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1.
目的观察动脉内超选择性尿激酶溶解血栓治疗急性缺血性脑梗死的疗效及并发症。方法对6例发病于4~12h内的急性缺血性脑梗死患者行动脉内超选择性尿激酶溶解血栓治疗。结果经溶解血栓治疗后完全再通4例,部分再通2例;溶解血栓治疗后14d基本痊愈1例,显著进步3例,进步1例,死亡1例。溶栓后无颅内出血。结论早期动脉内超选择性尿激酶溶解血栓能明显提高闭塞血管再通率,改善预后,是治疗急性缺血性脑梗死的一种有效和相对安全的方法。  相似文献   

2.
目的分析评估急性脑梗死代谢物氢质子磁共振波谱成像(1HMRS)的临床应用价值。方法 对32例急性期脑梗死患者进行常规核磁共振(MRI)及1HMRS扫描,梗死区N-乙酰天门冬氨酸(NAA),肌酸(Cr),胆碱化合物(Cho)与对侧相应正常脑区代谢产物比值(rNAA、rCr、rCho)及同侧乳酸/胆碱值(Lac/Cho),比较不同部位各代谢产物相对浓度。结果 rCr(F=6.102,P=0.085)各区域间无显著差异;rCho(F=2.229,P=0.094)各区域间无显著差异;rNAA中央部与外侧缘间有显著差异(F=2711.140,P〈0.05);Lac/Cho区域各组间均有显著差异(F=29127.575,P=0.000)。结论 1HMRS检查对急性期脑梗死的诊断价值明显高于常规MRI,可同时检测脑梗死的进展情况。作为一种无创伤活体显示组织代谢的影像学方法1HMRS具有广阔的应用前景。  相似文献   

3.
BACKGROUND: It has become generally accepted that measuring N-acetyl-L-aspartic acid through the use of 1H-magnetic resonance spectroscopy (1H-MRS) could be used to evaluate neuronal injury. OBJECTIVE: To study metabolic changes of N-acetyl-L-aspartic acid surrounding the acute cerebral ischemia area following vascular endothelial growth factor (VEGF) treatment using 1H-MRS imaging, and to evaluate the neuroprotective effects of VEGE DESIGN, TIME AND SETTING: Randomly controlled animal study, according to one-factor analysis of variance, was performed at the Shenzhen Hospital of Peking University and State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences from August 2003 to December 2005. MATERIALS: Twelve healthy, adult, Sprague Dawley rats were used to establish an ischemia/reperfusion model through the use of middle cerebral artery occlusion. The 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. VEGF164 was purchased from Shenzhen Jingmei Bioengineering Co., Ltd. Titus anesthesia machine was purchased from Draeger Medical AG & Co. KG METHODS: The rats were randomly divided into model control (n = 6) and VEGF-injected (n = 6) groups. All animals received 60-minute middle cerebral artery occlusion and 24-hour reperfusion. Lateral cerebral ventricle injection was performed by stereotaxic technique at respective time points. The VEGF group received 0.1 μg/μL L VEGF (5 μ L), and the model group received the same amount of normal saline, once daily for 3 days. MAIN OUTCOME MEASURES: Metabolic changes of N-acetyl-L-aspartic acid and lactic acid following cerebral ischemia and reperfusion were detected using 1H-MRS, and the ischemic volume was measured. RESULTS: Twelve rats were included in the final analysis.1H-MRS results revealed that the ischemic volume increased in the control group compared with prior to injection (P 〈 0.01). In the contro  相似文献   

4.
体外溶栓试验确定急性脑梗死治疗中尿激酶用量的研究   总被引:12,自引:1,他引:11  
目的 探讨体外溶栓试验确定尿激酶用量进行急性脑梗死溶栓治疗的效果。方法 对急性脑梗死患者立即应用体外溶栓试验,寻找处于溶柞状态的尿激酶用量进行溶栓,以后持续7d应用尿激酶40万U维持溶枪治疗,在溶栓治疗不同时间进行神经功能缺损程度评分及测定纤维蛋白原(Fbg)浓度、聚合反应速率(FMPV)、最大吸光度(ODmax)、FMPV/ODmax.结果 溶栓治疗组疗效明显高于非溶栓组(P〈0.05),〈6h治疗纰疗效优于6~24h治疗组,6~24h治疗组优于非溶栓组(均P〈0.05)。Fbg浓度、FMPV、FMPV/ODmax溶栓后开始下降,而于溶栓后24h反弹达到高峰,随后再下降,于第5d再次显著升高,与溶栓后其他时间段相比差异显著性(均P〈0.05),ODmax无明显变化。溶栓组并发出血1例(2.17%),非溶栓组无出血患者。结论 应用体外溶栓试验确定尿激酶用量进行急性脑梗死溶栓治疗是安全有效的。  相似文献   

5.
目的探讨急性脑梗死患者不同方式机械性动脉溶栓治疗的方法、时间窗、溶栓药物剂量。 方法选择海口市人民医院急性发病12h内的脑梗死患者60例,采用不同方式机械性动脉溶栓治疗(术中联合采用介入接触溶栓+导丝机械疏通、球囊机械扩张、支架拉栓和联合血管内支架成形术等),通过脑血管造影判断其血管开通情况并对其治疗疗效(依据神经功能缺损评分)进行评估。 结果60例急性脑梗死患者中血管完全再通率为55%(33/60),部分再通率为38.3%(23/60),未开通率为6.7%(4/60);临床治愈38例(63.3%),显著好转I0例(16.7%),有效9例(15%),无变化3例(5%),死亡0例。 结论经不同方式机械性动脉溶栓是急性脑梗死的一种安全有效的治疗方法。建立急救绿色通道和规范其治疗措施,能较好的提高急性脑梗死患者救治成功率,降低死亡率和致残率。  相似文献   

6.
目的 探讨尿激酶超选择性动脉溶栓治疗急性脑梗死的安全性和有效性。方法 前瞻性收集急性脑梗死病人217例,先行全脑血管造影明确责任血管部位,然后用导引导管或微导管按1万U/min的速度向责任血管泵入尿激酶,每注射10万U即重复血管造影,如果造影显示堵塞血管已经再通则停止溶栓治疗,在治疗2 h、 24 h、7 d、14 d按我国第四届脑血管病学术会议通过的脑卒中患者临床神经功能缺损程度评分标准评定疗效。结果 溶栓后,血管再通率为65.90%(143/217),溶栓2 h、24 h、7 d和14 d的有效率分别为70.05%、70.97%、76.96%和79.26%。结论 对于急性脑梗死患者,超早期溶栓能恢复血流灌注,阻断脑梗死病理过程,避免脑细胞坏死,明显提高治愈率,降低致残率。  相似文献   

7.
目的比较不同频率的重复经颅磁刺激(rTMS)对急性脑梗死患者静脉溶栓治疗的影响。方法 141例急性脑梗死患者随机分为假rTMS治疗组、rTMS 1 Hz组、rTMS 2 Hz组、rTMS 5 Hz组、rTMS 10 Hz组和溶栓对照组,均予以尿激酶溶栓治疗。rTMS 1~10 Hz各组依次分别在溶栓同时给予rTMS 1 Hz、2 Hz、5 Hz、10 Hz治疗,假rTMS治疗组予以假rTMS刺激。所有患者于治疗前及治疗后24 h时进行美国国立卫生研究院卒中量表(NIHSS)评分,观察并记录各组不良反应情况。结果各组治疗后NIHSS评分均较治疗前明显下降(均P<0.05)。治疗后rTMS 1~10 Hz各组NIHSS评分均较溶栓对照组明显下降,其中rTMS 5 Hz组NIHSS评分最低(均P<0.05)。rTMS 1~10 Hz各组有效率(64.0%、76.2%、81.8%、83.3%)均明显高于假rTMS治疗组(42.3%)和溶栓对照组(47.8%)(均P<0.05)。其中,rTMS 2 Hz组、rTMS 5 Hz组与rTMS 10 Hz组有效率均高于rTMS 1 Hz组(均P<0.05)。各组间不良反应的比...  相似文献   

8.
磁共振血管成像评定静脉溶栓治疗急性脑梗死疗效的价值   总被引:2,自引:0,他引:2  
目的探讨磁共振血管成像(MRA)评定静脉溶栓治疗急性脑梗死(ACI)疗效的价值。方法对13例发病24h内入院的ACI患者应用尿激酶100万U静脉溶栓治疗;观察患者治疗前后临床神经功能评分情况;并对治疗前后MRA表现进行比较。结果13例ACI患者溶栓后欧洲卒中量表(ESS)评分(24h~90d,评分为62.6~88.9分)较治疗前(45.8分)明显提高(均P<0.0001),其中24h、72h(71.8分)增加最快,至14d评分最好者达100分,至90d可正常生活者5例。患者治疗前MRA均为大脑中动脉M1或M2段闭塞,远端血管不显影。静脉溶栓后MRA示血管完全再通4例(30.8%);9例较治疗前血管显影增多,但多呈纤细或断续显影。结论(1)静脉溶栓治疗ACI疗效确切,ESS评分明显增加。(2)ACI患者于治疗前后行MRA检查可以确切了解血管闭塞以及血管再通情况。  相似文献   

9.
老年期抑郁症患者海马磁共振质子波谱研究   总被引:1,自引:0,他引:1  
目的:探讨老年期抑郁症患者海马的磁共振质子波谱(1H-MRS)特点。方法:应用1H-MRS成像技术检测11例晚发性抑郁症患者(患者组)予文拉法辛缓释剂治疗6周前后两侧海马头、体、尾部N-乙酰天门冬氨酸(NAA)、胆碱(Cho)和肌酸(Cr)3种代谢物,计算NAA/Cr和Cho/Cr比值。并且与15名健康对照者(对照组)的检测结果进行比较。结果:治疗前后患者组右侧海马头部NAA和Cho含量及左侧海马头部Cho含量均显著低于对照组(P<0.05或P<0.01)。患者组右侧海马头部Cho/Cr治疗前显著低于对照组(P<0.05),治疗后较治疗前显著升高(P<0.05),并且与对照组的差异无显著统计学意义(P>0.05)。患者组右侧海马体部Cho含量治疗前显著低于对照组(P<0.05),治疗后右侧海马体部NAA/Cr和Cho/Cr显著高于治疗前,与对照组的差异无显著统计学意义(P>0.05)。结论:老年期抑郁症患者可能存在左右两侧海马头部细胞膜代谢异常,右侧海马头部神经元活力下降。  相似文献   

10.
目的 观察重组组织型纤溶酶原激活物 (rtPA)动脉或静脉溶栓治疗急性脑梗死的疗效及安全性。方法  6 0例符合入选标准的急性脑梗死患者分为动脉溶栓组、静脉溶栓组和对照组 ,各 2 0例。动脉溶栓组给予rtPA 10~ 2 0mg ,30分钟内恒速动脉注入 ;静脉溶栓组给予rtPA总量 0 7~ 0 8mg/kg,最大剂量 5 0mg。 90分钟内静脉滴入 ;两组次日均用低分子肝素 (速避凝 4 10 0U或法安明 5 0 0 0U) ,每 12小时腹部皮下注射 1次 ,连续 7天 ;对照组应用低分子右旋糖酐 5 0 0ml加复方丹参 16ml静滴 ,每日 1次 ,连用 8天。采用欧洲卒中量表 (ESS)、Barthel指数 (BI)评价神经功能恢复状况。结果 两溶栓组疗效明显优于对照组 (均P <0 0 5 ) ,动脉溶栓与静脉溶栓组之间的疗效无明显差异 (P >0 0 5 ) ,但动脉溶栓能发现颅内外血管是否存在狭窄 ,通过实施支架成形术消除狭窄 ,预防再次的血栓形成。动脉溶栓组脑实质性出血 1例 ,非症状性脑出血 1例 ;静脉溶栓组和对照组非症状性脑出血各 1例。 3组均无死亡病例。结论 rtPA用于急性脑梗死 (发病 6小时内 ) ,无论动脉还是静脉溶栓均有效 ,且比较安全。  相似文献   

11.
目的 探讨磁共振成像 (magneticresonanceimaging,MR)及磁共振氢质子波谱 (1H magneticresonancespectroscopy ,1H MRS)对轻度阿尔茨海默病 (Alzheimerdisease ,AD)患者的早期诊断。方法 对 18例临床确诊轻度AD患者和 2 0名正常对照者的MR及1H MRS进行分析 :MR上观察两组的海马回钩间距 (AB)及同层颅腔左右径 (CD)并计算两者间 (AB/CD)的比值 ;对两组额、颞叶区行1H MRS检测 ,得到N 乙酰天门冬氨酸 (N acetylaspartate ,NAA)峰、肌酸 (creatine ,Cr)峰、胆碱 (choline ,Cho)峰的积分值及计算NAA/Cr、NAA/ (Cr Cho)。对 2组检测值 ( x±s)行t检验。结果 AD组的AB =(2 7 5 3± 2 1)mm ,AB/CD =(0 2 2± 0 0 5 )mm及额、颞叶的NAA分别是 32 74± 4 72和35 38± 3 5 2 ,颞叶的NAA/Cr=2 4 6± 0 4 3,与正常对照组比较均有统计学差异 (P <0 0 5 )。用ROC法找出诊断阈值并联合应用诊断早期AD ,敏感性为 87% ,特异性为 94 %。结论 海马回钩间距及其与同层颅腔左右径比值的增大 ;额、颞叶NAA的减少 ,尤其是颞叶NAA的减少有助于对轻度AD患者的早期诊断。  相似文献   

12.
BACKGROUND: The pathophysiological mechanisms of ischemia are extremely complicated. It is difficult to confirm and maintain the therapeutic effects if only one neuroprotective agent is used. It is hypothesized that a cocktail therapy involving a combined application of neuroprotective agents is feasible and offers excellent therapeutic potential. OBJECTIVE: To evaluate the neuroprotective effects of a cocktail therapy of insulin-like growth factor 1 (IGF1) combined with anti-intercellular adhesion molecule 1 (ICAM1) antibody in the treatment of cerebral ischemia/reperfusion injury using medical imaging, pathology, and functional neurological deficit scoring techniques. DESIGN, TIME AND SETTING: This randomized, controlled, neuroimaging analysis of function and pathological observation was performed at the Laboratory of Molecular Imaging, Second Hospital, Hebei Medical University between September 2006 and December 2007. MATERIALS: Transient middle cerebral artery occlusion (MCAO) was induced in 24 healthy adult cats. Anti-ICAM1 antibody and IGF1 were sourced from the Shanghai Kangcheng Biological Product Co., Ltd., China. Stereotaxic apparatus was purchased from the Center for Medical Apparatus and Instruments, Shandong Liaocheng People's Hospital, China. The in situ apoptosis kit was provided by the Beijing Zhongshan Biotechnique Co., Ltd., China. METHODS: Twenty-four cat models of MCAO were randomly divided into four groups (n = 6): control, IGF1, anti-ICAM 1 antibody and cocktail therapy. Following a 2-hour ischemia and subsequent lateral cerebral ventricular puncture, 100 μg IGFl(cerebral ventricular), 100 μg anti-ICAM1 antibody (i.v.), 50 μg IGFl(lateral cerebral ventricular) + 50 μg anti-ICAM1 antibody (i.v.), and 100 μg physiological saline (i.v.) were administered to the IGF1, anti-ICAM1 antibody, cocktail therapy and control groups, respectively. On the following day, the same administration was performed again. MAIN OUTCOME MEASURES: Pathologic  相似文献   

13.
目的观察静脉溶栓治疗频发TIA为临床表现的急性脑梗死患者的疗效及预后。方法选择我院2008-01-01—2013-12-31以频发TIA为临床表现的急性脑梗死静脉溶栓患者56例为治疗组,选择同期未行溶栓治疗的患者30例为对照组,采用NIHSS评分及改良的Rankin评分评价早期疗效及远期预后。结果 2组患者溶栓前ABCD2评分(6.12±3.49vs 5.78±4.13,P=0.23)、DWI阳性率(39.28%vs 36.67%,P=0.19)差别无统计学意义。溶栓后早期治疗有效率(51.78%vs 30.00%,P=0.001)、远期预后预后良好率(48.21%vs 33.33%,P=0.003)差别具有统计学意义。在出血转化率方面(8.93%vs 6.67%,P=0.07)差异无统计学意义。结论以频发TIA为临床表现的急性脑梗死患者静脉溶栓治疗安全有效。  相似文献   

14.
急性期脑梗死的磁共振化学位移成像研究   总被引:10,自引:1,他引:10  
目的采用磁共振化学位移成像(CSI)研究急性期脑梗死不同部位代谢产物浓度变化 的差异及其与弥散加权成像(DWI)表现的相关性。方法28例发病3d内非腔隙性脑梗死患者完成 CSI和DWI检查。测算梗死区N-乙酰天门冬氨酸(NAA),肌酸(Cr),胆碱化合物(Cho)与对侧相应 正常脑区代谢产物比值(rNAA、rCr、rCho)及同侧乳酸/胆碱值(Lac/Cho),比较不同部位各代谢产物 相对浓度;比较:DWI上梗死区相对信号强度(rDWI)、表观弥散系数(rADC)值与代谢产物浓度的相 关性。结果(1)与对应脑区比较,急性期脑梗死灶内NAA明显降低,Lac明显增加(P<0.001),cr、Cho无显著变化(P=0.543,0.817)。(2)梗死核心区、内缘、外缘及正常组织间rNAA及Lac/Cho差异均有显著意义(均P<0.001),rCr及rCho各部位间差异无显著意义(P=0.266,0.737)。rNAA梗死外缘与正常区域间差异无显著意义(P=0.733);Lac/Cho外缘与正常区域差异有显著意义(P=0.003)。(3)急性期脑梗死rNAA与Lac/Cho(r=0.496)、rADC(r=0.405)成正相关,与rDWI成负相关(r=-0.432);Lac/Cho与rDWI成负相关(r=-0.587),与rADC成正相关(r=0.561)。结论(1)急性期梗死灶NAA降低局限于DWI高信号范围内,而Lac升高范围可超过NAA下降和DWI高信号区域,可能预示缺血半影区。(2)急性期梗死区La  相似文献   

15.
BACKGROUND: The pathophysiological mechanisms of ischemia are extremely complicated. It is difficult to confirm and maintain the therapeutic effects if only one neuroprotective agent is used. It is hypothesized that a cocktail therapy involving a combined application of neuroprotective agents is feasible and offers excellent therapeutic potential. OBJECTIVE: To evaluate the neuroprotective effects of a cocktail therapy of insulin-like growth factor 1 (IGF1) combined with anti-intercellular adhesion molecule...  相似文献   

16.
目的观察大剂量尿激酶静脉溶栓治疗心源性脑栓塞的疗效及安全性。方法将109例心源性脑栓塞患者分为2组,溶栓组56例,对照组53例,溶栓组使用尿激酶100-150万单位加入100ml生理盐水中静脉溶栓治疗,非溶栓组(对照组)使用抗血小板聚集或抗凝治疗,并观察疗效。结果2组患者治疗后均减少了缺血性脑卒中的神经功能缺损评分,治疗前后比较有显著性差异(P〈0.05),且溶栓组较非溶栓组疗效为佳(P〈0.05),但2组出血转化发生率无显著性差异(P〉0.05)。进一步分析2组的医疗费用,溶栓组平均费用(6235.3±568.2)元,非溶栓组平均费用(8215.0±318.5)元,两组产生的医疗费用比较有显著性差异(P〈0.05)。结论大剂量尿激酶静脉溶栓治疗能有效改善心源性脑栓塞患者的神经功能,相对于抗凝或抗血小板聚集等抗栓方案,能减少患者医疗费用支出,而溶栓组和非溶栓组的出血转化发生率无明显差异。  相似文献   

17.
目的 探讨颅脑静脉窦内血栓磁共振弥散加权成像(DWl)的特征以及DWI表现与溶栓治疗后血管再通的关系.方法 回顾性分析14例颅脑静脉窦内血栓患者的MRI表现,包括常规MRJ、FLAIR、DWI及MRV,统计静脉窦内出现DWI高信号的部位、数量;以溶栓治疗后1~3个月的MRV确定原栓塞静脉窦是否再通;探讨溶栓前静脉窦内血栓T1WI、FLAIR、DWI表现与溶栓治疗后血管再通的关系.结果 14例颅脑静脉窦内血栓患者中9例出现21个部位的血栓DWI高信号.首诊MRI血栓内有DWI高信号的静脉窦的血管完全再通的几率较低(19.0%),血栓内无DWI高信号的静脉窦冉通率较高(68.2%),比较差异有统计学意义(P=0.005).结论 颅脑静脉窦内血栓患者血栓DWI信号可能与血栓的进展有关,首诊MRI发现静脉窦内血栓DWI呈高信号能预测溶栓治疗1~3个月后血管再通率较低.  相似文献   

18.
Recent studies showed that soluble annexin A2 dramatically increases tissue plasminogen activator (tPA)-mediated plasmin generation in vitro, and reduces thrombus formation in vivo. Here, we hypothesize that combining annexin A2 with tPA can significantly enhance thrombolysis efficacy, so that lower doses of tPA can be applied in ischemic stroke to avoid neurotoxic and hemorrhagic complications. In vitro activity assays confirmed tPA-specific amplification of plasmin generation by recombinant annexin A2. In a rat focal embolic stroke model, combination therapy with tPA and recombinant annexin A2 protein at 2 h post-ischemia decreased the effective dose required for tPA by four-fold and reduced brain infarction. Combining annexin A2 with tPA also lengthened the time window for thrombolysis. Compared with tPA (10 mg/kg) alone, the combination of annexin A2 (5 mg/kg) plus low-dose tPA (2.5 mg/kg) significantly enhanced fibrinolysis, attenuated mortality, brain infarction, and hemorrhagic transformation, even when administered at 4 h post-ischemia. Combination with recombinant annexin A2, the effective thrombolytic dose of tPA can be decreased. As a result, brain hemorrhage and infarction are reduced, and the time window for stroke reperfusion prolonged. Our present findings provide a promising new approach for enhancing tPA-based thrombolytic stroke therapy.  相似文献   

19.
目的 探讨超选择动脉内接触性溶栓治疗急性脑梗死临床效果.方法 选取急性脑梗死患者88例,随机分为两组.对照组43例采用常规药物治疗.溶栓组42例采用脑血管造影后,栓塞部位尿激酶局部溶栓治疗;治疗结束后评价临床治疗效果.结果 溶栓组患者治疗总显效率、血管总再通率及Barthel指数评分完全恢复率均明显高于对照组,组间比较差异有统计学意义(P<0.05);同时溶栓组患者治疗后美国国立卫生研究院卒中量表(NIHSS)评分明显低于对照组,组间比较差异亦有统计学意义(P<0.05).结论 超选择动脉内接触性溶栓早期治疗急性脑梗死安全、有效,具有临床推广使用价值.  相似文献   

20.
Diffusion-weighted magnetic resonance imaging (DWI) with calculation of the apparent diffusion coefficient (ADC) of water is a widely used noninvasive method to measure movement of water from the extracellular to the intracellular compartment during cerebral ischemia. Lamotrigine, a neuronal Na(+) channel blocker, has been shown to attenuate the increase in extracellular concentrations of excitatory amino acids (EAA) during ischemia and to improve neurological and histological outcome. Because of its proven ability to reduce EAA levels during ischemia, lamotrigine should also minimize excitotoxic-induced increases in intracellular water content and therefore attenuate changes in the ADC. In this study, we sought to determine the effect of lamotrigine on intra- and extracellular water shifts during transient global cerebral ischemia. Fifteen New Zealand white rabbits were anesthetized and randomized to one of three groups: a control group, a lamotrigine-treated group, or a sham group. After being positioned in the bore of the magnet, a 12-min 50-s period of global cerebral ischemia was induced by inflating a neck tourniquet. During ischemia and early reperfusion there was a similar and significant decrease of the ADC in both the lamotrigine and control group. The ADC in the sham ischemia group remained at baseline throughout the experiment. Lamotrigine-mediated blockade of voltage-gated sodium channels did not prevent the intracellular movement of water during 12 min 50 s of global ischemia, as measured by the ADC, suggesting that the ADC decline may not be mediated by voltage-gated sodium influx and glutamate release.  相似文献   

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