不同时间局部亚低温治疗弥漫性轴索损伤的预后分析

目的 探讨弥漫性轴索损伤(DAD后不同时间点行亚低温治疗与患者预后的关系.方法 回顾性分析桂林市全州县人民医院院神经外科自2006年1月至2010年1月收治的48例弥漫性轴索损伤患者的临床资料,按照伤后有无在常规治疗的基础上加用局部亚低温辅助治疗分为亚低温治疗组(n=23)和对照组(n=25),前者按治疗时间又分为伤后8h内亚低温治疗组(n=9)和伤后8 h后亚低温治疗组(n=14),治疗6个月后对患者行GOS评定,分析患者的预后.结果 3组患者年龄、性别比例、治疗前颅内压、GCS评分方面差异均无统计学意义(P>0.05);分别接受不同治疗后3组患者预后差异有统计学意义(x2-6.671,P=0.036),由平均秩次判断,预后最好的为伤后8 h内亚低温治疗组,其次为伤后8 h后亚低温治疗组和对照组.结论 弥漫性轴索损伤患者伤后早期(8 h内)进行局部亚低温辅助治疗有助于脑功能的恢复,提高预后.

Abstract：

Objective To investigate the effect of local mild hypothermia at different times on the prognosis of patients with diffuse axonal injury (DAI). Methods Forty-eight patients with DAI,admitted to our hospital from January 2006 to January 2010, were chosen, and their general clinical data were retrospectively analyzed.According to whether adjuvant treatment with mild hypothermia was performed besides conventional therapy, patients were divided into mild hypothermia (n=23) and control group (n=25). The former group was sub-divided into group A (giving mild hypothermia treatment within 8 h of injury, n=9) and group B (giving mild hypothermia treatment over 8 h of injury, n=14). Patients were assessed with Glasgow outcome scale (GOS) and the prognosis of these patients was analyzed 6 months after treatment. Results No significant differences on age, gender ratio, intracranial pressure before treatment and Glasgow coma scale (GCS) scores were found among the 3 groups (P>0.05).Significant differences on the prognosis were found among the 3 groups (x2=6.671, P=0.036). Determined from the average rank, the prognosis in group A was better than that in group B, and the prognosis in group B was better than that in the control group. Conclusion Local mild hypothermia therapy within 8h of injury has functional benefit in the recovery of patients with DAI and improves their prognosis.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

重型颅脑损伤患者亚低温治疗的临床研究

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.     

亚低温对大鼠弥漫性脑损伤后海马CA1区Apaf-1蛋白表达和学习记忆功能的影响

目的 探讨亚低温对大鼠弥漫性脑损伤(DBI)后海马CA1区Apaf-1蛋白表达及大鼠学习记忆功能的影响.方法 选择雄性Wistar大鼠48只,按照完全随机数字表法分为正常组、假手术组、脑损伤组和亚低温组,每组12只.正常组不做任何处理;假手术组仅给予麻醉及头皮切开、缝合,但不致伤;脑损伤组和亚低温组根据Marmarou方法制作DBI模型,亚低温组大鼠损伤后用冰毯及冰袋物理降温,使大鼠肛温在15 min内控制至30.0～31.0℃,维持2 h.14 d后比较各组大鼠Morris水迷宫实验成绩,同时比较各组大鼠海马CA1区Apaf-1蛋白的表达.结果 正常组、假手术组、脑损伤组和亚低温组大鼠搜索安全岛的次数分别为(10.1±1.9)次、(10.3±1.8)次、(3.8±2.3)次和(6.9±1.1)次,差异有统计学意义(P<0.05).脑损伤组及亚低温组海马CA1区Apaf-1蛋白含量高于正常组及假手术组,其中脑损伤组Apaf-1蛋白含量明显高于亚低温组,差异均有统计学意义(P<0.05).结论 亚低温可能通过抑制神经细胞凋亡对脑组织产生保护作用,从而改善大鼠脑损伤后学习记忆障碍.

Abstract：

Objective To investigate the influence of mild hypothermia on the apoptotic protease activating factor-1 (Apaf-1) protein expression in the hippocampal CA1 area and learning and memory functions of rats after diffuse brain injury (DBI). Methods Forty-eight male Wistar rats were equally randomized into normal group, sham-operated group, brain injury group and mild hypothermia treatment group (n=12). Rats in the normal group did not receive any treatment; rats in the sham-operated group only received anesthesia, and incision and suture of scalp; rats in the brain injury group and mild hypothermia treatment group were induced the DBI models according to Marmarou method; and rats in the mild hypothermia treatment group were performed hypothermia with ice blanket and ice bag to control the rectal temperature within 30.0-31.0 ℃ for 2 h. After DBI for 2 weeks, the times of searching refuge platform and the protein expression of Apaf-1 were compared among the 4 groups. Results The times of searching refuge platform in the normal group, sham operated group, brain injury group and mild hypothermia treatment group were (10.1 ±1.9), (10.3±1.8), (3.8±2.3) and (6.9±1.1), respectively,with significant differences between each 2 groups (P<0.05). The protein expression of Apaf-1 in the brain injury group and mild hypothermia treatment group was obviously higher than that in the other groups (P<0.05), and significantly lower protein expression of Apaf-1 in the mild hypothermia rats was noted as compared with that in the brain injury rats (P<0.05). Conclusion Mild hypothermia might play a protective role by inhibiting neuronal apoptosis for rats with DBI through the Apaf-1 pathway,which can improve learning and memory abilities.     

静脉溶栓联合亚低温治疗对急性脑梗死患者疗效及可能作用机制的研究

目的观察重组人组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓联合亚低温治疗急性脑梗死患者的疗效,探讨该方案治疗的可能作用机制。方法纳入60例急性脑梗死患者,随机分为3组,各20例:1对照组:rt-PA静脉溶栓;2治疗组1:静脉溶栓联合局部亚低温治疗12 h;3治疗组2:静脉溶栓联合局部亚低温治疗24 h。记录各组患者治疗前后神经功能缺损量表(National institute of health stroke scale,NIHSS)评分,颅内压(intracranial pressure,ICP)变化,记录溶栓后并发症,并随访患者3个月的改良Rankin量表(modified Rankin scale,MRS)评分。收集患者溶栓前后血液样本,检测血浆中超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)的水平。结果治疗后3个月治疗组1和治疗组2 MRS评分低于对照组(P0.05),其中治疗组2 MRS评分低于治疗组1(P0.05)。治疗72 h、7 d治疗组2 ICP较对照组降低,治疗7 d治疗组2 ICP低于治疗组1(P0.01)。治疗组1和治疗组2治疗24 h、72 h、7 d MDA浓度较溶栓前降低(P0.01),SOD浓度较溶栓前增高(P0.05)。治疗24 h、72 h、7 d治疗组1和治疗组2 MDA浓度较对照组均降低(P0.05),SOD浓度高于对照组(P0.05)。治疗72 h、7 d治疗组2 MDA浓度低于治疗组1(P0.01),治疗后7 d治疗组2 SOD浓度高于治疗组1(P0.05)。各组不良事件发生率及病死率差异无统计学意义(P0.05)。结论 rt-PA静脉溶栓联合亚低温治疗可改善脑梗死患者预后,静脉溶栓联合亚低温治疗24 h效果较12 h更优,未增加不良反应发生率,其作用机制可能是通过减轻患者氧化应激反应来实现的。     

静脉应用rt-PA联合亚低温治疗对急性脑梗死患者NIHSS评分、颅内压和血清SOD、MDA水平的影响

目的 探讨静脉应用rt-PA联合亚低温治疗对急性脑梗死患者NIHSS评分、颅内压和血清SOD、MDA水平的影响。方法 选取本院50例急性脑梗死患者并随机分为2组,每组各25例,其中对照组采用rt-PA静脉溶栓,观察组采用rt-PA静脉溶栓联合亚低温全身治疗1 d,观察时间分别为治疗1、3、7 d; 记录2组患者治疗前后的NIHSS评分、颅内压和血清SOD、MDA水平。结果 经过7 d的治疗后观察组患者的NIHSS评分、颅内压和血清MDA水平均显著低于对照组(P均<0.05); 观察组患者血清SOD水平显著高于对照组(P<0.05)。结论 静脉应用rt-PA联合亚低温治疗可能通过减轻患者的氧化应激反应而有利于急性脑梗死患者的预后。     

亚低温对脑梗死患者血NSE、SOD、NO、ET的影响及临床意义

目的　探讨亚低温对大面积脑梗死患者血NSE(神经元特异性烯醇化酶)、SOD(超氧化物歧化酶)、ET(血浆内皮素)的变化及临床意义。方法　大面积脑梗死患者4 3例,分为亚低温治疗组2 0例,常规治疗组2 3例。两组患者均在入院时、第7天、第14天、第30天进行NIHSS神经功能评分,第30天进行Barthel指数评分,第7天、第14天检测NSE的浓度,SOD的活力,NO、ET的含量。结果　两组NIHSS评分第14天、30天治疗组明显低于对照组(P<0 .0 5 )。Barthel指数比较第30天治疗组明显高于对照组(P<0 .0 5 ) ;治疗组NSE浓度下降,SOD活力升高,NO、含量降低(P<0 .0 5 )。治疗组第14天ET含量降低(P<0 .0 5 )。两组治疗后呼吸、脉搏、血钾等相比无明显差异(P>0 .0 5 )。结论　亚低温治疗可促进重症脑梗死患者神经功能恢复,明显改善预后。无不良反应。     

亚低温联合动脉溶栓治疗急性脑梗死的临床应用价值

目的 探讨亚低温联合动脉溶栓治疗急性脑梗死的临床应用价值。方法 选取2018年1月-2018年12月在本院神经内科住院并行溶栓治疗的急性脑梗死患者60例,并随机分为对照组和观察组,每组30例; 对照组患者接受常温下常规动脉溶栓治疗; 观察组患者接受亚低温技术联合常规动脉溶栓治疗; 记录观察组患者亚低温处理前后收缩压(SBP)、舒张压(DBP)、心率(HR)和呼吸(R)的变化情况; 比较2组患者的上消化道出血、肺部感染、静脉血栓形成、脑疝、心律失常等并发症发生情况及病死亡率情况; 分析2组患者治疗前后神经功能缺损(NIHSS)评分及改良Rankin量表(mRS)评分。结果(1)观察组患者在亚低温处理后HR明显降低,与亚低温处理前比较有明显差异(P<0.05);(2)2组患者在上消化道出血、肺部感染、静脉血栓形成、脑疝、心律失常等并发症发生率比较均无明显差异(P>0.05); 对照组和观察组发生脑梗死出血性转化分别有2例(6.7%)和10例(33.3%)(P<0.05); 观察组和对照组患者发生死亡分别有6例(20.0%)和8例(26.7%)(P>0.05);(3)神经功能缺损评估(NIHSS评分),2组患者溶栓后2、24 h,7和90 d的NIHSS评分与溶栓前比较均有明显差异(P<0.05); 观察组2、24 h,7和90 d的NIHSS评分改善较对照组更为明显(P<0.05);(4)观察组治疗14、30和90 d后的mRS评分明显低于对照组(P<0.05)。结论 亚低温联合动脉溶栓治疗能明显促进急性脑梗死患者神经功能缺损的恢复,减少脑梗死出血转化的发生     

rt-PA静脉溶栓治疗50例急性脑梗死疗效及安全性分析

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的临床效果及安全性。方法选择发病在4.5h内,平均2.86±0.8h内急性脑梗死患者73例,分为两组,溶栓组50例患者给予rt-PA 0.9mg·kg-1·d-1静脉溶栓,常规治疗组23例患者采用抗血小板聚集药物等治疗,比较溶栓和常规治疗后24h、7d及14d美国国立卫生研究院卒中量表(NIHSS)评分并记录不良反应。结果溶栓组治疗后24h、7d及14d时,NIHSS评分较溶栓前及对照组均明显减少,差异有统计学意义(P<0.05);溶栓后头颅MRI/CT及临床表现提示未出现症状性脑出血。结论 rt-PA静脉溶栓治疗发病4.5h内脑梗死是安全有效的。     

轻症脑梗死rt-PA静脉溶栓的疗效及安全性观察

目的观察静脉注射阿替普酶(rt-PA)治疗急性轻症脑梗死患者的临床疗效及安全性。方法采用前瞻性研究方法,收集110例起病4.5h内、美国国立卫生研究院卒中量表(NIHSS)评分≤7分的轻症脑梗死患者的临床资料,其中试验组53例接受rt-PA静脉溶栓治疗,对照组57例接受常规治疗,通过分析患者基线资料及溶栓后24h、7dNIHSS和改良Rankin量表(mRS)评分、90d的mRS评分及治疗期间的颅内出血转化、其他部位出血、药物过敏、死亡等不良事件,评估试验治疗方案的有效性和安全性。结果在2组患者人口学特征、影像学特点、实验室检查、神经功能评分等基线资料中,既往脑出血史对照组显著高于试验组,差异有统计学意义(P0.05),而其他基线资料2组间差异无统计学意义(P0.05)。24h后试验组NIHSS、mRS评分均显著低于对照组,差异有统计学意义(P0.05);7d后试验组NIHSS、mRS评分同样低于对照组,差异有统计学意义(P0.05);90d时试验组mRS为0分、0~1分的比例显著高于对照组,差异有统计学意义(P0.05)。安全性方面2组中轻型出血转化各1例,无过敏及死亡病例,差异无统计学意义(P0.05),但颅外少量局限性出血等不良反应,试验组显著高于对照组,差异有统计学意义(P0.05)。结论轻症脑梗死接受rt-PA静脉溶栓有效和相对安全。     

丁苯酞对急性脑梗死患者血清NSE S-100β及氧化标记物的影响

目的观察丁苯酞注射液对急性脑梗死患者神经功能、预后及血清神经元特异性烯醇化酶(NSE)、S-100β蛋白、丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法将60例急性脑梗死患者随机分为丁苯酞组和对照组各30例。2组均给予常规治疗,丁苯酞组在此基础上给予丁苯酞注射液静滴,2次/d。于治疗前、治疗后7d和14d检测2组患者血清NSE、S-100β、MDA和SOD的水平变化,并比较2组治疗前后美国国立卫生研究院卒中量表评分(NIHSS)和2组3个月后改良Rankin量表(modified Rankin Scale,mRS)评分变化。结果丁苯酞组在治疗后7d和14d,血清NSE、S-100β和MDA水平均较对照组明显降低(P0.05),血清SOD水平较对照组明显升高。丁苯酞组在治疗后7d和14d,NIHSS评分较对照组明显降低,差异有统计学意义(P0.05);3个月后,丁苯酞组mRS评分较对照组明显降低,差异有统计学意义(P0.05)。结论丁苯酞注射液可降低急性脑梗死患者血清NSE、S-100β和MDA水平,提高血清SOD水平,有助于神经功能恢复,改善患者预后。     

阿替普酶与尿激酶治疗急性轻型脑梗死的疗效及安全性分析

目的分析阿替普酶与尿激酶治疗急性轻型脑梗死的疗效及安全性。方法回顾性收集2018-03—2019-06在保定市第一中心医院神经内四科住院的急性轻型脑梗死患者73例,均接受静脉溶栓治疗。根据所用溶栓药物分为阿替普酶组41例,尿激酶组32例。通过分析2组患者静脉溶栓后2 h、24 h、3 d、7 d NIHSS评分及治疗期间的出血、早期神经功能恶化、纤维蛋白原减少、死亡等不良事件,分析两种静脉溶栓方案对于急性轻型脑梗死患者的疗效及安全性。结果阿替普酶组静脉溶栓后2 h、24 h、3 d、7 d NIHSS评分分别为2(1,3)、1(1,4)、1(1,4)、1(0,3.5),均低于其基线NIHSS评分3(1.5,4),差异均有统计学意义(分别为P=0.016、0.039、0.042、0.006);尿激酶组静脉溶栓后7 d NIHSS评分为1(0,3),低于其基线NIHSS评分2(1.3,4),差异有统计学意义(P=0.013)。阿替普酶组与尿激酶组静脉溶栓后2 h、24 h、3 d、7 d NIHSS评分差异均无统计学意义(分别为P=0.734、0.897、0.852、0.864),且2组患者出血并发症及总不良事件的发生率差异无统计学意义(P>0.05)。结论尿激酶与阿替普酶治疗急性轻型脑梗死均有效,且疗效及安全性相当。     

亚低温对脑缺血大鼠脑组织富含脯氨酸的Akt底物40与磷酸化的富含脯氨酸的Akt底物40表达的影响及其脑保护作用的研究

目的研究亚低温对脑缺血大鼠富含脯氨酸的Akt底物40(PRAS40)与磷酸化的PRAS40(pPRAS40)表达的影响及其脑保护作用。方法 56只大鼠随机分为正常对照组、假手术组、脑缺血组和脑缺血亚低温治疗组(亚低温组),后两组又分为缺血3 h、6 h、12 h、24 h、72 h、7 d亚组,每个亚组4只大鼠。用线栓法制作大鼠局灶脑缺血模型。亚低温组于缺血后30 min实施脑部亚低温(32~33℃)并持续4 h。在相应时间点行神经功能缺损评分,用免疫组化染色检测PRAS40及p-PRAS40的表达。结果脑缺血大鼠PRAS40和p-PRAS40的表达呈时间依赖性变化。PRAS40在缺血12 h开始减少,至缺血72 h表达最低,亚低温组12h、24 h、72 h、7 d亚组与脑缺血组的差异有统计学意义(均P0.05);p-PRAS40在缺血3 h开始减少,至缺血24 h表达最低,亚低温组3 h、6 h、12 h、24 h、72 h亚组与脑缺血组的差异有统计学意义(均P0.05)。神经功能缺损评分比较,亚低温组各亚组均明显低于脑缺血组(均P0.05)。结论脑缺血大鼠PRAS40和pPRAS40表达减少;亚低温能延缓其表达减少。亚低温能明显减轻脑缺血所致的神经功能缺损。     

尿激酶溶栓辅助亚低温疗法对脑梗死患者预后的改善作用

目的观察尿激酶溶栓辅助亚低温疗法对脑梗死患者预后的改善作用。方法选取我院2010-06—2011-06收治的68例脑梗死患者为研究对象,抽签随机分为观察组与对照组,每组34例。对照组给予尿激酶150万U溶栓治疗,观察组在对照组的基础上同时加亚低温疗法干预。采用美国国立卫生研究院卒中量表(NIHSS)评定神经功能缺损程度,观察2组发病3h内与发病3~6h内给予治疗的神经功能缺损程度,比较2组血管再通率、并发症发生率。结果发病3h内给予治疗,观察组治疗后1、7、30、90dNIHSS评分(7.96±3.52)分、(6.85±3.35)分、(4.52±2.85)分、(2.32±2.56)分均低于对照组,差异有统计学意义(P0.05);发病3~6h内给予治疗,观察组治疗后1、7、30、90dNIHSS评分均低于对照组,差异有统计学意义(P0.05)。观察组血管再通率73.53%显著高于对照组47.06%,差异有统计学意义(P0.05)。2组并发症发生率比较差异无统计学意义(P0.05)。结论尿激酶溶栓辅助亚低温疗法可提高患者血管再通率,具有较好的神经保护作用,可有效改善预后。