高血压小脑出血破入第四脑室29例的手术治疗体会

目的总结高血压小脑出血破入第四脑室的手术治疗体会。方法对行手术治疗的29例高血压小脑出血破入第四脑室患者的临床资料进行回顾性分析。结果血肿位于单侧小脑半球18例,位于小脑蚓部9例,小脑半球及蚓部同时累及2例。第四脑室及环池受压、变形16例,环池消失1例,梗阻性脑积水形成7例。血肿完全清除21例,大部分清除8例,再出血2例,术后死亡1例。术后6个月,28例预后按ADL分级：Ⅰ级3例,Ⅱ级13例,Ⅲ级8例,Ⅳ级3例,Ⅴ级1例。结论合理的手术时机和手术方式,可改善高血压小脑出血破入第四脑室患者的预后。     

外科手术治疗HICH80例疗效分析

目的总结外科手术治疗高血压脑出血的经验,探讨高血压脑出血患者的手术时机、手术方式、手术适应证及术后处理.方法回顾性分析2008年3月—2010年6月收治的80例高血压脑出血患者经手术治疗的临床资料.结果 80例患者按GOS评价,植物生存1例,重残6例,中残21例,良好50例,死亡2例.结论对高血压脑出血患者的外科手术治疗,应谨慎选择手术术式、时机,掌握手术指征,并重视术后并发症处理.     

小骨窗显微手术超早期治疗高血压脑出血64例的体会

目的:总结小骨窗显微手术在超早期治疗高血压脑出血患者中的应用。方法:回顾性分析64例用小骨窗显微手术超早期治疗的高血压性脑出血病例,对其疗效、手术后并发症及再出血率进行总结。结果:优(5分)10例(15.6%),良(4分)21例(32.8%),可(3分)25例(39.1%),差(2分)2例(3.1%),死亡(1分)6例(9.4%),优良率为48.4%。死于并发肺炎3例,死于术后再出血2例,急性心衰1例。结论:小骨窗显微手术超早期治疗高血压脑出血是一种简单、快速、有效的手术方式。     

血肿微创术治疗对脑出血康复及预后的影响

目的探讨影响微创法清除颅内血肿术治疗高血压脑出血的治疗效果厦预后因素．方法对126例高血压脑出血微创清除颅内血肿术的临床资料进行统计学处理．结果126例患者术后存活120例（95．3％），本组死亡6例（4馏％）．生存患者术后3个月随访，用ADL（日常生活能力）评定疗效．ADL1：恢复日常生活34例（26．9％）；AD12：生活自理35例（27．7％）；ADL3：部分生活自理33例（26．1％）；ADL4：卧床不起但有意识21例（16.6％）；ADL5：植物状态3例（2．4％）．结论出血至手术时间、意识与脑菇征、瞳孔改变、中线移位4项因素对微创清除颅内血肿术，治疗高血压脑出血患者具有显著的预后价值，超早期手术是治疗成功的关键．     

超早期与早期手术治疗高血压脑出血的疗效分析

目的:观察超早期(出血7h以内)、早期(出血7~72h)手术治疗对高血压脑出血患者的疗效。方法:回顾性分析186例超早期、早期手术治疗中老年性高血压脑出血患者的资料。结果:手术后3个月时超早期组ADL(日常生活能力)分级Ⅰ~Ⅲ级87例(80.6%)、早期组Ⅰ~Ⅲ级39例(50.0%),超早期组有术后并发症(肺部感染、急性肾功能衰竭、消化道出血)者24例(22.2%)、早期组有39例(50.0%),两组比较差异有显著性(P<0.01)。超早期组术后再出血12例(11.1%)、死亡6例(5.6%),早期组术后再出血8例(10.3%)、死亡9例(11.5%),两组比较差异无显著性(P>0.05)。结论:超早期手术治疗高血压脑出血可改善患者术后日常生活能力,降低术后并发症的发生。     

微创术治疗高血压脑出血现状

高血压脑出血是脑血管病中病死率和致残率较高的疾病，对于高血压脑出血的最佳治疗一直存在着争议。介绍了微创治疗高血压脑出血的适应证、手术时机的选择、手术操作、并发症、临床疗效等五个方面的现状，微创术治疗高血压脑出血不失为一种有效的方法。     

软、硬通道联合微创血肿清除术治疗高血压脑出血

目的探讨软、硬通道联合微创治疗高血压脑出血的手术方式及临床效果。方法将符合诊断标准的高血压脑出血患者随机分为联合应用组40例,对照组40例,联合应用组应用软、硬通道联合微创血肿清除术,对照组单纯应用软通道或硬通道微创血肿清除术,比较两组术后第1、3、5、7天时的血肿清除情况,以及术后3周时的临床疗效和术后3个月时的日常生活质量评定（ActivitiesofDailyLivingScale,ADL）分级。结果联合应用组在血肿清除速度方面明显快于对照组;术后3周时联合应用组和对照组的总有效率分别为70．00％、45．00％;术后3个月时随访ADL分级,生存质量较好的前三级中（ADL1～ADL3）两组分别占57．50％、32．5%,联合应用组患者生存质量明显高于对照组（P〈0．01）。结论软、硬通道联合微创血肿清除术治疗高血压脑出血能加快血肿清除,提高临床疗效,改善患者近期生存质量。     

小骨窗显微手术治疗老年性小脑幕上高血压性脑出血的疗效观察

目的了解小骨窗微创手术治疗高血压脑出血的指征及疗效。方法 206例老年性小脑幕上高血压脑出血患者（GCS〉7分）,随机分为治疗组（108例）和对照组（98例）。治疗组应用小骨窗（直径≤3cm）微创手术治疗,对照组应用传统骨瓣开颅手术治疗。比较两组术后7 d GCS评分、1个月GOS评分、术后再出血发生情况。结果术后治疗组、对照组7d GCS评分分别为（13.2±1.3）、（12.2±1.5）（P〈0.01）。1个月GOS评分为：治疗组Ⅱ～Ⅲ级15例,Ⅳ～Ⅴ级87例;对照组Ⅱ～Ⅲ级30例,Ⅳ～Ⅴ级59例,两组间差异有统计学意义（P〈0.01）;两组术后再出血分别为3例和9例（P〈0.05）。结论小骨窗微创手术适用于GCS〉7分幕上高血压性脑出血患者,降低术后再出血率,改善GOS评分,提高生存质量。     

高血压脑出血92例显微手术治疗体会

目的:总结高血压脑出血的显微手术治疗经验。方法:回顾性分析近三年来施行显微外科手术治疗的高血压脑出血92例患者病历资料。结果:本组恢复良好31例(33.70%),中残20例(21.74%),重残25例(27.17%),死亡16例(17.39%)。结论:对于重症高血压脑出血患者,采取早期显微手术治疗,清除血肿,彻底止血,对清除血肿后颅内压仍高者扩大骨窗减压,可提高生存率,改善生存质量。     

高血压性脑出血显微外科微创治疗效果探讨

目的探讨高血压性脑出血患者采用显微外科联合小骨窗微创治疗后的效果,为患者选择更完善的术式。方法分别采用单纯小骨窗的手术及显微外科联合小骨窗微创手术,按照颅内血肿清除率以及术后大面积脑梗死发生率来评定手术效果,最后按照日常生活能力表(ADL)来分级评定预后,并进行统计分析。结果根据两组患者术后血肿残留、术后大面积脑梗死发生率和愈后分级差异有的统计学意义,显微外科联合小骨窗微创手术组各项指标均优于单纯小骨窗手术组。结论采用显微外科联合小骨窗微创手术治疗高血压性脑出血,能够为有效减少术后大面积脑梗死发生率,有利于患者预后情况的改善。     

清热化痰通腑法防治高血压脑出血术后继发性肺部感染的临床观察

目的探讨清热化痰通腑法防治高血压脑出血术后继发性肺部感染的临床疗效。方法将高血压脑出血(出血量>30 mL)急诊行开颅血肿清除手术或钻孔置管血肿引流术后出现肺部感染患者162例,随机分为观察组82例和对照组80例,观察组予以鼻饲清热化痰通腑中药(千金苇茎汤合大承气汤加减)治疗,对照组予以鼻饲安慰剂处理。根据病情轻重,分别采用气管切开术,重型肺炎者使用支纤镜下肺泡灌洗,并结合痰培养结果使用敏感抗生素防治感染。治疗4周后观察两组患者气管切开例数、重型肺炎肺泡灌洗例数、咳痰消失时间和发热缓解时间及治疗总有效率。结果治疗后观察组气管切开例数和肺泡灌洗例数均显著低于对照组(P<0.05),咳痰消失时间、发热缓解时间均显著短于对照组(P<0.05),临床治疗总有效率显著高于对照组(P<0.01)。结论采用清热化痰通腑法能有效防治高血压脑出血术后继发性肺部感染,减轻临床症状,改善患者临床预后。 更多还原     

光照对小鼠下丘脑视上核及乳腺组织钟基因Clock表达的影响

分析光照对泌乳期小鼠下丘脑视上核(SCN)及乳腺组织内生物钟基因Clock表达的影响.采用荧光定量RT-PCR法测定不同光照条件下SCN和乳腺组织中Clock基因的昼夜表达规律.试验发现Clock基因的mRNA不但在SCN,而且在乳腺组织也具有昼夜节律性表达.在光照-黑暗交替光制下,SCN和乳腺组织Clock基因的mRNA表达的峰值相位存在约6 h的相位差;在全黑暗条件下,Clock基因的mRNA表达存在昼夜节律,SCN和乳腺组织Clock基因的mRNA表达的峰值相位基本同步.结果显示,Clock基因的昼夜节律表达具内源性特征;光照影响Clock基因mRNA的表达.     

Entrainment of the circadian clock in the liver by feeding

Circadian rhythms of behavior are driven by oscillators in the brain that are coupled to the environmental light cycle. Circadian rhythms of gene expression occur widely in peripheral organs. It is unclear how these multiple rhythms are coupled together to form a coherent system. To study such coupling, we investigated the effects of cycles of food availability (which exert powerful entraining effects on behavior) on the rhythms of gene expression in the liver, lung, and suprachiasmatic nucleus (SCN). We used a transgenic rat model whose tissues express luciferase in vitro. Although rhythmicity in the SCN remained phase-locked to the light-dark cycle, restricted feeding rapidly entrained the liver, shifting its rhythm by 10 hours within 2 days. Our results demonstrate that feeding cycles can entrain the liver independently of the SCN and the light cycle, and they suggest the need to reexamine the mammalian circadian hierarchy. They also raise the possibility that peripheral circadian oscillators like those in the liver may be coupled to the SCN primarily through rhythmic behavior, such as feeding.     

Circadian integration of metabolism and energetics

Circadian clocks align behavioral and biochemical processes with the day/night cycle. Nearly all vertebrate cells possess self-sustained clocks that couple endogenous rhythms with changes in cellular environment. Genetic disruption of clock genes in mice perturbs metabolic functions of specific tissues at distinct phases of the sleep/wake cycle. Circadian desynchrony, a characteristic of shift work and sleep disruption in humans, also leads to metabolic pathologies. Here, we review advances in understanding the interrelationship among circadian disruption, sleep deprivation, obesity, and diabetes and implications for rational therapeutics for these conditions.     

光照周期对尼罗罗非鱼幼鱼昼夜节律调节的作用

为了研究尼罗罗非鱼幼鱼游泳行为在不喂食时是否存在昼夜节律和光照周期的调节作用,设计了光周期为光照(L)∶黑暗(D)=12 h∶12 h,持续的黑暗(DD),持续的光照(LL),光周期为L∶D=6 h∶6 h和光周期为L∶D=2 h∶2 h。结果表明:(1)光周期为L∶D=12 h∶12 h时,尼罗罗非鱼具有明显的昼夜节律,昼夜节律周期为(24. 3±0. 2) h;(2)尼罗罗非鱼的昼夜节律在持续的黑暗和光照下仍然存在,分别为(25. 1±1. 1) h和(25. 6±1. 0) h;(3)光周期为L∶D=6 h∶6 h时,尼罗罗非鱼仍具有明显的昼夜节律(12. 6±0. 5) h;(4)在光周期为L∶D=2 h∶2 h时,尼罗罗非鱼的昼夜游泳行为仍具有明显的昼夜节律,节律周期为(4. 0±2. 0) h。这些结果表明,尼罗罗非鱼具有以24 h为周期的内源性生物钟,但相比与外源性光照调控,内源性的生物钟对罗非鱼的调控较弱,外源性的光照周期才是调节尼罗罗非鱼幼鱼昼夜行为节律的主要因素。     

Circadian system controlling release of sperm in the insect testes

Release of mature sperm from the testis into seminal ducts of the gypsy moth exhibits a circadian rhythm. The rhythm of sperm release was shown to persist in vitro, in isolated complexes of testis and seminal ducts cultured in light-dark cycles or in constant darkness. The phase of the rhythm was also reset in vitro by exposure to shifted light-dark cycles. Therefore, the testis-seminal ducts complex from the gypsy moth is photosensitive and contains a circadian pacemaker, which controls the rhythm of sperm movement. This finding extends the range of structures in multicellular organisms that are known to contain circadian oscillators and provides a new model system in which circadian mechanisms may be studied.     

Resetting central and peripheral circadian oscillators in transgenic rats

In multicellular organisms, circadian oscillators are organized into multitissue systems which function as biological clocks that regulate the activities of the organism in relation to environmental cycles and provide an internal temporal framework. To investigate the organization of a mammalian circadian system, we constructed a transgenic rat line in which luciferase is rhythmically expressed under the control of the mouse Per1 promoter. Light emission from cultured suprachiasmatic nuclei (SCN) of these rats was invariably and robustly rhythmic and persisted for up to 32 days in vitro. Liver, lung, and skeletal muscle also expressed circadian rhythms, which damped after two to seven cycles in vitro. In response to advances and delays of the environmental light cycle, the circadian rhythm of light emission from the SCN shifted more rapidly than did the rhythm of locomotor behavior or the rhythms in peripheral tissues. We hypothesize that a self-sustained circadian pacemaker in the SCN entrains circadian oscillators in the periphery to maintain adaptive phase control, which is temporarily lost following large, abrupt shifts in the environmental light cycle.     

Circadian activity rhythm of the deer mouse, Peromyscus: effect of deuterium oxide

Chemical modification of a vertebrate activity rhythm, the circadian (approximately 24-hour) rhythm of Peromyscus leucopus noveboracensis, has been demonstrated. Activity in a running wheel was used to measure the rhythms of mice kept individually in conditions of continuous darkness. Deuterium oxide was presented in the drinking water. The length of the periods of rhythm increased directly and linearly with the increase in concentration of deuterium oxide. There is no threshold for this effect, and the maximum concentration of deuterium oxide (30 percent) that was presented resulted in a 6 percent lengthening of the period of circadian rhythm. The mice reverted to rhythms similar in period length to control values after deuterium oxide was withdrawn from their drinking water.     

Transplantation of the cockroach circadian pacemaker

Surgical removal of the optic lobes of the cockroach Leucophaea maderae followed by transplantation of the optic lobes from another individual led to a restoration of the circadian activity rhythm in 4 to 8 weeks. The free-running period of the restored rhythm was determined by the period of the donor rhythm before surgery. The results suggest that the transplanted optic lobe contains a circadian clock that regenerates those neural connections with the host brain that are necessary to drive the circadian rhythm of activity.