夹闭和栓塞治疗颅内动脉瘤对蛛网膜下腔出血脑血管痉挛的影响

目的 研究夹闭和栓塞两种治疗方法对颅内动脉瘤性蛛网膜下腔出血所致脑血管痉挛的影响.方法 对123例颅内动脉瘤破裂导致蛛网膜下腔出血患者进行回顾性研究.分为2组,显微瘤颈夹闭组90例,血管内栓塞组33例.使用多元逻辑回归对治疗方式、性别、年龄、发病至入院时间、动脉瘤尺寸、部位、数量、Hunt分级、监护时间、住院时间进行统计学研究,明确影响脑血管痉挛及症状性脑血管痉挛的危险因子.结果 在动脉瘤显微手术夹闭组中,100%的患者发生了脑血管痉挛,75.6%的患者发生了症状性脑血管痉挛;在血管内栓塞组中,84.8%的患者发生了脑血管痉挛,45 5%发生了症状性脑血管痉挛.脑血管痉挛程度的独立预测因子是年龄较大,小动脉瘤,发病至入院时间短,Fisher 分级3、4级,Hunt和Hess分级Ⅲ、Ⅳ级;症状性脑血管痉挛的独立预测因子是动脉瘤位于后循环,Hunt和Hess分级Ⅱ、Ⅲ、Ⅳ级.结论 和显微瘤颈夹闭术比较,血管内栓塞治疗术所致脑血管痉挛程度较轻,症状性脑血管痉挛的发生率也降低.     

破裂颅内动脉瘤急诊介入栓塞治疗189例临床分析

目的 探讨应用血管内介入栓塞技术治疗急性期颅内破裂动脉瘤的临床疗效.方法 对以蛛网膜下腔出血（SAH）为首发症状的侣9例（198个）颅内动脉瘤早期（出血后3d内）采用血管内介入栓塞治疗.患者术前Hunt-Hess分级l-II级105例,m级48例,Ⅳ级34例,Ⅴ级2例;均采用电解或水解脱式微弹簧圈栓塞治疗,其中32例宽颈动脉瘤采用球囊瘤颈成型弹簧圈栓塞术,16例宽颈或者梭形动脉瘤采用支架辅助弹簧圈栓塞术.1例假性动脉瘤单纯采用带膜支架植入闭塞,1例载瘤动脉单纯采用球囊闭塞,2例动脉瘤采用胶水或者胶水加弹簧圈栓塞.结果 198个颅内动脉瘤完全致密栓塞166个,不完全致密栓塞21个,不完全栓塞10个,栓塞失败1个;术中发生出血6例.术后发生再出血2例,死亡3例.结论 对Hunt-Hess分级Ⅰ～Ⅳ级的患者实施急诊介入治疗安全可靠,可避免动脉瘤再次破裂出血,防止或减少并发症,明显降病死率和致残率.     

早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血189例临床观察

目的分析早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血的临床效果。方法选取189例就诊于新乡医学院第一附属医院神经外科的脑动脉瘤破裂出血患者为研究对象,所有患者均行早期显微手术夹闭瘤颈方法,对治疗的临床效果及病理分级进行回顾性分析。结果 189例患者实施手术治疗后,预后较好146例,占77.25%;预后较差28例,占14.81%;死亡15例,占7.93%,其中Ⅳ级9例,Ⅴ级6例。Hunt-HessⅠ级、Ⅱ级、Ⅲ级患者在早期手术治疗后的临床效果显著优于Hunt-HessⅣ级,差异有统计学意义(P<0.05)。另外,Ⅲ级组与Ⅱ级组临床治疗效果相比,差异无统计学意义(P>0.05),Ⅲ级组、Ⅱ级组的临床治疗效果与Ⅳ级组比较,差异有统计学意义(P<0.05)。结论早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血临床效果显著,并且Hunt-Hess分级越低患者效果越好,所以临床上一旦发现脑动脉瘤破裂出血,可积极采取显微手术夹闭治疗。     

颅内动脉瘤手术与介入治疗效果比较

①目的 比较手术与介入治疗颅内动脉瘤的效果。②方法 对165例（181个）动脉瘤分别采用手术与介入治疗的效果进行分析。手术治疗123例（手术组）132个动脉瘤，其中多发性动脉瘤9例。介入治疗42例（栓塞组）49个动脉瘤，其中多发性动脉瘤7例。③结果 手术组瘤颈夹闭动脉瘤126个，其中夹闭加切除16个；动脉瘤加固6个；治愈110例（89.4%)，有后遗症者8例（6.5%)，死亡5例(4.0%)，栓塞组动脉瘤完全闭塞38个（77.6%)，栓塞90%以上的6个（12.2%)，栓塞70%-90%的3个，2例多发性病人各栓塞了1个，其中1个栓塞不成功而行手术治疗，治愈37例（88.1%），有后遗症者2例（4.7%)，死亡3例（7.1%)。④结论 显微技术瘤颈夹闭术效果肯定，被公认为是目前最好的治疗方法之一。血管内介入治疗达到了近似开颅手术的治疗效果。尤其是手术处理困难的宽颈动脉瘤，巨大动脉瘤及多发性动脉瘤，栓塞治疗效果满意。破裂动脉瘤均应急症手术或栓塞治疗。     

颅内动脉瘤显微手术及血管内栓塞治疗的比较研究

目的比较显微外科手术和血管内栓塞治疗颅内动脉瘤疗效和相关并发症。方法对62例64个颅内动脉瘤外科治疗,其中行显微手术瘤颈夹闭34例,血管内电解可脱性弹簧圈栓塞治疗28例;对两组疗效和并发症进行比较分析。结果显微手术组:33例成功夹闭瘤颈(其中2例分离瘤颈时动脉瘤破裂),1例合并脑内血肿在清除血肿后急性脑膨出未能显露动脉瘤;手术相关并发症4例,死亡2例。31例术后两周复查血管造影,动脉瘤完全夹闭83.9%(26/31)。血管内栓塞组:动脉瘤完全闭塞70.0%(21/30);血管内栓塞相关并发症2例,无死亡。结论显微手术和血管内栓塞是治疗颅内动脉瘤的有效方法,二者互有优缺点,相互补充。     

前交通动脉瘤破裂的急诊手术处理

目的：探讨前交通动脉瘤破裂的急诊手术处理效果和治疗要点。方法：急诊开颅夹闭破裂前交通动脉瘤21例,按Hunt-Hess分级,其中Ⅲ级9例,Ⅳ级10例,Ⅴ级2例。结果：21例手术患者中出院时恢复良好者16例,中残2例,重残1例,死亡2例。术前Hunt-Hess分级为Ⅲ级者无一例死亡。结论：急诊手术夹闭前交通动脉瘤能防止因动脉瘤再次破裂引起的直接死亡和病情恶性,及时清除血肿,减轻脑血管痉挛,改善患者的预后。     

早期显微手术治疗前循环破裂脑动脉瘤68例临床分析

目的 研究前循环破裂脑动脉瘤的早期显微手术及脑血管痉挛的综合防治.方法 整群选择2014年2月—2016年2月医院收治的前循环破裂的脑动脉瘤患者68例,术前均急诊行DSA或CTA检查明确诊断,后交通动脉瘤36例,前交通动脉瘤12例,大脑中动脉瘤7例,大脑前动脉瘤4例,颈内动脉其它部位动脉瘤9例.所有患者均于发病后72小时内采用显微手术的方法 进行治疗,术中显微解剖分离动脉瘤载瘤动脉及瘤颈后夹闭,清除血肿及冲洗释放血性脑脊液,局部应用罂粟碱棉片贴敷,术后使用法舒地尔、尼莫地平等药物对脑血管痉挛进行预防.记录患者的动脉瘤成功夹闭率,病人功能恢复情况,同时记录患者的治疗效果.结果 动脉瘤颈成功夹闭率为88.24%(60/68),未能夹闭瘤颈8例:分别予动脉瘤孤立2例;载瘤动脉夹闭1例,动脉瘤包裹加固4例,血管塑形重建1例.改良Rankin量表评分0分17例、1分20例、2分17例、3分10例、4分2例、5分1例、6分1例;术后并发严重脑血管痉挛及脑梗塞1例,并发脑积水3例;随访6个月~2.1年,平均(11.3±5.6)个月,无动脉瘤复发病例,死亡1例.结论 早期显微手术治疗前循环破裂脑动脉瘤,能够取得理想的治疗效果,术中尽量彻底清除血凝块,释放血性脑脊液,局部应用罂粟碱,术后使用法舒地尔、尼莫地平等药物,能够有效防治脑血管痉挛的症状发生.     

多因素法分析GDC栓塞治疗颅内动脉瘤危险因素

目的：探讨影响应用GDC栓塞颅内动脉瘤的临床危险因素。方法：选择近期资料齐全的62例颅内动脉瘤病人，临床资料观察可能与治疗结果有关的26个指标，采用多因素分析。结果：Hunt-Hess分级、截瘤动脉是否闭塞、高血压或糖尿病病史、昏迷史、是否出现血管痉挛5个临床指标被多因素法筛出有统计学意义。结论：病人既往有无高血压或糖尿病病史、有无昏迷病史，治疗前Hunt-Hess分级、有无血管痉挛以及治疗过程中是否出现载瘤动脉闭塞和血管痉挛是应用GDC栓塞颅内动脉瘤的临床高危因素。     

颅内动脉瘤13例手术体会

目的:介绍13例颅内动脉瘤显微神经外科手术的疗效,探讨显微手术技巧及动脉瘤破裂的处理方法。方法:对13例颅内动脉瘤按照Hunt-Hess分级,其中Ⅱ级9例,Ⅲ级3例,Ⅳ级1例,根据术前DSA显示动脉瘤部位,结合CT等判断破裂动脉瘤位置,选择翼点入路或额部入路,在手术显微镜下对动脉瘤进行夹闭,必要时行瘤颈加固。结果:本组12例行动脉瘤夹闭,1例术中动脉瘤破裂。结论:显微神经外科技术对提高颅内动脉瘤手术成功率具有重要意义,术中采用控制性低血压及暂时行载瘤动脉阻断是术中动脉瘤破裂出血的重要措施。     

血管栓塞介入治疗35例脑动脉瘤临床报道

目的总结血管栓塞介入治疗35例脑动脉瘤临床报道。方法35例脑动脉瘤患者经股动脉插入微导管，将可脱性球囊送至动脉瘤颈口或其近端，充盈球囊闭塞载瘤动脉；或微导管直接进入脑动脉瘤内，将不同弹簧圈直接放置于瘤腔内栓塞瘤体。结果35例脑动脉瘤栓塞成功31例，成功率为88．57％，术后随访未见出血、复发。结论血管栓塞介入治疗35例脑动脉瘤临床疗效显著。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.