化痰通络汤治疗缺血性中风恢复期风痰瘀阻证29例的临床观察

目的 观察化痰通络汤对缺血性中风恢复期风痰瘀阻证的临床疗效.方法 将57例缺血性中风恢复期风痰瘀阻证患者随机分为两组,治疗组29例采用化痰通络汤治疗,对照组28例采用消栓通络胶囊治疗,治疗8周后评价临床疗效.结果 两组患者治疗后神经功能缺损评分均得到明显改善(P<0.01),且治疗组优于对照组(P<0.05):治疗组的临床疗效及显效率优于对照组(P<0.05).结论 化痰通络汤治疗缺血性中风恢复期风痰瘀阻证有效.     

A rating system for prompt clinical diagnosis of ischemic stroke

BACKGROUND: When a CT scan is not available, an early accurate clinical diagnosis of ischemic stroke is essential to initiate prompt therapy. Our objective was to construct a clinical index that is easy to use when stroke patients are first evaluated at the hospital, to identify those who probably are experiencing an acute ischemic episode. The study was conducted at a university-affiliated medical referral center and two community general hospitals in Mexico. METHODS: Clinical records were reviewed for 801 patients with sudden onset of a focal or global neurologic dysfunction, presumably of vascular origin lasting more than 24 h. Eligibility criteria for this study were admission to the hospital within the first 24 h after symptomatic onset, CT scan diagnosis between 24 and 72 h, and age >45 years. Ischemic stroke included cases of arterial brain infarction, while nonischemic stroke included subarachnoid or intraparenchymatous hemorrhage, mass lesion, venous infarction, and in cases without a CT scan evidence that could explain the clinical manifestations. Data excerpted for analysis were age, sex, history of diabetes mellitus or previous stroke/transient ischemic attack (TIA), time of onset of symptoms, presence of headache, vomiting, neck stiffness, hemiplegia, leukocytosis or atrial fibrillation, diastolic blood pressure, and Glasgow coma scale (GCS) rating. Two multivariable analyses were used: 1) step-wise multiple logistic regression (SMLR), and 2) conjunctive consolidation (CC). RESULTS: After appropriate exclusions, the study proceeded with 83 ischemic and 42 nonischemic stroke patients. With SMLR, six variables were selected as predictive for ischemic stroke, including neck stiffness, diastolic blood pressure, previous history of stroke/TIA, hemiplegia, GCS, and atrial fibrillation. An appropriate sum of weighted ratings had a positive predictive value (PPV) of 100% for ischemic stroke. With consolidated categories, the PPV was 97% when patients had the following: no neck stiffness; no atrial fibrillation but history of stroke/TIA and GCS > or =12, or no neck stiffness but atrial fibrillation. CONCLUSIONS: Among patients with acute stroke, clinical data can be used to identify a group with a high probability of ischemic stroke. There are slightly different results between both methods; while SMLR includes the four variables selected by CC, the latter included neither diastolic blood pressure nor hemiplegia/hemiparesia. However, CC results seem easier to understand and interpret than with SMLR.     

丹参注射液加强缺血预处理对大鼠心肌的保护作用

以整体麻醉SD大鼠心脏冠状动脉左前降支结扎／松开作为缺血／再灌注动物模型，研究丹参注射液（SM）在加强缺血须处理（IP）的心肌保护中的作用。结果显示，IP能减轻复灌性心律失常的严重程度，缩小心肌梗死范围；SM能缩小心肌梗死范围；SM联合IP与单纯IP比较，心肌梗死范围进一步缩小；SM联合IP与单纯SM比较，心律失常严重程度减弱且心肌梗死面积进一步减小。结果表明，SM能加强IP的心肌保护作用，特别是加强IP的抗心肌梗死作用。     

心脏和肾脏短暂缺血对心肌梗死后心律失常的影响

目的　研究心脏和肾脏短暂缺血预处理对急性心肌梗死(AMI)后心律失常的影响。方法　观察AMI组(A组)、心脏缺血预处理(MIP)组(B组)和肾脏缺血预处理(RIP)组(C组)新西兰兔在AMI前后的心律失常情况及QT间期离散度(QTd) ,并行心内电生理诱发室性心动过速(VT) ,对三组的指标进行比较,同时设置假手术组(D组)作对照。结果　四组在手术前心律失常及QTd差异无显著意义(P >0 . 0 5 ) ;D组手术前后心律失常及QTd比较差异无显著意义(P >0 . 0 5 ) ;在AMI后,B、C两组室性心律失常及QTd明显小于A组(P <0 . 0 5 ) ,而B、C两组室性心律失常及QTd比较差异无显著意义(P >0 .0 5 )。结论　MIP和RIP均可减少AMI后室性心律失常的发生,而且两者的作用没有明显差异。     

缺血预适应在老年急性心肌梗死中的临床意义

目的探讨心肌缺血预适应在老年急性心肌梗死(AMI)中的临床意义。方法对124例老年AMI患者,按梗死前48h有无心绞痛分为缺血预适应组(IPC,n=68)、无缺血预适应组(NIPC,n=56),对比两组患者的临床资料。结果IPC组比NIPC组的心肌梗死范围小(P<0.05),血清心肌酶学峰值低(P<0.05),恶性心律失常、心力衰竭、心源性休克、室壁瘤发生率及病死率均明显降低(P<0.05)。结论心肌缺血预适应具有保护心肌、缩小梗死范围,减少并发症及改善老年患者近期预后的作用。     

Piracetam in acute stroke: a systematic review

We studied whether the administration of piracetam in acute, presumed ischemic stroke affects case fatality and functional outcome. The Cochrane Stroke Group strategy was used to evaluate all randomized controlled trials of patients with presumed ischemic stroke examined within 48 h; death and (when available) functional outcome were used as end points. Three studies were included; the most recent one contributed more than 97% of the data. There were 501 patients treated with piracetam and 501 controls. Piracetam was associated with a nonsignificant 31% increase in the odds of death (95% CI –5% to 81%). This result was due almost completely to the effect of the larger trial, which, however, reported that the difference in case fatality rate between piracetam and control disappeared after correcting for the imbalance in stroke severity between the two groups. Data on functional outcome were available only for the largest study, and no difference was reported. Data obtained from the manufacturer suggested a nonsignificant trend (–10%) towards reduction in dependency with piracetam (CI –33% to 20%); the proportions of patients dead or dependent in the two groups were the same. Relevant adverse effects were not reported. The evidence from this review does not support routine administration of piracetam in patients with acute ischemic stroke; however, since a possible beneficial effect cannot completely be ruled out, further controlled trials are warranted. Received: 31 August 1999/Received in revised form: 3 November 1999/Accepted: 25 November 1999     

短暂性脑缺血发作对后继脑梗死影响的研究

目的:评价短暂性脑缺血发作(T IA)对后继脑梗死是否有保护作用。方法:选择2000~2005年我院老年神经病科及神经内科既往有同侧T IA的脑梗死患者98例,并对有同侧T IA的脑梗死患者根据T IA发作持续时间分为<10m in(26例)、10~20m in(38例)及>20m in(34例),并选择同期住院无T IA的脑梗死患者102例进行病例对照观察。在入院及病程一月时采用改良的爱丁堡-斯堪的那维亚卒中量表进行神经功能缺损评分,病程一月时进行预后评分。结果:两组患者年龄及其他危险因素包括高血压病、糖尿病、高脂血症及冠心病无差异(P>0.05);入院及病程一月时,无T IA的脑梗死患者其神经功能缺损评分及近期预后与T IA持续时间在10~20m in的脑梗死患者有显著性差异(P<0.05),但与T IA持续时间<10m in及>20m in的脑梗死患者无差异(P>0.05),且T IA持续时间在10~20m in之间与<10m in、>20m in比较有显著性差异(P<0.05)。结论:T IA对后继脑梗死有保护作用。     

他汀类与抗血小板药联合用药对缺血性脑血管病患者颈动脉粥样硬化的干预作用

目的:探讨缺血性脑血管病患者联合应用他汀类及抗血小板药对颈动脉粥样硬化和脑血管事件的干预作用。方法:选择146例缺血性脑血管病合并颈动脉粥样硬化患者,将其随机分为治疗组和对照组。治疗组74例,应用氟伐他汀(每晚40mg)和拜阿斯匹灵(100mg/d),对照组72例,仅给拜阿斯匹灵(100mg/d)。共随访2年,分别在治疗前,治疗后6月、12月、18月、24月检测血脂,颈动脉内-中膜厚度,颈动脉斑块积分。结果:治疗组平均颈动脉内-中膜厚度和颈动脉斑块积分,治疗前分别为(1.22±0.19)mm和4.4±2.5,治疗后分别为(0.87±0.15)mm和2.8±1.1,治疗前后比较差异具有显著性(P<0.01)。随访结束时,治疗组缺血性脑血管病复发率9.5%,与对照组复发率(26.3%)相比明显下降。结论:联合应用他汀类及抗血小板药能延缓和逆转缺血性脑血管病患者颈动脉粥样硬化的进展,对缺血性脑血管病的复发有很好的预防作用,且不增加脑出血发生率。     

丹参注射液对急性肾衰竭兔心肌缺血的保护作用

目的探讨丹参注射液对急性肾衰竭(ARF)家兔心肌缺血的保护作用。方法取家兔28只，随机分为3组，对照组8只，模型组12只，丹参组8只。麻醉后对照组和模型组给予0.9%氯化钠注射液耳缘静脉注射，丹参组给予丹参注射液耳缘静脉注射。均为0.5 mL·kg^-1，每6 h重复1次，共4次。第1次给药后0.5 h，对照组给予0.9%氯化钠注射液双侧后肢肌内加压注射，10 mL·kg^-1，模型组和丹参组制备家兔ARF模型，即给予50%甘油溶液双侧后肢肌内加压注射，10 mL·kg^-1。检测各组家兔不同时相血小板聚集功能、前列环素(PGI2)、血栓素A2(TXA2)、内皮素(ET)等指标及心肌组织形态学变化。结果与对照组比较，模型组肌内注射给药后2，24 h血小板聚集性、TXA2 、ET均明显升高(均P＜0.01)，6-酮-前列腺素F1a(6-Keto-PGF1a)明显降低(P＜0.01)，心肌组织出现严重的缺血性损害;丹参组则无明显变化。与模型组比较，丹参组家兔肌内注射给药后2，24 h，血小板聚集性、TXA2、ET明显降低(均P＜0.01)，6-Keto-PGF1a明显升高(P＜0.01)，心肌组织缺血性损害明显减轻。结论ARF时，家兔血小板聚集性改变和血管活性物质与氧自由基的增高可能是造成心肌组织缺血性损害的直接原因之一。丹参可通过抑制血小板聚集功能，降低TXA2、ET等明显减轻ARF家兔心肌组织缺血性损伤。     

11,12-EET对在体大鼠正常及再灌注心肌JNK1/JNK2表达的影响

目的　观察11, 12- 环氧二十碳三烯酸对再灌注心肌JNK1 /JNK2表达的影响,探讨其与心肌保护作用的关系。方法　制备大鼠缺血/再灌注心肌损伤模型,动态观察心功能的变化;实验后取心肌,用Western Blot法测定心肌JNK1 /JNK2的表达。实验分①正常组(Norm);②假手术组(Sham);③缺血再灌注组(I/R);④短阵缺血预处置组(SI+I/R);⑤11, 12 -EET预处置缺血/再灌注损伤组(EET+I/R)。结果　再灌注30min,I/R组+dp/dtmax、-dp/dtmax和LVDP均低于Sham组、SI+I/R组和EET+I/R组(P<0 .05);而I/R组大鼠心肌JNK1 /JNK2磷酸化表达高于Sham组、Norm组及EET+I/R组(P<0. 05 ),EET+I/R组与Sham组间;SI+I/R组与I/R组差异均无显著性(P>0 .05)。结论　11, 12- EET具有保护心功能的作用,这种保护作用可能是通过抑制JNK1 /JNK2的表达。