目的探讨脑桥旁正中梗死急性期运动功能缺损进展(progressive motor deficits,PMDs)的危险因素。方法2017年12月至2020年12月,在本院连续入组发病24 h内的脑桥梗死患者。入院后1周内每日行美国国立卫生院卒中量表(National Institutes o...目的探讨脑桥旁正中梗死急性期运动功能缺损进展(progressive motor deficits,PMDs)的危险因素。方法2017年12月至2020年12月,在本院连续入组发病24 h内的脑桥梗死患者。入院后1周内每日行美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,若其中运动项目评分较入院增加≥1分则纳入进展组,反之为非进展组。比较两组患者人口统计学、临床资料和影像学特征,采用单因素分析及多因素logistic回归分析。结果共纳入脑桥旁正中梗死患者109例,31例出现PMDs。单因素分析提示:进展组与非进展组在入院时吞咽障碍[14(45.1%)vs.14(17.9%)]、最大梗死灶位置处于脑桥下部[19(61.3%)vs.25(32.1%)]、病灶累及腹侧[19(61.3%)vs.22(28.2%)]及病因分型[小动脉疾病11(35.5%)vs.52(66.7%)、基底动脉分支动脉疾病16(51.6%)vs.19(24.4%)]方面,差异具有统计学意义(P<0.05)。多因素logistic回归分析提示病灶累及脑桥腹侧(OR=3.453,95%CI:1.402~8.505,P=0.007)、最大梗死灶位置处于脑桥下部(OR=2.795,95%CI:1.134~6.887,P=0.026)是发生PMDs的危险因素。结论病灶累及脑桥腹侧、最大梗死灶位置处于脑桥下部可预测脑桥旁正中梗死患者运动缺损进展。展开更多
目的探讨亚低温(mild hypothermia,MHT)联合丁基苯酞(dl-3n-butyphthalide,NBP)对溶栓时间窗外急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)且出现进展性运动功能缺损(progressive motor deficit,PMD)患者的脑侧支循环...目的探讨亚低温(mild hypothermia,MHT)联合丁基苯酞(dl-3n-butyphthalide,NBP)对溶栓时间窗外急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)且出现进展性运动功能缺损(progressive motor deficit,PMD)患者的脑侧支循环和短期预后的影响。方法纳入溶栓时间窗外且合并PMD的急性MCAO患者,随机分为常规治疗组、MHT组和MHT+NBP组。比较3组患者入院时基线资料、治疗14 d时Fugl-Meyer运动功能评分、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、出血性转化以及经颅多普勒超声检测的脑侧支循环通路开放情况、患侧与健侧大脑前动脉(anterior cerebral artery,ACA)收缩期峰值流速比值(RVaca)和大脑后动脉(posterior cerebral artery,PCA)收缩期峰值流速比值(RVpca);治疗90 d时改良Rankin量表(modified Rankin scale,m RS)评分、90 d死亡率。结果入组本研究且完成随访的患者共69例,其中常规治疗组23例,MHT组21例,MHT+NBP组25例。MHT+NBP组14 d Fugl-Meyer运动功能评分、前交通动脉通路开放、后交通动脉通路开放、RVaca及RVpca均高于MHT组和常规治疗组,差异有统计学意义(均P<0.05)。MHT+NBP组14 d NIHSS评分、90 d m RS评分低于MHT组和常规治疗组,差异有统计学意义(均P<0.05)。MHT+NBP组14 d出血性转化低于常规治疗组(P<0.05)。MHT组14 d RVaca、RVpca及90 d m RS评分低于常规治疗组(均P<0.05)。3组90 d死亡率的差异无统计学意义。结论 MHT联合NBP治疗可以改善溶栓时间窗外急性MCAO且出现PMD患者的脑侧支循环,并改善患者的短期预后。展开更多
目的探讨轻型卒中或TIA患者静脉溶栓后短期不良结局的危险因素。方法纳入自2019年10月至2020年7月就诊于苏州大学附属第一医院予以静脉溶栓的基线NIHSS评分0~5分的轻型卒中或TIA患者94例,将其按发病14 d mRS评分分为不良结局组(mRS>1...目的探讨轻型卒中或TIA患者静脉溶栓后短期不良结局的危险因素。方法纳入自2019年10月至2020年7月就诊于苏州大学附属第一医院予以静脉溶栓的基线NIHSS评分0~5分的轻型卒中或TIA患者94例,将其按发病14 d mRS评分分为不良结局组(mRS>1分)28例和良好结局组(mRS≤1分)66例,对基线指标以及危险因素进行单因素和多因素分析。结果年龄(OR=1.049,95%CI:1.003~1.096,P=0.035)、无责任大血管狭窄也无错配区(OR=2.808,95%CI:1.051~7.504,P=0.040)为溶栓后不良结局的独立危险因素。在CTA-Mismatch-亚组中,存在基线运动功能缺损(基线NIHSS评分中肌力评分≥1分)是患者预后不良的预测因子(P=0.004)。结论对基线NIHSS评分0~5分的患者进行溶栓决策时应将临床症状与多模式CT结合,对CTA-Mismatch-患者溶栓需谨慎。展开更多
OBJECTIVE:To investigate the effects of different frequencies of electro-acupuncture at Shuigou(GV 26) on the latent period and wave amplitude of motor evoked potentials(MEPs) in rats with focal cerebral infarction.ME...OBJECTIVE:To investigate the effects of different frequencies of electro-acupuncture at Shuigou(GV 26) on the latent period and wave amplitude of motor evoked potentials(MEPs) in rats with focal cerebral infarction.METHODS:Fifty healthy male Wistar rats were randomly divided into five groups:controls,model,2 Hz Shuigou,50 Hz Shuigou and 100 Hz Shuigou.There were 10 rats in each group.Using a modification of a technique for middle cerebral artery occlusion,focal cerebral ischemic injury was induced in all rats except those in the control group.The rats in the control group received no treatment.After behavioral deficit had been evaluated using the Zausinger 6-point neurological function score,therats in the Shuigou groups underwent acupuncture and continuous wave stimulation at a frequency of 2 Hz,50 Hz or 100 Hz(intensity 1 mA) for 10 min twice daily for 3 days.The control and model groups underwent no intervention.Zausinger 6-point neurological function score and MEPs were measured 72 h after the start of treatment.RESULTS:The neurological function scores of the three Shuigou groups were significantly higher than those of the model group(P<0.05).There was no significant difference between sides in the latency and amplitude of MEPs in the model group(P> 0.05).The latency on the affected side in the model group was significantly longer than that in the control group(P<0.05) and the amplitude on affected side was significantly reduced(P<0.01).After 3 days of electro-acupuncture,the latency on the affected side in the 2 Hz Shuigou group was significantly shortened(P<0.05) and the amplitude was significantly increased(P<0.05) compared with the model group.CONCLUSION:Low frequency electro-acupuncture at Shuigou(GV 26) can promote recovery of motor function after focal cerebral ischemic injury in rats.展开更多
文摘目的探讨脑桥旁正中梗死急性期运动功能缺损进展(progressive motor deficits,PMDs)的危险因素。方法2017年12月至2020年12月,在本院连续入组发病24 h内的脑桥梗死患者。入院后1周内每日行美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,若其中运动项目评分较入院增加≥1分则纳入进展组,反之为非进展组。比较两组患者人口统计学、临床资料和影像学特征,采用单因素分析及多因素logistic回归分析。结果共纳入脑桥旁正中梗死患者109例,31例出现PMDs。单因素分析提示:进展组与非进展组在入院时吞咽障碍[14(45.1%)vs.14(17.9%)]、最大梗死灶位置处于脑桥下部[19(61.3%)vs.25(32.1%)]、病灶累及腹侧[19(61.3%)vs.22(28.2%)]及病因分型[小动脉疾病11(35.5%)vs.52(66.7%)、基底动脉分支动脉疾病16(51.6%)vs.19(24.4%)]方面,差异具有统计学意义(P<0.05)。多因素logistic回归分析提示病灶累及脑桥腹侧(OR=3.453,95%CI:1.402~8.505,P=0.007)、最大梗死灶位置处于脑桥下部(OR=2.795,95%CI:1.134~6.887,P=0.026)是发生PMDs的危险因素。结论病灶累及脑桥腹侧、最大梗死灶位置处于脑桥下部可预测脑桥旁正中梗死患者运动缺损进展。
文摘目的探讨亚低温(mild hypothermia,MHT)联合丁基苯酞(dl-3n-butyphthalide,NBP)对溶栓时间窗外急性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)且出现进展性运动功能缺损(progressive motor deficit,PMD)患者的脑侧支循环和短期预后的影响。方法纳入溶栓时间窗外且合并PMD的急性MCAO患者,随机分为常规治疗组、MHT组和MHT+NBP组。比较3组患者入院时基线资料、治疗14 d时Fugl-Meyer运动功能评分、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、出血性转化以及经颅多普勒超声检测的脑侧支循环通路开放情况、患侧与健侧大脑前动脉(anterior cerebral artery,ACA)收缩期峰值流速比值(RVaca)和大脑后动脉(posterior cerebral artery,PCA)收缩期峰值流速比值(RVpca);治疗90 d时改良Rankin量表(modified Rankin scale,m RS)评分、90 d死亡率。结果入组本研究且完成随访的患者共69例,其中常规治疗组23例,MHT组21例,MHT+NBP组25例。MHT+NBP组14 d Fugl-Meyer运动功能评分、前交通动脉通路开放、后交通动脉通路开放、RVaca及RVpca均高于MHT组和常规治疗组,差异有统计学意义(均P<0.05)。MHT+NBP组14 d NIHSS评分、90 d m RS评分低于MHT组和常规治疗组,差异有统计学意义(均P<0.05)。MHT+NBP组14 d出血性转化低于常规治疗组(P<0.05)。MHT组14 d RVaca、RVpca及90 d m RS评分低于常规治疗组(均P<0.05)。3组90 d死亡率的差异无统计学意义。结论 MHT联合NBP治疗可以改善溶栓时间窗外急性MCAO且出现PMD患者的脑侧支循环,并改善患者的短期预后。
文摘目的探讨轻型卒中或TIA患者静脉溶栓后短期不良结局的危险因素。方法纳入自2019年10月至2020年7月就诊于苏州大学附属第一医院予以静脉溶栓的基线NIHSS评分0~5分的轻型卒中或TIA患者94例,将其按发病14 d mRS评分分为不良结局组(mRS>1分)28例和良好结局组(mRS≤1分)66例,对基线指标以及危险因素进行单因素和多因素分析。结果年龄(OR=1.049,95%CI:1.003~1.096,P=0.035)、无责任大血管狭窄也无错配区(OR=2.808,95%CI:1.051~7.504,P=0.040)为溶栓后不良结局的独立危险因素。在CTA-Mismatch-亚组中,存在基线运动功能缺损(基线NIHSS评分中肌力评分≥1分)是患者预后不良的预测因子(P=0.004)。结论对基线NIHSS评分0~5分的患者进行溶栓决策时应将临床症状与多模式CT结合,对CTA-Mismatch-患者溶栓需谨慎。
基金Supported by National Natural Science Foundation of China (No.30873304)
文摘OBJECTIVE:To investigate the effects of different frequencies of electro-acupuncture at Shuigou(GV 26) on the latent period and wave amplitude of motor evoked potentials(MEPs) in rats with focal cerebral infarction.METHODS:Fifty healthy male Wistar rats were randomly divided into five groups:controls,model,2 Hz Shuigou,50 Hz Shuigou and 100 Hz Shuigou.There were 10 rats in each group.Using a modification of a technique for middle cerebral artery occlusion,focal cerebral ischemic injury was induced in all rats except those in the control group.The rats in the control group received no treatment.After behavioral deficit had been evaluated using the Zausinger 6-point neurological function score,therats in the Shuigou groups underwent acupuncture and continuous wave stimulation at a frequency of 2 Hz,50 Hz or 100 Hz(intensity 1 mA) for 10 min twice daily for 3 days.The control and model groups underwent no intervention.Zausinger 6-point neurological function score and MEPs were measured 72 h after the start of treatment.RESULTS:The neurological function scores of the three Shuigou groups were significantly higher than those of the model group(P<0.05).There was no significant difference between sides in the latency and amplitude of MEPs in the model group(P> 0.05).The latency on the affected side in the model group was significantly longer than that in the control group(P<0.05) and the amplitude on affected side was significantly reduced(P<0.01).After 3 days of electro-acupuncture,the latency on the affected side in the 2 Hz Shuigou group was significantly shortened(P<0.05) and the amplitude was significantly increased(P<0.05) compared with the model group.CONCLUSION:Low frequency electro-acupuncture at Shuigou(GV 26) can promote recovery of motor function after focal cerebral ischemic injury in rats.
