标准大骨瓣减压术对重型颅脑损伤患者颅内压及预后的影响

目的探讨标准大骨瓣减压术对重型颅脑损伤患者颅内压和预后的影响。方法将我院神经外科2010年1月~2012年1月收治的128例重型颅脑损伤患者分成两组,对照组行常规去骨瓣减压术。观察组行标准大骨瓣减压术,术后第3、5、7天进行腰椎穿刺,监测两组患者的颅内压变化情况、术后的预后及并发症情况。结果标准大骨瓣组术后第3、5、7天的颅内压分别为(20.53±3.64)mmHg、(18.59±2.81)mmHg、(16.34±2.16)mmHg,分别明显低于常规去骨瓣组(P<0.05)。两组术后预后疗效总有效率分别为83.8%、63.3%,标准大骨瓣组术后预后疗效明显优于常规去骨瓣组(χ2=5.749,P<0.05)。标准大骨瓣组术后并发症发生率19.1%(13/68),常规去骨瓣组术后并发症发生率36.7%,两组并发症发生率比较,差异具有统计学意义(P<0.05)。结论与常规去骨瓣减压术相比,标准大骨瓣减压术治疗重型颅脑损伤疗效确切,可以明显降低颅内压,改善患者的预后且并发症少,值得推广和应用。     

大骨瓣减压联合选择性亚低温治疗脑外伤分析

目的探讨脑外伤患者采用大骨瓣减压手术并联合选择性头部亚低温疗法,观察两者联合作用的疗效和GOS的评分情况。方法82例脑外伤患者,试验组43例,采用大骨瓣减压手术与选择性亚低温联合治疗;对照组39例,采用大骨瓣减压手术与常温治疗,观察并比较两组颅内压、GOS预后有效率。结果试验组在1、2和3d的颅内压值分别是（19．6±2．4）、（20．2±2．1）、（17．1±2．0）mmHg,较对照组明显下降（P〈0．05）;对照组和试验组的半年预后有效率（GOS评分）分别为25．64％和46．51％（P〈0．05）,且试验组的植物状态病死率比对照组低（P〈0．05）。结论对脑外伤患者采用大骨瓣减压手术联合选择性头部局部亚低温疗法疗效显著。     

标准去大骨瓣开颅减压术治疗150例重型颅脑损伤临床疗效研究

目的 回顾性分析标准去大骨瓣开颅减压术治疗重型颅脑损伤的临床疗效。方法 选取该院2018年1月—2023年1月接受标准去大骨瓣开颅减压术治疗的150例重型颅脑损伤患者纳入观察组,同期进行常规骨瓣开颅术治疗的150例重型颅脑损伤患者纳入对照组,比较二组手术治疗的临床效果,比较术后1d、5d、7d的颅内压变化情况、术后并发症发生情况。结果 观察组手术总有效率为92.11%,对照组手术总有效率73.68%,差异有统计学意义（P<0.05）;术后1d、5d、7d颅内压观察组分别为（18.49±2.31）mmHg、（17.21±2.51）mmHg、（15.47±1.91）mmHg,对照组分别为（20.73±2.39）mmHg、（20.52±2.39）mmHg、（20.55±1.79）mmHg,观察组均低于对照组,差异均有统计学意义（均P<0.001）;术后并发症观察组患者出现6例（8%）,对照组出现12例（8%）,差异有统计学意义（P<0.05）。结论 标准去大骨瓣开颅减压术用于治疗重型颅脑损伤,其临床效果优于常规骨瓣开颅术。     

标准大骨瓣开颅血肿清除联合亚低温治疗重型颅脑损伤效果观察

目的：研究标准大骨瓣开颅血肿清除联合亚低温在治疗重型颅脑损伤的临床应用效果。方法：选取2012年1月—2013年1月在我院进行治疗的70例重型颅脑损伤患者,按随机分组原则分为实验组和对照组,实验组实施标准大骨瓣开颅血肿清除联合亚低温进行治疗,对照组实施标准大骨瓣开颅血肿清除术,通过比较两组患者治疗前、后颅内压的改变以及治疗结局进行效果评价。结果：实验组术后2、7d颅内压分别为（3．43±0．42）kPa和（2．83±0．42）kPa,对照组为（4．03±0．37）kPa和（3．69±0．28）kPa,实验组明显低于对照组,术后实验组患者严重不良事件发生率为31．43％,明显低于对照组的57．14％,P〈0．05,差异有统计学意义。结论：标准大骨瓣开颅血肿清除联合亚低温治疗重型颅脑损伤,可明显提高治疗效果,降低严重不良事件的发生率,建议在临床上推广应用。     

双侧平衡去骨瓣减压在重型闭合性颅脑损伤治疗中的 应用价值分析

目的 研究双侧平衡去骨瓣减压术治疗重型闭合性颅脑损伤的应用疗效.方法 回顾性分析本院近年诊治重型闭合性颅脑损伤患者52例,对照组26例行行单侧标准外伤大骨瓣减压术,研究组26例行双侧平衡去骨瓣减压术,比较两组的降压效果、生存质量及并发症情况.结果 研究组治疗后第1天和第3天颅内压分别为(22.5±4.2)mmHg、(20.8±4.1)mmHg,明显低于同期对照组(30.5±5.3)mmHg、(28.6±4.9)mmHg(P<0.05);术后生存质量上,研究组良好率42.3%均明显高于对照组15.4%;研究组并发症发生率11.5%明显低于对照组并发症发生率38.5%(P<0.05).结论 双侧平衡去骨瓣减压治疗重型闭合性颅脑损伤,能够有效快速降低颅内压,提高患者术后生存质量,降低死亡率和术后并发症率.     

标准大骨瓣减压术治疗重型颅脑损伤的临床效果研究

目的:分析标准大骨瓣减压术治疗重型颅脑损伤的临床疗效.方法:选取天津医科大学总医院滨海医院2015年2月—2020年2月收治的70例重型颅脑损伤患者,分为实验组(35例)和对照组(35例).实验组与对照组患者分别行标准大骨瓣减压术和常规骨瓣减压术进行治疗.对比两组手术前后颅内压情况、神经功能缺损情况及预后情况.结果:两组不同时间段的颅内压情况差异有统计学意义(t=2.489、4.968、11.333,P<0.05),且术后各时间段实验组颅内压均比对照组更低;两组术后30 d NIHSS评分较术前明显降低(t=9.917,P<0.05),且与对照组相比,实验组更低;实验组的预后优良率高于对照组(χ2=4.690,P<0.05).结论:对重型颅脑损伤患者应用标准大骨瓣减压术进行治疗,可以降低颅内压,改善神经功能缺损情况,患者预后良好.     

模拟颅内压骨窗保护装置在预防去骨瓣术后并发症中的应用

目的:探讨模拟颅内压骨窗保护装置在预防去骨瓣术后并发症中的应用效果。方法:从本院2014年6月-2016年5月收治的重型颅脑损伤行去骨瓣减压术的患者中随机选择42例设为观察组,从2008年6月-2010年5月收治的重型颅脑损伤行去骨瓣减压术患者中随机选择48例设为对照组。观察组术后给予模拟颅内压骨窗保护装置,对照组不给予保护,仅实施常规术后治疗,观察两组的脑膨出与硬膜下积液发生情况。结果:经术后并发症发生情况统计,观察组2例发生脑膨出,2例发生硬膜下积液;对照组5例发生脑膨出,6例发生硬膜下积液。观察组的并发症发生率为9.52%,显著低于对照组的22.92%,两组比较差异有统计学意义(P0.05)。结论:去骨瓣术后应用模拟颅内压骨窗保护装置可以有效降低术后并发症发生率,减少脑膨出与硬膜下积液的发生。     

大骨瓣减压术治疗重型颅脑损伤的临床研究

目的:探析大骨瓣减压术治疗重型颅脑损伤的疗效。方法:选取60例重型颅脑损伤患者作为研究对象,随机分成研究组(30例)与参照组(30例),前者采用大骨瓣减压术,后者采用常规骨瓣开颅术。将两组术后颅内压与预后评分(GOS)进行对比。结果:两组患者术后颅内压均有下降趋势,但研究组下降的程度更大,术后第1、第3、第7天,其颅内压分别为(2.05±0.30)、(1.62±0.20)和(1.42±0.20),均比参照组低,且差异具有显著统计学意义(P<0.05)。研究组63.33%的患者恢复良好,比参照组23.33%高,且数据差异显著,研究组重度残疾(6.67%)、植物生存(3.33%)患者所占的比重低于参照组,且差异具有显著统计学意义(P<0.05)。两组中度残疾与死亡患者所占的比例差异无显著统计学意义(P>0.05)。结论:相对于常规骨瓣开颅术,大骨瓣减压术在治疗重型颅脑损伤方面能获得更为理想的效果,具备减压充分,明显改善患者预后的优势,值得推广。     

重型颅脑损伤应用标准大骨瓣减压治疗疗效观察

目的:研究分析标准大骨瓣减压疗法临床上治疗重型颅脑损伤上的疗效及应用。方法:选择104例重型颅脑损伤患者,将其随机分为两组,两组患者分别给予常规骨瓣减压术和标准大骨瓣减压术,术后对两组手术的临床效果进行观察比较。结果:观察组患者术后6个月的GOS评分结果显示,17例患者的治疗效果良好,12例患者中残,10例患者重残。观察组有效率为75%,对照组为48%,二者差异有统计学意义(P<0.5);观察组患者术后第1、3、7天的颅内压分别降低至(21.4±3.1)、(19.3±2.4)、(15.7±2.2)mm Hg(1 mm Hg=0.133 3 kPa),与对照组比较,差异有统计学意义(P<0.05)。结论:标准大骨瓣减压术治疗重型颅脑损伤的临床疗效显著,降低了术后颅内压,提高患者的生活质量,值得临床借鉴推广。     

标准大骨瓣减压术治疗重型颅脑损伤的疗效分析

目的 探讨将标准大骨瓣减压术用于治疗重型颅脑损伤的临床效果.方法取在该院治疗的重型颅脑损伤患者72例,按照治疗方法的不同将其分为实验组与对照组.选取36例组成采用标准大骨瓣减压术治疗重型颅脑损伤的实验组,另36例则组成选用常规骨瓣开颅术治疗重型颅脑损伤的对照组.对比观察两组的患者的治疗效果、手术前后颅内压变化、并发症发生率以及预后良好率.结果 两组患者经治疗后发现,实验组手术前后颅内压的变化要比对照组手术前后颅内压的变化更安全,对照组患者的并发症发生率明显高于实验组患者的并发症发生率,实验组的预后良好率明显高于对照组的预后良好率.差异有统计学意义（P〈0.05）.结论 应用标准大骨瓣减压术治疗重型颅脑损伤比选用常规骨瓣开颅术治疗重型颅脑损伤的临床效果明显,手术前后颅内压降低、并发症发生率低及预后良好率高,治疗效果明显.     

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.