【摘要】 目的 探讨低场磁共振弥散加权成像（DWI）诊断急性脑梗死的价值。 方法 2007年7月-2009年9月对48例脑梗死患者行常规MRI扫描和DWI，分析不同时期脑梗死的DWI表现。 结果 在发病的超急性期及急性期，DWI病灶显示率均为100.0%，T2WI病灶显示率分别为37.5%、73.7%、100.0%。 结论 低场DWI对急性脑梗死的诊断准确率高，明显优于常规MRI。【Abstract】 Objective To investigate the diagnostic value of diffusion weighted imaging (DWI) in acute cerebral infarction. Methods From July 2007 to September 2009, 48 patients with ischemic stroke underwent conventional MRI and DWI, and the characteristics of DWI were analyzed. Results Abnormal DWI signals were displayed in all patients at hyperacute stage or acute stage, abnormal T2WI signals existed in 37.5%, 73.7%, and 100.0%, respectively. Conclusion DWI in low field MR is highly accurate in diagnosing acute cerebral infarction, which is superior to conventional MRI.
ObjectiveTo explore the clinical effect of comprehensive nursing on cerebral infarction patients with high blood glucose. MethodsEighty cerebral infarction patients with high blood glucose treated between March 2012 and February 2013 were divided into observation group and control group with 40 patients in each. Patients in the control group received routine nursing care, while those in the observation group were given comprehensive nursing care. Then, we compared the two groups of patients in terms of their blood glucose control level, the recovery of neurological function and life quality. ResultsThe fasting glucose, 2-hour postprandial blood glucose, National Institude of Health stroke scale (NIHSS), and modified Edinburgh Scandinavican scoring scale (MESSS) scores of the two groups were not statistically different at the time of hospital admission (P>0.05). However, fasting blood sugar, 2-hour postprandial blood glucose, NIHSS, and MESSS scores in the observation group were significantly lower than those in the control group before discharge (P<0.05). Life quality score of self-care, mental health, and social function before discharge in the observation group were significantly higher than those in the control group (P<0.05). ConclusionComprehensive nursing is helpful to control blood glucose in an ideal level range for cerebral infarction patients with hyperglycemia, which can also promote the recovery of neurological function and improve the life quality of patients.
ObjectiveTo evaluate the usage status of drugs in the treatment of senile cerebral infarction in Xuanwu Hospital of Capital Medical University in 2011, and to provide references for rational usage of drugs for inpatients with senile cerebral infarction. MethodsMedical records of the elderly (≥60 years old) inpatients with cerebral infarction in Xuanwu Hospital in 2011 were collected. ATC codes were used to standardize names of drug and classifications. Patients' general information, number of patients' used drugs, Defined Daily Doses (DDDs), and Drug Utilization Index (DUI) were calculated by using Microsoft Excel 2007 to evaluate the rationality of drugs usage. ResultsA total of 430 patients were included. The average age was 70.61±7.29 years old. The average types of diseases were 5.39. The major combined disease was circulatory system disease, accounting for 42.45%. A total of 15 656 medication records were included, involving 243 kinds of drugs (including different administration routes). The average number of used drugs for each patient during the admission was 17.11. The top 5 drugs based on percentage of patients with drug use were Ginkgo Biloba Preparation (injection), clopidogrel (oral), prostaglandin E1 (injection), atorvastatin (oral) and cinepazide (injection). The top 5 drugs of DDDs were Ginkgo Biloba Preparation (injection), ipratropium bromide (inhalation), prostaglandin E1 (injection), folic acid (orla), and clopidogrel (oral). The top 5 drugs of DUI were vitamin B12 (injection), multi-vitamin (oral), nikethamide (injection), methylprednisolone (injection), and vitamin C (oral). ConclusionFor therapeutic drugs used among the elderly patients with cerebral infarction in Xuanwu Hospital of Capital Medical University, the choice, dosage and administration route of medication are rational. However, the drugs with higher DUI are not related with major diseases, which indicates that we should pay attention to the irrational drug use of clinical application, so as to ensure safety, effectiveness and economy of drug application.
【摘要】 目的 探讨急性脑梗死溶栓治疗的疗效及安全性。 方法 2004年1月-2009年5月58例急性脑梗死患者，按接受尿激酶治疗时已发病时间分为3组，均接受尿激酶150万U加生理盐水150 mL静脉滴注溶栓治疗。分别在治疗后0、1、3、9 h进行神经功能评价，1、3、7 d进行神经功能评价及复查头颅CT。 结果 发病3 h内与发病3~6 h内溶栓治疗效差异无统计学意义（Pgt;0.05）；发病3 h内、3~6 h内与发病6~9 h尿激酶溶栓治疗疗效差异均有统计学意义（Plt;0.05）；发病6~9 h尿激酶溶栓治疗疗效差，多例并发脑出血，安全性差。 结论 发病6 h内的脑梗死患者，只要无禁忌证均应尽快行尿激酶溶栓治疗；发病6 h后的脑梗死患者，不宜尿激酶溶栓治疗；伴房颤者的溶栓治疗因样本量过小研究无意义，有待进一步研究。【Abstract】 Objective To discuss the efficacy and safety of thrombolytic therapy for acute cerebral infarction. Methods A total of 58 patients with acute cerebral infarction from January 2004 to May 2009 were enrolled in this study. Based on the onset time before accepting urokinase treatment, the patients were divided into three groups. All of them accepted thrombolytic treatment with 1.5 million U of urokinase and 150 ml of saline solution intravenously. Neurological function evaluation was carried out 0, 1, 3, and 9 hours after the treatment. Another neurological function evaluation and skull CT were done 1, 3, and 7 days later, respectively. Results There was no statistical difference between the efficacy of the treatment within 3 hours and between the 3rd hour and the 6th hour after the onset of the disease. However, there was a significant difference between the efficacy within 3 hours and between the 6th and 9th hour, and between the efficacy from the 3rd hour and 6th hour and from the 6th hour and the 9th hour after the onset of the disease. Between the 6th and the 9th hour after the onset, the efficacy and safety were poor with many cases of combined cerebral bleeding. Conclusions For patients within 6 hours after the onset of cerebral infarction, as long as no contraindications exists, thrombolytic therapy should be carried out as soon as possible; 6 hours after the onset, patients should not be treated with thrombolytic therapy. Further study is needed for patients combined with atrial fibrillation due to the small sample size in this study.
Objective To observe the short-term effect and safety of hyperbaric oxygen combined with edaravone and ozagrel sodium in treating progressive cerebral infarction. Methods A total of 65 in-patients with acute progressive cerebral infarction were randomly divided into two groups: 33 in-patients in the trial group were treated by hyperbaric oxygen combined with edaravone and ozagrel sodium, while the other 32 in-patients in the control group were treated by edaravone and ozagrel sodium. The course of treatment was 14 days. The following indications were assessed before and after the treatment respectively: the national institutes of health stroke scale (NIHSS), activities of daily living (ADL), and clinical effects. Results This study showed that the scores of both ADL and NIHSS in the trial group were higher than those in the control group, with significant differences (Plt;0.05). The clinical effective rate of the trial group was 90.91% which was obviously higher than the control group with a significant difference (P=0.028). There were no obvious adverse reactions in both groups. Conclusion Hyperbaric oxygen combined with both edaravone and ozagrel sodium is notable in short-term effect and safe, thus it is worth being popularized in clinical treatment.
Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000). Conclusion For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.
【摘要】 目的 探讨急性脑梗死对心脏自主神经活性的影响。 方法 Wistar大鼠32只随机分为正常组、假手术组和脑梗死组，脑梗死组用线栓法行右侧大脑中动脉阻塞。脑梗死组和假手术组于术前及术后24 h作心率变异性（HRV）检测，同时检测正常组HRV，将3组的HRV指标进行比较。实验终点取各组心肌组织检测儿茶酚胺和神经肽Y（NPY），进行组间比较。 结果 术后24 h脑梗死组和正常组、假手术组相比，窦性心搏间期标准差、均方根，总功率谱、高频功率谱（HF）、低频功率谱（LF）降低，差异有统计学意义。3组比较LF/HF和分数维无明显差异。脑梗死组心肌组织去甲肾上腺素（NA）和NPY高于正常组和假手术组。 结论 脑梗死引起心脏自主神经总活性降低、自主神经功能受损，自主神经末梢去甲肾上腺素和NPY的异常分泌可能是重要的原因。【Abstract】 Objective To investigate the effect of acute cerebral infarction on cardiac autonomic nervous activity. Methods A total of 32 Wistar rats were divided into normal group, sham operation group and infarction group by random. Experimental cerebral infarction in Wistar rats was induced by intraluminal occlusion of middle cerebral artery. About 24 hours after the occlusion or 24 hours after sham operation, the heart rate variability (HRV) sequences were measured, and the HRV values in the three groups were compared. The levels of catecholamine and neuropeptide (NPY) in myocardium were measured. Results At the 24th hour after the occlusion, the standard deviation and root mean square standard deviation of R-R interval, the total power, high frequency (HF) and low frequency (LF) in infarction group were lower than those in normal and sham operation group. LF/HF and fractal dimension did not differ much among the three groups. The levels of noradrenaline and NPY in myocardium in infarction group were higher than those in the other groups. Conclusion It is suggested that acute cerebral infarction may cause the decrease of autonomic nervous activity and damage of the autonomic nervous function; the abnormal secretion of noradrenalin in autonomic nerve ending and NPY may be the important reasons.
目的：研究外伤性脑梗死患者血小板P选择素动态变化的临床意义。方法：用流式细胞仪测定42例外伤性脑梗死患者，50例无脑梗死外伤患者及40例正常对照者外周血血小板P选择素。结果：急性期(1周内)外伤性脑梗死患者P选择素明显高于无梗死脑外伤患者和健康对照组(Plt;0.01)。14 d时，外伤性脑梗死患者血小板P选择素表达，与无梗死脑外伤患者和健康对照组无显著差异(Pgt;0.005)。结论：P选择素参与外伤性脑梗死的病理过程，测定它们有利于外伤性脑梗死的早期诊治，改善预后。