健脾和胃合剂缓解胰腺癌伽玛刀放疗后胃肠道反应的临床观察

目的观察健脾和胃合剂缓解胰腺癌伽玛刀放疗后出现胃肠道反应的临床疗效。方法对60例行伽玛刀放疗的胰腺癌患者进行回顾性分析,采用随机分组法将患者分为实验组和对照组,伽玛刀放疗第1天起,实验组给予肌肉注射胃复安联合口服健脾和胃合剂治疗,对照组给予肌肉注射胃复安治疗。观察伽玛刀放疗过程中和放疗结束后7 d内两组缓解胃肠道反应的临床疗效。结果实验组胃肠道反应总控制率明显高于对照组(P<0.05)。结论健脾和胃合剂具有益气健脾、和胃降逆之功效,能有效缓解胰腺癌伽玛刀放疗后胃肠道反应,改善患者食欲。     

原发性脑室内出血47例前瞻性临床研究

目的 研究并明确原发性脑室内出血(PIVH)的病因、临床特征、危险因素和预后.方法 前瞻性地制订严格的纳入标准,连续收集2008年9月至2010年10月在我院诊治的PIVH患者,对其临床资料、辅助检查、治疗方式及预后进行分析.结果 共纳入47例患者,男27例,女20例,比例为1.35∶1,平均年龄(52.6±126)岁.GCS评分10.8±2.6;Graeb评分5.8±26;合并梗阻性脑积水者22例(47%);确诊Moyamoya病12例(26%),动静脉畸形10例(21%)和动脉瘤5例(11%),病因不详20例(43%).单纯开颅手术12例(26%),开颅联合脑-硬膜-血管-肌肉血管融合术(EDAMS)6例(13%),单纯EDAMS治疗5例(11%),EDAMS联合吻合手术1例(2%),脑室外引流3例(6%),γ-刀治疗8例(17%),介入治疗2例(4%o),保守治疗10例(21%).患者均随访6个月,住院死亡7例(15%),6个月末mRS评分＜3分者31例(66%),≥3分者9例(19%),出院后无死亡病例.结论 PIVH临床少见,发病年龄相对较小;Moyamoya病、动静脉畸形和动脉瘤是排前三位的病因,高血压是最主要的危险影响因素;通过合理治疗,PIVH可获得较好的预后;年龄、高血压、糖尿病、吸烟史及入院时GCS评分可不同程度预测住院死亡率.

Abstract：

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage (PIVH).Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010.The clinical information, laboratory examinations, treatment and prognosis were analyzed.Results 47patients(27 males and 20 females, a ratio of 1.35: 1, with an average age of 52.6 ± 12.6 years old) were internalized in the study.The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases.The GCS score was 10.8 ± 2.6 and Graeb score was 5.8 ± 2.6.Combined obstructive hydrocephalus was found in 22 cases (47%).The diagnosis of moyamoya disease was confirmed in 12 patients (26%), while vascular malformations in 10 (21%) and aneurysm in 5( 11% ).The other 20 patients had unknown etiology (43%).Craniotomy was performed in 12 cases (26%), craniotomy combined EDAMS in 6(13%), EDAMS in 5(11% ), EDAMS combined with anastomosis in 1(2% ), ventricular drainage in 3(6% ), γ-knife in 8( 17% ), interventional therapy in 2(4% ), and conservative treatment in 10 patients (21%).All patients were followed - up for 6 months.7 cases of hospital mortality (15%) were found.31 patients (66%) got less than 3 points of mRS score at the end of the 6th month, and 9 patients ( 19% ) had greater than or equal to 3 points.After discharge there was no death.Conclusion PIVH is relatively rare in clinical practice.The age of onset for PIVH is relatively small.Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor.Through reasonable treatment, patients with PIVH could get better prognosis.Age, hypertension, diabetes, smoking history and admission GCS score could predict hospital mortality in varying degrees.     

益肝汤联合体部伽玛刀治疗原发性肝癌的临床研究

目的 观察益肝汤联合体部伽玛刀治疗原发性肝癌的临床疗效.方法 将患者随机分为两组,对照组使用体部伽玛刀及对症治疗,治疗组在对照组治疗基础上联合口服益肝汤.两组均治疗3个月后观察患者近期疗效、体力状况积分、生存期、肝功能及甲胎蛋白(AFP)等.结果 两组治疗后体力状况评分、肝功能、AFP方面与治疗前比较,差异均有统计学意义.治疗组在体力状况评分、AFP方面的疗效明显优于对照组.两组患者的近期疗效及6个月生存率相当,无明显差异;两组均未观察到明显不良反应.结论 益肝汤联合体部伽玛刀治疗原发性肝癌,可缓解患者症状、减轻痛苦、提高生活质量,降低血清AFP水平.     

耳硬化CT表现与临床症状的比较分析

目的 将耳硬化患者术前CT表现与临床症状进行对比,评估CT检查对耳硬化的诊疗意义.方法 回顾性分析2005年7月—2010年1月间在我科经手术证实且资料完整的耳硬化病例共84例168耳,术前均行颞骨薄层CT扫描、电测听、声阻抗检查,统计CT诊断耳硬化的阳性比例.结果 84例168耳中CT阳性耳143耳,阳性率85.1％...     

高血压丘脑出血的治疗探讨及疗效分析

目的 探讨高血压丘脑出血的治疗策略、疗效及手术适应证.方法 总结分析137例高血压丘脑出血患者的临床资料,对不同病情级别组患者的治疗方式、疗效及预后进行比较.结果 137例患者中,手术治疗62例;保守治疗75例.中小血肿组(≤30ml)77例,22例接受钻孔引流术,保守治疗55例;大血肿组(＞30ml)60例,开颅手术治疗40例,保守治疗20例.手术治疗死亡率11.3%(7/62);保守治疗死亡率9.3%(7/75),两组近期死亡率比较差异有统计学意义(P＜0.05);中小血肿组手术治疗与保守治疗的死亡率比较差异无统计学意义(P＞0.05);大血肿组手术治疗死亡率明显低于保守治疗(P＜0.05).随访3-9个月,中小血肿组预后明显好于大血肿组(P＜0.05);大血肿组手术治疗的远期预后明显好于保守治疗(P＜0.05);并发脑积水患者预后明显差于无脑积水患者(P＜0.05).mRS评分1～2分39例(31.7%),3～4分45例(36.6%),5分26例(21.1%),6分即远期死亡13例(10.6%).结论 丘脑中小血肿组首选保守治疗,若脑积水形成或血肿量扩大,应及时行钻孔引流术或开颅手术治疗;对于大血肿组手术疗效及预后较好,应尽早开颅手术治疗.根据患者具体情况制定合理的治疗方案,可以获得良好的预后.

Abstract：

Objective To investigate the treatment strategies, efficacy and surgical indications of hypertensive thalamic hemorrhage.Methods A retrospective analysis of the clinical data of 137 cases with hypertensive thalamic hemorrhage (HTH) from January 2008 to January 2010 in West China Hospital of Sichuan University were performed to compare the efficacy and prognosis between surgical treatment group and conservative treatment group.Results Of the 137 patients, 62 patients underwent surgery and 75 patients receivedconservative treatment.In small hematoma group, 22 patients underwent borehole and drainage and 55 cases received conservative treatment.In large hematoma group, 40 patients received craniotomy to remove     

高压氧治疗兔创伤性脑损伤的磁共振观察

目的 应用磁共振(MRI)动态观察高压氧(HBO)治疗对创伤性脑损伤导致的脑水肿、血脑屏障和神经行为学评分的影响.方法 将24只兔按数字随机表法分为3组:假手术组5只,仅开直径8 mm颅骨窗;对照组10只,颅骨开窗后给予0.2 MPa液压冲击;HBO组9只,在对照组的基础上给予HBO治疗.造模成功后分别于6、24、72、120 h进行MRI扫描,计算脑水肿的体积和表观弥散系数(apparent diffusion coefficient,ADC)值,并行神经行为学评分.结果 HBO组经过治疗后,神经行为学评分较对照组显著改善(P＜0.05),如伤后第5天时,HBO组(1.375±0.518)分,对照组(2.250±0.463)分.MRI观察假手术组未见异常,对照组和HBO组治疗前均可见明显脑水肿及血脑屏障破坏,HBO组经HBO治疗后水肿吸收及血脑屏障修复均较对照组快(P＜0.01),如伤后第5天时,HBO组脑水肿体积为(183.41±17.56)mm3,对照组为(246.63±24.27)mm3;ADC值小于对照组(P＜0.05).结论 HBO治疗可以加速液压冲击脑损伤后血脑屏障的恢复,减轻脑水肿,显著减轻其症状,降低致残率.

Abstract：

Objective To observe the effects of HBO therapy on cerebral edema, blood-brain barrier and neural behavioral scores, induced by brain trauma injury in rabbits with magnetic resonance imaging ( MRI). Methods Twenty-four rabbits were randomly divided into three groups: the sham operation group (n =5), with a skull window of only 8 mm in diameter; the control group (n = 10) , sustained with shock injury (shock intensity of 0.2 Mpa) following skull fenestration; the HBO group(n=90), also sustained with shock injury following skull fenestration, but with HBO treatment. Following the development of the model, MRI scans were made at 6th, 24th, 72nd, and 120th hours to calculate the volume of cerebral edema, apparent diffusion coefficient ( ADC), and neurological behavioral scores. Results After HBO treatment, neurological behavioral scores of the HBO group improved significantly, when compared with that of the control group (P＜ 0. 05). MRI showed that abnormality was not noted in the sham operation group. Before treatment, significant cerebral edema and damage of blood-brain barrier could be seen in both the HBO group and the control group. However, following HBO treatment, cerebral edema and blood-brain barrier damage of the HBO group recovered more rapidly, when a comparison was made between the groups (P＜0. 01) and ADC value of the HBO group was lower than that of the control group (P＜0. 05). Conclusions HBO could hasten recovery of the blood-brain barrier damage induced by cerebral damage with hydraulic impetus, reduce cerebral edema, significantly decrease symptoms of brain injury, and reduce disability rate.     

长沙市临床医生脑卒中知晓率调查

目的:调查长沙市临床医生对脑卒中危险因素、症状识别、治疗方法等的知晓情况,为医院脑卒中的预防及治疗提供科学建议.方法:采用整群随机抽样法抽取长沙市三级医院的381例在职临床医生为调查对象,采取脑卒中相关知识调查问卷进行调查.结果:不同特征临床医生对脑卒中危险因素的总知晓率最高的分别为40～50岁年龄段、急诊科、副主任医...     

颞骨孤立性骨浆细胞瘤的临床特征

目的总结以往文献报道的颞骨孤立性骨浆细胞瘤的临床特征、诊断和治疗,为其临床诊治提供依据。方法通过本文报道的1例颞骨孤立性骨浆细胞瘤及复习往文献报道的病例,对11例颞骨孤立性骨浆细胞瘤的症状体征、实验室检查、影像学、病理、诊断、治疗和预后进行比较分析。结果 11例颞骨孤立性骨浆细胞瘤病例中所有病例均有不同程度的听力下降,耳局部症状明显,其中9例有颅神经损害症状,骨质破坏明显。结论浆细胞瘤是源于B淋巴细胞的恶性肿瘤,原发于颞骨的孤立性浆细胞瘤极为罕见,诊断主要依靠临床表现、影像学和病理,治疗方法为手术和放疗。     

外耳道胆脂瘤CT分期及手术方式

目的探讨外耳道胆脂瘤(external auditorycanal cholesteatoma,EACC)的CT分期方法和手术方式。方法对66例(66耳)EACC手术病例进行回顾性分析,根据颞骨CT中EACC的侵犯范围进行分期,并对不同分期EACC的手术方式进行分析。结果 66例EACC中,I期13例(19.7%),II期35例(53.0%),III期18例(27.3%)。13例I期病例中,11例行胆脂瘤清除术,2例行外耳道成形术;35例II期病例中,34例行外耳道成形术,1例行乳突切开术+外耳道成形术;18例III期病例中,10例行鼓室成形术+外耳道成形术,2例行乳突切开术+外耳道成形术,6例行乳突切开术+鼓室成形术+外耳道成形术。随访6个月～3年,61例无复发,2例复发,3例失访。结论 EACC的CT分期有助于选择正确的EACC手术方式。     

功能性胃肠疾病患者的情绪障碍调查分析

对象与方法对象随机选自消化内科住院及门诊患者，根据美国学者Ｄｉｏｓｍａｎ主编《功能性胃肠疾病》（ＴｈｅＦｕｎｏｔｉｏｎａｌＧａｓｔｒｏｉｎｔｅｓｔｉｎａｌＤｉｓｏｒｄｅｒｓＦＧＩＤ）一书［１］的功能性胃肠疾病诊断标准诊断明确的１１８例ＦＧＩＤ患者。全...