原发性脑室出血的病因、治疗与预后(附35例报告)

35例经CT证实的原发性脑室出血(PIVH)患者。病因是高血压、烟雾病、动静脉畸形、动脉瘤。PIVH分为三型:Ⅰ型室管膜下出血、Ⅱ型部分脑室出血、Ⅲ型全脑室出血。对Ⅰ型非手术治疗。对Ⅱ、Ⅲ型合并意识障碍手术治疗。多数病人生存下来(35例生存29例),但记忆力减退持续存在。     

Tranexamic acid for major trauma patients in Ireland

BACKGROUND: The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2. METHODS: A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome. RESULTS: During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38). CONCLUSIONS: Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated.     

上海市肾综合征出血热流行病学监测

[目的 ]　了解 1999年上海市肾综合征出血热 (HFRS)发病特点和规律 ,宿主动物对发病的影响。 [方法 ]　对本市HFRS病例、动物种类分布、病原感染和人群隐性感染等进行流行病学和血清学监测。 [结果 ]　本市HFRS有冬季和夏季两个流行高峰 ,夏季发病有增加趋势。健康人群隐性感染为 2 .0 3 % ,野外和室内鼠类密度分别为2 .32 %和 1.42 % ,室内动物感染HFRS病毒率为 4.40 % ,野外动物感染率为 2 .43%。 [结论 ]　夏季HFRS发病增加与宿主动物带病毒率有关 ,应加强夏季流行前灭鼠防治工作。     

新生儿颅内出血CT及临床分析

目的：研究新生儿颅内出血ＣＴ表面及围产期影响因素。材料与方法：本研究对５６例新生儿颅内出血及其影响因素进行回顾性分析。结果：５６例患儿颅脑ＣＴ检查显示单纯蛛网膜下腔出血４３例（７６．８％）,蛛网膜下腔出血合并脑实质内或脑室内出血１０例（１７．９％）,单纯脑实质内出血３例（５．４％）,２７例（４８．２％）合并有缺氧性脑病。结论：新生儿颅内出血中蛛网膜下腔出血发病率最高,达９５．６％,常合并有缺氧缺血     

急性大出血及不同液体容量复苏对犬血清S100B蛋白的影响

目的 探讨急性大出血时及静脉输注6％羟乙基淀粉(6％HES)或单纯复方乳酸钠行容量复苏后血清S100B蛋白(简称S100B)的变化,评价6％HES对减轻失血性休克时脑神经损害的作用。方法 实验犬12只,随机分为6％HES治疗组(H组)和复方乳酸钠治疗组(L组),股动脉放血复制成急性大出血动物模型。在放血造成失血性休克60min后分别静脉输注6％HES和复方乳酸钠。于放血前(T0),放血完毕后60min(T1),液体治疗后30min(T2)、2h(T3)、4h(T4)抽取静脉血测定血清S100B含量。结果 放血造成失血性休克后,两组S100B均显著升高(P＜0．01);液体治疗后2h和4h,S100B均比前一时点显著下降(P＜0．01);液体治疗后,H组的S100B浓度显著低于L组(P＜0．01)。结论 急性大出血所致的失血性休克可导致血清S100B的急剧升高,提示急性大出血及失血性休克可能导致中枢神经损害。有效的容量治疗可促使S100B逐步下降。6％HES容量治疗对减少S100B的释放的效果优于复方乳酸钠。     

Treatment Options for Massive Irreparable Rotator Cuff Tears

Purpose of ReviewMassive irreparable rotator cuff tears present a significant challenge to the orthopedic surgeon. No single treatment, particularly among joint-preserving options, has been shown to be superior. The purpose of this review is to discuss recent advances in the treatment of massive irreparable rotator cuff tears, including partial repair with and without graft augmentation, interposition grafts, superior capsule reconstruction, subacromial balloon spacers, tendon transfer, and reverse total shoulder arthroplasty. We will also offer guidance on surgical indications based on our clinical experience.Recent FindingsPartial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates. Additionally, several types of interposition grafts have shown promising short-term results and may outperform repair alone. Subacromial balloon spacers may lead to clinical improvement, especially in patients without glenohumeral osteoarthritis or pseudoparalysis, and recently received FDA approval for use in the USA. Superior capsule reconstruction is a technically demanding procedure that appears to produce excellent short-term results particularly when performed at high volume, but long-term studies in heterogeneous study groups are needed. Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients. Reverse total shoulder arthroplasty (RTSA) is a reliable option for treatment of irreparable cuff tears in elderly patients with lower functional demands.SummaryIrreparable cuff tears remain a difficult condition to treat. Recommended treatment for younger patients without glenohumeral osteoarthritis is particularly controversial. For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option. For all discussed procedures, patient selection appears to play a critical role in clinical outcomes.     

别嘌呤醇对家兔低血容量性休克-再灌注损伤的防治作用

目的探讨别嘌呤醇对家兔血容量性休克—再灌注损伤的保护作用。方法制备家兔低血容量性休克模型,随机分为非保护组（n＝10）和别嘌呤醇保护组（n＝10）,并检测血浆和心、肺等组织黄嘌呤氧化酶（XO）活性、丙二醛（MDA）含量及平均动脉压（MAP）值。结果休克前两组动物XO、MDA及AIAP均无统计学差异。休克90分钟时两组动物MAP均显著下降,XO及MDA均明显升高。休克—再灌注后,保护组XO及MDA均逐渐下降,休克—再灌注3小时后接近休克前水平,明显低于休克90分钟时和非保护组同时相水平;保护组MAf,逐渐上升,休克—再灌注3小时后接近休克前水平,明显高于休克90分钟时及非保护组同时相水平。此外,别瞟吟醇保护组心、肺、肝、肾、肠道组织XO及MDA均明显低于非保护组XO及MDA值。结论别嘌呤醇通过抑制黄瞟吟氧化酶活性、减少氧自由基生成可减轻组织休克—再灌注损伤。     

大黄对危重症患者胃肠粘膜血流灌注的影响

目的　研究大黄对胃肠粘膜血流灌注的影响。方法　选用激光多普勒血流监测仪和胃肠粘膜内pH(pHi)值作为评估失血性休克动物模型和脓毒症患者胃肠粘膜血流灌注的指标。结果　动物实验显示 :失血性休克大鼠尽管予以充分复苏 ,但胃肠粘膜的血流量仅是对照组的一半 ,给予大黄治疗 (5 0mg/kg)后 ,胃肠粘膜的血流量接近正常对照组 (P <0 0 1VS休克组 )。此外正常大鼠喂服大黄后胃肠粘膜的血流量显著提高 (P <0 0 1VS正常对照组 )。临床研究显示 :脓毒症患者胃和直肠粘膜内pHi明显低于对照组 (P <0 0 0 1)。多器官功能障碍综合征 (MODS)患者 ,其pHi显著低于非MODS患者 (P <0 0 0 1VS治疗前 )。另外 ,大黄对应激性胃粘膜病变有效率达 73%。结论　大黄能提高失血性休克大鼠和危重症患者胃肠粘膜内血流灌注。     

应当提倡大面积脑梗死后恶性脑水肿的预防理念及其研究

大面积脑梗死是缺血性脑卒中致死致残的主要类型,恶性脑水肿是大面积脑梗死预后不良的常见原因,一旦发生,治疗效果极差。当前研究和临床指南多关注恶性脑水肿发生后监护室管理及手术治疗等下游处理措施,针对恶性脑水肿防治的适宜措施相关研究明显滞后。我们认为如果能将防治关口前移,在恶性脑水肿发生前进行早期预测并及时干预,将比发生后的治疗更合理且可行。在研究方面应探索大面积脑梗死患者脑水肿特别是恶性脑水肿发生发展的自然史规律,探索早期预防干预的时间窗;研究其发生的危险因素及早期预测因素,从而筛选适宜患者进行精准干预防止或减轻恶性脑水肿发生。临床医生应重视大面积脑梗死早期临床表现,动态观察记录病情变化,及时予以综合性个体化管理,通过预防恶性脑水肿发生达到降低脑卒中疾病负担的最终目的。