目的 探讨4.5 h内急性缺血性脑卒中患者的血清胆红素水平与脑卒中严重程度及TOAST分型的关系.?方法 2016年1月至2019年9月在台州市第一人民医院经重组组织型纤溶酶原激活剂静脉溶栓治疗的急性缺血性脑卒中患者558例.在基线时完善血化验及美国国立卫生研究院卒中量表(NIHSS).以胆红素为变量分析血清胆红素水平与脑卒中严重程度间的关系.通过TOAST分型分析胆红素水平与各亚型间的相关性.?结果 卒中严重的患者总胆红素、直接胆红素及间接胆红素均升高.Logistic回归分析显示,总胆红素、直接胆红素与神经功能缺损的严重程度相关[OR(95％CI)=1.017(1.010～1.0490)、1.096(1.028～1.134),P<0.05].根据TOAST分型显示心源性栓塞型患者的胆红素水平高于大动脉粥样硬化型及小血管闭塞型,存在统计学差异(F=22.659、34.871,P<0.05).?结论 急性缺血性脑卒中发生时,血清总胆红素和直接胆红素升高与卒中的严重程度呈正比.胆红素水平可能是判定心源性栓塞亚型的生化标记物.

目的 观察丁苯酞软胶囊联合尼莫地平治疗轻度血管性认知功能障碍的临床观察.方法 选择首次发病的急性缺血性脑卒中患者88例,随机分为治疗组48例,对照组40例.对照组在标准化治疗基础上加用尼莫地平,治疗组在标准化治疗基础上联合尼莫地平片和丁苯酞软胶囊.神经心理学评估采用北京版蒙特利尔认知评估量表(MoCA)、简易智能状态检查量表(MMSE)及日常生活活动能力量表(ADL),分别在基线、治疗后1、3个月进行.在基线时完善血液学及头颅MRI检查,1、3个月时再次完善血液学检查,以评估安全性.结果 治疗组治疗3个月MMSE和MoCA评分改善情况明显优于对照组[(4.17±0.61)分vs(2.31±0.72)分,P=0.021;(3.23±0.71)分vs(1.24±0.93)分,P=0.029].治疗组治疗3个月视空间与执行能力、命名、注意力及延迟记忆评分明显优于对照组(P＜0.05).治疗组治疗3个月视空间与执行能力、注意力及延迟记忆评分明显优于治疗前(P＜0.05).对照组治疗3个月注意力评分明显优于治疗前,差异有统计学意义(P＜0.05).结论 丁苯酞软胶囊联合尼莫地平可显著改善急性缺血性脑卒中后轻度血管性认知功能障碍.

目的 探讨老年心房颤动(下称房颤)患者急性缺血性脑卒中后阿替普酶静脉溶栓治疗的安全性和有效性.方法 回顾性分析2015年1月到2017年2月接受阿替普酶静脉溶栓的147例60～90岁的急性缺血性脑卒中患者,根据是否合并非瓣膜性房颤分为房颤组24例和非房颤组123例,比较两组的性别、年龄、静脉溶栓时间、改良Rankin量表评分、吸烟史、高血压病史、高脂血症病史、糖尿病史、溶栓前血压及颅内出血事件发生率.结果 两组一般资料比较差异无统计学意义.房颤组患者发生颅内出血事件1例(6.5％),90d改良Rankin量表评分≤2分19例(79.2％),非房颤组发生颅内出血事件2例(1.6％),90d改良Rankin量表评分≤2分85例(69.1％),两组比较差异均无统计学意义(均P>0.05).结论 老年心房颤动患者急性缺血性脑卒中后4.5h内进行阿替普酶静脉溶栓治疗有效,不增加颅内出血风险.

Objective To explore the implementation effect of evidence-based medicine combined with PBL teaching method in standardized training of neurology residents. Methods A total of 42 resident standardized training participants were randomly divided into experimental group (evidence-based medicine combined with PBL group, n=22) and control group (traditional teaching group, n=21). The experimental group used the PBL method to conduct evidencebased analysis of clinical cases, and the control group used traditional infusion teaching. The evaluation of teaching effects is divided into two parts: questionnaire survey and exit exam. Results The questionnaire survey showed that the experimental group had more advantages in terms of scientific research ability and innovation ability. The results of exit exam showed that the average score especially the evaluation of difficult cases, scientific research design evaluation, and innovative thinking ability of the experimental group was higher than that of the control group. And the difference was statistically significant (P<0.05). Conclusion Evidence-based medicine combined with PBL teaching method is suitable for the training of residents' standardized training innovation ability and scientific research ability.

目的 探讨丁苯酞联合瑞舒伐他汀治疗动脉粥样硬化型脑梗死的疗效观察及对血液流变学的影响.方法 将90例动脉粥样硬化型脑梗死患者分为联合用药组和他汀组.他汀组采用瑞舒伐他汀片治疗,联合用药组采用瑞舒伐他汀片联合丁苯酞针剂治疗,两组其他基础用药相同.采用美国国立卫生院卒中量表(NIHSS评分)评估入院时和治疗后的神经功能缺损情况,并比较两组治疗前后血液流变学的水平.采用超声检测对比两组治疗前后颈动脉最大斑块面积、内膜中层厚度(IMT)及斑块数量.结果 联合用药组的总有效率高于他汀组,差异有统计学意义(P<0.05);两组治疗后血液流变学均有一定程度的改善(P<0.05),且联合用药组治疗后的全血黏度、血浆黏度、纤维蛋白原均明显低于他汀组,差异有统计学意义(P<0.05).颈动脉粥样斑块改变方面,联合用药组治疗后最大斑块面积、IMT、斑块数量均较他汀组有明显改善(P<0.05).结论 丁苯酞联合瑞舒伐他汀可改善动脉粥样硬化性脑梗死神经功能缺损,并对血液流变学的改善及减少斑块形成有一定作用,延缓颈动脉斑块进展,改善预后.

Objective: To observe the effect of different doses of Urapidil injection before thrombolysis in acute ischemic stroke on the blood pressure or door-to-needle time (DNT).Methods: Thirty-six cases in our hospital who were treated with Urapidil injection before intravenous t-PA treatment were retrospectively ana-lyzed and were divided into 3 groups A, B, C according to the loading dose. Group A was with a loading dose of 5 mg Urapidil injection, Group B was with a loading dose of 12.5 mg, and Group C was with a loading dose of 25 mg. At last, shrinkage pressure (SBP), diastolic blood pressure (DBP), DNT and 3-month MRS score among the three groups were compared.Results: Compared to group A in which SBP was (173.27±6.92) mmHg and DBP (81.73±7.71) mmHg, the blood pressure of group B, with SBP (165.80±7.76) mmHg and DBP (80.93±6.95) mmHg, and group C, with SBP (154.80±10.69) mmHg and DBP (73.60±5.13) mmHg, decreased signiifcantly (P<0.001). Compared to group A with (89.00±25.76) min, the DNT of group B with (76.73±20.20) min and group C with (73.10±14.15) min the door-to-needle time (DNT) signiifcantly reduced (P<0.001). In addition, the percentage of MRS scores (0-1 points scale) after three months in group B (60.0%) was the highest among the three groups (P<0.001).Conclusion: Urapidil injection with the ifrst load of 12.5 mg can effectively decrease blood pressure to standard as soon as possible with a better outcome.

A simple and selective UPLC-MS/MS for simultaneous determination of clopidogrel, SR26334 and acetylsalicylic acid in rat plasma was developed. Chromatographic separation was achieved on a UPLC (R) BEH C18 column (2.1 x 100 mm, 1.7 mu m) column with acetonitrile-0.1% formic acid in water as mobile phase with gradient elution. The flow rate was set at 0.4 mL/min. An electrospray ionization source was applied and operated in positive and negative switching ion mode; multiple reactions monitoring mode was used for quantification. Mean recoveries were in the range of 94.1-97.5% for clopidogrel in rat plasma, 92.2-95.5% for SR26334 and 94.7-97.1% for acetylsalicylic acid. Matrix effects for clopidogrel, SR26334 and acetylsalicylic acid were measured to be between 92.1 and 109.2%. Coefficient of variation of intra-day and inter-day precision were both < 12%. The accuracy of the method ranged from 93.8 to 112.7%. The method was successfully applied in pharmacokinetic study of clopidogrel and acetylsalicylic acid in rats.

Objective To investigate tbe association of serum sodium level with cerebral edema and prognosis in patients with spontaneous intracerebral hemorrhage.Methods We prospectively studied 90 patients with spontaneous intracerebral hemorrhage within 24 hours from onset of symptoms.According to the target value of serum sodium level,the patients were divided into 3 groups,relatively low-sodium group (135-140 mmol/L),relatively high-sodium group (140-145 mmol/L),absolute high-sodium group (145 155 mmol/L)(n=30 for each).National institutes of health stroke scale (NIHSS),Glasgow coma score (GCS),and blood tests were measured within 24 hours from onset.Hematoma volumes,edema volumes,liver and kidney function were measured within 24 hours,3 days,7 days after onset.Modified rankin scale (MRS) were measured at 90 days to assess the recovery of neurological function.Modified rankin scale score ≤ 2 was considered as good outcome.Results The edema volume was smaller in absolute high-sodium group than in relatively low-sodium group and relatively high sodium group [(25.37 t 26.54) ml vs.(55.21 ± 58.21) ml,(59.48±55.84) ml,F=1.492,P=0.023].The percentage of patients with MRS score ≤2 was 70％ in absolute high sodium group,which had a better prognosis as compared with relatively low-sodium and relatively high-sodium group (both P＜ 0.05).The hematoma volume had no significant difference among the three groups.Conclusions The appropriate increase in serum sodium level is safe,which could reduce cerebral edema and get a better prognosis.