320排动态容积CT诊断脑血管病的价值

目的探讨320排动态容积cT诊断脑血管病的价值。方法对80例怀疑脑血管病患者行320排动态容积cT检查,经两位有经验的神经影像医师读片,评估其诊断价值。结果80例患者发现颅内血管性病变75例,其中60例为颅内动脉瘤,10例脑动脉硬化,3例脑动静脉畸形,2例烟雾病,5例未发现明确原因。结论320排动态容积CT-次扫描16cm容积数据采集,实现脑血管病cT平扫、脑血管造影及脑灌注一站式检查,具有快速、无创、准确性高等优点,对诊断脑血管疾病具有很高临床价值。     

急性脑血管病血糖水平与预后的临床分析

目的 :探讨急性脑血管病患者血糖水平与预后的关系。方法 :根据患者入院时的空腹血糖水平分为非高血糖组和高血糖组 ,分别对其预后进行临床分析。结果 :高血糖组的病死率明显高于非高血糖组 (45 .83%vs 12 .31% ,P <0 .0 1) ;死亡组的血糖均值也显著高于存活组 (8.6 1±1.0 2mmol/Lvs 6 .5 4± 1.15mmol/L ,P <0 .0 5 )。结论 :急性脑血管病患者发病早期血糖水平对判断病情 ,估计预后都具有一定的参考价值。     

静息状态的动态脑血流自动调节：检查方法及临床应用

CA是维持脑血流恒定的生理机制。测量CA的方法很多。本文要介绍的是在静息状态下， 利用传递函数计算外围动脉血压和脑血流间的低频相位差，即可测量CA。CA和脑血管疾病的预后有 关，因此它有潜力成为有用的临床诊疗工具。     

A mathematical model of the intracranial system including autoregulation

Abstract

Cerebral autoregulation plays an important role in the dynamic processes of intracranial physiology. This work develops a four-compartment, lumped-parameter model for the interactions of intracranial pressures, volumes, and flows as a test bed for examining the consistent inclusion of explicit autoregulation in mathematical models of the intracranial system. It is hypothesized that au.toregulation of the blood supply from the arterioles to the capillary bed can be modeled by allowing the flow resistance at the interface of the artery and capillary compartments in the model to be a function of pressure rather than a constant. The functional dependence on pressure of this resistance parameter is not specified in advance, but emerges naturally from the assumed relationship between pressure differences and flows. Results show that a constant flow from the artery to the capillary compartment can be maintained by a flow resistance which is directly proportional to the pressure difference between these two compartments. Oscillatory flow is re-established in the model at the capillary-cerebrospinal fluid and capillary-venous interfaces. [Neural Res 1997; 19: 441-450]     

Update on the treatment and prevention of ischaemic stroke

SUMMARY

Stroke continues to have a devastating impact on public health. Recent epidemiological studies suggest that stroke is becoming more common, perhaps due to the ageing of the population and increased survival of patients with cardiac disease. There are specific and well-defined risk factors in patients with stroke, the most important being hypertension. Treatment options to reverse the effect of acute ischaemic stroke are limited. The only approved therapy is intravenous tissue plasminogen activator (tPA). The disadvantage of tPA treatment is a rate of symptomatic haemorrhage of about 6%. Newer stroke prevention options are currently being investigated including statins, oestrogen, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). The challenge for physicians is to select the most effective intervention, and this depends on our knowledge of the underlying stroke mechanism and the patient's risk factors.     

Hotter monitoring in the evaluation and rehabilitation of post-cerebrovascular accident patients

Coronary artery disease, overt or silent, is frequently present in patients who have suffered a cerebrovascular accident (CVA). Rehabilitation therapy of CVA patients is based mostly on physical activity, which may be limited by fear of overloading the cardiovascular system. Therefore, assessment of the severity of coronary heart disease in CVA patients is of utmost importance. In this study we assessed the usefulness of 24-hour electrocardiographic Holter monitoring in the evaluation of post-CVA patients during daily activities and rehabilitation. Of the 43 post-CVA patients, 24 (55.8%) revealed pathological changes on Holter monitoring and 17 (71%) had a history of coronary artery disease prior to CVA. Holter monitoring revealed mainly ventricular and atrial arrhythmias and in three patients detected transient ischaemic episodes. Only six patients (14%) showed aggravation of arrhythmia during rehabilitation therapy, without aggravation of ST-T changes. The mean maximum heart rate during regular daily activities was 104±20 beats/min, which was significantly higher than the mean maximum heart rate during physical therapy (100±18 beats/min; p < 0.01) and during occupational therapy (87±18 beats/min; p < 0.001). These findings indicate that more vigorous physical and occupational therapy can be prescribed to these patients. The performance of Holter monitoring in post-CVA patients is a valuable substitute to exercise testing, and is useful for cardiovascular evaluation during daily activities and rehabilitation therapy.     

Surgical training technology for cerebrovascular anastomosis

Cerebrovascular anastomosis (for example in the management of Moyamoya disease or complex aneurysms) is a rarely performed but essential procedure in neurosurgery. Because of the complexity of this technique and the infrequent clinical opportunities to maintain skills relevant to this surgery, laboratory training is important to develop a consistent and competent performance of cerebrovascular anastomosis. We reviewed the literature pertaining to the training practices surrounding cerebrovascular anastomosis in order to understand the ways in which trainees should best develop these skills. A wide variety of training methods have been described. These may be classified into five general categories, according to training materials used, being synthetic material, living animal, animal carcass, human cadaver, and computer simulation. Ideally, a novice begins training with non-biological material. After gaining sufficient dexterity, the trainee will be able to practice using biological materials followed by high fidelity models prior to actual surgery. Unfortunately, the effectiveness of each model has generally, to our knowledge, only been judged subjectively. Objective quantification methods are necessary to accelerate the acquisition of competence.     

不同剂量辛伐他汀对缺血性脑血管患者脑血管储备能力的影响

目的：研究不同剂量辛伐他汀对缺血性脑血管患者脑血管储备能力的影响。方法将90例缺血性脑血管患者分为常规组、强化组和对照组。对照组患者口服拜阿司匹林，对症治疗；常规组患者服用常规剂量辛伐他汀治疗；强化组服用强化剂量辛伐他汀治疗。检测比较患者治疗前后的脑血管储备能力。结果治疗6个月后，常规组屏气指数为1·21±0·13，脑血管储备能力为30·44±5·09；强化组屏气指数为1·54±0·11，脑血管储备能力为36·14±5·13；对照组的屏气指数为0·95±0·11，脑血管储备能力为21·42±5·20。3组患者的屏气指数和脑血管储备能力较治疗前均有一定程度增加，但强化组增加的幅度最明显。结论强化剂量的辛伐他汀对患者CVR有较好疗效。