复方麝香注射液联合脑血肿引流术治疗中老年高血压脑出血疗效观察及费用对比

目的:探讨复方麝香注射液联合微创手术治疗中老年高血压脑出血的临床疗效.方法:将78例接受微创治疗的患者随机分组,两组均采用内科综合治疗.手术对照组在综合治疗基础上加用微创手术进行脑血肿引流;中西医结合组在微创手术治疗后加用复方麝香注射液(10～20 ml/d)静脉滴注1周.结果:中西医结合组显效率(66.67%)、有效率(82.05%)均明显高于手术对照组(46.15%和69.23%,P均<0.05),存活患者日常生活能力也明显优于手术对照组(P<0.05),意识恢复时间明显短于手术对照组(P<0.05),并发症的发生率(15.38%)明显低于手术对照组(38.46%,P<0.01),病死率(5.13%)明显低于手术对照组(10.26%,P<0.01),平均住院天数[(18.29±4.93)d]明显少于手术对照组[(26.23±5.82)d,P<0.05],平均住院费用[(5 916.23±826.39)元]明显少于手术对照组[(8 168.35±1 021.21)元,P<0.05].结论:脑血肿引流术后加用复方麝香注射液治疗中老年高血压脑出血,可降低病死率,减少并发症,降低病残程度,提高生存患者的生活质量,缩短住院时间,降低治疗费用.     

高血压脑出血微创外科治疗的预后因素分析

目的探讨影响高血压脑出血（HICH）微创外科治疗预后的相关因素。方法回顾性分析经微创手术治疗的HICH病人106例,总结其临床特点和疗效,并采用单因素和Logistic多因素回归分析,总结影响预后的有关因素。结果单因素分析显示：平均动脉压（MAP）、术前意识状态、血肿形态、出血部位、血肿量、血肿与脑室关系、血肿再发及术后并发症等因素与HICH微创外科治疗临床预后有关（P〈0.05）。多因素回归分析显示：术前意识状态、术后并发症及出血部位与HICH微创外科治疗预后密切相关（P〈0.01）。结论微创外科手术治疗HICH具有简单、安全、疗效好等优点;术前意识状态、术后并发症、出血部位是影响其预后的重要因素。     

头部外伤诱发颅内肿瘤卒中

目的 通过复习文献，对颅内肿瘤引起的颅内出血发生机制和临床特点进行探讨，旨在引起临床医师们的重视，以减少误诊误治。方法 本文报告9例误诊为外伤性颅内血肿的瘤卒中患者，其中5例术中发现颅内肿瘤同时切除，3例术后复查CT发现颅内肿瘤，二次手术切除。结果 全部病例随访6月，4例死亡，5例存活。结论 对疑为瘤卒中的颅内血肿患者，除仔细询问病史，全面体查外，术中应仔细寻找出血源，观察周围脑组织的改变，对可疑病变组织、血块及其腔壁一并切除，分送病检，从而作出正确的治疗方案。     

Ruptured aneurysm with intracerebral hemorrhage in an 8 year old boy

Report on a case of aneurysm in a child and its treatment with discussion of its rarity and origin.     

Presynaptic α2-adrenoceptor-mediated modulation of norepinephrine release from vascular adrenergic neurons in reduced renal mass salt hypertensive rats

The present study was designed to investigate the presynaptic alpha 2-adrenoceptor function to inhibit norepinephrine (NE) release in blood vessels of reduced renal mass salt hypertensive rats (Na-loaded HT). Isolated perfused mesenteric vasculatures were prepared from Na-loaded HT and normotensive control rats (NT-control), and the NE release and vascular responsiveness were examined. Periarterial nerve stimulation caused a significantly greater release of NE and pressor responses in Na-loaded HT than in NT-control. Yohimbine, a potent alpha 2-adrenoceptor antagonist, demonstrated the facilitatory effects on NE release during nerve stimulation. The effects were significantly attenuated in Na-loaded HT compared with NT-control. These results demonstrate that vascular sympathetic nervous activity might be enhanced in Na-loaded HT. Furthermore, the increased NE release from vascular adrenergic neurons in Na-loaded HT could partially depend on impaired presynaptic alpha 2-adrenoceptor-mediated modulation, which might contribute to the pathogenesis and maintenance of this form of salt-dependent hypertension.     

Spontaneous subcapsular hepatic hemorrhage associated with pregnancy: Report of a case

We report herein a case of spontaneous subcapsular hepatic hemorrhage which occurred in a 33-year-old woman 1 day after she had been delivered of her second child by cesarean section following an uneventful pregnancy. She complained of right upper quadrant pain on the 1st postoperative day, and computed tomography (CT) showed subcapsular low-density masses in both liver lobes, while extravasation was demonstrated by CO₂ intraarterial digital subtraction angiography (IADSA). The hemorrhage was successfully controlled by transcatheter arterial embolization (TAE). However, on the 3rd day after TAE, an exploratory laparotomy was performed to establish an exact diagnosis to explain the persistent abdominal pain and abnormal liver function tests. Subcapsular hematomas in both lobes were confirmed and no visible laceration was present. The patient recovered gradually by spontaneous absorption of the hematomas and was discharged on the 22nd postoperative day. Spontaneous hepatic hemorrhage associated with pregnancy is a very rare complication, and establishing a correct diagnosis and initiating appropriate therapy are essential for this life-threatening disease.     

腰穿放液治疗160例外伤性蛛网膜下腔出血的体会

目的：探讨腰穿放液对外伤性蛛网膜下腔出血的作用。方法：对１６０名外伤性蛛网膜下腔出血的病人行腰穿放液，少则２次，多则７次。结果：所有病人症状均好转，从脑脊液的力学上看脑脊液恢复正常性状的时间缩短，结论：腰穿放液治疗外伤性蛛网膜下腔出血是十分有效的方法，近期内临床症状明显改善，远期并发症减少。     

急性高血压脑出血的治疗体会

本文对62例急性高血压脑出血进行了着重于治疗的分析。脑出血病严重威胁患者生命,死亡率高,病残率高。治疗的关键是绝对卧床,避免搬动;积极治疗及控制脑水肿、降低颅内压;头置冰帽以减低脑耗氧量,减轻脑水肿,促进脑细胞功能的恢复;加强护理,预防及治疗并发症是提高患者生存时间及存活率的重要环节;对出血量多、患者一般情况较好者,作者主张手术治疗,清除颅内血肿,可减轻症状,提高存活率及降低病残率。     

自发性高血压大鼠内皮素A型受体基因的表达

应用反转录－聚合酶链式反应（ｒｅｖｅｒｓｅｔｒａｎｓｃｒｉｐｔｉｏｎ－ｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ，ＲＴ－ＰＣＲ）方法，测定大鼠ＥＴ－Ａ型受体（ｅｎｄｏｔｈｅｌｉｎＡｒｅｃｅｐｔｏｒＥＴＡ－Ｒ）ｍＲＮＡ在体内的分布，证明ＥＴＡ－ＲｍＲＮＡ不仅存在于血管平滑肌细胞，亦存在于内皮细胞中；而且广泛分布于脑、心、肾、肺等组织内。首次发现，在ＳＨＲ大鼠的脑、心、肾组织中，ＥＴＡ－ＲｍＲＮＡ水平明显升高，提示ＥＴＡ－Ｒ基因表达增加，亦可能是高血压发病的一个重要因素。