混合性中风的实验动物模型研究

目的探讨混合性中风的实验动物模型的制作方法，从而了解其发病机理。方法利用１８０只肾血管性高血压鼠（ＲＨＲｓ）通过升高或降低血压来改变血流动力学，及加用纤维蛋白原后再升高或降低血压，注意控制药物剂量及持续时间来引发脑卒中。筛选出梗塞出血并存的动物模型。结果发现加用纤维蛋白原（２００±５０）ｍｇ后，利血平０３ｍｇ，间隔２ｈ注射３次组引发混合性中风的发生率最高，达９５％。受损部位以小脑、内囊、皮质、海马、丘脑为多，以大梗塞－小出血型中风为多，梗塞以小脑、海马为著。这些梗塞灶和出血灶都在２４ｈ内发生。结论长期高血压脑动脉硬化是混合性中风的病理基础，血压剧烈的波动和血液粘滞度的变化是引起混合性中风的重要因素。     

脑出血合并梗塞

报告4例多年高血压的老年人,既往无中风史,突发偏瘫,CT显示大脑半球并存血肿和梗塞灶,呈现混合性中风的临床病理状态。认为出血和梗塞是同时或在短时间内相继发生的,当有2个部位病变的体征时更应注意混合性中风的可能,治疗上须将血压控制在适宜水平上,积极的中性治疗是重要的。     

混合性中风临床与CT(附58例报告)

本文报告58例混合性中风,均经CT证实为新鲜出血灶和梗塞灶并存,占同期脑出血病人的5.4％。本资料示:混合性中风之出血灶较单纯脑出血病灶偏小,98.3％小于40ml,其中半数以上小于10.5ml;梗塞灶绝大多数为腔隙灶,以底节区多见;出血部位、血肿大小与梗塞发生率无明显关系。临床双侧及多灶体征多见,出血灶体征多较明显,梗塞灶体征相对轻易被忽视。合理的中性或缓和活血化瘀治疗效果好。     

混合性中风22例临床分析

本文报道２２例混合性中风，占同期中风病人的１３．１％。临床观察和病理资料证实，中风急性期完全可同时存在两种不同性质的病变，出血性和缺血性。此二种病变可以互相促进，相互转化。本资料归纳为二种类型；出血一梗塞型；出血型。早期多次ＣＴ扫描对混合性中风有可靠诊断价值。治疗以中性为主，合理使用渗透性脱水剂，注意脱水后补充入量，适当控制血压水平是关键。     

肾血管性高血压大鼠自发脑卒中

通过研究双肾双夹型肾血管性高血压大鼠自发脑卒中的病理形态,发现高血压所致的脑内细小动脉纤维素样坏死、透明变性和微动脉瘤形成等是出血性脑卒中和脑梗塞的共同病理基础。探讨了高血压动脉硬化性脑卒中的发病机制,并为混合性脑卒中提供了实验依据。     

是独立疾病还是并发症─—对混合性中风的再思考

是独立疾病还是并发症─—对混合性中风的再思考韦兴昌中风是当代人类三大致死病因之一，传统分类将其分为缺血性和出血性两类。近年来随着ＣＴ、ＭＲ等新技术的广泛应用，发现越来越多的缺血性与出血性中风同时或短时间内先后发生，使脑卒中的临床表现更加复杂而多样，导...     

一九八九年目录索引

脑血管病脑出血的CT与病理对比分析不伴偏瘫的完全性失语手术治疗大脑中动脉瘤3例报告影响高血压脑出血预后的因素(综述)颈椎侧方穿刺致蛛网膜下腔出血4例报告脑梗塞病人双侧颈动脉B—扫描和超声脉冲 多普勒血流测定对比观察自发性小脑出血手术适应证的探讨胞二磷胆硷治疗脑动脉硬化痴呆13例胞二磷胆硷治疗脑卒中疗效观察轻微椎一基底动脉缺血性眩晕的视觉诱发电 位研究馄合性中风—一种应予重视的中风类型动脉硬化性混合性中风枕叶脑梗塞的半视野视觉诱发电位改变降低高血压性脑出血手术死亡率的探讨棍合性中风3例报告枕叶出血6例报告原…     

《中国神经精神疾病杂志》一九九一年目录索引

脑血管病用HDLC分析脑梗塞病人脑脊液中LEK和 一个未知组分急性缺血性中风的血浆和脑脊液精氨酸加压 素含量的观察脑卒中后血细胞流变学改变缺血性脑血管病血栓弹力图初步观察大面积脑梗塞10例分析钩体性脑动脉炎的CT所见(附28例报告)原发性蛛网膜下腔出血的心电图改变 (附280例临床及心电图资料)皮质下失语2例报告急性脑血管病人血清补体成份的测定脑血栓形成患者血浆t一PA、P人I活性和日- TG含量检测及相关性分析白细胞计数增高对中老年人蛛网膜下腔出血 预后的影响高血压性混合性中风自血光量子疗法对急性脑血管病患者48小时 疗效…     

易卒中型肾血管性高血压大鼠凝血和纤溶活性的动态观察

目的　动态观察易卒中型肾血管性高血压大鼠 (RHRSP)血液中凝血系统和纤溶系统的活性改变。方法　双肾双夹法制作RHRSP模型 ,分别于术后 2、4、6、8、1 0、1 2、1 4周取血 ,酶联免疫吸附测定 (ELISA)法检测凝血酶原片段 1 2 (F1 2 )和D 二聚体 (D dimer)含量。结果　 8周始RHRSP血浆中F1 2和D dimer含量逐渐增高 ,明显高于正常对照组 ,且F1 2与D dimer呈正相关 ,F1 2和D dimer均与大鼠收缩压密切相关。结论　血液中凝血系统和纤溶系统活性增高可能是RHRSP出现脑梗死或脑出血 ,甚至是混合性中风的原因之一     

混合性中风——一种应予重视的中风类型

中风是当代三大致死病因之一,历来被分为出血性和缺血性两大类型。但临床和病理研究都不断发现,在一个病人的一次中风期间,脑部可同时或相继发生出血和缺血两种病理过程。对这种混合性中风,迄今尚未引起足够的重视和深入的研究。这是因为:对脑出血或脑梗塞过去尚无完全可靠的临床诊断方法,而在混合并存时,则更难以确诊。在尸检时,虽可     

dl-3n-butylphthalide prevents stroke via improvement of cerebral microvessels in RHRSP

The purpose of the study is to establish a model of cold-induced stroke in hypertensive rats, and to study the preventive effect of dl-3n-butylphthalide ( NBP ) on stroke. Stroke-prone renovascular hypertension(RHRSP) was created in Sprague-Dawley rats. The animals were assigned randomly to NBP, aspirin treated and vehicle control group, with administration of the medications for 7 days, and then subjected to cold treatment in an environmentally controlled chamber for 3 days to induce the occurrence of stroke. The incidence of stroke, the volume of the brain lesion, patency of the microvessels by FITC-dextran perfusion and the number of microvessels by immunohisochemical detection of vwF were investigated. Cold induced different types of stroke in RHRSP. The incidence of ischemic stroke and the volume of the infarct were decreased, and the perfused microvessels were increased with NBP pretreatment. Our data suggest that NBP prevents cold-induced ischemic stroke via improvement of cerebral microvessels.     

Stroke-prone renovascular hypertensive rats

Purpose To summarized the methods for establishment, characteristics of vascular lesions in brain and heart and thc application of stroke-pronc renovascular hypertensive rats (RHRSP). Background Spontaneously hypcrtensivc rats (STR) and subtypes of SH R, especially stroke-prone spontaneously hypertensive rats (SHRSP) are considered as most important animal models at present for the studies of hypertension and its complications in heart and brain, evcn SHRSP arc considered as thc unique animal model in which prcvention of stroke can be studied cxperimentally Howcver, the applications of SHR and SHRSP are limited because of the effects of genetic deficits and thc difficulties with breeding Theretore, most of the researches on experimental stroke have been performed on the animal models with normotcnsion and normal structure of cerebral vessels. In fact, there are great differences in structure of cerebrovesscls, autoregulation of cerebral blood flow and extent of lesions in brain tissue, even the reaction to the medication after ischemia between the animals with extcnsive arteriosclerosis and with normal cerebral blood vessels. Obviously, thc relevancc of experimental stroke on normal animals to the stroke on cerebral arteriosclerotic patients clinically remains dubious. Data sources and methods Most published original articles about RHRSP in our laboratory were reviewed Results After the renal arteries were constricted bilaterally with ring-shape silver clips, the stroke-prone rcnovascular hypertensive rats were established. Hypertension was produced in all RHRSP(100%).The peak of blood pressure in RHRSP reached 29.1 ±3.0kPa. The lesions of cerebral arteries and arterioles and the damage of cerebral capillary structure by hypertension were observed in the RHRSP. The incidence of spontaneous stroke was 56.4% with in 40 weeks after the renal artery constriction. Left ventricular hypertrophy and small coronary arterial lesions in myocardium were discovered in all RHRSP. Myocardial infarction occurred spontaneously in 41.8% of RHRSP. The animal models have been used for the studies on mechanisms of stroke and myocardial infarction. Futhermore, RHlRSP with cercbrovascular basal pathological changes can be induced as cerebral thrombosis by thc photochemical method, which is quite similar to that of human being in evolution. Therefore. RHRSP with photochemical cerebral thrombosis can be used to appraised therapeutic effects of medication more objectively Conclusions Because the vascular lesions in cerebrum and heart in RHRSP are similar to that in human beings with hypertension, RHRSP can be used in the studies on mechanisms of hypertensive arterioscle-rotic stroke and cardiac lesions and on verifying the effects of different medications to complications of hypertension, and thc results might be more reliable than that in animal models without hypertension.     

脑梗死大鼠神经前体细胞增殖水平的研究

目的研究脑梗死病灶周围及海马处神经前体细胞增殖水平的动态变化。方法采用易卒中型肾性高血压大鼠(RHRSP)，电凝大脑中动脉(MCA)主干制成脑梗死(MCAO)模型。行大鼠神经功能评定，免疫组化观察并计数梗死灶边缘、对侧镜区及双侧海马5-溴脱氧尿核苷(Bromodeoxyuridine，BrdU)标记的细胞。结果MCAO后大鼠神经功能评分减低，5d时恢复正常。MCAO后梗死灶边缘、对侧镜区及双侧海马均有BrdU阳性细胞分布，且病灶侧多于病灶对侧，集中分布于病灶周围。结论脑缺血可诱导神经前体细胞增殖并移向病灶，可能成为脑梗死恢复的重要物质基础。     

易卒中型肾血管性高血压大鼠血浆CAM-1和P-选择素的动态观察

目的动态观察易卒中型肾血管性高血压大鼠（RHRSP）血浆ICAM-1和P-选择素的活性改变。方法双肾双夹法制作RHRSP模型,分别于术前及术后2、4、6、8、10、12、16周取血,酶联免疫吸附测定（ELISA）法检测ICAM-1和P-选择素含量。结果4周始RHRSP血中ICAM-1和P-选择素含量逐渐增高,明显高于正常对照组,且ICAM-1和P-选择素呈正相关,ICAM-1和P-选择素均与大鼠收缩压密切相关。结论血浆中ICAM-1和P-选择素含量升高提示梗死或出血的危险性增加,可作为脑卒中的预测指标之一。     

环维黄杨星D对高血压大鼠脑缺血GAP-43 mRNA表达与细胞损伤的影响

目的观察中药单体环维黄杨星D(CVB-D)对易卒中型肾血管性高血压大鼠(RHRSP)脑缺血再灌注不同时间脑组织生长相关蛋白-43(GAP-43)mRNA表达与细胞超微结构损伤的影响。方法采用环形银夹使SD大鼠的双侧肾动脉狭窄,制成RHRSP,再用线栓法制成一侧大脑中动脉闭塞(MCAO)模型。用原位杂交等方法观察CVB-D对脑缺血2h后复流1d、7d、14d、30d不同时间点大鼠脑组织GAP-43mRNA表达、水含量、梗死面积百分率、行为学评分及细胞超微结构的干预作用。结果脑缺血2h复流后1d缺血区周围及海马可见GAP-43mRNA表达,7d明显增多至高峰,14d开始下降,30d时则明显减少,CVB-D治疗组在上述区域各时间点较对照组显著增加。脑缺血再灌注7d后,治疗组较对照组大鼠脑水含量及梗死面积显著降低,受损脑组织神经元和血管壁的超微结构亦明显改善。结论CVB-D对RHRSP缺血性脑细胞损伤有一定保护作用,其促进轴突的再生可能与上调脑组织GAP-43mRNA表达有关。     

美托洛尔抗高血压预防脑卒中的实验病理学研究

目的探讨抗高血压治疗预防脑卒中的形态学机制。方法采用易卒中型肾血管性高血压大鼠口服美托洛尔治疗，观察抗高血压治疗各级脑动脉和心室壁厚度的形态学改变。结果治疗组大鼠血压仅短期轻度低于未治疗的高血压对照组，但治疗组各级脑动脉损害和左心室肥厚明显改善，脑卒、中发生率也显著低于高血压对照组。结论美托洛尔抗高血压治疗预防脑卒中的效果，不单纯由血压下降决定，还与其具有保护脑血管和逆转心室肥厚等作用有关。     

大鼠脑梗死后神经前体细胞的增殖及电针作用的实验研究

目的　研究脑梗死病灶周围及海马处神经前体细胞增殖水平的动态变化及电针治疗对其的影响。方法　采用易卒中型肾性高血压大鼠 (RHRSP) ,电凝法凝闭大脑中动脉 (MCAO)。用Garcia等的综合评分法评定大鼠的神经行为学功能 ,免疫组化观察梗死灶边缘、对侧镜区及双侧海马 5 溴脱氧尿核苷 (Bromodeoxyuridine,BrdU)标记细胞的变化。结果　MCAO后大鼠轻偏瘫 ,5天时神经行为学功能恢复正常。MCAO后梗死灶边缘、双侧镜区及双侧海马均有BrdU阳性细胞分布 ,且病灶侧多于病灶对侧 ,病灶周围分布密集。电针治疗促使梗死灶边缘BrdU阳性细胞增多 ,随着治疗时间增加细胞增多更明显。结论　脑梗死可诱导病灶周边及海马神经前体细胞增殖水平上调 ,2周内神经前体细胞随着电针治疗时间的增加而增多。神经前体细胞可能是脑梗死康复的重要物质基础。     

Hemorrhage after an acute ischemic stroke.MAST-I Collaborative Group

BACKGROUND AND PURPOSE: Hemorrhagic transformation is frequently seen on CT scans obtained in the subacute phase of ischemic stroke. Its prognostic value is controversial. METHODS: We analyzed 554 patients with acute ischemic stroke enrolled in the Multicenter Acute Stroke Trial-Italy (MAST-I) study in whom a second CT scan was performed on day 5. Presence of 1) intraparenchymal hemorrhages (hematoma or hemorrhagic infarction), 2) extraparenchymal bleeding (intraventricular or subarachnoid) and 3) cerebral edema (shift of midline structure, sulcal effacement or ventricular compression) alone or in association were evaluated. Death or disability at 6 months were considered as "unfavorable outcome." RESULTS: Patients who developed intraparenchymal hemorrhages, extraparenchymal bleeding, or cerebral edema had unfavorable outcome (83%, 100%, and 80%, respectively), but multivariate analysis demonstrated that only extraparenchymal bleeding (collinearity) and cerebral edema (OR=6.8; 95% CI, 4.5 to 10.4) were significant independent prognostic findings. Unfavorable outcome correlated with size of intraparenchymal hemorrhage (chi2 for trend=30.5, P<0.0001). Nevertheless, when a large hematoma was present the negative effect was mostly due to concomitant extraparenchymal bleeding (chi2=51.6, P<0.0001), and when hemorrhagic infarction was detected the negative effect was mostly explained by the association with cerebral edema (chi2=36.6, P<0.0001). CONCLUSIONS: Extraparenchymal bleeding and cerebral edema are the main prognostic CT scan findings in the subacute phase of ischemic stroke. Stroke patients with a high risk for developing these 2 types of brain damage should be identified. Measures to prevent and adequately treat their development should be implemented.     

Cerebral arterial dissection]

We investigated a total of 98 cases with stroke caused by cerebral arterial dissection recruited in Strategies against Stroke Study for Young Adults in Japan (SASSY-Japan). The most frequent site of dissection was the intracranial vertebrobasilar artery. The stroke subtype was divided into ischemic (TIA and cerebral infarction) and hemorrhagic types (subarachnoid hemorrhage). The ischemic type was predominant (69%) and patients with the ischemic type were younger than those with the hemorrhagic type (P < 0.01). In the intracranial arterial dissection, nearly all cases were of the ischemic type. In contrast, in the extracranial arterial dissection, 60% of cases were ischemic and 40% were hemorrhagic. Cerebral angiography was the most important diagnostic procedure in the hemorrhagic type. In the ischemic type, MRI and MRA were more frequently used to show the findings specific to the dissection such as an intimal flap or double lumen and intramural hematoma. The outcome at discharge is generally good such that the modified Rankin Score was among 0-II in 69% of cases. However, in the hemorrhagic type, recurrence during an acute stage was frequent, and the outcome was poor with a mortalit rate of 19%. The establishment of an effective intervention to prevent the recurrence of subarachnoid hemorrhage is urgently required.