急性脑血管病血栓弹力图临床检测的研究

目的 探讨急性脑血管病病人血栓弹力图的改变。方法 采用全血复钙法对225例急性脑血管病病人进行了血栓弹力图(Thrombelastogram,TEG)检测，并对其中70例进行治疗前后TEG对比观察。结果 脑梗死组存在明显的血液高凝状态，而脑出血组则存在明显的血液低凝状态。治疗后TEG各位改变均有明显改县(P＜0．01或P＜0．05)。结论 TEG可用于急性脑血管病血液凝固性异常的诊断、指导与监测药物治疗和估计预后。     

缺血性脑血管病血栓弹力图初步观察

采用操作简便,检测迅速的血栓弹力图计方法,对105例缺血性脑血管病患者进行了临床对照检测的初步观察。缺血性脑血管病患者在急性期存在血液高凝状态。以多发性脑梗塞、TIA、脑干梗塞和动脉深穿支闭塞脑梗塞患者改变为著。血栓弹力图(TEG)是监视血液凝固变化的一种可取的新方法。     

缺血性脑卒中的超早期治疗

目的研究东菱克栓酶和噻氯吡啶对缺血性脑卒中的超早期治疗效果。方法３２例急性缺血性脑卒中患者（起病６小时内）分成两组，治疗组（ｎ＝１２）前５天给予东菱克栓酶一疗程，噻氯吡啶２５０ｍｇ，一日２次，后１０天治疗同对照组；对照组（ｎ＝２０）给予精制蝮蛇抗栓酶１．０ｕ，肠溶阿司匹林４０ｍｇ，每日一次，治疗１５天。结果治疗组：显效率７５％，有效率８．３３％，总有效率８３．３３％；对照组分别为２０％，２０％，４０％（χ２＝４．１０，Ｐ＜０．０５）。结论东菱克栓酶和噻氯吡啶对缺血性脑卒中的超早期治疗，能显著改善临床症状，降低致残率     

卵圆孔未闭是青年缺血性脑卒中的危险因素

目的探讨卵圆孔未闭与青年缺血性脑卒中的相关性。方法对42例青年缺血性脑卒中病例进行回顾性分析。结果 42例患者中,病因明确22例,病因不明或可疑者20例。病因明确组卵圆孔未闭检出6例(27.3%),合并房间隔瘤1例;病因不明组卵圆孔未闭检出11例(55%),合并房间隔膨胀瘤4例,合并深静脉血栓和/或血液高凝状态2例。结论卵圆孔未闭是青年缺血性脑卒中的危险因素之一。     

纤溶酶对急性缺血性脑卒中患者血液流变学的影响

目的 观察纤溶酶对急性缺血性脑卒中患者血液流变学的影响.方法 本试验采用前瞻性开放性病例对照研究,将121 例急性缺血性脑卒中患者随机分为治疗组和对照组,对照组(50 例) 采用常规治疗,治疗组(71 例)在常规治疗的基础上加用纤溶酶(200IU 1次/d) 静滴,于治疗前及治疗10 d 后评定患者神经功能缺损程度,检测血液流变学指标.结果 常规治疗与纤溶酶治疗均对神经功能缺失有一定改善,治疗组有效率87.32%,对照组72.0%,2 组疗效差异有统计学意义(P<0.05) .常规组与纤溶酶组对血液流变学各项指标均有改善,纤溶酶组更加显著.结论 纤溶酶有改善急性缺血性脑卒中患者血液流变学指标的作用,同时又对促进急性缺血性脑卒中患者神经功能的恢复具有良好作用.     

藻酸双酯钠对缺血性脑血管病临床疗效、实验室观察及动物实验研究

本文报道用由褐藻提取的类肝素新药PSS治疗288例缺血性脑血管病。有效率92．0％，显效率62．2％，与对照组相比有显著性差异（P＜0．005，X^2＝35．75）。实验室观察，发现PSS有明显的抗凝血、降低血粘度、降低血脂以及改善微循环的作用。动物实验也发现PSS有稀释血液、降低血粘度、降低血液高凝状态以及高强的解聚能力。实验室各项指标临床疗效均发现有显著的进步。作者认为PSS预防和治疗缺血性脑血管病有一定的重要价值。     

中西医结合治疗急性缺血性脑卒中的疗效及对血清超敏C反应蛋白与血液流变学指标的影响

目的探讨中西医结合治疗急性缺血性脑卒中的疗效及对血清超敏C反应蛋白与血液流变学指标的影响。方法抽取2014-06—2016-02我院84例急性缺血性脑卒中患者,随机分为2组各42例。对照组采用常规治疗措施,研究组在常规治疗基础上采用中西医治疗。对比2组临床疗效、治疗前后超敏C反应蛋白水平及血液流变学指标水平变化情况。结果研究组总有效率92.86%,对照组为76.19%,2组对比差异有统计学意义(P0.05);治疗前2组超敏C反应蛋白、红细胞比积、纤维蛋白原、血浆黏度、全血黏度低切、全血黏度高切水平对比差异无统计学意义(P0.05),治疗后研究组优于对照组,差异有统计学意义(P0.05)。结论中西医结合治疗急性缺血性脑卒中疗效确切,可有效改善患者血清超敏C反应蛋白及血液流变学水平,提高临床疗效。     

疏血通联合血栓通治疗缺血性脑卒中的疗效分析

目的探讨分析疏血通联合血栓通治疗缺血性脑卒中的临床疗效。方法选取2011-02—2012-06我院收治的缺血性脑卒中患者90例,采用随机数表法平均分为实验组和对照组,实验组患者采用疏血通联合血栓通进行治疗,对照组患者仅使用血栓通治疗,对比观察2组患者治疗后效果。结果实验组治疗有效率为93.3%,对照组治疗有效率为77.8%,差异具有统计学意义(P<0.05),在血液流变学指标对比方面,实验组患者治疗后血浆黏稠度和全血黏稠度分别为1.55±0.28和4.11±0.17,对照组为2.09±0.51和5.36±0.21,差异有统计学意义(P<0.05),在红细胞比积和纤维蛋白原含量方面实验组治疗效果也显著优于对照组。结论临床使用疏血通联合血栓通治疗缺血性脑卒中安全有效,对疾病愈后恢复具有良好促进作用,提高患者生活质量,降低医药支出,适合在农村以及偏远地区的基层医院推广使用。     

偏头痛型脑卒中(附20例报告)

目的：探讨偏头痛型脑卒中的临床特征，以期引起对该病的认识与重视。方法：对20例偏头痛型脑卒中的临床资料进行分析，并结合文献讨论本病的可能发生机理。结果：20例患者平均年龄35.8岁，女性占95％，均有偏头痛史（平均15．6年），在偏头痛发作过程中发生脑梗塞（均经CT或MRI确诊）。主要临床表现以偏盲为最多；偏身感觉障碍，轻偏瘫次之。血液流变学均呈高凝状态。结论：本病是一种青年缺血性脑卒中，女性居多，均有偏头痛史，梗塞灶常发生在椎基底系统，以大脑后动脉受累为主。其发病机制可能与血管舒缩功能紊乱致严重的脑血管痉挛性狭窄及血液高凝状态有关。     

房颤对急性缺血性脑卒中患者尿激酶溶栓疗效的影响

目的 探讨房颤是否对急性缺血性脑卒中患者尿激酶溶栓疗效产生影响及对于合并房颤的急性缺血性脑卒中患者是否给予尿激酶溶栓治疗.方法 本研究为回顾性病例对照研究.从2006年4月到2012年1月连续收集发病6小时内给予尿激酶溶栓的急性缺血性脑卒中患者作为研究对象.根据有无合并房颤将符合入选标准的病例分为两组:房颤组(26例)和无房颤组(60例).采用美国国立卫生研究院卒中量表(NIHSS)、改良的Rankin量表评价治疗效果.结果 房颤组与无房颤组溶栓治疗后7d溶栓有效率比较,差异无统计学意义(57.7％ vs 56.7％,P＞0.05).在尿激酶静脉溶栓治疗后90 d,房颤组57.7％的病人功能恢复好,无房颤组65.0％的病人功能恢复好,两组比较差异无统计学意义(P＞0.05).房颤组颅内出血的发生率、症状性颅内出血的发生率及死亡率均较高,但与无房颤组比较差异均无统计学意义.结论 合并房颤的急性缺血性脑卒中患者与无合并房颤的急性缺血性脑卒中患者均可以从溶栓中获益,房颤对急性缺血性脑卒中患者尿激酶溶栓疗效无显著影响,合并房颤的急性缺血性脑卒中患者应予尿激酶溶栓治疗.     

Prior antiplatelet use and infarct volume in ischemic stroke

BACKGROUND: Conflicting data exist on the role of antiplatelet agents in reducing incident ischemic stroke magnitude, but most prior studies used clinically-assessed neurologic deficit as the index of stroke extent rather than more precise volumetric measurements of infarct size. We assessed the relation of premorbid antiplatelet use to initial diffusion-weighted MRI (DWI) lesion volumes among acute ischemic stroke patients. METHODS: Consecutive patients presenting within 24 h of ischemic stroke over an 18-month period were studied. DWI lesions were outlined using a semi-automated threshold technique. Subjects were categorized into two groups: antiplatelet (AP) or no antithrombotic (NA). The relationship between prestroke antithrombotic status and DWI infarct volumes was examined using multivariate quantile regression. RESULTS: One hundred sixty-six individuals met study criteria: 75 AP and 91 NA patients. Median DWI volume was lower in the AP group than in the NA group (1.5 cc vs. 5.4 cc, p=0.031). A multivariable model (adjusting for age, history of transient ischemic attack, admission temperature, admission blood pressure, admission serum glucose, stroke onset to imaging interval, stroke mechanism, premorbid statin and antihypertensive use) demonstrated smaller infarcts in the AP vs. NA group (adjusted volume difference: -1.3 cc, 95% CI=-0.09, -2.5, p=0.037). Prior statin use, no history of TIA, large vessel atherosclerosis and microvascular ischemic disease stroke mechanism were also independently associated with reduced infarct volume. CONCLUSIONS: Prior antiplatelet treatment is independently associated with reduced cerebral infarct volume among acute ischemic stroke patients. Premorbid statin use, TIA history and stroke mechanism also predict infarct volume in ischemic stroke.     

Use of antithrombotic drugs in the treatment of acute ischemic stroke: a survey of neurologists in practice in the United States

In an attempt to determine the opinions and practices of neurologists regarding the use of antithrombotic drugs in the treatment of acute ischemic stroke, we conducted a survey of 349 randomly selected neurologists from throughout the United States. Responses were received from 247 (71%), and 219 identified themselves as primary or consulting physicians for patients with acute ischemic stroke. During the previous 12 months, these 219 physicians estimated that they had seen a total of 14,636 patients within 24 hours of acute ischemic stroke, and 22% of these patients were treated with heparin. The most frequently reported indications were prevention of recurrent cerebral embolism (82% of physicians) and progressing stroke (70%). Despite the frequent use of heparin, only 6.4% of neurologists felt that it has been shown to be effective, and 16.4% felt that it has been shown to be of no value. The primary concern about the use of heparin was lack of proven efficacy in 48% and safety concerns in 41%. Results of a future trial testing the efficacy of antithrombotic drugs would be useful for most neurologists in their management of patients with acute or progressing ischemic stroke.     

Heparin therapy in embolic cerebral infarct. A retrospective study

Heparin therapy in acute stroke is a controversial issue. It is uncertain, whether heparin has a therapeutic or preventive effect in the early phase of the stroke. From 1984-1989, 1095 patients with acute ischemic stroke were treated, 141 (12.9%) of whom received heparin within 3 days of stroke onset. The mean duration of heparin anticoagulation was 10 days. In 28 cases (20%), heparin was used as antithrombotic agent (25/28 patients suffered a basilar artery occlusion, of whom 22 died). In 113 cases (80%), heparin was used in embolic stroke to prevent recurrence (24% cardioembolic stroke, 54% arterio-arterial embolism, and 22% embolism of unknown etiology). The rate of recurrent stroke in the early phase was 13% with a persistent deficit in 5.3%. The results are comparable with those of other trials reported in the literature. Only 2 patients had an anticoagulation-related haemorrhage with clinical deterioration. Heparin anticoagulation in acute stroke is a low-risk therapy, but its preventive value has not yet been demonstrated.     

899例缺血性脑卒中二级预防干预调查

目的 了解缺血性脑卒中患者住院期间二级预防药物的应用情况,为改进缺血性脑卒中二级预防工作提供依据.方法 回顾性调查899例缺血性脑卒中患者住院期间二级预防药物的服药率.结果 在899例缺血性脑卒中患者中,合并高血压者有632例,合并糖尿病者有220例,既合并有高血压又合并糖尿病者有177例.入选的899例患者中,服用抗血小板药物者占91.9％ (826例),在短暂性脑缺血发作组和脑梗死组间差异有统计学意义(P＜0.01);服用调脂药物者占77.2％(694例),在短暂性脑缺血发作组和脑梗死组间差异无统计学意义;632例缺血性脑卒中合并高血压患者中服用降压药者占95.4％(603例);220例缺血性脑卒中合并糖尿病患者中服用降糖药者(包括使用胰岛素)占84.5％(186例);177例既合并有高血压又合并有糖尿病的脑卒中患者中均用药者占83.1％(147例).结论 住院期间脑梗死患者抗栓药物服用率较短暂性脑缺血发作高,缺血性脑卒中二级预防用药尚不令人满意,临床医生应对脑卒中的二级预防治疗给予重视.     

脑梗死急性期血压变化特点及其与进展性脑梗死的关系

目的 观察脑梗死急性期血压变化特点,探讨其与进展性脑梗死的关系。方法 收集2013年7月～2014年4月本院收治的急性脑梗死患者129例。采用斯堪地那维亚卒中量表(Scandinavian Stroke Scale,SSS)评估病情是否发生进展,监测患者发病后72 h内的血压,分析血压变化特点及其与进展性脑梗死的关系。结果 脑梗死发病72 h内血压呈逐渐降低趋势。进展组患者高血压病史患病率显著高于非进展组,且各时段平均血压也显著高于非进展组。无高血压病史的患者各时段平均血压进展组显著高于非进展组,而有高血压病史的患者各时段平均血压2组比较无显著差异。结论 脑梗死急性期血压呈自发性下降。对于无高血压病史的患者急性期血压增高与进展性脑梗死有关,而对有高血压病史的患者急性期血压增高或许有保护作用。     

Influence of cerebral hemodynamics on stroke risk: one-year follow-up of 30 medically treated patients

The importance of hemodynamic factors in the pathogenesis and treatment of ischemic cerebrovascular disease is not clear. We have investigated the relationship between cerebral hemodynamics and the subsequent risk of stroke in 30 medically treated patients with symptomatic occlusion or greater than 75% intracranial stenosis of the carotid arterial system. Positron emission tomography (PET) was used to evaluate the regional hemodynamic status of the cerebral circulation. Clinical follow-up to 1 year post-PET was available for all patients. The incidence at 1 year of all strokes was 1/9 for patients with normal hemodynamics and 1/21 for patients with abnormal hemodynamics. The 1-year incidence of ipsilateral ischemic stroke was 1/9 for hemodynamically normal patients and 0/21 in the abnormal group. The 21 patients in the abnormal group fulfilled entry criteria for the Extracranial-Intracranial Bypass Trial. The 0/21 incidence of ipsilateral ischemic stroke at 1 year was compared with the 1-year rate of 0.109 for the 714 medically treated patients from the Bypass Trial. We were able to reject with better than 90% certainty (p = 0.089) the hypothesis that our sample of patients came from a population with an ipsilateral ischemic stroke rate of 0.109 or greater. Thus, in this small sample, we found no evidence that PET evidence of abnormal cerebral hemodynamics identifies a subgroup of patients at higher risk for early stroke if treated medically with antithrombotic drugs.     

住院患者不明原因栓塞性卒中诊治现状研究

目的 了解目前中国不明原因栓塞性卒中（embolic stroke of undetermined source,ESUS）诊治现状。 方法 回顾性分析2011年1月-2012年12月在北京大学第三医院神经内科住院的缺血性卒中患者,将 住院及随访期间未完善24 h心电监测（Holter）但已完成其他评估并符合ESUS标准者,定义为可疑 ESUS（suspected ESUS,sESUS）,将完善了包括24 h心电监测等在内全部评估并符合ESUS诊断标准者, 定义为“确定ESUS”（definite ESUS,dESUS）,以上均划分为ESUS组;其他卒中亚型为非ESUS组。比较 两组间一般情况、危险因素及临床特点;并随访ESUS组患者二级预防及复发情况。 结果 研究共纳入缺血性卒中患者900例,按照住院资料诊断dESUS 9 例（1.0%）,sESUS 9 5例 （10.6%）,合计104例（11.6%）;非ESUS组796例。ESUS患者活动中起病85例（81.7%）、病情波动58例 （55.8%）、入院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评 分2.0（0,4.0）分,非ESUS组分别是538例（67.6%）,245例（30.8%）和3.0（1.3,5.0）分,差异均有显 著性（P分别为0.010、<0.001、<0.001）。对ESUS组患者急性期及二级预防抗栓药物使用的调查发现, 随访dESUS患者均为抗血小板治疗,其中6例出现1年内缺血性卒中复发;sESUS患者也全部为抗血小板 治疗,其中10例出现1年内缺血性卒中复发。 结论 目前ESUS在缺血性卒中患者中比例较高,与非ESUS患者相比,其病情波动较大,神经功能缺 损较轻。对该类患者应该加强24 h心电图的监测以助查找病因。     

Antithrombotic and antihypertensive management 3 months after ischemic stroke : a prospective study in an inner city population

BACKGROUND AND PURPOSE: We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke. METHODS: The population-based South London Community Stroke Register prospectively collected data on first-in-a-lifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event. RESULTS: In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: OR=1. 60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS 相似文献   

血栓弹力图凝血酶原通道检测指标在评价急性缺血性脑血管病患者高血小板反应性以及预测复发缺血事件中的价值

目的 探讨血栓弹力图（thrombelastography,TEG）凝血酶原通道检测指标在评价急性缺血性脑血管 病患者高血小板反应性以及进一步预测复发缺血事件中的价值。 方法 连续纳入符合入选标准的在首都医科大学附属北京天坛医院脑血管病中心住院治疗的急性 缺血性脑血管病患者。在阿司匹林联合氯吡格雷双重抗血小板治疗5 d后进行TEG检测。根据TEG检 测的血小板抑制率,分为正常血小板反应组和高血小板反应组。比较两组患者TEG凝血酶原通道检 测指标的差异。采用多因素Logistic回归分析高血小板反应性的独立相关因素。随访患者出院后3个月、 6个月的复发性缺血事件,分析TEG凝血酶原通道检测指标与复发缺血事件的相关性。 结果 研究共纳入374例患者,与正常血小板反应性组（287例）患者相比,高血小板反应性组（87例） 患者血凝块成形时间水平低（P =0.047）,血凝块形成速率（P =0.026）、最大振幅水平高（P =0.007）。 多因素Logistic回归分析表明：既往缺血性卒中或短暂性脑缺血发作（transient ischemic attack,TIA）病 史（OR 1.723,95%CI 1.037～2.863,P =0.036）、血凝块形成速率（OR 1.090,95%CI 1.008～1.180, P =0.032）与高血小板反应性独立相关。共有355例患者完成6个月随访,其中有47例发生复发缺血事 件,复发缺血事件组（47例）与无复发缺血事件组（308例）相比,在凝血反应时间、血凝块成形时间、 血凝块形成速率、最大振幅方面均无显著差异。 结论 TEG凝血酶原通道检测指标有助于评价急性缺血性脑血管病患者高血小板反应性,但在预 测复发缺血事件方面的价值尚需进一步研究。     

The clinical effect of combination therapy with edaravone and sodium ozagrel for acute cerebral infarction]

Sodium ozagrel (ozagrel), a selective thromboxane A2 synthetase inhibitor, has been used for the treatment of various types of acute ischemic stroke, except cardioembolic stroke. Recently, edaravone, a novel free radical scavenger, has been approved for the treatment of acute ischemic stroke within 24 hours after onset. Since these two drugs differ in mode of action, we hypothesized that combination of both drugs would yield further improvement of the outcome of patients with acute ischemic stroke. The clinical efficacy of combination therapy with edaravone and ozagrel for acute ischemic stroke was studied retrospectively, and compared with that of ozagrel alone. A total of 62 patients who suffered acute ischemic stroke within 24 hours after onset during the 10-month period from June 2001 to March 2002, were treated with both edaravone and ozagrel (E-O group), while 76 patients during August 2000 to May 2001, were treated with ozagrel alone (O group). The rate of modified Rankin Scale (MRS) 0 and 1 at discharge in the total ischemic stroke and atherothrombotic stroke, was significantly higher in the E-O group than in the O group. The improvement in MRS also differed between E-O group and O group in total. The difference was significant in patients with atherothrombotic stroke but not in those with lacunar stroke. These results indicate that combination therapy with edaravone and ozagrel is more effective than mono-therapy with ozagrel for the treatment of acute ischemic, especially of atherothrombotic stroke.