实验性高血压所致的脑卒中与静息心率的关系

为探讨高血压个体中脑卒中发生与静息心率的关系。方法将易卒中型肾血管性高血压大鼠（ＲＨＲＳＰ）中，已发生脑卒中者的卒中前静息心率与未卒中者同时期静息心率进行比较；并观察不同药物抗高血压治疗后，脑卒中发生与静息心率的关系。结果高血压对照组中，已卒中大鼠卒中前心率快于未卒中大鼠同时期心率；静息心率≥３３０ｍｉｎ－１者，自发脑卒中率高于静息心率＜３３０ｍｉｎ－１者。美托洛尔减慢静息心率，显著降低ＲＨＲＳＰ的自发脑卒中率。结论静息心率是ＲＨＲＳＰ自发脑卒中的一个危险因素，能适当减慢静息心率的抗高血压治疗，可能有利于预防脑卒中。     

丁苯酞抗缺血性脑损害的靶细胞研究

目的 丁苯酞抗缺血性脑损害的细胞作用靶点.方法 培养大鼠原代脑微血管内皮细胞(BMECs)及神经元,将2种细胞联合培养或将BMECs培养液预处理神经元后,予神经元氧糖剥夺损伤(OGD),计算神经元存活率,观察丁苯酞对其影响.结果 丁苯酞不能直接提高神经元OGD损伤后的存活率,但能提高其中缺氧预处理及联合培养组的神经元OGD损伤后的存活率(P＜0.05).结论 丁苯酞对神经元的保护作用依赖于BMECs的正常功能,提示其脑保护的直接细胞靶点是BMECs.     

脑卒中组织化治疗与传统治疗的疗效和医学经济学比较

目的 探索符合我国国情的卒中治疗模式.方法 成立脑血管病专科,建立组织化的卒中病房,收集成立专科3年来我科住院病历资料完整的所有卒中病例,对普通病房与卒中病房在基本设置、诊治程序及卒中患者的住院时间、住院费用和预后方面进行了对比分析,并用方差分析和卡方检验进行了统计学检验.结果 卒中病房较普通病房有正规的基本设置和诊治程序易于实施组织化治疗,能轻度缩短住院时间,显著降低住院费用和死亡率、提高患者的好转率.结论 建立卒中病房简单、有效、可行,是符合我国国情的卒中治疗模式,有广泛的推广应用价值,具有蕈要的临床意义.     

Mixed Stroke

Purpose To summarize the chnical, autoptic and animal experimental dala of stroke, propose the concept of mixed stroke (MS) and demonstrate the enoiogy, pathogenesis, clinical mainfestations, prophylaxis and treatment of MS Background At present. stroke still is classified in the national and international academic fields as two main groups: hemorrhage and ischema In fact, thc cerebral vascular disease with hemorrhage forus and ischema focus at the same time is not rare moreover, this type of stroke has special etiology, pathogenesis and clinical manifestations. But it is always made a main dagnosis and neglected the other nature of coexistent focus on either clinical or pathological diagnosis according to traditional classification of stroke Data sources and methods Mort of pablished originsl articles about MS in our department and laboralory wcre reviewed. Resulta The clinical autoptic and animal experimental dats all prcved that hemorrhage and infarction could occur in the course of a stroke simultaneously or in suecession during a short time, which demonstrated the existence of MS It was found clinically that MS patients all had the hustory of hypcrtension and in the autoptic data the MS patients dying of stroke all had typical hypertensive changes in the heart and kidney. and had hypertensive arteriosclerosis in the cerebral arteriole and small artery. MS was cas lily thdueed in stroke-prone renovascular hypertensivc rats This kind of rats are free from genetic deficiency and arc not affected by senile factor, so their cerebral vascular foci are mainly induced by the single factor -hypertension. TThese indicate definitely that hypertensive cerebral vascular lesion is the basis inducing MS. The main lesions of hypertensive cerebral arteriole and small artery were hyalinosis and fibrinoid of the walls, and the formation of microaneurysms or hyperplasla of iniernal and external layers The math lcsions of hypertensive cerebral capillaries were increasing vascular permeability. mural damage. edema of brain tissuc surroumding the vessel. stenotie lumen and leakage of bloed cells These lcsions in varying degrees were observed at different part of thc same brain or at different length of the same vessel at the same time, on the basis of which both hemocrhagic stroke and ischemic stroke could occurr These indicate the brain of the same patient with hypertension has pathomocpliological base of hemorrhagic strokc and ischemic stroke at the same time After after acute cerebral vascular disease occurring, it can be complicated by the other opposite nature of focus during a short time owing to oppression. draw. vascular spasm, metabolic disotder. sharp fluctuation of systemic blood pressure and other factors. The MS patients often had alterations of consciousness and the sign5 of meningeal irritation. were easlily complicated by multiple system organ failure Few cascs had distinct mulufocal cerebral lesions climcally. but after a careful cxamination of the nervous system. bilateral pathologic reflexes were often found. CT or MRI is an important means to diagnose Mis and should be used in 1 -Sd after the onset The measures of treatment for MS should be more vigorous and reliable The factors aggravating pathological lesion should be paid special attention to prevent When MS suspected of occurring clinically, rational neutral measures of treatment are advisable With MS definitely diagnosed the doctors should treat the main foous positively. keep homeostasis, prevent the disorder of hypothafamic function. select proper drugs and treat mfection positively Preventing multiple system organ failure is a key to decrease the mortality of MS. Having spent many years exploring, we establish the anunal model of coexistent infarction and hemorrhage on the basis of stroke-prone renovascular hypertensive rats The incidence of MS up to 95% was found in the group. which were given an inIection of fiblinogen and resperpine. As this model can stimulate the clinical evolution of stroke very well and has very high incidence. it Is a good animal model of MS. conclusions It is essential to list MS as a type of stroke singly. Valuing and studying MS are im ponant for the whole fieid studying pathogenesis. prophylaxis and treatment of stoke.     

巴曲酶预防气温骤降所致脑卒中的实验研究

目的　观察巴曲酶对寒潮促发的易卒中型肾血管性高血压大鼠(RHRSP)的卒中是否有预防作用。方法　用持续高血压1 0周、1 2周、1 4周、1 6周的RHRSP分巴曲酶预处理组和生理盐水对照组,于寒潮来临前1天经股静脉注射巴曲酶( 2BU/kg) ,1天后处死,TTC染色,HE染色。结果　脑卒中发生率在巴曲酶组较对照组显著降低(P <0 . 0 5) ,其中以出血性脑卒中为著。结论　巴曲酶可预防寒潮促发的高血压性脑卒中的发生,对出血性卒中的作用尤其显著。     

眩晕的治疗原则

眩晕是人体自身空间定向和平衡障碍导致的一种运动性幻觉.具有突发性,患多突然出现旋转感,视蒙,不稳或倾倒,恶心、呕吐等症状,严重影响工作及生活,甚日常生活不能自理,尤其首次发作时可有极度恐惧感,甚至出现濒死感.因此,对于眩晕患首先应尽快控制症状,尽早消除其紧张或恐惧的心理.     

神经白塞病的临床和影像学分析

目的分析神经白塞病的临床和影像学改变,探讨该病的诊断和鉴别诊断。方法分析8例神经白塞病患者的临床 和影像学资料;随访5例神经白塞病患者,对该病的演变规律进行总结。结果 8例神经白塞病患者均有白塞病的基本临床表现,其 中口腔溃疡8例,生殖器溃疡6例,眼部病变3例,皮肤病变4例,针刺反应阳性5例;以神经系统损害为首发症状者只有1例,其余7 例从白塞病基本临床表现到出现神经系统症状的时间平均2．5年。8例中单纯中枢神经系统损害4例,周围神经损害1例,两者同时 合并者3例。6例行头颅MR检查均显示颅内散在点状或小片状T,加权像低信号、T2加权像高信号影,其中2例行头颅CT未见异 常。结论神经白塞病在中枢神经系统的任何部位均可因小血管炎而受损,临床表现随其受累部位不同而表现不同,以中枢神经系 统多见,周围神经较少,病程中有典型的缓解复发,病灶多且分散,影像学改变有助于临床诊断,针刺反应特异性高,结合白塞病的基 本临床表现综合分析可诊断神经白塞病。     

大骨瓣减压术抢救恶性大脑中动脉梗塞疗效分析

目的　总结大骨瓣减压术抢救恶性大脑中动脉梗塞 (mMCAI)的临床经验。方法　总结我院经头颅CT证实并进行大骨瓣减压术的 16例mMCAI患者的临床资料、辅助检查、治疗等 ,以分析手术时机及其他因素与预后的相关性。结果　死亡 6例 (6 / 16 )。死亡和存活患者的中线结构移位的中位数分别为 10 .5mm和 7mm ,手术距脑疝的时间中位数分别为 15 .5h和 4h。手术前加强脱水后瞳孔一度回缩的患者有 7例 ,其中 6例存活。手术前 12h内TCD检查示MCA主干闭塞的 3例患者均死亡 ,部分再通的 5例患者全部存活。 3个月时存活患者BI评分 ,仅有 1例严重残疾。结论　大骨瓣减压术治疗mMCAI是重要的救命措施 ,但要把握手术时机 ,术前强力脱水后瞳孔能短时回缩及TCD监测MCA有部分再通的患者预后较好。     

关于脑动脉硬化症的几点意见

关于脑动脉硬化症的几点意见苏镇培，黄如训脑动脉硬化症一直是临床常用的诊断．ＷＨＯ国际疾病分类的ＩＣＤ—９和１９８６年中华医学会第二次全国脑血管病学术会议第三次修订的《脑血管病分类草案》还有这一病名［１］．但到１９８９年ＷＨＯ卒中及其他脑血管疾病特别工...