缺血性脑卒中患者动态血压与预后的关系及相关因素探讨

目的探讨缺血性脑卒中患者动态血压与预后的关系及相关因素。方法选取我院2015年1月-2016年2月就诊的缺血性脑卒中患者108例,采用美国国立卫生院神经功能缺损评分(NIHSS)对患者神经功能进行评定,所有患者均进行动态血压监测,并分析其影响预后的相关因素。结果 108例缺血性脑卒中患者中,心血管事件组36例,无心血管事件组72例,其中事件组SBP、DBP夜间血压下降率均低于对照组(P0.05);经Logistic回归分析,发现年龄、既往脑卒中史、糖尿病、SBP夜间血压下降率、NIHSS评分是影响其预后的危险因素。结论缺血性脑卒中患者动态血压水平与其预后存在一定联系,其中年龄、既往脑卒中史、糖尿病、SBP夜间血压下降率、NIHSS评分是缺血性脑卒中患者预后的危险因素。     

高龄与中低龄老年轻型缺血性脑卒中临床特点及预后分析

目的 分析高龄与中低龄老年轻型缺血性脑卒中的临床特点和预后情况。方法 选择2016年1月-2019年6月在北京市东城区第一人民医院神经内科住院的老年轻型急性缺血性脑卒中患者247例,美国国立卫生研究院卒中量表 (National Institute of Health Stroke Scale, NIHSS) 评分≤3分,根据年龄分为高龄(≥80岁)老年组113例和中低龄(60~79岁)老年组134例。对比分析2组患者的一般资料、实验室检查结果、牛津郡社区卒中计划(Oxfordshire Community Stroke Project,OCSP)分型、病因分型、危险因素及预后情况。结果 高龄老年组患者入院时NIHSS评分、合并糖尿病、既往卒中史、房颤史、卒中后肺炎比例均高于中低龄老年组,差异均有统计学意义(P<0.05);两组患者在性别、体质量指数(body mass index,BMI)、合并高血压、高血脂、冠状动脉粥样硬化性心脏病(以下简称冠心病)、瓣膜性心脏病、抗血小板、抗凝、神经功能进展、实验室检查结果、OCSP分型、病因等方面比较,差异无统计学意义(P>0.05);采用多因素Logistic回归分析影响两组患者预后的相关因素显示,入院时NIHSS评分、合并糖尿病、既往卒中史、房颤史、卒中后肺炎均是高龄老年患者与中低年龄老年患者3个月预后不良的影响因素(P<0.05);高龄老年组患者预后不良率及病死率均高于中低年龄老年组患者(P<0.05)。结论 高龄轻型缺血性卒中患者入院时NIHSS评分、合并糖尿病、既往卒中史、房颤史、卒中后肺炎比例较高,为老年轻型缺血性脑卒中预后的危险因素,此类患者临床预后更差。     

急性出血性脑卒中并发低钠血症的危险因素及预后因素研究

目的 探讨急性出血性脑卒中并发低钠血症的危险因素及预后因素.方法 选择收入的脑卒中并发低钠血症的患者100例为实验组,另选100例脑卒中未并发低钠血症的患者为对照组.所有患者收集各项影响相关资料并随访2年.观察两组患者的预后差别,分析危险因素及预后因素.结果 患者的糖尿病史、NIHSS评分、血糖、纤维蛋白原、脱水剂使用情况与急性出血性脑卒中并发低钠血症的发生具有明显的相关性(P<0.05).且经Logistic回归分析得出,5项因素均为急性出血性脑卒中并发低钠血症的危险因素;患者的体温、糖尿病史、血糖、脱水剂使用情况与急性出血性脑卒中并发低钠血症的预后有明显的相关性(P<0.05).经多因素Logistic回归分析,4项因素均为急性出血性脑卒中并发低钠血症的预后危险因素.结论 患者的糖尿病史、BI评分、NIHSS 评分、血糖、纤维蛋白原为急性出血性脑卒中并发低钠血症的危险因素,体温、糖尿病史、血糖、脱水剂使用情况为急性出血性脑卒中并发低钠血症的预后因素.     

血清尿酸及同型半胱氨酸水平与缺血性脑卒中患者出院预后的相关性

目的探讨血清尿酸（SUA）及同型半胱氨酸（Hcy）水平与缺血性脑卒中患者出院预后的相关性。方法回顾性选取2021年1月至2022年6月浙江大学医学院附属金华医院125例急性缺血性脑卒中患者的临床资料。采用美国国立卫生研究院卒中评分量表（NIHSS）评估卒中严重程度,根据出院时改良Rankin量表（mRS）评分判断预后结局,并根据预后结果分为预后不良组和预后良好组。采用二元logistic回归分析缺血性脑卒中的独立危险因素,Spearman秩相关分析SUA及Hcy水平与NIHSS评分、mRS评分的相关性,ROC曲线分析SUA及Hcy水平预测缺血性脑卒中预后不良的效能。结果预后良好组93例,预后不良组32例。预后不良组患者年龄、糖尿病史占比、入院NIHSS评分、出院NIHSS评分、出院mRS评分、住院时间、WBC水平、GLU水平、Hcy水平均高于预后良好组（均P＜0.05）,SUA水平低于预后良好组（P＜0.05）,其余指标比较差异均无统计学意义（均P＞0.05）。高Hcy水平（OR=1.479,95%CI：1.168~1.872,P=0.001）是缺血性脑卒中预后不良的独立危险因素。SUA水平与入院时NIHSS评分、出院时NIHSS评分、出院时mRS评分均呈负相关（r=-0.267、-0.248、-0.275,P=0.003、0.005、0.002）;Hcy水平与入院时NIHSS评分、出院时NIHSS评分、出院时mRS评分及住院时间均呈正相关（r=0.526、0.496、0.555、0.433,均P＜0.001）。SUA水平预测缺血性脑卒中预后不良的AUC为0.700（95%CI：0.595~0.806,P=0.001）,在最佳截断值328μmol/L时,灵敏度为0.844,特异度为0.484;Hcy水平预测缺血性脑卒中预后不良的AUC为0.902（95%CI：0.827~0.976,P＜0.001）,在最佳截断值12.1μmol/L时,灵敏度为0.813,特异度为0.935;联合预测缺血性脑卒中的AUC为0.905（95%CI：0.830~0.979,P＜0.001）,灵敏度为0.875,特异度为0.892。结论SUA及Hcy水平与患者脑卒中严重程度及出院预后密切相关。     

老年患者急性缺血性脑卒中合并尿路感染特征及相关因素分析

目的 对老年急性缺血性卒中（AIS）患者合并尿路感染特征及危险因素进行分析,为临床预防及治疗提供参考。方法 回顾性分析2020至2022年医院收治的332例老年AIS患者合并尿路感染的特征及危险因素,并使用受试者工作特征（ROC）曲线对回归模型进行评价。结果 332例AIS患者中发生尿路感染81例,感染率为24.4%。G-杆菌中的大肠埃希菌与G+球菌中的肠球菌为主要致病菌。感染组与对照组患者年龄、性别、是否合并糖尿病、是否留置尿管、格拉斯哥昏迷评分量表（GCS）、住院天数比较,差异有统计学意义（P<0.05）。两组回归分析结果显示,年龄≥80岁、女性、合并糖尿病、留置尿管、格拉斯哥昏迷评分量表（GCS）评分降低、住院天数≥10天为AIS患者合并尿路感染的独立危险因素（P<0.05）。结论 年龄≥80岁、女性、合并糖尿病、留置尿管、GCS评分降低、住院天数≥10天为AIS患者合并尿路感染的独立危险因素。临床可根据感染特征与相关因素,有针对性进行干预。     

GCS与CT评分对中重型颅脑损伤患者预后的评估

探讨格拉斯哥昏迷评分（GCS）及CT评分在中重型颅脑损伤患者预后预测中的价值。方法 收集2019年6月—2021年6月山西省人民医院神经外科收治的248例中重型颅脑损伤患者的临床资料,随访患者住院存活情况、伤后6月的预后情况。运用SPSS 26.0软件对资料进行单因素、多因素分析,筛选预后相关的独立危险因素,采用Logistic回归分析影响中重型颅脑损伤患者住院死亡率及远期预后的危险因素,并建立预测模型,评估其预测预后的效能。结果 多因素分析显示GCS评分和Rotterdam CT评分是影响中重型颅脑损伤患者住院死亡率的独立危险因素（P＜0.05）,年龄、GCS-P评分和Helsinki CT评分是预测中重型颅脑损伤患者远期预后的独立危险因素（P＜0.05）,基于这些危险因素建立预测模型,其预测住院死亡率和远期预后的效能较单一指标明显提高。结论 GCS运动评分和Rotterdam CT评分是影响中重型颅脑损伤患者住院死亡率的独立危险因素;年龄、GCS-P评分和Helsinki CT评分是影响中重型颅脑损伤患者远期预后的独立危险因素。GCS运动评分和Rotterdam CT评分预测中重型颅脑损伤住院死亡率最强;年龄+GCS-P评分+Helsinki CT评分预测远期预后总体效能最强     

影响脑卒中患者预后的相关因素分析

目的探讨脑卒中患者生存情况及影响预后的相关因素。方法选择2012年1月至12月收治的脑卒中患者198例为研究对象,观察患者年龄、入院时神经系统功能评分（NIHSS）等指标,随访发病后12个月内生存结局,应用Cox比例风险回归进行影响生存因素的分析。结果 （1）患者发病14 d及1、6、12个月累计生存率分别是79.8%、77.3%、74.2%和70.9%（Kaplan-Meier法）。（2）单因素Cox比例风险回归分析：年龄、入院时眼球运动障碍、失语、尿失禁、格拉斯哥昏迷评分（GCS）、NIHSS和脑中线结构偏移与脑卒中12个月生存预后相关（P〈0.01）。（3）多因素Cox比例风险回归显示：入院时GCS（RR=0.727）、NIHSS（RR=1.137）和年龄（RR=1.078）是影响预后的独立因素。结论年龄、入院时神经系统功能缺损严重和昏迷程度是脑卒中患者预后（死亡）的独立影响因素。     

老年脑卒中患者吸入性肺炎相关危险因素及预后分析

目的:探讨老年脑卒中患者并发吸入性肺炎的相关危险因素及预后。方法:收集2019年1月至2020年6月温州医科大学第二附属医院收治的老年脑卒中患者的临床资料,其中合并吸入性肺炎者为观察组,同期未合并吸入性肺炎者为对照组。采用单因素和多因素logistic回归分析对老年脑卒中患者合并吸入性肺炎的相关危险因素进行筛查,并进一步分析患者预后情况。结果:273例符合诊断标准的病例,其中观察组84例(30.77%),对照组189例(69.23%);单因素分析后显示,鼻饲、吞咽困难、体位不当、咳嗽无力、既往脑卒中数、舌头歪斜、咀嚼肌瘫痪、无呕吐反射、NIHSS评分是老年脑卒中并发吸入性肺炎的危险因素(P<0.05);而多元回归分析结果显示,体位不当、吞咽困难、舌头歪斜、无呕吐反射、NIHSS评分是老年脑卒中并发吸入性肺炎的独立危险因素(P<0.05);对照组预后明显优于观察组。结论:体位不当、吞咽困难、舌头歪斜、无呕吐反射、NIHSS评分是脑卒中合并吸入性肺炎老年患者的高危因素,且这类患者预后差,制订相应的预防措施以降低吸入性肺炎发生率和改善预后。     

动脉瘤性蛛网膜下腔出血预后的危险因素探讨

目的研究和探讨动脉瘤性蛛网膜下腔出血（aSAH）的危险因素与预后情况相关性。方法回顾性分析2010年1月-2014年3月间aSAH患者120例的临床资料,根据格拉斯哥（GCS）量表分级评分评价预后,预后不良者42例,比较年龄、性别、意识障碍史、动脉瘤多发、合并高血压、糖尿病、血脂异常、Hunt Hess分级、脑血管痉挛、脑积水及手术时间与预后不良的相关性。结果单因素分析结果显示,年龄、动脉瘤多发、合并高血压、Hunt Hess分级、手术时间可能与预后存在相关性,多因素分析结果显示,年龄、动脉瘤多发、Hunt Hess分级为影响aSAH预后的独立危险因素。结论 aSAH患者预后的影响因素有多种,高龄、动脉瘤多发和Hunt Hess分级高为预后不良的独立危险因素,临床对于存在该类因素的患者应更加慎重对待,制定个体化治疗方案。     

喀什地区住院脑血管病患者的类型及其危险因素分析

目的：调查了解喀什地区住院脑血管病患者的类型及其危险因素。方法：对2007年12月1日-2009年12月1日在喀什地区第二人民医院住院的166例脑血管病患者进行回顾性调查，收集患者的临床资料，并进行统计学分析。结果：临床类型以脑梗塞患者最多，70％脑出血、脑梗塞、短暂性脑缺血发作患者发病年龄大于55岁，患者从发病到就诊时间平均为18小时，危险因素依次为：高血压痛、脂代谢紊乱、糖尿病，患者的NIHSS评分改善明显。结论：喀什地区住院脑卒中患者的临床类型以脑梗塞居多，喀什地区脑血管病患者发病到就诊时间较长，喀什地区脑血管病危险因素出现的频率从高到低依次为高血压病、脂代谢紊乱、糖尿病，患者的NIHSS评分明显改善，提示综合治疗在脑卒中治疗中的重要性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.