显微外科手术治疗颅内动脉瘤32例

目的 :介绍 32例颅内动脉瘤显微神经外科手术的经验 ,探讨手术时机、显微手术技巧及有关并发症的防治。方法 :在气管插管全麻及控制性低血压下进行显微手术。多采用改进的 Yasargil入路 ,在显微镜直视下操作 ,解剖动脉瘤蒂 ,准确地夹闭瘤蒂。结果 :本组 32例患者中行动脉瘤蒂夹闭术 2 9例 ,切除术 2例 ,包裹 1例 ,治愈率 90 .6 %,死亡率 9.4%。术中动脉瘤破裂 5例 ,死亡 2例 ,死亡率 40 %。结论 :显微神经外科手术技术提高了颅内动静脉瘤的手术成功率 ,术前病情过重及动脉瘤术中破裂出血是手术失败和死亡的主要原因。     

亚低温对实验性脑出血大鼠病死率影响的实验研究

目的观察32℃亚低温对实验性脑出血大鼠24h内病死率和脑组织钙含量的影响。方法将134只大鼠分成两组:①68只大鼠用于病死率观察;②66只大鼠用于脑组织钙含量测定。两组再分成假手术对照组、常温脑出血组及亚低温脑出血组。结果常温组24h内病死率为36.7%,亚低温组为4.6%;脑组织钙含量常温组较对照组和亚低温组为高。结论亚低温治疗能减少脑出血后脑组织钙的增加,减少钙平衡失调,显著减少实验性脑出血大鼠24h内病死率。     

临时起搏器联合主动脉内气囊泵在21例急性心肌梗死患者中的应用

目的：观察和评价急性心肌梗死患者中临时起搏器联合主动脉内气囊泵的运用。方法：回顾性研究我科2003年-2008年5月间因急性心肌梗死急诊治疗中联合使用临时起搏器和IABP的患者。结果：联合运用临时起搏器和IABP治疗急性心肌梗死患者21例,死亡10例,死亡率47．6％。死亡原因为严重难治性心源性休克6例,心脏破裂1例,感染并多脏器衰竭2例,其他原因1例。结论：临时起搏器联合主动脉内球囊反搏在治疗心肌梗死及缓慢性心律失常患者心梗所致心源性休克患者时仍存在较高死亡率。尿量、血管活性物质过多使用、EF值是增加死亡风险的预测因素。     

睡眠剥夺对大鼠胃运动及其神经中枢的影响

目的观察急性睡眠剥夺对胃排空及支配胃运动的神经中枢电生理活动的影响,为防治因睡眠剥夺对胃排空引起的胃动力障碍提供理论依据。方法采用同步实验,应用电生理学的方法,观察延髓中与胃运动密切相关的孤束核(nucleustractussolitary ,NTS)及迷走神经背运动核(Dorsalmotornucleusofthevagusnerve ,DMV)中神经元细胞放电的变化情况,同时采用浆膜法检测胃电的变化。结果随着睡眠剥夺时间的不断延长,延髓中与胃运动密切相关的孤束核(NTS)及迷走神经背运动核(DMV)中神经元细胞放电产生了不同的变化情况。在睡眠剥夺的第一周,迷走神经复合体的放电明显增加,胃电活动却呈现初始增加,逐渐减低状态,但无明显规律;而在睡眠剥夺的第二周,迷走神经复合体的放电呈现抑制状态,胃电活动呈现紊乱状态。结论急性睡眠剥夺对大鼠的胃运动影响明显,同时对支配胃运动的神经中枢亦有显著影响。     

老年急性心肌梗死低钠血症的临床意义

目的探讨老年急性心肌梗死（AMI）低钠血症的临床意义。方法选择2001年3月至2006年9月我院收治的140例老年AMI资料完整的患者进行回顾性分析，根据患者入院后即刻、24h、48h血清钠离子的最低值分为三组：A组Na^＋≥135mmol／L；B组Na^＋120—135mmol／L；C组Na^＋≤120mmol/L。比较各组心肌酶、心肌梗死面积、心力衰竭发生率及住院病死率。结果A组心力衰竭发生率为12．7％，B组为14．1％，C组为50．0％，C组与A组、B组比较具有统计学意义（P〈0．05）。A组住院病死率为6．2％，B组住院病死率为7．1％，C组住院病死率为37．5％，C组与A组、B组比较均具有统计学意义（P〈0．05）。C组肌酸激酶（CK）及心肌梗死面积分别与A组、B组比较有统计学意义（P〈0．05）。结论老年AMI低钠血症与心肌坏死标志物、梗死面积、心力衰竭发生率、病死率密切相关，老年AMI低钠血症预后不良。     

上海耐火材料厂矽肺患者死亡情况分析

本文对上海耐火材料厂历年（１９５８－１９９０）确诊的矽肺患者进行不同入厂年代矽肺发病，死亡情况分析；计算矽肺患者各类疾病死亡率，与当地居民的年龄别死亡率进行比较，计算标化死亡比；并对不同年代的矽肺病人的平均死亡年龄，确诊至死亡的平均年限进行分析。结果表明，该厂矽肺患者死因中，以非特异死亡的恶性肿瘤和循环系统疾病占第一，第二位；与矽肺直接有关的特异死亡占第三位。矽肺患者寿命与当地居民相比，无统计学…     

Relationship between annualized case volume and in-hospital motality in subarachnoid hemorrhage: A systematic review and meta-analysis

Studies on the relationship between hospital annualized case volume and in-hospital mortality in patients with subarachnoid hemorrhage (SAH) have shown conflicting results. Therefore, we performed a meta-analysis to further examine this relationship.The authors searched the PubMed and Embase databases from inception through July 2020 to identify studies that assessed the relationship between hospital annualized SAH case volume and in-hospital SAH mortality. Studies that reported in-hospital mortality in SAH patients and an adjusted odds ratio (OR) comparing mortality between low-volume and high-volume hospitals or provided core data to calculate an adjusted OR were eligible for inclusion. No language or human subject restrictions were imposed.Five retrospective cohort studies with 46,186 patients were included for analysis. The pooled estimate revealed an inverse relationship between annualized case volume and in-hospital mortality (OR, 0.53; 95% confidence interval, 0.42–0.68, P < .0001). This relationship was consistent in almost all subgroup analyses and was robust in sensitivity analyses.This meta-analysis confirms an inverse relationship between hospital annualized SAH case volume and in-hospital SAH mortality. Higher annualized case volume was associated with lower in-hospital mortality.     

Computerized semen analysis with sperm tail detection

We evaluated a recently developed computerized semen analyser that detects spermatozoa not only by the criteria of size, contrast and movement but also by the morphological characteristics of the sperm tail. Comparison of the sperm concentration in 33 semen samples measured by conventional and by computerized semen analysis, as well as by flow cytometry, showed acceptable agreement between all three methods, although the mean differences and standard deviations were less for conventional than for computerized analysis when compared to flow cytometry as a reference method. Motility estimates were lower by the computer system for values between 1 and 40%. Higher motilities showed no systematic error. In conclusion, the improved algorithms for sperm detection yield more reliable data for sperm concentration and motility than previous systems of computerized semen analysis.     

Fetal behavioural states and controlled sound stimulation

The aim of this study was to investigate responses of human fetuses near term (37-42 wks) (increase/decrease of fetal heart rate and/or fetal motility) to acoustic stimuli. The study group consisted of 43 patients and the control group of 27 patients. Polygraphic recordings of 5 different fetal variables were carried out synchronously for the categorization of the actual fetal behavioural state according to Nijhuis et al. (Nijhuis, J.G., Prechtl, H.F.R., Martin, C.B., Jr. and Bots, R.S.A.M. (1982): Early Hum. Dev., 6, 177-195). Controlled acoustic stimulation was performed either with sine wave tone (2 kHz, 120 dB and 5 s duration) or modulated sine wave tone (0.5-2 kHz, 'sawtooth' modulation, 120 dB and 5 s duration). An additional group of patients received 'sham' stimulation. Overall 84 acoustic stimulations have been carried out. In 26 out of 84 stimulations (30%) a fetal response could be observed within 5 s after acoustic stimulation. In general, there were far fewer fetal responses in sleep states than in states of wakefulness. Whereas in state 1 F only 1 out of 28 acoustic stimulations was followed by an immediate fetal response, more responses were observed in state 2 F. An obvious increase in fetal reactivity to acoustic stimulation was noted in states of wakefulness (states 3 F and 4 F). Comparison between the true and sham stimulations revealed a relatively high level of spontaneous fetal activity (high variation of fetal heart rate and fetal motility) present in states 2 F and 4 F. This must be taken into account in all assessments of fetal responses.(ABSTRACT TRUNCATED AT 250 WORDS)     

肌酸激酶浓度在劳力性热射病早期判别预后的研究

目的:分析血清肌酸激酶(CK)值作为劳力性热射病患者预后判别指标的意义.方法:回顾分析1995年9月-2007年8月6所部队医院的11例EHS病例.以预后为标准,将11例患者分为两组,死亡组(n=4)及存活组(n=7),比较两组病例入院后0 h、12 h、24 h、36 h、48 h、60 h、72 h的CK数值,并描绘48 h CK值的ROC曲线,分析CK值在发病早期判别预后的意义.结果:在人院后各时间点死亡组CK值持续升高,存活组CK值略升高后保持稳定并逐渐下降,两组CK值在48 h、60 h、72 h有显著差异(P<0.05),48 h CK值的ROC曲线AUC(area under the Roc curve)为0.893.结论:死亡患者与存活患者CK值的变化趋势显著不同,CK值可以在发病早期(48 h)判别预后.