交感神经在兔椎动脉被膜节段性分布的实验研究

目的旨在利用辣根过氧化物酶（horseradish peroxidase，HRP）逆行示踪技术对新西兰免进行实验，以明确交感神经纤维在椎动脉被膜上的分布规律，为临床颈性眩晕的分型提供实验依据，有助于对颈性眩晕的评估和治疗。方法选用20只新西兰兔，C2、C5左右侧各5只。将30％HRP5μl注于椎动脉外膜表面．48h后灌注处死，切取颈上神经节（SCG）、颈下神经节（ICG）（或星状神经节），TMB法成色反应，观察HRP标记细胞分市情况。结果实验侧同水平节段交感神经节发现以中、小细胞为主的HRP标记细胞。结论椎动脉被膜的交感神经分布具有节段性及同侧性的分布特点。     

阻塞性睡眠呼吸暂停低通气综合征患者脑血管自动调节潜力分析

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑血管的自动调节能力.方法 选择济南市第四人民医院神经科自2007年2月至2009年5月就诊或住院的OSAHS患者76例,根据患者呼吸暂停低通气指数(AHI)和夜间最低血氧饱和度(LSaO2)分为轻、中、重度OSAHS组,选择同期有打鼾史的健康体检者32例作对照组,利用多导睡眠仪监测睡眠相关指标及不同时段血压,通过经颅多普勒超声(TCD)检测结合倾斜实验、屏气实验评价患者脑血管的CO2反应性和自动调节能力.结果 与对照组比较,OSAHS组患者AHI较高、LSaO2较低、微觉醒指数(MI)较高,暂停时收缩压增高,S1占睡眠时间的百分比增高、S3+4占睡眠时间的百分比降低,差异均有统计学意义(P＜0.05).与对照组和轻度OSAHS组比较,中、重度OSAHS组患者呼吸抑制指数(BHI)降低、由卧位至立位平均动脉压恢复90%所用时间(TMAP)增加;与对照组比较,OSAHS组患者血管运动反应性(VMR)降低、由卧位至立位脑血流速度(CBFV)恢复90%所用时间(TCBFV)增加,差异均有统计学意义(P＜0.05).中重度OSAHS患者卧立位时血压、平均CBFV的差异均有统计学意义(P＜0.05),立位血压和平均CBFV之间呈正相关关系(r=0.384,P=0.005).结论 OSAHS患者尤其是中重度患者脑血管调节功能受损,卒中风险可能增加.导致OSAHS患者脑血管调节受损的主要因素为夜间低氧血症、高碳酸血症、血压波动及睡眠结构紊乱.

Abstract：

Objective To evaluate the cerebral autoregulation in patients with obstructive sleep apnea-hypopnea syndrome (OASHS) using transcranial Doppler (TCD)-CO2 test and head-upright tilt test (HUTT) from the aspects of nocturnal hypoxemia/hypercapnia and sleep structure. Methods Seventy-six patients with OSAHS visiting our hospital from February 2007 to May 2009 were chosen in our study and divided into severe OSAHS group (n=26), moderate OSAHS group (n=29) and mild OSAHS group (n=21) according to the apnea-hypopnea index (AHI), and the lowest oxygen saturation (LSaO2); 32 healthy controls, having snore history, were adopted too. Polysomnography monitor was used for night-7-h sleep monitoring and blood pressure monitoring; sleep-related indicators and blood pressure at different times were analyzed. Cerebrovascular reactivity was calculated in terms of the breath-holding index (BHI) and vascular motor reactivity (VMR) by TCD-CO2 test; Changes of cerebral blood flow velocity (CBFV), blood pressure (Bp), and the time from squatting-to-tilt position for the mean arterial pressure (TMAP) and the CBFV (TCBFV) returning to ＞90% of baseline levels were detected by HUTT to assess the cerebral pressure-autoregulation. Results The AHI, microarousal index (MI) and the percentages of S1 in the non-rapid eye movement sleep period in the severe, moderate and mild OSAHS groups were all significantly higher than those in the control group (P＜0.05); the LSaO2 and the percentages of S3+4 in the non-rapid eye movement sleep period in all the OSAHS groups were significantly lower than those in the control group (P＜0.05); no significant difference in blood pressure before apnea was noted between the OSAHS groups and the control group (P＞0.05), however, the systolic blood pressure while apnea in all the OSAHS groups was significantly higher than that in the control group (P＜0.05). As compared with the controls and mild OSAHS group (1.89±0.36, 1.75±0.41), severe and moderate OSAHS groups (0.71 ±0.17, 1.12±0.23, respectively) showed significantly decreased BHI (P＜0.05); As compared with the controls (0.68±0.11), and the mild, moderate and severe OSAHS groups (0.20±0.04, 0.34±0.07 and 0.55±0.17, respectively) showed significantly decreased VMR (P＜0.05); TMAP in the moderate and severe OSAHS groups was significantly longer than that in the controls and mild OSAHS group (P＜0.05); TCBFV in the mild, moderate and severe OSAHS groups was significantly longer than that in the controls (P＜0.05). Significant difference on the levels of Bp and CBFV during tilt was noted between the moderate and severe OSAHS groups (P＜0.05); Pearson analysis showed a linkage between Bp and CBFV changes (r=0.384, P=0.005). Conclusion Cerebrovascular autoregulation is impaired in patients with OSAHS, especially in the moderate and severe groups, which may increase the risk of stroke. The major risk factors for cerebrovascular autoregulation in patients with OSAHS are night hypoxemia, hypercapnia, blood pressure fluctuation and severe sleep disorders.     

急性脑血管病并下肢深静脉血栓形成D-二聚体的变化

目的探讨血浆D-二聚体数值的检测在急性脑血管病中并发下肢深静脉血栓形成(DVT)的临床价值.方法测定100例急性脑血管病患者入院时(A组)、发病第3～4周时的D-二聚体数值(其中未并发下肢DVT的为B组,并发下肢DVT的为C组).对三组间数值进行统计学处理.结果B组与A组(P＜0.05),C组与A组(P＜0.01),C组与B组(P＜0.05)三组间比较均有明显差异.并发下肢DVT的病人D-二聚体明显升高.结论D-二聚体数值的测定可作为判断急性脑血管病并发下肢DVT的一项指标.     

局灶性脑缺血大鼠脑中血小板内皮细胞黏附分子-1、Bel-2和Bax表达的动态改变

目的观察大鼠局灶性脑缺血后脑组织中血小板内皮细胞黏附分子-1（PECAM-1、CD31）、Bcl-2、Bax表达的动态改变。方法采用线栓法制作大鼠大脑中动脉局灶性脑缺血模型，脑组织切片免疫组化染色检测不同时间点PECAM．1、Bcl-2、Bax在脑组织中的表达变化。结果大鼠大脑中动脉闭塞后脑组织PECAM-1、Bcl-2、Bax的表达明显增高（均P〈0．001）。Bcl-2在闭塞后12h达到高峰，Bax在24h达高峰，PECAM-148h达高峰；至72h，三者仍明显高于对照组（P〈0．001）。结论脑组织表达的PECAM-1、Bcl-2、Bax分别参与了脑缺血不同时期的病理生理作用。     

急性脑血管病血清镁与钾的变化关系

目的 :观察急性脑血管病人血清镁离子的变化与血清钾的关系。从而为镁剂预防和治疗脑血管病提供科学依据。结果 :在血清钾低于正常的病人中血清镁的变化与血钾呈直线相关性关系 ,血钾越低 ,血清镁越低 ,而血钾正常的病人血清镁的变化与血清钾无直线相关关系。     

高压氧加消栓灵治疗脑梗塞60例

1993年10月～1994年6月我院收治经CT确诊的脑梗塞患者104例。随机分成高压氧与消栓灵治疗组60例,男38例,女22例,年龄42～82岁,病程6小时至10年。常规对照组44例,男36例,女8例,年龄40～82岁,病程1天至6年。 治疗方法:治疗组使用YC2212-22型12人舱,面罩吸氧,舱内压力2ATA,每日1次,每次吸氧60分钟,中间休息10分钟,10次为一疗程。同时给予消栓灵0.56U加入250ml液体静滴,15日为一疗程。对照组给予消栓灵、胞二磷胆碱等一般营养脑细胞及降压等药物。两组急性期同时给予静滴甘露醇,大量维生素C等脱水及清除自由基药物。 结果:治疗组基本痊愈(症状体征基本消失,     

中青年急性脑梗死发病危险因素分析

Background: People paid more attention to the search of onset risk factors of cerebral apoplexy of middle and young people because of its severe harmfulness. We analyzed clinical data of 57 patients with acute cerebral infarction of middle age and young people from 1997～ 2000.     

致高血压脑出血早期血肿扩大危险因素探讨

目的　探讨高血压脑出血早期血肿扩大的危险因素及早期应用甘露醇对其影响。方法　记录首次CT出血量、部位、形状 ,首次应用甘露醇的时间及有无肝病、饮酒史、服阿司匹林、糖尿病病史。于第 2天或第 3天复查脑CT ,对比血肿扩大的发生率 ,分析发病 <2h与≥ 2h应用甘露醇对早期血肿扩大的影响。记录发病时的重要体征。结果　高血压脑出血早期血肿扩大的发生率为 2 2 73 %。血肿形状不规则、肝功能异常、长期大量饮酒及发病时肌力较低、病理征阳性及年龄较低者血肿易扩大。早期应用甘露醇血肿易扩大。结论　血肿形态不规则、肝功异常、饮酒史、低龄、早期应用甘露醇是血肿扩大的危险因素     

不同剂量甘露醇治疗高血压脑出血患者血清神经元特异性烯醇酶的变化及其意义

目的　探讨不同剂量甘露醇治疗高血压脑出血患者血清神经元特异性烯醇酶的变化及其意义。方法　 97例高血压脑出血患者随机分为 2组 ,分别给予小剂量 (小剂量组 )和常规剂量 (常规剂量组 )甘露醇治疗 ,均于发病后第 1、3、7、14天测定其血清神经元特异性烯醇酶的浓度 ,比较两组患者同一天内测量值的变化。并与正常健康人进行对比。结果　两组患者起病后第 1、3、7天血清神经元特异性烯醇酶浓度较对照组显著升高 (P <0 .0 5 ) ,以第 3天最高。第 14天神经元特异性烯醇酶浓度与对照组比较无统计学差异(P >0 .0 5 )。两组间第 1、3、14天神经元特异性烯醇酶浓度比较均无显著差异 (P >0 .0 5 )。第 7天时小剂量组低于常规剂量组 (P <0 .0 5 )。结论　小剂量甘露醇治疗高血压脑出血可取得与常规量相同 ,甚至更好的疗效。     

自制踝足矫形器对急性脑血管病患者下肢运动功能的影响

目的探讨踝足矫形器能否改善急性脑血管病患者下肢运动功能。方法70例急性脑血管病患者随机分为踝足矫形器使用组(观察组)和不使用组(对照组),两组均接受神经内科常规治疗。与入院第1天,发病第3,4周,第10～12周进行下肢运动功能评分。结果发病第3,4周两组下肢运动功能评分无差别,第10～12周观察组下肢运动功能好于对照组。结论急性脑血管患者早期应用踝足矫形器,配合常规处理可改善下肢运动功能,促进恢复。