972例原发性高血压患者门诊调查分析

根据2002年全国营养与健康调查资料显示,我国成人高血压患病率为18.8%,有高血压患者1.6亿,但高血压的知晓率、控制率很低[1]。血压升高是中国人群脑卒中发病最重要的危险因素,是近年来青年缺血性脑卒中最重要的危险因素[2],也是冠心病、心衰及肾病的主要危险因素,积极控制高血压,可预防脑卒中及冠心病等事件的发生。本文通过对972例门诊初诊原发性高血压患者的调查,了解本地区高血压患者对高血压的认知程度及治疗情况,便于有针对性地开展高血压的群防群治。     

急性缺血性脑血管病患者一级预防中高血压防治现状

目的 调查分析急性缺血性脑血管病患者一级预防中高血压的防治状况.方法 回顾性统计分析我院1年中急性脑梗死或短暂性脑缺血发作(transient ischemic attack,TIA)伴有高血压的住院患者入院前的高血压知晓率、治疗率及控制率.按文化程度分为小学,初中,高中,大学及以上4组,分别比较各组的治疗率和控制率.针对各组中高血压病进行分级统计,比较相同级别的不同文化程度患者人群之间的控制率是否有不同.结果 以急性脑梗死或TIA入院的高血压患者518例中患者对高血压的知晓率、治疗率和控制率分别为51.9%、47.5%和25.2%.269例高血压知晓者中,按受教育层次分为小学、初中、高中和大学及以上4组,各组总体治疗率和控制率比较均P ＜ 0.05,差异有统计学意义,各组间控制率比较,小学和初中无统计学差异,P ＞ 0.05;初中和高中及高中与大学及以上组比较,均P ＜ 0.05,差异有统计学意义.各受教育组中,分别按高血压病分级法将患者分级,相同高血压分级患者,各组间总体的控制率有差异;在高血压病1级组中,各文化层次不同组产生的不同控制率之间的差异有统计学意义,与受教育程度呈正相关.结论 针对急性缺血性脑血管病的一级预防,高血压的防治工作仍旧十分滞后.需要提高针对低文化层次的患者宣教监督管理,来提高血压病的治疗率与控制率.     

899例缺血性脑卒中二级预防干预调查

目的 了解缺血性脑卒中患者住院期间二级预防药物的应用情况,为改进缺血性脑卒中二级预防工作提供依据.方法 回顾性调查899例缺血性脑卒中患者住院期间二级预防药物的服药率.结果 在899例缺血性脑卒中患者中,合并高血压者有632例,合并糖尿病者有220例,既合并有高血压又合并糖尿病者有177例.入选的899例患者中,服用抗血小板药物者占91.9％ (826例),在短暂性脑缺血发作组和脑梗死组间差异有统计学意义(P＜0.01);服用调脂药物者占77.2％(694例),在短暂性脑缺血发作组和脑梗死组间差异无统计学意义;632例缺血性脑卒中合并高血压患者中服用降压药者占95.4％(603例);220例缺血性脑卒中合并糖尿病患者中服用降糖药者(包括使用胰岛素)占84.5％(186例);177例既合并有高血压又合并有糖尿病的脑卒中患者中均用药者占83.1％(147例).结论 住院期间脑梗死患者抗栓药物服用率较短暂性脑缺血发作高,缺血性脑卒中二级预防用药尚不令人满意,临床医生应对脑卒中的二级预防治疗给予重视.     

缺血性脑卒中患者二级预防现状及再发脑卒中的危险因素分析

目的探讨缺血性脑卒中患者二级预防现状,并对其再发脑卒中危险因素及干预对策进行分析,以降低再发脑卒中的发生率。方法对2012-06—2013-06收治的278例脑卒中患者的临床资料进行回顾性分析,其中再发性脑卒中61例为观察组,未再发性脑卒中217例为对照组,采用Logistic逐步回归分析,分析其再发脑卒中的危险因素及干预对策。结果脑卒中患者再次发生脑卒中的发病率为24.10%(67/278),相关危险因素方面,2型糖尿病病史和高血压患病率较高,均为85.61%,控制率较低,分别为49.58%、49.16%,超重肥胖和总胆固醇水平异常的阳性率也较高,控制率也较低;单因素分析结果显示,缺血性脑卒中患者发生脑卒中有统计学意义的相关危险因素包括高血压、2型糖尿病、房颤病史、总胆固醇水平异常等相关因素;本研究中多因素分析进一步表明,再发缺血性脑卒中的独立相关危险因素是总胆固醇异常(OR=3.472)、2型糖尿病血糖未控制(OR=2.237),高血压未控制(OR=2.851)和房颤病史(OR=1.945)等。结论缺血性脑卒中患者在2型糖尿病和高血压控制率低,总胆固醇升高和超重肥胖发生率较高,总胆固醇水平升高、房颤病史及血糖、血压控制欠佳与脑卒中再发显著相关。     

北京市11家医院缺血性卒中和短暂性脑缺血发作患者血压控制状况的横断面调查

目的 评估北京地区缺血性卒中和短暂性脑缺血发作（transient ischemic attack ,TIA）患者血压控制及降血压药物使用现况。方法 采用横断面调查方法,对北京11个医院神经内科门诊就诊缺血性卒中或TIA诊断明确的连续病例近期的血压控制及降血压药物使用情况进行调查。结果 2006年7月1日～8月15日期间11个医院参加调查,总计1247例缺血性卒中和TIA患者患者连续入选纳入分析,其中伴高血压者919例 (73.7%),血压控制达标率[按收缩压（SBP）＜140 mmHg和舒张压（DBP）＜90 mmHg]为46.8％（413/919）。伴糖尿病者297例,血压控制达标率[按SBP<130mmHg和DBP<80mmHg]为13.1%（39/297）。伴高血压者919例中,739例患者使用各种降血压药物,使用比例分别为钙通道阻滞剂（calcium channel blocker,CCB）61.2%（452/739）、肾素-血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitor,ACEI）26.8%（198/739）、β-受体阻滞剂15.7%（116/739）、复方制剂15.2%（112/739）、利尿剂8.0%(59/739)、血管紧张素II受体拮抗剂（angiotensin II receptor antagonist,ARB）7.7%（57/739）、α-受体阻滞剂1.3％（13/739）。关于患者未用药的原因：42.7％（53/124）患者认为血压已控制故停药,其次29.8％（37/124）的患者回答是医生未建议。结论 北京市缺血性卒中和TIA患者血压控制水平参照临床指南要求目标值达标率偏低,伴糖尿病的患者血压控制更不理想,亟待加强对卒中患者血压的控制,缩短临床实践与指南间的差距。     

社区高血压患者健康教育效果评价

几十年来,高血压患病率呈现快速增加势头,特别近年来,我国高血压病率激进,每年新增高血压患者600多万,另有150万人死于高血压引起的脑卒中,而当前我国高血压普遍存在着患病率高、病死率高、残疾率高、知晓率低、治疗率低、控制率低的"三高"、"三低"特征.     

超高龄缺血性脑卒中患者生存预后及危险因素分析

目的 探讨超高龄缺血性脑卒中患者生存预后及危险因素.方法 回顾性分析2006年1月至2016年12月就诊于北京医院、首次发作缺血性脑卒中并≥80岁的住院患者67例,随访至2019年12月死亡37例、存活30例.收集并分析所有患者发病时性别构成、年龄、BM I(体重指数)、血管危险因素(糖尿病、高血压、血脂异常、缺血性心...     

原发性震颤三家系分析

目的探讨原发性震颤的临床表现、家系特点及治疗。方法对3例原发性震颤患者的临床特点和家族史进行分析。结果ET在同一家族中男女均可发病,3例先证者一级、二级亲属患病率分别为：41.2%、40.0%和50.0%。结论原发性震颤是具有家族遗传性的疾病,以姿势性或意向性震颤为主,手及头部受累明显,多数患者饮酒试验阳性,β受体阻滞剂普奈洛尔治疗有效。     

缺血性脑卒中的血压调控

近20年来,抗高血压治疗的最大收益是使卒中发病率降低了35%～50%。在缺血性脑卒中患者中患高血压的比例很高,TOAST研究亦提示腔隙性脑梗死患者中70%以上伴有高血压。由此可见,高血压与脑卒中密切相关,心内科和神经科医生在脑梗死急性期如何调控血压这个问题上一直存在分歧。因此,合理应用降压药,做好缺血性卒中的一级和二级预防以及脑卒中急性期如何合理调控血压是需要探讨的问题。     

卡维地洛伍用小量双氢克尿塞治疗高血压的疗效观察

卡维地洛是近几年应用于临床的新型β受体阻滞剂，国外研究认为是较好的降压药，能阻断心血管疾病进程。双氢克尿塞是传统的噻嗪类利尿药，但最新的JNC7报告推荐为最基础的降压药。我们用卡维地洛(商品名瑞欣乐，由深圳清华源兴药业有限公司生产)加小量双氢克尿塞(山西省临汾民康制药厂生产)，通过自身对照开放实验法，治疗60例原发性高血压，现将临床疗效观察报告如下。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.