Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency Hemodynamic changes are detected by transcranial Doppler test

BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency （VBI） through transcranial Doppler （TCD） detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN： Randomized grouping and controlled clinical study. SETTING： Department of Neurology, the Fourth People＇s Hospital of Jinan. PARTICIPANTS： A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People＇s Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confumed consent. They were randomly divided into low-dose treatment group （n =60）, high-lose treatment group （n =30） and control group （n =40）. METHODS： Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups （high-low flow velocity）. The vertebral artery （VA） and basal artery （BA） of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES： ①Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ②content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS： All 130 VBI patients were involved in the final analysis. ①Changes of hemodynamic indexes： Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference （P 〈 0.05）; meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course （P 〈 0.05）. However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference （P 〈 0.05）. ②Content of serum NO： After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group （P 〉 0.05）; but both groups were higher than control group, and there was significant difference （P 〈 0.05, 0.01）. CONCLUSION： NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.

翼点入路对大脑前动脉的显微应用解剖

目的 探索经翼点入路大脑前动脉及其穿通支的显微解剖及其临床应用。方法 对１０具（２０侧）红色乳胶颈内动脉和椎动脉灌注头颈部标本的大脑前动脉及其穿通支在手术显微镜下解剖观测。结果 大脑前动脉Ａ１段变异多，右侧Ａ１发育不全多见，Ａ１外径左侧大于右侧。Ａ２左右走行和前后走行各约占一半。大脑前动脉穿通支大多数由Ａ１上壁、内上壁发出并向后、上方行走。Ａ１近端３～５ｍｍ、中１／３区域穿通支少。结论 Ａ１变异多，这可能与前交通动脉瘤形成有关；在大脑前动脉下壁、外侧壁解剖或在Ａ１近端３～５ｍｍ、中１／３区域临时夹闭Ａ１可减少Ａ１穿通支的损伤。

远外侧经髁入路解剖标志的应用研究

目的对枕下远外侧经髁入路的解剖标志进行观测,以指导临床应用。方法模拟临床手术过程,在显微镜下对15例成年国人灌注头颅标本进行解剖观测。结果椎动脉从寰椎横突孔穿出后进入枕下三角内,走行在寰椎侧块的椎动脉沟内,被寰椎后弓的骨膜紧密包绕,覆盖丰富的椎静脉丛;颈静脉结节和枕髁阻碍了脑桥延髓腹侧的术野。结论游离椎动脉会增加出血和创伤的风险,一般情况下不予采用。颈静脉结节和枕髁的磨除有利于增大操作空间和视野,是否磨髁及其磨髁的多少应根据病变的性质和位置来决定,磨除颈静脉结节时勿损伤后组脑神经,术中均需行脑神经监测。

椎基底动脉和脑干腹侧面的显微解剖研究

目的 为前方经斜坡入路提供椎基底动脉和脑干腹侧面相关显微解剖参数。方法 对 2 0具成人头颅标本 ,模拟经斜坡入路进行椎基底动脉和脑干腹侧面显微解剖观察和测量。结果 经斜坡入路可充分显露椎基底动脉和延髓、脑桥腹侧面 ,而对基底动脉末端分支和中脑的显露 ,必须上抬垂体。右侧 6例脊髓前动脉缺失(30 % )。结论 经斜坡入路可以充分显露椎基底动脉和延髓。

颞下经岩骨前部入路的显微解剖观测及临床意义

目的 对颞下经岩骨前部入路的解剖结构进行观测 ,以指导临床应用。方法 模拟临床手术过程 ,在显微镜下对 1 0具 (2 0侧 )成年国人灌注头颅标本进行解剖观测。结果 除弓状隆起外 ,另可见中颅窝底有两个较恒定的骨性突起 ,一个位于中颅窝底的中央部 ,其对应的颅外颅底无解剖结构 ;另一个位于岩骨基底部 ,其颅外颅底对应为颞下颌关节。颈内动脉岩骨段水平部位于Kawase三角下方的骨质中 ,鼓膜张肌位于Glasscock三角下方的骨质中 ,咽鼓管位于颈内动脉岩骨段水平部和鼓膜张肌之间。上半规管延长线与岩骨嵴的交点至内耳孔前缘的距离相对恒定。结论 对中颅窝底恒定骨性突起的观测及命名 ,有利于扩大手术视野、减少对颞叶的牵拉和保护颞下颌关节。在Kawase三角中定位、显露颈内动脉岩骨段水平部 ,不会伤及鼓膜张肌和咽鼓管。熟悉解剖、术前CT扫描及术中对“蓝线”的识别 ,有助于保护骨迷路。

胃网膜右动脉-冠状动脉旁路移植术的应用解剖

在31具成人尸体上,结合胃网膜右动脉与冠状动脉搭桥术,调查了胃网膜右动脉的长度及外径,以及胃网膜右动脉起始处至冠状动脉主要分支之间的距离。并观察了胃网膜右动脉移植到冠状动脉的手术中所遇到的重要结构。

跖骨滋养动脉的观察

目的 :观察跖骨滋养动脉的起始、经过和管径。方法 :以 5 %明胶墨汁、硫酸钡墨汁或红色乳胶 ,分别对90侧婴儿～ 87岁的新鲜尸体下肢的动脉进行灌注。经固定后 ,对跖骨滋养动脉进行解剖观察和测量。结果 :跖骨滋养动脉的直径为 0 .2 4～ 0 .30 mm。第 1跖骨滋养动脉 5 9.6 %发自足底深支和第 1跖足底动脉 ,其它跖骨滋养动脉主要发自跖足底动脉、足底弓及其穿支。同时对此动脉入跖骨相关面的滋养孔进行了观察 ,发现 90 %以上位于跖骨体中 1/3段。结论

原发性高血压患者颈动脉结构与功能的改变

目的：观察原发性高血压患者颈动脉结构与功能的变化及其相关性。方法：将４７例原发性高血压患者按病期分为高血压Ⅰ期组和高血压Ⅱ期组，采用彩色多普勒超声检测技术观察颈动脉的结构、血流动力学及血管的扩张性和顺应性变化，并与正常对照组比较。结果：两组高血压病人的血管内膜中层厚度（ＩＭＴ）增加，血管收缩、舒张内径扩大，并随着高血压病期增加而增加。高血压病人的血管扩张性和顺应性都下降，但在两组高血压病人间无差异。血管的扩张性与年龄、脉压呈反比（ｒ分别为－０．４３２和－０．４７，Ｐ＜０．０１），与舒张压呈正比（ｒ＝０．４７，Ｐ＜０．０１），血管的顺应性与收缩压呈反比（ｒ＝－０．４４，Ｐ＜０．０１），与收缩内径呈正比（ｒ＝０．４３，Ｐ＜０．０１），顺应性、扩张性与血管内膜中层厚度增厚无关。结论：大动脉僵硬度的改变主要是由血压变化引起的，而非结构变化所致。

经颞浅动脉介入上颌动脉的解剖学研究

目的研究经颞浅动脉插管至上颌动脉行介入诊疗的解剖学基础。方法在２３具成人尸体上观测了该介入通路的相关参数。结果颧弓处颞浅动脉的外径为２．４ｍｍ±０．４ｍｍ，上颌动脉７３．９％从颈外动脉内侧壁发出，起始处外径为２．９ｍｍ±０．７ｍｍ。上颌动脉起点至颧弓处，颞浅动脉长度为３６．４ｍｍ±８．５ｍｍ。上颌动脉与颞浅动脉夹角为８５．９°±１９．９°。结论与Ｓｅｌｄｉｎｇｅｒ法相比，该通路短，仅有一个弯曲且不涉及其它大血管。