Relationship between glutathione and malonaldehyde levels in erythrocytes and the deformation index of erythrocyte in patients at various periods following acute cerebral infarction

BACKGROUND： Glutathione, as an in vivo free radical scavenger, plays an important role in the anti-oxidation defense mechanism in patients with acute cerebral infarction. OBJECTIVE： To observe the relationship between the levels of glutathione （GSH） and malonaldehyde （MDA）, the metabolite of lipid peroxidation, in erythrocyte and deformation index of erythrocyte in patients at various periods following acute cerebral infarction. DESIGN： Controlled observation.SETTING： Qilu Hospital of Shandong University and Institute of Cerebrovascular Disease of Qingdao Medical College. PARTICIPANTS： We chose 98 inpatients with acute cerebral infarction from Department of Neurology, Qilu Hospital of Shandong University from January to December 2000 , serving as cerebral infarction group, including 50 male and 48 female, with mean age of （62±7）years. There were 23 cases found on the 1^st day after onset; 25 cases on the 3^rd day after onset; 25 cases on the 7^th day after onset; 25 cases on the 14th days after onset, and they were all confirmed by craniocerebral CT or MRI. Another 30 homeochronous inpatients with neurosis, cervical syndrome, lumbar intervertebral disc herniation and motor neuron disease were chosen as control group, including 20 male and 10 female, with mean age of （52±8）years . There was no significant difference in age and gender distribution between two groups （P 〉 0.05）. Patients in the two groups were informed of detected index.METHODS：①Ulnar venous blood was chosen from the patients who were fasted on the 1^st, 3^rd,7^th and 14^th days after onset. Deformation index of erythrocyte was measured with BL88-CKX laser diffraction erythrocyte deformeter and photographing was performed. GSH level in erythrocyte was measured with DTNB assay introduced by Beu-tler. MDA level in erythrocyte was measured with modified thiobarbituric acid colorimetric method.②At each sample collecting , according to the criteria accepted by the Fourth National Conference of Cerebrovascular Disease, intergrant of neurologic impairment 〈 15 points was regarded as mild （n=46）, 15 to 30 points as moderate （n=40）and, 〉 30 points as severe （n=12）. ③ t test was used to compare data between two groups , and linear correlation analysis was used in relationship analysis among indexes. MAIN OUTCOME MEASURES ：① Comparison of erythrocyte GSH and MDA levels and deformation index of erythrocyte at various periods between patients with acute cerebral infarction and controls. ②Correlation of erythrocyte GSH level with erythrocyte MDA level and with deformation index of erythrocyte in patients with cerebral infarction . ③ Relationship between erythrocyte GSH level and severity of disease in patients with acute cerebral infarction. RESULTS： Totally 98 patients with acute cerebral infarction and 30 controls all entered the stage of result analysis. ① Erythrocyte GSH level and deformation index of erythrocyte were lower on the 1^st, 3^rd, 7^th and 14^th days after onset in cerebral infarction group than in control group （P 〈 0.05-0.01）, and erythrocyte MDA level was significantly higher in cerebral infarction group than in control group （P 〈 0.05-0.01）. The three indexes changed most significantly on day 3 after onset in patients, and began to recover or decrease on day 7 after onset and inclined to be normal on day 14 after onset. ② Erythrocyte GSH level was significantly negatively correlated with erythrocyte MDA level in patients with acute cerebral infarction on the 1^st, 3^rd, 7^th and 14^th days after onset （r=-0.534, -0.713, -0.645, -0.656, respectively, P 〈 0.05-0.01 ） ,and significantly positively correlated with erythrocyte deformation index （t-=0.502, 0.560, 0.455, 0.504, respectively, P 〈 0.05）. ③Erythrocyte GSH level was significantly lower in moderate or severe patients with acute cerebral infarction than in mild patients[（0.215±0.088）,（0.192±0.102）, （0.281±0.090） g/L, P〈 0.05]. CONCLUSION：①Erythrocyte GSH and MDA levels and deformation index of erythrocyte change significantly on the 3^rd day following acute cerebral infarction. Index detection results gradually tended to be normal on from the 7^th day to 14^th days day after onset. ② Change of erythrocyte GSH level can reflect the severity of disease of patients with acute cerebral infarction.③Decrease of erythrocyte GSH level in patients with acute cerebral infarction is one of reasons that result in the decrease of deformation ability of erythrocyte.

Electrocardiogram changes in acute cerebral infarction patients

BACKGROUND： Comparison of different stroke locations had been focused in past researches in electrocardiogram （ECG） changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history. OBJ ECTIVE： To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people. DESIGN： Contrast observation SETTING： Shanghai Ninth People＇s Hospital PARTICIPANTS ： A total of 57 patients with cerebral infarction ware selected from the Neurological Department of Ninth People＇s Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4^th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9 in frontal lobe and 14 in other parts. According to their infarction size （plus size in every different scan）, they were divided into three different groups： large-size group （n = 10） with size larger than 3.5 cm^3, medium-size group （n = 13） with size between 1.5-3.5 cm^3, and small-size group （n = 34） with size smaller than 1.5 cm^3. Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40- 82 years. All these cases knew and agreed of the examination. METHODS ： Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups. MAIN OUTCOME MEASURES： The ECG changes and differences in two hemispheres, in different infarction lo- cations and sizes. RESULTS： All 57 patients and 50 healthy subjects ware involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with opposite T wave of infarction group compared with control group （P 〉 0.05）. PR and QTc [（0.167±0.010）, （0.383±0.029） s] in infarction group were longer than those in control group [（0.159±0.008）, （0.361±0.022） s, t = 1.982, 2.363, P 〈 0.05, 0.01]. ST changes cases were 77% （44/57）, which was more than those in control group [46% （23/50）, x^2= 11.072, P 〈 0.01]. ② Comparison of infarction in two hemispheres. HR, PR interval, QRS time, cases with opposite T wave and ST changes showed no differences （P 〉 0.05）, and QTc interval in right hemisphere infarction was longer than left one [（0.391±0.054）, （0.380±0.034） s, t=1.673, P 〈 0.05]. ③ ECG changes in different infarction locations. HR, PR interval, QTc interval, QRS time, cases with opposite T wave and ST changes showed no statistically significantly differences （P〉 0.05）. ④ ECG changes in different infarction sizes. HR, PR interval, QRS time showed no differences （P〉 0.05）. QTc interval in large size group was longer than the others [（0.399±0.044）, （0.388±0.073）t （0.378±0.124） s, F= 3.19, P 〈 0.05]. Cases with opposite T wave and ST changes in large size group were 80% （8/10）, 100% （10/10）, which were higher than those in medium size group [46% （6/13）, 69% （9/13）] and small size group [44% （15/34）, 35% （12/34）, x^2 = 8.495, 10.538, P 〈 0.05, 0.01]. CONCLUSION ： ① PR interval and QTc interval prolonged in cerebral infarction patients. Furthermore, QTc interval was more obvious in large size infarction group and right hemisphere infarction group. ② Infarction location did not affect the changes of ECG.

Effect of ultraviolet blood irradiation and oxygenation on nerve function and function of the red blood cell membrane pump in patients with acute cerebral infarction

BACKGROUND： Ultraviolet blood irradiation and oxygenation （UBIO） has obtained better clinical effect in treating acute cerebral infarction, but the mechanism underlying this effect remains unclear. OBJECTIVE： To observe the effect of UBIO on the nerve function and activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase activities on the red blood cell （RBC） membrane of patients with acute cerebral infarction. DESIGN： A randomized and controlled study.SETTING： Department of Neurology, Xiangfan Central Hospital.PARTICIPANTS： From January 2000 to December 2001, excluding those above 70 years old, 58 cases of 700 patients with acute cerebral infarction admitted in the Department of Neurology, Xiangfan Central Hospital, were recruited and divided into two groups according to the random number table： UBIO treated group （n=28）, including 17 males and 11 females, aged 40-68 years; and control group （n=30）, including 20 males and 10 females, aged 44-69 years. All the patients agreed to participate in the therapeutic program and detected items. The general informations were comparable without obvious differences between the two groups （P 〉 0.05）.METHODS： ① The patients in both groups received routine treatments, besides, those in the UBIO treated group were given UBIO treatment by using the XL-200 type therapeutic apparatus produced in Shijiazhuang, whose ultraviolet wave was set at 253.7 nm with the energy density of 0.568 J/m^2 per second, UBIO treatment started from the second day after admission, once every other day, with a single course consisting of 5-7 treatments. ② In the UBIO treated group, the venous blood was sampled before and after the first, third and the completion of the treatment course respectively, the venous blood was taken at each corresponding time point in the control group. After centrifugation of the blood at 10 000 rounds per minute, the RBC membrane was separated and then the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase were detected by means of phosphorus determination.③ The nerve function was scored before and after treatment in both groups with European stroke scale, which included 13 items, the total score was 0-100 points, the higher the score, the better the nerve function. MAIN OUTCOME MEASURES ：①Score of European stroke scale before and after treatment in both groups.② Comparison of the activities of K^＋-Na^＋-ATPase and Ca2^＋-Mg2^＋-ATPase on RBC membrane between the two groups before treatment and after the first, third and the completion of the treatment. RESULTS： All the 58 patients with cerebral infarction were involved in the analysis of results.① The score of European stroke scale had no obvious difference between the two groups [（49.31±11.48）, （50.58±12.63）, P 〉 0.05], and it was obviously higher in the UBIO treated group than in the control group after treatment [84.66±13.75）, （77.05±11.17）, P 〈 0.05].②The activity of K^＋-Na^＋-ATPase on RBC membrane in the UBIO treated group was significantly increased after the first and third treatment as compared with before treatment [（31.56±19.25）, （27.64±15.83）, （17.67±13.83）, P 〈 0.01], it was still higher after the completion of the treatment than before treatment without obvious difference [（20.86±14.53）, P 〉 0.05]. After the first and third treatment, it was obviously higher in the UBIO treated group than in the control group [19.31±11.88）, （17.44±10.42）, P 〈 0.01]. ③ In the UBIO treated group, Ca2^＋-Mg2^＋-ATPase activity on RBC membrane significantly increased after the first treatment and remained higher than the pre-treatment level throughout the treatment [（27.49±14.72）, （17.41±4.82）, P 〈 0.01]. The activity of Ca2^＋-Mg2^＋-ATPase on RBC membrane was markedly higher in the UBIO treated group than in the control group after after the first, third and the completion of treatment respectively [（24.83±12.88）, （17.70±5.69）; （28.08±13.44）, （16.32±5.29）; （17.42±6.04）, P〈 0.05-0.01]. CONCLUSION： The effect of UBIO treatment against acute cerebral infarction may be mediated by the increased K^＋-Na^＋ ATPase and Ca2^＋-Mg2^＋-ATPase activities on RBC membrane, which enhances the RBC transformation ability so as to lower RBC aggregation and correct high blood viscosity.

Evaluation of corticospinal tract injury with three-dimensional diffusion tensor tract in patients with acute cerebral infarction

BACKGROUND:Three-dimensional diffusion tensor tract(DTT)is the newest imaging to describe the structure of white matter fiber in three-dimensions,it has great significance in dividing the concrete anatomic site of gray and white matter lesions,displaying the correlation with fibrous band and judging clinical prognosis,which is incomparable by other imagings.OBJECTIVE:To observe the conditions of corticospinal tract(CST)in acute cerebral ischemic stroke patients,and analyze the relationship between motor function and the severity of CST injury.DESIGN:A case-control observation.SETTING:Department of Medical Imaging,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS:Fifteen patients with acute cerebral infarction were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February to December in 2005.They all suffered from acute attack and motor disorder of hemiplegic limbs to different extent,and were conformed by CT or MRI.There were 9 males and 6 females,aging 16-87 years old,the median age was 51.7 years,and all were right handed.Fifteen right-handed normal subjects,who were matched by age and sex with the patients in the cerebral infarction group,were selected from the relatives of patients and physicians of the Imaging Department as the control group.All the subjects were informed and agreed with the study.METHODS:The patients with acute cerebral infarction and subjects in the control group received MR diffusion tensor imaging(DTI)with GE 1.5 T nuclear magnetic resonance system,fiber tracking with the software of dTV-Ⅱ.Fractional anisotropy(FA)maps and three-dimensional tractography of bilateral CST of all patients were created.Displacement,continuity and destroy of fibrous bands were observed.At the same time,muscle strength of ipsilateral hand of patients with cerebral infarction was measured with Brunnstrom standard.The correlation between the severity of CST injury and the muscle strength of ipsilateral hand was analyzed with spearman correlation analysis.MAIN OUTCOME MEASURES:①FA values in the infarcted sites and those in the contralateral corresponding sites of patients with cerebral infarction;②CST manifestations in the patients with cerebral infarction and the control group.RESULTS:All the 30 testees were involved in the analysis of results.①The FA values in infarcted sites of white matter were significantly lower than those in the contralateral ones(t=4.570,P<0.001).②In the control group,bilateral CST were reconstructed,they originated from precentral gyrus,went downwards to internal capsule,and extended to pontine and medulla oblongata,each fiber had good uniformity in continuous form.In the patients with cerebral infarction,the forms of contralateral CST were consistent with those in the control group with good continuity.Due to the involvement by the infarcted site to different extents,the ipsilateral CST manifested as continuous interruption and loss of uniformity in anatomic structure and form.The CST involvements were divided into three grades:integrated CST for grade 1(n=2);integrated CST but compressed or displaced for grade 2(n=5);interrupted CST for grade 3(n=8).③The severity of CST injury was obviously correlated with the muscle strength of the ipsilateral hand(r=0.888,P<0.05).CONCLUSION:①CST is injured to different extents in patients with acute cerebral infarction,and the severity of injury is associated with muscle strength.It is indicated that it can be used to judge the prognosis of rehabilitative treatment.②DTT can directly display the status of pyramidal tract more three-dimensionally.

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

Objective:To investigate the clinical effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and its impact on quality of life.Methods:60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated by ultra-low frequency(10mHZ)repetitive transcranial magnetic stimulation for 14 days.The changes of NIHSS score andADL score and NSE serum level and Wa Tian drinking water experiment and Fujishima Ichiro dysphagia scale score and SWAL-QOL score and SF-36 score were observed between the two groups before and after treatment.The clinical effect was evaluated by Wa Tian drinking water experiment.Results:After treatment,The clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly lower compared with the control group(P<0.05),ADL score and Fujishima Ichiro dysphagia score and SWAL-QOL score and SF-36 scores were significantly higher compared with the control group(P<0.05).After treatment,SF-36 total score(or SWAL-QOL Score)was negatively correlated with NSE serum level and NIHSS score,which was positively correlated with ADL score and Fujishima Ichiro dysphagia scale score score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively improve dysphagia in elderly patients with acute cerebral infarction and significantly improve the elderly patients'life quality.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Comparison of the level of thrombus precursor protein in blood plasma between patients with acute cerebral infarction and healthy persons at different time

BACKGROUND： Thrombus precursor protein （TpP） is the index of thrombus activity level, and it is also early referencing index in detecting thrombus diseases. OBJECTIVE： To dynamically observe the changes of TpP level in blood plasma of patients with acute cerebral infarction at different time after onset, and to compare the differences of plasma TpP level between patients with acute cerebral infarction and healthy persons who received health examination. DESIGN： Controlled observation SETTING： Department of Neurology, Affiliated Hospital of Xuzhou Medical College PARTICIPANTS： Totally 58 patients with acute cerebral infarction who received the treatment in the Department of Neurology, Affiliated Hospital of Xuzhou Medical College between September 2004 and March 2005 were recruited in this study. They all met the diagnostic criteria revised by the 4^th National Conference of Cerebrovascular Disorders in 1995 and were diagnosed by clinical and skull CT and （or） MRI examinations. The patients included 33 male and 25 female aged from 36 to 87 years. Time to onset 〈 6 hours, 6 to 11 hours, 12 to 23 hours, 24 to 48 hours and 〉 48 hours were found in 10,11,14,10 and 13 patients respectively. Another 51 persons who homeochronously received the health body examination in our hospital were recruited, including 34 male and 17 female, aged 38 to 85 years, serving as control group. Patients with cardio-cerebrovascualr diseases or liver and kidney diseases were excluded. All the involved subjects were informed of the detected items. METHODS： About 4 mL venous blood was respectively taken from patients admitted to the hospital within 6 hours, 6 toll hours, 12 to 23 hours, 24 to 48 hours and more then 48 hours after onset, and healthy persons when receiving health examination. The level of TpP in blood plasma was measured with enzymelinked immunosorbent assay. MAIN OUTCOME MEASURES： ① Comparison of the level of plasma TpP between patients and controls;② Comparison of the level of plasma TpP of patients with acute cerebral infarction at different time after onset. RESULTS： Totally 58 patients with acute cerebral infarction and 51 persons who received health examination participated in the result analysis. ①Comparison of plasma TpP level between patients and controls： The plasma TpP level of patients with acute cerebral infarction was significantly higher than that of control group [（16.12±3.28）vs （5.38±1.36） mg/L, t= 20.993, P〈 0.01 ]. ② Comparison of plasma TpP level of patients with acute cerebral infarction at different time after onset： The level of plasma TpP was （12.06±3.06） mg/L within 6 hours, （15.11±3.42） mg/L at 6 to 11 hours, （20.63±4.05） mg/L at 12 to 23 hours, （16.15±3.50） mg/L at 24 to 48 hours and （11.88±3.11） mg/L at more than 48 hours after onset. It increased from the 6^th hour, reached the peak at the 12^th to 23^rd hours, maintained at very high level at the 48= hour and then gradually decreased and recovered to the level within 6 hours after onset. The level of plasma TpP of patients with acute cerebral infarction was signiticantly higher at the 12^th to 23^rd hours after onset and the 24^th to 48^th hours after onset than within 6 hours after onset （t = 13.385, P 〈 0.05）. CONCLUSION： ①The level of plasma TpP of patients with acute cerebral infarction is significantly higher than that of persons who received health examination.② Plasma TpP levels of patients with acute cerebral infarction change in wave manner at the different time after onset.

Changes of biochemical indexes in patients with acute cerebral infarction after treatment with simvastatin

BACKGROUND: At present, it is believed that the important causes of cerebral infarction are the disorders of lipid metabolism and endothelial function, and the outcomes of clinical treatment can be improved by regulating serum lipids and antiinflammation, etc. OBJECTIVE: To observe the effect of simvastatin, inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, on the levels of serum lipids, serum enzymic indexes and inflammatory metabolic indexes in patients with cerebral infarction. DESIGN: A comparative observation. SETTING: Department of Geriatrics, Longquanshan Hospital of Liuzhou City. PARTICIPANTS: Forty-eight patients with acute cerebral infarction were selected from the Department of Geriatrics of Longquanshan Hospital of Liuzhou from March 2004 to February 2006, including 24 males and 24 females, the mean age was (54±12) years, average disease course was (10.0±4.5) days. They were all accorded with the diagnostic standard for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1999, and cerebral hemorrhage was excluded by cranial CT scanning. The 48 patients were randomly divided into control group (n =24) and treatment group (n =24). Informed consents were obtained from all the participants. METHODS: ① All the patients were treated according to the symptoms, besides those in the treatment group were given simvastatin (Harbin Pharm. Group Sanjing Pharmaceutical Shareholding, Co.,Ltd., No. H20010454; Batch number: 20040218; 5 mg/tablet). The initial dosage was 10 mg per day for 4 weeks, and then increased to 30 mg per day for another 4 weeks. ② Before treatment and within 1 week after treatment, the total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), creatine kinase and C reactive protein in serum were determined with Beckman-cx7 automatic biochemical analytical apparatus in both groups. ③ The differences of intergroup and intragroup data were compared with the independent-samples t test and paired samples t test. MAIN OUTCOME MEASURES: Changes of total cholesterol, triglyceride, HDL-C, LDL-C, AST, creatine kinase and C reactive protein before and treatment in both groups. RESULTS: All the 48 patients with cerebral infarction were involved in the analysis of results. ① Changes of serum lipids: The levels of serum lipids were close between the two groups before treatment (P > 0.05). After treatment, the HDL-C level in the treatment group was obviously higher than that in the control group and that before treatment [(1.34±0.12), (0.92±0.33), (0.93±0.21) mmol/L, t =7.922, 11.699, P < 0.01], and the levels of total cholesterol, triglyceride and LDL-C were obviously lower than those in the control group and those before treatment (t =2.780-7.591, P < 0.01). ② Changes of serum enzymic indexes and C reactive protein in serum: The levels of enzymes and C reactive protein in serum had no obvious differences between the two groups before treatment (P > 0.05). The levels of AST, creatine kinase and C reactive protein in serum after treatment were obviously lower than those before treatment in both groups (t =7.259-17.996, P < 0.01). The levels of levels of creatine kinase and C reactive protein in serum after treatment in the treatment group were obviously lower than those in the control group [(3.061±0.522) μkat/L, (4.6±3.1) mg/L; (4.348±0.580) μkat/L, (12.3±4.8) mg/L, t =7.910, 6.463, P < 0.01]. CONCLUSION: Compared with common treatment according to symptoms, the additional administration of simvastatin is better for improving the serum lipids, serum enzymic indexes of patients with cerebral infarction at acute period, and benefit for repairing their inflammatory damages.

Acute Myocardial Infarction in a 26-Year-Old Man with Normal ST-Segment

Acute myocardial infarction (AMI) is rare in young adults. The management of these patients is considered as a clinical challenge. We report the case of a 26-year-old man who was presented to the Emergency Room of Affiliated Hospital of Guilin Medical University with an acute onset of chest pain. Initially electrocardiogram (ECG) with no evidence of ST-segment abnormalities but QT prolongation a signal of sudden cardiac death, 20 minutes later, it revealed ST-segment elevation myocardial infarction (STEMI). Coronary angiography (CAG) demonstrated left main coronary artery occlusion. AMI was diagnosed based on clinical symptom, elevated cardiac biomarkers, electrocardiographic dynamic monitoring and CAG. The awareness of chest pain as possible underlying AMI symptom—especially in young patients presenting with QT prolongation—is crucial for clinical treatment, as a missed diagnosis can worsen the patient’s further prognosis. In addition, reperfusion arrhythmia is a challenge to short-term outcomes of young patients with AMI, so it is necessary to make preoperative risk stratification.

中青年急性脑梗死患者自我感受负担的影响因素

目的分析中青年急性脑梗死(ACI)患者自我感受负担的影响因素,为临床制定干预策略提供参考。方法选取2021年3月至2023年3月南阳市中心医院收治的186例中青年ACI患者为研究对象,采用自我感觉负担量表(SPBS)评估自我感受负担情况。收集临床资料并分析不同临床资料特征者SPBS评分。多元线性回归分析SPBS评分的影响因素。采用Pearson法分析SPBS评分与家庭关怀度量表(APGAR)、社会支持评定量表(SSRS)、慢性病病耻感量表(SSCI)、世界卫生组织生存质量简表(WHOQOL-BREF)、恐惧疾病进展简化量表(FoPQ-SF)、医学应对方式问卷(MCMQ)相关性。采用中介模型分析病耻感在自我感受负担、医学应对方式的中介效应。结果186例中青年ACI患者SPBS(36.24±5.63)分;主要照顾者、社会支持、生活自理能力、照顾者健康状况、家庭人均月收入、疾病进展恐惧水平、家庭关怀度、慢性病病耻感、医学应对方式、生存质量为自我感受负担的影响因素(P<0.05);SPBS评分与APGAR、SSRS、WHOQOL-BREF、面对维度呈负相关,与SSCI、FoPQ-SF、回避维度、屈服维度呈正相关(P<0.05)。结论主要照顾者、社会支持、生活自理能力、照顾者健康状况、家庭人均月收入、疾病进展恐惧水平、家庭关怀度、慢性病病耻感、医学应对方式、生存质量为自我感受负担的影响因素,临床医生应采取有效措施,改善自我感受负担,针对性干预措施及健康教育。

通心络胶囊应用于老年急性脑梗死中的效果及对患者脑循环的改善作用分析

目的探讨在ACI老年患者常规西医药物治疗的基础上应用通心络胶囊的临床价值,并分析给药后患者脑循环受到的影响。方法选取2021年9月至2022年9月入院治疗的120例ACI老年患者,用随机数表法分组,各60例。对照组行尤瑞克林治疗,观察组增用通心络胶囊,比较两组NIHSS评分、mRS评分、ADL评分、血液流变学指标与脑循环动力学参数。结果观察组NIHSS评分、mRS评分低于对照组(P<0.05),ADL评分高于对照组(P<0.05);观察组全血黏度高切变值、血浆黏度、血细胞比容低于对照组(P<0.05);观察组Qmean、Vmean高于对照组(P<0.05),Rv、CP参数低于对照组(P<0.05)。结论在尤瑞克林治疗的基础上给予通心络胶囊,可改善老年ACI患者的临床疗效,其作用机制可能与降低血黏度、改善脑循环有关。

提高急性脑梗死再灌注治疗率

目的提高急性脑梗死再灌注治疗率。方法针对急性脑梗死患者再灌注治疗率低的现状,成立品管圈小组,通过解析原因、拟订对策,从卒中院前筛查宣教一体化、多学科协作并加强培训、优化绿色通道等方面进行持续改进。结果急性脑梗死再灌注治疗率从26.1%提升至40.8%。结论品管圈活动的开展,有效提高了卒中救治能力及急性脑梗死患者再灌注治疗率,确保了患者安全。

患者及家属联合管理模式对急性脑梗死患者神经介入术后康复的影响

目的探讨患者及家属联合管理模式对急性脑梗死患者神经介入术后康复的影响。方法收集2022年1月至2023年6月在本院收治的急性脑梗死患者80例,按照入院顺序分组,即对照组、观察组,均40例,对照组接受常规护理,观察组在对照组的基础上增加患者及家属联合管理模式。分别于干预前1d、干预3个月后评估希望水平、情绪状态、自我效能感、神经功能及预后情况。结果观察组希望水平各个维度评分、PANAS评分(PA)均高于对照组(P<0.05);观察组SAS评分、SDS评分、PANAS(NA)评分、SSEQ各个维度评分及总分、NIHSS评分、mRs评分均低于对照组(P<0.05)。结论患者及家属联合管理模式对急性脑梗死患者神经介入术后康复具有积极的影响,患者希望水平更高,情绪状态更稳定,自我效能感更强,神经功能恢复更好,预后情况更为良好。

程序化急诊急救在急性脑梗死患者中的应用价值

急性脑梗死(ACI)是近年来中老年患者常发疾病,具有发病人数多、发病急、危害大、致残率高的特点,且死亡率一直居高不下。近年来,随着医疗技术的快速发展,ACI患者的静脉溶栓时间窗给临床急诊急救带来极大的挑战,特别是急诊急救的速度与质量直接影响患者生命状况及预后状况,优化ACI患者的急诊急救措施势在必行。文章首先概述了ACI的发病现状,分析了ACI的急诊急救要求,总结了ACI急诊急救中存在的问题,提出了程序化急诊急救在ACI患者中的应用措施。

阿替普酶联合依达拉奉右莰醇治疗急性脑梗死的临床效果

目的分析阿替普酶与依达拉奉右莰醇联合使用治疗急性脑梗死(ACI)的临床效果。方法选取2020年11月至2021年11月安丘市人民医院神经内科收治的100例ACI患者作为研究对象,按照随机数字表法将其分为对照组(50例)与观察组(50例)。对照组单独使用阿替普酶溶栓,观察组采用阿替普酶溶栓加依达拉奉右莰醇护脑。比较两组患者的临床疗效、治疗前后的神经功能情况、生命质量及不良反应。结果观察组患者的总有效率(94.00%)高于对照组(74.00%),差异有统计学意义(P<0.05)。治疗后观察组患者的美国国立卫生研究院卒中量表(NIHSS)评分低于对照组,健康调查简表(SF-36)各维度评分和总分高于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论在神经内科的临床实践中,ACI应首选阿替普酶联合依达拉奉右莰醇进行治疗,以提高治疗效率,提高患者预后的生命质量。

基于5步共情模型干预方案在急性脑梗死患者中的应用效果观察

目的评估基于5步共情模型(5-SEM)干预方案对急性脑梗死(ACI)患者负性情绪、心理应激反应和睡眠质量的应用效果.方法选择2022年11月至2023年4月温州医科大学附属第二医院收治的100例ACI住院患者作为研究对象.按住院时间将患者分为对照组与观察组,每组50例.对照组采用常规护理方法,观察组在对照组的基础上采用5-SEM共情干预方案.具体方案为:组建干预团队,成立共情干预方案管理小组,该小组由有5年以上工作经验且学历为本科及以上的主治医师、心理医生、主管护师和护师组成;干预团队基于中国知网、万方数据库、美国国立医学图书馆PubMed数据库、荷兰医学文摘EMBase数据库等检索并整理相关文献,由心理医生评估患者情况,形成基于5-SEM患者共情干预方案最终稿,主管护师负责5-SEM干预方案落实,由护师实施干预.采用阿森斯失眠量表(AIS)评估患者的睡眠质量;采用医院焦虑抑郁量表(HADS)评估患者的焦虑抑郁程度;采用心理应激反应问卷(SRQ)评估心理应激反应干预效果.结果两组干预后睡眠质量评分、焦虑抑郁评分、心理应激反应评分均较干预前明显降低[睡眠质量评分(分):对照组为6.74±1.77比12.08±2.94,观察组为4.84±2.04比11.90±2.80;焦虑评分(分):对照组为7.14±2.20比8.58±2.38,观察组为6.06±2.47比8.34±2.03;抑郁评分(分):对照组为7.28±2.12比8.72±2.34,观察组为6.26±2.03比8.82±2.80;躯体反应评分(分):对照组为17.72±4.29比22.94±3.73,观察组为16.10±3.19比22.62±3.25;情绪反应评分(分):对照组为21.82±2.98比26.80±3.21,观察组为20.60±2.45比26.32±4.32;行为反应评分(分):对照组为12.68±1.75比15.46±3.18,观察组为11.16±1.98比14.90±2.24;心理应激反应评分(分):对照组为55.40±4.89比69.46±6.28,观察组为50.98±4.68比68.08±6.18,均P<0.05],且干预后观察组各项评分均明显低于对照组(均P<0.05).结论基于5-SEM的共情干预方案能缓解ACI患者焦虑抑郁和心理应激反应,改善睡眠质量.

急性脑梗死溶栓后患者应用互动达标理论功能锻炼的效果研究

目的:探索和分析急性脑梗死溶栓后患者应用互动达标理论功能锻炼的效果研究。方法:从本院2020年2月到2022年2月选取142例急性脑梗死溶栓后患者作为研究对象,按照随机数表法将急性脑梗死溶栓后患者平均分为2组,一部分为对照组采用常规护理方法进行干预,一部分为观察组在对照组基础上添加以互动达标理论为基础功能锻炼方法进行干预。使用临床心脑血管患者生活质量评价量表(Short form 24 questionnaire,SF-24)对患者的生活质量进行评价,使用临床患者康复知识掌握程度评价表格对患者的康复知识掌握程度进行评价,测量和统计患者的自我管理能力评分值和6 min步行试验距离。结果:观察组急性脑梗死溶栓后患者的生活质量评分结果要高于对照组急性脑梗死溶栓后患者的生活质量评分结果,其中观察组工作状况、一般生活功能、社会心理功能与对照组患者的工作状况、一般生活功能、社会心理功能相比较有比较大幅度的提高;接受干预后观察组患者的完全掌握占比值和基本掌握占比值均高于对照组患者的完全掌握占比值和基本掌握占比值,另外观察组患者的康复知识总掌握率值和对照组患者的康复知识总掌握率值相比较有一定程度的提升;干预后观察组急性脑梗死溶栓后患者的自我管理能力评分值、6min步行试验距离值均要好于对照组患者的数据值(P<0.05)。结论:急性脑梗死溶栓后患者应用以互动达标理论为基础功能锻炼后能够一定程度上提高患者的生活质量以及康复知识掌握情况,并且患者接受干预后的自我管理能力以及6min步行试验距离均有较好的发展。

多元化睡眠干预对重症急性脑梗死患者睡眠质量的影响

目的 多元化睡眠干预对重症急性脑梗死患者睡眠质量的影响研究。方法 选取2020年8月至2022年8月收治的80例重症急性脑梗死患者,分为2组,对照组选择常规护理干预治疗,研究组选择多元化睡眠干预治疗。比较2组睡眠质量指数(PSQI),焦虑评分(SAS),抑郁评分(SDS),神经功能缺陷程度评分(NIHSS)、日常生活能力评分(ADL)和护理满意度。结果 与对照组比较,研究组PSQI评分更低(P<0.05);研究组的SAS、SDS评分更低(P<0.05);研究组的NIHSS评分和ADL评分更好(P<0.05);研究组的护理满意程度较高(P<0.05)。结论 多元化睡眠干预对重症急性脑梗死患者具有明显的护理效果,可以很好的改善其睡眠质量以及神经缺损程度,缓解其负面心理情绪,提高整体日常生活能力以及护理满意度,可推广使用。

IVIM-DWI灌注参数与中青年急性脑梗死神经功能缺损程度及溶栓后出血性转化的相关性

目的 分析体内不相干运动扩散加权成像(IVIM-DWI)灌注参数与中青年急性脑梗死神经功能缺损程度及溶栓后出血性转化(HT)的相关性。方法 选择2019年7月至2022年5月就诊于本院的90例中青年急性脑梗死患者,均接受IVIM-DWI检查与静脉溶栓治疗。治疗前按照美国国立卫生研究院卒中量表(NIHSS)评分分为轻度组(28例)、中度组(40例)、重度组(22例),对比三组IVIM-DWI灌注参数[伪扩散系数(D*)、纯扩散系数(D)、灌注分数(f)、表观扩散系数(ADC)]及NIHSS评分,经Pearson相关性分析IVIM-DWI参数与NIHSS评分的相关性。按照溶栓后48h头颅CT结果 分为HT组(22例)、非HT组(68例),对比两组基础资料、IVIM-DWI灌注参数,线性回归分析影响急性脑梗死溶栓后HT发生的因素,绘制ROC曲线评估IVIM-DWI灌注参数及联合预测急性脑梗死溶栓后HT生的价值。结果 不同程度患者健侧区的ADC值、D值、D*值、f值相比,差异无统计学意义(P>0.05);重度组梗死区的ADC值、D值、D*值、f值<中度组<轻度组,NHSS评分>中度组>轻度组(P<0.05);Pearson相关性发现,ADC值、D值、D*值、f值均与ADC值呈反比(r<0,P<0.05);HT组、非HT组性别、发病部位、基础疾病、年龄相比,差异无统计学意义(P>0.05);HT组疾病程度重于非HT组,发病至溶栓时间长于非HT组,ADC值、D值、D*值、f值低于非HT组(P<0.05);线性回归分析显示,ADC值、D值、D*值、f值均与脑梗死静脉溶栓后HT的发生相关(P<0.05);ROC曲线结果 发现,ADC值、D值、D*值、f值及联合预测脑梗死静脉溶栓后HT发生的AUC为0.916(95%CI:0.856~0.976)、0.837(95%CI:0.751~0.922)、0.749(95%CI:0.622~0.876)、0.708(95%CI:0.570~0.845)、0.924(95%CI:0.841~1.000)。结论 IVIM-DWI灌注参数与中青年脑梗死患者病情程度密切相关,且ADC值、D值、D*值联合f值可有效预测溶栓后HT的发生。

阿加曲班联合丁苯酞治疗老年急性缺血性脑梗死的临床疗效分析

目的:采用阿加曲班联合丁苯酞对老年急性缺血性脑梗死进行治疗,观察分析其临床疗效情况,并研究其安全性。方法:以我院2019年3月至2021年9月收治的130例明确诊断的老年急性缺血性脑梗死为研究对象,使用随机数字表采用简单随机分组方法,其中对照组患者65例采用阿加曲班治疗(第1、2天,60mg/d阿加曲班24h持续静脉泵入,第3、4、5天,阿加曲班10mg/d,3h/次,2次/d,静脉滴注),试验组患者65例采用阿加曲班(同对照组)联合丁苯酞(口服,0.2 g/次,3次/d),两组患者均连续治疗5d。分别在治疗前后对患者的Barthel指数、NIHSS以及mRS评分进行测量统计,并测定两组患者血栓弹力图的R值、K值、α角、MA值等指标。计算两组患者治疗后疗效情况,并统计治疗过程中出现的头晕、食欲减退、恶心等不良反应情况。结果:在治疗前,被不同方案治疗患者的NIHSS评分、Barthel指数评分和mRS评分差异无统计学意义(P>0.05);治疗后两组患者的NIHSS评分和mRS评分明显降低,且试验组患者治疗前后NIHSS评分差值(8.34±1.24)和mRS评分差值(1.60±0.12)显著高于对照组(5.07±1.14、0.73±0.09),差异有统计学意义(P<0.05);治疗后患者Barthel指数评分均明显升高的变化,且试验组治疗前后Barthel指数评分差值(17.58±5.41)明显高于对照组差值(9.70±4.22),差异有统计学意义(P<0.05)。在治疗前,两组患者的血栓弹力图指标(R值、K值、α角、MA值)比较无明显差异(P>0.05);治疗后两组患者R值、K值明显升高,α角、MA值明显降低,且试验组患者α角小于对照组,试验组治疗前后R值升高幅度(0.16±0.12)显著低于对照组(0.20±0.11),试验组治疗前后α角降低幅度(9.40±0.88)显著高于对照组(7.46±0.75),差异均有统计学意义(P<0.05)。试验组患者总有效率为90.77%,明显高于对照组患者的70.77%,差异有统计学意义(P<0.05)。患者主要不良反应为头晕、食欲减退、恶心等,试验组共5例(7.69%),对照组4例(6.15%)(P>0.05)。结论:阿加曲班联合丁苯酞治疗老年急性缺血性脑梗死可大幅降低患者的NIHSS评分和mRS评分,且患者的Barthel指数评分明显升高,较单纯采用阿加曲班治疗预后更好,有利于临床治疗。