马来酸桂哌齐特在颅脑损伤患者的治疗效果观察

目的通过随机分组对照观察探讨马来酸桂哌齐特对颅脑损伤患者的治疗效果。方法100例急性闭合性颅脑损伤患者，分为对照组和用药组，各50例病人。分析对比治疗后对照组和用药组的实验室各项检查指标：血液流变学，TCD检查结果等变化情况。并且对出院后3—6个月随访调查结果进行比较分析。结果治疗后血液流变学检查中，用药组（马来酸桂哌齐特组）各项指标均低于对照组（P〈0．05）。经颅多普勒检测结果显示：用药组的脑血流速度与对照组相比明显减慢（P〈0．05），血管痉挛得到缓解。对比两组出院后随访结果可以看出，用药组的GOS评分、KPS评分及Barthel指数预后明显好于对照组（P〈0.05）。结论初步证明急性颅脑损伤早期应用马来酸桂哌齐特可增加病变区的脑血流，改善微循环，改善颅脑损伤患者的预后。值得推广和进一步研究。     

早期应用马来酸桂哌齐特救治急性中重型颅脑损伤患者的临床研究

马来酸桂哌齐特是以腺苷增效作用为药理特征的新型的神经保护剂。国内外新近研究表明,腺苷是人体重要的内源性神经保护物质,在颅脑损伤早期发挥重要的内源性保护作用。本     

马来酸桂哌齐特治疗急性脑梗死的疗效分析

目的 探讨马来酸桂哌齐特在辅助治疗急性脑梗死中的应用价值.方法 选择我院2011-03-2013-03收治的急性脑梗死患者80例,按不同治疗方式随机均分为对照组（常规治疗辅以血栓通）和实验组（常规治疗辅以马来酸桂哌齐特）,对2组患者的治疗效果进行比较.结果 实验组总有效率82.5%,明显高于对照组的55.0%（P＜0.05）;实验组治疗14 d后神经功能缺损评分均明显低于对照组（P＜0.05）;2组患者经治疗14 d后的血浆纤维蛋白原水平比较差异有统计学意义（P＜0.05）.结论 马来酸桂哌齐特治疗急性脑梗死效果显著,能明显改善患者神经功能,值得临床推广应用.     

不同剂量马来酸桂哌齐特对脑梗死模型大鼠行为学影响

目的观察马来酸桂哌齐特对脑梗死模型大鼠行为学的影响;探索马来酸桂哌齐特大鼠实验的适合剂量。方法随机法把SD大鼠分为不同剂量马来酸桂哌齐特给药组和生理盐水组,分别给予不同剂量马来酸桂哌齐特及生理盐水干预5d后,以改良线栓法建立大脑中动脉阻塞脑梗死模型,并行行为学评定和头颅DWI检测;观察术后24h、72h和术后14d大鼠的行为学变化。结果模型大鼠术侧大脑皮层和基底节区均出现DWI高信号;术后24h各组大鼠偏瘫差异无统计学意义(p>0.05);术后72h和14d各组间偏瘫差异有统计学意义(P<0.05),表现为3.0 mg.kg-1组与6.0 mg.kg-1组评分值均降低,但此二组间评分降低差异无统计学意义(p>0.05)。结论马来酸桂哌齐特可能改善大脑中动脉阻塞脑梗死模型大鼠的偏瘫症状;3.0 mg.kg-1可能是经济有效的实验剂量。     

马来酸桂哌齐特联合长春西汀治疗急性脑梗死疗效观察

目的观察马来酸桂哌齐特联合长春西汀治疗急性脑梗死的临床疗效及安全性。方法选择临床确诊的急性脑梗死患者76例,随机分成治疗组和观察组各38例。治疗组给予马来酸桂哌齐特注射液320mg,长春西汀30mg,阿司匹林0.1g口服,每晚1次;对照组给予长春西汀30mg,阿司匹林0.1g口服,每晚1次,连用14d。治疗期间采用中国卒中量表（CSS）对神经功能缺损进行评定。结果 治疗组临床总有效率89.5%,对照组为65.8%,治疗组疗效明显优于对照组,2组总有效率比较差异有统计学意义（P〈0.01）。结论 马来酸桂哌齐特联合长春西汀治疗脑梗死疗效显著,能有效改善脑梗死患者神经功能,值得临床进一步推广。     

马来酸桂哌齐特联合舒血宁治疗急性脑梗死的疗效观察

目的观察马来酸桂哌齐特联合舒血宁治疗急性脑梗死的疗效及安全性。方法选取我院2009-02—2012-10收治的急性脑梗死患者200例,随机分成对照组和联合治疗组各100例。对照组在常规治疗的基础上加用舒血宁;联合治疗组在对照组的基础上加用马来酸桂哌齐特。治疗前后检查血、尿常规、血脂、血糖、肝肾功能、凝血功能、心电图等。结果经数理统计学分析,联合治疗组明显优于对照组(P<0.05);2组安全性方面比较差异无统计学意义(P>0.05)。结论马来酸桂哌齐特联合舒血宁在治疗急性脑梗死方面疗效确切、安全。     

马来酸桂哌齐特对脑出血血肿体积和周围水肿带的影响

目的探讨马来酸桂哌齐特对高血压性脑出血血肿、水肿吸收及神经功能恢复的影响。方法90例高血压性脑出血患者,随机分为2组,对照组给予常规治疗,治疗组加用马来酸桂哌齐特(160mg/d)静滴。入组前、治疗7、21d测定神经功能评分、血肿和水肿体积。结果治疗7d,治疗组血肿体积、水肿体积及CSS评分明显小于对照组(P<0.05);治疗21d,治疗组无论血肿体积、水肿体积还是CSS评分均较对照组显著减少(P<0.05)。治疗21d神经功能评分与血肿体积相关性较高(P<0.01),与水肿体积无相关性(P>0.05)。结论马来酸桂哌齐特有利于高血压性脑出血水肿和血肿的吸收,改善脑出血的预后。     

马来酸桂哌齐特注射液治疗急性脑梗死血液流变学变化及疗效观察

目的 观察马来酸桂哌齐特注射液治疗急性脑梗死的临床疗效和对血液流变学的影响.方法 选择发病72 h内的脑梗死患者152例,按随机数字表法分为观察组(n=88)和对照组(n=64).观察组给予马来酸桂哌齐特注射液320mg.对照组给予复方丹参注射液20mL,均静脉滴注,1次/d,连用14d,观察两组临床疗效和血液流变学指标变化.结果 观察组治疗14d后的中国卒中量表(CSS)评分与对照组比较差异有统计学意义(P<0.05);观察组疗效、显效率(62.5%)优于对照组(35.9%),差异有统计学意义(P<0.05);观察组治疗后的各血液流变学指标下降程度较对照组明显,差异有统计学意义(P<0.05).结论 马米酸挂哌齐特注射液治疗急性脑梗死疗效显著,并能有效降低血液黏度.     

川芎嗪联合马来酸桂哌齐特治疗TIA疗效观察

目的观察川芎嗪联合马来酸桂哌齐特治疗短暂性脑缺血发作(TIA)的疗效。方法对55例TIA患者随机分为治疗组30例与对照组25例,2组均给予川芎嗪注射液160mg加5%葡萄糖或生理盐水250mL,静滴,1次/d;治疗组联合应用马来酸桂哌齐特320mg,加5%葡萄糖或生理盐水250mL静滴,1次/d,疗程均为14d。结果治疗组、对照组总有效率分别为93.3%和76.0%,2组比较差异有统计学意义(P<0.05)。结论川芎嗪联合马来酸桂哌齐特治疗TIA疗效显著,值得临床推广。     

马来酸桂哌齐特治疗高血压脑出血术后疗效分析

高血压脑出血是脑血管病患者中死亡率和致残率最高的一种疾病,并且70%以上的幸存者遗留不同程度的功能残缺,因此如何采取有效的治疗措施,改善患者预后,降低病残率,减轻社会、家庭负担,为目前治疗研究的重点.我院神经外科自2002年11月至2003年5月开始应用马来酸桂哌齐特(商品名克林澳)治疗高血压脑出血术后恢复期患者60例,取得较好的疗效,现报告如下.     

依达拉奉治疗急性重型颅脑损伤的临床疗效观察

目的探讨依达拉奉对急性重型颅脑损伤的疗效及安全性。方法69例急性重型颅脑损伤患者,分为3组,依达拉奉治疗组32例;阳性药物对照组32例,用脑苷肌肽注射液治疗;空白对照组5例,给予常规治疗。治疗10d后,观测GCS、APACHE-Ⅱ评分及不良反应。结果与空白对照组相比,治疗组和阳性药物对照组GCS评分明显升高(P<0.05),APACHE-Ⅱ评分显著下降(P<0.01),但两组间差异无显著性。结论早期应用依达拉奉治疗急性重型颅脑损伤,可促进患者神经功能恢复,降低死亡风险,且副作用少,安全可靠。     

Mild Traumatic Brain Injury and Subsequent Acute Pulmonary Inflammatory Response

ObjectiveThe influence of moderate-to-severe traumatic brain injury (TBI) on acute pulmonary injury is well established, but the association between acute pulmonary injury and mild TBI has not been well studied. Here, we evaluated the histological changes and fluctuations in inflammatory markers in the lungs to determine whether an acute pulmonary inflammatory response occurred after mild TBI. MethodsMouse models of mild TBI (n=24) were induced via open-head injuries using a stereotaxic impactor. The brain and lungs were examined 6, 24, and 72 hours after injury and compared to sham-operated controls (n=24). Fluoro-Jade B staining and Astra blue and hematoxylin staining were performed to assess cerebral neuronal degeneration and pulmonary histological architecture. Quantitative real-time polymerase chain reaction analysis was done to measure inflammatory cytokines. ResultsIncreased neuronal degeneration and the mRNA expression of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, and transforming growth factor (TGF)-β were observed after mild TBI. The IL-6, TNF-α, and TGF-β levels in mice with mild TBI were significantly different compared to those of sham-operated mice 24 hours after injury, and this was more pronounced at 72 hours. Mild TBI induced acute pulmonary interstitial edema with cell infiltration and alveolar morphological changes. In particular, a significant infiltration of mast cells was observed. Among the inflammatory cytokines, TNF-α was significantly increased in the lungs at 6 hours, but there was no significant difference 24 and 72 hours after injury. ConclusionMild TBI induced acute pulmonary interstitial inflammation and alveolar structural changes, which are likely to worsen the patient’s prognosis.     

Hemispheric Differences in Cerebral Autoregulation in Children with Moderate and Severe Traumatic Brain Injury

Introduction  To examine hemispheric differences in cerebral autoregulation in children with traumatic brain injury (TBI). After IRB approval and consent, subjects underwent static cerebral autoregulation testing during the first 9 days after PICU admission. Cerebral autoregulation was quantified using the autoregulatory index (ARI). Results  Forty-two (27 M:15 F) children (10 ± 5 years) with TBI and admission Glasgow coma scale score (5 ± 2) were enrolled. Seven (54%) of the 13 children with focal TBI and 8 (28%) of 29 children with diffuse TBI had impairment or absence of cerebral autoregulation of atleast one hemisphere. In patients with isolated focal TBI, ARI was lower (0.40 ± 0.40 vs. 0.67 ± 0.40; P = 0.03) in the side of TBI than in the unaffected hemisphere, but cerebral autoregulation was often impaired on the side without TBI or shift (5/13) on head CT. There was no difference in ARI between hemispheres in children with diffuse TBI, with or without superimposed focal lesions (P = 0.17). Patients with bilateral intact cerebral autoregulation tended to have higher 6 month Glasgow Outcome Score (GOS) than patients with either unilateral or bilateral cerebral autoregulation impairment (GOS 4.0 ± 0.60 vs. 3.6 ± 0.80; P = 0.08). Conclusions  Hemispheric differences in cerebral autoregulation were common in children with isolated focal TBI. Absence of TBI on CT was not always associated with intact cerebral autoregulation. Patients with bilaterally intact cerebral autoregulation tended to have better outcomes.     

Intensive Insulin Therapy After Severe Traumatic Brain Injury: A Randomized Clinical Trial

Introduction  To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic events defined as a glucose concentration less than 80 mg/dl (<4.44 mmol/l) in patients admitted to the intensive care unit (ICU) after severe traumatic brain injury (TBI). Methods and Results  Ninety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups of target glycemia. Insulin was infused at conventional rates when blood glucose levels exceeded 220 mg/dl (12.22 mmol/l) or at intensive rates, to maintain glycemia at 80–120 mg/dl (4.44–6.66 mmol/l). The following primary and outcome variables were measured during follow-up: hypoglycemic episodes, duration of ICU stay, infection rate, and 6-month mortality and neurologic outcome measured using the Glasgow Outcome Scale (GOS). Episodes of hypoglycemia (defined as blood glucose <80 mg/dl or 4.44 mmol/l) were significantly higher in patients receiving intensive insulin therapy: median (min–max) conventional insulin therapy 7 (range 0–11) vs. intensive insulin therapy 15 (range 6–33); P<0.0001. Duration of ICU stay was shorter in patients receiving intensive insulin therapy (7.3 vs. 10.0 days; P < 0.05); while infection rates during ICU stay (25.0% vs. 38.8%, P = 0.15), and GOS scores and mortality at 6 months were similar in the two groups. Conclusions  Intensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must be taken to avoid hypoglycemia. This work was done in the Department of Neuroanaesthesia, University of Rome “La Sapienza”, Rome, Italy, and was in part presented at the Euroanaesthesia 2006 meeting Madrid, Spain.     

特重型颅脑损伤患者术中急性脑膨出的预防方法探讨

目的 探讨特重型颅脑损伤患者手术中发生急性脑膨出的防治措施。方法 采用扩大额颞顶开颅去骨瓣减压术治疗19例特重型颅脑损伤．术中均采取顺序硬脑膜切开法分次切开硬脑膜。对此19例病例临床资料进行了回顾性分析。结果 所有病例术中均未出现难以控制的脑膨出。术后复查头颅CT显示，血肿基本清除12例，血肿仍大片存在4例，其它部位继发血肿3例；环池、基底池、第三脑室复现12例,无明显变化7例。出院时行GOS预后评定：良好1例，中残1例，重残2例，植物生存4例．死亡11例（死亡率57．9％）。结论 特重型颅脑损伤患者颅内压高，术中减压过快容易出现急性脑膨出，采用“尽早减压、逐步减压”和顺序硬脑膜切开法能明显降低术中急性脑膨出发生率，降低残死率。     

重型颅脑损伤并发急性呼吸衰竭的救治

目的 报告２２例重型颅脑损伤并发急性呼衰的救治分析,以利提高诊治水平。方法 在维持呼吸道通畅、充分氧疗的同时,针对引起急性呼衰的不同病因进行治疗。结果 治愈１２例（５４．５％）,死亡１０例（４５．５％）。结论 在救治呼衰时,重视区别是中枢性还是外周性呼衰,并及早解除引科衰的原因,才能提高本病救治成功率。     

丁基苯酞治疗轻中型颅脑损伤患者记忆及智力障碍的临床观察

目的观察丁基苯酞对轻中、型颅脑损伤患者记忆和智力障碍的治疗作用。方法将60例轻、中型颅脑损伤患者按随机数字表随机分为常规对照组和丁基苯酞（NBP）治疗组,治疗前、后分别用韦氏记忆量表和简明智力状态检查量表评估患者记忆力和智力。结果NBP治疗组治疗前、后记忆商分别为63.77±7.88和74.13±7.10,两者间差异显著（P〈0.05）;智力状态评分分别为17.33±4.52和24.60±3.71,两者间差异显著（P〈0.05）。对照组治疗前、后记忆商分别为63.87±7.90和68.57±9.02,两者间差异显著（P〈0.05）;智力状态评分分别为17.56±5.06和22.03±5.45,两者间差异显著（P〈0.05）。NBP治疗组对记忆商和智力状态评分的提高效果好于对照组,差异具有显著性（P〈0.05）。结论NBP可有效促进轻、中型颅脑损伤患者的记忆力和智力恢复。     

纳络酮对重型脑损伤患者脑脊液中IL-6含量及预后的影响

目的研究纳络酮对急性重型颅脑损伤（sTBI）患者脑脊液中白细胞介素-6（IL-6）含量及预后的影响。方法按患者入院序号将68例sTBI患者平均分为纳络酮治疗组与对照组,采用放射免疫法检测纳络酮治疗前、后不同时段脑脊液中IL-6含量变化,同时对两组患者GCS、颅内压（ICP）及预后进行比较观察。结果sTBI患者早期脑脊液中IL-6含量明显增高。与对照组相比,纳络酮治疗后1d,治疗组病人ICP值与IL-6含量明显降低（P〈0.05）;3d后IL-6含量达到最低水平,直到治疗后21d仍明显低于对照组（P〈0.01）。在纳络酮治疗后3d和7d患者意识障碍较对照组改善明显（P〈0.05）。伤后6个月治疗组恢复较好者的百分率明显高于对照组（P〈0.01）。结论sTBI患者急性期脑脊液中IL-6含量增高,纳络酮可以降低ICP和抑制IL-6超表达,改善sTBI患者的临床预后。     

儿童重型颅脑损伤的临床特点和治疗对策（附106例分析）

目的 总结小儿急性重型颅脑损伤的临床特点与救治经验。方法 回顾分析我院1990年1月至2003年1月收治的106例小儿急性重型颅脑损伤病例。结果 恢复良好41例，轻残20例，中残9例，重残12例，死亡24例。结论 早期诊断、正确选择治疗方法及手术方式，配以积极的综合治疗能明显改善患儿预后。