高血压脑出血锥颅血肿抽吸引流术与开颅血肿清除术的对比研究

目的 探讨锥颅血肿抽吸引流术和开颅血肿清除术两种不同的手术方法治疗高血压脑出血的临床疗效.方法 选取在本院接受治疗的高血压脑出血患者98例作为研究对象,其中锥颅组50例行锥颅血肿抽吸引流术,开颅组48例行开颅血肿清除术.比较两组患者的临床效果.结果 锥颅组的平均手术时间少于开颅组（P＜0.05）;脑功能恢复情况锥颅组优于开颅组（P＜0.05）;死亡率锥颅组低于开颅组（P＜0.05）.结论 早期锥颅血肿抽吸引流术具有手术时间短、微创、操作相对简单、安全有效等优点,是治疗高血压脑出血的有效手术方式.     

立体定向手术抽吸对脑出血伴发脑水肿治疗的临床应用研究

目的 探讨立体定向手术抽吸联合尿激酶引流治疗高血压脑出血伴发脑水肿的疗效.方法 选择2009年10月～2011年10月高血压脑出血伴发脑水肿患者116例为研究对象,按照随机数字表法将患者随机分为立体定向手术组(n=58)和保守治疗组(n=58).立体定向手术组患者在三维立体定向下行血肿抽吸术,同时注入尿激酶50 kU进行引流;保守治疗组给予降压、降颅压、营养神经、改善脑代谢等药物治疗.比较两组治疗后1、2、4周血肿周边水肿消散情况及临床神经功能缺损程度评分.结果 治疗后1、2、4周血肿周边水肿体积立体定向手术组分别为(8.9±1.8)、(7.1±1.6)、(5.6±0.9) ml,保守治疗组分别为(16.6±2.8)、(14.9±1.8)、(6.6±1.2) ml,治疗后1、2周两组比较差异有统计学意义(P＜ 0.05),而治疗后4周两组比较差异无统计学意义(P＞0.05).治疗后1、2、4周神经功能缺损程度评分立体定向手术组明显低于保守治疗组,差异有统计学意义(P＜ 0.05).结论 立体定向手术抽吸联合尿激酶引流治疗脑出血伴发脑水肿可明显减轻早期血肿周边水肿,而且有利于改善患者的预后,提高患者的生活质量.     

超早期小孔多方位颅内血肿抽吸术治疗重症高血压脑出血的疗效观察

目的分析超早期小孔多方位颅内血肿抽吸术对重症高血压脑出血的治疗效果。方法 58例重症高血压脑出血患者采用小孔多方位颅内血肿抽吸术,52例重症高血压脑出血患者采用开颅血肿清除术。结果治疗组有效率60.71%,病死率39.28%;对照组有效率19.23%,病死率80.77%。结论超早期小孔多方位颅内血肿抽吸术治疗重症脑出血疗效确切,病死率低。     

颅脑损伤术后继发非手术区迟发性血肿41例的临床分析

目的 探讨急性颅脑损伤术后继发非手术区迟发性血肿的处理及预后。方法 回顾性分析41例急性颅脑损伤术后继发非手术区迟发性血肿的临床资料。结果 本组患者伤后治疗结果良好12例,轻残6例,重残10例,死亡13例。结论 部分颅脑损伤患者可在早期手术后形成非手术区域的迟发性血肿,严重影响患者的预后,只要能及时发现,尽早治疗和处理即可改善预后。     

Clinical evaluation of the infertile male with respect to genetic etiologies

Severe male factor infertility may have a presently identifiable genetic basis. Y chromosomal microdeletions (e.g., an AZFc microdeletion), karyotypic anomalies (e.g., Klinefelter Syndrome), and mutations in both alleles of the cystic fibrosis transmembrane conductance regulator (CFTR) gene may be found, depending upon the etiology of the reproductive compromise. Which patients should be tested, what are the tests that can be performed, when should those tests be ordered, and what might a positive outcome mean, are all critically valuable clinical questions for the couple that help guide evaluation and management. It is imperative that they be asked and results discussed prior to any intervention such as testis tissue extraction, microsurgical epididymal sperm aspiration, or intracytoplasmic sperm injection so that the couple can incorporate them in their decisions moving forward vis-à-vis their reproductive choices and options. The role of reproductive medicine clinicians should not be limited to just helping couples establish a pregnancy, but instead be expanded to educating them about the reasons and causes of their reproductive failure that affect not only them as individuals but also may have implications for their offspring.     

Clinical evaluation of the infertile male with respect to genetic etiologies

Severe male factor infertility may have a presently identifiable genetic basis. Y chromosomal microdeletions (e.g., an AZFc microdeletion), karyotypic anomalies (e.g., Klinefelter Syndrome), and mutations in both alleles of the cystic fibrosis transmembrane conductance regulator (CFTR) gene may be found, depending upon the etiology of the reproductive compromise. Which patients should be tested, what are the tests that can be performed, when should those tests be ordered, and what might a positive outcome mean, are all critically valuable clinical questions for the couple that help guide evaluation and management. It is imperative that they be asked and results discussed prior to any intervention such as testis tissue extraction, microsurgical epididymal sperm aspiration, or intracytoplasmic sperm injection so that the couple can incorporate them in their decisions moving forward vis-à-vis their reproductive choices and options. The role of reproductive medicine clinicians should not be limited to just helping couples establish a pregnancy, but instead be expanded to educating them about the reasons and causes of their reproductive failure that affect not only them as individuals but also may have implications for their offspring.     

腰椎管狭窄症术后应用胶原蛋白海绵减少引流量的对比研究

目的观察胶原蛋白海绵在腰椎管狭窄症术后减少引流量的作用。方法因腰椎管狭窄症行腰椎管扩大减压、椎间植骨融合术患者186例,按照随机数字表法将患者分为改进组和对照组。改进组96例患者术后硬膜后放置胶原蛋白海绵;对照组90例患者术后使用传统止血方法止血,未放置胶原蛋白海绵。术后均放置引流管。观察比较两组术后1、12、24h引流量,术前与术后48h血常规的变化,术中及术后48 h输血量及输血率等。结果与对照组比较,改进组术后1、12、24h引流量均明显减少[分别为(106.11±20.02) ml比(127.02±25.09) ml、(236.12±34.06) ml比(327.31±51.21) ml、(355.16±49.03) ml比(506.36±85.29)ml],差异有统计学意义(P＜0.05)。改进组输血量为(176.27±21.37)ml,输血率为10.42％(10/96),均较对照组[(445.94±24.56)ml、32.22％(29/90)]显著减少(P＜0.05)。改进组术后48 h红细胞计数为(2.96±0.45)×1012/L、血红蛋白为(106.75±7.30) g/L,均高于对照组[(2.35±0.57)×1012/L、(90.45±5.10) g/L](P＜ 0.05)。结论胶原蛋白海绵在腰椎管狭窄症术后应用能快速、有效、持久地止血及减少脑脊液渗漏,是减少术后引流量的有效、经济手段。     

尿激酶联合颅内微创血肿清除术对高血压脑出血分析

目的:探讨尿激酶联合颅内微创血肿清除术治疗高血压脑出血的临床疗效.方法:选取高血压脑出血患者40例,将其设定为观察组,并取同时期收治的接受保守治疗的高血压脑出血患者30例,将其设定为对照组.比较两组患者的临床治疗效果.结果:经过治疗后,相较于对照组,观察组的治疗总有效率以及Barthel更高(P<0.05),神经功能缺损评分更低(P<0.05).结论:尿激酶联合颅内微创血肿清除术可有效治疗高血压脑出血,促使患者的疾病转归得以改善.     

YL-1型颅内血肿粉碎针治疗高血压性脑出血41例分析

目的:观察微创治疗高血压性脑出血的疗效。方法:采用YL-1型颅内血肿粉碎针,在CT定位点处垂直穿刺,抽吸血肿,并用冷生理盐水冲洗及尿激酶溶解血肿,微创治疗41例脑出血患者,对照组40例为同期药物保守治疗患者。结果:微创组预后好于对照组。结论:微创治疗高血压性脑出血可改善预后,宜于基层医院推广。     

产道深部血肿的临床分析

目的:探讨产道深部血肿的临床处理方法。方法:回顾性分析1996年1月~2004年12月我科收治的产道深部血肿32例(含外院转入12例)的临床资料。结果:后窟窿及侧窟窿血肿12例,坐骨直肠窝血肿9例、膀胱侧窝血肿9例(左7例、右2例)、阔韧带血肿2例,我院产道深部血肿发生率1·86‰,绝大多数发生于不恰当的产程处理、阴道助产的初产妇,血肿2h内发现者12例(37·50%),失血量最多达3200ml。根据血肿大小、位置、局部特点、有无继续出血倾向,结合患者全身状况综合考虑处理措施。结论:产道深部血肿临床不少见,早期易被忽视,处理棘手,应引起临床重视和加强预防。     

钻孔引流治疗稳定型硬脑膜下血肿

目的 探讨稳定型硬脑膜下血肿的有效治疗方法.方法 对行钻孔引流治疗的68例稳定型硬脑膜下血肿患者的临床资料进行回顾性分析.结果 术后第2天68例患者症状均改善,复查头部CT,42例血肿清除约80％,其中26例血肿清除约60％;余下血肿予以尿激酶注入法,拔管前复查头部CT,59例血肿清除80％以上,9例血肿清除60％以上,中线系统和脑室系统均恢复正常,意识状况和症状均明显改善,预后良好.结论 钻孔引流术操作简单,并发症少;只要选择合适的患者,规范化的术中操作和术后管理,对于治疗符合手术指征的稳定型硬脑膜下血肿是可行的.     

肺减容手术治疗慢性阻塞性肺气肿的临床护理研究

目的:探讨慢性阻塞性肺气肿(COPD)予以肺减容手术治疗时的临床护理效果.方法:将收治的64例COPD患者作为研究对象,所有患者均予以肺减容手术治疗,将其随机分为常规组(予以常规护理)和全面组(予以全面护理),每组32例,对比两组患者的护理效果.结果:全面组患者并发症发生率显著低于常规组(P<0.05);全面组的PaO2水平及护理满意度评分显著高于常规组,且PaCO2较常规组更低,差异有统计学意义(P<0.05).结论:在对COPD患者予以肺减容手术治疗时,应从术前、术中及术后加强全面护理,改善血气分析指标、降低术后并发症发生率.     

微创穿刺治疗高血压脑出血术后颅内感染的临床特点及预防对策

目的分析微创穿刺治疗高血压脑出血术后颅内感染的临床特点,探讨可行的预防对策,降低颅内感染的发生率。方法对2005-2012年采用微创穿刺治疗的412例高血压脑出血患者临床资料进行统计分析,对感染与未感染患者治疗过程中的差异和患者自身的差异进行比较,数据采用采用SPSS15.0软件进行统计。结果 412例高血压脑出血患者经过微创穿刺治疗后发生颅内感染23例,感染率为5.58%,病原菌以金黄色葡萄球菌为主达39.13%;多针穿刺的感染率为9.29%,高于单针穿刺患者的1.08%;23例发生颅内感染的患者平均引流时间为(7.8±4.6)d,389例未感染患者平均引流时间为(5.2±3.4)d。结论血肿清除量、患者病情严重程度、引流时间等是影响高血压脑出血患者微创穿刺治疗后发生颅内感染的重要因素,有效的预防对策是降低颅内感染发生的关键。     

Clinical application of ibudilast for elder patients with chronic subdural hematoma

Ibudilast, an antagonist of platelet-activating factor receptors, was administered to patients with chronic subdural hematoma (CSDH) to assess its effectiveness in preventing recurrence. The remaining volumes of subdural hematomas on brain computed tomography were measured approximately 1-2 months after using ibudilast. The hematomas were significantly smaller and there was no recurrence. Ibudilast administration may be useful in the prevention of recurrence of CSDH.     

Helping the hypertensive patient to help himself.

The control of blood pressure in patients with hypertension is an important challenge in everyday medical practice. It can do much to reduce complications, but too often we fall short of our therapeutic goals. Much more can be done to help our patients help themselves if physicians, along with their paramedical staffs and their patients, make the effort. The results are gratifying in terms of motivation and successful long-term control of the blood pressure and the risks associated with hypertension. This paper outlines objectives and practical approaches to patient education and self-care of this common medical problem.