ObjectiveTo compare the keyhole approach and traditional craniotomy in the treatment of basal ganglia region hypertension cerebral hemorrhage postoperative epileptic curative effect comparison keyhole approach and traditional craniotomy in the treatment of basal ganglia region the curative effect of hypertensive cerebral hemorrhage postoperative epilepsy. MethodsCollected cases of basal ganglia region admitted in department of neurosurgery our hospital from September 2006 to March 2015, 108 cases of hypertensive cerebral hemorrhage patients, randomly divided into two groups:keyhole approach group (58 cases) and conventional surgery group (50 cases).Two groups of patients with perioperative all use the same management scheme, using statistical methods to analyze clinical data of two groups of patients, such as age, sex, blood loss, postoperative epilepsy, drug efficacy and the incidence of adverse drug reactions, etc. ResultsPostoperative follow-up of 2 years, keyhole approach group 12 cases sufferred postoperative seizure, 1 case of patients with status epilepticus, no death occurred; a total of 10 cases of mono-antiepileptic drug(AEDs) therapy effectively, and 7 cases present adverse drug reactions; Traditional surgical postoperative seizures 22 cases, 9 cases occurred status epilepticus, and five died as a result, only five were effective for single therapy, and 15 cases with adverse drug reactions.Statistical results suggest the incidence of postoperative epilepsy, the incidence of severe epilepsy, prognosis, single drug control and adverse drug reactions between the tuo groups have significant difference (P < 0.05). ConclusionCompared with traditional craniotomy for removal of hematoma, keyhole approach greatly reduce the incidnce of basal ganglia region hypertension cerebral hemorrhage postoperative complications, severe epilepsy and adverse reaction of AEDs.Therefore, keyhole approach in the treatment of basal ganglia region hypertension cerebral hemorrhage is an admirable way of treatment.
ObjectiveTo explore the related risk factors of epilepsy after traumatic skull defect repair.MethodsThe clinical data of 72 cases patients underwent cranial three-dimensional titanium mesh repair in Neurosurgery Department of Sichuan Baoshihua Hospital from February 2010 to December 2017 were collected and followed up for 6 months, retrospectively analysed the causes and operation problems of secondary epilepsy after repair.Results21 casese (29.2%) among the 72 cases patients underwent cranioplasty were found with secondary epilepsy. Univariate analysis showed that the rate of secondary epilepsy in patients with softening lesion of gray matter, no formal antiepileptic treatment after the first operation, suspension of dural during operation and repair time of the trauma >6 months was significantly higher than that in patients without secondary epilepsy (P<0.05). Multivariate Logistic regression was used to correct the results, showing that softening lesion in the gray matter [OR=8.425, 95% CI (2.541, 27.934), P<0.001)], no formal antiepileptic treatment after the first operation [OR=0.160, 95% CI (0.050, 0.518), P=0.002], intra-operative suspended dural [OR=13.306; 95% CI (3.769, 46.976), P<0.001] and repair time of trauma >6 months [OR=6.205, 95% CI (1.705, 22.583], P=0.006] were independent risk factors of secondary epilepsy.ConclusionAfter decompression of bone flap, regular antiepileptic therapy, shortening repair time, and proper peroperative management can reduce the incidence of postoperative epilepsy.
Objective?To systematically evaluate the effects of thoracic epidural anesthesia on outcome after coronary artery bypass surgery. Methods?We searched PubMed, EBSCO, Springer, Ovid, and CNKI databases from 1990 through Oct. 2009 to identify randomized controlled trials (RCTs) about thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone on outcome after coronary artery bypass surgery. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook. The homogeneous RCTs were pooled using RavMan 4.2.10 software. Results?Sixteen RCTs involving 1 316 patients met the inclusion criteria. The results of meta-analyses showed that thoracic epidural anesthesia significantly reduced time to tracheal extubation (MD= –332.43, 95%CI –640.19 to –24.68, P=0.03), visual analog scale (VAS) scores at rest on postoperation day 1 (MD= –1.23, 95%CI –2.19 to –0.27, P=0.01), VAS scores with movement on postoperation day 1 (MD= –2.52, 95%CI –4.65 to –0.39, P=0.02) and day 2 (MD= –1.5, 95%CI –2.56 to –0.43, P=0.006), and incidences of myocardial ischemia (RR=0.53, 95%CI 0.29 to 0.97, P=0.04). There were no significant differences between the two groups in postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. Conclusions?Thoracic epidural anesthesia could reduce postoperative time to tracheal extubation, VAS score, and incidences of myocardial ischemia, but it does not affect postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. More high-quality RCTs are required.
目的 系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。 方法 检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库，收集1990年－2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量，用Revman 5.1软件对提取的数据进行Meta分析。 结果 共纳入10项研究，包括342例产妇。与空白对照组相比，瑞芬太尼降低新生儿1 min Apgar评分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生时脐动脉pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生时窒息发生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；当诱导剂量为1.0～1.5 μg/kg时，对5 min Apgar评分无影响[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。 结论 瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒，但是会对新生儿产生一过性的呼吸抑制。
【摘要】 目的 建立血液中乙醇的直接稀释-填充柱气相色谱测定法，将其与现行推荐方法GA/T105-1995进行对比，同时对不同采血管对乙醇含量的影响进行研究。 方法 使用GDX-102填充柱作为分析柱，柱温160 ℃，汽化室190 ℃，检测器（FID）190 ℃；用1 mg/mL正丙醇溶液稀释血液50倍，经离心后，取上清液1 μL进样测定。 结果 本法回收率91.2%~105.7%，与GA/T105-1995推荐方法测定结果最大相对误差为7.1%，血液保存于非抗凝管的血醇浓度比抗凝管稍高。 结论 该法适用于血液中乙醇含量的测定，样品处理更简便。不同采血管对血醇含量有一定影响，综合考虑各因素后建议使用枸橼酸钠抗凝管作为采血管。【Abstract】 Objective To establish a direct dilution-gas chromatographic method for the determination of ethanol in blood, compare the method with GA/T105-1995 recommendation method, and study the effects of blood tubes with different anticoagulants on the ethanol contents. Methods GDX-102 packed column was used as separation column with an oven temperature of 160 ℃, an injector temperature of 190 ℃ and a flame ionization detector temperature of 190 ℃. Normal propanol solution at 1 mg/mL was adopted to dilute the samples with a volume 50 times of the propanol solution. After being centrifuged, 1ul of the supernatant liquid was injected for analysis. Results The recovery rate of the method was between 91.2% and 105.7%. The deviation of the method with GA/T105-1995 recommendation method was less than 7.1%. The concentration of blood ethanol preserved in the non-anticoagulant tubes was a little higher than that preserved in the anticoagulant tubes. Conclusions The method can be used for the determination of ethanol content in blood. Compared with GA/T105-1995 recommendation method, the sample treatment of this method is much simpler. And the blood tubes with different anticoagulants have influences on the ethanol contents. It is recommended that blood tubes with sodium citrate as anticoagulant can be used for blood sampling and preservers.