彩色多普勒超声对脑梗死与颈动脉粥样硬化的相关性分析

目的探讨颈动脉粥样硬化斑块与脑梗死的关系。方法将病例分为脑梗死组及非脑梗死组,使用彩色多普勒超声检测颈动脉内膜-中层的厚度(intima-medium thickness,IMT)及粥样硬化斑块。结果70例脑梗死患者44例颈总动脉IMT增厚,颈动脉粥样硬化斑块检出率85%;70例非脑梗死者10例颈总动脉IMT增厚,粥样硬化斑块检出率33%,2组有显著差异(P<0.001)。结论颈动脉粥样硬化与脑梗死密切相关。彩色多普勒超声是检测颈动脉粥样硬化斑块最简捷的方法,能早期发现颈动脉粥样硬化,对临床预防脑梗死有重要意义。     

彩色多普勒超声检测颈动脉粥样硬化与老年缺血性脑血管病的分析

目的探讨彩色多普勒超声检测颈动脉粥样硬化及对老年缺血性脑血管病(ICVD)的预测价值。方法选取120例ICVD患者为观察组,120例健康体检志愿者为对照组,采用彩色多普勒超声对2组患者颈动脉粥样硬化斑块进行检查,并对比分析。结果观察组患者IMT1.0 mm、颈动脉粥样硬化斑块形成、混合斑及硬斑率均显著高于对照组(P0.01);观察组管腔狭窄显著多于对照组(P0.01);观察组颈总动脉(CCA)内径显著大于对照组(P0.01),观察组颈总动脉舒张期峰值流速(EDV)、收缩期峰值流速(PSV)均显著低于对照组(P0.01)。结论彩色多普勒超声能够对颈动脉粥样硬化情况作出准确评价,对于缺血性脑血管病的预测具有重要临床意义。     

体外反搏治疗颈动脉粥样硬化斑块临床分析

1资料与方法1.1一般资料选择2010-05—2012-02在我院内科住院的颈动脉斑块患者200例,经彩色多普勒超声确诊。颈动脉粥样硬化斑块的超声诊断标准:以颈动脉内膜中层厚度(IMT)来确定。IMT值<1.0mm为正常,IMT 1.0～1.2mm内膜增厚,>1.2～1.4mm为斑块形成,IMT>1.4mm为颈动脉狭窄。低回声为软斑块即易损斑块,强回声为硬斑块。检测部位为双侧颈总动脉、颈内动脉、颈外动脉共6个部位。入选标准:(1)彩色多普勒超声颈动脉有软斑块;(2)管腔狭窄     

彩色多普勒超声分析缺血性脑血管病患者颈内动脉狭窄血流动力学改变的临床价值

目的应用彩色多普勒超声(CDUS)分析缺血性脑血管病(ICVD)患者颈内动脉狭窄血流动力学改变的临床价值。方法对50例健康成人和48例ICVD患者,常规行颈动脉彩色多普勒超声检查,通过二维灰阶超声检查(2D)、彩色多普勒血流成像(CDFI)计算颈内动脉(ICA)最狭窄处直径狭窄率,脉冲多普勒(PD)测量颈动脉收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),计算ICA与颈总动脉(CCA)收缩期峰值流速比值(ICA-PSV/CCA-PSV)。诊断ICA狭窄程度与磁共振血管成像(MRA)进行对比。结果 ICA组ICA-PSV、ICA-PSV/CCA-PSV与对照组无明显差异(P>0.05);ICA-EDV明显低于对照组(P<0.05),而RI明显高于对照组(P<0.05)。本研究诊断ICA中、重度狭窄和闭塞的结果 ,与MRA诊断结果比较无明显统计学差别(χ2=0.1557,P>0.05)。结论 CDUS通过ICA血流动力学变化反映脑血管病变,有助于ICVD的鉴别诊断及预后判断,为早期采取有效的预防和治疗措施提供依据。     

血糖水平、颈动脉粥样硬化与缺血性脑血管病的相关性研究

目的探讨血糖水平的波动对颈动脉粥样硬化(CAS)发生发展的作用及其与缺血性脑血管疾病(ICVD)的相互关系。方法用彩色多普勒超声诊断仪对136例2型糖尿病患者及14例正常者双侧颈动脉粥样硬化进行检测,根据颈动脉内中膜厚度(IMT)及观察颈动脉有无斑块,分T2DM伴颈动脉硬化(CAC)组96例,T2DM无颈动脉硬化(NCAC)组40例和正常对照(NC)组14例;采用动态血糖监测系统(CGMS)监测3组72 h血糖变化,计算日内平均血糖波动幅度(MAGE)和血糖波动系数(BGFC);出院后并随访12个月,观察脑梗死的复发率,A组脑梗死复发22例,B组脑梗死复发5例,C组新发1例,比较3组患者颈动脉粥样硬化的特征,同时检查头颅CT或头颅MRI证实。结果各组间年龄、性别差异及BMI比较差异无统计学意义(P>0.05);A、B组的HbA1c及颈内动脉中层内膜的厚度均高于对照组(P<0.05或P<0.01);同样A组与B组HbA1c比较均差异有统计学意义(P<0.01);A组与B组及正常对照组相比,颈内动脉硬化的发生率及内膜增加均明显增加(P<0.001)。2组DMMG、BGFC、MAGE均明显高于对照组(P<0.01),A组与B组比较,各指标差异显著(P<0.05)。同时研究还发现:BGFC、MAGE与IMT的相关性强(r=0.251,P<0.01)。A、B、C组随访12个月,A组脑梗死复发率均高于其他2组(P<0.01)。结论 2型糖尿病患者血糖波动可能促进了颈动脉硬化的发生与发展,动脉粥样硬化与脑梗死的复发密切相关,动脉粥样硬化的严重程度是脑梗死复发的危险因素,故血糖波动水平与脑梗死复发率有相关性。     

探讨彩色多普勒超声在急性前循环脑梗死患者颈动脉粥样硬化检测中的应用价值

目的探讨彩色多普勒超声在急性前循环脑梗死患者颈动脉粥样硬化检测中的应用价值。方法选择符合标准的急性前循环脑梗死患者80例(梗死组),以及同期健康体检者80例(体检组),均行颈动脉超声检查,了解有无斑块、斑块性质及血管狭窄程度,测量内-中膜厚度(IMT)及血流参数。结果梗死组IMT增厚发生率、各种类型斑块检出率、颈动脉中度及重度狭窄发生率均高于体检组,差异有统计学意义(P0.05)。梗死组颈总动脉、颈内动脉峰值流速(PSV)、舒张末期流速(EDV)明显低于体检组,差异有统计学意义(P0.05);二者颈总动脉阻力指数(RI)、搏动指数(PI)及收缩早期加速时间(AT)相似,差异无统计学意义(P0.05),但颈内动脉AT低于体检组,PI、RI高于体检组,差异有统计学意义(P0.05)。结论颈动脉粥样硬化与急性前循环脑梗死关联密切,彩色多普勒超声检查可以确定颈动脉粥样斑块特点、狭窄程度及血流参数,具有较高的临床应用价值。     

174例老年人颈动脉彩色多普勒超声特征分析

目的:评价老年人颈动脉彩色多普勒超声检查的临床意义,并探讨老年人脑梗死与颈动脉粥样硬化的关系。方法:回顾性分析了174例老年人颈动脉彩色多普勒超声检查结果,包括颈动脉内膜一中膜厚度(IMT)、颈动脉粥样硬化斑块、颈动脉狭窄程度及血流动力学参数。并将入选对象分为有传统危险因素的脑梗死组(A组)、有危险因素非脑梗死组(B组)和无危险因素无脑梗死组(C组)进行对照研究。结果:A组颈动脉IMT增厚、斑块积分、复合斑、舒张末期峰值流速与B组和C组相比差异有统计学意义(P＜0．05)。结论:IMT厚度的增加、斑块的检出率及形态学特征、舒张末期血流速度的降低等是颈动脉病变与脑梗死发生的有意义的检测指标,在脑梗死的防治中是参考意义较大的超声学指标。     

高血压病及糖尿病颈动脉粥样硬化的特征

目的 探讨高血压病及糖尿病颈动脉粥样硬化的特征.方法 用多普勒超声检测34例高血压病(EH)患者及27例糖尿病(DM)患者与47例正常人的颈总、颈内及颈外动脉的内膜至中膜厚度(IMT)、斑块总面积,以积分形式计算出斑块的性质.结果 EH 34例、DM 27例的IMT及斑块总面积较正常组(NOR)47例显著增加(P<0.01,其中EH组斑块总面积P<0.05);DM值比EH组,斑块总面积增多,斑块性质严重,有显著差异(P<0.01).结论 高血压病及糖尿病均可导致颈动脉产生粥样硬化,其中糖尿病患者的颈动脉斑块性质比高血压病的更不稳定.     

颈动脉粥样硬化与缺血性脑卒中相关性分析

目的探讨颈动脉粥样硬化与缺血性脑卒中的关系,为脑卒中的预防和治疗提供帮助。方法对72例缺血性脑卒中患者行颈动脉彩色多普勒超声检查,分别检查颈总动脉、颈总动脉窦部及颈内外动脉,并记录颈总动脉内膜厚度。结果 72例中发生颈动脉粥样硬化61例,发生率84.72%;斑块形成者50例,发生率69.44%。结论彩色多普勒超声检测颈动脉硬化及斑块形成情况,对缺血性脑卒中有重要的预警作用,可常规筛查,早期监测,积极治疗,以预防脑卒中的发生。     

高血压患者双侧颈动脉血流和形态的偏侧差异性分析

目的探讨高血压对双侧颈动脉血流动力学及动脉壁厚度的影响差异。方法纳入原发性高血压患者52例为高血压组,健康体检者46例为健康组。应用彩色多普勒超声分别检测两组患者左右侧颈总动脉搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、动脉血流收缩期峰值(peak systolic velocity,PSV)、舒张末期的谷值(end diastolic velocity,EDV)和内-中膜厚度(intima-media thickness,IMT)。对比两组组内左右侧颈动脉上述指标的差异,以及两组组间同侧颈动脉上述指标的差异。结果高血压组颈总动脉P(IP=0.019)、R(IP=0.012)及IMT(P=0.043)均为左侧大于右侧,而两侧血流速度无显著差异。健康组左右侧颈总动脉上述各项指标均无显著差异。高血压组双侧IMT、RI均显著高于健康组同侧颈总动脉,其中左侧IMT P=0.002,右侧IMT P=0.017,左侧RI P=0.023,右侧RI P=0.024,同时左侧PI高于健康组(P=0.011),而两组间血流速度无显著差异。结论原发性高血压对颈动脉血流动力学及形态学影响左侧大于右侧。     

Isolated brainstem involvement in posterior reversible encephalopathy syndrome: a case report and review of the literature

Posterior reversible encephalopathy syndrome (PRES) is a clinical–radiological syndrome, reversible vasogenic edema predominantly within parieto-occipital regions. However, isolated brainstem involvement in PRES has been rarely reported, little is known about its clinical manifestations, radiological features and outcomes. We reported a case with PRES with only brainstem involvement and performed a systematic review of published cases. Twenty-four cases, together with our case, were included in the analysis. Mean age was 43?years and 63% were males. Hypertension (50%), nephropathy (25%) and chemotherapy (21%) were the major risk factors. All patients except two had acute hypertension and 50% of patients had renal dysfunction at onset. The most common symptoms were altered consciousness (46%) and headache (46%), Seizure was only presented in 21% of patients. All patients except two were treated with antihypertension. Most patients recovered to their neurological baseline. Clinicians should recognize this unique variant finding in PRES. which always affects males with severe hypertension, especially combined with renal dysfunction. Antihypertensive treatment is the most widely used therapy. Outcome is usually well.     

心房利钠多肽与急性脑血管疾病

对５０例急性脑血管疾病患者血浆心钠素含量进行了测定，并与２０例正常对照比较。急性脑血管病患者入院时血浆心钠素水平明显高于对照（Ｐ＜０．０１），进一步分析发现患者血浆心钠素水平与继发性心电图异常改变、病情轻重及患者的血压情况有关。本文对血浆心钠素增高的机制及意义进行了讨论。     

腔隙性脑梗死和动脉粥样硬化血栓性脑梗死患者微量蛋白尿的研究

目的明确脑梗死患者微量蛋白尿(MA)阳性率及腔隙性脑梗死(lacunar infarction,LI)和动脉粥样硬化血栓性脑梗死(atherothrombotic infarction,AI)患者MA阳性率是否存在差别。方法采用竞争性放射免疫分析方法对未合并肝肾功能不全等影响尿蛋白排泄率(UAER)检测结果的83例LI和78例AI患者,以及40例原发性高血压对照者进行UAER测定。统计脑梗死患者MA的阳性率,比较合并高血压的LI、AI与高血压对照组MA阳性率。结果161例脑梗死患者MA阳性率为42·9%;单纯合并高血压病史的45例LI患者和34例AI患者MA阳性率分别为51·1%和58·8%,均高于高血压对照组(P<0·05),但两组间比较无统计学意义。结论脑梗死患者呈现MA高发率;合并高血压病史的LI和AI患者MA阳性率无差别;MA会增加脑梗死的发生风险。     

可逆性后部白质脑病综合征临床影像学特征

目的探讨可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)的临床和影像学特点。方法回顾性分析8例可逆性后部白质脑病综合征患者的发病原因、临床症状、影像学特征、治疗及预后。结果8例患者中,女5例,男3例;发病原因多样,系统性红斑狼疮2例,妊娠子痫2例,高血压病1例,真菌性脑炎1例,多发性骨髓瘤1例,肾移植1例;其中使用免疫抑制剂3例,化疗药物1例,使用抗真菌药物1例。以头痛、癫痫发作、视觉障碍、意识和精神障碍为主要临床症状。多数患者头颅MRI表现为双侧大脑后部白质对称性T1WI呈低或等信号,T2WI和FLAIR像呈高信号;经采取降压、脱水及对症等治疗2~3周后患者神经系统症状消失,MRI复查病灶完全或大部分消失。结论RPLS是以可逆性后部白质损害为主要神经影像学表现的临床综合征,及时、准确的诊断和治疗可使其临床症状和影像学改变完全可逆。     

脑卒中后癫痫50例临床研究

目的探讨脑卒中后癫痫的临床特点，癫痫对脑卒中恢复期神经功能康复的影响。方法50例脑卒中后继发癫痫患者进行发作部位、类型、治疗时间及效果等分析，并按病情轻、中、重三组进行功能康复评分。结果脑卒中后癫痫发生率5．1%（50／980），其中早发癫痫72％（36／50），迟发癫痫28％（14／50）。皮层病灶继发癫痫72％（36／50），皮层下病灶继发癫痫占28％（14／50）。早发癫痫中全身发作27例．部分性发作9例，迟发癫痫中全身发作4例，部分性发作10例。癫痫组神经功能缺损评分均差于对照绀组（P〈0．05），结论脑卒中后癫痫皮层病灶多见，早发癫痫以全身发作为主，迟发癫痫以部分发作为主。脑卒中合并癫痫患者的治疗效果差于对照组，抗癫痫治疗有利于神经功能康复。     

Headache and hemodialysis: evaluation of the possible triggering factors and of the treatment

A growing number of patients have been undergoing dialysis procedures all around the world. Around 70% of the patients receiving dialysis treatment complain about headaches. In spite of this, headache is not well studied in this group of patients. The aims of this study are: to evaluate possible triggering factors related to hemodialysis headache and to evaluate the analgesic treatments used under this situation. We prospectively studied 50 patients with chronic renal failure attending to three dialysis services from the town of Ribeir?o Preto, State of S?o Paulo, Brazil, from January 1998 to December 1999. All of them presented headaches strictly related to the hemodialysis sessions. Headache occurred mainly in the second half of the hemodialysis (86%). Arterial hypertension (38%), arterial hypotension (12%) and changes in the weight during the hemodialysis sessions (6%) were the most consistently triggering situations. In 28% of the cases no factors were identified. Dipyrone was, by far (56%), the most frequently analgesic used. Despite being so common it noteworthy how scarce are studies in literature concerning headaches in patients with chronic renal failure. These patients, besides having to bear the burden of living with a painful and boring procedure to keep them alive, many of them have the additional burden, to live with a headache in most of the sessions. The identification of possible triggering factors and further evaluations of the treatment might increase our knowledge and contribute to reduce the burden of the headaches in patients with chronic renal failure.     

2型糖尿病脑梗死临床分析

目的分析2型糖尿病脑梗死临床特点,为其防治提供依据。方法将糖尿病脑梗死50例与非糖尿病脑梗死50例进行危险因素、临床特点等比较。结果糖尿病组高血压发病率、血脂水平、进展性卒中比例及复发性脑梗死比例均高于非糖尿病组,差异有统计学意义(p<0.05),而发病年龄、神经功能缺损程度、脑梗死类型及部位无显著性差异。结论糖尿病脑梗死患者易合并高血压、高血脂等多种危险因素,病情容易进展,复发的风险高,而糖尿病对脑梗死类型、部位及病情轻重无明显影响。     

Posterior leukoencephalopathy syndrome in children--clinical and neuroradiological findings

We reported the clinical and neuroradiological findings of 8 patients (4 males; 4 females; age range; 3 - 14 years) with posterior leukoencephalopathy syndrome (PLES). Previous case reports suggested that one of the major factors leading to PLES was severe hypertension. We divided the patients into two groups with or without severe hypertension, and each group was divided furthermore into two corresponding to the reversibility of brain lesions. The four cases of PLES with severe hypertension were all due to renal hypertension, and half of them resulted in irreversible outcomes, which were considered to be associated with inappropriate treatment. On the other hand, the four cases of PLES without severe hypertension showed reversible change, suggesting intravascular endothelial dysfuncton in respect of their causing factors. We consider that PLES could be caused without sever hypertension, particularly in children. Those with severe hypertension must be treated immediately to prevent irreversible brain damage.     

Management of resistant hypertension in patients with carotid stenosis: high prevalence of renovascular hypertension

INTRODUCTION: Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. METHODS: A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension. RESULTS: Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures). CONCLUSION: Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.     

大骨瓣减压术在重型颅脑损伤治疗中应用探讨

目的探讨大骨瓣减压术在重型颅脑损伤治疗中的应用。方法治疗组选择重型颅脑损伤后难治性颅内高压36例,采用大骨瓣减压术;对照组选择前期重型颅脑损伤后难治性颅内高压19例,采用传统骨瓣减压术及保守治疗。比较两组病例疗效,并比较不同时期大骨瓣减压术疗效。结果两组间疗效评价采用出院时GOS评定,显示二组间有明显差别(P<0.05),且治疗组早期手术疗效优于晚期手术疗效(P<0.05)。结论早期大骨瓣减压术在治疗重型颅脑损伤后难以控制颅内高压是有效的。