脑血管病患者血浆中同型半胱氨酸的丰度及相关性研究

目的研究血浆中同型半胱氨酸（Hcy）的丰度在脑血管病患者中的分布及变化,观察它与脑血管病发生及其他相关危险因素间的关系。方法收集257例经临床及影像学确诊的脑血管病（包括脑梗死、脑出血、短暂性脑缺血发作）患者的临床资料,对其血浆Hcy水平与脑血管病发生及其他危险因素进行相关性研究,数据用SPSS13.0统计软件分析。结果脑梗死、脑出血、短暂性脑缺血发作（TIA）三组的Hcy水平明显高于正常对照组,高血压病、高脂血症与Hcy水平呈正相关,高Hcy血症与脑血管病发生呈显著正相关。结论高Hcy血症与脑血管病发生有关,是脑血管病的独立危险因素。     

Aspirin resistance determined with PFA-100 does not predict new thrombotic events in patients with stable ischemic cerebrovascular disease

Objective

Evidence is growing that some patients are not responsive to the antithrombotic action of aspirin. We prospectively evaluated the ability of aspirin resistance status, determined by PFA-100, to predict new thrombotic events in patients with stable ischemic cerebrovascular disease.

Methods

We studied 129 consecutive patients with stroke, transient ischemic attack (TIA) or vascular cognitive impairment. We assessed relationships between aspirin resistance, risk factors for ischemic cerebrovascular disease, and occurrence of new thrombotic events (composite of stroke, TIA, myocardial infarction, and cardiovascular death).

Results

Aspirin resistance, found in 26 (20.1%) cases, was unrelated to any of the examined vascular risk factors. During mean follow-up of 56 months, new thrombotic events occurred in 19 patients (14.7%), four with aspirin resistance (15.4%) and 15 (14.6%) without aspirin resistance (p = 1.00).

Conclusion

Aspirin resistance determined by PFA-100 does not predict new thrombotic events in patients with stable ischemic cerebrovascular disease.     

ABCD2评分法结合房颤改良评分法在短暂性脑缺血发作后早期脑梗死风险预测中的价值

目的 探讨ABCD2评分法结合房颤改良评分法（ABCD2F评分法）在短暂性脑缺血发作（TIA）患者早期脑梗死风险预测中的价值。方法 对260例TIA患者,按照ABCD2与ABCD2F评分法分别进行评分,观察两组患者2d和7d脑梗死发生率,用ROC曲线评价2种评分方法对于脑梗死的预测价值。根据2种评分法的危险分层（低、中、高危）,进一步比较两组患者脑梗死发生率的差异,并对危险因素进行多元回归分析。结果TIA患者2d和7d脑梗死发生率分别为10.0%和16.1%。预测2d脑梗死风险,ABCD2及ABCD2F评分法的ROC曲线下面积分别为0.67和0.65;预测7d脑梗死风险,2种评分的ROC曲线下面积分别为0.63和0.62。对7d发生脑梗死的危险因素进行多元logistic回归分析发现,房颤是7d脑梗死的独立危险因素（P＜0.05）。按ABCD2评分法危险分层,低、中、高危各组的脑卒中发生率：2d为1.22%、12.8%、16.98%,7d为3.66%、18.40%、30.19%;按ABCD2F评分法危险分层,低、中、高危各组的脑卒中发生率：2d为0%、12.69%、16.98%,7d为1.37%、18.66%、30.19%;两种评分法各危险分层分组间脑梗死发生率的差异均有统计学意义（均P＜0.01）。结论ABCD2F评分具有早期脑梗死预测价值,结合房颤的危险分层更具精确性。     

Long-term mortality and risk of stroke after transient ischemic attack

Background   Stroke and mortality rates in patients with transient ischemic attack (TIA) differ widely between community-based studies and research cohorts. Our aim therefore was to provide a reliable estimate for TIA patients treated in German neurology departments with an acute stroke unit. Methods   A total of 1951 consecutively admitted TIA patients were prospectively documented in 13 centers and 1480 (75.9 %) gave consent for long-term follow-up. During a mean follow-up of 23.4 months, we assessed recurrent cerebrovascular events and cause of death in 1448 patients via standardized telephone interview including confirmation of endpoint events by the treating physician. Results   Overall 94 patients (6.5 %) suffered a stroke and 118 patients (8.1 %) died, 21 due to stroke. The Kaplan-Meier estimate for stroke during the first year was 4.4 % (95 % CI 3.2–5.6 %) which corresponds to a relative risk of 9.5 (95 % CI 7.4–12.3) compared to the population-based stroke incidence in Germany. The annual rates after the first year were 2.2 % (95 % CI 1.7–2.7 %) for stroke and 3.2 % (95 % CI 2.7–3.8 %) for death. Independent predictors for stroke during follow-up were age and previous cerebrovascular events. The ABCD₂ score did not provide any meaningful prediction of stroke risk at 90 days. Conclusion   While the in-hospital risk of stroke was low, long-term stroke rates in our well-defined multicenter hospital-based cohort were comparable to a large randomized trial. In patients with a well-established diagnosis of TIA, only age and previous cerebrovascular events seem to constitute independent predictors for stroke during long-term follow-up. Participating Departments of Neurology (investigator): Ostalbklinikum Aalen (M. Heyden, MD), Klinikum Bernburg (M. Muller, MD), Krankenanstalten Gilead Bielefeld (C. Hagemeister, MD), Krankenhaus Buchholz (K. Luckner, MD), University of Essen (C. Weimar, MD), University of Freiburg (C. Fritzsch, MD), University of Greifswald (A. Khaw, MD), University of Hannover (K. Weissenborn, MC), Klinikum Heidenheim (S. Kaendler, MD), University of Jena (C. Terborg, MD), Krankenhaus Koln-Mehrheim (U. Frost, MD), University of Leipzig (D. Michalski, MD), Landesklinik Lubben (C. Rohrig, MD), University of Magdeburg (M. Goertler, MD), Ruppiner Kliniken Neuruppin (G. Zindler, MD), University of Rostock (A. Kloth, MD), Burgerhospital Stuttgart (T. Mieck, MD), University of Ulm (R. Huber, MD), Heinrich- Braun-Krankenhaus Zwickau (S. Grieshammer MD).     

颈动脉支架成形术治疗症状性颈动脉狭窄24例

目的 研究症状性颈动脉狭窄的血管内治疗的疗效.方法 分析24例颈动脉狭窄并有短暂性脑缺血发作(TIA)的支架治疗及溶栓+支架治疗的临床资料.结果 颈动脉支架释放成功,术后症状恢复满意.结论 支架治疗症状性颈动脉狭窄安全、有效,急性颈动脉血栓形成行动脉溶栓+支架治疗是可行的,但有待进一步积累经验.     

Dual Antiplatelet Therapy after Noncardioembolic Ischemic Stroke or Transient Ischemic Attack: Pros and Cons

Dual antiplatelet therapy simultaneously blocks different platelet activation pathways and might thus be more potent at inhibiting platelet activation and more effective at reducing major ischemic vascular events compared to antiplatelet monotherapy. Aspirin plus clopidogrel dual therapy is now the standard therapy for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. However, dual antiplatelet therapy carries an increased risk of bleeding. Patients with ischemic stroke or transient ischemic attack (TIA) are generally older and likely to have a fragile cerebrovascular bed, which further increases the risk of systemic major bleeding events and intracranial hemorrhage. Clinical trials and meta-analyses suggest that in comparison to antiplatelet monotherapy, dual antiplatelet therapy initiated early after noncardioembolic ischemic stroke or TIA further reduces the rate of recurrent stroke and major vascular events without significantly increasing the rate of major bleeding events. In contrast, studies of long-term therapy in patients with noncardioembolic ischemic stroke or TIA have yielded inconsistent data regarding the benefit of dual antiplatelet therapy over monotherapy. However, the harm associated with major bleeding events, including intracranial hemorrhage, which is generally more disabling and more fatal than ischemic stroke, is likely to increase with dual antiplatelet therapy. Physicians should carefully assess the benefits and risks of dual antiplatelet therapy versus antiplatelet monotherapy when managing patients with ischemic stroke or TIA.     

颈动脉系统TIA的血流动力学与发病机制初探

目的 探讨颈内动脉系统短暂性脑缺血发作（TIA）患者的血流动力学与发病的关系。方法 84例颈内动脉系统TIA患者均在末次发作后24h内进行经颅多谱勒（TCD）和血流动力学指数（CVDI）测定。结果 （1）TCD显示绝大多数患者脑动脉有严重狭窄或痉挛存在,从而引起脑血流速度的改变。（2）患者组与对照组CV-DI比较,零压顺应性（Co)明显下降,脑血管阻力（R）,特性阻抗（ZC）、脉搏波波速（WV）,动态阻力（DR）,临界压力（CP）增高,具有统计学意义,病灶侧与健侧比较,Co的下降及R、DR的增高具有统计学意义。结论 血流动力学的障碍是引起颈内动脉系统短暂性脑缺血发作的机制之一。     

乳癌手术麻醉方法的临床分析

目的对3种乳癌手术麻醉方法进行比较,以选择合理的麻醉方法。方法对800例乳癌手术病人的三种麻醉的方法、麻醉选择、麻醉并发症、麻醉注意事项等进行了分析总结。结果硬膜外阻滞麻醉（EPA）穿刺成功226例（98．15％）,阻滞效果满意208例（90．04％）,出现轻度并发症4例;静脉吸入复合麻醉（VICA）气管插管成功率100％,95例（20．43％）气管内插管时心血管反应较显著;全身静脉麻醉（TIA）94例（90．38％）心血管反应较显著,62例（59．62％）术中舌根后坠需置咽喉通气道或托起下颌维持呼吸道通畅。结论EPA、VICA发生并发症少于TIA,乳癌手术麻醉应选择EPA、VICA,TIA慎用。     

基于数据挖掘的中药治疗短暂性脑缺血用药规律分析

目的探究中药复方治疗短暂性脑缺血(transient cerebral ischemia,TIA)的用药特点分析。方法以中国知网、万方、维普作为数据来源,采用主题"短暂性脑缺血+临床"+全文"中药"进行高级检索,对1977-2019年与中医药治疗TIA相关的期刊文献进行筛选分类,筛选出相关中药复方或中成药制剂,将其药味录入Excel表数据库中,并采用SPSS Statistics 23.0、SPSS Modeler 14.1统计软件对数据进行分析。结果在纳入的67首方剂中,共涉及125种中药,使用频次≥10的中药共19种,以川芎(38次,56.72%)、丹参(33次,49.25%)、当归(26次,38.81%)、红花(25次,37.31%)、黄芪(25次,37.31%)、天麻(25次,37.31%)最为常见;对用药频率≥2的中药进行统计,中药治疗TIA在用药类别上以采用活血化瘀药(174次,28.90%)、补虚药(135次,22.43%)、平肝息风药(74次,12.29%)居多;药性以"温(200次,33.50%)、平(157次,26.30%)"为主,五味以"甘(303次,32.41%)、苦(278次,29.73%)"较多;归经中归肝经(426次,29.20%)的中药较多。关联规则分析得到20个支持度较高的中药组合,因子分析得到6个公因子。系统聚类分析共得到6个聚类。结论数据分析结果显示对于TIA的治疗,以活血化瘀药,补虚药,平肝息风类为主,清热药等为辅助,着重选择药性偏温,味甘并归肝经的中药,临床可着重考虑川芎、当归、丹参、红花、黄芪等中药的配伍使用。