缺血性脑卒中并发下肢深静脉血栓形成的病因探讨

下肢深静脉血栓形成(deepveinthrombosisinlowerlimb,LDVT)是缺血性脑卒中(cerebralinfarction,CI)严重并发症之一。下肢深静脉血栓形成可增加缺血性脑卒中患者的病死率和致残率。近年来,CI并发LDVT的临床发病率越来越高。据文献报道,CI患者LDVT发生率为22%-75%不等。LDVT的发病机制极其复杂,常是诸多因素综合作用的结果。因此,探讨缺血性脑卒中并发下肢深静脉血栓形成的病因,预防CI患者LDVT发生,是降低CI患者病死率和致残率的关键,也是近年来医学界的研究热点。本文分析了50例缺血性脑卒中并发下肢深静脉血栓形成患者的临床特点及凝血、抗凝及纤溶系统分子标志物水平变化,以探讨其发病原因。     

全髋置换后深静脉血栓的预防

目的：比较低分子肝素和吲哚美辛对预防全髋置换后深静脉血栓发生的疗效。 方法：选择北京世纪坛医院骨科收治的股骨头无菌坏死患者120例,男62例,女58例,年龄38~82岁,平均66.9岁;均计划行全髋置换。全部患者随机分为3组,对照组(n=41)：没有接受抗凝预防治疗;低分子肝素组(n=40)：接受低分子肝素治疗,以患者的体质量计算,给予皮下注射范围1 900~3 800 U/d;吲哚美辛组(n=39)：接受吲哚美辛治疗,剂量为 2次/d,口服25 mg/次,均从置换前1 d至出院当天。对比观察各组患者全髋置换后深静脉血栓的发生情况。 结果：120例患者在全髋置换后第1周行彩色多普勒超声检查,发现65例患者有深静脉血栓(54%),其中18例深静脉血栓发生在非手术侧肢体。在手术侧肢体发生深静脉血栓的患者中18例有临床症状(28%),在非手术侧肢体发生深静脉血栓的患者均未见临床症状。对照组深静脉血栓的发生率为71%,明显高于低分子肝素组48%和吲哚美辛组45%(P < 0.05)。 结论：全髋置换前应用低分子肝素或吲哚美辛明显降低了深静脉血栓发生。     

重型颅脑损伤并发下肢深静脉血栓形成的诊治

目的 探讨重型颅脑损伤术后并发下肢深静脉血栓形成的诊治. 方法 回顾性分析解放军第一六三医院自2003年12月至2008年12月收治的37例重型颅脑损伤并发下肢深静脉血栓形成的患者的临床资料. 结果 37例患者均行抗凝治疗,其中溶栓治疗18例,下腔静脉滤器置入14例.1例患者死亡,其余36例患者下肢肿胀疼痛症状均缓解,其中治愈11例,显效21例,有效4例. 结论 重型颅脑损伤患者容易发生下肢深静脉血栓形成,彩色多普勒超声、静脉造影及数字减影血管造影能够有效地诊断深静脉血栓形成.深静脉血栓形成主要治疗方法 为抗凝治疗,下腔静脉滤器置入对防止肺栓塞发生有重要作用,早期预防至关重要.     

抗凝治疗缺血性脑血管病的进展

目前 ,血栓性疾病在我国的发展呈现上升趋势 ,防治此类疾病的抗血小板、抗凝、降纤、溶栓治疗等陆续被应用于临床 ,取得了一定疗效。肝素类药物抗凝治疗作为一种新疗法越来越受到高度重视。1　抗凝治疗缺血性脑血管病进展目前常用的抗凝药物 :普通肝素、低分子肝素、华法令及其它。肝素家族包括普通肝素钠和钙、多种低分子肝素和肝素类物质。这些药物可用来阻止血栓的进展 ,防止早期卒中的复发 ,预防深静脉血栓形成和肺栓塞。肝素用于中风治疗之前 ,已被用于治疗冠状动脉疾病、深静脉血栓形成、肺栓塞以及在冠状动脉血管成形术后等。用于中…     

低分子肝素抗凝治疗高血压脑出血后症状性深静脉血栓的疗效和安全性

目的分析低分子肝素抗凝治疗高血压脑出血后下肢深静脉血栓的疗效和安全性。方法选取2009-01—2014-07我院就诊的高血压脑出血后下肢深静脉血栓患者73例为研究对象,对照组31例,采用常规脱水、营养脑神经、保护胃黏膜等治疗,并配合相应的辅助康复训练,研究组42例,采用低分子肝素抗凝治疗,余治疗措施与对照组相同,治疗结束后,观察2组患者的临床疗效、患肢水肿消退时间及并发症情况。结果研究组有效率高于对照组(P0.05),研究组并发症发生率低于对照组,但差异无统计学意义(P0.05)。结论低分子肝素抗凝治疗高血压脑出血后下肢症状性深静脉血栓效果显著,起效时间短,且并发症发生率低,值得应用。     

脑梗死急性期低分子肝素和阿司匹林对预防深静脉血栓及病情恶化的比较

目的比较低分子肝素和阿司匹林对预防急性脑梗死神经功能恶化、深静脉血栓的疗效。方法患者被随机分组两组,一组每日两次进行皮下注射低分子肝素4000抗因子Xa IU/0.4 ml,另一组口服阿司匹林每日200 mg,共治疗10 d,然后两组都接受每日1次的100 mg阿司匹林治疗,为期6 m。评估发病后10 d内早期神经功能恶化和深静脉血栓事件发生率。结果总数1368例患者,7.89%终止观察,2.85%在第1个10 d发生深静脉血栓,低分子肝素组和阿司匹林组比较有显著差异(分别为3.95%、1.46%和11.82%、1.46%)。结论对于急性缺血性卒中患者,在卒中48 h内使用低分子肝素治疗至发病10 d后可减少或避免深静脉血栓形成。     

脑静脉窦血管内治疗脑静脉窦血栓形成临床研究

目的对比静脉肝素抗凝与脑介入治疗脑静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析我院14例脑静脉窦血栓患者,按治疗方法分为介入组(脑静脉窦血管内治疗)和抗凝组(静脉肝素抗凝),每组7例,比较2组平均住院时间、血管完全再通率、mRS及并发症发生率。结果脑静脉窦介入组住院时间较抗凝组短,血管完全再通率高于抗凝组,mRS平均评分低于抗凝组,差异均有统计学意义(P0.05)。2组并发症发生率无显著差异(P0.05)。结论脑静脉窦血管内治疗可改善CVST患者的转归,疗效优于静脉肝素溶栓保守治疗。     

肝素预防急性脑梗死尿激酶溶栓后再瘫痪的临床观察

目的 探讨急性脑梗死瘫痪患者尿激酶溶栓后肝素持续静脉注射预防再瘫痪的疗效及安全性.方法 将36例溶栓成功患者按随机数字表法分成两组,治疗组18例溶栓后即用肝素1000 U/h持续静脉注射,监测部分凝血酶原时间(aPTT),调节肝索用量.保持aPTT在正常值1.5～2.0倍之间,连用5 d.对照组18例溶栓后24 h 口服阿司匹林0.1 g,1次/d.对两组7 d内发生再瘫痪及脑出血的例数,第14天神经功能缺损程度评分(NIHSS)进行统计学比较.结果 治疗组再瘫痪0例.无症状脑出血5例;对照组再瘫痪5例,无症状腩出血2例;两组再瘫痪发生率差异有统计学意义,脑出血发生率差异无统计学意义.第14天两组神经功能缺损程度评分差异有统计学意义.结论 急性脑梗死肢体瘫痪患者在尿激酶溶栓成功后应用肝素抗凝,维持aPTT在正常值的1.5～2.0倍,对于预防再瘫痪是有效和安全的.     

低剂量低分子肝素钠预防脑出血患者下肢深静脉血栓形成临床体会

目的探讨脑出血患者应用低分子肝素钠预防下肢深静脉血栓形成的安全性及有效性。方法将2011年1月至2013年3月期间收治的103例脑出血患者随机分为治疗组及对照组。对照组42例,给予常规治疗;治疗组61例,常规治疗基础上入院后第1~14天皮下连续注射低分子肝素钠4000IU·d-1。收集两组患者的临床资料进行统计学分析。结果治疗组发生1例深静脉血栓形成和1例颅内再出血,无肺栓塞发生;对照组8例发生深静脉血栓形成和3例肺栓塞,无颅内再出血发生。两组下肢深静脉血栓形成及肺栓塞发生率差异有统计学意义(P<0.05),颅内再出血差异无统计学意义(P>0.05)。结论皮下注射低剂量低分子肝素钠是预防脑出血患者下肢深静脉血栓形成的有效措施。     

重症颅内静脉窦血栓形成的血管内小剂量持续溶栓治疗

目的探讨重症颅内静脉窦血栓形成血管内接触性溶栓的合理给药方案、安全性、疗效。方法对6例重症颅内静脉窦血栓形成患者,行股静脉插管至静脉窦内接触性溶栓治疗,小剂量、持续给药2~3d,平均每天60万U尿激酶。辅以低分子肝素全身抗凝治疗2~3w。结果经治疗,静脉窦血栓均在2~3d内完全溶解,静脉窦恢复通畅,所有患者神志转清晰,颅内高压症状消失,无颅内出血及全身性不良反应。出院时未留下任何神经系统后遗症,随访3个月,未出现新症状及血栓再形成。结论对重症颅内静脉窦血栓形成的病例,行血管内小剂量持续溶栓治疗,可快速使闭塞的静脉窦恢复畅通,副作用小、安全可靠。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.