高血压患者平均动脉压与脑卒中的相关危险因素分析

目的探讨脑卒中发病的危险因素,分析高血压史和平均动脉压水平与脑卒中发病的相关性。方法对5 434例中老年人群进行基线调查,根据有无脑卒中分为脑卒中组和非脑卒中组,记录其高血压史、年龄、平均动脉压、性别、体重指数等一般资料,采用单因素分析探讨脑卒中的危险因素。高血压史和平均动脉压与脑卒中的相关性采用分层单因素分析,高血压史分为无高血压组、20a以下组和20a以上组3个亚组;平均动脉压分成75mmHg组、正常组和165mmHg组3个亚组。结果高血压病程、平均动脉压异常、年龄、性别等为脑卒中的危险因素;高血压史亚组组间比较,P0.01;平均动脉压75mmHg组与平均动脉压正常组比较,P0.01;平均动脉压正常组与平均动脉压165mmHg组比较,P0.01;平均动脉压75mmHg组与平均动脉压165mmHg组比较,P0.05。结论高血压史与脑卒中的发生率密切相关,病史越长,脑卒中发生几率越高;平均动脉压异常是脑卒中的危险因素,过高或过低对脑卒中发病率的影响不明显。     

脑卒中患者相关危险因素分析

目的探讨脑卒中发病的危险因素。方法对2 715例中老年人群进行调查,根据受试者有无脑卒中病史分为脑卒中组和非脑卒中组,记录其高血压史、年龄、平均动脉压、性别、体重指数等一般资料,采用单因素和Logistic多因素回归分析探讨脑卒中的危险因素;根据受试者高血压病程将受试者分为无高血压组、≤20a组和20a组3个亚组;根据平均动脉压水平将受试者分为正常组、≤75mmHg组和165mmHg组3个亚组,采用分层单因素方法进行研究。结果脑卒中的发生与高血压病程(OR=2.934,P=0.001)、收缩压(OR=3.046,P=0.014)、舒张压(OR=2.384,P=0.000)、平均动脉压(OR=1.879,P=4.273),年龄(OR=1.352,P=0.001),性别(OR=5.934,P=0.023)显著相关;高血压病程与脑卒中的分析中,患者的高血压史越长,发生脑卒中的几率越大(P0.05);平均动脉压水平与脑卒中的分析中,患者的平均动脉压越高,发生脑卒中的几率越大(P0.05)。结论高血压病程、收缩压、舒张压、平均动脉压、年龄、性别是发生脑卒中的危险因素;高血压病程越长、平均动脉压越大,发生脑卒中的几率越大,需临床关注。     

高血压性脑出血住院患者的近期预后影响因素回顾性分析

目的评价血压及其它因素对高血压性脑出血近期预后的影响.方法回顾性分析我院1185例高血压性脑出血住院患者的临床资料.分别分析不同等级水平的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)与近期预后之间的关系.采用Logistic回归分析血压及其它因素对高血压性脑出血近期预后的作用.结果平均动脉压2级组(MAP＞145mmHg)病死率明显高于平均动脉压1级组(MAP≤145mmHg),收缩压、舒张压最高等级组(SBP≥180 mmHg、DBP≥110 mmHg)病死率均最高,经统计有显著性差异.进入Logistic回归模型的自变量有5个:平均动脉压、出血量、并发症、意识水平、年龄.结论过高血压(MAP＞145mmHg)是提示近期预后不良的危险因素,平均动脉压较收缩压、舒张压更有代表性.合并并发症、重度意识障碍、高龄亦是近期预后差的重要危险因素.     

同型半胱氨酸对高血压患者脑卒中复发风险的影响

目的探讨高血压合并脑卒中患者的血浆同型半胱氨酸（Hcy）水平与其他危险因素对于脑卒中复发的影响。 方法分析徐州市中心医院心内科和徐州医科大学附属医院神经外科自2012年5月至2013年12月收治的1623例高血压脑卒中患者的基线资料，中位随访4.9年，根据随访事件中是否发生脑卒中分为复发组（312例）与未复发组（1311例）。Kaplan-Meier生存分析比较不同危险因素脑卒中复发率的差异，单因素与多因素Cox回归模型分析影响脑卒中复发的独立危险因素，以及危险因素之间的交互作用。 结果复发组年龄、空腹血糖、Lg Hcy的水平，以及糖尿病、房颤的患病率均高于未复发组（P<0.05）。Kaplan-Meier生存分析显示，糖尿病、房颤、年龄≥60岁、空腹血糖≥7.0 mmol/L、Hcy≥15 μmol/L的脑卒中复发率明显升高（Log-rank检验，P<0.05）。多因素Cox回归模型分析显示，高龄、Lg Hcy水平升高，以及房颤、糖尿病是脑卒中复发的独立危险因素。Lg Hcy分别与糖尿病、空腹血糖、年龄存在交互作用。 结论血浆Hcy水平升高既是高血压合并脑卒中患者卒中复发的独立危险因素，又通过与糖尿病、高龄、空腹血糖水平升高的交互作用显著增加脑卒中复发风险。     

肾血管性高血压大鼠自发脑卒中与左心室肥厚的关系

目的探讨高血压个体脑卒中与左心室肥厚的关系。方法比较易卒中型肾血管性高血压大鼠发生与未有脑卒中的血压水平及左心室肥厚程度，观察经１０周抗高血压后，其脑卒中与血压和左心室肥厚的关系。结果脑卒中大鼠的血压水平及左心室肥厚程度比未卒中者更高。抗高血压后期，其血压水平与高血压对照组无显著性差异，但随着左心室肥厚的减轻，脑卒中率显著降低。结论左心室肥厚和脑卒中均为高血压的并发症，而前者不是后者的独立危险因素。减轻左心室肥厚的抗高血压治疗，即使降血压轻微，对预防脑卒中仍有意义     

高血压脑卒中患者脉压的临床意义

目的探讨脑卒中合并高血压患者脉压(PP)与卒中发生的相关性。方法比较出血性脑卒中、缺血性脑卒中与对照组之间各血压参数(SBP、DBP、MBP、PP)的差异性,以及各组内PP变化(PP≥60mmHg、PP<60mmHg)与年龄亚组(≤45岁、46￣55岁、56￣65岁、66￣75岁、≥75岁)之间的关系。结果脑卒中两组与对照组各血压参数比较差异有显著性意义(P<0.05);在缺血性脑卒中组、出血性脑卒中组PP与年龄变化呈显著相关性(P<0.05),而对照组无显著相关性(P>0.05)。结论宽PP与脑卒中的发生有关,是脑卒中发生的重要危险因素。     

脑卒中患者血压管理的研究进展

高血压是脑卒中最重要的独立危险因素。脑卒中的病因和所引发的血流动力学具有多变 性,这使得脑卒中患者的血压管理变得复杂,因此需要准确的诊断和精准定义治疗目标。现回顾最新 关于动脉血压管理预防脑卒中首发和反复发作的研究进展,并对高血压亚急症和急症的血压管理,特 别是高血压脑病、出血性脑卒中和缺血性脑卒中急性期的血压管理进行综述。     

基线血压水平与急性缺血性脑卒中早期降压治疗3个月结局的关系

目的 探讨基线血压水平与急性缺血性脑卒中早期降压治疗3 m结局关系.方法 收集2009年8月-2013年5月发病48 h内住院且经影像学确诊合并高血压的急性期缺血性脑卒中患者828例,根据入组时收缩压(Systolic Blood Pressure,SBP)水平分为140 ～ 160 mmHg组(n=276)、160～...     

人工寒潮促发脑卒中的实验研究

目的　探索建立人工寒潮环境 ;探讨人工寒潮与脑卒中的关系。方法　观测用经改装的冷藏柜及人工气候箱模拟寒潮时所需条件及达标情况 ;分别将复制成功的易卒中型肾血管性高血压大鼠 (RHRSP)及正常大鼠置于人工寒潮环境中 ,观察大鼠的血压波动、脑血管病变及脑卒中的发生情况。结果　冷藏柜与人工气候箱均能模拟寒潮 ,后者除能控制温度外同时能控制相对湿度 ;人工寒潮来临时RHRSP组大鼠血压波动大、自发性脑卒中明显增多 ,与对照组比较有明显差异 (P <0 0 5 )。结论　人工气候箱较冷藏柜能更好模拟寒潮 ,人工模拟寒潮克服了季节限制且一致性好、易重复 ;人工寒潮可以使RHRSP发生脑卒中 ,可较好模拟气温骤降 (自然寒潮 )时的脑卒中 ,为进一步研究寒潮诱发脑卒中的机制提供了条件     

美托洛尔抗高血压预防脑卒中的实验病理学研究

目的探讨抗高血压治疗预防脑卒中的形态学机制。方法采用易卒中型肾血管性高血压大鼠口服美托洛尔治疗，观察抗高血压治疗各级脑动脉和心室壁厚度的形态学改变。结果治疗组大鼠血压仅短期轻度低于未治疗的高血压对照组，但治疗组各级脑动脉损害和左心室肥厚明显改善，脑卒、中发生率也显著低于高血压对照组。结论美托洛尔抗高血压治疗预防脑卒中的效果，不单纯由血压下降决定，还与其具有保护脑血管和逆转心室肥厚等作用有关。     

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.