REASSESSMENT OF DEFIBRASE IN TREATMENT OF ACUTE CEREBRAL INFARCTION： A MULTICENTER, RANDOMIZED, DOUBLE-BLIND,PLACEBO-CONTROLLED TRIAL

Objoctive To evaluate the efficacy and safety of defibrase in patients with acute cerebral infarction by a large sample, multicenter, randomized, double-blind, placebo-controlled clinical trial. Mothods Patients with acute cerebral infarction within 12 hours of stroke onset were randomly assigned to receive either an initial intravenous infusion of defibrase 15 U plus normal saline 250 mL or 250 mL of normal saline only. Subsequent infusions of defibrase 5 U or placebo （normal saline） were given on the 3rd, 5th, 7th, and 9th day, respectively. Both groups received standard care of acute cerebral infarction. The primary efficacy outcome was functional status （Barthel Index） at 3 months after treatment. Safety outcome were bleeding events and mortality rate. Secondary outcome included Chinese Stroke Scale （CSS） score at 14 days and recurrence rate of stroke at 1 year. A total of 1053 patients were enrolled at 46 centers from September 2001 to July 2003, and 527 patients were randomly assigned to receive defibrase and 526 to receive placebo. A similar proportion of patients in both groups completed a full course of treatment. There was a significantly greater proportion of favorable functional status （Barthel Index 1≥95） in defibrase group than in placebo group at 3 months （52.2% vs. 42.8%, P 〈 0.01）, and the proportion of dependent functional status （Barthel Index ≤60） was a little lower in defibrase group compared with placebo group （27.7% vs. 32.4%）. These differences were more obvious among patients who were treated within 6 hours of stroke onset. Patients in defibrase group had better improvement with respect to CSS score than those in placebo group at 14 days （P 〈 0.05）. Recurrence rate of stroke at 1 year was lower in the defibrase group compared with placebo group （6.2% vs. 10.1%, P = 0.053）. Patients in defibrase group had higher risk of extracranial bleeding events （4.7% vs. 1.5%, P 〈 0.01 ） and a tendency of higher risk of symptomatic intracranial hemorrhage. The hemorrhage incidence was higher in patients with fibrinogen level 〈 130 mg/dL than ≥ 130 mg/dL （10.6% vs. 3.8%, P 〈 0.05）. Mortality rate at 3 months were slightly higher in defibrase group than placebo group （5.9% vs. 4.2%）. Conclusions The defibrase is effective to improve neurological function and function of daily living for patients with acute cerebral infarction within 12 hours of symptom onset. The efficacy was even better for acute cerebral infarction within 6 hours of onset. The increased risks of intra- and extracranial hemorrhage during defibrase administration were related to the plasma fibrinogen level.     

Relationship between serum S-100 protein level and ischemic damage degree in patients with acute cerebral infarction

Objective： To investigate the time course of serum S-100 concentrations of patients with acute cerebral infarction,and their relation with the clinical data and the prognosis. Methods： Serum S-100 levels were serially determined in 36 patients with acute cerebral infarction within 12 h, at 24 h and day 2, 3, 4, 5, 7 and 10 after acute cerebral infarction and in 20 age- and sex-matched control subjects. An S-100 content assay was performed using a two-site radioimmunoassay technique. The clinical status was assessed using NIH Stroke Scale. The functional deficit at 4 weeks after acute cerebral infarction was scored using the modified Rankin scale. A cranial computed tomography was performed initially. Results： Elevated concentrations of S-100 （〉0.2μg/L） were observed in 29 of 36 patients with acute cerebral infarction,but none of the control subjects. The S-100 peak levels were at day 2 and 3 after acute cerebral infarction and were significantly high in those patients with severe neurological deficit at admission, with extensive infarction or with space-occupying effect of ischemic edema as compared with the rest of the populations. Conclusion： Serum S-100 level assay can be used as a peripheral marker of ischemic brain damage, and may be helpful for evaluation of therapeutic effects in acute ischemic stroke.     

Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery： a Meta-analysis of Randomized Controlled Trials

Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting （CABG） surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients＇ perioperative data, including patients＇ baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference （WMD） and 95% confidential interval （C/）. For dichotomous data, treatment effects were calculated as odds ratio （OR） and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity （Q test P〈0.05）. Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P〈0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups （all P〉0.05）. Patients randomized into sevoflurane group had higher post-bypass cardiac index （WMD=0.39, 95% CI： 0.18 to 0.60, P=0.0003）, lower troponin I level （WMD=-0.82, 95% CI：-0.87 to -0.85, P=0.0002）, lower incidence of myocardial ischemia （OR=0.37, 95% CI： 0.16 to 0.83, P=0.02）, shorter ICU and hospital stay length （WMD=-10.99, 95% CI： -12.97 to -9.01, P〈0.00001; WMD=-0.78, 95% CI： -1.00 to -0.56, P〈0.00001, respectively）. Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.     

Efficacy and tolerability of one-site versus two-site phaco- trabeculectomy: a meta-analysis of randomized controlled clinical trials

Background Phacotrabeculectomy can be performed using one-site or two-site incisions.This meta-analysis evaluated the efficacy and tolerability of one-site versus two-site phacotrabecuiectomy in the treatment of patients with coexisting cataract and glaucoma.Methods A comprehensive literature search was performed according to the Cochrane Collaboration methodology toidentify randomized controlled clinical trials comparing one-site with two-site phacotrabeculectomy.Studies meeting our predefined criteria were included in the meta-analysis.Efficacy estimates were measured by weighted mean difference （WMD） for the percentage intraocular pressure （IOP） reduction from baseline to end point, relative risk （RR） for the proportion of patients with a best-corrected visual acuity （BCVA） of 0.5 or better after surgery and complete success rates.Tolerability estimates were measured by RR for adverse events.All of outcomes were reported with 95% confidence interval （95% CI）.Data were synthesised by Stata 10.1 for Windows.Results Two-site phacotrabeculectomy was associated with greater reductions in IOP than the one-site procedure （WMD： -5.99, 95% CI： -10.74-1.24, P=0.01）.A greater proportion of patients also achieved a BCVA of 0.5 or better （RR：0.91, 95% CI： 0.74-1.12, P=0.36） and the target IOP without anti-glaucoma medication at the study end point （RR： 0.94,95% CI： 0.83-1.07, P=0.34） after two-site than one-site phacotrabeculectomy, but the differences were not significant.There were no significant differences in adverse events between two surgical procedures.Conclusions Two-site phacotrabeculectomy is superior to one-site phacotrabeculectomy in reducing IOP, but other post-operative effects are similar.One-site and two-site phacotrabeculectomies have similar adverse event rates.     

Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis

Background Surgical treatment has become the standard treatment for nontreumatic diseases of the spleen.This metaanalysis compared the relative merits of laparoscopic splenectomy （LS） with open splenectomy （OS） for nontraumatic splenic diseases.Methods A literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases.Pooled odds ratios （ORs） and weighted mean differences （WMD） with 95％ confidence intervals （C/s） were calculated using a fixed-or random-effects model.Results Thirty-five studies matched the selection criteria.Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases.OS was associated with shorter operation time （WMD=42.65,95％ CI：25.58-59.73）,whereas LS was associated with reduced operative blood loss （WMD=-133.95,95％ CI：-229.02 to-38.88）,need for blood transfusion requirement （OR=0.53,95％ CI：0.39-0.72）,overall postoperative morbidity rate （OR=0.44,95％ CI：0.38-0.51）,postoperative mortality rate （OR=0.38,95％ CI：0.24-0.59）,and length of hospital stay （WMD =-2.73,95％CI：-3.34 to-2.12）.Conclusions LS is superior to OS for nontraumatic diseases,with reduced operative blood loss,need for blood transfusion,postoperative morbidity and mortality rates,and length of hospital stay,although OS is associated with reduced operation time.LS may be a good alternative to OS for patients with nontraumatic splenic diseases.     

Meta-analysis on radiofrequency ablation in combination with transarterial chemoembolization for the treatment of hepatocellular carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was assoc     

~rognostic value of baseline C-reactive protein levels in patients mdergoing coronary revascularization

Background C-reactive protein （CRP） is a lowly expressed marker for inflammatory response. This study aimed to evaluate the prognostic value of baseline CRP levels in patients undergoing coronary revascularization in the context of modern medical treatment. Methods This was a retrospective study in a single center. Four hundred and fourteen patients were enrolled, who underwent coronary revascularization and received adequate medication for secondary prevention of coronary heart disease. The study compared the follow-up clinical outcomes between high level CRP group （CRP 〉5 mg/L） and low level one. The median follow-up time was 551 days. Results Compared with low CRP group, the relative risk （RR） of the major adverse cardiovascular and cerebral events （MACCE） in high CRP group was 5.131 （95% CI： 1.864-14.123, P=0.002）. There were no significant differences in death myocardial infarction and stroke during the follow-up between two groups, but a higher risk of re-revascularization was found in high CRP group （RR 6.008, 95% CI： 1.667-21.665, P=0.006）. Cox regression analysis showed that only CRP level could contribute to MACCE during the follow-up. MACCE-free rate was much lower in high CRP group （Kaplan-Meier log-rank P 〈0.001）. Conclusion In the context of modern medical treatment, the baseline level of CRP is an independent predictor for long-term prognosis in patients with coronary revascularization.     

Safety and efficacy of Danqipiantan capsule for treatment of stroke: a systematic review

OBJECTIVE: To evaluate the efficacy and safety of Danqipiantan capsule(DPC) for the treatment of stroke. METHODS: PubMed, China Science And Technology Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infrastructure, and the General Hospital of Tianjin Medical University’s Library were searched until July 2012. Randomized controlled trials(RCTs) and observational studies that reported the use of DPC for treatment of stroke were selected. RESULTS: Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participated in the studies. We found that there was a significant statistical difference between DPC treatment groups and the control groups in terms of the effective rate [risk ratio(RR), 1.14; 95% confidence intervals(CI), 1.04, 1.25; P=0.01], Fugl-Meyer Assessment Scale [weighted mean difference(WMD), 9.77; 95% CI(4.84, 14.70); P=0.00], Barthel Index [WMD=6.40; 95% CI(3.15, 9.65)], and mean flow velocity [WMD= 5.79; 95% CI(1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD=0.60; 95% CI(﹣1.09, 2.29)], visual field defects [left visual field: WMD=﹣203.10; 95% CI(﹣424.41, 18.21); right visual field: WMD=﹣ 172.60; 95% CI(﹣409.29, 64.09)] or the functional independence measure [WMD=﹣7.90; 95% CI(﹣16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two articles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quality, and most of the sample sizes were small, our analysis was likely affected by bias. CONCLUSION: DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.     

Effect of Transcranial Magnetic Stimulation on the Expression of c-Fos and Brain-derived Neurotrophic Factor of the Cerebral Cortex in Rats with Cerebral Infarct

The effect of transcranial magnetic stimulation （TMS） on the neurological functional recovery and expression of c-Fos and brain-derived neurotrophic factor （BDNF） of the cerebral cortex in rats with cerebral infarction was investigated. Cerebral infarction models were established by using left middle cerebral artery occlusion （MCAO） and were randomly divided into a model group （n=40） and a TMS group （n=40）. TMS treatment （2 times per day, 30 pulses per time） with a frequency of 0.5 Hz and magnetic field intensity of 1.33 Tesla was carried out in TMS group after MCAO. Modified neurological severity score （NSS） were recorded before and 1, 7, 14, 21, and 28 day（s） after MCAO. The expression of c-Fos and BDNF was immunohistochemically detected 1, 7, 14, 21, and 28 day（s） after infarction respectively. Our results showed that a significant recovery of NSS （P〈0.05） was found in animals treated by TMS on day 7, 14, 21, and 28 as compared with the animals in the model group. The positive expression of c-Fos and BDNF was detected in the cortex surrounding the infarction areas, while the expression of c-Fos and BDNF increased significantly in TMS treatment group in comparison with those in model group 7, 14, 21, and 28 days （P〈0.05） and 7 14, 21 days （P〈0.01） after infarction, respectively. It is concluded that TMS has therapeutic effect on cerebral infarction and this may have something to do with TMS＇s ability to promote the expression of c-Fos and BDNF of the cerebral cortex in rats with cerebral infarction.     

Dyslipidemia and Outcome in Patients with Acute Ischemic Stroke

Objective To study the relationship between dyslipidemia and outcome in patients with acute ischemic stroke. Methods Data about 2 568 patients with acute ischemic stroke were collected from 4 hospitals in Shandong Province from January 2006 to December 2008. National Institute of Health Stroke Scale （NIHSS） 〉10 at discharge or death was defined as the outcome. Effect of dyslipidemia on outcome in patients with acute ischemic stroke was analyzed by multivariate logistic regression analysis and propensity score-adjusted analysis, respectively. Results The serum levels of TC, LDL-C, and HDL-C were significantly associated with the outcome in patients with acute ischemic stroke. Multivariate logistic regression analysis and propensity score-adjusted analysis showed that the ORs and 95% CIs were 3.013 （1.259, 7.214）/2.655 （1.298, 5.43）, 3.157 （1.306, 7.631）/3.405 （1.621, 7.154）, and 0.482 （0.245, 0.946）/0.51 （0.282, O.921）, respectively, for patients with acute ischemic stroke. Hosmer-Lemeshow goodness-of-fit test showed no significant difference in observed and predicted risk in patients with acute ischemic stroke （chi-square=8.235, P=0.411）. Conclusion Serum levels of TC, LDL-C, and HDL-C are positively related with the outcome in patients with acute ischemic stroke.     

降纤酶、低分子肝素联合应用治疗急性脑梗死的临床观察

目的 观察降纤酶、低分子肝素联合应用治疗急性脑梗死是否优于巴曲抗栓酶及其安全性。方法 93例急性脑梗死病人随机分成2组,治疗组(52例)用低分子肝素2500U,每12h皮下注射1次;降纤酶10U、5U、5U各加入0.9％氯化钠注射液250ml分别于入院第1、3、5天静脉点滴,滴注时间为l～1.5h。对照组(41例)应用巴曲抗栓酶,用法同治疗组降纤酶。分别观察2组治疗前后血液学改变及临床疗效。结果 治疗组凝血酶原时间、纤维蛋白原量均较治疗前有明显改善,组间比较差异显著(P<0.01、0.05)。治疗组总有效率及显效率分别为92.3％、69.2％;对照组总有效率及显效率分别为83.0％、48.8％,2组比较差异非常显著(P<0.01)。治疗组及对照组均未发现出血性脑梗死情况。结论 降纤酶、低分子肝素联合应用治疗急性脑梗死,其改善血液学及临床疗效方面均优于巴曲抗栓酶,且安全、实用。     

CORRELATION BETWEEN FIBRINOGEN LEVEL AND CEREBRAL INFARCTION

FIBRINOGEN,a340-kDa protein synthesized inthe liver,is the precursor of fibrin and an acutephase reactant.As an important factor of thethrombotic waterfall and marker of inflammation,fibrino-gen was believed to be correlated with thromboembolic dis-ease.1…     

通心络胶囊辅治急性脑梗死有效性和安全性的系统评价

目的系统评价通心络胶囊治疗急性脑梗死的有效性和安全性。方法计算机全面检索Cochrane图书馆临床对照试验数据库(2009年第1期)、MEDLINE或PubMed(1978—2009)、EMbase(1978-2009)、Ovid(1978-2009)、中国生物医学文献数据库(1978—2009)、维普中刊数据库(1989-2009)、中国期刊全文数据库(1979—2009)、万方学位论文数据库(1978—2009)。手工检索相关中文期刊、相关会议论文集及所有检索到文献的参考文献。纳入通心络胶囊治疗急性脑梗死的所有随机对照试验(RCT),按Cochrane协作网推荐的方法进行系统评价。结果共纳入39个RCT,包括3262例患者。Meta分析显示:(1)总有效率:基础治疗+通心络胶囊组优于基础治疗组[OR=3.27,95%CI(2.61～4.11),P<0.01];通心络胶囊组优于复方丹参组[OR=3.31,95%CI(1.78～6.13),P<0.01];基础治疗+通心络胶囊治疗组优于基础治疗+维脑路通组[OR=4.69,95%CI(2.16～10.19),P<0.01]。(2)神经功能缺损评分:基础治疗+通心络胶囊组优于基础治疗组[WMD=-5.51,95%CI(-6.59～-3.71),P<0.01];(3)认知功能改善:基础治疗+通心络胶囊组优于基础治疗组[WMD=1.66,95%CI(1.05～2.27),p<0.01];(4)不良反应发生率:均无严重不良反应的报道。结论基于目前的证据,通心络胶囊治疗急性脑梗死具有较好的疗效和安全性。但由于纳入研究质量普遍不高,上述结果尚有待高质量大样本的随机双盲对照试验的证据。     

降纤酶治疗急性脑梗死的临床再评价--前瞻性随机双盲对照研究

目的:通过随机、双盲、安慰剂对照的临床研究,对降纤酶治疗急性脑梗死的有效性及安全性进行客观评价.方法:将在我院神经内科就诊的65例急性脑梗死病人随机分为降纤酶组和对照组.降纤酶的首剂量为10U,第2、3次剂量为5U,在发病24h内开始治疗.对照组按同样方式给予安慰剂.评定的终点指标包括脑卒中的临床神经功能缺损程度评分、Barthel指数、副作用、血浆纤维蛋白原(FIB)水平及发病3个月和1年时的病死率及脑卒中复发率.结果:(1)与对照组比较,降纤酶组治疗后血浆FIB水平明显下降(P＜0.001),没有增加出血事件及其他副作用的发生.(2)治疗后14天神经功能缺损程度评分、3个月时Barthel指数评分及病死率,降纤酶组与对照组比较差异无显著性.(3)随访1年时,两组病死率比较,差异无显著性,但卒中复发率对照组高于降纤酶组(P＜0.05).结论:降纤酶是降解血浆FIB安全有效的药物.在本研究方案下,降纤酶未显示出优于目前治疗急性脑梗死,常用药物的临床疗效.其在适应证、治疗剂量、给药方法及用药时限等方面与临床疗效的关系有待进一步研究.     

纤溶酶治疗急性脑梗死疗效Meta分析

目的 分析评价纤溶酶治疗急性脑梗死的有效性、显效性以及其对血浆纤维蛋白原的影响.方法 检索2004年1月至2011年12月国内公开发表的纤溶酶治疗急性脑梗死临床试验的相关文献,应用Meta分析方法进行同质性检验和合并效应量的估计.结果 ①同质性检验：11项有效性研究的χ2=9.01,P〉0.05;11项显效性研究的χ2=28.12,P〈0.05;4项血浆纤维蛋白原水平研究的χ2=68.57,P〈0.05.②合并效应量的估计：11项有效性研究的合并OR=4.39,95%可信区间[3.01,6.38],Z=7.72,P〈0.05;11项显效性研究的合并OR=4.69,95%CI[2.88,7.66],Z=6.19,P〈0.05,4项血浆纤维蛋白原水平研究的合并加权均数差为=-1.12,95%CI[-1.90,-1.52],Z=3.86,P〈0.05.结论 纤溶酶治疗急性脑梗死效果良好,是一种疗效确切的临床治疗用药.     

降纤酶联合奥扎格雷钠治疗进展型脑梗死的效果评价

目的研究降纤酶联合奥扎格雷钠治疗进展型脑梗死的疗效。方法选择在本院就诊的进展型脑梗死患者90例,随机分成观察组和对照组。两组均采用阿司匹林肠溶片、神经营养剂、尼莫地平等常规方法治疗,对照组在常规治疗基础上给予舒血宁。观察组在常观治疗基础上给予奥扎格雷钠联合降纤酶。结果观察组和对照组患者的血浆纤维蛋白原含量和神经功能缺损程度评分治疗后明显低于治疗前(P<0.05),但是观察组血浆纤维蛋白原和神经功能缺损程度评分的下降幅度明显高于对照组(P<0.05),同时观察组的治疗效果显著优于对照组(Z=2.983,P=0.003)。结论降纤酶联合奥扎格雷钠治疗进展型脑梗死,具有良好的安全性且疗效可靠。     

国产降纤酶治疗急性脑梗死的临床研究

目的研究国产降纤酶对急性脑梗死的疗效。方法选取65例急性脑梗死患者,随机分为观察组35例与对照组30例,其中观察组在对症治疗的基础上加用国产降纤酶治疗,对两组患者神经功能缺损评分（NDF）及Barthel指数的改善情况进行比较分析。结果采用降纤酶治疗的观察组疗效显著优于对照组,NDF及Barthel指数均明显改善,组间差异具有统计学意义（P〈0．05）。结论降纤酶用于急性脑梗死的治疗效果显著,安全可靠,值得临床推广应用。     

椎-基底动脉系统脑梗死118例病情恶化危险因素分析

目的 探讨椎-基底动脉系统(VBS)脑梗死病情恶化的危险因素.方法 将符合入选标准的439例VBS梗死患者根据病情是否进展恶化分为两组:进展性卒中组(PS组)和非进展性卒中组(nPS组),采用单因素和多因素回归分析,分析进展性脑卒中的危险因素.结果 单因素分析显示,PS组与nPS组比较,在VBS狭窄积分、神经功能缺损评分(NIHSS)、血压分级、心房纤颤(AF)发生情况及空腹血糖(FBS)、纤维蛋白原 (Fib) 水平、溶栓和降纤治疗方面差别均有统计学意义(P＜0.05),而两组的低密度脂蛋白胆固醇(LDL-C)水平及抗凝和抗血小板治疗情况间差别均无统计学意义(P＞0.05).多因素回归分析显示VBS狭窄积分、NIHSS、高血压、高血糖、AF、溶栓或降纤治疗与病情进展恶化相关.结论 VBS狭窄积分、NIHSS、高血压、高血糖、AF是VBS脑梗死病情恶化的危险因素,溶栓或降纤治疗能够部分逆转脑梗死病情恶化的发生和发展过程.     

降纤酶治疗急性脑梗死的临床探讨

目的 :探讨降纤酶治疗急性脑梗死的临床最佳剂量和疗效。方法 :将脑梗死患者按入院顺序分成四组 ,每组使用降纤酶静脉滴注总剂量相同 ,但每天剂量不同 ,大剂量组 2 0u/d× 3天 ,中剂量组 15u/d× 4天 ,小剂量组 10u/d× 6天 ,三组均进行基础治疗 ,用药同对照组 ,对照组用低分子右旋糖酐 5 0 0ml、脑复康 10～ 12g共 2 0天。结果 :四组的疗效差异有显著性 (P <0 .0 0 5 ) ,大剂量组有效率 79.4 % ,中剂量组 85 .5 % ,小剂量组 5 6 .9% ,对照组 5 6 .1% ,而且神经功能缺损评分中剂量组均优于其余 3组 (P <0 .0 1) ,纤维蛋白原的下降程度亦是中剂量组效果明显 (P <0 .0 5～P <0 .0 1)。结论 :降纤酶治疗急性脑梗死 ,使用中等剂量每天 15u总量 6 0u不导致出血 ,不但方法简便 ,经济实用 ,而且安全有效 ,是基层医院能普及的有效治疗方案。