Magnetic resonance diffusion tensor imaging following major ozonated autohemotherapy for treatment of acute cerebral infarction

Major ozonated autohemotherapy has been shown to promote recovery of upper limb motor function in patients with acute cerebral infarction,but whether major ozonated autohemotherapy affects remote injury remains poorly understood.Here,we assumed that major ozonated autohemotherapy contributes to recovery of clinical function,possibly by reducing remote injury after acute cerebral infarction.Sixty acute cerebral infarction patients aged 30–80 years were equally and randomly allocated to ozone treatment and control groups.Patients in the ozone treatment group received medical treatment and major ozonated autohemotherapy(47 mg/L,100 m L ozone) for 10 ± 2 days.Patients in the control group received medical treatment only.National Institutes of Health Stroke Scale score,modified Rankin scale score,and reduced degree of fractional anisotropy values of brain magnetic resonance diffusion tensor imaging were remarkably decreased,brain function improved,clinical efficiency significantly increased,and no obvious adverse reactions detected in the ozone treatment group compared with the control group.These findings suggest that major ozonated autohemotherapy promotes recovery of neurological function in acute cerebral infarction patients by reducing remote injury,and additionally,exhibits high safety.     

NIHSS评分为0分的急性脑梗死患者的临床特点

目的探讨美国国立卫生研究院脑卒中量表（National Institutes of Health Stroke Scale Score,NIHSS）评分为0分而磁共振弥散加权像显示急性脑梗死病灶患者的临床特点。方法对经NIHSS评分为0分、磁共振弥散加权像显示急性脑梗死病灶的发病48h内住院患者的临床症状、体征、影像学特点进行分析。结果共纳入急性脑梗死患者35例,主要症状有头痛、眩晕、恶心呕吐、肢体麻木、肢体无力。磁共振弥散加权像上均显示急性前循环梗死2（）例（57．1％）,后循环梗死11例（31．4％）,前后循环脑梗死3例（8．6％o）。26例脑梗死患者显示单发梗死病灶（74．3％）,其中穿支动脉小梗死19例（54．3％）。结论青年型脑梗死以男性多见,高血压病在致病危险因素方面男女均占据主要地位,男性还应警惕嗜烟酒及糖尿病。在TOAST分型NIHSS评分为0分不代表无脑梗死发生,主要为单发穿支动脉小梗死病灶。NIHSS评分项目不能很好地评价后循环急性梗死所引起症状和体征。     

Use of various CT imaging methods for diagnosis of acute ischemic cerebrovascular disease

Thirty-four patients with cerebral infarction and 18 patients with transient ischemic attack were examined by multi-slice spiral CT scan, CT perfusion imaging, and CT angiography within 6 hours after onset. By CT perfusion imaging, 29 cases in the cerebral infarction group and 10 cases in the transient ischemic attack group presented with abnormal blood flow perfusion, which corresponded to the clinical symptoms. By CT angiography, various degrees of vascular stenosis could be detected in 41 patients, including 33 in the cerebral infarction group and eight in the transient ischemic attack group. The incidence of intracranial artery stenosis was higher than that of extracranial artery stenosis. The intracranial artery stenosis was located predominantly in the middle cerebral artery and carotid artery siphon, while the extracranial artery stenosis occurred mainly in the bifurcation of the common carotid artery and the opening of the vertebral artery. There were 34 cases (83%) with convict vascular stenosis and perfusion abnormalities, and five cases (45%) with perfusion abnormalities but without convict vascular stenosis. The incidence of cerebral infarction in patients with National Institutes of Health Stroke Scale scores ≥ 5 points during onset was significantly higher than that in patients with National Institutes of Health Stroke Scale scores < 5 points. These experimental findings indicate that the combined application of various CT imaging methods allows early diagnosis of acute ischemic cerebrovascular disease, which can comprehensively analyze the pathogenesis and severity of acute ischemic cerebrovascular disease at the morphological and functional levels.     

Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction

A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.     

短暂性肢体缺血后处理治疗急性脑梗死的疗效观察

目的探讨肢体缺血后处理治疗急性脑梗死的临床疗效。方法选择2015年3月~2016年6月在我院住院治疗的158例未进行溶栓治疗的急性脑梗死(发病72 h内)患者作为研究对象,所有患者均经影像证实,按照入院先后顺序随机分为治疗组和对照组。所有患者均给予常规治疗,治疗组在常规治疗的基础上给予4个短周期单侧上肢缺血再灌注,每天进行1次连续7 d。比较入院时和病程14 d时两组患者的临床疗效;入院时、病程14 d和病程3 m时的美国国立卫生研究院卒中量表(NIHSS)和磁共振灌注加权成像(PWI);入院时和病程3 m时的改良Rankin量表(mRS)、梗死体积。结果治疗14 d后,治疗组总有效率(95.9%)高于对照组(79.0%),差异有统计学意义(P0.05);两组患者NIHSS评分、rMTT在入院时和病程14 d时差异无统计学意义,均在病程3 m时差异有统计学意义(P0.05);病程3 m时,治疗组mRS较对照组下降(P0.05),治疗组梗死体积较对照组减小(P0.05)。结论在急性脑梗死患者常规治疗的基础上给予短暂性肢体缺血后处理治疗,可以提高患者的临床疗效,减轻NIHSS评分及mRS评分,减小梗死体积,增加脑灌注。     

臭氧自体血回输治疗急性脑梗死期对血糖影响的对照分析

目的 研究臭氧自体血回输治疗急性脑梗死对血糖的影响.方法 将240例患者分为正常血糖组和高血糖组,2组均使用臭氧自体血回输治疗急性脑梗死.结果 治疗10 d后正常血糖组与高血糖组的NIHSS评分和MRS指数的降低程度比较差异有统计学意义（P＜0.05）;治疗10 d后正常血糖组与高血糖组血浆的NO、SOD含量相比明显增加,差异有统计学意义（F=6.12,P＜0.05;F=26.82,P＜0.01）;正常血糖组与高血糖组血浆MDA含量相比,含量减少,差异有统计学意义（F=35.81,P＜0.01）;正常血糖组总有效率明显高于高血糖组（P＜0.01）.结论 臭氧自体血回输治疗急性脑梗死,可明显改善急性脑梗死患者的神经功能缺损评分和精神状态,缩短急性脑梗死患者治疗时间,减少术后并发症,具有良好的临床治疗效果,值得推广应用.     

尤瑞克林治疗老年急性脑梗死

目的 评价尤瑞克林治疗老年急性脑梗死(ACI)的有效性和安全性.方法 采取随机的方法,选择82例老年ACI患者,随机分为对照组与治疗组,对照组给予常规治疗,治疗组在常规治疗的基础上加用尤瑞克林静脉滴注,于治疗前后进行美国国立卫生研究院卒中量表(NIHSS)评分及日常生活评定量表-Barthel指数(BI)评定.结果 两组患者用药前后的NIHSS评分、BI的差异有统计学意义(P＜0.05).治疗组较对照组改善比较明显(P＜0.05),且治疗组不良反应无明显增加.结论尤瑞克林治疗老年ACI值得进一步研究.     

尤瑞克林治疗急性脑梗死80例临床观察

目的观察尤瑞克林治疗急性脑梗死的有效性和安全性。方法起病48 h内急性脑梗死患者80例,随机分为2组。对照组为常规治疗,治疗组在常规治疗基础上加用尤瑞克林0.15 PNA/d慢速静滴,连用2周。治疗前后评定临床神经功能缺损程度(NIHSS)、日常生活活动能力(ADL)和MRS量表;检测肝肾功能、纤维蛋白原、血小板、C反应蛋白,记录不良反应。结果治疗组患者临床症状改善,NIHSS、ADL和MRS评分均明显改善(P<0.01);临床有效率达90%。结论尤瑞克林治疗急性脑梗死安全、有效。     

Low frequency repetitive transcranial magnetic stimulation improves motor dysfunction after cerebral infarction

Low frequency(≤ 1 Hz) repetitive transcranial magnetic stimulation(r TMS) can affect the excitability of the cerebral cortex and synaptic plasticity. Although this is a common method for clinical treatment of cerebral infarction, whether it promotes the recovery of motor function remains controversial. Twenty patients with cerebral infarction combined with hemiparalysis were equally and randomly divided into a low frequency r TMS group and a control group. The patients in the low frequency r TMS group were given 1-Hz r TMS to the contralateral primary motor cortex with a stimulus intensity of 90% motor threshold, 30 minutes/day. The patients in the control group were given sham stimulation. After 14 days of treatment, clinical function scores(National Institute of Health Stroke Scale, Barthel Index, and Fugl-Meyer Assessment) improved significantly in the low frequency r TMS group, and the effects were better than that in the control group. We conclude that low frequency(1 Hz) r TMS for 14 days can help improve motor function after cerebral infarction.     

依达拉奉治疗急性脑梗死的疗效分析

目的探讨自由基清除剂依达拉奉在急性脑梗死患者治疗中的有效性。方法采用随机分组方法将130例脑梗死患者分为治疗组及对照组,对照组常规运用拜阿司匹林口服等,治疗组在此基础上加用依达拉奉,采用美国国立卫生研究院脑卒中量表（NIHSS）和患者日常生活能力（ADL）进行疗效评定。结果治疗组神经功能缺损评分NIHSS明显低于对照组,日常生活能力（ADL）明显高于对照组,两组均有显著差异（P〈0.05）。结论依达拉奉作为自由基清除剂治疗脑梗死疗效确切、可靠。     

尤瑞克林治疗急性脑梗死的疗效及对血清MMP-9的影响

目的探讨尤瑞克林治疗急性脑梗死的临床疗效及对血清基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）水平的影响。方法采用随机单盲对照研究,将发病48h内入院的大面积脑梗死患者40例分为对照组和治疗组（尤瑞克林组）。评价治疗前后血清MMP-9水平,应用美国国立卫生研究院卒中量表（NIHSS）及Barthel指数（BI）记分法对入院后当天及治疗2周时神经功能缺损程度进行评分。结果各组2周后神经功能缺失程度评分与入院时相比,差异均有统计学意义（P〈0.01）,尤瑞克林组优于对照组（P〈0.05）。治疗后2组血清MMP-9水平均下降,与对照组相比,尤瑞克林组下降更明显（P〈0.05）。结论短期应用尤瑞克林可改善脑梗死患者的预后,其机制可能与降低血清MMP-9水平有关。     

Why do stroke patients with negative motor evoked potential show poor limb motor function recovery？

Negative motor evoked potentials after cerebral infarction, indicative of poor recovery of limb motor function, tend to be accompanied by changes in fractional anisotropy values and the cerebral pe-duncle area on the affected side, but the characteristics of these changes have not been reported. This study included 57 cases of cerebral infarction whose motor evoked potentials were tested in the 24 hours after the first inspection for diffusion tensor imaging, in which 29 cases were in the negative group and 28 cases in the positive group. Twenty-nine patients with negative motor evoked potentials were divided into two groups according to fractional anisotropy on the affected side of the cerebral peduncle： a fractional anisotropy 〈 0.36 group and a fractional anisotropy 〉 0.36 group. All patients underwent a regular magnetic resonance imaging and a diffusion tensor imaging examina- tion at 1 week, 1, 3, 6 and 12 months after cerebral infarction. The FugI-Meyer scores of their hemiplegic limbs were tested before the magnetic resonance and diffusion tensor imaging exami-nations. In the negative motor evoked potential group, fractional anisotropy in the affected cerebral peduncle declined progressively, which was most obvious in the first 1-3 months after the onset of cerebral infarction. The areas and area asymmetries of the cerebral peduncle on the affected side were significantly decreased at 6 and 12 months after onset. At 12 months after onset, the area asymmetries of the cerebral peduncle on the affected side were lower than the normal lower limit value of 0.83. FugI-Meyer scores in the fractional anisotropy ≥0.36 group were significantly higher than in the fractional anisotropy 〈 0.36 group at 3-12 months after onset. The fractional anisotropy of the cerebral peduncle in the positive motor evoked potential group decreased in the first 1 month after onset, and stayed unchanged from 3-12 months; there was no change in the area of the cerebral peduncle in the first 1-12 months after cerebral infarction. These findings confirmed that if the fractional anisotropy of the cerebral peduncle on the affected side is 〈 0.36 and the area asym-metries 〈 0.83 in patients with negative motor evoked potential after cerebral infarction, then poor hemiplegic limb motor function recovery may occur.     

经颅磁刺激治疗脑梗死的临床疗效观察

目的 观察经颅磁刺激（transcranial magnetic stimulation,TMS）对脑梗死患者的临床疗效。方法 符合病例入选标准的脑梗死患者60例,随机分为试验组及对照组,每组各30例,试验组及对照组均给予常规药物治疗,试验组在常规治疗基础上给予TMS治疗,疗程10 d,比较治疗前后患者的运动功能（Fugl-Meyer评分）、Barthel指数（Barthel index,BI）以及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分。结果 NIHSS评分：试验组由治疗前的6.57±2.66减少到治疗后4.01±2.83,对照组由6.29±3.00减少到5.10±2.43;Barthel指数：试验组由治疗前47.33±14.31增加到治疗后60.83±18.53,对照组由45.50±13.91增加到53.67±15.97;Fugl-Meyer评分：试验组由治疗前38.20±24.01增加到治疗后58.40±29.57,对照组由37.53±23.8增加到49.60±29.77,治疗前两组3项评分差异均无统计学意义,治疗后3项评分差异均有统计学意义（P分别为0.008、0.004和0.008）。结论 TMS对脑梗死患者肢体功能恢复有一定疗效,能提高患者的日常生活能力。     

rt-PA静脉溶栓治疗50例急性脑梗死疗效及安全性分析

目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死的临床效果及安全性。方法选择发病在4.5h内,平均2.86±0.8h内急性脑梗死患者73例,分为两组,溶栓组50例患者给予rt-PA 0.9mg·kg-1·d-1静脉溶栓,常规治疗组23例患者采用抗血小板聚集药物等治疗,比较溶栓和常规治疗后24h、7d及14d美国国立卫生研究院卒中量表(NIHSS)评分并记录不良反应。结果溶栓组治疗后24h、7d及14d时,NIHSS评分较溶栓前及对照组均明显减少,差异有统计学意义(P<0.05);溶栓后头颅MRI/CT及临床表现提示未出现症状性脑出血。结论 rt-PA静脉溶栓治疗发病4.5h内脑梗死是安全有效的。     

血浆和肽素水平对急性脑梗死患者预后的评估价值

目的 探讨血浆和肽素水平对急性脑梗死患者预后的评估价值.方法 对60例急性脑梗死患者(急性脑梗死组)和60例健康体检者(正常对照组)进行血浆和肽素水平检测;并对急性脑梗死患者进行血压、血糖、血清超敏C反应蛋白(hs-CRP)水平检测,应用美国国立卫生研究院卒中量表(NIHSS)进行评分,应用MRI测量脑梗死体积,3个月后采用改良的Rankin量表(mRS)评分评价预后;分析血浆和肽素水平对急性脑梗死患者预后的影响.结果 急性脑梗死组血浆和肽素水平[( 3.73±0.49) ng/ml]明显高于正常对照组[ (2.85±0.24) ng/ml](P＜0.01);脑梗死预后不良亚组(42例)[(3.84±0.44) ng/ml]明显高于预后良好亚组(18例)[ (3.47±0.53) ng/ml] (P＜0.05);两亚组间年龄、血糖、血清hs-CPR水平、NIHSS评分、脑梗死体积的差异有统计学意义(P ＜0.05 ～0.01);单因素Logistic回归分析显示,血浆和肽素水平、年龄、NIHSS评分是影响急性脑梗死患者预后的因素(P ＜0.05 ～0.01).ROC分析显示,影响急性脑梗死患者预后的因素中,血浆和肽素水平与年龄、hs-CRP水平、脑梗死体积、NIHSS评分间差异无统计学意义.结论血浆和肽素水平升高是预测急性脑梗死患者预后不良的因素之一.     

血清高敏C反应蛋白水平与脑梗死关系的研究

目的探讨血清高敏C反应蛋白(hsCRP)水平与脑梗死病情及预后的关系。方法测定90例急性脑梗死患者入院时血清hsCRP含量,观察梗死灶大小不同、神经功能缺损程度不同时含量变化,应用美国国立卫生研究院卒中量表(NIHSS)及Barthel指数(BI)分别对患者入院时及治疗6个月后进行评分,并将血清hsCRP水平与NIHSS及BI评分进行相关性分析。同时选取80例健康体检人员血清hsCRP含量进行对照。结果脑梗死患者血清hsCRP含量明显高于健康对照组(P<0.01);脑梗死血清hsCRP水平越高,梗死灶越大,神经功能缺损程度越重;患者血清hsCRP水平与入院时NIHSS呈显著正相关(P<0.01),与6个月后BI评分呈显著负相关(P<0.01)。结论血清hsCRP水平是临床评价脑梗死严重程度和预后的一个重要生物学指标。     

Predictors of good prognosis in total anterior circulation infarction within 6 h after onset under conventional therapy

OBJECTIVE: We investigated the predictors of good prognosis in total anterior circulation infarction (TACI), under conventional therapy. METHODS: We enrolled 166 patients with first-ever ischemic stroke within 6 h after onset with symptoms of TACI. Sixty-three patients (38.0%) with good outcome [G group, the modified Rankin Disability Scale (mRS) after 3 months < or =3] and 103 patients (62.0%) with bad outcome (B group, mRS >3) were compared. RESULTS: On univariate analysis, G group patients were significantly younger, had lower score in the National Institutes of Health Stroke Scale (NIHSS) of total and consciousness sub-score, had lower rate of clinical deterioration. On cranial CT at entry, three early CT signs [hyperdense middle cerebral artery (MCA) sign, hypodensity of >1/3 MCA and brain swelling] were significantly more frequent in the B group. On the second CT at 24-48 h, infarct area as assessed by the Alberta Stroke Programme Early CT Score (ASPECTS) was significantly smaller in the G group. Multivariate analysis with logistic regression revealed age <7 0 years, NIHSS < or =15, no clinical deterioration, and only no brain swelling in early CT signs, and ASPECTS > or =7 as independent predictors of good prognosis. CONCLUSIONS: Some clinical variables are useful in predicting outcome in TACI within the early period after stroke onset.     

脑梗死急性期血压与预后的相关研究

目的 研究脑梗死急性期血压变化与预后的关系,为临床血压管理提供依据.方法 采用前瞻性队列研究方法,连续登记2004年10月～2010年1月入住苏州大学附属第二医院神经内科及2004年10月～2006年8月入住苏州市立医院本部神经内科的发病24h内的脑梗死患者.连续观察入院7d内血压,记录随访6个月时死亡情况.对影响急性期预后的各因素进行Logist回归分析.结果 本研究共纳入480例脑梗死患者.入院时血压与预后呈L型关系,即当收缩压(SBP)<120mmHg,舒张压(DBP)<70mmHg时死亡率均明显升高.7d内平均SBP与预后呈U型关系(P<0.05),即当SBP在120～140mmHg之间预后最好,高于或低于此范围死亡率均升高.7d内连续性变异与死亡率呈正相关,变异率越大死亡率越高.24h内血压下降率与预后呈u型关系,下降率不超过20%时预后最好(P<0.05).影响预后的主要血压因素为血压的连续性变异率.结论 急性期血压独立影响脑梗死患者预后,入院7d内血压的处理应谨慎.     

臭氧自体血回输治疗急性脑梗死抗氧化指标的对照研究

目的研究臭氧自体血回输治疗急性脑梗死患者血浆抗氧化指标,进一步探讨其治疗急性脑梗死的作用机制。方法选取我院收治的60例急性脑梗死患者(具有单侧大脑中动脉供血区的皮质下累及内囊的单一病灶),随机分为治疗组和对照组各30例。2组基础用药均为拜阿司匹林肠溶片0.3g,1次/晚+血栓通注射液0.45g,1次/d,治疗组除基础治疗外加用臭氧自体血回输治疗,1次/d,(10±2)d一疗程;对照组仅使用基础治疗。于治疗前及治疗(10±2)d后,分别对2组进行抗氧化指标、如超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)的测定。结果治疗(10±2)d后,2组血浆中SOD、NO含量均较治疗前升高,且NO含量治疗组升高幅度高于对照组(P0.05);2组血浆中MDA含量均较治疗前下降,治疗组下降幅度大于对照组(P0.01)。结论臭氧可能通过抗氧化、清除自由基等途径减轻梗死灶局部及远隔部位的损伤而发挥治疗作用。     

Susceptibility-weighted imaging predicts infarct size and early-stage clinical prognosis in acute ischemic stroke

Susceptibility-weighted imaging (SWI) is a non-invasive technique that can reveal venous structures and iron in the brain. This retrospective study evaluated SWI, relative to other imaging techniques, for determining cerebral infarct size and early-stage clinical prognosis in patients with acute ischemic stroke. Within 3 days after onset, 22 patients with acute ischemic stroke underwent SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), and magnetic resonance angiography (MRA). At least 7 days after onset, the patients also underwent cranial FLAIR or computed tomography (CT). The severity of neurological damage was adjudged with NIHSS (National Institutes of Health Stroke Scale) scores. The imaged cranial lesions were evaluated according to ASPECTS (Alberta Stroke Program Early CT Score). The SWI-ASPECTS significantly correlated with mean transit time (MTT)-ASPECTS (Spearman’s test, r?=?0.662, P?=?0.001) in evaluating ischemic penumbra and significantly correlated with the FLAIR and CT-ASPECTS (Spearman’s test, r?=?0.765, P?<?0.001) in predicting infarct size. SWI is feasible for the early evaluation of cerebral infarct size and clinical prognosis of patients with acute cerebral infarction. SWI is a useful predictor of early infarct growth and early-stage outcome.