目的 探讨改良脑皮质静脉显影评分(cortical vein opacification score,COVES)对大脑中动脉(middle cerebral artery,MCA)供血区引流皮质静脉充盈程度的评估.方法 回顾性连续纳入2019年12月-2021年9月于濮阳市人民医院进行了头颈CTA和CTP检查并显示病灶侧MCA狭窄的缺血性卒中患者.收集患者的临床资料、病灶侧和对侧的CTP脑灌注指标[达峰时间(time to peak,TTP)、脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)].基于C TA进行皮质静脉充盈程度的评估,单支静脉不显影为0分,部分显影为1分,完全显影为2分.COVES评分包括病灶侧大脑中浅静脉、蝶顶窦和下吻合静脉的总分;改良COVES评分包括病灶侧的上吻合静脉、下吻合静脉和蝶顶窦的总分.通过ROC曲线及AUC分析改良COVES和COVES预测脑灌注不同指标(TTP、CBF、CBV)异常的敏感度及特异度.比较改良COVES和COVES对脑灌注异常的预测价值.结果 共纳入55例缺血性卒中患者,年龄20～79岁,中位年龄58.5岁,男性34例(61.8％).COVES≤2分时,预测TTP异常的敏感度为50.0％,特异度为95.2％;预测CBF异常的敏感度为47.2％,特异度为94.7％;预测CBV异常的敏感度为45.5％,特异度为86.4％.改良COVES≤3分时,预测TTP异常的敏感度为70.6％,特异度为95.2％;预测CBF异常的敏感度为66.7％,特异度为94.7％;预测CBV异常的敏感度为66.7％,特异度为86.4％.改良COVES、COVES预测TTP异常的AUC分别为0.845、0.735,差异有统计学意义(P=0.039).结论 改良COVES评估脑皮质引流静脉充盈程度、脑灌注的价值优于COVES.

目的 探讨偏头痛患者脑白质损害情况及影响因素分析.方法 对114例偏头痛患者行磁共振成像、经食道超声心动图及经颅多普勒超声声学造影检查,明确患者脑白质损伤及右向左分流情况,采用单因素及多元Logistic回归分析探讨偏头痛患者脑白质损伤的影响因素.结果 本组114例患者,发生脑白质损伤35例(30.7％),无脑白质损伤79例(69.3％).脑白质损伤患者中存在单发病灶7例,多发病灶28例,共计72个病灶;脑白质损伤部位以额叶(36.1％)、顶叶(23.6％)为主.脑白质损伤患者头痛病程、头痛持续时间显著高于无损伤患者(P<0.05),其他资料比较差异无统计学意义(P>0.05).有无脑白质损伤患者右向左分流分级比较差异有统计学意义(P<0.01),其中脑白质损伤患者大量分流占比为50.0％,显著高于无脑白质损伤患者(P<0.01).回归分析显示,头痛病程、右向左分流分级是偏头痛患者脑白质损害的危险因素(OR=2.440、3.174,P<0.01).结论 部分偏头痛患者存在脑白质损害,主要病灶在脑额叶、顶叶;头痛病程及右向左分流分级是偏头痛患者脑白质损害的危险因素.

目的 探讨脑梗死后血管性认知障碍病人血清胱抑素C(CysC)、视黄醇结合蛋白(RBP)、颈动脉狭窄程度与认知功能的关系.方法 选取2016年9月—2018年8月我院确诊的脑梗死后血管性认知障碍病人160例,根据认知功能受损程度分为轻度组(49例)、中度组(58例)和重度组(53例).比较3组血清CysC、RBP、颈动脉狭窄程度、一般资料等;采用有序多分类Logistic回归分析法探讨各指标与血管性认知障碍病人认知功能受损程度的关系.结果 3组年龄、受教育时间、体质指数、性别、合并高血压、血脂异常、冠心病、吸烟、饮酒比较,差异均无统计学意义(P>0.05).随着认知功能受损程度加重,糖尿病、血清CysC、RBP水平均逐渐升高,差异有统计学意义(P<0.05).血管性认知障碍病人认知功能障碍程度与颈动脉狭窄程度呈正相关(P<0.05).有序多分类Logistic回归分析结果显示:血清CysC、RBP水平增高,颈动脉狭窄程度加重,入院时美国国立卫生研究院卒中量表(NIHSS)评分升高是血管性认知障碍病人认知功能障碍程度进一步加重的独立危险因素(P<0.05).结论 脑梗死后血管性认知障碍病人血清CysC、RBP水平增高,颈动脉狭窄程度加重,入院时NIHSS评分升高,可能加重认知功能障碍风险.

目的 探讨吗替麦考酚酯治疗中枢神经系统特发性炎性脱髓鞘疾病(IIDDs)疗效及对血清尿酸(UA)、同型半胱氨酸水平(Hcy)的影响.方法 选定河南省濮阳市人民医院2017年1月至2020年2月收诊的50例IIDDs患者,便利取样法分为研究组(25例,吗替麦考酚酯)与对照组(25例,地塞米松),比较两组IIDDs患者的UA水平、Hcy水平、神经功能缺损程度评分问卷(SSS)评分、生活质量综合评定(GQOL-74)评分与总有效率.结果 研究组治疗后IIDDs患者的UA水平为(213.25±19.39)μmol/L、Hcy水平为(12.38±1.34)μmol/L、SSS评分为(10.16±2.35)分均低于对照组(P＜0.05);总有效率为96.00％、GQOL-74评分为(83.58±7.12)分均高于对照组(P＜0.05).结论 吗替麦考酚酯有助于改善IIDDs患者的免疫功能与神经功能,减低其UA水平、Hcy水平,应用价值良好.

目的:观察尤瑞克林联合七叶皂苷钠治疗糖尿病伴急性脑梗死的临床效果.方法:选取158例2型糖尿病伴急性脑梗死患者为研究对象,按照随机数字表法分为观察组和对照组,每组79例.两组均予常规治疗,对照组再予七叶皂苷钠治疗,观察组在对照组基础上予尤瑞克林治疗.比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)及日常生活能力量表(Barthel指数)评分,临床疗效及不良反应发生率.结果:治疗后,两组NIHSS评分低于治疗前,且观察组低于对照组,两组Barthel指数均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率为82.28％,高于对照组的60.76％,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:尤瑞克林联合七叶皂苷钠治疗糖尿病伴急性脑梗死效果更为理想,可有效改善神经功能缺损症状,且安全性较高.

目的 探讨磁敏感加权成像在急性脑梗死合并脑微出血诊断中的价值.方法 对89例急性脑梗死患者给予核磁共振成像常规序列、弥散加权成像序列及磁敏感加权成像序列检查,比较3种检查序列急性脑梗死及脑微出血检出率,统计脑微出血患者病灶分布情况,比较不同年龄、性别患者脑微出血检出率.结果 弥散加权成像序列急性脑梗死检出率显著高于核磁共振成像常规序列及磁敏感加权成像序列(P<0.01),核磁共振成像常规序列与磁敏感加权成像序列急性脑梗死检出率比较差异无统计学意义(P>0.05).磁敏感加权成像序列脑微出血检出率最高,显著高于核磁共振成像常规序列及弥散加权成像序列(P<0.01),弥散加权成像序列微出血检出率显著高于核磁共振成像常规序列(P<0.01).磁敏感加权成像序列检出的36例脑微出血患者病灶部位以基底节-丘脑区为主,其次为皮质-皮质下区、脑干.年龄≥60岁患者脑微出血检出率显著高于<60岁患者(P<0.05).结论 磁敏感加权成像在急性脑梗死合并脑微出血诊断中有较高的应用价值,值得临床应用.

目的 观察阿加曲班联合丁苯酞注射液对分水岭脑梗死的临床疗效及对神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平的影响.方法 将186例发病6～48 h内的分水岭脑梗死患者随机分为对照组、丁苯酞组、阿加曲班联合丁苯酞组(联合组)各62例;对照组按分水岭脑梗死常规方法治疗2周,丁苯酞组在对照组的基础上加用丁苯酞注射液,联合组在对照组的基础上加用丁苯酞注射液及阿加曲班;3组治疗前、治疗14 d后神经功能均采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)及日常生活能力量表(Barthel指数)评定;观察3组治疗前、治疗14 d后NSE水平的变化;治疗3个月后采用改良的Rankin量表(Modified rankin Scale,mRS)评分比较3组神经功能恢复情况;记录相关不良反应.结果 治疗14d后3组NIHSS评分、NSE水平均显著降低,Barthel指数显著升高,联合组、丁苯酞组均明显优于对照组,且联合组优于丁苯酞组(P＜0.01);治疗3个月后各组预后良好率比较,联合组、丁苯酞组明显优于对照组,且联合组优于丁苯酞组(P＜0.01),治疗期间无明显不良反应发生.结论 阿加曲班联合丁苯酞注射液治疗分水岭脑梗死安全有效,并能降低NSE水平,有效改善神经功能缺损症状及日常生活能力.

目的 探究注射用鼠神经生长因子联合节律性运动训练在脑梗死后偏瘫患者治疗中的临床效果.方法 选取濮阳市人民医院2017年2月至2018年1月收治的94例脑梗死后偏瘫患者,根据治疗方案分为对照组与观察组,各47例.两组均进行常规对症治疗,对照组在此基础上进行节律性运动训练治疗,观察组在对照组基础上联合注射用鼠神经生长因子治疗,比较两组临床疗效,治疗前后神经功能缺损(NIHSS)评分及运动功能(FMA)评分.结果 观察组总有效率(91.49％)较对照组(76.60％)高(P<0.05).治疗后观察组NIHSS评分低于治疗前,FMA评分高于对照组(均P<0.05).结论 注射用鼠神经生长因子联合节律性运动训练治疗可有效提高脑梗死后偏瘫患者临床效果,改善神经功能,提高运动能力.

Objective To assess the value of posterior circulation ASPECTS (pc-ASPECTS) based on SWI in predicting the clinical outcome of patients with posterior circulation acute ischemic stroke (AIS). Methods The clinical and imaging data of posterior circulation AIS patients who were not treated with endovascular recanalization and intravenous or intra-arterial alteplase were analyzed. The prognosis at 3 months after symptom onset was assessed by mRS, good prognosis was defined as mRS 0-2, and poor prognosis was defined as mRS 3-6. Multivariate logistic regression analysis was used to determine the independent predictors of clinical outcome. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the pc-ASPECTS based on SWI for the prognosis of patients with posterior circulation AIS. Results A total of 63 patients with posterior circulation AIS were included in the study, 42 (66.7%) patients had a good prognosis, and 21 (66.7%) patients had a poor prognosis. The univariate analysis showed that there was significant difference in the NIHSS on admission (P<0.001) and pc-ASPECTS (P<0.001) between good and poor prognosis groups. The multivariate logistic regression analysis showed that the pc-ASPECTS≥6 could independently predict favorable outcome in posterior circulation AIS patients ( OR 2.03; 95% CI 1.04-3.95, P=0.039). ROC analysis indicated that the area under the ROC curve of the pc-ASPECTS based on SWI was 0.80 (95% CI 0.69-0.91). Conclusions The pc-ASPECTS based on SWI can independently predict clinical outcome at 3 months after symptom onset in patients with posterior circulation AIS.

Objective To evaluate the predictive value of susceptibility weighted imaging (SWI) for ischemic penumbra in rats with ischemic stroke.Methods Thirty SD rats were used for modeling ofcerebral artery ischemia reperfusion via modified Longa method.After successful modeling,the rats underwentmagnetic resonanceexaminationfordiffusion-weighted imaging (DWI),SWI,and perfusion-weighted imaging (PWI) sequences.The 2,3 and 5-triphenyltetrazolium chloride (TTC) method was usedto detect the infarct size of brain tissues.The correlation between SWI and PWI was analyzed by Pearson correlation analysis.Kappa consistency test was performed to detect accuracy,sensitivity,specificity,positive predictive,negative predictive and Kappa values of SWI for detecting ischemic penumbra.The receiver operating characteristic (ROC) curve was generated to analyze predictive value of SWI for ischemic penumbra.The area under the curve (AUC) was calculated toevaluate the diagnosticaccuracy.Results The brain tissues ASPECTS scores of SWI and PWI were significantly positively correlated with DWI-unmatched areas (r=0.795,P=0.000.r=0.812,P=0.000).Kappaconsistency analysis showed that the accuracy,sensitivity,specificity,positive predictive,negative predictive and Kappa values of SWI for diagnosis of ischemic penumbra were 92.00％,100.00％,93.33％,100.00％,71.43％ and 0.793,respectively.ROC analysis showed that AUC of SWI for diagnosis of ischemia penumbra inischemic stroke rats was 0.933.Conclusion Relatively high predictive value ispossible with SWI for ischemic penumbra in ischemic stroke rats.

目的 探讨健康预防策略对缺血性脑卒中高危患者健康管理的效果,为缺血性脑卒中高危人群的健康管理提供参考.方法 选择2014年2月-2015年2月符合纳入标准而进入濮阳市人民医院神经内科的120名缺血性脑卒中高危受试者作为研究对象,将其按照入组先后顺序编号,采用数字随机表法将其分为对照组和观察组,每组60名.对照组受试者按照《中国脑血管病一级预防指南2015》中对脑卒中一级预防相关规范对其进行缺血性脑卒中的预防,观察组按照制定的缺血性脑卒中高危患者健康预防策略进行健康管理.比较两组患者入组2年后缺血性脑卒中危险因素控制率、患者生存质量评分(QOL-BREF)改善情况,2年内缺血性脑卒中发病率、相关并发症发生情况.结果 观察组患者入组2年后缺血性脑卒中危险因素(高血压、BMI指数、血脂异常、吸烟、饮酒、CHA2 DS2-VASc评分、饮食营养不合理、体育活动缺乏)控制率均明显高于对照组,组间比较差异有统计学意义(均P<0.05).两组患者QOL-BREF评分(生存质量主观感觉、健康状况主观感觉、生理领域、心理领域、社会关系领域)均较入组前有明显改善(均P<0.05),但观察组患者入组2年后的各维度评分明显高于对照组(均P<0.05).对照组患者2年内共发生缺血性脑卒中15例(25.00％),并发症21例(35.00％),观察组共发生缺血性脑卒中5例(8.33％),并发症12例(20.00％),观察组受试者缺血性脑卒中发生率明显低于对照组(χ2=6.0,P<0.05),并发症发生率差异无统计学意义(χ2=3.386,P>0.05).结论 缺血性脑卒中健康预防策略可有效控制高危患者缺血性脑卒中危险因素控制率,改善患者生存质量,降低缺血性脑卒中的发生率,具有扩大研究范围、进一步规范预防策略的临床价值.

Objective To observe the clinic efficacy of nasal-feeding Chinese medicine and conventional western medicine in the treatment of severe cerebral infarction.Methods Eighty patients with severe cerebral infarction were selected and divided randomly into two groups:control group (n=40) treated with edaravone,and treatment group (n=40) treated with edaravone and nasal-feeding Chinese medicine.The effective rate, National Institutes of Health Stroke Scale (NIHSS) scores,Glasgow Coma Score (GCS) before and after the treatment, blood rheology index and adverse reactions were observed.Results The total clinical effective rate was 92.5% in treatment group,which was significantly higher than that in control group (72.5%,P<0.05).After the treatment, the NIHSS scores in treatment group were higher than that in control group (P<0.05).The GCS score, the whole blood high shear viscosity, the whole blood low shear viscosity and plasma viscosity in treatment group were lower than that in control group (P<0.05).There was no obsvious adverse reactions,in two groups during the treatment period.Conclusion The nasal-feeding Chinese medicine and conventional western medicine can improve the effective rate, and improve the blood flow state in patients with severe cerebral infarction.

目的：探讨普瑞巴林联合氟哌噻吨美利曲辛片治疗丘脑出血后肢体疼痛的疗效、安全性及不良反应。方法选取2012年9月至2014年5月濮阳市人民医院收治的丘脑出血后疼痛患者50例，随机分为观察组（普瑞巴林+氟哌噻吨美利曲辛片）和对照组（卡马西平+氟哌噻吨美利曲辛片），各25例。两组按相应方案治疗3周后，观察并记录患者的疼痛视觉模拟量表（VAS）、汉密尔顿抑郁量表（HAMD）评分、用药剂量及不良反应等。结果观察组治疗3周末总有效率88.0％（(22/25），对照组为68.0％（17/25），两组疗效比较差异有统计学意义（P<0.05）。治疗后第1周，两组VAS评分较治疗前差异均无统计学意义（均P>0.05）；治疗后2、3周两组VAS评分较治疗前下降，观察组VAS评分显著低于对照组，差异有统计学意义（P<0.05）。两组在治疗1周末HAMD评分与治疗前比较差异无统计学意义（P>0.05），在治疗2、3周末均较治疗前明显改善，差异有统计学意义（P<0.05）。治疗1周两组不良反应差异无统计学意义（P>0.05），2、3周对照组不良反应发生率明显高于观察组（P<0.05）。结论与卡马西平相比，普瑞巴林联合氟哌噻吨美利曲辛片治疗丘脑出血后肢体疼痛，疼痛缓解程度较高，药物不良反应较少，患者易于接受，值得推广应用。

Objective To investigate the early diagnostic value of susceptibility weighted imaging (SWI) on hemorrhagic transformation (HT) after massive cerebral infarction. <br> Methods Thirty nine cases with massive cerebral infarction diagnosed by magnetic resonance were enrolled and head computed tomography (CT) and magnetic resonance imaging (MRI) including SWI were performed within 72 hours after onset. The detection rate and the sensitivity of two methods for diagnosing HT were compared. The HT after cerebral infarction was graded based on European Cooperative Acute Stroke Study (ECASS), the difference in HT grade by two examination methods was compared, HT grading and the National Institutes of Health Stroke Scale (NIHSS) score correlation were analyzed. <br> Results The positive rates of SWI or CT in the diagnosis of HT were 61.54% and 12.82%(P<0.001) respectively. Twenty four cases (61.54%) with HT after massive cerebral infarction were detected by SWI, grade 1 accounted for 12.82%, and grade 2, 3, 4 for 25.64%, 15.48%and 7.69%, respectively. SWI was signiifcantly superior to conventional CT in early detection of hemorrhagic transformation after massive cerebral infarction. HT grading by SWI was positively correlated with NIHSS scores (R=0.94, P<0.01). <br> Conclusion The HT after massive cerebral infarction can be early, sensitively, objectively evaluated by SWI, which provides the basis for the adjusting treatment programs.