【摘要】 目的 分析腦中心疝對腦出血患者預后的影響，明確早期判定的重要性。 方法 回顧分析2005年2月－2010年8月所有因腦出血行手術治療的173例患者的臨床資料，其中并發小腦幕切跡疝48例，并發腦中心疝37例。 結果 173例患者治愈97例，輕殘25例，中殘30例，持續植物狀態2例，死亡19例；死亡原因：腦功能衰竭11例，顱內感染2例，肺功能衰竭2例，腎功能衰竭3例，彌散性血管內凝血1例。腦中心疝患者病死率（27.03%）高于非腦中心疝患者（6.62%），差異有統計學意義（χ2=10.393，P=0.001）。腦中心疝分期與GOS分級呈負相關關系（rs=-0.827，P=0.000），分期越早，GOS分級越高；腦中心疝存活的27例患者日常生活、活動分級與腦中心疝分期呈正相關關系（rs=0.630，P=0.000），分期越早，ADL分級越低。 結論 腦中心疝的早期判定可以減少患者并發癥的發生，降低病死率及傷殘率。【Abstract】 Objective To Analyze the effect of brain center hernia on the prognosis of cerebral hemorrhage patients, and clarify the importance of early judgment of brain center hernia. Methods The recorded data of 173 patients undergoing surgery for cerebral hemorrhage in our hospital from February 2005 to August 2010 were retrospectively analyzed. Among them, there were 48 cases of combined transtentorial herniation and 37 cases of combined brain center hernia. Results Among the 173 patients, 97 were cured, 25 were slightly disabled, 30 were moderately disabled, 2 were in persistent vegetative state (PVS), and 19 died. In the 19 dead patients, 11 died of brain function failure, 2 of intracranial infection, 2 of lung failure, 3 of renal failure, and 1 of disseminated intravascular coagulation (DIC). The mortality of patients with brain center hernia (27.03%) was significantly higher than that of non-brain center hernia patients (6.62%) (χ2=10.393, P=0.001). The period of brain center hernia was negatively correlated with GOS′s stage (rs=-0.827, P=0.000), and the earlier the period, the higher the GOS stage. The brain center hernia period in the 27 survival patients was positively correlated with their ADL stage (rs=0.630, P=0.000), and the earlier the period, the lower the ADL stage. Conclusion Early judgement of brain center hernia can reduce patients′ complications, their mortality and disability rate.
Objective To investigate the effects and possible mechanism of the local content changes of nitrogen monoxidum on bile reflux in rats’ pylori stress ulcer. Methods Fifty adult SD rats were restrained in planes and then were soaked in cold water to make stress ulcer. They were divided into three groups randomly: the stress group (30 cases), the L-NAME group (10 cases), whose pylori were injected with L-NAME solution and the normal saline group (10 cases), whose pylori were treated with saline solution. Besides, there were another 10 rats taken as the control group. The gastric ulcer index, pH value and bile acid concentration of gastric juice in each group were measured before and after stress. The local concentrations of nitrogen monoxidum in rats’ pylori were also measured by nitrogen monoxidum Biochemical Detection Kit. Results The local content of nitrogen monoxidum in rats’ pylori increased to maximum at 1 h after stress （P＜0.01）, while the bile acid and pH value of gastric juice went up to the maximum at 2 h after stress （P＜0.01）. The ulcer index reached the peak value at 4 h after stress （P＜0.01）. The bile acid concentration and ulcer index of the group injected with L-NAME solution in rats’ pylori decreased significantly compared with those of the group treated with normal saline solution (P＜0.01). The local concentration of nitrogen monoxidum also decreased significantly in the L-NAME group (P＜0.05）. However, there was no difference on pH values of gastric juice between those two groups (Pgt;0.05). Conclusion There is a positive correlation between the local concentration of nitrogen monoxidum in pylori and bile acid in the stomach in rats with stress ulcer. Injection of L-NAME solution in rats’ pylori may reduce the local content of nitrogen monoxidum so that the pyloric sphincter become less tense, which may lead to the significant decreases of ulcer index and bile acid in the stomach. Thus, L-NAME may protect gastric mucus effectively.