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Objective:To explore the related factors of epilepsy secondary to aneurysmal subarachnoid hemorrhage in the elderly.Methods:From January 2015 to January 2019, 213 elderly patients with aneurysmal subarachnoid hemorrhage admitted to Wuhan Hospital of Traditional Chinese Medicine were divided into epilepsy group(46 cases) and non-epilepsy group(167 cases) according to whether secondary epilepsy.Univariate analysis was used to analyze the related factors affecting epilepsy secondary to aneurysmal subarachnoid hemorrhage in the elderly, and multivariate logistic regression was used to analyze the risk factors of epilepsy secondary to aneurysmal subarachnoid hemorrhage in the elderly.The investigation factors included sex, age, hypertension, diabetes mellitus, smoking history, location of responsible aneurysms, number of aneurysms, intracranial hematoma, hydrocephalus and neurological sequelae.Results:Univariate analysis showed that there were no statistically significant differences in sex, age, history of diabetes mellitus and smoking between the two groups(all P>0.05). There were statistically significant differences between the epilepsy group and non epilepsy group in hypertension(15 cases vs.22 cases), location of responsible aneurysms in middle cerebral artery(22 cases vs.24 cases), number of aneurysms(23 cases vs.41 cases), intracranial hematoma(15 cases vs.26 cases), hydrocephalus(15 cases vs.21 cases) and neurological sequelae(14 cases vs.20 cases)(χ 2=9.491, 23.840, 11.113, 6.737, 10.306, 9.161, all P<0.05). The results of multivariate analysis showed that hypertension, middle cerebral artery, multiple aneurysms, intracranial hematoma, hydrocephalus and neurologic sequelae were risk factors for epilepsy secondary to aneurysmal subarachnoid hemorrhage in the elderly[ OR(95% CI)2.361(1.476-3.421), 3.012(1.935-1.845), 1.494(1.027-1.845), 2.785(1.684-3.982), 1.920(1.283-2.984), 1.637(1.171-2.316)]. Conclusion:There are many factors influencing secondary epilepsy in elderly patients with aneurysmal subarachnoid hemorrhage.In order to reduce the incidence of secondary epilepsy, preventive measures should be taken against the above risk factors.
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Objective To investigate the effect of Wushen decoction on levels of serum cardiac troponin Ⅰ (cTnI),cardiac muscle enzyme and clinical parameters in patients with sepsis heart failure,and to analyze the correlations between cTnI and myocardial enzyme level and clinical parameters.Methods Forty-two patients diagnosed as sepsis admitted to Wuhan Hospital of Traditional Chinese Medicine from March 2014 to March 2016 were enrolled,and they were divided into a Wushen decoction treatment group and a control group by principle of single blind complete randomized method,21 cases in each group.The patients in control gToup were treated by conventional western medicine,while the patients in Wushen decoction treatment group,on the basis of conventional western medicine,they were treated additionally by Wushen decoction (composed of ginseng,radix sophorae flavescentis,radix glehniae,radix adenophorae,salvia,astragalus,notoginseng radix,rosewood,etc.),one dose a day,the therapeutic course in both groups being 7 days.The changes of biochemical indicators [cTnI,creatine kinase (CK),CK isoenzyme (CK-MB)],haemodynamics parameters [cardiac index (CI),central venous pressure (CVP),extravascular lung water index (ELWI),global ejection fraction (GEF),mean arterial pressure (MAP),heart rate (HR)],treatment condition and prognostic parameters [vasoactive drug dosage index,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,duration of mechanical ventilation,the length of stay in intensive care unit (ICU) and total hospitalization time] were compared before and after treatment for 7 days in the two groups.The correlations between the level of cTnI on admission before treatment and CK,CK-MB,APACHE Ⅱ,vasoactive drug dosage index,duration of mechanical ventilation,the length of stay in ICU and total hospitalization time were analyzed.Results The levels of cTnI,CK,CK-MB,CVP,ELWI,HR,vasoactive drug dosage index,APACHE Ⅱ score in two groups after treatment were obviously lower than those before treatment,the levels of CI,GEF,MAP were markedly higher than those before treatment,the duration of mechanical ventilation,the length of stay in ICU and total hospitalization time were significantly shorter than those before treatment,and the changes of above indexes were more remarkable in Wushen decoction group than those in control group [cTnI (mg/L):0.94-± 0.29 vs.1.30 ± 0.67,CK (U/L):96.00 ± 24.30 vs.101.38 ± 24.55,CK-MB (U/L):31.14 ± 6.78 vs.36.48 ± 8.17,CI (mL· s-1 · m-2):64.51 ± 5.83 vs.53.34 ± 4.67,CVP (cmH2O,1 cmH2O =0.098 kPa):10.56 ± 1.84 vs.11.94--2.16,ELWI (mL/kg):8.81±1.61 vs.11.66±2.30,GEF:(33.62±3.88)％ vs.(27.14±4.55)％,MAP (mmHg,1 mmHg =0.133 kPa):84.67 ± 5.58 vs.79.52 ± 5.74,HR (bpm):87.86 ± 9.02 vs.82.95 ± 5.26,vasoactive drug dosage index:2.44 ± 0.53 vs.2.89 ± 0.68,APACHE Ⅱ score:10.66 ± 1.66 vs.14.43 ± 1.82,duration of mechanical ventilation (days):1.67 ± 2.11 vs.2.10 ± 2.26,the length of stay in ICU (days):8.86 ± 2.59 vs.10.67 ± 2.96,total hospitalization time (days):13.24 ± 4.53vs.16.76 ± 5.04,all P ＜ 0.05].On admission before treatment,the correlations between the level of cTnI and CK,APACHE Ⅱ score,vasoactive drug dosage index,duration of mechanical ventilation and the length of stay in ICU were all positive (r =0.322,0.335,0.327,0.328,0.338,P =0.038,0.030,0.030,0.034,0.029).Conclusions The elevation of cTnI level may reflect the degree of myocardial damage in patients with sepsis cardiac failure,and it can be used as an indicator to predict the prognosis of the disease;the changes of many biochemical and clinical indexes suggest that the addition of Wushen decoction might elevate the clinical efficacy for treatment of patients with sepsis heart failure.
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Objective To investigate the clinical effect of plasmapheresis in the treatment of hyperlipidemic acute pancreatitis.Methods Twenty four patients with hyperlidemic acute pancreatitis were treated with plasmapheresis combined with the conventional therapeutic measures.The clinical symptoms,serum levels of lipids (triglycerides,cholesterol)and the prognosis of patients were observed and compared before and after the treatment of plasmpheresis.Results One case underwent plasmapheresis after surgery,one case with extremely severe symptoms underwent surgical treatment after plasmapheresis,twenty two cases didn't underwent surgical treatment.After the plasmapheresis treatment the clinical symptoms of twenty four patients were alleviated and the blood lipid levels decreased significantly.The triglyceride concentrations decreased significantly from(24.55 ± 10.76) mmol/L to ( 3.85 ± 3.02 ) mmol/L ( t =7.099,P ＜ 0.01 ) and the cholesterol concentrations decreased significantly from ( 10.82 ± 5.06 ) mmol/L to ( 3.43 ± 1.28 ) mnol/L ( t =5.826,P ＜0.01 ).Twenty four cases of patients were cured and discharged.Conclusion It is safe and effective of plasmapheresis in treatmeat of hyperlipidemic acute pancreatitis.