急性中重度颅脑损伤患者血浆B型脑钠肽前体水平对患者CT临床特征的影响

目的 探讨急性中重度颅脑损伤患者血浆B型脑钠肽前体水平(BNP)对患者CT临床特征的影响,为临床辅助评估颅脑损伤病情提供参考.方法 选取2013年1月-2014年8月该院收治的发病24h以内的69例急性中重度颅脑损伤患者为研究对象,所有患者入院后立即行头颅CT扫描,记录所有患者的CT临床特征表现,并行Rotterdam CT评分,同时检测患者血浆BNP水平,另外同期选取70例健康体检者为对照组做对照,分析血浆BNP水平对患者CT临床特征表现的影响.结果 颅脑损伤患者血浆BNP水平明显高于对照组(P＜0.05);CT检查临床特征表现中具有基底池完全闭塞、中线移位＞5mm、脑室受压比值≤0.2、伴有蛛网膜下腔出血、Rotterdam CT评分＞3分与血浆高水平BNP密切相关(P＜0.05);在血浆BNP高分组(BNP≥179.48pg/ml)组患者CT检查临床特征表现中,基底池情况及中线移位评分、Rotterdam CT评分、蛛网膜下腔出血的发生率高于低水平组(P＜0.05),而脑室受压比值及GSC评分小于低水平组(P＜0.05);相关分析提示血浆BNP水平与RotterdamCT评分、中线移位、基底池情况分级呈正相关(P＜0.05),而与脑室受压比值GSC评分呈负相关(P＜0.05);多因素Logistic回归分析显示:血浆BNP水平(OR=2.421,P＜0.05)是Rotterdam CT评分＞3分的独立预测因素.结论 血浆BNP水平对急性中重度颅脑损伤患者CT检查中不同临床特征表现有一定影响,并且与Rotterdam CT评分密切相关,有利于辅诊科室评估中重度颅脑损伤患者的病情严重程度并作出相应的影像学诊断.     

颅脑损伤患者CT征象特点及预后分析

目的探究颅脑损伤患者电子计算机断层扫描(CT)征象特点并分析其与预后的关系。方法回顾性分析我院72例颅脑损伤患者临床资料,记录其CT征象特点及鹿特丹CT计分(Rotterdam CT评分),并根据格拉斯哥预后评分(GOS)评估患者预后情况,采用Spearman分析CT征象特点及RotterdamCT评分与预后的相关性。结果共72例患者中基底池开放13例,部分闭塞36例,完全闭塞23例;中线移位≤5mm 51例,中线移位5mm 21例;脑室受压≤0.2者32例,脑室受压0.2者40例;RotterdamCT评分3分30例,4分21例,5分21例;预后良好48例,预后不良24例。预后良好组基底池情况评分、中线移位、Rotterdam CT评分均低于预后不良组(P0.05),且脑室受压情况比值也高于预后不良组(P0.05)。但脑室受压情况与预后无明显相关性(P0.05),而基底池情况、中线移位、Rotterdam CT评分则与预后良好呈显著负相关(r=-0.511、-0.456、-0.506,P0.05)。结论 CT征象特点及Rotterdam CT评分与颅脑损伤患者预后相关,可辅助预测颅脑损伤患者预后,对指导临床有一定意义。     

GCS与CT评分对中重型颅脑损伤患者预后的评估

探讨格拉斯哥昏迷评分（GCS）及CT评分在中重型颅脑损伤患者预后预测中的价值。方法 收集2019年6月—2021年6月山西省人民医院神经外科收治的248例中重型颅脑损伤患者的临床资料,随访患者住院存活情况、伤后6月的预后情况。运用SPSS 26.0软件对资料进行单因素、多因素分析,筛选预后相关的独立危险因素,采用Logistic回归分析影响中重型颅脑损伤患者住院死亡率及远期预后的危险因素,并建立预测模型,评估其预测预后的效能。结果 多因素分析显示GCS评分和Rotterdam CT评分是影响中重型颅脑损伤患者住院死亡率的独立危险因素（P＜0.05）,年龄、GCS-P评分和Helsinki CT评分是预测中重型颅脑损伤患者远期预后的独立危险因素（P＜0.05）,基于这些危险因素建立预测模型,其预测住院死亡率和远期预后的效能较单一指标明显提高。结论 GCS运动评分和Rotterdam CT评分是影响中重型颅脑损伤患者住院死亡率的独立危险因素;年龄、GCS-P评分和Helsinki CT评分是影响中重型颅脑损伤患者远期预后的独立危险因素。GCS运动评分和Rotterdam CT评分预测中重型颅脑损伤住院死亡率最强;年龄+GCS-P评分+Helsinki CT评分预测远期预后总体效能最强     

颅脑损伤CT影像特点及预后分析

目的探讨颅脑损伤CT影像特点及其与预后之间的关系。方法选取我院2013年1月-2018年1月收治的颅脑损伤患者180例,使用西门子16层螺旋CT扫描仪,调整好平衡状态,计算Rotterdam CT评分,将患者脑基底池情况分为三个部分,单独评价每各部分是否受压或开放,完全闭塞设为三翼均闭塞,部分闭塞为一或二翼闭塞,三翼都开放。测量每隔室间孔平面测量宽度的一半减去偏移颅内至透明隔的长度。结果预后良好组Rotterdam CT评分、中线移位、基底池情况显著高于预后不良组(P0.05),GOS评分低于预后不良组(P0.05)。预后与CT基底池情况的相关性最强,预后与Rotterdam CT评分、中线移位的相关性次之。其中预后与CT各项特征之间均具有显著相关性(P0.05)。结论颅脑损伤CT影像特点与预后相关,其中预后与CT基底池情况的相关性最强。     

七叶皂苷钠、纳洛酮联合治疗重型颅脑损伤疗效观察

目的:探讨七叶皂苷钠、纳洛酮联合应用治疗重型颅脑损伤的临床疗效.方法:在传统治疗基础上分别以七叶皂苷钠+纳洛酮、七叶皂苷钠和纳洛酮设为治疗组、对照1组、对照2组对重型颅脑损伤患者进行治疗.比较3组颅内压、GCS评分和头颅CT脑水肿变化,进行疗效评价及预后评估.结果:3组患者用药后颅内压(ICP)值比较,治疗组明显低于2个对照组,且下降趋势明显(P＜0.05),而对照1组与对照两组比较无统计学意义(P＞0.05);GCS评分比较治疗组明显高于2个对照组,呈明显上升趋势(P＜0.05),而对照1组与对照2组比较无统计学意义(P＞0.05);CT脑水肿治疗组较2个对照组明显缩小(P＜0.05),而对照1组与对照2组比较无统计学意义(P＞0.05).结论:七叶皂苷钠、纳洛酮联合应用能明显降低重型颅脑损伤患者颅内压、提高GCS评分和缩小脑水肿范围.     

早期应用高压氧及低温联合治疗重型颅脑损伤患者的临床疗效

目的 探讨早期应用高压氧（hyperbaric oxygen,HBO）及亚低温联合治疗重型颅脑创伤（traumatic brain injury,TBI）患者的临床疗效。 方法 选择2015年1月～2018年1月就诊于我院的100例重型颅脑损伤患者,应用数字随机表法将100例重型颅脑损伤患者随机分为2组（50例/组）,对照组采取早期亚低温联合后期高压氧治疗,观察组采取早期亚低温联合早期高压氧治疗,比较两组的临床疗效、组织氧分压、颅内压、神经功能缺损评分、日常活动能力评分、预后情况。 结果 在临床疗效方面,观察组的总有效率高于对照组（P＜0.05）。入院时,组织氧分压、颅内压在组间比较均无统计学意义（P＞0.05）,而在治疗后24 h、48 h、72 h,观察组的组织氧分压、颅内压均较入院时改善（P＜0.05）,其组织氧分压均高于同时间点的对照组（P＜0.05）,其颅内压均低于同时间点的对照组（P＜0.05）。治疗后3个月,两组的神经功能缺损评分均较入院时降低（P＜0.05）,两组的日常活动能力评分均较入院时增高（P＜0.05）,而观察组的神经功能缺损评分低于对照组（P＜0.05）,其日常活动能力评分高于对照组（P＜0.05）。在预后方面,观察组的预后良好率高于对照组（P＜0.05）。 结论 在重型颅脑损伤患者中采用早期高压氧联合早期亚低温治疗的疗效优于早期亚低温联合后期高压氧,不仅可有效降低颅内压,改善脑组织缺氧状况,还可促进患者神经功能损伤修复,改善其日常活动能力,有利于改善其预后结局。     

高压氧在重型颅脑损伤治疗中的临床应用

【摘要】目的：探讨高压氧治疗重型颅脑损伤的临床疗效。方法：100例重型颅脑损伤患者随机分为对照组和HBOT组，各50例。对照组根据病情采用手术和非手术治疗，HBOT组在对照组基础上给与高压氧治疗，比较治疗后两组患者各项指标及其后期疗效评分。结果：高压氧治疗后HBOT组患者颅内压明显低于对照组(P＜0.05)；高压氧治疗7天，HBOT组脑血流情况均优于对照组(P＜0.05)，HBOT组脑氧摄取率均高于对照组(P＜0.05 )。从总有效率看，HBOT组在伤后6月的治疗明显高于对照组(P＜0.05)。结论：对重型颅脑损伤患者实施高压氧的治疗措施，能明显降低颅内压，改善脑血流量，促进脑氧摄取率，改善患者预后。     

颅脑损伤后精神障碍的影像学表现分析

目的分析颅脑损伤后精神障碍的影像学表现。方法选取2014年8月至2016年9月我院收治的颅脑损伤后精神障碍患者63例为研究对象,均行CT及MRI检查,分析CT及MRI对颅脑损伤异常部位的检出率及影像特点,对比CT及MRI的诊断灵敏度、特异度、准确度,同时评价Rotterdam CT评分在判断颅脑损伤预后中的价值。结果 MRI共检出116处部位异常,CT检查显示87处部位异常,MRI对异常部位检出率80.0%高于CT60.0%(P0.05);CT检查显示中型颅脑损伤患者脑严重挫裂伤及脑水肿肿胀,见外侧裂及脑池积血、创伤性蛛网膜下腔出血,重型颅脑损伤患者右侧额颞少量硬膜下血肿及左侧脑室后角积血,MRI显示颅板骨质断裂者在T2WI线处见信号影,头皮损伤检查中显示等T1、长T2信号影,脑部受力同侧或对侧发生挫伤者MRI显示皮质下片状异常信号影,T1WI见低信号影,T2WI为高信号影,信号均匀;CT诊断颅脑损伤后精神障碍的灵敏度、特异度与MRI比较无显著差异(P0.05),但其准确度61.90%低于MRI 79.37%(P0.05);Rotterdam CT评分为轻、中、重型患者的死亡、中残及重残人数差异较大,具有统计学意义(P0.05)。结论 CT及MRI对颅脑损伤后精神障碍均有一定诊断价值,且MRI在准确性方面占优势,Rotterdam CT评分可用于预后评估,值得在临床推广应用。     

标准大骨瓣减压术在重型颅脑损伤中的应用

目的：比较标准大骨瓣减压术与常规骨瓣减压术在治疗重症颅脑损伤方面的临床疗效。方法回顾性分析该院于收治的131例重症颅脑损伤患者,随机分为对照组64例,行常规骨瓣减压术治疗;观察组67例采用标准大骨瓣减压术。两组患者性别、年龄及中线结构移位等一般资料比较,差异无统计学意义（P＞O．05）,具有可比性,比较两组术前、后颅内压、术后并发症及术后6个月GCS评分方面的差异。结果两组患者术后1、3、5 d颅内压均有所降低,观察组下降更为明显,差异有统计学意义（P＜0.05）;术后并发症比较两组间差异无统计学意义;术后6个月GCS评分观察组优于对照组,差异有统计学意义（P＜0.05）。结论标准大骨瓣减压术治疗重症颅脑损伤可显著降低患者颅内压及死亡率,显著改善预后,适合临床推广。     

高压氧综合治疗中重度颅脑损伤43例疗效观察

目的 观察高压氧综合治疗中重度颅脑损伤的临床效果.方法 选择该院80例中重度颅脑损伤患者,随机分为两组,对照组37例给予常规治疗,观察组43例给予高压氧综合治疗(常规治疗+高压氧治疗).观察两组的疗效及格拉斯哥昏迷评分(GCS)情况.结果 治疗后,观察组GCS评分明显提高,与对照组比较差异有统计学意义(P＜0.05);观察组的愈显率为90.7%,明显高于对照组的73.0%,两组间差异有统计学意义(P＜0.05).结论 高压氧综合治疗中重度颅脑损伤疗效满意,能改善患者的GCS评分,值得临床关注.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.