【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.
【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.
目的：探讨C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)在急性脑梗死中的作用及相互关系。方法：测定了32例脑梗死急性期患者和37例健康人的外周血CRP，TNF-α的含量水平。结果：脑梗死患者急性期CRP 及TNF-α明显升高且呈显著正相关。结论：CRP，TNF-α的升高在急性脑梗死发生发展中可能起一定的作用。
Objectives To assess the efficacy and safety of dl-3-butylphthalide for patients with acute ischemic stroke. Methods We collected randomized controlled trials, which compared dl-3-butylphthalide agents with placebo or open control in patients with acute ischaemic stroke, by searching the electronic bibliographic databases, scanning references listed in articles and handsearching journals. Meta-analysis was conducted based on the methods recommended by the Cochrane Collaboration. Results Twenty-one trials involving 2 123 patients were included, of which 2 were placebo-controlled and 19 were open-label controlled. Meta-analysis of 10 trials (n=958), in which neurological deficits were assessed by CSS, suggested that there were significant differences favoring butylphthalide in the mean change of neurological deficits’ score during the treatment period [MD=2.30, 95%CI (1.57, 3.03)]. Meta-analysis of 6 trials (n=590), in which neurological deficits were assessed by NIHSS, also favored butylphthalide [MD=2.06, 95%CI (0.65, 3.46)]. Adverse events (AEs) were reported in 13 trials. Gastrointestinal discomfort (1.7%~8%) and abnormal liver function including abnormal ALT (1.4%~17.5%) and abnormal AST (1.9%~8.82%) were the two most common AEs. However, no severe adverse events (SAEs) were reported. Numbers of dead and dependent patients at the end of followup (at least three months) were not reported in the 21 included trials. Quality of life was not assessed in any of the trials. Conclusion Dl-3-butylphthalide can improve the neurological function after acute ischemic stroke and appears to be safe. However, further study is needed to confirm its effects for lowering rates of death and dependency.
Massive and severe cerebral infarction can lead to a high mortality and disability rate, and it is the bottleneck of preventing and treating cerebrovascular disease. Once the malignant brain edema of massive cerebral infarction or the critical status of severe cerebral infarction occurs, the treatment effect is very poor. Therefore, we should not only focus on the treatment of critical cerebral infarction, but also prevent its occurrence. It is clinically important to prevent the occurrence of this critical condition in advance and to prevent the occurrence of massive cerebral infarction and severe cerebral infarction. This article points out that some patients with massive or severe cerebral infarction can be prevented from becoming critically ill. The definition, key risk factors and corresponding prevention and treatment strategies of critical cerebral infarction have also been proposed. Critical cerebral infarction can be divided into two categories with or without malignant brain edema, and the risk factors and prediction and prevention strategies by categories andphases can be studied separately.
Objective To investigate the relationship between systolic blood pressure (SBP) and etiological subtype in patients with cerebral infarction. Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018. Patients within 24 h of symptom were included. Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype. Results A total of 944 eligible cases were included, accounting for 37.3% (944/2528) of the total number of registered cases. The mean age was (65.35±14.17) years, and 57.5% (543/944) were male. The median time from onset to admission was 15 h, with 54.7% (516/944) of patients having elevated blood pressure. Among the patients, large artery atherosclerosis, small artery occlusion, cardiogenic embolism, other definite causes and undetermined causes accounted for 24.9% (235 cases), 21.2% (200 cases), 20.0% (189 cases), 1.8% (17 cases), and 32.1% (303 cases), respectively. Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology [odds ratio (OR)=0.987, 95% confidence interval (CI) (0.977, 0.998)]; normal SBP at admission [<140 mm Hg (1 mm Hg=0.133 kPa)] was significantly positively correlated with cardioembolic etiology [OR=2.016, 95%CI (1.211, 3.357)]. Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology, which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.
目的:观察依达拉奉联合高压氧治疗脑梗死的疗效。方法:50例脑梗死随机分成2组，对照组25例采用依达拉奉治疗30 mg，静脉滴注2次/d，疗程14 d，观察组采用依达拉奉治疗的同时给予高压氧治疗，14 d后评定疗效。结果:观察组和对照组的有效率分别是96%和88%，对照组与观察组比较Plt;0.05，差异有统计学意义。结论:依达拉奉联合高压氧治疗脑梗死是一种更有效的治疗方法，值得推广。
Objective To assess the effectiveness and safety of edaravone for acute cerebral infarction. Methods We searched The Cochrane Central Register of Controlled Trials （ Issue 2, 2005 ）, MEDLINE （ 1966 to Aug. 2005）, EMBASE （ till Aug. 2005 ）, the China Biological Medcine Database （ till Aug. 2005 ）, the Chinese Stroke Clinical Trials Database （ till August 2005 ） and the reference lists of related articles. Two reviewers independently selected studies, assessed quahty of studies and extracted data. The RevMan 4.2 software was used for statistical analysis. Results We identified 12 randomized controlled trials, of which 9 （ n = 948 ） were included. The level of methodology quality was B. Since the conventional therapy was different among some studies, the improvement of disability and long-term death rate and incidence of adverse reactions were not included by meta-analysis. Meta-analysis on the improvement of neurological deficit showed a better effectiveness of edaravone than control with statistical significance [ OR2.98, 95% CI （ 1.39,6.39 ） ]. Possible adverse reactions to edaravone included abnormal liver function and skin rash. Conclusions With relatively poor quality of most included trials and small sample size, insufficient evidence is obtained to support the conclusion that edaravone is safe or effective in the treatment of acute cerebral infarction. Further high quality and large sample randomized controlled trials should be carried out.