微创钻孔血肿引流术治疗高血压性脑出血的护理体会

目的讨论微创钻孔血肿引流术治疗高血压性脑出血的护理措施。方法回顾鹤壁市人民医院36例采用微创钻孔血肿引流术治疗高血压性脑出血患者的临床资料,分析术前、术中以及术后的护理措施。结果采用微创钻孔血肿引流术治疗后,治愈7例,显效10例,有效15例,无效4例,总有效率88.89%（32/36）,无死亡病例。结论微创钻孔血肿引流术配合围手术期护理治疗高血压性脑出血疗效确切,在促进患者早期康复和改善神经功能方面具有非常重要的意义。     

临床硬膜下血肿的手术治疗与分析

目的 探讨硬膜下血肿的手术治疗效果及并发症的预防方法。方法 根据CT表现决定行钻孔冲洗引流术或骨瓣开颅清除血肿术，即对于CT显示为低密度改变者，等密度改变者和混杂密度改变无新鲜出血者行钻孔冲洗引流术，其中采用常规钻孔引流术者14例，采用改良钻孔冲洗引流术者18例，对于CT血肿包膜表现为钙化者，血肿内有钙化者和混杂密度有新鲜出血者均行骨瓣开颅清除血肿术。结果 骨瓣开颅清除血肿术均为一次性手术治愈，行钻孔冲洗引流术者拔管前血肿完全消失者17例，随防半年均无复发，拔管前残余少量硬膜下血肿者12例，随防半年复发1例，其余3例患者由于血肿量大，分两次手术治愈。行常规钻孔冲洗引流术组的患者术后均有不同程度的颅内积气，占100％，改良钻孔冲洗引流术组，颅内积气患者仅有2例，占11％。结论 钻孔冲洗引流术是治疗硬膜下血肿的有效方法，采用改良钻孔冲洗引流术可以明显减少颅内积气的发生。     

微创钻孔引流术与开窗血肿清除术治疗高血压脑出血疗效观察

目的:分析微创钻孔引流术与开窗血肿清除术治疗高血压脑出血的手术效果,探讨微创钻孔引流术的应用价值。方法:将某院2016年30例高血压脑出血患者作为分析对象,按照住院顺序分成对照组和观察组各15例,观察者采用微创钻孔引流术治疗,而对照组采用开窗血肿清除术治疗,观察两组手术时间、复发出血率和住院时间,对比两组患者的1、3、5d的血肿量。结果:观察者患者的手术时间、住院时间明显低于对照组,差异具有统计学意义(P0.05);两组患者的复发出血率差异无统计学意义(P0.05);两组患者术前血肿量对比差异无统计学意义,但观察组术后1、3、5d血肿量均显著低于对照组(P0.05)。结论:采用微创钻孔引流术治疗高血压脑出血效果显著,能够有效清除患者脑部的血肿,预防复发,提高生活质量,与开窗血肿清除术比更为安全快捷,具有临床推广意义。     

依达拉奉在急性颅内血肿微创术后神经功能恢复中的临床应用

目的探讨依达拉奉在急性颅内血肿微创术后神经功能恢复中的临床应用价值。方法本文采用颅内血肿微创术治疗急性脑出血患者,并探讨依达拉奉对急性脑出血患者术后神经功能恢复的影响。结果微创血肿清除术后第14、30天观察组血清炎性因子水平明显低于对照组患者,且神经功能恢复较好、较快。结论依达拉奉可以改善脑出血患者微创引流术后神经功能,有利于保护健康脑组织及全身其他脏器,明显有利于脑出血的恢复及痊愈。     

微创钻孔引流与开颅血肿清除术治疗高血压脑出血的临床效果

目的分析高血压脑出血患者采用微创钻孔引流术与开颅血肿清除术治疗的效果差异。方法将我院收治的高血压脑出血患者120例纳入本研究,根据随机数字表法分为2组,将应用开颅血肿清除术治疗的60例患者设为开颅组,应用微创钻孔引流术治疗的60例患者设为微创组。对比2组患者术前术后的血肿量、术后神经功能缺损评分和日常生活活动能力(ADL)评分、术后并发症及病死率情况。结果微创组术后1、3、5d的血肿量与开颅组相比明显较低,差异有统计学意义(P<0.05)。微创组术后2周神经功能缺损评分和术后3个月的ADL评分与开颅组相比较为优异,差异有统计学意义(P<0.05);微创组的并发症发生率(6.7%)与对照组(28.3%)相比明显较低,差异具有统计学意义(P<0.05),但微创组和开颅组术后病死率(1.7%、3.3%)差异无统计学意义(P>0.05)。结论采用微创钻孔引流术治疗高血压脑出血的效果显著,明显优于开颅血肿清除术,血肿清除率较高,对患者神经功能的损伤较少,并发症较少发生,病死率低,患者ADL有所提高,值得在临床上推广应用。     

微创脑室滴注灌洗联合终池引流术治疗脑室内血肿

目的 探讨微创脑室滴注灌洗联合终池引流术对提高颅内血肿清除的意义.方法 将60例颅内血肿患者分为对照组(26例)和观察组(34例).两组患者均采用血肿微创脑室滴注灌洗治疗,但观察组在此基础上联合终池引流术,比较两组的疗效.结果 对照组总有效率34.6%;观察组总有效率82.4%.观察组总有效率高于对照组(P<0.05).结论 微创脑室滴注灌洗联合终池引流术可以加速脑室血肿的清除,是一种有效的治疗方法.     

侧脑室穿刺术联合腰大池引流术治疗脑室铸型疗效观察

目的观察微创侧脑室穿刺术联合腰大池穿刺引流术治疗脑出血后脑室铸型的疗效。方法对25例脑室铸型患者采取侧脑室穿刺联合腰大池引流术治疗,观察治疗效果。结果本组无院内死亡病例,1周后院外死亡1例,3～6个月后随防存活患者无脑积水发生。结论侧脑室穿刺术联合腰大池穿刺引流术能有效降低死亡率,明显缩短患者住院时间,清除颅内积血速度较单纯侧脑室穿刺引流术快。     

亚急性硬膜下血肿两种手术方法疗效比较

目的采用钻孔引流术治疗亚急性硬膜下血肿,并与开颅术的疗效相比较。方法从2005年1月至2010年7月,收治亚急性硬膜下血肿患者65例,回顾性分析65例患者的临床及神经影像学特征、手术方法和治疗效果,对比钻孔引流术与开颅血肿清除术的疗效差异。结果 65例患者均采用手术治疗;钻孔引流组38例,其中36例治愈,2例复发,无死亡;开颅组27例,其中治愈26例,1例死于术后并发肺部感染,无复发;两组在治愈率、复发率、及死亡率上均无显著性差异。结论钻孔引流术与开颅术均是治疗亚急性硬膜下血肿的有效方法,前者具有操作简便、微创、及避免行开颅手术等优势,可作为治疗的首选。     

丘脑出血32例临床分析

目的探讨穿刺颅内血肿粉碎清除术的临床疗效。方法回顾性分析32例高血压丘脑出血的疗效，其中20例出血量〉15ml的丘脑出血采用微创穿刺颅内血肿粉碎清除术（使用YL-1型穿刺针和技术）及脑室引流术治疗，12例出血量〈10ml的丘脑出血采用非手术治疗。结果12例血肿量〈10ml的丘脑出血，经保守治疗均获得痊愈；20例血肿量〉15ml的丘脑出血用微创穿刺颅内血肿清除术及脑室引流术治疗，其中2例死于脑干继发性损伤．3例死于上消化道大出血并发多器官功能衰竭。15例术后3～6个月随访：ADLⅠ级6例、Ⅱ级4例、Ⅲ级4例、Ⅳ级1例。结论微创穿刺颅内血肿清除术及脑室引流术治疗丘脑出血，可较大地改善疗效和预后。     

颅内血肿微创清除术联合神经节苷脂治疗脑出血的疗效观察

目的研究应用神经节苷脂联合颅内血肿微创清除术治疗脑出血的临床效果。方法抽取88例患有脑出血的患者,随机分为对照组和治疗组,每组44例。采用颅内血肿微创清除术对对照组患者实施治疗;采用神经节苷脂联合颅内血肿微创清除术对治疗组患者实施治疗。结果治疗组患者脑出血疾病治疗效果明显优于对照组;治疗前后神经缺损程度评分的改善幅度明显大于对照组;脑出血病情控制时间和留院观察时间明屁短于对照组。结论应用神经节苷脂与颅内血肿微创清除术联合对患有脑出血的患者实施治疗的临床效果非常明显。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.