神经内镜微创手术与显微镜手术对高血压基底节区脑出血患者神经功能及并发症的影响研究

目的 探讨高血压基底节区脑出血患者行神经内镜微创手术、显微镜手术治疗的临床效果。方法 选取收治的102例高血压基底节区脑出血患者的临床资料，根据接受手术方法的不同分为对照组和观察组各51例，对照组行显微镜手术治疗，观察组行神经内镜微创手术治疗。观察两组围术期相关指标、手术前后颅内压、神经功能、预后与术后并发症发生率。结果 观察组手术时间、意识恢复时间、住院时间均短于对照组，血肿清除率高于对照组，术中出血量少于对照组（P<0.05）。手术前，两组颅内压无显著差异（P>0.05），手术后3、7 d两组均有下降，且观察组低于对照组（P<0.05）。手术前两组NIHSS评分、GCS评分无显著差异（P>0.05），手术后两组NIHSS评分均降低，GCS评分均提升，且观察组变化幅度大于对照组（P<0.05）。观察组术后并发症发生率为7.84%，低于对照组的23.53%(P<0.05)。结论 神经内镜微创手术治疗高血压基底节区脑出血患者相比显微镜手术具备手术时间短、创伤小且康复速度快等优势，更有助于提升血肿清除率，降低术后颅内压与并发症发生率，促进神经功能及意识状...     

大面积脑梗死的脑血流动力学动态变化与卒中预后的观察

目的探讨大面积脑梗死后颅内血管血流动力学动态变化特点及其与临床预后的关系。方法 64例大面积脑梗死患者根据影像学供血模型分为完全大脑中动脉(MCA)型和MCA皮质型,急性期大面积脑梗死患者,利用床旁经颅彩色多普勒(TCD)于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值(RVACA和RVPCA),观察颅内血管血流动力学变化。应用美国国立卫生研究院卒中量表(NIHSS)及3个月后存活者日常生活活动能力量表(Barthel指数)评分评价脑血流动力学和神经功能变化与临床预后的关系。选取我院健康体检者64例作为对照组。对照组为同期健康体检人群。性别与年龄选取与病例组具有可比性。结果大面积脑梗死病灶侧MCA平均血流速度(Vm)、颈内动脉(ICA)平均血流速度均明显低于对照组(P<0.05),完全MCA型组较MCA皮质型组MCA血流速度明显减慢(P<0.01);完全MCA型与MCA皮质型梗死后动态观察除部分再通外,MCA血流动态变化不明显(P>0.05),NIHSS评分及脉动指数(PI)在第3,5,7天较第1天明显增高(P<0.05),在第3,5,7天比较差异无统计学意义(P>0.05)。结论大面积脑梗死患者可通过床旁TCD动态检测,可评价大面积脑梗死患者的闭塞血管部位,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,观察脱水降颅压治疗效果;在完全MCA型患者中,治疗过程中如果存在RVACA和RVPCA增高,且NIHSS评分稳定,往往对脱水剂治疗敏感,预后较好,可以考虑内科保守治疗。     

B超引导神经内镜微创手术对高血压脑出血术后的影响

目的:探讨B超引导神经内镜微创手术对高血压脑出血患者术后血肿清除率及格拉斯哥昏迷指数(GCS)评分的影响。方法:选取2015年9月～2016年12月我院收治的98例高血压脑出血患者为研究对象,随机分为对照组和观察组各49例。对照组给予开颅血肿清除术治疗,观察组给予B超引导神经内镜微创手术治疗。观察两组患者治疗效果、血肿清除率、颅内压、脑水肿体积及GCS评分。结果:观察组治疗总有效率高于对照组(P0.05);两组血肿清除率比较无明显差异(P0.05);术前,两组颅内压、脑水肿体积、GCS评分比较无明显差异(P0.05);术后1 d,观察组颅内压低于对照组,脑水肿体积小于对照组,GCS评分高于对照组(P0.05)。结论:应用B超引导神经内镜微创手术治疗高血压脑出血患者效果显著,可降低颅内压,缩小脑水肿体积,改善神经功能,值得推广应用。     

经颅多普勒超声检测对脑出血急性期预后判断的价值

【目的】探讨脑出血病人脑血流动力学有关参数与CT脑血肿量和GCS评分的相关性,评价TCD对急性期脑出血预后判断价值。【方法】对起病≤12 h病人,头部CT确诊的78例幕上单侧自发性脑出血病人通过经颅多普勒(TCD)进行双侧大脑中动脉TCD检测和GCS评分。【结果】TCD双侧大脑中动脉PI值均明显升高,Vd及Vm呈现降低,Vs无明显变化;TCD有关参数与CT血肿量pearson相关系数分析,aPi和uPi P值均<0.001,Vd、Vs和Vm与CT血肿量大小无统计学显著性差异;ICP(颅内压)升高时,TCD最直接的特征是脑血流频谱的变化:即典型的"三峰形"频谱消失,出现收缩峰高尖、S1和S2峰融合、舒张期前切迹加深、搏动增加等;TCD参数与GCS评分pearson相关系数分析,PI值呈负性相关,并具有统计学显著性差异(P<0.0001)。【结论】TCD对急性期脑出血病人脑血流动力学的检测显示:及时反映颅内高压程度和脑血流灌注,为脑出血早期预后判断和及时调整治疗方案提供了简便有效方法。     

GCS评分与NIHSS评分在脑梗死急诊溶栓后出血的预测价值

目的:评估美国国立卫生研究院卒中量表(NIHSS)评分与Glasgow昏迷评定量表(GCS)评分在预测脑梗死急诊溶栓后出血的护理价值。方法:选择我院69例接受急诊溶栓治疗的脑梗死患者,依据溶栓后有无脑出血将患者分为出血组24例和未出血组45例。两组均按照指南予以静脉溶栓,比较两组溶栓前后的收缩压(SBP)、舒张压(DBP)、心率(HR)、血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)、NIHSS评分和GCS评分。应用多因素logistic回归分析评估与脑梗死急诊溶栓后出血发生相关的危险因素。结果:与溶栓前相比,溶栓后两组的SBP、DBP、PT、INR及GCS评分均增加,NIHSS评分减少(P0.05),而HR及PLT均无显著变化(P0.05)。与未出血组相比,出血组患者溶栓前的SBP、DBP及NIHSS评分显著较高,GCS评分显著较低(P0.05),而HR,PT,INR及PLT均无显著差异(P0.05);出血组患者溶栓后的NIHSS评分较高、GCS评分较低(P0.05),但SBP,DBP,HR,PLT,PT及INR均无显著差异(P0.05)。多因素logistic回归分析显示,NIHSS评分及GCS评分是脑梗死急诊溶栓后出血的独立危险因素(P0.05)。结论:NIHSS评分及GCS评分能有效预测脑梗死急诊溶栓后出血的危险性,为临床护理提供预警。     

方体定向置管联合核磁共振弥散张量成像微创血肿清除术治疗内囊血肿的临床研究

目的:观察方体定向置管联合核磁共振弥散张量成像(DTI)微创血肿清除术对内囊外侧血肿治疗的临床疗效。方法:高血压脑出血患者90例随机分为内科保守组(内科保守治疗)、单纯微创组(在内科保守治疗基础上给予方体定向置管微创血肿清除术)、联合微创组(在内科保守治疗基础上给予方体定向置管联合DTI精确定位穿刺微创血肿清除术),各30例。比较术后5 d各组血肿大小。入院时及术后第5天进行DTI检查,比较各组出血侧内囊锥体束的微小各向异性(FA)值。比较各组入院时、术后第5天和第56天的改良美国国立卫生院脑卒中量表(m NIHSS)评分,比较术后第56天的改良Barthel指数(mBI)评分。结果:治疗前,3组的血肿大小、PT的FA值、神经功能缺损和日常生活能力差异无统计学意义(P>0.05);治疗后,单纯微创组和联合微创组的血肿体积较保守治疗组显著减小、PT的FA值显著增高、神经功能缺损程度显著改善、日常生活能力显著提高(均P<0.05),且联合微创组优于单纯微创组(均P<0.05)。结论:方体定向置管联合DTI微创血肿清除术是治疗高血压脑出血的有效方法。     

微创穿刺引流术与内科保守治疗基底核区中等量自发性脑出血的对照研究

目的:比较分析脑出血微创穿刺引流术与内科保守治疗两种方法治疗基底核区中等量自发性脑出血的临床疗效。方法:基底核区中等量自发性脑出血患者50例,按患者或家属意愿分为微创组31例和保守组19例,分别给予微创穿刺引流术和内科保守治疗。比较2组患者治疗1周后的Glasgow昏迷评分(GCS)和血肿体积变化、并发症发生率、死亡率、住院天数及3个月后日常生活能力(ADL)评分。结果:与保守组相比,微创组患者入院1周后GCS评分明显升高,血肿体积明显减少,住院天数明显缩短(P<0.05);再出血发生率、住院期间死亡率、3个月后ADL评分2组之间差异无统计学意义。结论:微创穿刺引流术能显著改善基底核中等量自发性脑出血患者的意识障碍,明显减小血肿体积。     

颅内血肿微创清除术联合亚低温治疗重症高血压脑出血患者的临床疗效

目的探讨颅内血肿微创清除术联合亚低温治疗对重症高血压脑出血患者的临床疗效。方法选取102例重症高血压脑出血患者,随机分为对照组(n=51)和观察组(n=51)。对照组行颅内血肿微创清除术治疗,观察组在对照组的基础上加用亚低温治疗。比较2组患者临床疗效、并发症发生率及生活质量。结果 2组患者治疗后总有效率比较,差异有统计学意义(P0.05)。治疗前,2组患者日常生活能力评定指数(BI)、格拉斯哥昏迷评分(GCS)及美国国立卫生研究院卒中量表(NIHSS)评分相比均无显著差异(P0.05);治疗后,2组BI指数、GCS评分和NIHSS评分比较,差异有统计学意义(P0.05);2组患者并发症发生率相比无显著差异(P0.05)。结论重症高血压脑出血患者采用颅内血肿微创清除术联合亚低温治疗可以有效改善临床症状,提高临床疗效。     

微创颅内血肿清除术对高血压性基底节区脑出血患者的临床疗效观察

选取2012年2月~2014年11月我院收治的78例高血压性基底节区脑出血患者。随机分为观察组和对照组各39例。观察组给予微创颅内血肿清除术,对照组给予内科保守治疗。比较两组患者临床疗效、NIHSS、BI评分、并发症发生率和死亡率。结果观察组患者临床疗效有效率为87.18%较对照组71.79%显著提高,治疗后3、7、14、28d、3个月NIHSS和BI评分均优于对照组,发症发生率和死亡率均低于对照组,差异具有统计学意义(P<0.05)。微创颅内血肿清除术治疗高血压性基底节区脑出血血肿清除率高,颅内压降低显著,减低患者致残率和死亡率,且加快患者术后康复,神经功能损伤小,值得进一步在临床上推广应用。     

微创穿刺引流术联合亚低温疗法治疗高血压脑出血的疗效及护理观察

目的探讨微创穿刺引流术联合亚低温疗法治疗高血压脑出血的临床疗效。方法将65例接受微创穿刺引流术联合亚低温疗法的高血压脑出血患者随机分为观察组和对照组,并分别于术后3 h内给予观察组亚低温治疗、对照组常规治疗。比较2组患者治疗后的临床疗效及术后第2、5、7天时的颅内压。结果观察组治疗后临床疗效显著优于对照组,且死亡率略低于对照组,但差异无统计学意义;观察组患者术后第2、5、7天时的颅内压均显著低于对照组。结论微创穿刺引流术联合亚低温疗法能有效降低高血压脑出血患者的颅内压,缓解痛苦,提高生存质量及满意度。     

Creatine kinase and myoglobin determination in myocardial infarction

Summary In order to evaluate the diagnostic and prognostic impertance of serum myoglobin (Mb) determination during acute myocardial infarction (AMI) we determined the time of first rise of both CK and Mb, that is the time in hours between the onset of pain and the last normal myoglobin and enzyme determination (TFR for Mb=2.2±1.5 h; TFR for CK=4.0±2.5 h). We also attempted to evaluate infarct size by mathematical analysis of the serum concentrations of Mb. The average percentage difference between the infarct size calculated from the CK concentrations and Mb concentrations was 35.8±35.2%. The results show that the determination of serum myoglobin is a useful and sensitive test for the early diagnosis of AMI. On the other hand, the serum myoglobin cannot be utilized to evaluate infarct size. The main limitation in the determination of infarct size from the serum Mb concentrations lies in the extreme variability of the disappearance rate (Kd), mainly resulting from the renal elimination of the substance.     

In vivo study assessed meropenem and amikacin combination therapy against carbapenem-resistant and carbapenemase-producing Enterobacteriaceae strains

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE), especially for carbapenemase-producing Enterobacteriaceae (CPE), is an emerging cause that pose a significant threat to public health. However, efficient therapy has not been established. We assessed the antimicrobial efficacy of meropenem (MEPM) and amikacin (AMK) combination therapy.Material and methodsTotal eight isolates of Escherichia coli or Klebsiella pneumoniae, including CRE and/or CPE have carbapenemase genes were used. The relationship between phenotype and in vivo efficacy was assessed in neutropenic murine thigh infection model. Efficacy was determined using the change in bacterial density and survival rate.ResultsThe combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-K. pneumoniae isolates than MEPM monotherapy (0.63 ± 0.04 vs. 2.56 ± 0.24 ⊿log₁₀ cfu/mL, p < 0.05; −1.05 ± 0.15 vs. −0.48 ± 0.30 ⊿log₁₀ cfu/mL, p < 0.05). Likewise, the combination therapy showed enhanced antimicrobial activities against CRE+/CPE+ and CRE+/CPE-E. coli isolates than MEPM monotherapy (0.90 ± 0.68 vs. 1.86 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05; −1.81 ± 0.06 vs. −0.88 ± 0.23 ⊿log₁₀ cfu/mL, p < 0.05). Also, combination therapy group showed similar to higher survival rates in CRE + E. coli infection mice, compared to MEPM monotherapy group.ConclusionOur results are the first supportive data to threat CRE infections with combination therapy of MEPM and AMK with in vivo model. The current results verify the promising utility of the combination therapy with MEPM and AMK against CRE isolates with a wide range of MEPM MICs.     

血清雌孕激素及输卵管组织白血病抑制因子及其受体表达与输卵管妊娠的关系

目的探讨白血病抑制因子(LIF)及其受体(LIFR)和血清雌孕激素[雌二醇(E2)、孕酮(P)]与输卵管异位妊娠的关系。方法采用免疫组化技术检测11例非孕组、12例宫内妊娠组和36例输卵管异位妊娠组输卵管组织中LIF和LIFR的表达水平,半定量分析其在各组间的表达差异。电化学发光法检测32例正常宫内孕组、40例异位妊娠组血清E2和P。结果 LIF在非孕组、宫内妊娠组和异位妊娠组间的表达无明显差别;在输卵管腺上皮中,异位妊娠组LIFR的表达高于其他两组(P<0.05),而非孕组和宫内妊娠组上皮间表达无明显差异(P>0.05);但是在间质中,LIFR的表达在输卵管妊娠组明显低于其他两组(P<0.01),而非孕组和宫内妊娠组上皮间其表达无明显差异(P>0.05)。异位妊娠组血清E2、P水平明显均低于正常宫内妊娠组(P<0.05,P<0.01)。相关性分析显示输卵管妊娠时输卵管腺上皮LIFR和患者血清E2正相关,间质LIFR和E2负相关。结论 LIFR的异常表达可能与输卵管异位妊娠的发生密切相关。输卵管异位妊娠组血清E2、P均明显低于正常宫内妊娠组。E2能上调输卵管腺上皮的LIFR表达,下调输卵管间质LIFR的表达。     

脑卒中与血同型半胱氨酸水平的关系

目的探讨脑卒中与同型半胱氨酸 (Hcy)的关系。 方法选取脑卒中患者 5 7例 ,其中脑出血 (CH)组 2 1例 ,脑梗死(CI组 ) 3 6例 ,另选正常对照 2 8例 ,分别测定血浆Hcy、VitB12 、叶酸、肌酐浓度 ,对所有患者进行临床神经功能缺损指数 (CNDS)评定 ,并测定CH组的血肿体积 (HV)。结果CI组和CH组的Hcy水平均比对照组高 (P <0 0 5或P <0 0 1) ,而CI组和CH组之间比较无显著性差异。CI组和CH组Hcy与叶酸水平呈高度显著负相关性 (r =-0 44 2 ,P =0 0 0 7)或显著负相关 (r =-0 5 3 1,P= 0 0 13 ) ,均与VitB12 水平无显著相关性。结论高Hcy血症与脑卒中关系密切 ;血浆Hcy水平与叶酸水平呈负相关 ,与VitB12 相关不显著。     

The relationship between the visual evoked potential and the gamma band investigated by blind and semi-blind methods

Gamma Band Activity (GBA) is increasingly studied for its relation with attention, change detection, maintenance of working memory and the processing of sensory stimuli. Activity around the gamma range has also been linked with early visual processing, although the relationship between this activity and the low frequency visual evoked potential (VEP) remains unclear. This study examined the ability of blind and semi-blind source separation techniques to extract sources specifically related to the VEP and GBA in order to shed light on the relationship between them. Blind (Independent Component Analysis-ICA) and semi-Blind (Functional Source Separation-FSS) methods were applied to dense array EEG data recorded during checkerboard stimulation. FSS was performed with both temporal and spectral constraints to identify specifically the generators of the main peak of the VEP (P100) and of the GBA. Source localisation and time-frequency analyses were then used to investigate the properties and co-dependencies between VEP/P100 and GBA. Analysis of the VEP extracted using the different methods demonstrated very similar morphology and localisation of the generators. Single trial time frequency analysis showed higher GBA when a larger amplitude VEP/P100 occurred. Further examination indicated that the evoked (phase-locked) component of the GBA was more related to the P100, whilst the induced component correlated with the VEP as a whole. The results suggest that the VEP and GBA may be generated by the same neuronal populations, and implicate this relationship as a potential mediator of the correlation between the VEP and the Blood Oxygenation Level Dependent (BOLD) effect measured with fMRI.     

联合检测CA125和雌孕激素受体在子宫内膜癌中的作用

目的探讨血清CA125和雌激素受体(ER)、孕激素受体(PR)在子宫内膜癌中与手术分期、病理分级的关系。方法收集我院经手术治疗子宫内膜癌的患者43例,术前放射免疫法检测血清CA125,术后病理免疫组化检测ER、PR。结果单一检测CA125,CA125阳性率与手术分期有关(P<0.05),与病理分级无关(P>0.05);单一检测ER、PR,ER的阴性率与手术分期有关(P<0.05),与病理分级无关(P>0.05),PR阴性率与手术分期和病理分级都有关(P<0.05);联合三项在手术分期和病理分级均明显高于三项单独检测值(P<0.05),三项均阳性(CA125值阳性、ER和PR阴性)时提示患者病理分级为中低分化,手术分期中浸润深肌层或附件转移或淋巴结转移,预后差。结论联合检测三项在判断子宫内膜癌的预后优于单一检测。     

Headache-related circuits and high frequencies evaluated by EEG,MRI, PET as potential biomarkers to differentiate chronic and episodic migraine: Evidence from a systematic review

BackgroundThe diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened.FindingsAmong the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups.ConclusionsAlthough a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.     

血液透析中C型利钠肽、心脏扩张肽的连续动态观察

目的通过对血液透析过程中CNP(c-type natriuretic peptide)、CDN(cardiodilatin)的连续动态观测,对单次血液透析的影响作出评估.方法选取2000年6月～2001年8月在我中心长期维持性血液透析全部患者18例,透析前血肌酐>500μmol/L,其中男14例,女4例,年龄29～74岁(平均48.4岁),血液透析时间2个月～55个月(平均17个月),每次血液透析5小时,每周2～3次;血液透析器为德国Braun HE1400,血液透析液为碳酸氢盐透析液.随机观测30次血液透析过程,选取血液透析开始前、血液透析治疗第1、2、3、4小时及血液透析结束时(第5小时)共6个时间,记录血压及采取血标本.用放免法检测CNP及CDN.数据按血液透析中标本采取时间分为6个组进行自身组间对照,因素间行直线相关分析.结果①CNP正常参考值14.40～25.52ng/L[(19.96±5.56)ng/L].血液透析前较血液透析中各组均低,有显著性差异;血液透析过程中及血液透析后各组间无显著性差异.各组均数均明显高于正常参考值.②CDN正常参考值210～260ng/L.从均数上显示血液透析前、透析后较高,超出正常参考值上限,透析中降低,透析中各组均数均在正常参考值内,各组间两两比较无显著性差异.③相关分析显示CNP与收缩压、CNP与舒张压呈正相关.结论慢性肾衰竭及血液透析影响了血浆内多种血管活性肽的变化.CNP值高于正常参考值,血液透析过程中浓度逐渐升高;CDN血液透析前、透析后较高,超出正常参考值上限,透析中降低,透析中各组均数均在正常参考值内.CNP与收缩压、CNP与舒张压呈正相关.