital of Jingzhou City for craniotomy from January 2016 to June 2022, the infected were 20 cases, and continuous drainage of the lumbar pool was used under the premise of systemic application of sensitive antibiotics. Results: Twenty cases in this group were discharged cured. Conclusion: Lumbar pool placement drainage combined with systemic application of antibiotics for intracranial infection is a safe and effective treatment method.

Clinical characteristics and outcomes of primary intracranial alveolar soft-part sarcoma: A case report

BACKGROUND Primary intracranial alveolar soft-part sarcoma(PIASPS)is a rare malignancy.We aimed to investigate the clinical profiles and outcomes for PIASPS.CASE SUMMARY We firstly reported five consecutive cases from our institute.Then,the cases from previous studies were pooled and analyzed to delineate the characteristics of this disease.Our cohort included two males and three females.The median age was 21-years-old(range:8-54-years-old).All the patients received surgical treatment.Gross total resection(GTR),radiotherapy,and chemotherapy were administered in 3 patients,4 patients,and 1 patient,respectively.After a median follow-up of 36 mo,tumor progression was noticed in 4 patients;and 3 patients died of the disease.Pooled data(n=14)contained 5 males and 9 females with a median age of 19 years.The log-rank tests showed that GTR(P=0.011)could prolong progression-free survival,and radiotherapy(P<0.001)resulted in longer overall survival.CONCLUSION Patients with PIASPS suffer from poor outcomes.Surgical treatment is the first choice,and GTR should be achieved when the tumor is feasible.Patients with PIASPS benefit from radiotherapy,which should be considered as a part of treatment therapies.

Intracranial Fungal Infections: Overview from Two Large Tertiary Hospital in Upper Egypt and Literature Review

Purpose: Fungal infections of the central nervous system (CNS) are potentially lethal conditions with high morbidity and mortality. In this review, we summarise the most common clinical manifestations, diagnostic methods, and treatment strategies for intracranial fungal infection at two tertiary care teaching hospitals. Material and methods: Prospective hospital study is carried out at Department of Neurosurgery;Assiut and Suhaj University Hospitals between January2010 to January 2018 (Minimum 12-months follow-up). Radiographs and hospital data of 74 patients with proven intracranial fungal infections were gathered and analyzed. There were no exclusion criteria: age, gender, clinical presentations, immunity status, radiological findings, laboratory, and microbiological data, types of management and outcome. In surgically treated patients, diagnosis was confirmed by pathologic evaluation. Gathered data were coded and entered into a computer and analyzed using SPSS version 22. Results: The greatest number of the patients had 40 to 60 years old (49;66%) and the mean age was 44 years. There was an overwhelming male patient’s ranged preponderance 66%;49 cases. Sixty-three patients (85%) were immunosuppressed;11 cases (15%) were immunocompetent. The most common causes of immunosuppression were diabetes 27 patients;43%, on chemotherapeutic agents 19 patients;31%, on corticosteroid 16 patients;25% and AIDS in one patient;1%. Five different fungal types were identified but Cryptococcus spp. was the most common cause of CNS fungal infection, occurring in 39 patients (53%). This was followed by Candida spp. in 14 patients (19%), Aspergillus in 11 patients (15%), Blastomyces in 7 patients (9%) and Coccidiosis in 3 patients (4%). Headache was the most common presenting symptom, occurring in 33 patients (45%). Other relatively common symptoms were nausea or vomiting 11 patients (15%), fever 10 patients;(13%), seizures 9 patients (12%), acute mental status changes 8 patients;(11%) and stroke like Symptoms 3patients (4%). Different surgical procedures were done. Stereotactic biopsy is in 19 patients (deep;located in an eloquent region of the brain or multiple small lesion) or excision in 38 patients (cortical, relatively accessible regions of the brain), and CSF shunting in 17 patients. All patients received parenteral and, in some cases, oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 52.7% (39 deaths). An additional 8 surviving patients exhibited permanent morbidity due to neurological deficits and seizure disorders. Conclusion: This prospective population study demonstrates an insight into the intracranial fungal infection and management. CNS fungal infections have increased in frequency, particularly in immunocompromised patients;most infections are caused by Cryptococcus spp. Diabetes was the most common cause of immunosuppression and headache was the most common symptom at presentation. CNS fungal infection is still associated with a high mortality and morbidity. Prompt diagnosis;early and appropriate medical and surgical management are fundamental to optimize the outcome.

Meningeal Hemangiopericytoma: A Rare Intracranial Tumor—About a Case

Introduction: Hemangiopericytoma is a very rare vascular tumor, difficult to diagnose, often confused with a meningioma. Imaging is not very specific and the diagnostic certainty remains histological. Observation: We report a case of meningeal hemangiopericytoma in a 48-year-old patient with a history of active smoking and whose sister died of glioblastoma. He was brought to the emergency room for a fall, confusion, and tonic-clonic seizures. The diagnosis was suspected on imaging (CT and MRI, in front of a syndrome of right temporal intraventricular mass measured at 37 mm in diameter, centered on the choroid plexus, with perilesional vasogenic edema and posterior white commissure. There was homogeneous enhancement of the lesion after gadolinium injection. The diagnosis was confirmed by immunohistochemical study, which showed diffuse expression of STAT6 and partial labeling for CD34, without significant expression of SSTR2. Expression of neurofilament protein was also found in the brain parenchyma. Conclusion: Hemangiopericytoma is a rare tumor, characterized by its malignant potential, its high rate of recurrence and distant metastasis. The management is based on a total microsurgical resection followed by radiotherapy.

3D-Slicer重建CTA在颅内动脉瘤夹闭术后随访中的应用

目的 探究基于3D-Slicer后处理CT血管造影(CTA)在颅内动脉瘤夹闭术后复查中的应用价值。方法 回顾性收集57例动脉瘤夹闭术患者的术后CTA影像资料,图像后处理方法包括多平面重组(MPR)、容积再现(VR)及最大密度投影重组(MIP),并与放射科工作站处理结果进行定性、定量对比,评价其临床应用价值。结果 57例患者69个动脉瘤共夹闭63个,术后CTA除5例图像质量不佳,余均可轻清晰显示瘤夹位置、残余瘤体、载瘤动脉瘤通畅性;术后CTA见2例夹闭不全,2例新发动脉瘤,9例血管广泛痉挛显影浅淡;脑出血3例,脑积水5例,脑梗死1例,以上结果与放射科工作站一致。两种方法重建3D-CTA对于夹闭后载瘤动脉瘤管径大小呈现无统计学差异,且一致性高。结论 3D-Slicer软件对于夹闭术后CTA的图像后处理结果令人满意,可作为一种备选的工具服务于临床。

颅脑术后继发颅内感染患者脑脊液膜联蛋白A2和S100钙结合蛋白A10表达水平及临床意义

目的探讨颅脑术后继发颅内感染患者脑脊液膜联蛋白A2(Annexin A2)和S100钙结合蛋白A10(S100A10)表达水平及临床意义。方法选取收治的颅脑术后继发颅内感染患者120例为试验组,选取同期颅脑术后未感染的120例患者为对照组。采用酶联免疫吸附测定(ELISA)检测脑脊液中Annexin A2、S100A10水平;采用Pearson相关分析法分析Annexin A2、S100A10与各临床指标的相关性;采用Logistic回归分析法分析颅脑术后继发颅内感染的影响因素;采用受试者工作特征(ROC)曲线分析Annexin A2、S100A10水平对颅脑术后继发颅内感染的预测价值。结果试验组的糖尿病占比、脑脊液渗漏占比、血乳酸脱氢酶(LDH)、脑脊液中Annexin A2及S100A10水平高于对照组,差异有统计学意义(P<0.05)。颅内感染患者脑脊液中Annexin A2与S100A10、血LDH水平呈正相关,S100A10水平与LDH水平呈正相关(P<0.05)。多因素Logistic回归分析显示,糖尿病、脑脊液渗漏、血LDH、脑脊液中Annexin A2和S100A10均是颅脑术后继发颅内感染的独立影响因素(P<0.05)。ROC曲线显示,脑脊液中Annexin A2、S100A10水平单独预测及二者联合预测颅脑术后继发颅内感染的曲线下面积(AUC)分别为0.788、0.768、0.865,其中联合预测AUC大于二者单独预测(P<0.05)。结论颅脑术后继发颅内感染患者脑脊液中Annexin A2、S100A10表达水平升高,是颅脑术后继发颅内感染的独立影响因素,二者联合预测价值较高。

未破裂颅内动脉瘤栓塞术后中长期生活质量和心理状态研究

目的探究栓塞手术能否改善未破裂颅内动脉瘤患者的生活质量、焦虑和抑郁的中长期结果。方法前瞻性纳入诊断30 d内的未破裂颅内动脉瘤患者,按处理方式分为栓塞组和保守组。在入组时、3个月时、5年时等时间点使用健康调查简单表36项(medical outcome study short form-36,SF-36)、抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)分别对生活质量、抑郁和焦虑进行评估。栓塞组患者在术后3个月时和5年时使用事件影响量表修订版(impact of event scale-revised,IES-R)分别评估患者的心理创伤水平。结果共纳入113例患者,其中栓塞组76例,保守组37例。栓塞组在3个月时SF-36的生理机能(80.3±16.4 vs.86.1±12.8,P=0.046)和生理职能(47.37±43.32 vs.67.57±34.29,P=0.015)评分比保守组低,但精神健康评分较高(68.16±18.80 vs.61.62±14.62,P=0.048)。5年时,SF-36的各维度评分均较入组时改善(P<0.05)。栓塞组的SDS和SAS评分在3个月时和5年时均较入组时下降(均P<0.05),评分增量比较,栓塞组的SDS(-2.8±10.6 vs.0.5±6.5)和SAS(-2.7±11.8 vs.1.2±5.4)评分3个月时变化值大于保守组(均P<0.05)。亚组分析中,栓塞组中在入组时存在抑郁或焦虑的患者,在3个月时和5年时的SDS和SAS评分较入组时下降(均P<0.05)。此外,栓塞组3个月时IES-R评分(37.5±13.8)分,高于临界值(P=0.005),但在5年时下降为(33.8±13.3)分。结论未破裂颅内动脉瘤栓塞手术后患者中长期生活质量较术前改善,栓塞手术有助于缓解患者的抑郁和焦虑。

新型神经介入灌注系统的设计与应用

目的:设计神经介入灌注系统并探讨其在颅内动脉瘤介入治疗术中的应用效果。方法:自主改良设计和制作新型神经介入灌注系统,该装置由加压袋及内部固定的可调节挂钩、压力显示表、改良输液线、气泡检测传感器组成。采用便利抽样法,选取2021年10月—2022年5月江西省某三级甲等综合医院收治的99例行颅内动脉瘤神经介入治疗手术的病人为研究对象,使用随机数字表法将其分为研究组(n=49)和对照组(n=50),研究组采用新型神经介入灌注系统,对照组采用传统神经介入灌注系统,比较两组建立灌注时间、更换灌注平均耗时、术中灌注系统更换例数、术中血液逆流发生率。结果:研究组建立灌注时间、更换灌注耗时均短于对照组;术中灌注系统更换例数少于对照组,差异均有统计学意义(P<0.05)。结论:设计的新型神经介入灌注系统应用于颅内动脉瘤介入治疗术可有效缩短建立灌注时间、更换灌注时间,降低术中灌注系统更换例数。

颅内动脉瘤介入术后康复护理质量评价指标体系的构建与应用

目的:构建颅内动脉瘤介入术后康复护理质量评价指标体系,通过临床应用检验其效果。方法:检索研究主题相关文献,阅读文献、提取颅内动脉瘤介入术后康复护理质量评价指标,根据“结构-过程-结果”三维质量模式构建颅内动脉瘤介入术后康复护理质量评价指标体系初稿,通过德尔菲法专家函询对指标实施评价、筛选、修订,最终确立颅内动脉瘤介入术后康复护理质量评价指标体系。自2022年7月起应用颅内动脉瘤介入术后康复护理质量评价指标体系,此前均实施常规护理模式,选取本院神经外科2022年1月—6月、7月—12月收治的颅内动脉瘤介入术病人,各75例,根据指标体系应用前后分为对照组和观察组,比较两组病人康复效果及护理满意度。结果:函询结果显示,两轮问卷回收率均为100%,两轮专家权威度系数分别为0.863,0.876,函询意见肯德尔和谐系数分别为0.492,0.537,差异有统计学意义(P<0.001),最终形成的颅内动脉瘤介入术后康复护理质量评价指标体系包括一级指标3个、二级指标10个、三级指标38个,变异系数为0.076~0.148。应用效果显示,观察组病人康复效果评价指标表现优于对照组,观察组病人护理满意度评价高于对照组,差异均有统计学意义(P<0.05)。结论:颅内动脉瘤介入术后康复护理质量评价指标体系有较好的科学性与可靠性,其在临床护理中应用,可实现对颅内动脉瘤介入术后康复护理质量有效评价、持续改进,有助于改善术后康复效果,提升护理满意度。

颈外动脉-桡动脉-大脑中动脉搭桥术治疗血流代偿不良的大型或巨大型颈内动脉动脉瘤的临床观察

目的探讨颈外动脉(ECA)-桡动脉(RA)-大脑中动脉(MCA)M2段搭桥联合动脉瘤孤立术对于血流代偿不佳的大型或巨大型颈内动脉(ICA)动脉瘤患者的临床疗效。方法本研究为单中心回顾性研究,纳入2016年1月至2021年6月天津市环湖医院神经外科收治的8例采用ECA-RA-M2搭桥联合动脉瘤孤立术治疗的大型(最大径为16~25 mm)或巨大型(最大径>25 mm)ICA动脉瘤患者,共10个动脉瘤(2例为串联动脉瘤)。其中,破裂动脉瘤2例,未破裂动脉瘤6例。所有患者均通过术前评估证实球囊闭塞试验阳性和(或)磁共振灌注加权成像提示血流灌注分期为Ⅱ2期。采用O′Kelly-Marotta(OKM)分级评估术后即刻动脉瘤的闭塞程度。观察围手术期手术相关并发症。术后定期行临床和影像学随访,观察临床症状的变化情况,采用改良Rankin量表评分(mRS)和Karnofsky功能状态评分评估患者的预后。结果8例患者中,术后6例达到完全闭塞(OKM分级D1级),1例为近全闭塞(OKM C1级)。围手术期2例患者发生缺血性卒中。8例患者均获得随访,临床随访时间[M(Q_(1),Q_(3))]为69.9(55.0,85.3)个月。至末次随访,6/8的患者术前临床症状缓解或治愈,随访期间1例患者发生缺血性卒中。8例患者末次随访的mRS[M(Q_(1),Q_(3))]为0(0,1)分,其与术前mRS[1(1,1)分]的差异无统计学意义(Z=-1.19,P=0.236)。末次随访,8例患者的Karnofsky功能状态评分为(92.5±13.9)分。影像学随访时间[M(Q_(1),Q_(3))]为35.8(5.8,68.8)个月,1例患者的动脉瘤较术前缩小,其余7例患者的动脉瘤达到完全或近全闭塞。结论对于血流代偿不佳的大型或巨大型ICA动脉瘤,ECA-RA-M2搭桥联合动脉瘤孤立术的动脉瘤闭塞率高,患者的临床预后良好,安全性较理想。

快速康复外科护理在急诊颅内动静脉畸形出血栓塞术患者中的临床应用

目的探讨快速康复外科护理在急诊颅内动静脉畸形出血栓塞术患者中的效果。方法选取2023年1月至11月厦门市第三医院神经外科接受治疗的40例颅内动静脉畸形出血并接受栓塞手术的患者为研究对象,按照随机数字表法分为观察组(20例)与对照组(20例)。对照组给予栓塞手术常规护理,观察组应用快速康复外科护理,比较两组患者的术后并发症发生情况、首次下床时间、住院时间及满意度。结果两组患者均未见再出血、股动脉血栓的发生,观察组的术后并发症总发生率低于与对照组,差异有统计学意义(P<0.05)。观察组患者的首次下床时间和住院时间均短于对照组,差异有统计学意义(P<0.05)。观察组患者的总满意度高于对照组,差异有统计学意义(P<0.05)。结论对于急诊颅内动静脉畸形栓塞术应用快速康复外科护理,可以减少术后并发症的发生,缩短患者的下床时间和住院天数,有效促进患者术后恢复。

不同剂量替罗非班联合尼莫地平治疗颅内动脉瘤介入术后疗效观察

目的探讨不同剂量替罗非班联合尼莫地平治疗颅内动脉瘤介入术后的疗效。方法选取河北省衡水市人民医院2020年1月至2023年1月收治的行颅内动脉瘤介入术患者100例,随机分为A组和B组,各50例。两组患者均予介入治疗、抗凝方案和抗血小板方案。于支架置入后即刻,A组患者静脉注射替罗非班10µg/kg负荷剂量3 min、0.15µg/(kg·min)维持输注(全剂量),B组患者静脉注射替罗非班5µg/kg负荷剂量3 min、0.075µg/(kg·min)维持输注(半剂量),48 h后服用尼莫地平。结果A组和B组缺血性和出血性并发症发生率相当(8.00比6.00%,6.00%比0,P>0.05)。B组术后即刻栓塞程度显著优于A组(P<0.05)。两组患者术前及术后24 h的凝血酶时间、凝血酶原时间、活化部分凝血活酶时间和纤维蛋白原水平比较均无显著差异(P>0.05)。A组与B组患者出院时的临床预后良好率和死亡率相当(78.00%比88.00%,6.00%比2.00%,P>0.05)。A组和B组患者不良反应发生率相当(20%比10.00%,P=0.161>0.05)。结论全剂量和半剂量替罗非班静脉注射联合尼莫地平用于颅内动脉瘤介入术后安全、有效,患者的围术期并发症、凝血指标、预后、不良反应发生率相当,但半剂量替罗非班预防围术期栓塞发生的效果更好。

外周血miRNA-126与miRNA-143表达对颅内动脉瘤介入术后患者复发的预测价值

目的:探讨外周血微小RNA-126(miRNA-126)、miRNA-143表达水平对颅内动脉瘤介入术后患者复发的预测价值。方法:选取113例行介入栓塞术治疗的颅内动脉瘤患者为研究对象,根据术后不同Raymond分级分为RaymondⅠ级组(n=88)、RaymondⅡ级组(n=13)和RaymondⅢ组(n=12);根据不同预后分为复发组(n=19)和未复发组(n=94)。比较不同分级患者、不同预后患者外周血miRNA-126、miRNA-143表达水平,分析其与Raymond分级的相关性及其对颅内动脉瘤患者介入栓塞术后复发的预测价值。结果:与RaymondⅠ级组相比,RaymondⅡ级组和RaymondⅢ级组患者miRNA-126表达水平均升高(P<0.05),miRNA-143表达水平均降低(P<0.05)。相关性分析显示,miRNA-126水平与Raymond分级正相关(r=0.364,P<0.05),miRNA-143水平与Raymond分级负相关(r=-0.347,P<0.05)。复发组患者外周血miRNA-126表达水平高于未复发组(P<0.05),miRNA-143表达水平低于未复发组(P<0.05)。ROC曲线分析显示,外周血miR-126、miR-143及其联合预测颅内动脉瘤患者介入栓塞术后复发的曲线下面积分别为0.767、0.826、0.968,联合检测预测的价值高于两者单独预测(P<0.05)。结论:外周血miRNA-126、miRNA-143联合检测能提高颅内动脉瘤介入术后复发的预测价值。