目的:探讨依折麦布联合辛伐他汀在老年冠状动脉粥样硬化性心脏病(简称冠心病)患者中的应用效果,并为该疾病的治疗提供证据.方法:选择 2021 年 1 月—2023 年 1 月南京市溧水区人民医院收治的 91 例老年冠心病患者作为研究对象,根据随机数表法将患者分为对照组(n=45)和观察组(n=46).对照组给予辛伐他汀,观察组在对照组基础上给予依折麦布.对比两组治疗效果及治疗前后心功能、颈动脉斑块、氧化应激反应的变化情况.结果:治疗后,观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05);治疗后,两组左室射血分数(left ventricular ejection fraction,LVEF)高于治疗前,且观察组高于对照组,两组左室收缩末期内径(left ventricular end-systolic dimension,LVESD)、左室舒张末期内径(left ventricular end diastolic dimension,LVEDD)低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组颈动脉斑块数量、颈动脉内膜中层厚度优于治疗前,且观察组优于对照组,两组颈动脉内径均大于治疗前,且观察组大于对照组,差异有统计学意义(P<0.05);治疗后,两组超氧化物歧化酶(superoxide dismutase,SOD)水平高于治疗前,且观察组高于对照组,两组丙二醇(maleic dialdehyde,MDA)和髓过氧化物酶(myeloperoxidase,MPO)低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05).结论:依折麦布联合辛伐他汀治疗老年冠心病患者效果显著,能明显改善心脏功能,稳定颈动脉粥样硬化斑块,降低氧化应激反应.

目的:分析对颅脑外伤、高血压脑出血(HICH)的患者,进行颅内压监测对患者治疗预后的作用.方法:选取2019年1月—2020年8月本院收治的80例颅脑外伤及高血压脑出血患者作为研究对象,遵循随机数字表法的分组原则,分别为实验组与对照组每组各40例,两组均给予手术治疗,其中对照组术后进行常规的止血、抗感染及脱水等干预,实验组则是在对照组的基础上进行持续的颅内压监测,根据监测的颅内压情况对治疗方案进行调整,观察两组甘露醇用量、预后情况及并发症发生情况.结果:实验组患者在第3?d、7?d、14?d及总甘露醇用量上均较对照组少(P<0.05);实验组预后良好率95.00％明显高于对照组的80.00％,实验组并发症总发生率7.50％低于对照组的25.00％,组间比较差异具有统计学意义(P<0.05).结论:颅脑外伤及H I C H在术后予以颅脑压监测,根据颅内压监测情况调整治疗方式,可明显减少甘露醇的使用量,降低术后并发症的发生及改善患者预后,值得应用.

目的:观察优质化护理联合康复护理对脑出血留置尿管手术患者尿路感染预防作用及生活质量的改善作用.方法:选择南京市溧水区人民医院2017年6月至2019年12月期间收治的70例脑出血留置尿管手术患者为研究对象,利用电脑抽签的方式,将70例患者均分为两组.针对对照组患者展开康复护理措施,针对观察组患者展开优质化护理联合康复护理措施,观察两组患者的尿路感染发生率、生活质量评分、平均住院时间、菌尿发生率等指标之间的差异.结果:观察组尿路感染发生率低于对照组;生活质量评分高于对照组;平均住院时间低于对照组;菌尿发生率低于对照组;差异均有统计学意义(均P<0.001).结论:优质化护理联合康复护理能够有效预防脑出血留置尿管手术患者尿路感染的发生,提升患者生活质量,值得推广.

Objective To analyze the significance of intracranial pressure (ICP)-related parameters on outcome in patients with severe traumatic brain injury. The ICP-related parameters included ICP, ICP dose (DICP), regression of the correlation coefficient between amplitude and pressure (RAP), pressure reactivity index (PRx), and cerebral perfusion pressure (CPP). Methods A retrospective analysis was performed using clinical information from 29 patients with severe traumatic brain injury who were admitted to the Department of Neurosurgery from January 2018 to January 2019. All patients underwent ICP probe implantation after admission. Patients were followed up for 6 months after discharge, and were categorized into either the favorable or unfavorable outcome group based on their Glasgow Outcome Scale score. The differences in ICP, DICP, RAP, PRx, and CPP between the two groups were analyzed for their effects on outcome. Results The average ICP, DICP, PRx, and RAP values in patients with favorable outcomes were significantly lower than in patients with unfavorable outcomes, while CPP values were significantly higher in the favorable outcome group. Conclusion Average ICP, DICP, PRx, RAP, and CPP values may indicate disease status and relate to patient outcomes. It is important to use multiple parameters to predict patients’ disease severity and prognosis.

目的 探讨颅内压(ICP)及相关参数与老年高血压性脑出血预后的关系.方法 回顾性分析南京市溧水区人民医院神经外科2017年1月—2018年7月收治的37例老年高血压性脑出血患者的临床资料.根据患者出院后的格拉斯哥预后量表(GOS)评分分成预后良好组及预后不良组,分析比较两组患者的平均ICP、平均压力反应指数(PRx)、Dicp20及平均颅内压波幅(mean ICP wave amplitude,MWA)值的差异.结果 预后良好组患者的平均ICP、平均PRx、Dicp20及平均MWA值圴明显低于预后不良组,差异有统计学意义(均P<0.01).结论 平均ICP、平均PRx、Dicp20及平均MWA与老年高血压性脑出血患者的预后有密切的关系;其数值低的患者预后较好.

Objective: Traumatic brain injury (TBI) is a serious health problem with few available treatment options.Rh-erythropoietin (rh-EPO) is a potential therapeutic drug for TBI, but it cannot cross the blood-brain barrier (BBB) directly.In this regard, a novel strategy to deliver rh-EPO for enhanced TBI treatment is via the development of Tween 80 modified albumin nanoparticles using electrostatic spray technology.Methods: The rh-EPO loaded Tween 80 modified albumin nanoparticles (rh-EPO-Tw-ABNPs) were prepared by electrostatic spray technology, while the process parameters were optimized via a single factor design.Investigation of physicochemical properties, bioactivity and stability of rh-EPO-Tw-ABNPs was carried out.The in vitro release and biocompatibility with nerve cells were also analyzed.The in vivo brain targeting efficiency, brain edema relieving effect and the expression of aquaporin 4 (AQP4) and glial fibrillary acidic protein (GFAP) in the brain were evaluated in TBI model rats. Results:The particle size of optimal rh-EPO-Tw-ABNPs was about 438 ± 45 nm, with a zeta potential of -25.42 ± 0.8 mv.The average drug loading ratio of rh-EPO-Tw-ABNPs was 21.3± 3.7 IU/mg with a relative bioactivity of 91.6 ± 4.1%.The in vitro release of rh-EPO from the nanoparticles was rather slow, while neither the blank Tw-ABNPs nor rh-EPO-Tw-ABNPs exhibited toxicity on the microglia cells.Furthermore, in vivo experiments indicated that the rh-EPO-Tw-ABNPs could enhance the distribution of EPO in the brain and relieve brain edema more effectively.Moreover, compared with an rh-EPO injection, the rh-EPO-Tw-ABNPs could increase the AQP4 level but reduced GFAP expression in the brain with more efficiency. Conclusion:The rh-EPO-Tw-ABNPs could enhance the transport of rh-EPO into the brain with superior therapeutic effect for TBI.

目的 探讨持续颅内监测在老年重症高血压脑出血患者手术治疗中的应用价值.方法 回顾性的分析了溧水区人民医院2015年1月～2017年12月收治的40名老年重症高血压患者.分为颅内压监测组和对照组.对照组予常规治疗;监测组在常规治疗的基础上监测颅内压,并根据颅内压数值采取阶梯式降颅压方案.比较两组患者的脱水剂的使用时间、住院时间、术后并发症和术后三个月的GOS评分.结果 两组患者的性别、年龄和术前GCS评分无统计学差异,差异无统计学意义(P>0.05).与对照组相比,颅内压监测组的脱水剂使用时间缩短,差异有统计学意义(P<0.05)、住院时间缩短,差异有统计学意义(P<0.05),GOS评分提高,差异有统计学意义(P<0.05).结论 在老年重症高血压脑出血患者的手术治疗中应用连续有创颅内压监测能减少脱水剂的使用,缩短平均住院日,改善预后,具有很高的临床应用价值.

目的:探讨重症脑出血患者颅内压(intracranial pressure,ICP)相关参数与预后的关系.方法:回顾性分析54例脑出血患者的临床资料,患者术中均植入颅内压监测探头,术后均行有创动脉血压、ICP监测,采用NEUMATIC信息收集与科研系统采集ICP相关数据.主要包括平均颅内压波幅(mean wave amplitude,MWA)等,压力反应指数(pressure reactivity indexpressure reactivity index,PRx)及颅内压波幅与动脉压波幅相关系数(ICP-arterial blood pressure wave amplitude correlation,IAAC),选取1h为时间节段连续计算相应的平均MWA及PRx,再分别计算出MWA＞5 mmHg/h、平均PRx＞0.25所占的百分比及所有患者住院期间平均IAAC.根据出院后患者格拉斯哥预后评分(Glasgow outcome score,GOS)将所有患者分为预后不良(GOS Ⅰ ～Ⅲ级)和预后良好(GOSⅣ、Ⅴ级),比较两组患者相关数据的差异.结果:预后不良组平均IAAC数值、平均PRx＞ 0.25出现的百分比、MWA＞5 mmHg/h出现的百分比明显高于预后良好组,差异均有统计学意义.平均MWA＞5 mmHg/h提示异常,其持续时间越长,出现频率越高,患者预后越差.结论:MWV、平均PRx及平均IAAC与患者预后密切相关,其数值越高,患者预后越差;MWA＞5 mmHg/h持续时间越长,出现越频繁,患者预后越差.

目的:研究颅脑外伤手术患者采用有创颅内压监测术后发生颅内感染的危险因素.方法:选取进行有创颅内压监测的脑外伤开颅术后患者100例;根据是否发生感染分为感染组50例和非感染组50例,比较2组颅内感染情况、GCS评分及临床资料,应用Logistic回归分析统计颅内感染的影响因素.结果:颅内压监测放置探头部位(χ2=5.862,P=0.020)、脑脊液漏(χ2=12.784,P=0.062)、手术时间(t=2.12,P=0.049)、切口类型(χ2=4.098,P=0.068)、内置颅内压监测探头留置时间(t=2.96,P=0.01)、切口引流管留置颅内时间(t=4.08,P=0.01)是颅内感染的影响因素;颅内压监测探头的留置时间、切口引流管留置时间及脑脊液漏是颅内感染的独立危险因素.结论:脑脊液漏、切口引流管留置时间过长及颅内压探头留置时间延长是颅脑外伤术后应用有创颅内压监测并发颅内感染的独立危险因素.

目的 观察血栓弹力图(TEG)和传统凝血功能检查在自发性脑出血患者中的相关性,探讨其临床应用价值.方法 收集40例自发性脑出血患者在人院时、术中2h、术后24 h、术后1周行TEG和传统凝血功能检查的结果,比较两者的相关性.结果 血栓弹力图R值与APTT、PT呈正相关(P＜0.01),血栓弹力图α角、K值、MA值分别与Plt及Fib呈负相关(P＜0.01);R值与PT的一致性分析:Kappa值=-0.110,P=0.013;R值与APPT的一致性分析:Kappa值=-0.119,P=0.006;K值与Fib的一致性分析:Kappa值=0.831,P=0.000;α角与Fib的一致性分析:Kappa值=0.761,P=0.000;MA值与Plt的一致性分析:Kappa值=-0.612,P=0.000.结论 TEG与传统凝血检测4项之间存在一定的相关性但一致性较差,两种方法不能相互替代,两种方法诊断出血的灵敏度均较低,联合应用TEG和传统凝血功能检查更能全面评估脑出血患者的凝血功能状态,指导临床治疗.

目的:探讨分析用大骨瓣开颅术治疗高血压脑出血的效果与安全性.方法:择取2012年1月～2017年10月江苏省南京市溧水区人民医院神经外科收治的45例高血压脑出血患者作为研究对象,对其实施大骨瓣开颅术.然后,观察记录这些患者的手术成功率、手术用时、术中出血量、术后住院时间、并发症的发生率、颅内血肿的清除率及治疗的总有效率.结果:这些患者的手术成功率为100％,其平均手术用时为(3.4±0.55)h,其术中平均出血量为(356±50.8)ml,其术后平均住院时间为(28.9±3.6)d,其并发症的发生率为8.89％,其颅内血肿的清除率为84.54％,治疗的总有效率为95.56％.结论:用大骨瓣开颅术治疗高血压脑出血的临床疗效确切、安全性较高.

目的:探讨标准外伤大骨瓣开颅术治疗重型颅脑损伤的临床效果.方法:以2014年1月-2017年10月笔者所在医院神经外科76例重型颅脑损伤患者为研究对象,依据治疗方法不同分为两组.试验组38例,患者行标准外伤大骨瓣开颅术;对照组38例,患者行常规骨瓣开颅术.对比观察两组预后,统计并发症.结果:试验组术后良好/轻残率52.63％,高于对照组的21.05％,重残/死亡率47.37％,低于对照组的78.95％,差异均有统计学意义(χ2=5.79、5.79,P<0.05).试验组迟发出血2.63％,脑脊液漏2.63％,切口疝0,各发生率均低于对照组,差异均有统计学意义(χ2=4.94、4.61、4.16,P<0.05);试验组急性脑膨出23.68％,外伤性癫痫0,颅内感染2.63％,与对照组比较,差异均无统计学意义(χ2=1.89、1.82、1.82,P>0.05).结论:标准外伤大骨瓣开颅术治疗重型颅脑损伤效果优于常规骨瓣开颅术,对提高生存率、改善患者具有积极作用,值得临床推广使用.

Objective To observe the change and significance of both tau and A-beta 42 in serum and CSF of patients with brain injury.Methods The expression levels of tau protein and A-42 was detected in 60 patients with craniocerebral injury in our hospital from May 2015 to April 2016, and the correlation between the protein expression level and the injury degree was studied.Results Compared with healthy control group, Both tau protein level and A-beta 42 level were significantly increased in the serum and CSF of the A group and the B group. Both the tau protein level and A-beta 42 level were considerably higher in the serum and CSF of the A group than those in the B group (P<0.05). Compared with A group, the percentage of patients with GOS 1~3 score was significantly lower in the B group, the percentage of patients with GOS 4~5 score was significantly increased in the B group (P<0.05).Conclusion The tau and amyloid beta 42 expression levels were closely related to brain injury, was acted as the brain damage important index to evaluate the prognosis of brain injury patients, and a beta 42 might play an important role in the pathophysiology of cognitive dysfunction after severe traumatic brain injury.

Objective To investigate the curative effect of recombinant activated factor Ⅶ ( rFⅦa) on treating patients with severe traumatic brain injury (TBI).Methods 40 patients with TBI were randomly divided into the treatment group (n=20) and the control group (n=20).Patients in the control group accepted only conventional treatment , while the treatment group accepted an addition dose rFⅦa (40 mg/kg) on admission.The observation window was 168 hours for change of coagulation parameters and adverse events .And the other changes in intraoperative blood loss , reoperation rate ,mortality ,3 months Glasgow outcome scale ( GOS ) score were observed .Results Compared with the control group ,differences were significant with regard to PT ,APTT,FDP,DD ( all P<0.05).The intraoperative blood loss was (500 ±194.3) ml and (1030 ±427.0)ml,the 168 h concentrated red cell transfusion amount was (1.70 ±1.72)u and (3.61 ±1.73)u,the reoperation rate was 15%(3/20) and 45%(9/20),the mortality was 15%(3/20) and 45%(9/20),the 3 months GOS score was (3.20 ±1.28) and (2.35 ±1.31) in the treatment and control group respectively (all P<0.05).Conclusion Early application of rFⅦa for patients with TBI can improve blood coagulation function , reduce reoperation rate and mortality , which can improve the clinical efficacy and activity ability of daily living .

目的：分析外伤性急性硬脑膜下血肿手术治疗预后的相关因素。方法选择2006年1月～2014年6月我院收治的123例急性硬脑膜下血肿手术患者。按照外伤至手术清除血肿之间的时间间隔，术前瞳孔改变，GCS评分，致伤原因、年龄、性别等因素对患者进行分组，统计术后恢复情况。结果外伤至手术清除血肿之间的时间间隔，术前瞳孔改变，GCS评分，脑损伤类型，患者年龄五个指标与急硬脑膜下血肿患者的预后相关，性别、致伤原因与预后关系不大。结论 GCS评分，瞳孔改变，外伤至手术清除血肿之间的时间等指征是特急性硬脑膜下血肿患者的预后的主要影响因素，患者手后应接受密切观察以降低硬脑膜外血肿，脑内血肿等并发症的风险。

Objective To explore the curative effect of micro-invasive external ventricular drainage treatment for intraventricular hemorrhage .Methods The clinical data of 39 patients with ventricular hemorrhage were underwent micro-invasive external ventricular drainage surgery and postoperative treatment of infusion of urokinase in our hospital from September 2003 to October 2014 , were analyzed retrospectively and the surgical curative effect were summarized.Results Of 39 patients, 5 died after the surgery(12.8%),1 suffered from delayed hydrocephalus and underwent ventriculoperitoneal shunt surgery .According to the activities of daily living score 3 monthes after the therapy,15 recovered well(38.5%),11 remained the abilities of daily living (28.2%),and 8 even lost basic abilities (20.5%).Conclusion For intraventricular hemorrhage,micro-invasive external ventricular drainage can be an easy-operative therapy with obvious curative effect ,low fatality rate and low disability rate .

Objective To compartive analyse the clinical curative effect of minimally invasive surgery and traditional craniotomy treatment of cerebral hemorrhage patients, to improve the treatment effect. Methods Seventy cases of cerebral hemorrhage patients given surgical treatment were selected in our hospital from May 2006 to June 2012 as the research object, included minimally invasive surgical 35 cases, the traditional surgical 35 cases. The two groups after treatment of recovery were observed and compared. Results After surgery 3 d, the awake, sleepiness, shallow degree coma, moderate coma and depth comatose number in minimally invasive group respectively, 20, 5, 8, 2, 0 cases. And control group respectively for 10, 5, 16, 4, 0 cases. After surgery 3 months, the vegetative state (ADL5) and death 4 cases in minimally invasive group and control group for 11 cases, the difference between the two groups had statistical significance (P 0.05). For 1 month after, the total effective rate in minimally invasive group was 80.00%, far higher than 54.29% in control group (P 0.05). Conclusion Cerebral hemorrhage surgery to minimally invasive surgical treatment is good for patients, postoperative consciousness is better, minimally invasive plants state and the incidence of death more low, higher efficiency, it is worth of clinical application.

目的 比较微创与传统手术方法治疗基底节区高血压脑出血(HICH)的临床效果,探讨治疗基底节区高血压脑出血的最佳术式.方法 基底节区HICH患者81例,随机分为治疗组和对照组；治疗组接受锥颅穿刺引流液化术,对照组接受传统大骨辩开颅血肿清除术,追踪随访临床效果.结果 治疗后治疗组功能评分明显好于对照组,两者差异均有统计学意义(P＜0.05)；治疗组2周病死率、6个月病死率分别为10.26％、12.82％,与对照组差异无统计学意义(P＞0.05).结论 微创手术在改善患者预后、提高生活质量等方面明显优于传统开颅术,是基底节区高血压性脑出血较理想的术式。

Objective To study the clinical prognosis and prognostic factors of surgical treatment of traumatic special acute subdural hematoma (TSASDH). Methods 117 patients diagnosed as TSASDH and treated in our hospital were reviewed retrospectively. Statistical analysis was performed. Results In the age group 17 ~ 70, the overall mortality of TASDH was 48.7%, the overall good recovery rate was 37.6%. But, in age group 61 ~ 70, the good recovery rate was only 20.0%, and in patients with advanced herniation before operation, the good recovery rate was only 6.0%. Conclusions Patients with indications of TASDH should be operated as early as possible; elderly and herniation patients have poor prognosis, only a few younger patients have good recovery.