Background: Patients with neurocritically illness are an under-recognized population at high risk of sepsis. We aimed to investigate the prevalence, early predictors, and outcomes of sepsis in neuro-ICU. Methods: Daily and accumulative incidences of sepsis in neuro-ICU were explored. Demographics, medical history, baseline disease severity scores, and baseline biomarkers regarding inflammation, immunology, organ function, and nutritional status were collected and analyzed as potential predictors of sepsis. Logistic regression analyses were used to determine the independent predictors, and a nomogram was used to estimate the individual probability of sepsis in neuro-ICU. Results: 153 patients were included in this study. Fifty-nine (38.6%) patients developed sepsis, and 21 (14%) patients developed septic shock. More than 86% of the septic cases occurred within the first week. Sequential organ failure assessment score ((relative risk) RR 1.334, P = .026), history of diabetes (RR 2.346, P = .049), and transferrin (RR 0.128, P = .042) on admission are independent predictors of sepsis. Septic patients had significantly higher mortality (P = .011), higher medical cost (P = .028), and a lower rate of Conclusions: Sepsis afflicted more than one-third of neurocritically-ill patients and occurred mostly in the first week of admission. History of diabetes, serum transferrin, and sequential organ failure assessment score on admission were early predictors. Sepsis led to significantly worse outcomes and higher medical costs. (c) 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Patients with severe stroke are at high risk of developing acute respiratory distress syndrome (ARDS), but this severe complication was often under-diagnosed and rarely explored in stroke patients. We aimed to investigate the prevalence, early predictors, and outcomes of ARDS in severe stroke. This prospective study included consecutive patients admitted to neurological intensive care unit (neuro-ICU) with severe stroke, including acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The incidence of ARDS was examined, and baseline characteristics and severity scores on admission were investigated as potential early predictors for ARDS. The in-hospital mortality, length of neuro-ICU stay, the total cost in neuro-ICU, and neurological functions at 90 days were explored. Of 140 patients included, 35 (25.0

Background:Inflammatory mechanisms play important roles in intracerebral hemorrhage (ICH) and have been linked to the development of stroke-associated pneumonia (SAP). The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) are inflammatory indexes that influence systemic inflammatory responses after stroke. In this study, we aimed to compare the predictive value of the NLR, SII, SIRI and PLR for SAP in patients with ICH to determine their application potential in the early identification of the severity of pneumonia.Methods:Patients with ICH in four hospitals were prospectively enrolled. SAP was defined according to the modified Centers for Disease Control and Prevention criteria. Data on the NLR, SII, SIRI and PLR were collected at admission, and the correlation between these factors and the clinical pulmonary infection score (CPIS) was assessed through Spearman's analysis.Results:A total of 320 patients were enrolled in this study, among whom 126 (39.4%) developed SAP. The results of the receiver operating characteristic (ROC) analysis revealed that the NLR had the best predictive value for SAP (AUC: 0.748, 95% CI: 0.695-0.801), and this outcome remained significant after adjusting for other confounders in multivariable analysis (RR=1.090, 95% CI: 1.029-1.155). Among the four indexes, Spearman's analysis showed that the NLR was the most highly correlated with the CPIS (r=0.537, 95% CI: 0.395-0.654). The NLR could effectively predict ICU admission (AUC: 0.732, 95% CI: 0.671-0.786), and this finding remained significant in the multivariable analysis (RR=1.049, 95% CI: 1.009-1.089, P=0.036). Nomograms were created to predict the probability of SAP occurrence and ICU admission. Furthermore, the NLR could predict a good outcome at discharge (AUC: 0.761, 95% CI: 0.707-0.8147).Conclusions:Among the four indexes, the NLR was the best predictor for SAP occurrence and a poor outcome at discharge in ICH patients. It can therefore be used for the early identification of severe SAP and to predict ICU admission.

Abstract Background Inflammatory mechanisms play important roles in intracerebral hemorrhage (ICH) and have been linked to the development of stroke-associated pneumonia (SAP). The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory index that reflects systemic inflammatory responses after stroke. In this study, we aimed to evaluate the predictive value of the NLR for SAP and ICU admission in patients with ICH.Methods Patients with ICH in four hospitals were prospectively enrolled. Data on the NLR were collected at admission, and the correlation between these factors and the clinical pulmonary infection score (CPIS) was assessed through Spearman’s analysis. Outcomes at discharge were collected and assessed by the modified Rankin scale (mRS). Propensity score matching (PSM) analysis was used to compare outcomes between the groups.Results A total of 320 patients were enrolled in this study, among whom 126 (39.4%) developed SAP. A total of 176 patients were enrolled in the PSM cohort, among whom 66 (37.5%) developed SAP. The results of the receiver operating characteristic (ROC) analysis revealed that the NLR had predictive value for SAP in both the original cohort (AUC: 0.748, 95% CI: 0.695–0.801) and PSM cohort (AUC: 0.657, 95% CI: 0.575–0.739). The NLR also predicted ICU admission in both the original cohort (AUC: 0.732, 95% CI: 0.671–0.786) and the PSM cohort (AUC: 0.646, 95% CI: 0.563–0.723). The NLR remained significant after adjusting for other confounders in the multivariable analysis in both the original cohort (adjusted OR = 1.090, 95% CI: 1.029–1.155, P = 0.003) and PSM cohort (adjusted OR = 1.057, 95% CI, 1.004–1.113, P = 0.034). Spearman’s analysis showed that the NLR was correlated with the CPIS in both the original cohort (r = 0.537, 95% CI: 0.395–0.654) and PSM cohort (r = 0.504, 95% CI: 0.292–0.669). ROC curve analysis also showed that the NLR predicted poor outcomes at discharge in both the original cohort (AUC: 0.761, 95% CI: 0.707–0.815) and the PSM cohort (AUC: 0.584, 95% CI: 0.500–0.670).Conclusions A high NLR value at admission predicted SAP in patients with ICH, and the best cutoff value was 6.06. The NLR also contributed to predicting severe SAP and ICU admission. Patients with higher NLR levels had higher in-hospital mortality and poorer outcomes at discharge.

脑和肾的生理病理交互现象在神经危重症患者的诊疗过程中不容忽视.神经危重疾病常常可因中央自主网络受损、神经内分泌系统紊乱、炎症和免疫反应激活等原因导致肾功能障碍,进而引起电解质紊乱、多种器官功能障碍、休克等一系列严重并发症;同时亦可通过多种途径进一步加重脑组织损伤.中医学理论认为,神经危重症患者多合并"虚、瘀、浊、毒",从而极易引起气化不利、气滞水停、毒损肾络、虚损及肾,最终导致肾脏受损.神经危重症患者肾功能损伤后,病邪内生、五脏虚损、脑髓失养等虚实病机相互夹杂,反过来促使颅脑损伤进一步加重.本文旨在从中西医理论角度阐述神经重症患者脑与肾之间生理病理的交互关系,以期为防治神经重症患者肾功能障碍提供研究思路及理论指导.

OBJECTIVE:This study was undertaken to characterize the blood-brain barrier (BBB) dysfunction in patients with new onset refractory status epilepticus (NORSE) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).METHODS:This study included three groups of adult participants: patients with NORSE, encephalitis patients without status epilepticus (SE), and healthy subjects. These participants were retrospectively included from a prospective DCE-MRI database of neurocritically ill patients and healthy subjects. The BBB permeability (Ktrans) in the hippocampus, basal ganglia, thalamus, claustrum, periventricular white matter, and cerebellum were measured and compared between these three groups.RESULTS:A total of seven patients with NORSE, 14 encephalitis patients without SE, and nine healthy subjects were included in this study. Among seven patients with NORSE, only one had a definite etiology (autoimmune encephalitis), and the rest were cryptogenic. Etiology of encephalitis patients without SE included viral (n = 2), bacterial (n = 8), tuberculous (n = 1), cryptococcal (n = 1), and cryptic (n = 2) encephalitis. Of these 14 encephalitis patients without SE, three patients had seizures. Compared to healthy controls, NORSE patients had significantly increased Ktrans values in the hippocampus (.73 vs. .02 × 10-3 /min, p = .001) and basal ganglia (.61 vs. .003 × 10-3 /min, p = .007) and a trend in the thalamus (.24 vs. .08 × 10-3 /min, p = .017). Compared to encephalitis patients without SE, NORSE patients had significantly increased Ktrans values in the thalamus (.24 vs. .01 × 10-3 /min, p = .002) and basal ganglia (.61 vs. .004 × 10-3 /min, p = .013).SIGNIFICANCE:This exploratory study demonstrates that BBBs of NORSE patients were impaired diffusely, and BBB dysfunction in the basal ganglia and thalamus plays an important role in the pathophysiology of NORSE.

Abstract Background Neurocritically ill patients are at high risk of developing acute respiratory distress syndrome (ARDS), but related studies are still scarce. We aimed to investigate the prevalence, early predictors, and clinical outcomes of ARDS in in the neurological intensive care unit (NICU). Methods This prospective study included consecutive patients in the NICU. The incidence of ARDS was examined, and baseline characteristics were investigated as potential early predictors for ARDS. The in-hospital mortality, length of NICU stay, total cost in NICU, and neurological functions at 90 days were explored. Results Of 165 NICU patients included, 41 (24.8%) developed ARDS (29 [71%] were moderate to severe ARDS). 88% of ARDS cases occurred within one week of admission. NUTRIC score (RR 1.246 95% CI 1.003–1.550, p = 0.047) and PaO2/FiO2 (RR 0.985, 95% CI 0.979–0.992, p < 0.001) on admission were independent associated with ARDS, and high BNP (RR 0.995, 95% CI 0.992–0.998, p = 0.001) was a red flag biomarker warning that the respiratory symptoms may be caused by cardiac failure rather than ARDS. ARDS patients had longer stay (13.8 ± 8.2 vs 10.8 ± 7.3 days, P = 0.029) and higher expenses (51001 ± 29787 vs 34811 ± 29897 Chinese YUAN, P = 0.003) in NICU, compared to non-ARDS patients. None of the NICU patients with moderate to severe ARDS had a favorable outcome at 90 days. Conclusions ARDS is common in NICU, with most cases occurring in the first week of admission. NUTRIC score and PaO2/FiO2 on admission are early predictors of ARDS. ARDS worsens both short-term and long-term outcomes.

神经重症是一门新兴学科,如何在该学科发挥中医药的作用仍处于探索中.笔者结合自身实践经验,依照前人"十问歌"形式,新编撰"神经重症十问歌",具体内容如下:"一问寒热二问汗,三问头身四问便,五问痰食六胸腹,七(气)促八躁俱当辨,九因舌脉察虚实,十要听声异象连,监护波形均了解,神志肢体当优先.凡见异常必有妖,即辨即除重症消".目的在于对神经重症科诊疗过程中常见的十余方面进行中西医学的解读,寻找共通之处,对中西结合神经重症诊疗提纲挈领,初步建立中西医结合神经重症的诊疗体系,指导初学者之应用.

通过对粤北部分县级中医院的现状进行调研,发现存在的问题.针对如何破解县级中医院定位方向、发展动力、学科建设和人才培养等难题,提出了通过明确县级中医院定位,利用经济杠杆,加强党建文化建设,发掘现有设备和人力潜力、建设大科主任领导下的小型亚专科制度等一些具体纾困措施,并将其应用于实践,取得了良好成效.

中枢神经系统感染(CNSI)是指各种生物病原体侵犯中枢神经系统实质、被膜及血管等引起的急性或慢性炎症性(或非炎症性)疾病,其临床症状表现复杂、多样、无特异性.中医古籍缺乏对本病的全面认识,中医学关于本病的归属观点繁杂,其中医病名缺乏统一的认识.本文从CNSI的临床表现和中医病因病机特点的角度出发,结合与传统温病的异同,提出"脑温病"可作为本病的中医病名,旨在为CNSI确立中医学病名,促进该病中医临床研究的开展及辨证诊疗体系的建立.

基于现代医学脑保护原则及脑血流动力学特点,并结合中医对急性缺血性卒中(中风)的认识,采用传统医学表述方式提出现代临床诊治急性缺血性脑卒中的"脉定律"理念,即认为急性缺血性卒中的核心病机在于各种原因导致的脑脉缺血;"气血津液"与脑脉血供呈正相关关系,"痰瘀"是引起疾患或使之加重的病理因素,"气血津液"与"痰瘀"决定了血脉(血流)的充盈或不足.对于急性缺血性中风的临床治疗,益气活血、补液生津、化痰祛瘀为其基本治则.基于"脉定律"理念对急性缺血性脑卒中进行防治的"益气"原则主要体现为保持呼吸气道通畅、血氧供应及提高机体免疫能力,"活血"治疗原则主要体现为调整血压和改善血容量,"补液生津"治疗原则主要体现在维持正常血容量,"化痰"治疗原则主要体现在降脂稳斑与清理痰液以保持气道通畅,"祛瘀"治疗原则主要体现在溶栓、抗凝与预防静脉血栓事件以及改善微循环.

目的 探讨低颅压疗法治疗大面积小脑梗死的疗效与手术适应证.方法 采用回顾性研究方法,对用低颅压疗法治疗的8例小脑梗死患者的临床资料进行分析.结果 8例患者无1例死亡,6例入院时神志清醒的患者,出院时仍神志清醒,美国国立卫生研究院脑卒中量表(NIHSS)评分0～1分,改良Rankin量表(MRS)0～1分;2例入院时昏迷的患者,出院时1例转为嗜睡,另外1例仍为昏迷状态.结论 大面积小脑梗死病情较重,进展较快,一经明确诊断应密切观察病情变化,对于未波及脑干的小脑梗死采用低颅压疗法能取得较好的疗效.

中医学理论认为,卒中(即中风)的病因病机,主要以“风”“火”“痰”“气”“瘀”“虚”为主.随着近现代医学发展,目前中医脑病专家对卒中有一些新的认识:如病位在脑,且与心、肝、肾关系密切.情志内伤为其常见的诱发因素.风(肝风)、火(心火、肝火)、痰、瘀乃其重要的病理因素,常相兼互化,相互影响、互为因果等[1-4].本文从中西结合治疗中风临床实践过程得到一些认识,现总结如下.

近年来脑血管病已成为我国居民首要死亡原因,脑梗死作为脑血管病的常见病种,发病率和致残率高,颈动脉狭窄是导致脑梗死的独立危险因素[1].近年来颈动脉支架术(carotid artery stenting,CAS)由于其微创性已逐步被人们广泛接受,而脑过度灌注综 合 征(cerebral hyperperfusion syn-drome,CHS)作为其严重并发症之一,虽不常见,但一旦出现,很可能是灾难性的,有较高的病死率和致残率[2].分期支架成形术是近年来提出的预防CHS 的一种治疗方法,我中心自 2012年 7 月至 2017 年 6 月采用该治疗方式治疗颈动脉重度狭窄患者,取得良好的效果,现报告如下.

[目的]研究急性脑梗死超早期闭塞血管开通治疗前后的中医证候的变化特点,为脑血管再通治疗后中医临床治疗方案的制定奠定基础.[方法]以《中风病诊断与疗效评定标准》为依据,制定中风病证候诊断量表,收集29例接受了超早期闭塞血管介入开通治疗的急性脑梗死患者,分析患者接受治疗前及治疗后1d、3d、7d的临床证候特点.[结果]共纳入29例接受闭塞血管开通治疗的急性脑梗死患者,脑血管造影显示,以大脑中动脉闭塞为主,基底动脉闭塞次之.血管开通治疗前,患者的中医证候要素构成以风证居首位,痰证和血瘀证次之.经过开通治疗后,各类型中医证候要素的构成比均逐渐减少,其中风证减少最早也最明显,痰证、血瘀证和气虚证逐渐减少,差异有统计学意义(均P<0.05).到开通治疗后7 d,以痰证居多,血瘀证和气虚证次之.血管开通治疗前,以四证并见和三证并见居多,经开通治疗后,二证并见及一证独见的患者逐渐增多,在开通治疗后3 d和7 d,甚至出现了六证全无的患者.[结论]急性脑梗死患者经过超早期血管开通治疗后,中医证候特点由风痰瘀血相兼逐渐变成痰瘀阻络合并气虚;而且证候要素的组合由复杂逐渐变得简单.

目的:探讨祛风化痰、活血通络法联合耳穴压豆治疗风痰上扰夹瘀型脑卒中后失眠症的临床效果.方法:将85例风痰上扰夹瘀型脑卒中后失眠症患者随机数表法分为观察组(n=45)和对照组(n=40).对照组予西药联合耳穴压豆,观察组予祛风化痰、活血通络法联合耳穴压豆治疗.观察两组临床疗效、夜间睡眠时间,治疗前后以匹兹堡睡眠质量指数(PSQI)量表评定睡眠质量,Barthel指数评分评估日常生活能力,并评估安全性.结果:观察组临床总有效率显著高于对照组(P<0.05).治疗后观察组夜间睡眠时间>6 h的患者比例显著高于对照组,<3 h的患者比例显著低于对照组(P<0.05).治疗后两组PSQI评分、Barthel指数评分有显著差异(P<0.05).两组不良反应比较无统计学意义(P>0.05).结论:祛风化痰、活血通络法联合耳穴压豆治疗风痰上扰夹瘀型脑卒中后失眠症的临床疗效显著,可延长夜间睡眠时间,改善睡眠质量,提高日常活动能力.

Objective To compare long-term follow-up effect of stent implantation and drug therapy in treating moderate-severe symptomatic intracranial artery stenosis. Methods By using retrospective study,Kaplan-Meier analysis, Cox regression model and other statistical methods, the clinical data of 199 patients with moderate-severe symptomatic intracranial artery stenosis who received stent implantation or drug therapy were analyzed. The safety, effectiveness and short-term as well as long-term benefits were compared between the two therapies. Results The technical success rates of implantation of Apollo stent, Wingspan stent and Solitaire stent were 100%, 97.4% and 98.5% respectively. The instant residual stenosis were decreased from preoperative 70.2%±12.02%, 78.61%±12.15%, 78.44%±11.82% to postoperative 18.00%±6.33%, 23.65%±10.71% and 17.21% ±8.02% respectively. The perioperative complications in the stent group occurred in 9patients(8.5%), including perforating artery occlusion due to embolus falling off(n =4), acute thrombus formation(n =1), vasovagal reflex(n =2) and massive cerebral hemorrhage caused by reperfusion(n =1),and five days after the treatment artery-artery embolism event occurred in one patient. No statistically significant differences in the incidence and cumulative incidence of the primary end point events existed between the stent group and the drug therapy group(P=0.824,P=0.867). Conclusion In treating moderatesevere symptomatic intracranial artery stenosis, the use of Solitaire stent and Wingspan stent is very safe and effective, its long-term benefits are quite the same as drug therapy.

目的 探讨三维DSA技术在动脉瘤诊断和治疗中的应用价值.方法 88例蛛网膜下腔出血、脑梗死或头痛头晕查因的患者,行DSA检查确诊为动脉瘤,所有患者对载瘤血管行三维旋转造影,对动脉瘤分析测量并进行介入栓塞治疗.结果 三维造影可立体观察动脉瘤,清晰显示瘤体形态、瘤颈以及与周围血管的关系,88例患者动脉瘤均完全栓塞,效果良好.讨论 三维DSA技术可帮助介入医师全方位了解动脉瘤的情况,根据三维立体影像可选择最佳工作角度和介入材料,以及对微导管头端重塑最佳形态,对动脉瘤的治疗具有重要的指导意义.

为探讨DSA二维和三维图像测量技术在solitaire AB型支架治疗颅内动脉狭窄中的临床应用价值。对92例缺血性颅内动脉狭窄，行solitaire AB型支架治疗的患者，应用DSA图像测量技术对其颅内动脉进行测量和狭窄分析。测量结果准确，手术达到了良好的治疗效果。DSA图像测量技术对颅内动脉支架术具有重要的指导意义，可准确评估血管狭窄情况，对介入医师选择合适的扩张球囊和支架等介入材料起到了重要作用。

目的：探讨中西结合治疗脑动静脉畸形（AVM）破裂出血栓塞术后并发症的有效性及预后分析。方法回顾2012年1月至2014年2月收治的40例动静脉畸形破裂出血患者，行动静脉畸形栓塞术，围术期给予常规西医治疗，中医以中风及阴阳类证论治，23例接受中医治疗，17例未予中医治疗。分析术后6个月格拉斯哥预后评分（ GOS）评分，比较围术期并发症发生率及预后。结果采取中西医结合治疗可降低栓塞术后并发症发生率（P＜0.05），改善患者预后。结论中西结合治疗能减少AVM破裂出血栓塞术后并发症的发生率，改善患者预后。