目的 观察脑血管球囊成形支架置入术治疗急性脑梗死的疗效。方法 选取我院和珠江医院2015年1月—2017年7月收治的急性脑梗死患者40例,根据随机数表法分为观察组及对照组,各20例。对照组单纯施以药物治疗,观察组在对照组基础上加以脑血管球囊成形支架置入术治疗,对比两组治疗前后凝血功能指标水平变化情况及疗效。结果 治疗后,观察组APTT、PT、TT、INR水平高于对照组,Fbg水平低于对照组,治疗总有效率高于对照组,差异有统计学意义(P＜0.05)。结论 脑血管球囊成形支架置入术治疗急性脑梗死疗效确切,患者临床症状得到更好更快的改善,可改善患者凝血功能,对急性脑梗死的早期救治有着极为重要的应用价值。

目的 分析神经营养类药物单唾液酸四己糖神经节苷脂(monosialotetrahexosylganglioside,GM1)与胞磷胆碱(citicoline)联合使用在新生儿缺血缺氧性脑病(neonatal hypoxic-ischemic encephalopathy,NHIE)的临床疗效并探讨其可能的作用机制。方法 收集2014年1月—2017年6月在广州市第一人民医院新生儿病房住院的54例新生儿缺血缺氧性脑病患儿的临床资料,将收集到的患儿随机分为2组,对照组27例,治疗组27例。治疗组与对照组的治疗的不同在于前者予以单唾液酸四己糖神经节苷脂GM1联合胞磷胆碱治疗,而对照组仅用单唾液酸四己糖神经节苷脂GM1,无用胞磷胆碱。治疗三个疗程后,比较2组用药前后的临床表现、神经功能评分及MRI变化情况。结果 治疗组中临床总有效24例(88.9%);对照组中总有效17例(63.0%)(P<0.05);经过三个疗程后2组的神经功能评分均有上升,且治疗组的效果更明显(P<0.05);MRI检查示2组较用药前病灶范围减少,水肿减轻,治疗组改善更明显(P<0.05)。即经过三个疗程治疗后,两组患儿病情均有好转,且治疗组疗效更明显。结论 神经营养类药物GM1联合胞磷胆碱通过修复、重构神经元、改善其代谢等促进受损的神经功能的恢复,在新生儿缺血缺氧性脑病的应用中具有良好的疗效。

Objective To analysis the clinical therapeutic effect of monosialotetrahexosylganglioside and citicolineon neonatal hypoxic-ischemic encephalopathy, and explore its possible mechanism.Methods A total of 54 newborn with hypoxicischemic encephalopathy were enrolled from January 2015 to June 2017 in Guangzhou First People's Hospital, and they were divided into control group and treatment group according to the treatment methods, with 27 cases in the control group and 27 cases in the treatment group. Both groups were treated with conventional treatment, the control group added gangliosides, and the treatment group used ganglioside and citicoline. The clinical effects, neurological score and MRI were observed in the two groups.Results The total effective rate was 88.9% in the treatment group,which was higher than 73.0% in the control group (P<0.05). There was no significant difference on neurological score between the two groups before treatment (P>0.05). After treatment, the neurological scores of the two groups were significantly improved, and the score of the treatment group was higher than that of the control group (P<0.05). MRI examinations found that the lesions were significantly improved in the two groups after treatments, and the effect of the treatment group was higher than that of the control group (P<0.05).Conclusion Monosialotetrahexosylganglioside combined with citicolineinthe in treatment of newborn with hypoxicischemic encephalopathy has good effects through repairing and rebuilding the neurons, improving the metabolism to promote the recovery of neurological functions.

目的 评估方体定向置管治疗创伤性非功能区硬膜外小血肿的疗效。方法 回顾分析65例创伤性非功能区硬膜外血肿患者,血肿量在15～30 mL。依据治疗方法分为2组,35例对照组患者采用传统药物治疗而30例观察组患者同时采用药物及方体定向置管治疗。对比分析2组患者住院期间血肿清除率及并发症发生率,术后3个月及6个月时再发头痛、焦虑及血肿清除的情况。结果 两组相比,观察组患者血肿清除率(66.7%),高于对照组(25.7%),两组差异有统计学意义,而并发症发生率,两组无统计学差异;3个月后再发头痛、焦虑及硬膜外血肿清除的情况存在显著差异;而6个月后上述情况无显著差异。结论 方体定向置管治疗在不增加患者并发症发生的同时,能在短时间内快速清除硬膜外血肿,降低患者伤后近期头痛、焦虑症状的发生,改善患者近期生活质量,具有一定临床应用的价值。

Objective To evaluate the clinic value the technique of Cuboid stereotactic catheter (TCSC) in the treatment of small-volume traumatic extradural hematoma in non-functional areas.Methods We performed a retrospectively analysis of 65 patients with small-volume(15-30 mL) traumatic extradural hematoma in non-functional areas. All of which were divided into two groups according to the different treatments. 35 cases treated with drugs were control group, while the rest of 30 cases with both drugs and TSCS were treatment group. The complication incidence and hematoma clearance rate in hospitalization time, recurrence rate of headache, anxiety,hematoma clearance rate at 3 and 6 months follow-up were compared between the two groups.Results The hematoma clearance rate in control group and treatment group were 25.7% and 66.7%,respectively. (P=0.001), while the complication rate was no obvious differences. The recurrence rate of headache, anxiety and hematoma clearance rate at 3 months follow-up were different between the two groups. These conditions were not happened at 6 months follow-up.Conclusion TCSC may eliminate the hematoma within a short hospitalization time by avoiding extra complication coincidence, improve the short-term life quality of patients such as relief the symptoms like headache and anxiety in the patients with small-volume(15~30 mL) traumatic extradural hematoma in non-functional areas. Above of results indicates the impact of this technique on neurosurgical practice.

目的 探讨复合声及心理辅导联合耳后注射利多卡因与甲强龙综合治疗特发性耳鸣的临床疗效。方法 选择符合纳入标准的耳鸣患者60例,随机分为耳后注射利多卡因与甲强龙组(A组)20例、心理辅导联合复合声组(B组)20例、耳后注射利多卡因与甲强龙联合心理辅导及复合声组(C组)20例,分别于治疗后1月、3月,通过耳鸣严重程度评估指标及评分标准评估三种治疗方式的疗效。结果 3组患者治疗3个月后A组总有效率为50 %, B组45%, C组90%,且组间有差异(P＜0.05)。另外,除A组与B组之间无差异外,C组与A组(P=0.0058)、B组(P=0.0024)之间均有差异。结论 实验结果表明复合声及心理辅导联合利多卡因与甲强龙综合治疗特发性耳鸣能有效治疗耳鸣,提高患者生存质量,在耳鸣临床治疗中明显具有积极作用,临床应用前景广阔。

目的 观察⁹⁹锝-亚甲基二膦酸盐对前列腺癌骨转移患者骨痛、骨质疏松的治疗效果。方法 对76例前列腺癌骨转移患者给予⁹⁹锝-亚甲基二膦酸盐治疗1年(每疗程15 d,每天静滴22 mg,15 d为一个疗程,共12个疗程),比较治疗前及治疗1年后患者骨密度(BMD)值及血清钙、磷、碱性磷酸酶、骨钙素、I型胶原交联羧基末端肽、1,25二羟维生素D3等指标的变化。结果 云克治疗后腰椎(L1-4)及左股骨颈、大转子及小转子骨密度(BMD)值均较治疗前增加(P＜0.05);云克治疗后AKP、ICTP均较治疗前明显下降(P＜0.01)。OC云克治疗后较治疗前增加(P＜0.05)。血钙、血磷、1,25-二羟维生素D3云克治疗后与云克治疗前相比无明显变化,P<0.05。前列腺癌骨转移轻度骨痛组及中度骨痛组治疗1年后骨痛VAS评分明显降低,差异有统计学意义,P＜0.05。重度骨痛组云克治疗前、治疗后VAS评分比较,差异无统计学意义,P<0.05。结论 ⁹⁹锝-亚甲基二膦酸盐在治疗前列腺癌骨转移的骨痛、骨质疏松方面,具有缓解骨痛,促进骨增殖,抑制骨吸收,提高骨密度,防治骨质疏松的作用。

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 探讨无创呼吸机辅助常规药物治疗重症哮喘的疗效及对肺功能的影响。方法 选取我院于2014年2月—2017年6月间收治的60例重症哮喘患者作为研究对象,按照随机数字法分为对照组和研究组,对照组30例予以常规药物治疗,研究组30例予以无创呼吸机辅助常规药物治疗。比较两组患者临床疗效、肺功能指标、气血指标、心率、哮喘症状评分以及药物使用情况。结果 研究组临床有效率(96.66%)高于对照组(76.66%)(P＜0.05)。2组患者干预前肺功能指标、气血指标及心率比较无差异(P＞0.05),干预后两组心率、PaCO₂均较干预前降低,PaO₂、FEV1、FEV1/FVC均较干预前升高(P＜0.05),研究组较对照组改善明显(P＜0.05)。两组患者干预前哮喘症状评分比较无差异(P＞0.05),干预后两组哮喘症状评分均较干预前降低,且研究组较对照组降低明显(P＜0.05)。研究组使用茶碱类药物、糖皮质类激素、受体激动剂药物比例均低于对照组(P＜0.05)。结论 无创呼吸机辅助常规药物治疗重症哮喘可显著改善患者血气指标及肺功能,疗效确切。

目的 探讨焦虑障碍与冠心病经皮冠状动脉介入治疗(PCI)患者术后发生对比剂肾病(CIN)的相关性及机制,为早期发现CIN高危人群及其预防提供理论依据。方法 入选2014年6月—2016年12月于天津市第四中心医院心内科住院确诊冠心病并接受PCI患者,进行综合医院焦虑/抑郁情绪测定表(HAD)及汉密尔顿焦虑量表(HAMA)评价,依据量表的评分标准,最终纳入研究共120例,其中焦虑障碍组60例,非焦虑障碍组60例。观察2组患者PCI术前及术后72 h肌酐(SCr)、肌酐清除率(Ccr)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)、C反应蛋白(CRP)、白细胞介素-18(IL-18)的变化情况,并记录CIN的发生率。结果 2组患者PCI术前Scr、Ccr水平差异无统计学意义(P>0.05);2组患者PCI术后Scr水平均较术前升高,Ccr水平较术前降低(P<0.01)。PCI术后,焦虑障碍组Scr水平高于非焦虑障碍组,Ccr水平低于非焦虑障碍组(P<0.05)。2组患者PCI术前sICAM-1、CRP、IL-18、TNF-α差异无统计学意义(P>0.05);2组患者PCI术后sICAM-1、CRP、IL-18、TNF-α水平较术前均升高(P<0.01);PCI术后焦虑障碍组sICAM-1、CRP、IL-18、TNF-α水平高于非焦虑障碍组,差异有统计学意义(P<0.05)。PCI术前,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01);非焦虑障碍组患者PCI术后较术前HAD、HAMA评分差异无统计学意义(P>0.05);焦虑障碍组PCI术后HAD、HAMA评分高于术前,差异有统计学意义(P<0.01);PCI术后,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01)。结论 焦虑障碍可能是冠心病患者PCI术后发生对比剂肾病的危险因素之一。

目的 研究参附注射液在小儿川崎病治疗中的应用价值。方法 将2015年1月—2016年12月期间在我院接受治疗的川崎病患儿120例作为研究对象,并按照随机数表法将其随机分为两组,对照组和观察组,每组60例。对照组采取丙种球蛋白注射、口服阿司匹林、激素等常规治疗措施,观察组在对照组的基础上实施参附注射液治疗。对比2组患儿的退热时间、住院时间、C反应蛋白变化情况、红细胞沉降率,观察2组治疗期间的不良反应发生情况。结果 治疗后,观察组患儿的C-反应蛋白水平、红细胞沉降率与白细胞水平均小于对照组,血小板与血红蛋白水平高于对照组,退烧时间与治疗时间均小于对照组,差异有统计学意义(P＜0.05);2组的不良反应发生率相比较,差异无统计学意义(P＞0.05)。结论 参附注射液可以有效降低川崎病患儿机体内的C-反应蛋白水平、红细胞沉降率,改善血常规指标,加快康复进程,且具有一定的安全性。

目的 探究血必净联合乌司他丁治疗重症急性胰腺炎的疗效及对血清细胞因子水平的影响。方法 选择2016年2月—2017年3月我院收治的重症急性胰腺炎患者88例,随机将其为两组,各44例。对照组采用乌司他丁治疗,在此基础上给予观察组血必净治疗,比较2组临床疗效、血清细胞因子及药物不良反应。结果 观察组总有效率较对照组高,TNF-α、IL-6、hs-CRP水平较对照组低,差异有统计学意义(P＜0.05);观察组不良反应率略低于对照组,但差异无统计学意义(P＞0.05)。结论 血必净联合乌司他丁可提高重症急性胰腺炎临床疗效,减轻炎性反应,且不增加不良反应率,安全性较高。