目的 通过探讨发病机制和结合1例蛛网膜下腔出血并发脑耗盐综合征病例分析,提高临床上对此类少见疾病的认识。方法 回顾性分析蛛网膜下腔出血并发脑耗盐综合征病例,运用“阴阳”、“六经”理论阐述疾病的中医病机及五苓散的中西医作用机制。结果 通过回顾性对比,使用五苓散组的患者明显比其他患者的病程短(五苓散组7.83±2.25天,对照组11.84±2.51天,P＜0.05),差异有统计学意义,说明五苓散能够缩短脑耗盐综合征的病程。结论 五苓散治疗蛛网膜下腔出血合并脑耗盐综合征有良好的前景,未来可以通过前瞻性病例对照研究进一步明确其疗效。

Objective By investigating the pathogenesis and analyzing a case of subarachnoid hemorrhage complicated with cerebral salt wasting syndrome, to improve the clinical understanding of this rare disease. Methods A retrospective analysis of cases of subarachnoid hemorrhage complicated with cerebral salt wasting syndrome was made, using the theory of “yin and yang” and “six classics” to explain the pathogenesis of the disease and the mechanism of Chinese and Western medicine of Wuling powder. Results Through retrospective comparison, patients in the Wuling powder group had a shorter course of disease than other patients [(7.83±2.25) days in the Wuling powder group, (11.84±2.51) days in the control group, P<0.05], and there was a significant statistical difference, indicating that Wuling powder can shorten the course of cerebral salt wasting syndrome. Conclusion Wuling powder has a good prospect in the treatment of subarachnoid hemorrhage complicated with cerebral salt wasting syndrome, and its efficacy can be further clarified through prospective case-control studies in the future.

目的 分析基底节区脑出血患者接受神经内镜手术治疗的疗效。方法 将2019年6月—2020年8月接诊且行开颅血肿清除术的33例基底节区脑出血患者作为对照组,将同期接诊且行神经内镜手术的33例基底节区脑出血患者作为观察组,对组间美国国立卫生研究院卒中量表(NIHSS)、独立功能量表(FIM)、日常生活能力(ADL)评分、手术情况、血清水通道蛋白4(AQP4)水平、脑水肿体积、并发症情况展开分析。结果 (1)组间NIHSS、FIM、ADL评分在术前无明显差异,P>0.05;术后,观察组NIHSS评分更低,且FIM、ADL评分更高,P<0.05;(2)观察组骨窗大小(2.53±0.66)cm、切口长度(4.22±0.67)cm、术中失血量(47.58±11.25)mL、手术用时(1.58±0.42)h均少于对照组(10.88±1.13)cm、(11.84±2.31)cm、(149.83±33.76)mL、(2.99±0.63)h,且血肿清除率(88.84±9.62)%大于对照组(75.31±7.24)%,P<0.05;(3)观察组术后1周、术后2周、术后1个月时的AQP4水平、脑水肿体积均小于对照组,P<0.05;(4)观察组发生1例并发症(3.03%),对照组发生7例并发症(21.21%),P<0.05。结论 对基底节区脑出血患者进行神经内镜手术治疗,手术创伤小,可以降低AQP4水平,减少脑水肿体积及并发症,提高生活能力,值得推广。

Objective To analyze the curative effect of neuroendoscopic surgery in patients with basal ganglia intracerebral hemorrhage. Methods From June 2019 to August 2020, 33 patients with basal ganglia intracerebral hemorrhage who received craniotomy and hematoma clearance were selected as the control group, and 33 patients with basal ganglia intracerebral hemorrhage who received neuroendoscopic surgery at the same period were selected as the observation group. NIHSS,FIM and ADL scores,details of the surgery, levels of AQP4, brain edema volume and complications were analyzed. Results (1) There were no significant differences in NIHSS, FIM and ADL scores between the two groups before operation, P＞0.05; after operation, NIHSS score of the observation group was lower, and FIM and ADL scores were higher, P＜0.05. (2) Bone window size of the observation group was (2.53±0.66) cm, incision length was (4.22±0.67) cm, intraoperative blood loss was (47.58±11.25) mL, and operation time was (1.58±0.42) h, which were less than those of the control group [(10.88±1.13) cm and (11.84±2.31) cm, (149.83±33.76) mL, (2.99±0.63) h], and the hematoma clearance rate (88.84±9.62)% was higher than that of the control group (75.31±7.24)%, P＜0.05. (3) The AQP4 level and brain edema volume of the observation group 1 week, 2 weeks and 1 month after operation were lower than those of the control group, P＜0.05. (4) There was one complication (3.03%) in the observation group and seven complications (21.21%) in the control group,P<0.05. Conclusion Neuroendoscopic surgery for patients with basal ganglia cerebral hemorrhage can reduce the level of AQP4, the volume of brain edema and complications, and improve the ability of life, which is worthy of promotion.

目的 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

目的 探讨高血压性脑出血在不同时点给药丹参酮ⅡA磺酸钠的疗效分析及对神经保护作用。方法 选取我院2014年10月—2016年10月期间收治的66例高血压性脑出血患者作为研究对象,按照随机数字表的方法分为观察组(n=33)和对照组(n=33),对照组患者于入院后第10天采用丹参酮ⅡA磺酸钠进行治疗,观察组则于入院后第3天采用丹参酮ⅡA磺酸钠进行治疗,分别对2组患者的临床疗效、不良反应、治疗前后的神经功能以及随访一年的脑卒中影响量表(SIS)进行客观比较。结果 经比较,观察组患者的临床总有效率为90.90%,对照组的临床总有效率为69.70%,2组比较,差异有统计学意义(P<0.05);观察组患者的不良反应稍低于对照组,但2组比较差异无统计学意义(P>0.05);此外,观察组患者治疗后的神经功能评分优于对照组和治疗前,差异有统计学意义(P<0.05);在随访一年的时间里发现,观察组患者的SIS量表亦更优于对照组(P<0.05)。结论 早期采用药丹参酮ⅡA磺酸钠治疗高血压性脑出血的临床疗效显著,不良反应相对较小,且在一定程度上发挥了保护患者神经功能的作用,值得推广。

Objective: To investigate the effect of tanshinone II A sulfonate treatment on hypertensive cerebral hemorrhage at different time and the neuroprotective effect. Methods: In our hospital from October 2014 to October 2016 66 cases of hypertensive cerebral hemorrhage patients were enrolled as the research object, according to the random number table method divided into observation group (n=33) and control group (n=33), patients in the control group on the tenth day after admission of sodium tanshinone A sulfonate treatment, The observation group was treated with tanshinone A sodium sulfonate on the third day after admission. The clinical efficacy, adverse reactions, neurological function before and after treatment, and Stroke Scale (SIS) were compared between the two groups. Results: by comparison, the observation group of patients with clinical total efficiency 90.90%, clinical control group in the total efficiency 69.70%, compared with significant difference (P<0.05); to observe the adverse reaction of patients was slightly lower than that of control group, but the difference between the two groups was not statistically significant (P>0.05); in addition, the patients in the observation group the neurological score was significantly better than the control group and before treatment, the difference was significant (P<0.05); Conclusion: the early treatment of sodium tanshinone II A sulfonate in the treatment of hypertensive intracerebral hemorrhage has a significant clinical effect, a relatively small adverse reaction, and to a certain extent, it plays a protective role in patients with neurological function, and is worthy of promotion.

目的 比较分析神经内镜和常规开颅手术在治疗高血压脑出血时的优劣。方法 回顾性分析我院神经外科2015年12月1日—2017年12月31日收治的60例高血压脑出血患者,根据治疗术式的不同,分为对照组和观察组,各30例。对照组行常规开颅手术,观察组给予神经内镜治疗,通过对比两组患者的手术时长、术中出血量、血肿清除率、住院时间、术后并发症及术后6个月随访效果,分析两组优劣。结果 观察组手术时长短于对照组,差异有统计学意义（P<0.05）;观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组血肿清除率高于对照组,差异有统计学意义（P<0.05）;观察组术后并发症（颅内感染、肺部感染）发生率低于对照组,差异有统计学意义（P<0.05）,而两组再次出血及死亡率差异均有统计学意义（P>0.05）;观察组患者术后预后效果优于对照组,差异有统计学意义（P<0.05）。结论 神经内镜在治疗高血压脑出血时对比常规开颅手术具有显著缩短手术时长及住院时间,提高血肿清除率,减少术中出血,降低颅内及肺部感染率等优势,值得临床推广应用。

Objective To compare and analyze the advantages and disadvantages of neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage. Methods 60 patients with hypertensive intracerebral hemorrhage admitted to our hospital from December 1,2015 to December 31,2017 were divided into the control group and the observation group,each with 30 cases. The control group underwent conventional craniotomy,and the observation group underwent neuroendoscopic treatment. The length of operation,intraoperative blood loss,hematoma clearance,length of hospital stay,postoperative complications,and follow-up after 6 months were compared between the two groups, to analysis the advantages and disadvantages of both groups. Results The duration of operation in the observation group was shorter than that in the control group （P<0.05）. The intraoperative blood loss in the observation group was less than that in the control group （P<0.05）;The hematoma clearance rate in the observation group was higher than that in the control group （P<0.05）;The incidence of postoperative complications （intracranial infection,lung infection） in the observation group was lower than that of the control group （P<0.05）. There was no statistically significant in rebleeding and mortality between the two groups （P>0.05）. The prognosis of the observation group was better than that of the control group. In the control group,the difference was statistically significant （P<0.05）. Conclusion Neuroendoscope in the treatment of hypertensive intracerebral hemorrhage compared with conventional craniotomy may shorten the length of operation and hospital stay,improve hematoma clearance rate,reduce intraoperative bleeding,reduce intracranial and pulmonary infection and other advantages. It is worthy of clinical promotion and application.

目的 探讨产后出血(PPH)应用一次性囊式宫颈扩张器治疗的临床效果。方法 选取我院2001年1月—2016年12月收治的50例PPH产妇,按就诊先后顺序进行分组,2001年1月—2015年12月就诊的25例为对照组(予以宫腔填塞纱布治疗);2016年1月—2016年12月就诊的25例为观察组(给予一次性囊式宫颈扩张器治疗),并按照分娩方式不同分为阴道分娩组(15例),剖宫产组(10例)。记录比较观察组和对照组的治疗与预后情况;阴道分娩组与剖宫产组的治疗情况。结果 与对照组比较,观察组在操作时间、填塞物留置时间及起效时间方面,均显著更优(P<0.01);两组放置后12 h出血量、显效率相比,差异无统计学意义(P>0.05);观察组子宫切除、子宫动脉结扎及产褥感染等发生率均低于对照组,但差异均无统计学意义(P>0.05);阴道分娩组的起效时间、留置时间、T2时间段阴道总流血量、显效率及产褥感染率,较剖宫产组比较,差异均无统计学意义(P>0.05),阴道分娩组T1时间段阴道总流血量显著低于剖宫产组(P<0.01)。结论 PPH产妇应用一次性囊式宫颈扩张器治疗操作简便,更有利于缩短操作时间,改善预后,效果切实,且对于阴道分娩与剖宫产产妇的疗效相当,适用于基层医院,具有较高临床推广价值。

目的 探讨小骨窗显微手术不同手术时机对高血压脑出血患者疗效及神经功能的影响。方法 选取我院2014年5月—2016年5月收治的80例高血压脑出血患者作为研究对象,脑出血量约30～40 mL,根据出血到手术时间不同分为两组,每组40例。从出血到手术时间<6 h者为超早期作为观察组,出血到手术时间处于6~24 h间者为早期作为对照组,比较两组患者治疗后1个月GOS(格拉斯哥预后)优良率,治疗后3周、6周的斯堪的纳维亚(SSS)评分,治疗后3个月、6个月的生存质量评分及治疗后的生存情况、再出血情况。结果 观察组治疗后1个月GOS优良率为77.50%,相对于对照组明显上升(P<0.05);观察组治疗后3周、6周的SSS评分较对照组明显降低(P<0.01);观察组治疗后3个月、6个月的生存质量评分较对照组明显升高(P<0.01);两组治疗后的生存率差异有统计学意义(P<0.05),再出血率差异无统计学意义(P>0.05)。结论 对高血压脑出血患者在超早期行小骨窗显微手术可提高疗效,明显改善患者神经功能,提高生活质量及生存率,值得临床推广。

Objective To investigate the curative effects of microsurgical treatment with small bone flap craniotomy in patients with hypertensive cerebral hemorrhage and on their nerve function in different timing of surgery. Methods To select 80 cases of hypertensive cerebral hemorrhage in our hospital from May 2014 to May 2016 as the research object. The amount of cerebral hemorrhage of the patients was about 30-40 mL. According to the different time of bleeding, they were divided into two groups, 40 cases in each group. The super early period that the time from bleeding to operation was less than 6 h was regarded as the observation group, and the early period that the time from bleeding to operation is during 6~24 h was regarded as the control group. To compare the GOS (Glasgow outcome) excellent rate of patients in two groups in 1 month after treatment, the Scandinavia (SSS) score in 3 weeks and 6 weeks after treatment, and the quality of life score and survival and re-bleeding condition after treatment in 3 months and 6 months. Results Compared with the control group, the GOS excellent rate in the observation group in 1 month after treatment was 77.50% which increased significantly (P<0.05); the SSS score in the observation group in 3 weeks and 6 weeks after treatment was significantly lower than that in the control group (P<0.01); The quality of life score in the observation group in 3 months and 6 months after treatment was significantly higher than that in the control group (P<0.01); There was statistically significant difference in survival rate between the two groups after treatment (P<0.05), and the re-bleeding rate showed no significant difference (P>0.05). Conclusion The curative effects of microsurgical treatment with small bone flap craniotomy on patients with hypertensive cerebral hemorrhage is significant, which can improve the patients' neurological function, the life quality and survival rate, thus it is worthy of clinical promotion.

目的 探讨血清铁蛋白及超敏C反应蛋白联合检测对急性脑出血患者的临床意义。方法 2012年1月—2015年12月,自发性脑出血的患者77例,男42例,女35例;年龄45～82 a,平均年龄(67.19±10.17)a。根据Rankin 评分将患者分成两组,A组,MRS≤2分,预后良好; B组,MRS＞2分,预后差;另选取同期健康体检者35例作为健康对照组,即C组。分别于入院时、发病后第3天、7天、14天时,采静脉血化验血常规、Hs-CRP及SF;于入院时和发病后第3天时,进行头颅CT检查。采用美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS) 分别于入院及随访12个月时,对两组患者神经功能损伤及恢复情况进行评估。结果 77例脑出血患者在发病12个月随访时, 53例患者MRS≤2分,预后良好;24例患者MRS＞2分,预后较差。于入院时、发病后第3天、7天、14天,脑出血患者的Hs-CRP及SF水平均显著高于健康体检人员,差异具有统计学意义(P<0.05);在各时间点脑出血患者中的预后较差组Hs-CRP及SF水平均不同程度高于预后良好组;但在入院发病后第3天则显著高于预后良好组,差异具有统计学意义(P<0.05),同时,脑出血患者中的预后较差组脑水肿量及水肿系数均显著高于预后良好组,差异具有统计学意义(P<0.05)。影响脑出血预后的独立危险因素包括NIHSS评分(P=0.012),Hs-CRP(P=0.027)和SF水平(P=0.041)。结论 Hs-CRP及SF水平在一定程度上可作为脑出血预后的重要评估指标。

Objective To investigate the clinical significance of combined detection of serum ferritin and high sensitive C reactive protein in patients with acute cerebral hemorrhage. Methods From January 2012 to December 2013, 77 cases with cerebral hemorrhage male 42, female 35; aged 45 to 82 year old, average age (67.19±10.17)years old. According to MRS(Modified Rankin Scale) score criteria, patients were divided into good prognosis group(group A) with MRS ≤2, and poor prognosis group (group B)with MRS ＞2. Another 35 cases of healthy physical examination were selected as the healthy control group(group C). RT(Routine blood test), Serum Ferritin(SF)and Hs-CRP were tested at the time of admission, the third, the seventh and the fourteenth day from onset of the disease respectively. Head CT were done at the time of admission, the third day from onset of the disease respectively. Neurological assessment were scored according to the NIHSS criteria(National Institutes of Health Stroke Scale) for the patients in the two groups at the time of admission and 12 months of follow up. Results 77 cases of cerebral hemorrhage were followed up for 12 months, 53 cases with MRS ≤2, the prognosis was good; And 24 cases with MRS >2, the prognosis was poor. The levels of Hs-CRP and SF were all higher in patients with cerebral hemorrhage than that in healthy control group (P<0.05) at the time of admission, the third day,seventh and fourteen day from onset of the disease respectively. The levels of Hs-CRP and SF were higher in group B than that in control group at the time of admission, the third day, the seventh day and the fourteenth day from onset of the disease respectively, but only at the time of admission, three days from onset of the disease, the difference was statistically significant (P<0.05). At the same time, the brain edema and edema index in the group B were higher than those in group A. The independent risk factors influencing the prognosis of cerebral hemorrhage were NIHSS score (P=0.012), Hs-CRP(P=0.027) and SF(P=0.041). Conclusion Hs-CRP and SF may be important indicators of the prognosis for cerebral hemorrhage in a certain degree.

目的 探讨小肠出血的诊断策略。方法 回顾性分析我院2010年1月— 2015年6月收治的42例小肠出血病例的诊治经历。结果 42例患者中肿瘤15例(35.7% );血管发育不良和畸形10例(23.8%);炎性肠病9例(21.4%),憩室7例(16.7%),原因不明1例(2.4%)。气钡双重造影阳性率11.8%;B超检查阳性率15%;核素扫描阳性率44.4%;CT检查阳性率46.7%;血管造影阳性率50%,小肠镜检查阳性率58.9%;胶囊内镜阳性率61.5%;术中肠镜检查阳性率88.9%。结论 小肠出血病因多样,检查缺乏特异性;隐性出血者可选择CT或胶囊内镜,结果阳性者进一步可行小肠镜检查或治疗;活动性出血患者选择ECT或DSA,手术探查或术中肠镜是最后选择。

Objective To investigate the diagnosis of small intestinal haemorrhage. Methods The diagnosis and treatment of 42 cases of small intestinal haemorrhage between January 2010 and June 2015 were analyzed retrospectively. Results Among the patients, small bowel tumors were found in 15 cases,angiodysplasia in 10,inflammation disease in 9,diverticulum in 7 and obscure bleeding in 1 each. Positive rate of diagnostic methods was followed:enteroclysis 11.7％,B-ultrasound 15%, ECT 44.5%,CT 46.7％,DSA 50%, device-assisted enteroscopy 58.9％, capsule endoscopy 61.5%,enteroscope examination during operation 88.9%. Conclusion There are various etiological factors and lack of specificity in small intestinal haemorrhage. Capsule endoscopy or CT should be used first if the patient had occult bleeding, positive patients were suggested to taken enteroscopy. ECT and DSA must be applicable for active bleeding or other positive patients. Operation or enteroscope examination during operation could be the last measure.

目的 研究限制会阴切开及会阴不同切口对产妇产后出血、疼痛及性功能的影响。方法 选取我院2012年4月—2013年4月头位自然分娩产妇480例,抽签随机分为三组,每组160例,实施限制会阴切开的为限制组,实施会阴侧切的为侧切组,实施会阴正中切开的为正切组,比较三组产妇产后2 h出血量、产后住院时间、产妇会阴阴道裂伤率、产后疼痛程度和性功能满意程度。结果 产后2 h产妇出血量限制组(203.65±76.68)mL较侧切组(241.41±80.63)mL和正切组(239.15±85.19)mL少(P＜0.05);侧切组(1.64±0.87)d产后住院时间较限制组(1.37±0.64)d较长(P＜0.05);限制组会阴Ⅰ/Ⅱ°裂伤率为86.25%较侧切组1.25%和正切组6.88%较高(P＜0.05);侧切组2.50%和正切组3.13%会阴Ⅲ/Ⅳ°裂伤较限制组0%较高(P＜0.05);女性性功能指数限制组(22.69±2.65)分较侧切组(19.12±2.05)分与正切组(18.96±2.16)分较高(P＜0.05)。结论 实施限制会阴切开的产妇术后出血量少,会阴重度裂伤率低,保证了会阴完整性,产后性功能满意度高,值得临床上应用推广。