醒后卒中临床诊治的研究新进展

醒后卒中（WUS）是指睡前无新发卒中症状，在醒后或睡眠过程中出现新发神经系统功能缺损的急性脑血管病，症状开始时间未知，多属缺血性卒中。近年来，随着对WUS发病机制的探究以及电子计算机断层扫描和磁共振成像等影像学技术的应用和发展，临床可以对缺血半暗带及脑灌注进行探索，判断是否存在可挽救的脑组织，制定合适的治疗方案，已成为临床研究热点。本文就WUS的临床诊断及治疗等方面进行综述。     

觉醒型卒中的研究进展

觉醒型卒中(WUS)是一类睡眠中起病,且发病时间不明的脑血管病。受到时间窗的限制,针对脑梗死最有效的重组组织型纤溶酶原激活剂溶栓治疗常难以实施。WUS独有的危险因素、病因、发病机制、临床表现及治疗的局限性决定了其不良预后。近年WUS逐渐成为临床研究热点,特别是基于影像学对缺血半暗带区的识别,以影像学指导的溶栓治疗及协同血管内治疗方案可能使该类患者临床获益。     

急性缺血性卒中治疗进展

<正>脑卒中是当前威胁人类健康的三大主要疾病之一,具有高发病、高致残及高致死的特点。其中缺血性卒中发病率占人口总数60%~80%。随着循证医学的发展,越来越多的临床证据可以用于指导缺血性卒中的治疗,急性缺血性卒中患者需要多方面     

成人Moyamoya病59例回顾性临床分析

目的提高Moyamoya病（烟雾病）的认识水平,指导临床诊治。方法回顾性分析59例成人Moyamoya病患者的临床表现、影像学资料、治疗效果及预后,随访时间3～10年。结果首次发病表现为缺血性脑卒中共32例（54.2%）,其中有4例以后发生出血性卒中;首次发病表现为出血性脑卒中27例（45.8%）。缺血性脑卒中患者中27例全部行脑-硬膜-动脉贴敷术（EDAS）,其余表现为出血性卒中病例均行药物保守治疗。GOS评分预后好的51例,预后差的8例。结论烟雾病是一种复杂的多阶段的疾病,不同时段应给予不同治疗方法,缺血期行手术治疗是一种有效方法。     

小剂量阿替普酶在醒后卒中溶栓治疗中的效果分析

目的分析小剂量阿替普酶在醒后卒中（WUS）患者溶栓治疗中效果。方法选择2015年11月至2020年11月温岭市第一人民医院收治的急性WUS患者116例，依据MRI检查结果分为观察组[弥散加权成像（DWI）（+）/液体衰减反转恢复成像（FLAIR）（-），34例]及对照组[DWI（+）/FLAIR（+），82例]，在血管评价的基础上按TOAST分型分为5个亚型，对照组给予常规抗血小板聚集、降脂、改善循环及防治并发症等治疗，观察组在对照组基础上给予小剂量阿替普酶（0.6mg/kg）溶栓治疗。评估并比较观察组与对照组的第30天的美国国立卫生院卒中量表（NIHSS）评分，两组患者及各亚型的显效率、总有效率。结果观察组与对照组的NIHSS评分治疗后均较治疗前改善，且观察组NIHSS评分低于对照组,显效率、总有效率均优于对照组，差异均有统计学意义（均P＜0.05）。治疗后，观察组S、L亚型NIHSS评分均低于对照组，且均低于治疗前，观察组S、L亚型的显效率、总有效率均高于对照组，差异均有统计学意义（均P＜0.05）。结论对于FLAIR（-）的WUS患者，影像学评估后给予小剂量阿替普酶溶栓治疗，可以改善S及L亚型脑梗死患者的临床预后。     

卒中后焦虑和抑郁的研究进展

卒中后焦虑（post?stroke anxiety,PSA）以及卒中后抑郁（post?stroke depression,PSD）是中风后普遍的后遗症,不仅破坏了中风患者的生活品质,同时对其身心健康造成极大干扰。当前支持较多的卒中后情感障碍发病机制有生物学机制和心理社会机制,由这些不同的发病机制形成了不同的治疗策略,包含药物干预和非药物干预两大类。文章针对近年来卒中后情感障碍的发病机制和临床治疗方法进行了综述。     

进展性缺血性卒中的临床治疗研究进展

进展性缺血性卒中( progressive ischaemic stroke, PIS)简称进展性卒中,在急性缺血性脑卒中患者中约占26％～43％[1] ,是严重影响患者预后、危及患者生命的一类疾病. 许多患者即使在发病早期接受治疗后神经功能缺损症状仍不断加重,具有较高的致残率及致死率. 因此,选择有效方法治疗该疾病显得尤为重要,本文通过对进展性缺血性卒中的治疗研究进展做一综述,希望为临床治疗该疾病提供参考.     

脑血管疾病的神经影像诊断和进展

脑血管疾病是我国首位致死致残类疾病,对患者进行精确的影像学评估是制定救治方案并改善预后的重要环节,这对急性缺血性脑卒中(acute ischemic stroke,AIS)患者尤为关键.神经影像学近年来得到飞速发展,各项新技术的涌现有助于临床医生对缺血卒中患者的梗死面积、缺血半暗带区域及责任血管病变情况进行全面评估,为临床个体化治疗提供有益的信息.本文简要总结电子计算机断层成像(computerized tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)等在脑血管疾病诊疗方面的新技术和应用进展,以期对临床脑血管疾病的影像学应用提供借鉴和参考.     

卒中后抑郁

脑卒中已经成为人类第二大致死和致残的重大疾病,并且其发病年龄逐渐年轻化。而卒中后抑郁（Post-stroke depression,PSD）是脑卒中后常见的并发症,严重影响卒中患者的治疗和预后,增加了患者家庭及社会的负担。     

ASPECT评分在急性缺血性卒中血管内治疗中的应用

脑卒中作为导致人类致残和致死的最主要病因之一,而急性缺血性卒中(acute ischemic stroke,AIS)约占其中的80%。Alberta卒中项目早期CT评分(ASPECTS)是一种评价急性缺血性卒中病人大脑中动脉供血区早期缺血性改变的简单、可靠、系统化方法,有助于预测血管内治疗的效果和远期预后。多模影像的发展拓展了ASPECTS评分的应用手段,提高了病情判断的可靠性和有效性。对ASPECTS在急性脑卒中的血管内治疗中的应用进行综述。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.