缺血性脑卒中是指脑部的供血不畅,导致相应组织出现缺血、缺氧,最终该部位损伤,并出现一些相应临床的表现,常见的有偏瘫、失语等[1].多发于老年人,因其致残率相对较高,如何预防和降低该疾病的发生,改善预后,是我们医者时刻关注的问题.然而该疾病的发病机制复杂,临床表现多样,单纯使用药物对临床症状改善作用有限.针灸对于偏瘫患者肢体活动不利的疗效确切,可促进自身的修复和恢复[2].长期针刺非常考验患者的耐受力,所以在治疗的同时也要兼顾患者的情绪,适时给予精神上的鼓励.与此同时,如何在减轻患者精神的压力和肉体痛苦的前提下来提高针灸的治疗效果,是值得深究的问题.眼针只在眼睛局部针刺,针刺浅,取的穴位少而精,疗效确切,在治疗偏瘫后肢体活动不利已有相关报道[3].本研究拟观察眼针傍刺法联合中药化痰祛瘀方治疗卒中后偏瘫的临床疗效.

Objective: It is reported that miR-26a-5p could regulate neuronal development, but its underlying mechanisms in Alzheimer’s disease (AD) progression is unclear. Methods: APP (swe)/PS1 (ΔE9) transgenic mice served as AD mice. Morris water maze test was used to measure the spatial learning and memory ability of mice. The expressions of miR-26a-5p, DYRK1A, phosphorylated-Tau, Aβ40, and Aβ42 were detected. The relationship between miR- 26a-5p and DYRK1A was explored using dual luciferase reporter assay. The effects of miR-26a- 5p on AD mice was determined. Results: AD mice walked a lot of wrong ways to find the platform area and the latency time to reach the platform was longer. There was low expression of MiR-26a-5p in AD mice. Overexpression of miR-26a-5p inhibited Tau phosphorylation and Aβ accumulation. MiR-26a-5p negatively regulated DYRK1A via targeting its 3’UTR. In vivo, increased miR-26a-5p down-regulated Aβ40, Aβ42, p-APP and p-Tau levels in AD mice through decreasing DYRK1A. Meanwhile, the swimming path and the latency time, to reach the platform, was shorten after enhancing miR-26a-5p expression. Conclusion: Overexpression of miR-26a-5p could repress Tau phosphorylation and Aβ accumulation via down-regulating DYRK1A level in AD mice.

通过查阅大量国内外文献研究资料,系统地综述了近年来中医在治疗脑卒中后失眠的研究进展.从中药、针灸以及其他中医治疗手段着手,详细阐述中药辨证疗法的历史来源、病因病机及治疗药物,针灸疗法中众多特色针法及灸法的治疗形式,以及推拿、浴足、耳穴压豆、穴位埋线、中药药氧、五行音乐、中药药枕等多种中医特色疗法.查阅文献显示:中医在治疗卒中后失眠方面具有不可替代的作用,中药、针灸及其他多种中医特色治疗手段在改善卒中后失眠方面疗效显著,并且减少卒中的二次发生率,进而提高患者的生活质量.

目的:观察滋水涵木方联合多巴丝肼片对肝肾亏虚型帕金森患者认知功能及血清炎性因子的影响,为临床治疗帕金森患者认知功能提供有效治疗方法.方法:将73例肝肾亏虚型帕金森患者随机分为治疗组37例与对照组36例,对照组给予多巴丝肼片口服,治疗组在对照组基础上给予滋水涵木方加减,治疗90 d,观察两组治疗前后帕金森病评定量表(U PDRS)、蒙特利尔认知评估量表(M oCA)、中医证候积分表、日常生活能力量表(ADL)、血清炎性因子IL-1β、IL-2、IL-6、神经营养因子-3(N T-3)等.结果:①治疗组完全缓解率为29.7％,总缓解率为91.8％;对照组完全缓解率为11.1％,总缓解率为80.5％,两组在缓解率方面比较(P<0.05);② 两组治疗后帕金森病评定量表(UPDRS)、蒙特利尔认知评估量表(MoCA)、中医证候积分表、日常生活能力量表(ADL)对比,两组对比治疗组优于对照组(P<0.05);③两组治疗后IL-1β、IL-2、IL-6、N T-3方面对比(P<0.05).结论:滋水涵木方联合多巴丝肼片对肝肾亏虚型帕金森患者认知功能有确切疗效.

目的:观察整脊推拿结合中药化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块的的效果及安全性.方法:伴有颈动脉斑块的颈源性眩晕患者按随机数字表法分为两组,对照组45例采用基础治疗联合中药化痰祛瘀方,观察组43例在对照组基础上结合整脊推拿干预,治疗后统计比较两组眩晕指征和血脂改善情况.结果:治疗后两组患者眩晕、耳鸣、恶心欲呕、头痛、视力障碍、猝倒发作、颈项不适、反应迟钝等症状的恢复率比较,差异有统计学意义(P＜0.01);治疗结束后观察组的总有效率为95.35％,明显优于对照组的77.78％,差异有统计学意义(P＜0.05);疗程结束后两组患者血脂均较治疗前有所改善(P＜0.05),观察组中的总胆固醇(TC)、低密度脂蛋白(LDL)明显低于对照组,高密度脂蛋白(HDL)明显高于对照组,差异均有统计学意义(P＜0.05),但三酰甘油(TG)和对照组比较差异无统计学意义(P＞0.05).结论:整脊推拿结合化痰祛瘀方治疗颈源性眩晕伴颈动脉斑块,在改善眩晕相关指征和血脂方面疗效较好.

目的:观察刺激悬雍垂对卒中后吞咽障碍患者呛咳状态和进食速度的影响.方法:脑卒中后吞咽障碍急性期患者70例随机分为观察组和对照组,均采用VitalStim低频电刺激辅助咽三针,观察组再加刺激悬雍垂法,均1次/d,每部位每次3～5下,诱发咽反射.治疗2周后,观察和记录患者的呛咳状态和进食速度改善情况.结果:两组吞咽功能均较治疗前有所改善,观察组疗效优于对照组(P＜0.05).结论:在卒中合并吞咽障碍的急性期患者中,采用刺激悬雍垂法,对于改善呛咳状态和进食速度有良好的临床效果.

目的 观察验证中药化痰祛瘀方联合脑超声治疗对颈动脉斑块的改善效果.方法 将120例颈动脉斑块患者随机分组为观察组(阿托伐汀+超声治疗+化痰祛瘀方)和对照组(阿托伐汀+超声治疗),足疗程治疗后对比两组治疗后的效果.结果 观察组和对照组的患者颈动脉斑块测量值和血脂指标均有明显改善,且观察组的疗效明显优于对照组(P＜0.05).治疗后观察组斑块的内膜-中层厚度和长径明显小于对照组,观察组的总胆固醇和低密度脂蛋白低于对照组(P＜0.05),高密度脂蛋白高于对照组(P＜0.05),甘油三酯没有显著差异(P＞0.05).结论 中药化痰祛瘀方联合脑超声治疗的疗效明显优于对照组,可以明显改善颈动脉斑块患者的斑块测量值和血脂指标,对于甘油三酯并没有明显改善.

Objective: To observe the clinical effect of Huatan Quyu Recipe combined with psychological counseling in the treatment of stable angina pectoris of coronary heart disease. Method: 87 patients with coronary heart disease with stable angina pectoris were randomly divided into two groups. 44 patients in the control group were treated with psychological counseling on the basis of symptomatic treatment of western medicine, and 43 patients in the treatment group were treated with traditional Chinese medicine Huatan Quyu Recipe. Result: After treatment, angina symptoms, electrocardiogram and blood lipids ( TC, TG, LDL, HDL) were significantly improved in both groups ( P ＜ 0. 05). Between groups, TC and LDL were significantly lower in the treatment group than in the control group, HDL was significantly higher than the control group ( P ＜ 0. 05), but there was no difference of TG between the treatment group and the control group ( P＞ 0. 05). Conclusion: Huatan Quyu Recipe combined with psychological counseling for the treatment of stable angina pectoris of coronary heart disease can significantly improve myocardial ischemia and blood lipid levels in patients, and effectively reduce the occurrence of angina pectoris.

Objective:To evaluate the efficacy of Huatan Quyu decoction in treatment of isch function defect score to determine the efficacy ,and statistical analysis .Methods :The control group was treated with routine west-ern medicine ,the treatment group ,in addition to plus conventional therapy of western medicine to Huatan Quyu de-coction .After treatment of two groups of patients with clinical curative effect ,the degree of neural control group was 73% .There were significant differences between the two groups ,the experimental group was better than the control group .After the treatment of the two groups of patients with NIHSS scale scores were compared ,there were signif-icant differences between the two groups ,the experimental group was better than the control group .Results :The total effective rate of the experimental group was 93% ,and the emic stroke recovery period .Conclusion :The effect of Huatan Quyu decoction can significantly improve symptoms of ischemic cerebral stroke patients ,improve the quality of life of patients ,reduce the disability rate .

为加快中医临床专科人才培养,提高中医医疗机构中医药服务能力和水平,陕西省开展了中医临床专科人才培训,作为中医脑病临床专科人才培训承办单位,我们在此次培训过程中进行了大胆的教学改革尝试,更深刻的理解了中医脑病临床专科人才培养的意义.

目的 观察醒脑解郁胶囊对卒中后抑郁患者的临床疗效及对NEI网络的影响.目的 60例卒中后抑郁患者随机分为治疗组及对照组,治疗组口服醒脑解郁胶囊,对照组口服黛力新,两组均给予脑卒中基础治疗,在治疗前及治疗8周后分别进行疗效评价、安全性指标及NEI网络指标检测.结果 两组患者治疗后NIHSS评分、BI指数及HAMILTON抑郁量表评分较治疗前均有一定改善(P＜0.05),两组间比较无显著性差异(P＞0.05);两组治疗前后安全性指标检测均正常;治疗前,两组NEI网络指标均存在一定程度的紊乱,治疗组治疗后DA、NE、ACTH、CD4+、CD4+/CD8+、IL-2、-EP均较治疗前升高,CD8+、IL-6较治疗前下降,且与对照组相比有统计学差异(P＜0.05).结论 醒脑解郁胶囊治疗卒中后抑郁疗效与黛力新相当,无明显不良反应,且对NEI网络有一定调节作用.

目的:评价耳穴贴压对脑卒中患者和脑卒中高危人群的预防效果,为社区脑卒中防治管理提供参考依据.方法:在陕西省泾阳县城关区选择脑卒中患者100人和脑卒中高危人群150人,将脑卒中患者和高危人群再按照干预类别分组,治疗组在对照组一般西医管理的基础上加用耳穴贴压干预.结果:脑卒中患者经耳穴治疗,其血糖、血压、低密度脂蛋白等指标下降更为明显,与干预前相比有明显差异(P＜0.05),两组间对比,耳穴治疗组仅在血压达标人数上明显优于对照组(P＜0.05),其余指标与对照组相比无明显差异.针对脑卒中高危人群开展的一级预防中,耳穴治疗组在血糖、血压及体重指数的控制上都较干预前有明显下降(P＜0.05),两组间对比,脑卒中高危人群耳穴贴压组的血糖达标人数、血压达标人数、舒张压、胆固醇及体重指数等指标改善程度优于对照组(P＜0.05).结论:耳穴贴压可有效改善患者血压、血糖、血脂等脑卒中高危因素,用于脑卒中一、二级预防效果显著.

笔者有幸跟随导师闫咏梅教授门诊,导师运用天麻钩藤饮加减治疗脑血管常见疾病如头痛、眩晕、不寐等,疗效满意.介绍如下. 1 头痛(血管性头痛) 刘某,女,45岁.2个月前无明显诱因出现头痛,以前额及颞顶部明显,疼痛呈跳动感,偶有口干、口苦,烦躁少寐,二便正常,舌边尖红苔黄,脉弦细.TCD示脑供血不足.诊断为头痛(肝阳上亢证).治宜平肝熄风,补益肝肾,清热止痛.方用天麻钩藤饮加减.天麻10g,钩藤10g(后下),石决明20g(先煎),杜仲10g,川牛膝10g,桑寄生10g,焦栀子10g,黄芩8g,远志10g,茯神12g,川芎12g,葛根12g,郁金10g.7剂,日1剂,水煎400mL,分早晚两次空腹温服.

探讨醒脑解郁胶囊在中风后遗症患者肢体功能康复训练中的疗效观察,方法应用:搜集住院病人80例分为治疗组、对照组,治疗组给予"醒脑解郁胶囊联合肢体功能康复训练",对照组给予肢体功能康复训练,治疗一月.结果 治疗组总有效率89.92%,对照组66.75%,醒脑解郁胶囊联合肢体功能康复训练的治疗方法明显优于单纯肢体功能康复训练法,值得临床推广应用.

中风是常见的急性脑血管疾病,其病因不外风、火、痰、虚、血、气六端,其发作则以风、火、痰、瘀标实为主,张建夫教授在前人认识的基础上,认为缺血性中风中痰瘀互结是其病机之关键,辨证用药应以化痰祛瘀为主,并创立化痰祛瘀汤辨治缺血性中风,取得较为良好的的疗效.