目的:探究替罗非班桥接双联抗血小板聚集应用于急性脑梗死患者的效果.方法:选取 2021 年 9 月至2022 年 9 月期间收治的 90 例急性脑梗死患者,根据随机数字表法分为对照组和观察组各 45 例.对照组接受阿司匹林肠溶片和氯吡格雷治疗,观察组先静脉泵入替罗非班治疗 48 h,后过渡为阿司匹林肠溶片和氯吡格雷双联治疗,对比两组神经功能[脑特异性蛋白(S100-β)、神经元特异性烯醇化酶(NSE)、基质细胞衍生因子-1(SDF-1)、视锥蛋白样蛋白-1(VILIP-1)],预后[改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(ADL)评分]和不良事件发生情况(颅内出血、全身性出血和 3 个月内死亡发生情况).结果:治疗后,观察组NIHSS评分、mRS评分与S100-β、NSE、VILIP-1 水平均低于对照组,SDF-1 水平、ADL评分均高于对照组,差异均有统计学意义(P＜0.05).结论:急性脑梗死患者经替罗非班桥接双联抗血小板聚集治疗,可有效改善其日常生活能力和神经功能,提高预后效果,安全性高.

目的 探讨急性缺血性脑卒中脑白质疏松与认知功能、功能结局的关系.方法 我院收治的106例急性缺血性脑卒中患者,根据脑白质疏松程度分为轻度组(n=35)、中度组(n=39)和重度组(n=32).比较三组的认知功能[简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、汉密顿抑郁量表(HAMD)]和功能结局[美国国立卫生研究院脑卒中量表(NIHSS)、日常生活活动能力量表(BI)、改良兰金量表(mRS)];分析影响急性缺血性脑卒中患者认知功能及功能结局的独立危险因素;分析急性缺血性脑卒中脑白质疏松与认知功能、功能结局的相关性.结果 三组MMSE、MoCA、BI评分比较轻度组>中度组>重度组,HAMD、NIHSS、mRS评分比较轻度<中度<重度(P<0.05);年龄、吸烟史、糖尿病史、高血脂、脑白质疏松是影响急性缺血性脑卒中患者认知功能及功能结局的的独立危险因素(P<0.05);急性缺血性脑卒中脑白质疏松与HAMD、NIHSS、mRS呈正相关,与MMSE、MoCA、BI呈负相关(P<0.05).结论 急性缺血性脑卒中脑白质疏松越严重,患者认知功能及功能结局随之下降,可作为急性缺血性脑卒中患者认知功能及功能结局的预测因子.

Objective To investigate expression level changes and clinical significance of plasma mirnas-23a/30a in Ischemic cerebral apoplexy patients. Methods By case-control study method, 40 ischemic cerebral apoplexy patients were selected as the research objects from July 2014 to July 2015. According to the Patient's condition, they were divided into mild and severe group. 20 cases physical healthy subjects were selected as control group. There were the same gender and age in two groups. By real-time fluorescent quantitative PCR method, peripheral blood micrornas-23a/30a expression levels of two groups were detected, the correlation was analyzed. Results On admission, expression level of plasma mirnas-23a/30a in the mild and severe group was compared with that in the mild group and the control group, the difference was statistically significant (P＜0.05). Expression levels of plasma mirnas-23a/30a of the mild and severe group in the different time had a comparison, the difference was statistically significant (P＜0.05). After the patients were treated for 1 weeks, expression levels of plasma mirnas-23a/30a of the mild and severe group had a correlation analysis, it showed that they were positively correlated (r =0.917, P＜0.05). Conclusion expression levels of plasma mirnas-23a/30a was closely associated with ischemic brain stroke, it was expected to become an important objective of biomarkers for the ischemic cerebral apoplexy disease severity and risk prediction.

Objective To explore the curative effect and the value of clinical application of cerebrospinal fluid replacement by lumbar puncture in subarachnoid hemorrhage(SAH).Methods Fifty-one cases of SAH were randomLy divided into two groups:treatment group with 26 cases in it and control group with 25 cases in it.Both groups were given conventional treatment and the cerebrospinal fluid by lumbar puncture was added to the treatment group.Results Duration of headache and disappeared time of meningeal stimulation symptom and time of CSF returning to normal in the treatment group were less than those in the control group,with a significant difference between the two groups(P0.01).The rates of hydrocephalus,cerebral vasospasm(cvs)and death were decreased obviously,with a significant difference(P0.05).Conclusion The cerebrospinal fluid replacement for subarachnoid hemorrhage is safe and effective,and can reduce the incidence of complications and mortality.

Objective Early observation of the progress of low-dose mannitol treatment of cerebral infarction.MethodsThe progress of 86 cases of cerebral infarction were randomly divided into treatment and control groups,each of the 43 cases,effects were compared between two groups.ResultsTreatment group,neurological deficit scores to reach statistical difference(P<0.05),the treatment group than the control group.ConclusionThe progress of low-dose mannitol treatment of cerebral infarction was superior to the control group,The method is simple and affordable.

目的观察超早期脑梗死(ACI)应用尿激酶(UK)的临床疗效。方法将急性ACI分为治疗组与对照组。治疗组给予UK静滴,对照组静滴奥扎格雷钠。同时使用脱水、扩管、清除自由基。治疗前、治疗后1、7、14、21、90d比较两组CSS及日常活动量评分。结果治疗组近期及远期疗效均显著高于对照组。结论UK溶栓治疗时间越早、效果越好,相对安全。

Objective Observation of minimally invasive brain surgery to remove directional hematoma of the efficacy of the treatment of cerebral hemorrhage.Methods Sixty-four patients were randomly divided into of minimally invasive medical conservative treatment group(32 cases) and internal medicine group(32 cases),effects were compared between the two groups.Results The total effective rate of minimally invasive group(87.5%) was higher than internal medicine group(65.6%),the difference was statistially significant(P<0.05).Fatality rate of minimally invasive group(12.5%) was significantly lower than that of internal medicine group(28.1%)the difference was statistially significant(P<0.05).Admission and treatment of 2 weeks,4 weeks after the neurological deficit scores,the difference was statistically significant(P<0.05).Conclusion Minimally invasive for the treatment of cerebral hemorrhage simple,minimally invasive,safe,reliable,economical and practical.It should help to significantly improve the prognosis of patients and reduce mortality in patients with effective and reliable.

目的:观察低分子肝素(LMWH)对急性脑梗死的临床疗效及安全性.方法:治疗组和对照组各45例均使用低分子右旋糖酐作基本治疗,治疗组加用LMWH7天,停药10天后观察疗效.结果:治疗组总有效率88.9%,对照组66.6%,治疗组明显优于对照组(P＜0.05),治疗组未发现严重出血及血小板减少等毒副作用.结论:低分子肝素治疗急性脑梗死有效、安全、简便、实用.

1998年11月～2000年11月,我们应用利多卡因联合脉络宁治疗急性脑梗死50例,取得满意疗效.现报告如下.