脑卒中后运动障碍的治疗

脑卒中后可出现多种运动增多或减少性运动障碍,常发生于脑卒中急性期或脑卒中后一段时间,多由基底节或丘脑损害引起.临床脑卒中与多种运动障碍之间的关联近年才得以重视并取得显著进展.本文综述脑卒中后运动障碍的相关临床诊治要点.     

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

Objective

To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.

Methods

A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency.

Results

Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson’s disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities.

Conclusion

Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.     

安脑丸治疗颅脑损伤合并中枢性高热21例

目的:观察安脑丸治疗颅脑损伤合并中枢性高热的临床疗效。方法:选取2013年1月—2014年5月在本院接受治疗的颅脑损伤合并中枢性高热症患者42例,随机分为治疗组和对照组,每组21例。两组患者均给予西医常规治疗,治疗组在常规治疗的基础上加用安脑丸治疗,将2丸溶于50 m L质量分数0.9%生理盐水中,对于呕吐、意识模糊、吞咽功能异常等不能口服的患者采用鼻饲或者保留灌肠给药,对于意识清晰、吞咽功能正常的患者经口服给药,每日2次,5 d为1个疗程。结果:治疗组治疗后TNF-α、IL-6、CRP水平优于对照组(P0.05);对照组有效率为76.19%,治疗组有效率为90.48%,治疗组优于对照组(P0.05)。结论:安脑丸治疗颅脑损伤合并中枢性高热症临床疗效显著,其作用机制与降低炎症因子TNF-α、IL-6、CRP有关。     

神经科住院老年患者维生素B12缺乏的调查

目的调查神经科住院老年患者维生素(Vit)B12缺乏的状况。方法对本院神经内科2007年3月~2008年7月间连续住院的、年龄≥60岁、无严重肝肾功能障碍、且近3个月未补充VitB12的827例患者血清叶酸、VitB12、同型半胱氨酸(Hcy)等指标进行检测,筛查VitB12缺乏者;对VitB12正常者和缺乏者的神经系统症状、体征及实验室检查结果进行比较和分析。结果827例患者中,平均年龄(77.1±7.5)岁,检出VitB12缺乏者163例(19.7%),女性患病率(21.9%)高于男性(17.4%),并随年龄增长有增加的趋势。VitB12缺乏者中伴有胃肠道疾病的比率较高。与VitB12正常者比较,VitB12缺乏者更易出现行走不稳(27.0%)及振动觉减退(34.4%),更多合并脑梗死(62.6%)、高血压(68.7%)、冠心病(39.9%)等慢性疾病。VitB12缺乏者的神经电生理检查多有异常(77%),但巨幼红细胞贫血仅为9.82%。结论神经科住院老年患者VitB12缺乏常见,症状表现多样,神经系统表现较巨幼红细胞贫血更常见。     

心房颤动相关卒中预防：口服抗凝治疗究竟有多难

心房颤动是卒中的独立危险因素,可使卒中风险增加4—5倍。不接受抗血栓治疗的心房颤动患者的年缺血性卒中风险为5％,并随年龄而增加,风险从50—59岁的1．5％增加到80—89岁的23．5％。心房颤动相关卒中更严重、死亡率更高,致残风险更高且更易复发,因而其预防尤为重要。     

尤瑞克林对急性脑梗死患者脑循环动力学的影响

目的 观察尤瑞克林治疗急性颈内动脉系统脑梗死患者的临床疗效及其对患侧脑循环动力学的影响。方法 急性单侧颈内动脉系统脑梗死患者78例,随机分为尤瑞克林治疗组和对照组。两组均给予抗血小板药物等常规治疗,治疗组另加用尤瑞克林治疗,疗程14d。在治疗前、后分别用美国国立卫生研究所脑卒中评分（National Institutes of Health Stroke Scale,NIHSS）评估两组患者的神经功能缺损程度,检测两组患者的脑循环动力学指标（cerebralvascular dynamics indexes,CVDI）,比较两组之间及治疗前后神经功能及脑循环动力学变化。结果 急性脑梗死患者经尤瑞克林治疗后神经功能恢复明显优于对照组,NIHSS评分、临床总有效率均显著改善（P<0.05）。两组患者治疗后患侧颈动脉最小血流速度、平均血流速度、最小血流量及平均血流量均较治疗前明显增加（P<0.05,P<0.01）,外周阻力均有所下降（P<0.01）;治疗组治疗后最小血流速度、平均血流速度、最小血流量及平均血流量的增加及外周阻力的下降均较对照组更明显（P<0.01）。治疗组治疗后的血管特性阻抗显著降低（P<0.01）。结论 尤瑞克林能改善急性脑梗死患者脑循环动力学指标,降低脑血管的阻力,增加脑动脉的供血量,促进神经功能恢复。