听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

组织蛋白酶D在星形细胞瘤中心区、周缘区和水肿区的表达情况

目的 探讨组织蛋白酶D(CathD)在人脑星形细胞瘤瘤体中心区、周缘区和瘤周水肿区的表达情况及临床意义.方法 选择核磁共振检查未见肿瘤坏死或囊变且瘤体区与水肿区有明显分界的41例星形细胞瘤患者,分为复发组13例、未复发组28例.术中对照磁共振FLAIR序列留取瘤体中心区、周缘区和水肿区后行CathD免疫组化染色,对其在不同区域表达水平进行分析.结果 CathD在正常脑组织无或弱表达,其在瘤体中心区、瘤周水肿区和周缘区呈阳性表达,且周缘区[(10.780±1.557)分]高于中心区[(2.610±0.945)分],差异有统计学意义(P<0.05).在瘤体周缘区复发组CathD表达[(11.539±1.127)分]强于未复发组[(10.429±1.620)分],差异有统计学意义(P<0.05),而在瘤体中心区复发组与未复发组CathD表达差异无统计学意义(P>0.05).结论 周缘区和水肿区CathD明显表达提示瘤周水肿区可能是瘤细胞易于发生浸润的区域:中心区CathD相对低表达说明该区细胞外基质已被降解殆尽,是肿瘤侵袭较早发生的区域;周缘区和水肿区CathD表达情况可作为一种判断肿瘤复发的指标.     

鼻内窥镜下下鼻甲部分切除术加微波热凝止血80例疗效观察

目的 :探讨经鼻内窥镜下下鼻甲部分切除术的疗效、优点。微波在鼻甲手术后的止血应用价值。方法 :对经鼻内窥镜下下鼻甲部分切除术后的 80例 (15 0侧 )鼻甲残端进行微波热凝止血 ,并进行了总结。结果 :80例术后无并发症、无出血、无需鼻腔填塞 ,6个月以上随访 ,治愈率达 10 0 %。结论 :该手术直视下进行 ,简捷、安全、出血少、患者痛苦小、无并发症、疗效高 ,适合老年体弱患者     

刮痧疗法治疗慢性疼痛疾病的临床观察

刮痧疗法是中医传统的外治方法之一,对疼痛性疾病有立竿见影的效果,笔者用于临床不同疾病所致疼痛,均获佳效. 1 临床资料 选择2005年1月至2009年1月的我科门诊病人123例,经检查确诊为颈椎病65例,肩周炎43例,腰肌纤维织炎15例,均有不同程度的功能障碍(活动受限).其中男性47例,女性76例;年龄17岁～70岁;病程最短3个月,最长4年.     

C_5颈椎神经阻滞结合针刀松解术治疗颈肩综合征疗效观察

目的探讨C5颈椎神经阻滞及颈肩部针刀松解术治疗神经根型颈椎病引发的颈肩综合征疗效。方法选择80例颈椎病及肩周炎(颈肩综合征)患者,随机分为2组:治疗组40例采用颈神经根阻滞联合颈肩针刀松解术,对照组40例采用颈肩针刀松解术,术后1周、3个月对2组患者疗效进行随访,根据视觉模拟评分(VAS)、Constant murley法进行疗效评定。结果最终治疗组39例、对照组39例完成随访。2组治疗后1周、3个月VAS值均较治疗前明显降低(P均0.01),治疗后1周VAS值2组比较差异无统计学意义(P0.05),治疗后3个月VAS值治疗组低于对照组(P0.05);治疗后3个月治疗组有效率明显高于对照组,差异具有统计学意义(P0.05)。结论颈椎神经阻滞联合肩背部注射治疗颈肩综合征疗效显著,作用持久,值得临床推广。     

地塞米松对脑出血术后血清IL-6的影响

目的观察脑出血患者术后血清IL-6浓度的动态变化及地塞米松治疗对其表达的影响。方法随机将120例脑出血术后患者分为常规治疗组（n=60）、地塞米松治疗组（n=60），以60例健康体检者为对照组。测定术后第1、3、7、10、14天清晨空腹外周静脉血清IL-6、白细胞总数、单核细胞、淋巴细胞和CSS评分变化。结果常规治疗组术后第1天血清IL-6含量最高，第3天开始下降，第10天仍高于对照组（P〈0．05），第14天与对照组基本一致。地塞米松治疗组各期均低于常规治疗组（P〈0．05）。IL-6含量与单核细胞密切相关。结论血清IL-6参与了脑出血急性期的炎性病理生理过程，地塞米松可使血中IL-6含量降低，减轻炎性反应。     

西沙必利治疗老年人糖尿病性胃轻瘫——附36例疗效分析

本文通过口服西沙必利10mg,1日3次,共4周,治疗老年人糖尿病性胃轻瘫36例,观察消化不良症状的改善,以及记录胃电图的改变。结果表明,对上腹胀满、早饱的有效率分别95%、93%;治疗后,胃电图振幅明显增大,说明西沙必利治疗老年人糖尿病性胃轻瘫取得满意疗效。     

推拿合用蠲痹洗剂熏蒸治疗腰椎间盘突出症108例

目的:观察推拿合用蠲痹洗剂熏蒸治疗腰椎间盘突出症的疗效。方法:采用推拿合用自拟蠲痹洗剂(伸筋草、透骨草、川椒、艾叶、川乌头、草乌头、地鳖虫、补骨脂、骨碎补、红花、乳香、没药)熏蒸治疗。结果:108例总有效率95.4%。提示:本方法对本病具有温经散寒,通痹止痛的功效。     

实验性大鼠脑出血急性期血浆及脑组织中白介素8表达的研究

目的 探讨白介素8(IL-8)在实验性大鼠脑出血急性期脑组织和血浆中的含量变化,阐明其在脑出血过程中的作用.方法 SD大鼠100只,体质量250～300 g,随机分为4组:对照组、小量出血组、中量出血组、大量出血组;每组又分成15个小组,每小组5只.采用未抗凝新鲜自体股动脉血注入大鼠尾状核建立脑出血动物模型.用放射免疫法测定脑出血后3 h、6 h、12 h、24 h和48 h各时间点血浆及脑组织中IL-8的含量.结果 脑组织中IL-8含量,脑出血后3 h开始升高,6 h明显增加,12 h达高峰,24 h开始下降,48 h恢复正常.6 h、12 h、24 h各实验组与对照组比较差异具有显著性(P＜0.05),6 h、12 h、24 h各组间比较大量组与中、小量组差异具有显著性(P＜0.05),中量与小量组间仅在12 h和24 h差异具有显著性(P＜0.05).血浆中IL-8含量在脑出血后3 h开始升高,6 h达高峰,12 h开始下降,24 h恢复正常.3 h、6 h、12 h各实验组与对照组比较差异具有显著性(P＜0.05),6 h、12 h各组间比较大量组与中、小量组以及中量与小量组间差异具有显著性(P＜0.05).结论 IL-8升高是脑出血后中枢神经系统受损后免疫应答致炎症反应所致,监测IL-8浓度变化对了解脑出血后的脑组织变化和判别预后有重要意义.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.