Bilirubin and its oxidation products damage brain white matter

Brain injury after intracerebral hemorrhage (ICH) occurs in cortex and white matter and may be mediated by blood breakdown products, including hemoglobin and heme. Effects of blood breakdown products, bilirubin and bilirubin oxidation products, have not been widely investigated in adult brain. Here, we first determined the effect of bilirubin and its oxidation products on the structure and function of white matter in vitro using brain slices. Subsequently, we determined whether these compounds have an effect on the structure and function of white matter in vivo. In all, 0.5 mmol/L bilirubin treatment significantly damaged both the function and the structure of myelinated axons but not the unmyelinated axons in brain slices. Toxicity of bilirubin in vitro was prevented by dimethyl sulfoxide. Bilirubin oxidation products (BOXes) may be responsible for the toxicity of bilirubin. In in vivo experiments, unmyelinated axons were found more susceptible to damage from bilirubin injection. These results suggest that unmyelinated axons may have a major role in white-matter damage in vivo. Since bilirubin and BOXes appear in a delayed manner after ICH, preventing their toxic effects may be worth investigating therapeutically. Dimethyl sulfoxide or its structurally related derivatives may have a potential therapeutic value at antagonizing axonal damage after hemorrhagic stroke.     

Role of red blood cell lysis and iron in hydrocephalus after intraventricular hemorrhage

Thrombin and iron are two major players in intracerebral hemorrhage-induced brain injury and our recent study found that thrombin contributes to hydrocephalus development in a rat model of intraventricular hemorrhage (IVH). This study investigated the role of red blood cell (RBC) lysis and iron in hydrocephalus after IVH. There were three parts to this study. First, male Sprague-Dawley rats received an injection of saline, packed, or lysed RBCs into the right lateral ventricle. Second, rats had an intraventricular injection of iron or saline. Third, the rats received intraventricular injection of lysed RBCs mixed with deferoxamine (0.5 mg in 5 μL saline) or saline. All rats underwent magnetic resonance imaging at 24 hours and were then euthanized for brain edema measurement, western blot analysis, or brain histology. We found that intraventricular injection of lysed RBCs, but not packed RBCs, resulted in ventricular enlargement and marked increases in brain heme oxygenase-1 and ferritin at 24 hours. Intraventricular injection of iron also resulted in ventricular enlargement and ventricular wall damage 24 hours later. Coinjection of deferoxamine reduced lysed RBC-induced ventricular enlargement (P<0.01). These results suggest that iron, a degradation product of hemoglobin, has an important role in hydrocephalus development after IVH.     

经皮肾镜取石术后严重出血行选择性肾动脉栓塞11例临床分析

目的:总结选择性肾动脉栓塞术(SRAE)治疗经皮肾镜取石术(PCNL)术后严重出血的临床经验。方法:回顾性分析我院于2007年2月~2014年2月行PCNL发生术后严重出血的11例患者的临床资料和对其行SRAE的血管造影表现和疗效。结果:PCNL术后严重出血需行SRAE治疗的患者止血效果均满意,手术成功率100%;SRAE后1~3d患者肉眼血尿完全消失,血红蛋白指标上升,全身症状改善。1例SRAE后第3天出现发热、患侧腰痛症状,予对症治疗后不适消退。本组患者SRAE治疗后5d出院,随访1~6个月,术后恢复良好。结论:PCNL术后严重出血与术中动脉损伤有关,在临床操作中具有不可预见性,应严格规范PCNL的操作以减少术后严重出血的发生。术后出血严重者早期行SRAE能够达到迅速止血、尽可能保全患肾功能、有效挽救生命的诊疗效果。     

欣母沛治疗宫缩乏力性产后出血的疗效和安全性分析

目的探讨欣母沛治疗宫缩乏力性产后出血的临床疗效及安全性。方法选取2010年3月～2013年2月我院收治的66例宫缩乏力性产后出血患者,随机分为观察组和对照组各33例,对照组采用常规治疗措施,观察组在对照组常规治疗的基础上给予欣母沛治疗,观察并比较两组患者的临床疗效、治疗后出血量及不良反应的发生率。结果观察组总有效例数为32例,总有效率为96.97%,对照组总有效例数为25例,总有效率为75.76%,两组患者临床疗效比较差异有统计学意义（P〈0.05）;观察组产后2h及24h出血量分别为（223.1±47.5）mL和（298.4±58.1）mL,对照组产后2h及24h出血量分别为（345.3±55.5）mL及（457.2±71.2）mL,观察组均低于对照组,两组患者产后出血量比较差异有统计学意义（P〈0.05）;两组患者治疗过程中均无严重不良反应发生,对照组有1例患者出汗,1例患者出现面部潮红,1例患者出现恶心呕吐,不良反应的发生率为9.09%,观察组有1例患者出现恶心呕吐,不良反应的发生率为3.03%,两组患者不良反应发生率相比较差异有统计学意义（P〈0.05）。结论采用欣母沛治疗宫缩乏力性产后出血临床疗效好,不良反应的发生率低,值得在临床上予以推广。     

剖宫产产后出血的危险因素分析

目的探究剖宫产产后出血的危险因素。方法对本院508例行剖宫产的患者的临床资料进行回顾,分析可能与剖宫产产后出血相关的危险因素。结果 508例剖宫产分娩的产妇中发生产后出血的有45例(8.9%,45/508)。不同病理特征分组的组间分析结果显示:高龄、多胎妊娠、多次流产史、妊娠期高血压、胎盘早剥、前置胎盘和子宫切口撕裂均是产妇行剖宫术分娩后产后出血的重要危险因素。单因素分析和多因素回归分析结果显示:前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素(P0.05)。结论前置胎盘、多胎妊娠、子宫切口撕裂和胎盘早剥是剖宫产产后出血的独立危险因素。     

高血压脑出血治疗的研究进展

高血压脑出血（HICH）是由于高血压所致脑内细小动脉或毛细血管破裂而发生的脑实质内的一种自发性出血疾病。目前仍然面临较多治疗难题,本文就高血压脑出血的病理生理、药物治疗、手术治疗以及肠内营养支持治疗方面的研究进展作综述如下。     

临床护理路径在脑出血患者护理中的应用

目的：进一步研究临床护理路径在脑出血患者护理中的应用。方法选取我院于2012年2月～2013年4月收治的脑出血患者75例,将其按照随机数字表法分为两组,对照组37例采用常规护理方法,观察组38例采用临床护理路径方法,用Brthel指数对日常生活活动能力进行评定,比较两组患者的住院费用、住院时间、Brthel指数、患者满意度和掌握相关知识程度。结果两组患者在入院前的Brthel指数比较无显著差异无统计学意义（P＞0.05）,但出院后观察组的Brthel指数明显优于对照组（P＜0.05）;观察组的住院费用、住院时间、患者满意度和掌握相关知识程度明显优于对照组（P＜0.05）。结论针对脑出血患者给予实施临床护理路径措施,可增加了患者满意度,减少了医疗费用和住院时间,保证治疗效果。     

尼莫地平在创伤性蛛网膜下腔出血治疗中的临床疗效

目的探讨尼莫地平治疗创伤性蛛网膜下腔出血的临床疗效。方法回顾性分析创伤性蛛网膜下腔出血患者60例的临床资料。28例患者采用常规治疗为对照组,32例患者在常规治疗的基础上给予尼莫地平治疗为研究组。比较两组患者的临床疗效。结果治疗后,研究组MCA Vp显著快于对照组（P〈0.01）,颅内压和脑血管痉挛率以及再出血率均显著低于对照组（P〈0.01）。随访3个月,研究组19例生活自理,7例部分自理,4例重残,2例死亡,生活自理患者比例显著高于对照组,死亡患者比例显著低于对照组（P〈0.05）。两组不良反应差异无统计学意义（P〉0.05）。结论尼莫地平治疗创伤性蛛网膜下腔出血能够显著降低患者的颅内压,降低脑血管痉挛率以及再出血率,改善患者的预后。     

MRI检查在急性期脑出血诊断中的临床价值

目的：探讨MRI检查在急性期脑出血诊断中的临床价值。方法回顾性分析2009～2011年收治的急性期脑出血患者54例患者影像学资料,所有患者均分别进行CT与MRI检查,对两种检查的诊断敏感性与对脑血肿量进行统计并做对比分析。结果 T2＊WI和CT的敏感性明显好于T1WI与T2WI的敏感性,差异具有统计学意义（P＜0.05）。CT、T1WI、T2WI、T2＊WI测量脑血肿量分别为（31.28±3.34）mL、（32.03±3.96）mL、（27.12±4.83）mL、（29.17±5.43）mL。CT与T2＊WI检测结果相接近,无明显差异（P＞0.05）,T1WI与T2WI对脑血肿量的测量值较CT 和T2＊WI略小,但无明显统计学差异（P＞0.05）。CT与T2＊WI检查成像中较清晰,显示血肿部位有明显的边界和高信号。结论 MRI检查可有效检查出急性脑出血。MRI检查在急性期脑出血诊断中的临床价值不亚于CT检查,其可为急性脑出血诊断提供了重要的依据。