依达拉奉联合降纤酶治疗脑梗死临床疗效观察

目的观察依达拉奉联合降纤酶治疗急性脑梗死的临床疗效及安全性。方法48例患者随机分为2组,分别采用单用降纤酶及依达拉奉联合降纤酶治疗。以疗程14 d神经功能缺损评分及3个月时Barthel指数评分为标准观察疗效。结果两组病人疗程14 d神经功能缺损评分及3个月时Barthel指数差异有显著性意义。结论依达拉奉联合降纤酶治疗急性脑梗死安全有效,能显著改善患者的预后。     

依达拉奉联合纳络酮治疗急性脑梗死的疗效

目的 探讨依达拉奉联合纳络酮治疗急性脑梗死的疗效.方法 120例进展型脑梗死随机分为纳络酮组(对照组)和依达拉奉联合纳络酮治疗组(治疗组).分别对两组治疗前、治疗14 d后的神经功能缺损及临床疗效进行评价.结果 两组治疗后14 d的神经功能缺损较治疗前均有显著改善P＜0.01,治疗组与对照组比较有显著性差异P＜0.01.治疗14 d后临床疗效评价治疗组总有效率(85%)较对照组(71.67%)有显著性差异P＜0.01.结论 依达拉奉联合纳络酮治疗急性脑梗死能保护脑细胞,有效改善神经功能.     

纳络酮治疗急性脑梗死的疗效观察

目的 通过纳络酮与复方丹参对急性脑梗死疗效对比，探讨纳络酮对急性脑梗死的治疗作用。方法 将72例急性脑梗死病人随机分为2组，纳络酮治疗组(36例)和复方丹参对照组(36例)，分别给予纳络酮0．8—2．0mg和复方丹参注射液20ml每日1次静滴，14天为1疗程，共2个疗程，治疗过程中观察两组疗效及副作用。结果 纳络酮组对急性脑梗死疗效明显优于复方丹参组(P＜0．05)，而副作用与后无明显差异。结论 纳络酮能够逆转急性脑梗死引起的神经功能障碍，对急性脑梗死有显疗效。     

尤瑞克林联合依达拉奉治疗急性后循环脑梗死疗效观察

目的观察尤瑞克林联合依达拉奉注射液治疗急性后循环脑梗死的疗效。方法将95例急性后循环脑梗死患者随机分为治疗组(尤瑞克林联合依达拉奉)45例和对照组(单用依达拉奉)40例,分别于入院时和治疗后14 d、28 d进行临床神经功能缺损程度(NIHSS)评分,治疗后90 d进行Barthel指数评分;分别在治疗前后测血液流变学并行经颅多普勒(TCD)检查。结果 2组治疗后14 d及28 d神经功能缺损评分均有明显改善,但治疗组与对照组的NIHSS、Barthel指数、血液流变学、TCD变化等比较差异均有统计学意义(P<0.05或P<0.01)。结论尤瑞克林联合依达拉奉可增加急性后循环脑梗死患者的脑血流,改善微循环,并有助于急性后循环脑梗死患者的神经功能恢复。     

国产降纤酶治疗急性脑梗死的评价

目的　评价国产降纤酶治疗急性脑梗死的疗效及安全性。方法　采用前瞻性随机双盲对照方法 ,2 8例患者随机分两组。治疗中监测纤维蛋白原水平、凝血酶原时间及凝血酶原活动度。评估指标包括临床神经功能缺损程度评分、Barthel指数、安全性及治疗一年后患者卒中复发率。结果　 ( 1)治疗 14d临床神经功能缺损程度评分和Barthel指数 ,降纤酶组与对照组相比有显著性差异 (P <0 0 5 ) ,1年后两组卒中复发率有显著性差异。降纤酶组没有增加出血事件及肝肾功能损害等不良反应。 ( 2 )用药后降纤酶组与同期对照组纤维蛋白原、凝血酶原时间及凝血酶原活动度有显著性差异 (P <0 0 5 )。结论　降纤酶是降解纤维蛋白原安全有效的药物 ,可改善急性期临床神经功能评分及Barthel指数     

尤瑞克林治疗急性脑梗死的临床疗效观察

目的 探讨尤瑞克林对急性脑梗死的疗效。方法 随机将住院急性脑梗死患者60例分为治疗组（n=30）和对照组（n=30）,治疗组给予尤瑞克林及常规治疗,对照组仅予常规治疗。于治疗前及治疗后14d按照美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）进行神经功能缺损程度评定及日常生活活动量表（Barthel指数）评分并记录不良反应。90d随访时再次评定Barthel指数。结果 与治疗前相比,治疗后14d两组NIHSS评分均下降（治疗组：8.57±2.25 vs 15.32±2.16,P =0.003;对照组：9.23±0.96 vs 14.76±1.93,P =0.012）,治疗组优于对照组（P =0.023）。与治疗前相比,治疗后14d两组Barthel指数差异无统计学意义;随访90d时两组Barthel指数均明显下降（治疗组：83.05±2.11 vs 47.75±1.52,P =0.004;对照组：72.15±2.22 vs 50.25±0.23,P =0.022）,且治疗组优于对照组（P =0.034）。两组均无明显不良反应。结论 尤瑞克林可明显改善急性脑梗死所致的神经功能缺损,改善远期预后,安全性良好。     

丁苯酞联合康复训练对急性脑梗死的早期疗效观察

【目的】观察丁苯酞联合康复训练治疗急性脑梗死患者的临床疗效。方法 147例急性脑梗死患者随机分为丁苯酞治疗组和常规治疗组。治疗前后均采用NIHSS评分、临床神经功能缺损程度评分标准、FMA及Barthel指数进行评估,观察早期临床疗效。结果丁苯酞治疗组及常规治疗组患者症状均较入院时改善,NISS评分、神经功能缺损评分较入院时降低,FMA评分及Barthel指数较治疗前升高。丁苯酞治疗组各观察指标改善情况均优于常规治疗组,差异有统计学意义(P0.05)。结论丁苯酞联合康复训练的方案与常规治疗方案相比可更好地改善急性脑梗死患者的神经缺损程度,提高患者日常生活质量。     

依达拉奉联合氯吡格雷治疗急性脑梗死疗效分析

目的评价依达拉奉注射液联合氯吡格雷治疗急性脑梗死(acute cerebral infarction,ACI)的临床疗效。方法选择发病72 h内的急性脑梗死患者70例,随机分为依达拉奉加氯吡格雷组35例(治疗组)及常规治疗组35例(对照组),进行神经功能缺损评分和日常生活能力(ADL)评分,神经功能缺损评分采用美国国立卫生院卒中量表(NI HSS),ADL评分采用Barthel指数。结果治疗组与对照组NI HSS,ADL评分在治疗后7 d、14 d、21 d均有统计学差异(P0.05)。结论依达拉奉和氯吡格雷联合治疗能有效改善急性脑梗死患者神经功能缺损和日常生活能力,能显著改善预后。     

抗栓药物联合应用治疗急性脑梗死

目的探讨脑梗死急性期降纤、抗凝和抗血小板聚集联合治疗的效果和安全性。方法选择发病后6~24h符合颈内动脉系统闭塞的急性脑梗死病人随机分为治疗组和对照组,治疗前后分别给与神经功能缺损评分、Barthel指数测定及凝血功能测定,并进行疗效判定。结果神经功能缺损评分及Barthel指数得分2组治疗前后均有进步,但治疗组明显优于对照组;临床疗效治疗组总有效率93%,对照组总有效率57%,2组有效率比较有显著性差异(P<0.01);凝血功能检查,FIB治疗后明显下降,治疗前后比较有显著性差异(P<0.01),而PLT、PT、INR、APTT均无显著性差异。结论降纤、抗凝、抗血小板聚集联合应用治疗急性脑梗死安全、效果好。     

依达拉奉联合奥扎格雷钠治疗脑梗死临床研究

目的 观察依达拉奉联合奥扎格雷钠治疗脑梗死的疗效及安全性.方法 120例脑梗死患者随机分为2组,分别采用奥扎格雷钠及依达拉奉联合奥扎格雷钠治疗.以疗程14d神经功能缺损程度评分及2个月时日常生活能力指数评分(Barthel)为标准观察疗效.结果 治疗组显效率、总有效率、神经功能缺损程度评分和日常生活能力指数评分改变与对照组比较,差异均有统计学意义(均P<0.05),2组均无明显不良反应.结论 依达拉奉联合奥扎格雷钠治疗脑梗死安全有效,能显著改善患者的预后.     

Comparison of short (3-day) hospitalization followed by home care treatment and conventional (10-day) hospitalization for acute ischemic stroke

This prospective randomized controlled study was designed to compare the treatment efficacy, safety and quality of life of ischemic stroke patients treated with conventional (10-day) hospitalization or short (3-day) hospitalization followed by home care treatment. One hundred and two patients with acute ischemic stroke who arrived within 48 h after symptom onset and met the inclusion criteria were studied. Patients were randomly assigned to either of two groups of treatment. Patients in the 'hospitalization' group were hospitalized for 10 days, whereas those in the 'home care' group were admitted only for the first 3 days and were followed at home under the home care program. The baseline characteristics were similar in the two groups. There was no difference in the number of deaths or dependency defined by the Modified Rankin scale more than or equal to 3 between the two groups at 6 months. The relative risk was 0.85 with a 95% confidence interval between 0.35 and 2.04. There was also no difference in the number of patients who had good outcome (NIHSS between 0 and 2 and Barthel index between 75 and 100) at 6 months. One patient in the home care group died due to massive intracerebral hemorrhage. Seventy-nine percent of patients in the home care group were satisfied with the home treatment program.     

Treatment of acute cerebral infarction with arginine esterase: a controlled study with heparin

BACKGRROUND AND PURPOSE: There is no treatment proven to be of definitive benefit for ischemic stroke. Arginine esterase, a natural product from a snake venom, has been shown to reduce the serum fibrinogen level in human beings and may be useful in the treatment of ischemic stroke. In the present study, we compared the therapeutic effect of arginine esterase with that of heparin. SUBJECTS AND METHODS: We studied 50 consecutive patients with acute ischemic stroke who were admitted to the Asan Medical Center. We randomly administered either arginine esterase 0.005 unit/kg x 2 times/day or heparin (activated partial thromboplastin time 2-3 times of baseline value) intravenously for 7 days. Antiplatelets were administered afterwards in both groups. Blood fibrinogen, fibrinogen degradation product (FDP) and D-dimer levels were measured at 0, 6, 12, 18 h and 1, 2, 3, 7 and 30 days after the onset of stroke. NIH stroke scale was measured daily by 2 neurologists while Barthel index and Rankin scale were assessed at 7 days and 1 month after the onset of stroke by a research nurse. All these investigators were blinded to the therapeutic regimen each patient received. RESULTS: There were no significant differences in the mean age, gender proportion, stroke subtypes and baseline neurological severity between the two groups. One patient in the arginine esterase group died in an acute stage due to massive herniation and 1 in the heparin group underwent surgery for herniation. One (arginine esterase group) died of massive gastrointestinal bleeding due to previously unrecognized stomach cancer. Otherwise, no significant clinical and laboratory side effects were observed in both groups. In the arginine-esterase treated group, D-dimer and FDP levels were significantly (p < 0.05) elevated, and fibrinogen level significantly (p < 0.05) decreased at 2-7 days after the onset of stroke compared to the heparin-treated group. However, there was no significant difference in the neurological improvement reflected by NIH stroke scale, Barthel index and Rankin scale. CONCLUSION: Arginine esterase seems to be safe and has significant fibrinolytic effects when administered in the patients with acute ischemic stroke. However, in this preliminary study, it was not superior to heparin in terms of the improvement of neurological deficits. Further studies with larger doses and a larger number of subjects are required.     

Effect of Early and Intensive Rehabilitation after Ischemic Stroke on Functional Recovery of the Lower Limbs: A Pilot,Randomized Trial

Objective: We aimed to develop an early and intense lower extremity training technique using a recumbent cycle ergometer system in patients with acute ischemic stroke. Methods: This was a pilot, prospective, randomized, controlled study with 2 parallel groups followed for 3 months with blinded assessment of outcomes. Thirty-one eligible patients were randomized to experimental and control groups. To strengthen the motion of the lower extremities within 48 hours after stroke, the control and experimental groups received conventional treatment and additional interventions under a therapist's guidance combined with conventional treatment, respectively. The primary outcome measure was the change in lower extremity motor control from admission to 4 weeks, assessed by the Fugl-Meyer Assessment. Secondary outcomes were the number of days to walking 50 m and the change in the Berg Balance Scale score and Barthel index. The modified Rankin Score was used to assess the overall function and prognosis at 3 months. Results: Fugl-Meyer Assessment and Berg Balance Scale scores and Barthel index increased over time in the experimental group, as did the Berg Balance Scale score and Barthel index in the control group (P < .001). However, Fugl-Meyer Assessment scores in the control group were similar over time (F = 2.303, P = 1.119). Fugl-Meyer Assessment scores in the experimental group were higher than those in the control group after 2 and 4 weeks (P = .084 and .037, respectively). Compared with the control group at 2 weeks or at discharge, the percentage of patients who returned to unassisted walking in the experimental group showed an increasing trend (56.3% versus 26.67%, P = .095), but there was no significant difference between the 2 groups after 3 months (P = .598). The modified Rankin Score at 3 months showed no significant difference between the 2 groups (P > .05). Conclusions: Our early and intense lower extremity training technique involving a leg cycle ergometer system contributes to the recovery of lower extremity function in patients with acute ischemic stroke. This finding will provide a basis for future investigations on the applicability of the intervention in early lower extremity and walking rehabilitation among individuals with neurological disorder.     

dl-3-正丁基苯酞软胶囊与阿司匹林治疗急性缺血性脑卒中的多中心、随机、双盲双模拟对照研究

目的 观察国家一类新药正丁基苯酞(NBP)治疗急性缺血性脑卒中的疗效及安全性.方法 在使用复方丹参静脉点滴的基础上,对197例首次发作72 h以内,NIHSS评分在5～25分的颈内动脉系统急性脑梗死患者进行多中心、随机、双盲、阿司匹林对照研究,分为NBP治疗组和阿司匹林对照治疗组.结果 总有效率(基本痊愈+显著进步)NBP组为74.7%,阿司匹林组为60.9%(CMH检验值为4.0,P=0.047);NIHSS总评分、总评分差值、Barthel指数在治疗后第11天和第21天改善的程度明显优于对照组.两组治疗后血常规和血液生化指标变化无统计学意义.NBP的主要不良反应是氨基转移酶升高,以天冬氨酸氨基转移酶轻度升高为主,两组的异常率分别为4.34%和0.结论 NBP对缺血性脑卒中的急性期治疗有效,临床应用安全.     

血糖与急性缺血性脑卒中患者预后相关性分析

目的探讨血糖对急性缺血性脑卒中患者预后的影响。方法选择急性缺血性脑卒中患者240例,依照血糖水平将患者分为血糖正常组和高血糖组,在治疗第15、30 d及3个月对两组患者神经功能缺损和预后分别采用美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(MRS)进行评价。结果两组患者神经功能缺损比较在治疗第15天差异无统计学意义(P0.05),第30天及第3个月高血糖组的神经功能缺损明显高于血糖正常组,差异有统计学意义(P0.05)。结论高血糖是加重急性缺血性脑卒中患者神经功能缺损,影响患者预后的因素之一,调控好血糖对预后有十分重要的意义。     

氟西汀联合奥扎格雷钠对急性缺血性卒中后抑郁患者神经功能及心理状态的影响

目的 分析氟西汀联合奥扎格雷钠对急性缺血性卒中后抑郁患者神经功能及心理状态的影响.方法 选取2018年2月～2020年2月期间本院收治的113例急性缺血性卒中后抑郁患者作为研究对象,采用随机数字表法将研究对象分为观察组和对照组.对照组56例患者给予奥扎雷纳静脉滴注治疗,观察组57例患者增加氟西汀联合治疗,均持续治疗12...     

Efficacy and safety of ginsenoside-Rd for acute ischaemic stroke: a randomized, double-blind, placebo-controlled, phase II multicenter trial

Background and purpose:  Ginsenoside-Rd is a selective competitive Ca²⁺ receptor antagonist. A phase II randomized, double-blind, placebo-controlled, multicenter study was conducted to examine the efficacy and safety of ginsenoside-Rd in patients with acute ischaemic stroke.
Methods:  A total of 199 patients were randomized equally to receive a 14-day infusion of placebo (group B), ginsenoside-Rd 10 mg (group A) or ginsenoside-Rd 20 mg (group C). Primary end-points were National Institutes of Health Stroke Scale (NIHSS) scores at 15 days. Secondary end-points were NIHSS scores and the Barthel Index at 8 days, the Barthel Index and the modified Rankin scale at 15 days and 90 days. The safety end-points included serious and non-serious adverse events, laboratory values and vital signs. Analysis was by intention to treat.
Results:  For the primary study outcome, there is significant difference amongst the three groups at 15 days in NIHSS scores ( P  = 0.0003). Comparing group A with B and group B with C, the difference in the mean for NIHSS was significant in statistics ( P  = 0.0004, P  = 0.0009 respectively). This is no significant difference between group A and C ( P  = 0.9640). For the secondary study outcome, ginsenoside-Rd did not improve neurological functioning. Incidence of serious and non-serious adverse events was similar amongst the three groups.
Conclusions:  Ginsenoside-Rd may be of some benefit in acute ischaemic stroke.     

盐酸舍曲林预防性治疗卒中后抑郁的多中心研究

目的 探讨缺血性卒中后早期应用盐酸舍曲林对卒中后抑郁（post-stroke depression，PSD）和认知功能障碍的影响。      

Selfotel in acute ischemic stroke : possible neurotoxic effects of an NMDA antagonist

BACKGROUND AND PURPOSE: Based on neuroprotective efficacy in animal models, we evaluated the N-methyl D-aspartate antagonist Selfotel in patients with ischemic stroke, after doses up to 1.5 mg/kg were shown to be safe in phase 1 and phase 2a studies. METHODS: Two pivotal phase 3 ischemic stroke trials tested the hypothesis, by double-blind, randomized, placebo-controlled parallel design, that a single intravenous 1.5 mg/kg dose of Selfotel, administered within 6 hours of stroke onset, would improve functional outcome at 90 days, defined as the proportion of patients achieving a Barthel Index score of >/=60. The trials were performed in patients aged 40 to 85 years with acute ischemic hemispheric stroke and a motor deficit. RESULTS: The 2 trials were suspended on advice of the independent Data Safety Monitoring Board because of an imbalance in mortality after a total enrollment of 567 patients. The groups were well matched for initial stroke severity and time from stroke onset to therapy. There was no difference in the 90-day mortality rate, with 62 deaths (22%) in the Selfotel group and 49 (17%) in the placebo-treated group (RR=1.3; 95% CI 0.92 to 1.83; P=0.15). However, early mortality was higher in the Selfotel-treated patients (day 30: 54 of 280 versus 37 of 286; P=0.05). In patients with severe stroke, mortality imbalance was significant throughout the trial (P=0.05). CONCLUSIONS: Selfotel was not an effective treatment for acute ischemic stroke. Furthermore, a trend toward increased mortality, particularly within the first 30 days and in patients with severe stroke, suggests that the drug might have a neurotoxic effect in brain ischemia.