影响青年高血压性脑出血预后的相关因素分析

目的:探讨影响青年高血压性脑出血预后的相关因素。方法:收集58例已接受开颅手术的青年高血压性脑出血患者,分为好转组(术后第30天GCS术前)和未好转组(死亡或术后第30天GCS评分≤术前),统计2组患者年龄、性别、体重、出血量、出血部位、术前GCS、出血是否破入脑室、是否合并脑疝、最高收缩压、血肿清除率等资料,分析上述因素与患者预后是否相关。结果:出血量、术前GCS、出血破入脑室、合并脑疝、术前最高收缩压等为预后的危险因素(x2=4.430、-8.432、14.560、9.134、2.160,P0.05)。结论:青年高血压性脑出血患者颅内出血量越大、术前GCS越低、出血破入脑室、合并脑疝、术前最高收缩压越高,患者预后越差。     

幕上高血压脑出血术后近期预后的影响因素分析

目的：探讨幕上高血压脑出血手术治疗近期预后的影响因素。方法：回顾经手术治疗的73例幕上高血压脑出血患者的临床资料,分析患者性别、年龄、术前GCS评分、出血部位、术前瞳孔有无散大、出血是否破入脑室、出血量、手术时机8个因素对患者预后的影响。评定患者日常生活能力（ADL）分级,将ADL 1-3级划为预后良好组,ADL 4-6级划为预后差组。结果：预后良好组和预后差组在术前GCS评分、出血量、出血是否破入脑室、术前瞳孔有无散大及手术时机上在统计学上有显著性差异（P〈0.05）,而患者的年龄、性别及出血部位则在统计学上未见显著性差异（P〉0.05）。Logistic回归分析,术前GCS评分、出血量、出血是否破入脑室与预后ADL分级相关（P〈0.05）。其相关系数分别为：-0.456、0.124、0.341。结论：术前GCS评分、出血量、出血是否破入脑室是估计患者手术治疗近期预后有意义的指标,术前瞳孔有无散大、手术时机对评价患者预后有一定的参考价值。了解影响高血压脑出血预后的因素可以更有效的制定治疗方案,估计预后。     

高血压脑出血微创治疗的近期疗效影响因素分析

目的:探讨高血压脑出血微创治疗的近期疗效影响因素。方法:对382例高血压脑出血患者经微创血肿清除术治疗的近期疗效进行回顾分析。预后据神经功能缺损评分分为好转(基本痊愈和显著进步)和未好转(进步、病情无变化、恶化和死亡),采用单因素分析方法统计,使用u检验和卡方检验分析相关因素对预后的影响。结果:术前血压水平和性别不是危险因素,而患者年龄、入院GCS评分、出血量、出血部位、糖尿病史、破入脑室、意识障碍、脑室受压、术后有无再出血和并发症在预后好转组和未好转组均差异有统计学意义(均P<0.05)。结论:影响微创血肿清除术近期疗效的因素很多,术前应积极干预。年龄、入院GCS评分、出血量、出血部位、糖尿病史、破入脑室、意识障碍、脑室受压、术后有无再出血和并发症是影响高血压脑出血微创血肿清除术近期疗效的相关因素。     

神经内镜微创手术治疗高血压脑出血短期预后 危险因素及其对IL-2、IL-6、TNF-α的影响

目的:探讨神经内镜微创手术治疗高血压脑出血的短期预后危险因素及其对白细胞介素(IL)-2、IL-6、肿瘤坏死因子(TNF)-α的影响。方法:选择我院收治的高血压脑出血患者90例,按随机数表法分为微创组(65例)和开颅组(25例)。开颅组采用开颅血肿清除术,微创组采用神经内镜微创手术治疗,比较2组血肿清除量、术后并发症及炎症因子水平。分析微创组各影响因素和短期预后之间的相关性。结果:与开颅组对比,微创组术后血肿量清除率更高(P0.05);术后并发症更少(P0.05)。年龄、入院格拉斯哥昏迷量表(GCS)评分、出血量、是否破入脑室与神经内镜微创手术患者预后有显著相关性;影响预后的独立因素包括高龄、入院GCS评分≤5分、破入脑室、出血量≥50 m L。结论:神经内镜微创手术治疗高血压脑出血疗效好、创伤小、预后好。影响预后的独立因素包括高龄、入院GCS评分≤5分、破入脑室、出血量≥50 m L。     

高血压脑出血62例死亡原因分析

目的：探讨高血压脑出血的死亡原因，及时找出高血压脑出血最佳治疗方案。方法：对62例高血压脑出血死亡的临床资料进行系统分析。结论：对出血量较大，血肿破入脑室，脑干受压，有明显脑积水征象及脑疝形成者宜尽早手术治疗，积极防治并发症，可降低死亡率，改善预后。     

高龄高血压脑出血患者康复效果的影响因素分析与护理干预对策

目的探讨高龄高血压脑出血患者康复效果的影响因素及护理干预对策。方法回顾性分析我院2016年10月至2018年10月收治的88例高龄高血压脑出血患者的临床资料,根据日常生活活动能力分级量表评价患者康复效果,其中预后良好28例,预后差60例。分析影响患者康复效果的相关因素,并提出针对性的护理对策。结果单因素分析显示,年龄、术前合并症、术前格拉斯哥昏迷(GCS)评分、出血量、破入脑室预后效果方面比较差异有统计学意义(P 0. 05),多因素logistic回归分析显示,年龄(≥80岁)、术前合并症、术后并发症(≥2种)、术前GCS评分(9分)、出血量(≥50 ml)、破入脑室、发病至手术时间( 72 h)是导致高龄高血压脑出血患者康复效果差的独立危险因素(P 0. 05)。结论影响高龄高血压脑出血患者康复效果的危险因素较多,术前综合评估患者状况,做好对症治疗和术后并发症预防,可有效提高患者康复效果。     

96例高血压性脑出血患者30天生存相关因素分析

目的 探讨影响高血压脑出血患者30天生存的早期因素。方法 对96例有明确高血压病史、头颅CT确诊的脑出血患者，采用Log-rank检验进行单因素分析，再将有显著性的指标用多因素COX模型进行分析。结果 入院时的GCS评分、收缩压、舒张压、体温、血糖、出血量、是否破人脑室等，在单因素分析时均影响患者的30天生存情况；多因素COX模型分析显示，GCS评分、体温、血糖、出血量等是影响30天生存的主要危险因素。结论 高血压脑出血急性期死亡的影响因素很多，昏迷、GCS评分低、出血量大、体温和血糖升高是预后差的早期主要临床征象。     

75例脑出血的预后分析

目的探讨高血压性脑出血的预后影响因素。方法回顾性分析75例高血压性脑出血的临床资料,分析年龄、意识水平、出血量、出血部位、血液破入脑室情况、血压等因素对高血压性脑出血预后的作用。结果年龄大、出血量大、昏迷及出血继发破入脑室、血压高的患者治疗有效率与对应组比较,经统计学处理差异有显著性。结论患者预后情况与意识水平、血压水平、出血量、出血破入脑室、年龄有关。     

高血压脑出血患者血浆P-selectin表达水平 与预后的相关性研究

目的:研究高血压脑出血患者血浆P-selectin表达水平与预后的相关性。方法:选择高血压患者100例(高血压组)、高血压脑出血患者100例(脑出血组)及健康人员100例(对照组),均检测血浆P-selectin表达水平并比较。脑出血组根据预后情况分为预后良好亚组和预后不良亚组,采用多因素Logistic回归分析观察影响高血压脑出血患者预后的危险因素。结果:3组的血浆P-selectin水平具有组间差异(P<0.05),其中脑出血组的血浆P-selectin水平高于高血压组,高血压组的血浆P-selectin水平高于对照组。预后不良亚组的P-selectin表达水平、入院GCS评分、出血量、并发脑疝比例、发生肺内感染比例、消化道出血比例及合并糖尿病比例均高于预后良好亚组,差异均有统计学意义(P<0.05)。患者P-selectin表达水平高、入院GCS评分低、出血量大、并发脑疝及合并糖尿病是影响高血压脑出血的独立危险因素。结论:P-selectin表达水平可能是影响高血压脑出血发病和预后的重要因素。     

内科保守治疗脑出血急性期患者死亡与存活对比分析

目的研究脑出血急性期非手术治疗的预后因素.方法回顾性研究105例非手术治疗的脑出血急性期患者的预后情况.结果死亡组严重昏迷、高热(≥39.1℃)、平均动脉压(＞145mmHg)、血液破入脑室及蛛网膜下腔出血患者的发生率明显高于存活组(P＜0.1或P＜0.05).死亡组中脑出血量、收缩压、脉压、血清Ca2+、AG、ALT、AST、LDH、CK、HBD、糖、Cr和TG的均值亦明显高于存活组(P＜0.01或P＜0.05).结论脑出血合并严重昏迷、高热、高血压、脑出血量大和破入脑室、蛛网膜下腔出血、血肿扩大及血液生化异常改变的患者预后不佳.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.