急性脑梗死患者血液流变学及凝血功能的临床意义

目的探讨急性脑梗死患者血液流变学和凝血功能的变化及其临床意义。方法选择75例急性脑梗死为观察组,其中轻度、中度、重度各25例,选择同期75例健康体检者为对照组,比较2组血液流变学和凝血功能,记录观察组不同程度脑梗死患者的血液流变学和凝血功能。结果观察组全血高切黏度、全血低切黏度、血浆黏度和红细胞比积显著高于对照组(P0.05)。观察组血浆纤维蛋白原(FIB)明显高于对照组(P0.05),2组活化部分凝血活酶时间(APTT)和血浆凝血酶原时间(PT)比较差异无统计学意义(P0.05)。重度、中度和轻度患者的全血高切黏度、全血低切黏度、血浆黏度和红细胞比积比较差异有统计学意义(P0.05);重度、中度和轻度患者的FIB比较差异有统计学意义(P0.05)。结论急性脑梗死患者的血液流变学和凝血功能存在异常,且与病情严重程度成正比,监测其动态变化可为临床治疗提供参考价值。     

148例急性脑梗死危险因素临床分析

目的探讨脑梗死发生的相关危险因素。方法回顾性分析148例脑梗死患者和115例对照组的临床资料、血压、血糖、血脂、纤维蛋白原、血液流变学、经颅多普勒及颈部血管超声检查结果等指标,并进行统计学分析。结果脑梗死组中合并高血压史、糖尿病史、TIA史及脑血管病家族史患者显著高于对照组,2组比较差异有统计学意义(P<0.05)。脑梗死组中合并血压升高、高血糖、纤维蛋白原增高、D-二聚体增高、CRP增高、高脂血症、颈动脉斑块显著高于对照组,差异有统计学意义(P<0.05);全血黏度低切和中切、全血还原黏度中切、红细胞比积、红细胞刚性指数2组比较差异有统计学意义(P<0.05)。结论高血压、糖尿病、TIA、脑血管病家族史、纤维蛋白原增高、D-二聚体增高、CRP增高、高脂血症、颈动脉斑块及大血管狭窄与脑梗死关系密切。     

急性脑梗死患者血EPO和血液流变学的相关性研究

目的研究急性脑梗死患者血EPO和血液流变学的相关性。方法收集本院急性脑梗死的患者90例(脑梗死组),另选取同期无脑血管疾病的患者55例(对照组),比较两组血EPO和血液流变学是否存在差异;两组分别进行EPO和血红蛋白、红细胞、血液流变学相关性分析。结果脑梗死组和对照组在EPO和血液流变学有统计学差异(P 0. 05);对照组EPO与血液流变学无相关性(P 0. 05);脑梗死组EPO与血浆黏度(r=0. 373)、红细胞沉降率(r=0. 459)及血沉方程K值(r=0. 282)呈正相关(P 0. 05);脑梗死组EPO与血红蛋白(r=-0. 589)、红细胞(r=-0. 410)、红细胞比容(r=-0. 547)、全血黏度切变率1. 00 L/s(r=-0. 400)、全血黏度切变率5. 00 L/s(r=-0. 361)、全血黏度切变率30. 00 L/s(r=-0. 408)、全血黏度切变率200. 00 L/s(r=-0. 300)、红细胞压积(r=-0. 520)呈负相关(P 0. 05)。结论急性脑梗死患者血液流变学相关指标存在异常;急性脑梗死患者EPO会增高,增高的EPO可增加血液黏度,但不是通过促进红细胞的生成来调节的。     

进展性脑梗死血凝、血流变检测的临床意义

目的 观察进展型脑梗死患者血凝、血流变指标的变化, 为预防脑梗死及早期治疗脑梗死提供依据.方法 分别检测54例进展型脑梗死患者与54例完全型脑梗死患者血凝和血液流变学的各项指标.结果 进展型脑梗死患者与完全型脑梗死患者比较,血浆凝血酶原时间、凝血酶时间、部分凝血活酶时间显著缩短,而纤维蛋白原水平显著升高(P<0.05);全血黏度、全血还原黏度、红细胞聚集指数和红细胞变形指数均较完全型脑梗死组明显升高(P<0.05).结论 进展型脑梗死患者存在着明显的高凝状态、血流变异常.     

依达拉奉联合脑心通治疗老年进展型脑梗死的临床疗效

目的分析依达拉奉联合脑心通治疗老年进展型脑梗死的临床疗效。方法 120例老年进展型脑梗死患者随机分为对照组和观察组各60例。对照组采用依达拉奉治疗,观察组采用依达拉奉联合脑心通治疗。比较2组疗效,治疗前后神经功能缺损程度(NIHSS)、日常生活活动能力(ADL)评分及血液流变学指标。结果治疗14d后观察组NIHSS评分显著低于对照组,ADL量表评分显著高于对照组,观察组总有效率为85.00%,显著高于对照组的65.00%(P0.05)。治疗后第14天观察组全血高切黏度、全血低切黏度、全血中切黏度、血浆黏度、红细胞聚集指数均显著低于对照组,(P0.05)。结论依达拉奉联合脑心通能有效改善PCI神经功能缺失,促进患者日常生活能力的恢复,具有很高的临床应用价值。     

糖尿病性眼肌瘫痪患者血糖、糖化血红蛋白、血脂水平和血液流变学的变化及其关系

目的探讨糖尿病性眼肌瘫痪患者血糖、糖化血红蛋白(HbA1c)和血液流变学、血脂水平的变化及其关系。方法对36例糖尿病性眼肌瘫痪患者(糖尿病组)与36名健康对照者(正常对照组)进行血HbA1c、空腹血糖(FBG)和餐后2 h血糖(2h-PG)、血液流变学、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)检测;并进行相关性分析。结果糖尿病组红细胞变形指数与血HDL水平显著低于正常对照组(均P<0.01),HbA1c、FBG、2h-PG水平及其他血液流变学指标和血脂显著高于正常对照组(均P<0.01)。糖尿病组血糖、HbA1c水平与全血黏度(低切、中切、高切)、血浆黏度呈正相关(r=0.42～0.86;均P<0.05),与红细胞变形指数呈负相关(r=-0.53、-0.79;均P<0.01)。结论糖尿病性眼肌瘫痪患者血糖、HbA1c、血脂水平增高,血液流变学异常;高血糖是其血脂和血液流变学异常的重要因素。     

急性脑出血患者血液流变学指标变化的相关研究

目的探讨血液流变学指标在急性脑出血中的变化规律和临床价值。方法于发病24 h内检测100例急性期脑出血患者(脑出血组)的血液流变学指标,并与30名正常对照者(正常对照组)进行比较。分析高血压病史、出血量、出血部位对血液流变学指标的影响。结果与正常对照组比较,脑出血组全血黏度、血浆黏度和血沉均升高,红细胞聚集指数、红细胞变形指数和红细胞压积均降低(均P0.01)。其中,高血压性脑出血组各指标均变化显著(均P0.01),非高血压性脑出血组中仅全血黏度(200 s~(-1)和50 s~(-1))、红细胞聚集指数、红细胞压积和血沉变化有统计学意义(P0.05~0.01)。与非高血压性脑出血患者比较,高血压性脑出血患者除血沉外,其余指标均变化显著(均P0.05)。随着血肿量增加,脑出血患者全血黏度(200 s~(-1)和50 s~(-1))和血浆黏度均升高,红细胞聚集指数下降,差异有统计学意义(P0.05~0.01)。不同出血部位脑出血患者200 s~(-1)和1 s~(-1)全血黏度、血浆黏度、红细胞聚集指数及血沉差异有统计学意义(均P0.05)。结论急性脑出血患者广泛存在着血液流变学异常,提示脑出血急性期血液呈现浓、黏、聚、凝状态且合并高血压者变化显著。随着血肿量增加,血液流变学变化明显,不同出血部位影响也不同。     

盐酸丁咯地尔联合丹参治疗脑梗死临床观察

目的探讨盐酸丁咯地尔联合丹参对脑梗死的临床治疗效果。方法将起病在6h以上的64例脑梗死患者随机分成治疗组及对照组,对照组仅用丹参注射液20ml加入生理盐水250ml中静滴,1次/d,连续2周。治疗组在丹参注射液静滴的基础上再应用盐酸丁咯地尔注射液200mg加入生理盐水250ml中静滴,1次/d,连续2周。所有患者在治疗前后进行检测血液流变学,并对其进行临床神经功能缺损评定。结果治疗组临床疗效总有效率87.5%,对照组65.6%,临床神经功能缺损改善程度治疗组高于对照组(P<0.05)。治疗组的红细胞变形、红细胞聚集、全血高切黏度和全血低切黏度治疗前后有显著的改善(P<0.05),对照组红细胞变形和全血高切黏度无改善(P>0.05)。结论盐酸丁咯地尔联合丹参是治疗脑梗死有效的药物。     

复发脑梗死危险因素的分析

目的　探讨复发脑梗死的危险因素。方法　对 4 1例复发脑梗死 (复发组 )、5 8例初发脑梗死 (初发组 )和对照组的危险因素进行单因素和多因素统计分析。结果　复发组高血压病、房颤、糖尿病、肥胖和中风家族史的发生率显著高于初发组 (P<0 .0 5～ 0 .0 0 5 ) ;复发组血 TC、TG、Apo B1 0 0 、中低切全血粘度、血浆粘度、全血高切还原粘度和 HCt明显高于初发组 (P<0 .0 5～ 0 .0 1) ,HDL- C则低于初发组 (P<0 .0 5 ) ;复发组和初发组血红细胞刚性与对照组比较均有显著差异 (P<0 .0 5～ 0 .0 1)。结论　复发脑梗死的危险因素主要是高龄、高血压病 ,血纤维蛋白原、TC水平和红细胞刚性升高及 HDL- C降低 ;而高血压病和红细胞刚性增加是复发与初发脑梗死患者共同的危险因素     

尤瑞克林对进展性脑梗死患者血液流变学及神经功能恢复的影响

目的探讨尤瑞克林治疗进展性脑梗死的临床疗效及对脑血液流变学和神经功能恢复的影响。方法选取经颅脑CT或MRI确诊的进展性脑梗死患者110例,随机分为观察组和对照组。对照组给予常规治疗,观察组在常规治疗基础上加尤瑞克林静滴治疗。均连续治疗2周,观察临床疗效,NIHSS评分及检测血浆黏度、全血高切/低切黏度、纤维蛋白原及红细胞压积等变化。结果观察组临床疗效显著优于对照组(P0.05);治疗后,2组NIHSS评分显著降低,且观察组NIHSS评分降低幅度显著大于对照组(P0.05);治疗后,血浆黏度、全血高切/低切黏度、纤维蛋白原及红细胞压积水平均显著降低,且观察组各项水平降低幅度显著大于对照组(P0.05)。结论尤瑞克林治疗进展性脑梗死患者能改善脑血液流变学指标,恢复神经功能,具有较好疗效。     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -