微创血肿清除术治疗颅内血肿24例分析

我院 1999年 5月引进首都医科大学附属北京红十字会朝阳医院研制的微创血肿清除术治疗高血压脑出血、外伤性脑硬膜外血肿 2 4例 ,取得了较好的效果 ,现报告如下。1　资料与方法1.1　一般资料本组 2 4例 ,男性 19例 ,女性 5例。发病年龄 6～ 82岁 ,平均 5 8.2岁。脑出血 14例 ,外伤性脑硬膜外血肿 10例。脑出血超早期 (发病 7h内 )就诊 6例 ,早期 (发病 1～ 3d) 5例 ,延期(发病 3d以上 ) 3例 ;外伤性血肿发病 3d内 4例 ,3d以上 6例。1.2　治疗方法根据 CT或以 CT检查时应用立体定向确定穿剌部位 ,应用由北京万特福科技有限责任公司生产的 Y…     

微创颅内血肿清除术治疗高血压脑出血的护理体会

高血压脑出血是一种严重危害人类健康的常见病、多发病 ,其死亡率及偏瘫、失语等严重后遗症的发生率极高。早期清除颅内积血 ,保持脑脊液、脑血流循环通畅 ,减少继发性颅内损伤是抢救成功的关键。该方法具有手术范围易控制 ,且不留盲区、创伤小、密闭好、通畅度好、冲洗和引流方便等优点。资料与方法　　本组 2 1例 ,男 1 4例 ,女 7例 ,年龄在 54岁～ 87岁之间 ,平均 68岁 ,其中超早期 (发病6小时 )就诊的 1 2例 ,早期 ( 1～ 3 )天 6例 ,延期 (发病 3天以上 ) 3例 ,既往均有高血压病史 ,昏迷 1 1例 ,意识清楚 1 0例 ,ＣＴ证实血肿部位 :其中…     

微创颅内血肿穿刺引流治疗高血压脑出血

高血压脑出血是神经外科常见的危重急症 ,病死率高 ,且遗留严重后遗症 ,是神经内外科医生应迫切解决的问题。本病传统的治疗方法是手术开颅血肿清除术 ,但多需在全麻下进行 ,开颅时间长 ,且易造成脑组织再损伤。我院引进首都医科大学附属北京红十字朝阳医院研制的颅内血肿穿刺粉碎针进行射流冲碎、液化术 ,治疗 36例高血压脑出血 ,取得了良好疗效 ,现报告如下。1　资料和方法1.1　一般资料　本组 36例 ,男 2 5例 ,女 11例 ,年龄 34～ 82岁 ,平均 5 4 .6岁。其中超早期 (发病 7h内 )就诊 15例 ,早期(发病 1～ 3d) 14例 ,延期 (发病 3d以上 ) …     

微创治疗脑出血20例观察

资料与方法2005年5月至今收治高血压脑出血患者20例,男14例,女6例,发病年龄16~80岁。其中脑血管畸形1例(16岁),并通过脑血管造影证实,血肿穿刺干净后进行了畸形血管栓塞;另1例慢性硬膜下血肿(80岁),进行微创术后痊愈。其余18例均为高血压脑出血患者,早期发病(1~3天)8例,中期(5~7天)11例,晚期(11天)1例。临床表现:均有高血压病史,间断口服降压药。初入院时半数患者血压>24/16kPa,其余患者均不同程度地在医院外进行了脱水、降压治疗,血压接近正常或稍偏高。浅-中昏迷13例,GCS9~12分;深昏迷2例,GCS5分;意识朦胧-清醒3例。其中一侧瞳孔散大3…     

微创治疗颅内血肿30例分析

我院近年应用YL - 1型颅内血肿粉碎穿刺针 ,进行抽吸、射流冲碎、液化引流治疗各类颅内血肿30例 ,取得良好效果。现报道如下。1　临床资料1.1　一般资料本组 30例 ,男性 2 4例 ,女性 6例 ,平均年龄 5 2(4～ 80 )岁。出血量 2 0～ 2 0 0mL。脑内血肿 18例 ,慢性硬膜下血肿 12例 ;高血压脑出血 15例 ,其中 ,左侧 8例 ,右侧 7例 ,基底节区 (壳核 ) 12例 ,皮质下2例 ,丘脑出血 1例 ,出血破入脑室系统者 5例。入院时偏瘫、失语 2 2例 ,昏迷 13例。手术距发病时间 :高血压脑出血 7h内手术 11例 ,7～ 2 4h手术l例 ,1～ 3d手术 3例 ,慢性硬膜下血…     

昏迷患者暴露性角膜炎30例分析

脑外科患者常出现昏迷,对于长期昏迷的病人,眼科最常见的并发症是暴露性角膜炎,我院脑外科自1998年至2 0 0 3年收治病人2 96例,发生暴露性角膜炎的患者30例,现报告如下。1　一般资料30例暴露性角膜炎均为昏迷患者,其中男16例,女14例;昏迷原因为脑外伤致颅内血肿18例,高血压脑出血12例;年龄38岁～72岁,发病时间为昏迷后3d～11d,均为双眼。2　临床表现角膜上皮干燥、模糊、脱落、溃疡,一般从角膜下方开始,其中1例高血压糖尿病病人在昏迷后第3天先出现右眼发病,2 d后左眼发病且右眼迅速发展为角膜溃疡、穿孔。3　治疗一旦发现角膜炎存在,应及时…     

微创颅内血肿清除抽吸术治疗高血压脑出血

高血压颅内出血是临床多发病 ,严重威胁着人们的生命 ,我院从 1998年～ 1999年中高血性脑出血进行微创进颅抽吸血肿 ,挽救了一些患者生命 ,现报告如下。1　临床资料1.1　一般资料　本组男性 2 0例 ,女性 6例 ,年龄最大78岁 ,最小 35岁 ,平均年龄 6 2岁 ,全部病例均有高血压史。1 .2　出血量及血肿部位　血肿量 30～ 6 0ｍｌ 2 2例 ,6 0ｍｌ以上 4例 ,出血部位 :基底节 14例 ,丘脑出血 2例 ,皮层下 7例 ,小脑出血 2例 ,其中破入脑室 3例 ,穿刺前昏迷 12例 ,一侧瞳孔散大 5例 ,双侧散大 3例。1.3　手术时间　发病至手术间隔时间 8小时之内 6例…     

锥颅血肿碎吸、冲洗和引流治疗老年高血压脑出血36例疗效观察

我们从 1998年 7月至 2 0 0 2年 2月 ,对 3 6例老年高血压脑出血患者 ,采用锥颅血肿碎吸、冲洗及血肿内注入尿激酶后进行引流的治疗方法 ,取得了明显效果 ,现报告如下。1　临床资料1.1　一般资料　高血压脑出血病例 3 6例 ,男 2 0例 ,女 16例 ,年龄 60～ 78岁 ,平均 66.4岁 ,全部有高血压病史 ,入院时血压2 0～ 2 8/ 12～ 16kpa,手术时间 :发病后 4～ 2 4h 3 2例 ,2 4～ 48h 4例。1.2　临床表现　手术前按意识状态分级 [1 ] :意识清楚 ( 级 ) 1例 ,嗜睡 ( 级 ) 8例 ,浅昏迷 ( 级 ) 2 0例 ,中度昏迷不伴脑疝( a) 5例 ,昏迷伴脑疝 ( b) 2例 ,…     

早期强化降压对高血压脑出血患者颅内血肿及水肿的影响

目的 探讨早期强化降压对高血压脑出血患者颅内血肿扩大及血肿周围水肿的影响.方法 回顾性分析本院2013年9月至2015年6月收治的幕上高血压脑出血患者的临床资料,根据我院神经内、外科对高血压脑出血早期血压管理方式的不同,将病例资料分为强化降压组(3h内收缩压降至≤140 mmHg,并维持120～140 mmHg 1周)和对照组(目标收缩压160 ～ 180 mmHg,平均动脉压100 ～130 mmHg).分别从年龄、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、收缩压、起病后干预时间、血肿体积5个方面分层次比较2组3d内血肿扩大发生率,并计算相对危险度降低率(relative riskreduction,RRR),对比2组第3、7、14天水肿变化.结果 共筛选出90例行强化降压幕上高血压脑出血患者的临床资料,再筛选出与之相匹配的对照组90例,2组的一般资料比较差异无统计学意义(P＞0.05).强化降压组血肿扩大9例(10.0％),对照组血肿扩大24例(26.7％),差异有统计学意义(P＜0.01),RRR值为62.5％(95％ CI为23.9％～81.5％).2组水肿量在第3、7、14天差异无统计学意义(P＞0.05).结论 脑出血早期强化降压能减少患者颅内血肿扩大概率,不增加血肿周围水肿体积.     

脑出血开颅减压术后脑梗塞的危险因素分析及预防

1992年3月～1998年3月,本院对58例高血压脑出血病人行手术治疗,术后发生脑梗塞3例,现就脑出血开颅减压术后脑梗塞有关问题报道如下. 1 临床资料本组3例,男1例,女2例,平均年龄55岁,就诊时多出现偏瘫症状及昏迷,入院后均急诊行小骨窗开颅减压,血肿清除,术后3～7 d出现梗塞,平均5 d,死亡2例,植物生存1例.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.