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1.
急性脑梗死动静脉联合与单纯静脉溶栓治疗的疗效观察   总被引:8,自引:2,他引:6  
目的观察急性脑梗死动静脉联合(IA/IV)与单纯静脉(IV)重组组织型纤溶酶原激活物(rtPA)溶栓治疗的临床疗效。方法对20例急性脑梗死患者分别进行IA/IV(10例)与IV(10例)溶栓治疗,治疗前后分别进行欧洲卒中量表评分(ESS)和Barthel指数(BI)评分,观察其疗效及不良反应。结果IA/IV组患者闭塞段血管均有效再通,其中8例完全再通,2例部分再通;ESS及BI评分均明显高于IV组(均P<0.01),临床总有效率IA/IV组为90%,明显优于IV组的30%(P<0.05)。结论IA/IV溶栓治疗急性脑梗死是一种安全、有效的治疗方法,效果优于IV溶栓治疗。  相似文献
2.
rt-PA应用后MMP-2、MMP-9表达的改变及Neuroserpin的影响   总被引:5,自引:3,他引:2  
目的 观察重组组织型纤溶酶原激活剂(rt-PA)对血管再通后基质金属蛋白酶-2(MMP-2)、MMP-9表达的影响以及神经源性丝氨酸蛋白酶抑制剂(neuroserpin,NSP)的干预作用。方法 应用易卒中型肾血管性高血压大鼠复制大脑中动脉缺血模型,缺血3 h后再灌注并静脉注射rt-PA,于预组在应用rt-PA前脑内注射NSP,1天后处死,常规病理检查,并应用免疫组织化学和原位杂交的方法观察MMP-2、MMP-9在脑组织的表达。结果 缺血再灌注后MMP-2、MMP-9表达均升高;应用rt-PA后可见缺血再灌注区有灶性出血及红细胞漏出,同时使MMP-9进一步升高,但对MMP-2影响不大;应用rt-PA的同时使用NSP可以减轻缺血损伤,减少出血的发生,并使升高的MMP-9减少至接近正常水平,但NSP可以使MMP-2表达略有升高。结论 rt-PA溶栓后出血转化的发生可能与MMP-9表达增加有关,溶栓时联合应用NSP可能通过降低rt-PA所致的MMP-9表达上调而减轻溶栓治疗的出血并发症。  相似文献
3.
目的 通过对超早期脑梗死患者接受不同剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的分析,探讨使用rt-PA对超早期脑梗死预后的影响。方法 超早期脑梗死患者308例,根据家属的意愿及是否签署溶栓治疗知情同意书分别给予溶栓治疗和非溶栓治疗。溶栓组221例,接受rt-PA静脉溶栓,其中92例给予rt-PA 0.9 mg/kg,发病在3 h内68例,>3~≤4 h内9例,>4~≤6 h内15例。129例给予rt-PA0.6~0.8 mg/kg,发病在3 h内72例,>3~≤4 h内24例,>4~≤6 h内33例。对照组87例,未应用rt-PA治疗。记录各组在基线、治疗24 h、发病90 dNIHSS评分、Barthel指数。预后良好定义为发病90 d Barthel指数≥95;颅内出血分为症状性颅内出血和非症状性颅内出血。同时记录随访期间的血管性死亡事件和卒中再发事件。应用logistic多因素分析预后的独立相关因素。结果 预后良好的独立相关因素为患者接受治疗前NIHSS评分(OR=2.067,95%CI 1.201~3.556,P =0.009),冠心病史(OR =1.942,95%CI 1.040~3.625,P =0.037)和溶栓治疗(rtPA 0.9 mg/kg时,OR =0.414,95%CI 0.207~0.826,P =0.012;rtPA 0.6~0.8 mg/kg时,OR =0.261,95%CI 0.137~0.497,P<0.01)。症状性颅内出血发生率在rtPA 0.9 mg/kg溶栓组与rtPA 0.6~0.8 mg/kg溶栓组分别为3.3%(3/92)和4.7%(6/129),差别无统计学意义。结论 静脉应用r t - PA溶栓治疗超早期急性脑梗死可获得较好的预后,不同剂量 r t - PA(0.6~0.8 mg/kg vs 0.9 mg/kg)对预后的影响无统计学差异,伴有心房颤动、糖尿病史将可能影响预后。  相似文献
4.
OBJECTIVE: Intravenous recombinant tissue plasminogen activator (rt-PA) is the only therapy of proven value for patients with acute ischemic stroke (AIS). Controversy exists with regard to the prognostic significance of early computed tomography (CT) changes in patients receiving rt-PA for AIS. The authors retrospectively reviewed all cases of AIS who received intravenous rt-PA for AIS in University of South Alabama hospitals between January 1996 and May 1999. A neuroradiologist, blinded to clinical outcomes, reviewed all baseline CT scans for the presence of the following signs: hyperdense middle cerebral artery (HMCA), loss of gray-white differentiation (LGWD), insular ribbon sign (IRS), parenchymal hypodensity (PH), and sulcal effacement (SE). Modified Rankin Scale (mRS) score was recorded 90 days after thrombolysis, and clinical outcome was dichotomized as favorable (0-1) or unfavorable (2-6). The authors performed both univariate and multivariate analyses to investigate the relationship between early CT signs, baseline clinical variables, and functional outcome as measured by the 90-day mRS scores. Any one early CT finding was detected in 23(64%) patients. The frequency of specific findings were as follows: SE in 13 patients (36%), LGWD in 12 patients (33%), PH in 9 patients (25%), HMCA in 4 patients (11%), and IRS in 3 patients (8%) patients. There was no statistically significant association between the occurrence of these imaging findings and subsequent functional outcome after thrombolysis. The data suggest that the presence of subtle acute CT changes in AIS patients is not predictive of clinical outcome following administration of rt-PA as per National Institute of Neurological Disorders and Stroke protocol.  相似文献
5.
The objective of this study was to test the hypothesis if thrombolysis induced by recombinant tissue-type plasminogen activator, (rt-PA) could be facilitated by inhibiting carboxypeptidase U (CPU, active Thrombin Activatable Fibrinolysis Inhibitor, TAFIa) activity. The efficacy of rt-PA alone, or in combination with the carboxypeptidase inhibitor MERGETPA, was compared in a dog model of coronary artery thrombosis. Twenty dogs were randomised in two groups, one received rt-PA, 1 mg kg−1, as intravenous infusion over 20 min starting 30 min after thrombus formation, and the other group received rt-PA, 1 mg kg−1, as group one with the addition of MERGEPTA 5 mg kg−1 starting 25 min prior to coronary artery occlusion and followed by infusion of 5 mg kg−1 h−1 until the end of experiment. Efficacy was assessed by determination of time to lysis, duration of patency and blood flow during patency. Both groups had similar baseline characteristics with respect to haemodynamic parameters, i.e., heart rate, blood pressure and coronary artery blood flow. Coadministration of rt-PA and MERGETPA resulted in significant decrease in time to lysis (15±1.5 min vs. 20±1.7 min, p=0.03), increased patency time (87±16 min vs. 46±12 min, p=0.047) and increased coronary blood flow during patency (1131 mL h−1 vs. 405 mL h−1, p=0.015), compared to rt-PA alone. These results indicate that an inhibitor of CPU activity may have a beneficial effect in patients undergoing thrombolytic therapy by attaining shorter time to reperfusion and improved coronary patency.  相似文献
6.
Thrombolysis (T) is limited by reperfusion-associated injury and the short therapeutic window after stroke onset. The present study investigates whether hypothermia alone or in combination with thrombolysis has beneficial effects after experimental thromboembolic stroke. Wistar rats (n = 60) were subjected to thromboembolic occlusion (TE) of the middle cerebral artery (MCA). Thrombolysis (T) was performed with intravenous recombinant tissue-plasminogen activator (rt-PA) 1 h (early T) or 3 h (late T) after TE. Hypothermia (Hy) was applied for 4 h at 33 degrees C started 1 h after TE. Experimental groups included control (C), early thrombolysis (ET), late thrombolysis (LT), hypothermia (Hy), early thrombolysis plus hypothermia (ET+Hy), and late thrombolysis plus hypothermia (LT+Hy). Animals were investigated by MRI and silver infarct staining (SIS) to assess the cerebral infarct size. All animals of group Hy survived, in contrast to 40% in group C (P < 0.05). ET+HY and LT+Hy showed a trend towards better survival as compared to ET and LT alone. PWI parameters were not significantly different between ET versus ET+HY and LT versus LT+Hy, but rt-PA administration led to improved cerebral perfusion in MRI. Significant differences in infarct volumes (T2/SIS) were found after 24 h in all treatment groups versus the control group (P < 0.05). The lesion volume calculated from T2 was significantly smaller in ET (16% +/- 5%), ET+Hy (10 +/- 4%), and LT+Hy (20% +/- 9%) after 5.5 h (10.8% +/- 4.8%) versus C (42% +/- 15%), (P < 0.05). These data indicate that hypothermia improves survival and decreases infarct volume. However, there were no significant differences between the use of rt-PA alone or in combination with hypothermia. Further studies are needed to confirm these effects, also several days after stroke onset.  相似文献
7.
目的:探讨发病6h内急性脑梗死给予重组组织型纤溶酶原激活物(rt-PA)溶栓治疗的疗效及并发症,并分析预后相关因素。方法:共收集本院2001-2005年70例溶栓治疗的急性脑梗死病例,其中52例静脉溶栓,18例动脉溶栓,分析比较两组病例溶栓前后及3个月随访的ESS评分及Barthel指数结果;同时分析与预后相关的因素。结果:静脉和动脉溶栓组溶栓前及溶栓30min后ESS评分及Barthel指数迅速增加,溶栓前后分值有显著差异。1个月内颅内出血率为5.77%(静脉组)和16.67%(动脉组)。3个月时ESS评分及Barthel指数较溶栓后30min的评分有显著改善。结论:6h内动脉、静脉溶栓治疗均安全有效。  相似文献
8.
rt-PA治疗急性脑梗死的临床研究   总被引:1,自引:0,他引:1  
目的探讨重组组织型纤溶酶原激活剂(rt-PA)治疗急性脑梗死的有效性和安全性。方法选择发病6 h内的急性脑梗死患者5 0例,采用rt-PA(5 0 mg/例)静脉溶栓,其中1 O%剂量5 min内静脉推注,余90%剂量60~90 min内静脉滴注。评定患者治疗前、治疗24 h及21 d时的神经功能缺损程度评分(NIFISS),21 d、90 d日常生活能力评分(ADL)及90 d综合生活能力(改良Rankin评分,mRS)。结果治疗后24 h及21 d的NIHSS评分与治疗前比较差异均有统计学意义(P均<0.01)。随访3个月,mRS为0~3分者33例(66%);脑出血者7例(14%),其中症状性脑出血3例(6%);死亡13例(26%)。在发病4.5 h内进行溶栓治疗的41例患者中有25例(60%)获得良好预后(mRS为0~1分),在4.5~6 h内进行溶栓治疗的9例患者中只有3例(33%)获得良好预后。13例心源性脑梗死患者仅有5例(38%)获得良好预后。结论在排除心源性脑梗死的情况下,采用rt-PA 50 mg/例治疗发病4.5 h内的脑梗死患者,能够改善神经功能,恢复生活能力。  相似文献
9.
rt-PA治疗急性脑梗死的临床研究   总被引:1,自引:0,他引:1  
目的探讨重组组织型纤溶酶原激活剂(rt-PA)治疗急性脑梗死的有效性和安全性。方法选择发病6 h内的急性脑梗死患者5 0例,采用rt-PA(5 0 mg/例)静脉溶栓,其中1 O%剂量5 min内静脉推注,余90%剂量60~90 min内静脉滴注。评定患者治疗前、治疗24 h及21 d时的神经功能缺损程度评分(NIFISS),21 d、90 d日常生活能力评分(ADL)及90 d综合生活能力(改良Rankin评分,mRS)。结果治疗后24 h及21 d的NIHSS评分与治疗前比较差异均有统计学意义(P均<0.01)。随访3个月,mRS为0~3分者33例(66%);脑出血者7例(14%),其中症状性脑出血3例(6%);死亡13例(26%)。在发病4.5 h内进行溶栓治疗的41例患者中有25例(60%)获得良好预后(mRS为0~1分),在4.5~6 h内进行溶栓治疗的9例患者中只有3例(33%)获得良好预后。13例心源性脑梗死患者仅有5例(38%)获得良好预后。结论在排除心源性脑梗死的情况下,采用rt-PA 50 mg/例治疗发病4.5 h内的脑梗死患者,能够改善神经功能,恢复生活能力。  相似文献
10.
rT—RA溶栓治疗急性颈内动脉系统脑梗死   总被引:1,自引:0,他引:1  
目的:探讨rt-PA治疗发病6h内颈内动脉系统脑梗死的得失。方法:rt-PA0.8mg·kg-1,低分子肝素、右旋糖酐40和复方丹参联合应用。结果:3个月后痊愈或基本痊愈7例,预后较好6例,较差2例,死亡6例。死亡病例的初始中风量表(SSS)低,脑肿胀严重。死于严重的缺血性脑水肿2例,出血性梗死1例,巨大脑内血肿1例。结论:初始SSS越低,预后越差;严重缺血性脑肿胀是导致死亡的值得注意的因素。  相似文献
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