目的：了解大鼠脑出血后血肿周围组织细胞凋亡与神经元特异性烯醇化酶（NSE）的表达及大鼠神经功能缺损程度的关系。方法：用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、NSE免疫组织化学染色及TUNEL分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围NSE及TUNEL的表达。用Longa评分法评价大鼠神经功能缺损程度。结果：大鼠在胶原酶注入6 h后形成稳定的血肿，在造模24～48 h神经功能缺损程度最重；6 h即见到TUNEL阳性细胞的表达，在48 h最明显；NSE从神经元中漏出弥散到细胞间隙也在48 h达高峰。结论：脑出血血肿周围凋亡与神经功能缺损及NSE的变化有关，凋亡可能在脑出血的神经损伤中起重要的作用。
摘要:目的:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.
目的 探讨糖尿病对主动脉壁内血肿的预后影响。 方法 纳入 2012 年 10 月至 2014 年 11 月我院连续 24 例主动脉壁内血肿患者，其中男 17 例、女 7 例，年龄（58.83±10.42）岁，定期复查主动脉 CTA（复查时间为 3～4 周），观察糖尿病患者和非糖尿病患者主动脉壁内血肿的进展情况。 结果 24 例患者在复查时，出现 A 型主动脉夹层 2 例，B 型主动脉夹层 3 例（均为腹部局限性夹层）；4 例患者合并糖尿病，复查时 2 例进展为主动脉夹层，2 例血肿及溃疡加重。 结论 主动脉壁内血肿整体呈吸收趋势，无并发症发生。手术事件的发生率与患者合并糖尿病有密切关系。
目的:改良钻孔引流术治疗慢性硬膜下血肿27例,提高临床治疗效果。方法:术中可控下持续生理盐水冲洗后,加入尼莫地平注射液排空,术后低渗或等渗液体维持脑灌注压。结果:27例慢性硬膜下血肿经上述措施处理后,经随访均达到满意临床治疗效果。结论:慢性硬膜下血肿钻孔引流术中加用尼莫地平注射液冲洗、排气,及规范化术后处理措施可提高临床疗效。
【摘要】 目的 比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。 方法 2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组，n=34）和小骨窗开颅术（B组，n=30）的高血压脑出血患者共64例（出血量30~50 mL，无脑疝），两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。 结果 A组手术时间短于B组，两组比较，有统计学意义（Plt;0.05）。术后1、6个月，A组疗效优于B组，两组比较，有统计学意义（Plt;0.05）。A、B组术后近期和远期死亡率比较，无统计学意义（Pgt;0.05）。 结论 对出血部位在基底节区、出血量在30~50 mL，无脑疝的高血压脑出血患者，钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。【Abstract】 Objective To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage. Methods A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared. Results The operation time was shorter in group A than that in group B (Plt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (Plt;0.05); the difference in mortality between the two groups was not significant (Pgt;0.05). Conclusion The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.
Objective To investigate the value of applying closed continuous negative pressure drainage in preventing postoperative complications of inguinal hernia. Methods The clinical data of 107 adult male patients diagnosed with inguinal giant hernia (incarcerated 16 cases, non-incarcerated 91 cases) undergoing tension-free hernioplasty using the Ultrapro Hernia System (UHS) between April 2011 and June 2016 in our hospital were retrospective analyzed. Prophylactic use of antibiotics was not adopted except patients with incarcerated hernia, diabetes, or elderly. Multi-lateral hole plasma drainage tube were used in 61 patients, 46 cases without indwelling plasma tube. The postoperative scrotum pain, scrotal hematoma, scrotal effusion, and incision infection of two groups patients were observed. Results Of the 61 patients with plasma drainage, the mean drainage time was 2 days, the longest was 5 days. Postoperative scrotal pain was found in 2 cases (3.3%) without scrotal hematoma or scrotal effusion. Of the 2 patients, the drainage of 1 case was obstructed, the drainage was extubated and the patient was cured and discharged after 5 days by sucking the drainage tube using empty needle. The average hospital stay in this group was 4 days. Of the 46 patients without plasma drainage, 7 patients (15.2%) suffered scrotal pain, 7 patients (15.2%) suffered scrotal hematoma. The average hospital stay was 6 days. The incidence of scrotal pain and scrotal hematoma was significantly higher in patients without plasma drainage than those with drainage (P<0.05). The condition of scrotal hematoma would be improved after 1–3 times outpatient dressing change and repeated hematoma sucking. One case was not improved after repeated suction, the condition was improved after scrotum incision, drainage, and dressing. Conclusion Closed continuous negative pressure drainage potentially prevents oblique hernia pain and scrotal hematoma without increasing the incidence of incision infection or hospitalization time.
Objective To explore the clinical features of spontaneous spinal epidural hematoma (SSEH) and to find out factors influencing its prognosis. Methods From September 1998 to October 2006, 23 patients with SSEH (10 males and 13 females) were treated. Their ages ranged from 10 to 69 years. The primary neurological status were classified as grade A in 7 patients,B in 2 patients, C in 4 patients, D in 9 patients and E in 1 patients accordingto ASIA grading system. The progressive intervals of their symptoms were divided as four period: less than 12 hours (12 patients), 12 to 24 hours(2 patients), 24 to 48 hours(3 patients) and more than 48 hours(6 patients). SSEH was diagnosedby MRI or by histopathological examination. The cases history, laboratory examination, radiological image, treatment, pathological result and prognosis were recorded and analyzed after 3 month. Results In 23 patients, there were 1 case of deterioration, 8 cases of no change, 9cases of improvement and 5 cases of complete recovery. The gender had no correlationwith prognosis(P＞0.05). In the patients who had shorter progressive interval and more severe edema of spinal cord, the prognosis was worse(P＜0.05). Inthe patients who had mild neurological deficit, the prognosis was good (P＜0.01). In 17 patients undergoing surgery, the scores for prognosis was 1 point in 1 case, 2 points in 5 cases, 3 points in 6 cases and 4 points in 5 cases; the operation time had no correlation with prognosis(r=0.056, P＞0.05). In6patients undergoing conservative treatment, the scores for prognosis were 2 points and 3 points in 3 cases respectively. Conclusion Prognosis of patient with SSEH is influenced by his primary neurological status, progressive interval, spinal edema and size of hematoma. The major treatment is surgical evacuation of hematoma as early as possible to break the aggravation of spinal function. Conservative treatment is not considered unless the neurological defects recovered in the early period.