老年糖尿病合并急性脑梗死临床影像特点

目的研究老年糖尿病合并急性脑梗死的临床影像特点。方法选择老年糖尿病合并急性脑梗死患者80例(老年糖尿病合并急性脑梗死组),其中男性40例,女性40例;年龄60~88岁,平均年龄69.69岁。另选择非糖尿病的老年急性脑梗死患者80例(老年急性脑梗死组),其中男性42例,女性38例;年龄60~90岁,平均年龄70.55岁。做实验室检查,行颈部血管超声和头部MRI,分析两组患者影像特点。结果老年糖尿病合并急性脑梗死组高血脂史比例、甘油三酯、空腹血糖、糖化血红蛋白、纤维蛋白原水平高于老年急性脑梗死组(P0.05)。老年糖尿病合并急性脑梗死组不稳定斑块发生率高于老年急性脑梗死组(63.75%vs 47.50%;P0.05)。两组患者颈动脉粥样硬化斑块大部分位于颈总动脉窦部,斑块呈强回声、混合回声或低回声。两组头部MRI病灶均以单发病灶为主,病灶空间分布差异无统计学意义(P0.05)。结论老年糖尿病合并急性脑梗死患者的血脂代谢异常明显,不稳定斑块增多,血脂检测及颈动脉颅外段超声对糖尿病患者预防急性脑梗死具有一定临床价值。     

急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平相关研究

目的 分析急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平的相关性.方法 选择2019年1月至2020年12月间收治的150例急性脑梗死患者作为观察组,100例脑梗死但未见颈动脉粥样硬化斑块患者作为对照组;入组后检测患者血糖、血脂、脂蛋白a、MMP-9及D-D水平.结果 观察组血糖、TG、TC、HDL及LDL水平均明显高于对照组,且差异具有统计学意义(P<0.05);观察组脂蛋白a、MMP-9及D-D水平均明显高于对照组,且差异具有统计学意义(P<0.05);脂蛋白a、MMP-9及D-D三指标均呈现明显的两两线性相关关系,且具有统计学意义(P<0.05);脂蛋白a、MMP-9及D-D水平与颈动脉粥样硬化斑块形成呈显著正相关关系,且具有统计学意义(P<0.01);脂蛋白a、MMP-9及D-D水平是影响颈动脉粥样硬化斑块形成的独立性危险因素(P<0.05).结论 急性脑梗死患者颈动脉粥样硬化斑块形成与血清脂蛋白a、MMP-9、D-D水平呈显著性正相关关系.     

脑梗死患者经颅多普勒超声检测脑血管狭窄与血糖、血脂水平的关系

目的:探讨脑梗死患者经颅多普勒超声检测脑血管狭窄与血脂、血糖水平的关系。方法:选取2018年4月至2019年9月江苏省中医院脑病中心收治的100例脑梗死患者为研究对象,其中男87例,女13例,年龄32~98岁。所有患者在发病48 h内均接受经颅多普勒超声(TCD)和血糖、血脂检查,根据TCD检查结果分为血管狭窄组(n=62)和非血管狭窄组(n=38),血管狭窄组患者经CT血管造影(CTA)确诊,非血管狭窄组经CTA证实无血管结构异常。比较两组患者血糖、血脂水平。结果:血管狭窄组患者总胆固醇(TC)、低密度脂蛋白(LDL-C)水平高于非血管狭窄组[(5.85±1.31)mmol/L比(4.42±0.14)mmol/L,(3.85±0.79)mmol/L比(2.48±0.12)mmol/L],差异有统计学意义(P<0.05);血管狭窄组高密度脂蛋白(HDL-C)水平低于非血管狭窄组[(0.78±0.22)mmol/L比(1.54±0.55)mmol/L],差异有统计学意义(P<0.05);而血管狭窄组与非血管狭窄组三酰甘油(TG)水平比较差异无统计学意义(P>0.05)。血管狭窄组患者空腹血糖、糖化血红蛋白(HbA1c)水平高于非血管狭窄组[(7.21±0.53)mmol/L比(5.34±0.42)mmol/L,(7.78±1.65)%比(5.80±0.69)%],差异有统计学意义(P<0.05)。血管狭窄组中血脂升高率为69.4%(43/62例),非血管狭窄组中血脂升高率为44.7%(17/38例),差异具有统计学意义(x^2=5.94,P=0.01)。血管狭窄组中血糖升高率为74.2%(46/62例),非血管狭窄组中血糖升高率为52.6%(20/38例),差异具有统计学意义(x^2=4.88,P=0.03)。结论:脑梗死患者血糖和/或血脂水平升高是脑血管狭窄的重要原因之一,应引起临床关注和积极干预。     

脑梗死并发糖尿病护理体会

目的探讨脑梗死并发糖尿病的护理效果。方法选取2011年1月~2014年8月我院收治的脑梗死合并糖尿病患者78例作为研究对象。按照随机数字表法将患者均分为观察组和对照组,每组39例。两组患者均进行常规对症治疗。对照组患者进行常规护理,缓解患者病情,包括病情观察、血糖监测、血压监测等。观察组患者在对照组护理的基础上,进行综合护理干预。具体包括局部皮肤护理、偏瘫护理、心理护理等。观察患者临床疗效、NIHSS评分、ADL评分变化情况。结果观察组临床总有效率为97.44%,对照组为71.79%,观察组高于对照组,两组比较,差异具有统计学意义(P<0.05)。治疗前,两组NIHSS评分、ADL评分差异无统计学意义(P>0.05)。治疗后,观察组NIHSS评分、ADL评分均高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组NIHSS评分、ADL评分均高于同组治疗前,差异具有统计学意义(P<0.05)。结论对脑梗死并发糖尿病患者进行整体综合护理,可提高临床疗效,改善患者生活能力、活动能力评分,值得临床推广。     

眼动脉侧支循环对颈内动脉闭塞患者的脑血流代偿作用

目的探讨眼动脉(OA)侧支循环对颈内动脉颅外段闭塞患者的脑血流代偿作用。方法选择在开滦总医院经MRI血管成像和颈部血管彩色双重功能超声检查均证实的单侧颈内动脉颅外段完全闭塞患者96例,其中男性81例,女性15例;平均年龄61.64岁。均为右利手,其中左侧颈内动脉闭塞46例,右侧颈内动脉闭塞50例。应用彩色经颅多普勒超声(TCD)检测OA和Willis环侧支循环开放情况,大脑中动脉(MCA)收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)、搏动指数(PI)的血流动力学状态,观察颅脑MRI中脑梗死和临床眼部缺血的发生情况。结果颈内动脉颅外段完全闭塞96例患者中OA侧支循环开放60例(62.50%),OA侧支循环未开放36例(37.50%);两者比较,差异有显著统计学意义(χ~2=11.406,P=0.001)。OA侧支循环开放组有Willis环侧支循环开放者52例(86.67%),OA侧支循环未开放组有Willis环侧支循环开放者36例(100.00%);两组比较,差异有显著统计学意义(χ~2=11.847,P=0.001)。MCA血流动力学指标Vs、Vd、Vm、PI,两组比较,差异无统计学意义(P 0.05)。MCA供血区有脑梗死灶者,OA侧支循环开放组34例(56.67%),OA侧支循环未开放组24例(66.67%);两组比较,差异无统计学意义(χ~2=2.122,P=0.145)。眼部缺血体征,OA侧支循环开放组11例(18.33%),OA侧支循环未开放组9例(25.00%);两组比较,差异无统计学意义(χ~2=1.452,P=0.228)。结论慢性颈内动脉颅外段闭塞患者可通过启动OA侧支循环,弥补Willis环侧支循环代偿作用衰减引起的部分血流灌注不足,但OA和Willis环侧支循环代偿能力依然有限,仍然具有较高的MCA供血区脑梗死发病率和一定程度的眼部缺血病变发生。     

2型糖尿病并发急性脑梗死86例临床分析

目的：探究糖尿病合并脑梗死的临床特征和影响因素。方法2型糖尿病合并脑梗死降糖治疗为：对于空腹≥10 mmol/L患者,予以胰岛素治疗;对于空腹≤10mmol/L患者,予以口服降糖药物。结果2型糖尿病并发脑梗死组(DACI)单纯头晕而不伴有局灶性脑损伤症状患者48例,发病率为55.81%,显著高于非2型糖尿病并发脑梗死组(NDACI);DACI组多发性和腔隙性脑梗死发病率显著高于NDACI组;DACI组患者胆固醇、甘油三酯、纤维蛋白原、血液粘度水平分别为(6.91±1.15)mmol/L、(2.85±0.74)mmol/L、(3.87±0.35)g/L、(2.04±0.38)mpa/s;DACI组治疗有效率为74.42%,NDACI组治疗有效率为90.80%。且差异具有统计学意义(P<0.05)。结论2型糖尿病并发脑梗死患者单纯头晕而不伴有局灶性脑损伤症状多见,并且常为多发性脑梗死,大多合并高血液粘度、高血脂,临床疗效较差。     

缺血性脑血管病患者颈动脉粥样硬化的研究

目的:探讨颈动脉粥样硬化与缺血性脑血管病的关系。方法:将缺血性脑血管病患者99例分成TIA组,脑梗塞组,均接受颈部动脉多普勒超声检查,观察指标为动脉粥样硬化斑块的好发部位,超声分型及颈内动脉(ICA)颅外段狭窄度。结果:颈部动脉多普勒超声检查显示TIA组和脑梗塞组异常率均明显高于健康人,差异有显著性(P<0.01),TIA组与脑梗塞组异常率相比也有显著性差异(P<0.05)。病变血管分布与症状间有相关关系P<0.01)。从动脉粥样硬化斑块好发部位及超声分型来看,动脉粥样硬化斑最多见于颈总动脉分叉处(BIF).其次是颈总动脉(CCA),再其次是ICA起始部,TIA组与脑梗塞组均以扁平斑多见,其次是软斑和硬斑,溃疡斑少见。另外ICA颅外段狭窄度与症状间呈显著相关(P<0.01)。结论:颈动脉粥样硬化班块,是缺血性脑血骨病发生的重要危险因素之一。颈动脉粥样硬化程度越重.发生严重缺血性卒中的危险性越高。     

彩色多普勒超声对颈动脉粥样硬化与脑梗死的相关性分析

目的探讨颈动脉粥样硬化与脑梗死的关系。方法应用彩色多普勒超声检测82例脑梗死患者和46例非脑梗死患者颈动脉内-中膜厚度（intima-media thickness,IMT）、斑块检出率、管腔狭窄率,并观察斑块性质。结果脑梗死组斑块检出率及颈动脉内膜厚度较对照组明显增加,两组比较差异有统计学意义（P〈0.01）,脑梗死组斑块检出率（70.7%）明显高于对照组（32.6%）;脑梗死组颈总动脉（CCA）内膜厚度（1.38±0.14）明显高于对照组（0.89±0.16）,脑梗死组颈内动脉（ICA）内膜厚度（1.16±0.27）明显高于对照组（0.78±0.17）。斑块多发生于颈动脉分叉处（44.4%）,以软斑块、溃疡斑块（59.2%）居多。结论颈动脉粥样硬化程度与脑梗死的发病关系密切,彩超评估颈动脉粥样硬化程度,对脑梗死的早期预防和治疗具有重要的临床价值。     

血管内支架成形术治疗颅外段颈内动脉夹层的疗效分析

目的探讨血管内支架成形术治疗颅外段颈内动脉夹层(ICAD)的临床效果。方法回顾性分析我院2015年7月至2016年12月收治的25例颅外段ICAD患者的临床资料,其中15例表现为头颈痛,12例出现短暂性脑缺血或者脑梗死表现(肢体偏瘫等),6例伴有Horner综合征,1例以搏动性耳鸣、晕厥首发,2例无明显临床症状,颈部血管超声偶然发现。25例ICAD患者均行血管内支架成形术治疗,通过数字减影血管造影(DSA)计算狭窄程度、经颅多普勒(TCD)测量血流速度以及观察患者临床表现,6个月后随访复查。结果 25例ICAD患者中24例血管内支架成形术顺利完成,未出现内膜损伤、出血、栓塞等并发症,1例血管走形迂曲,放弃支架置入;DSA显示平均动脉狭窄程度由术前的(76.70±10.57)%降至术后(即刻)的(11.07±4.18)%,差异有统计学意义(P0.01);TCD测量颈内动脉狭窄段收缩峰值流速(PSV)由术前平均(189.55±54.27)cm/s降至术后(1周)平均(88.41±17.06)cm/s,差异有统计学意义(P0.01);6个月后复查头颈部CT血管造影(CTA),与术后即刻比较,23例未见新的狭窄形成,1例出现支架内再狭窄;19例症状明显缓解或消失,4例部分缓解,1例复发,未出现梗死及其他严重并发症。结论血管内支架成形术是治疗颅外段ICAD相对安全、有效的方法,能有效改善狭窄程度、血流状况以及临床症状,且近期复发率低,不良反应较少,但不适用于血管严重迂曲患者。     

腔隙性脑梗死颈动脉超声检查及风险因素和预后研究

目的分析腔隙性脑梗死患者的颈动脉超声表现和风险因素及预后,对临床上颈动脉超声检查在早期诊断腔隙性脑梗死中的意义进行探讨。方法选择邢台市人民医院接受超声检查的80例患者,其中男性47例,女性33例;年龄36～84岁,平均年龄65.0岁;体质量指数20.2～27.3 kg/m~2,平均体质量指数23.7kg/m~2;高血压51例,糖尿病17例,血脂异常40例。按腔隙性脑梗死和非腔隙性脑梗死分为2组,每组40例。行超声检查和脑MRI扫描。比较两组患者基本临床资料、颈动脉斑块数量、腔隙性脑梗死风险因素及患者预后。结果腔隙性脑梗死颈动脉无斑块患者数显著低于非腔隙性脑梗死(χ~2=13.11,P 0.05);腔隙性脑梗死颈动脉稳定斑块患者数和不稳定斑块患者数均显著高于非腔隙性脑梗死(P 0.05);腔隙性脑梗死患者脑梗死同侧颈动脉不稳定斑块数与对侧比较,差异有统计学意义(t=3.06,P 0.05);腔隙性脑梗死患者脑梗死同侧颈动脉稳定斑块数与对侧相比,差异无统计学意义(t=2.17,P 0.05)。腔隙性脑梗死患者脑梗死同侧颈动脉稳定斑块数和不稳定斑块数与非腔隙性脑梗死患者脑梗死双侧颈动脉稳定斑块数和不稳定斑块数相比,差异均具有统计学意义(P 0.05)。Logistic回归分析显示,年龄、男性、高血压、血脂异常和糖尿病都是腔隙性脑梗死的风险因素(P 0.05)。预后分析显示,腔隙性脑梗死患者全因死亡率较低(χ~2=4.06,P 0.05),Barthel指数评分较高(t=3.17,P 0.05),但脑出血复发比例与非腔隙性脑梗死组差异无统计学意义(χ~2=3.12,P0.05)。结论腔隙性脑梗死的风险因素有颈动脉粥样硬化、年龄、男性、高血压、血脂异常和糖尿病。虽然腔隙性脑梗死患者短期预后良好,但远期预后较差。因此,明确腔隙性脑梗死的常见风险因素,并通过超声检查评估患者颈动脉粥样硬化的情况对腔隙性脑梗死的早治疗具有重要的临床价值。     

Improvement in depression with oestrogen treatment in women with schizophrenia

Archives of Women's Mental Health - Women with schizophrenia are often noted to suffer with comorbid depression. Many studies have shown associations between fluctuating oestrogen levels in the...     

癫(癎)患者抗癫(癎)治疗时脑电图和发作诱因与再发关系

目的:探讨癫癎患者在药物治疗中脑电图、发作诱因与再发的关系,企为临床治疗提供参考指标。方法:分别对97例青少年癫癎患者行脑电图检查并追踪再发情况,比较脑电图、发作诱因与临床再发之间的关系。结果:97例患者中有49例脑电图正常,其中9例(18％)有癫癎再发,48例脑电图异常,其中38例(79％)有癫癎再发。此38例癫癎再发分别属于Ⅰ、Ⅱ、Ⅲ型异常脑电图,相应各有8、11、19例再发。脑电图正常而出现癫癎再发的9例中,有诱因者8例(89％),无诱因者1例(11％),脑电图异常而出现癫癎再发的38例中,有诱因者20例(53％),无诱因者18例(47％)。结论:青少年癫癎患者抗癫癎治疗时的脑电图表现与临床再发有相关性,其中有癎样放电者出现再发可能性最大。脑电图正常时出现再发常有诱因,而脑电图异常时出现再发常缺乏诱因。     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

伊立替康联合奈达铂治疗复发的晚期食管癌

目的评价伊立替康联合奈达铂治疗复发的晚期食管癌的疗效和毒副反应.方法19例晚期食管癌接受CPT-1180mg/m2静脉滴注,d1、d8、d15;奈达铂40 mg/m2静脉滴注d1、d8,每4周重复,至少2周期评价疗效.结果19例可评价,客观有效率36.8%,疾病控制率57.9%,QoL稳定率68.4%,主要毒副反应为骨髓抑制、腹泻、呕吐等,经相应处理后均能控制.结论伊立替康联合奈达铂治疗复发的晚期食管癌有一定疗效,值得进一步探讨.     

Cognitive functions in patients with phenylketonuria in long-term treatment with tetrahydrobiopterin

Cognitive functions were assessed in 9 patients with mild to moderate phenylketonuria (PKU) ranging from 6 to 18 years of age, who were in long-term treatment (>5 years) with 5–9 mg/kg/day tetrahydrobiopterin (BH4) on compassionate use, provided by Schircks Inc. An extensive study of cognitive functions (intelligence quotient (IQ), visuospatial, visual memory, fine motor, executive and attentional functions) was conducted, and behavior was assessed using the ADHD Rating Scale and the Behavior Rating Inventory of Executive Function (BRIEF). All patients had normal IQ (M = 107, SD = 10). The most notable area of impairment was fine motor function, but no significant difference was found between the PKU patients in BH4 treatment who participated in the current study and PKU patients in dietary treatment who participated in a previous study. These results, however, should be interpreted with caution. It is necessary to conduct further studies with a larger number of patients, using more sensitive tests of motor function and using the formulation of BH4 that is currently available.     

不同年龄精神分裂症患者的工作记忆

目的:探讨不同年龄精神分裂症患者的工作记忆差异,以及工作记忆与精神分裂症患者临床症状的关系。方法:采用横断面研究方法,用数字广度和空间广度测验分别对124例健康被试和123例符合美国精神障碍诊断与统计学手册第四版(DSM-Ⅳ)中精神分裂症诊断标准的住院患者进行工作记忆评估,采用阳性和阴性症状量表(PANSS)对患者进行临床症状评定。结果:除数字广度逆序分外,精神分裂症组数字广度和空间广度测验其余各项成绩均低于正常对照组(均P<0.05)。精神分裂症组和正常对照组的数字广度总分、正序分、逆序分均与年龄呈负相关(r=-0.21～-0.37,均P<0.05)。将两组按照年龄分为高年龄组和低年龄组进行协方差分析,数字广度和空间广度测验均表现出显著的组别和年龄效应(均P<0.05),但组别和年龄无交互作用(均P>0.05)。在精神分裂症组中,数字广度总分和数字广度逆序分与PANSS总分负相关(r=-0.22,-0.24,均P<0.05);数字广度总分、正序分、逆序分、空间广度总分、逆序分与阴性症状负相关(r=-0.22～-0.26,均P<0.05)。结论:本研究提示同正常人一样,精神分裂症患者的言语工作记忆随年龄增长逐渐下降,但这种下降并无疾病特异性,患者工作记忆水平的下降与阴性症状存在一定负相关。     

Placebo-controlled challenges with perfume in patients with asthma-like symptoms

A group of nine patients with respiratory symptoms after nonspecific irritating stimuli, but without any IgE-mediated allergy or demonstrable bronchial obstruction, were referred to the asthma/allergy outpatient department for evaluation of suspected asthma. In order to find a provocation model and objectively assess these patients' symptoms in controlled studies, provocation with perfume or placebo was performed. The same patients were also subjected to perfume provocation with or without a carbon filter mask to ascertain whether breathing through a filter with active carbon could prevent the symptoms. The patients breathed through the mouth during the provocations, as they used a nasal clamp to prevent any smell of perfume. We found that the patients' earlier symptoms could be verified by perfume provocation. Breathing through the carbon filter had no protective effect. The conclusion is that symptoms suggesting hyperreactivity of the respiratory tract and asthma can be provoked by perfume without the presence of bronchial obstruction, and that using a carbon filter mask has no preventive effect. The symptoms are not transmitted via the olfactory nerve, since the patients could not smell the perfume, but they may have been induced by a trigeminal reflex via the respiratory tract or by the eyes.