目的 分析脑梗死抑郁应用盐酸氟西汀的治疗效果.方法 随机选择于2013年6月~2015年5月本院收治的脑梗死抑郁患者80例作为本研究对象,采用电脑随机分组方式将此次收治于本院的患者随机分为研究组与常规组,2组各40例;其中常规组患者给予神经内科常规治疗方案;研究组患者给予神经内科常规治疗加盐酸氟西汀治疗方案,使用神经功能缺损评分量表、HAMD(汉密尔顿抑郁)量表评价患者神经功能恢复情况以及抑郁改善状况,并观察2组患者用药的不良反应.结果 研究组患者神经功能恢复总效率达到85%、抑郁恢复达到70%;常规组患者神经功能恢复总效率达到了67.5%、抑郁恢复达到45%;研究组的治疗效果显著优于常规组(P<0.05).结论 针对脑梗死抑郁患者予以盐酸氟西汀进行治疗,其临床效果十分显著,疗效满意,即可显著改善患者抑郁状态,提升患者生活质量以及生活活动能力.

目的 利用磁共振弥散张量成像(DTI)技术,观察养血清脑颗粒治疗卒中后抑郁(PSD)的疗效差异,以及其对脑白质结构改变的影响.方法 给予卒中后抑郁患者养血清脑颗粒4 g,口服,3次/d;疗程12 w,治疗前、后均收集汉密尔顿抑郁量表评分(HAMD-24)、DTI扫描数据.治疗后HAMD-24≤8分纳入治愈组,反之纳入难治组.比较两组治疗前、后FA值变化情况.结果 养血清脑颗粒治愈率约44.6％.与治疗前相比,治愈组的左侧额叶FA值治疗后明显升高(P＜0.05);比较两组治疗前的FA值,发现难治组左侧额叶、右侧海马的基线FA值低下(P＜0.05).结论 养血清脑颗粒治疗PSD有效.PSD患者存在可逆性前额叶深部白质损伤;且难治性PSD患者左侧额叶、右侧海马的基线FA值低下,提示DTI可作为抗抑郁疗效评估的预测指标.

目的：观察氟西汀对脑梗死患者治疗1年内不同时期运动功能及认知功能障碍的影响。方法选取发病72 h内住院的急性脑梗死患者230例，随机分为治疗组及对照组，治疗组在住院48 h内常规二级预防的基础上加用氟西汀治疗，观察时间1年。截取住院48 h内，即氟西汀治疗前、脑梗死后1 w、1个月、3个月、1年5个时间点分别对两组患者进行NIHSS及MoCA量表检测及一般情况评定，并进行比较。同时比较1年内两组患者脑梗死复发情况。结果脑卒中后3个月、1年MoCA评分两组比较有统计学差异（ P＜0.05），1 w、1个月MoCA 评分两组比较无明显统计学差异（P＞0.05）。脑卒中后3个月，1年治疗组NIHSS评分与对照组比较具有明显的统计学意义（P＜0.001），脑卒中后1 w、1个月 NIHSS评分两组比较无明显统计学差异。结论氟西汀治疗能显著改善脑梗死后1年的运动功能及认知功能。

Objective:To discuss the correlation and prognosis on the levels of plasma coagulation factorⅩⅢ(FⅩⅢ)and IL-17in patients with cerebral infarction.Method:①According to the infarction size of CT or MRI of head,50patients with cerebral infarction were divided into three groups:great dimension infarction group(infarction size>10cm3),middle dimension infarction group(infarction size 4to 10cm3)and small dimension infarction group(infarction size<4cm3).Healthy control group included 20cases.Damage degree of nerve function was evaluated according to NIHSS score.Anticoagulant specimens of cerebral infarction group were collected within 24h,at 3rd day,7th day and 14th day respectively.The levels of FⅩⅢ and IL-17were measured by enzyme linked immune double antibody sandwich assay.②According to NIHSS scores within 24hand 14th day of cerebral infarction group,recent prognosis was compared.Result:①The levels of FⅩⅢ and IL-17of great dimension infarction group within 24hwere obviously higher than those of control group(P<0.01),the levels of FⅩⅢand IL-17of middle dimension infarction group and small dimension infarction group within 24hwere higher than those of control group(P<0.05).②Compared with small dimension infarction group,the levels of FⅩⅢ and IL-17of great dimension infarction group were different(P<0.05).③Along with the state of illness improved,the levels of FⅩⅢand IL-17had decline tendency(P>0.05).④The level of FⅩⅢ was positively correlated with the recent prognosis in patients with cerebral infarction groups(r=0.33),the level of IL-17was positively correlated(r=0.31).Conclusion:The levels of FⅩ Ⅲ and IL-17in patients with cerebral infarction would have positive correlation with course and prognosis,and their changes could be used as diagnose indexes of treatment and prognosis.

Objective To explore the impact of depressive disorders on early progressive motor deficits among patients with cerebral infarcts of basal ganglia region.Methods Eighty-five patients with first cerebral infarcts in basal ganglia region were enrolled into this study.All patients were examined with brain magnetic resonance imaging(MRI),magnetic resonance angiography(MRA) and diffusion weighted imaging(DWI).According to the Hamilton Depression Rating Scale scores on admission,patients were divided into non-depressive disorders group and depressive disorders group.Based on NIHSS scores of early progressive motor deficits,each above-mentioned group was further divided into stable subgroup and progressive subgroup.The occurrence rate of early progressive motor deficits,front-to-back ratio of volume of lesions(V2/V1),pathological changes in the middle cerebral artery(MCA),blood pressure,blood lipids and fasting blood glucose were compared between non-depressive disorders and depressive disorders groups.Results The occurrence rate of early progressive motor deficits in depressive disorders group was significantly higher than that of non-depressive disorders group(10/27,37.04% vs 9/58,15.52%,χ2=4.92,P=0.03).MCAs were obviously stenosing or occlusive(37/85,43.53%) in cerebral infarcts of basal ganglia region,but no statistically significant difference was found in the pathological changes in the MCA between non-depressive disorders and depressive disorders groups(χ2=0.34,P=0.56).V2/V1 of progressive subgroups was larger than that of stable subgroups,and V2/V1 of depressive disorders groups was significantly different from that of non-depressive disorders in progressive subgroups(F=167.39,P=0.00).Systolic blood pressure and fasting blood glucose were significantly higher in the progression of the disease,and there was a significantly correlation between fasting blood glucose and depressive disorders(r=0.425,P=0.000).Conclusions Depressive disorders can promote the progression of early motor deficits in cerebral infarcts of basal ganglia region.

<正>患者,男,30岁,某公司保安,因被人发现神志不清8h入院。患者被人发现时倒卧在浴室,当时燃气瓶已空,患者意识不清,呼之不应,双眼向上凝视,眼球及脖子可无意识转动,肢体僵硬,在当地医院就诊,查血HbCO为弱阳性,考虑一氧化碳中毒,予吸氧、脱水处理后为进一步治疗转送我

Objective To explore the effects of fluoxetine on motor functional deficits and cognitive functional deficits at different time points after acute cerebrovascular diseases.Methods This was a 3 months randomized,controlled trial.202 cases were enrolled in our study.They were randomly assigned to receive either conventional therapy or induceing fluoxetine based traditional treatment.Four follow up visits were occurred to test scores of National Institutes of Health Stroke Scale(NIHSS) and Montreal cognitive assessment(MoCA)within the 3 months after stroke to assess difference between two groups.Results At 3 months,scores were obviously decrease in NIHSS tests and were greatly increase in MoCA tests in test group.There was no significant difference between two groups at 7 days and 1 months either on motor functional deficits or cognitive functional deficits.Changes of MoCA scores were significant at 48 hours after admission and in 3 months.Conclusion 3 months fluoxetine usage exhibited obvious effects on improving motor function as well as cognitive function with acute cerebrovascular diseases.

Objective To investigate the characteristics of the carotid artery wall motion in patients with hyperlipidemia before and after treatment by using velocity vector imaging(VVI) technique.Methods Thirty patients with hyperlipidemia took atorvastatin for 12 months.The maximum velocity(Vmax),maximum strain(Smax) and maximum strain rate(SRmax) of the anterior wall,internal wall,posterior wall and lateral wall of left short-axis section of carotid artery were measured with velocity vector imaging technique before treatment,and 3,6 and 12 months after treatment,and were compared with another 30 healthy volunteers.Results The Vmax((1.89±0.21)×10-2 cm/s),Smax((3.43±0.99)%) and SRmax((0.31±0.02)s-1) of lateral wall of left short-axis section of carotid artery were significantly higher 3 months after treatment than those before treatment(Vmax(0.90±0.28)×10-2 cm/s,Smax:(1.80±1.04)%,SRmax:(0.10±0.06)s-1)(P0.05).The Vmax,Smax and SRmax of anterior,internal and posterior wall of left short-axis section of carotid artery were significantly higher 6 and 12 months after treatment than those before treatment(P0.05).Conclusion VVI technique can evaluate the biomechanical characteristics of the carotid artery in patients with hyperlipidemia before and after treatment,which plays an important role in the prevention and therapy of cerebrovascular disease.

目的：探讨血浆凝血因子XⅢ（FXⅢ）、IL-17水平与脑梗死患者病程进展及预后的相关性。方法：①对50例脑梗死患者根据头部CT或MRI病灶大小，梗死体积按Pullicino公式（长×宽×层数／2）计算进行分组：大梗死组（病灶体积〉10cm3），中梗死组（病灶体积4～10cm3），小梗死组（病灶体积〈4cm3）；健康对照组20例，神经功能受损程度按照NIHSS进行评分。分别在24h内、第3天、第7天、第14天采集脑梗死组抗凝血标本。采用酶联免疫双抗体夹心法检测FXⅢ、IL-17含量。②根据脑梗死组发病24h内和第14天的NIHSS评分进行近期预后分型比较。结果：①大梗死组发病24h内FXⅢ、IL-17水平明显高于对照组（P〈0．01），中、小梗死组发病24h内FXⅢ、IL-17水平高于对照组（P〈0．05）。②大梗死组FXⅢ、IL-17水平与小梗死组比较差异有统计学意义（P〈0．05）。③随着梗死病情好转，FXⅢ、IL=17水平有下降趋势（P〉0．05）。④脑梗死组患者近期预后与FXⅢ水平下降呈正相关（r=0．33），与IL-17水平下降呈正相关（r=0．31）。结论：脑梗死患者血浆FXⅢ、IL-17水平与病程及预后呈正相关，其水平变化可作为脑梗死治疗及预后的判断指标。

随着现代社会人口老龄化及饮食结构的变化，急性脑梗死的发病率越来越高，给社会和家庭带来沉重的经济负担。目前，临床治疗的药物和手段不少，但如何选择最优化的方案仍是一个值得研究的课题。笔者应用长春西汀注射液联合丹红注射液治疗40例急性脑梗死患者，获得较好疗效，现分析报道如下。

This study was aimed to explore the correlation of mean platelet volume (MPV), fibrinogen (FIB) and blood rheology with the youth patients with cerebral infarction, so as to provide the basis for the clinical early diagnosis and treatment. The 109 patients with cerebral infarction aged between 18 - 45 were divided into three group: the large (> 10 cm(3)), middle (4 - 10 cm(3)) and small (< 4 cm(3)) area infarction; 30 healthy persons were served as control group. All the four groups were subjected to 16 examinations, such as MPV, FIB, and rheology (Lηb, Mηb, Hηb, ηp, Lηr, Mηr, Hηr, KVE, EAI, ERI, EDI, EEI, HCT, ESR). The results showed that all the MPV, FIB and rheology indexes of the different infarction groups were higher than those of healthy control group (P < 0.05). The MPV, FIB and rheology indexes in the large area infarction group were all higher than those in the small area infarction group (P < 0.05). The indexes of MPV, FIB and rheology in the various cerebral infarction area groups obviously decreased, but those did not reach to the level in the healthy control group (P < 0.05). The MPV, FIB content and rheology level correlated with infarction areas (r = 0.36, 0.29 and 0.48, respectively). It is concluded that the serious intensity of youth patients with cerebral infarction positively correlated with the levels of MPV, FIB and rheology indexes. Regular examination of above mentioned index may be useful to prevent youth patients from cerebral infraction.

Objective To explore the correlation of FIB,IL-17 with the patients with cerebral infarction.Methods According to the infarction size of CT or MRI of head,the 50 patients with cerebral infarction were divided into three group: the large(10 cm3),middle(4~10 cm3)and small(4 cm3) area infarction;According to the damage degree of nerve function,were divided into three type: the serious(30~42 scores),moderate(15~29 scores) and mild(0~14 scores) NIHSS scores,20 healthy persons were served as control group.To collect anticoagulant specimens within 24 h,IL-17 were measured by two-layer antibody sandwith enzyme linked immunosorbent assay.FIB were measured by blood coagulation function full-automatic analyser.Results The levels of FIB,IL-17 of the large group obviously higher than control group(P 0.01),the levels of FIB,IL-17 of middle and small group higher than control group(P 0.05);the levels of FIB,IL-17 of the serious type obviously higher than control group(P 0.01),the levels of FIB,IL-17 of moderate and mild type group higher than control group(P 0.05);the levels of FIB,IL-17 of the large group compared with small group were difference(P 0.05);the levels of FIB,IL-17 of the serious type compared with mild type group were difference(P 0.05).Conclusion It is closely relevant that serious intensity of cerebral infarction and the levels of plasma FIB,IL-17.There is great value to regular test FIB,IL-17 to prevent from cerebral infarction.

Objective To explore the significance of LDL-C/HDL-C ratio in the pathogenesis of symptomatic intracranial atherosclerotic stenosis(sICAS) among young and middle-aged patients.Methods According to the NIHSS scores,37 young and middle-aged patients with newly-diagnosed sICAS were divided into two case-groups.Meanwhile,40 young and middle-aged patients with dizziness were selected as control group.The differences of LDL-C/HDL-C ratio between case-groups and control group were analyzed.After 6-month treatment,vascular lesions and LDL-C/HDL-C ratio were analyzed again,and then compared with the data collected prior to the treatment.Results As compared with normal controls,lower HDL-C value and increased LDL-C/HDL-C ratio were observed in young and middle-aged patients with sICAS.The differences between case-groups and control group were statistically significant.As compared with the condition before the treatment,64.71% of case-groups showed improved intracranial vascular stenosis and decreased LDL-C/HDL-c ratio upon treatment.The difference between before and after the treatment was also statistically significant.Conclusions Increased LDL-C/HDL-c ratio is an important risk factor for young and middle-aged patients with sICAS.Aspirin plus atorvastatin combined therapy can decrease LDL-C/HDL-c ratio and improve sICAS in young and middle-aged patients.

<正>骨筋膜室综合征(osteofascial compartment syndrome)是急性一氧化碳中毒的严重并发症之一,该病的发病率不高,但病情严重,目前国内外对该病报道和讨论较少[1,2]。我院通过高压氧配合其他综合治疗成功救治该病患者1例,现报告如下。

Objective To analyze the influencing factors of mild cognitive impairment in silent cerebral infarction(SCI).Methods 82 patients with SCI were carried out minimental state examination(MMSE)and the Chinese version of the Montreal cognitive assessment(MOCA).The incidence of mild cognitive impairment were compared between the two scales.According to the testing results,patients were divided into mild cognitive impairment(MCI)group and non-cognitive impairment(NCI)group.All patients were evaluated about the general state of health and laboratory examination.Hamilton depression rating scale(HAMD)was used to test depression.We observed brain photographic classification.Carotid arteries(CAS)was assessed by two dimensional color Doppler ultrasonography in two groups.Results The sensitivity of MoCA was higher than MMSE(MoCA 41.46%,MMSE12.20%,P<0.01).Depressions in MCI group were more than those in NCI group(P<0.01).The lesions of frontal,temporal,subcortical and thalamus in MCI group were more than those of NCI group.Inner diameters of CCA and ICA were different between the two groups.The carotid intima-media thickness of patients with mild cognitive impairment was thicker than that of the NCI group.There were differences between the two groups on plaque instability of carotid(P<0.01).Conclusion MoCA is more sensitive than MMSE on detection of patients with MCI.MoCA has clinical significance on detecting MCI.MCI is very common in patients of SCI.The occurrence of MCI is significantly correlated with sides and locations of the lesions,inner diameters of CCA and ICA,IMT,plaque stability,and depression.

目的 观察骨髓间充质干细胞回输脑缺血再灌注模型大鼠后脑组织中caspase-3的表达.方法 无菌分离骨髓间充质干细胞,用培养液DMEM/F12(含2% B27,EGF 40 ng/ml,bFGF 20 ng/ml)诱导骨髓间充质干细胞向神经样细胞分化,免疫组化检测NSE表达.线栓法建立大鼠缺血再灌注模型.RT-PCR 检测 MSCs 回输脑缺血再灌注模型大鼠脑组织中caspase-3 mRNA的表达.结果 骨髓间充质干细胞诱导神经样细胞后,免疫组化检测NSE呈阳性表达.RT-PCR检测caspase-3 mRNA 表达,治疗组 caspase-3表达明显低于模型组(P<0.05).治疗组Caspase-3低于对照组,但无统计学意义(P>0.05).结论 骨髓间充质干细胞回输脑缺血再灌注模型大鼠后脑组织caspase-3基因下调,抑制神经细胞凋亡.

目的对进展性脑梗死相关危险因素进行分析。方法对深圳市龙岗区人民医院40例进展性脑梗死患者入院时的血压、血糖、血脂、纤维蛋白原、同型半胱氨酸、血白细胞、颈部血管彩超、经颅多普勒、MRA及既往病史等因素进行回顾性分析。结果进展性脑梗死患者与对照组比较,在入院时收缩压、空腹血糖、同型半胱氨酸、白细胞等指标升高以及颈部大血管中重度狭窄、颅内血管狭窄等因素密切相关。结论进展性脑梗死影响因素是多方面的。这些因素互相影响产生SIP。故治疗应从不同的环节着手,阻止SIP的发生。

Objective To investigate the value of brainstem auditory evoked potential(BAEP),somatosensory evoked potential(SEP)united electroencephalogram(EEG)in comatose patients with acute stroke.Methods BAEP,SEP united EEG were used in 60 comatose patients with acute stroke and the prognosis were analyzed.Results Compared with Glasgow score group,the sensitivity was 96.9%,the specificity was 96.4%,,the accuracy was 96.7% in BAEP,SEP united EEG group.Significant difference was found between BAEP,SEP united EEG group and Glasgow score group.Conclusion BAEP,SEP united EEG testing can provide an objective indicator not only for evaluating brain function of comatose patients with acute stroke,but also for estimating prognosis.

目的探讨脑梗死后抑郁症(PSD)的发生率及相关因素。方法采用汉密尔顿抑郁量表对450例脑梗死进行分析观察,统计分析抑郁与性别、神经功能缺损程度以及其他因素的相关性。结果 PSD发生率为32.2%,PSD发生与年龄、长期疾病困扰、脑梗死后病程、急性期神经功能缺损程度及病灶大小、数量、部位等因素有关。结论脑梗死后抑郁与脑损伤的生物效应有关,且受多种因素影响。