Objective To explore the effect of preoperative dual antiplatelet therapy assisted mechanical thrombectomy in the treatment of acute ischemic stroke（AIS）. Methods 150 cases of AIS patients were divided into two groups, with 75 cases in each group.The control group received mechanical thrombectomy, and the observation group received preoperative regular dual antiplatelet therapy combined with mechanical thrombectomy. The therapeutic effect, neurological function, vascular patency and prognosis were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group, the NIHSS scores at 1 d, 3 d and 14 d after treatment were lower than those of the control group, the vascular patency rate and collateral compensation rate were higher than those of the control group, and the reocclusion rate, rebleeding rate and mortality rate were lower than those of the control group（P ＜0.05）. Conclusions Preoperative dual antiplatelet therapy assisted mechanical thrombectomy in the treatment of AIS has good effect, which can promote the recovery of neurological function, improve the vascular patency rate and improve the prognosis of patients.

目的 探讨替罗非班辅助血管内支架取栓对急性基底动脉闭塞脑卒中病人预后的影响.方法 选取2018年7月—2019年7月我院收治的急性基底动脉闭塞脑卒中病人172例,随机分为对照组与联合组,每组86例.两组病人均行常规治疗,对照组采用血管内支架取栓治疗,联合组采用替罗非班联合血管内支架取栓治疗.采用散射比浊法检测血小板聚集率(PAgT)、血小板黏附性(PAdT);采用酶联免疫吸附法检测神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平;采用格拉斯哥昏迷量表(GCS)、美国国立卫生研究院卒中量表(NIHSS)检测病人昏迷程度及神经功能受损程度;根据临床症状评价临床疗效及不良反应发生情况.结果 治疗后,联合组PAgT、PAdT、NGF、BDNF水平及NIHSS评分均较对照组降低,GCS评分较对照组升高,差异均有统计学意义(P<0.05).联合组治疗总有效率高于对照组,差异有统计学意义(P<0.05).结论 替罗非班辅助血管内支架取栓治疗急性基底动脉闭塞脑卒中,能提高病人自理能力,促进术后快速恢复,降低手术风险.

目的 观察曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死的临床效果.方法 选择2019月12—2021年12月南阳市中心医院接收的106例急性脑梗死患者,随机分为对照组和治疗组,每组各53例.对照组予以注射用阿替普酶0.9 mg/kg,在超声引导下给药,先静推10％,60 s内结束,剩余静脉滴注,60 min内结束,依照超声监测结果可适当调整剂量,治疗1次,溶栓后继续予以常规治疗至2周.治疗组在对照组基础上静脉滴注曲克芦丁脑蛋白水解物注射液,10 mL融于250 mL生理盐水混匀,1次/d,持续应用2周.观察两组患者临床疗效,比较治疗前后两组患者美国国立卫生研究院脑卒中量表(NIHSS)和改良Rankin量表(MRS)评分,脑血流动力学指标平均血流速度(Vm)、舒张末期血流速度(Vd)和收缩期峰值血流速度(Vp)水平,以及膜联蛋白A2(Annexin A2)、同型半胱氨酸(Hcy)和血管内皮生长因子(VEGF)水平.结果 治疗后,治疗组临床总有效率(90.57％)较对照组(75.47％)明显升高(P<0.05);治疗后,两组NIHSS评分、MRS评分均较治疗前显著降低(P<0.05),且治疗组较对照组降低更明显(P<0.05).治疗后,两组大脑中动脉(MCA)的Vm、Vd、Vp均较治疗前显著升高(P<0.05),且治疗组较对照组升高更显著(P<0.05).治疗后,两组患者Annexin A2、VEGF水平均较治疗前明显升高,而Hcy水平均较治疗前明显降低(P<0.05),且治疗组患者Hcy、Annexin A2、VEGF水平明显好于对照组(P<0.05).结论 曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死可调节Annexin A2、Hcy、VEGF水平,改善脑血流动力学,发挥良好神经保护作用,改善疗效及预后.

目的:基于神经调节蛋白(NRG)/表皮生长因子受体(ErbB)信号通路探讨三七总皂苷(TSPN)对偏头痛大鼠的保护机制.方法:将SD大鼠随机分为对照组、模型组、TSPN(10 mg/kg)组和TSPN(10 mg/kg)+NRG/ErbB信号通路抑制剂AG825(50μg/kg)组(TSPN+抑制剂组),每组12只.给药1周后,模型组、TSPN组和TSPN+抑制剂组大鼠用2 mL硝酸甘油溶液(剂量为10 mg/kg)皮下注射建立偏头痛模型,对照组相同部位注射等体积的生理盐水.各组进行行为学评分;苏木精-伊红(HE)染色检测脑组织神经元形态;酶联免疫吸附分析(ELISA)检测血清中一氧化氮(NO)、白细胞介素6(IL-6)和IL-1β水平,以及脑组织中5-羟色胺(5-HT)、β-内啡肽(β-EP)和降钙素基因相关肽(CGRP)含量;Western blot法检测脑组织中NRG1、ErbB2、ErbB3、ErbB4、caspase-3和cleaved caspase-3蛋白水平.结果:模型组神经元空泡状明显,细胞萎缩、坏死严重,出现局部坏死、血管阻塞现象;TSPN组神经元得到一定修复,仅存在部分空泡现象;TSPN+抑制剂组细胞空泡现象明显,出现部分血管阻塞现象.与对照组相比,模型组在0～30 min、60～90 min和120～150 min中行为学评分,血清中NO、IL-6和IL-1β水平,脑组织中CGRP含量,以及脑组织中cleaved caspase-3/caspase-3蛋白水平显著升高(P<0.05),脑组织中5-HT和β-EP含量及NRG1、ErbB2、ErbB3和ErbB4蛋白水平显著降低(P<0.05);与模型组相比,TSPN组上述指标有所缓解,耳红出现时间延长(P<0.05),耳红消失时间缩短(P<0.05);与TSPN组相比,NRG/ErbB信号通路抑制剂AG825逆转TSPN对上述指标的缓解.结论:TSPN可能通过激活NRG/ErbB信号通路实现对偏头痛的缓解.

Abstract Introduction: Mechanical thrombectomy (MT) has become part of the standard treatment for patients who have acute ischemic stroke due to large-vessel occlusion in the anterior cerebral circulation. But the safety and effectiveness of MT for posterior cerebral artery (PCA) is still controversial. Patient concerns: We report a 40-year-old man with a medical history of hypertension who was non-compliant with the treatment. He presented to the hospital with right extremity paralysis, aphasia, and left gaze paralysis due to the occlusion of left PCA P2 segment (National Institutes of Health Stroke Scale Score 16). Head computed tomography showed infarction area of left temporal lobe and occipital lobe. Diagnosis: A head computed tomography angiography examination showed left PCA P2 segment occlusion. Interventions: The patient underwent MT and subsequent angiography showed left PCA P2 segment occlusion was recanalized after MT. Outcomes: The patient's symptoms improved completely after MT. Conclusion: The clinical symptoms due to PCA P2 segment occlusion may be mistaken clinically for MCA stroke syndrome, which may lead to severe functional deficit. MT seems to be safe and effective in treating PCA P2 segment occlusion.

目的:分析丁苯酞氯化钠注射液治疗脑梗死后失语患者的效果.方法:选择南阳市中心医院于2019年1月至2020年2月收治的110例脑梗死后失语的患者作为研究对象,通过抽签的方法将所有患者随机分为两组,其中对照组(55例),实施常规方式治疗,观察组(55例),在对照纽患者治疗基础上增加丁苯酞氯化钠注射液治疗,分析两种治疗方法的临床效果.结果:治疗前,观察组患者的美国国立卫生研究院脑卒中量表(NIHSS)评分与对照组比较,差异无统计学意义(P＞0.05);治疗后,观察组患者的NIHSS评分低于对照组,差异具有统计学意义(P＜0.05).治疗前,观察组患者的失语指数(AQ)评分与对照组比较,差异无统计学意义(P＞0.05);治疗后,观察组患者的AQ评分高于对照组,差异具有统计学意义(P＜0.05).观察组患者的治疗总有效率为94.55％,高于对照组的74.55％,差异具有统计学意义(P＜0.05).结论:患者在发生脑梗死后失语时,对其增加使用丁苯酞氯化钠注射液治疗能够有效提升治疗效果,可以及时改善相关临床症状,有利于患者疾病的康复.

目的 探讨丁苯酞对急性脑梗死(ACI)重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后HT的影响.方法 将80例ACI患者按照入院时间分为对照组(rt-PA静脉溶栓+常规治疗)和观察组(rt-PA静脉溶栓+常规治疗+丁苯酞)各40例.对比两组治疗有效率,治疗前后炎性指标、血管内皮功能指标,HT发生率.结果 相比于对照组,观察组治疗总有效率更高(P＜0.05)治疗后,观察组IL-6、TNF-α水平低于对照组(P＜0.05);治疗后,观察组NO水平高于对照组,ET-1水平低于对照组(P＜0.05);治疗后,观察组HT发生率显著低于对照组(P＜0.05).结论 rt-PA静脉溶栓治疗基础上,给予丁苯酞注射液,可显著改善患者IL-6、TNF-α、NO、ET-1,降低出血性转化发生率,疗效显著.