益气活血化瘀方治疗高血压性脑基底节出血术后的临床研究

目的观察益气活血化瘀方治疗高血压性脑基底节出血术后的临床疗效。方法将60例高血压性脑基底节出血患者随机分为观察组28例与对照组32例,对照组予单纯手术治疗,观察组在手术基础上联合益气活血化瘀方治疗。观察两组患者在治疗前后格拉斯哥昏迷指数(GCS)评分、肌力、血肿体积、中医证候积分、住院时间,并评估疗效。结果经治疗后,两组患者GCS评分明显下降,血肿体积明显缩小,中医证候积分明显降低,术后瘫痪侧肌力均明显改善(均P<0.05),观察组改善程度优于对照组(P<0.05);观察组中医证候总有效率为75.00%,明显高于对照组的59.38%(P<0.05);观察组的住院时间明显短于对照组(P<0.05)。结论益气活血化瘀方联合手术治疗可明显改善高血压性脑基底节出血患者的GCS评分、肌力,降低中医证候积分,缩小血肿体积,缩短住院时间,提高中医证候疗效。     

体医结合视角下社区人群健康管理突破点解析

作为建国以来首次由国家层面提出的健康战略规划,《“健康中国2030”规划纲要》明确提出应将体医结合作为大健康命题实现的重要手段。随着社区卫生服务机构健康管理功能的不断强化,体育健身服务与卫生服务相结合逐渐成为构建社区居民健康屏障的最佳组合。本研究系统梳理了体医结合手段在我国社区各类人群健康管理中的应用现况及瓶颈,并进一步分析国外体医结合的发展现况及特点,最终对比提出突破点。研究结果发现,我国现有社区层面体医结合应用尚处于起步阶段,关键问题包括:现有的居民体质监测结果呈现孤岛,体质监测数据并未与医疗系统打通、运动处方干预缺乏科学性和精准性、体医结合专业人才队伍建设存在不足。对比国际经验,部分发达国家体医结合开展较早,特别是在覆盖人群及疾病类别、运动处方精细度、复杂疾病精准化干预、与医疗系统结合方面均做得较好。基于此,提出我国社区人群体医融合促进健康管理的突破口在于,社区卫生服务机构应更多地参与体医结合健康管理、各类体医数据的整合与利用需进一步完善、精准运动干预需不断提升,以及复合型社区体医人才培养应不断跟进,通过多渠道实现体医结合在社区健康管理的应用突破。      

破裂椎动脉夹层动脉瘤血管内治疗致Wallenberg综合征一例

病例报告 患者 男,41岁.因突发头痛伴头晕、恶心1d于2011年12月17日入院.检查:一般情况良好,精神不振,颈部抵抗,余神经系统检查未见异常.头颅CT示:蛛网膜下腔出血,出血位于小脑幕、大脑纵裂池及双侧大脑沟回内,脑室系统正常.于12月19日局麻下行DSA显示:右侧椎动脉夹层动脉瘤,梭形,位于右侧小脑后下动脉(PICA)近端约0.8 cm处,大小约3.6mm×5.1 mm;左侧椎动脉正常.双侧股动脉穿刺置管,应用球囊闭塞右侧椎动脉起始部,左侧椎动脉造影显示血流经汇合部返流,右侧PICA显影良好.     

术中皮层脑电监测并癫痫诱发试验在癫痫手术中的应用

目的 探讨术中癫痫诱发试验对癫痫灶切除的方法和疗效.方法 对118例难治性癫痫患者,在术中首先唤醒患者,利用皮层和深部电极,监测患者的棘波、尖波或棘慢、尖慢复合波等,数码标签标出致痫灶的范围,加深麻醉后手术切除和(或)皮层热灼,再次促醒患者并给予过度换气,使二氧化碳分压(PCO2)在20～25 mmHg,持续5 min,复测脑电波,测得棘波、尖波标记后,再次加深麻醉给予切除和(或)皮层热灼.结果 (1)118例患者中,除3例儿童患者因术中不合作,在较浅的麻醉下完成手术外,115例患者经过麻醉的清醒、过度换气诱发试验后,均顺利完成了手术.术中无一例出现癫痫发作.(2)根据唤醒条件下测得结果,手术后虽然癫痫波基本消失,但经过度换气诱发试验,发现仍有63例再次测出癫痫波,经再次手术后,过度换气诱发,复测癫痫波消失.(3)术后随访:本组无手术死亡,2例不全性运动性失语,术后半年恢复,2例不完全偏瘫术后1年基本恢复,3例胶质细胞瘤患者死亡,5例失访,110例患者得到了随访,时间3-33个月,平均18.5个月.根据Engel术后效果分级进行评估:Ⅰ级74例,Ⅱ级27例,Ⅲ级6例,Ⅳ级3例.结论 术中癫痫诱发试验,在癫痫灶切除术中具有非常重要的指导意义,值得进一步探讨.

Abstract：

Objective To study intraoperative epilepsy inducing test and its effect in the epileptogenic focus resection. Method The study included 118 patients with refractory epilepsy. During surgery, the patients were first woken up. With cortical and depth electrodes, the patient's spike wave, sharp wave or spike slow, sharp slow complex wave, etc. were monitored. The range of epileptogenic foci was marked with digital label. Under deep anesthesia, the foci was resected and the cortex was heat burned. The patients were woken up again, and hyperventilated, the carbon dioxide partial pressure (PCO2) kept at 20～25 mmHg for 5 minutes. The brain waves were measured again. After marking the spike and sharp waves, the anesthesia was deepened again, and resection and cortex heat burning were applied. Results (1)Of the 118 patients, except 3 children performed under light anesthesia because of noncooperation, 115 patients all successfully underwent the surgery, going through consciousness recovery, hyperventilation inducing test after general anesthesia, without intraoperative seizures. (2) According to the results by arousal conditions, despite postoperative epileptic wave basically disappeared, the epileptic waves were still detected in 63 patients after hyperventilation inducing test. The epileptic wave disappeared after repeated operation and hyperventilation inducing test.(3) Postoperative follow - up showed no operative death, incomplete motor aphasia in 2 cases and recovered in 6 months. 2 cases with incomplete paralysis recovered after 1 year. 3 patients with glioblastoma died. 5 patients were not traceable. 110 patients were followed up for 3-33 months (mean 18. 5 months). According to Engel's postoperative evaluation, 74 cases were grade Ⅰ , 27 cases were grade Ⅱ , 6 cases were grade Ⅲ, 3 cases were grade Ⅳ. Conclusions Intraoperative epilepsy inducing test has very important significance in the epileptic focus resection and deserves to further exploration.