目的 观察醒脑开窍针刺法联合通窍化栓汤对脑梗死患者氧化应激反应、脑血流动力学的影响.方法 收集北京中医药大学孙思邈医院2020年4月-2022年4月收治的脑梗死患者80例,随机分为对照组40例,醒脑开窍针刺法、治疗组40例,醒脑开窍针刺法+通窍化栓汤,两组均进行基础治疗,评估治疗效果,测量治疗前及治疗后患者脑内血流动力学、脑损伤标志物及氧化应激指标水平,对比日常生活自理能力及神经损伤情况.结果 治疗后治疗组大脑(前动脉、中动脉、后动脉)平均血流速度、总有效率、血清超氧化物歧化酶(Superox-ide dismutase,SOD)、日常生活能力量表(Activity of Daily LivingScale,ADL)评分显著高于对照组,丙二醛(malond-ialdehyde,MDA)、神 经元特异性烯 醇化酶(neuron specific enolase,NSE)、星形胶质源 性蛋白(Soluble protein-100β,S100β)、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分显著低于对照组(P＜0.05).结论 给予脑梗死患者醒脑开窍针刺法联合通窍化栓汤治疗可显著改善其脑血流动力学及氧化应激反应,恢复患者生活自理能力.

目的 通过多重生物信息学分析探索非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)与缺血性脑卒中(ischemic stroke,IS)共病的潜在机制.方法 根据纳入标准,从GEO数据库中分别下载NAFLD、IS高通量芯片数据集并进行预处理.利用加权基因共表达网络分析(weighted gene co-expression network analysis,WGCNA)分别对NAFLD、IS各自数据集构建共表达网络,进一步筛选与NAFLD、IS临床特征具有相关性的模块和基因,对NAFLD和IS潜在的共病基因进行富集分析,通过CytoNCA初步筛选NAFLD、IS共病的关键基因.用mirTarBase等数据库预测NAFLD与IS共病关键基因的相关微小RNA(miRNA),用Enrichr数据库预测NAFLD与IS关键性共病关键基因的相关转录因子(transcription factors,TF),构建miRNA-TF-mRNA调控网络.用DSigDB数据库预测与NAFLD、IS共病基因相关的药物分子.结果 NAFLD与IS有86个潜在共病基因,GO功能富集分析显示NAFLD与IS共病基因主要参与炎症反应、固有免疫反应、适应性免疫反应等生物过程;KEGG分析显示NAFLD与IS共病基因主要参与细胞因子-细胞因子受体相互作用、细胞粘附分子信号通路.通过CytoNCA插件初步筛选出BTLA、CCR7、POU2AF1等13个NAFLD与IS共病的关键基因;miRNA-TF-mRNA调控网络显示NAFLD与IS的关键性共病基因是BTLA、CCR7、POU2AF1,关键共病miRNA是hsa-miR-335-5p,关键共病TF是NR1H3;最后,维生素D3、阿托伐他汀可能作为针对NAFLD与IS共病的常见药物.结论 在生物学机制上,NAFLD与IS共病可能主要与作为关键基因的BTLA、CCR7、POU2AF1,以及作为关键miRNA的hsa-miR-335-5p和作为关键TF的NR1H3协同调控密切相关.而在临床上,维生素D3与阿托伐他汀可能作为针对NAFLD与IS共病的主要治疗药物.

目的 观察通络化痰方治疗前循环脑梗死急性期(风痰阻络证)的疗效及对血流动力学指标的影响.方法 将170例前循环脑梗死急性期(风痰阻络证)患者以随机数字表法分为观察组与对照组各85例.对照组予西医常规治疗,观察组在对照组治疗基础上采用通络化痰方.7 d为1个疗程,治疗2个疗程后观察神经功能疗效和中医证候疗效,比较两组治疗前后的主要症状评分、血液流变学指标和美国国立卫生院神经功能缺损评分(NIHSS)、纤维蛋白原(FIB)水平、简化Fugl-Meyer运动功能量表(FMA)和Barthel指数(BI)评分.结果 观察组神经功能总有效率为85.88％,明显高于对照组的69.41％(P＜0.05).观察组中医证候总有效率为94.12％,明显高于对照组的78.82％(P＜0.05).观察组治疗后7、14d的半身不遂、口舌歪斜、言语謇涩、舌苔白腻症状评分明显低于对照组(P＜0.05),全血高切黏度、全血低切黏度、FIB水平及NIHSS、FMA、BI评分明显优于对照组(P＜0.05).结论 对急性前循环脑梗死患者采用通络化痰方,疗效良好,有助于改善主要症状和血液流变学指标,促进神经功能和运动功能恢复,提高生活质量.

目的 观察应用谷红注射液联合阿替普酶治疗对急性脑梗死患者血清相关因子水平的影响.方法 选取2018年2月至2021年2月该院收治的96例急性脑梗死患者作为研究对象,根据治疗方法不同分为谷红注射液联合阿替普酶治疗组(联合治疗组)和阿替普酶单独治疗组(单独治疗组),每组各48例,统计分析两组患者血清相关因子水平、神经功能缺损程度、日常生活活动能力、预后、临床疗效、不良反应发生情况.结果 联合治疗组患者治疗后血清肿瘤坏死因子-α、血管内皮生长因子、内皮素-1水平均低于单独治疗组,差异均有统计学意义(P<0.05).联合治疗组患者治疗后美国国立卫生研究院卒中量表评分、改良Rankin量表评分均低于单独治疗组,Barthel指数量表评分高于单独治疗组,差异均有统计学意义(P<0.05).联合治疗组患者治疗总有效率为97.92％,高于单独治疗组的77.08％,差异有统计学意义(P<0.05).联合治疗组和单独治疗组患者不良反应发生率均为6.25％,差异无统计学意义(P>0.05).结论 应用谷红注射液联合阿替普酶治疗较阿替普酶单独治疗能更有效降低急性脑梗死患者血清相关因子水平,改善患者神经功能、预后及日常生活活动能力,提升临床疗效,且不会增加不良反应.

目的 探讨补阳还五汤加减治疗气虚血瘀型脑梗死的临床效果及对患者凝血-纤溶功能和miR-151a-3p、miR-210表达的影响.方法 选取2017年6月至2020年6月收治的86例气虚血瘀型脑梗死患者,采用抽签法以单双号形式随机将其分为对照组(43例,常规西药治疗)和观察组(43例,常规西药+补阳还五汤加减治疗).比较两组的治疗效果.结果 观察组的治疗总有效率为95.35％,明显高于对照组的81.40％(P<0.05).治疗后,观察组的PT、APTT长于对照组,t-PA水平高于对照组,PAI-1水平低于对照组(P<0.05).治疗后,观察组的miR-151a-3p水平低于对照组,miR-210水平高于对照组(P<0.05).结论 补阳还五汤加减治疗气虚血瘀型脑梗死的临床效果显著,可提高患者凝血-纤溶功能,并有效改善miR-151a-3p、miR-210表达情况,值得临床推广应用.

目的 观察曲克芦丁脑蛋白水解物联合补阳还五汤合虫藤饮对急性脑梗死患者炎性反应介质和神经功能的影响.方法 选取2018年5月—2020年5月北京中医药大学孙思邈医院收治的206例急性脑梗死患者,按随机平行分组法分为对照组与观察组各103例,对照组患者给予临床常规治疗及曲克芦丁脑蛋白水解物静滴,观察组在对照组治疗基础上联合应用补阳还五汤合虫藤饮治疗,2组均连续治疗2周.观察2组患者治疗前后美国国立卫生院卒中评分(NIHSS)、中医症状积分、血清炎症相关因子[超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、细胞黏附分子-1(ICAM-1)、肿瘤坏死因子-α(TNF-α)水平]变化情况,并观察2组治疗后效果.结果 治疗后2组NIHSS评分及中医症状积分均较治疗前明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);治疗后2组hs-CRP、IL-1β、ICAM-1、TNF-α水平均明显下降(P均<0.05),观察组各炎性反应介质水平明显低于对照组(P均<0.05);观察组治疗总有效率为90.3％(93/103),明显高于对照组的77.7％(80/103),差异有统计学意义(P<0.05).结论 曲克芦丁脑蛋白水解物联合补阳还五汤合虫藤饮对急性脑梗死患者进行治疗能明显降低炎性反应介质水平,促进患者神经功能恢复,疗效确切.

Abstract Background: Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI. Methods: The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation. Results: The work of this research will be published in peer-reviewed scientific journals. Conclusion: The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI. Registration: INPLASY2021100065.

BACKGROUND:Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI.METHODS:The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation.RESULTS:The work of this research will be published in peer-reviewed scientific journals.CONCLUSION:The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI.REGISTRATION:INPLASY2021100065.

目的 探讨急性缺血性脑卒中(AIS)合并糖尿病患者糖化血红蛋白(HbAlc)、同型半胱氨酸(Hcy)、血脂水平[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]及神经功能状况,为其临床预防和治疗提供指导.方法 选取2017年5月至2019年5月期间北京中医药大学孙思邈医院脑病科确诊的55例AIS合并糖尿病患者作为研究组,55例AIS患者作为对照1组,同期在我院体检的健康人员55例作为对照2组,比较三组受检者入院后的HbA1c、Hcy和血脂水平,并对患者入院时和入院14 d后采用美国国立卫生院神经功能缺损评分表(NIHSS)和入院14 d后的改良RINKIN量表(mRS)评估患者的神经功能.结果 研究组患者的Hcy、HbAlc水平明显高于对照1组和对照2组,对照1组患者的Hcy、HbAlc水平又明显高于对照2组,差异均有统计学意义(P<0.05);研究组患者的TC、TG、LDL水平明显高于对照1组和对照2组,对照1组患者的TC、TG、LDL水平又明显高于对照2组,差异均有统计学意义(P<0.05);研究组患者的HDL水平明显低于对照1组和对照2组,对照1组患者HDL水平明显低于对照2组,差异均有统计学意义(P<0.05);研究组患者入院时和入院14 d的NIHSS分别为(15.34±4.05)分、(10.32±3.23)分、入院14 d的mRS为(1.68±0.34)分,明显高于对照1组的(14.54±6.12)分、(7.38±3.70)分、(1.08±0.40)分,差异均有统计学意义(P<0.05).结论 AIS合并糖尿病患者HbA1c、Hcy水平明显升高,神经功能缺损程度较重,血脂水平也会发生明显改变,HbA1c、Hcy、血脂水平检测及神经功能状况评估对AIS合并糖尿病患者的临床诊断和治疗具有重要意义.

目的 探讨胃癌合并糖尿病患者血清胰岛素样生长因子-1(IGF-1)和胰岛素样生长因子结合蛋白-3(IGFBP-3)的变化及其临床意义.方法 选取2017年3月至2018年12月间收治的100例胃癌患者,按照是否合并糖尿病进行分组,其中,合并糖尿病的55例患者纳入糖尿病合并胃癌组,未合并糖尿病的45例患者纳入单纯胃癌组,比较两组患者的血清IGF-1和IGFBP-3水平.结果 糖尿病合并胃癌组IGF-1和IGFBP-3阳性率显著较单纯胃癌组高,差异均有统计学意义(均P＜0.05).糖尿病合并胃癌组IGF-1和IGF-1/IGFBP-3水平显著高于单纯胃癌组,差异均有统计学意义(均P＜0.05),两组患者IGFBP-3组间比较,差异无统计学意义(P＞0.05).糖尿病合并胃癌组空腹血糖、餐后2h血糖和糖化血红蛋白显著高于单纯胃癌组,差异均有统计学意义(均P＜0.05).IGF-1与IGFBP-3呈正相关,差异有统计学意义(P＜0.05).将以上影响因素纳入多因素分析,结果表明,IGF-1、IGFBP-3、IGF-1/IGFBP-3、空腹血糖和糖化血红蛋白是糖尿病合并胃癌发生的危险因素,差异均有统计学意义(均P＜0.05),餐后2h血糖对糖尿病合并胃癌发生无明显影响,差异无统计学意义(P＞0.05).结论 IGF-1和IGFBP-3均参与糖尿病合并胃癌疾病发生过程,其值对于预测病情发展具有一定作用.

目的 探讨血管生成素样蛋白2(Angiogenin-like protein 2,ANGPTL2)在大鼠缺血/再灌注后脑损伤过程中的炎症保护机制.方法 选择健康雄性Wister大鼠60只,建立大鼠局灶性脑缺血/再灌注损伤模型,随机分为假手术组和ANGPTL2组.建模后6,12,24,48和72 h后,采用实时定量PCR(real-time quantitative PCR)以及苏木精-伊红染色法(hematoxylin-eosin,HE)检测每组大鼠体内ANGPTL2的表达水平.在建模48h后分别记录每组大鼠的神经功能评分,检测其脑组织含水量、血脑屏障(blood brain barrier,BBB)通透性以及脑梗死体积.采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)在建模前(T0)、建模后2 h(T1)、建模后6 h(T2)、建模后12 h(T3)和建模后24h(T4)分别检测大鼠血清中S-100β、肿瘤坏死因子-α(tumornecrosisfactorα,TNF-α)和白细胞介素-1(interlenkin-1,IL-1)的表达水平.结果 在缺血30和90 min中的ANGPTL2组再灌注6,12,24,48和72 h的ANGPTL2 mRNA表达水平均高于假手术组.ANGPTL2组大鼠的脑组织含水量、伊水思蓝含量和脑梗死体积均显著低于假手术组,而神经功能评分高于假手术组,差异均有统计学意义(t=2.431～6.058,均P＜0.05).相较于T0,大鼠在T1时的S-100B显著增加,随着建模时间的延长,S-100β水平逐渐降低,并且与T0的差异均有统计学意义(t=2.346～3.649,均P＜0.05).相较于T0,ANGPTL2组大鼠在T1,T2,T3,T4时血清中的TNF-α和IL-1水平均显著升高,且差异具有统计学意义(t=5.036～9.775,均P＜0.05).结论 ANGPTL2可以降低大鼠局灶性脑缺血/再灌注后血脑屏障的通透性,并减轻脑血管炎症反应,对脑缺血/再灌注损伤具有保护作用.

Objective To investigate the influence factors of serum stimulating hormone levels and coronary atherosclerosis in postmenopausal women.Methods During January 2015 to January 2016 in our hospital,300 cases of healthy postmenopausal women were selected to study,to collect the general clinical data and blood biochemical index,300 patients were divided into the health group (n =272) and the coronary atherosclerosis (n =28).To compare the general data of the two groups,and analyze serum thyroid hormone levels and related factors the general index of correlation and influence of serum thyroid hormone level,and regression analysis in healthy postmenopausal women's risk of coronary atherosclerosis risk factors by univariate and multivariate logistic.Results The TSH,age,SBP,fasting blood glucose,total bilirubin,total cholesterol,high-density lipoprotein,low density lipoprotein and triglyceride in coronary atherosclerosis group were significantly higher than those in healthy group(t =4.953,3.459,3.242,4.553,6.075,4.263,4.563,3.562,5.035,P=0.000,0.015,0.026,0.004,0.000,0.002,0.001,0.012,0.000).;the serum TSH levels were positively correlated with age,triglycerides (r=0.148,0.169,P =0.020,0.008),and negatively correlated with high density lipoprotein (r=-0.145,P =0.024);multiple regression analysis showed that age,high density lipoprotein and triglycerides significantly effected serum TSH levels (P＜0.05);multivariate logistic regression analysis showed that age and TSH levels are risk factors of coronary atherosclerosis in healthy postmenopausal women (OR=1.109,1.304,95％CI:1.024-1.197,1.024-1.678,P=0.013,0.034).Conclusion The healthy postmenopausal women with increased serum thyrotropin levels significantly increased risk of coronary atherosclerosis,it was worthy of clinical attention.

Objective To investigate the clinical effect of compound Danshen dropping pills therapy in patients with congestive hearts failure, and to analysis its effect on the plasma pro-BNP. Methods Ninety-two patients with congestive hearts failure were randoly divided into control group and observation group, each group 46 cases. The control group were treatment by routine western medicine, and the observation group were treatment by compound Danshen dropping pills 10 pills one time, 3 times one day, one course of the treatment of each group is six months . Then observed and recorded the level of the plasma pro-BNP before and one, three, six months after treatment, the clinical effect and the adverse reaction . Results In the control group,six months after treatment, the level of the plasma pro-BNP was significantly lower than that before treatment, a statistically significant difference . In observation group, three and six months after treatment, these levels of the plasma pro-BNP were significantly lower than those before treatment, and also significantly lower than those in the control group, a statistically significant difference . Six months after treatment, the total efficacy rates of the observation group (91.3%) was significantly higher than that in the control group (76.1%), a statistically significant difference . Conclusion Compound Danshen dropping pills can effectively reduce the level of the plasma pro-BNP, enhance the clinical effect, safe and reliable.

Objective:Toanalyze the difference of plasma lipoprotein associated phospholipase A2 (LP-PLA2) and matrix metalloproteinase-9 (MMP-9) levels in patients with different severity of coronary artery disease and the impact of percutaneous coronary intervention (PCI),investigating the role and clinical significance of two inflammatory factors in the occurrence and development of coronary artery disease.Methods:150 patients with acute coronary syndrome (ACS),128 patients with stable angina pectoris (SAP) and 100 healthy subjects were divided into ACS group,SAP group and control group.The plasma levels of MMP-9 and LP-PLA2 were compared between the three groups,and changes of plasma MMP-9 and LP-PLA2 levels before and after PCI treatment were compared in the ACS group.Results:Compared with the control group,the plasma MMP-9 and LP-PLA2 levels in the SAP and the ACS group were significantly higher (P ＜ 0.05);and compared with the SAP group,those of the ACS group were significantly higher (P ＜ 0.05).Compared with preoperative,the plasma MMP-9 and LP-PLA2 levels in the ACS group were significantly lower (P ＜ 0.05).There was a significant positive correlation between MMP-9 and LP-PLA2 in the ACS group (r=0.617,P ＜ 0.05),and no correlation in the SAP group and the control group (P ＞ 0.05).Conclusions:Plasma MMP-9 and LP-PLA2 levels may be correlated with the severity of coronary artery disease,which have some clinical values in predicting ACS high risk population and evaluating the curative effect.

Objective It is to observe the clinical curative effect of point-through-point acupuncture combined with func-tional exercise on acute cerebral infarction and blood rheology in the patients .Methods 120 cases of patients with acute cere-bral infarction were selected and divided into observation group (n=60)and control group (n=60) by random number table method.Both the groups were given symptomatic support therapy such as anti platelet aggregation , nutrition,improving circula-tion,lipid regulation, plaque stabilization, controlling blood pressure and other risk factors ,the control group was given func-tional exercise on the basis of conventional treatment;the observation group was given point-through-point acupuncture on the basis of the control group .Two weeks was one treatment course and after one course , the clinical curative effect ,the changes of NIHSS scores, ADL scores, blood rheology indexes before and after treatment were observed in both groups .Results The total effective rate in observation group was higher than that in control group (P<0.05).NIHSS score and ADL score after treat-ment were all improved significantly in both groups compared with that before treatment (P<0.05), and the improvements in observation group were more significantly (P<0.05).There was no significant difference in red blood cells deposited between the two groups before and after treatment (P>0.05), but the levels of whole blood viscosity ,plasma viscosity,fibrinogen after treatment were lower than that before treatment in both groups (P<0.05), and the decrease was more obvious in observation group(P<0.05).Conclusion Point-through-point acupuncture combined with functional exercise has exact effect on acute cerebral infarction ,which can effectively improve nervous function ,ADL and blood rheology indexes ,so it is worthy of clinical popularization and application .

Objective:To observe the clinical efficacy of Banxia Baizhu Tianma Decoction combined with canalith repositioning procedure in treating benign paroxysmal positional vertigo , and to explore the correlation between its pathogenesis and blood lipid metabolic abnormalities .Methods:A total of 53 cases conforming to the diagnostic criteria in department of internal medicine of traditional Chinese medicine of our hospital from January 2013 to January 2015 were selected and divided into two groups under completely random design by PEMS 3.0, with 23 cases in the treatment group and 30 cases in the control group based on sequen-tial order .Patients of the two groups were asked to stay in bed during the stage of attack , being given the persistent low flow oxy-gen therapy .At the same time, improved Epley respositioning procedure was applied to patients in the control group , while those in the treatment group were treated with both modified Epley respositioning procedure and modified Banxia Baizhu Tianma Decoc -tion .Then clinical curative effect of two days , two weeks and three months after treatment in both groups were recorded respective-ly, as well as changes of blood lipid level before and after treatment .Results:The total effective rate of two days in the treatment group was 73.91%, while that in the control group was only 60.00%, showing a significant difference between two groups (χ2 =6.782, P=0.002<0.05);After treatment of two weeks, the treatment group total effective rate was 86.96%, while the control group total effective rate was 73.33%, indicating a statistical difference between two groups (χ2 =7.540, P=0.000<0.05);Af-ter treatment of three months , the treatment group total effective rate was 95.65%, while that in the control group was 83.33%, which showed a statistically significant difference between two groups (χ2 =8.351, P=0.000<0.05); As for changes of blood lipid level , compared with the control group , TG, TC, LDL and Apo-A1 in the treatment group after treatment of three months had a statistically significant difference ( P<0.05 ) , whereas there was no obvious statistical significance in HDL and Apo-B ( P>0.05).Conclusion:Banxia Baizhu Tianma Decoction combined with canalith repositioning procedure has a good clinical efficacy in treating BPPV , and lipid metabolism abnormality is closely associated with CRP , therefore , this scientific method , with high de-pendability , is worthy of clinical popularization and application .

目的 探究丹龙醒脑方治疗脑梗的临床疗效.方法 将2013-05～2014-05于铜川市人民医院南院就诊并符合纳入标准的70例患者,按照随机数字表法分为两组(治疗组35例予以丹龙醒脑方治疗;对照组35例予以常规治疗),两组患者均治疗6周且每3周予以复查,综合比较两组患者临床疗效、不良反应等情况,并采用SPSS16.0统计软件进行统计分析.结果 治疗前两组患者对比差异无统计学意义(P＞0.05);治疗后治疗组临床疗效明显优于对照组(P＜0.05).结论 丹龙醒脑方治疗脑梗安全有效,能缓解患者临床症状与不良反应,改善患者神经功能缺损症,提高患者生活自理能力与生活质量,是临床治疗脑梗患者的新思路.

Objective To investigate the clinical effect of shuxuening injection combined with fasudil on cerebral angiospasm caused by aneurysmatic subarachnoid hemorrhage. Methods A total of 74 patients with cerebral angiospasm caused by aneurysmatic subarachnoid hemorrhage were selected in the People′s Hospital of Tongchuan from February 2008 to December 2013,and they were randomly divided into control group and experiment group,each of 37 cases. Patients of control group were treated with fasudil, while patients of experiment group were treated with shuxuening injection combined with fasudil;both groups treated for 14 days. The effective rate,clinical symptoms remission,incidence of CVS,cerebral infarction and adverse reactions,mortality,GCS score and blood flow velocity of middle cerebral artery before and after treatment were compared between the two groups. Results No statistically significant differences of emesis remission rate,mortality or GCS score,blood flow velocity of middle cerebral artery before treatment was found between the two groups ( P >0. 05 );the effective rate, headache remission rate,meningeal irritation remission rate and GCS score after treatment was higher than that of control group, respectively,while incidence of CVS and cerebral infarction,and blood flow velocity of middle cerebral artery after treatment was lower,respectively(P<0. 05). The incidence of adverse reactions of control group was 27. 0%,that of experiment group was 24. 3%,the difference was not statistically significantly different ( P >0. 05 ). Conclusion Shuxuening injection combined with fasudil has certain clinical effect on cerebral angiospasm caused by aneurysmatic subarachnoid hemorrhage,can effectively relive the clinical symptoms,reduce the incidence of CVS and cerebral infarction,improve the prognosis,and is safe.

目的:调查铜川市H型高血压病患者急性脑梗死发生的危险因素.方法:铜川市H型高血压病发生急性脑梗死确诊病例561例,进行1∶1配对进行病例对照研究,获得环境暴露等资料,采用EPI-info(6.04)和SPSS(15.0)统计软件进行单因素和多因素Logistic回归分析,计算各因素的调整比值比(OR)和95％可信限(CI).结果:单因素分析发现,H型高血压病的561例患者并发高脂血症、糖尿病、高C-反应蛋白血症、短暂性脑缺血发作(TIA)、肥胖、吸烟、酗酒等危险因素与急性脑梗死成正相关,差异有统计学意义(均P＜0.05).而马来酸依那普利叶酸片能降低H型高血压病患者患脑梗死的风险.多因素分析结果显示,糖尿病、高C-反应蛋白血症、重度颈动脉狭窄、TIA是H型高血压病发生急性脑梗死的主要危险因素,差异有统计学意义(均P＜0.05).结论:铜川市H型高血压病患者急性脑梗死的独立危险因素是高C-反应蛋白血症、糖尿病、重度颈动脉狭窄、TIA,马来酸依那普利叶酸片是其保护因素.