高血压并发急性脑卒中患者心电图变化临床研究

目的探讨高血压并发急性脑卒中患者心电图的变化及临床意义。方法选取2014-06—2015-06我院高血压并发急性脑卒中患者80例为观察组,另将高血压无并发急性脑卒中80例患者为对照组,比较2组异常心电图的检出率和异常表现形式。结果观察组心电图异常发生率为85%,高于对照组的56.6%;观察组ST-T改变比率为45.8%,高于对照组的20.8%;Q-T延长比率为30.0%,高于对照组的14.1%;心律失常为35.8%,高于对照组的20.8%;房室肥大、左心室高电压发生率为23.3%,高于对照组的10.4%;在此类患者中,病情在治疗过程中有所恶化甚至死亡的97.22%检查出了异常心电图,在病情有所好转的患者中77.5%的查出异常心电图,差异有统计学意义(P0.05)。结论高血压并发急性脑卒中会使心电图出现异常情况,且异常类型变得复杂多样;临床上可通过分析心电图的变化情况来推断病情的变化情况,以便及时制定有效治疗方案。     

高血压并发急性脑卒中患者心电图的变化临床分析

目的探讨原发性高血压并发急性脑卒中患者心电图的变化及临床意义。方法选取2011-07—2014-07Ⅱ~Ⅲ级270例原发性高血压患者为研究对象,根据是否发生脑卒中分为观察组和对照组,180例并发急性脑卒中患者为观察组,90例未并发急性脑卒中患者为对照组,对比2组心电图异常检出率,并对心电图异常率与急性脑卒中的部位、类型及患者临床预后的关系进行分析。结果 2组分别有146例和44例心电图异常者,心电图异常率分别为81.11%和48.89%,观察组心电图异常率高于对照组;观察组在T波异常(31.67%)、ST-T改变(52.22%)、心律失常(42.78%)、左心室高电压(5.56%)、左心室肥大(7.78%)与两种及以上的心律失常(22.78%)发生率均高于对照组,差异均有统计学意义(P0.05);观察组出血性脑卒中心电图异常率94.12%,脑干、丘脑、基底节部位的心电图异常率为87.85%,病情恶化或死亡患者心电图异常率95.12%,分别高于缺血性脑卒中和发生在脑叶、小脑、腔隙部位的脑卒中以及病情好转稳定患者,差异有统计学意义(P0.05)。结论原发性高血压并发急性脑卒中患者的心电图异常检出率较高,且与急性脑卒中的发生部位和类型显著相关,并能反映其预后,应对心电图改变进行监测,以便及时采取合理措施改善其预后。     

原发性高血压合并急性脑卒中患者心电图的改变临床分析

目的分析原发性高血压合并急性脑卒中患者心电图改变的临床特点。方法搜集2015-03—2016-02原发性高血压患者156例,依据其是否合并急性脑卒中分为脑卒中组80例和对照组76例,2组患者均进行心电图检查,分析心电图异常检出率情况。结果脑卒中组心电图异常率(81.3%)高于对照组(52.6%),且不同心电图异常类型高于对照组(P0.05)。80例高血压合并脑卒中患者中,不同类型、不同部位、不同预后脑卒中患者,其异常心电图检出率差异有统计学意义(P0.05)。结论原发性高血压并发急性脑卒中患者中具有较高的心电图异常率,心电图异常率与脑卒中的类型及部位有关,且能够预测患者的预后。     

急性脑卒中并发脑心综合征62例临床分析

目的 探讨急性脑卒中并发脑心综合征的发生机制及防治措施。方法 结合临床资料对238例急性脑卒中患者心电图及心肌酶谱进行回顾性分析。结果 脑心综合征发病率为26．1％，出血性脑卒中发病率明显高于缺血性脑卒中（P〈0．01）；合并脑心综合征的脑卒中患者病死率为46．8％，明显高于同期未合并脑心综合征的脑卒中患者（7．4％）（P〈0．01）。结论 急性脑卒中脑心综合征的发生可能与脑卒中类型有关；机制可能与脑卒中直接或间接导致植物神经中枢功能失调，神经体液功能紊乱等有关；脑心综合征预后不良的因素：①年龄大；②脑部病变重；③有无重视心脏异常。脑心综合征在临床工作中不容忽视，应及早积极防治。     

急性脑卒中患者异常宽大T波心电图的临床研究

目的分析急性脑卒中患者异常心电图与预后的相关性,以期为临床提供借鉴。方法回顾2009-06—2013-12入我院诊断为急性脑卒中患者为研究对象,分析患者心电图的变化情况及预后等数据,评价急性脑卒中患者异常宽大T波心电图与预后的相关性。结果 160患者,73例脑梗死,51例脑出血,36例蛛网膜下腔出血。存活118例,死亡42例。通过统计分析,死亡组与存活组在心率、ST段抬高、ST段压低、T波倒置、U波倒置、室性心律失常出现的频率无明显差异(P0.05);在出现异常Q波、室上性心律失常频率、异常宽大T波、心电图评分偏高时,格拉斯哥预后(GOS)评分明显偏低,差异有统计学意义(P0.05,通过多因素Logistic回归分析,异常Q波(OR=1.777,95%CI:0.347~3.741)、异常宽大T波(OR=2.850,95%CI:1.173~6.925)、室上性心律失常(OR=1.664,95%CI:1.433~2.020)是影响预后的影响因素。结论心电图异常急性脑卒中的病情和预后均有重要的指导意义,出现异常Q波、异常宽大T波、室上性心律失常,尤其异常宽大T波常提示病情危重及预后不良。     

高血压患者颈动脉斑块和急性缺血性脑卒中的相关性研究

目的探讨高血压患者颈动脉斑块和急性缺血性脑卒中的相关性,以减少其发生率。方法对2013-06—2014-06收治入院的177例高血压患者的临床资料进行回顾性分析,其中发生急性缺血性脑卒中的81例为观察组,未发生急性缺血性脑卒中的96例为对照组,分析2组患者颈动脉斑块类型及发生率,采用Logistic逐步回归分析,分析颈动脉斑块的发生与急性缺血性脑卒中的相关性。结果 2组患者颈动脉斑块发生率分别为76.54%和43.75%,观察组高于对照组,差异有统计学意义(P0.05);多因素回归分析表明,颈动脉斑块的发生增加急性缺血性脑卒中风险(OR=5.867,P=0.001)。结论合并急性缺血性脑卒中的高血压患者发生颈动脉斑块的几率高于未发生急性缺血性脑卒中的高血压患者,颈动脉斑块形成是高血压患者发生急性缺血性脑卒中的独立危险因素。     

妊娠期和产褥期并发脑卒中诊治分析

目的：探讨妊娠期和产褥期的孕产妇并发脑卒中的临床诊治情况。方法选择2007‐03—2012‐05收治的36例妊娠期和产褥期并发脑卒中的孕产妇以及同期36例接受治疗的正常孕产妇,对2组孕产妇、新生儿的并发症情况以及一般病症发生情况进行比较。结果对照组孕产妇的产后出血、早产、妊高症、羊水过多以及剖宫产的发病率分别为5.6％、13.9％、19.4％、8.3％、77.8％,显著高于观察组的2.8％、8.3％、11.2％、2.8％、27.8％,差异有统计学意义（P＜0.05）;对照组新生儿的窒息、宫内窘迫、巨大儿、低血糖以及低蛋白血症的发病率分别为11.2％、19.4％、8.3％、50％,显著高于观察组的0、2.8％、8.3％、2.8％、22.2％;对照组孕产妇的头痛、恶心呕吐、肢体功能障碍以及半瞳孔改变发生率33.5％,显著高于观察组的8.4％,差异均有统计学意义（P＜0.05）。结论脑卒中对孕产妇以及新生儿的生命和健康造成严重影响,妊娠期以及产褥期的脑卒中孕产妇以及新生儿的临床病症的发生率显著高于正常产妇,其可对妊娠期以及产褥期脑卒中的发生有一定的预测价值。     

急性脑卒中与脑心综合征

目的探讨急性脑卒中后脑心综合征（Cerebral-cardiac syndrome，CCS）的发病率、临床特点、发病机制、防治措施、预后及其相关因素。方法对324例急性脑卒中后脑心综合征患者入院后作心电图（ECG），心肌酶谱动态观察并结合临床资料进行回顾性分析。结果急性脑卒中后脑心综合征发生率为31．5％，91％的患者于脑卒中后数小时至1周内发生，出血性脑卒中CCS发生率远高于缺血性脑卒中（P〈0．05），非大脑半球（脑干、小脑、基底节）卒中者远高于大脑半球卒中者（P〈0．01）。CCS心电图主要表现为心律失常、心肌缺血和类心肌梗死。心肌酶谱异常率为46．1，52．9％合并低钾血症和／或低钠血症。死亡率31．3％，明显高于未合并CCS的脑卒中患者（14．1％）（P〈0．05）。结论CCS发生与脑卒中类型及部位、低钾、低钠等因素有关，预后都较未合并CCS脑卒中者差。其发病机制可能为脑卒中直接或间接导致植物神经功能紊乱，神经体液功能紊乱有关。CCS患者须加强心脏功能监护，积极防治脑心综合征。     

脑卒中并发上消化道出血的临床研究

目的掌握急性脑卒中患者并发上消化道出血的临床特点。方法对763例急性脑卒中患者并发上消化道出血的情况进行调查研究。结果在763例患者中,急性脑出血并发上消化道出血的发生率明显高于急性脑梗死组,病变累及脑干时尤为突出。伴意识障碍的患者并发上消化道出血的发生率较高。脑卒中并发上消化道出血发生时间多在发病后24h内出现,亦可发生于病程10d左右。并发上消化道出血的脑卒中患者死亡率明显高于未并发上消化道出血者。结论脑卒中并发上消化道出血预后不良,早期应采取措施,积极预防。     

急性脑卒中与便秘57例分析

目的 探讨急性脑卒中与便秘的关系。方法 57例脑卒中患者分成动脉粥样硬化血栓性脑梗死（ATI）组23例；腔隙性梗死（LI）组23例；脑出血（ICH）组11例，观察各组便秘发生率并进行比较。结果 脑卒中者第1周便秘发生率50.88％，显著高于正常老年人对照组（P〈0．05）。基底节区脑卒中者便秘发生率57．1％，明显高于非基底节卒中者（P〈0.05）。结论 脑卒中患者急性期常发生便秘，基底节区脑卒中者便秘发生率较非基底节区脑卒中者高。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。