脑小血管病认知障碍与血清VEGF及PEDF的相关性研究

目的： 探讨血清血管内皮生长因子（vascular endothelial growth factor,VEGF）及色素上皮衍生因子（pigment epithelial derived factors,PEDF）与脑小血管病（cerebral small-vascular disease,CSVD）认知障碍的关系,为筛查CSVD血管性认知功能障碍（vascular cognitive impairment,VCI）提供有效的生物学标记物。 方法： 连续性纳入2019年6月至2020年6月包头医学院第一附属医院神经内科住院的CSVD患者,完善患者临床信息资料、3.0 T头颅MRI检查包括T1加权成像、T2加权成像、液体衰减反转恢复序列、弥散加权成像及磁敏感加权成像等相关检查,采用VEGF、PEDF ELISA试剂盒检测血清VEGF、PEDF浓度。应用多变量logistic回归分析确定CSVD认知障碍的独立影响因素,运用SPSS 26.0描绘受试者工作特征（receiver operating characteristic,ROC）曲线,评价血清VEGF、PEDF浓度对CSVD认知障碍的预测价值。 结果： ①共纳入193例患者,VCI组90例（46.6%）,非VCI组103例（53.4%）。2组比较显示,VCI组受教育年限、既往高血压病史、腔隙性梗死或短暂性脑缺血发作史（transient ischemic attack,TIA）、入院收缩压、舒张压、空腹血糖、血肌酐、胱抑素C、血清VEGF浓度、血清PEDF浓度与非VCI组比较,差异有统计学意义（P<0.05）。②运用多变量logistic回归模型分析显示VEGF浓度较高（优势比1.393,95%CI=1.011～1.920,P=0.042）是CSVD认知障碍的独立危险因素;而血清PEDF相对低表达（优势比0.521,95%CI=0.384～0.707,P=0.000）是脑小血管病患者认知功能障碍的独立保护因素;ROC曲线分析显示血清VEGF浓度联合PEDF浓度联合预测脑小血管病认知障碍的曲线下面积为0.769（95%CI=0.705～0.832,P<0.001）,敏感性为0.911,特异性为0.612;最佳截断值为128.61 pg/mL、100.95 ng/mL,均具有较好的预测价值。 结论： 血清VEGF浓度和PEDF浓度与CSVD认知障碍存在显著相关性,血清VEGF浓度联合PEDF浓度可作为CSVD认知障碍的指标。     

小切口化学性胆囊切除临床应用

目的：总结临床上行小切口化学性胆囊切除的经验。方法：通过对23例胆囊结石患采用右上腹3～5cm斜切口．在切口加用冷光源探头作照明，充分显露胆囊三角，直视下寻找胆囊管，用钛夹钳施钛夹来闭塞胆囊管，取尽胆囊结石及胆汁并向胆囊腔灌注硬化剂无水乙醇(≥99．5％)，反复3次，硬化剂共灌注20min，胆囊底开放，放置胆囊窝引流管。结果：在灌注硬化剂时可见胆囊黏膜脱落、坏死，2周内胆囊明显萎缩，纤维组织开始形成，10周左右胆囊全部被纤维组织所代替，全部萎缩完全，23例胆囊全部化学性切除成功，除2例术后出现腹痛外，余未发现有并发症发生。结论：硬化剂灌注最佳时间为20min，硬化剂灌注要反复多次，小切口化学性胆囊切除是一种安全、可行的微创手术。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

大面积脑梗死诊治研究进展

大面积脑梗死是缺血性脑卒中最为严重的类型,预后极差。目前虽然采用静脉溶栓、降颅压、亚低温治疗、清除自由基、改善脑代谢等内科方法治疗,但效果欠佳。去骨瓣减压可能是降低患者病死率的有效治疗手段之一,但没有确切的数据证实可以降低患者残疾率。丁苯酞是我国自主研发的化学一类新药,有可能为大面积脑梗死提供一种新的治疗手段。本文全面检索大面积脑梗死的相关文献,对大面积脑梗死的治疗做一系统总结。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

男性老年病人导尿方法的探讨

目的 探讨男性老年病人导尿的新方法.方法 随机将260例男性老年病人分成两组,一组采用传统式导尿法(直接插管法),另一组采用改进式导尿法(先行利多卡因尿道表麻后插管法)进行导尿.结果 两组病人一次导尿成功率和疼痛感觉比较,差异有统计学意义,而血尿比较,两组之间的差异无统计学意义.结论 改进式导尿方法在提高一次导尿成功率和减轻病人导尿时的痛苦方面明显优于传统式导尿方法,而在尿道损伤方面两者没有明显的差异.     

不同时间应用丁苯酞注射液对阿替普酶静脉溶栓的影响

目的明确阿替普酶静脉溶栓前或后应用丁苯酞氯化钠注射液对急性缺血性脑卒中预后的影响。方法纳入包头医学院第一附属医院神经内二科2014-01—2018-01接受阿替普酶静脉溶栓联合丁苯酞氯化钠注射液治疗的60例急性缺血性脑卒中患者,其中溶栓前应用丁苯酞氯化钠注射液的患者25例为溶栓前组,溶栓后应用的患者35例为溶栓后组,比较2组14d、90d的NIHSS评分,90d的mRS评分,并作多因素分析。结果 2组14dNIHSS评分分别为(4.56±4.263)分、(5.69±6.876)分,差异无统计学意义(P0.05)。2组90dNIHSS评分分别为(2.44±2.347)分、(2.74±3.127)分,差异无统计学意义(P0.05)。2组90dmRS评分分别为(1.40±0.500)分、(1.51±0.507)分,差异无统计学意义(P0.05)。2组预后多因素比较,年龄、心脏病史可影响缺血性脑卒中预后,丁苯酞使用时间点对预后无影响。结论阿替普酶静脉溶栓前或后应用丁苯酞氯化钠注射液对急性缺血性脑卒中预后无影响,年龄、心脏病史是预后的相关影响因素。     

大鼠脑缺血再灌注损伤后尼莫地平对神经细胞凋亡影响的研究

目的研究大鼠脑缺血再灌注后尼莫地平对神经细胞凋亡的影响。方法雄性Wistar大鼠120只,随机分为空白对照组、假手术组、脑缺血组和尼莫地平组,后两组按时间分成再灌注1、3、6、12、24、36、48、72h和7d组。制作MACO动物模型致大鼠形成局灶性脑缺血,记录大鼠的神经功能缺损情况,应用TUNEL法检测脑缺血再灌注后神经细胞凋亡的情况。结果大鼠脑缺血再灌注后神经细胞凋亡缺血组各时间点同正常对照组、假手术组相比均明显增高,且差异有统计学意义(P0.05);尼莫地平干预后可以显著减少大鼠脑缺血再灌注损伤后凋亡细胞数量(P0.05)。结论尼莫地平可以减少神经细胞凋亡,从而保护大鼠脑缺血再灌注后脑细胞的损害。     

成都卒中登记方法及3123例患者基本特征和功能结局

目的 探讨卒中登记方法、了解卒中患者基本特征和功能结局.方法 前瞻性、连续性登记自2002年3月1日起在四川大学华西医院神经内科住院的卒中患者.由统一培训的专科医师填写卒中登记表,登记患者临床特点、住院诊治情况,并随访各时点结局(发病后7d,1、3、6和12个月末的死亡和残疾).结果 纳入自2002年3月1日至2006年8月31日连续性登记的卒中患者共3123例.其中65.5％来自城区,34.5％来自农村.年龄14～98(63.05±17.98)岁,男性占60.3％,住院期间完成头颅CT和(或)MRI者占97％(3028/3123).2002年3月至2004年9月纳入各类卒中患者共1804例.其中缺血性卒中62.1％ (1120/1804),脑出血 28.4％(513/1804),蛛网膜下腔出血4.0％ (72/1804),TIA 5.5％ (99/1804).2004年10月后未纳入蛛网膜下腔出血和TIA患者.入院时中位NIHSS评分脑出血患者8(3 ～ 15)分,脑梗死5(2 ～10)分.糖尿病(OR=2.427,95％ CI1.811 ～3.253,P=0.000)、房颤(OR =6.121,95％ CI3.535 ～ 10.60,P=0.000)、冠心病(OR=4.144,95％ CI2.944～5.832,P=0.000)、TIA史(OR =4.342,95％ CI1.726 ～ 10.92,P=0.001)发生比例脑梗死组高于脑出血组,而饮酒史脑梗死组低于脑出血组(OR=0.740,95％ CI0.611 ～0.896,P=0.002).缺血性卒中患者溶栓占0.9％(20例),抗血小板治疗83.0％,甘露醇23.5％,神经保护剂(胞二磷胆碱)68.1％,中成药89.7％.7d和1个月病死率脑出血组分别为10.7％和13.9％,脑梗死组分别为3.0％和5.2％.3、6及12个月死亡或残疾率脑出血组分别为40.4％、40.3％和38.9％;脑梗死组分别为37.1％、35.0％和33.4％.结论 本研究是国内目前报告的最大样本、最长时间的前瞻性连续性单中心卒中登记项目,提供了深入研究卒中临床特点的重要平台;本组患者病情偏轻,近期病死率及远期病死或残疾率低于国外,中国卒中防治的干预性临床试验设计应注意考虑这些特点.