小骨窗开颅治疗高血压脑出血64例分析

目的 探讨小骨窗开颅手术治疗高血压性脑出血的临床疗效.方法 回顾性分析采用小骨窗开颅治疗高血压性脑出血患者64例的临床资料.结果 血肿清除＞85%以上者36例,血肿清除60%～85%者19例,血肿清除30%～60%者5例,血肿复发者4例,死亡12例.术后生存患者功能恢复:I级15例,Ⅱ级18例,Ⅲ级12例,Ⅳ级4例,V级3例.结论 小骨窗开颅微创术治疗高血压性脑出血效果满意,值得推广.     

小骨窗手术治疗高血压性脑出血

目的：探讨小骨窗开颅手术治疗高血压性脑出血的临床疗效。方法：回顾性分析采用小骨窗开颅治疗高血压性脑出血患者53例的临床资料。结果：53例患者中,39例血肿完全清除,10例大部分清除,4例发生再次出血,术后死亡3例,术后生存患者功能恢复按ADL分级法评价,Ⅰ级9例,Ⅱ级21例,Ⅲ级13例,Ⅳ级3例,Ⅴ级4例,死亡3例。结论：小骨窗开颅微创术治疗高血压性脑出血效果满意,值得推广。     

改良小骨窗开颅与大骨瓣开颅血肿清除术治疗高血压脑出血的分析

目的:探讨改良小骨窗开颅与大骨瓣开颅血肿清除术治疗高血压脑出血的临床效果。方法:分析我院收治的70例高血压脑出血患者临床资料,依据手术方式不同分为观察组(改良小骨窗开颅血肿清除术组)50例和对照组(大骨瓣开颅血肿清除术组)20例。结果:观察组高血压脑出血患者手术时间、术中输血量、住院时间、复发率及生存率均优于对照组,P<0.05,差异均有统计学意义。结论:改良小骨窗开颅血肿清除术治疗高血压脑出血创伤小、复发率低、生存率高,值得临床借鉴应用。     

小骨窗开颅治疗高血压脑出血42例体会

目的：总结小骨商开颅血肿清除术在治疗高血压脑出血方面的应用及特点。方法：对42例高血压脑出血采用小骨窗开颅血肿清除术治疗,并进行观奈和分析。结果：除6例死亡,包括术后3例家属放弃自动出院,且证实数日内死亡,重残5例,其余31例恢复良好。结论：小骨窗开颅治疗高血压脑出血具有创伤小、效果好、基层医院易开展等特点。     

微创小骨窗开颅在高血压脑出血中的应用

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2002年6月-2005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。     

小骨窗血肿清除术治疗高血压脑出血的疗效分析

目的:探讨小骨窗开颅血肿清除术治疗高血压脑出血的临床效果.方法:18例幕上高血压脑出血病例行小骨窗(4 cm×5 cm)开颅血肿清除术.结果:18例中1例术毕再次大出血死亡,1例术后15天因多器官功能衰竭死亡,其余16例全部存活,优良生存率75%.结论:高血压脑出血小骨窗开颅血肿清除术具有视野清楚、便于止血、血肿清除彻底、减压快等优势,死亡率低,优良生存率高.     

小骨窗开颅血肿清除术治疗高血压脑出血的临床效果观察

目的：观察分析小骨窗开颅血肿清除术治疗高血压脑出血的临床效果。方法观察组选择2010年1月-2014年1月本院接受小骨窗开颅血肿清除术的高血压脑出血患者108例,对照组为2010年前在本院采用大骨瓣开颅血肿清除术治疗的高血压脑出血患者108例,观察并比较两组患者经过手术治疗后的临床效果。结果观察组患者采用小骨窗开颅血肿清除术治疗高血压脑出血手术时间和平均住院时间都明显短于对照组,观察组总有效率（96.30%）明显高于对照组总有效率（68.52%）,差异有统计学意义（P〈0.05）。结论小骨窗开颅血肿清除的手术方法可以减少对脑组织的损伤,明显缩短手术时间,术后患者清醒也较快,并发症较少,神经功能恢复好,在临床上值得广泛应用和推广。     

CT定位小骨窗开颅血肿清除术治疗46例高血压脑出血疗效观察

目的观察探讨在高血压性脑出血患者中利用CT定位小骨窗开颅清除血肿的临床效果。方法46例高血压脑出血患者,采用CT定位小骨窗开颅手术清除血肿,术后辅以脱水降颅内压,并给予营养支持和控制血压。结果46例高血压性脑出血患者随访3～6个月,根据日常生活活动能力（ADL）分级对患者进行预后评价：I级21例,Ⅱ级12例,Ⅲ级8例,Ⅳ级5例。结论利用CT定位小骨窗开颅血肿清除术治疗高血压脑出血,是一种清除血肿彻底、操作简单、创伤小、安全有效的方法,可以在临床推广应用。     

小骨窗开颅血肿清除术与传统大骨瓣开颅血肿清除术对高血压脑出血的效果比较分析

目的:探讨高血压脑出血患者实施小骨窗开颅血肿清除术与传统大骨瓣开颅血肿清除术的效果差异性。方法:选取本科室2016年1月～2017年12月间80例高血压脑出血患者,采用随机数表法分为传统组和干预组各40例。传统组进行传统大骨瓣开颅血肿清除术治疗,干预组进行小骨窗开颅血肿清除术治疗,对比不同方案的远近期疗效。结果:干预组患者术中输血量、手术时间、术后住院时间及术后6个月NIHSS、ADL评分均明显优于传统组(P<0.05)。结论:高血压脑出血患者实施小骨窗开颅血肿清除术远近期疗效均优于传统大骨瓣开颅血肿清除术。     

小骨窗脑血肿清除术治疗高血压脑出血患者的效果

目的探讨小骨窗脑血肿清除术治疗高血压脑出血患者的效果。方法选取我院收治的90例高血压性脑出血患者,对照组采用大骨瓣开颅术,试验组采用小骨窗脑血肿清除术,观察两组高血压脑出血患者的临床效果。结果 1试验组高血压性脑出血患者的疗效总有效率(86.7%)明显高于对照组的疗效总有效率(75.6%)(t=2.826,P=0.038<0.05);2试验组治疗后的血肿量以及血肿吸收率明显优于对照组患者治疗后的血肿量以及血肿吸收率。结论小骨窗开颅术治疗高血压性脑出血患者的临床疗效明显好于大骨瓣开颅术,有利于减少患者的痛苦,提高患者的生活质量。     

实时荧光PCR法检测脑出血患者ApoE基因多态性的意义及探讨

目的探讨载脂蛋白E（ApoE）基因多态性与脑出血的关系及实时荧光聚合酶链反应（PCR）技术在ApoE基因多态性检测中的应用价值。方法对福建附一医院住院的74例脑出血患者进行研究,正常对照组为80例本院健康体检者;ApoE基因型采用实时荧光PCR方法检测,血清TC、TG、LDL、HDL在全自动生化仪上采用动力学法检测。结果脑出血患者组ApoEε4等位基因频率为14.9%,明显高于正常对照组（P〈0.01）;比较不同ApoE基因型脑出血患者的血清TC、TG、LDL、HDL含量,结果ε4组的TC含量明显高于ε3和ε2组（P〈0.05,P〈0.01）,LDL含量明显高于ε3和ε2组（P〈0.05）。结论ApoEε4等位基因可能是脑出血的易感因子和风险因素;实时荧光PCR技术检测ApoE基因多态性具有方便、快捷的优点,值得推广。     

高血压脑出血外科治疗临床研究

目的探讨高血压脑出血（HICH）手术治疗方法的选择和疗效。方法回顾采用CT立体定向穿刺引流、微创开颅及骨瓣开颅血肿清除三种术式治疗高血压脑出血患者278例,按照GCS评分和血肿量各分为三组,对不同术式和疗效对比分析。结果高血压脑出血CT立体定向穿刺引流组预后良好74例（59．6％）,微创开颅组预后良好48例（56．4％）,两组差异无统计学意义（P〉0．05）。骨瓣开颅组病死率21．7％（15例）。结论高血压脑出血手术治疗三种术式各有其特点,CT立体定向穿刺引流具有创伤小、恢复快、及时有效解除脑受压的特点,是一种治疗高血压脑出血简便有效的治疗方法。     

江门地区季节变化对心脑血管病患者急诊的影响

目的 探索江门地区月份季节对心脑血管病患者急诊的影响。方法对江门市中心医院急诊科2006年7月-2010年6月收治的13685例心脑血管病急诊患者的临床资料进行回顾性调查分析。结果日均心脑血管疾病急诊患者数为7．5人次／天,日均就诊人数在11—12月份较高,为8．1-9．0人次／天,在5-8月份较低,为6．4。6．7人次／天;冠心病就诊人数12月最多,5月最少,冬季明显高于夏季;高血压就诊人数1月最多,6月最少,冬季明显高于夏季;脑梗死就诊人数7月最多,12月最少,夏季明显高于冬季;脑出血1月就诊较高,但和心律失常一样没有明显的季节性。结论江门地区的心脑血管疾病患者的急诊具有一定的季节规律性。     

小儿脑萎缩的CT分析

目的 探讨分析小儿不同程度脑组织损伤后脑萎缩的CT表现.方法 搜集郑州市某医院46例不同程度脑组织损伤后脑萎缩患儿的临床及CT资料进行分析.结果 46例中,弥漫性脑萎缩15例,局限性脑萎缩31例,周围性脑萎缩19例,中心性脑萎缩27例;患儿所患疾病,新生儿HIE 19例,先天性宫内感染(TORCH)10例,病毒性脑炎5例,迟发Vk缺乏脑实质出血3例,脑血管畸形4例,脑外伤脑实质出血3例,营养不良及不正确使用脱水剂和大量使用类固醇药物的患儿2例.结论 脑萎缩是小儿脑组织损伤后常见的脑部表现,只要通过对CT征像仔细对比分析并严密结合临床病史资料,就不会发生误诊漏诊现象延误治疗.     

小儿亚急性硬脑膜下血肿临床分析

目的总结小儿亚急性硬脑膜下血肿的诊治经验。方法回顾性分析我科收治36例小儿亚急性硬脑膜下血肿的临床资料。结果36例患儿全部作开颅血肿清除术,术后气管切开22例,高压氧治疗24例;治愈23例,轻残7例,中残4例,重残2例。结论小儿亚急性硬脑膜下血肿原发损伤轻,继发损伤重,首诊易误诊;要及时确诊,尽早手术,术后强调综合治疗,是提高患儿生存质量的关键。     

Advances in hemorrhagic stroke therapy: conventional and novel approaches

Treatments for spontaneous intracerebral, thrombolytic-induced and intraventricular hemorrhages (IVH) are still at the preclinical or early clinical investigational stages. There has been some renewed interest in the use of surgical evacuation surgery or thrombolytics to remove hematomas, but these techniques can be used only for specific types of brain bleeding. The STICH (Surgical Trial in Intracerebral Haemorrhage) clinical trials should provide some insight into the potential for such techniques to counteract hematoma-induced damage and subsequently, morbidity and mortality. More recently, clinical trials (ATACH [Antihypertensive Treatment in Acute Cerebral Hemorrhage] and INTERACT [Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial]) have begun testing whether or not regulating blood pressure affects the well-being of hemorrhage patients, but the findings thus far have not conclusively demonstrated a positive result. More promising trials, such as the early stage CHANT (Cerebral Hemorrhagic And NXY-059 Treatment) and the late stage FAST (Factor VIIa for Acute Hemorrhagic Stroke Treatment), have addressed whether or not manipulating oxidative stress and components of the blood coagulation cascade can achieve an improved prognosis following spontaneous hemorrhages. However, CHANT was halted prematurely because although it showed that the spin trap agent NXY-059 was safe, it also demonstrated that the drug was ineffective in treating acute ischemic stroke. In addition, the recombinant activated factor VII FAST trial recently concluded with only modestly positive results. Despite a beneficial effect on the primary end point of reducing hemorrhage volume, controlling the coagulation cascade with recombinant factor VIIa did not decrease the mortality rate. Consequently, Novo Nordisk has abandoned further development of the drug for the treatment of intracerebral hemorrhaging. Even though progress in hemorrhage therapy that successfully reduces the escalating morbidity and mortality rate associated with brain bleeding is slow, perseverance and applied translational drug development will eventually be productive. The urgent need for such therapy becomes more evident in light of concerns related to uncontrolled high blood pressure in the general population, increased use of blood thinners by the elderly (e.g., warfarin) and thrombolytics by acute ischemic stroke patients, respectively. The future of drug development for hemorrhage may require a multifaceted approach, such as combining drugs with diverse mechanisms of action. Because of the substantial benefit of factor VIIa in reducing hemorrhage volume, it should be considered as a prime drug candidate included in combination therapy as an off-label use if the FAST trial proves that the risk of thromboembolic events is not increased with drug administration. Other promising drugs that may be considered in combination include uncompetitive NMDA receptor antagonists (such as memantine), antioxidants, metalloprotease inhibitors, statins and erythropoietin analogs, all of which have been shown to reduce hemorrhage and behavioral deficits in one or more animal models.     

Advances in hemorrhagic stroke therapy: conventional and novel approaches

Treatments for spontaneous intracerebral, thrombolytic-induced and intraventricular hemorrhages (IVH) are still at the preclinical or early clinical investigational stages. There has been some renewed interest in the use of surgical evacuation surgery or thrombolytics to remove hematomas, but these techniques can be used only for specific types of brain bleeding. The STICH (Surgical Trial in Intracerebral Haemorrhage) clinical trials should provide some insight into the potential for such techniques to counteract hematoma-induced damage and subsequently, morbidity and mortality. More recently, clinical trials (ATACH [Antihypertensive Treatment in Acute Cerebral Hemorrhage] and INTERACT [Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial]) have begun testing whether or not regulating blood pressure affects the well-being of hemorrhage patients, but the findings thus far have not conclusively demonstrated a positive result. More promising trials, such as the early stage CHANT (Cerebral Hemorrhagic And NXY-059 Treatment) and the late stage FAST (Factor VIIa for Acute Hemorrhagic Stroke Treatment), have addressed whether or not manipulating oxidative stress and components of the blood coagulation cascade can achieve an improved prognosis following spontaneous hemorrhages. However, CHANT was halted prematurely because although it showed that the spin trap agent NXY-059 was safe, it also demonstrated that the drug was ineffective in treating acute ischemic stroke. In addition, the recombinant activated factor VII FAST trial recently concluded with only modestly positive results. Despite a beneficial effect on the primary end point of reducing hemorrhage volume, controlling the coagulation cascade with recombinant factor VIIa did not decrease the mortality rate. Consequently, Novo Nordisk has abandoned further development of the drug for the treatment of intracerebral hemorrhaging. Even though progress in hemorrhage therapy that successfully reduces the escalating morbidity and mortality rate associated with brain bleeding is slow, perseverance and applied translational drug development will eventually be productive. The urgent need for such therapy becomes more evident in light of concerns related to uncontrolled high blood pressure in the general population, increased use of blood thinners by the elderly (e.g., warfarin) and thrombolytics by acute ischemic stroke patients, respectively. The future of drug development for hemorrhage may require a multifaceted approach, such as combining drugs with diverse mechanisms of action. Because of the substantial benefit of factor VIIa in reducing hemorrhage volume, it should be considered as a prime drug candidate included in combination therapy as an off-label use if the FAST trial proves that the risk of thromboembolic events is not increased with drug administration. Other promising drugs that may be considered in combination include uncompetitive NMDA receptor antagonists (such as memantine), antioxidants, metalloprotease inhibitors, statins and erythropoietin analogs, all of which have been shown to reduce hemorrhage and behavioral deficits in one or more animal models.     

内窥镜辅助经外侧裂-岛叶入路显微外科手术治疗基底节区高血压脑出血研究

目的 探讨使用神经内窥镜辅助下经外侧裂-岛叶入路显微外科手术治疗基底节区高血压脑出血的疗效.方法 回顾分析2008年1月～2011年12月我院12例高血压基底节区脑内血肿患者的资料,患者均在急性期接受神经内窥镜辅助下经外侧裂-岛叶入路显微手术治疗.结果 术后即刻复查CT示9例血肿基本清除,3例清除约80％,其中2例出现了术后少量迟发出血,均保守治疗成功.随访6个月时GOS评分:恢复良好8例,轻度残疾2例,重度残疾2例,无植物生存及死亡病例.结论 经外侧裂-岛叶入路显微外科手术治疗基底节区高血压脑出血具有微创的特点,内窥镜辅助下能有效清除脑内血肿,并减少了颞叶皮层及血管的损伤,有益于改善患者的预后.     

乳腺癌根治/仿根治术后皮瓣下积液44例的处理

目的探讨乳腺癌根治术/仿根治术后皮瓣积液的处理方法,提高乳腺癌的近期疗效。方法回顾44例皮瓣下积液负压引流的再通畅,加压包扎和橡皮条的引流。结果 44例皮瓣积液中,除1例小动脉凝血痂脱落,行手术止血外,其余43例经负压引流再通畅16例,局部橡皮条引流21例,注射器抽吸和局部加压6例,消除局部皮瓣积气积液,未明显影响皮瓣和组织创面的愈合,无皮瓣坏死。皮瓣积液临床病程1.0～6.5d,平均(3.5±3.0)d。拔管时间标准:负压引流液<10mL/24h,拔管时间4～15d,平均(7.5±4.0)d。皮瓣愈合时间12～21d,平均(15.5±4.0)d。皮瓣在术后3周内一期临床愈合。结论乳腺癌根治术/仿根治术后皮瓣下积液的及时有效处置,对于预防乳腺皮瓣坏死,乳腺癌根治术/仿根治术后的近期疗效有积极的临床意义。     

手术治疗鹿角状肾结石45例的体会

目的:探讨不同术式治疗鹿角状肾结石的临床疗效.方法:回顾性分析1999～2007年我院采用肾盂切开取石和肾后唇中下1/3肾实质切开取石治疗各种不同形状及大小的鹿角状肾结石45例.结果:41例一次性取尽结石,术后2例出血,1例出现尿瘘.结论:针对不同结石采用不同术式,其疗效满意、安全,值得临床推广使用.