老年急性缺血性脑卒中患者早期阿斯匹林治疗的临床对照研究

目的：探讨老年急性缺血性脑卒中早期抗血小板治疗效果,以及降低致残率的临床观察,方法：采用随机双盲对照研究,对入院48小时内急性脑卒中患者,经头颅CT扫描除外脑出血,无阿斯匹林禁忌的给予160mg 1/日口服或安慰剂治疗四周,结果：共入选180例,住院期间阿斯匹林组死亡2例,对照组死亡3例,阿斯匹林组治疗期间63％基本恢复,无再发脑卒中及出血,两组治疗结果比较判别显著（P＜0．05）, 结论：阿斯匹林辅佐治疗,不影响其它常规治疗,药源方便,价廉,具有促进恢复,预防复发作用。     

缺血性脑血管病阿司匹林规范应用共识

1．1证据 在急性缺血性卒中患者已经评价过阿司匹林的作用，尚未评价过其他抗血小板药物的作用（包括噻氯吡啶、氯吡格雷、阿司匹林和双密哒莫的复合制剂）。目前已经完成两个大规模的临床试验，包括国际脑卒中试验（IST）和中国急性卒中试验（CAST）。两项研究均在卒中发病48h内应用阿司匹林（IST平均用药在卒中发病后19h，CAST则是25h）。IST研究一共入选了19435例患者，结果显示阿司匹林组患者14d病死率显著降低（9．0％比9．4％，2P=0．03），缺血性卒中复发率明显减少（2．8％比3．9％，2P〈0．001），出血性卒中则与对照组差异无统计学意义（0．9％比0．8％）；阿司匹林组随访6个月患者的死亡发生率和致残率显著降低（61．2％比63．5％，P=0．03）。CAST研究一共包括21106例缺血性卒中患者，发病48h内给予阿司匹林160mg／d，共用4周。结果显示，     

急性脑卒中100例临床分析

目的总结急性脑卒中临床特点。方法回顾性分析我院2003年1月-2005年12月我科收治的100例急性脑卒中病人。结果出血性卒中37例，缺血性卒中63例；高血压、冠心病为常见诱发疾病；动态发病以出血性卒中常见（64．0％），静态发病以缺血性卒中常见（61．0％）；CT显示卒中好发部位为基底节多见。结论急性脑卒中患者有自身临床特点，针对高血压、冠心病的治疗，对预防此病有积极意义。     

北京市房山区老年非瓣膜性房颤的华法林抗凝治疗研究

目的：研究适宜剂量的华法林对北京市房山区65岁以上老年持久性非瓣膜性房颤（NVAF）患者的疗效。方法：对纳入研究的870例持久性NVAF患者抗凝治疗资料进行回顾性分析。患者被分为阿司匹林组（471例）和调整剂量华法林（维持INR在2．0～3．0）组（369例）。两组在年龄、性别、伴随病等方面无显著差异。比较两组主要、次要终点事件。结果：入选病例共937例,有效病例870例,失访67例（7．1％）。随访时间（19．2±2．1）个月。华法林组主要终点事件（死亡和缺血性脑卒中）较阿司匹林组降低62％（1．06％：6．52％,P=0．04）。华法林组的缺血性脑卒中较阿司匹林组下降68％（0．42％：4．76％,P=0．04）;华法林组总死亡率低于阿司匹林组（0．42％：3．00％,P=0．02）。包括主要和次要终点的联合终点事件华法林组低于阿司匹林组（2．97％：13．03％,P=0．04）。华法林组出血率较阿司匹林组显著减少（1．69％：12．02％,P=0．04）。结论：对于老年持久性非瓣膜性房颤患者,给予华法林维持INR在2．0～3．0的剂量,可以较阿司匹林更大程度地降低并发症和死亡率,而且是安全的。     

急性脑卒中202例心电图分析及与预后的关系

目的 探讨急性脑卒中心电图改变特点及对预后的影响。方法 对202例急性脑卒中合并有心电图异常的118例患者的临床资料进行回顾性分析。结果 急性脑卒中心电图异常占58．4％，其发生率与年龄呈正相关（P〈0．01）。出血性脑卒中心电图异常发生率明显高于缺血性脑卒中（P〈0．01）。出血性脑卒中患者中，心电图异常以心肌缺血或类心肌梗死及窦性心动过速为主，缺血性脑卒中患者中，心电图改变无明显特异性。合并有心电图异常的急性脑卒中死亡率明显增高。结论 急性脑卒中患者中，≥50岁患者心电图异常发生率高，出血性脑卒中合并心电异常发生率高，且死亡率明显增加。     

抗血小板药预防缺血性卒中患者缺血事件再发

目的：比较氯吡格雷、阿司匹林和阿司匹林加双嘧达莫对缺血性卒中患者再次发生缺血事件的影响。方法：2003年1月-2005年1月收治的急性脑梗死患者314例，分为氯吡格雷组（82例，75mg/d）、阿司匹林组（106例，肠溶阿司匹林75—100mg/d）和阿司匹林加双嘧达莫组（126例，阿司匹林肠溶75～100mg/d和双嘧达莫150mg/d）。至少在出院后1、3、6、12个月各随访1次。主要终点指标：（1）再次缺血性卒中或短暂性脑缺血发作（TLA）；（2）经CT证实的脑出血；（3）外周血管血栓栓塞；（4）出现胃肠道、眼底或皮肤出血。结果：氯吡格雷组缺血性卒中和TIA的发生率（6．1％）低于阿司匹林组（26．7％，P〈0．05）或阿司匹林加双嘧达莫组（20．6％，P〈0．05），阿司匹林组与阿司匹林加双嘧达莫组组无显著差异（P〉0．05）。氯吡格雷组出血发生率为7．32％，低于阿司匹林组（7．62％）或阿司匹林加双嘧达莫组（7．94％），但无统计学差异（P〉0．05）。结论：氯吡格雷预防缺血事件再发的效果优于阿司匹林或阿司匹林加双嘧达莫，且并未增加出血性并发症。     

依达拉奉治疗急性脑梗死病人神经功能缺损评分的变化

目的观察依达拉奉治疗急性脑梗死的临床效果。方法入选病人随机分为治疗组和对照组，治疗组32例，对照组31例。对照组用常规治疗方法（维脑路通针，阿司匹林片），治疗组在常规治疗的基础上加用依达拉奉注射液30rng，静脉输注，每日2次，治疗前后定期对病人进行欧洲卒中评分（ESS），并于第21天进行疗效评定。结果第21天时治疗组神经功能改善显效率为62．5％，对照组为38．7％，两组间比较有统计学意义（P〈0．05）。结论依达拉奉治疗急性脑梗死安全有效，其强大的自由基清除功能所起到的神经保护作用，对急性缺血性脑卒中病人非常有益。     

经皮冠状动脉介入治疗后血小板聚集率高的患者强化抗血小板治疗的研究

目的研究经皮冠状动脉介入治疗（PCI）后血小板聚集率仍然高的患者强化抗血小板治疗与主要心脏事件的关系。方法选择2004年1月至2006年6月我院住院进行择期PCI的冠心病患者1556例,服药前、术后24小时、28天检测二磷酸腺苷（ADP）诱导的血小板聚集率。其中有402例患者[男178例,女224例,平均年龄（57．34±6．47）岁]术后血小板聚集率仍然高,其24小时的血小板聚集度与基线（服药前）的绝对值〈30％。把这部分患者随机分为两组,对照组（n=201）继续服用阿司匹林100mg、氯吡格雷75mg;治疗组（n=201）除继续服用阿司匹林100mg、氯吡格雷75mg,每天加西洛他唑200mg,分两次服用。连续应用6个月,观察两组患者6个月主要心脏不良事件（包括死亡、非致死性急性心肌梗死、急性或亚急性血栓、靶血管重建、脑卒中）以及出血等不良事件的发生率。结果28天血小板聚集的抑制〈30％患者对照组有89．6％（180／201）,治疗组有9．4％（19／201）,两组相比,差异有统计学意义（P〈0．05）。两组均无急性血栓发生;亚急性血栓对照组有3．0％（6／201）,治疗组有0．5％（1／201）,两组相比,差异无统计学意义（P〉0．05）;对照组有2例死亡,治疗组无死亡;两组均未发生脑卒中;非致死性急性心肌梗死对照组1．5％（3／201）,治疗组0．5％（1／201）;两组相比,差异无统计学意义（P〉0．05）;靶血管重建对照组有15．9％（32／201）,治疗组6．5％（13／201）,两组相比,差异有统计学意义（P〈0．01）;出血的发生率对照组4．0％（8／201）,治疗组6．0％（12／201）,两组相比,差异无统计学意义（P〉0．05）。主要心脏事件的累计危险率治疗组低于对照组,差异有统计学意义（P〈0．05）。结论PCI后应用抗血小板药物,血小板聚集率经治疗后仍然高（即血小板聚集抑制〈30％）的患者,强化抗血小板治疗可以减少主要心脏事件的累计危险率,而没有增加出血并发症。     

早期干预对预防脑卒中后应激性溃疡出血的作用

目的探讨早期应用抑酸荆对急性脑卒中后应激性溃疡出血的预防作用。方法急性脑卒中病人184例随机分成两组，治疗组（奥美拉唑）和对照组（无药物预防）。测定不同时间胃液pH值，观察两组病人应激性溃疡出血的发生率、病死率。结果入院时两组病人pH值均无差异．应用奥美拉唑后治疗组DH值显著升高，治疗组溃疡出血发生率为8．5％，病死率为3．8％．明显低于对照组的25．6％和11．5％（P〈0．05）。结论早期干预可以降低急性脑卒中后应激性溃疡出血的发生率和病死率。     

急性期抗血小板及调脂治疗对缺血性卒中患者预后影响的前瞻性随访研究

目的：探讨缺血性卒中患者急性期抗血小板、调脂治疗与预后的关系。方法：收集自2007年1月～2008年5月在卒中单元病房住院治疗的1016例急性缺血性脑卒中患者,男630例,女386例,平均年龄64．54±11．60岁。根据是否服用抗血小板的药物和是否应用他汀类调脂药进行分组,分别分为使用组和未使用组。应用N1HSS评分了解各组入院时、随访3月和随访12月后的神经功能缺损程度,根据改良Rankin评分（mRs）评价各组患者预后、复发率和病死率的差异。结果：缺血性脑卒中男性患者发病年龄较女性患者早（P〈0．001）。其中使用抗血小板治疗927例,随访3月及12月抗血小板治疗组神经功能缺损程度较术使用者轻,NIHSS评分比较有显著性差异（P〈0．05）,使用抗血小板治疗组改善明显（P〈0．05）,预后不良发生率和病死率均较术使用背低（P〈0．001）,然而,复发率在两组之间比较无差异（P〉0．05）。同样,使用他汀类调脂药者随访3月和随访12月的病死率和预后不良发生率均低于未使用组（P〈0．001）,但复发率在两组之间比较无差异（P〉0．05）。结论：使用抗血小板药及他汀类调脂药将能改善患者预后,明显降低缺血性卒中患者的预后不良的发生率和病死率。     

Effects of Batroxobin with Continuous Transcranial Doppler Monitoring in Patients with Acute Cerebral Stroke: A Randomized Controlled Trial

Our objective was to determine whether continuous transcranial Doppler (TCD) monitoring could safely enhance the efficacy of batroxobin, a thrombin‐like enzyme extracted from Bothrops atrox moojeni venom, in the treatment for acute cerebral stroke beyond the thrombolytic time window. Ninety patients suffering an acute cerebral stroke were recruited into the study within 12 hours after the onset of symptoms. Patients were randomized to receive batroxobin with (target group) or without 1 hour of continuous TCD monitoring (control group). Clinical evaluation of stroke was based on the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index (BI), Thrombolysis in Brain Ischemia score (TIBI), the incidence of advancing stroke, and the recurrence of cerebral infarction. The patients receiving continuous TCD monitoring showed significant improvement in NIHSS score at 57 days post treatment compared with the control. Similarly, patients receiving continuous TCD monitoring also showed significant improvement in BI at 3 months compared with the controls. Consistently, both the incidence of advancing stroke after 1 week and the incidence of stroke recurrence after 3 months were significantly lower in TCD monitored group than control group. Moreover, the safety of the employment of TCD monitoring in the treatment of these patients was confirmed as there was no significant difference of the incidence of intracranial hemorrhage at 1 week after the treatment between the target and control groups. Taken together, our study showed that batroxobin, in combination with continuous TCD monitoring at the middle cerebral artery, reduced the incidence of advancing stroke and stroke recurrence after treatment without adverse effects in terms of poststroke intracranial hemorrhage.     

缺血性脑卒中急性期抗血小板疗法临床协作研究(计划与设计部分)

脑卒中是当今世界各国最常见的疾病之一 ,据估计下一个 10年在欧洲和美国将有 15亿人患急性脑卒中。在中国每年有 10 0多万人死于脑卒中 ,因其致残的人数则更多 ,对患者和社会带来严重的影响和负担。虽然目前临床上治疗急性脑卒中的方法与药物很多 ,但由于缺乏严格的科学的疗效     

The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure.

AIMS: To determine the cardiovascular benefits in those originally assigned atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-2.2 years after closure of the lipid-lowering arm of the trial (ASCOT-LLA). METHODS AND RESULTS: The Blood Pressure Lowering Arm of the ASCOT trial (ASCOT-BPLA) compared two different antihypertensive treatment strategies on cardiovascular outcomes. ASCOT-LLA was a double-blind placebo-controlled trial of atorvastatin in those enrolled into ASCOT-BPLA with total cholesterol concentrations at baseline of < or =6.5 mmol/L. A total of 19 342 hypertensive patients were enrolled in ASCOT-BPLA and 10 305 were further assigned either atorvastatin, 10 mg, or placebo. ASCOT-LLA was stopped prematurely after a median 3.3 years follow-up because of substantial cardiovascular benefits in those assigned atorvastatin. Trial physicians were invited to offer atorvastatin to all ASCOT-LLA patients until the end of ASCOT-BPLA. The primary outcome of ASCOT-LLA was combined fatal coronary heart disease (CHD) or non-fatal myocardial infarction. Secondary outcomes included all coronary events, all cardiovascular events and procedures, fatal and non-fatal stroke, cardiovascular mortality, all cause mortality, development of chronic stable angina, heart failure, and peripheral arterial disease. By the end of ASCOT-LLA, there was a 36% relative risk reduction in primary events (n = 254) in favour of atorvastatin [hazard ratio (HR) 0.64, 95% CI: 0.50-0.83, P = 0.0005]. At the end of ASCOT-BPLA, 2.2 years later, despite extensive crossovers from and to statin usage, the relative risk reduction in primary events (n = 412) among those originally assigned atorvastatin remained at 36% (HR 0.64, 95% CI: 0.53-0.78, P = 0.0001). For almost all other endpoints, risk reductions also remained essentially unchanged and in the case of all cause mortality, the risk reduction of 15% now achieved borderline statistical significance (P = 0.02). CONCLUSION: Carry-over benefits from those originally assigned atorvastatin but no longer taking the drug may account for unchanged relative risk reductions in most cardiovascular endpoints observed 2 years after ASCOT-LLA closed.     

A Versatile Punch Stroke Correction Model for Trial V-Bending of Sheet Metals Based on Data-Driven Method

During air bending of sheet metals, the correction of punch stroke for springback control is always implemented through repeated trial bending until achieving the forming accuracy of bending parts. In this study, a modelling method for correction of punch stroke is presented for guiding trial bending based on a data-driven technique. Firstly, the big data for the model are mainly generated from a large number of finite element simulations, considering many variables, e.g., material parameters, dimensions of V-dies and blanks, and processing parameters. Based on the big data, two punch stroke correction models are developed via neural network and dimensional analysis, respectively. The analytic comparison shows that the neural network model is more suitable for guiding trial bending of sheet metals than the dimensional analysis model, which has mechanical significance. The actual trial bending tests prove that the neural-network-based punch stroke correction model presents great versatility and accuracy in the guidance of trial bending, leading to a reduction in the number of trial bends and an improvement in the production efficiency of air bending.     

Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial

Background

Recent reports showing the favorable role of patent foramen ovale (PFO) closure in patients with cryptogenic stroke have raised the issue of selecting optimal candidates.

Effects of an Avocado-based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke Trial (ADD-SPISE): Study protocol

Background:A poor or unhealthy diet is responsible for an important fraction of ischemic stroke risk. Adherence to dietary patterns, such as the Mediterranean diet, rich in monounsaturated fatty acids mainly from olive oil, is associated with a lower stroke risk. Furthermore, lowering low-density cholesterol (LDL-C) levels decreases stroke recurrence. Interestingly, Avocado-substituted diets, which are also rich in monounsaturated fatty acids, significantly decrease LDL cholesterol levels. This study aims to evaluate whether a Mediterranean diet based on Avocados reduces LDL-C compared to a low-fat high-complex carbohydrate diet after 3 months of the intervention in patients who had a recent acute ischemic stroke. The trial will also assess safety and feasibility.Patients and methods:Prospective, randomized open-label, blinded outcome assessment clinical trial. Participants are patients within a month of being admitted with an ischemic stroke, who consent and fulfil the eligibility criteria. Patients are randomly assigned to either diet intervention in a 1:1 ratio on top of the usual secondary prevention treatment. The intervention diet is:

• A)Avocado-based Mediterranean diet with intake of 1/2 portion of Avocado per day and
• B)The control diet is a low-fat high-complex carbohydrate diet.

The main efficacy outcome is a reduction in plasma LDL-C levels at 3 months of the dietary intervention. Secondary outcomes include changes in the levels of serum lipid profile and serum inflammation markers, safety, and feasibility. A sample size of 200 patients was estimated to provide 80% power and 5% level of significance (10% loss and 5% crossover) to detect a minimum difference of 4.6 mg/dL in LDL-C after 3 months of intervention.Conclusion:We hypothesize that an Avocado-based Mediterranean diet will further reduce the levels of LDL-cholesterol at 3 months compared to the control diet, and that the intervention is safe and feasible.Registration:The study is registered under ADDSPISE at www.clinicaltrials.gov. Identifier {"type":"clinical-trial","attrs":{"text":"NCT03524742","term_id":"NCT03524742"}}NCT03524742. Protocol ID CAS-605 version 3.0 (May 2nd, 2019).