抗栓药物联合治疗急性脑梗死

Objective To investigate the efficacy and safety of combinative antithrombotic therapy for patients with acute cerebral infarction who were not eligible for thrombolysis. Methods Eighty-three patients with acute cerebral infarction at six to twelve hours after the onset were randomly allocated into two groups : treat-ment group(n=46) recived batroxobin, aspirin and dipyridamole; control group(n=37) received aspirin. Neuro-logic impairment scole was measured at days 0, and 14. Barthel index of the two groups were observed at days 0 and 90. Blood coagulation action of the treatment group was also measured at days 0,5 and 11. Results In treatment group, the nervous function defect integral examined 14 d after trearment (12.7±6.4 )was markedly decreased than that of control group (20.1±7.2). A remarkable difference (P<0.01 ) was noticed between them. The Barthel index of the treatment group at 90 d after trearment (86.8±12.9 )was markedly increased than that of control group(43.4±15.1 ) (P<0.01 ). The total effective rate of treatment group and control group were 93.5% and 56.8% respectively( P<0.01). Conclusion The efficacy of combinative antithrombotic therapy for patients with acute cerebral infarction who were not eligible for thrombolysis is better than aspirin a-lone. Further more, the risk of bleeding may not increase in combinative antithrombotic therapy.     

伴有阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血浆溶血磷脂含量的测定

Objective To observe the changing characteristics of plasma lysophosphatidic acid (LPA) or acidia phospholipid (AP) levels in patients with obstructive sleep apnea syndrome-associated(OSAS)acute cerebral infarction and to explore the pathophysiological mechanisms of OSAS-related stroke so as to provide basis for clinical antithrombotic therapy. Methods Thirty-six patients of OSAS, 32 patients of OSAS-related acute stoke and 36 patients of acute stoke without OSAS diagnosed by clinical and accessory examinations were enrolled in the current study. Thirty-eight age-matched healthy subjects were recruited as controls. The changes of the plasma LPA and AP levels were measured. Results Within 24 hours after symptom onset, the plasma LPA and AP levels in the OSAS-related acute cerebral infarction group (LPA(3. 78 ±0. 56) μmol/L; AP(7. 63 ± 1. 38) μmol/L) were significantly higher than those in the OSAS group(LPA(3. 17 ±0. 65) μmol/L; AP(6. 60 ± 1. 20) μmol/L) ,the not OSAS-related acute cerebral infarction group (LPA (3. 40 ± 0. 59)μmol/L; AP (6. 41 ± 1. 37)μmol/L) and the control group (LPA(2.76±0.45)μmol/L;AP(4.52±0. 83) μmol/L (P < 0. 01)) . The levels of LPA and AP in the OSAS group and the not OSAS-related acute cerebral infarction group were significantly higher than those in the control group(P<0. 01). Seven days after symptom onset, the plasma LPA and AP levels in the OSAS-associated acute cerebral infarction group (LPA(3.08 ± 0. 58) μmol/L; AP(6. 15 ±1. 14)μmol/L) were still higher(P < 0. 01) . The plasma LPA levels were not significantly different among the OSAS-related acute cerebral infarction group, the not OSAS-related acute cerebral infarction group and the control group 21 days after symptom onset, whereas the plasma AP levels in the OSAS-related acute cerebral infarction group (5. 04 ± 0. 83) μmol/L were still significantly higher than those in the not OSAS-related acute cerebral infarction group (4. 57 ± 0. 94) μmol/L and the control group (P < 0.05). Conclusions The significantly elevated plasma LPA and AP levels in patients with OSAS suggested that platelets in vivo are in an activated state and in cerebral ischemia and hypoxia state, especially for the OSAS-related acute cerebral infarction patients. The activated state of platelet may persist for a long time, thus the time window for antithrombotic therapy may be longer.     

伴有阻塞性睡眠呼吸暂停综合征的急性脑梗死患者血浆溶血磷脂含量的测定

Objective To observe the changing characteristics of plasma lysophosphatidic acid (LPA) or acidia phospholipid (AP) levels in patients with obstructive sleep apnea syndrome-associated(OSAS)acute cerebral infarction and to explore the pathophysiological mechanisms of OSAS-related stroke so as to provide basis for clinical antithrombotic therapy. Methods Thirty-six patients of OSAS, 32 patients of OSAS-related acute stoke and 36 patients of acute stoke without OSAS diagnosed by clinical and accessory examinations were enrolled in the current study. Thirty-eight age-matched healthy subjects were recruited as controls. The changes of the plasma LPA and AP levels were measured. Results Within 24 hours after symptom onset, the plasma LPA and AP levels in the OSAS-related acute cerebral infarction group (LPA(3. 78 ±0. 56) μmol/L; AP(7. 63 ± 1. 38) μmol/L) were significantly higher than those in the OSAS group(LPA(3. 17 ±0. 65) μmol/L; AP(6. 60 ± 1. 20) μmol/L) ,the not OSAS-related acute cerebral infarction group (LPA (3. 40 ± 0. 59)μmol/L; AP (6. 41 ± 1. 37)μmol/L) and the control group (LPA(2.76±0.45)μmol/L;AP(4.52±0. 83) μmol/L (P < 0. 01)) . The levels of LPA and AP in the OSAS group and the not OSAS-related acute cerebral infarction group were significantly higher than those in the control group(P<0. 01). Seven days after symptom onset, the plasma LPA and AP levels in the OSAS-associated acute cerebral infarction group (LPA(3.08 ± 0. 58) μmol/L; AP(6. 15 ±1. 14)μmol/L) were still higher(P < 0. 01) . The plasma LPA levels were not significantly different among the OSAS-related acute cerebral infarction group, the not OSAS-related acute cerebral infarction group and the control group 21 days after symptom onset, whereas the plasma AP levels in the OSAS-related acute cerebral infarction group (5. 04 ± 0. 83) μmol/L were still significantly higher than those in the not OSAS-related acute cerebral infarction group (4. 57 ± 0. 94) μmol/L and the control group (P < 0.05). Conclusions The significantly elevated plasma LPA and AP levels in patients with OSAS suggested that platelets in vivo are in an activated state and in cerebral ischemia and hypoxia state, especially for the OSAS-related acute cerebral infarction patients. The activated state of platelet may persist for a long time, thus the time window for antithrombotic therapy may be longer.     

依达拉奉对急性大面积脑梗死患者高敏C反应蛋白影响的临床研究

Objective To explore the effects of edaravone on high sensitivity C-reaction protein (hsCRP) in patients with acute massive cerebral infarction. Methods 86 cases with acute massive cerebral infarction were selected from December 2006 to December 2008. all the cases were divided into two groups, control group and cure group. routine treatment was used to the control group, on the basis of control group'therapy,edaravone was given to cure group. the level of hsCRP was detected before and after treatment, and the results of cure was compared. Results ①the total effective rate in two groups existed statistical difference (P<0.05);② the level of hsCRP in two groups before treatment and in the 7th and the 14th of treatment existed statistical difference(P<0.01), the level of hsCRP in the 7th and the 14th of treatment in cure group existed statistical difference(P<0.05). Conclusion Edaravone can decrease the level of hsCRP in patients with massive cerebral infarction, and has significant clinical efficacy,which should be the reference for the doctors.     

高压氧对脑梗死患者血浆SOD和CRP的影响及临床意义

Objective To study the effect of hyperbaric oxygenation(HBO) therapy on the activities of serum SOD and CRP of patients with cerebral infarction and its clinical significance. Methods 78 patients with cerebral infarction were randomly divided into hyperbaric oxygen group (HBO Group, 40 cases)and clinical group (38 cases). The clinical group was treated with clinical conventional treatment only. HBO group was treated with HBO combined with clinical conventional treatment. 21 healthy volunteers were assigned to control group. Before and after treatment, the activities of serum SOD and CRP level were measured, and the curative effect were evaluated. Results The pretreatment serum SOD and CRP of the HBO group and clinical group were significantly different from the control group (P＜ 0. 01). Compared with the pretreatment and posttreatment serum level of the HBO group, SOD raised, CRP lowered, the difference was significant(P＜ 0. 01).Compared with clinical group, SOD raised, CRP lowered and the total cure rate of the HBO group were more significant different(P ＜0.01). Conclusion HBO therapy raised the activities of SOD and lower the level of CRP in serum of the patients with cerebral infarction, and improved the free radicals scavenging ability in the body. Therefore, HBO therapy has a good effect for cerebral infarction. The experiment suggests that the activities of SOD and CRP level in serum can be used to judge the curative effect and prognosis of HBO therapy for cerebral infarction.     

依达拉奉对急性大面积脑梗死患者高敏C反应蛋白影响的临床研究

Objective To explore the effects of edaravone on high sensitivity C-reaction protein (hsCRP) in patients with acute massive cerebral infarction. Methods 86 cases with acute massive cerebral infarction were selected from December 2006 to December 2008. all the cases were divided into two groups, control group and cure group. routine treatment was used to the control group, on the basis of control group'therapy,edaravone was given to cure group. the level of hsCRP was detected before and after treatment, and the results of cure was compared. Results ①the total effective rate in two groups existed statistical difference (P<0.05);② the level of hsCRP in two groups before treatment and in the 7th and the 14th of treatment existed statistical difference(P<0.01), the level of hsCRP in the 7th and the 14th of treatment in cure group existed statistical difference(P<0.05). Conclusion Edaravone can decrease the level of hsCRP in patients with massive cerebral infarction, and has significant clinical efficacy,which should be the reference for the doctors.     

心理干预联合高压氧治疗对脑卒中后抑郁患者生命质量的影响

Objective To investigate the effect of the psychological intervention combined with hyperbaric oxygen therapy on the mental status and the quality of life of patients with depression after cerebral stroke.Methods 45 patients with depression after cerebral stroke were randomly divided into the study group (n = 22)and the control group(n = 23). The two groups had the same clinical routine treatments including improving cerebral cirulation, reducing intracranial pressure, drugs to anti-infection, nervous nutrition and corresponding operation for 8 weeks as a course of treatment, and psychological behavior intervention combined with hyperbaric oxygen therapy was added to the study group. The scores of Hamilton depression rating scale (HAMD) on both groups were evaluated before and spitzer' s quality of life index(QL-INDEX) were used and investigated on two groups at the end of 8 weeks. Results There was no significant difference on the scores of HAMD between the two groups before therapy (P ＞ 0. 05). The scores on HAMD of the study group after the treatment notably dropped compared to the control group (P＜ 0. 01). The difference of the scores on group index of quality of life between the study group (8.57 ± 1.94) and the control group (7.30 ± 1.98) had statistical significance (P ＜0. 05). Conclusion Psychological intervention combined with hyperbaric oxygen therapy plays an important role in the treatment of patient with depression after cerebral stroke to improve their mental status, treatment effectiveness and quality of life.     

急性前壁心肌梗死伴心力衰竭患者急诊经皮冠状动脉介入治疗围手术期应用重组人B型钠尿肽的心肾保护效应

Objective To evaluate the protective effect of recombinant human B-type natriuretic peptide (rhBNP) on cardiac and renal functions in heart failure (HF) patients as a result of acute anterior myocardial infarction (AAMI) in peri-operative period of primary percutaneous coronary intervention (pPCI).Methods One hundred and twenty-six patients with AAMI-HF were enrolled into this study.All patients undertaken pPCI were randomly assigned to the rhBNP group (n=62) or the control group(n=64).rhBNP or nitroglycerin was intravenously administered on the basis of conventional treatment from first day of admission to 24 hours after pPCI in both groups.Heart rate (HR), systolic blood pressure (SBP), B-type natriuretic peptide (BNP), estimated lomerular filtration rate (eGFR) and heart function were observed.All patients were followed up for 30 days for the observation of main adverse cardiac events (MACE).Results The HR was significantly decreased compared with that at admission in rhBNP group, but such condition was not found in the control group.The SBP was reduced obviously in both groups.The plasma level of BNP, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) were improved significantly at different time points compared with those before administration in both groups.The improvement of above parameters in rhBNP group was more significant than that in the control group[BNP (ng/L) 30 hours after pPCI: 303.5±128.4 vs.354.0± 133.6, 14 days after pPCI:157.8±78.6 vs.201.1±91.7; LVEF 1dayafter pPCI: 0.420±0.052 vs.0.378±0.055, 14 days after pPCI:0.444±0.050 vs.0.393±0.055, 30 days after pPCI: 0.469±0.053 vs.0.413±0.052; LVEDD (mm) 1 day after pPCI: 53.5±4.4 vs.57.6±4.4, 14 days after pPCI: 49.6±5.1 vs.53.4±4.6, 30 days after pPCI: 46.5±4.4 vs.50.2±4.8, P＜0.05 or P＜0.01].The eGFR was reduced obviously 1 day after pPCI than that at admission in both groups, and eGFR recovered to baseline 3 days after pPCI.The level of eGFR was significantly increased 7 days and 14 days after pPCI than that at admission, but there was no difference between rhBNP group and control group.The incidence of contrast-induced nephropathy showed a lowering tendency in the rhBNP group than that in the control group[19.4% (12/62) vs.29.7% (19/64),P=0.178].The incidence of ventricular arrhythmias was obviously lowered 7 days after pPCI in the rhBNP group than that in the control group[48.4% (30/62) vs.75.0% (48/64), P＜0.01].The rate of MACE was lower in rhBNP group than that in control group in 30 days[12.9% (8/62) vs.26.6% (17/64), P＜0.05].Conclusion Administration of rhBNP can effectively improve the heart function in AAMI-HF patients undergoing pPCI, and it lowered the incidence of MACE in 30 days, without influence on renal function, and it can reduce the incidence of contrast-induced nephropathy.     

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.     

调脂和抗血小板治疗对内皮脂肪酶表达的影响

Objective To investigate the effects of lipid-modulation and antiplatelet treatment on the expression of endothelial lipase (EL) of patients with coronary artery disease (CAD), and investigate the role of EL in the development of CAD.Methods One hundred and fifty-seven cases were divided into three groups according to clinical manifestations and the results of coronary artery angiography: control group (n=41) with more than one risk factors of CAD and the vessel lesions was <30%; stable angina pectoris (SAP)group (n=55); acute coronary syndrome (ACS) group (n= 61).The EL positive cell rate was measured 2 weeks after cessation of lipid-sodulation and aspirin treatment, and 6 months after treatment with simvastatin and/or aspirin.The drug was ceased for the complications or not tolerance for the treatment.Results Except the patients in control group with aspirin treatment, the EL positive cell rate was significantly decreased among other groups[control group with simvastatin: (3.93 ± 0.87) % vs.(5.28 ±1.05)%, SAP group: (8.16±2.11)% vs.(15.12±2.53)%, ACS group: (13.93±3.22)% vs.(38.44±4.36)%; SAP group with aspirin: (10.57±4.07)% vs.(14.66±2.29)%, ACS group: (18.28±5.14)%vs.(40.27±3.96)%; control group with aspirin and simvastatin: (3.13±0.87)% vs.(5.33± 1.25)%,SAP group: (5.68±2.20)% vs.(14.89±2.15)%, ACS group: (7.81±3.96)% vs.(39.27±5.17)%,P<0.05 or P< 0.01].Conclusion The treatment with lipid-modulation and/or antiplatelet drug may significantly decrease the expression of EL, implying that EL participates in the progression of CAD.