老年脑出血患者血清乙酰肝素酶和血管内皮生长因子水平变化及其与出血量和出血部位的关系

目的探讨老年脑出血患者血清乙酰肝素酶(HPA)和血管内皮生长因子(VEGF)水平变化情况及其与出血量和出血部位的关系。方法选择老年脑出血患者50例作为脑出血组和健康体检老年人50例作为对照组,计算脑出血患者的脑出血量,采用酶联免疫吸附法(ELISA)测定两组血清HPA和VEGF水平。结果脑出血组脑出血1 d、脑出血1 w、脑出血2 w血清HPA和VEGF水平均显著高于对照组(P<0.05),脑出血组脑出血1 w、脑出血2 w血清HPA和VEGF水平均显著高于脑出血1 d(P<0.05),脑出血组脑出血2 w血清HPA和VEGF水平均显著高于脑出血1 w(P<0.05)。脑出血量≤15 ml组患者各时点血清HPA和VEGF水平均显著低于脑出血>15 ml组(P<0.05)。丘脑出血组患者各时点血清HPA和VEGF水平和壳核出血组比较差异均无统计学意义(P>0.05)。脑出血患者各时点血清HPA和VEGF水平均呈正相关(P<0.05)。结论老年脑出血患者血清HPA和VEGF水平升高,随脑出血时间的延长,血清HPA和VEGF水平呈升高趋势,血清HPA和VEGF水平和脑出血量有关,和脑出血部位无相关性,血清HPA和VEGF水平呈正相关。     

脑出血发病机制研究进展

<正>脑出血是脑卒中的第二大类型,其死亡率和致残率高。学者们对脑出血发病机制开展了深入研究,现对其相关研究进行综述。1发病原因脑出血包括原发性自发性脑出血和继发性自发性脑出血,高血压与淀粉样脑血管病是导致原发性自发性脑出血的主要原因。此外,颅内动脉瘤、脑动静脉畸形、动脉硬化等也是导致脑出血的原因之一。1.1高血压高血压是脑出血最常见的危险因素,原发性脑出血与高血压密切相关[1]。一般认为,长期高血压导致脑     

脑出血病人发病时间规律的研究

目的　分析脑出血病人发病时间的变化规律 ,判断不同病因脑出血病人发病的时间模式。方法　评价 819例脑出血病人发病时间的变化规律及脑出血的发生与气温变化的关系。所有病例根据病因分为 3组 :高血压性脑出血组 487例 ,继发性脑出血组 193例及原因不明性脑出血组 139例。同时评价临床因素对脑出血病人在时间分布上的影响。结果　脑出血病人常在冬季及早晨清醒状态时发病 ,在时间上均存在显著的季节性和昼夜性差异。这种差异在高血压组尤为明显 ,而非高血压性脑出血组无此差异。高血压性脑出血组中老年病人的发病时间比年青病人更具有显著的季节性。脑出血病人的发病时间没有明显的周期性变化。结论　脑出血常发生于寒冷的季节及早晨清醒状态     

急性脑出血大鼠脑组织含水量和外周血糖变化的研究

目的　探讨脑组织含水量和外周血糖水平在大鼠脑出血急性期的变化规律 ,分析两者在脑出血急性期的病理生理意义。方法　 42只成年SD大鼠 ,随机分为对照组和脑出血组。采用胶原酶诱导大鼠脑出血模型 ,脑干 湿重法测定脑组织含水量变化 ,用快速血糖测定法检测外周血糖水平。结果　手术对照组大鼠脑组织含水量和外周血糖与正常对照组比较差异无显著性意义 ,脑出血组大鼠在出血后 12h、1d、2d、3d脑组织含水量和外周血糖水平均明显高于对照组。脑组织含水量和外周血糖水平在脑出血急性期均增高。结论　大鼠脑出血后脑组织含水量和外周血糖水平对脑出血急性期的病理过程具有同样重要的意义     

脑出血患者的认知损害

脑出血是致死率和致残率较高的脑血管病。与缺血性卒中相比,对脑出血相关认知损害的研究较少。脑出血相关认知损害可分为脑出血前认知损害以及出血后急性期和远期认知损害。文章对脑出血相关认知损害的发生率、危险因素、可能的发病机制及其治疗进行了综述。     

脑出血的病因及预防

1脑出血的病因 引起脑出血的病因大致可分为两类，即与高血压有关的脑出血和非高血压所致的脑出血。1.1高血压性脑出血 高血压病是脑出血最常见、最重要的原因，脑出血患者中，伴高血压者约占95％。其发病机理可能与下列因素有关：①脑内小动脉病变：表现为脑内小动脉分叉处或其附近中层退变、平滑肌细胞不规则性萎缩甚至消失，     

脑出血后继发性脑损伤机制研究进展

脑出血是具有高病死率和高致残率的神经科常见疾病。近年研究证实,脑出血发病过程中存在炎症反应、氧化应激、凝血酶神经毒性、小胶质细胞激活、细胞凋亡等继发性脑损伤机制,继发性脑损伤是导致脑出血后神经细胞损伤的重要因素。目前尚缺乏有效的治疗脑出血手段,研究脑出血后继发性脑损伤机制,为脑出血治疗提供一条新途径。     

脑出血模型

自体血注入法和胶原酶诱导法脑出血模型的血肿大小一致且重复性好,适合研究脑出血过程的病理生理变化,且与人类脑出血的特点相似,目前应用较多;微球囊充胀法脑出血模型适合研究脑出血后占位效应和血肿清除的病理生理过程、颅内压变化和脑血流改变等;自发性脑出血模型可产生与人类高血压动脉硬化相同的病理改变,但由于模型不确定、重复性差且无可比性,应用较少。     

脑出血血肿周围组织损伤的炎症反应机制

脑出血后血肿周围脑组织存在继发性脑损伤 ,其病理机制十分复杂。近几年的研究发现 ,脑出血后血肿内和血肿周围存在明显的炎症反应 ,包括白细胞和小胶质细胞渗出 ,多种细胞因子和黏附分子显著表达和补体系统激活。炎症反应在脑出血后血肿周围继发性脑组织损伤中起着十分重要的作用。对脑出血后炎症反应机制的研究 ,有望找到脑出血治疗新的切入点。     

自发性脑出血的处理

自发性脑出血发病率高 ,易造成死亡或重残。小动脉或微动脉病变是引起脑出血的最重要原因 ,高血压和高龄是最重要的危险因素。脑出血时常突发多种神经功能障碍症状。及时CT检查是早期诊断脑出血的关键。治疗时应根据病情尽快清除血凝块 ,通过控制血压来控制颅内压 ,同时应针对各危险因素采取相应措施以降低脑出血发生率、死亡率和致残率     

破裂动脉瘤致蛛网膜下腔出血患者急性期血清单核细胞趋化蛋白1水平的临床意义

目的探讨老年破裂动脉瘤致蛛网膜下腔出血患者急性期血清单核细胞趋化蛋白1(MCP-1)的水平及临床意义。方法脑动脉瘤破裂致蛛网膜下腔出血患者26例(破裂出血组),未破裂动脉瘤患者22例(未破裂组)。另选择同期老年健康体检者25例(对照组),采用ELISA法检测破裂出血组患者出血第1、2、3天血清MCP-1水平,未破裂组患者入院当天血清MCP-1水平及对照组血清MCP-1水平,并进行组间比较。结果破裂出血组患者血清MCP-1水平明显高于未破裂组和对照组,差异有统计学意义(P<0.05)。未破裂组患者血清MCP-1水平与对照组比较,差异无统计学意义(P>0.05)。破裂出血组患者出血后第1、2、3天血清MCP-1水平逐渐升高,但差异无统计学意义(P>0.05)。结论破裂动脉瘤致蛛网膜下腔出血患者急性期血清MCP-1水平升高,且出血急性期逐渐上升,可能参与动脉内外炎性反应。     

Suzuki分级及异常代偿血管与成人烟雾病脑出血及缺血的关系

目的进一步探讨成人烟雾病患者脑出血及脑缺血事件的发生机制。方法对86例经全脑血管造影证实的成人烟雾病患者[脑出血52例(104个大脑半球,脑出血组),脑缺血34例(68个大脑半球,脑缺血组)]的临床资料进行回顾性分析,对Suzuki分级、烟雾样血管的丰富程度分期及颅内小动脉扩张不同者的脑出血及脑缺血发生率进行χ2检验及Mann-Whitney U检验。结果①两组Suzuki分级无显著差异,Mann-Whitney U检验Z=0.656、P=0.512;Suzuki分级Ⅲ～Ⅳ级者脑出血率显著高于脑缺血率(P<0.05)。②两组颅底烟雾样异常血管丰富程度分期有显著差异,Mann-Whitney U检验Z=3.909、P=0.000;其中2～4期者脑出血率显著高于脑缺血率(P<0.05)。③两组扩张小动脉无显著差异,Mann-Whitney U检验Z=1.183,P=0.237;同种血管扩张者脑出血率显著高于脑缺血率(P<0.05)。结论成人烟雾病患者脑出血及缺血发生与Suzuki分级无显著相关;烟雾样血管的丰富程度升高及颅内主要小动脉扩张预示脑出血事件发生的可能性大。     

CLINICAL INVESTIGATION OF UPPER GASTROINTESTINAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Background: Upper gastrointestinal (GI) hemorrhage after percutaneous endoscopic gastrostomy (PEG) is sometimes reported as one of the serious complications. Our purpose was to clarify the cause of upper GI hemorrhage after PEG. Patients and Methods: We retrospectively investigated the causes of upper GI hemorrhage among a total of 416 patients out of 426 consecutive patients who underwent PEG in our institution, excluding 10 patients who showed upper GI tumors on PEG placement. Results: Among 17 patients who developed upper GI hemorrhage after PEG, three and four patients showed PEG tube placement and replacement‐related hemorrhage, respectively; these lesions were vascular or mucosal tears around the gastrostomy site. Ten patients experienced 12 episodes of upper GI hemorrhage during PEG tube feeding. The lesions showing bleeding were caused by reflux esophagitis (five patients), gastric ulcer (two patients), gastric erosion due to mucosal inclusion in the side hole of the internal bolster (two patients), and duodenal diverticular hemorrhage (one patient). Anticoagulants were administered in six patients, including four patients with replacement‐related hemorrhage and one patient each with reflux esophagitis and gastric ulcer. Conclusions: Reflux esophagitis was the most frequent reason for upper GI hemorrhage after PEG. The interruption of anticoagulants should be considered for the prevention of hemorrhage on the placement as well as replacement of a gastrostomy tube.     

脑出血患者出血部位与病因构成的相关性研究

目的分析脑出血患者不同出血部位的病因构成,探讨两者的相关性。方法纳入2002年3月—2006年12月成都卒中登记库的脑出血患者831例。其中男540例(65.0%),女291例(35.0%),平均年龄(59±13)岁。根据出血部位分为深部、脑叶、脑干、小脑、脑室、多部位出血。根据病因将脑出血分为原发性和继发性脑出血,并进一步分析出血部位和病因的关系。采用Logistic回归分析出血部位与病因的相关性。结果①常见的出血部位依次是深部(63.2%)、脑叶(17.4%)、脑干(9.0%)、多部位(4.2%)、脑室(3.6%)及小脑出血(2.5%)。②出血病因以高血压最多见,占62.2%。③各部位出血均以原发性为主,与继发性比较,差异有统计学意义(χ2=26.549,P<0.01)。不同病因在各部位出血中所占的比例差异有统计学意义(χ2=618.256,P<0.01)。④多因素分析显示,深部出血与高血压呈正相关(OR=1.96,95%CI:1.33～2.88),与血管畸形呈负相关(即危险性较小,OR=0.23,95%CI:0.07～0.72);脑叶出血与高血压呈负相关(OR=0.29,95%CI:0.13～0.61),与动脉瘤呈正相关(OR=10.70,95%CI:2.35～48.66);小脑出血与血管畸形呈正相关(OR=17.84,95%CI:3.64～87.40);脑室出血与烟雾病呈正相关(OR=10.85,95%CI:2.14～55.11)。结论脑出血部位与病因有一定相关性。高血压是深部出血、动脉瘤是脑叶出血、血管畸形是小脑出血、烟雾病是脑室出血的重要病因。结合临床特点,根据出血部位推测病因有一定参考意义。     

一氧化氮含量在脑出血病人不同时期动态变化的临床研究

目的　探讨脑出血 (CH)病人不同时期血清中一氧化氮 (NO)含量变化的临床意义。方法　采用Green改良法检测 38例不同时期CH病人血清中NO含量 ,并配有 30例正常对照组。结果　CH不同时期血清中NO含量的均数低于对照组 ,7d组NO含量最低 ;而 2 4h组NO含量明显高于其它组及对照组。脑出血的出血量与NO含量呈负相关。不同出血部位的NO含量从高到低依次是 :小脑、丘脑、壳核和脑叶。结论　脑出血病人的NO含量的动态变化说明 :NO是脑出血后病理生理变化的重要因素之一。     

Prohemostatic interventions in obstetric hemorrhage

Obstetric hemorrhage is a major cause of maternal morbidity and mortality. Pregnancy is associated with substantial hemostatic changes, resulting in a relatively hypercoagulable state. Acquired coagulopathy can, however, develop rapidly in severe obstetric hemorrhage. Therefore, prohemostatic treatments based on high fresh frozen plasma and red blood cell (FFP:RBC) ratio transfusion and procoagulant agents (fibrinogen concentrates, recombinant activated factor VII, and tranexamic acid) are crucial aspects of management. Often, evidence from trauma patients is applied to obstetric hemorrhage management, although distinct differences exist between the two situations. Therefore, until efficacy and safety are demonstrated in obstetric hemorrhage, clinicians should be cautious about wholesale adoption of high FFP:RBC ratio products. Applications of transfusion protocols, dedicated to massive obstetric hemorrhage and multidisciplinarily developed, currently remain the best available option. Similarly, while procoagulant agents appear promising in treatment of obstetric hemorrhage, caution is nonetheless warranted as long as clear evidence in the context of obstetric hemorrhage is lacking.     

Diagnosis of pulmonary hemorrhage in the immunocompromised host

The efficacy of bronchoalveolar lavage (BAL) in diagnosing pulmonary hemorrhage was studied in 51 immunosuppressed patients with new pulmonary infiltrates. Similar studies were performed in a control group of 8 nonimmunocompromised patients. Hemosiderin content in Prussian-blue-stained alveolar macrophages obtained by BAL was graded using a numerical scale. This "hemosiderin score" correlated closely with the degree of hemorrhage seen in corresponding histologic sections in the 26 patients from whom a lung biopsy or autopsy specimen was available. Severe pulmonary hemorrhage was ultimately diagnosed in 14 cases, and a mild degree of hemorrhage was found in an additional 19 cases. Thrombocytopenia and invasive fungal infections were statistically associated with severe hemorrhage, as was an increased percentage of alveolar macrophages in the BAL sample. This study demonstrates the efficacy of BAL in diagnosing occult pulmonary hemorrhage in the immunosuppressed host and highlights risk factors associated with hemorrhage in this setting.     

Acute unilateral adrenal hemorrhage following ACTH administration in a patient with Cushing's syndrome.

A patient with Cushing's syndrome and a concomitant unilateral adrenal hemorrhage following ACTH administration is described. Although stress is commonly associated with the onset of adrenal hemorrhage, a pathologically documented adrenal hemorrhage has not been previously in association with ACTH administration in Cushing's syndrome. Repeated doses of ACTH should not be given to patients with Cushing's syndrome as this has little diagnostic value and may lead to adrenal hemorrhage in such patients.     

Upper digestive hemorrhage as a complication of postoperative reflux gastritis

Seven cases of upper gastrointestinal hemorrhage after gastroduodenal surgery are presented; in all the cases the pyloric region had been resected or excluded. The gastritis was documented by endoscopy and/or surgery; it was located in the area proximal to the anastomosis. There were no other causes of bleeding. In five cases the hemorrhage was controlled with medical treatment. In one case it was necessary to operate on urgently. Another case was that of a recurrent hemorrhage after surgery for bleeding peptic ulcer located in the anastomosis. We emphasize the possibility of acute gross hemorrhage as a complication of reflux gastritis; the common clinical finding of previous treatment with antiinflammatory drugs; and the rarity of this lesion as the cause of gastrointestinal hemorrhage and as a complication of postoperative reflux gastritis.