介入治疗鞍内动脉瘤并蛛网膜下腔出血1例临床分析

探讨鞍内动脉瘤出血的临床表现、诊断与治疗策略。分析1例鞍内动脉瘤出血患者临床资料并复习文献。头颅CT检查确定为蛛网膜下腔出血,急诊行脑血管造影确诊为动脉瘤,成功介入手术治疗。破裂的鞍内动脉瘤诊断较为容易,未破裂动脉瘤尤其是巨大鞍内动脉瘤诊断困难,易与鞍内肿瘤混淆,对可疑者应及时行多层螺旋CT血管成像(CTA)、磁共振血管造影(MRA),确诊依靠数字减影血管造影(DSA)检查,确诊后选择恰当治疗方案。     

对颅内宽颈动脉瘤血管内治疗的哲学思考

1　血管内技术治疗宽颈动脉瘤的发展过程1.1　宽颈动脉瘤的治疗效果回顾宽颈动脉瘤如果采用常规的开颅神经外科手术(动脉瘤颈夹闭术 )手术成功率较低 ,主要是因为瘤颈宽大 ,不容易充分地暴露 ,而且开颅手术的创伤较大 ,故目前逐渐采用血管内介入技术来治疗宽颈动脉瘤。初期人们用电解可控铂金弹簧圈技术(Guglielmidetachablecoil,GDC )来治疗宽颈动脉瘤。但逐渐认识到该技术的复发率较高。对于宽颈动脉瘤 (颈宽 >4mm、直径 >10mm ) ,初次治疗的完全栓塞率只有 31.2 %～ 5 0 .0 % [1] 。对于不完全栓塞的动脉瘤的长期随访发现 :小而宽颈的…     

尼莫地平联合法舒地尔治疗颅内动脉瘤介入栓塞术后脑血管痉挛的应用

研究分析颅内动脉瘤介入栓塞术后应用尼莫地平联合法舒地尔对脑血管痉挛(CVS)。选择2013年1月~2016年12月收治的颅内动脉瘤介入栓塞术后脑血管痉挛的患者158例,均采用神经介入术治疗,按照用药分为观察组79例(采用尼莫地平联合法舒地尔治疗)、对照组79例(采用尼莫地平治疗)。观察两组患者术后格拉斯哥评分(COS)、大脑中、后动脉血流速度情况、不良反应等情况。结果,观察组COS评分由(8.26±1.28)分增加至(13.51±1.21)分,对照组(8.42±1.09)分增加至(10.49±1.06)分,组间比较P0.05。观察组大脑中、后动脉血流速度治疗前分别为(101.91±32.42)cm/s、(50.72±20.65)cm/s;对照组分别为(100.12±33.61)cm/s、(50.40±20.54)cm/s;以上指标组间比较P0.05。治疗后,观察组分别为(83.25±15.84)cm/s、(39.59±11.12)cm/s;对照组分别为(90.83±17.58)cm/s、(46.37±13.52)cm/s;P0.05。观察组、对照组均无严重不良反应,总发生率分别为10.13%、8.86%,组间比较P0.05。观察组总有效77例(97.45%),无效2例(2.53%);对照组总有效70例(88.61%),无效9例(11.39%),P0.05。颅内动脉瘤介入栓塞术后应用尼莫地平联合法舒地尔对脑血管痉挛治疗效果较佳,能够促进患者神经功能的恢复,减轻COS程度,并发症少,适合临床推广。     

浅析间变性脑膜瘤的治疗及预后

探讨颅内间变性脑膜瘤的治疗及预后分析。对笔者所在医院2010年1月~2014年1月接受颅内间变性脑膜瘤治疗的患者50例,对其临床资料进行分析,分析预后相关因素。50例患者均为颅内间变性(恶性)脑膜瘤。所有患者按照Simpson分级法评估术后肿瘤切除的程度,其中26例患者接受SimpsonⅠ级切除;24例患者接受SimpsonⅡ级、Ⅲ级切除。50例患者分为四组,其中SimpsonⅠ级切除合并放疗组13例,SimpsonⅠ级切除无放疗组13例,SimpsonⅡ级、Ⅲ级切除合并放疗组12例,SimpsonⅡ级、Ⅲ级切除无放疗组12例。SimpsonⅠ级切除合并放疗组的无进展生存期(PFS)为68个月,复发率为48%。SimpsonⅠ级切除无放疗组PFS为22个月,复发率为90%。SimpsonⅡ级、Ⅲ级切除合并放疗组PFS为23个月,复发率为87%。SimpsonⅡ级、Ⅲ级切除无放疗组PFS为12个月,复发率为92%。SimpsonⅠ级切除合并术后放疗是有效治疗颅内间变性脑膜瘤并延长生存率的有效治疗方法。     

颅内动脉瘤治疗方案的比较

手术和血管内介入是目前临床上治疗颅内动脉瘤的有效方法,针对两者的优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴。     

颅内动脉瘤治疗方案的比较

手术和血管内介入是目前临床上治疗颅内动脉瘤的有效方法,针对两者的优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴.     

预防患者术中知晓的早期心理干预——颅内动脉瘤介入栓塞术患者中的研究

探讨早期心理干预在预防颅内动脉瘤栓塞术患者术中知晓的效果.将100例患者按入院先后顺序随机分为观察组和对照组,各50例,均实行整体护理,对照组给予常规的术前、术后护理,观察组在常规护理的基础上给予一系列针对术中知晓的心理护理干预措施.观察组干预前后焦虑程度明显减轻(P＜0.01),对护理质量满意度均优于对照组(P＜0.05),差异有统计学意义.针对不同患者心理状态进行系统的早期心理干预可减轻脑血管介入患者术前焦虑情绪,从而积极有效地预防颅内动脉瘤栓塞术患者术中知晓的发生,提高护理质量满意度.     

出血性脑血管病介入治疗进展

出血性脑血管病的介入栓塞治疗由于血管内辅助技术与各种栓塞材料的综合应用取得快速发展,主要有以下三个方面：（1）生物修饰弹簧圈、封堵球囊和支架技术的应用使复杂颅内动脉瘤的介入治疗成为可能;（2）非粘附性液体栓塞剂的应用提高了脑动静脉畸形和硬脑膜动静脉瘘的单纯栓塞治愈率;（3）带膜支架在颅底部巨大动脉瘤和创伤性动静脉瘘取得开创性应用。     

预防患者术中知哓的早期心理干预——颅内动脉瘤介入栓塞术患者中的研究

探讨早期心理干预在预防颅内动脉瘤栓塞术患者术中知晓的效果。将100例患者按入院先后顺序随机分为观察组和对照组,各50例,均实行整体护理,对照组给予常规的术前、术后护理,观察组在常规护理的基础上给予一系列针对术中知晓的心理护理干预措施。观察组干预前后焦虑程度明显减轻（P〈0．01）,对护理质量满意度均优于对照组（P〈0．05）,差异有统计学意义。针对不同患者心理状态进行系统的早期心理干预可减轻脑血管介入患者术前焦虑情绪,从而积极有效地预防颅内动脉瘤栓塞术患者术中知晓的发生,提高护理质量满意度。     

颅内动脉瘤介入治疗手术麻醉中丙泊酚及舒芬太尼联合应用效果研究

探讨丙泊酚复合舒芬太尼在动脉瘤介入手术麻醉中的临床应用效果,选取具有动脉瘤介入手术指征的患者200例,分为舒芬太尼组及丙泊酚复合舒芬太尼组,比较两组血流动力学变化、麻醉恢复情况、恶心、呕吐、躁动等不良反应发生率。结果显示:丙泊酚复合舒芬太尼组在插管即刻、插管后1min、插管后5min、拔管时的收缩压、舒张压、心率均显著低于舒芬太尼组(P0.05);自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间均短于舒芬太尼组(P0.05)。因此,丙泊酚复合舒芬太尼在动脉瘤介入手术的麻醉中使血流动力学更平稳,苏醒质量更高,不良反应率降低。     

Surgery of aneurysms of the cerebral arteries--results and problems

Surgery has been performed on 100 intracranial aneurysms during the past seven years. Of these, 96 involved the application of microsurgical techniques and could definitely be clipped. Lethality was 8%. Post-surgical deterioration of the clinical neurological status was observed in another 20 patients, but vanished subsequently in 16 of them. Immediate surgery within 48 hours of the subarachnoidal hemorrhage is recommended to avoid subsequent hemorrhage and prevent severe vasospasmic phenomena. Only patients whose general status is good (Hunt and Hess degree 1 or 2) are suitable for immediate surgery.     

颅内动脉瘤治疗方案选择的多维思考

针对颅内动脉瘤手术治疗和血管内治疗的优缺点,分析不同治疗方式的疗效与经济费用比较,就如何选择治疗方法提出医疗原则,并对医疗原则进行伦理学思考,认为治疗应该体现安全、有效、经济的原则.     

远外侧入路治疗颅颈交界区腹侧病变

探讨远外侧入路在颅颈交界区腹侧病变治疗中的应用。14例患者全部采用远外侧入路显微手术治疗。11例肿瘤全切除7例,次全切除2例,大部切除2例;3例动脉瘤均顺利夹闭;行枕颈融合术3例。术后最常见的并发症是后组脑神经损伤症状;获得随访11例,恢复良好。远外侧入路是治疗颅颈交界区腹侧病变的理想入路,但治疗方案应个体化。     

Screening for intellectual disability in Dutch police suspects

The screener for mild intellectual disability (SCIL) was developed to screen for mild intellectual disability (IQ below 85). The aims of this study were (a) to examine the predictive validity of the SCIL in screening for intellectual disability among police suspects and (b) to explore the prevalence of cognitive intellectual disability among suspects in police custody in the Netherlands. An unselected sample of police suspects (N = 178) charged with a variety of offences was assessed with the SCIL, a Wechsler Adult Intelligence Scale (WAIS)‐III‐NL short form, and a malingering measure. The SCIL screened 50.0% of the sample as having mild intellectual disabilities, whereas the short WAIS classified 84.3% of the sample with an IQ below 85. A principal component analysis of the SCIL showed ambiguous results. Furthermore, the short WAIS classified 55.6% of our sample with a borderline IQ (IQ = 70–84), 84.3% with an IQ below 85 and 28.7% with an IQ below 70. The prevalence of intellectual disability in this sample of Dutch (police) suspects appears to be higher than prevalence rates found in previous international studies. More exhaustive research is needed to examine the prevalence of intellectual disabilities in police suspects, and the utility of the SCIL to screen for these disabilities.     

Phonemic analysis and severe reading disability in children

Forty-five first-grade children of average intellectual ability were studied, consisting of one group of average readers, one group with mild reading difficulty, and one group with severe reading disability. A striking deficit in phonemic analysis was observed in children with severe reading disability. These children were unable to segment spoken syllables into individual speech sounds, while children with only mild reading difficulty or none were quite proficient at this skill. In fact, using phonemic analysis scores, it was possible to distinguish the severe reading disability group from the others with perfect accuracy.This research was supported in part by U.S. Public Health Service, Maternal and Child Health Project 916, and by Grants HD-03110 and ES-01104 from the National Institutes of Health.     

The Influence of Group Size and Stigma Severity on Social Acceptance: The Case of People with Intellectual Disability Moving into Neighbourhoods

Dutch adults from a nationwide Internet panel (N = 426) were asked to imagine that their next‐door neighbours would move out and that people with intellectual disability would move in. Severity of disability and group size were varied to manipulate intergroup threat. These two factors independently influenced social acceptance and a variety of emotional and behavioural measures. In particular, it was found that a large group with severe disability aroused the strongest negative response, whereas a small group with mild disability aroused the weakest negative response. Small groups with a severe disability and large groups with a mild disability aroused similar and intermediate negative responses. Results are discussed in terms of theories of intergroup threat and stigmatisation. Practical implications for predicting the success of de‐institutionalisation and social integration of groups with special needs are addressed. Copyright © 2011 John Wiley & Sons, Ltd.     

Adaptation to juvenile rheumatic disease: a controlled evaluation of functional disability with a one-year follow-up.

Compared the adaptation of 165 patients with juvenile rheumatic disease (JRD) to that of their healthy siblings. Patients were divided into those with mild functional disability and those with moderate/severe disability. Adaptation in several domains was assessed by parents and children on two occasions 1 year apart. The adjustment difficulties of the JRD children were limited primarily to social functioning but appeared also in the psychological and family problems domains. Compared to "mild" patients, "moderate/severe" patients had more adjustment difficulties; in some areas, mild patients functioned as well as their healthy siblings. Some Time 1 differences were replicated at Time 2. The results help to delineate (a) the specific domains in which children with chronic disease have adjustment difficulties and (b) the factors that put children at risk for developing adjustment problems.     

特殊类型的无骨折脱位型颈髓损伤治疗分析

为了探讨多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤的治疗,回顾了本院收治的4例多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤患者的临床资料,并结合相关文献报道进行分析。结果显示,4例患者均早期行前后路联合手术椎管减压,3例患者行预防性气管切开,4例患者术后随访时间6个月～48个月,平均随访24个月。固定节段均获骨性融合,内固定物无松动、断裂;后路手术无再关门现象。术后神经功能评价按Frankel分级,均有1个～2个级别恢复,术前A级2例,B级2例;术后B级2例,C级1例,D级1例。提示对于多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤早期行前后路联合手术减压;预防性气管切开可获得良好的治疗结果。     

湖北省智力残疾现状分析及预防对策

以湖北省第二次全国残疾人抽样调查的资料为依据,对智力残疾发生率、智力残疾等级、智力残疾的致残原因等现状进行分析。农村组智力残疾率明显高于城市组;三、四级智力残疾比率明显高于一、二级智力残疾比率;智力残疾的主要致残原因为遗传性疾病和脑疾病。说明智力残疾的康复任务仍很重,需要社会及政府的广泛重视。