Ischemic and hemorrhagic cerebral lesions of the newborn

Neonatal pathology comprises a large array of cerebral lesions due to ischemic and/or hemorrhagic mechanisms. Pathogenesis, neuropathology, clinical settings in the acute stages as well as short and long-term outcome are discussed.     

重症脑出血微创术后下呼吸道感染病原学分析

目的:重症脑出血微创术后气管切开病人痰培养病原菌分布与耐药情况分析,其院内感染发生的原因、探讨防治对策。方法:应用痰培养检出的病原菌及耐药性分析。结果:重症脑出血微创术后气管切开病人下呼吸道感染41例,其中G-杆菌26例占63.4%,G 球菌15例占36.6%,其中金葡菌11例,药敏仍以敏感菌株为主,但耐药菌株有增多趋势。结论:重症脑出血微创术后气管切开病人下呼吸道感染以G-杆菌为主,G 球菌以金葡菌为主,仍以敏感菌珠为主,耐药有增多趋势。万古霉素对G 球菌,氨曲南对G-杆菌敏感性较敏感,故在培养结果未出来之前经验用药是非常重要的。     

腹腔镜子宫肌瘤切除术在临床中的应用

目的:为要求微创手术保留子宫的年轻患者,寻找一种子宫肌瘤切除术的好方法,并进一步研究腹腔镜下子宫肌瘤切除术(laparoscopic myomectomy,LM)的优越性。方法:脑垂体后叶素6U用50ml生理盐水稀释后,子宫肌层注射,用电刀纵向切开表面肌层,切口选择肌瘤最突出处,其长度视肌瘤大小而定,一般小于肌瘤直径1~3cm,用抓钳钳夹肌瘤牵拉,电钩切断肌瘤与假包膜连接致密处,将肌瘤完整切除,尽可能减少切断肌层及血管,以减少出血。子宫切口用1号可吸收线连续缝合,腹腔镜组用子宫粉碎器将肌瘤粉碎取出。术后常规持续静脉点滴催产素24h共30U。结果:腹腔镜组与开腹组出血量差异无显著意义,排气时间、离床活动时间及术后住院时间差异有显著意义。结论:LM是肌壁间子宫肌瘤年轻患者理想的手术方式。     

利多卡因治疗外伤性蛛网膜下腔出血疗效分析

目的探讨早期静脉注射利多卡因对外伤性蛛网膜下腔出血（tsAH）继发性脑损伤的治疗作用。方法重度颅脑损伤后SAH患者60例（GCS评分≤8分）。随机分为治疗组（早期静脉注射利多卡因组）和对照组。在治疗前后对患者均进行GCS评分、颅内压（ICP）测定以及头部CT、发射计算机体层摄影（ECT）、经颅多普勒（TCD）检查。结果利多卡因治疗7d后即出现颅内压降低、挫伤脑组织血流供应改善、脑水肿减轻，与对照组比较，有明显差异（P〈0．01）；GCS评分在利多卡因治疗7d、14d后较对照组明显增加（P〈0．01）。结论早期静脉注射利多卡因能明显减轻颅脑损伤后SAH继发性脑组织损伤的程度，有利于神经功能的早期恢复。     

大剂量纳洛酮治疗急性脑出血疗效观察

目的观察大剂量纳洛酮对急性脑出血的临床疗效。方法对60例急性脑出血患者随机分为2组,常规组30例采用脱水等常规脑出血治疗;治疗组30例在常规治疗基础上加用纳洛酮4.0mg,1次/d静滴。2组均治疗14d,同时观察意识状态恢复时间及治疗后评价神经功能缺损恢复情况。结果纳洛酮治疗组意识恢复时间及神经功能缺损减少程度均明显优于对照组。结论大剂量纳洛酮治疗急性脑出血不仅可以缩短昏迷时间,而且可明显改善神经功能,安全可靠。     

磁场治疗白兔脑出血的安全性及疗效的实验研究

目的　探讨磁场治疗对实验性脑出血的治疗作用和安全性。方法　实验一 :5 0只大耳白兔被钩破大脑中动脉以建立脑出血模型。用CT扫描和解剖的方法观察脑出血的情况。实验二 :45只大耳白兔随机分为 0 .4T组、0 .8T组和对照组 ,每组 15只。每只白兔均采用实验一的方法建成脑出血模型。磁疗前CT扫描观察出血情况 ,磁疗后CT扫描观察血肿吸收情况。结果　实验一 :5 0只大耳白兔大脑中动脉钩破术后均出现对侧后下肢无力 ,肌张力降低 ,回缩反射减弱或消失。CT和解剖证实有脑出血。实验二 :45只大耳白兔均成功建成脑出血模型。磁疗前CT扫描 3组之间脑出血差异无显著性意义 (P >0 .0 5 ) ;磁疗后CT扫描 2磁疗组之间血肿吸收差异无显著性意义 (P >0 .0 5 ) ,与对照组比较血肿吸收差异有显著性意义 (P <0 .0 1)。结论　用钩破兔大脑中动脉的方法可建立脑出血动物模型。磁场治疗可促进实验性白兔脑出血的血肿吸收 ,且不产生继发性脑出血     

Study of drug control over postoperative hemorrhage after selective caesarean section

Objective: To compare the efficacy and safety of carbetocin and oxytocin in the prevention of postpartum hemorrhage after selective caesarean section. Methods: Two hundred and sixteen pregnant women who were going to deliver by caesarean section were randomly divided into two paralleled and controlled groups, of which the oxytocin group(group A) contained 105 women and the carbetocin group(group B) 111 women. 20 IU of oxytocin was administrated during operation for both groups, 10 IU directly into uterus and 10 IU intravenously. When the operation was over, 20 IU of oxytocin was dripped for group A lasting for 8 hours, while for group B 100μg of carbetocin was immediately injected intravenously for 1 minute. Blood loss as well as hemoglobin alteration was measured for the comparison of the effect of the two drugs. Blood biochemical indicators were introduced for the evaluation of the safety of carbetocin including the function of liver and kidney and the fasting glucose.Results: No significant difference was revealed between the two groups concerning the postpartum hemorrhage within 24 hours, the postpartum hemorrhage incidence and the changes of hemoglobin. There was no significant difference in the change of liver and kidney function, fasting glucose and electrolyte changes as well.Conclusions: Carbetocin has a similar effect and safety of oxytocin in controlling the blood loss of selective caesarean section.     

青光眼术后早期眼内出血的原因分析

目的分析青光眼术后早期眼内出血的原因，以预防眼内出血的发生。方法对261例（共493只眼）手术治疗的青光眼病人进行回顾性分析。结果术后早期发生眼内出血者17例，共17眼（前房出血6例，眼底出血11例），年龄均在68岁以上。其中闭角型青光眼术前持续性高眼压14眼，新生血管性青光眼3眼；伴糖尿病者6例，伴高血压者5例。结论青光眼术后早期发生眼内出血的主要原因是术前顽固性高眼压。其次与高龄和是否伴有糖尿病、高血压有一定关系。     

TCD观察动脉瘤性SAH后脑血管痉挛的血流动力学改变

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛的血流动力学改变。方法经CT、DSA证实为动脉瘤性SAH患者179例,床旁经颅超声多谱勒(TCD)在术前、术后1~3d、5~7d、9~11d、12~14d记录并分析大脑中动脉(M CA)的血流参数及频谱改变。结果M CA平均血流速度(Vm)于SAH后1~3d开始升高,5~7d、9~11d达到高峰;L I(血管痉挛指数)为3~6时预后良好;>6时可以出现神经系统功能损害,颅内压增高且有脑血管痉挛(CV S)者预后较差。结论TCD能无创、实时评价SAH后CV S的动态变化,可以推断SAH后CV S的严重程度及临床转归。     

高血压脑出血患者血肿周围血-脑屏障葡萄糖转运蛋白1表达的研究

目的观察高血压脑出血(ICH)患者血肿周围血-脑屏障葡萄糖转运蛋白1(GLUT1)表达的变化。方法采用免疫组化方法检测28例高血压ICH患者不同病程血肿周围脑组织GLUT1的表达情况。结果与对照组相比,ICH组发病12 h GLUT1表达开始增强,24 h、48 h表达最强(均P<0.01);72 h表达明显下降(P<0.01)。结论ICH早期血肿周围GLUT1表达增多,有助于恢复脑的能量代谢。