目的 观察美多巴联合普拉克索治疗帕金森病(PD)的疗效及对患者运动功能、血清同型半胱氨酸(Hcy)和血尿酸(UA)水平的影响.方法 选取2019年9月至2020年10月间延安大学咸阳医院收治的90例PD患者为研究对象,按随机数表法分为观察组和对照组,每组45例.对照组患者采用美多巴治疗,观察组患者在对照组治疗的基础上联合普拉克索治疗,两组均持续治疗12周,比较两组患者治疗后的临床效果、治疗前后的自主神经功能障碍程度[PD自主神经症状量表(SCOPA-AUT)]、运动功能[PD统一评分(UPDRSⅢ)量表]和血清指标[Hcy、UA]水平,并记录治疗期间不良反应发生情况.结果 治疗后,观察组患者的治疗总有效率为95.56％,明显高于对照组的77.78％,差异有统计学意义(P<0.05);治疗后,观察组患者的SCOPA-AUT评分、UPDRS总评分分别为(16.24±3.06)分、(24.58±1.76)分.明显低于对照组的(21.21±4.82)分、(29.31±1.86)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清Hcy水平为(11.05±1.12)μmol/L,明显低于对照组的(27.58±6.61)μmol/L,而血UA水平为(324.24±21.96)μmol/L,明显高于对照组的(260.11±31.85)μmol/L,差异均有统计学意义(P<0.05);观察组患者治疗期间的总不良反应总发生率为13.33％,明显低于对照组的31.11％,差异有统计学意义(P<0.05).结论 美多巴联合普拉克索治疗PD可有效改善患者的自主神经系统障碍及运动功能,临床治疗效果显著,且安全性较高.

目的 探讨赣龙抗栓胶囊联合抗血小板聚集药物治疗脑出血后急性脑梗死的临床效果.方法 选取2015年1月至2019年12月我院收治的90例脑出血后急性脑梗死患者为研究对象,按照不同治疗方法将其分为抗血小板聚集药物组(n=30,抗血小板聚集药物治疗)、赣龙抗栓胶囊组(n=30,赣龙抗栓胶囊治疗)、联合组(n=30,赣龙抗栓胶囊联合抗血小板聚集药物治疗).比较三组的治疗效果、治疗前、后神经功能缺损情况、血管再通率及并发症发生情况.结果 联合组的治疗总有效率显著高于抗血小板聚集药物组及赣龙抗栓胶囊组,差异具有统计学意义(P<0.05).治疗后,三组的NIHSS评分均显著降低,且联合组低于抗血小板聚集药物组及赣龙抗栓胶囊组,差异具有统计学意义(P<0.05).联合组的血管再通率显著高于抗血小板聚集药物组及赣龙抗栓胶囊组,差异具有统计学意义(P<0.05);三组的并发症总发生率比较,差异不具有统计学意义(P>0.05).结论 赣龙抗栓胶囊联合抗血小板聚集药物治疗脑出血后急性脑梗死的临床效果显著,可促使患者神经功能缺损情况明显改善,且血管再通率高,并发症少,值得临床全方位推广.

目的 探讨急性脑梗死早期静脉溶栓患者溶栓效果的相关影响因素.方法 回顾性分析本院2017年5月至2018年12月收治的64例急性脑梗死患者的病历资料,所有患者均接受静脉溶栓治疗,依据早期静脉溶栓治疗24 h后NIHSS评分变化情况进行分组,治疗24 h后NIHSS评分下降≥4分为有效组(n=30),治疗24 h后NIHSS评分下降<4分为无效组(n=34).比较两组的临床特征,分析溶栓效果的相关影响因素.结果 有效组的糖尿病、高血压和颅内外动脉狭窄或闭塞患者占比、入院NIHSS评分均低于无效组,发病至溶栓治疗时间短于无效组(P<0.05).影响急性脑梗死早期溶栓治疗患者溶栓效果的危险因素为糖尿病、发病至溶栓治疗时间、入院NIHSS评分和颅内外动脉狭窄或闭塞(P<0.05).结论 急性脑梗死早期静脉溶栓患者的溶栓效果与患者的发病至溶栓治疗时间、入院NIHSS评分、颅内外动脉狭窄或闭塞以及是否合并糖尿病密切相关.

目的 探讨重症肌无力(MG)患者血清白细胞介素(IL)-9、IL-15、连接素抗体(Titin-Ab)、乙酰胆碱受体抗体(AchR-Ab)水平检测及临床意义.方法 将该院2016年2月至2019年8月收治的42例MG患者设为观察组,选取该院同期体检健康者42例作为对照组.使用酶联免疫分析法检测所有研究对象的血清IL-9、IL-15、Titin-Ab、AchR-Ab水平,并进行对比分析.结果 观察组患者血清IL-9、IL-15、Titin-Ab、AchR-Ab水平均高于对照组,差异有统计学意义(P<0.05).眼睑型组患者血清IL-9、IL-15水平虽低于全身型组患者,但差异无统计学意义(P>0.05);眼睑型组患者血清Titin-Ab、AchR-Ab水平均低于全身型组患者,差异有统计学意义(P<0.05).胸腺疾病组患者血清IL-9、IL-15水平较非胸腺疾病组患者高,但差异无统计学意义(P>0.05);胸腺疾病组患者血清Titin-Ab、AchR-Ab水平均高于非胸腺疾病组患者,差异有统计学意义(P<0.05).结论 MG患者血清IL-9、IL-15、Titin-Ab、AchR-Ab水平均较高,可作为诊断MG的灵敏指标,其中血清Titin-Ab、AchR-Ab水平对鉴别患者是否合并胸腺疾病、是否为全身型MG具有重要意义.

目的 探讨缺血性脑梗死患者应用依达拉奉与丹参多酚酸盐联合治疗的效果及对其脑血流动力学和神经功能损伤的影响.方法 回顾性分析2016年5月—2018年5月于我院收治的102例缺血性脑梗死患者临床资料,按用药不同分为对照组和观察组,每组51例.对照组采用依达拉奉治疗,观察组在对照组基础上加用丹参多酚酸盐.比较2组临床疗效、脑血管储备能力、脑血流动力学及神经功能损伤的变化情况.结果 观察组临床疗效高于对照组(P<0.05).2组治疗后大脑中动脉血流速度、脑血管阻力、脉动指数高于治疗前,且观察组高于对照组(P<0.05);2组血浆黏度、红细胞压积、纤维蛋白原、全血高切黏度、全血低切黏度显著降低,且观察组低于对照组(P<0.05);2组神经功能缺损量表、改良的Rankin量表评分低于治疗前,且观察组低于对照组(P<0.05);2组日常生活量表评分高于治疗前,且观察组高于对照组(P<0.05).2组不良反应发生率比较差异无统计学意义(P>0.05).结论 依达拉奉联合丹参多酚酸盐治疗缺血性脑梗死患者疗效好,能显著改善患者脑血管储备能力与脑血流动力学状态,降低神经功能损伤.

Objective To study the effect of blood pressure changes on heart and brain ischemia in patients with acute cerebral infarction and coronary heart disease and find the range of blood pressure suitable for these patients.Methods 107 patients of acute cerebral infarction complicated with coronary heart disease were divided into hypertension group (n=59) and non-hypertension group (n=48).The patients were simultaneously monitored by ambulatory blood pressure and dynamic electrocardiogram.The blood pressure values and their corresponding ischemia events were studied.Blood pressure values are divided into five subgroups:A (～120/～80mmHg),B (120～140/80～90mmHg),C (140～160/90 ～100mmHg),D (160～180/100～110mmHg) and E (180～/110～mmHg).Ischemia events in four categories:heart ischemia,cerebral ischemia,heart-cerebral ischemia and heart-cerebral without ischemia.The distribution of different classification of cardiovascular and cerebrovascular events in each blood pressure subgroup were observed.Results Heartbrain without ischemic events of hypertension group were mainly distributed in SBP C,D group(x2 =106.158,60.465,P ＜0.01) and DBP B,C group(x2 =79.196,55.099,P＜0.01).Heart-brain without ischemic events of non-hypertension group were mainly distributed in SBP B,C group(x2=56.090,123.131,P＜0.01) and DBP B,C group(x2 =124.196,74.130,P＜0.01).Conclusion There is no heart-brain ischemia event in patients with acute cerebral infarction complicated with coronary heart disease.The appropriate range of blood pressure of hypertension group is 140 ～ 180/80 ～100mmHg.Non-hypertension group of appropriate blood pressure range is 120～160/80～100mmHg.

Objective :To observe the therapeutic effect of B-subacute selective nerve root block combined with pregabalin on post-stroke neuropathic pain .Methods:Sixty-seven patients with post-stroke neuropathic pain were randomly divided into observation group (38 cases) and control group (38 cases) .Both groups were treated with pregabalin .The observation group was given B-Nerve root block treatment ,the treatment of total effective rate , pain score (VAS) ,sleep quality score (QS) ,nervous system function recovery and adverse reactions were com-pared .Results :The total effective rate of the observation group was 94 .74% ,while that of the control group was 71 .05% ,the difference was statistically significant (P< 0 .05) .The VAS score and QS score of the two groups were decreased after treatment ,and the scores of the observation group decreased significantly (P< 0 .05) .The scores of NHISS and ADL in observation group after treatment were (13 .01 ± 1 .34) and (57 .19 ± 9 .84) ,respec-tively ,which were significantly better than those in control group (P<0 .05) .The incidence of adverse reactions in the observation group was 7 .89% ,which was lower than 21 .05% of the control group (P<0 .05) .Conclusion :B-suboptimal selective nerve root block combined with pregabalin is effective in treating post-stroke neuropathic pain . It can effectively relieve the patient's pain ,improve neurological function and reduce the incidence of adverse reac-tions ,and has important clinical value .

Objective To study the relationships between blood pressure variability and cerebral white matter lesions (WML) in patients with ischemic cerebrovascular disease.Methods Ninety cases of patients with ischemic cerebrovascular disease were selected and divided into the WML group (n=52) and the non WML group (n=38) according to the results of head MRI examination.The WML group was further divided into the mild group (n =25) and the severe group (n =27) according to the severity of symptoms.The changes of ambulatory blood pressure,blood pressure variability and circadian rhythm of blood pressure were analyzed.Results The levels of dSBP,dDBP,dSBP-SD,dDBP-SD,nSBP,nSBP-SD,24hSBP,maxSBP,maxDBP and 24hSBP-SD in the WML group were significantly higher than those in the non WML group (P＜0.05),and the difference in the levels of nDBP,nDBP-SD,24hDBP and 24hDBP-SD was not statistically significant between the two groups (P＞0.05).The levels of dSBPV,dDBPV,nSBPV,nDBPV,24hSBPV and 24hDBPV in the WML group were significantly higher than those in the non WML group (P＜0.05),but there was no significant difference between the mild group and the severe group in the WML group (P＞0.05).The incidence of dipper type WML was 40.63％,that of the non-dipper type was 64.71％ and that of the dipping type was 70.83％.Logistic regression analysis showed that dSBP and nSBP-SD were independent risk factors for WML increase.Conclusion The changes,variability and circadian rhythm of blood pressure are all influencing factors of WML,among which dSBP and nSBP-SD are independent risk factors that affect the increase of WML.

Objective To investigate the effects of early serum bilirubin level on the prognosis of patients with acute cerebral infarction.Methods The clinical data of 257 patients with acute cerebral infarction (acute cerebral infarction group) admitted to Department of Neurology,Xianyang Hospital of Yan'an University from February to October 2016 was analyzed retrospectively,and they were divided into higher group (≥ 10.9 μmol/L) and lower group (＜10.9 μmol/L)according to different serum bilirubin levels.At the same time,30 healthy persons were taken as control group.The serum bilirubin level at the second day after admission was detected,and the incidence of hemorrhagic transformation (HT) and multiple organ dysfunction syndrome (MODS) after admission was made statistics,the prognosis at discharge was evaluated,and the patients with different serum bilirubin levels were compared with the events above.Results The early serum bilirubin level of acute cerebral infarction group was lower than that of control group,the difference was highly statistically significant (P ＜ 0.01).During patients with different bilirubin levels,the incidence of HT between lower group and higher group had no statistically significant difference (P ＞ 0.05),while the incidence of MODS in the higher group was lower than that of lower group,the difference was statistically significant (P ＜ 0.05).Compared with those at admission,the scores of neural function deficient scale (NDS) in the two groups at discharge were all decreased,the scores of activity of daily living (ADL) in the two groups at discharge were all increased,the differences were all highly statistically significant (P ＜ 0.01).At discharge,the score of NDS in the higher group was slightly lower than that of lower group,but there was no statistically significant difference (P ＞ 0.05),while the score of ADL in the higher group was higher than that of lower group,the difference was highly statistically significant (P ＜ 0.01).Conclusion Compared with normal persons,the serum bilirubin level of patients with acute cerebral infarction is lower,and among the patients with acute cerebral infarction,the higher the serum bilirubin level is,the lower the incidence of complications is,the better the prognosis is.

Objective:To investigate the protective effects of ginsenoside Rd (GS-Rd) on the remote damage in thalamus after focal cerebral ischemia in rats.Methods:Adult SD male rats were subjected to middle cerebral artery occlusion (MCAO),and then randomly divided into sham group,MCAO group (1,3 and 5 d) and GS-Rd treatment group (5 mg/kg,10 mg/kg),and 5 rats in each group.Rats in the GS-Rd treatment group were given GS-Rd 5 mg/kg,or 10 mg/kg intraperitoneally half an hour before MCAO surgery,followed by intraperitoneal injection of corresponding dose per day.Body weight of each group of rats was recorded.Thalamic tissues were collected and the levels of TNF-αt,IL-1β and IL-16 in the thalamus were detected by a Milliplex kit.Results:The body weight of MCAO group was lower than that of the sham group (P ＜ 0.05),but the levels of TNF-α,IL-1β and IL-16 were increased (P ＜0.05).With the treatment of 10 mg/kg GS-Rd,the levels of TNF-o,IL-1β and IL-16 were decreased,compared with the MCAO group (P ＜ 0.05),whereas change of the body weight,no significant were observed in rats treated with 5 mg/kg GS-Rd (P ＞ 0.05).Conclusion:10 mg/kg GS-Rd may protect against the remote damage in thalamus after focal cerebral ischemia in rats by reducing the levels of inflammatory factors TNF-α,IL-1β and IL-16.

目的 探讨利用奥扎格雷钠联合黛力新对脑梗死患者抑郁、焦虑的病情的治愈效果以及预后的影响.方法 将我院2013年4月至2014年8月期间收诊的90例脑梗死患者随机分成实验组和对照组.对照组给予奥扎格雷钠治疗,实验组给予奥扎格雷钠+黛力新治疗,3个月后观察两组在治疗前后的焦虑抑郁症状改善情况、日常生活能力、神经功能及预后效果.结果 治疗前,两组患者焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分无显著差异(P＞0.05),治疗3个月后,实验组SAS评分和SDS评分以及日常生活能力(MBI)、神经功能(CNS)评分均显著低于对照组(P＜0.01);实验组和对照组的总有效率分别为91.11％、73.33％,差异有统计学意义(P＜0.01).结论 奥扎格雷钠联合黛力新对脑梗死患者的焦虑和抑郁等负面情绪有良好的治疗效果,具有积极的临床意义.

Objective To analyze the pathogenic bacteria distribution,structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection,in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents.Methods A total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014.Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health.Drug sensitivity examination was done by Kirby-Bauer (k-b).Super-extensive spectrum β lactamase (ESBL) and methicillin resistant staphylococcus aureus (MRSA) were detected to analyze the bacterial species and resistance transition.Results A total of 864 samples were cultivated,in which G-bacteria accounted for 61.2％.The main pathogenic bacteria was Klebsiella pneumoniae bacteria,Escherichia coli,Pseudomonas aeruginosa,Acinetobacter baumanmii and Staphylococcus aureus.Imipenem had high antimicrobial activity to G-bacilli,especially to Escherichia coli and Klebsiella pneumoniae bacteria.Linezolid,vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus.Vancomycin resistant Staphylococcus aureus was not found.Ciprofloxacin had high antibacterial activity to Pseudomonas aeruginosa,while imipenem had low antibacterial activity to Pseudomonas aeruginosa.Amikacin had high antibacterial activity to acinetobacter.Conclusions G-bacilli are predominant in acute stroke complicated with pulmonary infection.ESBLs and MRSA detection rate is high,and we should pay attention to the rational use of antibiotics to reduce drug resistance.

目的 研究复发性脑出血的临床特征及预后,并提出相应的预防措施.方法 对2010年1月～2013年10月住院治疗的复发性脑出血患者的危险因素、复发间隔时间、服药情况等资料进行分析,并对幸存患者进行电话随访.结果 调查脑出血患者共1800例,其中复发性脑出血患者367例,有高血压病痛史201例;第1次出血到第2次出血时间以1年内复发率最高;复发时间最短1个月,最长达20年.再出血发生于对侧200例,同侧74例,病人未规律服药是诱发再出血的重要因素之一,服用抗血小板聚集药物后脑出血的复发率及死亡率比未服用抗血小板聚集药物的患者明显升高(P＜0.05).电话随访复发性脑出血367例,其中有67例因电话停机、空号等因素不能接通,12例接通后拒绝进一步回答并挂断电话,12例诉“电话打错了”.其余274例患者,经电话随访得知已有50例去世,45例日常生活不能自理,130例生活可自理,49例不详.结论 复发性脑出血病灶大多在首发病灶的对侧,病死率、致残率高,且再发与高血压关系密切,任何可能引起血压剧烈波动的原因都可能导致脑出血的再发,因此控制血压是防止复发性脑出血发生的关键,而提高患者的服药依从性至关重要,服用抗血小板聚集药物的获益与风险仍待进一步研究与探索.大多数患者生活态度乐观并坚持康复锻炼,肢体功能恢复良好,有一部分患者因再次出血后出现抑郁等不良情绪,对其终点事件(死亡)起到了推动作用;主要死因为脑疝形成、上消化道出血、肺部感染及心力衰竭.

自身免疫性溶血性贫血(AIHA)合并Guillain-Barré综合征(GBS)临床少见,现报告1例如下. 1 病例 女,12岁.因“双下肢无力8d”于2012年10月15日入院.患者2周前出现腹痛、头痛,按“感冒”治疗3d后缓解.8d前起出现双下肢无力,枕、腰部及大腿后部痛.到当地医院就诊,查血常规:WBC 12.6×109/L,RBC 3.1×1012/L,血红蛋白(HGB) 100 g/L;腹部B超:脾肋下6 cm;颈、腰椎及头颅MRI和肌电图检查均未见异常.予以“头孢噻肟钠”治疗3d无效,双下肢无力进行性加重.有AIHA 8年.查体:巩膜轻度黄染,脾肋下平脐.双侧鼻唇沟变浅,闭眼露白3mm,双上肢肌力Ⅳ级,双下肢肌力Ⅱ级,四肢腱反射(-),颈抵抗征(+),Brudzinski征(+),Kemig征(+);其他无异常.