CO2 reactivity and autoregulation in fetal brain

Intraventricular hemorrhage (IVH) in preterm infants is well known to be associated with the high morbidity and mortality of this group. Previous studies have suggested altered cerebral blood flow (CBF) as an important pathologic factor. We measured the CBF in nearterm rabbit fetuses using the hydrogen clearance technique. The local CBF of the rabbit fetuses was significantly low compared with that of the maternal rabbits. The response of CBF to changes in PaCO₂ was observed in rabbit fetuses. The CO₂ reactivity index of the fetal rabbit was lower than that of the maternal rabbit. This low CO₂ reactivity might reflect the immaturity of the fetal brain and its low CBF. We were unable to monitor the fetal blood pressure, but the fetal CBF remained stable when the maternal blood pressure was altered. It is well known that IVH in preterm infants originates from the subependymal germinal matrix and that this has many fragile vessels. Our observation suggests that even a small increase of CBF during hypercapnia might have a large effect towards producing hemorrhage.     

脑出血后的抑制细胞凋亡干预

脑出血后血肿周围组织可发生继发性损伤。研究表明，细胞凋亡在脑出血后继发性损伤中起着重要作用。抑制细胞凋亡可显著改善脑出血后的神经功能缺损。     

顺平县11年间产后出血相关因素分析和防治措施研究

目的分析与产后出血相关的因素，提出合理的防治措施。方法以12600例产妇为研究对象，将胎儿娩出后2h内出血量达到或超过400ml，或胎儿娩出后24h出血量达到或超过500ml定义为产后出血，测量产后出血量。通过非条件Logistic回归分析，筛选出与产后出血相关的主要危险因素，对比出血发生率的变化。结果在12600例分娩产妇中，符合产后出血的有198例，单因素分析中有10个因素有统计学意义。结论加强孕前宜教和孕期管理，提高助产技术，规范缩官素在产前的应用，降低了产后出血的发生。     

超早期颅骨锥孔尿激酶冲洗治疗脑出血102例

目的总结超早期颅骨锥孔尿激酶冲洗治疗脑出血的经验与教训。方法对102例发病在6h内的脑出血病人,采用颅骨锥孔置管后,用尿激酶冲洗引流。结果恢复正常29例(28.5%),轻残36例(35.3%),重残20例(19.6%),植物生存5例(4.9%),死亡12例(11.8%)。住院治疗期间无一例复发和颅内感染。结论超早期颅骨锥孔尿激酶冲洗治疗脑出血,血肿溶解迅速,引流效果好,且不会破坏患者凝血机制。     

高血压性脑出血血肿周围脑组织细胞间粘附分子-1的表达

目的探讨急性高血压性脑出血患者细胞间粘附分子-1(ICAM-1)在血肿周围脑组织和正常脑组织中的表达及其意义。方法选择30例行开颅手术治疗的急性高血压性脑出血患者,采用免疫组化技术检测ICAM-1在血肿周围脑组织及正常脑组织中的表达。结果实验组血肿周围脑组织可见ICAM-1的表达水平上调,其表达水平明显高于正常脑组织的表达水平(P<0.01)。神经元和血管内皮细胞共同表达ICAM-1,且神经元表达较明显。结论ICAM-1在人类高血压性脑出血血肿周围脑组织的表达水平上调,其表达上调可能参与了血肿周围脑组织的白细胞浸润,最终引发炎性反应和继发性脑损伤。     

Chronic intestinal pseudo-obstruction: manifestations, natural history and management

Chronic intestinal pseudo-obstruction (CIPO) is a rare pathological condition characterized by a marked derangement of gut propulsive motility mimicking mechanical obstruction, in the absence of any lesion occluding the gut lumen. This disease is often associated with a disabling and potentially life-threatening complications and is still too often unrecognized even in referral centres. As a result, patients receive neither appropriate care nor recognition of their severe health condition. Medical and surgical therapies are often unsatisfactory and long-term outcome turns out to be poor in the vast majority of cases. This article focuses on the main clinical features, the management and long-term outcome of patients affected by CIPO, with particular emphasis on those aspects which remain a matter of debate.     

小骨窗术和碎吸术治疗脑出血的临床应用研究

目的对比研究颅内血肿小骨窗清除术和颅内血肿(钻孔)碎吸清除术治疗脑出血的疗效。方法87例脑出血患者分为小骨窗组(行颅内血肿小骨窗清除术)、碎吸组(行颅内血肿碎吸清除术)和对照组(行内科保守治疗)。分别比较小骨窗组、碎吸组、保守组治疗前后的GCS评分及3组的GCS评分差。采用t检验、χ2检验和单因素方差分析比较。结果小骨窗组、碎吸组与保守组的GCS评分差比较均有差异(P<0.05);小骨窗组和碎吸组的GCS评分差比较也有差异(P<0.05)。结论小骨窗颅内血肿清除术、碎吸颅内血肿清除术、内科保守疗法在脑出血治疗中均能发挥一定的作用。小骨窗术和碎吸术在治疗中均能提高疗效、加快神经功能恢复,但小骨窗术较碎吸术能更好地发挥疗效、提高病人的生存质量。     

胰岛素抵抗和脑血管病关系的研究

目的：探讨胰岛素抵抗与脑梗死、脑出血的关系，为针对胰岛素抵抗的治疗可以有效地预防脑血管疾病提供理论依据。方法：选取42例脑梗死（脑梗死组）、40例脑出血（脑出血组）及30例非脑血管病患者（对照组），分别测定空腹胰岛素（FINS）、空腹血糖（FBG），计算胰岛素敏感指数（ISI），各组间进行比较。结果：脑梗死组和脑出血组患者ISI低于对照组（P〈0.05），而FINS高于对照组（P〈0．05），FBG与对照组差异无统计学意义（P〉0．05）。结论：胰岛素抵抗可能是脑血管病的一个重要危险因素。     

胶原酶诱导不同部位脑出血大鼠模型的神经功能比较

目的 观察胶原酶诱导纹状体和内囊部位脑出血模型的行为学和神经纤维损伤差异.方法 利用立体定向技术,将一定量的Ⅳ型胶原酶用微量进样器分别精确注入大鼠纹状体和内囊诱导脑出血模型,观察两组大鼠的运动功能差异,并进行大体形态学和神经纤维受损程度的比较.结果 内囊组大鼠的运动功能受损程度明显重于纹状体组大鼠,前者的神经纤维破坏程度显著重于后者.结论 不同部位的脑出血模型的神经损害程度存在差异,内囊区脑出血模型更适合于研究神经纤维的损伤机制及神经纤维的再生和修复.     

Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?

This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.