脑梗死后痴呆的危险因素分析

目的探讨脑梗死后痴呆的发生率及其危险因素.方法选择200例脑梗死患者,入院时均详细询问病史、进行血生化检查、神经功能缺损评分及智能评估.结果200例脑梗死患者中有65例发生痴呆(痴呆组),发生率为32.50%;135例无痴呆发生(非痴呆组).高龄、文化程度低、无职业、家庭支持不足、有卒中史、自理能力差者其痴呆组显著高于非痴呆组(P＜0.05,P＜0.01);发生脑梗死后肌酐及血糖、纤维蛋白原、总胆固醇、甘油三酯痴呆组显著高于非痴呆组(P＜0.05,P＜0.01)、脂蛋白水平两组差异无显著性意义(P＞0.05);脑梗死发生于左半球高,右半球低;脑梗死多发于体积大、神经功能缺损程度严重者,其痴呆组显著高于非痴呆组(均P＜0.01).结论脑梗死后痴呆常见,且与年龄、文化程度、职业、家庭支持不足、有卒中足、脑梗死的部位、体积、病灶数目和神经功能缺损的程度、血糖、纤维蛋白原、血脂及肌酐水平升高等因素有关.     

奥扎格雷钠联合依达拉奉注射液治疗急性脑梗死的临床疗效研究

目的:分析探讨奥扎格雷钠联合依达拉奉注射液治疗急性脑梗死的临床疗效及安全性。方法:120例脑梗死患者随机分为观察组和对照组各60例,观察组采用奥扎格雷钠联合依达拉奉治疗,对照组单用奥扎格雷钠治疗,观察治疗前及治疗2周、4周后神经功能缺损评分。结果:观察组总有效率显著高于对照组(P<0.05);治疗前两组患者神经功能缺损评分无显著差异(P>0.05);治疗2和4周后两组较治疗前均有所改善,且观察组明显优于对照组,差异有统计学意义(P<0.05);两组患者均无明显不良反应发生。结论:奥扎格雷钠联合依达拉奉治疗急性脑梗死疗效显著且不良反应少,是较理想的安全有效的药物,值得临床推广应用。     

尼膜同治疗急性脑梗死74例临床分析

目的探讨尼膜同治疗急性脑梗死的临床疗效。方法将74例急性脑梗死患者随机分为尼膜同＋常规治疗组（治疗组）、常规治疗组（对照组）,疗程均为2周,主要观察临床疗效及治疗前后的神经功能缺损评分。结果治疗组总有效率显著高于对照组（P〈0.05）;治疗前后神经功能缺损评分减少程度治疗组明显大于对照组（P〈0.05）。结论尼膜同能改善急性脑梗死的症状并减轻脑梗死患者神经功能缺损,并能显著改善预后,提高其疗效。     

动脉僵硬度与脑梗死患者神经功能缺损程度的关系研究

目的探讨脑梗死患者动脉僵硬度与其神经功能缺损程度的关系。方法130例脑梗死患者（脑梗死组）根据美国国立卫生研究院卒中量表（NIHSS）评分．分为轻、中、重度三组,另选择105例健康体检者作为健康对照组。采用脉搏波传导速度（PWV）自动测定系统对上述人群测定颈动脉．股动脉PWV（cfPWV）。结果健康对照组、轻度组、中度组、重度组患者的cfPWV分别为（8．62±0．82）、（9．97±1．26）、（12．82±1．84）和（16．56±1．64）m／s,在校正了年龄、性别、血压、血糖和血脂参数后,神经功能缺损程度与ctPWV呈显著正相关（P〈0．01）。结论动脉僵硬度增加与脑梗死患者神经功能缺损程度相关,改善动脉僵硬度可能对改善神经功能缺损程度有益。     

帕瑞昔布对大鼠局灶脑缺血-再灌注脑组织GFAP及IL-1β、TNF-α的影响

目的探讨帕瑞昔布术前给药对大鼠局灶性脑缺血-再灌注损伤的影响及其机制。方法雄性SD大鼠64只,体重250～300g,随机均分为四组:假手术组(S组),单纯缺血-再灌注组(IR组),缺血-再灌注+帕瑞昔布5mg/kg术前给药组(P5组),缺血-再灌注+帕瑞昔布10mg/kg术前给药组(P10组)。采用线栓法制作大鼠大脑中动缺血2h再灌注24h模型,在缺血2h及再灌注24h时行神经功能缺损评分;TTC染色观察脑梗死体积及体积百分比;HE染色观察海马CA1区神经元病理改变;放射免疫法检测缺血侧额区皮质中前列腺素E2(PGE2)、白细胞介素1β(IL-1β)及肿瘤坏死因子α(TNF-α)含量;免疫组化法检测缺血侧星形胶质细胞(AS)中胶质纤维酸蛋白(GFAP)的表达。结果缺血2h、再灌注24h时IR、P5、P10组神经功能缺损评分均高于S组(P<0.01);再灌注24h时P10组神经功能缺损评分显著低于IR组(P<0.05)。P5、P10组脑梗体积及体积百分比均低于IR组(P<0.01)。P5、P10组PGE2、IL-1β、TNF-α含量低于IR组,且P10组显著低于P5组(P<0.05或P<0.01)。IR组海马区GFAP阳性细胞数显著多于S组;P5、P10组GFAP阳性细胞数显著少于IR组,且P10组明显低于P5组(P<0.05或P<0.01)。结论帕瑞昔布术前给药对大鼠局灶性脑缺血-再灌注损伤具有保护作用,其机制可能与减少脑组织中PGE2含量、抑制AS过度激活、减少IL-1β、TNF-α释放有关。     

重型颅脑损伤患者血糖和糖化血清蛋白的检测价值

目的通过检测重型颅脑损伤后血糖(Glu)和糖化血清蛋白(GSP)水平变化,探讨其检测价值。方法按颅脑损伤前是否有糖尿病病史分为糖尿病史组和非糖尿病组,血清Glu和GSP检测分别采用葡萄糖氧化酶法、果糖胺法。结果①重型颅脑损伤患者血清Glu水平均显著高于对照组(P<0.01);糖尿病史组血清GSP水平显著高于非糖尿病组和对照组(P<0.01),非糖尿病组血清GSP水平与对照组相比差异无统计学意义(P>0.05);非糖尿病组存活者入院时和出院时比较血清Glu水平差异有统计学意义(P<0.01),血清GSP水平无显著性变化(P>0.05);追踪观察6个月,两组比较,重型颅脑损伤患者糖尿病史组病死率(37.93%)显著高于非糖尿病组(23.68%),P<0.05,糖尿病史组恢复良好率(24.14%)显著低于非糖尿病组(42.11%),P<0.05,轻、重度伤残及植物生存差异无统计学意义(P>0.05)。结论血清Glu检测对重型颅脑损伤患者病情监测、评估预后具有重要临床使用价值,血清GSP检测对重型颅脑损伤患者应激性或糖尿病性血糖增高具有鉴别价值。     

疏血通注射液治疗进展型脑梗死的临床分析

目的观察疏血通注射液治疗进展型脑梗死的疗效。方法将进展型脑梗死患者30例,随机分为疏血通治疗组16例和对照组14例。两组患者入院后均给予脑梗死的常规治疗,治疗组再给予疏血通注射液6mL加入生理盐水250mL静脉滴注,1次/d,连用14d。分别于治疗前和治疗后进行神经功能缺损程度评分和临床疗效比较。结果疏血通治疗组治疗后神经功能缺损改善程度明显优于对照组（P〈0.05）。疏血通组总有效率显著高于对照组。结论疏血通注射液治疗进展型脑梗死疗效较好,无明显不良反应。     

非超重型PCOS患者身体成分特点及其与糖代谢的关系

目的探讨非超重型PCOS患者的身体成分特点及其与糖代谢的关系。方法选择2018年6月至2019年1月首次被诊断为PCOS的非超重患者164例,对照组纳入月经规律的非超重妇女165例。用生物电阻抗分析法测定身体成分,同时检测两组的血糖和胰岛素水平,统计分析两组之间的差异。结果病例组的骨骼肌质量指数(RSMI)显著低于对照组(12.79vs.13.15,P<0.01),内脏脂肪指数显著高于对照组(6.91vs.6.52,P<0.01);两组的BMI、体脂率和骨骼肌率均无显著性差异(P>0.05),但病例组"体脂率>28%"的占比(28.05%vs.18.79%)、"骨骼肌率<35%"的占比(42.68%vs.32.12%)均显著高于对照组(P<0.05)。病例组胰岛素抵抗稳态指数的异常程度显著高于对照组(P<0.05),且糖代谢异常程度与体脂率和内脏脂肪指数均呈正相关(P<0.05),与骨骼肌率和RSMI均呈负相关(P<0.05)。结论非超重型PCOS患者的身体成分中,RSMI较低,内脏脂肪指数较高,且肌肉、脂肪含量均与糖代谢异常相关。     

黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎轻中度蛋白尿的临床研究

目的:观察黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎轻中度蛋白尿的疗效。方法:将96例非IgA系膜增生性肾小球肾炎患者随机分为黄葵胶囊联合缬沙坦组(治疗组)和单用缬沙坦组(对照组),分别检测两组治疗前后24 h尿蛋白定量、血清白蛋白、血肌酐,并进行组间比较。结果:治疗组临床疗效总有效率显著高于对照组(P<0.01)。治疗组与对照组均能显著降低24 h尿蛋白(P<0.01),两组比较差异有统计学意义(P<0.01)。治疗组与对照组均能显著提高血清白蛋白(P<0.05),但两组比较差异无统计学意义(P>0.05)。结论:黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎比单用缬沙坦能更显著地降低尿蛋白排泄量,未见明显不良反应。     

孕期家庭亲密度适应性对产后抑郁的影响

目的探讨孕期家庭亲密度适应性对产后抑郁的影响,为采取有效措施降低产后抑郁提供参考。方法采用家庭亲密度适应性量表和爱丁堡产后抑郁量表对224例妇女,分别于产前(孕28周至产前)及产后6周进行调查。结果45例(20.09%)产妇发生产后抑郁;抑郁组实际亲密度和实际适应性评分显著低于无抑郁组,亲密度不满意程度和适应性不满意程度评分显著高于无抑郁组(P<0.05,P<0.01);孕期实际亲密度、实际适应性、亲密度不满意程度和适应性不满意程度为产后抑郁的影响因素(均P<0.05)。结论孕期家庭亲密度适应性差可导致产后抑郁。护理人员应在产前或孕前护理健康教育工作中宣传家庭亲密度预防产后抑郁的重要性,降低产妇产后抑郁发生率。     

骨质疏松性与肿瘤转移性椎体骨折患者代谢指标的比较

目的比较分析骨质疏松性与肿瘤转移性椎体骨折患者相关代谢指标及其关系。方法回顾从2003年01月至2011年06月期间在我院介入血管外科行椎体成形术的146例骨质疏松性椎体骨折患者与111例肿瘤转移性椎体骨折患者的相关代谢指标,运用统计学方法进行统计。统计内容为:性别、年龄、椎体骨折数、手术次数、超敏C-反应蛋白、纤维蛋白原含量、血清总钙、磷、碱性磷酸酶(ALP)、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白。结果两组患者在性别、年龄、手术次数、血清碱性磷酸酶、甘油三酯、总胆固醇、高密度脂蛋白水平间有统计学差异(P<0.05)。结论骨质疏松性与肿瘤转移性椎体骨折患者在骨代谢及脂代谢方面存在差异,可帮助临床医生及时找出骨折病因,制定合理的治疗方案。     

运动训练诱发脑缺血耐受的机制研究进展

运动训练能够减轻脑缺血发生后的运动功能障碍,临床和基础研究均对其作用机制进行了深入探索。但是,关于缺血前的运动训练减轻脑缺血发生后神经损伤的具体机制尚不明确,本文就其相关机制进行了综述。缺血前运动训练可通过降低炎症反应,减少神经细胞凋亡,减轻血脑屏障功能障碍,改善脑血管系统,减轻谷氨酸毒性,从而诱发脑缺血耐受。运动训练的神经保护作用机制的阐明有利于针对脑卒中高危人群进行运动干预,减轻缺血性脑卒中后神经功能障碍,产生良好的社会效益。     

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction

BACKGROUNDThe main pathological factor of cerebral infarction is atherosclerosis, which is the pathological process of chronic inflammatory diseases such as vascular smooth muscle hyperplasia, inflammatory cell infiltration, extracellular matrix increase, and thrombosis. At present, the focus of clinical treatment is anti-platelet aggregation and improving blood status, and current research is limited to improving symptoms only.AIMTo observe the effect of sodium ozagrel and atorvastatin on type 2 diabetes patients with lacunar cerebral infarction.METHODSEighty-two patients with type 2 diabetes and lacunar cerebral infarction admitted to our hospital from January 2018 to February 2020 were equally categorized into two groups according to their treatment method. The control group was administered atorvastatin, and the observation group was administered sodium ozagrel combined with atorvastatin. The National Institutes of Health stroke scale (NIHSS) score, activities of daily living (ADL) score, blood glucose, lipid levels, inflammatory factors, high-mobility group box 1 (HMGB1) levels, paraoxonase-1 (PON-1) levels, erythrocyte sedimentation rate (ESR), and macrophage migration inhibitory factor (MIF) levels were recorded before and after treatment. The total effective rate and adverse reaction rate of the two groups were analyzed. RESULTSThe total effective rate of the observation group (94.00%) was significantly higher than that of the control group (80.00%) (χ² = 3.998; P = 0.046). The blood glucose indexes, total cholesterol levels, triglyceride levels, low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein levels, interleukin-1β levels, tumor necrosis factor-α levels, HMGB1 Levels, ESR, MIF levels, platelet aggregation rates, and plasma viscosity of the two groups decreased after treatment; however, high-density lipoprotein cholesterol and PON-1 Levels increased after treatment. After treatment, the blood glucose indexes; blood lipid indexes; inflammatory factors; HMGB1, PON-1, and MIF levels; ESR; platelet aggregation rate; and plasma viscosity of the observation group were better than those of the control group (P < 0.05). After treatment, all patients in the observation group had higher ADL scores and lower NIHSS scores than those in the control group (P < 0.05).CONCLUSIONSodium ozagrel with atorvastatin can reduce inflammatory reactions; regulate ESR and HMGB1, PON-1, and MIF levels; control blood glucose and lipid indexes; and alleviate nerve injury without increasing adverse effects of atorvastatin alone.     

Case report: Aggressive blood pressure management for carotid endarterectomy hyperperfusion syndrome

PURPOSE: Cerebral hyperperfusion syndrome (CHS) is a rare but potentially devastating complication following cerebral revascularization. Management of CHS requires aggressive blood pressure control to prevent stroke and intracerebral hemorrhage. This case report documents a severe case of CHS, and outlines a successful outcome associated with aggressive blood pressure control. CLINICAL FEATURES: A 67-yr-old gentleman, nine days post left carotid endarterectomy, required tracheal intubation and intensive care unit admission following seizures and acute right-sided weakness. A computed tomography scan and magnetic resonance imaging revealed significant vasogenic edema in the left middle cerebral artery territory, without evidence of infarction. The history and radiographic findings suggested CHS. As such, a systolic blood pressure target was set at 90-140 mmHg. This blood pressure parameter was lower than typically targeted following acute ischemic or hemorrhagic stroke. Rapid clinical improvements were seen by day five, and tight blood pressure control was maintained throughout. Repeat computed tomography and magnetic resonance imaging revealed improved edema and no evidence of infarct or hemorrhage. CONCLUSION: Cerebral hyperperfusion syndrome is believed to occur following restoration of blood flow to a brain with impaired autoregulation due to chronic hypoperfusion. Massive brain edema and hemorrhage can result from higher pressures. Clinicians should be aware of this potential complication following cerebral revascularization procedures, and the importance of establishing blood pressure targets which are considerably lower than for other patients with similar clinical presentations.     

Etiologic mechanism and prevention of perioperative stroke

Despite advances in surgical techniques and improvements in perioperative care, the incidence of perioperative strokes has not decreased, reflecting the aging of the population and the increased number of patients with complication. We investigated the cases who were consulted due to perioperative stroke. From April, 2004 to March, 2007, a total of 102 patients were referred for neurological evaluation because of perioperative stroke. Types of planned or performed surgery, risk factors, types of stroke and timing of the events were analyzed. Sixty-seven cases were consulted preoperatively for history or risk factors of stroke. Forty-seven cases had ischemic risk factors and cerebral vascular recanalization was carried out in four patients who experienced severe cerebral hypoperfusion. The other patients with ischemic risk factors were treated to avoid dehydration or hypotension perioperatively. Nine cases with hemorrhagic risk factors, such as cerebral aneurysm, were treated to avoid significant hypertension during surgery. The types of planned surgery were cardiovascular surgery in 29 cases, abdominal surgery in 13, cervical surgery in 7, and thoracic surgery in 6. Except for one case, who suffered cerebral embolism due to cardiac surgery, those who were consulted preoperatively did not experience stroke. Neurological events had occurred in 35 patients and they were consulted postoperatively. The surgical procedures were cardiovascular surgery in 19 patients, thoracic surgery in 6, abdominal surgery in 6. The types of stroke were cerebral infarction in 20 cases, hypoxic brain in 8, and transient ischemic attack in 5. The cause of the cerebral infarction was considered as cerebral embolism in 19 cases. Those who were consulted preoperatively were treated to prevent intraoperative stroke and did not suffer neurological complication. Most stoke in patients undergoing surgery were not related to hypoperfusion but due to embolism.     

脑出血合并脑梗死临床治疗分析

目的通过对脑出血合并脑梗死病例的临床分析，探讨迟发性损害的重要性，进一步加深对该病的认识，指导临床治疗。方法总结临床54例脑出血合并脑梗死病例，通过对临床症状、体征的分析，CT及MR的诊断，迟发性损害的研究，治疗效果的观察，总结经验。结果统计结果显示，通过手术和保守治疗，重视迟发病变的治疗，该组病例，有5例死亡，疗效理想。结论脑出血合并脑梗死是一种混合性中风，各种原因所致的疾病，治疗并不矛盾，最终治疗通路是统一的，预防迟发性损害，防止神经细胞受损，恢复缺血区血供，改善脑细胞神经功能。     

同型半胱氨酸、超敏C反应蛋白、低密度脂蛋白胆固醇、D-二聚体与脑梗死的关系

目的：探讨血清同型半胱氨酸（Hcy）、血脂、超敏c反应蛋白（hs—CRP）、凝血功能、D-二聚体的变化与脑梗死的关系。方法：收集2012年3月-2013年2月于我院住院治疗的急性脑梗死患者172例为观察组,并根据病灶大小分为大梗死组、小梗死组和腔隙性脑梗死组。分别对3组患者入院后次日晨测定血清Hcy、血脂、hs—CRP、凝血功能、D-二聚体。100例健康体检者作为正常对照。结果：脑梗死患者血清Hcy、血脂、hs—CRP、纤维蛋白原（Fib）、D-二聚体水平均高于正常对照组,APTT和TT均低于正常对照组（P〈0．05）。血清Hcy水平与LDL、hs—CRP和血浆胁二聚体水平有一定相关性（r值分别为0．739,0．681和0．803,P〈0．01）。大梗死组、小梗死组血清Hcy、hs—CRP、LDL和血浆D-二聚体水平明显高于腔隙性脑梗死组（P〈0．05）,大梗死组血浆Fib水平明显高于腔隙性脑梗死组和小梗死组（P〈0．05）。脑梗死面积大小与血清Hcy、hs—CRP、LDL和血浆胁二聚体水平具有良好的相关性（r值分别为0．604、0．587、0．515、0．333,P〈0．05或P-〈0．01）。结论：血清Hcy、hs—CRP、LDL和D-二聚体水平升高可能是脑梗死的危险因素。     

2型糖尿病合并脑梗死患者临床危险因素分析

目的探讨糖尿病合并脑梗死患者的相关危险因素及防治方法。方法选取笔者所在医院2008年1月-2011年7月收治入院的糖尿病患者47例,随机分为糖尿病合并脑梗死（实验组）23例、糖尿病无脑梗死组（对照组）24例两组,进行相关因素比较,并评判其影响程度及采取的对策。结果本研究证实糖尿病合并脑梗死的危险因素与生活习惯有关。高血糖、高胰岛素血症、高血压能够增加糖尿病合并脑梗死的危险性。结论糖尿病合并脑梗死的危险因素与很多的生活因素和疾病因素相关,且预后不良,患者病残率高、致死率高,了解糖尿病合并脑梗死的危险因素对于临床治疗及患者愈后有重要意义。     

Red blood cell distribution width as a marker of cerebral infarction in hemodialysis patients

Background: Red blood cell distribution width (RDW) is a cardiovascular biomarker. We evaluated the association between RDW and cerebral stroke risk in hemodialysis patients.

Methods: A cohort of 442 adult patients on hemodialysis was studied. Strokes were defined according to ICD-10 diagnosis codes. Routine complete blood counts, evaluated every 3–6?months, were used for RDW values.

Results: Among 442 hemodialysis patients, during the 50-month follow-up, there were 62 cases (14.0%) of cerebral stroke: 41 (9.3%) with cerebral infarction and 21 (4.8%) with cerebral hemorrhage. Compared with nonstroke patients, a significantly higher RDW was measured in patients with cerebral stroke and cerebral infarction. However, no significant difference was seen in RDW between patients with cerebral hemorrhage and nonstroke patients. After adjustment by age, hypertension, albumin, Charlson Comorbidity Score, and C-reactive protein in different multivariable Cox regression models, patients with the highest mean RDW quartile had a 2.55-fold (hazard ratio?=?3.55; 95% confidence interval: 1.33–9.51) higher risk of developing cerebral infarction relative to those with the lowest mean RDW quartile. RDW was not an independent risk factor for cerebral hemorrhage.

Conclusions: Increased RDW is an independent risk factor of cerebral infarction in hemodialysis patients.     

Carotid endarterectomy after recent stroke: preliminary observations in patients undergoing early operation

Three patients with recent stroke underwent carotid endarterectomy 1, 4, and 8 days after the onset of maximal symptoms. In each case, computed tomography (CT) demonstrated recent cerebral infarction and cerebral arteriography showed high grade cervical carotid stenosis. No patient developed worsened neurological symptomatology, intracerebral hemorrhage, or vasomotor paralysis. These results suggest that carotid endarterectomy, if indicated, can be performed safely after acute stroke under certain conditions. These criteria include the following: normal level of consciousness, relatively small cerebral infarction without mass effect on CT, and meticulous control and monitoring of systemic blood pressure during the perioperative period. These initial observations suggest that a specific subgroup of patients with recent cerebral infarction may be able safely to undergo carotid endarterectomy shortly after diagnosis.