目的 探讨依达拉奉右莰醇(ED)对大鼠液压冲击脑损伤的影响及机制.方法 取96只SD大鼠随机分为假手术组、模型组、ED组和ED+脂多糖(LPS,TLR4激活剂)组,每组24只;采用液压冲击法制备脑损伤大鼠模型.ED组腹腔注射(ip)给予5.6 mg·kg-1依达拉奉+1.4 mg·kg-1右莰醇,ED+LPS组ip给予5.6 mg·kg-1依达拉奉+1.4 mg·kg-1右莰醇+0.4 mg·kg-1 LPS,假手术组和模型组ip给予生理盐水,均1次·d-1连续14d.通过mNSS评分评价大鼠神经功能缺损状况,干湿重法检测脑组织含水量(BWC),苏木精-伊红染色法、TUNEL染色法观察脑组织病理变化和神经元凋亡状况,ELISA法检测炎症因子水平,Western blot检测Toll样受体4(TLR4)/核因子-κ B p65(NF-κ B p65)通路相关蛋白表达.结果 治疗后,ED组大鼠mNSS评分和BWC均明显低于模型组(P＜0.05);模型组脑组织呈现结构疏松、神经元间隙增大、空泡变性、炎细胞浸润等病理变化及大量神经元凋亡,ED组脑组织病理学变化及神经元凋亡状况较模型组明显改善、凋亡指数明显降低(P＜0.05);ED组脑组织肿瘤坏死因子-a(TNF-a)、白细胞介素-1 β(IL-1 β)水平和TLR4表达量及p-NF-κ B p65/NF-κ B p65、p-I κ B a/I κ B a表达比值较模型组均明显降低(P＜0.05).LPS能够明显逆转ED对液压冲击脑损伤大鼠上述各指标的调控作用(P＜0.05).结论 ED可抑制液压冲击脑损伤大鼠炎症反应、减轻脑损伤,其作用机制可能与抑制TLR4/NF-KB通路活化有关.

Purpose The main aim of this study was to investigate the risk factors of traumatic subdural effusion (TSE) development in traumatic brain injury (TBI) patients who did not undergo decompressive craniectomy (DC). Methods This is a retrospective study based on a database of patients treated in a single institution from January 2020 to January 2022. The clinical and demographic characteristics of the enrolled patients, including gender, age, Glasgow Coma Scale score at admission, characteristics of the initial CT scan on admission, mechanism of injury and the mannitol treatment were recorded retrospectively. Results Two hundred fifty-four patients with TBI who did not receive DC were enrolled in this study. Among them, 78 (30.71%) patients were assigned to the TSE group, while 176 patients (69.29%) without TSE were assigned to the control group. Univariate analysis showed that patients in the TSE group were more likely to be male ( p = 0.019), older ( p < 0.001), have a subarachnoid haemorrhage ( p = 0.016) and have a basal cistern haemorrhage ( p = 0.014). Logistic regression analysis identified that older age (odds ratio [OR] = 1.056, p < 0.001), presence of subarachnoid haemorrhage (OR = 2.022, p = 0.018) and presence of basal cistern haemorrhage (OR = 2.861, p = 0.027) were risk factors independently associated with the development of TSE. Conclusion Our results showed that older age, presence of subarachnoid haemorrhage and presence of basal cistern haemorrhage were risk factors independently associated with the development of TSE for TBI patients without DC.

The medical and health industry has successively experienced three stages of digital medical treatment, local area network medical treatment, and internet medical treatment. With the rapid development of technologies such as the Internet of Things, big data, and artificial intelligence, emerging applications and service models have gradually penetrated into all aspects of the medical and health field. At this point, the informatization development process of the medical industry has entered the stage of smart medical treatment. (Smart medical system is a new medical system that improves users’ medical experience and provides users with better services. Due to the cumbersome, complicated, and mechanically rigid environment of the past medical service, there was no uniform standard. In order to create a reliable and open medical service environment, an intelligent medical system came into being.). A diversified technical foundation and smart medical protection, conducive to providing patients with high-quality medical services, are established. This article mainly introduces the analysis of the therapeutic effect of smart medical electronic endoscopic hematoma removal on hypertensive basal ganglia cerebral hemorrhage and aims to inject advanced technology and vitality of smart medical treatment into the treatment of hypertensive basal ganglia cerebral hemorrhage by hematoma removal and help the doctor to treat the patient. This article proposes the research methods of smart medical application in the treatment of hypertensive basal ganglia cerebral hemorrhage with electronic endoscopic hematoma removal, including smart medical overview, intracranial hematoma removal for hypertensive basal ganglia cerebral hemorrhage, and smart medical bioelectric signal classification. The recognition algorithm is used to realize the smart medical application of the electronic endoscopic hematoma removal in the treatment of hypertensive cerebral hemorrhage in the basal ganglia area. The experimental results show that the removal of intracranial hematoma based on smart medicine can effectively improve the removal rate of intracranial hematoma, with a recovery rate of 26.73% and a significant efficiency of 36.49%.

目的 研究3D Slicer辅助下微创手术与开颅显微手术对高血压基底节区脑出血患者手术后脑脊液生化指标及凝血功能的影响.方法 选取2017年9月至2019年9月该院收治的142例高血压脑出血患者,采用随机数字表法将患者分为试验组(70例)和对照组(72例).试验组采用3D Slicer辅助下微创手术治疗,对照组采用开颅显微手术治疗.比较2组患者手术指标,手术后第1、7天的血肿清除率和格拉斯哥昏迷量表(GCS)评分,手术前及手术后第1、7天的脑脊液生化指标、凝血功能及日常生活活动能力量表(ADL)评分.结果 试验组手术时间和手术后清醒时间短于对照组(P<0.05),手术后再出血率低于对照组(P<0.05);试验组手术后第1、7天血肿清除率及GCS评分均高于对照组(P<0.05),脑脊液葡萄糖、乳酸脱氢酶、乳酸水平均低于对照组(P<0.05),凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均短于对照组(P<0.05),手术后第7天ADL评分高于对照组(P<0.05).结论 3D Slicer辅助下微创手术治疗高血压基底节区脑出血,可缩短手术时间和手术后清醒时间,提高血肿清除率,有效改善患者脑脊液生化指标水平和日常生活活动能力,对凝血功能的影响更小,值得临床推广.

目的 研究高血压性脑出血(HICH)微创手术治疗中3D Slicer的应用效果.方法 150例高血压性脑出血患者按采用的手术治疗方法不同,分为3D Slicer软件辅助神经内镜微创手术组(内镜微创组)和传统开颅手术组(对照组),每组各75例.对比两组患者的手术时间、血肿清除率等手术相关指标,以及术后清醒时间、再出血及预后状况.结果 内镜微创组患者的血肿清除率明显高于对照组、手术时间和再出血率低于对照组(P ＜0.05 ～0.005);术后清醒时间和改良Rankin量表(mRS)评分明显低于对照组,格拉斯哥昏迷量表(GCS)评分显著高于对照组,术后并发症发生率明显低于对照组,格拉斯哥预后量表(GOS)评分显著优于对照组(P ＜0.05 ～0.001).结论 应用3D Slicer软件辅助内镜微创手术治疗高血压性脑出血,能够显著发挥微创手术治疗和软件定位的优势,能使手术相关指标和血肿清除效果得到显著提高;同时还有助于降低手术创伤,改善患者的预后.

背景 神经内镜下血肿清除术、显微镜下小骨窗开颅血肿清除术是目前临床治疗基底核区出血的常用手术方式,而3D-Slicer软件可利用患者术前颅脑CT或MRI扫描图像原始数据,在短时间内对头皮、颅骨、血肿进行三维重建,便于术者更清楚地了解术区的解剖关系.目的 比较3D-Slicer三维重建技术辅助神经内镜下血肿清除术与显微镜下小骨窗开颅血肿清除术治疗高血压基底核区出血的临床效果.方法 选取邯郸市中心医院神经外4科2018年3月—2019年10月收治的高血压基底核区出血患者109例,按照随机数字表法分为治疗组59例和对照组50例.治疗组患者采用3D-Slicer三维重建技术辅助神经内镜下血肿清除术治疗,对照组患者采用显微镜下小骨窗开颅血肿清除术治疗.比较两组患者手术时长、术前血肿量、术后残留血肿量、血肿清除率、再出血发生率及并发症发生率.术后随访3个月,比较两组患者日常生活活动能力量表(ADL)评分、格拉斯哥预后量表(GOS)评分及生活能力恢复良好率、神经功能恢复良好率.结果 两组患者术前血肿量比较,差异无统计学意义(P>0.05);治疗组患者手术时长短于对照组,术后残留血肿量少于对照组,血肿清除率大于对照组(P<0.05).治疗组患者术后再出血发生率、并发症发生率低于对照组(P<0.05).术后3个月,治疗组患者ADL评分、GOS评分高于对照组(P<0.05).治疗组患者生活能力恢复良好率、神经功能恢复良好率高于对照组(P<0.05).结论 与显微镜下小骨窗开颅血肿清除术相比,3D-Slicer三维重建技术辅助神经内镜下血肿清除术治疗高血压基底核区出血患者可更有效地缩短手术时长,提高血肿清除率,降低再出血发生率,提高患者日常生活能力,改善患者预后,且安全性高.

目的 探讨神经生长因子用于高血压脑出血微创软通道引流术后的疗效,以及对患者神经功能的影响.方法 选取医院2018年9月至2019年9月收治的高血压脑出血患者106例,按盲法随机分为观察组和对照组,各53例.两组均予微创软通道引流术治疗,观察组术后加用神经生长因子,两组均治疗4周.结果 观察组总有效率为90.57％,显著高于对照组的75.47％(P<0.05).与对照组比较,治疗后观察组患者的美国国立卫生研究院卒中量表评分显著降低,格拉斯哥昏迷指数评分、蒙特利尔认知功能评分均显著升高;神经元特异性烯醇化酶、胶质纤维酸性蛋白、血浆内皮素1水平均显著降低,巴塞尔指数评定量表、日常生活活动能力评定量表评分均显著升高(P<0.05).观察组与对照组不良反应发生率相当(15.09％比9.43％,P>0.05).结论 神经生长因子用于高血压脑出血微创软通道引流术后疗效较好,可改善患者的神经功能缺损评分,降低脑损伤标志物水平,提高预后生活质量,且安全性较好.

目的 观察脑外伤去骨瓣减压术联合早期颅骨成形术的临床效果,并分析术后硬膜下积液的危险因素.方法 选取脑外伤行去骨瓣减压术患者120例为研究对象,根据术后行颅骨成形术的时间分为对照组(n=80)与研究组(n=40).比较2组患者颅骨成形术后神经功能、运动功能、日常功能及术后并发症发生情况,并分析术后硬膜下积液的危险因素.结果 术后2个月,研究组美国国立卫生研究院卒中量表(NIHSS)评分低于术前、术后15 d及对照组,Fugl-Meyer评分、生活质量(Barthel)评分高于术前、术后15 d与对照组,差异有统计学意义(P＜0.05);研究组硬膜下积液、颅脑缺损综合征发生率低于对照组,差异有统计学意义(P＜0.05).中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素(P＜0.05).结论 脑外伤去骨瓣减压术联合早期颅骨成形术能有效改善患者神经功能、运动功能与日常生活功能,降低术后并发症发生率.中线移位、脑内血肿、蛛网膜撕裂、皮层切开、骨瓣边缘距中线距离、骨窗面积均为术后硬膜下积液的影响因素.

目的 将3D-Slicer软件应用于高血压基底节区脑出血患者的血肿清除术中,探讨本病手术治疗的优化方案.方法 选择邯郸市中心医院2018年9月至2019年9月收治的高血压脑出血患者178例,按照随机数字表法分为观察组86例和对照组92例,两组均采取微创血肿穿刺抽吸术并术后引流,观察组采取术前3D-Slicer辅助定位,对照组采取CT检查定位法.比较两组穿刺部位准确性、血肿清除率、拔管时间、手术时间、术后并发症、手术预后.结果 观察组引流管置管准确率、术后第3天时血肿清除率均高于对照组,手术时间、引流管拔管时间短于对照组,差异有统计学意义(P＜0.01).观察组并发症总发生率显著低于对照组,差异有统计学意义(8.14％ vs 27.17％,x2=10.921,P＜0.01).术后3个月,两组NIHSS评分均低于术前,且观察组低于对照组,差异有统计学意义(P＜0.01).术后3个月,观察组ADL分级优于对照组,差异有统计学意义(P＜0.01).结论 3D-Slicer为高血压基底节区脑出血手术提供精确的穿刺部位,对提高血肿清除效率,改善手术预后具有积极意义.

目的:探讨高血压基底节区血肿清除术中3D-Slicer软件辅助神经内镜的应用.方法:选取医院收治的106例高血压基底节区出血患者,按照随机数表法将其分为治疗组(56例)和对照组(50例).治疗组采取3D-Slicer软件辅助神经内镜血肿清除术,对照组采取显微镜血肿清除术.比较两组的穿刺达到预计位置的成功率、术后并发症发生率、血肿清除率及大脑中动脉血流,以及美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力巴氏指数(BI)量表和简易智能量表(MMSE)的评分情况.结果:治疗组穿刺成功率为100％,对照组为92％,差异有统计学意义(x2=4.656,P<0.05);治疗组术后并发症发生率为1.79％,对照组为10％;差异有统计学意义(x2=4.468,P<0.05);治疗组血肿清除率在术后第1 d、第3 d均高于对照组,组间差异有统计学意义(t=4.02、t=4.35;P<0.05).两组患者术前大脑中动脉血流情况比较,差异无统计学意义;治疗组大脑中动脉血流速度在术后3个月高于对照组,组间差异有统计学意义(t=6.75,P<0.05);治疗组术后3个月NIHSS评分低于对照组,而BI及MMSE评分均高于对照组,差异有统计学意义(t=11.13,t=3.95,t=4.09;P<0.05).结论:3D-Slicer软件辅助神经内镜血肿清除术,能够提高高血压基底节区出血患者临床效果,促进患者康复,改善手术预后.

目的 探讨苦参素对大鼠全脑缺血再灌注后脑组织的保护作用.方法 通过夹闭血管20 min复制大鼠全脑缺血再灌注模型并随机分为假手术组(0.9％氯化钠溶液)、模型组(0.9％氯化钠溶液)和苦参素低剂量组[25 mg/(kg·d)]、中剂量组[50 mg/(kg·d)]、高剂量组[100 mg/(kg·d)],各20只.术前10 min腹腔注射给药,再灌注6 h后检测相关指标,记录翻正反射及脑电恢复时间,计算脑组织含水量,通过苏木精-伊红(HE)染色、末端脱氧核苷酰基转移酶介导dUTP切口末端标记(TUNEL)法分别观察海马CA1区神经元形态及凋亡状况;测定海马组织炎症细胞因子含量,生化分析脑组织抗氧化酶活性和丙二醛(MDA)含量.结果 与模型组比较,苦参素中剂量组、高剂量组翻正反射和脑电恢复时间均显著缩短(P<0.01),脑组织含水量显著降低(P<0.05或P<0.01),海马CA1区神经元病理性形态结构变化和凋亡状况均明显改善,凋亡指数显著降低(P<0.01),炎症细胞因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]含量均显著降低(P<0.05或P<0.01),抗氧化酶[超氧化物歧化酶(SOD)、过氧化氢酶(CAT)]活性升高,MDA含量降低(P<0.05或P<0.01).结论 苦参素对全脑缺血再灌注损伤具有保护作用,可能与抑制氧化应激和炎症反应有关.

[目的]研究苦参素(OMT)对局灶性脑缺血再灌注大鼠血液流变学指标的影响并探讨其可能的作用机制.[方法]通过线栓法复制局灶性脑缺血再灌注大鼠模型,设假手术组 、模型组和OMT低[25 mg/(kg·d)]、中[50 mg/(kg·d)]、高[100 mg/(kg·d)]剂量组,每组20只,术后第2天开始腹腔注射给药,疗程7 d.通过盲法神经功能评分评测神经功能损伤,测定脑组织含水量及脑组织梗死体积.通过苏木精-伊红(HE)染色观察海马CA1区神经元形态;生化分析脑组织抗氧化酶活性和丙二醛(MDA)含量;测定血液流变学指标及红细胞膜流动性指标.[结果]与模型组比较,OMT中、高剂量组神经功能评分显著降低(P<0.01)、神经功能状况明显改善,脑组织含水量显著降低、梗死体积显著减小(P<0.05或P<0.01);海马CA1区神经元病理性形态结构改变明显改善,抗氧化酶[(超氧化物歧化酶(SOD)、过氧化氢酶(CAT)]活性显著升高且MDA含量显著降低(P<0.05或P<0.01);血液流变学指标(全血黏度、血浆黏度、红细胞聚集指数、红细胞变性指数、红细胞刚性指数、红细胞压积、血沉)显著降低(P<0.05或P<0.01),红细胞膜流动性指标(荧光偏振度、平均微黏度、各向异性)显著降低(P<0.05或P<0.01).[结论]OMT可能通过改善血液流变学而对脑缺血再灌注损伤起到一定的保护作用.

Objective It is to study the effect of oxymatrine on learning and memory ability after chronic cerebral ischemia in rats and to explore its possible mechanism. Methods 100 SD rats were randomly divided into sham operation group, model group, oxymatrine low dose group, oxymatrine medium dose group and oxymatrine high dose group, 20 rats in each group. Except for the sham operation group, the rat models of chronic cerebral ischemia were established by ligation of bilateral common carotid arteries. On the 2nd day after operation, the low, medium and high doses of oxymatrine groups were given intraperitoneal injection of oxymatrine 25 mg/ (kg · d) , 50 mg/ (kg · d) and 100 mg/ (kg · d) , respectively, 1time/d, continously treating for 7 days. On the 2nd day after the last injection, Morris water maze test and platform test were used to evaluate the learning and memory ability of the rats. Hematoxylin-Yinhong (HE) staining and TUNEL method were respectively used to observe the morphology and necrosis of hippocampal CA1 neurons. The expression of Bcl-2 and Bax protein in hippocampus was detected by immunohistochemistry. The activities of antioxidant enzymes [superoxide dismutase (SOD) , catalase (CAT) ] and content of malondialdehyde (MDA) in hippocampus were analyzed by biochemical analysis. Results In the water maze experiment, the escape latency and escape route of the oxymatrine medium and high dose groups were significantly shorter, and the number of crossing platforms was significantly higher than that of the model group (P ＜ 0. 05). In the platform test, the number of errors in the middle and high dose groups of oxymatrine was significantly lower, the total time of electric shock was significantly shorter than that in the model group (P ＜ 0. 05). The morphological changes and apoptosis of hippocampal CA1 neurons in the middle and high dose groups of oxymatrine were significantly less, the neuronal apoptosis index was significantly lower, the expression of Bcl-2 and the ratio of Bcl-2/Bax in the hippocampus were significantly higher, and the expression of Bax was significantly lower than those of the model group (P ＜0. 05). The activities of SOD and CAT in the hippocampus of rats in the middle and high dose groups of oxymatrine were significantly higher, and the MDA content was significantly lower than that of the model group (P ＜ 0. 05). Conclusion Oxymatrine can improve the learning and memory ability of rats with chronic cerebral ischemia. The mechanism may be related to the regulation of hippocampal apoptosis-related gene expression, inhibiting hippocampal neuronal apoptosis and increasing antioxidant enzyme activity and reducing oxidative stress injury.

Objective To study the effect of oxymatrine on oxidative stress and inflammatory reaction after cerebral ischemia reperfusion in rat. Methods A total of 140 SD rats were randomly divided into the sham group, model group and oxymatrine low, medium, high-dose groups (28 in each group). Beyond the sham group, the other groups were established the rat model of focal cerebral ischemic reperfusion with Zea-Longa occluded suture. The the low-, medium- and high-dose matrine groups were given 25, 50, and 100 mg/kg oxymatrine solutions injected intraperitoneally from the second day after operation for 7d. , The model group and the sham group were injected with an equal volume of saline. The neurological deficits, ratio of infarct volume, water content of the brain were evaluated; the morphological changes of brain tissue were observed by HE Staining, and the cell apoptosis were observed after TUNEL staining; the activity of antioxidant enzymes and malondialdehyde (MDA) in brain tissue were measured by biochemical analysis; the content of NO and the activity of iNOS were measured; the expression of NF-ĸB were determined by Western blotting. The inflammatory cytokines in brain tissue were determinated. Results Compared with the model group, the neurological function score, brain tissue water content, infarct volume and apoptotic index decreased in the rats of oxymatrine medium-, high-dose groups (P<0.05 or P<0.01). The activity of SOD (148.68 ± 9.12 U/mg, 161.34 ± 10.09 U/mg vs. 140.63 ± 8.47 U/mg), CAT (3.90 ± 1.32 U/mg, 4.15 ± 1.47 U/mg vs. 2.73 ± 0.89 U/mg), GSH-Px (11.46 ± 2.65 U/mg, 13.59 ± 3.27 U/mg vs. 9.35 ± 2.03 U/mg) were significantly increased (P<0.05 or P<0.01). The content of MDA (20.18 ± 3.59 μmol/g, 17.46 ± 3.21 μmol/g vs. 29.86 ± 5.40 μmol/g), iNOS (12.64 ± 1.83 U/mg, 11.75 ± 1.62 U/mg vs. 14.17 ± 2.06 U/mg), NO (23.64 ± 2.18 μmol/g, 21.27 ± 2.03 μmol/g vs. 27.82 ± 2.42 μmol/g), TNF-α (43.9 ± 6.3 nmol/L, 37.2 ± 5.8 nmol/L vs. 56.3 ± 6.9 nmol/L), IL-1β (715.0 ± 68.5 nmol/L, 683.9 ± 70.8 nmol/L vs. 930.8 ± 91.4 nmol/L), IL-6 (168.4 ± 22.5 nmol/L, 133.7 ± 18.1 nmol/L vs. 212.5 ± 24.7 nmol/L) were significantly decreased (P<0.05 or P<0.01). The expression of NF-ĸB in brain (0.35 ± 0.13, 0.24 ± 0.08 vs. 0.62 ± 0.15) were significantly down-regulated (P<0.05 or P<0.01). Conclusions The Oxymatrine inhibits oxidative stress injury and inflammatory response after cerebral ischemia-reperfusion in rats. Key words: Matrine; Brain ischemia; Reperfusion injury; Oxidative stress; Inflammatory; Rats

[目的]研究苦参素对大鼠慢性脑缺血后大脑海马CA1区神经元凋亡的保护作用并探讨其机制.[方法]将100只SD大鼠采用结扎双侧颈总动脉的方法复制慢性脑缺血大鼠模型,设假手术组、模型组和苦参素低[25 mg/(kg·d)]、中[50 mg/(kg·d)]、高[100 mg/(kg·d)]剂量组,各20只,术后第2天开始腹腔注射给药,疗程7 d.通过苏木精-伊红(HE)染色、末端标记(TUNEL)法分别观察海马CA1区神经元形态及凋亡状况;免疫组织化学(IHC)法检测海马B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关X蛋白(Bax)蛋白表达;蛋白免疫印迹(Western blot)法检测半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)、核因子-κB(NF-κB)蛋白表达;生化分析海马区氧化酶活性和丙二醛(MDA)含量;测定海马组织炎症细胞因子含量.[结果]与模型组比较,苦参素中、高剂量组慢性脑缺血大鼠海马CA1区神经元形态结构变化和凋亡状况均明显改善,凋亡指数(AI)显著降低(P<0.01),海马区Bcl-2表达上调、Bax表达下调且Bcl-2/Bax比值显著提高(P<0.05或P<0.01),Caspase-3、NF-κB蛋白表达均显著下调(P<0.05或P<0.01),抗氧化酶[超氧化物歧化酶(SOD)、过氧化氢酶(CAT)]活性显著升高且MDA含量显著降低(P<0.05或P<0.01);炎症细胞因子[白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)]含量均显著降低(P<0.05或P<0.01).[结论]苦参素具有抑制慢性脑缺血大鼠海马CA1区神经元凋亡的药理学作用,其机制可能与苦参素调节凋亡相关蛋白表达以及提高氧自由基清除能力、抑制炎症反应有关.

Objective:To study the protective effect of oxymatrine on brain mitochondrial damage after cerebral ischemia.Methods:The model of focal cerebral ischemic was established with Zea-Longa occluding suture,setting sham operating group,the model group and oxymatrine low,medium,high-dose (25,50,100 mg/kg) groups,n =20.10 minutes before operation,the drugs were given by intraperitoneal injection.24 hours later,the extent of mitochondria swelling,membrane fluidity of mitochondria and breathing function of mitochondria in the ischemic brain were measured;the ultrastructural changes of mitochondria by electron microscope was observation;the activity of SOD,GSH-Px,Na+-K+-ATPase,Ca2+-Mg2+-ATPase and the content of MDA were measured;the content of free Ca2+ was measured.Results:Compared with the model group,oxymatrine pretreatment with middle and high dose could obviously improve the mitochondrial swelling,improve the membrane fluidity,improve the mitochondrial respiratory function,inhibit the mitochondrial uhrastructural damage,improve the activity of SOD and GSH-Px and reduce the content of MDA(P＜0.05 or P＜0.01),and improve the activities of Na+-K+-ATPase and Ca2+-Mg2+-ATPase significantly(P＜ 0.05 or P＜ 0.01),and decrease the concentration of free Ca2+(P＜0.05).Conclusion:Oxvmatrine has a protective effect on brain mitochondrial damage after cerebral ischemia,whose mechanism may be related to its effects of reducing calcium concentration,inhibiting oxidative stress damage and improving ATPase activity.

Objective: To study the effect of oxymatrine(OMT) on hemorheoloqy after acute cerebral ischemia-reperfusion in rats and to explore its mechanism. Methods: The models of focal cerebral ischemic reperfusion were established with Zea-Lonqa occludinq suture,settinq the sham operatinq qroup,the model qroup and OMT low,medium,hiqh-dose (25,50,100 mq/kq) qroups and extracts of Ginkqo biloba leaves (EGB) 50 mq/(kq·d) qroup (positive druq control qroup),n=20. The druqs were qiven by intraperitoneal injection from the second day after operation for 7d,once a day. Nerve function impairment was assessed by blind nerve function score,and wa-ter volume and infarct volume of brain tissue were measured. Neuron morpholoqy in hippocampal CA1 area was observed by HE staininq. Biochemical analysis was made in brain tissue antioxidant enzyme activity and malondi-aldehyde(MDA) content;hemorheoloqy and erythrocyte membrane fluidity index were determined. Results: Com-pared with the model qroup,the neuroloqical scores of OMT medium,hiqh-dose qroups and EGB qroup were siq-nificantly decreased(P＜0.05 or P＜0.01);neuroloqical function was siqnificantly improved;water content in brain tissue was siqnificantly reduced and infarct volume was siqnificantly reduced(P＜0.05 or P＜0.01). The patholoqi-cal morpholoqical and structural chanqes of neurons in the hippocampal CA1 area were obviously improved,and the activity of antioxidant enzymes [(superoxide dismutase(SOD),catalase(CAT)] increased siqnificantly and the content of MDA decreased siqnificantly (P＜0.05 or P＜0.01). Hemorheoloqical indexes,includinq the blood vis-cosity,plasma viscosity,erythrocyte aqqreqation index,erythrocyte denaturation index,erythrocyte riqidity index, red blood cell pressure,erythrocyte sedimentation rate,were siqnificantly reduced (P＜0.05 or P＜0.01). Erythro-cyte membrane fluidity index (fluorescence polarization,mean micro viscosity and anisotropy) decreased siqnifi-cantly(P＜0.05 or P＜0.01). Conclusion: OMT may play a protective role in cerebral ischemia-reperfusion injury by improvinq hemorheoloqy.

目的：分析神经内窥镜下血肿清除术、小骨窗开颅血肿清除术与单纯脑室外引流术治疗基底节区脑出血并脑室铸型的疗效。方法筛选我院96例基底节区脑出血并脑室铸型患者，按手术方式不同分成3组，每组各32例，观察1组：神经内窥镜下血肿清除术；观察2组：小骨窗开颅血肿清除术；对照组：单纯脑室外引流术。对比分析观察组与对照组的临床疗效、血肿清除时间、意识障碍持续时间、死亡人数及并发症。结果观察1组、观察2组总有效率明显高于对照组，且2组与对照组比较差异均具有统计学意义（P均＜0.05），但观察组1组与观察2组间差异无统计学意义（P＞0.05）。观察1组和观察2组患者意识障碍持续时间、血肿清除时间、死亡人数及并发症方面均明显小于对照组，差异均有统计学意义（P＜0.05）。结论神经内窥镜下血肿清除术和小骨窗开颅血肿清除术清除血肿较为彻底，止血可靠，疗效较传统脑室外引流术好，是治疗基底节区脑出血并脑室铸型的有效方式，值得有条件的医院临床推广应用。

目的：探讨应用显微手术治疗基底核区合并脑室出血的临床疗效。方法：选取基底核区合并脑室出血患者85例，分为显微组50例和常规组35例，显微组行小骨窗显微镜血肿清除术，常规组行大骨瓣开颅血肿清除术，术后均置管脑室外引流。记录2组术后血肿消除情况及并发症，随访观察日常生活能力。结果：显微组的血肿清除情况明显好于常规组，血肿复发率低于常规组，差异有统计学意义（P＜0.05）。术后2组并发症差异无统计学意义（P＞0.05）。术后随访6个月，显微组的术后日常生活能力优于常规组，差异有统计学意义（P=0.03）。结论：小骨窗显微镜血肿清除术加脑室外引流术，能有效清除基底核区合并脑室血肿，减轻血肿复发，有效改善患者术后日常生活能力。

To explore the efficacy of microscopic vs .neuroendoscopic single nostril transsphe-noidal approach surgical methods for the treatment of invasive pituitary adenomas .[Methods]Totally 60 pa-tients with invasive pituitary adenoma in our hospital from Jan .2013 to Sept .2013 were enrolled in the study . All patients were randomly divided into two groups .The observation group( n =30) underwent neuroendo-scopic single nostril transsphenoidal approach surgery ,while the control group( n=30) underwent microscop-ic single nostril transsphenoidal approach surgery .The efficacy was compared between two groups .[Results]The operation time ,intraoperative blood loss ,postoperative hospital stay and other indicators in observation group were obviously better than the control group ,and there was significant difference between two groups ( P <0 .05) ,but there was no significant difference in vision improvement and total tumor resection rate be-tween two groups( P >0 .05) .After operation ,nasal septum defect and sinus infection rate in control group were obviously higher than those in observation group .The incidence rate of total complications in control group was 73 .3 % (22/30) which was obviously higher than that in observation group(20% ,6/30) ,and there was significant difference( P <0 .05) .[Conclusion] Neuroendoscopic single nostril transsphenoidal approach surgery for the treatment of invasive pituitary adenoma has very significant efficacy with short operation time , less intraoperative blood loss ,and can shorten postoperative hospitalization time and reduce the incidence of postoperative complications ,and is helpful for the patients'recovery .