【摘要】 目的 探讨难治性癫痫不同类型手术的预后与病程长短有无相关关系。 方法 回顾性分析2005年1月-2009年12月在四川大学华西医院神经外科进行难治性癫痫手术的143例患者，根据Engel分级对预后进行评估，分别分析各类型手术不同病程时间之间的预后差异以及相关关系。 结果 不同病程组颞叶手术和颞叶合并颞叶外手术的预后差异无统计学意义（Pgt;0.05），两者之间无相关关系；颞叶外手术的预后在不同病程组间差异有统计学意义（Plt;0.05），两者之间呈负相关。 结论 颞叶外癫痫手术的预后与病程存在相关关系；病程越短，预后越好。【Abstract】 Objective To discuss the relationship between prognosis of different intractable epilepsy surgeries and the disease course. Methods A total of 143 patients who had undergone surgeries for intractable epilepsy in the Neurosurgery Department of West China Hospital of Sichuan University from 2005 to 2009 were enrolled, and the prognosis with different disease course were assessed based on the Engel classification. Results Between different disease duration groups, the difference between the prognosis of the temporal surgery and the surgery of temporal lobe combined with other lobes was not statistically significant (Pgt;0.05), which indicated no relationship between the disease course and the prognosis. However, the difference between the prognosis of the surgeries outside the temporal lobe was statistically significant (Plt;0.05), which showed that patients with a longer disease course had a worse prognosis. Conclusion The prognosis of the epilepsy surgery outside the temporal lobe is correlated with the disease course. The shorter course has a better prognosis after surgery.
Objective To discuss the correlation between glutamate receptor 5 (GLUR5) and the pathogenesis of intractable temporal lobe epilepsy (ITLE), through detecting the GLUR5 expression in human with ITLE and Coriaria lactone-induced rhesus monkey temporal lobe epilepsy model. Methods Fifty-four patients with ITLE treated in West China Hospital between January 2007 and December 2015 were regarded as clinical case group in this study. The other 43 patients who underwent temporal lobe removal decompression surgery in the same time period due to trauma, tumor or large area cerebral hemorrhage complicated with cerebral hernia were designated as the clinical control group. Quantitive polymerase chain reaction (PCR) and Western blot methods were used to detect mRNA and protein levels of GLUR5. Western blot was also used to detect the GLUR5 protein level in the hippocampus and temporal lobe tissues of Coriaria lactone-induced rhesus monkey epilepsy model, and the result was compared with that of animal controls. Results Quantitive PCR results showed that the expression ratio (R value) of GLUR5 in the temporal lobe of the clinical case group to the clinical control group was 0.262, without significant difference (P>0.05), while theR value in the hippocampus was 4.896, with a significant difference (P<0.05). The amplification curve showed that the GLUR5 level in the hippocampus of the clinical case group was higher than that of the clinical control group, but the GLUR5 mRNA level in the temporal lobe tissue was not significantly changed. GLUR5 PCR amplified product electrophoresis showed that the amplified fragment was 161 bp. Western blot analysis showed that the GLUR5/actin value of the temporal lobe tissue in the clinical case group was 2.172±0.063, while the value in the clinical control group was 2.142±0.060, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the hippocampus in the clinial case group was 2.548±0.509, while it was 1.584±0.415 in the clinial control group, and the difference was statistically significant (P<0.05). The GLUR5/actin value of the hippocampus of the rhesus monkey model of epilepsy was 1.007±0.034, and it was 1.001±0.032 in the animal control group, and the difference was not statistically significant (P>0.05). The GLUR5/actin value of the temporal lobe tissue in the animal experimental group of rhesus model of epilepsy was 0.763±0.026, and it was 0.742±0.034 in the animal control group, and the difference was not statistically significant (P>0.05). The target protein bands showed that GLUR5 protein expression in the temporal lobe tissue and hippocampus of the rhesus model of epilepsy and animal controls was not significantly different (P>0.05). Conclusions GLUR5 participates in the pathogenesis of human ITLE by acting on the hippocampus. The expression of GLUR5 in human ITLE is abnormal, but the expression of GLUR5 is not changed in the rhesus model of epilepsy. The abnormal expression of GLUR5 may play a role in the pathogenesis of ITLE.
目的 探讨颅脑损伤急性期血小板（PLT）参数与外伤性脑梗死（TCI）的关系。 方法 选取2010年9月－2012年1月符合纳入除标准的颅脑损伤患者191例。将伤后14 d内发生脑梗死的患者划入观察组，余为对照组。分别于伤后第24、48小时，第3、7、14天，采集肘静脉血对PLT计数、PLT平均体积（MPV）、PLT体积分布宽度（PDW）；伤后24 h行格拉斯哥昏迷评分（GCS），伤后6个月随访行格拉斯哥结果评分（GOS）。分别分析脑梗死与上述PLT参数的关系、PLT参数与颅脑损伤病情轻重的关系以及与预后的关系。 结果 观察组PLT计数降低、MPV升高、PDW升高；观察组患者GCS/GOS与PLT计数呈正相关，与MPV、PDW呈负相关。 结论 PLT计数、MPV、PDW均与TCI有关，三者中PLT最具临床意义。PLT计数越低、MPV和PDW越高，脑梗死可能性越大，颅脑损伤可能越严重，预后可能越差。
【摘要】 目的 探讨中型和重型颅脑损伤后患者血小板（platelet，Plt）参数的变化特点及临床意义。 方法 选取2009年3月-2010年3月脑外伤后24 h内入院的颅脑损伤患者75例作为观察组，于伤后1、3、7、14 d采血测定Plt数量、血小板平均体积（mean platelet volume，MPV）、血小板体积分布宽度（platelet distribution width，PDW），并同时进行格拉斯哥昏迷评分（Glasgow coma scale，GCS）。同时选取60例健康体检者，测定Plt、MPV和PDW作为对照组。 结果 观察组伤后1、3、7 d Plt计数分别为（106.21±36.31）、（102.76±35.23）、（108.37±31.32）×109/L，较对照组[（210.41±68.56）×109/L]明显降低（Plt;0.05）；观察组伤后1、3、7 d MPV分别为（12.34±1.34）、（11.21±1.52）、（10.78±1.36） fL，PDW分别为（15.78±1.26）、（17.67±1.16）、（16.72±1.21） fL，均较对照组[MPV：（8.24±1.76） fL，PDW：（12.86±1.42） fL]明显升高（Plt;0.05）；伤后14 d Plt、MPV和PDW均较对照组差异无统计学意义（Pgt;0.05）。GCS≤8分组伤后1 d Plt计数为（96.85±36.52）×109/L，明显低于GCSgt;8分组[（123.85±35.78）×109/L]，而GCS≤8分组MPV为（12.14±1.32） fL，PDW为（18.63±1.21） fL，均明显高于GCSgt;8分组[MPV：（9.78±1.34） fL，PDW：（16.72±1.34） fL]，差异均有统计学意义（Plt;0.05）。伤后第1天Plt与随访6个月GOS评分呈正相关（r=0.625，Plt;0.05）。 结论 中型和重型颅脑损伤后Plt计数明显降低，MPV和PDW值明显升高，且与伤情及预后有关。Plt及其参数的检测有助于对伤情、预后的判断。【Abstract】 Objective To investigate the platelet parameters changes and its clinical significance in medium and severe head injury patients. Methods From March 2009 to March 2010, 75 brain injury patients hospitalized within 24 h after injury were included in this study. The platelet number (Plt), mean platelet volume (MPV), platelet volume distribution width (PDW) and Glasgow coma scale were measured on the first, third, seventh and fourteenth day after injury respectively. We also measured the Plt, MPV and PDW of 60 healthy volunteers to make comparisons. Results The Plt counts were (106.21±36.31), (102.76±35.23), and (108.37±31.32)×109/L in the head injury patients on the first, third, and 7th day respectively, which were significantly lower than those in the control group [(210.41±68.56)×109/L] (Plt;0.05); the MPV and PDW values measured on the first day [MPV: (12.34±1.34) fL, PDW: (15.78±1.26) fL] and the third day [MPV: (11.21±1.52) fL, PDW: (17.67±1.16)fL] were both significantly lower than those of the control group (Plt;0.05); There was no evidence of a difference in Plt, MPV and PDW between the two groups fourteen day after injury (P＞0.05); The Plt count was (96.85±36.52)×109/L in GCS≤8 group on the first day, which was significantly lower than that of GCSgt;8 group [(123.85±35.78) fL, Plt;0.05]; However, the MPV and PDW values in GCS≤8 group [(MPV: (12.14±1.32) fL, PDW: (18.63±1.21) fL] were both significantly higher than those of GCSgt;8 group [MPV: (9.78±1.34) fL, PDW: (16.72±1.34) fL, Plt;0.05]; The Plt count was correlated with GOS score positively (r=0.625,Plt;0.05). Conclusions Medium and severe head injury patients are significantly associated with a lower Plt count and increased MPV and PDW values. The Plt parameters changes are correlated with the prognosis of patients. Therefore, the measurement of Plt parameters may contribute to the valuation of severity and prognosis, and provide new ideas for treatment of head injury patients.
Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.