营养支持在重症心脏瓣膜病外科的临床应用

目的 探讨营养支持在重症心脏瓣膜病外科治疗中的作用。方法2000年5月-2005年5月对182例重症心脏瓣膜病行瓣膜置换术，围术期采用营养支持疗法。其中单瓣病变74例，二尖瓣合并主动脉瓣病变108例。135例行三尖瓣成形术，37例行左房折叠术。结果 182例住院死亡5例，死亡率2.7%，术后并发低心排15例，死亡1例，随访151例，结论 科学的应用营养支持方案，可以明显地提高重症心脏瓣膜病外科手术成功率。     

数字减影脑血管造影对原发性脑室出血的病因诊断价值

目的探讨DSA在原发性脑室出血(PIVH)原发病因检出中的应用价值。方法回顾性分析25例原发性脑室出血患者的DSA检查结果。结果25例患者中检出AVM8例,MoyaMoya病3例,颅内动脉瘤3例,海绵状血管瘤1例,造影阴性10例。结论DSA检查对甄别原发性脑室出血的病因具有重要的诊断意义,对有条件的PIVH病例均应行DSA检查以明确病因,作进一步病因治疗。     

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

Abstract It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke patients. However, the term “intracerebral hemorrhage” (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear to be a general marker of various types of bleeding- prone small vessel disease and a predictor of recurrent vascular events. Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not be ruled out.      

米索前列醇预防剖宫产后出血344例临床观察

目的:观察米索前列醇预防剖宫产手术后出血的临床效果。方法:随机将有剖宫产手术指征的344例孕妇分为3组,分别为在胎儿娩出后给予米索前列醇200mg舌下含化(A组)、缩宫素静脉滴注及子宫肌层注射(B组)和对照组(C组,不给予任何药物),观察产后不同时间的出血量。结果:产后出血量及出血发生率A、B组均明显少于C组(P<0·05)。结论:米索前列醇对分娩后子宫具有较好的收缩作用,且给药方便、安全性较好。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

亚低温治疗重型颅脑损伤中脑组织氧分压的临床意义

目的观察亚低温治疗重型颅脑损伤过程中患者颅内压及脑组织氧分压的变化及临床意义。方法将80例急性重型颅脑损伤患者,随机分为亚低温治疗组(40例)和对照组(40例)。亚低温组入院后或术后立即给予亚低温治疗,保持肛温在32~34℃,持续24h~5d;对照组给予常规治疗。两组均观察颅内压(ICP)和脑组织氧分压(PbtO2)变化。结果亚低温组治疗后,ICP明显下降,PbtO2逐渐升高,与对照组相比有显著性差异。结论亚低温治疗能降低脑外伤后增高的ICP,提高PbtO2;伤后24h内持续PbtO2<5mmHg预示患者预后不良。     

动脉瘤性蛛网膜下腔出血后慢性脑积水

目的探讨动脉瘤性蛛网膜下腔出血后(aSAH)慢性脑积水的发生率及其易患因素。方法回顾性研究2003年1月至2005年9月我科aSAH病例221例,采用单因素及多因素统计方法分析与慢性脑积水发生的相关影响因素。结果慢性脑积水的发生率为12.7%(28/221)。经单因素分析显示,患者年龄、Hunt-Hess级别、Fisher级别、前交通动脉瘤、aSAH次数以及脑室内出血具有统计学意义;多因素logistic回归分析显示,Fisher级别、脑室内出血、aSAH次数、前交通动脉瘤具有统计学意义。结论慢性脑积水为aSAH后一较常见并发症,影响其发生的高危因素包括Fisher级别、脑室内出血、aSAH次数、前交通动脉瘤。对具上述危险因素的aSAH患者应注意跟踪随访,及时诊治。     

未控制出血性休克与TNF—a的关联性及不同液体复苏的作用

目的 研究未控制出血性休克时不同液体复苏的作用以及，INF—a的变化规律，以期阐明限制性液体复苏降低未控制出血性休克的死亡率和改善预后的相关机制。方法采用改良后的Krausz方法建立重度脾创伤未控制出血性休克大鼠模型。采用随机分组的原则将大鼠分为假处理组、限制输液组、常规输液组、不输液组。观察各组动物的出血量、输液量、存活率、存活时间及各时间点的血压、血细胞比容（Hct）和TNF—a的变化情况。结果①限制输液组的输液量明显少于常规输液组（P〈0．05），出血量也明显少于常规输液组（P〈0．05）。②限制输液组Hct明显高于常规输液组（P〈0．05）。②限制输液组的存活时间比常规输液组及不输液组明显延长（P均〈0．05）。限制输液组在72h内的存活率明显高于常规输液组和不输液组。但低于假处理组（P均〈0．1）。④除假处理组外其余各组在伤后90min和180min血TNF—a水平均较伤前均有明显升高（P均〈0．05）；常规输液组，TNF—a水平明显高于限制输液组（P〈0．05）。⑤死亡者TNF—a水平明显高于生存者。结论本研究结果表明，在重度未控制出血条件下，限制性液体复苏可明显降低出血量，提高存活率。未控制性出血休克时的TNF—a水平与预后密切相关，TNF—a高预后不良，而限制性液体复苏时TNF—a水平明显降低。