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1.
We estimated hemorheological parameters of vein blood samples and cutaneous microvascular blood flow in patients with acute ischemic stroke and in controls. The worsened blood rheological properties were registered in patients with stroke: the enhanced whole blood viscosity was due to the substantial increase of plasma viscosity and the impairment of microrheological blood properties: elevated erythrocyte aggregability and decreased deformability compared to the healthy group. The decrease of oxygen consumption fixed by rheological methods and by laser Doppler flowmetry led us to conclude that the tissue hypoxia took place in patients with stroke. The regulatory mechanisms aimed to maintain blood supply to tissue were activated under cerebral infarction and the impact of unfavorably changed rheological blood properties was markedly enhanced. Revealed close interrelations between rheological and microcirculation parameters testified the important role of hemorheological factors in maintenance of microvascular blood flow and oxygen delivery to tissue.  相似文献   

2.
目的探讨肢体远隔缺血预适应对缺血性脑血管病患者的脑保护作用。方法收集既往有短暂性脑缺血发作(TIA)或脑梗死病史,并经药物规范治疗,将高血压、血糖、血脂等危险因素控制在正常范围内,并经影像学证实为颅内外多发性狭窄的患者145例。按照3∶2的比例随机分为肢体远隔缺血预适应组(rIPC组)85例,对照组60例。两组均严格按照2011年美国卒中和TIA二级预防指南用药,控制危险因素。同时给予rIPC组患者肢体缺血预适应训练,采用双臂血压计将双上肢加压至180~200 mm Hg,维持5 min,放气休息5 min,为1个循环,每次连续训练5个循环,1次/d,共治疗6个月。观察患者神经功能改善的情况及再梗死的发生率。其中rIPC组35例,对照组26例,接受单光子发射计算机断层显像术(SPECT)检查,观察脑血流及代谢改善的情况。结果①与治疗前比较,治疗后rIPC组中神经功能缺损有改善的有71例(83.5%),对照组有40例(66.7%),差异有统计学意义,P〈0.05。②MRI检查显示,rIPC组有3例(3.5%)再次发生脑梗死,对照组有8例(13.3%)再次发生脑梗死,差异有统计学意义,P〈0.05。③SPECT检查显示,rIPC组脑代谢及血流较治疗前有改善的有29例(82.9%),对照组有13例(50.0%),两组差异有统计学意义,P〈0.01。④rIPC后,无一例患者出现心率、血压改变及其他不适感。结论肢体远隔缺血预适应可以明显改善缺血性卒中导致的神经功能损伤、改善脑血流及代谢,并且可以预防脑梗死的再发生。  相似文献   

3.
目的 研究A型行为 (TAB)与脑梗死及血液流变学的关系 ,为脑梗死的预防提供依据。方法 采用 1∶1配对病例对照设计 ,应用全国心身医学协作组编制的“A型行为类型问卷”对 2 45例脑梗死患者及 2 45名健康对照进行问卷调查 ;并随机筛选出A型行为脑梗死患者 (TAB组 )和与之相匹配的非A型行为脑梗死患者 (非TAB组 )各 5 0例 ,同时随机选取TAB和非TAB健康人员各 5 0名作为对照组 ,4组受试者均于晨 6时空腹抽静脉血进行血液流变学检测。结果 脑梗死组TAB者占 79.5 % ,对照组TAB者占 5 4.8% ,优势比值为 3.16 (95 %可信限为 2 .0 6~ 4.84,P <0 .0 0 5 )。TAB组患者全血低切粘度 (1s- 1 )、血浆粘度 (10 0s- 1 )、红细胞聚集指数及血浆纤维蛋白原显著高于非TAB组及对照组 (P <0 .0 5 )。结论 A型行为可能是导致脑梗死的危险因素之一 ;对A型行为给与适当的干预 ,应是脑梗死一级预防的内容之一。  相似文献   

4.
A complete neurological and laboratory assessment was made of 31 transient ischemic attack (TIA) and 33 acute ischemic stroke patients. Laboratory parameters were compared with 33 age- and sex-matched controls. Erythrocyte deformability was characterised by determining the relative cell transit time (RCTT) with a St. George filtrometer. Plasma viscosity was measured with a Haake microviscosimeter. In comparison with controls, fibrinogen content, erythrocyte sedimentation rate (ESR), platelet and leukocyte count, erythrocyte RCTT and plasma viscosity were found to be significantly higher in stroke patients. In TIA patients the elevation of these values was not significant with the exception of platelet count. Our results suggest that the hemorheological alterations observed in TIA and stroke are largely non-specific findings and associated with the atherosclerotic disease of patients. The significant elevation of leukocytes, fibrinogen and plasma viscosity in acute stroke versus TIA probably reflects the systemic acute phase response of organism to cerebral infarction.  相似文献   

5.
急性缺血性卒中患者采取何种头位,目前仍存在争议。近年来越来越多研究提示改变卒中患者头部位置会影响患者脑血流灌注,进而可能影响患者神经功能恢复。作者总结了近年来发表的急性缺血性卒中头位研究的相关文献,探讨了改变头部位置对脑血流及卒中患者神经功能结局的影响,以提高有关头位对急性脑梗死影响的认识。  相似文献   

6.
进展性缺血性卒中的临床分析   总被引:3,自引:0,他引:3  
目的探讨不同类型的脑梗死患者进展性卒中的发生率、可能的预测指标以及预后。方法将起病在24小时内486例首次发病的脑梗死患者分成四组:即完全前循环梗死组(TACI),部分前循环梗死组(PACI),腔隙性脑梗死组(LACI)和后循环梗死组(POCI)。进展性卒中的诊断根据起病到7天内肌力下降情况或神经功能缺损评分来判断。比较各组有进展与无进展的脑梗死患者的特征、危险因素、重要体征、头部CT、彩超下颈动脉粥样硬化特征以及预后情况。结果486例患者中有116例发展为进展性卒中(23.87%),其中完全前循环梗死组发生率最高为36.59%,其次为腔隙性脑梗死组26.70%及后循环梗死组20.34%,而部分前循环梗死组发生率最低为12.10%。完全前循环梗死组患者中,有进展的患者头颅CT早期异常及严重颈动脉狭窄的患者较无进展的患者多。腔隙性脑梗死组中,有进展的患者入院时血糖较无进展的高,而头颅CT早期异常率较无进展的患者低。有进展的脑梗死患者急性期病死率高,神经功能恢复差,影响到患者预后。结论不同脑梗死组患者进展性卒中的发生率不同,有进展的患者预后差。完全前循环梗死组头颅CT早期异常、颈动脉粥样硬化的严重程度及狭窄程度、腔隙性脑梗死组入院时高血糖及低头颅CT异常,均可能是进展性卒中发生的预测指标。  相似文献   

7.
目的 探讨高血压病和缺血性脑卒中发生发展过程中凝血因子 相关抗原血管性假血友病因子 (v WF)及D-聚合体 (D- D)水平的变化及临床意义。方法 用酶联免疫双抗体夹心法分别测定 2 0 0例高血压病患者 (其中包括76例急性缺血性脑卒中患者 )和 76例健康对照者的血浆 D- D及 v WF水平 ,比较高血压 2级、3级及合并急性缺血性脑卒中时的 D- D及 v WF的变化。结果 高血压病 3级血浆 v WF显著高于高血压 2级及正常对照组 (P<0 .0 1) ;高血压 2级也高于正常对照组 (P<0 .0 5 ) ;缺血性脑卒中急性期治疗前后二者比较差异显著 (P<0 .0 0 1) ,各级高血压病 D- D变化无差异。结论 随着高血压病的进展 ,血浆中 v WF水平随之升高 ,急性缺血性脑卒中发生时达到高水平 ,经过治疗后 v WF水平下降  相似文献   

8.
颅内外血管架桥术治疗缺血性脑血管病疗效的再评价   总被引:3,自引:4,他引:3  
目的 对颅内外血管架桥术治疗缺血性脑血管病的疗效进行再评价。 方法 对30例经正规内科治疗后仍有颈内动脉系统缺血症状的患者,进行了颞浅动脉-大脑中动脉吻合术,并对术后患者的脑血流改善情况及临床情况进行了分析。 结果 术前患者均为一过性缺血发作神经性缺损(TIA),可逆性缺血性神经障碍(RIND)和不典型脑缺血症状,术前CT,MRI检查无大面积脑梗死,SPECT·rCBF均有脑血流减低区。术后血管造影显示吻合口通畅率为86.7%,术后局部脑血流改善率为70%,随访仅发现2例患者有2次TIA,无完全性卒中发生,术前有轻度神经功能障碍的8例患者,术后均有不同程度的恢复。 结论颞浅动脉-大脑中动脉吻合术可预防颈内动脉系统血流动力学障碍性脑缺血发展成完全性卒中。  相似文献   

9.
目的 探讨早期血压变异性与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性.方法 前瞻性收集住院治疗的急性缺血性卒中患者.连续记录入组患者入院72 h内的血压值,计算收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)的平均值(mean)、最大值(maximum,max)、极差(differences between the maximum and minimum,max-min)、标准差(standard deviation,SD)和变异系数(coefficient of variation,CV).END定义为美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)最高时的评分较基线增加≥2分.采用多变量logistic回归分析在校正混杂因素后确定不同血压变异性参数与急性缺血性卒中后END的独立相关性.结果 共纳入128例急性缺血性卒中患者,其中男性75例,女性53例;平均年龄(63.30±11.82)岁.经过标准治疗,35例(27.34%)患者在入院72 h内发生END.END患者与非END患者年龄、性别、糖尿病、基线NIHSS评分、C反应蛋白以及SBPmax、SBPmax.mm、SBPsD、SBPCv、DBPmax、DBPmax-min、DBPsD和DBPCV的差异有统计学意义(P<0.05).多变量logistic回归分析表明,血压变异性指标中的SBPmax--min[优势比(odds ratio,OR)1.040,95%可信区间(confidence interval,CI)1.014 ~1.067]、SBPsD(OR 1.191,95% CI 1.052~1.347)、SBPCv(OR 1.317,95% CI1.100 ~1.578)、DBPmax-min(OR 1.076,95% CI1.018 ~1.138)、DBPSD(OR 1.508,95% CI1.128~2.016)和DBPCv(OR 1.338,95% CI1.093 ~1.638)是急性缺血性卒中患者发生END的独立危险因素.结论 急性缺血性卒中患者72 h内血压变异性与END显著相关.  相似文献   

10.
目的探讨白细胞介素6(IL-6)、C-反应蛋白(CRP)在进展性缺血性脑卒中发病中的作用。方法分别采用双抗体夹心酶联免疫法和透射比浊法测定80例急性脑梗死患者不同时期血清IL-6、CRP水平变化,并根据临床神经功能缺损程度量表(NDS)评分判断是否发展为进展性脑卒中。另选40名健康体检者作为对照组。结果 80例急性脑梗死患者中有27例(33.75%)于7d内发展为进展性脑卒中,其发病后第1、3、7、14天外周血IL-6、CRP水平明显高于无进展的脑梗死患者(P0.05),第14天与正常对照组比较差异无统计学意义(P0.05)。发病当天IL-6、CRP水平与人院时体温、血白细胞数、血浆纤维蛋白原呈正相关(相关系数r=0.87、0.66、0.51,P均0.01),IL-6、CRP是进展性脑卒中危险因素。结论急性脑梗死患者血清IL-6、CRP增高与进展性缺血性脑卒中密切相关,可能在进展性缺血性脑卒中的发病过程中具有重要作用,监测血清IL-6、CRP水平对于监测疾病活动情况及严重程度等具有重要意义。  相似文献   

11.
目的探讨缺血性卒中病史对急性心肌梗死患者入院后死亡的影响作用。方法回顾性分析2004年2月—2009年8月以心电图初发急性sT段抬高型心肌梗死入院的患者共918例,以入院期间是否死亡将患者分为存活组(811例)及死亡组(107例)。比较两组患者的一般资料、发病特点和治疗情况,采用多元Logistic回归分析探讨缺血性卒中病史是否为急性心肌梗死患者近期死亡的独立危险因素。结果①死亡组缺血性卒中患者比例(22例,20.6%)高于存活组(101例,12.5%),差异有统计学意义(,=5.354,P〈0.05)。②存活组和死亡组患者的年龄、糖尿病史及高血压病史比例、血压、空腹血糖、白细胞计数、血肌酐、严重心律失常并发症比例、左心室射血分数、治疗方式比较后,差异均具有统计学意义,P〈0.05。③多元Logistic回归分析表明,缺血性卒中病史并不是急性心肌梗死患者死亡预后的独立危险因素(P〉0.05,OR=1.027,95%CI.O.263~4.004)。结论合并缺血性卒中的患者在急性心肌梗死入院死亡的人群中具有更集中的现象,但是经过校正后,其对急性心肌梗死入院死亡预后的独立影响作用尚不明确。  相似文献   

12.
目的研究阿托伐他汀联合尿激酶溶栓对大鼠大脑中动脉急性脑梗死的疗效。方法选择SD大鼠48只,采用血栓栓塞法制备大鼠大脑中动脉急性脑梗死模型,随机分为阿托伐他汀组、尿激酶组、联合治疗组和对照组,每组12只。缺血3h给予阿托伐他汀或生理盐水,缺血4h给予尿激酶或生理盐水治疗。治疗前和缺血24h行神经功能缺损评分,缺血24h取脑行2,3,5-氯化三苯基四氮唑染色检测脑梗死体积。结果与对照组比较,阿托伐他汀组缺血24h神经功能显著改善[(6.5±4.3)分vs(12.5±4.3)分],脑梗死体积明显降低[(13.8±7.5)%vs(30.5±23.4)%,P<0.05]。与阿托伐他汀组比较,尿激酶组和联合治疗组神经功能改善程度及脑梗死体积降低程度更显著(P<0.05)。与尿激酶组比较,联合治疗组神经功能改善、脑梗死体积减小,但差异无统计学意义(P>0.05)。结论阿托伐他汀对脑梗死组织有保护作用,阿托伐他汀与尿激酶联合治疗有进一步提高疗效的趋势。  相似文献   

13.
目的 分析院前转运方式对急性缺血性卒中患者入院后静脉溶栓时间效率指标及早期神经功能改善的影响.方法 回顾性连续纳入2018年6月至2021年5月北京丰台医院神经内科急性缺血性卒中接受静脉溶栓治疗患者302例,均经头部CT或MR证实有新发梗死灶,并在院内接受静脉溶栓治疗,排除了静脉溶栓桥接取栓治疗患者.根据登记的院前转运...  相似文献   

14.
The patients with acute cerebral stroke suffer from stress situation which may induce the catabolic state. The aim of our study was to evaluate the influence of the nutrition intervention and follow-up of the nutrition parameters in the patients with acute ischemic cerebral stroke. We have examined 30 patients with acute ischemic cerebral stroke, the average age 71.4 +/- 8.6 years. In all the patients we have measured some antropometric, biochemic and immunologic parameters of the nutrition status on admission. At the same time we have evaluated the size of the neurological deficit with NIH stroke scale and Barthel index. Every day we have monitored in all the patients the nutrition intake. In case the food intake has not reached 30 kcal/kg/day we have started the nutrition intervention by giving polymer enteral nutrition: either like sipping or if necessary through nasogastric tube. The nutrition intervention has been necessary in 18 patients (60%). The measurement of antropometric, biochemical and immunologic parameters have been repeated after 14 days. The evaluation of nutrition parameters have shown no significant changes since admission. The changes of the nutrition parameters in this group of the patients we have compared with the earlier reported group of the patients where no nutrition monitoring and intervention were applied and the nutrition parameters have deteriorated significantly in 2 weeks. By comparing we have confirmed that the careful monitoring of nutrition intake and in the majority of patients also nutrition intervention are necessary, especially because the improvement of the neurological deficit have been noticed more in the group of the monitored and intervened patients. The nutrition intervention can stabilize the followed nutrition parameters which may play the significant role in the speed and efficacy of the rehabilitation.  相似文献   

15.
The presence of a hemorheological disturbance must be considered in the pathophysiological and therapeutical approach to vascular diseases, including cerebral diseases. A reduction of blood fluidity, due either to increase of hematocrit (polycythemic hyperviscosity) or of fibrinogen concentration (plasmatic hyperviscosity) or of red cell rigidity (sclerocythemic hyperviscosity) is commonly considered a condition of high risk for acute or chronic brain ischemia. So many attempts have been made for improving blood fluidity with the purpose to prevent stroke and to delay cerebral deterioration in chronic condition. This paper will present a review of the literature on this subject and the personal experience of our research group with the use of hemodilution, plasmapheresis and pharmacological agents. In our opinion the possible correction of hyperviscosity is very helpful in the prevention of acute ischemic attacks and in the reduction of their incidence in chronic cerebral ischemia. During the acute phase of stroke, hemorheological disturbance is only a part of the complex hemodynamic situation: a primary blood hyperviscosity can favor the onset of the disease but, because of its secondary increase after stroke, a vicious circle might be set in motion resulting in a further reduction of blood supply to the brain. Considering this, attempts in improving blood fluidity during stroke could be made, but with the caution that is required in this complicated "circulatory storm".  相似文献   

16.
目的 观察急性脑梗死患者外周血CD34+细胞水平的变化,探讨其与脑血管病危险因素、神经功能缺损评分及颈动脉内膜-中层厚度(IMT)的相关性.方法 选择急性期脑梗死(发病72 h内)患者45例(梗死组)和具有脑血管危险因素的非脑梗死患者27例(高危组)为研究对象.记录两组患者脑血管病危险因素,包括酗酒史、吸烟史、冠心病、高血压、糖尿病、血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平;通过流式细胞仪测定两组患者外周血CD34+细胞水平,再将两组外周血CD34+细胞水平与脑血管病危险因素进行相关性分析;分别记录梗死组神经功能缺损评分及颈动脉IMT,将外周血CD34+细胞水平与神经功能缺损评分及颈动脉IMT进行相关性分析.结果 (1)脑血管病危险因素中冠心病、高血压、糖尿病和LDL-C水平均与外周血CD34+细胞水平呈显著负相关(r分别为-0.749,-0.717,-0.688,-0.764),差异均有统计学意义(P<0.01);(2)通过多元线性回归分析得出外周血CD34+细胞水平可以作为急性脑梗死的独立影响因素(P<0.05);(3)梗死组患者外周血CD34+细胞水平低于高危组,其与神经功能缺损评分呈负相关(r=-0.721,P<0.01),与颈动脉IMT亦呈负相关(r=-0.695,P<0.01).结论 外周血CD34+细胞水平可以作为急性脑梗死的独立影响因素;急性脑梗死患者外周血CD34+细胞水平与神经功能缺损评分及颈动脉IMT呈显著负相关;外周血CD34+细胞水平可以作为缺血性脑卒中患者早期血管内皮功能的细胞学标志物.
Abstract:
Objective To observe the change of peripheral blood CD34+ cell level in patients with acute cerebral infarction, and explore its relationships with cerebrovascular risk factors,neurological function and carotid artery intima-media thickness (IMT). Methods The 45 patients with acute cerebral infarction (onset within 72 h) (infarction group) and 27 patients with cerebr ovascular risk factors but without cerebral infarction (high-risk group) were chosen for the study. The cerebrovascular disease risk factors including history of alcohol abuse, smoking, coronary heart disease, hypertension, diabetes, abnormal levels of serum triglycerides, total cholesterol,low-density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were recorded in all subjects. The peripheral blood CD34+ cell levels were measured by flow cytometry.The correlations of peripheral blood CD34+ cell level with cerebrovascular disease risk factors were analyzed. The neurological function and carotid artery IMT were recorded in infarction group, and the correlations of peripheral blood CD34+ cell level with neurological function and carotid artery IMT were analyzed. Results (1) The peripheral blood CD34+ cell level was significantly negatively correlated with coronary heart disease, hypertension, diabetes and LDL-C level (r =- 0. 749,-0. 717, - 0. 688, - 0. 764, all P<0. 01) ; (2) Multiple linear regression analysis showed that peripheral blood CD34+ cell level was an independent relative factor of acute cerebral infarction (P<0.05); (3) The peripheral blood CD34+ cell level was lower in infarction group than in high-risk group, and was significantly negatively correlated with neurological deficit score (r=-0. 721, P<0.01) and carotid artery IMT (r= -0. 695, P<0. 01). Conclusions Peripheral blood CD34+ cell level could be an independent relative factor of acute cerebral infarction; The peripheral blood CD34+ cell level is significantly negatively correlated with neurological function and carotid artery IMT in patients with acute cerebral infarction; And it can be used as cytological marker which reflect early vascular endothelial function in patients with ischemic stroke.  相似文献   

17.
目的通过经颅多普勒超声动态评价立普妥对脑梗死患者脑血流动力学的影响。方法通过经颅多普勒超声检查100例首次急性脑梗死住院患者的脑血流动力学,根据是否规律服用立普妥分为:服药组53例和未服药组47例。发病3个月后再次随访经颅多普勒超声。结果与发病1周内比较,服药组患者发病3个月后大脑中动脉血流速度明显增快,搏动指数明显下降(P0.05);未服药组患者发病3个月后双侧大脑中动脉血流速度和搏动指数差异无统计学意义(P0.05)。结论立普妥对改善脑梗死脑血流动力学有一定作用。  相似文献   

18.
目的观察脑梗死急性期患者血压变化规律,探讨脑梗死急性期降压治疗与14 d预后的关系,为脑梗死急性期血压管理提供临床依据。方法将入选的143例急性脑梗死患者随机分为干预组70例和对照组73例。干预组给予降压治疗,使其1 d内收缩压下降10%~20%,入院7 d时血压降至140/90 mm Hg(1 mm Hg=0.133 kPa)以下,入院14 d内血压稳定在上述水平。动态监测2组患者14 d内的血压变化,采用美国卫生研究院卒中量表(NIHSS),观察2组患者入院时、14 d神经功能缺损程度及死亡/残疾比率。结果 2组入院14 d NIHSS评分呈降低趋势。与对照组比较,干预组患者14 d NIHSS评分、死亡/残疾比率明显降低(P<0.05)。多因素logistic回归分析显示,在调整了年龄、性别、高血压、入院NIHSS评分、入院血压及1 d血压下降幅度等因素后,降压治疗独立影响急性脑梗死14 d预后,降低14 d死亡/残疾的风险(OR=0.338,95%CI:0.136~0.840,P<0.05)。结论脑梗死急性期给予合理降压干预,有利于早期神经功能恢复,可降低14 d死亡/致残的风险。  相似文献   

19.
前循环急性进展性缺血性卒中相关危险因素的分析   总被引:7,自引:0,他引:7  
目的探讨前循环急性进展性缺血性卒中住院患者的危险因素。方法选择前循环急性缺血性进展性卒中100例患者为研究对象,均进行抗血小板聚集治疗。分为进展组32例,非进展组68例。由1名经过相关培训的神经科主治医师询问病史并进行体检,记录与前循环急性进展性缺血性卒中发生可能相关的24个危险因素,进行χ2或t检验,对所有入组的患者以病情是否进展为因变量(Y),以单因素分析后差异有统计学意义的因素作为自变量,采用Logistic多因素逐步回归后退法分析,筛选出独立的危险因素。结果两组患者危险因素的多因素分析显示:有颈动脉狭窄(OR=22.069,95%CI:5.169~94.223)、入院体温增高(OR=13.404,95%CI:1.958~91.736)、有糖尿病史(OR=12.598,95%CI:2.867~55.359)3个因素进入模型(P<0.05)。结论颈动脉狭窄、入院体温增高、有糖尿病史是前循环急性进展性缺血性卒中的主要危险因素。前循环急性进展性缺血性卒中是多种因素、多种机制共同作用的结果。  相似文献   

20.
增加缺血半暗带脑血流有利于促进神经功能恢复.成纤维细胞生长因子与卒中后血管发生密切相关,可使缺血半暗带脑血流得到改善,从而促进神经功能恢复.其应用将成为治疗缺血性卒中的一种新方法.  相似文献   

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