卒中是一组发病率、致残率和病死率均很高的疾病,高血压脑出血约占全部脑卒中的10％～20％,其病死率和致残率高居各类卒中之首[1].近30余年来,有大量的研究表明,健康者脑脊液乳酸(cere-brospinal fluid lactate,CSF-LA)含量很低,脑脊液乳酸水平的升高与中枢神经系统的感染、颅脑损伤、颅内出血及脑梗死等有关[2,3].本研究以高血压脑出血破入脑室的患者为研究对象,于2017年1月至2018年9月完成脑室外引流术+颅内压探头置入术治疗高血压脑出血破入脑室患者共26例.同期取排除中枢神经系统疾病而需要行蛛网膜下腔麻醉的患者共18例作为对照组.通过收集并检测高血压脑出血破入脑室患者及对照组脑脊液乳酸浓度,对比2组脑脊液乳酸浓度的差异,分析高血压脑出血破入脑室患者脑脊液乳酸水平与患者入院时格拉斯哥昏迷评分(GCS)评分、颅内压及术后3个月格拉斯哥预后量表(GOS)评分等的相关性,现报告如下.
目的:探究神经内镜治疗幕上高血压脑出血的手术方式与疗效评估.方法:对照组予以开颅血肿清除术治疗,观察组予以神经内镜微创治疗,观察对比两组手术时间等围术期观察指标,并对比两组术后并发症,术后随访6个月,对比两组预后质量.结果:观察组的手术时间、术中出血量、血肿清除率及住院时间均优于对照组(P＜0.05);观察组术后并发症率为5.0％,明显低于对照组的22.5％(P＜0.05);术后随访6个月,观察组预后良好率为90.0％,明显高于对照组的77.5％ (P＜0.05).结论:神经内镜治疗幕上高血压脑出血即可清除血肿,又能减少创伤,减少术后并发症发生,且对改善临床预后有重要临床价值.
目的 探究靶向栓塞联合伽玛刀治疗颅内动静脉畸形的有效性和安全性.方法 48例颅内动静脉畸形患者,随机分为观察组和对照组,每组24例.对照组给予靶向栓塞治疗,观察组在对照组的基础上给予伽玛刀治疗.比较两组的临床效果及安全性差异.结果 观察组患者并发症发生率为12.50%,低于对照组的37.50%,差异具有统计学意义(P<0.05).观察组患者出院时评估水平优于对照组,差异具有统计学意义(P<0.05).随访后观察组患者预后情况优于对照组,差异具有统计学意义(P<0.05).结论 靶向栓塞联合伽玛刀治疗颅内动静脉畸形具有良好的临床效果,且安全性良好.
Objective To explore the value and advantage of intracranial pressure (ICP) monitoring in the treatment of hypertensive intracerebral hemorrhage (HICH) through minimally invasive surgery. Methods Seventy-three HICH cases were randomly selected and then divided into control group and treatment group. Thirty-four of them in control group received soft-channel minimally invasive hematoma removal. The head of the soft-channel was placed in the center of the hematoma. One third to half of the initial hematoma was extracted during the operation. Urokinase was injected into the soft channel to dissolve the hematoma. Thirty-nine of them in treatment group underwent the same operation procedure but with ICP monitoring to control aspirating hematoma during the operation. The target ICP was 15 mmHg. The aspiration of hematoma may stop once the ICP down to the target. Treatment such as urokinase injection was adjusted according to the value of ICP monitoring throughout the operation. The incidence of rebleeding, hematoma evacuation time and the average length of stay between two groups were compared. Results The results showed that one fifth of hematoma extracted was enough for a desired ICP. There found no rebleeding case in treatment group while 4 cases in control group and the difference had statistical significance. The hematoma evacuation time and the average length of stay between two groups had statistical significance. Conclusion Continuous ICP monitoring combined with directional software channel minimally invasive surgery changes the concept of empirically intraoperative hematoma evacuation and postoperative drug injection and proposes the idea of controlling drainage. It can shorten the course, provide sensitive and objective indicators and basis, reduce the secondary brain injury and improve prognosis.
Objective:To study clinical efficacy of the integrative medicine on hypertensive cerebral hemorrhage.Methods: 120 patients with cerebral hemorrhage were randomly divided the integrative medicine group and WM group,60 cases in each. Western medicine group with Western medicine, integrative medicine group received the combination therapy. Results:with x2 test data, integrative medicine group clinical efficiency was significantly higher than Western medicine group (P<0.05).Data analysis was performed with the t test statistics,in the integrative medicine group NIHSS scores were significantly lower than western medicine group (P<0.05).Barthel index was significantly higher than Western medicine group (P<0.05).Conclusion:The integrative treatment for hypertensive intracerebral hemorrhage can make significant clinical effect, also can improve their quality of life.
To investigate the relationship between serum miRNA-21 (miR-21) expression in esophageal squamous cell carcinomas (ESCCs) and their clinicopathologic features, a 1:1 matched case-control study including 21 patients with ESCC and 21 age- and gender-matched healthy controls was carried out. Serum specimens were taken from all subjects. Total RNA was extracted and the stem-loop real time polymerase chain reaction was used to measure serum miR-21 in both groups. Clinical parameters were assessed to determine associations with serum miR-21 concentrations. Serum miR-21 expression in ESCC samples was significantly higher than in paired cancer-free samples (P <0.05). Metastasis was associated with mir-21 expression in serum (P <0.05), ESCC patients with metastasis having 8.4-fold higher serum miR-21 concentrations than healthy controls. There were no statistically significant associations between miR-21 expression and clinicopathologic parameters, such as gender (P >0.05), age (P >0.05), tumor location (P >0.05), cell differentiation (P >0.05), TNM staging (P >0.05), whether chemo/radiotherapy had been administered (P >0.05), or whether surgery had been performed (P >0.05). These findings suggest that the detection of microRNA-21 in serum might serve as a new tumor biomarker in diagnosis and assessment of prognosis of ESCCs.
微小RNAs(miRNAs)的异常表达与肿瘤的发生、分化、转移及复发等密切相关。研究发现,在食管癌组织中,miR-NAs在表达水平上明显区别于癌旁正常组织;在外周血中,miRNAs也表达出显著的肿瘤相关性、组织特异性和表达稳定性。本文将对miRNA作为食管癌血清标志物的研究进展作一综述。
