目的 探究康复训练联合纳美芬对重型颅脑损伤急性期脑血管痉挛的治疗效果及对ET-1、NO的影响.方法 选择2015年1月～2017年12月在本院救治的重型颅脑损伤患者74例作为研究对象,按随机数字表法分为对照组和观察组,每组各37例,对照组采用常规治疗联合康复训练,观察组在对照组基础上予以纳美芬治疗,连续治疗2周,比较两组患者治疗期间脑血流速度、脑血管痉挛(cerebral vasospasm,CVS)发生情况、格拉斯哥昏迷评分(glasgow coma scale,GCS)、内皮素-1(endothelin-1,ET-1)及一氧化氮(nitric oxide,NO)的含量、Fugl-Meyer量表评分(fugl-meyer assessment,FMA)以及Barthel指数评定量表(barthel index,BI)评分.结果 经治疗后两组患者颅内各血管血流速度均明显下降,且观察组各血流速度明显低于对照组(P<0.05),观察组CVS发生率明显低于对照组(P<0.05),经治疗后观察组GCS评分明显高于对照组(P<0.05),观察组脑脊液ET-1水平明显低于对照组,NO含量明显高于对照组(P<0.05),经治疗后,两组患者FMA、BI评分均明显改善,但观察组患者改善更显著(P<0.05).结论 康复训练联合纳美芬对重型颅脑损伤患者可有效减轻脑组织的继发性损伤,有良好的脑保护作用,减少脑血管痉挛的发生,促进意识的恢复,降低脑脊液ET-1水平,提高NO水平,提高患者生活自理能力.

癫痫是中枢神经系统常见疾病之一,严重危害人类健康.大约30％的癫痫患者通过现有抗痫药物的治疗仍然不能得到有效控制,因此神经调控方法,如迷走神经刺激、深部脑刺激和经颅磁刺激等成为人们关注的焦点.基于无创、无痛、有效、操作方便等多重优点,经颅磁刺激逐渐被应用于癫痫患者的诊断和治疗方面.本文就经颅磁刺激在癫痫疾病的诊断和治疗两方面的内容进行综述,总结其最新研究进展,并指出其存在的不足与缺陷,为今后癫痫的诊断和治疗制订优化和个性化的经颅磁刺激方案.

目的 观察不同参数的重复经颅磁刺激(rTMS)对大鼠血清中脑源性神经营养因子(BDNF)的影响.方法 Sprague-Dawle大鼠共 54只,分为 Sham组(n= 18)、1 Hz rTMS组(n= 12)、10 Hz rTMS组(n= 12)和间断θ节律性刺激(iTBS)组(n = 12).根据刺激强度,即静息运动阈值(rMT),分为 Sham组、低强度组(80％rMT)和高强度组(120％rMT)进行实验,每组各 6只.按照预先设定的参数进行 rTMS持续刺激大鼠前额皮质 5 d,并应用酶联免疫吸附试验(ELISA)检测大鼠血清中 BDNF水平的变化.结果 低强度 1 Hz rTMS组 BNDF表达显著高于Sham组,差异有统计学意义(P＜ 0.05).而高强度 1 Hz rTMS组与 Sham组比较,差异无统计学意义(P＞ 0.05).Sham组、低强度 10 Hz rTMS和高强度 10 Hz rTMS组 BDNF水平比较,差异无统计学意义(P＞ 0.05).高强度iTBS组血清中 BNDF表达明显低于 Sham组,差异有统计学意义(P＜ 0.05).而低强度 iTBS组与 Sham组比较,差异无统计学意义(P＞ 0.05).结论 强度是影响rTMS效果的重要因素,不同模式的 rTMS对 BDNF的效果随强度的不同而变化.

In recent years,the incidence of stroke in China has been increasing year by year,and the neural function defect caused by it has seriously affected the quality of life of the patients.Repetitive transcranial magnetic stimulation (rTMS),as a new method of rehabilitation,is widely used in the neurological rehabilitation of stroke patients.rTMS can generate magnetic field by a coil to regulate brain excitability and maintain interhemispheric excitatory balance,promoting the repair of the injured cortex and improving the neurological function.However,different stimulus programs have different effects,high-frequency transcranial magnetic stimulation can increase cortical excitability,while low frequency stimulation reduces cortical excitability,so for different functions of nerve injury after stroke(movement disorders,cognitive disorders,difficult swallowing etc.),rTMS treatment plans are correspondingly different.In the future,more effective and safer treatment should be further explored.

焦虑障碍是现今最为常见的精神障碍之一,严重影响患者的生活质量[1].尽管目前有众多治疗方法用于改善焦虑障碍,包括药物治疗、心理疗法以及认知行为治疗等,但仍约有25％患者治疗无效[2].研究发现,焦虑障碍患者脑内存在紊乱的神经回路或异常的皮层兴奋区域[3],调节这些神经回路或皮层兴奋性成为治疗焦虑障碍的关键.重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)通过线圈产生磁场,直接作用于大脑皮层,促进皮层产生感应电流,从而改变皮层兴奋性,并调节突触可塑性,以改变脑内紊乱的神经连接[4].研究发现,高频刺激(频率>3Hz)往往能够增加皮层兴奋性,而低频刺激(频率≤1Hz)可降低皮层兴奋性[5].针对不同类型的焦虑障碍,rTMS治疗方案及疗效不尽相同.本综述总结rTMS治疗焦虑障碍的分子机制,阐述不同治疗方案的临床疗效,为焦虑障碍的临床治疗提供新思路.

目的 探讨重复经颅磁刺激(rTMS)治疗对焦虑症患者的血清脑源性神经生长因子(BDNF)和抑制性神经递质γ-氨基丁酸(GABA)的影响.方法 选取28例焦虑症患者给予低频重复经颅磁刺激治疗,治疗10 d.于治疗前后,分别测定患者的BDNF浓度和GABA水平,并评定汉密尔顿焦虑量表(HAMA).结果 治疗后患者HAMA评分较治疗前降低(P<0.05),治疗后患者血浆BDNF、GABA浓度均较治疗前升高(P<0.05).血浆BDNF变化与血浆GABA变化呈正相关(P<0.05).血浆BDNF变化与HAMA评分差值呈负相关(P<0.05);血浆GABA变化与HAMA评分差值呈负相关(P<0.05).结论 重复经颅磁刺激治疗改善焦虑症症状可能是通过提升脑内BDNF水平,进而促进脑内GABA释放来实现.

Objective To investigate the effect of the location of middle cerebral artery (MCA) occlusion on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke.Methods The consecutive patients with stroke of acute MCA occlusion treated with rtPA intravenous thrombolysis within 4.5 h after onset were included.The locations of MCA occlusion were divided into either a proximal MCA segment (proximal M1 segment) or a distal MCA segment (distal M1 segment,M2 segment and more distally).Early neurological improvement was defined as National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline or NIHSS 0 point at 24 h after thrombolysis.They were divided into a good outcome group (0-2) and a poor outcome group (3-6) according to the modified Rankin Scale (mRS) scores.Results A total of 70 patients with MCA occlusion were enrolled in the study,including 22 (31.4％) with proximal MCA occlusion and 48 (68.6％) with distal MCA occlusion;52 (74.3％) with good outcome and 18 (25.7％) with poor outcome.The proportion of atrial fibrilhtion (x2 =4.541,P =0.033),the NIHSS scores on admission (t =5.192,P =0.026) and 24 h after thrombolysis (t =5.365,P =0.024) in the proximal MCA occlusion group were higher than those in the distal MCA occlusion group.The proportion of early neurological improvement in the proximal MCA occlusion group was significantly lower than that in the distal MCA occlusion group (x2 =9.434,P =0.002),and the incidence of symptomatic intracranial hemorrhage (x2 =9.563,P =0.002)and the mortality rate within 7 d (x2 =14.491,P ＜0.001) were significantly higher than those in the distal MCA occlusion group.The time from onset to thrombolysis (t =6.346,P =0.014),NIHSS scores on admission (t =4.498,P =0.038) and at 24 h after thrombolysis (t =4.866,P =0.028),and the proportion of proximal MCA occlusion (x2 =18.710,P ＜0.001) in the poor outcome group were significantly longer or higher than those in the good outcome group.Multivariatelogistic regression analysis showed that the proximal MCA occlusion (odds ratio [OR] 14.385,95％ confidence interval [CI] 2.525-81.925;P =0.003),longer time from onset to thrombolysis (OR 12.927,95％ CI 2.624-61.748;P =0.002),higher NIHSS score at 24 h after thrombolysis (OR 3.492,95％ CI 1.027-11.880;P=0.045) were the independent predictors for poor outcome at 90 d.Conclusions There are differences in the outcomes after intravenous thrombolysis in patients with MCA occlusion at different locations.The locations of MCA occlusion,time from onset to thrombolysis,and NIHSS score at 24 h after thrombolysis,and age are the independent predictors for the outcomes after intravenous thrombolysis in patients with acute MCA ischemic stroke.