微创颅内血肿清除术治疗高血压性脑出血疗效分析

目的 探究微创颅内血肿清除术治疗高血压性脑出血疗效。 方法 将我院2016年3月~2017年3月收治的82例高血压脑出血患者,随机分为对照组与实验组,每组41例,对照组行传统手术治疗,实验组行微创颅内血肿清除术,比较两组治疗效果并分别于治疗前、治疗2周后记录两组血肿、水肿体积,NIHSS评分、观察治疗效果。 结果 实验组治疗有效率85.36%高于对照组51.22%,差异有统计学意义（P<0.05）;治疗2周后实验组血肿体积、水肿体积、NIHSS评分指标低于对照组,存在统计学差异（P<0.05）。结论 相比于传统手术而言,微创颅内血肿清除术手可有效降低手术对患者带来的侵入性伤害,可提高治疗效果,值得临床推广。     

高血压脑出血不同治疗方法比较研究

目的 比较高血压脑出血内科保守治疗、小骨窗开颅手术及立体定向置管引流加尿激酶溶解治疗的三种治疗方法的临床疗效,探讨治疗高血压脑出血的合理方案.方法 选择120例高血压脑出血患者,随机选入对照组、小骨窗开颅组和立体定向组,每组40例.对照组给予内科保守治疗;小骨窗开颅组采用小骨窗经侧裂入路显微手术;立体定向组给予立体定向置管引流加尿激酶溶解治疗.术后3个月比较各组的疗效.结果 立体定向组和小骨窗开颅组疗效均优于对照组,P<0.05,均有统计学意义.立体定向组生活自理P<0.01,差异有显著性有统计学意义.结论 立体定向清除血肿对高血压脑出血有较好的疗效,可在临床广泛推广.     

综合治疗高血压性脑出血120例疗效观察

目的　观察综合治疗对高血压性脑出血急性期的疗效,探索有效治疗方法。方法　将2 40例高血压性脑出血患者随机分为两组,综合治疗组采用颅内血肿微创清除术、康复训练、西医治疗和中药三七散治疗;西医治疗组则采用微创手术加西医治疗。两组各12 0例,治疗时间均为2 8d ,比较两组疗效。结果　综合治疗组血肿吸收率为(98.17±6.3 2 ) % ,临床治愈率为43 3 3 % ,总有效率为96.67% ;西医治疗组血肿吸收率为(87.60±5 .84) % ,临床治愈率为3 0 .0 0 % ,总有效率为88.3 3 %。综合治疗组疗效优于西医治疗组(P <0 .0 5 )。结论　综合治疗可提高高血压性脑出血患者的生存率,缩短病程,减少致残率,提高生活质量。     

30例高血压性脑出血行微创颅内血肿清除术治疗疗效探讨

目的：观察分析临床面对高血压性脑出血患者时,对其实施微创颅内血肿清除术治疗后的临床疗效。方法择取我科室在近期内接诊的60例高血压性脑出血患者,按照患者治疗内容的不同对患者进行分组,其中A组30例患者实施内科保守治疗、B组30例患者实施微创颅内血肿清除术进行治疗。结果 B组患者的临床治疗有效率为90%,明显高于A组患者的70%(P<0.05)。结论临床面对高血压脑出血患者时,给予其实施微创颅内血肿清除术进行治疗后的疗效是理想的,值得临床广泛应用。     

小骨窗开颅治疗高血压脑出血38例

目的探讨微创小骨窗在治疗高血压脑出血中的临床经验和体会。方法回顾性分析2004年6月-2007年6月经用小骨窗微创手术治疗高血压脑出血38例的临床资料,均采用小骨窗开颅早期或超早期显微镜下血肿清除,术后予尿激酶溶解引流残余血肿。结果38例中疗效优者8例;良好者17例;疗效差者10例;死亡3例。病死率7.9%。结论微创小骨窗开颅是高血压脑出血的一种效果满意的手术方法。其手术操作损伤小、时间短、创伤轻微;术后防治并发症和积极的康复治疗对预后至关重要。     

脑出血血肿碎吸术的护理

目的总结颅内血肿小骨窗开颅手术的护理方法,探讨提高高血压脑出血患者的手术治疗效果的途径。方法对98例小骨窗开颅术治疗脑出血患者随机分为观察组和对照组各49例。术后高血压性脑出血组患者常规护理,观察组患者进行颅内压监护,加强基础护理,比较两组患者脑出血术后7d血肿清除。结果脑内血肿患者小骨窗开颅手术98例,术后7d头颅CT血肿体积院观察组,25例70%~80%血肿清除,12例81%~90%血肿清除,12例血肿清除>90%;对照组,31例血肿70%~80%清除,13例81%~90%血肿清除,5例>90%血肿清除。7d后两组患者血肿清除率差异明显。结论高血压脑出血术后颅内压监测的作用可有效减少并发症,提高治疗效果,降低死亡率和致残率,促进患者早日康复。     

微创碎吸术及小骨窗手术治疗基底节区脑出血的疗效比较

目的比较微创血肿碎吸术及小骨窗经外侧裂血肿清除术治疗基底节脑出血的疗效。方法高血压基底节脑出血（30-70ml）84例,采用二种手术方法 ,其中微创血肿碎吸术（微创组）43例,小骨窗经外侧裂血肿清除术（小骨窗组）41例。对两组患者的近远期疗效、日常生活能力（ADL）、死亡率、血肿清除率及并发症进行评价。结果治疗21d后微创组的并发症发生率明显少于小骨窗组（P〈0.05）,3月后随访患者生活能力评定（ADL）微创组优于小骨窗组（P〈0.05）,死亡率二组无明显差异。结论微创颅内血肿清除术能减少患者的并发症,可提高患者的日常生活能力。     

颅内血肿微创清除术治疗高血压脑出血术后并发症的防治

我科自1999年2月始,开展了颅内血肿微创清除技术治疗高血压脑出血,此方法一改过去内科保守治疗的窘境,又避免了外科开颅手术对脑组织造成的新创伤,且适应症广,致死率、致残率明显降低,取得了良好的效果。本文12例微创清除技术治疗脑出血病人,发现术后并发症的预防和治疗是直接影响到病人死亡率和致残率的一个重要环节。现就颅内血肿微创清除技术治疗高血压脑出血病人术后早期主要并发症的预防和治疗报告如下:     

高血压脑出血的手术治疗体会

目的探讨高血压脑出血患者手术治疗的合理方案。方法选择120例高血压脑出血患者,随机分为3组,对照组、立体定向组和小骨窗开颅组,各40例。对照组：给予内科治疗;立体定向组：给予立体定向置管引流,尿激酶溶解治疗;小骨窗开颅组：采用小骨窗经侧裂入路显微手术。比较术后3个月的疗效。结果立体定向组和小骨窗开颅组疗效均优于对照组,立体定向组疗效明显优于小骨窗开颅组（P〈0.05）。结论立体定向清除血肿对高血压脑出血有较好的疗效。     

微创碎吸术及小骨窗手术治疗基底节区脑出血的疗效比较

目的 比较微创血肿碎吸术及小骨窗经外侧裂血肿清除术治疗基底节脑出血的疗效.方法 高血压基底节脑出血(30-70ml)84例,采用二种手术方法,其中微创血肿碎吸术(微创组)43例,小骨窗经外侧裂血肿清除术(小骨窗组)41例.对两组患者的近远期疗效、日常生活能力(ADL)、死亡率、血肿清除率及并发症进行评价.结果 治疗21d后微创组的并发症发生率明显少于小骨窗组(P＜0.05),3月后随访患者生活能力评定(ADL)微创组优于小骨窗组(P＜0.05),死亡率二组无明显差异. 结论微创颅内血肿清除术能减少患者的并发症,可提高患者的日常生活能力.     

MRI-monitored long-term therapeutic hydrogel system for brain tumors without surgical resection

To overcome the unresolved issues of conventional therapeutic approaches such as radiation therapy, chemotherapy, combinational chemotherapy, and surgical treatment, we designed an injectable 'MRI-monitored long-term therapeutic hydrogel (MLTH)' system as an alternative/adjuvant approach for brain tumors. The MLTH system consists of a thermosensitive/magnetic poly(organophosphazene) hydrogel (the magnetic hydrogel) as a biodegradable imaging platform and an anticancer drug as a therapeutic agent via a simple physical mixing. The MLTH system has adequate properties for the MRI-monitored long-term therapy as follows: injectability, localizability due to fast gelation at body temperature, biocompatibility, biodegradability, sustained drug release, and MR imaging function. Since the MLTH system only requires a very small-sized pin hole injected into the area of brain tumors stereotactically, we suggest that the MLTH system can be an alternative/adjuvant approach to treat the malignant brain tumors without any surgical resection. Furthermore, we expect that the MLTH system can minimize the side effects from either an intravenous injection or surgical operation because one of the aims of MLTH is to focus on the sustained local delivery of anticancer drugs via a one- or two-time intratumoral injections. Thus, we assessed successfully the MRI-monitored long-term therapeutic potentialities of the MLTH system for brain tumors and estimated the inhibition efficacy of tumor growth via an MRI-monitored long-term therapy in this study.     

Experience with using extremely high frequency radiotherapy of the millimeter wave range in cerebrovascular disorders

Vascular diseases of the brain (functional transient and ischemic apoplexy, circulatory encephalopathy) in 79 patients were treated by UHF electromagnetic field of millimetric wave range. 14 patients entered the control group. The treatment results are indicative of clear-cut trend to a decrease of arterial pressure, normalization of blood glucose level, arrest of DIC syndrome development.     

微创克氏针置入并外固定架修复桡骨远端不稳定骨骺骨折

背景：单纯使用克氏针或外固定架治疗桡骨远端骨骺骨折的临床实践中,仍存在桡骨短缩、骨折移位等固定后并发症,尤其在不稳定骨骺骨折情况下。克氏针主要治疗桡骨远端骨折,对其骨骺骨折使用相对较少。 目的：观察外固定支架结合经皮克氏针复位固定微创治疗桡骨远端不稳定性骨骺骨折的临床效果。 方法：对90例桡骨远端骨骺骨折患儿行固定治疗,在不切开情况下微创闭合复位骨折骨骺,随机分成2组,对照组采用单纯跨腕关节外固定支架固定方案;观察组采用跨腕关节外固定支架结合经皮克氏针闭合帮助复位固定骨骺骨折方案。固定后行腕关节功能锻炼,分别于固定后9周及24个月随访观察。对比两组患者固定后中远期的临床疗效、腕关节功能恢复及X射线检查情况。 结果与结论：固定后24个月随访按Cooney标准评定腕关节功能,对照组优良率77%,X射线评定优良率63%;观察组腕关节功能优良率93%,X射线评定优良率为90%,两组差异具有显著性意义(P < 0.01)。两组骨骺骨折患者均获临床骨愈合,腕关节均功能恢复。提示外固定支架结合克氏针闭合复位微创治疗桡骨远端不稳定骨骺骨折,可应用克氏针辅助复位掌倾角及尺偏角,治疗简单,固定可靠,腕关节功能恢复良好,骨骺畸形愈合并发症少,固定后基本生活学习功能恢复正常,疗效稳定满意,其临床疗效明显优于单纯跨外固定支架固定。     

Hyperbaric oxygen treatment reduced the lung injury of type II decompression sickness

Objective: To detect the ultrastructural changes in rabbits with type II decompression sickness (DCS), and study the therapeutic effects of hyperbaric oxygen (HBO). Methods: Twenty-seven male New Zealand rabbits were randomly divided equally into the DCS group, HBO treatment group and control group. Experimental models of each group were prepared. Lung apex tissues were harvested to prepare paraffin- and EPON812-embedded tissues. Results: In the DCS group, macroscopic and histological examination revealed severe and rapid damage to lung tissue. Ultrastructural examination revealed exudation of red blood cells in the alveolar space. Type I alveolar epithelial cells exhibited retracted cell processes and swollen mitochondria, and type II cells showed highly swollen mitochondria and decrease in cytoplasmic lamellar bodies. Dilatation and congestion of capillary vessels were accompanied by swelling of endothelial cells and incomplete basement membrane. In the HBO treatment group, the findings were somewhat similar to those in the DCS group, but the extent of damage was lesser. Only a small amount of tiny bubbles could be seen in the blood vessels. Type I alveolar epithelia cells and endothelial cells of the capillaries illustrated slight shortening of cells, swollen cytoplasm and decreased cell processes. Type II alveolar epithelial cells showed slight swelling of the mitochondria, decreased vacuolar degeneration of lamellar bodies, and increase in the number of free ribosomes. Conclusions: Our microscopic and ultrastructural findings confirm that the lung is an important organ affected by DCS. We also confirmed that HBO can alleviate DCS-induced pulmonary damage.     

基于直接数字频率合成技术的脑循环功能治疗仪

电刺激小脑顶核 (Fastigial nucleus,FN)可以增加局部脑血流量 (Regional cerebral blood flow) ,缩小梗塞体积 ,提示对脑缺血可能有益。基于直接数字频率合成技术的脑循环功能治疗仪应用国际国内最新科研成果 ,采用直接数字频率合成技术 ,实现安全、有效的治疗 ,通过粘贴于体表的电极 ,无创引入小脑顶核 (FN) ,从而改善脑供血状态和神经传导失调失络症状 ,增加大脑血流量 ,减少半影区坏死神经元数目 ,减轻脑水肿 ,最终达到改善脑循环功能的作用。     

Calcium antagonists decrease capillary wall damage in aging hypertensive rat brain

Chronic hypertension during aging is a serious threat to the cerebral vasculature. The larger brain arteries can react to hypertension with an abnormal wall thickening, a loss of elasticity and a narrowed lumen. However, little is known about the hypertension-induced alterations of cerebral capillaries. The present study describes ultrastructural alterations of the cerebrocortical capillary wall, such as thickening and collagen accumulation in the basement membrane of aging spontaneously hypertensive stroke-prone rats. The ratio of cortical capillaries with such vascular pathology occurred significantly more frequently in hypertensive animals.Nimodipine and nifedipine are potential drugs to decrease blood pressure in hypertension but their beneficial effects in experimental studies reach beyond the control of blood pressure. Nimodipine and nifedipine can alleviate ischemia-related symptoms and improve cognition. These drugs differ in that nifedipine, but not nimodipine reduces blood pressure at the here-used concentration while both drugs can penetrate the blood-brain barrier. Here we show that chronic treatment of aging hypertensive stroke-prone rats with nimodipine or nifedipine could preserve microvascular integrity in the cerebral cortex.     

Akkreditierung in der Pathologie

In the last ten years, almost 60 departments of surgical pathology were accredited in Germany according to DIN EN ISO/IEC 17020. Accreditation in pathology was accompanied by the adoption of a highly dynamic process, which requires staff to be more aware of quality and to introduce a quality-oriented system. The accreditation body in turn needed to consider all the duties, responsibilities and processes in surgical pathology and was supported in this regard by the Sector Committee of Pathology and Neuropathology of the DGA German Association for Accreditation. In this review we illustrate the various problems associated with accreditation in surgical pathology by answering eight questions that have arisen over many years of activity. These include the registration and appropriate presentation of the scope of accreditation, the terminology, as well as the extent and depth of documentation. A department of pathology applying for accreditation is required to document the entire step-wise process leading to a surgical pathological diagnosis.     

椎间孔镜下椎间盘髓核摘除治疗腰椎间盘突出症的疗效

目的 观察椎间孔镜下椎间盘髓核摘除治疗腰椎间盘突出症的疗效。方法 选择2017年3月~2019年3月在我院治疗的腰椎间盘突出症患者80例,采用随机数字表法分为对照组和观察组,各40例。对照组采用后路椎板间开窗髓核摘除术治疗,观察组采用椎间孔镜下椎间盘髓核摘除术治疗,比较两组临床治疗优良率、手术相关指标、治疗前后疼痛度（VAS）评分、治疗前后Oswestry功能障碍评分。结果 观察组治疗优良率为82.50%,高于对照组的67.50%,差异有统计学意义（P＜0.05）;观察组手术时间、切口长度、术中出血量、卧床时间均短于对照组,差异有统计学意义（P＜0.05）;治疗后两组VAS评分、Oswestry功能障碍评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）。结论 椎间孔镜下椎间盘髓核摘除治疗腰椎间盘突出症疗效良好,对患者创伤小,且可在短期内改善功能障碍,减轻患者疼痛,具有临床应用的重要价值。     

经导管介入治疗肺动静脉瘘5例诊治体会

目的探讨经导管介入治疗肺动静脉瘘（PAVF）的疗效与并发症的预防方法。方法选择5例PAVF患者临床资料进行回顾性分析,其中男性2例,女性3例;年龄5~41岁,平均年龄12.64岁。应用弹簧圈、国产动脉导管未闭（PDA）封堵器和外科胶行经导管介入封堵治疗。结果 2例患者应用弹簧圈封堵,1例患者应用PDA封堵器封堵,1例患者应用外科胶栓塞成功,术后股动脉血氧饱和度显著升高。1例患者为弥漫型细小PAVF,未进行封堵。1例术后有一过性左侧肢体无力,诊断为轻微脑栓塞,给予抗凝治疗,20 h后肌力恢复正常。随访10个月到8年,1例弥漫性PAVF患者确诊3年后死于大咯血,其余4例均无再通及封堵器脱落、移位等并发症。结论经导管介入封堵治疗PAVF安全有效,操作简单,创伤小,恢复快,可最大限度地保留正常肺组织及其功能,规范操作可预防并发症的发生。     

氧驱动雾化吸入补钾纠正低钾血症的疗效观察与护理

目的探讨氧驱动雾化吸入补钾纠正低钾血症的临床疗效与护理。方法将25例低钾血症的患者随机分为实验组和对照组，每组各25例，分别用氧驱动雾化吸入和静脉滴注。结果两组在提高血钾浓度无差异。结论应用氧驱动雾化的方法给低血钾患者进行补钾，是一种较理想的方法，具有操作简单、患者易于接受，符合消毒隔离原则。值得临床推广应用。