脑梗死是神经内科常见疾病之一,但临床上脑梗死致同侧偏瘫的病例却很少见.同侧偏瘫被定义为与近期卒中病变同侧的偏瘫.对同侧偏瘫的研究有助于对脑梗死后可塑性重组的研究,特别是了解对侧皮质脊髓束的代偿功能.我科现遇1例同侧偏瘫患者,报道如下.

目的 探讨卒中后发生认知障碍的危险因素.方法 回顾性纳入2018年6月-2019年6月邯郸市第一医院神经内科连续收治的急性缺血性卒中患者,采用MMSE、MoCA量表评估认知功能,将其分为卒中后认知障碍(post-stroke cognitive impairment,PSCI)和无认知障碍(no cognitive impairment,NCI)两组,并采用多因素logistic回归模型分析卒中后发生认知障碍的危险因素.结果 共纳入162例急性缺血性卒中患者,平均年龄59.79±6.71岁,男性97例(59.9％);PSCI组78例(48.1％),NCI组84例(51.9％).多因素分析结果显示,初中及以上教育水平(OR?0.153,95％CI 0.052～0.454)、既往卒中史(OR?2.915,95％CI?1.262～6.730)、大面积梗死(OR?7.710,95％CI 1.591～37.364)、脑萎缩(OR?4.494,95％CI?1.210～16.698)是PSCI的独立影响因素.结论 PSCI的发生比例较高;高教育水平是PSCI发生的独立保护因素,既往卒中史、梗死面积大、脑萎缩是PSCI发生的独立危险因素.

目的 探索红细胞微粒(red blood cell microparticles,RMPs)对急性脑梗死(acute cerebral infarction,ACI)患者近期临床预后的影响.方法 招募2015年12月—2018年3月就诊于邯郸市第一医院的ACI患者共168例,根据患者电子病历系统收集患者临床基线资料,入组后抽取静脉血进行实验室指标检测,同时出院后随访患者近期预后,根据预后情况将患者分为预后良好组(n=127)及预后不良组(n=41),比较两组患者临床特征差异性,应用多因素Logis?tic回归分析RMPs与ACI预后不良的相关性,通过受试者工作特征(ROC)曲线评估RMPs预测ACI预后不良的价值.结果 本研究发现,预后不良组低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、超敏C反应蛋白(high-sensitivity C-reactive protein,Hs-CRP)、RMPs、D-二聚体及NIHSS评分高于预后良好组,同时多因素Logistic发现,RMPs、D-二聚体、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分与ACI患者近期预后不良有相关性,其优势比(OR)(95％CI)分别为29.93(3.14～285.40)、3.55(1.36～9.27)及6.44(1.09～38.14);RMPs预测ACI患者近期预后不良的价值曲线下面积(AUC)(95％CI)为0.83(0.75～0.92),其最佳预测界值为51.36％,该界值下敏感性(95％CI)为0.85(0.78～0.91),特异性(95％CI)为0.53(0.49～0.62).结论 RMPs是预测ACI近期预后不良的指标,同时RMPs也是ACI患者预后不良的独立危险因素.

动脉粥样硬化(Atherosclerosis,AS)是一种慢性炎症反应过程,从斑块的发生、发展,以及不稳定斑块的破裂、溃疡、血栓形成中都有炎性介质的参与.C反应蛋白、基质金属蛋白酶、脂蛋白相关磷脂酶A2、正五聚蛋白3等与不稳定性斑块密切相关.本文即对与颈动脉不稳定型斑块相关的血清炎症标记物做一综述.

目的 帕金森病痴呆患者常采用药物进行治疗,该研究主要对胆碱酯酶抑制剂治疗效果及其对患者血清PRL水平的影响进行分析.方法 研究样本为90例帕金森病痴呆患者,时间为2015年1月—2018年12月,根据患者抽签结果分为实验组与对照组,对照组采取神经内科基础药物治疗,实验组加用胆碱酯酶抑制剂进行治疗,对比治疗结果.结果统计学软件中完成MMSE、Blessed-Roth、WMS评分比较,治疗后,实验组患者数据较为显著[(25.64±3.18)分vs(20.11±1.89)分;(26.29±3.14)分vs(32.16±2.62)分;(92.64±3.16)分vs(85.73±3.67)分],差异有统计学意义(t=10.028、9.629、7.678,P<0.05);完成两组患者血清hcy、PRL的对比分析[(11.06±0.95)μmol/L vs(13.88±0.74)μmol/L;(9.84±1.23)μg/L:(8.01±0.85)μg/L],差异有统计学意义(P<0.05);对两组患者发生的不良反应情况比较(4.44％vs 8.89％),差异无统计学意义(x2=0.714,P<0.05).结论 胆碱酯酶抑制剂应用于帕金森痴呆患者疾病的治疗过程中,可有效缓解患者的临床症状,改善血清PRL水平.

目的 帕金森病患者当今医疗的治疗阶段中,仍然存在着难治愈的特点,该文主要是针对帕金森病患者在治疗过程中的训练措施等进行概述,探讨对帕金森病患者中进行康复运动训练的治疗效果以及应用价值,希望为更多的医疗工作者提供经验.方法 随机选取在2015年1月—2018年12月在该院接受过治疗的患者,患者均是患有帕金森病疾病,选取了100例.采用随机分组的方式,将患者平均分为了两组,并命名为实验组和常规组.我们将传统的常规训练应用在常规组中,实验组中则使用康复运动训练训练配合常规训练的综合训练措施.经过一段时间的训练后,我们设置专业的调查问卷,有家属和患者共同完成,目的是对训练期间的满意度进行调查,并且根据患者的生活实际,来进行评估分级,主要关注患者的肌力变化以及患者在日常生活中是否可以自理,是否能够正常生活.结果 经过数据的统计,实验组患者的精神面貌以及生活状态较好,并且实验组与医护人员的关系相处融洽,并对患者的日常生活的自理能力进行测评了,实验组患者可以进行简单的自主生活,对家属的依赖程度相对较低,差异有统计学意义(P＜0.05).结论 我们将康复运动训练训练与常规训练相结合的综合训练运用在帕金森病患者的临床训练中,患者可以有更好的心态去面对疾病,这就有利于患者的身体康复,并且患者在整个治疗过程中,能够放轻松,与医护人员和谐相处,对患者的生活提供了一定的保障,值得在临床界所推广.

炎症反应是缺血性卒中后病理生理的核心内容,其过程涉及免疫和炎症细胞,不同途径和来源的被激活的炎症因子共同参与.早期小胶质细胞、中性粒细胞被激活,随之淋巴细胞的聚集和浸润也增加了对脑细胞的损伤;但也有研究发现,在特定刺激下,中性粒细胞可以从促炎表型向抗炎表型转变,进而保护脑细胞;淋巴细胞中部分T细胞亚型可以抑制促炎因子的表达、调节淋巴细胞的活性,从而起到脑保护作用.另外,在缺血性卒中后,除脑内局部的炎症反应外,外周循环的炎性反应和免疫抑制也参与其病理机制.免疫调节有望成为未来缺血性卒中治疗的靶点.

目的 探讨出血性脑卒中(ICH)病人睡眠障碍影响因素及睡眠结构改变与预后的相关性.方法 选取2016年9月—2018年12月我院神经内科收治的ICH病人126例,根据匹兹堡睡眠质量指数(PSQI)分为睡眠障碍组(56例)和非睡眠障碍组(70例).比较两组临床资料,采用Logistic回归分析ICH病人睡眠障碍的影响因素.比较两组睡眠结构及预后,采用Pearson相关性分析ICH病人睡眠结构改变与预后的关系.结果 两组性别、年龄、糖尿病、卒中部位比较差异无统计学意义(P>0.05),睡眠障碍组病人美国国立卫生研究院卒中量表(NIHSS)评分、高血压、冠心病、肺部感染及尿路感染的比例均高于非睡眠障碍组,差异有统计学意义(P<0.05).多因素分析得出NIHSS评分>15分、冠心病、肺部感染及尿路感染为ICH睡眠障碍的危险因素(P<0.05).睡眠障碍组S1睡眠阶段、觉醒期(WASO)比例高于非睡眠障碍组,S2、S3睡眠阶段及快速动眼期(REM)比例低于非障碍组,差异有统计学意义(P<0.05).睡眠障碍组预后良好者16例,非睡眠障碍组预后良好者45例,两组预后比较差异有统计学意义(χ2=15.89,P=0.00).ICH病人睡眠结构中S1及WASO与预后呈负相关,S2、S3、REM与预后呈正相关(P<0.05).结论 NIHSS评分>15分、冠心病、肺部感染及尿路感染为ICH睡眠障碍的危险因素,S2、S3、REM比例减少不利于ICH病人预后.

目的 探讨同型半胱氨酸(homocysteine,Hcy)与高血压患者轻度认知障碍的相关性.方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血压患者,根据其血浆Hcy水平,将患者分为单纯型高血压组(Hcy<15?μmmol/L)与H型高血压组(Hcy≥15?μmmol/L),采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性,并采用Logistic回归分析高血压患者轻度认知功能障碍的影响因素.结果 共纳入原发性高血压患者113例,其中单纯型高血压组49例,H型高血压组64例.H型高血压组患者的MMSE和MoCA评分均低于单纯型高血压组(分别为24.94±1.83?vs?27.96±1.54和23.45±2.47 vs?27.24±1.80,均P<0.001).相关分析显示,Hcy水平与MMSE和MoCA评分存在负相关性(分别为r=-0.513和r=-0.500,均P<0.001).多因素Logistic回归分析显示,高龄(OR?1.236,95％CI 1.124～1.361)、H型高血压(OR?22.218,95％CI?8.243～59.654)是高血压患者轻度认知功能障碍的独立危险因素.结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素.

目的;评价机械取栓辅助动脉内溶栓对急性缺血性脑卒中的疗效及对患者颅内血流动力学和神经损伤标志物的影响.方法;回顾性分析本院2015-06—2017-12收治的86例急性缺血性脑卒中患者资料,根据不同治疗方式分为对照组(41例)和观察组(45例),对照组采用动脉内溶栓治疗,观察组采用机械取栓辅助动脉内溶栓治疗,比较两组血管再通情况、治疗前后颅内血流动力学指标水平、神经损伤标志物、美国国立卫生研究院卒中量表(NIHSS)评分、并发症和预后情况.结果;观察组血管再通率、恢复良好率均高于对照组(P<0.05).治疗后,两组最大峰值流速(Vs)、平均流速(Vm)均较治疗前上升,血管阻力指数(RI)、血管搏动指数(PI)、血清谷氨酸(Glu)、神经元特异性烯醇化酶(NSE)、S100β蛋白水平及NIHSS均较治疗前下降,且观察组改善情况均优于对照组(P<0.01).两组不良反应总发生率比较无统计学差异(P>0.05).结论;机械取栓辅助动脉内溶栓对急性缺血性脑卒中患者疗效优于单纯动脉内溶栓治疗.

本文报道1例合并尺神经肘部卡压的胸廓出口综合征患者,探讨其电生理特点,并随访其术后电生理改变.

investigate the relationship between BMI and in-hospital pneumonia in acute stroke patients. Methods Data of acute stroke patients who consecutively admitted to Handan First Hospital from April 2017 to July 2018 were collected. Based on whether occurring in-hospital pneumonia, all the patients were divided into pneumonia group and no-pneumonia group. Multivariate analysis was performed to analyze the relationship between BMI and in-hospital pneumonia. Results A total of 1073 acute stroke patients were enrolled into the study, with a mean age of 62.95±11.45 years old and 677 males (63.1%). Of all, 56 (5.2%) patients suffered from in-hospital pneumonia. Multivariate analysis showed that age (1 year increase: OR 1.05, 95% CI 1.02-1.08, P=0.003), BMI <18.5 kg/m2 ( OR 2.51, 95% CI 1.28-8.07, P=0.001), less fruit intake (OR 2.10, 95% CI 1.06-4.14, P=0.033), disturbance of consciousness ( OR 8.65, 95% CI 4.13-18.12, P<0.001) and dysphagia ( OR 3.40, 95% CI 1.67-6.94, P=0.001) were independent risk factors for in-hospital pneumonia. Conclusions BMI <18.5 kg/m2 was independent risk factors for in-hospital pneumonia in acute stroke patients.

Objective To explore the relationship of post-stroke depression and anxiety with cognitive impairment. Methods 98 patients with first ischemic stroke who were admitted to the First Hospital of Handan from January 2017 to March 2018 were selected. 50 inpatients with non-stroke in the same period were chosen as control group.The patients of the two groups were assessed using the following scales within 2 days after hospitalization, including Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), activity of daily living scale (ADL), Montreal cognitive assessment (MOCA) and NIHSS. The cognitive impairment, anxiety and depression in both groups were analyzed. The correlation analysis of ADL, MoCA, NIHSS and HAMA, HAMD scores were performed. Results 62 (63.3%) patients in stroke group were diagnosed with cognitive dysfunction, 53 (54.1%) patients with anxiety, and 42 (42.9%) patients with depression; while in control group, 14 (28%) cases with cognitive dysfunction, 17 (34.0%) ones with anxiety, and 9 (18.0%) ones with depression. The MoCA and ADL scores in stroke group were both lower than that in control group, and the differences were statistically significant. The correlation analysis of HAMA and ADL, MoCA, NIHSS score showed that the correlation coefficients r=-0.526 (P<0.001), r=-0.592 (P<0.001) and r=0.412 (P<0.001), respectively; the correlation coefficients of HAMD score and ADL, MoCA, NIHSS were r=-0.490 (P<0.001), r=-0.571 (P<0.001) and r=0.606 (P<0.001), respectively. The correlation coefficients of ADL, MoCA and NIHSS were r=0.933 (P<0.001) and r=-0.842 (P<0.001). The correlation coefficient of MoCA and NIHSS wasr=-0.911 (P<0.001). Conclusions The incidence of anxiety and depression after ischemic stroke were higher, and they were both correlated with cognitive impairment. The more severe post-stroke anxiety and depression, the more serious the neurological deficit and the worse the activity of daily living.

Objective To explore the influencing factors of mild vascular cognitive impairment (mVCI). Methods Patients with acute ischemic stroke within 14 days from onset who were admitted to Handan First Hospital From August 2015 to October 2018 were selected. All the patients were assessed by mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). According to the scores, these patients were divided into mVCI group and normal cognition (NCI) group. The clinical data were compared between the two groups, using univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of mVCI. Results Finally, a total of 205 patients were included in this study, with 97 cases in mVCI group and 108 cases in NCI group. The proportion of patients with low education (P=0.006), hypertension (P=0.032), diabetes (P=0.041) and smoking (P=0.026) in mVCI group were significantly higher than that in NCI group. The levels of plasma homocysteine (P=0.016), triglyceride (P=0.040), cholesterol (P=0.026) and Pittsburgh sleep quality index (P<0.001) were significantly higher in mVCI group than that in NCI group. Elevated plasma homocysteine level ( OR 1.139, 95% CI 1.012-1.283, P=0.031) and multivariate logistic regression analysis showed that poor sleep quality (OR 1.301, 95% CI 1.107-1.530, P=0.001) were independent risk factors for mVCI, and high education degree ( OR 0.652, 95% CI 0.434-0.978, P=0.039) was a protective factor. Conclusions Hyperhomocysteinemia and poor sleep quality are independent risk factors for mVCI, while high education degree is a protective factor for mVCI.

In recent years, blood pressure variability (BPV) is regarded as a new cause of target organ damage. More and more studies have found that BPV is associated with many diseases, such as target organ damage in hypertensive patients (including carotid atherosclerosis, left ventricular hypertrophy, heart failure, arrhythmia, and so on), prognosis of stroke events (including the prognosis of cerebral infarction, the prognosis of cerebral venous thrombolysis, the transformation of cerebral hemorrhage, the prognosis of cerebral hemorrhage, and so on), leukoaraiosis, cognitive function in patients with cerebral infarction and so on. This article is to review the effects and prognosis of BPV on stroke.

卒中以其较高的发病率、致死率和致残率已成为目前危害人类健康的重大疾病之一,给家庭和社会带来沉重的负担.斑块破裂及血栓形成被认为是急性缺血性事件的直接原因.近年来,光学相干断层扫描(optical coherence tomography,OCT)技术以其极高的分辨率,可精确地评估血管的超微结构,更好地分辨血管内成分,从而逐渐用于动脉粥样硬化斑块的临床检测和指导治疗.本文就此技术在斑块评估中的应用做一综述.

目的 观察临床应用丁苯酞软胶囊改善帕金森痴呆患者认知功能和日常生活能力的效果及其对相关因子的影响.方法 采用前瞻性研究方法,将2012年8月至2016年8月邯郸市第一医院收治的帕金森痴呆患者92例按照随机平行分组法随机分为对照组和观察组,每组各46例.对照组患者给予临床常规治疗,观察组则在常规治疗基础上联合应用丁苯酞软胶囊治疗,对比分析两组患者的临床疗效,蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分,C反应蛋白(CRP)、帕金森病蛋白7(PARK7)及神经营养因子-3(NT-3)水平.结果 患者治疗后临床治疗总有效率组间比较,观察组明显高于对照组(91.3％vs.76.1％,P<0.05);两组患者治疗前MoCA、ADL评分组间比较,差异均无统计学意义(21.15±3.14 vs.21.22±3.47,54.62±2.13 vs.54.63±3.39,P>0.05);两组患者治疗后MoCA、ADL评分均较治疗前明显升高,差异具有统计学意义(P<0.05),且观察组治疗后MoCA、ADL评分明显高于对照组(P<0.05);两组患者治疗前CRP、PARK7、NT-3水平组间比较,差异均无统计学意义(P>0.05);两组患者治疗后CRP、PARK7均较治疗前明显下降,NT-3水平明显升高(P<0.05),观察组CRP、PARK7、NT-3变化幅度明显高于对照组,差异具有统计学意义(P<0.05).结论 丁苯酞软胶囊治疗帕金森痴呆可明显提高患者认知功能和日常生活能力,改善相关因子水平,可在临床推广应用.

Cerebral infarction possesses the characteristics of high morbidity, mortality and disability rate. The methods for its therapy are diversified, mainly including drug therapy, interventional therapy and surgical therapy. Nowadays, arterial embolectomy therapy has been applied into clinical practice widely. In this paper, the causes for cerebral infarction, CT perfusion imaging concept and application, and the research progress of arterial embolectomy are reviewed.

目的 探讨丁苯酞对帕金森病认知障碍患者血清同型半胱氨酸的影响.方法 选取医院2012年8月至2016年8月收治的帕金森病患者288例,依据蒙特利尔认知评估量表(MoCA)评分将患者分为A组(认知障碍组,MoCA评分<26分,132例)和B组(无认知障碍组,MoCA评分≥26分,156例),再分别均分为A1组、A2组及B1组、B2组.4组患者均给予左旋多巴片治疗,在此基础上,A2组和B2组患者加服丁苯酞软胶囊.结果 治疗第4,12,24周时,4组患者MoCA评分、简易智能状态检查量表(MMSE)评分、简明健康状况调查量表(SF-36)评分、健康相关生活质量(HRQoL)评分均逐渐升高,A2组和B2组评分升高幅度较大,且评分分别高于A1组和B1组(P<0.05);4组患者统一帕金森病评定量表(UPDRS)评分、39项帕金森病调查表(PDQ-39)评分、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分均逐渐降低,A2组和B2组评分降低幅度较大,且评分分别低于A1组和B1组(P<0.05);治疗后,4组患者血清同型半胱氨酸(HCY)水平较治疗前均降低,且A2组和B2组分别低于A1组和B1组(P<0.05);4组不良反应发生率均较低且相当,均未出现严重不良反应,并自行康复.结论 帕金森病认知障碍患者HCY水平显著高于无认知障碍患者,丁苯酞可显著改善患者不良情绪,且可改善认知障碍和帕金森病,提高生活质量.

Non-disabling ischemic cerebrovascular events is the most common cerebrovascular disease, which usually be ignored because of its clinical manifestation is lighter. However, more and more studies have identified its characteristics of the high recurrence rate and poor prognosis. It is considered to be "Early Warning" stroke event which is serious and worthy of clinical emergency intervention. This paper reviews the concept, epidemiology, risk assessment and treatment of non-disabling cerebrovascular diseases.