鼠神经生长因子联合蕲蛇酶注射液治疗急性脑梗死的临床疗效

目的 探讨鼠神经生长因子联合蕲蛇酶注射液治疗急性脑梗死的临床疗效。方法 急性脑梗死136例患者按入院时间随机分为治疗组(n=68)和对照组(n=68),2组均采用常规治疗,包括口服阿司匹林,合理控制血压、血糖,调脂,降低颅压及其合并症和有关并发症的处理;对照组采用血栓通600 mg及蕲蛇酶注射液0.75 U分别加入0.9%氯化钠注射液250 mL中静脉滴注,每日1次,连用14 d;治疗组在对照组基础上应用鼠神经生长因子18 μg,肌肉注射,每日1次,连用14 d;比较2组患者住院期间美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分和牛津残障评分(Oxford disability score,OHS)的变化、治疗显效率及总有效率,观察2组患者不良反应的发生情况。结果 治疗组疗效明显优于对照组(P<0.05),治疗前治疗组和对照组NIHSS评分及OHS评分比较,差异均无统计学意义;疗程第21天,治疗组NIHSS评分及OHS评分均显著优于对照组(P<0.05),治疗组显效率和总有效率(72.1%和94.1%)显著高于对照组(58.8%和86.8%)(P<0.05)。结论 鼠神经生长因子联合蕲蛇酶注射液可有效改善急性脑梗死患者的神经功能,且效果优于单用蕲蛇酶注射液。     

阿托伐他汀强化降脂对急性脑梗死患者的疗效及血脂和血清炎性因子水平影响

摘 要 目的： 探讨阿托伐他汀强化降脂对急性脑梗死患者血脂和血清炎性因子水平的影响及其疗效。方法: 94例急性脑梗死患者随机分为强化组(47例)和普通组(47例)。两组患者均予降颅内压脱水、控制血压和血糖、抗血小板聚集、神经保护等基础治疗。普通组同时口服阿托伐他汀钙片20 mg,qd;强化组同时口服阿托伐他汀钙片40 mg,qd,两组均连用8周。比较两组患者治疗前后血脂,血清炎性因子hs-CRP、TNF-α和IL-10水平及临床疗效。结果: 治疗8周后,两组TC、TG和LDL-C水平均较前不同程度下降,HDL-C水平均较前不同程度上升(P<0.05或P<0.01),且强化组变化幅度较普通组更明显(P<0.05);两组血清hs-CRP和TNF-α水平较治疗前均不同程度下降,血清IL-10水平较治疗前均不同程度上升(P<0.05或P<0.01),且强化组变化幅度较普通组更明显(P<0.05)。强化组临床总有效率为95.74%,明显优于普通组的80.85%(P<0.05)。两组药品不良反应发生率比较,差异无统计学意义(P>0.05)。结论:阿托伐他汀强化降脂治疗急性脑梗死疗效显著,安全性较好,能显著降低血脂水平,降低血清hs-CRP和TNF-α水平,升高血清IL-10水平,抑制局部炎性反应。     

麝香醒脑滴丸对脑缺血再灌注损伤的保护作用

目的：探讨麝香醒脑滴丸（Shexiang Xingnao dropping pills,SXD）对大鼠脑缺血再灌注损伤的保护作用及其机制。方法线栓法建立大鼠局灶性脑缺血（MCAO）再灌注模型,按 Bederson 的方法对 MCAO 再灌注0、4、8、22 h 时大鼠的神经功能损伤进行评分;测定脑梗死百分比、脑指数、脑含水量;检测血浆中血小板聚集率和脑组织超氧化物歧化酶（SOD）、乳酸脱氢酶（LDH）活性以及丙二醛（MDA）含量;HE 染色观察脑组织病理变化。结果与模型组比较,SXD（0．42、0．84 g·kg －1）对MCAO 再灌注大鼠的神经功能损伤评分有一定的改善作用,能减少脑梗死百分比、脑含水量、脑指数和血小板聚集率,提高脑组织 SOD 和 LDH 活性,降低脑组织中 MDA 含量,减轻脑组织皮质神经元的损伤。结论SXD 对脑缺血再灌注损伤具有一定的保护作用,其机制可能与抗氧自由基损伤及抑制血小板聚集等有关。     

卒中后抑郁的早期干预与神经功能恢复的临床研究

目的 探讨卒中后抑郁的早期干预对急性脑梗死患者神经功能、生活质量恢复的影响。方法 所选病例随机分为治疗组(舍曲林50 mg 每晚)和对照组(淀粉片1#每晚),两组均联合心理治疗,疗程12周,监测治疗前后血浆皮质醇(COR)水平,依据美国国立卫生研究院卒中量表(NIHSS)、9条目病人健康问卷(PHQ-9)、汉密尔顿抑郁量表(HAMD)、日常生活能力量表(ADL)标准进行评分,评价急性期脑梗死抑郁患者早期干预疗效、神经功能的恢复及生活质量的改善及随访观察卒中后抑郁(PSD)的发生率。结果 两组患者治疗有效率前后对比差异均具有统计学意义 (P<0.05),尤以治疗组明显,治疗后治疗组与对照组对比差异有统计学意义 (P<0.05);治疗后治疗组NIHSS、HAMD评分及COR水平均低于对照组; ADL评分高于对照组,PSD发生率明显低于对照组,差异均具有统计学意义 (P<0.05)。结论 卒中后抑郁的早期干预能促进患者神经功能恢复,提高生活质量,降低COR水平和PSD发生率。应重视卒中后急性期内抑郁的早期筛查。     

小儿脑性瘫痪的影响因素及护理对策探讨

目的：通过回顾性研究探讨小儿脑性瘫痪的影响因素及护理对策。方法选取2012年1月—2014年2月于该院就诊的303例患儿为研究对象,将其分为观察组（脑瘫轻症）202例和对照组（脑瘫重症）101例,应用 Logistic 回归模型对小儿脑性瘫痪进行影响因素分析。结果单因素分析结果,观察组患儿宫内感染（8．42％）、妊娠高血压（16．83％）、难产（44．55％）、早产（14．85％）、新生儿窒息（43．56％）、低出生体重（44．55％）、呼吸窘迫综合征（46．04％）、高胆红血症（27．72％）,与对照组相比具有统计学差异（P ＜0．05）。经 Logistic 回归分析,低出生体重、新生儿窒息、早产、宫内感染、高胆红血症为脑瘫的危险因素。结论低出生体重、新生儿窒息、早产、宫内感染、高胆红血症与小儿脑瘫有一定的相关性,积极预防出生前、出生时、出生后的高危因素对于降低脑瘫的发生具有重要的意义,多方面综合护理措施可以促进小儿脑性瘫痪功能的恢复。     

不同巴曲酶治疗时间窗对急性脑梗死患者脑血管储备的影响

目的 探讨不同时间窗使用巴曲酶治疗急性脑梗死患者对脑血管储备(CVR)的影响.方法 根据发病时间以及治疗方法,123例急性脑梗塞患者分为对照A组(29例,发病12 h以内开始常规治疗)、对照组B组(33例,发病12 h以后开始常规治疗)、治疗A组(29例,发病12 h内常规治疗基础上加用巴曲酶)、治疗B组(32例,发病12 h以后常规治疗基础上加用巴曲酶).对比4组患者治疗前后斯堪地那维亚卒中量表(SSS)评分、大脑中动脉平均血流流速增加值(MFV1-MFV0)、CVR、动脉指数(PI)及两治疗组治疗前后各指标的变化量Δ(MFV1-MFV0)、ΔCVR、ΔPI.结果 治疗后4组患者SSS评分、MFV1-MFV0及CVR较治疗前均升高(P<0.05),PI值较治疗前降低(P<0.05);治疗A、B组治疗后上述指标均优于相应对照组(P<0.05);治疗A组Δ(MFV1-MFV0)、ΔCVR、ΔPI高于治疗B组相应指标(P<0.05).结论 巴曲酶对急性脑梗死患者有显著疗效,能改善患者CVR.早期使用巴曲酶对急性脑梗死患者CVR功能改善作用较为显著,随着时间的推移,疗效降低.     

Y-configuration double-stent-retriever thrombectomy for refractory thrombus in middle cerebral artery bifurcation: A case report

Rationale:Stent retriever mechanical thrombectomy is a recommended treatment for acute ischemic stroke. However, refractory thrombus in artery bifurcation can reduce the rate of successful revascularization.Patient concerns:A 72-year-old male, owing to the acute onset of almost complete right-sided hemiplegia and global aphasia, received bridging therapy. National Institutes of Health Stroke Scale score was 16 at the time of admission.Diagnoses:Cerebral digital subtraction angiography revealed occlusion of the M1 segment of the left MCA.Interventions:Thrombectomy with 3 passes of the Solitaire FR device (Medtronic, Minneapolis, MN) was unsuccessful. Two stent retrievers were inserted in parallel by one microcatheter access point to each M2 branch, and then both stents were gradually retrieved out of the catheter while continuous suction was maintained.Outcomes:After thrombectomy, subsequent follow-up angiograms showed mTICI 3 reperfusion of MCA. The patient has mRS 2 at discharge and the 3-month mRS score after stroke is 1 score.Lessons:The presented Y-configuration double-stent-retriever thrombectomy technique constitutes a safe and effective rescue treatment method for refractory thrombus in MCA bifurcation.     

Free-floating and spinning thrombus of the basilar artery: A case report

Rationale:Free-floating thrombi in the intracranial artery are rare. We report a case of a free-floating and spinning thrombus caused by turbulent flow distal to the basilar artery stenosis. We compare thrombus changes in a series of images according to time and describe the approach to treatment and thrombosis resolution.</abstract>Patient concerns:A 55-year-old man presented to the emergency department on March 21, 2020, with left-sided weakness, bilateral limb ataxia, and a one-day history of dysarthria. Brain magnetic resonance imaging showed multifocal infarctions in the pons and cerebellum with severe basilar stenosis.Diagnoses:Digital subtraction angiography showed severe focal stenosis. A relatively large oval-shaped mobile thrombus was observed spinning due to turbulent flow at the distal portion of the stenosis.Interventions:We administered a combination antithrombotic regimen of warfarin and clopidogrel for 50 days.Outcomes:No thrombus was observed on the third follow-up digital subtraction angiography.Lessons:No previous study has directly observed a mobile thrombus in the intracranial artery using digital subtraction angiography. We used a combination antithrombotic strategy, which was effective after long-term, rather than short-term, use.     

Phenotype-dependent alteration of pathways and networks reveals a pure synergistic mechanism for compounds treating mouse cerebral ischemia

Aim:

Our previous studies have showed that ursodeoxycholic acid (UA) and jasminoidin (JA) effectively reduce cerebral infarct volume in mice. In this study we explored the pure synergistic mechanism of these compounds in treatment of mouse cerebral ischemia, which was defined as synergistic actions specific for phenotype variations after excluding interference from ineffective compounds.

Methods:

Mice with focal cerebral ischemia were treated with UA, JA or a combination JA and UA (JU). Concha margaritifera (CM) was taken as ineffective compound. Cerebral infarct volume of the mice was determined, and the hippocampi were taken for microarray analysis. Particular signaling pathways and biological functions were enriched based on differentially expressed genes, and corresponding networks were constructed through Ingenuity Pathway Analysis.

Results:

In phenotype analysis, UA, JA, and JU significantly reduced the ischemic infarct volume with JU being superior to UA or JA alone, while CM was ineffective. As a result, 4 pathways enriched in CM were excluded. Core pathways in the phenotype-positive groups (UA or JA) were involved in neuronal homeostasis and neuropathology. JU-contributing pathways included all UA-contributing and the majority (71.7%) of JA-contributing pathways, and 10 new core pathways whose effects included inflammatory immunity, apoptosis and nervous system development. The functions of JU group included all functions of JA group, the majority (93.1%) of UA-contributing functions, and 3 new core functions, which focused on physiological system development and function.

Conclusion:

The pure synergism between UA and JA underlies 10 new core pathways and 3 new core functions, which are involved in inflammation, immune responses, apoptosis and nervous system development.