标准大骨瓣开颅术治疗大面积脑梗塞的临床研究

目的 探讨标准大骨瓣开颅(standard large craniotomy)去大骨瓣减压术与常规大骨瓣开颅去大骨瓣减压术对大面积脑梗塞的治疗效果.方法 将60例大面积脑梗塞患者(脑梗塞面积＞4 cm)随机分成研究组(标准大骨瓣开颅)和对照组(常规大骨瓣开颅),在治疗前后对全部患者均进行GCS评分、头颅CT检查并测量脑梗塞灶范围和中线结构移位,TCD监测脑血流情况.根据两组的治疗结果比较其疗效.结果 术后7 d研究组较对照组的GCS评分、脑梗塞范围和中线结构移位有显著性差异(P＜0.05);脑血流明显改善.14 d后研究组的各项指标接近正常.研究组死亡率为3.33%.对照组为16.6%.结论 标准大骨瓣开颅去大骨瓣减压术治疗大面积脑梗塞伴天幕裂孔疝能减少并发症,降低死亡率,是手术治疗大面积脑梗塞的有效方法.     

标准大骨瓣开颅血肿清除对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效观察

目的 探讨标准大骨瓣开颅血肿清除去大骨瓣减压术对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效.方法 57例重度颅脑外伤侧裂区损伤致单侧脑肿胀患者随机分成观察组(32例)和对照组(25例),分别采用标准和常规大骨瓣开颅血肿清除术治疗.观察并比较两组患者术后的格拉斯哥评分(GCS)、颅内压(ICP)、脑水肿体积、中线移位情况和生存率.结果 观察组术后3 d和7 d时评分GCS明显高于对照组,而ICP、脑水肿体积和中线移位均明显少于对照组,差异有统计学意义(P<0.05);术后随访1年,观察组生存率为75%,明显高于对照组的48%,差异有统计学意义(χ2=4.39,P<0.05).结论 标准大骨瓣开颅血肿清除去大骨瓣减压术可以明显改善重度颅脑外伤侧裂区损伤致单侧脑肿胀患者的预后,降低病死率.     

急性重度颅脑外伤并侧裂区损伤的手术治疗

目的探讨采用标准外伤大骨瓣开颅血肿清除并侧裂池减压,术中对天幕裂孔疝患者行天幕切开脑疝复位术治疗急性重度颅脑外伤并侧裂区损伤的临床意义。方法 31例急性重度颅脑伤并侧裂区损伤患者(格拉斯哥昏迷评分GCS≤8分),采用标准外伤大骨瓣开颅血肿清除去骨瓣减压后,在显微镜下将侧裂池蛛网膜切开,冲洗引流,敞开侧裂池充分减压,对术前天幕裂孔疝患者行天幕切开并复位。结果 12个月全部病例获得随访,随访MRI+MRV检查:侧裂区水肿消退,侧裂区静脉回流畅顺。术后生存25例,生存率为80.6%,死亡6例,死亡率为19.4%;GOS评分:恢复良好19例,中残3例,重残2例,植物生存1例。结论采用标准外伤大骨瓣开颅血肿清除去大骨瓣减压、侧裂池减压并天幕裂孔疝复位术能提高急性重度颅脑外伤并侧裂区损伤,可提高生存率、降低死残率、提高生存质量,值得临床推广应用。     

开颅血肿清除加去骨瓣减压术在高血压脑出血患者治疗中的应用效果

目的:探讨开颅血肿清除术联合去骨瓣减压术治疗高血压脑出血患者的应用价值.方法:选取天津医科大学总医院滨海医院2015年2月—2020年2月收治的50例高血压脑出血患者,随机分为研究组(25例)与对照组(25例),研究组采取开颅血肿清除术联合去骨瓣减压术治疗,对照组仅采取开颅血肿清除术进行治疗.对比两组并发症情况、神经功能缺损评分(CSS)、生活质量评分(SF-36).结果:研究组并发症总发生率较对照组明显降低;术后2周研究组CSS评分明显低于对照组;研究组患者SF-36各项评分(躯体疼痛、活力、情感职能、社会功能、精神健康、生理功能、生理职能、总体健康)均显著高于对照组.结论:应用开颅血肿清除术联合去骨瓣减压术治疗高血压脑出血患者,可以降低并发症发生率,改善患者神经功能损伤,提高患者生活质量.     

钻孔与开颅去骨瓣减压治疗高血压脑出血适应症探讨

目的探讨钻孔颅内血肿清除术与开颅去骨瓣减压颅内血肿清除术,治疗高血压脑出血的最佳适应症。方法将74例有手术指征的(基底节区≥30ml,丘脑≥10ml,小脑≥10ml,皮层下≥30ml,额叶颞叶≥20ml)高血压脑出血病人,分别分两组:1组35例,出血量达手术指征不伴有大脑半球脑水肿行钻孔引流术;2组39例,出血量达手术指征,伴有大脑半球脑水肿行开颅去骨瓣减压颅内血肿清除术。手术前后GCS评分对比。术后半年观察疗效。结果高血压脑出血出血量达手术标准,不伴有大脑半球脑水肿行钻孔引流术。术后GCS评分与术前对比不下降,术后半年病人恢复良好(穿刺后再出血1例除外)。高血压脑出血出血量达手术标准,伴有大脑半球脑水肿行开颅去骨瓣减压颅内血肿清除术,术后GCS评分大部分不下降,术后半年病人恢复可。结论高血压脑出血出血量达手术标准,不伴有大脑半球脑水肿,最好行钻孔颅内血肿清除术。高血压脑出血出血量达手术标准,伴有大脑半球脑水肿,最好行开颅去骨瓣减压颅内血肿清除术。     

钻孔与开颅去骨瓣减压治疗高血压脑出血适应症探讨

目的 探讨钻孔颅内血肿清除术与开颅去骨瓣减压颅内血肿清除术,治疗高血压脑出血的最佳适应症.方法 将74例有手术指征的(基底节区≥30ml,丘脑≥10ml,小脑≥10ml,皮层下≥30ml,额叶颞叶≥20ml)高血压脑出血病人,分别分两组:1组35例,出血量达手术指征不伴有大脑半球脑水肿行钻孔引流术;2组39例,出血量这手术指征,伴有大脑半球脑水肿行开颅去骨瓣减压颅内血肿清除术.手术前后GCS评分对比.术后半年观察疗效.结果 高血压脑出血出血量达手术标准,不伴有大脑半球脑水肿行钻孔引流术.术后GCS评分与术前对比不下降,术后半年病人恢复良好(穿刺后再出血1例除外).高血压脑出血出血量选手术标准,伴有大脑半球脑水肿行开颅去骨瓣减压颅内血肿清除术,术后GCS评分大部分不下降,术后半年病人恢复可.结论 高血压脑出血出血量达手术标准,不伴有大脑半球脑水肿,最好行钻孔颅内血肿清除术.高血压脑出血出血量达手术标准,伴有大脑半球脑水肿,最好行开颅去骨瓣减压颅内血肿清除术.     

小骨瓣开颅血肿清除术联合骨瓣复位术治疗高血压基底节区脑出血并发脑疝

目的分析采用小骨瓣开颅血肿清除术联合骨瓣复位术治疗高血压基底节区脑出血并发脑疝的临床效果。方法选取2015年9月至2018年1月太康县人民医院收治的66例高血压基底节区脑出血并发脑疝患者,以随机数表法将患者分为观察组和对照组,每组33例。观察组患者接受小骨瓣开颅血肿清除术联合骨瓣复位术,对照组接受大骨瓣开颅血肿清除术联合骨瓣减压术。对两组患者手术时间、瞳孔恢复时间、住院天数进行比较,采用格拉斯哥昏迷量表(GCS)评估患者意识状态,统计患者并发症发生率并进行组间比较。结果观察组患者手术时间和住院天数均短于对照组,差异有统计学意义(均P<0.01);观察组术后2周GCS评分高于对照组,差异有统计学意义(P<0.01);观察组患者并发症发生率为6.06%,低于对照组的27.27%,差异有统计学意义(P<0.05)。结论采用小骨瓣开颅血肿清除术联合骨瓣复位术手术治疗高血压基底节区脑出血并发脑疝能缩短手术时间,促进患者恢复,安全可靠。     

大骨瓣开颅术对重症高血压脑出血的临床分析

目的探讨大骨瓣开颅术治疗重症高血压脑出血的疗效。方法采用大骨瓣开颅血肿清除术加骨瓣减压的方法治疗41例高血压病患者脑出血。结果恢复良好(ADL1-3级)36例,占87％．经过手术病人其疗效以及生活质量明显提高。结论高血压基底节区出血术后脑水肿严重,持续时间长．约3—4周,所以,同时行去骨瓣减压是必要的。     

高血压脑出血合并脑疝超早期手术方法探讨

目的比较大骨瓣开颅血肿清除并去骨瓣减压和小骨窗开颅血肿清除两种术式超早期治疗高血压脑基底节出血脑疝的疗效。方法回顾性分析72例重症高血压脑基底节出血脑疝病人的临床资料,32例行大骨瓣开颅血肿清除并去骨瓣减压4,0例行小骨窗开颅血肿清除。随访6个月,综合比较其临床疗效、血肿清除率及手术并发症。结果两组在血肿清除程度,术后并发症发生率（除外消化道出血）,死亡率及6个月随访疗效等方面无显著差异,在术后消化道出血发生率、手术时间及输血量等方面小骨窗组优于大骨瓣组（P〈0.05）。结论在高血压脑出血脑疝病人超早期手术治疗中,小骨窗开颅血肿清除术可作为首先考虑的手术方式。     

联合术式对高血压脑出血合并脑疝患者预后的影响

目的探讨微创穿刺引流和开颅血肿清除术的联合应用对高血压脑出血合并脑疝患者预后的影响。方法将32例高血压脑出血合并脑疝患者分为联合治疗组和对照组,各16例。联合治疗组患者在开颅血肿清除及去骨瓣减压术前采用微创穿刺引流治疗,对照组患者接受常规开颅血肿清除及去骨瓣减压治疗;采用格拉斯哥转归量表(GOS)的评价两组患者治疗后6个月的预后情况,比较其临床疗效。结果联合治疗组患者术后GOS分级明显优于对照组(P<0.05)。结论微创穿刺引流在开颅血肿清除术前的应用能快速缓解高血压脑出血合并脑疝患者的颅内压,减轻继发性脑干的损伤程度。     

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.     

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.     

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.