目的 探讨脑梗死后脑梗死区及对侧大脑半球相应区域感兴趣区（VOI）的代谢变化和高糖对各区域代谢的影响。方法 采用磁共振定域波谱技术（MRS)，在同一活体上分别连续测定梗死区与对照区的¹H-MRS。结果 梗死区胆碱（Cho)、磷酸肌酸/肌酸（Pcr/Cr)、N-乙酰天门冬氨酸（NAA）强度均低于对照区，NAA在梗死区急性期变化明显，加用高糖30分钟后可见梗死区原有乳酸（Lac）信号成倍增加（Lac/NAA-0.3013）。结论 （1）采用MRS定域谱技术可更精确、更客观地检测各VOI区代谢变化。（2）脑梗死区NAA、Cho、Cr均有下降，而NAA下降更为明显，非梗死半球各指标无明显变化，NAA可望作为MRS早期诊断脑梗死的有效指标。（3）高糖可加剧脑梗死区的病理代谢导致Lac积聚，及时停用高糖可望缓解Lac积聚状态：本文客观地直接展示了高糖加剧梗死区病理代谢的全过程，为改进临床治疗提供了直接有力的证据。

Background and Purpose—Many patients with acute stroke are excluded from receiving thrombolysis agents within thenecessary time limit (3 or 6 hours from stroke onset) because they or their family members are unable provide the time of stroke onset. Brain tissue sodium concentration ([Na﹢]) increases gradually and incessantly during the initial hours of experimental focal cerebral ischemia but only in severely damaged brain regions. We propose that this steady increase in [Na﹢] can be used to estimate the time after arterial occlusion in the rat middle cerebral artery occlusion model of ischemic stroke. Methods—Sixteen anesthetized Sprague-Dawley rats underwent permanent middle cerebral artery occlusion combined with bilateral common artery occlusion. After 100 to 450 minutes, diffusion-weighted MRI was used to generate apparent diffusion coefficient (ADC) maps, cerebral blood flow (CBF) was determined with 14C-iodoantipyrine (in asubset of 7 animals), and the brain was frozen. Autoradiographic CBF sections and punch samples for Na1 analysis were obtained from the brain at the same level of the MR image. Severely at risk regions were identified with an ADC of﹤520 μm2/s and, in the subset, with both ADC of﹤520 μm2/s and CBF of﹤40 mL• 100 g﹣¹ • min﹣¹.Results—Both CBF and the ADC dropped quickly and remained stable in the initial hours after ischemic onset. Linear regression revealed strong linearity between [Na﹢] and time after onset, with a slope of 0.95 or 1.00 (mEq/kg DW)/min, with both ADC and ADC-plus-CBF criteria, respectively. The 95% CIs at 180 and 360 minutes were between 41 and 52 minutes.Conclusions—The time after ischemic onset can be estimated with this 2-step process. First, ADC and CBF are used toidentify severely endangered regions. Second, the [Na﹢] in these regions is used to estimate time after onset. The favorable 95% CIs at the time limits for thrombolytic therapy and the availability of measurements of ADC, CBF, and [Na1] in humans through the use of MRI suggest that this time-estimation scheme could be used to assess the appropriateness of thrombolysis for patients who do not know when the stroke occurred.

当前经蝶垂体瘤手术是应用最多的手术入路。现有经鼻-蝶窦入路主要有：经唇下切口-鼻中隔-蝶窦入路、经鼻前庭-鼻中隔-蝶窦入路、经鼻腔直接经蝶入路。后者是近几年随着手术器械和操作技术的发展而趋于成熟的手术方法，已被越来越多的神经外科医师所采用。该入路创伤小，但双瓣鼻窥器管径小，手术操作空间小，操作技术要求高，且手术显微镜调整直视区的范围受到限制。为充分发挥其优点、避免其不足，我院采用内镜辅助单鼻腔直接经蝶垂体瘤手术，取得了满意的效果。为对其临床疗效进行综合正确评估，结合本院近年病例前瞻性设计比较研究上述% 种经鼻$蝶窦入路临床指标，现报道如下。

目的 比较总结单鼻腔经蝶内镜辅助垂体瘤手术和经口鼻蝶窦垂体瘤手术的临床疗效及特点。方法 前瞻设计，将近2年75例垂体瘤病例以2:3随机分为单鼻腔经蝶内镜辅助手术（I组29例）和经口鼻蝶窦手术（Ⅱ组46例）2组，进行比较研究。结果 术前2组病例临床资料无明显差异（P>0.05）；肿瘤切除率：I组27/29；Ⅱ组39/46；出血情况：术中平均输血量I组50mL，Ⅱ组200 mL（P<0.01）。术后48h内鼻部敷料平均更换次数I组0次，Ⅱ组3次。其他：①术中误伤鞍隔脑脊液漏I组1例，Ⅱ组5例；②术后尿崩I组3例，Ⅱ组14例；③术后内分泌功能恢复者I组11例（11/19），Ⅱ组10例（10/32）；④术后鼻外形改变Ⅱ组31例，鼻中隔穿孔Ⅱ组3例，蝶窦囊肿Ⅱ组2例，而I组均未见此类病例；⑤术后平均住院I组5d，Ⅱ组8.7 d。2组病例均无手术死亡和感染病例。结论 单鼻腔直接经蝶垂体瘤手术就手术人路比较而言具有损伤小、出血少、并发症少及恢复快的优点。内镜辅助垂体瘤手术可提高全切除率和治愈率，并可减少鞍内组织损伤、减少并发症。

巨大颅内血供丰富肿瘤因颅内巨大的占位效应而不得不手术治疗，但术中出血又使得手术进行异常困难，有时甚至切除肿瘤时创面出血汹涌而不得不放弃手术，本文利用射频灭活技术#BGR，的组织热凝固作用。在开颅切除巨大颅内血供丰富肿瘤的过程中，首先用BGR热凝肿瘤&使血管闭塞，再分块切除，取得十分满意的效果，现介绍如下。