立体定向血肿引流术与神经内镜治疗高血压脑出血的疗效对比

目的:比较立体定向血肿引流术与神经内镜治疗高血压脑出血(HICH)的临床疗效。方法:回顾性收集HICH患者70例,采用神经内镜治疗的35例为内镜组,采用立体定向血肿引流术治疗的35例为定向组,比较2组相关手术指标、术后并发症、术后1月死亡率及术后6月格拉斯哥预后评分(GOS)。结果:与内镜组比较,定向组的手术时间较短(t=-9.483,P=0.000),血肿清除率低于内镜组(t=-11.105,P=0.000);内镜组术后无再出血患者,定向组的再出血率显著高于内镜组(χ~2=9.032,P=0.003),内镜组各项并发症发生率及死亡率与定向组相比无统计学差异(P>0.05),术后6月内镜组远期GOS评分优于定向组(P<0.05)。结论:采用神经内镜下手术治疗HICH,疗效优于立体定向血肿引流术。     

经额入路神经内镜手术在慢性硬膜下血肿治疗中的应用

目的 评价经额入路神经内镜手术治疗慢性硬膜下血肿（CSDH）的疗效。方法 分析80例CSDH病例的临床资料,依据手术方式,分为传统顶结节钻孔外引流术组（钻孔引流组,n=40）,以及经额入路神经内镜下小骨窗血肿清除术组（神经内镜组,n=40）,比较两组患者治疗有效率、术后1个月血肿复发率、手术时间和术中出血量。结果 神经内镜组治疗有效率为95.0%,明显高于钻孔引流组的75.0%,神经内镜组术后1个月血肿复发率为5.0%,明显低于钻孔引流组的25.0%,神经内镜组手术时间为（54.1±7.5） min,较钻孔引流组的（40.7±9.4） min长,差异均有统计学意义（P <0.05）。神经内镜组术中出血量为（30.1±4.5） mL,与钻孔引流组的（27.1±6.4） mL比较,差异无统计学意义（P> 0.05）。结论采用经额入路神经内镜手术治疗CSDH,能明显提高手术疗效,且术后血肿复发率极低。值得应用于临床。     

三种不同手术方式治疗基底节区脑出血的对侧下肢肌力预后比较

目的:初步探讨神经内镜手术、立体定向抽吸手术、导航辅助内镜手术治疗基底节区脑出血的术后对侧下肢肌力预后差异。方法:对基底节区脑出血患者经单纯内镜手术治疗17例(内镜组)、立体定向抽吸手术治疗的16例(立体定向组)和导航辅助内镜手术治疗的8例(导航内镜组)的临床资料进行回顾性分析。比较3组手术时间、血肿清除率、术后CT显示不良事件、住院时间及术后3个月肌力恢复情况等资料。结果:三组的平均手术时间、皮层造瘘口大片梗塞或再次出血的不良事件发生率、血肿清除率、平均住院时间、术后肌力恢复情况差异无统计学意义(P0.05)。结论:较之神经内镜手术清除基底节区血肿,导航辅助内镜手术和立体定向抽吸手术对于促进术后肌力恢复的差异无统计学意义。     

微创穿刺引流联合尿激酶治疗慢性硬膜下血肿的临床效果及短期预后观察

目的探讨微创穿刺引流联合尿激酶治疗慢性硬膜下血肿(chronic subdural hematoma, CSDH)的临床效果及短期预后。方法选取2016年1月—2018年2月收治的86例CSDH,按照随机数字表法分为观察组和对照组,每组各43例。观察组予微创穿刺引流联合尿激酶治疗,对照组予常规椎颅置管引流术治疗。观察术后7 d的临床疗效,记录手术时间、血肿消失时间及住院时间,采用健康调查简易问卷量表(又称SF-36量表)评价治疗前、治疗半年后的生活质量,比较术后并发症发生情况及术后半年的血肿复发情况。结果观察组、对照组治疗总有效率分别为95.35%(41/43)、81.40%(35/43),比较差异有统计学意义(χ~2=2.508、P=0.028)。与对照组比较,观察组手术时间、血肿消失时间、住院时间均缩短,且治疗后SF-36量表各维度评分均升高,差异有统计学意义(P0.05);与本组治疗前比较,两组治疗后SF-36量表各维度评分均升高,差异有统计学意义(P0.05)。观察组嗜睡、颅内积气、硬膜下积液的发生率及血肿复发率均低于对照组,比较差异有统计学意义(P0.05)。结论微创穿刺引流联合尿激酶治疗CSDH操作简单、创伤小,可有效提高血肿清除率,改善术后生活质量,减少并发症的发生,降低血肿复发率。     

比较内镜下“小天窗”血肿清除术与钻孔引流术治疗高血压脑出血的疗效分析

目的 对比高血压脑出血应用内镜下“小天窗”血肿清除术与钻孔引流术的有效性。方法 选取2019年1月—2020年12月陇南市第一人民医院收治的50例高血压脑出血患者,根据不同手术方式分为内镜组(25例)与钻孔组(25例),对比两组的治疗效果。结果 内镜组患者的手术时间(89.35±11.54)min长于钻孔组(34.27±5.92)min、住院时间(11.24±3.54)d短于钻孔组(14.92±3.49)d、术中出血量(48.24±7.56)mL多于钻孔组(10.77±3.26)mL、术后3 d血肿清除率(89.57±4.51)%高于钻孔组(68.93±6.49)%,差异有统计学意义(t=21.234、3.701、22.756、13.058,P<0.05);两组患者在消化道出血、再出血、死亡方面差异无统计学意义(χ²=0.189、0.272、0.000,P=0.663、0.602、1.000);内镜组的颅内感染与肺内感染发生率相比于钻孔组低,差异有统计学意义(χ²=4.735、4.878,P=0.030、0.027);两组患者的NIHS...     

神经内镜辅助脑室内血肿引流术治疗丘脑出血破入脑室的临床效果

目的探讨神经内镜辅助脑室内血肿引流术治疗丘脑出血破入脑室的效果。方法将本院70例丘脑出血破入脑室患者按照随机数表法分为观察组和对照组。观察组(n=35)采用神经内镜辅助脑室内血肿引流术清除血肿,对照组(n=35)采用脑室外引流清除血肿。观察2组患者血肿清除率、手术情况、置管时间、并发症发生率及预后情况。结果观察组血肿清除率显著优于对照组,手术时间显著长于对照组,术后引流管放置时间显著短于对照组,术后并发症发生率显著低于对照组(P 0. 05);术后随访3个月,观察组预后优良率高于对照组,差异均有统计学意义(P 0. 05)。结论神经内镜辅助脑室内血肿引流手术治疗丘脑出血破入脑室,血肿清除率高,并发症及后遗症较少,较常规脑室外引流的治疗效果更佳。     

3种甲状腺手术方式的比较

目的 比较3种甲状腺手术的优缺点.方法 该院2003年3月～2008年10月,统计306例3种甲状腺手术的资料,其中乳晕入路内镜下甲状腺手术116例(完全内镜组),颈前小切口内镜辅助甲状腺手术90例(内镜辅助组),传统开放手术100例(传统组),比较3组的手术时间、术中出血量、住院时间、住院费用、术后并发症、术后疼痛、术后不适及美容效果.结果 306例均成功完成手术.完全内镜组和内镜辅助组的手术时间较传统组明显延长(F=32.458,P=0.000),住院费用增加(F=26.401,P=0.000),术中出血量明显减少(F=56.802,P=0.000),术后出现颈前感觉异常减退、吞咽不适明显减少,但完全内镜组术后可出现胸前紧张感.内镜辅助组的住院时间较完全内镜组和传统组缩短(F=36.068,P=0.000),术后24 h疼痛较其他两组明显减轻(X2=17.453,P=0.001).3组并发症发生率无统计学差异.完全内镜组术后美容效果最佳,内镜辅助组次之,传统组最差(X2=38.260,P=0.000).结论 完全内镜甲状腺手术美容效果最佳,创伤较大,比较适合年轻女性或有特殊职业需求的患者.内镜辅助甲状腺手术适应面更广,创伤最小,灵活易学,更容易推广.     

锥颅穿刺抽吸引流血肿清除术治疗老年高血压脑出血的效果评价

目的:探讨老年高血压脑出血(HCH)应用锥颅穿刺抽吸引流血肿清除术治疗的临床效果。方法:选取我院2014年1月~2016年1月收治的94例老年HCH患者,按照随机数字表法均分为两组。对照组行常规开颅血肿清除术;观察组行锥颅穿刺抽吸引流血肿清除术。记录比较两组手术时间、住院时间、住院费用、术后7 d血肿清除率等手术情况,术后6个月时格拉斯哥预后量表(GOS)评分效果,术后并发症情况。结果:观察组手术时间、住院时间及住院费用均显著低于对照组(P0.01),术后7 d血肿清除率显著高于对照组(P0.01);经Ridit分析,术后6个月观察组GOS评分效果明显优于对照组(P0.05);观察组术后并发症总发生率为36.17%,与对照组的31.91%比较,差异无统计学意义(P0.05)。结论:老年HCH应用锥颅穿刺抽吸引流血肿清除术更有利于减小创伤,提高血肿清除率,降低医疗成本,改善预后,且安全有效,具有较高临床推广价值。     

基于病灶CT密度值选择颅内微创血肿清除术治疗 慢性硬膜下血肿的疗效研究

目的:探讨病灶CT密度值指导颅内微创血肿清除术治疗慢性硬膜下血肿(CSDH)的疗效。方法:回顾性收集CSDH患者142例,根据手术方式分为对照组(66例,常规手术治疗)和观察组(76例,病灶CT密度值指导血肿清除)。比较2组手术情况及血肿清除效果,术前及术后1、3月美国国立卫生院神经功能缺损量表(NIHSS)评分、Fugl-Meyer运动功能(FMA)评分和Barthel指数(BI),术后随访2年统计复发情况。结果:观察组的手术时间长于对照组(P0.05),术后拔管时间、术后住院时间比较差异无统计学意义(P0.05),术后1月残余血肿量低于对照组(P0.05)。观察组治愈率显著高于对照组(78.95%v.s.62.12%,P0.05),总有效率比较差异无统计学意义(98.68%v.s. 93.94%,P0.05)。术后1、3月,观察组的NIHSS评分低于对照组,FMA及BI评分高于对照组(P0.05)。2组术后并发症发生率差异无统计学意义(6.58%v.s. 10.61%,P0.05),观察组术后3月、2年复发率低于对照组(1.33%v.s. 11.29%,8.82%v.s.21.43%,P0.05)。结论:病灶CT密度值分析技术指导血肿清除术治疗CSDH可提高近期疗效,有利于神经功能、运动功能及日常生活活动能力的康复,且有利于降低远期复发风险。     

不同超早期手术干预对高血压脑出血的临床疗效分析

目的比较三种代表性的手术方法对高血压脑出血超早期的临床疗效差异,为临床决策提供证据支持。方法采用病例对照回顾性研究法,将210例高血压脑出血患者分为大骨瓣开颅术组、小骨窗开颅术组以及血肿穿刺抽吸引流术组,每组70例。观察各组患者术后病死率,6个月后的神经功能缺损和日常生活能力。结果手术后6个月,血肿穿刺抽吸引流术组患者术后美国国立卫生研究院卒中量表(NIHSS)评分明显优于小骨窗开颅术组(t=3.201,P=0.001)以及大骨瓣开颅术组(t=5.747,P=0.000),小骨窗开颅术组术后NIHSS评分明显优于大骨瓣开颅术组(t=2.517,P=0.01),三种手术方式患者病死率差异无统计学意义(P>0.05),血肿穿刺抽吸引流术组有效率明显高于小骨窗开颅术组(χ2=5.60,P=0.01)以及大骨瓣开颅术组(χ2=10.36,P=0.01),小骨窗开颅术组与大骨瓣开颅术组差异无统计学意义(χ2=0.77,P=0.37)。结论三种手术方式均能有效治疗高血压脑出血,但血肿穿刺抽吸引流术术后神经功能恢复更佳、治疗有效率较高,能有效治疗高血压脑出血,应当针对不同类型的高血压脑出血采用相适宜的手术方式治疗。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.