氢化麦角碱注射液治疗缺血性中风临床疗效观察

采用单盲对照，将１２２例缺血性中风患者随机分为氢化麦角碱注射液治疗组５８例（Ａ组）和同期维脑路通注射液对照组６４例（Ｂ组）进行对比，以观察患者神经功能缺损的改善情况及药物副作用。１资料与方法治疗组（Ａ组）共治疗观察缺血性中风患者５８例，其中男性３８例...     

氢化麦角碱治疗帕金森病的疗效观察

帕金森病 (parkinson’sdisease,PD)是影响人类健康、发生残障的主要疾病之一。目前尚无根治办法 ,只能长期服药控制症状。复方左旋多巴仍是治疗PD的金标准 ,但随着病情的缓慢进展 ,剂量会逐渐增加 ,副作用也随之增加。溴隐亭是用于治疗PD的主要的多巴胺受体激动剂 ,但常需较大剂量才能维持疗效 ,且副作用较大 ,患者常不能耐受。我们自2 0 0 1年 11月至 2 0 0 3年 1月两年间用氢化麦角碱片 (商品名 :斯托芬 )加左旋多巴 /苄丝肼 (商品名 :美多巴 )治疗PD ,取得较好的疗效。现报道如下。1　资料与方法1.1　病例选择　按原发性帕金森病诊…     

氢化麦角碱致过敏性皮疹1例

1　病历简介男 ,5 2岁。因椎基底动脉供血不足入院。既往有磺胺过敏史。予以口服尼莫地平 2 0 mg,3次 / d、维生素 E 0 .1g,1次 / d、肠溶阿司匹林 75 mg,每晚 1次 ,并静脉滴注灯盏花素治疗。未出现不良反应。第 3天加用氢化麦角碱 1mg,3次 / d,口服 ,因患者腹泻同时予以环丙沙星 0 .2 g,3次 / d,口服。第 4天患者双手背外侧各出现一个直径约 3.0 cm的红色皮疹伴瘙痒 ,触之不褪色。考虑环丙沙星过敏的可能性大 ,停用所有口服药物。患者皮疹逐渐消退 ,皮肤瘙痒缓解。于第 6天再次予以尼莫地平、维生素 E、肠溶阿司匹林及氢化麦角碱口服 (剂…     

氢化麦角碱治疗糖尿病周围神经病变观察

糖尿病周围神经病变 (DPN)是糖尿病常见的慢性并发症 ,其发生率可高达 6 0 %～ 90 % [1 ] 。其治疗的困难性以及晚期不可逆性 ,严重影响患者的生活质量。我们采用氢化麦角碱治疗糖尿病周围神经病变 32例 ,并与其他扩血管药物的治疗作为对照 ,获得较满意疗效 ,现总结如下。1　对象与方法1.1　对象　选择 1999年 10月至 2 0 0 1年 4月收住院的 DPN患者 6 1例。 DPN 的诊断依据 :1符合 WHO1985年或AFD1997年糖尿病诊断标准。 2四肢不同程度感觉异常。 3查体发现四肢有对称性痛觉障碍平面 ,膝、腱反射减弱或消失。 4排除其他神经系统疾患…     

不同剂量尿激酶治疗急性缺血性脑卒中临床对比研究

我们自 1 996年 1 1月～ 2 0 0 0年 1 2月应用不同剂量尿激酶 (ＵＫ)治疗急性缺血性脑卒中 46例 ,结果报告如下。1　资料与方法1 1　临床资料　全部 46例病人均为 1 996 1 1～ 2 0 0 0 1 2来我科就诊的急诊患者 ,所有病例均符合 1 995年全国第四届脑血管病会议制定的脑梗死诊断标准。其中男性 30例 ,女性1 6例。病例入选标准 :( 1 )临床诊断为缺血性脑卒中 ,发病 <3ｈ。 ( 2 )年龄 <70岁。 ( 3)头部ＣＴ排除颅内出血 ,且无与神经功能缺损相对应的低密度灶。 ( 4)经颅多普勒(ＴＣＤ)显示相应区域血管狭窄 ,血流量减少。 ( 5)血压 <1 6 0 /…     

丹参类药物治疗急性缺血性脑卒中的系统评价

目的评价丹参类药物能否改善急性缺血性脑卒中患的功能性结局及可能的不良反应。方法通过计算机检索、手工检索及向药厂索取资料，全面收集全世界范围内丹参类药物治疗急性缺血性脑卒中的随机对照试验／半随机对照试验，并按Cochrane协作网推荐的方法进行系统评价。结果共初步检索到8个可能符合纳入标准的临床试验，但经筛选，仅3个试验、304例患符合纳入标准，2个试验被排除，3个试验待评价。3个纳入试验的方法学质量均较低，疗程21～28天，均未报告3个月时的死亡或依赖人数，仅1个试验报告了治疗过程中出现的不良反应。3个试验在治疗结束时均进行了神经功能缺损／病残程度的评价。Meta分析结果显示，治疗组有效率与对照组相比，其差异有统计学意义[RR1．07，95％CI(1．01，1．14)]。治疗过程中均未发生死亡。没有试验进行生存质量的评价。结论本研究所纳入试验的方法学质量均较低，虽显示丹参类药物有改善急性缺血性脑卒中近期神经功能缺损评分和／或病残程度的趋势，但因缺乏评价其远期功能性结局的指标，尚不能对其疗效得出肯定性结论。因此，继续开展高质量、大样本的随机对照试验非常必要。     

高压氧治疗急性缺血性脑卒中的剂量优化

目的:探讨高压氧疗法(HBOT)治疗急性缺血性脑卒中(AIS)的最佳治疗剂量.方法:在PUBMED数据库、EMBASE医药学数据库、MEDLINE、中国知网全文数据库(CNKI)搜索已发表的高压氧疗法治疗AIS的相关文献,根据纳入和排除标准收集文献.所提取的数据包括高压氧舱内氧分压(pO2,ATA)、每次HBOT时总吸氧时间(Ts)、总治疗次数(Nt)、治疗有效率.HBOT的总治疗剂量(DHBOY)按下列公式计算:DHBoT=pO2×Ts×Nt.当治疗有效率达到最高时,所对应的DHBOY为最佳治疗剂量.用线性回归的方法探索DHBOY与治疗有效率的关系.结果:根据纳入和排除标准,共收集19篇文献,共涉及700例患者,根据公式计算得出DHBOY与治疗有效率呈正相关关系,当平均DHBOT处于30-32治疗剂量单位(UMD)时,治疗有效,最高可达100％;当DHBOT＜13.5UMD,疗效甚微.结论:本研究显示,治疗AIS时DHBOY与治疗有效率呈正相关关系;当DHBOY处于30-32UMD时,治疗有效.     

尼麦角林联合石杉碱甲治疗血管性痴呆的疗效观察

目的:探讨尼麦角林联合石杉碱甲治疗血管性痴呆(VD)的临床疗效及安全性。方法:VD患者80例随机分为对照组(石杉碱甲治疗)和联合组(尼麦角林联合石杉碱甲治疗),各40例,均治疗3个月。治疗前后采用欧洲卒中评分(ESS)和Barthel指数(BI)对患者进行评分,比较临床疗效,并检查心电图、血常规、肝肾功能等。结果:2组治疗后ESS及BI评分均较治疗前增加(P<0.01),且联合组的ESS及BI评分均高于对照组(P<0.05);联合组治疗有效率及显效率均高于对照组(P<0.05);2组均未发现严重不良反应。结论:尼麦角林联合石杉碱甲治疗VD血管性痴呆患者安全、有效。     

丹参类药物治疗急性缺血性脑卒中的研究进展

缺血性脑卒中急性期的药物治疗疗效均不令人满意，仅阿司匹林、t—PA等药物有一定疗效。在中国，许多具有活血化淤的中药是研究的热点，丹参类药物是广泛用于治疗急性缺血性脑卒中的常用药物，文献报道丹参已用于治疗脑血管病三十余年。通过对丹参类药物的药理研究、临床研究、经济学评价、临床疗效评价方法等作以介绍，显示其具有广泛而复杂的药理作用和潜在的应用前景，丹参类药物被认为不良反应小，相对较为安全。当前是否已有充分证据证明丹参类药物对急性缺血性脑卒中有肯定的疗效，还需要进行系统评价予以证实。     

中西医结合治疗急性缺血性脑梗塞的临床分析

目的:观察葛根素注射液对急性缺血性脑梗塞的临床疗效。方法 :将60例急性缺血性脑梗塞患者随机分为治疗组和对照组 ,两组均使用尿激酶 ,治疗组同时还静滴葛根素注射液等 ,综合判定疗效。结果 :葛根素注射液治疗组优于对照组 ,同时还发现葛根素具有降低血液粘滞性、增加脑血流的作用 ,总有效率达83 % ,包括改善肢体运动功能、言语功能等。结论 :葛根素注射液是治疗急性缺血性脑梗塞的有效药物     

Recognition and initial management of acute ischemic stroke

This article addresses the recognition and management of acute ischemic stroke. It includes a discussion of cerebrovascular anatomy, common ischemic stroke syndromes, and central venous thrombosis. Extensive attention is paid to the initial emergency department management of stroke, addressing medical and systems issues, and treatment of ischemic stroke by thrombolysis.     

不同中医征候急性缺血性脑卒中患者的心理状况分析

目的 探讨不同中医征候急性缺血性脑卒中患者的心理问题,以指导临床护理人员进行相应的心理干预.方法 应用症状自评量表（SCL-90）对154例急性缺血性脑卒中住院患者进行心理调查,根据中医症候诊断进行相关分析.结果 急性缺血性脑卒中患者存在明显的心理问题;不同中医征候患者心理问题表现不同,＂实证＂和＂虚证＂患者在躯体化、强迫症状、抑郁、敌对方面的表现差异有统计学意义（P＜0.01或P＜0.05）.结论 急性缺血性脑卒中患者存在明显的心理问题,征候虚实不同,临床表现各异,临床护理人员应重视对急性缺血性脑卒中患者的心理护理,并针对不同的证型给予相应的心理干预,以减轻患者的心理问题,改善预后.     

急性缺血性脑卒中缺血半暗带的影像学研究进展

急性缺血性脑卒中是临床最常见的脑血管病，具有较高的致死率和致残率。缺血半暗带的存在及对其及时、精准的影像学判断，对于临床治疗方案及时间的合理选择具有重要意义。本文对不同的影像学技术中，急性缺血性脑卒中患者缺血半暗带的研究进展作一综述，以期为缺血半暗带在急性缺血性脑卒中中的应用提供依据，进而提高急性缺血性脑卒中诊断准确率。     

瑞替普酶治疗急性缺血性脑卒中临床研究

目的 评价瑞替普酶在急性缺血性脑卒中溶栓治疗中的有效性及安全性.方法 纳入泰安市中医院急诊科收治的急性缺血性脑卒中溶栓患者63例,随机分为瑞替普酶组和尿激酶组,比较两组溶栓前后NIHSS评分、Barthel指数、出血并发症等.结果 两组治疗后较治疗前NIHSS评分改善明显,两组溶栓药物效果肯定,不同时点差异有统计学意义...     

脉络宁注射液和复方丹参注射液治疗急性缺血性中风的疗效观察

目的：观察脉络宁注射液和复方丹参注射液治疗急性缺血性中风的临床疗效；并探讨脉络宁注射液的临床疗效与给药时间、药物剂量及中医证型的关系。方法：将急性缺血性中风患者５０２例随机分为脉络宁注射液治疗组３７７例和复方丹参注射液对照组１２５例，连续治疗１４日～２８日。结果：脉络宁注射液的基本显效率（７０．０３％）及总有效率（９５．７６％）均明显优于对照组（２６．４０％和８１．６０％），Ｐ均＜０．０１。时效关系：脉络宁注射液的起效时间在７日，持续作用到１４日；量效关系：脉络宁注射液每日４０ｍｌ为治疗的最佳剂量；证效关系：脉络宁注射液可广泛应用于急性缺血性中风的各个中医证型。结论：脉络宁注射液更适合于急性缺血性中风的治疗     

Therapeutic hypothermia for acute ischemic stroke

Intravenous recombinant tissue plasminogen activator remains the only US FDA-approved treatment for acute ischemic stroke. However, the very limited time window for its administration restricts its usefulness. Furthermore, it is becoming increasingly clear that, given the numerous pathways via which cerebral ischemia causes cell death, the capacity to inhibit multiple mechanisms simultaneously may provide additive or synergistic beneficial clinical effects for stroke patients. Although no clinical trials have yet investigated the efficacy of therapeutic hypothermia in focal cerebral ischemia, its pleiotropic neuroprotective actions, positive results in preclinical studies, as well as proven enhancement of neurologic outcomes in survivors of cardiac arrest and newborns with hypoxic-ischemic encephalopathy, make this neuroprotective strategy highly promising. This review presents an overview of the potential role of hypothermia in the treatment of acute ischemic stroke and discusses ischemic cell death pathophysiology, neuroprotective mechanisms of hypothermia, methodologies employed for the induction of hypothermia, results from animal models of cerebral ischemia, and finally, currently available clinical trial data. Two valuable lessons learned thus far are that first, rapid induction of hypothermia is key and is best accomplished with a combination of ice-cold saline infusion and the use of endovascular cooling devices, and second, that shivering can be overcome with aggressive anti-shivering protocols including meperidine, buspirone and surface warming. We await the results of clinical trials to determine the utility of therapeutic hypothermia in acute ischemic stroke. If proven efficacious, hypothermia would be a welcome complement to established reperfusion therapies for ischemic stroke patients.     

Prevention of venous thromboembolism after acute ischemic stroke

Venous thromboembolism (VTE) is a common complication after acute ischemic stroke. When screened by 125I fibrinogen scanning or venography, the incidence of deep-vein thrombosis (DVT) in stroke patients is comparable with that seen in patients undergoing hip or knee replacement. Most stroke patients have multiple risk factors for VTE, like advanced age, low Barthel Index severity score or hemiplegia. As pulmonary embolism is a major cause of death after acute stroke, the prevention of this complication is of crucial importance. Prospective trials have shown that both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective in reducing DVT and pulmonary embolism in stroke patients. Current guidelines recommend the use of these agents in stroke patients with risk factors for VTE. Some clinicians are concerned that the rate of intracranial bleeding associated with thromboprophylaxis may outweigh the benefit of prevention of VTE. Low-dose LMWH and UFH seem, however, safe in stroke patients. Higher doses clearly increase the risk of cerebral bleeding and should be avoided for prophylactic use. Both aspirin and mechanical prophylaxis are suboptimal to prevent VTE. Graduated compression stockings should be reserved to patients with a clear contraindication to antithrombotic agents.     

Headache associated with acute ischemic stroke

Headache occurs frequently in acute ischemic stroke, but its frequency varies widely among different studies. We have prospectively studied headache features in patients with first-ever ischemic acute stroke and assessed the relationship between headache, stroke location, and etiology. The study included consecutive patients admitted to our Stroke Unit for a first-ever ischemic acute stroke. The study included 154 consecutive patients with ischemic stroke, and 54 of these (35.1%) had headache during stroke onset. Twelve patients (22.2%) with headache during stroke had history of headache; no patients without headache had history of headache. Headache was present in 25.8% (32/124) of the patients with anterior circulation stroke and in 73.3% (22/30) of the patients with posterior circulation stroke (p=0.001). Large artery disease was more frequent with than without headache (40.7% versus 14.0%, p=0.04). Headache was present in more than one-third of the patients with ischemic stroke. All patients with positive history for headache had headache during stroke onset. The cephalic pain was much more common among patients with infarcts in the posterior circulation than in patients in whom the anterior circulation was involved. Headache was more common when the cause of stroke was large artery disease. Received: 5 January 2001 / Accepted in revised form: 6 April 2001     

Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke

BackgroundDefining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache.MethodsThis prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache.ResultsOur previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%.ConclusionsWe suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.