OBJECTIVES:Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy. MATERIALS AND METHODS:A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups. RESULTS:The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03-0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08-0.96]) CONCLUSIONS: Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.

IntroductionAmyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease characterized by a progressive loss of motor neurons and muscle atrophy. Genetic factors are known to play important roles in ALS and concomitant presence of rare variants in ALS patients have been increasingly reported.MethodsIn order to explore the genetic variants in ALS patients within the context of oligogenic inheritance and to elucidate the clinical heterogeneity observed in these patients, we conducted whole-genome sequencing on 34 familial ALS (FALS) probands.ResultsIn one proband, we identified a CHCHD10 p.Gly66Val variant, along with three additional variants: UNC13A p.Leu1034Val, SUSD1 p.Trp704Ser, and SQSTM1 p.His359del. This patient exhibited a slow disease progression and a prolonged survival duration, consistent with the clinical features of ALS patients with CHCHD10 variants. This suggests that the CHCHD10 p.Gly66Val variant may play a predominant role in shaping the patient's phenotype, while the other variants may primarily contribute to ALS occurrence.DiscussionVariants in CHCHD10 have been found in ALS and other neurodegenerative diseases, exhibiting significant clinical variability. However, the combinatorial effect of CHCHD10 and other ALS-related gene variants has not been fully studied. Our findings suggest that the combined impact of these four variants contributes to this patient's ALS phenotype, distinguishing it from other, less severe neuromuscular disorders associated with CHCHD10 mutations. Overall, this study further supports the oligogenic pathogenic basis of ALS and offers new insights into understanding the intricate clinical presentations associated with CHCHD10 variants.

AIMS:This study aimed to evaluate the effects of riluzole on survival and changes in ALS Functional Rating Scale (ALSFRS) among Chinese patients with Amyotrophic Lateral Sclerosis (ALS). PATIENTS & METHODS:Propensity score matching was used to balance baseline variables between the riluzole group (n = 238) and control group (n = 454). Survival was analyzed using Kaplan - Meier curves and Cox regression, while multivariable linear regression assessed ALSFRS changes at 6 and 12 months. Subgroup analyses were conducted to identify potential responders. RESULTS:Riluzole did not significantly improve survival (p = 0.478) or ALSFRS changes at 6 months (p = 0.380) or 12 months (p = 0.175). Subgroup analyses revealed no survival benefit in any subgroup, and further stratification showed inconsistent adverse effects on ALSFRS scores. CONCLUSIONS:Riluzole neither prolonged survival nor slowed functional decline in Chinese ALS patients, with no subgroup demonstrating a better response.

Objective:To evaluate the efficacy and safety of Shuxuening injection, a Chinese remedy from Ginkgo biloba, in treating patients with acute ischemic stroke (AIS). Methods:A randomized, double-blind, placebo-controlled, multi-center clinical trial was conducted from 21 November 2018 to 20 January 2022 in 31 participating research centers involving 446 patients with AIS. Patients received either a Shuxuening injection (experimental group) or a placebo (control group) alongside basic treatment (aspirin enteric-coated tablets). The primary efficacy endpoint was the percentage of patients with a modified Rankin scale (mRS) score ≤ 2 at 90-day post-stroke. The secondary efficacy endpoints were the changes in mRS, National Institute of Health stroke scale (NIHSS), and Barthel index (BI) scores, and the incidence of adverse events. Results:The percentage of patients with mRS scores ≤ 2 at 90-day post-stroke was significantly higher in the experimental than in the control (P < 0.05) group. The percentage of patients with scores ≤ 1 at 90-day post-stroke was higher in the experimental group (P < 0.05). The change value of NIHSS scores in the experimental group was higher at 10-day post-treatment and 90-day post-stroke (P < 0.05). The percentage of NIHSS score reduction ≥ 50% was higher in the experimental group at 90-day post-stroke (P < 0.05). The change value of BI score and percentage of BI score ≥ 75 were higher in the experimental group at 90-day post-stroke (P < 0.05). Safety profiles did not differ between the groups. Conclusion:Shuxuening injection effectively improves the functional outcome of patients, reduces disability rates, improves neurological deficits, enhances activities of daily living, and demonstrates good safety profiles.

Objective To investigate the independent risk factors of cerebral infarction caused by large vessel occlusion, and to construct and validate a nomogram risk prediction model.Methods A total of 335 patients with cerebral infarction admitted to Department of Neurology of Peking University Third Hospital from September 2021 to July 2022 were selected as the research objects.According to whether cerebral infarction was caused by large vessel occlusion, they were divided into large vessel infarction group（n=58） and non-large vessel infarction group（n=277）.The clinical data of the patients were collected, and the independent risk factors of cerebral infarction caused by large vessel occlusion were screened by univariate and multivariate analyses, and the nomogram risk prediction model was constructed and verified.Results The incidence of cerebral infarction caused by occlusion of large vessels was 17.31% in the cohort.The large vessel infarction group had significantly larger proportions of aged ≥60 years, hypertension, stroke history, smoking history, NIHSS score ＞5,and mRS score ＞2 when compared with the non-large vessel infarction group（P＜0.05,P＜0.01）.Logistic regression analysis showed that age, hypertension, history of stroke, smoking history, and NIHSS and mRS scores were independent risk factors for cerebral infarction caused by large vessel occlusion（95%CI:1.477-8.654,P=0.005;95%CI:1.202-6.514,P=0.017;95%CI:1.117-1.680,P=0.002;95%CI:1.332-4.745,P=0.004;95%CI:2.145-20.594,P=0.001;95%CI:1.203-3.808,P=0.010）.A nomogram risk prediction model for cerebral infarction caused by large vessel occlusion was established based on the above factors.Model validation results showed that the consistency index of the nomogram model was 0.791（95%CI:0.653-0.887）.Conclusion Age, hypertension, stroke history, smoking history, NIHSS and mRS scores are independent risk factors for cerebral infarction caused by large vessel occlusion.Our established nomogram prediction model can effectively assess the risk of cerebral infarction caused by large vessel occlusion.

目的 探讨老年新发恶性肿瘤患者合并急性脑梗死的临床和影像学特点.方法 回顾性分析2014年1月～2019年6月北京大学第三医院神经内科诊治年龄≥60岁的老年急性脑梗死合并恶性肿瘤患者71例,其中3个月内新发恶性肿瘤患者18例为新发肿瘤组,恶性肿瘤病史>3个月患者53例为对照组,收集受试者临床和影像学资料,采用多因素logistic回归分析.结果 新发肿瘤组年龄明显低于对照组,D-二聚体水平明显高于对照组,差异有统计学意义(P<0.05,P<0.01).2组幕下病灶及颅内外血管狭窄程度比较,差异无统计学意义(P>0.05).新发肿瘤组多发病灶、皮质/皮质下病灶比例明显高于对照组,深部病灶比例明显低于对照组,差异有统计学意义(P<0.01).多因素logistic回归分析显示,年龄、D-二聚体、多发病灶及缺少深部病灶与新发恶性肿瘤合并急性脑梗死相关(95％CI:0.695～0.931,P=0.004;95％CI:1.576～34.789,P=0.011;95％CI:1.131～55.581,P=0.037;95％CI:0.009～0.828,P=0.034).结论 老年脑梗死患者D-二聚体升高,影像学呈多发病灶,尤其是双侧且前后循环均受累,应警惕合并恶性肿瘤的风险.

1病历摘要 患者,31岁,因剖宫产术后7小时,子宫切除术后6小时,于2020年9月29日急诊转至北京大学第三医院重症监护室.患者孕期于某二甲医院规律产前检查,孕24周时,诊断妊娠期糖尿病,饮食运动控制血糖正常.2020年9月27日因宫内孕40周,妊娠期糖尿病入院引产,分娩前实验室指标大致正常,纤维蛋白原(FIB)2.35 g/L.9月28～ 29日予米索前列醇25 μg促子宫颈成熟,9月29日下午自然破膜,破膜后30分钟孕妇出现烦躁、紫绀,胎心出现延长减速,考虑胎儿窘迫,立即行子宫下段剖宫产术.术中出血多,血不凝,予按摩子宫、宫腔纱条填塞后出血未见减少,并出现酱油色尿.

阻塞性睡眠呼吸暂停综合征(OSAS)是一种常见的睡眠障碍性疾病,其特征是睡眠中上呼吸道反复出现部分或完全性阻塞,从而导致间歇性动脉血氧饱和度下降和高碳酸血症,伴或不伴睡眠觉醒,进而引发机体一系列的病理生理改变.全球有 9.36 亿 30～69 岁成年人患有 OSAS,其中 4.25亿人患有中度至重度 OSAS,受影响的人数在中国最多,男性比女性更普遍[1].脑卒中是全球死亡和严重残疾的主要原因之一,相关的社会负担是巨大的,积极识别和管理脑卒中的危险因素,是降低脑卒中发病率的基础.然而,近年来年轻人脑卒中发病率并没有显著下降,中低收入国家仍在飙升,对已确定的危险因素管理不足,或者对危险因素的认识不足,或许能解释脑卒中的全球负担[2].有大量证据支持OSAS与心脑血管疾病之间的相关性,尤其是动脉粥样硬化(AS)、高血压、缺血性心脏病、脑卒中、心力衰竭、心房颤动(房颤)和心源性猝死.最近的临床试验和观察性研究强调了 OSAS在缺血性脑卒中发生、发展中起重要的作用[3].每周≥2 个晚上习惯性打鼾与 25％的脑卒中风险相关,中度至重度 OSAS患者缺血性脑卒中风险增加 2 倍[4-5].在不同种类的急性脑卒中患者中,睡眠呼吸障碍的患病率在 44％～72％,急性期后仍高于一般人群.因此明确 OSAS对缺血性脑卒中的发生、发展及预后的影响有着重大的意义.

Background: Atherosclerosis is the leading cause of cardiovascular disease worldwide, including in China. Primary prevention, through lipid-lowering, could avert development of atherosclerosis. Carotid intima-media thickness (CIMT) is a well-validated measure of atherosclerosis used in intervention studies as the primary outcome and alternative end point for cardiovascular disease events. Methods: This randomized, double-blind, placebo-controlled, multicenter, parallel-group study assessed the effects of rosuvastatin 20 mg/d compared with placebo on progression of CIMT over 104 weeks in Chinese people with subclinical atherosclerosis. The primary end point was the annualized rate of change in mean of the maximum CIMT measurements taken 7× over the study period from each of 12 carotid artery sites (near and far walls of the right and left common carotid artery, carotid bulb, and internal carotid artery). Secondary end points included CIMT changes at different artery sites and lipid-parameter changes. Safety was also assessed. Results: Participants were randomized (1:1) to receive rosuvastatin (n=272) or placebo (n=271). Baseline characteristics were well balanced between groups. The change in mean of the maximum CIMT of the 12 carotid sites was 0.0038 mm/y (95% CI, −0.0023–0.0100) for the rosuvastatin group versus 0.0142 mm/y (95% CI, 0.0080–0.0204) for the placebo group, with a difference of −0.0103 mm/y (95% CI, −0.0191 to −0.0016; P =0.020). For the CIMT secondary end points, the results were generally consistent with the primary end point. There were clinically relevant improvements in lipid parameters with rosuvastatin. We observed an adverse-event profile consistent with the known safety profile of rosuvastatin. Conclusions: Rosuvastatin 20 mg/d significantly reduced the progression of CIMT over 2 years in Chinese adults with subclinical atherosclerosis and was well tolerated. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02546323.

目的 探讨卒中预警综合征(SWS)患者早期神经功能恶化(END)与磁共振成像(MRI)特征的关系.方法 回顾性分析2015年10月至2020年10月于北京市海淀医院诊治的32例SWS患者的临床资料.根据入院7d内是否发生END,分为END组(21例)和非END组(11例).收集患者的基线资料.所有患者发病7d内完善颅脑MRI检查,比较2组梗死病灶≥2层、责任血管穿支病变比例.随访3个月,比较2组患者功能预后不良比例.采用多因素Logistic回归方法分析SWS患者发生END的独立危险因素.结果 2组年龄、性别、吸烟史、饮酒史、冠状动脉粥样硬化性心脏病、心房颤动、高血压、糖尿病比例,体重指数、总胆固醇、三酰甘油水平以及肺部感染、泌尿系感染、消化道出血、下肢静脉血栓、责任血管穿支病变比例比较,差异均无统计学意义(均P ＞0.05).END组梗死病灶≥2层比例、功能预后不良比例均高于非END组[81.0％ (17/21)比18.2％ (2/11)、57.1％(12/21)比0(0/11)],差异有统计学意义(均P＜0.01).Logistic回归分析结果显示,梗死病灶≥2层是SWS患者发生END的独立危险因素(比值比=33.489,95％置信区间:2.705 ～ 414.670,P=0.006).结论 颅脑MRI梗死病灶≥2层是SWS患者发生END的独立危险因素,存在END者更易出现功能预后不良.

目的 探讨脑脉利颗粒治疗急性前循环缺血性卒中的有效性及安全性.方法 2015年5月-2018年3月前瞻性入组13家研究中心神经内科收治的前循环急性缺血性卒中患者,随机分为治疗组和对照组,对照组给予常规药物治疗并加用脑脉利颗粒模拟剂治疗20?d,治疗组在常规药物治疗的基础上加用脑脉利颗粒(每次10?g,每天3次)口服,治疗20?d.治疗后30?d、60?d和90?d随访评估患者的NIHSS和Barthel指数(Barthel index,BI)评分,90?d随访评估mRS,以mRS≤2分为功能独立.比较两组上述治疗指标的差异,并比较两组90?d急性心脑血管事件(包括心肌梗死、缺血性卒中、TIA)和不良反应的发生率.结果 研究共入组190例患者,排除脱落患者,共187例纳入最终统计分析,其中治疗组93例,对照组94例.治疗组90?d NIHSS评分低于对照组(2.54±2.16分vs?3.84±3.08分,P=0.006),60?d(86.08±17.24分vs?82.61±16.91分,P=0.031)及90?d BI评分(89.62±13.50分vs?83.78±17.08分,P=0.004)高于对照组;90?d治疗组和对照组分别有50例和42例完成mRS评分,治疗组功能独立率高于对照组(70.00％?vs?45.24％,P=0.016).研究期间,两组不良反应发生率及急性心脑血管事件发生率差异均无统计学意义.结论 在常规药物治疗基础上加用脑脉利颗粒能有效减轻急性缺血性卒中患者的神经功能缺损与残障,改善日常生活能力,且治疗安全性良好.

目的 应用超声探查帕金森病(Parkinson's disease,PD)患者和健康人群颈部迷走神经横截面积,探讨PD患者颈部迷走神经横截面积与临床特征的相关性.方法 30例PD患者为观察组,同期31例体检健康者为对照组.观察组采用统一PD评分量表Ⅲ(unified Parkinson's disease rating scale-Ⅲ,UPDRS-Ⅲ)评估运动症状.比较2组自主神经症状量表(the scales for outcomes in Parkinson's disease-autonomic,SCOPA-AUT)评分;2组均行颈部迷走神经超声探查,计算左、右侧迷走神经横截面积;Pearson相关法分析PD患者左、右侧颈部迷走神经横截面积与病程、UPDRS-Ⅲ、SCOPA-AUT评分的相关性.结果 观察组左、右侧颈部迷走神经横截面积[(0.72±0.25)、(0.82±0.31)11m12]均小于对照组[(0.99±0.13)、(1.18±0.21)mm2](P<0.05);观察组左、右侧颈部迷走神经横截面积比较差异无统计学意义(P>0.05),对照组左侧颈部迷走神经横截面积小于右侧(P<0.05).PD患者左、右侧颈部迷走神经横截面积与病程(r=-0.033,P = 0.863;r=0.097,P = 0.611)、UPDRS-Ⅲ(r=-0.145,P = 0.445;r=-0.359,P = 0.052)、SCOPA-AUT评分(r=-0.361,P=0.050;r=-0.296,P=0.113)均无相关性.结论 PD患者颈部迷走神经横截面积缩小,颈部迷走神经横截面积与病程、UPDRS-Ⅲ、SCOPA-AUT评分无相关性.

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对急性缺血性卒中患者脑血管反应性(cerebrovascular reactivity,CVR)的影响.方法 前瞻性连续入组2017年10月-2020年8月住院治疗的急性缺血性卒中患者,入院2周内完善多导睡眠监测,根据是否合并OSAHS及呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为非OSAHS组、轻度OSAHS组(AHI 5～15次/小时)和中重度OSAHS组(AHI>15次/小时).在完成多导睡眠监测后24?h内对患者进行TCD检查,检测CVR指标包括平静呼吸时、屏气后大脑中动脉的平均血流速度(Vm),计算屏气指数(breath holding index,BHI).比较三组间CVR指标的差异,并在中重度OSAHS组中分析CVR指标与入院时和发病3个月时NIHSS评分的相关性.结果 共纳入228例急性缺血性卒中患者,男性140例(61.4％),其中非OSAHS组49例,轻度OSAHS组42例,中重度OSAHS组137例.中重度OSAHS组BMI、高血压比例、3个月时NIHSS评分均高于非OSAHS组,差异有统计学意义.中重度OSAHS组平静呼吸时Vm低于非OSAHS组(57.4±10.6?cm/s?vs?62.1±12.2 cm/s,P=0.010)和轻度OSAHS组(57.4±10.6?cm/s?vs?59.6±11.2?cm/s,P=0.007),BHI低于非OSAHS组(1.4％±0.6％?vs?1.7％±0.7％,P=0.002)和轻度OSAHS组(1.4％±0.6％?vs?1.5％±0.6％,P=0.001).中重度OSAHS组发病3个月时NIHSS评分与平静呼吸时Vm(r=-0.696,P<0.001)和BHI(r=-0.832,P<0.001)呈负相关.结论 伴中重度OSAHS的急性缺血性卒中患者CVR明显下降,而且CVR的下降可能与急性缺血性卒中患者的预后不良有关.

目的 评价胜任力为导向的神经内科住院医师培训模式的效果.方法 选取2016-2020年在北京大学第三医院神经内科完成或正在参加住院医师培训的研究生、规范化培训的基地学生和住院医师,采取问卷调查或一对一访谈的形式对目前神经内科的系统模式培训效果进行评价,包括神经内科知识和技能评价以及人文相关内容评价两方面.结果 共纳入40名医师,培训总体满意度为85％.获益最大的带教方式是"学生为主体"的病例导入学习(90％),希望培训的内容包括神经影像学(82.5％)、心电图和胸片等内科基础知识(70％)、肌电图和脑电图(65％).最需要提升的疾病种类规培生更多希望掌握常见疾病的诊断和处理,八年制及硕士研究生则把培训的需求放在罕见疾病的认识和提高.人文素质提升较大的方面包括同情心和爱伤观念(75％)、职业自豪感(65％)、责任意识(62.5％).结论 胜任力为导向的神经内科住院医师培训模式有助于提高专业知识和技能以及人文素质.

目的 探讨觉醒型脑卒中(WUS)与阻塞性睡眠呼吸暂停综合征(OSAS)之间的关系.方法 纳入147例急性缺血性脑卒中患者,根据发病时间分为WUS组43例及非觉醒型脑卒中(NWUS)组104例,患者均行多导睡眠监测,用二元logistic回归分析危险因素.结果 WUS组中重度OSAS比例(62.8％vs 39.4％,P=0.011),呼吸暂停低通气指数[AHI,24.7(5.9,45.1)次/h vs 12.7(5.3,32.9)次/h,P=0.031]和 LDL 水平明显高于 NWUS 组(P＜0.05).二元 logistic 回归分析显示,中重度OSAS(OR=3.099,95％CI:1.628～15.288,P=0.011)、AHI(OR=1.371,95％CI:1.203～1.561,P=0.007)是WUS的独立危险因素.结论 WUS患者中重度OSAS发生率高,且中重度OSAS是WUS的独立危险因素.

随着医疗卫生体制改革的深化,医疗集团模式是近年来大型公立医院发展的一种重要模式."慕课"式培训可以有助于解决医疗集团模式下神经内科培训目前存在的诸多问题."慕课"由具有专业特长和带教经验丰富的医师精心准备并录制培训课程,再上传至网络平台,由住院医师根据自身的时间和临床需求自行学习."慕课"式培训集中了师资力量,具有形式更灵活、内容更丰富的特点,是可供临床教学实践探索的方式.

目的 探讨散发性Creutzfeldt-Jakob病(克雅病,sCJD)的临床表现和影像学特点,随访生存期,以期更好地指导临床诊断.方法 对北京大学第三医院神经内科2002年1月至2020年12月收治的9例sCJD患者进行回顾性分析.结果 患者发病年龄为(62±10)岁;最常见的症状包括无动性缄默7例(7/9),肌阵挛发作6例(6/9),反应迟钝5例(5/9),共济失调4例(4/9),精神行为异常、言语混乱3例(3/9),行走不稳3例(3/9).首发症状以反应迟钝,精神行为异常为主.磁共振弥散加权成像皮层高信号6例(6/9),脑脊液14-3-3蛋白4例(4/9),基底节异常高信号3例(3/9),脑电图三相波1例(1/9).中位生存期4个月,24个月随访生存2例(2/9).结论 本研究中,sCJD中老年发病,首发症状无特异性,弥散加权成像皮层、基底节高信号检出率高,中位生存期较短.

静息性脑梗死(silent brain infarction,SBI)又称无症状性脑梗死,因无临床表现,临床医师对其重视程度不够.近年来,随着头颅MRI的普及和广泛应用,很多老年人在行头颅影像学检查时,可发现脑部有陈旧性脑梗死灶,但这些患者并无典型的肢体麻木、无力、言语不利等神经功能缺损的症状或体征,这种脑梗死灶称为“无症状”或“静息性”或“隐匿性”脑梗死.此类患者既往无脑梗死史,而头颅MRI检查时,可见排除其他非血管因素的新发的或者陈旧的脑梗死病灶.SBI病灶在头颅MRI上的信号与脑梗死的病灶相符,主要通过MRI弥散加权成像(b=1000)的高低信号进行判断是否是新发的病灶.临床医师极易对SBI患者漏诊或者过度诊治,为加强临床医师对SBI的认识,本综述结合国内外相关文献,对SBI的最新研究进展进行详细阐述.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与急性缺血性脑卒中预后的关系.方法 连续收集2018年1月～2020年1月郑州市第三人民医院及郑州市第二人民医院神经内科收治的急性缺血性脑卒中患者91例,根据呼吸暂停低通气指数(AHI)分为单纯脑梗死组33例(AHI<5/h),轻度OSAHS组18例(AHI 5～14/h)及中重度OSAHS组40例(AHI≥15/h).对比3组一般资料、血管危险因素、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数及改良的Rankin量表(mRS)评分的差异.随访脑卒中发病后3个月,3组Barthel指数及mRS评分的差异.结果 3组性别、年龄、BMI、颈围、糖尿病、冠心病、高脂血症、心房颤动和NIHSS评分比较,差异无统计学意义(P>0.05).单纯脑梗死组、轻度OSAHS组和中重度OSAHS组高血压患病率比较,差异有统计学意义(48.5％ vs 61.1％ vs 77.5％,P=0.036).3组入院当天Barthel指数及mRS评分比较,差异无统计学意义(P>0.05);3组发病后3个月Barthel指数和mRS评分比较,差异有统计学意义(P<0.01).中重度OSAHS组发病后3个月Barthel指数明显低于单纯脑梗死组[(77.0±7.1)分vs(85.3±7.2)分,P<0.05],mRS评分明显高于单纯脑梗死组[(2.2±0.8)分vs(1.3±0.8)分,P<0.05].结论 中重度OSAHS与急性缺血性脑卒中预后不良结局有关.

目前国内以胜任力为导向的人才培养模式尚处起步阶段,存在一些困难,如针对各个专科统一的胜任力培养细则尚未完备、传统教育模式难以适应以胜任力为导向的教育模式、实际执行过程中落地难等.作为独立二级学科,阶梯式评估反馈模式可能为神经科教学提供落地实施的方法.建立以胜任力为导向的评价体系,为各年资住院医师设立要求指标,每年考核,不合格学员由带教老师有针对性地反复强化培训、补考,直至达到标准.以胜任力为导向的阶梯式评估反馈模式,是对神经科住院医师教学方法的一种初探,希望能够探索出一套临床可行的高效模式.