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弹力绷带“8”字包扎法对经皮穿刺股动脉行心脏介入诊疗后伤口出血或血肿发生率的影响

【摘要】　目的　研究弹力绷带“8”字包扎法对经皮穿刺股动脉行心脏介入诊疗后伤口出血或血肿发生率的影响。　方法　2010年 1-6月收治的600例经皮穿刺股动脉行心脏介入诊疗后患者，随机分为对照组（300例）和试验组（300例），两组在年龄、性别、病理、心功能、有无高血压、器质性心脏病、术中肝素使用量、术后人工压迫止血时间、下床活动时间等差异均无统计学意义（Pgt;0.05），术后72 h观察出血或血肿发生情况。　结果　对照组出血或血肿发生率9/300（3%），试验组出血/血肿发生率2/300（0.67%），两组差异有统计学意义（P=0.033）。　结论　对经皮穿刺股动脉行心脏介入诊疗后，用弹力绷带“8”字包扎法包扎伤口能降低血肿的发生率。

The Relationship between Apoptosis, NSE, and Neurological Impairment in Experimental Intracerebral Hemorrhage in Rats

目的：了解大鼠脑出血后血肿周围组织细胞凋亡与神经元特异性烯醇化酶（NSE）的表达及大鼠神经功能缺损程度的关系。方法：用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、NSE免疫组织化学染色及TUNEL分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围NSE及TUNEL的表达。用Longa评分法评价大鼠神经功能缺损程度。结果：大鼠在胶原酶注入6 h后形成稳定的血肿，在造模24～48 h神经功能缺损程度最重；6 h即见到TUNEL阳性细胞的表达，在48 h最明显；NSE从神经元中漏出弥散到细胞间隙也在48 h达高峰。结论：脑出血血肿周围凋亡与神经功能缺损及NSE的变化有关，凋亡可能在脑出血的神经损伤中起重要的作用。

Sequential Study of the Complement Activation and Cell Apoptosis in Perihematoma tissue in rats

摘要:目的:动态观察大鼠脑出血后血肿周围组织补体激活与细胞凋亡的规律。方法:用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、免疫组织化学染色及原位末端脱氧核苷酸转移酶介导的dUTP 缺口末端标记法(TUNEL)分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围补体C3、促凋亡基因(Bax)、抑凋亡基因(Bclxl)及TUNEL的表达。结果补体C3的表达峰值在24~48 h;TUNEL、Bax蛋白表达术后12h增加,48~72 h达高峰,而Bclxl蛋白表达高峰在48h。结论:大鼠脑出血后血肿周围组织补体C3的表达增加与细胞凋亡的演变趋势一致,C3与凋亡有相关。Abstract: Objective: To study the complement activation and apoptosis regular genes changes in the tissues of the perihematoma of intracerebral hemorrhage (ICH) in rats. Methods: Intracerebral hemorrhage was induced in rats by injection of bacterial collagenase into the caudate nucleus. Histopathological changes were studied in 6 h,12 h, 24 h, 2 d, 3 d, 5 d, 7 d after the injection. The immunohistochemistry and TUNEL analysis were performed. The expression of complement factor C3, the TUNELpositive cells, the proapoptotic gene expression (Bax) and the antiapoptotic gene (Bclxl) were examined. Results: The expression of C3 increased to its maximum between 2448 h. The TUNELpositive cells and Bax protein expression increased gradually and reached the peak level between 4872 h. The Bclxl protein reached the peak level at 48 h. The correlation analysis showed that the quantity of C3 was positively related to that of the TUNELpositive cells, but the bax protein was not related to Bclxl protein. Conclusion: The expression of complement factor C3 may contributes to the nerve injury after cerebral hemorrhage and relate to the apotosis in the tissues surrounding the hametoma in rats.

左侧慢性自发性胸腔巨大包裹性血肿一例

创伤性纵隔血肿的特点及处理

目的 探讨创伤性纵隔血肿的临床特征、诊断方法和治疗.方法 对12例纵隔血肿病例进行了总结,对其临床表现、治疗方法、疗效和预后进行了分析.结果 486例胸部创伤患者中发生纵隔血肿12例,占胸部创伤的2.5%.根据病情进行开胸手术及B型超声波定位引导下血肿穿刺治疗,治愈11例,死亡1例.结论 严重胸部创伤时,即使无明显临床症状,亦应考虑纵隔血肿的存在,并给予必要的检查,积极治疗,效果满意.

强直性脊柱炎伴颈椎硬膜外血肿的诊治

目的总结强直性脊柱炎伴颈椎硬膜外血肿的特点和诊治方法。 方法1994年1月－2009年2月，收治4例外力作用后发生颈椎硬膜外血肿的强直性脊柱炎男性患者。年龄56～67岁，平均62.8岁。出现症状至入院时间为8 h～5 d，平均46 h。Frankel分级：B级2例，C级2例。MRI检查示硬膜外血肿位于C3～T2。1例行颈椎后路手术；2例并发Ⅱ型呼吸衰竭及1例并发高血压、劳力型心绞痛者，行保守治疗。 结果手术治疗患者术后切口Ⅰ期愈合，获随访14个月，感觉平面由C6下降至C8，双上肢肌力较术前增加1级，双下肢肌力较术前无改善；Frankel分级为B级。保守治疗患者中，1例并发Ⅱ型呼吸衰竭者死亡；其余2例患者分别获随访12、18个月，感觉平面、双上下肢肌力及Frankel分级与治疗前比较均无改善。 结论颈椎硬膜外血肿是强直性脊柱炎的少见并发症，多由轻微过伸伤引起，常迟发性出现临床症状，MRI是首选诊断方法，预后较差。

PREVENTION OF HAEMATOMA AFTER CEMENTED TOTAL HIP ARTHROPLASTY

Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.

CLINICAL FEATURES OF SPONTANEOUS SPINAL EPIDURAL HEMATOMA AND INFLUENTIAL FACTORS OF ITS PROGNOSIS

Objective To explore the clinical features of spontaneous spinal epidural hematoma (SSEH) and to find out factors influencing its prognosis. Methods From September 1998 to October 2006, 23 patients with SSEH (10 males and 13 females) were treated. Their ages ranged from 10 to 69 years. The primary neurological status were classified as grade A in 7 patients,B in 2 patients, C in 4 patients, D in 9 patients and E in 1 patients accordingto ASIA grading system. The progressive intervals of their symptoms were divided as four period: less than 12 hours (12 patients), 12 to 24 hours(2 patients), 24 to 48 hours(3 patients) and more than 48 hours(6 patients). SSEH was diagnosedby MRI or by histopathological examination. The cases history, laboratory examination, radiological image, treatment, pathological result and prognosis were recorded and analyzed after 3 month. Results In 23 patients, there were 1 case of deterioration, 8 cases of no change, 9cases of improvement and 5 cases of complete recovery. The gender had no correlationwith prognosis(P＞0.05). In the patients who had shorter progressive interval and more severe edema of spinal cord, the prognosis was worse(P＜0.05). Inthe patients who had mild neurological deficit, the prognosis was good (P＜0.01). In 17 patients undergoing surgery, the scores for prognosis was 1 point in 1 case, 2 points in 5 cases, 3 points in 6 cases and 4 points in 5 cases; the operation time had no correlation with prognosis(r=0.056, P＞0.05). In6patients undergoing conservative treatment, the scores for prognosis were 2 points and 3 points in 3 cases respectively. Conclusion Prognosis of patient with SSEH is influenced by his primary neurological status, progressive interval, spinal edema and size of hematoma. The major treatment is surgical evacuation of hematoma as early as possible to break the aggravation of spinal function. Conservative treatment is not considered unless the neurological defects recovered in the early period.

介入治疗盆部外伤性巨大血肿一例

Comparison between Skull Drill Drainage-urokinase Perfusion and Small Bone Flap Craniotomy for Removing the Hematoma in Hypertensive Cerebral Hemorrhage

【摘要】　目的　比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。　方法　2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组，n=34）和小骨窗开颅术（B组，n=30）的高血压脑出血患者共64例（出血量30~50 mL，无脑疝），两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。　结果　A组手术时间短于B组，两组比较，有统计学意义（Plt;0.05）。术后1、6个月，A组疗效优于B组，两组比较，有统计学意义（Plt;0.05）。A、B组术后近期和远期死亡率比较，无统计学意义（Pgt;0.05）。　结论　对出血部位在基底节区、出血量在30~50 mL，无脑疝的高血压脑出血患者，钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。【Abstract】　Objective　To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage.　Methods　A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared.　Results　The operation time was shorter in group A than that in group B (Plt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (Plt;0.05); the difference in mortality between the two groups was not significant (Pgt;0.05).　Conclusion　The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.