Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

REAL-TIME MONITORING OF MITOCHONDRIAL FUNCTION AND CEREBRAL BLOOD FLOW FOLLOWING FOCAL ISCHEMIA IN RATS

Focal ischemia due to reduction of cerebral blood flow(CBF),creates 2 zones of damage:the core area,which suffers severe damage,and penumbra area,which surrounds the core and suffers intermediate levels of injury.Objectives:A novel method is introduced,which evaluates mitochondrial function in the core and in the penumbra,during focal cerebral ischemia.Methods:Wistar rats underwent focal cerebral ischemia by middle cerebral artery occlusion(MCAO)for 60 minutes,followed by 60 minutes of reperfusion.Mitochondrial function was assessed by a unique Multi-Site—Multi-Parametric(MSMP)monitoring system,which measures mitochondrial NADH using fluorometric technique,and CBF using Laser Doppler Flowmetry(LDF).Results:At the onset of occlusion,CBF dropped and NADH increased significantly only in the right hemisphere.CBF levels were significantly lower and NADH significantly higher in the core than in the penumbra.After reperfusion,CBF and NADH recovered correspondingly to the intensity of ischemia.Conclusion:Application of the MSMP system can add significant information for the understanding of the cerebral metabolic state under ischemic conditions,with an emphasis on mitochondrial function.

Effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke

Objective:To investigate the effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke.Methods: One hundred cases of ischemic stroke admitted in our hospital from February 2015 to January 2017 were randomly divided into control group and observation group. The control group was given routine treatment. The observation group was given Shuxuetong injection on the basis of the control group. The changes of platelet function, hemorheology and cerebral blood flow before and after treatment were detected in both groups.Results: After treatment, the whole blood viscosity, plasma viscosity and fibrinogen level in both groups were significantly lower than those before treatment. The whole blood viscosity, plasma viscosity and fibrinogen level in the observation group were (4.18±0.05) mPa?s, (1.66±0.12) mPa?s and (3.45±0.08) g/L, respectively, which were significantly lower than the control group;After treatment, the levels of MCA, ACA and PCA in both groups were significantly increased. MCA, ACA and PCA levels in the observation group were (70.82±4.13) cm/s, (60.62±3.55) cm/s and (54.11±2.36) cm/s, which were significantly higher than those in the control group;After treatment, the maximum platelet aggregation rate, PLT, MPV and PDW levels in the two groups significantly decreased. The maximum platelet aggregation rate, PLT, MPV and PDW levels in the observation group were (27.93±1.44)% and (155.32±13.46)×109/L, (9.42±0.32) fL and (9.12±0.24) fL, respectively, which were significantly lower than those in the control group. Conclusions: Shuxuetong injection can effectively improve the patient's hemorheology and platelet function, improve the level of cerebral blood flow in patients with significant effect, it is worth further clinical application.

Curative Effects of Warming Needle Moxibustion Combined with Manipulation Massage on Cervical Spondylotic Vertebral Arteriopathy and Its Influence on the Cerebral Blood Flow Parameters and Cervical Vertebral Function

OBJECTIVE: To explore the curative effects of warming needle moxibustion combined with manipulation massage on cervical spondylotic vertebral arteriopathy and its influence on the cerebral blood flow and cervical vertebra function. METHODS: A total of 84 patients with cervical spondylotic vertebral arteriopathy admitted to our hospital from February 2016 to June 2017 were selected, and all patients were divided into an observation group (n=42) and a control group (n=42) according to the random number table method. The patients in the control group were given conventional western treatment, and the patients in the observation group were treated with warming needle moxibustion combined with manipulation massage on the basis of the control group. After 4 weeks of treatment, the changes of main clinical symptoms (vertigo, headache, neck and shoulder pain, tinnitus), cervical function (clinical symptoms, clinical examination, daily life action) and cerebral blood flow parameters (average blood flow velocity of left vertebral artery, right vertebral artery and basilar artery) of the 2 groups were observed, and the clinical efficacy of the 2 groups were statistically analyzed. RESULTS: The scores of vertigo, headache, neck and shoulder pain and tinnitus in the 2 groups were all significantly lower than before treatment (P < 0.05), and the clinical symptom scores in the observation group were significantly lower after treatment (P < 0.05);After treatment, the scores of clinical symptoms, clinical examination and daily life action in the 2 groups were significantly higher than those before treatment (P < 0.05), and the increase of cervical vertebral function score in the observation group was better than that in the control group (P < 0.05);The mean blood flow velocity of the left vertebral artery, right vertebral artery and the basilar artery in the 2 groups after treatment were significantly higher than before treatment (P < 0.05), and the increase of the above cerebral blood flow parameters in the observation group were higher than the control group (P < 0.05). The total effective rate was 92.9% in the observation group and 76.2% in the control group after treatment, and the difference between the 2 groups was statistically significant (P < 0.05). CONCLUSION: Warming needle moxibustion combined with manipulation massage can quickly relieve the clinical symptoms of patients with cervical spondylotic vertebral arteriopathy, improve the cervical function and cerebral blood flow parameters, increase the vertebrobasilar artery blood flow, and promote the recovery of the disease.

Correlation between special brain area and blood perfusion in patients with cerebral infarction at convalescent period Feasibility for quantitative determination and estimation of learning and memory function

BACKGROUND： Presently, clinic memory scale is used to evaluate learning memory ability in most studies, and the influence of difference in measurement condition of individuals exists. OBJECTIVE： To study the correlation between regional cerebral blood flow （rCBF） perfusion and learning memory function in special brain regions of patients with cerebral infarction at convalescent period, and to try to find out a method which can quantitatively evaluate learning ability. DESIGN： Case observation, and correlation analysis. SETTINGS： Shandong Institute for Behavioral Medicine; the Affiliated Hospital of Jining Medical College. PARTICIPANTS： Totally 70 patients with cerebral infarction admitted to Department of Neurology, Jining Medical College between January 2004 and December 2005 were involved. The involved patients, 58 male and 12 female, were averaged （52±3） years, and they were all right handed. They all met the diagnosis criteria instituted by the Fourth National Conference on Cerebrovascular Disease, and were confirmed as cerebral infarction by skull CT or MRI. Informed consents of detected items were obtained from all the patients and relatives. METHODS： When the patients were at convalescent period, their learning and memory ability were measured with “ clinic memory scale （set A）”. The 18 patients whose total mark over 100 were regarded as good learning memory function group; The 23 cases whose total mark less than 70 were regarded as poor learning memory function group. RCBF of hippocampus, nucleus amygdalae, temporal cortex and prefrontal lobe of patients between two groups were measured and compared by single photon emission computed tomography （SPECT）. The total scores of the 18 good learning memory patients and 23 poor learning memory patients were taken as dependent variable Y, and their rCBFs of hippocampus, nucleus amygdale, temporal cortex and prefrontal lobe respectively as independent variable X for linear correlation analysis. MAIN OUTCOME MEASURES： Correlation of rCBF in different brain regions and learning memory ability in patients with cerebral infarction. RESULTS： ①The rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex of good learning memory function group were significantly higher than those of poor learning memory function group （P 〈 0.05）. ②In the good learning memory function group, rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex were significantly positively correlated with memory scale scores （ r = 0.961, 0.926, 0.954, 0.907, P 〈 0.05 ） , and also in the poor learning memory function group （r = 0.979, 0.976, 0.991, 0.953, P 〈 0.05 ） . CONCLUSION： The rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex of patients with cerebral infarction are significantly positively correlated with memory scale scores. Predicting learning memory ability of patients by quantitative determination of rCBF provides a quantitative and objective method for evaluating learning memory ability.

Sufficiently Elevated Core Body Temperature May Be Necessary to Maintain Cerebral Blood Flow Response throughout the Morning

In comparison to a carbohydrate-rich breakfast, a nutritionally balanced breakfast reportedly leads to a higher core body temperature because of diet-induced thermogenesis (DIT) and also results in higher task performance. This study aimed to examine the relationships among the core body temperature, blood glucose level, cerebral blood flow, and cognitive performance when the core body temperature is raised to a similar extent as in DIT in the morning. This crossover study included 18 male participants who performed four sets of cognitive tests in the morning with four different foot baths and glucose intake conditions. In elevated body temperature (EBT) conditions, the core body temperature was increased by a foot bath at 42&#730;C or 39&#730;C, while in low body temperature (LBT) conditions, it was maintained at 35&#730;C by a foot bath;the participants received no glucose or two intakes of 20-g glucose for each thermal condition. In addition to the core body temperature measurement, the cerebral blood flow in the dorsolateral prefrontal cortex (DLPFC) was measured using near-infrared spectroscopy. Three blood collections were performed to measure the changes in blood glucose levels. The results revealed that in the EBT conditions, the core body temperature remained 0.3&#730;C - 0.5&#730;C higher than that at wake-up time, while the glucose intake conditions increased blood glucose levels which remained higher than those during fasting. No significant between-treatment difference was observed in the results of cognitive tests. However, the blood flow in the DLPFC increased during the second test period in the EBT/glucose and LBT/glucose conditions, whereas during the fourth test period, it increased solely in the EBT/glucose condition. Thus, in addition to the blood glucose level, an elevated core body temperature within the physiological range may be needed for long-term maintenance of the cerebral blood flow response.

How does the motor relearning program improve neurological function of brain ischemia monkeys?

The motor relearning program can significantly improve various functional disturbance induced by ischemic cerebrovascular diseases. However, its mechanism of action remains poorly understood. In injured brain tissues, glial fibrillary acidic protein and neurofilament protein changes can reflect the condition of injured neurons and astrocytes, while vascular endothelial growth factor and basic fibroblast growth factor changes can indicate angiogenesis. In the present study, we induced ischemic brain injury in the rhesus macaque by electrocoagulation of the M1 segment of the right middle cerebral artery. The motor relearning program was conducted for 60 days from the third day after model establishment. Immunohistochemistry and single-photon emission CT showed that the numbers of glial fibrillary acidic protein-, neurofilament protein-, vascular endothelial growth factor- and basic fibroblast growth factor-positive cells were significantly increased in the infarcted side compared with the contralateral hemisphere following the motor relearning program. Moreover, cerebral blood flow in the infarcted side was significantly improved. The clinical rating scale for stroke was used to assess neurological function changes in the rhesus macaque following the motor relearning program. Results showed that motor function was improved, and problems with consciousness, self-care ability and balance function were significantly ameliorated. These findings indicate that the motor relearning program significantly promoted neuronal regeneration, repair and angiogenesis in the surroundings of the infarcted hemisphere, and improve neurological function in the rhesus macaque following brain ischemia.

Evaluation of Prognosis of Brain Function with Early Transcranial Color Doppler Ultrasound in Patients after Cardiopulmonary Resuscitation

Objective: To evaluate the clinical value of transcranial color Doppler ultrasound (TCCD) in assessing cerebral function after cardiopulmonary resuscitation (CPR). Methods: A prospective study was conducted in 52 patients with cardiac arrest treated by CPR from January 2018 to January 2020, and its clinical data were analyzed. According to classification of cerebral performance category (CPC), 31 cases (CPC grade 1 - 2) were selected in the good prognosis group and 21 cases (CPC grade 3 - 5) in the poor prognosis group. The cerebral blood flow was measured by transcranial Doppler ultrasound (TCCD) 24 h after CPR, and the differences were compared between the two groups in stroke index, diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function. Results: The data showed that the pulsatility index of middle cerebral artery of the poor prognosis group decreased within 24 h;the difference between the two groups was statistically significant (p < 0.05);the Vd, Vs, Vm increased in the good prognosis group;the difference between the two groups was statistically significant (p < 0.05). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function, and the results showed that the area under the curve and the optimal critical value of cerebral blood flow were 0.731 and 5.69. The sensitivity and specificity were 67.3% and 79.1% respectively. Conclusion: The cerebral blood flow increase in the early stage of successful CPR is positively correlated with the prognosis of cerebral functional resuscitation. Monitoring intracranial blood flow after CPR by TCCD has clinical value to evaluate prognosis of brain function.

不同针灸介入时机对大脑中动脉供血区急性脑梗死神经功能预后的影响

目的观察不同针灸介入时机对大脑中动脉供血区急性脑梗死神经功能预后的影响。方法回顾性选取2020年1月—2022年8月收治的116例大脑中动脉供血区急性脑梗死患者的临床资料进行分析,根据针灸介入时机分为两组。两组均进行静脉溶栓及常规药物治疗,观察组61例患者于发病72 h内给予针灸治疗,对照组55例患者于发病2周时给予针灸治疗。检测两组不同时间点侧支循环代偿情况、脑损伤标志物的水平,评估两组不同时间点简易精神状态检查(Mini-mental state examination,MMSE)评分、神经功能评分、Barthel指数(Barthel index,BI)评分、肢体运动功能评分、中医症状评分的差异,统计两组疗效。结果治疗前,两组侧支循环代偿情况比较,差异无统计学意义(P>0.05)。治疗4周和随访时,两组患侧大脑前动脉平均血流速度与对侧大脑中动脉平均血流速度的比值(Ratio of the average flow ve⁃locity of the affected anterior cerebral artery to the average flow velocity of the contralateral middle cerebral artery,iVACA/cVM⁃CA)较治疗前升高,观察组同时间点较对照组更高(P<0.05);两组患侧大脑后动脉平均血流速度与对侧大脑中动脉平均血流速度的比值(Ratio of the average flow velocity of the affected posterior cerebral artery to the average flow velocity of the contralateral middle cerebral artery,iVPCA/cVMCA)与治疗前比较,差异无统计学意义(P>0.05)。治疗前,两组脑损伤标志物比较,差异无统计学意义(P>0.05)。治疗4周和随访时,两组脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)较治疗前升高,观察组同时间点较对照组更高(P<0.05);两组钙结合蛋白β(Calcium binding proteinβ,S100β)、神经胶质纤维酸性蛋白(Glial fibrillary acid protein,GFAP)较治疗前下降,观察组同时间点较对照组更低(P<0.05)。治疗前,两组Fugl-Meyer评分、中医症状评分等相关评分比较,差异无统计学意义(P>0.05)。治疗4周和随访时,两组MMSE评分、BI评分及上肢和下肢Fugl-Meyer评分较治疗前升高,观察组同时间点较对照组更高(P<0.05);两组美国国立卫生院神经功能缺损(National institutes of health stroke scale,NIHSS)评分、中医症状评分较治疗前下降,观察组同时间点较对照组更低(P<0.05)。观察组总有效率为88.52%(54/61)高于对照组的72.73%(40/55),差异有统计学意义(P<0.05)。结论发病72h内采用针灸治疗可改善大脑中动脉供血区急性脑梗死脑损伤标志物的表达,改善脑血流,促进神经功能的恢复,有利于疾病的康复。

阿加曲班联合尤瑞克林治疗急性脑梗死的临床疗效

目的探究阿加曲班联合尤瑞克林治疗急性脑梗死的效果及对神经功能恢复、脑血流灌注、血清血管内皮因子(VEGF)、白介素-33(IL-33)、超敏C反应蛋白(hs-CRP)水平的影响。方法选取吉林省人民医院2021-03—2024-03收治的92例急性脑梗死患者为研究对象,分为联合给药组和单一给药组各46例。单一给药组予以尤瑞克林治疗,联合给药组在单一给药组基础上予以阿加曲班治疗,2组患者均治疗30 d。比较2组患者神经功能恢复情况、脑血流灌注状态及实验室指标(VEGF、IL-33、hs-CRP)水平。结果治疗后,联合给药组患者美国国立卫生研究院卒中量表(NIHSS)评分为(6.22±1.78)分,低于单一给药组的(10.23±2.59)分,Barthel指数为(77.85±13.19)分,高于单一给药组的(62.76±14.08)分(t=8.654、5.305,P<0.05)。联合给药组患者的脑血流灌注指标脑血流通过时间(MTT)和峰值时间(TTP)分别为(6.17±2.71)s和(32.13±9.23)s,均低于单一给药组(7.59±2.45)s和(36.21±9.36)s,局部脑血流量(CBF)和脑血容量(CBV)分别为(72.8±13.6)mL/100 mg和(9.85±3.43)mL/100 mg,均高于单一给药组(62.4±14.9)mL/100 mg和(8.03±2.25)mL/100 mg(t=2.636、2.105、3.496、3.009,P<0.05)。联合给药组患者的实验室指标VEGF(238.12±30.65)ng/L,高于单一给药组(185.86±32.12)ng/L,血清IL-33和hs-CRP分别为(57.67±15.94)ng/L和(6.02±1.12)mg/L,均低于单一给药组(76.02±19.12)ng/L和(11.67±3.04)mg/L(t=7.983、4.000、11.828,P<0.05)。结论阿加曲班与尤瑞克林联合用药能够促进急性脑梗死患者神经功能恢复,积极改善脑血流灌注情况并减轻炎症反应及血管内皮损伤。

通隧补肾解语汤治疗缺血性脑卒中后失语症疗效分析与探讨

目的探讨缺血性脑卒中后失语症实施通隧补肾解语汤进行治疗的效果。方法回顾性选取2021年1月—2022年10月泰安市中医医院接收的90例缺血性脑卒中后失语症患者的临床资料,按不同治疗方法分为对照组和观察组,各45例。对照组给予常规治疗,观察组加用通隧补肾解语汤治疗,对比两组治疗效果。结果研究组治疗总有效率(97.78%)高于对照组(82.22%),差异有统计学意义(χ^(2)=4.444,P<0.05)。治疗后,观察组口语表达、听语理解、阅读以及书写方面均优于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组脑血流变化优于对照组,差异有统计学意义(P均<0.05)。结论常规治疗加用通隧补肾解语汤治疗缺血性脑卒中后失语症的效果较为显著,同时可以改善患者的言语能力以及脑血流变化情况。

针灸推拿联合黄芪穴位注射对脑瘫患儿运动功能、脑血流的影响研究

目的分析针灸推拿联合黄芪穴位注射对脑性瘫痪(脑瘫,CP)患儿运动功能、脑血流的影响。方法100例CP患儿作为研究对象,按照随机数字表法分为常规组和治疗组,每组50例。常规组实施针灸推拿疗法,治疗组实施针灸推拿联合黄芪穴位注射疗法。比较两组患儿的临床治疗效果,治疗前后的粗大运动功能测试量表(GMFM)、脑瘫患儿精细运动能力测试量表(FMFM)评分及脑血流情况[大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)的平均血流速度和血管搏动指数(PI)]。结果治疗组治疗总有效率96.00%显著高于常规组的82.00%,组间比较体现出差异性表现(P<0.05)。两组患儿治疗前GMFM、FMFM评分组间比较显示出相似性表现(P>0.05);治疗后,治疗组GMFM评分(199.76±21.22)分、FMFM评分(154.37±14.65)分相较于常规组的(176.56±20.34)、(141.43±13.48)分更高,组间比较均体现出差异性表现(P<0.05)。两组患儿治疗前MCA、ACA、PCA的平均血流速度和PI比较显示出相似性表现(P>0.05);治疗后,治疗组MCA、ACA、PCA的平均血流速度分别为(48.21±6.37)、(36.25±3.45)、(33.27±3.78)cm/s,高于常规组的(42.45±6.53)、(34.78±3.27)、(30.76±4.12)cm/s,PI(0.87±0.23)低于常规组的(1.23±0.45),组间比较均体现出差异性表现(P<0.05)。结论将针灸推拿与黄芪穴位注射联合应用在CP患儿治疗中,可以对患儿的粗大、精细运动功能进行改善,同时可以改善脑血流情况,使CP患儿的肌张力、姿势异常得到显著改善,起到不可替代的效果。

高压氧联合银杏叶提取物治疗老年血管性痴呆疗效观察

目的探讨高压氧联合银杏叶提取物治疗老年血管性痴呆的临床疗效。方法选择2019年1月至2022年12月在郑州市第九人民医院就诊的132例老年血管性痴呆患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组66例。2组患者均给予常规治疗,在此基础上,对照组患者给予高压氧治疗,每日1次;观察组患者给予高压氧联合银杏叶提取物治疗,每日1次;2组患者均连续治疗1个月。分别于治疗前后采用蒙特利尔认知评估量表(MoCA)和Barthel指数评估2组患者的认知功能和日常生活活动能力,并依据MoCA评分和Barthel指数评估2组患者治疗后的临床疗效。分别于治疗前后采用经颅多普勒超声仪检测2组患者大脑前动脉、大脑后动脉、大脑中动脉及椎动脉平均血流速度等脑血流动力学指标。结果治疗前2组患者MoCA评分及Barthel指数比较差异无统计学意义(P>0.05)。治疗后,2组患者MoCA评分及Barthel指数均高于治疗前(P<0.05),且观察组患者的MoCA评分及Barthel指数显著高于对照组(P<0.05)。治疗后,对照组和观察组患者总有效率分别为84.85%(56/66)和95.45%(63/66),观察组患者总有效率显著高于对照组(χ^(2)=4.181,P<0.05)。治疗前2组患者大脑前动脉、大脑后动脉、大脑中动脉及椎动脉平均血流速度比较差异无统计学意义(P>0.05)。治疗后,2组患者大脑前动脉、大脑后动脉、大脑中动脉及椎动脉平均血流速度大于治疗前(P<0.05),且观察组患者大脑前动脉、大脑后动脉、大脑中动脉及椎动脉平均血流速度大于对照组(P<0.05)。治疗期间对照组和观察组患者总不良反应发生率分别为16.67%(11/66)、18.18%(12/66),2组患者总不良反应发生率比较差异无统计学意义(χ^(2)=0.218,P>0.05)。结论高压氧联合银杏叶提取物可更显著地改善老年血管性痴呆患者脑血流状态和认知功能障碍,提高患者日常生活活动能力,总体疗效好,且安全性高。

允许性高碳酸血症对腹腔镜胆囊切除术老年患者颈动脉血流和早期认知功能的影响

目的观察腹腔镜胆囊切除术(LC)建立气腹后给予允许性高碳酸血症(PHC)通气策略对老年患者颈动脉血流和早期认知功能的影响。方法选择全身麻醉下行LC的老年患者90例,其中男性45例,女性45例;年龄65~80岁,平均年龄71.00岁(标准差6.71岁);身高150~185 cm,平均身高163.77 cm(标准差9.35 cm);体质量46~90 kg,平均体质量66.98 kg(标准差9.60 kg);美国麻醉医师协会(ASA)分级Ⅱ级73例,Ⅲ级17例;美国纽约心脏病协会(NYHA)分级Ⅱ级79例,Ⅲ级11例;文化程度小学20例,中学60例,大学10例。随机分为PHC组(H组,n=45)和常规通气组(C组,n=45)。所有患者在手术开始之前均采用常规通气模式,在建立气腹后,C组调整动脉血二氧化碳分压(PaCO_(2))为35~45 mmHg,H组调整PaCO_(2)在46~55 mmHg。记录所有患者麻醉诱导前(T0)、麻醉诱导后手术前(T1)、气腹后稳定目标值15 min(T2)、气腹后稳定目标值30 min(T3)、缝皮结束(T4)5个时间点的局部脑氧饱和度(rSO_(2))、右颈内动脉收缩期峰值流速(PSV-RICA)、舒张末期峰值流速(EDV-RICA)、右颈内动脉平均流速(VM-RICA)、右颈内动脉流量(Q-RICA)、左颈内动脉流量(Q-LICA)、右颈总动脉收缩期峰值流速(PSV-RCCA)、心率(HR)、平均动脉压(MAP)、心输出量(CO)、鼻咽温度、动脉血气,PaCO_(2)、动脉血氧分压(PaO_(2))、乳酸(Lac)、血糖(Glu),血红蛋白(Hb);并于术前1 d、术后12 h、术后1 d、出院前对患者进行简易精神状态评价量表(MMSE)评分和认知功能筛查量表(CASI)评分。结果(1)与C组比较,H组手术后住院时间较短[(4.60±0.65)d vs(5.17±0.84)d。t=2.915,P<0.05];H组在T1、T2、T3、T4时间点CO均高于C组(均P<0.05);H组PSV-RICA、PSV-RCCA、双侧颈内动脉流量(Q-ICA)在T2、T3、T4时间点均高于C组(P<0.05);H组脑循环阻力(C-SVR)值在T2、T3时间点均低于C组(P<0.05)。(2)与C组比较,T2、T3、T4时H组rSO_(2)、PaCO_(2)、Lac明显升高(P<0.05)。(3)与C组比较,MSE评分在术后12 h和出院前较高(P<0.05),H组CASI评分在术后12 h、术后1 d和出院前较高(P<0.05)。C组和H组MMSE评分和CASI评分在术后12 h、术后1 d均低于术前(P<0.05),且C组MMSE评分和CASI评分在出院前低于术前(P<0.05)。(4)在PHC下,T1时PSV-RICA与rSO_(2)为正相关(P<0.05),相关性大小为0.261。T2时PSV-RICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.303、0.578、0.350。T3时PSV-RICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.259、0809、0.419。T4时PSVRICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.387、0.785、0.263。在PHC下,T1、T2、T4时,PSVRICA与CO呈正相关(R=0.265、0.422、0.405);PSV-RICA、Q-RICA与rSO_(2)呈正相关;在T3时Q-RICA与CO(R=0.301)呈正相关。结论PHC可以增加LC老年患者的颈内动脉血流量及收缩期流速,提高其脑灌注,维持脑氧供需平衡,从而发挥脑保护作用,也可能有利于改善患者手术后早期认知功能的恢复。

高压氧联合尼莫地平在接受颅内动脉瘤夹闭术患者中的效果

目的 探讨颅内动脉瘤(IA)夹闭术患者术后接受高氧与尼莫地平治疗的效果。方法 选取2018年1月至2023年1月在漯河市源汇区人民医院接受IA夹闭术的90例患者作为研究对象,采用随机数字表法分为观察组(45例)和对照组(45例)。术后对照组接受尼莫地平治疗,观察组在对照组基础上接受高压氧治疗。比较两组患者不同时点脑血流动力学指标、神经功能损伤情况、脑血管痉挛(CVS)发生情况、预后、生活质量及日常生活能力。结果 治疗后第14天,观察组大脑中动脉平均血流速度(MFV)、收缩期最大峰值流速(SPV)均高于对照组(P<0.05),而血管阻力指数(RI)及搏动指数(PI)低于对照组(P<0.05),CVS发生率低于对照组(P<0.05),简明健康状况调查表(SF-36)评分及日常生活能力评定量表(ADL)评分高于对照组(P<0.05),格拉斯哥结局量表(GOS)预后情况优于对照组(P<0.05);治疗后第7、14天,观察组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组(P<0.05)。结论 高压氧联合尼莫地平可改善IA夹闭术患者术后脑血流及神经功能,并降低脑血管痉挛发生率,改善患者预后,提高生活质量及日常生活能力。

脑氧代谢率的功能磁共振成像方法

目的提出一种可用于脑氧代谢率(Cerebral Metabolic Rate of Oxygen,CMRO_(2))功能磁共振成像研究的方法——基于灌注的多回波非对称性自旋回波(Perfusion Multiecho Asymmetric Spin Echo,PMASE)技术。方法PMASE技术主要结合了流动敏感交替反转恢复技术与多回波非对称性自旋回波技术,可同步测量得到脑血流量(Cerebral Blood Flow,CBF)和脑氧摄取分数(Oxygen Extraction Fraction,OEF)的动态变化,根据菲克定律最终实现对CMRO_(2)动态变化的测量。研究通过右手握拳任务设计验证该技术的可行性。结果所有受试者的CBF和OEF激活区都位于左侧运动皮层,且右手握拳任务引起的CBF、OEF和CMRO_(2)的相对变化分别为-21.4%±4.5%、48.2%±9.6%和16.1%±8.3%,与先前的研究结果保持一致。结论PMASE技术具有为探索脑功能和疾病相关的CMRO2提供新的功能磁共振成像技术的潜力。

Effects of regional cerebral blood flow perfusion on learning and memory function and its molecular mechanism in rats

Objective:To study the effects of regional cerebral blood flow(r CBF)perfusion on learning and memory function in special brain areas and its molecular mechanism in rat.Methods:Sixty-four adult male healthy Sprague-Dawley(SD)rats were randomly divided into two groups:A false operation group and an operation group.The false operation group was randomly divided into four subgroups(A_0,B_0,C_0,and D_0)and the operation group was randomly divided into four subgroups(A,B,C,and D),with eight rats in each subgroup.The operation group underwent bilateral common carotid artery permanent ligation,while the other group only underwent a skin incision without the bilateral common carotid artery permanent ligation.Learning memory function of rats in each subgroup was measured using a Y-maze at 4 h,8 h,24 h,and 3 days after surgery.The r CBF in the right frontal lobe and hippocampus was detected using the Periflux PF model laser Doppler flowmetry and c-fos,c-jun,Bcl-2,and Bax protein expression in the right frontal lobe and hippocampus was measured using immunohistochemistry.Results:The r CBF in the right frontal lobule division and right hippocampus division was significantly lower in the operation group than in the false operation group(P<0.05).The error number(EN),time to reach the target,and total reaction time(TRT)for the learning index using the Y-type labyrinth test in the operation group were significantly higher than that in the false operation group(P<0.05);however,the active avoid rate in the operation group was significantly lower than that of the false operation group.Expression of c-fos and c-jun as well as the average absorbency in the right frontal lobule division and right hippocampus division in the operation group were significantly higher than those in the false operation group(P<0.05).The number of Bax and Bcl-2-positive cells was significantly higher in the operation group,and the expression ratio of Bax/Bcl-2 in the operation group was significantly higher than that in the false operation group(P<0.01).Conclusions:r CBF decrease can impair learning and memory function in rats,which may be related to the increased expression of c-fos,c-jun,Bcl-2,and Bax proteins in the frontal cortex and hippocampus.

自动分割海马亚区感兴趣区与3D-pCASL融合测量脑血流量一致性及可重复性

目的评价颞叶内侧癫痫伴海马硬化患者MRI影像研究中自动分割海马亚区感兴趣区(ROI)与动脉自旋标记(ASL)功能像融合测量脑血流量(CBF)的一致性及可重复性。资料与方法回顾性收集2021年1月—2022年10月宁夏医科大学总医院经MRI诊断或病理证实为海马硬化的52例颞叶内侧癫痫,患者均在3.0T MRI上采用轴位T1加权三维磁化强度预备梯度回波(3D-T1WI-MPRAGE)序列及三维伪连续式ASL序列进行扫描。对3D-T1WI-MPRAGE图像进行自动分割海马亚区,由2名医师进行海马亚区ROI与ASL功能图像融合并测量CBF值,分析测量者内、测量者间的一致性与可重复性。结果2名医师测得CBF值ICC均>0.750,平均为0.868±0.095,左、右侧海马各亚区ICC分别为:下托:0.818/0.801、海马角(CA)1:0.920/0.907、CA2~3:0.759/0.978、CA4:0.757/0.758、齿状回:0.990/0.991;同一名医师ROI勾画的ICC均>0.990,平均为0.994±0.002,左、右侧海马各亚区ICC分别为:下托:0.993/0.993、CA1:0.996/0.995、CA2~3:0.989/0.994、CA4:0.992/0.995、齿状回:0.993/0.996。BlandAltman图可直观展示散点分布和一致性,获取重复性系数。同一观察者对自动分割ROI与ASL功能像融合测量具有一定可重复性。结论基于自动分割海马亚区ROI与ASL功能像融合测量的CBF值具备较高的一致性及可重复性。

法舒地尔联合尤瑞克林治疗脑梗死后血管性认知障碍临床研究

目的探讨法舒地尔联合尤瑞克林治疗脑梗死后血管性认知障碍(VCI)的临床疗效及对患者脑血流灌注、神经电生理指标及同型半胱氨酸(Hcy)的影响。方法选取医院2020年6月至2022年12月收治的脑梗死后VCI患者116例,根据治疗方案的不同分为观察组(69例)和对照组(47例)。两组患者均接受常规抗血小板聚集治疗及注射用尤瑞克林静脉滴注,观察组患者加予盐酸法舒地尔注射液静脉滴注。两组均持续治疗2个月。结果观察组总有效率为91.30%,显著高于对照组的76.60%(P<0.05)。与对照组比较,观察组患者治疗后的脑基底的脑血流量、脑血容量显著增加,平均通过时间显著缩短,P300波幅显著增大,P300潜伏期显著缩短,脑电波比值[(δ+θ)/(α+β)]、血清Hcy水平显著降低(P<0.05)。观察组与对照组不良反应发生率相当(13.04%比8.51%,P>0.05)。结论法舒地尔联合尤瑞克林治疗脑梗死后VCI,能改善患者的脑血流灌注及神经电生理功能指标,降低Hcy水平。

亚低温治疗重型颅脑损伤患者的前瞻性对照研究

目的前瞻性对照分析亚低温治疗对重型颅脑损伤患者的影响。方法选取83例重型颅脑损伤患者,入院时间2022-01—2023-09。所有患者随机数字表法分为对照组40例(标准大骨瓣减压术治疗)与亚低温组43例(标准大骨瓣减压术+亚低温治疗),评价2组患者治疗前后基本生命体征、血气指标、脑血流指标、神经功能,观察并发症发生率。结果治疗后,2组rSO2、CPP升高,亚低温组高于对照组[(86.24±3.87)mmHg比(79.64±3.48)mmHg,(69.24±4.25)比(62.34±4.31)],ICP均降低,亚低温组低于对照组[(26.18±2.25)mmHg比(31.28±2.28)mmHg],差异均有统计学意义(P<0.05);治疗前后比较,亚低温组体温明显降低[(36.37±0.27)℃比(34.15±0.31)℃,P<0.05],对照组体温无显著变化[(36.45±0.21)℃比(36.56±0.16)℃,P>0.05];2组患者SaO、PaO2水平均明显升高,亚低温组高于对照组[(95.64±2.16)%比(92.31±2.13)%,(86.27±5.10)mmHg比(81.31±5.14)mmHg],PaCO_(2)均下降,亚低温组低于对照组(36.15±3.11)mmHg比(42.72±3.23)mmHg],差异均有统计学意义(P<0.05);2组患者Qm、Vm均升高,亚低温组高于对照组[(15.63±4.38)mL/s比(11.49±3.61)mL/s,(42.67±5.18)cm/s比(38.56±4.26)cm/s],DR均降低,亚低温组低于于对照组[(263.36±22.57)kPa/s比(295.27±26.64)kPa/s],差异均有统计学意义(P<0.05);2组患者GCS评分均升高,亚低温组高于对照组(9.24±1.18)分比(7.56±1.26)分,NIHSS评分降低,亚低温组低于对照组[(22.65±3.39)分比(25.63±3.53)分],6个月后GOS评分亚低温组高于对照组(4.25±0.24)分比(3.85±0.14)分,差异均有统计学意义(P<0.05);2组患者并发症发生率无统计学差异(16.67%比33.33%,P>0.05)。结论重型颅脑损伤患者行基础颅脑手术后联合亚低温辅助治疗能够改善患者脑氧代谢及脑血流,从而促进神经功能恢复,改善预后。