目的 研究沙利度胺作为镇痛药发挥其镇痛效果的机制及TRPV-1通路在沙利度胺发挥其镇痛效果过程中的作用.方法 采用过表达HEK293细胞和背根神经节(DRG)神经元,予以辣椒素激活受体,沙利度胺孵育.通过离子荧光成像测量技术,观察不同细胞不同干预因素下TRPV1通道变化;通过TRPV1基因敲除小鼠和C57小鼠,结合TRPV1通道抑制剂应用,分别予以沙利度胺干预,通过观察试验小鼠行为学变化,测量动物模型的痛觉改变.监测在不同的动物模型中,沙利度胺的镇痛效果及TRPV1通道参与沙利度胺的镇痛作用的机制.结果 激动剂辣椒素激活细胞模型过程中,在300μmol/L沙利度胺预处理20 min,激活的TRPV1通道内的阳离子流入显著下降,RFU读数由320下降至150单位(P<0.01),而且,TRPV1活性的这种衰减呈沙利度胺剂量依赖性.KCl溶液处理下的DRG神经元均被激活,在没有沙利度胺预处理的情况下,对辣椒素溶液敏感的神经元占(62±11)％.在应用20～50μmol/L沙利度胺预处理的情况下,对辣椒素溶液敏感神经元为(41±9)％和(28±9)％.醋酸扭体试验,可见野生型小鼠经沙利度胺预处理后,平均扭体次数由原来的54次减少到28次.与对照组(野生型WT组)比较(P<0.01);热板试验中,野生型小鼠经沙利度胺预处理后15 min,平均热痛觉阈值由原来的26 s增加到49 s(15 min);52 s(30 min);46 s(60 min),正常对照组热痛觉阈值几乎无变化,与对照组比较差异有统计学意义(P<0.01);在TRPV1敲除小鼠和使用TRPV1通道抑制剂(A784168)的小鼠中,经沙利度胺干预后,与对照组比较,扭体数和热痛觉时间差异无统计学意义(P>0.05).结论 沙利度胺可通过TRPV1通道的调控,发挥其镇痛作用.

OBJECTIVE:To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH).METHODS:Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared.RESULTS:The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001).CONCLUSIONS:The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.

目的 探讨最大径<10 mm纯磨玻璃结节(pure ground glass nodule,pGGN)肺腺癌临床、CT、病理亚型资料的相关性.方法 回顾性分析2017年5月至2019年4月53例经手术切除且病理证实为肺腺癌的53个最大径<10 mm pGGN患者的临床、CT、病理资料,分析不同病理亚型pGGN患者临床及CT影像特点.结果 浸润前病变组性别比、年龄、吸烟史、肿瘤史、CEA升高比例与浸润性病变组比较,差异无统计学意义(P>0.05).浸润前病变组pGGn病灶分布于右肺上叶、右肺中叶、右肺下叶、左肺上叶和左肺下叶所占比例与浸润性病变组比较,差异无统计学意义(P>0.05).浸润前病变组直径、密度和瘤肺界面清楚所占比例低于浸润性病变组,差异均有统计学意义(P<0.05).2组球/类球形比例比较,差异无统计学意义(P>0.05).浸润前病变组空泡征所占比例低于浸润性病变组,差异有统计学意义(P<0.05),2组空气支气管征、分叶征、毛刺征、血管集束征和胸膜凹陷征所占比例比较,差异均无统计学意义(P>0.05).浸润前病变组与浸润性病变组pGGN大小的ROC曲线分析显示最佳临界值为7.65 mm,曲线下面积为0.828,敏感度87.5％,特异度70.3％.浸润前病变组与浸润性病变组pGGN密度的ROC曲线分析显示最佳临界值为-533.5 Hu,曲线下面积为0.777,敏感度75.0％,特异度73.0％.结论 直径<10 mm pGGN肺腺癌中,浸润性病变组较浸润前病变组病灶最大径更大,密度更高,且瘤肺界面清楚和空泡征发生率更高;当pGGN病灶最大径>7.65 mm,密度>-533.5 Hu时,其诊断为浸润性病变的可能性更大.

目的 探讨不同手术方式对危重高血压幕上脑出血患者术后转归的影响.方法 146例老年危重高血压幕上脑出血患者,采用随机数字表分配法,按照治疗方式不同,分为观察组(钻孔引流联合开颅血肿清除术组)和对照组(开颅血肿清除术组).通过院内、门诊或电话及家访方式,收集和记录2组患者术后1周、2周、3周的GCS评分,并计算其术后GCS评分增量.采用多元线性回归分析研究入院患者一般资料与术后GCS评分增量的关系.采用方差分析比较不同出血部位和不同手术方式对术后GCS评分增量的影响.结果 患者入院年龄、出血量和GCS评分对术后不同时间点GCS评分增量具有影响(P<0.05);不同出血部位的术后GCS评分增量差异无统计学意义(P>0.05);观察组术后第1周、第2周和第3周的GCS评分增量均高于对照组,差异均有统计学意义(P<0.05).结论 患者入院年龄、出血量和GCS评分对危重高血压幕上脑出血术后GCS评分变化具有影响,且钻孔引流术联合开颅血肿清除术可提升恢复速率,改善预后.

目的 检测脑梗塞患者血脂、血尿酸水平并分析其临床意义,为临床脑梗塞的诊断提供依据.方法 选取我院神经内科收治的脑梗塞患者80例为观察组.并选取同期健康查体中心,查体的健康人群80例为对照组.所有的患者均行血脂及尿酸检查.对比两组患者血脂、血尿酸等危险因素指标,通过单因素及多因素Logistic回归分析确定尿酸是否为脑梗塞的独立危险因素,并通过直线相关与回归分析:血脂与血尿酸的相关性.结果 糖尿病、高血压、TG、TC、尿酸均为脑梗塞的独立危险因素.结论 尿酸可以独立影响脑梗塞的发生.

目的 研究缺血性脑梗死预后与磁共振成像的相关性.方法 选取我院神经内科收治的缺血性脑梗死患者80 例.根据mRS评分结果 分为两组:预后良好组(36例)及预后不良组(44例).对比两组患者的磁共振检查结果 ,判断病灶的血流量与mRS的相关性.结果 血流动力学参数rCBF与mRS 评分呈正相关,(OR＝1 .21 ;95%可信区间,1 .02-1 .45;P＜0.05).结论 磁共振灌注成像结果 可以作为缺血性脑梗死预后判断的相关指标,为临床缺血性脑梗死预后提供依据.

目的:分析颈动脉溶栓桥接血管内技术在急性脑梗死中的治疗效果.方法:对我院2015-11-2017-12期间进行颈动脉溶栓桥接血管内技术治疗的143例急性脑梗死患者临床资料进行回顾性分析,分析治疗前后NIHSS评分变化、手术一般情况、临床疗效、并发症及预后情况.结果:治疗后2h、1d、7 d NIHSS评分较治疗前有显著降低,差异有统计学意义(P＜0.05),且随着时间的延长不断降低;就诊到颈动脉穿刺溶栓所用时间平均为(3.14±0.58)h,颈动脉穿刺注药平均时长(98.26±15.23) min,血管内治疗平均时长(85.17±15.16) min;神经功能缺损评分评价临床疗效显示:术后1个月,治愈75例,有效41例,无效27例,恶化0例,总有效率为81.12％;mRS量表评价预后显示:术后3个月,143例患者中97例mRS评分≤2分,46例mRS评分＞2分,有效率为67.83％;Gonner评分评价血管再通情况显示,0级0例,1级0例,2级42例,3级101例,血管再通率为100.00％.结论:颈动脉溶栓桥接血管内技术确实兼具溶栓治疗简单便捷以及血管内技术成功率高、预后好的优点,值得进一步探索.

目的 探讨右美托咪定在危重高血压脑出血开颅术后的临床应用价值.方法 80例危重高血压基底节区脑出血患者随机单盲法分为试验组和对照组,每组40例.对照组在常规脑出血开颅术后给予常规治疗,试验组在常规治疗基础上给予右美托咪定以0.2μg·kg-1·h-1速度静脉泵入至术后24 h.比较2组患者术后相同时间点的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)、脑氧摄取率(CERO2)、脑动静脉血糖含量差(A-VDG)、颅内压增量(I-ICP)及脑脊液中GABA增量(I-GABA)和Glu增量(I-Glu).结果 试验组术后12 h、24 h、72 h的HR、MAP均低于对照组,差异有统计学意义(P<0.05);试验组的SpO2和对照组相比,差异无统计学意义(P>0.05);2组在术后即刻(0 h)的CERO2、A-VDG、ICP及脑脊液中GABA和Glu含量差异均无统计学意义(P>0.05);术后12 h、24 h、72 h试验组CERO2均小于对照组,A-VDG均大于对照组,差异均具有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-ICP均小于对照组,差异均有统计学意义(P<0.05);术后12 h、24 h、72 h试验组I-GABA高于对照组,I-Glu小于对照组,差异有统计学意义(P<0.05).结论 右美托咪定在危重症高血压脑出血开颅术后持续应用,能够减轻应激反应,稳定血流动力学,改善脑氧和脑糖代谢,缓解颅内高压,达到脑保护和促进功能恢复作用.

目的 观察Trevo支架取栓对缺血性脑卒中患者的疗效及对血清丝氨酸蛋白酶抑制剂(Vaspin)、神经元特异性烯醇化酶(NSE)、血液流变学、认知功能的影响.方法 2015年9月-2018年8月河北医科大学附属人民医院(石家庄市第一医院)神经外科收治急性缺血性脑卒中患者116例,按随机数字表法分为2组,每组58例.对照组采用人组织型纤溶酶原激活剂进行溶栓治疗,观察组采用Trevo支架取栓治疗.比较2组治疗前及治疗后24 h、72 h血清Vaspin、NSE水平、MoCA评分、NIHSS评分、血液流变学变化.结果 与治疗前比较,治疗后24h、72 h,2组血清Vaspin、MoCA评分均升高,且观察组优于对照组(t/P=2.378/0.019、2.693/0.008,8.321/＜0.001、7.699/＜0.001);治疗72 h,2组血浆黏度、全血黏度切变率、纤维蛋白原、NIHSS评分均降低,且观察优于对照组(t/P =3.210/0.002、3.106/0.002、3.185/0.002、5.483/＜0.001);2组治疗后24 h血清NSE均升高,治疗后72 h血清NSE均降低,观察组治疗后24h、72 h血清NSE均低于对照组(t/P=3.910/ ＜0.001、4.659/＜ 0.001);观察组预后良好率89.66％高于对照组70.69％(x2/P=6.562/0.011).结论 Trevo支架取栓可提高缺血性脑卒中患者血清Vaspin水平,降低NSE水平,改善神经缺损程度、血液流变学及认知功能,临床疗效满意,不良反应少,具有重要的临床应用价值.

Objective:To investigate the clinical effects of neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior approach. Methods:86 patients with hypertensive intracerebral hemorrhage (HICH) in our hospital from June 2015 to March 2017 were selected,and they were divided into two groups by random number table,43 cases in each. Control group was given routine stereotactic vacuation of hemato-ma,observation group was given neuroendoscopic evacuation of hematoma via CT-guided coronal suture ante-rior approach.The surgical indexes,surgical effects,rebleeding rate,fatality rate and the incidence of compli-cations of two groups were compared.Results:The surgical indexes of observation group were significantly bet-ter than those of control group,and the total surgical effective rate was significantly higher than control group, the rebleeding rate,fatality rate and the incidence of complications were significantly lower than control group (P<0.05). Conclusion:Neuroendoscopic evacuation of hematoma via CT-guided coronal suture anterior ap-proach can effectively shorten surgery time and recovery time of hemiplegia,protect normal brain tissues,de-crease surgical risks,reduce complications and death.

目的 对比单纯开颅血肿清除术与联合钻孔引流术治疗高血压脑出血(HICH)的临床疗效.方法 采用回顾性研究方法,选取石家庄市第一医院2014年12月至2017年8月收治的100例HICH患者作为研究对象,依据手术方式不同分为对照组40例,采用单纯开颅血肿清除术治疗;观察组60例,采用开颅血肿清除术联合钻孔引流治疗.比较两组患者术后首次血肿清除速率、并发症发生率、神经功能变化及近期疗效.结果 对照组患者术后首次血肿清除率为(52.6±6.0)％低于观察组的(79.9±7.8)％,差异有统计学意义(P＜0.01);术后对照组患者肺部感染、水电解质代谢平衡紊乱发生率均高于观察组(P＜0.05);术后两组患者再出血、颅内感染发生率比较,差异无统计学意义(P＞0.05);术后3个月对照组患者神经功能缺损评分为(13.1±1.4)分高于观察组的(8.8±1.2)分(P＜0.01);术后6个月对照组患者格拉斯哥预后评分(GOS=5分)预后良好率低于观察组(P＜0.05).结论 采用开颅血肿清除术联合钻孔引流治疗效果优于单纯开颅血肿清除术,能提高血肿清除率,减少并发症发生,改善患者神经功能和近期预后.

Objective To study the influence of early microporous surgery on the prognosis and cerebral edema after hypertension-related basal ganglia cerebral hemorrhage with low and medium volume.Methods 60 cases of basal ganglia hematomas in our hospital from June 2008 to June 2010 were selected and divided into two groups,microporous surgery group and conservative treatment group,30 cases in each group.The two groups received the conventional treatment including blood pressure control,nourishing nerve,reducing cranial pressure and treating and preventing infection.The microporous surgery group was performed the microporous puncture by disposable YL-1 type hematoma smashing puncture needle for eliminating hematoma within 24 h after admission.The consciousness,limbs movement,language and increment of GCS at 1,2,3 weeks were compared between the two groups.Results The relative increment(RE)of brain edema at 1,2,3 weeks in the microporous surgery group were 0.162±0.374,0.026±0.367 and 0.087±0.337 respectively,which were lower than 0.472±0.232,0.338±0.292 and 0.067±0.205 in the conservative treatment group,respectively.RE at 2,3 weeks showed the linear relation with BS at 3 weeks and in 3 months.Conclusion Early microporous surgery can improve prognosis of low and medium volume of basal ganglia hematoma mainly through decreasing RE.

Objective To investigate the effect of surgical intervention to brain edema formation and the development after hypertensive intracerebral hemorrhage(HICH).Methods 160 patients with HICH were divided into conservative group(C group),surgery group which includes craniotomy group(Sc group) and minimally invasive group(Sm group).Simple linear regression,multiple linear regression and analysis of variance were used to study the correlation between the baseline volume of hematoma and the perihematomal edema volume,the effect of hematomato the relative growth of perihematomal edema volume(RE) with different bleeding sites,different volume and different time point.Analysis of variance was used to compare the effects of C group,Sc group and Sm group on RE at different time.Results There was a highly significant correlation between hematoma and perihematomal edema volumes at baseline(r2=0.583 1),hematoma and RE at different time(P<0.01).There was no significant statistic difference of RE in different bleeding sites(P>0.05).The largest RE(P<0.05) was the small supratentorial intracerebral hematoma.There was no significant difference of RE between Sc group and Sm group,but they were significantly lower compared with C group(P<0.05).There was no significantly difference between RE of C group and Sc group with infratentorial intracerebral Hemorrhage(P>0.05).Conclusion The degree of perihematomal edema and RE are strongly related to the size of the baseline hematoma of HICH.And a small quantity of supratentorial hematoma could largely impact the development of brain edema.Removing hematoma by surgery can reduce the development of brain edema.