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中华神经医学杂志
南方医科大学珠江医院
中华神经医学杂志

南方医科大学珠江医院

徐如祥

月刊

1671-8925

journal@126.com

020-61643273

510282

广州市工业大道中253号珠江医院

中华神经医学杂志/Journal Chinese Journal of NeuromedicineCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要刊载神经医学的新理论、新进展、新技术、新业务等，内容涵盖神经外科、神经内科以及神经生物等基础神经科学领域。本刊设置的主要栏目有基础研究、临床研究、专家论坛、国际动态、短篇论著、经验交流、病例报告、综述等，目前已成为展示和共享我国神经科学领域学术成就和科研成果的重要载体和平台。杂志迄今已被美国《化学文摘（CA）》、俄罗斯《文摘杂志（AJ）》、《中文核心期刊要目总览》、《中国科技论文统计源期刊（中国科技核心期刊）》、《中国科学引文数据库》等国内外数据库和检索机构收录。
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    神经重症患者中枢神经系统感染多黏菌素局部应用的中国专家共识（2024年版）

    石广志冯光张玲
    109-118页
    查看更多>>摘要：神经重症患者中枢神经系统感染治疗难度大、病死率高，多重耐药革兰阴性杆菌感染占比逐年升高。多黏菌素是治疗多重耐药革兰阴性杆菌的有效药物，但其血脑屏障通过率低，静脉给药难以达到有效的药物浓度，脑室内或鞘内给药等局部应用的方式近年来越来越多地被临床采用，但缺乏相关的规范化操作指引，故本共识专家委员会围绕多黏菌素局部应用治疗中枢神经系统感染的适应证、用法用量、治疗途径等问题进行反复讨论，形成14条共识推荐意见，以期为多黏菌素中枢神经系统局部应用提供科学和切实可行的临床指导。 Treatment of severe central nervous system infections in patietns with neurological severe diseases is difficult， with high mortality rate。 Proportion of multidrug-resistant Gram negative bacteria has been increasing year by year。 Polymyxin is an effective drug for multidrug-resistant Gram negative bacteria， but its blood-brain barrier permeability is low， making it difficult for intravenous administration to achieve effective drug concentration。 Topical applications such as intracerebroventricular or intrathecal administrations have been increasingly used in clinical practice in recent years， but lack relevant standardized guidelines。 Therefore， the expert committee of this consensus has repeatedly discussed the indications， dosage， and treatment routes of topical application of polymyxin in central nervous system infections， and has formed 14 consensus recommendations， with a view to provide scientific and practicable clinical guidance for standardized topical application of polymyxin in central nervous system。

    神经重症中枢神经系统感染多黏菌素鞘内给药脑室内给药

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    特异性抑制海马CA1区GABA能神经元NLRP3表达对小鼠TBI后认知障碍的改善作用研究

    苗慧涛宋荣欣邵京京贾世艳...
    119-130页
    查看更多>>摘要：目的 探讨海马CA1区γ-氨基丁酸（GABA）能神经元NOD样受体热蛋白结构域相关蛋白3（NLRP3）基因敲除对小鼠创伤性颅脑损伤（TBI）后认知障碍的改善作用。 方法 将48只清洁级健康雄性NLRP3flox/flox小鼠按随机数字表法分为假手术+对照病毒组（SV组）、假手术+GABA能神经元NLRP3基因特异性敲除组（SG组）、TBI+对照病毒组（TV组）及TBI+GABA能神经元NLRP3基因特异性敲除组（TG组），每组12只。其中，TV组、TG组小鼠采用自由落体法构建TBI模型，SV组、SG组小鼠仅行头皮剪开及开骨窗等外科操作、不予打击，SG组、TG组小鼠于TBI造模前21 d于海马CA1区注射腺病毒制备GABA能神经元NLRP3基因特异性敲除模型，SV组、TV组小鼠仅于海马CA1区注射空载病毒作为对照。TBI造模后第30、31天应用新物体识别实验评价各组小鼠的认知功能，第32~36天应用Morris水迷宫实验评估各组小鼠的学习及记忆功能，第31天应用在体电生理记录小鼠在新物体识别实验中探索新物体时海马CA1区场电位。上述实验结束后，处死小鼠并取材，采用免疫荧光染色检测各组小鼠海马CA1区微管相关蛋白2（MAP2）、谷氨酸脱羧酶67（GAD67）、突触后密度蛋白95（PSD95）的荧光强度，以及焦亡相关炎性因子白细胞介素-18（IL-18）/GAD67双阳性神经元占总GAD67阳性神经元的百分比。 结果 与SV组、SG组比较，TV组、TG组小鼠的新物体识别指数明显下降，水迷宫实验中实验阶段的穿越平台次数明显下降、训练阶段第3、4天的逃避潜伏期明显上升，海马CA1区θ、γ振荡功率在探索新物体时明显下降，海马CA1区MAP2、GAD67、PSD95的荧光强度明显减弱，IL-18/GAD67双阳性神经元百分比明显上升，差异均有统计学意义（P<0。05）。与TV组比较，TG组小鼠的新物体识别指数明显上升，水迷宫实验中实验阶段的穿越平台次数明显上升、训练阶段第3、4天的逃避潜伏期明显下降，海马CA1区θ、γ振荡功率在探索新物体时明显上升，海马CA1区MAP2、GAD67、PSD95的荧光强度明显增强，IL-18/GAD67双阳性神经元百分比明显下降，差异均有统计学意义（P<0。05）。 结论 海马CA1区GABA能神经元NLRP3基因敲除能够改善小鼠TBI后的认知障碍，其机制可能与抑制GABA能神经元焦亡相关。 Objective To explore the effect of NOD-like receptor thermal protein 3 (NLRP3) knockout in γ-aminobutyric acid (GABA)-ergic neurons in the hippocampal CA1 area on improving cognitive dysfunction in mice after traumatic brain injury (TBI)。 Methods Forty-eight healthy male NLRP3flox/flox mice weighing 25-28 g were randomly divided into 4 groups (n=12): sham-operated+control virus group (SV group)， sham-operated+NLRP3 specific knockout group (SG group)， TBI+control virus group (TV group)， TBI+NLRP3 specific knockout group (TG group)。 TBI in the TV and TG groups was established by free-fall method， while surgical procedures such as scalp incision and cranial window opening without impact were given to the SV and SG groups。 Adenovirus was injected into the hippocampal CA1 area of SG and TG groups 21 d before TBI to induce NLRP3 specific knockout in GABA-ergic neurons in the hippocampal CA1 area empty virus was injected into the CA1 area of SV and TV groups。 Cognitive function was evaluated using novel object recognition test 30 and 31 d after TBI， and learning and memory functions were assessed using Morris water maze test 32-36 d after TBI。 Field potentials in the hippocampal CA1 area were recorded during novel object recognition 31 d after TBI。 After behavioral tests， these mice were sacrificed。 Immunofluorescent staining was used to detect the fluorescent intensity of microtubule-associated protein2 (MAP2)， glutamic acid decarboxylase 67 (GAD67)， and postsynaptic density protein 95 (PSD95) in the hippocampal CA1 area， as well as percentage of pyroptosis-associated inflammatory factor interleukin-18 (IL-18)/GAD67 double-positive neurons in total GAD67 positive neurons。 Results Compared with the SV and SG groups， the TV and TG groups had decreased novel object recognition index， decreased number of platform crossings during the experimental period， increased escape latency on day 3 and day 4 of the training period in Morris water maze test， decreased θ and γ oscillation power in the hippocampal CA1 area during novel object recognition， decreased fluorescent intensity of MAP2， GAD67， and PSD95 in the hippocampal CA1 area， increased percentage of IL-18/GAD67 double-positive neurons， with significant differences ( P<0。05)。 Compared with the TV group， the TG group had increased novel object recognition index， increased number of platform crossings in Morris water maze test， decreased escape latency during the training period， increased θ and γ oscillation power in the hippocampal CA1 area during novel object recognition， increased fluorescence intensity of MAP2， GAD67， and PSD95 in the hippocampal CA1 area， decreased percentage of IL-18/GAD67 double-positive neurons， with significant differences (P<0。05)。 Conclusion Specific inhibition of NLRP3 expression in GABA-ergic neurons in the hippocampal CA1 area can improve cognitive dysfunction in mice after TBI， whose mechanism may be related to inhibited GABA-ergic neuronal pyroptosis in the hippocampal CA1 area。

    颅脑损伤认知障碍NOD样受体热蛋白结构域相关蛋白3γ-氨基丁酸能神经元细胞焦亡在体电生理

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    促肾上腺皮质激素释放因子2型受体参与慢性偏头痛小鼠痛觉敏化及焦虑的机制研究

    邹鲁宏阎春红武琳智张雪娟...
    131-139页
    查看更多>>摘要：目的 探讨促肾上腺皮质激素释放因子2型受体（CRFR2）对慢性偏头痛小鼠痛觉敏化及焦虑的调控作用及潜在机制。 方法 将48只C57BL/6J小鼠按随机数字表法分为对照组、模型组、NBI35965组、K41498组，每组12只。后3组小鼠于第1、3、5、7、9天腹腔注射10 mg/kg硝酸甘油建立慢性偏头痛模型，NBI35965组及K41498组小鼠于第2、4、6、8天双侧三叉神经脊束尾核分别注射100 nL NBI35965、K41498溶液，对照组小鼠注射同体积生理盐水。第1、3、5、7、9天腹腔注射2 h后及第10天上午11时采用Von frey纤维丝检测小鼠眶额部机械痛阈值。于第11天上午11时采用高架十字迷宫实验检测小鼠的焦虑样行为。采用Western blotting实验检测小鼠三叉神经脊束尾核中促肾上腺皮质激素释放因子（CRF）、促肾上腺皮质激素释放因子1型受体（CRFR1）、CRFR2蛋白的表达。采用实时荧光定量聚合酶链式反应（RT-qPCR）检测小鼠三叉神经脊束尾核中CRFR1及CRFR2 mRNA的表达。采用免疫荧光染色检测小鼠三叉神经脊束尾核中降钙素基因相关肽（CGRP）、即刻早期基因（c-fos）、胶质纤维酸性蛋白（GFAP）及离子钙结合适配器分子1（Iba-1）蛋白的表达。 结果 （1）与对照组比较，模型组、NBI35965组、K41498组小鼠第3、5、7、9、10天的眶额部机械痛阈值较低，差异均有统计学意义（P<0。05）。与模型组比较，K41498组小鼠第7、9、10天的眶额部机械痛阈值较高，差异均有统计学意义（P<0。05）。（2）与对照组比较，模型组、NBI35965组、K41498组小鼠的开臂进入次数较少，开臂停留时间较短，差异均有统计学意义（P<0。05）。与模型组比较，K41498组小鼠的开臂进入次数较多，开臂停留时间较长，差异均有统计学意义（P<0。05）。（3）与对照组比较，模型组、NBI35965组、K41498组小鼠三叉神经脊束尾核中CRF和CRFR2蛋白的表达较高，差异均有统计学意义（P<0。05）。与模型组比较，K41498组小鼠三叉神经脊束尾核中CRF蛋白的表达较低，差异有统计学意义（P<0。05）。（4）与对照组比较，模型组、NBI35965组、K41498组小鼠三叉神经脊束尾核中CRFR2 mRNA的表达较高，差异均有统计学意义（P<0。05）。（5）与对照组比较，模型组、NBI35965组、K41498组小鼠三叉神经脊束尾核中CGRP、c-fos、Iba-1、GFAP蛋白的表达均较高，差异均有统计学意义（P<0。05）。与模型组比较，K41498组小鼠三叉神经脊束尾核中CGRP及c-fos蛋白的表达较低，差异均有统计学意义（P<0。05）。 结论 CRFR2通过调控三叉神经脊束尾核的神经元活化及CGRP释放而影响慢性偏头痛小鼠眶额部痛觉敏化及焦虑样行为的发生发展。 Objective To explore the role of corticotrophin releasing factor receptor 2 (CRFR2) in regulating pain sensitization and anxiety and its mechanism in chronic migraine mice。 Methods Forty-eight C57BL/6J mice were randomly divided into control group， model group， NBI35965 group and K41498 group (n=12) chronic migraine models in the later 3 groups were established by intraperitoneally administrating 10 mg/kg nitroglycerin on the 1st， 3rd， 5th， 7th and 9th d mice in the NBI35965 group and K41498 group were injected with 100 nL NBI35965 or K41498 solution into the bilateral trigeminal nucleus caudalis on the 2nd， 4th， 6th and 8th d， and mice in the control group were injected with same volume of normal saline。 Von frey fiber was used to detect the orbitofrontal mechanical pain threshold 2 h after intraperitoneal injection on the 1st， 3rd， 5th， 7th and 9th d， and at 11 a。m。 on the 10th d。 Elevated plus maze was used to detect the anxiety-like behaviors at 11 a。m。 on the 11th d。 Western blotting was performed to detect the protein expressions of corticotrophin releasing factor (CRF)， corticotrophin releasing factor receptor 1 (CRFR1)， CRFR2 in the trigeminal nucleus caudalis。 Real-time quantitative PCR (RT-qPCR) was used to detect the CRFR1 and CRFR2 mRNA expressions in the trigeminal nucleus caudalis。 Immunofluorescent staining was used to detect the protein expressions of calcitonin gene-related peptide (CGRP)， immediate-early gene c-fos， glial fibrillary acidic protein (GFAP) and ionized calcium-binding adapter molecule 1 (Iba-1) in the trigeminal nucleus caudalis。 Results Compared with the control group， the model group， NBI35965 group and K41498 group had significantly decreased orbitofrontal mechanical pain thresholds 3， 5， 7， 9， and 10 d after intraperitoneal injection (P<0。05) compared with model group， the K41498 group had significantly increased orbitofrontal mechanical pain thresholds 7， 9， and 10 d after intraperitoneal injection (P<0。05)。 Compared with control group， the model group， NBI35965 group and K41498 group had significantly decreased entries and shorter time in opened arms (P<0。05) compared with the model group， the K41498 group had significantly increased entries and shorter time in opened arms (P<0。05)。 Compared with the control group， the model group， NBI35965 group and K41498 group had significantly higher CRF and CRFR2 protein expressions in the trigeminal nucleus caudalis (P<0。05) compared with the model group， the K41498 group had statistically lower CRF protein expression in the trigeminal nucleus caudalis (P<0。05)。 Compared with the control group， the model group， NBI35965 group and K41498 group had significantly higherCRFR2 mRNA expression in the trigeminal nucleus caudalis (P<0。05)。 Compard with the control group， the model group， NBI35965 group and K41498 group had significantly increased CGRP， c-fos， Iba-1 and GFAP protein expressions in the trigeminal nucleus caudalis (P<0。05) compared with the model group， the K41498 group had significantly decreased CGRP and c-fos protein expressions in the trigeminal nucleus caudalis (P<0。05)。 Conclusion CRFR2 can alter the orbitofrontal pain sensitization and anxiety-like behaviors in chronic migraine mice by regulating neuronal activation and CGRP release in the trigeminal nucleus caudalis。

    慢性偏头痛促肾上腺皮质激素释放因子三叉神经脊束尾核痛觉敏化焦虑

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    双反转恢复序列对急性缺血性脑卒中患者脑白质高信号病灶的探测价值研究

    陈佳琦岳云龙付睿牛睿...
    140-145页
    查看更多>>摘要：目的 评价双反转恢复（DIR）序列对急性缺血性脑卒中患者脑白质高信号（WMH）的检测效果，并与T2WI、液体衰减反转恢复（FLAIR）序列进行对比。 方法 选择首都医科大学附属北京世纪坛医院神经内科自2018年11月至2021年3月收治的发病14 d内且存在WMH的73例急性缺血性脑卒中患者，采用MRI T2WI、FLAIR及DIR序列分别检测WMH。根据Fazekas量表评分将存在侧脑室旁白质高信号（PVWMH）及深部白质高信号（DWMH）患者分别分为轻度组（0~1分）及中重度组（≥2分）。比较T2WI、FLAIR及DIR序列检测的WMH体积，孤立病灶的信号强度、截面积、对比度的差异。 结果 （1）73例患者检出PVWMH，其中轻度组36例，中重度组37例。在中重度组患者中，与DIR序列比较，FLAIR序列检测的PVWMH体积较大，差异有统计学意义（P<0。05)；与FLAIR序列比较，T2WI序列检测的PVWMH体积较小，差异有统计学意义（P<0。05)。57例患者检出DWMH，其中轻度组44例，中重度组13例。无论是轻度组还是中重度组患者，与DIR序列比较，FLAIR、T2WI序列检测的DWMH体积较大，差异均有统计学意义（P<0。05)。（2）共检出孤立病灶60个，长径5。0~9。1 mm。与DIR序列比较，FLAIR、T2WI序列检测孤立病灶的截面积较大、信号强度较高、对比度较低，差异均有统计学意义（P<0。05)。与FLAIR序列比较，T2WI序列检测孤立病灶的信号强度、对比度较高，差异均有统计学意义（P<0。05)。 结论 DIR序列探测WMH效果优于FLAIR和T2WI序列。DIR序列与FLAIR、T2WI序列WMH不匹配区域提示可能存在WMH半暗带。 Objective To evaluate the detective effect of double inversion recovery (DIR) sequence on cerebral white matter hyperintensities (WMH) in patients with acute ischemic stroke， and compare with those of T2WI and FLAIR sequences。 Methods Seventy-three acute ischemic stroke patients with WMH within 14 d of onset， admitted to Department of Neurology， Beijing Shijitan Hospital， Capital Medical University from November 2018 to March 2021， were chosen。 MRI T2WI， FLAIR and DIR sequences were used to detect WMH。 According to Fazekas scale， patients with periventricular white matter hyperintensities (PVWMH) or deep white matter hyperintensities (DWMH) were divided into mild group (score of 0-1) and moderate to severe group (scores≥2) the differences in WMH volume detected by T2WI， FLAIR and DIR sequences， and signal intensity， cross-sectional area and contrast of isolated lesions were compared。 Results (1) Seventy-three patients were with PVWMH (36 into the mild group and 37 into the moderate to severe group) in patients from the moderate to severe group， PVWMH volume detected by FLAIR sequence was statistically larger compared with that by DIR sequence， and PVWMH volume detected by T2WI sequence was significantly smaller compared with that by FLAIR sequence (P<0。05)。 Fifty-seven patients were with DWMH (44 into the mild group and 13 into the moderate to severe group) the DWMH volume detected by FLAIR and T2WI sequences was significantly larger than that by DIR sequence (P<0。05)。 (2) A total of 60 isolated lesions were detected， ranged 5。0-9。1 mm in length isolated lesions enjoying significantly larger cross-sectional area， higher signal intensity， and lower contrast detected by FLAIR and T2WI sequences compared with those by DIR sequence (P<0。05) isolated lesions enjoying significantly higher signal intensity and contrast detected by T2WI sequence compared with those by FLAIR sequence (P<0。05)。 Conclusion DIR sequence enjoys better effect in detecting WMH than FLAIR and T2WI sequences the mismatch area of DIR sequence with FLAIR or T2WI sequences suggests WMH penumbra。

    脑白质高信号双反转恢复序列脑白质高信号半暗带

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    脑静脉引流与急性前循环大血管闭塞机械取栓术首通效应的关系

    王星智吕炳辰祖洁顾诗媛...
    146-151页
    查看更多>>摘要：目的 探讨行机械取栓术治疗的急性前循环大血管闭塞患者中，通过术前CT血管造影（CTA）评估的脑静脉引流情况与首通效应（FPE）之间的关系。 方法 回顾性连续纳入徐州医科大学附属医院神经内科自2018年7月至2021年6月收治的急性前循环大血管闭塞患者，所有患者均行机械取栓术治疗并完成术前CTA检查。使用皮质静脉显影评分（COVES）对基线CTA中脑静脉引流进行评估，根据首次机械取栓后闭塞血管的再通情况将患者分为FPE组和非FPE组，比较2组患者一般资料、临床特征、影像学资料和手术相关数据；将单因素分析中P<0。1的变量纳入多因素Logistic回归模型，以明确COVES评分和FPE之间的关系，同时通过受试者工作特征（ROC）曲线评估COVES评分对FPE的预测价值。 结果 研究共纳入143例患者，其中FPE组患者52例，非FPE组患者91例。与非FPE组患者比较，FPE组患者的COVES评分较高、脑静脉引流良好（COVES评分≥3分）患者的比例较高、核心梗死体积较小、股动脉穿刺至血管再通时间较短，差异均有统计学意义（P<0。05）。多因素Logistic回归分析结果显示，调整患者的基线美国国立卫生研究院卒中量表（NIHSS）评分、核心梗死体积和股动脉穿刺至血管再通时间等协变量后，COVES评分仍然和急性前循环大血管闭塞机械取栓FPE相关（OR=0。730，95%CI：0。567~0。940，P=0。015）。ROC曲线显示COVES评分联合其他因素（COVES评分+基线NIHSS评分+核心梗死体积+股动脉穿刺至血管再通时间）模型预测FPE的曲线下面积为0。757（95%CI：0。672~0。841，P<0。001），对应的敏感性为61。5%，特异性为78。0%。 结论 在接受机械取栓治疗的急性前循环大血管闭塞患者中，良好的脑静脉引流是FPE的独立预测因素。 Objective To explore the association of cerebral venous outflow assessed by CT angiography (CTA) with first pass effect (FPE) in patients with acute anterior circulation large vessel occlusion accepted mechanical thrombectomy (MT)。 Methods A retrospective analysis was performed patients with acute anterior circulation large vessel occlusion accepted MT and CTA in Department of Neurology， Affiliated Hospital of Xuzhou Medical University from July 2018 to June 2021 were consecutively enrolled。 Cerebral venous outflow in baseline CTA was evaluated using Cortical Vein Opacification Score (COVES)。 Patients were categorized into either FPE or non-FPE groups based on recanalization of occluded vessels after initial MT。 General information， clinical features， radiological data， and surgery-related data between the 2 groups of patients were collected and compared。 Significant variables (P<0。1) from univariate analysis were included into a multivariable Logistic regression model to explore the relation between COVES and FPE。 Predictive value of COVES in FPE was assessed using receiver operating characteristic (ROC) curve。 Results Out of the 143 patients enrolled in this study， 52 were into the FPE group and 91 were into the non-FPE group。 Compared with the non-FPE group， the FPE group had higher COVES scores， higher proportion of patients with good cerebral venous drainage (COVES≥3)， smaller core infarct volume， and shorter time from femoral artery puncture to vessel recanalization， with significant differences (P<0。05)。 Multivariable Logistic regression analysis revealed that COVES was still corelated with FPE after adjusting covariates such as baseline NIHSS scores， core infarct volume， and time from femoral artery puncture to vessel recanalization (OR=0。730， 95%CI: 0。567-0。940， P=0。015)。 ROC curve demonstrated that the combined model of COVES with aforementioned factors (COVES scores+baseline NIHSS scores+core infarct volume+time from femoral artery puncture to vessel recanalization) had an area under the curve of 0。757 (95%CI: 0。672-0。841， P<0。001)， with sensitivity of 61。5% and specificity of 78。0%。 Conclusion Favorable cerebral venous drainage is an independent predictor for successful FPE in patients with acute anterior circulation large vessel occlusion accepted MT。

    急性缺血性脑卒中大血管闭塞机械取栓首通效应脑静脉引流

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    低频Meynert基底核脑深部电刺激对早发型重度阿尔茨海默病患者的长期改善作用研究

    许军鹏余新光张艳阳刘斌...
    152-158页
    查看更多>>摘要：目的 初步探讨低频Meynert基底核脑深部电刺激（DBS）对早发型重度阿尔茨海默病（AD）患者认知障碍、神经精神症状及睡眠障碍的长期改善作用。 方法 回顾性收集解放军总医院第一医学中心神经外科自2016年1月至2022年12月收治的18例早发型重度AD患者，依据治疗方式的不同分为NBM-DBS组与对照组，其中6例NBM-DBS组患者在常规药物保守治疗基础上接受低频NBM-DBS，12例对照组患者接受常规药物保守治疗。分析2组患者治疗前及随访1年后简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、神经精神问卷（NPI）、汉密尔顿抑郁量表（HAMD）、倍克-拉范森躁狂量表（BRMS）、匹兹堡睡眠质量指数（PSQI）、Zarit照顾者负担量表（ZBI）评分的变化情况。 结果 随访1年后，NBM-DBS及对照组患者的MMSE、MoCA量表评分较治疗前均有所降低，但NBM-DBS组患者治疗前后的差异均无统计学意义（P>0。05），而对照组患者治疗前后的差异有统计学意义（P<0。05）；2组患者间随访1年时的MMSE、MoCA量表评分差异均无统计学意义（P>0。05）。NBM-DBS组患者的NPI、HAMD、BRMS、ZBI量表评分较治疗前差异均有统计学意义（P<0。05），对照组患者的NPI、HAMD、ZBI量表评分较治疗前差异均无统计学意义（P>0。05），BRMS量表评分较治疗前明显升高，差异有统计学意义（P<0。05）；2组患者间随访1年时的NPI、HAMD、BRMS、ZBI量表评分差异均有统计学意义（P<0。05）。 结论 相较于单纯药物治疗，联合低频NBM-DBS能在控制早发型重度AD患者认知障碍进展同时，也可有效改善其神经精神症状及睡眠障碍，以及降低照顾者的负担。 Objective To preliminarily explore the long-term improvement of low-frequency deep brain stimulation (DBS) on the nucleus basalis of Meynert (NBM) in cognitive disorders， neuropsychiatric symptoms and sleep disorders of patients with early-onset severe Alzheimer's disease (AD)。 Methods A retrospective study was performed 18 patients with early-onset severe AD admitted to Department of Neurosurgery， First Medical Center of PLA General Hospital from January 2016 to December 2022 were included。 These patients were divided into NBM-DBS group and control group according to different treatments 6 patients received low-frequency NBM-DBS on basis of conservative treatments 12 patients accepted conservative treatments。 Changes in Brief Mental State Examination (MMSE)， Montreal Cognitive Assessment (MoCA)， Neuropsychiatric Inventory (NPI)， Hamilton Depression Rating Scale (HAMD)， Becker-Lavanson Mania Scale (BRMS)， Pittsburgh Sleep Quality Index (PSQI)， and Zarit Caregiver Burden Interview (ZBI) were observed before treatment and 1 year after follow up。 Results MMSE and MoCA scores 1 year after follow up obviously reduced compared with those before treatment in both NBM-DBS and control patients MMSE and MoCA scores in NBM-DBS patients showed no significant differences between 1 year after follow up and before treatment (P>0。05)， while significant differences were noted in the control group between 1 year after follow-up and before treatment (P<0。05) and no significant differences in MMSE and MoCA scores were noted between the 2 groups 1 year after follow up (P>0。05)。 NPI， HAMD， BRMS and ZBI scores in the NBM-DBS group 1 year after follow up were significantly different compared with those before treatment (P<0。05) no significant differences were noted in NPI， HAMD and ZBI scores in the control group between 1 year after follow up and before treatment (P>0。05)， while significant difference was noted in BRMS scores (P<0。05) significant differences in NPI， HAMD， BRMS and ZBI scores were noted between the 2 groups 1 year after follow up (P<0。05)。 Conclusion Low-frequency NBM-DBS is not only effective in improving cognitive disorders， but also effective in improving neuropsychiatric symptoms and sleep disorders， as well as reducing caregiver burden in patients with early-onset severe AD。

    阿尔茨海默病脑深部电刺激Meynert基底核认知障碍神经精神症状睡眠障碍照顾者负担

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    滑轨CT在帕金森病患者脑深部电刺激手术中的应用价值

    赵有让王艳敏田毅王朋飞...
    159-163页
    查看更多>>摘要：目的 评价滑轨CT在帕金森病（PD）患者脑深部电刺激（DBS）手术中的临床应用效果。 方法 选择郑州大学第一附属医院神经外科自2019年5月至2023年5月采用DBS手术治疗的117例PD患者，其中采用局麻46例，全麻71例；73例患者行双侧丘脑底核（STN）DBS手术，43例患者行双侧苍白球内侧部（GPi）DBS手术，1例患者行右侧GPi DBS、左侧STN DBS手术。通过术前/术中滑轨CT图像与术前MRI图像融合，计算患者术前计划靶点与术中实际靶点的空间距离（如空间距离大于2 mm，表示电极位置偏移，及时调整电极位置）。比较不同麻醉、手术方式患者术前计划靶点与术中实际靶点空间距离的差异。 结果 117例PD患者手术均顺利完成，共植入234根电极。无因电极错位或疗效欠佳行二次手术的患者。CT扫描期间未发生麻醉脱管及机械碰撞，无颅内出血并发症。117例患者术前计划靶点与术中实际靶点的空间距离为（1。35±0。50） mm。术中4根电极的位置明显偏移，术中即刻调整电极位置，再次复查CT证实电极位置良好。全麻组和局麻组、STN组和GPi组患者双侧术前计划靶点与术中实际靶点空间距离的差异均无统计学意义（P>0。05）。 结论 滑轨CT操作简便、安全有效，有助于术中及时调整电极位置，避免二次手术及并发症的发生，从而提高DBS手术的安全性和疗效。 Objective To evaluate the clinical value of intraoperative sliding CT in deep brain stimulation (DBS) for Parkinson's disease (PD)。 Methods A total of 117 PD patients accepted DBS in Department of Neurosurgery， First Affiliated Hospital of Zhengzhou University from May 2019 to May 2023 were chosen 46 patients had local anesthesia and 71 had general anesthesia。 Bilateral subthalamic nucleus (STN) DBS was performed in 73 patients， bilateral medial globus pallidus (GPi) DBS was performed in 43 patients， and right GPi and left STN DBS was performed in 1 patient。 Preoperative/intraoperative sliding CT images and preoperative MRI images were fused to calculate the spatial distance between the preoperative planned target and actual target (adjusting electrode position timely in case of spatial distance greater than 2 mm [electrode displacement])。 Differences of spatial distance between preoperative planned target and actual target in patients accepted different types of anesthesia and surgical modalities were compared。 Results All 117 patients were successfully operated and 234 electrodes were implanted。 No patients needed a second operation for misalignment of electrodes or poor efficacy。 During CT scan， neither anesthesia extubation or mechanical collision nor intracranial hemorrhage complications occurred。 Spatial distance between the preoperative planned target and actual target was (1。35±0。50) mm in 117 patients。 Displacement was noted in 4 electrodes and immediately adjusted during the operation and CT re-examination confirmed good electrode position。 No statistical significance in spatial distance between the preoperative planned target and actual target was noted between the general anesthesia group and local anesthesia group， and between the STN group and GPi group (P>0。05)。 Conclusion Intraoperative sliding CT is simple， safe and effective， which helps to timely adjust the electrode position during operation， avoids second operation and complications， and improves the safety and efficacy of DBS。

    脑深部电刺激帕金森病滑轨CT

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    血管内介入治疗破裂椎动脉颅内段夹层动脉瘤的安全性及策略分析

    朱浩武银刚崔浩余舰...
    164-168页
    查看更多>>摘要：目的 探讨不同的血管内介入治疗方式治疗破裂椎动脉颅内段夹层动脉瘤的疗效及安全性。 方法 回顾性分析自2020年1月至2023年6月中国科学技术大学附属第一医院神经外科收治的25例破裂椎动脉颅内段夹层动脉瘤患者（25个动脉瘤）资料。所有患者均根据动脉瘤位置等情况采用动脉瘤及载瘤动脉闭塞或支架辅助弹簧圈栓塞治疗，采用Raymond分级评估动脉瘤术后即刻栓塞程度，记录患者围手术期不良事件发生情况。随访6~48个月，根据DSA复查结果判断动脉瘤有无复发；采用改良Rankin量表（mRS）评分评估患者预后，0~2分为预后良好，3~6分为预后不良。 结果 25例均为单侧破裂椎动脉颅内段夹层动脉瘤，动脉瘤及载瘤动脉闭塞（闭塞夹层节段）10例，支架辅助弹簧圈栓塞15例。术后即刻Ⅰ级栓塞19例，Ⅱ级栓塞4例，Ⅲ级栓塞2例。术中无破裂出血及支架内血栓形成事件，术后死亡3例，死亡原因分别为术后再出血1例，术后出现小脑梗死合并呼吸衰竭1例，基础疾病多合并重症肺炎死亡1例。存活的22例患者中预后良好18例，预后不良4例。5例患者复发（均为支架辅助弹簧圈栓塞患者），4例接受再次介入治疗；1例瘤颈处少量显影，且再次复查相对稳定，定期随访中。 结论 本研究结果初步显示，非优势椎动脉且不累及大脑后下动脉的动脉瘤可选择动脉瘤及载瘤动脉闭塞的治疗方式，复发率较支架辅助弹簧圈栓塞治疗患者低。 Objective To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA)。 Methods A retrospective analysis was performed 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery， First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023， were chosen。 Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms， degrees of aneurysm immediate embolization were evaluated by Raymond grading， and perioperative adverse events were recorded。 The patients were followed up for 6-48 months， and aneurysm recurrence was determined according to DSA results prognoses were assessed by modified Rankin Scale (mRS)， with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis。 Results All 25 patients had unilateral ruptured IVADA， 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization。 Immediately after surgery， 19 patients (76%) had grading I embolization， 4 (16%) grading II embolization， and 2 (8%) grading III embolization。 No aneurysm rupture or stent related thrombosis was observed during procedure 3 patients (12%) died after procedure， with postoperative rebleeding in 1， postoperative cerebellar infarction with respiratory failure in 1， and severe pneumonia in 1。 In the 22 survivals， 18 had good prognosis and 4 had poor prognosis。 In the 5 relapsed patients (all accepted stent-assisted embolization)， 4 underwent re-intervention， and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up。 Conclusion Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery， whose recurrence rate is lower than that of stent-assisted coil embolization。

    椎动脉夹层破裂动脉瘤介入治疗安全性

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    神经内镜治疗复发或残余鞍区及斜坡区肿瘤研究

    徐家坤李西西杨佳苏伟杰...
    169-173页
    查看更多>>摘要：目的 探讨神经内镜治疗复发或残余鞍区及斜坡区肿瘤的临床应用价值以及手术并发症的防治要点。 方法 回顾性收集中山大学附属第一医院神经外科自2021年11月至2023年10月采用神经内镜治疗的49例复发或残余鞍区及斜坡区肿瘤患者（垂体瘤45例、颅咽管瘤3例、斜坡区脊索瘤1例）的临床资料，总结分析其手术疗效及并发症情况。 结果 49例患者中全切除29例（59。2%）、近全切除12例（24。5%）、部分切除8例（16。3%）。2例（4。1%）患者术中出现颈内动脉破裂，予急诊行覆膜支架置入术，恢复良好出院，但其中1例遗留单侧动眼神经麻痹。术后随访1~24个月，97。2%（35/36）患者的头痛及视力下降症状好转，无一例患者出现永久性尿崩或脑脊液鼻漏等并发症；3例（6。1%）患者出现残余肿瘤增大，但肿瘤全切除患者均无复发。 结论 神经内镜治疗复发或残余鞍区及斜坡区肿瘤安全有效，但术中需重视对颈内动脉加强保护。 Objective To investigate the clinical value of neuroendoscopic resection in recurrent or residual sellar and clivus tumors and the prevention and treatment of operative complications。 Methods A retrospective study was performed。 Clinical data of 49 patients with residual or recurrent sellar and clivus tumors after neuroendoscopic resection in Department of Neurosurgery， First Affiliated Hospital of Sun Yat-sen University from November 2021 to October 2023 were collected 45 patients were with pituitary adenoma， 3 were with craniopharyngioma， and 1 patient was with clivus chordoma their surgical efficacy and complications were summarized and analyzed。 Results Total resection was achieved in 29 patients (59。2%)， subtotal resection in 12 (24。5%)， and partial resection in 8 (16。3%)。 Two patients (4。1%) had intraoperative internal carotid artery rupture and were given emergency laminar stenting， discharging with good recovery， but one of them left with unilateral motor nerve palsy。 During 1-24 months of follow-up， 97。2% patients (35/36) had headache relief and visual acuity improvement， and no patient had permanent diabetes insipidus or cerebrospinal fluid rhinorrhea。 Residual tumors increased in 3 patients (6。1%) no tumor recurrence after total resection was noted。 Conclusion Endoscopic resection of recurrent or residual sellar and clivus tumors is safe and effective attention should be paid to the internal carotid artery during the operation。

    神经内镜复发残余鞍区肿瘤斜坡区肿瘤

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    术中多模式神经电生理监测联合血压精准控制对颈动脉内膜剥脱术后急性脑梗死发生的影响

    张洪振张树新史红卫任春圃...
    174-177页
    查看更多>>摘要：目的 探讨术中多模式神经电生理监测联合血压精准控制对颈动脉内膜剥脱术（CEA）后急性脑梗死发生的影响。 方法 选择自2020年1月至2023年9月聊城市东阿县人民医院血管神经外科收治的305例因颈动脉粥样硬化性狭窄入院并完成CEA的患者为研究对象，其中自2020年1月至2021年12月收治的153例患者应用术中多模式神经电生理监测联合传统经验方式控制血压（对照组），自2022年1月至2023年9月收治的152例患者应用术中多模式神经电生理监测联合基于监测所示的感觉或运动波波幅变化的血压精准控制方式（试验组）。回顾性分析2组患者术后急性脑梗死发生率的差异。 结果 试验组患者的术后总脑梗死发生率明显低于对照组（4。6% vs。 13。0%），差异有统计学意义（P<0。05）；其中无症状性脑梗死发生率亦明显低于对照组（3。3%vs 9。8%），差异有统计学意义（P<0。05），而症状性脑梗死发生率的差异无统计学意义（P>0。05）。 结论 术中多模式神经电生理监测联合血压精准控制能够降低患者CEA后急性脑梗死尤其是无症状性脑梗死的发生，从而有助于提高手术安全性。 Objective To investigate the impact of intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control on incidence of acute cerebral infarction after carotid endarterectomy。 Methods A retrospective study was peformed 305 patients with atherosclerotic stenosis of the carotid artery admitted to and accepted carotid endarterectomy in Department of Vascular Neurosurgery， Dong'e County People's Hospital from January 2020 to September 2023 were selected。 Intraoperative multimodal neurophysiological monitoring combined with traditional empirical modalities for blood pressure control was applied to 153 patients admitted to our hospital from January 2020 to December 2021 (control group)， and intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control (based on monitored sensory or motor wave amplitude changes) was applied to 152 patients admitted to our hospital from January 2022 to September 2023 (experimental group)。 Difference in postoperative acute cerebral infarction incidence between the 2 groups was compared。 Results The experimental group had significantly lower postoperative acute cerebral infarction incidence compared with the control group (4。6% vs。 13。0%， P<0。05)。 The experimental group had significantly lower postoperative asymptomatic acute cerebral infarction incidence compared with the control group (3。3%vs。 9。8%， P<0。05)， while no significant difference was noted in postoperative symptomatic acute cerebral infarction incidence between the 2 groups (P>0。05)。 Conclusion Intraoperative multimodal neurophysiological monitoring combined with blood pressure precise control can reduce the postoperative acute cerebral infarction incidence in patients accepted carotid endarterectomy， especacailly postoperative asymptomatic acute cerebral infarction incidence， thereby enhancing surgical safety。

    神经电生理监测血压精准控制颈动脉内膜剥脱术急性脑梗死

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