混合性中风

随着CT成像技术的应用,脑出血和脑梗塞同时或几乎同时出现于同一患者的混合性中风已日渐受到重视。为认识混合性中风的临床特征和探讨其发病机理,现将我院1983～1990年cT证实的收住院治疗的21例混合性中风资料报告如下: 临床资料男14例、女7例。男女之比为2:1,年龄最小45岁,最大74岁,平均年龄为63.23岁。其中45～54岁3例,55～64岁3例,65～74岁15例。有高血压病史(7～20年)13例,占61.9％。既往有中风史者5例,但距本     

混合性中风

混合性中风黄如训，谭盛自从我们１９８８年首先报道“混合性中风”的有关病例并提出这一概念后［１］，有关报道日益增多，积累了大量资料，显示我国学者最先提出的一个中风领域，取得了引人注目的研究成果。现将有关文献作一综述。１一次中风的两种性质病变混合性中风的...     

混合性中风19例报告

混合性中风１９例报告王耀，张颖，闫秀欣，安志荣现将近５年来收治的混合性中风１９例报告如下。临床资料一。一般资料男１１例，女８例。年龄４６～９４岁，平均６１．８岁。６０岁以上１０例（５２．６％）。既往有高血压者１５例，其中＞１０年者１１例（７３．３％）...     

混合性中风22例临床分析

本文报道２２例混合性中风，占同期中风病人的１３．１％。临床观察和病理资料证实，中风急性期完全可同时存在两种不同性质的病变，出血性和缺血性。此二种病变可以互相促进，相互转化。本资料归纳为二种类型；出血一梗塞型；出血型。早期多次ＣＴ扫描对混合性中风有可靠诊断价值。治疗以中性为主，合理使用渗透性脱水剂，注意脱水后补充入量，适当控制血压水平是关键。     

降纤酶治疗混合性中风临床疗效观察

混合性中风系一次中风同时存在出血与梗塞两种不同的病理过程。出血与梗塞并存，是临床医生感到棘手的难题，到目前为止，仍无肯定有效的治疗方案，即止血及使血肿迅速吸收，又不至于加重梗塞或再诱发新的梗塞。我院于1996年10月至1998年1月应用降纤酶治疗混合性中风30例，疗效满意，现总结如下。1；临床资料1．1一般资料治疗组30例中，男18例，女12例，年龄最小四例，最大周岁。平均47．4岁，。高血压史平均5．7a糖尿病患者14例，病史平均4．8a，眼底检查均有动脉梗化。排除了原发性蛛网膜下腔出血，无中风史。30例心电图均有S－T段或T波…     

混合性中风临床治疗分析

混合性中风病灶大多在双测大脑深部,且临床表现复杂,诊断主要靠CT检查。高血压起重要的发病作用,治疗应采用减轻脑水肿、自由基清除,改善微循环及血液稀释综合疗法。     

混合性中风30例临床分析

回顾性分析我院急诊观察室及神经内科病房收治的混合性中风30例。发病时以出血灶为主者18例，以梗死灶为主者12例；具有单侧体征者20例，具有双侧体征者10例。结果提示：本组混合性中风以大血肿、小梗死较多；体征单侧较双侧为多；出血灶多位于基底节，其次为脑叶和脑干，梗死灶多位于出血灶的对侧或为双侧小梗死。本文还讨论了有关混合性中风的诊断与治疗问题。     

刺五加注射液治疗混合性中风急性期的临床观察

30例脑动脉硬化性混合性中风患者在常规疗法基础上加用紫外线辐射血液疗法作为对照组,另30倒在上述疗法基础上加用刺五加注射液静脉滴注为治疗组。结果治疗组治愈显效率93.3％,总有效率100％,对照组治愈显效率63．4％,总有效率83．4％,治疗组明显优于对照组（P＜0．01）。表明刺五加注射液不仅用于缺血性中风,也可用于缺血性和出血性并存的混合性中风的治疗。对加快意识的恢复,血肿和脑水肿的吸收以及梗塞灶的改善都有明显作用。     

在改良法血栓栓塞性脑卒中大鼠模型上进行尿激酶静脉溶栓治疗

目的　在改良法自体血血栓栓塞性脑卒中大鼠模型上使用尿激酶静脉溶栓 ,试图建立理想化的溶栓治疗脑卒中研究的模型体系。方法　治疗组于大脑中动脉闭塞后 0 .5h尿激酶进行静脉溶栓。 5h和2 4h后进行神经功能缺损评分 ,用TTC染色法测定梗死灶体积 ,并观察梗死后 6h的脑组织病理变化。结果　此模型可产生范围较恒定的梗死灶 ,治疗组梗死灶体积明显小于对照组 (P <0 .0 1)。但两组 5h和 2 4h神经功能缺损评分无显著性差异。结论　这种模型超早期使用尿激酶静脉溶栓疗效好 ,由于可能存在缺血性神经元顿抑 ,尽管溶栓组脑梗死体积减小 ,但早期神经功能恢复不明显。     

Acute stroke centre - the changing focus of stroke unit care. The Bergen NORSTROKE Study

Thomassen L, Waje‐Andreassen U, Broegger J, Næss H. Acute stroke centre – the changing focus of stroke unit care. The Bergen NORSTROKE Study.
Acta Neurol Scand: 2012: 125: 410–415.
© 2011 John Wiley & Sons A/S. Objectives – The basic stroke unit studies selected patients primarily for rehabilitation and did not deal with the critical first hours after stroke. The aim of this study was to analyse a unselected cohort of patients admitted to an acute stroke centre with primary focus on emergency diagnosis and treatment. Materials and Methods – All patients with suspected stroke were admitted as emergencies. Patients with definite cerebrovascular disease were prospectively included in the Bergen Stroke Study, patients with other diseases were excluded, but final diagnosis was registered. Results – Fifty per cent of the admitted patients had other diagnosis than stroke. Of 1267 consecutive patients with cerebrovascular disease, 70% had no or minor neurological deficits on admission. After 1 week, 56% were independent, 30% needed long‐term rehabilitation, 10% were bedridden and 4% were dead. Conclusion – An acute stroke centre today requires a high degree of neurological expertise in assessing patients admitted with possible stroke. Most patients with stroke have no or mild deficits and need above all rapid diagnostic work‐up, acute and prophylactic treatment. In‐hospital rehabilitation is essential for a smaller number of patients who suffer from persisting neurological deficits after stroke.     

二氧化锗诱导的线粒体肌病动物模型的发病机制的研究

目的建立线粒体肌病的动物模型，以探讨线粒体肌病的发病机制。方法利用二氧化锗喂养Ｗｉｓｔａｒ大鼠２４周，进行肌肉病理检查，测定生化功能及线粒体ＤＮＡ含量。结果线粒体肌病动物模型被建立，其细胞内自由基含量增多，线粒体ＤＮＡ拷贝数明显减少。结论可能有部分线粒体肌病由环境毒素引起，细胞内自由基含量增多是其重要的发病环节     

A meta-analysis of remote ischaemic conditioning in experimental stroke

Remote ischaemic conditioning (RIC) is achieved by repeated transient ischaemia of a distant organ/limb and is neuroprotective in experimental ischaemic stroke. However, the optimal time and methods of administration are unclear. Systematic review identified relevant preclinical studies; two authors independently extracted data on infarct volume, neurological deficit, RIC method (administration time, site, cycle number, length of limb occlusion (dose)), species and quality. Data were analysed using random effects models; results expressed as standardised mean difference (SMD). In 57 publications incorporating 99 experiments (1406 rats, 101 mice, 14 monkeys), RIC reduced lesion volume in transient (SMD −2.0; 95% CI −2.38, −1.61; p < 0.00001) and permanent (SMD −1.54; 95% CI −2.38, −1.61; p < 0.00001) focal models of ischaemia and improved neurological deficit (SMD −1.63; 95% CI −1.97, −1.29, p < 0.00001). In meta-regression, cycle length and number, dose and limb number did not interact with infarct volume, although country and physiological monitoring during anaesthesia did. In all studies, RIC was ineffective if the dose was <10 or ≥50 min. Median study quality was 7 (range 4–9/10); Egger’s test suggested publication bias (p < 0.001). RIC is most effective in experimental stroke using a dose between 10 and 45 min. Further studies using repeated dosing in animals with co-morbidities are warranted.     

组织化卒中医疗模式对出血性脑卒中的近期效果研究

目的:探讨组织化卒中医疗模式治疗出血性脑卒中的近期效果。方法:将符合标准的81例出血性脑卒中患者随机分为组织化卒中治疗组(A组)及常规治疗组(B组)进行治疗,比较分析两组临床神经功能缺损程度、日常生活活动能力、意识障碍程度、并发症及近期临床疗效的差异,并对经济社会效益进行分析。结果:A组在神经功能缺损程度评分、日常生活活动能力评分、意识障碍程度评分及近期临床疗效方面,均明显优于B组(均P<0.01),并发症的发生率亦显著低于对照组(P<0.01)而且组织化卒中医疗组每提高患者的一个功能单位,所需的花费较常规治疗组患者明显减少。结论:组织化卒中医疗模式治疗出血性脑卒中有确切疗效。     

Hypertension and experimental stroke therapies

Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta-analysis and meta-regression, partitioned on the basis of hypertension, stroke model, and therapy. Results: Hypertensive animals were used in 10% of experiments testing 502 therapies. Hypertension was associated with lower treatment efficacy, especially in larger infarcts. Overall, anti-hypertensives did not provide greater benefit than other drugs, although benefits were evident in hypertensive animals even when given after stroke onset. Fifty-eight therapies were tested in both normotensive and hypertensive animals: some demonstrated superior efficacy in hypertensive animals (hypothermia) while others worked better in normotensive animals (tissue plasminogen activator, anesthetic agents). Discussion: Hypertension has a significant effect on the efficacy of candidate stroke drugs: standard basic science testing may overestimate the efficacy which could be reasonably expected from certain therapies and for hypertensive patients with large or temporary occlusions.     

Animal models of neonatal stroke and response to erythropoietin and cardiotrophin-1

Neonatal stroke is increasingly recognized in preterm and term infants, and the rate of arterial ischemic infarction occurring around the time of birth is as high as the annual incidence of large-vessel ischemic stroke in adults. Thus, neonatal stroke is a major contributor to perinatal morbidity and mortality, and a considerable number of these children will develop long-term neurodevelopmental disabilities. Our ability to investigate this situation has been limited by the technical challenges in developing suitable animal models. Our objective is to describe recent evidence in relation to animal models of neonatal stroke. In addition, we review and report potential neuroprotective strategies specific to neonatal stroke, with a focus on erythropoietin and cardiotrophin-1 because of their potential role in protection as well as repair.     

Evaluation of MCAO stroke models in normotensive rats: standardized neocortical infarction by the 3VO technique

The temporary three-vessel occlusion (3VO) technique with a surgical approach for middle cerebral artery (MCA) produces consistent cerebral infarction in the neocortex in normotensive rats. The intraluminal thread-occlusion technique with an endovascular approach targeting the MCA occlusion (MCAO) is more widely used since it does not require complicated intracranial procedures. The aim of this study was to review the methods/models for MCAO stroke in normotensive rats and to evaluate a 3VO stroke model that provides consistent degrees and variance of cortical stroke injury for additional discussion. First, we analyzed a model with modified temporary 3VO technique requiring less complicated procedures than the temporary 3VO model, i.e., temporary occlusion of the bilateral common carotid arteries (CCAs) superimposed on a permanent occlusion of the MCA, in Sprague-Dawley rats or C57BL/6J mice. In the microvascular tissue (cerebral) perfusion study, significant reductions in regional cerebral perfusion during the 3VO accompanied a rapid return to baseline after release of the CCAs, showing that the technique induces temporary focal ischemia. The average sizes and variances of the neocortical infarction in this model, together with those in the other normotensive rat models caused by the 3VO technique in the literature, indicated a standard size and variance of infarcted lesion in the control groups relative to the specific ischemic period. However, stroke injuries in the neocortex induced by the thread occlusion technique showed greater variability with less consistent lesion sizes. Inclusion/exclusion criteria to avoid inappropriate cases with too mild (no/faint infarction) or too great (huge/fatal infarction) severity in the ischemic injury may differ between laboratories in the thread occlusion model.     

注射糖皮质激素和慢性束缚应激抑郁样大鼠模型的比较及其机制探讨

目的 比较束缚应激和注射糖皮质激素两种应激抑郁造模方法以及神经内分泌机制的探讨.方法 24只雄性Sprague Dawley(SD)大鼠随机分为正常对照组(NC组,8只), 束缚应激组(MS组,8只)和糖皮质激素组(CO组,8只),用长期束缚制动方法和注射氢化可的松建立大鼠应激抑郁模型,建模时间21天,每周进行体质量、1%蔗糖水消耗、旷场试验测定,造模结束后用逆转录-聚合酶链反应(RT-PCR)检测各组大鼠海马区糖皮质激素受体(Glucocorticoid receptor ,GR)mRNA表达的变化.结果 ① MS组和CO组大鼠体质量增加量,1%蔗糖水消耗量,行为学水平评分和垂直评分在第3周末均较NC组明显降低(F=26.36, 16.66, 18.72,13.36,P<0.01).②MS组和CO组在第2周和第3周各项行为学评分差异无统计学意义.③建模后MS组和CO组GRmRNA表达较NC组明显降低(F=30.126,P<0.01).结论 两种造模方法均能较好模拟了抑郁症的精神运动迟滞和快感缺失,是可靠的应激抑郁动物模型,而GRmRNA表达的变化是应激介导抑郁样反应的神经内分泌机制之一.