脑梗塞患者体感诱发电位的研究

对CT证实脑梗塞的患者50例,测定中潜伏期体感诱发电位异常,并测定了正常人30例为对照组。结果表明,脑梗塞患者病灶侧P_3,N_3异常,主要是波峰潜伏期延长,部分患者波幅降低或消失。     

体感诱发电位在小儿脊髓疾病中定位诊断的研究

目的 探讨体感诱发电位(SEP)在小儿脊髓疾病中的定位诊断价值。方法 以180例0-14岁小儿刺激正中神经和胚后神经体感诱发电位正常值为标准，对临床诊断脊髓疾病的71例年龄2个月-13岁小儿的体感诱发电位进行分析比较。结果 71例临床诊断脊髓疾病的小儿SEP总异常率95．8％(68／71)，3例脊柱畸形SEP正常。其中周围神经SEP异常率为29．4％(20／68)，脊髓SEP异常率为88.2％(60／68)，皮层SEP异常率为75％(51／68)。表现为峰潜伏期记录延长或消失；68例异常SEP中，除1例颈椎外伤病人正中神经SEP异常外，其余67例患儿的正中神经SEP均为正常。结论 正确利用正中神经、胫后神经体感诱发电位对小儿脊髓疾病定位诊断具有十分重要作用。     

糖尿病神经系统并发症的诱发电位检查

对60例糖尿病患者进行了脑干听觉诱发电位和上、下肢体感诱发电位检查,结果异常率为91.7％。该检查对神经系统的病损定位准确,可作为早期诊断神经系统并发症的有效办法。     

缺血性完全性卒中病人的短潜时体感诱发电位研究

自1973年 Tsumoto 等记录单侧大脑半球脑血管病变病人的体感诱发电位(SEP),发现 N_1～P_1～N_2消失以来,体感诱发电位已被广泛用于脑血管病的研究。我们于1986年2月～1986年11月对62例病     

胫后神经刺激的体感诱发电位和身高的关系

对51例健康人进行胫后神经刺激的体感诱发电位检查.结果表明,身高与脊髓电位N_22及皮层电位P_40的峰潜伏期高度相关,说明身高为胫后神经体感诱发电位正常值非常重要的参数。     

体感诱发电位在静脉麻醉下推拿治疗肩周炎的临床应用

目的:利用体感诱发电位在静脉麻醉下推拿治疗肩周炎术中进行监测,以预防臂丛神经损伤。方法:2008年1月-2011年12月,对50例肩周炎患者术前清醒状态下、术中麻醉后行体感诱发电位监测,均采用静脉麻醉,麻醉药品的使用和单位体质量的用药剂量尽量相同,术后清醒状态下再次行体感诱发电位检查。结果:与术前清醒状态下比较,麻醉后患者的体感诱发电位波幅峰值和潜伏期均有不同程度的改变,但是两者改变程度均未超过体感诱发电位异常的判断标准,而与麻醉后体感诱发电位的波幅峰值和潜伏期比较,患者术中监测的结果无明显改变。结论:体感诱发电位监测对预防静脉麻醉下推拿治疗肩周炎术中臂丛神经损伤有一定帮助。     

老年Ⅱ型糖尿病视觉和体感诱发电位的改变

对２６例老年Ⅱ型糖尿病进行视觉和体感诱发电位（ＥＰ）检查，视觉诱发电位（ＳＥＰ）异常１６例（６１．５４％）；体感诱发电位（ＳＥＰ）异常１４例（５３．８５％）。两种检查至少有一项异常者共２５例，总异常率为９６．１６％，其中有６例（２３．０８％）无临床症状。认为ＥＰ检查灵敏度高，检出异常率高，对老年Ⅱ型糖尿病神经系统并发症的早期诊断有重要意义。     

皮层体感诱发电位监护在脊柱手术中的应用价值

目的探讨脊柱手术中体感诱发电位监护技术的准确性、影响因素及临床应用价值。方法对120例脊柱手术患者术中采用皮层体感诱发电位（CSEP）监测,观察术前、术中、术后以及重要手术步骤的CSEP变化,结合术后脊髓功能改变,判断CSEP的准确性和临床价值。结果120例患者CSEP术中检测正常者112例（93．3％）,术后无脊髓功能损伤;6例（5％）患者术中CSEP达到预警值标准,告诫术者注意手术操作,术后无脊髓损伤,本体感觉无异常;出现假阳性2例,术后本体感觉正常。结论排除各种干扰因素后体感诱发电位可以较准确地对脊髓功能进行监测,是具有临床应用价值的良好脊柱手术监护技术。     

脑梗死患者体感及脑干听觉诱发电位的研究

目的 研究脑梗死后患者的体感诱发电位（SEP）及脑干听觉诱发电位（BAEP）变化。方法 对50例此类疾病患者进行SEP检查。其中36例行BAEP检查。结果 SEP异常率为72％,BAEP异常率为47％,患者SEP异常和病灶及体积关系密切,而BASP则与病灶体积有关,SEP及BAEP均随病情发生改变。结论 SEP及BAEP检查可在一定程度上反映脑梗死患者大脑及脑干的功能,并对此类疾病患者病情和预后的判断有一定价值。     

正常成年人脑诱发电位研究

本文报告了正常成年人体感、听觉脑干及视觉诱发电位的检查结果,3项诱发电位均各测定50人,体感诱发电位(SEP)出现P_1、N_1、P_2、N_2、P_3、N_3波,听觉脑干诱发电位(ABR)出现Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ波,视觉诱发电位(VEP)出现N_1、P_2、N_2波,各波的形态基本一致,波峰潜伏期均数值呈正态分布。发现男性SEP双侧P_1、N_1波峰潜伏期较女性延长(P<0.01),男女ABR右耳Ⅱ波峰潜伏期均较左耳延长(P<0.001)。     

Surgical treatment of brachiocephalic vessel involvement in Takayasu’s arteritis

Background Takayasu＇s arteritis （TA） is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty （PTA）. Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.Methods From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15-42 years （mean 26.5 years）. All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.Results There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients （20%） required further surgery for stenosis （5 patients） or anastomotic aneurysms （3 patients）. Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5-24 months.Conclusions When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.     

PREDICTION OF THE BRAIN TOLERANCE TO CAROTID ARTERY OCCLUSION USING NONINVASIVE METHODS

R6sumeObjectifEssainoninvasildelatoldranceceribraledl,occlusioncarotidienne.MdthodesAvantetopre8l,occlusioncarotidiennechez15oPdres,lesvitessespic(PV)etmoyenne(mV)ducourantsanguincarotidien,l'indicepulSabilite(PIdesarterescerebralesanterieureetmoyenneontetemesuresparsystemediagnostiqueultrason8DoPPler(TCD,ycomPriseslesevaluationsd,oxygenecerdbralrdgional(rSOz)etdepotentielssomatosensoriels(SSEPal.RdsuItatsNulddlcitneurologiquen,estrencontre.Unereductionde31.79%t13.59%(12.58%~56.16%)d…     

灌注CT联合CO2吸入测定症状性大脑中动脉缺血患者脑血管储备

目的 观察灌注CT联合CO2吸入测定症状性大脑中动脉缺血患者脑血管储备的可行性及脑血管储备的影响因素.方法 灌注CT采用10排的螺旋CT,激发试验采用5% CO2和95%O2混合气体,应用具有单向通气功能的简易呼吸气囊对40例症状性大脑中动脉缺血患者进行了脑血管储备的测定.另外检测了36名健康志愿者及32例症状性大脑中动脉缺血患者吸入5%CO2和95%O2混合气体2 min后呼气末CO2浓度的变化.结果 36名健康志愿者和32例症状性大脑中动脉缺血患者吸入混合气体后呼吸末CO2浓度增加值分别为0.93%±0.31%和0.89%±0.23%(P＜0.05).脑血管储备测定值可达20%以上.大脑中动脉支配区的脑血管储备与侧支循环数目和侧支循环分级呈正相关,与大脑中动脉M1段狭窄程度未发现明显相关关系.结论 经过初步观察,灌注CT联合CO2吸入是一种安全可行的测定症状性大脑中动脉缺血患者脑血管储备的方法,值得进一步研究.     

Short latency somatosensory evoked potentials and brainstem auditory evoked potentials in patients with head trauma

The SSEPs in 115 patients with head trauma were analysed by NT+ W value, da, db and b/a methods. The results revealed that the abnormal rates of the SSEPs were 94.8%. The pathological bases resulting in it were the direct and/or indirect lesion on the somatosensory pathway. The SSEPs recorded six months after the trauma indicated that the electric activities of neurons in some of the patients were still abnormal although they recovered well. The patients complicated with traumatic lesion of acoustic nerve, blood clots in external ear canal and pre-existing hearing loss had abnormal BAEPs that could not be used in diagnosing brainstem lesion. The patients without these complications in whom BAEPs were abnormal had an unfavourable outcome. The SSEPs and BAEPs simultaneously recorded could aid localization of the injury in the brain and enable discovery of the fact that the rigidity after decortication or decerebration is a result of severe injury of the cerebral hemisphere.     

经人工血管行股动脉插管在主动脉夹层手术中的应用

目的：探讨经股动脉插管行主动脉夹层动脉瘤手术的结果。方法：对159例主动脉夹层动脉瘤经股动脉插管进行手术,并观察其疗效。159例主动脉瘤中：StanfordA型89例,StanfordB型70例,90例全心转流,其中31例深低温停循环,69例左心转流。结果：7例（4．4％）在术中出现假腔灌注;7例（4．4％）出现脑部并发症,4例死亡,2例广泛脑缺氧,5例脑栓塞;12例（9．0％）皮肤切口延迟愈合,局部感染2例（1．5％）,无插管侧下肢缺血或股动脉血栓形成。采用经人工血管行股动脉插管有效地降低了股动脉狭窄,血栓形成和下肢缺血的发生,股动脉插管主动脉逆行灌注造成的脑部并发症在本组发生率较低,但后果严重。结论：经股动脉插管行体外循环或左心转流手术治疗主动脉夹层动脉瘤的方法是非常有效的。     

急性脑出血患者颅内血肿及其周边区局部脑血流量与躯体感觉神经诱发电位的研究

目的研究急性脑出血患者血肿区、周边区和对侧脑组织局部脑血流量以及躯体感觉神经诱发电位(si-matosensoryevokedpotential,SSEP)的变化。方法利用单光子发射计算机断层(singlephotonemissioncomputedtomo-graphy,SPECT)显像技术检查25例急性基底核区出血患者,根据中国卒中评分分型,轻型组16例,中型组9例,发病后1~5d、13~19d各做1次SPECT检查。采用感兴趣区模型分析法,分别于局部脑血流量(regionalcerebralbloodflow,rCBF)减低区的中心和其周围额顶叶、小脑中心及上述区域的对侧镜像区做放射性摄取计数,并计算病变侧与对侧放射性计数的摄取比(R),同时测定两组患者的SSEP各波潜伏时。结果两组患者行第1、2次SPECT检查时,血肿区病变侧放射性计数均显著低于对侧(P<0.01)。第1、2次检查时两组患者病变侧血肿区放射性计数均低于周边区(P<0.01)。病变对侧小脑的放射性计数低于病变侧,差异有显著性意义(P<0.01)。轻型组患者病变侧SSEP各波在P40、N60潜伏时及中型组患者病变侧SSEP各波在P25、N30、P40、N60潜伏时均较相应的对侧延长,差异有显著性意义(P<0.05);中型组患者病变侧SSEP各波在P25、N30、P40、N60潜伏时较轻型组相应波的潜伏时长,差异有显著性意义(P<0.05)。结论急性脑出血患者血肿区及其周边区的rCBF下降,血肿对侧小脑的血流量亦有下降,而且血肿侧的中枢神经系统功能有明显损害。     

血管重建术治疗糖尿病下肢缺血临床分析

目的 探讨糖尿病动脉硬化造成下肢缺血濒临截肢的外科治疗方法和可行的方案。方法2001年1月至2002年9月收治糖尿病合并严重下肢缺血患者20例，术前平均踝／肱指数(ABI)=0．29，对其中17例21条肢体进行血管重建术，其中人工血管旁路术19条肢体，自体大隐静脉旁路术2条肢体。结果手术后均可及足背或胫后动脉搏动，术后平均ABI=0．87，2例术后24h血管通路阻塞，再次行手术取栓及血管重建术。术后随防2～20个月，一期通畅率88％，再次手术后总通畅率为94．1％。结论对糖尿病伴严重下肢缺血造成下肢濒临截肢的患者采用血管重建术为抢救肢体、降低截肢平面的有效方法。     

大动脉炎所致的脑缺血的治疗

目的　探讨由大动脉炎所致的脑缺血的外科治疗.方法　本文报导了我们自1984年6月至1999年9月治疗93例因头臂型大动脉炎(TA)所致脑缺血的临床经验.其中，男性10例,女性83例,升主动脉－腋动脉或锁骨下动脉－颈动脉搭桥47例；锁骨下动脉－颈动脉搭桥7例；经皮腔内球囊成形（PTA）5例；合并支架置放术1例.结果　显效30.3％，有效34.9％，改善21.2％，无效4.6％，死亡9.0％；平均48个月随访疗效分别为：30.6％，38.8％，16.3％，4.1％和2.0％；复发8.2％.结论　当脑供血不足时，于病情相对稳定阶段，应以积极正确的方法予以治疗.如有可能，PTA可作为首选，但术后易复发.据我们的经验，颈部四血管阻塞性病变在造影时多不能显示远端流出道.但升主动脉－颈动脉搭桥在绝大多数情况下是可行的.然而，术后脑组织再灌注损伤至今仍未能完全解决.     

Management of cerebral ischemia due to Takayasu''''s arteritis

Ａｏｒｔｏａｒｔｅｒｉｔｉｓ ,ａｌｓｏｃａｌｌｅｄＴａｋａｙａｓｕ’ｓａｒｔｅｒｉｔｉｓ ,ｉｓａｃｈｒｏｎｉｃｉｄｉｏｐａｔｈｉｃｉｎｆｌａｍｍａｔｏｒｙｄｉｓｅａｓｅｔｈａｔａｆｆｅｃｔｓｌａｒｇｅａｎｄｍｅｄｉｕｍｓｉｚｅａｒｔｅｒｉｅｓ Ｃｌｉｎｉｃａｌｆｅａｔｕｒｅｓｒｅｆｌｅｃｔｌｉｍｂｏｒｏｒｇａｎｉｓｃｈｅｍｉａｒｅｓｕｌｔｉｎｇｆｒｏｍｓｔｅｎｏｓｉｓｔｏｏｂｌｉｔｅｒａｔｉｏｎｏｆｉｎｖｏｌｖｅｄａｒｔｅｒｉｅｓ Ｔｈｉｓｄｉｓｅａｓｅ ,ｄｅｓｃｒｉｂｅｄｂｙＴａｋａｙａｓｕｉｎ…     

Management of cerebral ischemia due to Takayasu’s arteritis

Objective To explore the management of cerebral ischemia caused by Takayasu’s arteritis. Methods Ninety-three cases treated from June 1984 to September 1999 at the General Post &amp; Telecom Hospital, the Sir Run Run Shaw Hospital, the First Af filiated Hospital of Zhejiang University, the Second Medical College of Beijing University, Beijing An Zhen Hospital, and the Beijing Union Medical College Hosp ital, including 10 men and 83 women, were reviewed.Of the 93 cases, bypasses f rom the ascending aorta to the axillary or subclavian artery and from graft to t he carotid artery were performed in 47 cases.Subclavian to carotid bypass was performed in six cases.Percutaneous transluminal angioplasty (PTA) was used in five cases and stenting in one.Results Marked improvement was achieved in 30.3%, fair in 34.9%, improvement in 21.2 %, unchanged in 4.6%, and death in 9.0% before discharge; 30.6%, 38.8%, 16 .3%, 4.1%, and 2.0% respectively during a mean follow-up of 48 months, and r ecurrence requiring revision in 8.2%.Conclusion Patients with occlusive lesions of all four cervical arteries always have severe cerebral ischemia and their distal runoff is always unvisualised by angiography . However, we found by exploration that the internal carotid artery is patent in all but one patient. Therefore, an ascending aorta to carotid bypass is feasib le in most instances, and this can and should be done when the cerebral perfusio n is jeopardized at a time when the patient is in a stable or relatively stable condition. Unfortunately, the cerebral re-perfusion syndrome is still a serious and not completely solved problem.