不同手术方法对高血压脑出血患者康复的影响

目的：探讨不同手术方法对高血压脑出血患康复影响的临床意义。方法：采用立体定向血肿排空术(34例)和骨瓣开颅术(40例)进行对照研究。结果：2组近期疗效无明显差异，远期疗效立体定向组并发症发生率低，神经功能恢复快，ADL评定优于骨瓣组。结论：微创、减压及超早期手术是高血压脑出血较佳的外科治疗方法。     

微创术治疗高血压脑出血的临床研究

目的 探讨微创清除(微创)颅内血肿治疗高血压脑出血患者的疗效.方法 对32例(微创术组)基底节区高血压脑出血、血肿量大于60ml的患者,采用脑CT片进行穿刺点定位,YL-1型颅内血肿粉碎穿刺针对血肿进行穿刺、液化、引流,评估其病死率、好转率及治疗3周时神经功能评分,并与单纯药物治疗组(对照组32例)进行比较.结果 微创术治疗组死亡8例,病死率25.00%,好转23例,好转率71.88%;单纯药物治疗组死亡16例,病死率50.0%,好转15例,好转率46.88%.微创术组病死率显著低于单纯药物治疗组(P＜0.01),好转率则显著高于单纯药物治疗组(P＜0.01);治疗3周时,微创术组神经功能评分为15.47±3.75分,单纯药物治疗组为21.45±4.46分.两组差异有非常显著意义(P＜0.01),提示微创术治疗组患者神经功能恢复程度好于单纯药物治疗组.结论 微创术治疗高血压脑出血患者效果较好,值得临床应用.     

产后出血48例临床分析

目的：探讨产后出血发生的病因及防治措施。方法：对2004—2005年48例产后出血的临床资料进行分析。结果：发病原因依次为：子宫收缩乏力、子宫颈撕裂伤、子宫切口的撕裂、胎盘因素。结论：针对出血主要原因，应采取快速、有效的止血方法，加强产程的观察及产前的预测，减少产后出血的发生率。     

钻颅碎吸治疗急性期高血压性脑出血疗效观察

目的总结钻颅碎吸治疗高血压性脑出血的疗效。方法利用配对方法与保守治疗病人进行对比。碎吸组反复穿刺血肿,调整血压。对照组采取降颅压,营养脑细胞等内科治疗。结果碎吸组病死率15.6%,对照组病死率27%,两组相比P<0.05,CT观察发现,碎吸治疗可加速血肿的吸收。半年后随访结果表明,碎吸治疗可降低致残率。结论钻颅碎吸术可作为治疗部分高血压性脑出血病人的理想选择。     

脑动脉瘤破裂伴发急性硬膜下血肿的诊治

目的 探讨脑动脉瘤(AN)破裂所致的急性硬膜下血肿(ASDH)的临床、影像学特点和诊治方案。方法 回顾288例破裂AN，发现10例伴有ASDH。Huni Hess分级，Ⅱ级3人，Ⅲ级1人，Ⅳ级3人，Ⅴ级3人，均经CTA诊断为AN破裂，除2例外均被脑血管造影或手术所证实。保守治疗2例，血肿清除加AN夹闭术4例，电解脱弹簧圈(GDC)栓塞后加血肿清除2例，栓塞加脑室外引流1例，单纯栓塞l例。结果 疗效优者2例，中残者l例，7例死亡。结论 AN性ASDH的预后极差，同术前分级相关；CTA检查后立即行血肿清除加动脉瘤夹闭有助于提高预后，合适患者可联合栓塞和血肿清除术。     

帕金森病立体定向手术并发脑内出血的原因分析

目的:探讨帕金森病立体定向手术颅内出血并发症原因及对策。方法:自1999年4月至2003年3月我们对药物治疗效果不理想的510例帕金森病病人行立体定向毁损手术，术后出现颅内出血9例，其中毁损灶出血3例，穿刺道出血6例。结果:手术治疗4例．保守治疗5例。术后意识恢复但遗留偏瘫4例，经非手术治疗5例．恢复良好，未遗留明显功能障碍。全组无死亡病例。结论:采用磁共振结合微电极导向提高靶点定位精确度，减少微电极记录针道数，降低毁损温度，重视围手术期处理等措施，有助于降低颅内出血并发症的危险。     

实验性蛛网膜下腔出血后脑血管痉挛兔海马组织中Bcl-2和Bax mRNA的表达

目的：探讨蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)造成脑损伤的机制．方法：用反转录聚合酶链式反应(RT—PCB)技术检测兔SAH后CVS时海马组织Bcl—2和BaxmRNA的表达变化．结果：Bcl—2mBNA的表达水平在SAH组1d时即开始下降，3d时降至最低，持续至7d．SAH组海马组织中BaxmRNA的表达呈上升趋势，3d时达最高，7d时仍显著高于正常组．在假手术组海马组织内的Bcl—2和BaxmRNA的表达水平保持相对恒定．结论：Bcl—2和Bax可能参与了SAH后CVS所造成的海马神经元损伤过程。     

Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006.

Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.     

Influence of statins on postoperative wound complications after inguinal or ventral herniorrhaphy

The lipid-lowering agents, statins, are the most commonly prescribed class of drugs in the western world. Because of their widespread use, many patients undergo surgical procedures while on statins. Statins, in addition to cholesterol-lowering effects, also have anticoagulant, immunosuppressive, and antiproliferative properties that may affect the risk of local wound complications. This study investigated the relationship between statins and postoperative wound complications in a large cohort of patients undergoing inguinal or ventral hernia repair. Data mining was performed in the Veterans Integrated Service Network (VISN)16 Data Warehouse. This database contains clinical and demographic information about all veterans cared for at the ten VA Medical Centers that comprise the South Central VA Healthcare Network in the mid-south region of the US. Aggregate data (age, body mass index, smoking history, gender, race, history of diabetes, statin use, and postoperative wound complications) were obtained for all patients who underwent inguinal or ventral hernia repair during the period October 1, 1996–November 30, 2004. During the period of the query, 10,782 patients (10,676 male, 106 female), 1,242 (11.5%) of whom received statins, underwent herniorrhaphy. Statin use did not affect the risk of wound infection or delayed wound healing. Statin use was, however, associated with an increased rate of local postoperative bleeding complications (P=0.01). When the type of hernia, age, smoking, diabetes, and body mass index were included in a multivariate analysis, statins remained borderline significant as an independent predictor of wound hematoma/postoperative bleeding (P=0.04), odds ratio 1.6 (95% CI 1.03–2.44). Patients who undergo inguinal herniorrhaphy while on statins have an increased risk of postoperative wound hematoma/hemorrhage. Focus on additional factors that may affect the propensity to postoperative bleeding and on meticulous intraoperative hemostasis are particularly important in such patients.