高压氧联合神经节苷脂对高血压脑出血患者术后的影响

目的:分析高压氧联合神经节苷脂对高血压脑出血患者微创血肿清除术后的临床疗效。方法:选择2012年1月-2016年10月我院收治的高血压脑出血患者100例,根据随机数字表法分成观察组、对照组,每组各50例。所有患者均先行微创血肿清除术,对照组患者术后24 h内确定体征平稳,病情稳定后给予高压氧治疗,观察组在对照组治疗方法的基础之上加用神经节苷脂。比较两组患者的临床疗效、治疗前后神经功能缺损评分(NIHSS)、脑水肿体积、血清基质金属蛋白酶-9(MMP-9)、S100β蛋白及神经生长因子(NGF)的水平的变化及术后3个月时的日常生活活动能力。结果:治疗后,观察组的基本痊愈率显著高于对照组(P0.05),两组NIHSS评分都较治疗前显著降低,且观察组NIHSS评分显著低于对照组(P均0.05)。两组手术后第7 d、14 d及28 d的脑水肿体积均显著低于治疗前(P0.05),且观察组各时间点的脑水肿体积均显著低于对照组(P0.05)。两组血清MMP-9、S100β均较治疗前降低(P0.05),NGF较治疗前升高(P0.05),且观察组治疗后的血清MMP-9、S100β水平显著低于、血清NGF水平显著高于对照组(P0.05)。观察组患者术后3个月时的日常生活活动能力总良好率显著高于对照组(P0.05)。结论:高压氧联合神经节苷脂辅助微创血肿清除术治疗高血压脑出血临床疗效显著,有利于改善患者预后。     

认知康复训练联合醒脑通督针刺疗法对脑卒中后认知功能障碍患者认知功能、脑血流动力学和血清神经损伤标志物的影响

摘要 目的：探讨认知康复训练联合醒脑通督针刺疗法对脑卒中后认知功能障碍患者的影响。方法：按照随机数字表法,将2019年6月~2021年9月期间我院收治的脑卒中后认知功能障碍患者114例分为对照组（57例,接受常规药物治疗和认知康复训练）和研究组（57例,在对照组的基础上接受醒脑通督针刺疗法）。观察两组疗效、认知功能、脑血流动力学、血清神经损伤标志物及不良反应情况。结果：研究组84.21%（48/57）临床总有效率高于对照组64.91%（37/57）。研究组治疗4周后简易智能状态检查量表（MMSE）评分和大脑动脉平均流速（Vm）、血流最大峰值（Vs）高于对照组（P<0.05）。研究组治疗4周后神经元特异性烯醇化酶（NSE）、血管阻力指数（RI）、神经胶质原纤维酸性蛋白（GFAP）、泛素羧基末端水解酶-1（UCH-L1）、S100β蛋白（S100β）低于对照组（P<0.05）。治疗期间,两组不良反应发生率组间对比未见差异（P>0.05）。结论：认知康复训练联合醒脑通督针刺疗法可有效改善脑卒中后认知功能障碍患者的认知功能,可能与调节脑血流动力学和血清神经损伤标志物水平有关。     

Further Characterization of the Guinea Pig Cerebral Cortex Idazoxan Receptor: Solubilization, Distinction from the Imidazole Site, and Demonstration of Cirazoline as an Idazoxan Receptor-Selective Drug

We have demonstrated previously that [3H]idazoxan, besides being able to bind to alpha 2-adrenergic receptors, may also bind to a nonadrenergic idazoxan-receptor site with high affinity. The idazoxan receptor is tightly bound to cellular membranes, and we have now developed a method to solubilize it from the guinea pig cerebral cortex by using the detergent 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS). The CHAPS-solubilized receptor retains its binding properties for drugs: the membrane-bound, as well as the solubilized, idazoxan receptor shows high affinities for a number of imidazolines (cirazoline, idazoxan, tolazoline, naphazoline, tramazoline, clonidine, and oxymetazoline), some imidazoles (medetomidine, detomidine), and guanfacine. By contrast, catecholamines (adrenaline, noradrenaline, isoprenaline, and dopamine) and a number of other neurotransmitters and neuromodulators (serotonin, histamine, glutamic acid, gamma-aminobutyric acid, glycine, and adenosine) show negligible affinities for the idazoxan receptor. Moreover, the idazoxan receptor shows grossly different binding properties for histamine, cimetidine, and imidazole-4-acetic acid compared to what has been described for the nonadrenergic imidazole site labeled by p-[3H]amino-clonidine, indicating that the two receptor sites are distinct. Radioligand binding data further indicate that cirazoline is an idazoxan receptor-selective drug (KD = 1 nM) showing a 50-210-fold selectivity for binding to the idazoxan receptor when compared to alpha 2-adrenergic receptors and an about 500-fold selectivity when compared to alpha 1-adrenergic receptors. We have also reviewed the literature for possible nonadrenergic actions of idazoxan and cirazoline, and we suggest that idazoxan receptors might be involved in the control of prolactin release from the pituitary.     

NT-proBNP 与H-FABP在高血压性脑出血患者近期预后的相关性分析

目的:探讨血清N末端B型钠尿肽原(NT-proBNP)与心脏型脂肪酸结合蛋白(H-FABP)与高血压性脑出血患者近期预后的相关性分析。方法:选取我院收治的160例高血压脑出血患者为研究对象,检测患者入院第1 d、3 d、7 d的血清NT-proBNP、H-FABP水平,按照入院后3个月的改良Rankin量表(m RS)评分对患者的预后进行评估,分为预后良好组(m RS评分≤2分)及预后不良组(m RS评分2分);比较两组相关指标的差异。用Logistic回归方程分析血清NT-proBNP、H-FABP与m RS评分的关系。结果:与预后良好组比较,预后不良组患者入院后3个月的m RS评分较高,而入院格拉斯哥昏迷量表评分(GCS)评分较低(P0.05);预后不良组患者入院第3 d、7 d的血清NT-proBNP、H-FABP高于预后良好组(P0.05);Spearman相关性分析提示入院第1 d、3 d、7 d的血清NT-proBNP、H-FABP分别与m RS评分呈正相关,而与GCS呈负相关(P0.05);多因素Logistic回归分析显示:入院第3d、7d的血清NT-proBNP、H-FABP是高血压脑出血患者预后不良的独立危险因素(P0.05)。结论:血清NT-proBNP、H-FABP与高血压脑出血患者的近期预后具有一定的相关性,可能是患者近期预后不良的独立危险因素。     

Ommaya 囊在神经外科治疗中的研究进展

Ommaya囊是巴基斯坦神经外科医师Ommaya发明的脑室引流工具,包括一个扁平状的储液器与一根引流管相接而成,其最初设计目的是在治疗真菌性脑膜炎时进行侧脑室内持续给药,因此又称为"储药囊"。Ommaya囊的引流管也可以置入患者四脑室、疆池、囊腔与脑池。其对颅脑肿瘤、脑室出血、脑膜炎等疾病的治疗、中枢神经系统感染与脑脊液药理学、细胞学的实验研究等方面也有重要意义。     

蛛网膜下腔出血合并脑积水的治疗方法探讨

目的:探讨蛛网膜下腔出血(SAH)合并脑积水的治疗方法。方法:回顾性分析31例SAH合并脑积水患者的临床资料,除常规脱水、防治血管痉挛、营养神经等治疗方法外,其中10例给予行脑室-腹腔分流术,21例行侧脑室外引流术,对比分析两种治疗方案的利弊。结果:10例脑室-腹腔分流术患者9例手术效果良好,术后复查颅脑CT显示脑室明显减小,间质水肿消失,1例患者术后1月内再次出现脑积水,给予行同侧分流管探查再通、对侧脑室-腹腔分流术,术后效果良好,颅脑CT示脑室减小。21例行侧脑室外引流术患者,术后感染2例,全部患者均术后7天内拔除引流管,术后1月9例复发脑积水,给予再次行脑室-腹腔分流术,术后效果良好。结论:在手术指征明确的情况下,早期给予SAH合并脑积水患者行脑室腹腔分流术,分流管堵塞可能性小,术后感染发生率低,临床效果令人满意。     

MRI对糖尿病急性脑梗死患者颈动脉粥样硬化斑块稳定性的评估价值

目的:探讨核磁共振成像(MRI)对急性脑梗死合并糖尿病患者颈动脉粥样硬化斑块稳定性的评估价值。方法:选取2013年5月-2015年5月在我院接受治疗的83例糖尿病合并急性脑梗死患者作为研究组,另选择单纯急性脑梗死患者61例作为对照组。两组患者均采用MRI评估颈动脉血管及斑块稳定性,并分析影响颈动脉斑块稳定性的危险因素。结果:研究组患者颈动脉粥样硬化易损斑块的发生率高于对照组,差异具有统计学意义(P0.05);研究组患者斑块最大厚度明显高于对照组,差异具有统计学意义(P0.05);两组患者血管总面积、血管壁面积、血管腔面积及血管壁标准化指数比较,差异均无统计学意义(P0.05)。性别、糖尿病以及饮酒是影响急性脑梗死患者颈动脉斑块稳定性的独立危险因素(P0.05)。结论:MRI能够有效评估急性脑梗死患者颈动脉粥样硬化斑块的稳定性,有利于临床诊断以及确定治疗方案,值得推广应用。     

十六酰胺乙醇对大鼠脑缺血再灌注损伤的抗氧化及抗凋亡作用

目的:探讨十六酰胺乙醇(Palmitoylethanolamide PEA)对大鼠脑缺血再灌注损伤的保护作用及机制。方法:将雄性SD大鼠随机分为:假手术组、药物组、模型组。采用线栓法制造大脑中动脉缺血再灌注模型,药物组于缺血后30分钟及再灌注后2小时给予PEA(10mg/Kg)腹腔注射。于再灌注24h后,对各组大鼠进行神经功能评分,TTC染色法测脑梗死体积,硫代巴比妥法测丙二醛(MDA)含量,黄嘌呤氧化酶法测超氧化物歧化酶(SOD)活性,WesternBlot法测Bcl-2和Bax蛋白含量。结果:药物组神经功能评分均值为1.33±0.49分,而模型组为2.20±0.41分,药物组神经功能评分显著低于模型组(P0.05);药物组的脑梗死体积为114.00±8.63mm3,而模型组脑梗死体积为243.40±14.19mm3,药物组脑梗死体积显著低于模型组(P0.05);药物组MDA含量为3.85±0.29nmol/mgprot,SOD活性为13.95±0.71U/mgprot,而模型组MDA含量为4.85±0.30nmol/mgprot,SOD活性为12.44±0.40U/mgprot,与模型组相比,药物组的MDA含量显著降低,而SOD活性显著增高(P0.05);药物组Bcl-2蛋白与β-action蛋白的IOD值比值为0.53±0.013%,Bax蛋白与β-action蛋白的IOD值比值为0.54±0.012%,模型组Bcl-2蛋白与β-action蛋白的IOD值比值为0.40±0.012%,Bax蛋白与β-action蛋白的IOD值比值为0.80±0.012%。药物组Bax蛋白含量显著低于模型组(P0.05),而Bcl-2蛋白含量显著高于模型组(P0.05)。结论:PEA对大鼠脑缺血再灌注损伤具有保护作用,可能是通过抗凋亡、抗氧化应激等作用实现。     

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.