神经内镜下与开颅手术治疗脑出血临床疗效分析及安全性的影响因素探讨

目的探讨神经内镜下与开颅手术治疗脑出血的临床疗效及影响安全性的因素。方法对许昌市中心医院近3年行神经内镜下和开颅手术脑出血患者的一般临床资料、术后情况及安全性进行分析。结果与开颅组相比,内镜组手术时间、术中出血量、住院时间、术后并发症发生率明显减少,血肿清除率、术后1 d GCS评分明显提高(P<0.05);入院血肿、年龄、是否伴有脑室出血是影响患者术后并发症的影响因素。结论神经内镜下血肿清除术在术后恢复以及术后并发症的控制方面具有显著优势,而术后并发症的发生与年龄、术前血肿量、GCS评分以及伴有脑室出血等因素有关。     

神经内镜辅助超早期手术治疗丘脑出血破入脑室的疗效

目的 探讨神经内镜辅助超早期手术治疗丘脑出血破入脑室的临床效果.方法 选取2015年7月至2017年7月在太和县人民医院进行治疗的丘脑出血破入脑室的患者80例,40例患者采用神经内镜辅助超早期手术治疗(观察组),另40例患者采用单纯脑室外引流术进行治疗(对照组).比较两组患者治疗前后血肿体积大小、手术相关情况(术中出血量、术后引流时间、手术时间)以及术后3个月时格拉斯哥结局评分(GOS)优良率.结果 术前两组患者血肿体积大小差异无统计学意义(P>0.05),术后观察组患者血肿体积小于对照组(P<0.05),观察组患者手术时间长于对照组(P<0.05),术中出血量两组差异无统计学意义(P>0.05),观察组患者术后引流时间短于对照组(P<0.05).观察组患者术后3个月GOS评分优良率为57.50％,高于对照组的35.00％,差异有统计学意义(P<0.05).结论 神经内镜辅助超早期手术治疗丘脑出血破入脑室效果较好,能够改善患者的预后.     

前额锁孔入路神经内镜血肿清除术联合自制透明鞘管辅助治疗基底节区脑出血的效果分析

目的:探究前额锁孔入路神经内镜血肿清除术联合自制透明鞘管辅助治疗基底节区脑出血的效果,并分析其应用推广的价值,为疾病的治疗、康复提供依据。方法:经严格的入选标准和排除标准,回顾性选取基底节区脑出血患者共58例,按照患者的意愿,将其分为对照组(32例)和观察组(26例),对照组采用常规开颅手术的方法清除血肿,而观察组采用前额锁孔入路神经内镜血肿清除术联合自制透明鞘管进行治疗,比较两组患者治疗的效果,记录结果并经统计学软件分析处理。结果:与对照组相比,观察组手术时间短、术中出血量少、血肿清除率高、术后GOS评分高,差异具有统计学意义(P<0.05)。结论:前额锁孔入路神经内镜血肿清除术联合自制透明鞘管辅助治疗的方法效果显著,值得推广使用。     

神经内镜辅助治疗脑室出血的疗效观察

目的 观察神经内镜辅助治疗脑室出血的临床疗效。方法 选取我院收治的脑室出血患者68例,采取数字随机法分成两组,对照组(n=34)采取传统的脑室穿刺外引流术治疗,观察组(n=34)则采取神经内镜辅助脑室穿刺外引流术治疗,比较两组临床疗效。结果 观察组患者血肿清除程度优于对照组,差异有统计学意义(P0.05)。两组术前ADL评分比较,差异无统计学意义(P0.05)。两组患者术后ADL评分均低于术前,差异有统计学意义(P0.05)。观察组患者术后ADL评分低于对照组,差异有统计学意义(P0.05)。观察组患者引流管留置时间短于对照组,差异有统计学意义(P0.05)。观察组并发症率2.94%,对照组并发症率23.52%,观察组患者并发症率低于对照组,差异有统计学意义(P0.05)。结论 神经内镜辅助治疗脑室出血的效果显著,是一种优秀的手术辅助手段。     

神经内镜血肿清除术治疗重型脑室出血患者的临床价值

目的:分析神经内镜血肿清除术在重型脑室出血患者中的应用价值.方法:选取接受治疗的重型脑室出血患者60例,依照手术方案不同分为钻孔组和内镜组,各30例.钻孔组患者采用钻孔外引流术,内镜组患者采用神经内镜血肿清除术,比较两组患者的手术时间、引流管放置时间、住院时间、术后48 h血肿清除率、并发症发生率及术前、术后3个月Barthel指数、爱丁堡-斯堪的纳维亚(MESSS)评分.结果:内镜组患者术后48 h血肿清除率高于钻孔组(P<0.05);术后3个月内镜组Barthel指数评分高于钻孔组,MESSS评分低于钻孔组(P<0.05);内镜组并发症发生率6.67％低于钻孔组的26.67％(P<0.05).结论:神经内镜血肿清除术治疗重型脑室出血患者血肿清除率高于钻孔外引流术,可改善患者神经功能及日常生活能力,且安全性高.     

完全神经内镜与显微手术治疗高血压基底节区脑出血对比研究

目的：探讨完全神经内镜与显微手术用于高血压基底节区脑出血治疗的优劣。方法对106例基底节区高血压脑出血的患者分别进行完全神经内镜手术和显微镜辅助微创手术,观察记录2组患者的手术时间、血肿清除率、再出血率、术后清醒时间及GCS评分和ADL评分。结果神经内镜组患者的手术时间、清醒时间和再出血率显著低于显微手术组,而血肿清除率、术后GCS评分和ADL评分显著高于显微手术组,差异均具有统计学意义（P<0.05）,不良反应发生率和死亡率比较差异无统计学意义。结论完全神经内镜比显微镜辅助治疗基底节区高血压脑出血清除血肿更彻底、止血更可靠,具有较高的疗效。     

老年基底节区脑出血微侵袭手术治疗的临床疗效观察

目的 观察老年基底节区脑出血不同微侵袭手术方式的临床疗效。方法 本研究为回顾性病例对照研究,收集2020年1月至2022年12月住院手术治疗的老年基底节区脑出血患者60例,采用神经内镜经额中回入路清除血肿的20例患者为内镜组;采用显微镜经侧裂入路清除血肿的20例患者为显微镜组;采用软通道穿刺置管引流术清除血肿的20例患者为穿刺组。观察3组患者手术时间、术中出血量、术后术区残余血肿量、术后术区再出血例数、术后手术并发症发生情况;术前术后7 d格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表评分(NIHSS);术后6个月格拉斯哥预后评分(GOS)。结果 3组患者术后7 d GCS、NIHSS评分较术前明显改善,3组间比较差异有统计学意义(P<0.05),内镜组和显微镜组明显优于穿刺组(P<0.05);3组患者术后6个月GOS评分差异有统计学意义,内镜组和显微镜组明显优于穿刺组(P<0.05);3组手术时间、术中出血量、术后术区残余血肿量差异有统计学意义(P<0.05),穿刺组手术时间、术中出血量明显小于内镜组和显微镜组(P<0.05),但穿刺组术后术区残余血肿量明显多于内镜组和显微镜组(P<0.05);穿刺组术后术区再出血例数明显多于显微镜组(P<0.05);3组术后肺部感染和泌尿道感染例数比较差异有统计学意义(P<0.05),穿刺组肺部感染、泌尿道感染、手术部位感染明显高于内镜组(P<0.05)。结论 临床上要根据老年基底节区脑出血患者的具体情况选择手术方式,条件允许的情况下优先选择神经内镜直视下清除血肿,近期和远期疗效佳,术后并发症发生率低。     

微创手术早期治疗脑室内出血的疗效分析

目的:探讨神经内镜手术结合腰椎穿刺置管引流在脑室内血肿治疗中的作用。方法:神经内镜组28例,发病1d内清除脑室内血肿,放置脑室引流管,术后行尿激酶脑室内灌洗,腰椎穿刺置管持续引流;对照组25例,行侧脑室穿刺引流术,术后常规注入尿激酶溶化血肿。结果:神经内镜组28例,术后次日8例脑室内血肿完全清除,17例大部分清除,3例部分清除。术后2周GCS为(13.21±0.79)分,显著高于术前的GCS(9.21±0.34)分,P<0.001。脑室穿刺组组25例,术后次日脑室内血肿无明显变化,术后1周18例大部分清除,7例部分清除。术后2周GCS为(11.06±1.15)分,显著高于术前评分(9.27±0.28)分,P<0.001。随访2个月后,神经内镜组GOS为(13.54±0.45)分,显著高于脑室穿刺组(11.09±0.53)分,P<0.001。结论:神经内镜手术清除血肿,联合腰椎穿刺置管持续引流可以明显缩短脑室出血的病程,改善预后。     

导航辅助神经内镜硬通道技术治疗基底节区高血压脑出血患者的临床疗效

目的 探讨导航辅助神经内镜硬通道技术治疗基底节区高血压脑出血的疗效.方法 选取桂林医学院附属医院入住的82例基底节区高血压脑出血患者为研究对象,其中37例采用神经内镜硬通道技术治疗,45例采用小骨窗开颅血肿清除术治疗.比较两组患者手术时间、术中出血量、血肿清除率、并发症发生率,以及生存患者术后3个月美国国立卫生院神经功能缺损评分(NIHSS评分)等方面的差异.结果 与骨窗组相比,内镜组的手术时间更长、血肿清除率更高、颅内再出血的发生率更低、短期预后更佳(P<0.05).在术中出血量和其他术后并发症方面,两组患者差异无统计学意义(P>0.05).结论 导航辅助神经内镜硬通道技术可以提高基底节区高血压脑出血患者的治愈率.     

神经内镜微创手术和开颅血肿清除术治疗基底节区高血压脑出血疗效对比研究

目的探讨神经内镜微创手术和开颅血肿清除术在基底节区高血压脑出血中的临床疗效。方法对我院收治的50例基底节区高血压脑出血资料进行分析,根据不同治疗方法将患者分为开颅组和内镜组,开颅组采用开颅血肿清除术治疗,内镜组采用神经内镜微创手术治疗,比较两组疗效。结果内镜组手术时间为(1.5±0.8)h、术中出血量为(40.0±19.7)m L,显著少于对照组(P0.05);内镜组血肿平均清除率为(92.6±9.4)%,显著高于开颅组(P0.05);内镜组GCS评分3~5分者住院时间为(11.5±1.5)d,GCS评分6~8分者住院时间为(7.8±2.2)d,GCS评分9~13分者住院时间为(3.0±1.2)d,均显著短于开颅组(P0.05);内镜组术后并发症发生率为4%,显著低于对照组20%(χ2=4.15,P0.05)。结论基底节区高血压脑出血患者采用神经内镜微创手术治疗效果理想,值得临床推广使用。     

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.