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脑缺血彩色多谱勒诊断的临床价值
1 临床表现根据脑缺血脑损害的程度,其临床表现可分为两类,一类由于轻度或短暂的供血不足引起暂时性神经功能缺失,但无明显脑梗死存在,临床上表现为短暂性脑缺血(transient ischemic attack,TIA);另一类缺血程度较重,持续时间较长,造成脑梗死,临床上表现为可逆性神经功能缺失(reversibleischemic neurological deficit,RIND) (又称可逆性脑缺血发作)、进行性卒中(progressive stroke,PS)和完全性卒中(complete stroke,CS).
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The aim of this study is to investigate the effect of electro-acupuncture treatment in acute phase of cerebral infarction on the motor functions. In this randomly controlled trial, 86 patients were allocated to two groups, the experimental group given clinical and electro-acupuncture treatments for a period of 4 weeks, and the control group given clinical treatment plus active and/or passive functional exercise. The result showed that the level of impairment and disability in both groups were improvement according to the Chinese Stroke Scale, Brunnstrom-Fugl-Meyer score, and Barthel Index throughout the study and 3 months after. The motor functions and the activities of daily living (ADL) were improved significantly in the electro-acupuncture group as compared with the control group (P<0.05). Also, the results showed greater reduction of neurological deficit in the electro-acupuncture group than in the control group. Conclusion: Early acupuncture treatment for acute stroke patients may improve motor functions, and consequently the activities of daily living.
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Puerarin, a major isoflavonoid derived from the Chinese medical herb radix puerariae (Gegen), has been reported to inhibit neuronal apoptosis and play an anti-inflammatory role in focal cerebral ischemia model rats. Recent findings regarding stroke pathophysiology have recognized that an-ti-inflammation is an important target for the treatment of ischemic stroke. The cholinergic an-ti-inflammatory pathway is a highly robust neural-immune mechanism for inflammation control. This study was to investigate whether activating the cholinergic anti-inflammatory pathway can be in-volved in the mechanism of inhibiting the inflammatory response during puerarin-induced cerebral ischemia/reperfusion in rats. Results showed that puerarin pretreatment (intravenous injection) re-duced the ischemic infarct volume, improved neurological deficit after cerebral ischemia/reperfusion and decreased the levels of interleukin-1β, interleukin-6 and tumor necrosis factor-αin brain tissue. Pretreatment with puerarin (intravenous injection) attenuated the inflammatory response in rats, which was accompanied by janus-activated kinase 2 (JAK2) and signal transducers and activators of transcription 3 (STAT3) activation and nuclear factor kappa B (NF-κB) inhibition. These observa-tions were inhibited by the alpha7 nicotinic acetylcholine receptor (α7nAchR) antagonistα-bungarotoxin (α-BGT). In addition, puerarin pretreatment increased the expression of α7nAchR mRNA in ischemic cerebral tissue. These data demonstrate that puerarin pretreatment strongly protects the brain against cerebral ischemia/reperfusion injury and inhibits the inflammatory re-sponse. Our results also indicated that the anti-inflammatory effect of puerarin may partly be me-diated through the activation of the cholinergic anti-inflammatory pathway.
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他汀类药物治疗脑血管痉挛机制的研究
脑血管痉挛(cerebral vasospasm,CVS)是神经外科的常见临床问题,其基础和临床研究是目前国内外神经外科领域内的热点问题之一,特别是动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)是致死、致残的重要原因.CVS即"颅内动脉的持续性收缩状态",其诊断主要根据患者的临床症状体征及脑血管造影的影像,如果仅在血管造影时发现血管处于痉挛状态,而患者没有相应的神经功能缺损症状,称为无症状性血管痉挛.反之,则称为症状性血管痉挛,或迟发性缺血性神经功能障碍(delayed ischemic neurological deficit,DIND).根据现有研究成果,CVS发生的病理生理机制与下列因素有关:①血液及手术器械对血管壁的机械性刺激;②血块压迫、血管壁营养障碍等导致血管壁结构破坏;③氧合血红蛋白氧化成高铁血红蛋白并释放氧自由基造成的损伤;④各种血管活性物质,如5-HT、儿茶酚胺、血红蛋白及花生四烯酸代谢产物的缩血管作用;⑤颅内压增高,过量脱水治疗而不及时补充血容量;⑥血管壁的炎症和免疫反应[1].
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高凝状态与蛛网膜下腔出血后症状性脑血管痉挛
动脉瘤性蛛网膜下腔出血(SAH)后2~3 d内血管造影很少发现有脑血管痉挛,但在4~12 d内血管造影有30%~70%的病人可发现不同程度和范围的脑血管痉挛,其中有20%~30%的病人发生症状又称"症状性脑血管痉挛",以脑灌注不足,产生缺血性神经症状为主,而又在出血后延迟发生,也称为延迟性缺血性神经功能障碍(delayed ischemic neurological deficit ,DIND).
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液体高压氧对急性脑卒中患者神经功能缺损恢复的作用
Background:Liquid hyperbaric oxygen therapy is a quickly developed therapy for acute cerebral infarction in recent years.It has characteristics of high safety,low toxicity,easy manipulation,especially good recovering effect on neurological deficit in acute stroke patients.We observed this effect in this paper.
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急性脑卒中患者入院时血糖水平与神经功能改善程度及预后关系
Objective To evaluate the admission blood sugar level and prognosis and neurological improvement in acute stroke patients.Method 285 cases of acute stroke were reviewed wih a vies of possible correlation of admission blood sugar level to prognosis and admission condition.Result No significant correlation of blood sugar level to neurological deficits 1 month after stroke was showed(r=0.103,P >0.05).Improvement of neurological deficits was closely related to admission neurological deficits(P<0.01).Conclusion It seems to be a stress response that hyperglycemia appears in acute stroke.
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脑血管痉挛的介入治疗进展
脑血管痉挛(cerebral vasospasm,CVS)是动脉瘤性蛛网膜下腔出血( Aneurysmal subarachnoid hemorrhage,aSAH)患者残疾甚至死亡的一种重要原因,其在aSAH患者中的发病率约为30%~70%[1-2]。此类患者发生延迟性神经功能缺失( delayed ischemic neurological deficit,DIND)的几率约为30%, CVS不仅可导致局部神经功能障碍,还可导致病患功能及认知恢复障碍。故如何防治CVS是降低aSAH病患致残率和病死率的关键。早期动脉瘤的处理,脑池内血凝块的清除,早期足量全程的尼莫地平的使用、镁剂、“3H”治疗、血管内介入治疗等措施,在一定程度上改善了患者的预后[3],尽管如此,因CVS发生比例较高,如何防治CVS仍是学者们不懈追求的目标。