依达拉奉治疗急性脑梗死的疗效分析

目的探讨自由基清除剂依达拉奉在急性脑梗死患者治疗中的有效性。方法采用随机分组方法将130例脑梗死患者分为治疗组及对照组,对照组常规运用拜阿司匹林口服等,治疗组在此基础上加用依达拉奉,采用美国国立卫生研究院脑卒中量表（NIHSS）和患者日常生活能力（ADL）进行疗效评定。结果治疗组神经功能缺损评分NIHSS明显低于对照组,日常生活能力（ADL）明显高于对照组,两组均有显著差异（P〈0.05）。结论依达拉奉作为自由基清除剂治疗脑梗死疗效确切、可靠。     

Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis

Introduction: Usefulness of intravenous thrombolysis in patients with acute lacunar cerebral infarction is questionable. The aim of this study was to evaluate the efficacy and safety of intravenous thrombolysis in patients with lacunar infarction in comparison with patients with nonlacunar infarction as well as with patients with lacunar infarction who were not treated with intravenous thrombolysis. Materials and methods: In the first part of the study, among patients with acute ischemic stroke treated with intravenous thrombolysis, characteristics and outcomes of 46 patients with lacunar and 221 patients with nonlacunar infarction were compared. In the second part, 46 patients with lacunar infarction treated with intravenous thrombolysis were compared with 45 lacunar infarction patients who were not treated with intravenous thrombolysis. Results: Patients with lacunar infarction had a lower National Institutes of Health Stroke Scale score (9.2 versus 13.9, P < .001), a greater Alberta Stroke Program Early computed tomography (CT) score (9.7 versus 9.2, P?=?.002), a lower prevalence of atrial fibrillation (6.5% versus 41.2%, P < .001), and significantly more frequently an excellent outcome after 3 months (76.1% versus 36.2%, P < .001) compared with patients with nonlacunar infarction. Among patients with lacunar infarction, an excellent outcome at discharge was significantly more frequent in the intravenous thrombolysis group (41.3% versus 15.6%, P?=?.01), and the length of hospitalization was significantly shorter (9.5 days versus 14.3 days, P?=?.002). There was no hemorrhagic transformation among patients with lacunar infarction treated with intravenous thrombolysis. Conclusion: Intravenous thrombolysis has proven to be effective and safe in patients with lacunar infarction and should always be applied if there are no absolute contraindications.     

尤瑞克林治疗急性脑梗死患者临床疗效及安全性观察

目的 探讨尤瑞克林治疗急性脑梗死的临床疗效及安全性。 方法 急性脑梗死患者200例分为对照组和治疗组,每组各100例,两组予相同的基础治疗,但治疗组加用尤瑞克林0．15PNA单位静脉滴注,每日1次,连用7～14d,同时使用抗血小板药物或抗凝药物进行病因治疗及神经康复治疗,于治疗前后评定患者神经功能缺损程度、日常生活活动能力、伤残或严重程度,并记录不良反应事件。 结果 治疗后两组患者的神经功能缺损、日常生活活动能力、伤残或严重程度评分均有改善,与治疗前相比差异具有统计学意义（P相似文献   

Use of various CT imaging methods for diagnosis of acute ischemic cerebrovascular disease

Thirty-four patients with cerebral infarction and 18 patients with transient ischemic attack were examined by multi-slice spiral CT scan, CT perfusion imaging, and CT angiography within 6 hours after onset. By CT perfusion imaging, 29 cases in the cerebral infarction group and 10 cases in the transient ischemic attack group presented with abnormal blood flow perfusion, which corresponded to the clinical symptoms. By CT angiography, various degrees of vascular stenosis could be detected in 41 patients, including 33 in the cerebral infarction group and eight in the transient ischemic attack group. The incidence of intracranial artery stenosis was higher than that of extracranial artery stenosis. The intracranial artery stenosis was located predominantly in the middle cerebral artery and carotid artery siphon, while the extracranial artery stenosis occurred mainly in the bifurcation of the common carotid artery and the opening of the vertebral artery. There were 34 cases (83%) with convict vascular stenosis and perfusion abnormalities, and five cases (45%) with perfusion abnormalities but without convict vascular stenosis. The incidence of cerebral infarction in patients with National Institutes of Health Stroke Scale scores ≥ 5 points during onset was significantly higher than that in patients with National Institutes of Health Stroke Scale scores < 5 points. These experimental findings indicate that the combined application of various CT imaging methods allows early diagnosis of acute ischemic cerebrovascular disease, which can comprehensively analyze the pathogenesis and severity of acute ischemic cerebrovascular disease at the morphological and functional levels.     

青年脑梗死患者远期认知功能障碍的相关因素分析

目的筛选青年脑梗死患者远期认知功能障碍的相关因素。方法选择2008年1月至2013年6月在我院就诊的青年脑梗死患者58例,根据远期随访蒙特利尔认知量表(Mo CA)评分分为认知功能正常组和认知功能障碍组,比较两组患者的人口学、病情资料和活动功能,从中筛选出青年脑梗死患者远期认知功能障碍的危险因素。结果共有42例患者完成随访,平均随访时间为5.5年(3.3~7.1年),总体Mo CA评分(27.4±3.7)分。认知功能正常组18例,认知功能损害组24例,两组在性别、教育程度、TOAST分型、伴随疾病及嗜好、是否接受溶栓治疗进行组间比较,差异无统计学意义(P0.05)。认知功能障碍组的发病时年龄、美国国立卫生研究院卒中量表(NIHSS)评分大于认知功能正常组;左前循环梗死、出院时Rankin修订量表评分(mRS)2、复诊时工具性日常生活活动能力量表(IADL)8比例均高于认知功能正常组(P0.05)。经多因素Logistic回归分析得出,入院时NIHSS评分、左前循环梗死、出院时mRS2、复诊时IADL8均为认知功能障碍的独立危险因素(OR=1.039,4.329,5.143,12.800,21.333;P0.05)。结论入院时NIHSS评分左前循环梗死、出院时mRS2、复诊时IADL8是青年脑梗死患者远期认知功能障碍的危险因素;而认知功能与入院时NIHSS评分呈负相关。     

Vitamin E and memantine in Alzheimer's disease: Clinical trial methods and baseline data

BackgroundAlzheimer's disease (AD) has been associated with both oxidative stress and excessive glutamate activity. A clinical trial was designed to compare the effectiveness of (i) alpha-tocopherol, a vitamin E antioxidant; (ii) memantine (Namenda), an N-methyl-D-aspartate antagonist; (iii) their combination; and (iv) placebo in delaying clinical progression in AD.MethodsThe Veterans Affairs Cooperative Studies Program initiated a multicenter, randomized, double-blind, placebo-controlled trial in August 2007, with enrollment through March 2012 and follow-up continuing through September 2012. Participants with mild-to-moderate AD who were taking an acetylcholinesterase inhibitor were assigned randomly to 2000 IU/day of alpha-tocopherol, 20 mg/day memantine, 2000 IU/day alpha-tocopherol plus 20 mg/day memantine, or placebo. The primary outcome for the study is the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory. Secondary outcome measures include the Mini-Mental State Examination; the Alzheimer's Disease Assessment Scale, cognitive portion; the Dependence Scale; the Neuropsychiatric Inventory; and the Caregiver Activity Survey. Patient follow-up ranged from 6 months to 4 years.ResultsA total of 613 participants were randomized. The majority of the patients were male (97%) and white (86%), with a mean age of 79 years. The mean Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory score at entry was 57 and the mean Mini-Mental State Examination score at entry was 21.ConclusionThis large multicenter trial will address the unanswered question of the long-term safety and effectiveness of alpha-tocopherol, memantine, and their combination in patients with mild-to-moderate AD taking an acetylcholinesterase inhibitor. The results are expected in early 2013.     

睡眠质量、生活事件与新发脑梗死关系的研究

目的 探讨生活事件刺激及睡眠质量对脑梗死发病的影响,并进一步研究其对脑梗死严重程度及 卒中后情绪障碍的影响。 方法 入组新发脑梗死患者与非脑梗死患者（对照组）,比较两组的一般临床资料,分析脑梗死 的危险因素,采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）量表进行病前1个月睡 眠质量评价,生活事件量表（Life Event Scale,LES）进行病前生活事件刺激量评估,并在患者住院 第一周内采用汉密尔顿抑郁量表、汉密尔顿焦虑量表评价情绪障碍,美国国立卫生研究院卒中量表 （National Institutes of Health Stroke Scale,NIHSS）、日常生活能力量表（Activity of Daily Living Scale, ADL）评价发病严重情况。 结果 共纳入脑梗死组95例,对照组85例。单因素分析结果显示,脑梗死组的生活事件量表得分 显著高于对照组[6.00（14.00）vs 0.00（6.25）,P <0.001],其中负性生活事件得分显著高于对照组 [6.00（16.00）vs 0.00（3.25）,P <0.001];PSQI总得分脑梗死组高于对照组[8.50（7.00）vs 6.00（6.5）, （P =0.007）],其中有5项睡眠质量因子分别为主观睡眠质量（P =0.021）、睡眠潜伏期（P =0.034）、 睡眠持续性（P =0.002）、睡眠紊乱（P =0.023）、白天功能紊乱（P =0.012）的得分均显著高于对照 组;非条件性Logistic回归分析提示负性事件[比值比（odds ratio,OR）1.054,95%可信区间（confidence interval,CI）1.003～1.108,P =0.038）、睡眠持续性（OR 1.601,95%CI 1.133～2.264,P =0.008）及舒 张压（OR 1.037,95%CI 1.006～1.069,P =0.019）是脑梗死的危险因素。另外,在脑梗死患者中,病 前睡眠障碍患者汉密尔顿抑郁量表得分较无睡眠障碍者显著增高[9.00（15.00）vs 0.00（8.00）, P =0.047]。 结论 生活事件、睡眠障碍均对脑梗死发病率有影响,其中负性生活事件、睡眠持续性、舒张压高 是脑梗死的独立危险因素,病前睡眠障碍有可能引起更严重的卒中后抑郁症状。     

The sensitivity to change over time of the Bristol Activities of Daily Living Scale in Alzheimer's disease

Activities of daily living scales can be a useful tool in assessing change in people with dementia, either as the disease progresses or in response to treatment. However, little data exist as to the sensitivity to change of instruments used. The Bristol Activities of Daily Living Scale was developed with assistance from the carers of community dwelling people with dementia to be completed by such people and has been shown to have internal consistency as well as face and construct validity. This study aimed to analyse the sensitivity to change of the Bristol Activities of Daily Living Scale in people with Alzheimer's disease receiving anticholinesterase medication. Using the Clinician's Global Rating of Change as a gold standard for change, differences between Bristol Activities of Daily Living Scale scores before and after medication were compared with change in Mini-Mental State Examination, Alzheimer's Disease Assessment Scale - Cognitive and the Nurses Observation Scale for Geriatric Patients, in 61 older adults receiving anticholinesterase medication for Alzheimer's disease. Both the Bristol Activities of Daily Living Scale and the Nurses Observation Scale for Geriatric Patients are sensitive and specific in predicting improvement or stability as measured by the clinician's global rating of change. However, unlike the Nurses Observation Scale for Geriatric Patients, change over time in the Bristol Activities of Daily Living Scale significantly correlates with change in the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale - Cognitive. The Bristol Activities of Daily Living Scale is sensitive to change in activities of daily living and shows the expected and desirable relationship with measures of cognition.     

叶酸和维生素B_(12)对高Hcy急性脑梗死患者血Hcy水平及神经功能的影响

目的观察叶酸和维生素B12对高同型半胱氨酸(Hcy)急性脑梗死(ACI)患者血Hcy水平及神经功能的影响。方法选取100例高Hcy水平ACI患者为研究对象,随机分为观察组和对照组各50例。对照组患者给予常规治疗,观察组患者在常规治疗的基础上加用口服叶酸和维生素B12治疗。观察和比较2组患者治疗前后的血浆Hcy水平、血清一氧化氮(NO)水平、血清内皮素(ET)水平、日常生活能力量表(ADL)评分、美国国立卫生研究院卒中量表(NIHSS)评分。结果观察组患者治疗后血浆Hcy水平、血清NO水平、血清ET水平均较治疗前显著改善(t=25.146、-11.405、15.493,P0.05),且均优于对照组(t=-26.364、10.550、-15.181,P0.05);2组患者治疗后NIHSS评分、ADL评分均较治疗前显著改善(t=22.802、16.870、-22.181、-11.871,P0.05),且观察组患者治疗后的NIHSS评分、ADL评分均显著优于对照组(t=-7.798、10.516,P0.05)。结论应用叶酸和维生素B12治疗ACI,能够降低血浆Hcy水平,改善血管内皮功能,促进神经功能的恢复,增强日常生活能力,有助于改善患者的生存质量和预后。     

丁苯酞对急性脑梗死患者疗效及VEGF、BDNF、bFGF水平的影响

目的观察丁苯酞软胶囊治疗急性脑梗死(ACI)患者疗效及血清中VEGF、BDNF、bFGF水平变化。方法选取符合标准ACI患者80例,随机分为40例治疗组(男性21例,女性19例)和40例对照组(男性20例,女性20例),对照组行常规药物治疗,治疗组在此基础上加用丁苯酞软胶囊。采用美国国立卫生研究院卒中量表(NIHSS)和日常生活活动能力评分量表(ADL量表)评价疗效。采用酶联免疫分析法(ELISA)检测血清中3种因子的水平,比较两组患者治疗前后血清中3种因子水平变化。结果治疗后两组患者血清中3种因子水平均较治疗前显著升高(P0.01),治疗组比对照组增高更明显(P0.01)。两组治疗后ADL量表评分较治疗前显著增高(P0.01),治疗组比对照组增高更明显(P0.01)。两组治疗后NIHSS评分较治疗前显著减少(P0.01),治疗组比对照组减少更明显(P0.01)。结论丁苯酞可提高ACI患者血清BDNF、VEGF、bFGF的表达,疗效优于常规药物且安全。     

The Scandinavian Multi-Infarct Dementia Trial: a double-blind, placebo-controlled trial on nimodipine in multi-infarct dementia

Vascular dementia is a major cause of mental and physical disability in Western countries. Treatment of vascular dementia is currently based on the recognition and control of vascular risk factors, while specific drugs have not been approved yet. The aim of the present multinational, double-blind, placebo-controlled study was to evaluate the safety and efficacy of nimodipine administered for as long as 26 weeks in improving cognition or slowing cognitive deterioration in patients defined as having multi-infarct dementia (DSM-III-R criteria). Two hundred and fifty-nine patients were included (128 nimodipine, 131 placebo), and 251 were available for the intention-to-treat analysis. No significant difference between drug-treated and placebo patients was noted on the Gottfries-Brane-Steen scale score (primary efficacy criterion), the remaining neuropsychological tests (Zahlen-Verbindungs-Test, Fuld-Object-Memory Evaluation, Word Fluency Test, Digit Span, Mini-Mental State Examination), and the functional scales (index of Activity of Daily Living, Instrumental Activity of Daily Living, Rapid Disability Scale, Clinical Dementia Rating), although the majority of changes were in favor of the active drug group. A lower incidence of cerebrovascular and cardiac events was observed in the nimodipine-treated patients in comparison with the placebo group. This study failed to show a significant effect of nimodipine on cognitive, social or global assessments in patients defined as affected by multi-infarct dementia according to the DSM-III-R criteria. A post-hoc analysis (presented in an accompanying paper) suggests that nimodipine may have a favorable effect in the subgroup of patients defined as affected by subcortical (small vessel) vascular dementia.     

Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction

Major ozonated autohemotherapy is classically used in treating ischemic disorder of the lower limbs. In the present study, we performed major ozonated autohemotherapy treatment in patients with acute cerebral infarction, and assessed outcomes according to the U.S. National Institutes of Health Stroke Score, Modified Rankin Scale, and transcranial magnetic stimulation motor-evoked potential. Compared with the control group, the clinical total effective rate and the cortical potential rise rate of the upper limbs were significantly higher, the central motor conduction time of upper limb was significantly shorter, and the upper limb motor-evoked potential amplitude was significantly increased, in the ozone group. In the ozone group, the National Institutes of Health Stroke Score was positively correlated with the central motor conduction time and the motor-evoked potential amplitude of the upper limb. Central motor conduction time and motor-evoked potential amplitude of the upper limb may be effective indicators of motor-evoked potentials to assess upper limb motor function in cerebral infarct patients. Furthermore, major ozonated autohemotherapy may promote motor function recovery of the upper limb in patients with acute cerebral infarction.     

Who does well after a stroke? The Sydney Stroke Study

Research addressing positive outcomes one year after stroke has been limited. The sample comprised 125 participants with complete Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Mini-Mental State Examination (MMSE) scale scores at baseline (～4 months after ischaemic stroke) and at follow-up (1 year later), 31 persons were defined as having a favourable outcome (an MMSE score of ≥28/30 and combined ADL/IADL score equal to 14/14 at follow-up) and 94 as having a poorer outcome. Predictors of a favourable outcome following stroke included being younger, having higher premorbid IQ, no atrial fibrillation, no dementia, less apathy and fewer intercurrent cerebrovascular events. We conclude that people can have good outcomes in the year after stroke except if they experience further cerebrovascular events and/or have risk factors for cerebrovascular disease. Brain reserve appears to be protective.     

Frequency and clinical determinants of poststroke cognitive impairment in nondemented stroke patients

The objective of this study was to examine the prevalence and clinical correlates of poststroke cognitive impairment in Chinese stroke patients in Hong Kong. One hundred seventy-nine stroke patients were interviewed by a psychiatrist 3 months after their stroke. Cognitive impairment was determined according to the Mini-Mental State Examination score. Thirty-nine participants (21.8%) had cognitive impairment. Univariate analysis found that cognitive impairment was associated with age, female sex, level of education, previous stroke, prestroke Rankin score, National Institutes of Health Stroke Scale dysarthria and total scores, urinary incontinence, and cerebral atrophy index. Multivariate logistic regression suggested that female sex, education, National Institutes of Health Stroke Scale dysarthria score, urinary incontinence, and atrial fibrillation were independent risk factors of poststroke cognitive impairment. After removal of 54 patients with previous stroke from the sample, the frequency of cognitive impairment decreased to 18.4%. It was concluded that cognitive impairment is common among nondemented Chinese stroke patients in Hong Kong.     

尤瑞克林治疗急性前循环脑梗死的近期疗效和安全性研究

目的 评价尤瑞克林治疗急性前循环脑梗死的近期疗效和安全性.方法 采用随机、单盲、对照设计,纳入珠江医院神经内科自2006年10月至2009年4月收治的61例急性前循环脑梗死患者,并按随机数字表法分为尤瑞克林组(31例)和对照组(30例).两组患者根据病情给予相同的基础治疗,尤瑞克林组存此基础上予以每天0.15 PNA单位尤瑞克林(以100mL生理盐水稀释,30～40滴/min静脉滴注,每天1次,连续14 d).在治疗前及治疗后第21天分别观察两组患者神经功能缺损程度(NIHSS评分)及日常生活能力(mRS评分),并进行血尿常规、肝肾功能、血糖、血脂及心电图等检查,监测血压和脉率,必要时复查头颅CT,观察药物相关的出血性事件及不良反应.结果 与对照组相比,尤瑞克林能明显改善患者NIHSS评分和提高mRS评分,差异有统计学意义(P=0.022,P=0.032).依据平均秩次(尤瑞克林组23.86,对照组35.93)判断,尤瑞克林组疗效优于对照组.除尤瑞克林组2例有哮喘病史患者因治疗期间诱发哮喘发作而退出试验外,其他患者未见不良反应.尤瑞克林组用药前后血尿常规、肝肾功能、血糖、血脂及心电图等检查无异常变化,用药后头颅CT检查未见药物相关的出血性事件.结论 应用尤瑞克林治疗急性前循环脑梗死患者安全、有效,能显著改善患者神经功能缺损症状和提高日常生活能力.

Abstract：

Objective To evaluate the short-term therapeutic efficacy and safety of kallikrein in patients with acute anterior circulation cerebral infarction. Methods Sixty-one patients with anterior circulation cerebral infarction, admitted to our hospital from October 2006 to April 2009, were enrolled in the randomized single-blind control trail. These patients were assigned to kallikrein treatment group (n=31) and control group (n=30). They were both treated by identical basis therapy, such as antiplatelet,dilute blood viscosity, neurotrophy therapy and symptomatic treatment. The patients in the treatment group were treated by intravenous infusion administration of 0.15 PNA kallikrein diluted in 100 mL 0.9% saline at 30-40 drops /min once daily for 14 consecutive days. On the pretherapy and 21st post-treatment day, the National Institutes of Health Stroke Scale (NIHSS), activity of daily living (ADL) of modified Rankin Scale (mRS) in these patients were performed;blood routine examinations and urinalysis,hepatorenal function, levels of blood glucose and lipid, and ECG were assessed;blood pressure and pulse rate were monitored. CT scan was employed for ICH if necessary. Drug relative hemorrhage and adverse drug reaction (ADR) were recorded in detail. Results As compared with those in the control group,significantly reduced NIHSS scores and obviously improved ADL scores in the kallikrein treatment group were noted (P=0.022, P=0.032, respectively). According to the mean rank (kallikrein treatment group:23.86, control group: 35.93), the efficacy in the treatment group was better than that in the control group.Except that asthmatic attack happened to 2 patients (having the history of asthma) during treatment period, no other ADRs were noted in all the patients. No abnormal changes of blood routine examinations, urinalysis, hepatorenal function, levels of blood glucose and lipid, and ECG and head CT features in the kallikrein treatment group were detected before and after the treatment;no drug relative hemorrhage was noted either. Conclusion Kallikrein is safe and effective in treating patients with acute anterior circulation cerebral infarction, through reducing the neurologic function impairment and improving ADL.     

Correlating interleukin-10 promoter gene polymorphisms with human cerebral infarction onset

Evidence suggests that interleukin-10 (IL-10) deficiency exacerbates inflammation and worsens the outcome of brain ischemia. In view of the critical role of the single nucleotide polymorphic sites -1082 (A/G) and -819 (C/T) in the promoter region of the IL-10 gene, we hypothesized that they are associated with cerebral infarction morbidity in the Chinese Han population. We genotyped these allelic gene polymorphisms by amplification refractory mutation system-polymerase chain reaction methods in 181 patients with cerebral infarction (cerebral infarction group) and 115 healthy subjects (control group). We identified significant differences in genotype distribution and allele frequency of the IL-10-1082 A/G allele between cerebral infarction and control groups (χ² = 6.643, P = 0.010). The IL-10-1082 A allele frequency was significantly higher in the cerebral infarction group (92.3%) than in the control group (86.1%) (P = 0.015). Moreover, cerebral infarction risk of the AA genotype was 2-fold higher than with the AG genotype (OR = 2.031, 95%CI: 1.134–3.637). In addition, AA genotype together with hypertension was the independent risk factor of cerebral infarction (OR = 2.073, 95%CI: 1.278–3.364). No statistical difference in genotype distribution or allele frequency of IL-10-819 C/T was found between cerebral infarction and control groups (P > 0.05). These findings suggest that the IL-10-1082 A/G gene polymorphism is involved in cerebral infarction, and increased A allele frequency is closely associated with occurrence of cerebral infarction.     

The Effect of Occupation-Based Bilateral Upper Extremity Training in a Medical Setting for Stroke Patients: A Single-Blinded,Pilot Randomized Controlled Trial

Background: Occupation used in occupation-based intervention requires the use of 2 naturally coordinated hands. Objective: To investigate by implementing occupation-based bilateral upper extremity training in medical setting to stroke patients and determine its effect in patients’ bilateral upper extremity function recovery. Methods: A total of 20 patients were randomly assigned to the experimental group (occupation-based bilateral upper extremity training) or control group (task-based bilateral upper extremity training). The intervention of the 2 groups was conducted 30 minutes a day, 5 times a week, and 4 weeks long. The outcome was assessed using the Canadian Occupational Performance Measure, Stroke Impact Scale, Action Research Arm Test, the Yonsei-Bilateral Activity Test, Accelerometer, and participants were assessed at baseline and after 4 weeks. Results: There was a significant change in the satisfaction and performance status of occupational performance, strength, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), emotion, participant recovery in stroke recovery, gross movement in the function of the affected side, satisfaction in perform bilateral upper extremity in the experimental group compared to the control group. Conclusions: The clinical significance of this study is that this study demonstrated the effectiveness and usefulness of the training in the actual medical setting in improving upper extremity function and psychosocial factors.     

经颅磁刺激治疗脑梗死的临床疗效观察

目的 观察经颅磁刺激（transcranial magnetic stimulation,TMS）对脑梗死患者的临床疗效。方法 符合病例入选标准的脑梗死患者60例,随机分为试验组及对照组,每组各30例,试验组及对照组均给予常规药物治疗,试验组在常规治疗基础上给予TMS治疗,疗程10 d,比较治疗前后患者的运动功能（Fugl-Meyer评分）、Barthel指数（Barthel index,BI）以及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分。结果 NIHSS评分：试验组由治疗前的6.57±2.66减少到治疗后4.01±2.83,对照组由6.29±3.00减少到5.10±2.43;Barthel指数：试验组由治疗前47.33±14.31增加到治疗后60.83±18.53,对照组由45.50±13.91增加到53.67±15.97;Fugl-Meyer评分：试验组由治疗前38.20±24.01增加到治疗后58.40±29.57,对照组由37.53±23.8增加到49.60±29.77,治疗前两组3项评分差异均无统计学意义,治疗后3项评分差异均有统计学意义（P分别为0.008、0.004和0.008）。结论 TMS对脑梗死患者肢体功能恢复有一定疗效,能提高患者的日常生活能力。     

醒脑静联用生脉注射液对脑出血患者CD62P和炎症因子表达的影响及其临床作用

目的探讨醒脑静联用生脉注射液对脑出血患者循环中CD62P和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)表达的影响及其临床作用。方法纳入2014年4月至2015年10月我院神经内科经症状、体征和辅助检查确诊为脑出血的患者152例,随机分为治疗组78例,对照组74例。对照组采用常规治疗方法,治疗组在常规治疗方法的基础上加用醒脑静联用生脉注射液,观察两组患者治疗前后循环中CD62P、TNF-α、IL-6水平的变化,以及美国国立卫生研究院脑卒中量表(NIHSS)、日常生活能力评估量表(ADL)评分的变化。结果经过治疗7 d和14 d后,治疗组循环中CD62P、TNF-α、IL-6的水平均显著低于对照组(P0.05)。经过治疗7 d和14 d后,治疗组NIHSS评分显著低于对照组(P0.05);治疗组ADL评分显著高于对照组(P0.05)。结论醒脑静联用生脉注射液可能通过降低体内血小板激活水平,减少炎症因子表达,从而达到保护脑出血患者神经系统功能的效果。     

盐酸美金刚联合谷红注射液对脑外伤后认知障碍患者的疗效观察

目的观察盐酸美金刚联合谷红注射液治疗脑外伤后认知障碍的疗效。方法将123例脑外伤后认知障碍患者分为3组,其中Ⅰ组63例在常规治疗的基础上加用盐酸美金刚口服联合谷红注射液静滴,Ⅱ组40例仅给予美金刚口服,Ⅲ组20例仅给予安慰剂;于治疗前、治疗后2个月分别行简易智能精神状态量表(MMSE)、日常生活活动能力量表(ADL)及蒙特利尔智能量表(MoCA)评测疗效。结果治疗2个月后,Ⅰ组与Ⅱ组MMSE、ADL、MoCA评分提高幅度均大于Ⅲ组(P0.05),Ⅰ组治疗后MMSE评分提高幅度大于Ⅱ组(P0.05)。结论盐酸美金刚联合谷红注射液可明显改善脑外伤后认知障碍患者的认知功能和行为能力,值得推广。