Objective:To evaluate the safety and feasibility of catheter ablation in patients with atrial fibrillation(AF) and left atrial appendage(LAA) sludge.Methods:Patients with AF and LAA sludge who underwent catheter ablation were enrolled consecutively from 1st January, 2020 to 1st December, 2021 in Center of Atrial Fibrillation, Beijing Anzhen Hospital.The general clinical data, echocardiographic results, laboratory test results, drug therapy, catheter ablation and left atrial appendage occlusion(LAAO) were collected.Patients were followed up at 3, 6 and 12 months after the procedure by telephone or via outpatient service.We recorded the procedure-related complications both in-hospital and post-discharge, including death, thromboembolism, vascular access complications and so on.Results:Nine patients were included in the study, the average age was (68.8±10.2) years old, and eight were male.Nine patients were all diagnosed with persistent AF.The median duration of AF was 3(1, 5)years.The nine patients all achieved bilateral pulmonary veins electrical isolation and complete block of ablation lines.Among them, five patients underwent synchronous LAAO, there were no residual shunt and device translocations during operation.After a median follow-up of six months, there were no perioperative death, thromboembolism, vascular access complications, cardiac tamponade, atrial-esophageal fistula.Only one patient developed pericardial effusion, which was absorbed spontaneously.Conclusion:It may be safe and feasible for patients with AF and LAA sludge to undergo catheter ablation with/without synchronous LAAO.Further studies with larger patient cohort are warranted to confirm this conclusion.

目的 探讨电子巡视单在急诊脑血管病患者输液流程优化中对护理服务质量改善的效果.方法 前瞻性连续入组2020年1-12月在首都医科大学附属北京天坛医院急诊科进行静脉输液治疗的脑血管病患者.2020年6月在急诊护理个人数字助理(personal digital assistant,PDA)掌上电脑中增加巡视模块优化急诊输液流程,以此为节点,分为优化前流程组(2020年1-6月)和优化后流程组(2020年7-12月).采用自制问卷对两组患者的总体满意度、护理工作、业务水平、服务态度等进行调查和比较.结果 研究共纳入3000例患者,优化前流程组1400例,优化后流程组1600例.优化后流程组总体满意率高于优化前流程组(98.75％?vs?90.29％,P<0.0001);患者对护理工作(86.21±3.64分vs 85.84±5.47分,P<0.0001)和业务水平(87.24±3.70分vs?86.73±5.49分,P=0.0069)的评价均高于优化前流程组,但两组对护理服务态度的评价差异无统计学意义(85.27±3.42分vs?84.81±4.96分,P=0.4832).结论 基于电子巡视单的急诊脑血管病患者输液流程的优化,有利于急诊护理质量的提升,显著提高患者对护理的满意度,但仍需关注护理服务态度的提升,为患者提供更优质的护理.

目的 评估骨髓增生异常综合征(MDS)高危患者造血干细胞移植(HSCT)后绝望感及心理韧性,分析绝望感与心理韧性的关系.方法 选择2016年1月至2020年9月潞河医院骨髓移植病房拟行HSCT的120例MDS高危患者,分别于移植前、移植后1个月、移植后6个月评估患者的绝望感[使用Beck绝望感量表(BHS)评估]和心理韧性[使用心理韧性量表(RS)-14评估],观察患者绝望感和心理韧性的变化,并分析绝望感与心理韧性间的关系.结果 与移植前比较,移植后1个月、移植后6个月,MDS高危患者的BHS各维度评分和总分随移植时间延长逐渐降低,组内各时点比较差异有统计学意义(P<0.05);与移植前比较,移植后1个月、移植后6个月,MDS高危患者的RS-14各维度评分和总分随移植时间延长逐渐升高,组内各时点比较差异有统计学意义(P<0.05);经一般线性双变量Pearson直线相关性分析检验结果显示,MDS高危患者HSCT后BHS各维度评分、总分均与RS-14各维度评分、总分呈负相关(P<0.05).结论 MDS高危患者HSCT后绝望感逐渐减轻,心理韧性水平逐渐提升,患者绝望感与心理韧性间呈负相关.

目的 探讨医院内高钙血症的流行病学情况.方法 从首都医科大学宣武医院信息中心获取2011年全年住院患者信息,31 018例住院患者中,18 388例(59.3％)检测血钙;其中56例血钙值＞2.67 mmol/L,进一步分析高钙血症原因,从中筛出可疑原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者,对其进行随访,并复查血钙及血甲状旁腺素(parathyroid hormone,PTH),两次及以上高钙血症及高PTH(＞65 ng/L)者确诊为PtPT.结果 该院2011年住院患者高钙血症患病率为0.3％,56例高钙血症患者中,死亡6例(10.7％),拒绝复查及失访6例(10.7％),复查血钙和PTH结果正常9例(16.1％),实验室误差7例(12.5％),医源性高钙血症l例(1.8％),原因不明4例(7.1％),恶性肿瘤导致高钙血症13例(23.2％),PHPT7例(12.5％),慢性肾衰竭3例(5.4％).恶性肿瘤所致高钙血症中,肺癌所占比例最高[6例(46.1％)].该院住院患者中PHPT的患病率为38.1/10万.结论 该院住院患者高钙血症的最常见原因为恶性肿瘤,其次是PHPT.该院的住院患者高钙血症患病率与欧美的研究数据相近,而PHPT患病率却低于欧美报道,应重视PHPT的筛查.

目的 回顾性分析血液肿瘤患儿感染病原菌的分布情况及药敏结果,为合理抗感染治疗提供依据.方法 菌株来源为2016年1月1日至2017年6月30日首都医科大学附属北京儿童医院(我院)血液肿瘤中心因怀疑感染而送检、病原培养阳性且排除污染和定植的标本,分析病原菌的构成和耐药情况.药敏试验采用纸片扩散法或自动化仪器法,按照2014年美国临床实验室标准化委员会标准进行结果判定.结果 2095例次病原学培养阳性标本中共分离到病原菌2188株,革兰阴性菌1053株(48.1％)、革兰阳性菌837株(38.3％)、真菌298株(13.6％).革兰阴性菌中以肺炎克雷伯杆菌、铜绿假单胞菌、阴沟肠杆菌和大肠埃希菌为主要致病菌.革兰阳性菌以凝固酶阳性表皮葡萄球菌、人葡萄球菌和凝固酶阴性葡萄球菌多见.药敏情况:①耐甲氧西林葡萄球菌占革兰阳性菌的41.6％(348/837),以表皮葡萄球菌(84.9％,169/199)和人葡萄球菌(90.8％,129/142)为主,未检测到万古霉素、利奈唑胺和替加环素耐药菌株.②超广谱β内酰胺酶(ESBL)阳性菌占革兰阴性菌的31.9％(336/1053),以肺炎克雷伯杆菌(63.8％,134/210)和大肠埃希菌(92.8％,90/97)为主;碳青霉烯类耐药肠杆菌科细菌占革兰阴性菌的23.6％(248/1053),以肺炎克雷伯杆菌(63.8％,134/210)、大肠埃希杆菌(51.5％,50/97)和阴沟肠杆菌(34.5％,38/110)为主;肠杆菌科细菌对亚胺培南和美罗培南的耐药率均接近或超过50％,但对替加环素的耐药率为0.9％～13.4％,对阿米卡星的耐药率为10.0％～26.8％.③多重耐药、广泛耐药和全耐药鲍曼不动杆菌占全部鲍曼不动杆菌的32.6％(28/86).鲍曼不动杆菌对碳青霉烯类的耐药率为52.3％～58.1％,对多黏菌素的耐药率为1.2％.结论 血液肿瘤患儿合并感染以革兰阴性菌为主,耐药菌及条件致病菌检出率有增长趋势.

目的 探讨儿童急性淋巴细胞白血病化疗期间合并消化道穿孔的临床特点及治疗,以进一步减少该合并症的发生率及病死率.方法 总结2011年8月至2018年8月我院血液肿瘤中心收治的急性淋巴细胞白血病化疗期间合并消化道穿孔的病例,针对其病因、临床特点、治疗情况进行分析.结果 共有5例患儿在化疗期间出现消化道穿孔,均给予手术治疗,其中1例患儿术中未找到穿孔部位,术后死亡;1例于术后第6天死亡;1例患儿因经济原因放弃治疗;2例患儿术后经过积极抗感染、营养支持治疗及加强护理后继续完成化疗,随访无远期并发症,原发病无复发.结论 儿童急性淋巴细胞白血病并发消化道穿孔病情重、病死率高,早期诊断、选择适合时机手术、术后给予积极地抗感染及营养支持治疗是挽救患儿生命的有效手段.

目的 总结分析有家族史的视网膜母细胞瘤(RB)患儿临床发病特点,收集RB患儿家系谱情况,了解RB基因突变携带情况,进行遗传咨询探讨.方法 选取我院儿科2006年11月-2013年5月收治的1247例RB患儿中有明确RB家族史的41例患儿作为研究对象,无家族史1206例RB患儿作为对照组.对两组患儿的发病年龄、临床表现、实验室检查、治疗效果、家系谱遗传情况进行回顾性总结.统计分析两组RB患儿双眼发病情况,根据RB遗传模式分为3组:直接遗传、间接遗传、隐形嵌合体,分析研究组RB患儿的家系谱特点.结果 41例研究组RB患儿中单眼8例(19.5％),双眼33例(80.5％);中位发病年龄10.2个月;双眼发病率为80.5％.1206例无家族史RB患儿双眼发病率为31.5％(318例).具有明确家族史RB患儿双眼发病率高于无家族史RB患儿(X2=42.746,P=0.00).41例患儿中3例死亡,总体生存率为92.6％.RB患儿家系谱:直接遗传29例,间接遗传4例,隐形嵌合体8例.结论 有家族史RB患儿双眼发病率较无家族史患儿高;单眼发病、散发病例和家系谱中未发病的亲属都可能携带RB基因突变,对RB基因突变的筛查,有助于判断其子代患病风险性.

目的:探讨鼻饲管喂养与空肠管内营养支持治疗2种不同喂养方式对出血性脑卒中并发卒中相关性肺炎(SAP)患者预后的影响.方法:选取2015-01 2017-06在我科接受治疗的227例出血性脑卒中并发SAP患者作为研究对象,其中对照组99例,观察组128例,对照组患者给予鼻胃管喂养,观察组患者给予空肠管内营养支持治疗治疗.比较两组患者入院治疗前、治疗第7天、治疗第14天时的血红蛋白(Hb)、血清白蛋白(Alb)及总蛋白指标;采用美国国立卫生研究院卒中量表(NIHSS)、序贯性器官衰竭评估量表(SOFA)及格拉斯哥昏迷评分量表(GCS)对两组患者在不同时间点进行评估;记录并比较两组患者营养状况、并发症发生情况及疾病发展.结果:与治疗前比较,两组患者治疗第7天、第14天的Hb、Alb、总蛋白和体重水平均逐渐升高,差异有统计学意义(P＜0.05).治疗第7天时,观察组患者的Alb水平明显高于对照组,差异有统计学意义(P＜0.05);治疗第14天时,观察组患者的Hb、Alb、总蛋白及体重均明显高于对照组,差异有统计学意义(P＜0.05).治疗第7天、第14天时,两组NIHSS评分、SOFA评分及GCS评分比较,差异均无统计学意义(P＞0.05).对照组不良反应发生率为22.2％,观察组为11.7％,两组比较差异有统计学意义(P＜0.05).两组患者SAP治愈率、抗生素使用时间及住院时间比较,差异均无统计学意义(P＞0.05).结论:本研究中,相较于鼻胃管喂养,空肠管肠内营养支持治疗在改善出血性脑卒中并发SAP患者营养方面具有更好的效果,但2种营养方式对患者的预后影响无明显差异.

To investigate the value of GUSS on evaluating the timing for extubation of gastric tube in ischemic stroke patients with dysphasia. Methods One hundred and eighty ischemic stroke patients with dysphagia indwelling gastric tube from January 2017 to April 2018 in emergency department were admitted. Patients were randomly divided into three groups.Two observation group used 15≤GUSS＜20 or GUSS=20 as the indication of extubation of gastric tube separately, while the control group used drinking water test. The incidence of reintubation of the gastric tube ,neumonia and malnutrition were compared among three groups after 3 months. Results The incidence of reintubation of the gastric tube and pneumonia in 2 observation groups were lower than that of control group(P<0.05).There was no statistical difference in the rate of malnutrition among 3 groups. Conclusion GUSS was better than the water swallow test for evaluating the timing for extubation of gastric tube in ischemic stroke patients with swallowing disorders. The influence of different points of GUSS on the outcomes of extubation of gastric tube was not found in this study.

Objective To analyze the clinical data of trilateral retinoblastoma,and investigate the diagnosis, treatment and prognosis. Methods Four cases of TRB patients diagnosed in our hospital were retrospectively reviewed their clinical presentation, treatment, and outcome were described. Results Among the 4 cases of TRB, only 1 patient was familial. Binocular were involved in 3 patients, and uniocular in 1 patient. The para saddle occupied 1 case, the pineal body occupied 2 cases, and the sella region occupied 1 case. NSE were elevated in 3 patients and returned to normal after treatment. Two patients was treated standardizedly, including PECV chemotherapy protocol, and improved gradually, one patient obtained complete response (CR), and 1 patient obtained partial response (PR). The other 2 patients abandoned treatment. In the follow-up, of the 2 patients who survived with tumors, one obtained partial response, the other 1 obtained progressive disease. Conclusions Trilateral retinoblastoma is rare and prognosis is poor. PECV chemotherapy protocol was effective, but still needs to be further validated by increasing sample numbers.

Objective To investigate the clinical research on optimization of the green channel process in acute ischemic stroke for the emergency mode with seamless connection in hospital. Methods A total of 202 patients with acute ischemic stroke receiving green channel treated in emergency in our hospital from January 1, 2015 to November 30, 2015 were selected as the control group. Another 210 patients with acute ischemic stroke receiving green channel treated in emergency in our hospital from January 1, 2016 to November 30, 2016 were selected as the experimental group. The control group received the conventional green channel process of acute ischemic stroke, while the experimental group received the optimized emergency mode with seamless connection in hospital in acute ischemic stroke. The time from admission to intravenous thrombolysis, the time points of each key link, the satisfaction of doctors to nursing staffs, and the satisfaction of patients and families to nursing staffs between the two groups were compared to see whether there were any differences. Results Through optimizing the green channel process of acute ischemic stroke, the time from admission to intravenous thrombolysis for patients with acute ischemic stroke was continuously shortened (P<0.05); the time of each key link was decreased (P<0.05); thrombolysis rate got increased (P=0.020); the incidence of complications was reduced (P=0.006); and mortality reduced (P=0.009), which had significant differences. Conclusion Through optimizing the green channel process in acute ischemic stroke, the time from admission to intravenous thrombolysis was shortened and the satisfaction was improved, further improving the emergency mode with seamless connection in hospital.

Objective To investigated the risk factors for pediatric acute leukemia complicated with fungemia. Methods Pediatric acute leukemia patients with blood culture fungus positive from 01/2002 to 06/2014 were taken as fungemia group,from Oncology Center of Beijing Children's Hospital affiliated to Capital Medical University;While the control group included the patients with same in hospital time,same sex,without fungal infection history and fungemia happened. The sample size was 1:2 for fungemia group to control group. The data of age,morbid state( remission or not),relapse situation,in hospital time,using hormonal chemotherapy regimens or not,neutropenia time and degree,central venous indwelling catheter,using broad-spectrum antibiotics and accompanied with septicemia were collected. Single factor and multiple-factor analyses were used to investigate the risk factors for pediatric acute leukemia complicated with fungemia. Results There were 48 cases in fungemia group,male patients 38,median time of using chemotherapeutics was 98(3-300)d,median age was 5. 6(1. 4-13. 8)years. There were 96 cases in control group,male patients 64,median time of using chemotherapeutics was 201(4 -1 080)d,median age was 6. 7(1 -15) years. ① All 48 cases had fever in fungemia group,median time of fever duration time was 8. 6(1 -42)d. Median time from admitting to hospital to fungemia was 17. 6(1 ~115)d;② 5 cases were with fungal infection history(10. 4%);7 cases were complicated with organ function failur(14. 6%);10 cases with bacteria septicemia(20. 8%);11 cases died or giving up treatment (22. 9%).③ Cultivating result showed that in 17 cases both candida parapsilosis and tropicalis(35. 4%)were positive,in 8 cases candida albicans(16. 7%)positive,in 2 cases season and candida(4. 2%)positive,and candida glabrata,penicilium,fusarium and trichosporon asahii positive in one case respectively(2. 1%).④Single-factor analysis showed that morbid state(no remission),&nbsp;neutropenia time>7 days,neutropenia degree<0. 5 × 109 · L-1 ,using broad-spectrum antibiotics and complicating with other organs fungal infection were risk factors of pediatric acute leukemia complicated with fungemia. Multi-factor analysis showed that using broad-spectrum antibiotics was independent risk factors of pediatric acute leukemia with fungemia,OR=28. 3(95%CI:5. 9-136. 2). Conclusion The main pathogen agent of fungimia was candida,especially non-candida albicans. Using broad-spectrum antibiotics was an independent risk factor of pediatric acute leukemia with fungemia.

Objective To evaluate the marrow composition and microstructurechangesin animal model of steroid-induced avascular osteonecrosis of femoral head ( SANFH ) by estimating MR transverse relaxation.Methods Sixty pure-bred New Zealand rabbits were divided randomly into 5 groups,including a control group(n=8) and 4(M2w, M4w, M6w, M8w) experimental groups(n=13 × 4). Animal model was established according to the methods mentioned by Yamamoto. At the end of each experiment, MR was performed by GE Signa EXICITE scanner and the original transverse relaxation images were transferred to GE AW4. 2 workstations for the further data analysis using functool software. T2 , T2*values of the region of interest in the femoral head, metaphysis and marrow cavity were calculated, and the color-coded maps were created. Experimental animals were sacrificed and the femoral heads were collected for the followed histomorphological investigation.Results The actual sample size of the control group and the groups of M2w , M4w , M6w , M8w was 8 ( 16 hips ) , 10 ( 20 hips ) , 9 ( 18 hips ) , 9 ( 18 hips ) , 10 ( 20 hips ) . Statistical differences in T2 values(F=51. 601, P<0. 01), T2* values(F=36. 889, P<0. 01) were observed between the groups of M2w , M4w , M6w , M8w and control group in all anatomic femoral regions. The T2 and T2* values of the experimental groups were lower than the control group. This decreasing began at the initial stage of the modeling( M2w ) , reached the lowest point at M4w , and then rebounded in group of M6w and M8w. The T2(F=86. 274, P<0. 01), T2*(F=53. 172, P<0. 01) values were statistically different between the different anatomical regions. The T2 and T2*values of the femoral head area were higher than the metaphyseal and marrow cavity area. It was distinguished that both the amount and the size of fat cells increased in marrow and trabeculae, whereas the hematopoietic tissues decreased. Microthrombi in the arterioles and extravasation of erythrocytes were observed in the femora metaphysic at the earlier stage of the modeling. Such pathologic changes showed particular significance in group M4w . Then trabecular bone necrosis, inflammatory reaction and fibrosiswereobserved obviously in group of M6w and M8w . Conclusions Determination of MR transverse relaxation can sensitively reflect the bone marrow composition and microstructure changes in the SANFH models. This technique may have potential applications in the early diagnosis and monitoring the disease progression of SANFH.

Objective To explore the validity of the potential risk assessment table used for patients with severe cerebrovascular disease referred from EICU to ward observation room under intensive nursing care to assess the risk during the transition period.Methods There were two groups of patients with severe cerebrovascular disease referred to ward observation room from EICU (n =200 in each).The patients of first group admitted from January 2015 to June 2015 as a control group,and the patients of second group were admitted from July 2015 to December 2015 as a assessment group.The potential risk assessment table was developed by the Nurse Department in July 2015 based on three kinds of risky morbidity to be susceptible to in those patients and the specific nursing strategy was worked out to deal with these kinds of morbidity.Results Compare with control group,the success rate of resuscitation and patients' satisfaction were significantly higher in assessment group.The unexpected extubation,aspiration,lung infections,respiratory failure,the incidence of MODS,stress ulcer incidence in assessment group were lower than those in control group (P ＜0.01).Conclusions The risk assessment table is practicable and useful for patients with severe cerebrovascular disease referred from EICU to ward observation room under intensive nursing care in respects of early detection of patients condition deteriorated,saving the golden time for resuscitation,avoidance of morbidity,guarantee of nursing safety,improving the quality of nursing care and the degree of patients' satisfaction.

随着对室性早搏治疗效果的提高,室性早搏消除后,在心脏无器质性病变患者中发现其心功能及心脏腔径较治疗前恢复,因此,认为长期频发室性早搏激发和损害心脏功能可导致心肌病.本文就频发室性早搏对心功能的影响及其诱发心肌病的发病机制、致病相关因素及治疗作一综述.

目的:观察艾灸对血液透析中肌肉痉挛的预防治疗作用.方法:选取入组前12周在血液透析过程中发生过肌肉痉挛的患者共67例,分为治疗组与对照组,治疗前与治疗后两组均同时给予西医常规治疗方法,治疗期间治疗组加用艾灸防治方法,三个阶段各观察8周.比较两组患者治疗前、治疗中、治疗后血液透析过程中肌肉痉挛的发生率、缓解时间及疼痛程度.结果:使用艾灸治疗期间治疗组肌肉痉挛发生率、缓解时间及疼痛程度均较治疗前及同期对照组有明显改善(P＜0.05);治疗后治疗组肌肉痉挛发生率、缓解时间及疼痛程度与治疗期间相比,无显著性差异(P＞0.05),且明显优于治疗前及同期对照组(P＜0.05).结论:艾灸防治血液透析中肌肉痉挛有显著疗效.

目的 探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者心电图出现碎裂QRS波(fragmented QRS,fQRS)与心脏磁共振扫描(cardiac magnetic resonance,CMR)心肌延迟增强的相关性.方法 HCM患者141例,均行CMR及心电图检查.记录患者一般情况、家族史、超声心动图指标、心电图指标、CMR是否检出心肌延迟增强及部位,分析心电图fQRS与CMR检出心肌延迟增强的相关性.结果 141例心电图出现病理性Q波9例(6.4％),余132例心电图出现fQRS者52例(fQRS组)、未出现fQRS者80例(无fQRS组);fQRS组最大室壁厚度、E/A比值及HCM家族史、家族猝死史、伴束支阻滞、CMR检出心肌延迟增强比例与无fQRS组比较差异均有统计学意义(P＜0.05);HCM家族史、心电图伴束支传导阻滞及CMR检出心肌延迟增强是HCM患者心电图出现fQRS的独立危险因素.结论 HCM患者心电图fQRS与CMR检出心肌延迟增强相关,HCM患者心电图出现fQRS可能与早期心肌纤维化有关.

目的 通过运用核磁动态增强扫描(MRI-Dynamic contrast-enhanced scan)的成像方法,研究激素致兔股骨头缺血性改变模型的血流动力学改变,为SANFH早期诊断以及疗效评价提高无创、敏感的影像学方法.方法 健康成年纯种新西兰大耳白兔60只,采用随机区组抽样方法将不同体重的实验动物分入5组.正常空白对照1组(N组)、不同时相模型组(M组).参照Yamamoto的方法对M组进行造模处理.在每组实验结束时进行MRI动态增强扫描.采用Functool软件进行后处理,获得时间—信号强度曲线并计算出半定量参数.结果 各解剖区域M2、M4、M6、M8及N组处理组间早期强化指标、峰值强化指标及流出指标SS、Ee、Emax、Eslop、Tmax、Ewash、Vwash差异具有显著的统计学意义.结论 MRI动态增强扫描可以反映股骨头缺血的病理生理变化,提示股骨头缺血的微循环变化.MRI动态增强扫描早期强化指标、峰值强化指标及流出特征指标可敏感的反映激素对股骨头血流微循环的影响,为研究激素性股骨头缺血坏死骨质血供情况提供无创的功能影像学方法.

本指南对预测一个人发生首发卒中的风险的方案进行了评估.首发卒中的危险因素或者危险标识根据是否能被干预分类(不可干预的、可干预的和潜在可干预的),或者根据证据强度分类(证据充分和证据不充分).不可干预的险因素包括年龄,性别、低出生体重、种族和遗传易感性.证据充分并可干预的危险因素包括高血压、暴露于吸烟环境、糖尿病、心房颤动和某些其他心脏疾病、血脂异常,颈动脉狭窄,镰状细胞病、绝经后激素治疗、饮食不当、缺乏运动,肥胖和身体脂肪分布.证据不充分或者潜在可干预的危险因素包括代谢综合征、酗酒、滥用药物、口服避孕药、睡眠呼吸紊乱、偏头痛、高同型半胱氨酸血症,高脂蛋白(a)、高凝状态、炎症和感染.本指南还对使用阿司匹林预防首次卒中的数据进行了回顾,针对各种危险因素,提出了减少卒中风险可采取的策略.本指南综述了各种已经明确和近期明确的危险因素的证据,对2006年的指南进行了完整的修订.新版指南涉及的范围更加广泛.2006年指南着重于缺血性卒中的预防,由于危险因素和预防措施的重叠,本指南新加了出血性卒中的预防,并将重点放在以患者为本的个体化卒中预防.

(上接第8期第670页) 2 证据充分的可干预危险因素 2.1 高血压高血压既是脑梗死的危险因素,也是脑出血(intracerebral hemorrhage, ICH)重要的危险因素.血压和卒中之间存在强烈的、连续的、分级别的、一致的和独立的相关性,而且是有预测意义以及病因学意义的.