目的 观察丁苯酞序贯疗法联合双联抗血小板对急性脑梗死(ACI)患者血清高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶-9(MMP-9)、巯基丙酮酸硫基转移酶-3(3-MST)和扣针蛋白-5(Fibulin-5)的影响.方法 选取2014年4月至2018年4月本院收治的ACI患者104例,随机分为观察组和对照组各52例.对照组给予常规治疗和双联抗血小板治疗,观察组在对照组基础上加用丁苯酞序贯疗法.比较两组临床预后,治疗前后评价美国国立卫生研究院卒中量表(NIHHS)、Fugl-Meyer量表(FMA)、改良Barthel指数(MBI)和简易精神状态量表(MMSE)评分,并测定外周血HMGB1、MMP-9、3-MST、Fibulin-5水平.结果 治疗28d、3个月后,观察组的NIHSS评分、FMA评分、MBI和MMSE评分均优于对照组,差异有统计学意义(P<0.05);治疗第3d、7d、28d,观察组血清HMGB1、MMP-9、Fibulin-5低于对照组,3-MST高于对照组,差异均有统计学意义(P<0.05);观察组预后良好率为88.46％,高于对照组的71.15％,差异有统计学意义(P<0.05).结论 丁苯酞序贯疗法联合双联抗血小板治疗ACI能够保护患者的神经功能,促进神经功能、运动功能及认知功能的恢复,并提高日常生活活动能力,其机制可能与降低血清HMGB1、MMP-9、Fibulin-5和上调3-MST有关.

目的 探讨miRNAs及血清神经元PAS结构域蛋白4(NPASDP-4)、神经元特异性烯醇化酶(NSE)、S100β蛋白水平对急性脑血管病(ACVD)患者认知障碍的影响.方法 选取延安大学附属医院神经内科2016年1月-2019年1月收治的167例ACVD合并认知功能患者进行临床实验,按其认知功能障碍严重程度将其分成A、B、C组(轻度组、中度组和重度组),各81例、51例和35例,将三组患者的各项临床指标均纳入SPSS21.0软件处理,分别比较三组miRNAs(miRNA-34、21、135)、NPASDP-4、NSE、S100-β蛋白水平差异,以上指标与ACVD患者MMSE评分关系用Spearman秩和分析,以上指标与ACVD患者认知障碍严重程度的关系采用ROC曲线评估.结果 ①A组miRNAs(34、21、135)低于B组、B组低于C组(P<0.05),A组NPASDP-4低于B组、B组低于C组,NSE、S100-β蛋白水平高于B组,B组高于C组(P<0.05);②Spearman秩和分析发现,除NPASDP-4与MMSE评分呈负相关(r=-0.442,P<0.01)外,miRNAs-135相对表达量及NSE、S100-β蛋白水平与MMSE评分均呈正相关(r=0.412、0.472、0.453,P<0.05),而miRNAs-34、21相对表达量与MMSE评分无相关性(P>0.05);③ROC曲线结果 表明,ACVD合并认知障碍患者miRNAs-135、NPASDP-4、NSE、S100-β蛋白的AUC值分别为0.749、0.731、0.750、0.758,最佳截断值分别为0.70、2.04ml·L-1、13.78U·mL-1和0.23ug·L-1.结论 在ACVD合并认知障碍患者的认知功能判定中miRNAs-135、NPASDP-4、NSE、S100-β蛋白与其认知障碍严重程度相关,而miRNAs-34、21则与其认知障碍严重程度无关.

Objective? To explore the therapeutic effect of cerebral metabolic activator combined with conventional therapy on acute cerebral infarction (ACI). Method 78 patients with ACI admitted in Apr 2016 to Apr 2018 were selected as the study subjects, the random digital table was divided into 39 patients in the control group and 39 patients in the observation group. The control group received conventional therap including intravenous thrombolysis, intracranial pressure reduction, antiplatelet aggregation, and dilation of blood vessels, the observation group added cerebral metabolic activator oxiracetam on the basis of the control group. The therapeutic effects, the changes of neurological function and cognitive function before and 2 weeks after treatment and the adverse reactions during medication of the two groups were observed. Results? The total effective rate of the observation group was 94.87%, compared with the control group (81.58%), the difference was statistically significant (P<0.05); There was no significant difference in the degree of nerve function defect and cognitive function between the two groups before treatment (P>0.05), all improved after treatment. After 2 weeks of treatment, the activity of daily living scale (ADL) and Scandinavia Stroke Scale (SSS) were compared with those in the control group, which was significantly lower, the mini-mental state examination scale (MMSE) and montreal cognitive assessment scale (MoCA) was significantly higher than that of the control group , the difference was statistically significant (P<0.05); the adverse reactions during medication in the observation group was 20.51%, compared with the control group (15.38%), the difference was not statistically significant (P>0.05). Conclusion? Cerebral metabolic activator combined with conventional therapy in the treatment of ACI can significantly improve the curative effect, reduce the nerve function defect, improve the cognitive function, and have high safety, have clinical application value.

Objective To investigate the effects of α-linolenic acid (ALA) on acute inflammation and neurological functional recovery of mice with traumatic brain injury (TBI). Methods The C57BL6/N mice were divided into high ALA dietary group (20 pregnant and 88 new-born mice) and low ALA dietary group (20 pregnant and 84 new-born mice) in this study. The contents of polyunsaturated fatty acids in the brain of the two groups were detected by gas chromatography. Mouse TBI model was established by control cortical impact method. The expression levels of inflammatory cytokines and cellular markers of the two groups were detected by reverse transcription-quantitative polymerase chain reaction and enzyme linked immunosorbent assay or Western Blotting at 0, 4, 24 and 96 h after TBI, respectively. The neurological functions were analyzed by the rotarod, beam walk test and fear conditioning experiment. Results The content of brain docosahexoenoic acid (DHA) was significantly higher in the high ALA dietary group than in the low ALA dietary group (15.48±1.20% vs 9.98±1.10%, P<0.05). The expression levels of TNF-α, IL-1β , IL-6 and CCL12 were lower in high ALA groups than in low ALA group after TBI (P<0.05). The motor function recovery 24 h after TBI was faster in the high ALA dietary group than in the lower ALA diet group. The cognitive function 24 h after TBI was better in the high ALA dietary group than in the low ALA group. Conclusion Increasing DHA levels in the brain can reduce acute inflammation and improve neurological function recovery after TBI.

目的:探讨单侧大脑中动脉(MCA)中重度狭窄患者脑灌注情况与脑血管储备力(CVR)的相关性.方法:选取单侧MCA中重度狭窄患者42例,CO2吸入试验前后行CT灌注成像(CTP)检查,分析患侧MCA供血区的脑灌注与患侧CVR的关系.结果:患侧MCA脑灌注未见异常14例,CTP显示患侧低灌注28例.CO2吸入后患者的脑血流速度(CBFV)为(142.18±14.11)cm/s,较CO2吸入前提高,差异有统计学意义(P＜0.05).患侧CVR正常20例(47.62％),患侧CVR下降22例(52.81％),患侧CVR的变化范围为-10.21％～18.10％;CVR与脑血流量(CBF)呈正相关(r=0.754,P＜0.05),与平均通过时间(MTT)呈负相关(r=-0.512,P＜0.05),与脑血容量(CBV)无相关性(P＞0.05).结论:单侧MCA中重度狭窄患者脑灌注受损时CVR可出现下降,与CBF有一定的相关性.

目的:探讨中重度颅脑损伤患者早期血磷水平与近期预后的相关性.方法:将97例中重度颅脑损伤患者按照入院后24h内的血磷水平分为低磷血症组(n=23例,血磷＜0.80 mmol/L)和正常血磷组(n=74例,血磷≥0.80 mmol/L);记录患者入院后28 d的预后情况,按照是否死亡分为死亡组及存活组,比较两组相关指标的差异.用Logistic回归方程分析血磷水平与患者死亡的关系,应用ROC曲线评估血磷水平预测患者死亡的临床价值.结果:与血磷正常组比较,低磷血症组患者发病至入院时间较长、入院时血压及GCS评分较低、入院APACHE Ⅱ评分较高,死亡率偏高(P＜0.05);死亡组患者入院GCS评分低于存活组,而APACHE Ⅱ评分高于存活组(P＜0.05);血磷水平及低磷血症的发生率高于存活组(P＜0.05),多因素Logistic回归方程分析提示:血磷降低是中重度颅脑损伤患者入院28d后死亡的独立危险因素(P＜0.05).血磷水平(＜0.68 mmol/L)预测患者死亡的曲线下面积(RO-CAUC)分别为:0.889;灵敏度和特异度分别为:83.9％;77.6％.最佳诊断截点为0.68 mmol/L.结论:血磷水平降低可能是中重度颅脑损伤患者近期死亡的独立危险因素,早期检测血磷水平对评估患者近期预后具有一定的临床意义.

Objective To explore the relationship between the surgical operation and prognosis of patients with ruptured intracranial aneurysms. Methods A retrospective analysis of 251 cases of ruptured intracranial aneurysms in our hospital from July 2010 to June 2015 was performed in 89 patients with intracranial aneurysms (63 to 10d) and 99 patients with intracranial aneurysms (to 3D),and 4 patients with intracranial aneurysms (to>10d). Results Early patients with good prognosis 48 cases (76.19%),medium-term good prognosis group 52 cases (58.43%),40 cases with good prognosis late group (40.40%),the rate of early good prognosis group was significantly higher than the mid and late group of patients,the rate of medium-term progno-sis is good group of patients was significantly better than the late group of patients. For Hunt-HessⅠgrade,Ⅱgrade,Ⅲgrade ruptured intracranial aneurysms in patients with good prognosis early rate was significantly higher than the mid and late group patients, the prognosis is good mid-rate of patients with advanced patients showed no significant difference. For Hunt-Hess IV class, V class ruptured intracranial aneurysms,early group, the prognosis is good mid-rate was significantly higher than the late group of patients,the prognosis is good group rate between early and mid-group patients no statistically significant;hydrocepha-lus occurs early group rate 1.59%,the mid-group rate 3.37%occurrence of hydrocephalus were significantly lower than the 12.12%of patients in the late group. Conclusion For ruptured intracranial aneurysms in patients with early surgery in favor of the prognosis of patients,whether patients with increased risk of aneurysm rebleeding require further research.

Objective To study the relationship between serum brain red protein content and the degree of nerve injury in patients with brain injury. Methods 38 cases of traumatic brain injury patients in Affiliated Hospital of Yan'an Univer-sity (“our hospital”for short) from April 2012 to October 2015 were selected as observation group, including 13 cases of mild injury, 16 cases of moderate injury and 9 cases of severe injury, 40 cases of healthy volunteers received physi-cal examination in our hospital during the same period were selected as control group. Serum of two groups were col-lected and the contents of brain neuroglobin (NGB), ubiquitin carboxy terminal terminal hydrolase L1 (UCH-L1), neuron specific enolase (NSE), S100 beta protein, glial fibrillary acidic protein (GFAP) were determined. Neurological function of the observation group was determined by full outline of unresponsiveness. Results The contents of serum NGB [(325.27±55.11) vs (57.33±8.15) pg/mL)], UCH-L1 [(1.14±0.17) vs (0.15±0.02) ng/mL], NSE [(32.46±6.11) vs (6.71±0.82) ng/mL], S100 beta [(1.05±0.16) vs (0.53±0.08) pg/mL], GFAP [(22.52±4.18) vs (10.69±1.73) pg/mL] of the observation group were significantly higher than those in control group (P< 0.05), the more serious the degree of brain injury, the higher the contents of serum NGB, UCH-L1, NSE, S100-β, GFAP, the lower the scores of eyes reaction, motion response, brain-stem reflex, respiratory rhythm (P<0.05);content of serum NGB was positively correlated with UCH-L1, NSE, S100β, GFAP (r=0.668, 0.637, 0.701, 0.725, all P<0.05);content of serum NGB was negatively correlated with eyes reaction, motion response, brainstem reflex, respiratory rhythm (r=-0.628,-0.714,-0.683,-0.709, all P<0.05). Conclusion Content of serum NGB of patients with traumatic brain injury is significantly increased, and has good correlation with the de-gree of nerve function injury, it is an ideal laboratory index to evaluate the severity of brain injury.

目的 探讨颅脑外伤患者早期血清超敏C反应蛋白(hs-CRP)与伤后抑郁的相关性分析.方法 选取2012年4月至2015年4月我院收治的185例颅脑外伤患者为研究对象,检测所有患者入院时、入院12h、入院24h的血清hs-CRP水平,记录患者相关临床资料,按照伤后是否出现抑郁将患者分为抑郁组(n=48例)和非抑郁组(n=137例),比较两组患者相关临床资料的差异.结果 185例颅脑损伤患者中出现伤后抑郁的有48例(发病率25.9％);抑郁组中患者入院时格拉斯哥昏迷评分(GCS)低于非抑郁组(P＜0.05)、低氧血症的比例高于非抑郁组(P＜0.05);抑郁组中患者入院12h、24h的血清hs-CRP水平高于非抑郁组(P＜0.05);回归分析提示入院12h的血清hs-CRP(OR=1.887,P＜0.05)、和24h的血清hs-CRP (OR=1.452,P＜0.05)是颅脑损伤患者中出现伤后抑郁的独立危险因素.结论 血清hs-CRP与颅脑外伤后抑郁的发生具有一定的相关性,早期检测血清hs-CRP水平对于评估伤后抑郁的发生具有一定的临床意义.

<正>本组对214例重型颅脑损伤、脑出血长期昏迷患者进行诊治,未行气管切开术,采用综合治疗方法预防肺部感染,收到良好疗效,现报告如下。