经颅超声溶栓联合尿激酶治疗急性脑梗死的疗效分析

目的观察经颅超声溶栓联合尿激酶治疗急性脑梗死的临床效果。方法选取80例超早期急性脑梗死患者作为研究对象,随机分为观察组及对照组各40例。观察组在对照组基础上加经颅超声溶栓治疗。对比分析2组疗效、神经功能缺损评分、血管再通率等。结果 2组脑动脉闭塞率、总有效率、治疗(7d、14d、28d)后神经功能缺损评分比较,差异均有统计学意义(P0.01);治疗3d后组间神经缺损评分和BI指数比较,差异有统计学意义(P0.05)。结论经颅超声溶栓联合尿激酶静脉溶栓治疗可显著改善急性脑梗死患者神经功能缺损状况,提高患者生活质量,可推广应用。     

经颅超声溶栓对急性脑梗死患者神经功能缺损及日常生活活动能力的改善情况

目的分析经颅超声溶栓对急性脑梗死患者神经功能缺损和日常生活活动能力的积极影响。方法选择我院收治的110例急性脑梗死患者为研究对象,随机分为A组30例、B组45例、C组35例,A组给予尿激酶溶栓治疗,100万U尿激酶+100mL生理盐水静滴;B组给予经颅超声溶栓治疗仪治疗(频率为800kHz、1.25 W/cm2、脉冲超声,20min/次,1次/d,连续治疗10d);C组给予联合溶栓治疗。通过NIHSS(神经功能缺损评分)及BI(Barthel指数,日常生活活动能力评分)观察比较3组治疗前后神经功能缺损改善指标、日常生活能力指标等。结果治疗后C组NIHSS评分明显低于A组、B组,B组NIHSS评分明显低于A组,差异具有统计学意义(P0.05);治疗后C组BI评分明显高于A组、B组,B组BI评分均明显高于A组,差异具有统计学意义(P0.05)。结论经颅超声溶栓对急性脑梗死患者具有极高的应用价值,溶栓效果较高,能加速神经功能恢复,改善患者日常生活活动能力,是一种操作简单、安全有效的溶栓治疗方法。     

尿激酶联合镁剂治疗大鼠急性脑梗死的实验研究

目的　观察尿激酶溶栓联合硫酸镁神经保护对大鼠急性脑梗死的疗效。方法　应用光化学诱导法建立大鼠大脑中动脉闭塞(MCAO)模型,分别于术后2 h、6 h和10 h 3 个时间点进行干预,每个时间点内再分为生理盐水对照组、尿激酶溶栓组、尿激酶加硫酸镁治疗组,术后24 h观察大鼠神经功能缺损评分及脑梗死体积的变化。结果　MCAO后2 h尿激酶溶栓组神经功能显著改善,梗死体积缩小(与生理盐水对照组相比,P<0.01),尿激酶加硫酸镁治疗组效果更好;MCAO后6 h、10 h尿激酶溶栓组与生理盐水对照组相比无显著性差异(P>0.05),而尿激酶加硫酸镁治疗组的神经功能缺损评分、脑梗死体积与生理盐水对照组及尿激酶溶栓组相比有显著差异(P<0.05或P<0.01)。结论　早期脑梗死特别是2 h内的超早期脑梗死应用尿激酶溶栓有效;加用镁剂进行神经保护可对尿激酶溶栓疗效产生协同作用,并可能扩大脑梗死溶栓治疗的时间窗。     

经颅超声激发与尿激酶溶栓治疗在急性脑梗死中的应用

目的探讨经颅超声激发联合尿激酶溶栓治疗急性脑梗死的临床疗效。方法选取我院2012-06-2014-06收治的急性脑梗死患者96例,按随机数字表分为2组,对照组46例,在常规治疗的基础上采用小剂量尿激酶溶栓治疗,观察组50例在对照组治疗的基础上,给予经颅超声激发治疗。2组患者均于治疗前、溶栓术后2h、24h、7d行美国国立卫生研究院卒中量表(NIHSS)评分评估,并采用经颅多普勒超声对患者血管再通情况进行评估;采用CT检查评估患者脑出血情况。结果观察组治疗后2h、24h、7dNIHSS评分明显低于对照组;观察组治疗后2h、24h时血管再通率明显高于对照组,差异有统计学意义(P0.05);观察组总有效率明显优于对照组(P0.05),2组脑出血发生率差异无统计学意义(P0.05)。结论经颅超声激发联合尿激酶溶栓可显著提高急性脑梗死患者血管再通率,改善神经功能损伤,提高日常生活能力,提高了临床有效率,改善了患者的预后,且无明显不良反应,未增加颅内出血转化率,安全性高,值得临床推广。     

经颅多普勒超声持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效观察

目的观察经颅多普勒超声(TCD)持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效。方法 28例急性脑梗死患者随机分为TCD组和对照组。两组均予以尿激酶动脉溶栓治疗;TCD组在此基础上予以TCD持续监测。根据TCD检查血流信号的改变判断血管再通情况;采用美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数(BI)评估患者神经功能缺损的程度。治疗后3 d内采用CT检查判断有无颅内出血等不良反应。结果治疗后30 d、90 d时,TCD组NIHSS评分均明显低于对照组(均P<0.05);BI均明显高于对照组(P<0.05~0.01)。TCD组治疗后24 h时血管再通率(78.6%)明显高于对照组(30.8%)(P<0.05),治疗后再通时间[(34.5±10.5)min]明显短于对照组[(55.8±13.6)min](P<0.01)。两组治疗后3d内CT检查均未发现颅内出血等不良反应。结论 TCD持续监测辅助尿激酶动脉溶栓治疗急性脑梗死的疗效较好,且无明显不良反应。     

经颅超声溶栓对急性脑梗死患者神经功能缺损及日常生活活动能力的改善情况

目的探讨分析经颅超声溶栓对急性脑梗死患者神经功能缺损及日常生活活动能力的改善情况。方法回顾性分析2012-06—2014-04在我院进行治疗的104例急性脑梗死患者的临床资料。结果治疗组总有效率90.38%,高于对照组的75.00%,差异有统计学意义(P0.05);治疗组在治疗2d、5d、10d的NIHSS评分均明显低于对照组,Barthel指数评分均明显高于对照组,差异有统计学意义(P0.05)。结论经颅超声溶栓治疗急性脑梗死的临床疗效显著,可快速恢复神经功能和改善日常生活活动能力,值得临床推广应用。     

经颅超声辅助治疗脑梗死的疗效研究

目的观察经颅超声治疗对脑梗死神经功能恢复的效果。方法 84例急性期脑梗死患者随机分为经颅超声治疗组和对照组,经颅超声治疗组42例于住院后即予常规药物及康复加经颅超声治疗,对照组42例仅接受常规药物及康复治疗。治疗前及治疗后30d、60d、90d分别采用美国国立卫生院卒中量表(NIHSS)、改良量表(MRS)、卒中影响量表(SIS)对神经功能缺损程度、残疾程度、生活质量进行评定。结果治疗前经颅超声治疗组和对照组在NIHSS、MRS、SIS评分差异均无统计学意义(P0.05);治疗30d后两组NIHSS、MRS、SIS评分与治疗前比较差异有统计学意义(P0.01);经颅超声治疗组改善更明显,与对照组比较差异有统计学意义(P0.01);治疗60d、90d随访,经颅超声组改善程度优于对照组,组间差异有统计学意义(P0.01)。结论急性期脑梗死在常规治疗基础上结合经颅超声疗法,能显著减轻神经功能缺损程度,提高患者生活质量。     

MRI新技术在急性脑梗死诊治中的应用

目的探讨MRI弥散成像(DWI)、灌注成像(PWI)对急性脑梗死的诊断及治疗指导价值。方法发病<24h的急性脑梗死患者79例。立即行MRI常规检查及DWI,16例行PWI检查,14例接受尿激酶溶栓治疗为治疗组,其余65例为对照组。结果DWI对急性脑梗死的诊断率为100%,DWI、T2加权成像(T2WI)、T1加权成像(T1WI)对急性脑梗死诊断准确率为100%、50.6%、36.7%;有显著差异。治疗组治疗前及治疗后72h、3周神经功能缺损程度评分为35.3±3.8、15.7±2.4、12.5±1.6;对照组分别为38.3±3.2、25.7±2.9、19.5±2.6。两组治疗前后神经功能缺损程度评分比较有显著差异。结论DWI对急性脑梗死诊断具有明显优势,DWI与PWI联合应用判断缺血半暗带是否存在,对溶栓治疗有指导作用。超急性期溶栓治疗效果优于其它治疗。     

尿激酶介入溶栓术对急性脑梗死患者神经功能恢复的影响

目的探讨尿激酶经导管选择性脑动脉内介入溶栓术对急性脑梗死患者术后神经功能恢复的影响。方法选取2013-04—2016-04入住我院的169例急性脑梗死患者为研究对象,采用随机化数字表分为研究组89例,对照组80例。对照组给予药物常规基础治疗,研究组在基础治疗的基础上给予尿激酶经导管选择性脑动脉内介入溶栓术。比较2组治疗效果、神经功能缺损评分(NIHSS)差异,采用日常生活能力量表(BI)评价日常生活活动能力(ADL)的改善情况。结果研究组有效率为80.90%,对照组为61.25%,2组比较差异有统计学意义(P0.05);研究组NIHSS评分及BI评分均优于对照组,差异有统计学意义(P0.05)。结论尿激酶经导管选择性脑动脉内介入溶栓术可显著减轻患者神经功能缺损,改善神经功能及日常生活活动能力。     

尿激酶溶栓治疗急性脑梗死52例疗效分析

目的 观察尿激酶溶栓治疗急性脑梗死的临床疗效。方法 将104例急性脑梗死病人随机分为治疗组和对照组。治疗组应用尿激酶50万U加入100ml生理盐水中静滴,1次/d,连用3d,之后尿激酶20万U加入生理盐水100ml静滴,1次/d,连用4d,共治疗7d;对照组给予尿激酶75万U加入生理盐水100ml静滴,1/2h滴完;两组均同时给予肠溶阿司匹林片0.lg/(次·d),并给子脱水、改善微循环等综合治疗。治疗4周后进行神经功能缺失评分及凝血功能、血流变比较,判定疗效。结果 治疗4周后神经功能缺失评分及凝血功能、血流变指标分析,治疗组与对照组相比差异有显著性。结论 尿激酶溶栓治疗急性脑梗死疗效确切,简单易行,副作用小,值得临床推广应用。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.