血液流变学异常与高血压和脑梗死发生、转归的相关性

Background:Increased blood pressure in hypertension is related to vessels resistance,cardiac output,as well as blood viscosity.Stroke is common following hypertension.A number of studies reported that abnormal blood rheology was frequent in stroke suggesting correlation of blood rheology with onset,development,recovery of hypertension.Hypertension is the most one of independent risk factors of stroke.In the current paper,we investigated pathogenesis and development of hypertension and cerebral infarction to provide principle foundation for early prevention and treatment of cerebral infarciton.     

Relationship between abnormal blood rheology and development and recovery of hypertension and cerebral infarction

Increased blood pressure in hypertension is related to vessels resistance,cardiac output,as well as blood viscosity.Stroke is common following hypertension.A number of studies reported that abnormal blood rheology was frequent in stroke suggesting correlation of blood rheology with onset,development,recovery of hypertension.Hypertension is the most one of independent risk factors of stroke.In the current paper,we investigated pathogenesis and development of hypertension and cerebral infarction to provide principle foundation for early prevention and treatment of cerebral infarciton.     

An overview of stroke. Epidemiology, classification, risk factors, clinical aspects

Although evidence indicates that the incidence of stroke has declined over the past 30 years, stroke remains one of the leading causes of disability and death in the United States. Prevention appears to be the best treatment. According to the Straub Stroke Registry, 52% of strokes in its patient population can be attributed to a thrombotic mechanism. Besides thrombosis, the major causes of stroke are embolism, lacunar infarct, cerebellar infarction, and hemorrhage. Hypertension is a widely recognized risk factor for stroke, but the risks vary for each type of stroke. Transient ischemic attacks may precede stroke and thus are a warning signal. Since acute stroke cannot be cured, management includes symptomatic care and control of related problems such as hypertension. Carotid endarterectomy is useful in prevention of initial or recurrent stroke. The prognosis of stroke patients varies depending on the size of the lesion.     

Sudden death due to stroke and its management

Subarachnoid hemorrhage and cerebral hemorrhage are the most frequent causes of sudden death due to stroke. Brainstem hemorrhage, which is the cause of respiratory and vasomotor centers dysfunction, is frequently the direct cause of sudden death caused by stroke, and not only cerebral edema, but also secondary lethal arrhythmia, myocardial infarction, pulmonary embolism, or asphyxiation by dysphagia may be indirect causes of death associated with stroke. To prevent sudden death due to stroke, management of respiratory and circulatory systems as well as treatment corresponding to the type or severity of the disease are required. In this issue, we discuss the cause, management, and prevention of sudden death due to stroke.     

Neuroendovascular treatments/procedures: are they efficacious and have they improved patient outcomes poststroke?

ABSTRACT: Stroke is the second most common cause of death in women and African Americans, the fourth leading cause of death in Caucasians, and the fifth leading cause of death in men in the United States (). In addition, stroke costs the nation greater than $57 billion dollars annually through its direct and indirect costs. For example, in the year 2009 alone, the estimated expenditure on the cost of stroke for hospitalization, rehabilitation, and institutionalization was $68.9 billion. Fortunately, there are many treatment strategies available to individuals who had a stroke if they meet certain clinical and time criteria as well as being geographically located in a region where these treatments are available, such as nationally certified stroke centers. Specifically, intravenous and intra-arterial recombinant tissue plasminogen activator (rtPA) and mechanical thrombolysis are used for acute ischemic stroke, whereas treatments for acute hemorrhagic stroke resulting from subarachnoid hemorrhage secondary to ruptured cerebral aneurysm include both endovascular coiling as well as surgical clipping. However, patient outcomes from some of these treatments are controversial. First, it appears that, although revascularization post mechanical thrombectomy has high success rates, patient clinical and neurological outcomes as evidenced by low modified Rankin Scale scores are not as favorable when compared with intravenous or intra-arterial thombolysis. However, endovascular coiling for ruptured cerebral aneurysms resulting in subarachnoid hemorrhage appears to be superior to aneurysm clipping in both clinical and neurological outcomes. Future studies need to focus on making subject pools more homogeneous as well as using standardized outcome measures to facilitate external validation of their results.     

小量脑出血与脑出血及脑梗死临床比较分析

大脑半球脑出血≤10ml时临床症状较轻，临床表现极似脑梗死，易于误诊。作者回顾分析42例小量脑出血，CT检查前均误诊，其头痛、呕吐、颈抵抗、意识障碍及病理征等相关症状与同期多量脑出血组比较有极显著性差异，而与同期脑梗死组比较无显著差异，故较多误诊为脑梗死。为减少少量脑出血的误诊，作者建议对无颅内高压征的脑卒中患者尽早行头颅CT检查。     

A left MCA territory infarction during intravenous recombinant tissue plasminogen activator therapy for right MCA territory ischaemic stroke

An 81 year old man with a history of hypertension received intravenous recombinant tissue plasminogen activator (tPA) for right middle cerebral artery (MCA) infarction. He had not had stroke or arrhythmia previously. The initial National Institute of Health Stroke Scale (NIHSS) score was 8. However, a left MCA territory infarction developed 2 minutes after the full course of tPA therapy was completed, and 24 hours after tPA infusion, NIHSS score was 17. The subsequent magnetic resonance imaging scan confirmed an extensive left MCA territory infarction and a small right MCA territory infarction. Although the intracerebral haemorrhage after tPA therapy is relatively more common, tPA infusion may result in an ischaemic cerebral stroke in rare cases.     

高血压脑卒中不同类型的动态血压变化比较

目的探讨高血压脑出血与脑梗塞患者血压的昼夜变化规律。方法８２例高血压患者中３６例发生脑出血；４６例发生脑梗塞。４０例Ⅰ期高血压作对照。全部患者均作２４小时动态血压测定。结果脑出血组与脑梗塞组２４小时及夜间平均收缩压和舒张压均较对照组升高，有显著差异（Ｐ＜０．０５），但脑出血组较脑梗塞组更明显，二者有显著差异（Ｐ＜０．０５）。上午平均舒张压和下午平均收缩压脑出血组高于脑梗塞组，差异显著（Ｐ＜０．０５）。血压下降率在脑出血组与脑梗塞组亦有明显差异（Ｐ＜０．０５）。结论血压的昼夜波动变化特点与发生脑卒中的类型有密切关系。     

初发完全性脑卒中发病时血压与神经功能缺损关系的研究

目的：研究初发完全性脑卒中患者发病时血压与临床神经功能缺损（ＮＦＤ） 的关系。方法：２３７ 例初发完全性脑卒中患者分二组,脑出血组：９１ 例,其中有高血压病史者５０ 例,无高血压病史者４１ 例;脑梗塞组：１４６例,其中有高血压病史者８１ 例,无高血压病史者６５ 例,每例均测定发病时血压和就诊后ＮＦＤ积分。结果：无论脑出血或脑梗塞,也无论过去有无高血压病史, ＮＦＤ积分重、中、轻三组间,起病时收缩压水平均有显著性差异（Ｐ＜０．０１）, ＮＦＤ积分越高, 收缩压水平越高; ＮＦＤ积分重组者起病时舒张压高于轻组者, 二者有显著性差异（Ｐ＜０．０１）．结论：初发完全性脑卒中发病时血压水平与神经功能缺损程度呈正相关系。     

高血压合并脑卒中24 h动态血压的变化

目的；研究高血压并脑卒中患者24h动态血压变化特征。方法 应用美国Spacelabs90217动态血压监测仪观察了90例高血压并脑卒中患者24h动态血压，并与年龄、性别相配对的90例原发性高血压（EH）患者进行比较；比较了脑卒中患者中35例脑出血患者和55例脑梗死患者的24h动态血压。结果：高血压并脑卒中患者24h动态血压均值高于EH患者；24h血压曲线：波峰血压值相近，夜间波谷两值差别较大。两组昼夜节律有极显著差异（P〈0．01）。脑卒中组中脑出血组24h动态血压均值高于脑梗死组。结论：血压增高，昼夜节律消失有发生脑卒中可能，应加紧防治。     

成都市缺血性脑卒中的亚型分布：基于住院病人的研究

目的：了解成都市住院缺血性脑卒中患者的临床亚型,为脑卒中的分型治疗、预后估计及临床试验的设计提供依据。方法：采用英国苏格兰脑卒中登记法和Bamford的OCSP分型法,对104例住院的缺血性脑卒中患者进行前瞻性登记和分型。结果：完全性前循环梗死（TACI）26%,部分性前循环梗死（PACI）23.4%,腔隙性梗死（LACI）34.4%,后循环梗死（POCI)14.1%。结论：本组前循环梗死的病例约占住院缺血性脑卒中的一半,腔隙性梗死占1/3以上。为获取更有代表性的资料,进一步扩大样本的前瞻性研究是很有必要的。     

Ischemic middle cerebral artery stroke: a case study

Stroke is the third leading cause of death, ranking lower only to cardiac disease and cancer. Patients with stroke involving large vessels, including the middle cerebral artery, account for almost half of all patients with ischemic strokes and have an increased risk for poor outcomes and mortality at 6 months. Despite the availability and use of published guidelines for the early management of ischemic stroke, evidence to support treatment modalities for cerebral edema is still lacking. This case presentation will include the pathophysiology of an ischemic stroke and outline the established management guidelines. Literature related to the management of cerebral edema will also be discussed.     

浅谈脑梗死的中医病因病机与中医药治疗近况

脑梗死是缺血性卒中之一,随着人口老龄化发展趋势,目前已越居我国居民致残和死亡的首要病因。中医药治疗脑梗死有着重要特色和优势,目前在医学领域中仍占着不可动摇的地位,现就针对古代医家及近现代医家对中风病中医病因病机认识,以及中医药治疗方面针对经典方、经验方、中成药、中医外治等方面进行总结综述。     

脑卒中合并真性红细胞增多症19例临床分析

目的探讨脑卒中合并真性红细胞增多症（PV）的临床特点及治疗方法。方法对19例脑卒中合并PV患者的临床资料进行回顾性分析。结果①本组PV并发脑梗死14例（14／19,73．4％）,其中多发性脑梗死12例（12／14,85．7％）;短暂性脑缺血发作2例（2／15,13．3％）;脑出血2例（2／19,10．5％）;蛛网膜下腔出血（SAH）1例（1／19,5．3％）。均符合PV的临床表现和体征及血象、骨髓象的改变;②影像学检查显示脑梗死以多发小梗死灶多见（13／19,68．4％）,常见于脑叶、基底节、内囊;脑出血的出血灶内密度不均匀,周边水肿明显;③本组采用静脉放血加小剂量化疗治疗,脑卒中痊愈7例,显著进步11例,无效1例。结论脑卒中合并PV以脑梗死多见,其中又以多发性梗死为主,并发脑出血和SAH较少,采用静脉放血加小剂量化疗治疗的效果较好。     

Differences in left ventricular hypertrophy and dysfunction between patients with cerebral hemorrhage and those with cerebral infarction

Left ventricular (LV) hypertrophy and dysfunction due to hypertension have been established as risk markers for stroke in hypertensive patients. The purpose of this study was to examine the differences in LV hypertrophy and dysfunction between patients with cerebral hemorrhage and those with cerebral infarction. The study enrolled 23 hypertensive patients with cerebral infarction, 25 hypertensive patients with cerebral hemorrhage, and 24 normotensive controls (controls). Standard echocardiography was performed; LV mass index was measured to evaluate LV hypertrophy, and conventional diastolic transmitral flow velocities were measured to assess LV diastolic function, which was also evaluated by measuring mitral annular velocities using tissue Doppler echocardiography. The Tei index, which reflects both the diastolic and systolic function of LV, was also calculated. The LV mass index and Tei index were significantly higher in cerebral hemorrhage (116 +/- 38 g/m(2) and 0.57 +/- 0.13) than those in controls (92 +/- 20 g/m(2) and 0.46 +/- 0.10) (p < 0.05). In contrast, the LV mass index and Tei index in cerebral infarction (100 +/- 27 g/m(2) and 0.46 +/- 0.12) were not different from those in controls. Thus, the Tei index was significantly worse in the patients with cerebral hemorrhage than in those with cerebral infarction (p < 0.05). On the other hand, the parameters, which reflect diastolic function, showed no significant differences between cerebral hemorrhage and cerebral infarction. These results indicate that LV hypertrophy and dysfunction due to hypertension are more apparent in patients with cerebral hemorrhage than in those with cerebral infarction.     

超早期重组组织型纤溶酶原激活物溶栓治疗脑梗死的临床研究

目的 探讨重组组织型纤溶酶原激活物（rt—PA）静脉溶栓治疗超早期脑梗死的安全性与有效性。方法 按入选标准筛选合适患者21例进行溶栓，以相同时期非溶栓治疗的具有相同条件的患者20例为对照组，在溶栓前及溶栓后24h、21d按欧洲脑卒中神经功能缺损评分标准（ESS）进行评定，3个月时按Barthel指数进行评定。结果 溶栓组疗效优于对照组（P〈0．05）。溶栓组脑出血发生1例，预后仍然良好。两组患者均无死亡病例。结论 rt—PA静脉溶栓治疗超早期急性脑梗死安全、有效。     

高脂蛋白(A)水平与脑卒中发病危险因素的关系

背景流行病学及临床观察表明,脂蛋白(A)是一个新的脑血管病危险因素,与缺血性脑卒中关系较大.目的探讨高脂蛋白(A)水平与脑卒中的关系.设计病例-对照分析.单位中南大学湘雅医院神经病学研究所.对象选择1999-09/2002-03在中南大学湘雅医院神经内科住院的294例脑卒中患者.294例脑卒中患者分为脑梗死组159例,急性高血压性脑出血组135例.脑梗死组中动脉粥样硬化性脑梗死者109例,腔隙性脑梗死者50例.并选择来自门诊连续健康体检人员94例为健康体检组.方法采用夹心酶联免疫吸附法测定各组的血浆脂蛋白(A),并将动脉粥样硬化性脑梗死患者及急性高血压性脑出血患者分别按血脂各项正常与否(脂蛋白(A)除外)分成两组,血脂正常组与血脂异常组脂蛋白(A)水平比较采用独立样本t检验,采用多元线性回归法分析性别、高血压及血脂各项与脂蛋白(A)血清水平有无相关性.主要观察指标①动脉粥样硬化性脑梗死组、腔隙性脑梗死组和急性高血压性脑出血组及健康对照组间脂蛋白(A)的比较.②血浆脂蛋白(A)水平与血脂各项的相关性分析.结果所纳入的294例患者及94例正常对照组均进入结果分析.①动脉粥样硬化性脑梗死组、腔隙性脑梗死组和急性高血压性脑出血组及健康对照组间脂蛋白(A)的比较动脉粥样硬化性脑梗死、脑出血组患者脂蛋白(A)水平均较健康对照组增高(P＜0.05).动脉粥样硬化性脑梗死组脂蛋白(A)浓度较急性高血压性脑出血组高(P＜0.05);腔隙性脑梗死患者的脂蛋白(A)水平稍高于对照组,但差异无显著性意义(P＞0.05).②血浆脂蛋白(A)水平与血脂各项的相关性分析血脂正常组与血脂异常组脂蛋白(A)水平比较采用独立样本t检验,显示两组脂蛋白(A)水平接近(P＞0.05).采用多元线性回归法分析亦显示性别、高血压及血脂各项与脂蛋白(A)血清水平无相关性. 结论高脂蛋白(A)可能是脑出血及动脉粥样硬化性脑梗死的独立危险因素.     

脑卒中患者神经功能缺损程度与既往高血压治疗行为的关系

背景有关高血压与脑卒中之间的关系以及血压高低对脑卒中发病率影响的研究比较多见,而高血压的治疗情况与脑卒中起病后的神经功能缺损程度方面的研究还未广泛开展.目的探讨高血压脑卒中患者卒中后神经功能缺损程度与既往高血压治疗情况之间的关系.设计病例对照研究.地点和对象选择复旦大学附属上海市第五人民医院急诊科高血压脑卒中患者,非高血压脑卒中患者及蛛网膜下腔出血患者不属于研究对象.根据其既往高血压治疗情况将研究对象分为持续治疗组(82例)、间断治疗组(95例)与无治疗组(103例).主要观察指标观察各组患者的神经功能缺损程度、脑卒中类型的构成.结果间断治疗组、无治疗组与持续治疗组相比,神经功能缺损程度较重,脑出血较多见(P均＜0.000 1).结论规则的抗高血压治疗有望减少高血压性脑卒中尤其是脑出血的发生、减轻脑卒中的病情.因此,有必要采取措施使更多的高血压患者接受规则的抗高血压治疗.     

Stroke in patients with acute myocardial infarction

The analysis has been performed of 40 cases of acute myocardial infarction with concomitant stroke versus 26 cases of acute myocardial infarction alone. Being a complication of acute myocardial infarction in 0.94% of the cases, the stroke was ischemic in 95% and hemorrhagic in 5% of the patients. Association of the two events accounted for lethal outcomes in 80% of the cases. The principal factors of the stroke risk in myocardial infarction are suggested. They involve: an advanced age, cardiac arrhythmias, cardiogenic shock, diabetes mellitus, recurrent or transmural myocardial infarction, previous acute episodes of disturbed cerebral circulation, essential hypertension and hyperglycemia.     

急性脑卒中后脑心综合征的临床特点及其对患者预后的影响

目的 探讨急性脑卒中后脑心综合征（CCS）的临床特点及其对患者预后的影响。方法 选择150例急性脑卒中后患者,分为脑梗死组52例、脑出血组51例、蛛网膜下腔出血组47例。所有患者均行心电图、实验室检查以及在内科基础上进行保护心肌治疗。治疗完成后,比较2组患者的心电图变化情况、CCS的发病率、心肌酶变化,并随访6个月,比较有无CCS的急性脑卒中患者病死率的差异。结果 脑出血组和蛛网膜下腔出血组的心律失常及入院第3日心肌酶异常发生率均高于脑梗死组（P均< 0.017）。脑梗死组、脑出血组、蛛网膜下腔出血的CCS发生率分别为6%、20%、38%,蛛网膜下腔出血组的CCS发生率高于脑梗死组（P < 0.017）。随访6个月,发生CCS的急性脑卒中患者病死率为58%,高于未发生CCS患者的20%（P < 0.001）。结论 急性脑卒中尤其是出血性脑卒中后患者较易出现CCS,造成患者的不良预后,需重视对该类患者心功能的监测,若患者出现CCS,应立即调整治疗方案控制CCS病情,以改善患者的预后。