老年人颅脑外伤后缺血性脑卒中发作特点及治疗

目的探讨老年人颅脑外伤后缺血性脑卒中发作特点及个性化治疗方案。方法针对7例颅脑外伤后急性期出现缺血性脑血管病症状的老年患者，通过脑血管造影检查分析其发病原因并根据不同的脑血管特点决定治疗方案。结果大多数患者（6／7）受伤前已存在不同程度的颅内外血管狭窄、血管壁溃疡以及附壁血栓形成等改变，提示脑缺血发作主要与这些病变为基础的脑血流下降、血栓脱落等因素密切相关。而外伤后脑灌注降低、脑血管痉挛是脑缺血发作的诱发因素。结论老年人外伤后的缺血性脑卒中发作主要与原有的脑血管基础疾病有关，预防和治疗老年人外伤后缺血性脑卒中发作，应基于这些病变特征并选择个体化治疗方案。     

A national stroke quality register: 12 years experience from a participating hospital

Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994–2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias.     

依达拉奉防治缺血性脑损伤研究的新进展

近年来,依达拉奉脑保护作用的研究取得了很大进展,尤以对缺血性脑卒中和新生儿缺血缺氧性脑病的防治研究最为深入,而联合治疗策略也得到了广泛的重视.本文就近5年这些热点研究的新进展进行综述.     

急性缺血性卒中大血管闭塞性质的判断与取栓方式和材料的选择

血管内机械取栓是治疗大血管闭塞性急性缺血性卒中的有效治疗方法。应结合病史、发
病形式及影像学检查等综合判断病变性质；依据病变性质并参考手术路径，个性化选择支架取栓、
抽吸取栓、球囊/支架血管成形术、动脉溶栓任一种或多种方法联合取栓；并依据手术方式选择手
术材料，以快速高效地完成手术。     

急性缺血性卒中患者发生院内消化道出血的危险因素分析

目的 分析急性缺血性卒中患者（acute ischemic stroke，AIS）住院期间消化道出血（gastrointestinal
bleeding，GIB）的发生率、发生时间及危险因素。
方法 本研究纳入首都医科大学附属北京天坛医院急性卒中院内并发症队列（inhospital medical
complication after acute stroke，iMCAS）研究中AIS患者。收集患者临床信息，根据住院期间是否发生
GIB分为GIB组和无GIB组，采用多因素Logistic回归模型，分析AIS患者发生GIB相关危险因素。
结果 共纳入1129例AIS患者，平均年龄58.7±12.5岁，女性230例（20.4%）。47例住院期间发生GIB，
发生率为4.2%，卒中发作至GIB确诊时间为5（3～13）d。合并肝硬化（OR 10.06，95%CI 2.44～41.38）、
高入院NIHSS评分（OR 1.13，95%CI 1.08～1.19）、高白细胞计数（OR 1.25，95%CI 1.13～1.38）、住院时
间长（OR 1.05，95%CI 1.01～1.10）是AIS患者发生消化道出血的独立危险因素。
结论 本单中心研究数据提示合并肝硬化、高入院NI HSS评分、高白细胞计数、住院时间长是AI S患
者住院期间发生GIB的独立危险因素。     

远隔性小脑出血

远隔性小脑出血极为罕见，可见于多种类型的神经外科手术，一般出现在手术远隔部位，多分布于单侧或双侧小脑沟、蚓部，小脑上部出血也较为多见。远隔性小脑出血总体预后良好，病死率约为10％～15％。     

DTI在急性缺血性脑卒中所致皮质脊髓束损伤中的应用研究

目的:利用DTI探讨急性缺血性脑卒中病人大脑白质纤维束各向异性特征和皮质脊髓束受损与肌力的关系。方法:对9例正常被试和9例急性期缺血性脑卒中病人进行常规MR T1WI、T2WI和DTI检查,对数据进行离线后处理,采用dTV.II软件处理,获得FA图及方向编码彩色(DEC)图,并重建双侧皮质脊髓束3D纤维束图。结果:在正常组双侧白质纤维束FA值无明显差异,重建FA值图与方向编码彩色图可显示大部分主要的白质纤维束。在脑卒中病人组梗死区FA值显著低于健侧,两侧相比差异有显著性意义(t=4.570,P<0.001)。病变侧皮质脊髓束受压、变形、移位、部分断裂,皮质脊髓束受累情况与肌力有相关性(rs=0.888,P<0.05)。结论:DTI可显示脑内白质纤维束的走行及分布,为大脑白质纤维束的研究开辟了新的广阔领域。DTI FA值图及DEC图可以显示卒中病人梗死区白质纤维的方向与各向异性程度。3D纤维束图可以更立体直观的显示锥体束状况,有利于探讨皮质脊髓束损伤程度与肌力的关系,对临床及判断预后有重要价值。     

One-year outcome after first-ever stroke according to stroke subtype, severity, risk factors and pre-stroke treatment. A population-based study from Tartu, Estonia

The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.