布比卡因硬膜外阻滞对凝血功能的影响

目的　研究硬膜外阻滞时布比卡因对血液凝固的影响。方法　 4 0例病人随机分成0 75 %布比卡因组 (A组 ,n =2 0 )和 1%利多卡因、0 2 5 %丁卡因复合液组 (B组 ,n =2 0 )。分别于麻醉前 (T1)、用药后 30分钟 (T2 )、用药后 3小时 (T3 )测定激活部分凝血活酶时间 (APTT)、血浆凝血酶原时间 (PT)、凝血酶时间 (TT)、血小板聚集率 (PAgT)。 结果　A组中APTT、PAgT不同时点存在显著差异 (P <0 0 1) ,PT、TT之间无显著差异。B组中APTT、PT、TT、PAgT不同时点之间均无显著差异。结论　布比卡因用于硬膜外阻滞时可显著延长APTT ,抑制血小板聚集     

硬膜外阻滞在中期妊娠引产镇痛时机选择的临床观察

目的：比较硬膜外阻滞在中期妊娠引产不同时点开始镇痛的临床效果。方法选取我院60例因计划外妊娠或有胎儿畸形等妊娠合并症要求终止妊娠者,随机分为两组实施硬膜外阻滞,A组为病房常规处理后产妇有疼痛感即开始实施麻醉,B组为病房常规处理后有规律宫缩开始实施麻醉,每组30例;记录镇痛开始前及镇痛后生命体征、各时点孕妇的VAS评分和运动神经阻滞分级、引产时间、出血量及不良反应情况。结果与B组比较,A组在镇痛后各时点VAS评分降低、引产时间延长,差异均有统计学意义（P＜0.05）;两组间孕妇引产期间生命体征平稳,出血量及不良反应差异无统计学意义（P＞0.05）。结论中期妊娠引产无须考虑胎儿因素,早期实施麻醉镇痛干预更为合理,在不增加出血量和不良反应的基础上引产时间略有延长。     

羟乙基淀粉对硬膜外阻滞血管扩张致血压下降的预防作用

目的 :探讨羟乙基淀粉对硬膜外阻滞血管扩张致血压下降的预防作用。方法 :选择硬膜外麻醉下行子宫切除术患者 12 0例 ,随机分为两组 ,羟乙基淀粉组 :硬膜外开始注药前 10分钟即输 6 %羟乙基淀粉 ,麻醉完全显效时 (首剂量后 10分钟 )输完 5 0 0ml,继之用平衡液维持。平衡液组 :硬膜外开始注药前 10分钟只输平衡液 ,麻醉完全显效时 (首剂量后 10分钟 )输完 5 0 0ml,继之用平衡液维持。观察硬膜外麻醉注药前以及注药后 5、10分钟收缩压、舒张压的变化。结果 :羟乙基淀粉组注药后 5、10分钟收缩压、舒张压较注药前无明显变化 (P >0 .0 5 )。平衡液组注药后 5、10分钟收缩压、舒张压较注药前明显降低 (P <0 .0 5 )。结论 :羟乙基淀粉可预防硬膜外麻醉致血管扩张引起的血压下降。     

How does subchorionic hematoma in the first trimester affect pregnancy outcomes?

IntroductionSubchorionic hematoma (SCH) in pregnancy has been associated with increased risk of adverse pregnancy outcomes. We aimed to investigate the association of SCH with adverse pregnancy outcomes in pregnant women in relation to size of hematoma and control subjects.Material and methodsThis study included 178 pregnant women with sono-graphically detected SCH in the 1^st trimester, and 350 pregnant controls without SCH. Data on maternal age, smoking status, gestational week at diagnosis, location of SCH, medications before diagnosis, gestational week at delivery, delivery route and pregnancy outcomes (first trimester vaginal bleeding, pre-eclampsia, gestational diabetes, intrauterine growth restriction (IUGR), placental abruption, preterm delivery < 37 weeks, early pregnancy loss and intrauterine death) were retrieved retrospectively from hospital records. Pregnant women with SCH were divided into 3 groups according to the size of hematoma including small SCH (SCH-I group, n = 47), medium-size SCH (SCH-II group, n = 110) and large SCH (SCH-III group, n = 21) groups.ResultsSubchorionic hematoma was associated with significantly lower gestational age at delivery (p < 0.001) and higher rate of first trimester bleeding (p < 0.001) compared with the control group, regardless of the size of the hematoma. Placental abruption (p = 0.002) and early pregnancy loss (p < 0.001) were significantly more common in SCH-II and -III groups than in the control group. SCH-III group was associated with a significantly higher rate of < 37 gestational weeks at delivery (p < 0.001), first trimester vaginal bleeding (p < 0.001), early pregnancy loss (p < 0.001), IUGR (p = 0.003) and preterm delivery (p < 0.001) compared to both lesser size hematoma and control groups.ConclusionsOur findings suggest that large SCH might indicate an increased risk of adverse pregnancy outcomes such as 1^st trimester vaginal bleeding, early pregnancy loss, IUGR, placental abruption or preterm delivery. These findings are important to guide the patients with SCH for detailed clinical evaluation.     

Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.     

改良翼点入路治疗颅底脑挫伤及血肿78例分析

目的:总结改良翼点入路治疗颅底脑挫伤及血肿的方法及经验。方法:运用改良翼点入路对78例颅脑损伤患者进行手术治疗。结果:本组67例术后存活,病死率14.1%,骨瓣回植率65%。结论:该入路暴露彻底,减压充分,便于手术操作和减轻术后脑肿胀,病死率低。     

微创血肿穿刺术治疗高血压脑出血的疗效及其对炎性因子表达水平的影响

目的：通过对高血压脑出血患者采用微创血肿穿刺术治疗,评估其疗效及对炎性因子表达水平的影响。方法：对本院74例高血压脑出血患者依据建档顺序分2组,各37例。对照组采用小骨窗血肿清除术,研究组采用微创血肿穿刺术,术后3～6个月进行随访。对比两组手术情况、临床疗效、并发症发生率,评估术前及末次随访时两组神经功能缺损评分（NIHSS）、日常生活能力评分（BI）及检测其血清炎性因子［肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、高敏C反应蛋白（hs-CRP）］水平变化。结果：①手术情况：研究组手术用时（12.34±5.54）min,术中失血量（40.31±10.27）mL,下床活动时间（5.04±2.82）d,住院时间（16.30±2.61）d,均少于对照组,差异有统计学意义（P＜0.05）;②神经功能及日常生活能力：术前两组NIHSS评分及BI评分比较,差异无统计学意义（P＞0.05）,术后研究组NIHSS评分［（4.08±1.35）分］低于对照组［（6.49±1.13）分］,BI评分［（60.63±8.08）分］高于对照组［（46.82±6.81）分］,差异有统计学意义（P＜0.05）;③临床疗效：研究组治疗有效率91.89%（34/37）高于对照组72.97%（27/37）,差异有统计学意义（P＜0.05）;④血清炎性因子：术前两组hs-CRP、IL-6、TNF-α水平比较,差异无统计学意义（P＞0.05）,术后1周2组血清炎性因子水平均较术前降低,且研究组hs-CRP（7.14±3.05）mg/L、IL-6（14.18±3.16）ng/L、TNF-α（40.10±3.03）μg/L,低于对照组［（12.11±3.35）mg/L、IL-6（27.19±3.98）ng/L、TNF-α（53.22±3.32）μg/L］,差异有统计学意义（P＜0.05）;⑤并发症发生率：研究组并发症发生率5.41%（2/37）低于对照组24.32%（9/37）,差异有统计学意义（P＜0.05）。结论：采用微创血肿穿刺术治疗高血压脑出血效果显著,可有效改善患者神经功能及日常生活能力,减少手术用时及术中失血量,降低血清炎性因子水平,提高治疗效果,且安全性较高。     

张力性脑出血的CT及MRI特征分析

目的 探讨脑内张力性血肿CT及MRI征象.方法 经CT或MRI扫描并为手术或穿刺证实的脑内张力性血肿共24例,结合临床表现对CT和MRI影像资料回顾分析.结果 张力性脑出血24例分布在基底节区居多血肿量15～75 ml,具有一定张力,血肿大部分呈混杂密度或混杂信号,可出现密度或信号分层现象,具有一定特征性,周围有血管源性水肿,部分增强有包膜样强化,随访12例在发病1～2周血肿体积增大,占位效应加重,与一般高血压出血演变不一致,是诊断脑内张力性血肿的主要依据.结论 张力性血肿不同于一般高血压脑出血,临床选择治疗方案也截然不同,在CT和MRI表现上具有一定特征性,结合临床可以早期诊断,从而节省患者宝贵治疗时间     

硬膜外麻醉时皮肤电传导变化的临床观察

目的探讨硬膜外麻醉时皮肤电传导(SC)基态值和反应波的变化。方法选择25例ASAⅠ或Ⅱ级下肢手术患者。记录硬膜外给药前(T0)、给予1%利多卡因5ml后5min(T1)、给予0.75%罗哌卡因10ml后5、10、15、25和45min(T2～T6)时的SC基态值(SC0)、针刺非阻滞区SC反应波的振幅差值(SC1)和痛觉阻滞区的SC反应波的振幅差值(SC2)。使用ROC曲线、逻辑回归分析评价SC反应波的振幅差值区分痛觉阻滞区和非阻滞区的准确性。结果与T0时比较,T3～T6时的SC0及SC1的均值明显降低(P<0.05),T1～T6时SC2明显低于SC1(P<0.05)。SC反应波的振幅差值ROC曲线下面积为0.928±0.017(P<0.01),特异性与敏感性分别为78%和88%,预测整体准确率84%。结论 SC基态值及反应波振幅差值的变化对定位硬膜外麻醉平面有一定指导作用。