高原地区卒中后抑郁临床干预疗效观察

目的:探讨高原地区脑卒中后抑郁临床治疗的意义.方法:高原地区脑卒中后抑郁患者70例随机分为观察组和对照组,另选35例平原地区脑卒中患者作为平原组进行对比,三组均给予常规脑卒中治疗,观察组及平原组均同时给予盐酸帕罗西汀口服治疗,三组在治疗前及治疗12周后分别进行HAMD评分及NIHSS评分判定疗效.结果:观察组和平原组均能显著改善抑郁症状(P ＜0.001),对照组抑郁症状基本无改善,观察组、平原组和对照组均能改善神经功能缺损症状(P ＜0.001、P＜0.001和0.01),观察组和平原组改善神经功能缺损的优势更突出,而观察组和平原组在改善抑郁症状及神经功能缺损方面差异无显著性(P＞0.05).结论:高原地区卒中后抑郁临床干预能明显改善抑郁症状,进而改善神经功能缺损症状,显著提高生活质量,与平原地区疗效相当,差异无显著性.     

醒脑静联合法舒地尔对急性缺血性脑梗死患者神经功能及血流动力学的影响

 目的 探讨醒脑静联合法舒地尔对急性缺血性脑梗死患者神经功能及血流动力学的影响。方法 选取医院2016-08至2018-08收治的急性缺血性脑梗死患者188例,按照随机数字表法分为对照组和研究组,每组94例,对照组采用常规治疗,研究组在此基础上联合醒脑静与法舒地尔治疗。比较两组患者临床疗效、治疗后血流动力学指标和不良反应发生率、治疗前后神经功能评分、相关因子水平及日常生活能力评分。结果 研究组治疗有效率较对照组明显升高,差异有统计学意义(P＜0.05);治疗后,两组患者美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分、日常生活能力量表(activities of daily living,ADL)评分、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100β蛋白(S100β protein ,S100β)、脑源性神经营养因子(brain-derived neurotrophic factor ,BDNF)均明显优于治疗前(P＜0.05),研究组患者相关指标均明显优于对照组(P＜0.05);治疗后研究组基底动脉(basilar artery,BA)和大脑中动脉(middle cerebral artery,MCA)舒张期低值血流速度(diastolic flow velocity,Vd)、收缩期峰值血流速度(systolic blood flow velocity,Vs)和平均血流速度(average blood flow velocity,Vm)均明显高于对照组(P＜0.05);两组患者均未发生严重不良反应,不良反应发生率比较差异无统计学意义(P＞0.05)。结论 醒脑静联合法舒地尔对急性脑梗死具有较佳的临床疗效,不仅能有效改善患者血流动力学,同时还能促进神经功能恢复。     

卒中单元管理模式对脑卒中预后的影响

目的：探讨卒中单元管理模式下治疗脑卒中与传统常规治疗相比的优越性。方法：将503例急性脑卒中患者随机分成卒中单元组（试验组）与传统常规治疗组（对照组）,试验组给予卒中单元管理模式下治疗,对照组给予传统常规治疗,通过量表评分的方法进行比较,观察两组治疗前后运动功能、日常生活能力的改善情况和神经功能的恢复情况。结果：治疗后14、30d试验组NIHSS降低趋势明显优于对照组（P〈0.05）,但治疗后14dBI的变化无显著差异（P〉0.05）,治疗后30dBI的变化有显著差异（P〈0.05）;治疗后90d试验组mRS良好预后的患者比例显著高于对照组（P〈0.05）。结论：卒中单元管理模式可促进脑卒中患者神经功能恢复,明显改善患者的良好预后比例,减低了严重残疾的预后,提高了非生活依赖和回归社会的比例。     

高压氧治疗对急性脑梗死患者血清C反应蛋白和白细胞介素-6含量的影响及疗效观察

目的 观察高压氧(HBO)治疗对急性脑梗死患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)的影响及其治疗效果.方法 经患者知情同意,并签署知情同意书后,将83例急性脑梗死患者按完全随机法分为对照组(43例)和HBO组(40例),另取40名健康体检者作为正常对照(正常组).对照组给予必要的脱水、阿托伐他汀、阿司匹林、奥扎格雷、胞二磷胆碱等常规治疗;HBO组在行常规治疗的同时加用HBO治疗1个疗程.治疗前后行血清CRP、IL-6含量检测及美国国立卫生研究院卒中量表(NIHSS)及生活能力Barthel指数(BI)评分,CRP、IL-6分别采用免疫比浊法和ELISA检测,梗死后6个月随访时再次行BI评分.结果 治疗前2组患者血清CRP和IL-6含量差异无统计学意义(P＞0.05),NIHSS评分分别为23.4 ±5.28、24.8 ±4.92,BI评分分别为30.7±10.14、31.1±11.45,差异均无统计学意义(P＞0.05);治疗后2组CRP和IL-6含量较治疗前均明显降低(P＜0.05),NIHSS评分分别为16.30±5.57、12.70±5.92,较治疗前均明显下降(P＜0.05),BI评分分别为44.20±12.18、52.40±13.36,较治疗前均明显升高(P＜0.05);与对照组比较,HBO组CRP和IL-6含量降低及NIHSS评分下降、BI评分升高均更为明显(P＜0.05);6个月后随访时2组BI评分分别为76.30±18.49、85.40±19.27,与治疗后比较均有明显升高(P＜0.05),HBO组较对照组升高更为明显(P＜0.05).结论 HBO治疗可显著降低急性脑梗死患者血清CRP和IL-6含量,减轻脑组织炎性反应,促进神经功能的恢复,从而提高临床疗效.     

脑康口服液治疗缺血性脑卒中后继发神经功能损害的疗效

 目的 探讨脑康口服液治疗缺血性脑卒中后继发神经功能损害的疗效。方法 选择我院神经内科2015-09至2016-09住院患者中缺血性脑卒中患者100例,按照随机数字表法分为研究组和对照组,对照组给予常规治疗,研究组在常规治疗基础上加服脑康口服液,治疗28 d后,观察两组NIHSS评分、MBI评分及血液流变学各检测值。结果 治疗后两组患者临床症状均得到有效改善,28 d治疗后研究组NIHSS评分(11.07±2.01)分明显低于对照组(14.95±1.85)分,MBI评分研究组(41.58±15.42)分显著高于对照组(36.24±13.56)分,差异均有统计学意义(P<0.05),同时研究组血液流变学各检测值均低于对照组,两组比较差异有统计学意义(P<0.05)。结论 脑康口服液能显著降低缺血性脑卒中导致的神经功能损害,提高日常生活自理能力,同时能明显改善血液流变,有利于脑部血液循环。     

探讨早期康复护理在脑梗死患者中对提高护理满意度的有效性分析

目的 探讨早期康复护理在脑梗死患者中对提高护理满意度的有效性分析.方法 选取2018年3月-2020年3月收治的脑梗死患者60例,根据随机数据表分为对照组(30例)与研究组(30例),对照组予常规护理,在此基础上研究组予早期康复护理,比较两组患者干预前后神经功能缺损情况,运动功能(Fugl-Meyer量表运动功能评分)、生活质量评分(SS-QOL)与护理满意度.结果 护理前两组患者神经功能损伤程度与运动功能、生活质量比较(P＞0.05),护理后两组患者NIHSS评分均明显下降,Fugl-Meyer评分明显升高,但研究组患者各项评分明显更优(P＜0.05);研究组患者生活质量评分提升更明显(P＜0.05);研究组患者护理总满意度(96.67％)明显高于对照组70.00％(P＜0.05).结论 对脑梗死患者采取早期康复护理可提高患者运动能力及神经功能恢复,促进生活质量改善,进而提高患者满意度.     

大剂量阿托伐他汀预防缺血性脑卒中后抑郁的初步研究

目的：初步探究大剂量阿托伐他汀预防缺血性脑卒中后抑郁的临床疗效。方法选取2013年1月～2014年12月神经内科收治的78例缺血性脑卒中后抑郁患者为研究对象,按照入院顺序均分为观察组和对照组各39例,对照组给予基础治疗药物及常规量阿托伐他汀钙分散片治疗;观察组在对照组基础上给予大剂量阿托伐他汀钙分散片治疗,两组疗程均为一个月,比较治疗前后两组临床疗效,观察治疗前后两组患者汉密尔顿抑郁量表评分（HAMD）、神经功能缺损评分（SSS）、和日常生活能力评分（ADL）变化情况。结果治疗后观察组总有效率94.87％比对照组66.67％高,差异具有统计学意义（ P＜0.05）。两组患者HAMD、SSS均较治疗前减小,BI较治疗前增大,观察组差异具有统计学意义（ P＜0.05）,对照组无统计学意义（ P＞0.05）;治疗后观察组HAMD （6.59±1.25）分、SSS（10.59±1.31）分均较对照组减小地更显著,BI（75.78±10.18）分较对照组增大地显著,差异具有统计学意义（ P＜0.05）。结论大剂量阿托伐他汀对出血性脑卒中后抑郁患者预防作用疗效显著,改善患者神经功能缺损程度,同时改善脑卒中后抑郁患者抑郁程度,并且能够让患者恢复自主生活能力。大剂量阿托伐他汀对出血性脑卒中后抑郁患者预防作用具有临床应用价值。     

蕲蛇酶联合尿激酶治疗急性脑梗死的疗效观察

目的 观察蕲蛇酶联合尿激酶治疗急性脑梗死的临床疗效.方法 将120例急性脑梗死患者按随机数字表法分为治疗组(n=60)和对照组(n=60).除常规治疗外,两组患者均采用尿激酶溶栓,在溶栓24h后,治疗组患者加用蕲蛇酶,静脉滴注,每日1次,连续7d.比较两组患者住院期间NIHSS和OHS评分的变化,治疗显效率及总有效率,并观察2组患者不良反应的发生情况.结果 治疗组疗效明显优于对照组(P＜0.05).治疗前两组NIHSS和OHS评分比较无统计学差异;治疗后第21 d,治疗组NIHSS及OHS评分显著优于对照组(P＜0.05),治疗组显效率和总有效率显著高于对照组(P＜0.05).结论 蕲蛇酶联合尿激酶可有效改善急性脑梗死患者的神经功能,且效果优于单用尿激酶.     

依达拉奉联合奥拉西坦治疗高血压脑梗死的疗效及对神经功能的影响

目的观察在高血压脑梗死的治疗中依达拉奉与奥拉西坦联合用药的疗效及对神经功能的影响。方法以2016年6月-2018年6月就诊的高血压脑梗死患者68例为研究对象,随机分研究组和对照组。比较两组间病人的治疗效果、改良Barthel指数、卒中量表及不良反应。结果研究组治疗有效率91.18%,对照组70.59%,差异有统计学意义(P<0.05);患者在治疗14天及28天后的日常生活自理能力评定(BI指数)和神经功能缺损评分(NIHSS)较对照组显著改善,研究组的NIHSS评分及BI指数改善情况均优于对照组(P<0.05),两组患者的不良反应率无显著差异(P>0.05)。结论依达拉奉与奥拉西坦联合用药治疗高血压脑梗死临床效果显著,对于病人神经功能的修复有很大帮助。     

品管圈管理应用于老年呼吸系统疾病护理管理中的价值研究

目的 探究品管圈管理应用于老年呼吸系统疾病护理管理中的临床价值.方法 选取接受治疗的90例老年呼吸系统疾病患者,依据不同的护理方式分为观察组和对照组,每组45例.观察组患者实施品管圈管理进行护理,对照组患者给予常规护理,比较两组患者的健康知识掌握情况、疾病控制情况及护理满意度.结果 观察组患者疾病知识掌握评分和药物常识掌握评分均优于对照组(P＜0.05);观察组患者的疾病控制有效率93.3％显著优于对照组患者的疾病控制有效率68.9％ (P ＜0.05);观察组患者的护理满意度97.8％优于对照组患者的护理满意度80％ (P ＜0.05),具有统计学意义.结论 将品管圈管理应用于老年呼吸系统疾病护理管理中的临床效果显著,不仅使患者增强了健康知识的掌握,而且提高了护理满意度.     

Imaging-Based Management of Acute Ischemic Stroke Patients: Current Neuroradiological Perspectives

Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.     

Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents

BACKGROUND AND PURPOSE:Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting.MATERIALS AND METHODS:We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4). We analyzed patient demographics, vascular risk factors, clinical presentations, imaging/angiographic findings, technical procedures/complications, and clinical outcomes.RESULTS:Fifteen patients (mean age, 51.5 years) with acute ischemic stroke (mean NIHSS score, 15) underwent endovascular stent reconstruction for vessel and/or ischemic tissue salvage. All carotid dissections presented with >70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b–3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of <20% in-stent stenosis. Early clinical improvement resulted in a mean discharge NIHSS score of 6, and 9/15 (60%) patients achieved a 90-day mRS of ≤2.CONCLUSIONS:Emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes, allowing successful thrombectomy, vessel salvage, restoration of cerebral perfusion, and/or prevention of recurrent thromboembolic stroke.

Cervical carotid or vertebral artery dissections are a common cause of acute ischemic stroke (AIS) in middle-aged and young adults.^1–3 The prognosis of cervical dissections is favorable, with the standard of care being medical management as the majority of patients respond to anticoagulation/antiplatelet therapy.^4,5 Delayed endovascular stenting of cervical dissections is reserved for patients presenting with recurrent ischemic symptoms and/or thromboembolic strokes refractory to medical management, progression of dissection-related stenosis, or symptomatic/enlarging dissecting pseudoaneurysms. Emergent endovascular treatment may also be required for cervical dissections presenting with concomitant intracranial thromboemboli/emergent large-vessel occlusion (ELVO), flow-limiting and long-segment lesions with impending occlusion, and/or hypoperfusion-related ischemia at risk of cerebral infarction.Multiple randomized controlled trials have proved endovascular thrombectomy the standard of care in the treatment of ELVO.^6–8 Since superimposed extracranial carotid or intracranial atherosclerotic disease and dissections are often an etiology of ELVO, recent studies have evaluated endovascular angioplasty/stenting techniques combined with intracranial thrombectomy. Adjunctive angioplasty/stenting techniques may be valuable in tandem carotid-intracranial occlusions secondary to acutely ruptured carotid atherosclerotic plaques, underlying intracranial atherosclerotic disease at risk for rethrombosis, or severe flow-limiting cervical/intracranial dissections. Furthermore, extracranial carotid stent placement may be necessary in emergent settings to provide distal access for intracranial thrombectomy, vessel salvage, or revascularization in hypoperfusion ischemic syndromes without sufficient intracranial collaterals. Several investigators have demonstrated the feasibility of emergency ICA stenting combined with intracranial thrombectomy for tandem ICA–MCA occlusions with acceptable rates of successful recanalization, complications, and clinical outcomes.^9–14 In two of the recent multicenter trials that demonstrated a benefit of endovascular thrombectomy for AIS, carotid artery stent placement was necessary in 8.6%–12.9% of patients.^6,7Few studies have focused on the endovascular management of spontaneous cervical dissections with or without tandem intracranial ELVOs in the AIS setting, often limited to small sample sizes because most dissections can be managed medically postthrombectomy.^15–17 We report on a unique cohort presenting for AIS intervention secondary to long-segment and flow-limiting carotid dissections requiring multiple tandem stents for endovascular reconstruction, irrespective of intracranial ELVO or successful thrombolysis/thrombectomy.     

Stroke

Today stroke represents a major medical and political problem in Western industrial nations. High demands need to be placed on the initial diagnostic work-up and therapeutic treatment to ensure that the patients benefit from the recent advancements achieved in diagnostic and therapeutic fields. According to the motto "time is brain" the clinical examination and imaging have to be performed within 60 min ("door to needle time") so that potential patients can be quickly treated with systemic or intra-arterial lysis. However, it should be taken into consideration that the selection of diagnostic imaging facilities depends on several factors such as infrastructure, the time remaining in the diagnostic window, and the severity of the clinical symptoms.     

Stroke associated with coronary artery bypass surgery

Medical records and neuroimaging studies of 30 patients with major neurologic events after coronary artery surgery were reviewed. Two thousand and twenty-nine coronary artery bypass graft operations were performed in our institution between October 15, 1985, and December 27, 1989. Of these, there were 30 documented neurologic events suggesting acute ischemic injury during the intraoperative or the postoperative period. Clinical manifestations included hemiparesis, monoparesis, aphasia, bilateral cortical dysfunction, cortical and brainstem dysfunction, and left homonymous hemianopsia. There were five deaths directly attributable to neurologic injury. Twenty-two patients had a CT scan of the head, of which 15 showed evidence of acute infarction, two suggested watershed lesions from cerebral hypoperfusion, and the remainder showed findings consistent with multiple cerebral emboli or primary intracranial occlusion. Five carotid arteriograms and one digital subtraction arteriogram of the carotids were obtained. Angiographic findings revealed two common carotid artery occlusions, one callosal marginal artery occlusion, and two cases of bilateral high-grade internal carotid stenoses. Our findings support the contention that in patients who suffer cerebral infarction associated with coronary artery bypass grafting, the main mechanism of injury is cerebral embolization rather than cerebral hypoperfusion.     

用近红外光谱术评价缺血性脑梗塞的血流动力学变化

在标准的动物脑梗塞模型上 ,对近红外光大脑地形图技术反映梗塞灶血流动力学变化进行评价。方法建立大鼠线栓脑中动脉梗塞模型和光敏剂诱导皮层梗塞模型 ,用近红外光大脑地形图(NCT) ,功能核磁共振成像 (fMRI)和TTC染色成像技术分别对皮层进行定位测量和成像检测 ,并进行结果比较。结果光敏剂诱导模型 ,2 4h组 ,NCT对梗塞灶成像面积和TTC染色样本的相关系数为 0 .897(P <0 .0 5) ;对 2月组 ,相关系数为 0 .90 6(P <0 .0 1 )。大脑中动脉梗塞模型 ,常温组 ,NCT梗塞面积和染色样本相关系数为 0 .82 0 (P <0 .0 5) ,NCT和fMRI对梗塞灶成像面积的相关系数为 0 .874(P <0 .0 5) ;亚低温组 ,NCT梗塞灶成像面积和样本梗塞灶染色面积的相关系数为 0 .851 (P <0 .0 5) ,NCT、fMRI对梗塞灶成像面积的相关系数为 0 .782 (P <0 .0 5)。结论NCT技术能较好地反映局部脑血流的变化 ,该技术可望成为脑卒中趋向病人的实时预测及康复监测。