尼莫地平胶囊剂和片剂治疗偏头痛384例疗效观察

目的：评价尼莫地平胶囊剂治疗偏头痛的疗效。方法：在３８４ 例偏头痛患者中，以尼莫地平片剂进行随机对照研究。结果：尼莫地平胶囊剂组的总有效率为９７ ．５ ％ 和９６ ．９ ％ ，尼莫地平片剂组的总有效率为８７ ．５ ％ 和７８ ．１ ％ 。结论：尼莫地平胶囊剂的疗效优于片剂。     

持续泵入尼莫地平治疗蛛网膜下腔出血后脑血管痉挛的疗效研究

目的探讨持续泵入尼莫地平防治蛛网膜下腔出血后脑血管痉挛的疗效。方法 53例蛛网膜下腔出血患者随机分为观察组和对照组,观察组在常规治疗基础上持续泵入尼莫地平,对照组行常规治疗,口服尼莫地平片。比较持续泵入和口服尼莫地平的疗效。结果两组患者脑血管痉挛发生率有明显差别,有统计学意义,观察组疗效优于对照组。结论持续泵入尼莫地平预防和治疗蛛网膜下腔出血后脑血管痉挛有明显疗效。     

尼莫地平治疗妊高征疗效观察

为观察尼莫地平对妊高征患者视网膜中央动脉血流的影响，在１４例妊高征患者口服尼莫地平前后用彩色多普勒检测视网膜中央动脉血流，并与同用１４例静滴硫酸镁者比较。结果显示尼莫地平显著降低视网膜中央动脉搏动指数（ＰＩ）（Ｐ＜０．０１），同时明显降低血压（Ｐ＜０．０５）。尼莫地平扩张视网膜中央动脉，提示其对脑部其它小动脉有相似作用。故尼莫地平可能成为今后妊高征治疗的另一种选择。     

钙拮抗剂尼莫地平救治重型颅脑伤的临床研究

观察了钙拮抗剂尼莫地平对重型颅脑损伤的治疗作用，尼莫地平治疗组３４６例，常规治疗对照组１４２例，结果表明，尼莫地平治疗组颅升高幅度较小，ＣＴ动态扫描水肿明显减轻，临床恢复良好率达８０．１％，病死率明显下降，仅为１８．２％，并就尼莫地平救治重型颅脑损伤的作用及有关机制等进行了讨论。     

钙拮抗剂尼莫地平救治重型颅脑损伤的临床研究

观察了钙拮抗剂尼莫地平对重型颅脑损伤的治疗作用。尼莫地平治疗组３４６例，常规治疗对照组１４２例，结果表明，尼莫地平治疗组颅内压升高幅度较小，ＣＴ动态扫描脑水肿明显减轻，临床恢复良好率达８０．１％，病死率明显下降，仅为１８．２％。并就尼莫地平救治重型颅脑损伤的作用及有关机制等进行了讨论。     

应用CT灌注和CTA研究尼莫地平对SAH的影响

目的尼莫地平是一种降低蛛网膜下腔出血(SAH)患者发病率和死亡率的疗法,对SAH兔模型,使用功能性CT成像研究尼莫地平的作用。方法在52只新西兰怀孕中诱导SAH兔子随机分为2组:治疗(尼莫地平)或对照组(无治疗)。CT灌注和CT血管造影用于测量SAH后基线水平,10,30和60min的CBF和基底动脉直径,以及第3,5,7,9和16天。结果治疗组基底动脉直径大于对照组SAH后(P0.05)。当血管痉挛15%时,尼莫地平组的CBF明显高于对照组脑干,小脑,枕叶脑和深部灰质(P0.05)。尼莫地平组神经功能评分明显优于对照组,差异有统计学意义(P0.05)。结论尼莫地平治疗动物显示:1)平均基底动脉直径增加;2)增加平均CBF,尽管延迟性血管痉挛的发生率和严重程度无明显差异。这些数据为未来研究比较了SAH新疗法与尼莫地平疗效的依据。     

尼莫地平治疗蛛网膜下腔出血伴脑血管痉挛100例

原发性蛛网膜下腔出血发病急、死亡率高。流入蛛网膜下腔的血液或因直接刺激，或因血细胞破坏，释放大量促血管痉挛物质，引起脑血管痉挛，并发脑梗死，加剧脑水肿，导致病情进一步恶化（1）。因此，较好地防治蛛网膜下腔出血（SAH）并发的脑血管痉挛，成为抢救SAH成功的关键。1991年1月～1996年4月，我们应用尼莫地平治疗SAHIOO例，并与1991年1月以前70例未用尼莫地平治疗的SAH患者的疗效进行对比，发现尼莫地平对蛛网膜下腔出血所致的脑血管痉挛有较好的对抗作用。1临床资料1．五一般情况用尼莫地平组（治疗组）100例与未用尼莫地平…     

联合药物方案辅助治疗对脑动脉瘤栓塞术后脑血管痉挛患者GCS评分、生活质量及脑梗死发生率影响

目的探讨法舒地尔联合尼莫地平方案辅助治疗对脑动脉瘤栓塞术后脑血管痉挛患者Glasgow昏迷评分(GCS)、生活质量及脑梗死发生率的影响。方法选取脑动脉瘤栓塞术后脑血管痉挛患者100例,采用随机数字表法分为尼莫地平组(n=50)与联合组(n=50)。尼莫地平组给予尼莫地平单用辅助治疗;联合组给予法舒地尔联合尼莫地平辅助治疗。比较两组患者治疗前、治疗后GCS评分、Barthel指数评分、神经功能缺损评分(NFI)、大脑中动脉(MCA)平均血流速度、术后3个月Glasgow预后分级(GOS)情况及术后30 d脑梗死发生率等。结果联合组患者治疗后GCS评分、Barthel指数评分及NFI评分均显著优于尼莫地平组及治疗前,差异有统计学意义(P<0.05);联合组患者治疗后,MCA平均血流速度显著快于尼莫地平组及治疗前,差异有统计学意义(P<0.05);联合组患者术后3个月GOS分级显著优于尼莫地平组,差异有统计学意义(P<0.05);联合组患者术后30 d脑梗死发生率显著低于尼莫地平组,差异有统计学意义(P<0.05)。结论联合药物方案辅助治疗脑动脉瘤栓塞术后脑血管痉挛,可有效改善意识状态,降低神经功能损伤程度,促进脑动脉血流灌注恢复,提高日常生活质量,且有助于避免远期脑梗死发生。     

180例尼莫地平治疗偏头痛的临床观察

目的 探讨尼莫地平治疗偏头痛的疗效、不良反应.方法 180例偏头痛患者给予尼莫地平30mg,每日3次,口服,两周为一疗程,可用多个疗程治疗.结果 180例偏头痛患者,控制85.0%,显效30.0%,无效8.3%.结论 尼莫地平为二氢吡啶类钙离子拮抗剂,通过观察,用于治疗偏头痛,效果好,副作用小,安全性高.     

针灸结合尼莫地平治疗轻度认知功能障碍的疗效观察

目的观察针灸联合尼莫地平治疗轻度认知功能障碍（MCI）患者的临床疗效。方法将符合纳入标准的60例MCI患者随机分为针药组和药物组,每组30例。药物组单使用尼莫地平治疗,针药组在使用尼莫地平的同时运用针灸治疗。共治疗8周;治疗前、治疗4周和8周后分剐进行MMSE量表检测。结果两个试验组分组均衡,具有可比性。治疗4、8周后两个组MMSE量表得分均较治疗前有显著增加（P〈0．01）,针药组在8周后MMSE量表得分显著高于药物组（P〈0．01）。结论针灸联合尼莫地平对MCI有良好的治疗效果,并且其疗效优于单独使用尼莫地平。     

Dynamic CT perfusion imaging in subarachnoid hemorrhage-related vasospasm

BACKGROUND AND PURPOSE: Nimodipine is a therapy that reduces morbidity and mortality in patients with subarachnoid hemorrhage (SAH), though the mechanisms by which it does so are not well understood. In a rabbit model of SAH, we studied the effects of nimodipine by using functional CT imaging. We hypothesized that the nimodipine treatment group would have (1) increased mean basilar artery diameter, (2) less diminished cerebral blood flow (CBF) following vasospasm, and (3) better neurologic outcomes. METHODS: SAH was induced in 26 New Zealand White rabbits randomized to 2 groups: treated (nimodipine) or control (no treatment). CT perfusion and CT angiography were used to measure CBF and basilar artery diameter at baseline, 10, 30, and 60 minutes after SAH, and on days 3, 5, 7, 9, and 16. Neurologic assessments were performed on each day of scanning. RESULTS: Basilar artery diameter in the treated group was greater than in the control group post-SAH (P < .05). When vasospasm was >15%, CBF in the nimodipine group was significantly greater than in the control group in the brain stem, cerebellum, parieto-occipital cerebrum, and deep gray matter (P < .05). Neurologic scores in the nimodipine group were significantly better than in the control group on days 5 and 9 (P < .05). CONCLUSION: Animals treated with nimodipine showed (1) increased mean basilar artery diameter, (2) improved neurologic outcome, and (3) increased mean CBF despite no significant difference in the incidence and severity of delayed vasospasm. These data provide a basis for future studies comparing the efficacy of new treatments for SAH to that of nimodipine.     

外伤性脑肿胀的临床研究

本研究的目的在于探讨外伤性脑肿胀的临床特征、临床分类和病理生理基础。将３４例此类患者分为致死组和非致死组，并进行ＣＴ、颅内压、动脉血压、脑灌注压、脑血流、脑氧代谢率和脑动静脉氧差检查和测定。结果显示致死组患者有明显脑受压，中线移位，ＣＴ值低，ＩＣＰ升高，ＣＰＰ、ＣＢＦ、ＣＭＲＯ２、ＡＶＤＯ２降低，与非致死组比较，差异有显著性。说明脑血容量和脑水含量增加引起的严重脑缺血可能是致死性脑肿胀的主要病理生     

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric artery dissection. In case 2, there was an acute mesenteric artery dissection with intestinal infarction. In both cases 1 and 2, segmental mediolytic arteriopathy was found in the vertebral arteries. Cases 3 and 4 were sudden deaths from traumatic subarachnoid hemorrhage with intracranial vertebral artery rupture. Genetic testing in all four cases revealed point mutations in the type 3 procollagen gene (COL3A1), as observed in vascular Ehlers-Danlos syndrome. Based on the first two cases, we propose that segmental mediolytic arteriopathy may be a marker for this disease. We further suggest that vascular Ehlers-Danlos syndrome may be related to the pathogenesis of traumatic vertebral artery injury, in some cases. We recommend that cases of segmental mediolytic arteriopathy and traumatic subarachnoid hemorrhage undergo genetic testing for COL3A1 mutations.     

急重症颅脑外伤颅内压监测与脱水剂合理使用的临床研究

目的 持续动态监测急重症颅脑外伤的颅内压变化,探讨有效降低颅内压的脱水剂合理使用.方法 通过持续动态监测56例中重型颅脑外伤的颅内压变化,分析其特点; 并选择其中31例颅内压≥30mmHg,以自身对照方式比较两种脱水剂组合(三联组合: 甘露醇+甘油果糖+呋塞米; 二联组合: 甘露醇+呋塞米)的降颅压效果.结果 56例颅...     

高原头痛头昏与脑血流改变的关系

在西藏山南（3600m)观察了高原头痛、头昏的发生情况和与脑血流的关系。结果表明，快速进驻高原和久居高原人头痛、头昏的人数均达一半以上，快速进驻高原头痛、头昏者的脑血流图（REG）主峰波幅、流入容积速度和上升角明显高于无症状者，久居高原头痛、头昏者的REG主峰波幅明显高于无症状者，流入容积速度和上升角明显小于无症状者，提示高原急、慢性缺氧头痛、头昏的原因不同，急性缺氧头痛，头昏同脑血流过度增加有关；慢性缺氧头痛、头昏主要同脑血管的顺应性降低、脑血流减少有关。     

颅脑创伤早期兴奋性氨基酸的变化及其意义

目的探讨兴奋性氨基酸（ＥＡＡ）在颅脑创伤早期的变化及钙通道阻断剂治疗外伤性脑水肿的机制。方法通过大鼠脑外伤模型检测了外伤后脑组织含水率、脑脊液中ＥＡＡ含量以及钙通道阻断剂（尼莫地平）对两者变化的影响；通过神经细胞培养模型观察了钙通道激动剂（Ｂａｙ－Ｋ－８６４４）、谷氨酸（Ｇｌｕ）、天门冬氨酸（Ａｓｐ）及尼莫地平对神经元钙通道电流（ＩＣａ）的影响。结果外伤后脑组织含水率、脑脊液ＥＡＡ含量均较对照组明显增加（Ｐ＜０．０５），用尼莫地平治疗后两者均明显下降（Ｐ＜０．０５）。Ｂａｙ－Ｋ－８６４４、Ｇｌｕ、Ａｓｐ可使培养神经元ＩＣａ增加，并存在明显的剂量依赖关系。结论颅脑创伤早期ＥＡＡ释放增加，ＥＡＡ促进Ｃａ２＋内流。钙通道阻断剂治疗外伤性脑水肿的机制是抑制脑外伤后ＥＡＡ释放及直接减少Ｃａ２＋内流。     

MR多模态对慢性大脑中动脉闭塞侧支循环的临床研究价值

目的 探讨MR多模态的磁共振血管成像(MRA)、液体衰减反转恢复成像序列(FLAIR)和三维的伪连续式动脉自旋标记技术(three dimensional pseudo continuous arterial spin labeling,3D-PCASL)对慢性大脑中动脉闭塞(chronic middle cerebr...     

高渗盐复合液治疗急性颅脑损伤的实验研究

目的:探讨高渗氯化钠羟乙基淀粉40溶液(以下简称高渗盐复合液)对外伤性颅内高压和脑水肿的治疗作用。方法:制作猫中型液压颅脑损伤模型,伤后3 h行高渗盐复合液、甘露醇和乳酸林格氏液治疗。比较伤前、治疗时、治疗后 30、60、90和120 min的颅内压及血钠变化。动物处死后测量脑组织含水量。结果:高渗盐复合液组和甘露醇组用药后动物颅内压均立即下降,维持时间上无明显差异(P>0．05);而乳酸林格氏液组颅内压无下降。3组动物受伤侧脑组织含水量无明显差别(P>0．05);高渗盐复合液组和甘露醇组的未损伤侧脑组织含水量差别不大,但均明显低于乳酸林格氏液组(P<0．05);高渗盐复合液组于用药后30、60、90 min时血钠明显升高。结论:高渗盐复合液具有与甘露醇同样的作用,可有效地降低颅内压和对未损伤侧脑组织脱水,从而为临床救治急性颅脑损伤提供一种有效的复苏液体。     

Dipyridamole, cold pressor test, and demonstration of endothelial dysfunction: a PET study of myocardial perfusion in diabetes.

Much evidence suggests endothelial dysfunction to be present in non-insulin-dependent diabetes mellitus (NIDDM) and to be important for the development of myocardial ischemia. Endothelial function in the coronary vessels may be studied in various ways. We compared the effect of cold pressor testing (CPT) with that of dipyridamole, a pharmacologic vasodilator, on coronary blood flow (CBF) measured by PET in NIDDM patients and healthy volunteers. In addition, we studied the effect of acute angiotensin-converting enzyme (ACE) inhibition on the flow response. METHODS: Ten NIDDM patients and 10 control subjects participated. Myocardial perfusion was determined at baseline, during CPT, and after dipyridamole infusion by PET using intravenous (13)N-ammonia. RESULTS: Resting CBF was similar in NIDDM patients and in control subjects. CPT increased CBF by 20% in the control group, whereas no increase was observed in the patients. After dipyridamole infusion, CBF increased 2- to 3-fold in patients and 3- to 4-fold in control subjects. The increase and maximal CBF were significantly higher in control subjects than in patients. During ACE-inhibitor infusion, which had no influence on resting CBF in patients or control subjects (n = 5), CPT increased CBF by 14% in the NIDDM group. After dipyridamole, CBF increased 3- to 4-fold in both groups. The increase in CBF and maximal CBF in the 2 groups were not different during ACE-inhibitor infusion. CONCLUSION: In these NIDDM patients without evidence of epicardial coronary disease, endothelial dysfunction is strongly suggested by an impaired increase in CBF both to dipyridamole and to CPT. This dysfunction was reversed by infusion of an ACE inhibitor. Although ACE inhibition during CPT did induce significant increases in CBF in the patients, the changes during ACE inhibition were small compared with the dipyridamole response, and the absence of CBF increase during CPT in 3 of the 10 control subjects further limits the value of CPT for the study of coronary endothelial dysfunction.     

运用经颅多普勒超声对脑损伤血流动力学变化与脑顺应性关系的研究

目的：探讨脑血流动力学变化与脑顺应性的关系。方法：制作中、重度脑损伤动物模型，分别于伤后不同时相点用经颅多普勒超声（ＴＣＤ）仪探测猫大脑中动脉（ＭＣＡ）血流速度，计算搏动指数（ＰＩ），阻力系数（ＲＩ）及收缩峰与舒张期末血流速度比值（Ｓ／Ｄ），同时测量颅内压（ＩＣＰ）、容积压力反应（ＶＰＲ）及压力容积指数（ＰＶＩ），比较各指标间的关系。结果：脑损伤早期，ＭＣＡ血流速度增快，６小时后达高峰，以后逐渐减慢，２４小时后血流速度显著低于伤前；ＰＩ、ＲＩ及Ｓ／Ｄ值逐渐增大，２４小时后明显高于伤前（Ｐ＜０．０５）；损伤越重，变化越明显。ＩＣＰ、ＶＰＲ逐渐增大，ＰＶＩ降低。ＩＣＰ与收缩峰血流速度（Ｖｓ）、平均血流速度（Ｖｍ）、搏动指数（ＰＩ）及Ｓ／Ｄ值间有良好线性关系（Ｐ＜０．０１）；ＰＶＩ与Ｖｓ、舒张期末血流速度（Ｖｄ）、Ｖｍ及ＰＩ间有良好线性关系（Ｐ＜０．０１），但ＶＰＲ与ＭＣＡ各测量值间关系不明显。结论：ＴＣＤ仪能较好地反映脑损伤后血流动力学变化，以此可推测ＩＣＰ及脑顺应性的改变。