脑深部刺激治疗帕金森病的并发症和不良反应分析(附63例报告)

目的:总结脑深部刺激(DBS)治疗帕金森病的并发症和不良反应.方法:自2000年1月至2004年3月用DBS治疗帕金森病63例,共93侧.手术采用磁共振扫描结合微电极记录技术进行靶点定位.术后随访3个月至4年,平均7.3个月,对其并发症和不良反应进行分析.结果:DBS并发症和不良反应有电极放置不准重新调整2例,刺激电极与皮下导线连接处头皮切口破溃1例,胸部脉冲发生器植入处皮下感染1例,记忆力轻度减退2例,情绪改变7例,肢体异动19例,睁眼困难1例,但未发生明显的致残性永久并发症和不良反应.结论:DBS是一种微创外科治疗手段,提高手术熟练程度可降低其并发症和不良反应发生率.     

采用丘脑深部电刺激治疗癫痫患者的长期随访

本文对采用丘脑前核(AN,n=6)或中央中核(n=2)脑深部电刺激(DBS)治疗癫痫患者的长期随访(平均5年)结果进行描述。尽管2例患者一直延迟到5、6年后才出现疗效,但在更换抗癫痫药物后5例患者(全部为AN)的癫痫发作减少50%以上。给予AN患者植入DBS电极后,患者在激活刺激前的1～3个月癫     

同一术者的822例帕金森病患者脑深部电刺激手术相关并发症及学习曲线效应分析

目的分析帕金森病(PD)患者脑深部电刺激(DBS)手术相关并发症, 并探讨在并发症方面是否存在学习曲线效应。方法回顾性分析中国科学技术大学附属第一医院(安徽省立医院)2012年12月至2022年12月间由同一术者进行的822例PD患者DBS手术资料。评估DBS相关并发症, 并对每100例DBS手术的并发症进行分析。结果 822例PD患者, 男453例, 女369例, 年龄31～80(62±7)岁。DBS手术后, 最短随访期为6个月。手术相关的并发症为55例(6.69%), 其中5例(0.61%)患者出现电极周围少许出血, 1例(0.12%)患者出现脑梗死, 4例(0.49%)患者术后出现癫痫症状, 42例(5.11%)患者术后出现谵妄症状, 2例(0.24%)患者发生呼吸窘迫, 1例(0.12%)患者急性心功能不全。DBS硬件相关的并发症16例(1.94%), 其中4例(0.48%)出现感染, 1例(0.12%)出现脉冲发生器与延伸导线连接处折角断裂, 8例(0.97%)出现延伸导线过紧, 3例(0.36%)出现脉冲发生器(IPG)囊袋血肿。在感染病例中, 2例患者移除了IPG和延伸导...     

脑深部刺激术中丘脑底核靶点定位方法探讨

目的 分析脑深部刺激术(DBS)中丘脑底核(STN)靶点的定位方法。方法 对30例帕金森病(PD)患者进行STN DBS治疗，其中单侧19例，双侧11例。MRI扫描后，采用图像和坐标相结合的方法计算STN靶点坐标，微电极记录细胞放电，植入电极刺激，观察刺激效果和不良反应。结果 MRI能显示STN，微电极记录能明确STN边界，术中植入电极刺激能观察患者的刺激效果和不良反应。结论 MRI图像直接定位STN较准确，微电极记录和植入电极刺激能对靶点定位作进一步验证和适当调整。     

帕金森病丘脑底核植入3.0 T磁共振兼容脑深部电刺激系统术后早期的脑影像学改变及其对电极阻抗的影响

目的分析3.0 T磁共振(MRI)兼容脑深部电刺激(DBS)系统在帕金森病(PD)丘脑底核(STN)刺激术后早期的影像学改变及其对电极阻抗的影响。方法回顾性分析2022年10月至2023年4月在中国科学技术大学附属第一医院(安徽省立医院)进行3.0 T MRI兼容DBS系统STN-DBS手术治疗的43例PD患者资料, 男27例, 女16例, 年龄43～68(56±5)岁。所有患者进行了术后1周头部3.0 T MRI、头部CT扫描和阻抗测定, 15例患者在术后1个月进行了头部3.0 T MRI和阻抗测定, 比较3.0 T MRI扫描前后电极触点阻抗值的差异, 并且分析患者术后电极周边水肿(PLE)的发生情况, 比较两种成像在PLE检出率的差别;比较不同微电极记录(MER)次数、不同时间节点的PLE差异;并分析电极阻抗与核团周边水肿(SE)体积的相关性。结果 43例患者均成功完成手术, 共植入86根电极, 术后1周和1个月行3.0 T MRI检查前后的电极阻抗值差异无统计学意义;3.0 T MRI的PLE的检出率为95.12%(39/43), 显著高于CT成像的17.07%(7/43)(χ...     

脑深部电刺激治疗老年帕金森病的围手术期护理-附14例病例

目的对应用双侧丘脑底核(STN)脑深部电刺激(DBS)治疗老年中晚期帕金森病(PD)的护理方法进行分析总结,寻求行之有效、方便使用的护理方法。方法对14例全麻下将刺激电极分别植入双侧丘脑底核,并同期植入刺激发生器的老年帕金森病患者重点进行围手术期心理、药效观察、预防并发症三方面进行针对性护理。结果14例PD患者行STN DBS术后症状改善好,无发生颅内出血、偏瘫、癫痫或感染等并发症,治疗效果满意。结论老年帕金森病人行DBS治疗的围手术期护理,尤其是心理护理、药效观察、预防并发症及安全护理对保证手术效果,促进症状改善有十分重要。     

脑深部电刺激治疗老年帕金森病的围手术期护理-附14例病例

目的对应用双侧丘脑底核(STN)脑深部电刺激(DBS)治疗老年中晚期帕金森病(PD)的护理方法进行分析总结,寻求行之有效、方便使用的护理方法。方法对14例全麻下将刺激电极分别植入双侧丘脑底核,并同期植入刺激发生器的老年帕金森病患者重点进行围手术期心理、药效观察、预防并发症三方面进行针对性护理。结果14例PD患者行STN DBS术后症状改善好,无发生颅内出血、偏瘫、癫痫或感染等并发症,治疗效果满意。结论老年帕金森病人行DBS治疗的围手术期护理,尤其是心理护理、药效观察、预防并发症及安全护理对保证手术效果,促进症状改善有十分重要。     

神经外科机器人辅助脑深部电刺激治疗高龄帕金森病的疗效分析

目的探讨神经外科机器人脑深部电刺激(DBS)治疗高龄帕金森病(PD)的手术疗效。方法回顾性收集2016年9月至2022年9月在北部战区总医院神经外科行神经外科机器人辅助DBS手术的高龄(≥75岁)PD患者的临床资料, 分析统计手术时间、电极植入时间、术后颅内积气, 电极植入精度, 陶氏DBS手术评分、围手术期并发症, 药物关期时术前、术后6、12、24个月及末次随访时的统一帕金森病评定量表(UPDRS)、UPDRS-Ⅲ、震颤、强直、运动迟缓、轴性症状、日常生活活动指数(ADL-Barthel)、左旋多巴等效日剂量(LEDD)、蒙特利尔认知评估量表(MoCA)、汉密顿焦虑量表(HAMA)及汉密顿抑郁量表(HAMD)等评分及死亡情况。结果共入组25例高龄患者, 男14例, 女11例, 年龄(78.3±3.2)岁, 9例患者合并基础疾病。其中双侧苍白球内侧部脑深部电刺激术(GPi-DBS)9例(36%), 双侧丘脑底核脑深部电刺激术(STN-DBS)16例(64%)。手术时间(1.56±0.19)h, 电极植入时间(1.01±0.19)h, 颅内积气体积9.8(4.7, 23.3)cm3, ...     

脑深部刺激:来自单中心硬件及手术经验所致并发症的长期分析

目的:在一个单中心确定脑深部刺激(D BS)的硬件及手术相关并发症。方法:本研究对1996年2月至2003年3月间在本中心接受DBS手术的262例连续患者(472个电极)进行回顾性分析,以收集急性不良事件的相关资料(手术后30d)。对其中180例患者的资料进行额外校正,以评估患者的长期并发症(3     

立体定向手术治疗帕金森病的临床研究

目的:总结微电极导向立体定向技术行脑内核团毁损和脑深部电刺激(DBS)治疗帕金森病的临床经验.方法:1999～2004年期间采用微电极导向立体定向毁损手术治疗帕金森病510例和DBS治疗帕金森病62例,其中脑核团毁损术组中行单侧苍白球腹后部毁损术(PVP)385例,丘脑腹中间核(Vim)毁损术91例,行同期同侧PVP和Vim毁损术12例,进行同期双侧PVP 8例,分期双侧PVP 10例,分期双侧PVP Vim术4例.DBS组中,刺激靶点为丘脑底核(STN)61例和Vim 1例,其中单侧31例,双侧31例.结果:脑核团毁损组于术后进行UPDRS运动评分,在"关"状态下症状改善率为47.3%;在"开"状态下症状改善率为23.4%.开-关症状和异动症均消失.220例平均随访11.6个月,其中显效130例(59.9%),改善75例(34%),无效15例(6.8%).DBS组术后UPDRS运动评分,在"关"状态下改善率为45.2%,在"开"状态下改善率为25.7%,平均随访11.8个月,其中40例于1个月内调整参数后再无调整,12例术后需再次调整参数.结论:根据患者的症状合理选择不同的脑核团毁损靶点,可明显控制患者症状.DBS手术并发症少,术后可调节参数,已成为治疗帕金森病的重要手术方法.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.