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中国卒中杂志

中国卒中杂志

CSTPCD

Chinese Journal of Stroke
本刊主要服务卒中领域的学术研究及学术传播，并为相关医院、教学研究单位提供具有前瞻水平有特色期刊刊。
  • 发文量：3532
  • 被引量：1868
  • H指数：1
  • 开始收录时间：2006(1)
  • CNKI综合因子：0.726
  • 维普期刊影响因子： 1.68
  • 万方期刊影响因子：1.43
  • 创刊时间：2006
  • 国内刊号/CN：11-5434/R
    国际刊号/ISSN：1673-5765
  • 发行周期：月刊
    邮发代号：80-507
  • 主管单位：中华人民共和国科学技术部
    主办单位：中国科学技术信息研究所（ISTIC） 科学技术文献出版社
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  • 地址：北京市朝阳区东四环北路2号上东公园里11层
  • 邮编：100016
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中国卒中杂志 >2023年第11期

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  • 摘要：目的分析肺动静脉瘘（pulmonary arteriovenous fistula，PAVF）致隐源性卒中患者临床表现，比较各种诊断方法特点，寻找筛查方法。　　方法2例PAVF所致隐源性卒中患者详细临床资料，并行经食管超声（transesophageal echocardiography， TEE）、经颅多普勒增强试验（contrast transcranial Doppler，cTCD）。　　结果2例患者cTCD结果显示栓子信号具备出现晚、数量多、时间久、持续性（即不受Valsalva动作影响）的特点。TEE结果显示CDFI未见异常，右心声学造影Valsalva动作（valsalva maneuver，VM）后5个心动周期左房内肺静脉开口处见大量微泡。　　结论缺血性卒中是PAVF最常见的肺外表现，发生与PAVF与供血动脉直径及数量有关。cTCD敏感易操作，结合动脉血气分析可用于该病的初筛，而且适于疗效评价及随访。%Objective To analyze the clinical features of the patients with cryptogenic stroke caused by pulmonary arteriovenous fistula (PAVF), and compare the characteristics of different diagnostic methods to ifnd preliminary screening method. Methods Detailed clinical data of 2 patients with cryptogenic stroke were collected. Transesophageal echocardiography (TEE) and contrast transcranial Doppler (cTCD) were performed. Results cTCD in 2 patients showed the following characteristics of microemboli signals: late appearance, large number, long duration, and the number was not inlfuenced by Valsalva maneuver (VM). TEE showed that there were no abnormal CDFI and large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM. Conclusion Ischemic stroke is the most common extra-pulmonary manifestation of PAVF, inlfuenced by the diameter of feeding artery and quantity of PAVF. cTCD combined with arterial blood gas analysis is useful for preliminary screening, efifcacy evaluation and follow-up for PAVM.
  • 摘要：Pentraxin 3 (PTX3) is the ifrst identiifed long chain ifve polymer structure protein, which plays an important role in innate humoral immunity. This paper reviewed the function of PTX3 in three aspects, including inhibiting pathogen infection, resisting arteriosclerosis and participating in acute and chronic diseases of the central nervous system, so as to provide ideas for further research.%正五聚素蛋白3（pentraxin 3，PTX3）是第一个被识别的长链五聚素，在先天性体液免疫中发挥重要作用。本文分别从抑制病原体感染、抗动脉粥样硬化和参与中枢神经系统急慢性疾病等3个方面对PTX3的功能进行了综述，以期对其进一步的研究提供思路。
  • 摘要：每年的十月初,是全世界科学家最期盼的日子,因为一年一度的诺贝尔奖在这个时候颁布。作为全球科学研究的风向标,颁奖的日子像是科学家的节日。
  • 摘要：Objective To investigate the association between recanalization and prognosis of acute cerebral infarction patients with middle cerebral artery (MCA) occlusion after intravenous thrombolytic treatment. Methods The data of acute cerebral infarction patients with MCA occlusion who received intravenous thrombolytic treatment were retrospectively analyzed. The recanalization rate after thrombolysis was analyzed. The safety and efifcacy outcome between recanalization group and no recanalization group were compared. Results A total of 67 patients were included. The rate of recanalization of MCA was 55.2%. For the functional independence outcome at 90 days, recanalization group (n=37) was signiifcantly better than no recanalization group (n=30) (72.97%vs 43.33%,OR=3.5,P=0.014). For the excellent recovery outcome at 90 days, the former was also significantly better than the latter (64.86%vs 26.67%, OR=5.1,P=0.002). There were no signiifcant differences for the symptomatic intracranial hemorrhage and mortality between the two groups. Conclusion The recanalization rate of acute cerebral infarction patients with MCA occlusion is relatively high, and recanalization is strongly associated with prognosis. For these patients, bridge-treatment is the optimal choice.%目的探讨急性大脑中动脉闭塞性脑梗死后静脉溶栓的血管再通情况及其与预后关系。　　方法回顾性选取大脑中动脉闭塞性脑梗死静脉溶栓患者资料，分析溶栓后血管再通情况，并对再通组与无再通组的有效性及安全性结局进行比较分析。　　结果共入选67例患者，溶栓后血管再通率为55.2%，有再通组（37例）90 d随访获得生活自理（72.97%vs 43.33%，OR=3.5，P=0.014）及良好预后（64.86%vs 26.67%，OR=5.1，P=0.002）的比例均显著优于无再通组（30例），而两组的症状性颅内出血发生率及死亡率均无显著性差异。　　结论大脑中动脉闭塞性脑梗死患者静脉溶栓也具有较高的血管再通率，血管再通与预后显著相关，桥接治疗是最佳选择。
  • 摘要：目的探讨大骨瓣减压术治疗大面积脑梗死的临床效果和内科保守治疗临床效果。　　方法回顾性研究总结徐州医科大学附属医院2012年1月-2015年1月41例大面积脑梗死后行去骨瓣减压手术治疗的患者和30例大面积脑梗死后行内科保守治疗的患者，比较两组患者的死亡率及对生存者中两组患者不同时期的神经功能变化进行随访（12个月），评价术后3个月和12个月时的预后评分（Glasgow Outcome Scale，GOS）变化。　　结果手术治疗组与内科保守对照组相比较，死亡率明显降低（χ2=4.522，P=0.02）。手术治疗组中60岁以上患者死亡率明显比60岁以下患者要高（χ2=5.634，P=0.04）。根据GOS进行临床评分，手术治疗组术后3个月和12个月随访结果，较内科保守对照组发病3个月和12个月随访结果，患者死亡率降低，且患者生活质量提高明显（χ2=6.437，P=0.03）。　　结论大面积脑梗死手术治疗组比保守治疗组可明显降低患者死亡率，且患者生活质量提高明显。%Objective To investigate the clinical effect of medical treatment and decompressive craniectomy in treatment of massive cerebral infarction. Methods Decompressive craniectomy was performed in 41 patients with massive cerebral infarction from January 2012 to January 2015 in Xuzhou Medical University Afifliated Hospital. The data of these 41 patients and 30 patients who received conservative medical treatment after massive cerebral infarction were retrospectively studied. The changes of Glasgow Outcome Scale (GOS) of functional recovery at 3 and 12 months after surgery and mortality rates between two groups were compared retrospectively. Results Comparing the operative patients and medical treatment patients, the mortality of operative patients was lower, and overall prognosis of operative patients was better (χ2=4.522,P=0.02). The mortality of operative patients above the age of 60 was higher than those under 60 (χ2=5.634, P=0.04). The comparison between operative patients and medical treatment patients were categorized according to the GOS classiifcation 3 months later and 12 months later after discharge. The comparison between operative patients and medical treatment patients in 3 months later and 12 months later: overall prognosis was better and the disability rate of survivors was lower (χ2=6.437, P=0.03). Conclusion Comparing the surgical therapy with medical treatment in the massive hemispheric infarction patients, the surgical therapy decreases mortality and improves the quality of life.
  • 摘要：Objective To investigate the inlfuence of nursing intervention based on Roy adaption theory on improving mood disorder and neurological deifcit in patients with stroke. Methods A total of 82 patients diagnosed with stroke admitted in our hospital from Jun. 2014 to Feb. 2015 were chosen as subjects with two-month nursing intervention, and divided into conventional group and Roy group according to their date of admission. Conventional group received conventional medical care and general rehabilitation exercise, and Roy group added psychological intervention comprehensive care based on Roy adaption theory, including psychological support, cognitive therapy, psychological suggestion, music therapy, etc. Then to compare the scores of Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Clinical Nerve Function Limitation Score (CNS) between two groups pre/post-nursing intervention. Results There was no signiifcant difference in SAS, SDS, and CNS between conventional group and Roy group before nursing intervention (P>0.05), after nursing intervention, the scores of SAS, SDS, and CNS of the Roy group was signiifcantly lower than those of the conventional group (P<0.05). Conclusion The psychological intervention comprehensive care based on Roy adaption theory can signiifcantly improve stroke patients mood disorder and neurological deifcit, which is worth to be popularization.%目的探究罗伊适应理论护理对卒中患者情绪障碍及神经功能缺损改善的影响。　　方法选择2014年6月-2015年2月我科收治的82例卒中患者为研究对象进行为期两周的护理，按其入院时间分为常规护理组与罗伊护理组。常规护理组接受常规药物及一般康复锻炼护理，罗伊护理组在其基础上增加基于罗伊适应理论的心理干预综合护理，包括心理支持、认知疗法、心理暗示、音乐疗法等。以焦虑自评量表（Self-rating Anxiety Scale，SAS）、抑郁自评量表（Self-rating Depression Scale，SDS）、神经功能缺损程度量表（Clinical Nerve Function Limitation Score，CNS）评分进行护理前后两组卒中患者情绪障碍及神经功能缺损的比较。　　结果护理干预前两组患者情绪评分（SAS、SDS）与神经功能评分（CNS）比较，差异均无显著性（P>0.05）；护理干预后，罗伊护理组SAS、SDS及CNS评分显著低于常规护理组（P<0.05），且罗伊护理组干预前后三项评分差异均有显著性（P<0.05）；常规护理组干预前后三项评分差异无显著性（P>0.05）。　　结论基于罗伊适应理论的心理干预能显著改善卒中患者情绪障碍及神经功能缺损，值得在临床推广。
  • 摘要：卒中具有发病率高、死亡率高和致残率高的特点，卒中单元是能有效改善卒中患者预后的措施，首都医科大学附属北京天坛医院每年举办全国卒中进修医师培训班，在进修人员筛选、理论教学、技能培养、临床实践、医患沟通等方面形成一系列完善的制度和方法，并在实践中发现问题并提出改进和优化措施。%Cerebral stroke has the characteristics with high incidence, high mortality and high disability. Stroke unit is an effective method to improve the prognosis of patients with stroke. Beijing Tiantan Hospital, Capital Medical University provides continuing education training program of stroke unit every year. We established a series of system and methods in personnel screening, theory teaching, skills training, clinical practice, doctor-patient communication, etc, and found the problems and put forward optimization measures and improved it during practice.
  • 摘要：目的为进一步验证脑出血患者颅内压（intracranial pressure，ICP）与经颅多普勒超声（transcranial Doppler ultrasound，TCD）血流参数间的相关性，确立脑出血患者TCD血流参数预测ICP的最优数学模型并评价其预测准确性。　　方法根据纳入、排除标准，共登记22例脑出血患者的人口学资料、主要神经功能评分和病灶特征资料，所有患者行持续床旁脑实质颅内压监测，期间每天复查TCD，监测大脑中动脉（middle cerebral artery，MCA）及颈内动脉（internal carotid artery，ICA）血流参数并记录即时ICP数值、体温、血压、心率和血氧饱和度等。筛选最优TCD血流参数，对即时ICP与TCD血流参数行相关性分析及多元线性回归分析，建立TCD参数评估ICP数学模型，并对其诊断颅高压（ICP>15 mmHg）的准确性进行评价。　　结果相关性分析示脉搏指数（pulsatility index，PI）与ICP呈正相关，相关系数为r=0.66（P<0.01）。TCD血流参数预测ICP数学模型为ICPe=-16.8+26.8×PI+0.12×Vm，调整R2为0.46；颅高压（ICP>15 mmHg）时，ICPe的曲线下面积为0.93，95%可信区间为0.88～0.97。　　结论 TCD血流参数PI与ICP呈正相关，是预测ICP最重要的指标。ICPe=-16.8+26.8×PI+0.12×Vm（调整R2为0.46）可准确诊断颅高压（ICP>15 mmHg）。%Objective To further verify the correlation between intracranial pressure (ICP) and blood flow parameters of transcranial Doppler ultrasound (TCD) in patients with cerebral hemorrhage. The optimal mathematical models of intracranial pressure were established, which were predicted quantitatively by blood lfow parameters of TCD, and then evaluated the accuracy. Methods According to the inclusion and exclusion criteria, demographic data, major neurological function scores and characteristics of lesions of 22 patients with cerebral hemorrhage were registered. The intracranial pressure monitor was used to monitor the intraparenchymal pressure continuously at the bedside. TCD detection was reviewed daily. The blood lfow parameters of MCA and ICA, the instant ICP values, temperature, blood pressure, heart rate, and oxygen saturation were recorded. The analyses of multiple linear regression were completed to establish the optimal mathematical model of ICP evaluated by TCD parameters, and then evaluate the accuracy for the diagnosis of intracranial hypertension (ICP>15 mmHg). Results The correlation analysis of PI and ICP showed positive correlation, and the correlation coefficient wasr=0.66 (P<0.01). The mathematical model was ICPe=-16.8+26.8×PI+0.12×Vm, adjusted R2=0.46; When ICP>15 mmHg, the area under curve of ICPe was 0.93, and 95% conifdence interval was 0.88-0.97. Conclusion PI is positively correlated with ICP, and is the most important predictive indicator of the ICP evaluation. ICPe=-16.8+26.8×PI+0.12×Vm (adjusted R2=0.46) could predict the ICP to diagnose the intracranial hypertension (ICP>15 mmHg) with high accuracy.
  • 摘要：目的旨在探索老年病科临床教学改革的目标和具体途径。　　方法将本科室一年来的临床教学实践与相关重要理论相结合，论证老年病科教学改革的可行性和现实性。　　结果确定了老年病科以强化全科医学教育为中心，以传统生物医学模式向新型生物-心理-社会医学模式转变为理念的老年病学教学改革方向。　　结论本文探讨了强化全科医学教育及传统生物医学模式向新型生物-心理-社会医学模式转变在老年病学教学改革中的积极意义；老年病科将通过不断改进老年病学教学方法、创新老年病学教学理念，培养适应老龄化社会需求的、合格的老年病学专业人才。%Objective To explore targets and practical ways of reform in clinical teaching in geriatrics. Methods The feasibility and the reality of reforms in geriatrics clinical teaching were demonstrated by integrating the clinical teaching practice for the past one year along with relevant important theories. Results The direction of reforms was established for our department’s clinical teaching by strengthening general medicine education, as the core content of our job, and by transforming traditional biomedical model to modern bio-psycho-social medical model in geriatrics educations, as the guide of our job. Conclusion The positive significance of general medicine education and transformation from traditional biomedical model to modern bio-psycho-social medical model in geriatrics educations is discussed in this paper. The department of geriatrics will continue to improve teaching methods and establishing new teaching ideas of geriatrics educations, to culture more qualiifed gerontology professionals for the community to satisfy the aging society.
  • 摘要：＂缺血性卒中/TIA抗血小板治疗临床研究基金＂从今年3月启动以来,受到神经内科临床青年医生的广泛关注,至6月30日截稿为止,共计收到179个临床方案。
  • 摘要：Objective To assess the effectiveness of cognitive behavioral therapy with antidepressants on post-stroke depression. Methods All published research about randomized controlled trials (RCTs) focusing on cognitive behavioral therapy with antidepressants on post-stroke depression on PubMed, Cochrane library, CNKI, VIP, Wanfang Standards Database were searched. Meta-analysis was conducted by RevMan 5.3 software based on data which was eligible for inclusion criteria. The improvement condition of Hamilton Depression Scale (HAMD) and rehabilitation status of neuro-function by Fugl-Meyer Motor-Function Scale were analyzed to compare the effectiveness of two therapies. Results A total of 9 RCTs were included, involving 584 post-stroke depression patients. The results of meta-analysis of the subgroup of early phase (4 weeks, 8 weeks) and long-term phase (12 weeks, 21 weeks, 52 weeks) revealed that cognitive behavioral therapy with antidepressants was more effective in decreasing depression score than control group (4 weeksWMD -1.42, 95% conifdence interval [CI] [-2.02,-0.78],P<0.001; 8 weeksWMD -3.74, 95%CI [-5.50,-1.99],P<0.001; 12 weeksWMD -1.86,95%CI [-2.55,-1.17],P<0.001; 21 weeksWMD -2.20, 95%CI [-3.09,-1.30],P<0.001; 52 weeksWMD-3.73, 95%CI [-4.75,-2.70],P<0.001), and the results also showed that cognitive behavioral therapy with antidepressants was more effective in motor function rehabilitation than control group (WMD-0.32, 95%CI [-0.60, -0.04],P=0.03). Conclusion Cognitive behavioral therapy with antidepressants on post-stroke depression is more effective in decreasing depression score, and promotes the motor functional recovery of patients.%目的系统评价认知疗法联合抗抑郁药物对卒中后抑郁（post-stroke depression，PSD）患者的疗效。　　方法计算机检索PubMed、Cochrane图书馆、中国知网、中国生物医学文献数据库、中文科技期刊数据库、万方数据库中所有关于认知疗法联合抗抑郁药物治疗PSD患者的随机对照试验（randomized controled trial，RCT）。对符合纳入标准的文献用ReVMan 5.3软件对数据进行Meta分析，分析两组治疗方法对汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）评分的改善情况，以及神经功能恢复情况（Fugl-Meyer运动评分量表）。　　结果共纳入9个RCTs，共计584例患者，对认知行为联合抗抑郁药物治疗PSD的早期（4周、8周）及长期（12周、21周、52周）疗效做亚组分析，结果显示，与对照组相比，认知行为合并抗抑郁药物治疗组更能显著降低患者早期及长期的HAMD评分[4周WMD -1.42，95%可信区间（confidence interval， CI）（-2.02，-0.78），P＜0.001；8周WMD -3.74，95%CI（-5.50，-1.99），P＜0.001；12周WMD -1.86，95%CI（-2.55，-1.17），P＜0.001；21周WMD -2.20，95%CI（-3.09，-1.30），P＜0.001；52周WMD-3.73，95%CI（-4.75，-2.70），P＜0.001]，同时也促进了治疗8周后患者Fugl-Meyer运动评分量表的改善[WMD -0.32，95%CI（-0.60，-0.04），P=0.03]。　　结论认知行为联合抗抑郁药物较单纯使用抗抑郁药物更能显著降低PSD患者的抑郁评分，促进患者运动功能的康复。
  • 摘要：目的依据国际通用的诊断标新，分析比较原发性中枢神经系统血管炎（primary central nervous system vasculitis，PCNSV）诊断手段。　　方法收集2012年1月1日-2015年12月31日于首都医科大学附属北京天坛医院神经病学中心神经感染与免疫科住院治疗的PACNS患者共8例，回顾性分析患者临床资料，总结其临床表现、实验室检查、神经影像学及神经病理学特征。　　结果临床表现：本组8例患者中，居于前五位的首发症状为慢性头痛、痫性发作、类卒中样局灶性神经功能缺损、精神行为异常和锥体外系症状，所有患者均未发现特异性的血生化及脑脊液异常结果，头颅磁共振成像（magnetic resonance imaging，MRI）均可见颅内异常信号，磁共振血管造影（magnetic resonance angiography，MRA）及数字减影血管造影（digital subtraction angiography，DSA）均未见明显异常。患者行脑组织活检，病理结果符合PCNSV表现。　　结论 PCNSV的诊断要综合考虑患者的临床表现、实验室检查和影像学检查结果，脑组织活检的广泛开展，有助于提高本病的诊断率。%Objective To analyze and compare the diagnosis method of primary central nervous system vasculitis (PCNSV) according to the international standard. Methods A total of 8 cases who were admitted to Department of Neuro-infection and Immunology of Neurological Disease Center of Beijing Tiantan Hospital, Capital Medical University during Jan.1st, 2012 to Dec.31st, 2015 and diagnosed with PCNSV were reviewed. Their clinical descriptions, laboratory examinations, neuroimaging and pathological characteristic were analyzed. Results The most common clinical symptoms were: chronic headache, seizures, stroke like focal neurological deifcits, mental and behavioral abnormalities and symptoms of the external pyramidal system. No speciifc blood biochemical and cerebral spinal lfuid (CSF) abnormalities were found in all patients. Intracranial abnormal signal was seen in magnetic resonance imaging (MRI). Magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) were not significantly abnormal. Brain biopsy was performed in 8 patients and the pathologic results were consistent with PCNSV expression. Conclusion The diagnosis of PCNSV should consider the patient's clinical manifestations, laboratory tests and imaging findings. The extensive development of brain biopsy is helpful to improve the diagnostic rate of the disease.
  • 摘要：Intravenous alteplase is one of the most effective medicines to improve prognosis for acute ischemic stroke patients. The effect of intravenous thrombolysis of stroke patients with different severity varies a lot. There comes a new statement for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke from the American Heart Association/American Stroke Association in February, 2016. In the statement it recommended to use intravenous alteplase for severe stroke patients or mild stroke patients who has disability risk within 3 hours. It should be cautious for patients with mild stroke and without disability risk to use alteplase within 3 hours.%急性缺血性卒中患者使用阿替普酶静脉溶栓治疗是改善预后最有效的方法。不同严重程度的卒中患者其溶栓的效果不尽相同。2016年2月新发表的声明中对不同严重程度的卒中患者使用阿替普酶静脉溶栓提出了新的观点，建议对于症状严重的，或者症状轻微但是有残疾可能的卒中患者，应当在症状开始3 h内静脉使用阿替普酶，而在症状出现3 h内对于症状轻微且判断没有致残风险的卒中患者，静脉阿替普酶治疗是待考虑的。
  • 摘要：神经重症患者因静脉血栓栓塞而死亡的风险很高，这是由瘫痪后的静脉血液瘀滞风险增加以及潜在的病理改变激活血管内皮增加血栓形成风险导致的。在许多情况下，标准的静脉血栓预防能够导致相关的出血风险。目前，尚缺乏前瞻性研究来验证不同的静脉血栓栓塞的治疗策略。由于缺乏可靠的证据基础，使得建立统一、基于循证医学的临床实践标准变得困难重重。因为对该指南的需求，美国神经重症监护协会决定通过推荐强度结构以及证据分级原则建立基于循证医学的指南，从而降低静脉血栓栓塞的发生率及相关并发症。
  • 摘要：卒中是全球第二大致死性疾病,而在中国已跃居到第一位,其发病人数占全球所有卒中人数的1/5。目前,超过700万的中国人患有卒中,其中约65%是缺血性卒中。随着人数的增加,中国的卫生系统面临着巨大的压力和负担。1996年重组组织型纤溶酶原激活物（recombinant tissue plasminogen activator,rtPA）在美国上市,
  • 摘要：目的应用卒中预后特异和非特异评估体系以及卫生经济学评估体系，评价急性缺血性卒中血管内治疗的临床效果与效率。　　方法选择首都医科大学附属北京天坛医院于2015年1-4月收治的符合急性缺血性卒中血管内治疗的患者，分为血管内治疗组和对照组，评价指标包括：①特异性指标：入院后14 d神经功能缺损程度卒中量表（National Institute of Health Stroke Scale，NIHSS）评分，90 d后改良Rankin量表（modified Rankin Scale，mRS）评级，90 d及1年内卒中发生率；②非特异指标：1年内院内感染、急性心肌梗死、症状性脑出血的发生率；③卫生经济学指标：患者1年医疗总费用、总药费，1年内住院次数及累计住院日、累计重症监护病房（Intensive Care Unit，ICU）住院日。　　结果急性缺血性卒中患者给予血管内治疗预后较对照组在入院后14 d NIHSS评分采用秩和检验比较，血管内治疗组明显优于对照组（P<0.01）；90 d及1年内卒中发生率采用χ2检验，发现血管内治疗组的90 d卒中再发率（P<0.05）及1年内卒中再发率（P<0.01）均低于对照组。与对照组相比，血管内治疗组患者1年内院内感染、急性心肌梗死、症状性脑出血采用χ2检验，两组间差异无显著性。入院后90 d mRS评级采用秩和检验，对照组无残疾或轻度（0～1级）、中度（2～3级）、重度残疾（4～5级）及死亡人数分别为3例、15例、23例和4例，血管内治疗组分别为17例、12例、3例和5例，血管内治疗组较对照组明显改善（P<0.05）。血管内治疗组在1年内累计医疗花费与对照组比较，差异无显著性，但在1年内住院次数（P<0.01）、药费（P<0.05）以及ICU住院日（P<0.01）较对照组明显下降。　　结论急性缺血性卒中患者的血管内治疗可以提高患者的预后，在提高医疗质量的同时并没有增加患者的住院费用，可以减少患者的住院次数及药费。%Objective To evaluate the clinical effect and efifciency of endovascular treatment of acute ischemic stroke through utilization of stroke prognosis speciifc and non-speciifc as well as health economics evaluation system. Methods Patients who were eligible for acute ischemic stroke endovascular treatment and admitted to Beijing Tiantan Hospital, Capital Medical University from January to April in 2015 were divided into the endovascular treatment group and control group. The main criteria for evaluation were:①Speciifc indicators: 14 days National Institute of Health Stroke Scale (NIHSS) score after admission, 90 days after the modified Rankin scale (mRS) rating, 90 days and 1 year of stroke incidence;②Non-speciifc indicators: 1 year incidence of nosocomial infection, acute myocardial infarction and symptomatic intracerebral hemorrhage;③Health economics indicators: 1 year total health care costs, the total cost of drugs, hospital days in hospital cumulative intensive care unit (ICU) length of stay. Results The endovascular treatment group had a better prognosis than the control group at 14 days NIHSS score after admission (P<0.01); 90 days (P<0.01) and one year (P<0.05) incidence of stroke (byχ2 test) were both lower than the control group. There was no difference in the incidence of 1 year nosocomial infections, acute myocardial infarction and symptomatic intracerebral hemorrhage rate byχ2 test. The 90 d mRS rating used rank sum test. The number of no disability or mild disability (grade 0-1), moderate disability (grade 2-3), severe disability (grade 4-5) and death of the control group and endovascular treatment group were 3vs 17, 15vs 12, 23vs 3, 4vs 5, respectively. And there was no difference in the 1 year cost with the control group. Compared with the control group, the endovascular treatment group decreased signiifcantly in the number of hospitalizations per year (P<0.01), medicine (P<0.05) and ICU length of stay (P<0.01). Conclusion Endovascular treatment for acute ischemic stroke patients can improve the prognosis of patients, improving quality of care at the same time. It doesn’t increase the expense of hospitalization and can reduce the cost for patient's hospitalization and medication.
  • 摘要：Objective To explore the impact of life event stimulation and sleep quality on the incidence of cerebral infarction, and to further study its impact on the severity of cerebral infarction and post-stroke mood disorder. Methods The patients with cerebral infarction and subjects without cerebral infarction were enrolled into the study. The general clinical data of two groups were compared to analyze the risk factors of cerebral infarction. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the 1-month sleep quality before cerebral infarction and life event stimulation assessment was performed by using Life Event Scale (LES). The Hamilton Depression Scale and the Hamilton Anxiety Scale were used in the first week of hospitalization to evaluate the emotional disorder. National Institutes of Health Stroke Scale (NIHSS), and Activity of Daily Living Scale (ADL) were used to evaluate the severity of the illness. Results A total of 95 patients were enrolled in the cerebral infarction group and 85 patients were enrolled in the control group. Univariate analysis showed that the scores of LES in the cerebral infarction group were signiifcantly higher than those in the control group [6.00 (14.00)vs 0.00 (6.25), P<0.001] and cerebral infarction group scored signiifcantly higher than those in the control group on negative life event [6.00 (16.00)vs 0.00 (3.25),P<0.001]. The cerebral infarction group scored signiifcantly higher than those in the control group on the total scores of PSQI [8.50 (7.00)vs 6.00 (6.5), (P=0.007)] and ifve factors of sleep quality, which were subjective sleep quality (P=0.021), sleep latency (P=0.034), sleep duration (P=0.002), sleep disturbances (P=0.023) and daytime dysfunction (P=0.012); Unconditional logistic regression analysis showed negative life event (odds ratio [OR] 1.054, 95% conifdence interval [CI] 1.003-1.108,P=0.038), sleep duration (OR 1.601, 95%CI 1.33-2.264,P=0.008) and diastolic blood pressure (OR 1.037, 95%CI 1.006-1.069,P=0.019) were the risk factors of cerebral infarction. In addition, the Hamilton Depression Scale score was significantly higher in patients with sleep disorders than in those without sleep disorders [9.00 (15.00)vs 0.00 (8.00),P=0.047]. Conclusion Life event and poor sleep quality have impact on the incidence of cerebral infarction. Negative life event, sleep duration and diastolic blood pressure are the independent risk factors of cerebral infarction. Sleep disorders before the onset of cerebral infarction may lead to more severe symptoms of post-stroke depression.%目的探讨生活事件刺激及睡眠质量对脑梗死发病的影响，并进一步研究其对脑梗死严重程度及卒中后情绪障碍的影响。　　方法入组新发脑梗死患者与非脑梗死患者（对照组），比较两组的一般临床资料，分析脑梗死的危险因素，采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index，PSQI）量表进行病前1个月睡眠质量评价，生活事件量表（Life Event Scale，LES）进行病前生活事件刺激量评估，并在患者住院第一周内采用汉密尔顿抑郁量表、汉密尔顿焦虑量表评价情绪障碍，美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）、日常生活能力量表（Activity of Daily Living Scale， ADL）评价发病严重情况。　　结果共纳入脑梗死组95例，对照组85例。单因素分析结果显示，脑梗死组的生活事件量表得分显著高于对照组[6.00（14.00）vs 0.00（6.25），P<0.001]，其中负性生活事件得分显著高于对照组[6.00（16.00）vs 0.00（3.25），P<0.001]；PSQI总得分脑梗死组高于对照组[8.50（7.00）vs 6.00（6.5），（P=0.007）]，其中有5项睡眠质量因子分别为主观睡眠质量（P=0.021）、睡眠潜伏期（P=0.034）、睡眠持续性（P=0.002）、睡眠紊乱（P=0.023）、白天功能紊乱（P=0.012）的得分均显著高于对照组；非条件性Logistic回归分析提示负性事件[比值比（odds ratio，OR）1.054，95%可信区间（confidence interval，CI）1.003～1.108，P=0.038）、睡眠持续性（OR 1.601，95%CI 1.133～2.264，P=0.008）及舒张压（OR 1.037，95%CI 1.006～1.069，P=0.019）是脑梗死的危险因素。另外，在脑梗死患者中，病前睡眠障碍患者汉密尔顿抑郁量表得分较无睡眠障碍者显著增高[9.00（15.00）vs 0.00（8.00）， P=0.047]。　　结论生活事件、睡眠障碍均对脑梗死发病率有影响，其中负性生活事件、睡眠持续性、舒张压高是脑梗死的独立危险因素，病前睡眠障碍有可能引起更严重的卒中后抑郁症状。
  • 摘要：1病例介绍 患者男性，37岁，因“头晕伴左侧偏身麻木11 h”于2014年9月28日入院。入院前11 h，患者安静状态下突然出现头晕、左侧偏身麻木，无眩晕、恶心、呕吐，无偏侧肢体无力。发病30 min就诊于北京市海淀医院急诊神经内科，行头颅计算机断层扫描（computed tomography，CT）检查示未见明显异常，拒绝溶栓治疗，予以抗血小板聚集、调脂稳定斑块治疗、改善循环后，以“缺血性卒中”收入院。
  • 摘要：Objective To analyze the effect of 3-D printing model-assisted traditional medical imaging technology in clinical teaching for neurosurgery postgraduates and explore new education teaching methods. Methods We taught junior neurosurgery postgraduates typical cases by using traditional medical imaging technology. The 3-D printing model-assisted traditional medical imaging technology was used in secondary teaching. We evaluated the new method by questionnaires and direct questions after teaching course. Results Students generally relfected that the sensory understanding and spatial recognition of the disease had a very big promotion after integrating the two technologies. However, the problems existing in current 3-D printing technology, such as low printing speed and shortness of simulation were the obstacles to the further understanding of diseases for students. Conclusion In the teaching field of neurosurgery postgraduates, 3-D printing model-assisted traditional medical imaging technology is a great potential method. With the development of 3-D printing technology, the advantage will become even more apparent.%目的分析快速成型技术即3D打印辅助医学影像技术在神经外科研究生教学中的作用，探索教学新方法。　　方法利用医学影像技术对神经外科低年级研究生进行典型病例的教学；使用3D打印辅助医学影像技术进行二次教学。使用现场提问、调查问卷等方式评估学生对新方法的反映。　　结果学生普遍认为两种技术结合后，对疾病的感觉理解、空间认识能力有了很大的提升。但当前3D打印技术存在的问题，如打印时间长、不能完全模拟病变等，是限制学生认识水平进一步提升的障碍。　　结论在神经外科研究生教学领域，3D打印辅助医学影像技术是一个非常有潜力的教学方法，随着3D打印技术的提高，这种优势将更加明显。
  • 摘要：约翰·雅各布·卫普菲（Johann Jakob Wepfer，1620-1695）是第一个把卒中（Apoplexy）定性为脑血管病的人（图1）。希波克拉底在公元前400多年发明了卒中一词，意为患者像是被闪电击中，一下突然被打倒，但是病因一直不明。直到2000年后在1658年，Wepfer在历史上首先推测卒中是因为脑出血造成的。他描述了4例患者，其中一例突然昏倒，抽动，数小时后死亡，尸检硬膜下和脑室到处是血，血块有两磅重。但是没有找到破裂的动脉和静脉（小血管破裂当时看不到），也排除了脑外伤。Wepfer也是第一个描述脑大血管阻塞造成卒中的人。从此后卒中意味着脑血管疾病。
  • 摘要：睡眠障碍(sleep disorders)是临床常见病，多发疾病。不仅损害人体身体健康，同时影响认知功能、降低生活质量，给患者带来极大的痛苦。睡眠障碍与认知功能的关系是目前研究的热点，本文就其研究进展进行综述。%Sleep disorders is a clinical common and multiple disease. It not only damages human health, but also affects cognitive function, lowers the quality of life, brings great pain to humans. The relationship between sleep disorders and cognitive function is the focus of study in abroad currently. In this paper, the related research progress is reviewed.
  • 摘要：1病例介绍 病例1，患者，男，80岁。主因“言语不清、左上下肢无力80 min”于2015年7月9日入聊城市第三人民医院神经内科。患者于入院前80 min在吃饭过程中突然出现言语含糊不清，左侧上下肢无力，伴有双眼斜视，饮水呛咳。当时无头痛、头晕，无恶心、呕吐，无耳鸣和听力下降，无肢体麻木、无四肢抽搐，无大小便障碍，不伴意识障碍。患者在家未予药物治疗，就诊后立即行头颅计算机断层扫描（computed tomography， CT），未见新鲜梗死灶，未见出血，脑中线结构居中，门诊以“急性缺血性卒中”收入院。
  • 摘要：The cultivation of postgraduates in clinical practice is crucial for the cultivation of surgery system, in particular to the postgraduates in the department of cardiovascular surgery. The positive working attitude, professional morality, clinical skills and operation procedures, technical innovation, clinical research, etc are the fundamental elements to become an excellent surgeon of cardiovascular diseases. At present, most of medical universities and colleges adopt the same cultivation system and model to cultivate clinical medical postgraduates. However, the factors of patient’s disease severity, high risk for operation and personal characteristics of each postgraduate should be taken into consideration of teaching. The education about strengthening professional value, operation skills, science and technology innovation, responsibility to patients, self-conifdence could bring certain degree of help for the growth of postgraduates.%临床阶段的培养是医学生最接近临床行医的培养阶段，对于培养一位外科系统的研究生至关重要，尤其对于心脑血管外科的研究生，在临床阶段形成良好的行医态度、职业道德、临床技能操作规范、技术创新、临床科研等方面的素养，是将来成为一名优良的心脑血管外科医师的基础条件。目前大多数医学院校对临床研究生的培养采用相同的培养制度及模式。心脑血管外科患者患病程度重、手术风险大，重视每个研究生的自身特点，因材施教，强化职业操守、操作技能、科研创新、对患者的责任心、对自己的自信心等方面的教育，对研究生的未来成长有一定帮助。
  • 摘要：听到一个爸爸的教育方法，孩子上小学，但是贪恋电脑游戏，无奈之下，爸爸决定允许孩子玩游戏，但是需要每周写一份电脑游戏攻略，如果不能完成就不可以继续玩游戏。爸爸的如意算盘是这样：孩子只有两个选择，要么通过写游戏攻略争取玩游戏的权利，搞不好几年之后孩子会成为游戏玩家，还可以自食其力；要么就好好学习功课，因为或许孩子会觉得写攻略比学习难多了。可怜的家长，不过这也是陪着孩子成长中甜蜜的烦恼吧。但是这个爸爸的方法实在是纸上谈兵了，从纯逻辑的角度，爸爸的分析或许有道理，但是在实际操作上，孩子可能会周周交游戏攻略，但是谁来评判游戏攻略的水准呢，谁来判别孩子是否用心完成这份攻略呢？如果孩子认为自己交了作业，而爸爸认为这份攻略只是敷衍，那么新的矛盾又会产生，治标不治本，核心的问题并没有解决。
  • 摘要：目的评价炎症介质白介素-2（interleukin-2，IL-2）、肿瘤坏死因子-α（tumor necrosis factor-α， TNF-α）及尿液内源性甲醛浓度（formaldehyde，FA）与血管性痴呆（vascular dementia，VaD）的关系，为临床VaD的早期诊断提供生化标志物诊断方法。　　方法选取北京老年医院精神心理门诊和病房VaD患者42例为试验组，选取社区内认知功能正常者54例为对照组，测定研究对象血浆中IL-2和TNF-α的水平，测定尿液内源性甲醛的含量，以尿液中甲醛浓度除以肌酐（creatinine，Cr）浓度值（FA/Cr）作为内源性甲醛校正浓度，比较两组上述指标的差异。　　结果与对照组相比，VaD患者尿液内源性甲醛浓度含量显著升高（6.31±0.53vs 4.40±0.31， P=0.007）。　　结论 VaD患者尿液中内源性甲醛浓度升高，或可作为临床诊断VaD的生物标志物之一。%Objective To evaluate the correlation of inflammatory medium (interleukin-2, IL-2 and tumor necrosis factor-α, TNF-α) and vascular dementia (VaD), so as to provide the biochemical markers for clinical early diagnosis of VaD. Methods A total of 42 patients in outpatient and wards with VaD were taken as experimental group, and 54 cases in the community without cognitive impairment were taken as control group. The level of IL-2 and TNF-α in serum and the formaldehyde concentration (FA) in urine were detected. The FA/Cr was used as rectiifed concentration to compare the differences in above mentioned indexes between two groups. Results The concentration of urine formaldehyde is observably higher in VaD than in the control group (6.31±0.53vs 4.40±0.31), which had statistical signiifcance (P=0.007). Conclusion The concentration of urine formaldehyde in VaD patients was signiifcantly increased. The increased formaldehyde concentration in the urine is expected to be one of the biomarkers in the diagnosis of VaD.
  • 摘要：Objective By analyzing the relationship between daytime sleepiness and neurological function prognosis in patients with acute stroke, to explore the relationship between daytime sleepiness and acute ischemic stroke. Methods Patients with acute ischemic stroke within 48 hours were consecutively enrolled from Beijing Haidian Hospital during June 2015 to September, 2015. And data were collected including demographics, chronic disease history, National Institutes of Health Stroke Scale (NIHSS) on admission and the 14th day, and Epworth Sleepiness Scale (ESS) on admission. ESS 1 month before admission, which is the premorbid ESS, were retrospectively evaluated. The correlation between premorbid ESS with demographics, chronic disease history, NIHSS on admission and the 14th day, delta NIHSS (the result of NIHSS on admission minus NIHSS of the 14th day) and ESS on admission were analyzed. According to premorbid ESS, patients were divided into sleepiness group and non-sleepiness group, compared NIHSS on admission and the 14th day, delta NIHSS and ESS on admission between two groups. Results One hundred and six patients were consecutively enrolled. The results showed that①Premorbid ESS had positive correlation with admission NIHSS, the 14th day NIHSS and admission ESS. Pearson correlation coefifcient were 0.199, 0.276 and 0.407, andP values were 0.041, 0.004 and <0.001. Premorbid ESS had negative correlation with delta NIHSS. Pearson correlation coefifcient was-0.189 andP value was 0.042.② In daytime sleepiness group, admission NIHSS, the 14th NIHSS and admission ESS were signiifcantly higher than in non-daytime sleepiness group. P values were 0.033, 0.043 and <0.001 respectively. In daytime sleepiness group, delta NIHSS was signiifcantly lower than in non-daytime sleepiness group.P value was 0.046. Conclusion Premorbid daytime sleepiness patients will be more severely on admission and in 14th day, meanwhile their prognosis in the acute phase is worse. The degree of daytime sleepiness will aggravate when ischemic stroke happens.%目的通过分析急性缺血性卒中患者日间嗜睡及急性期神经功能转归情况，探索日间嗜睡与急性缺血性卒中短期预后之间的关系。　　方法连续收集2015年6月-2015年9月北京市海淀医院神经内科收治的发病48 h内的住院急性缺血性卒中患者临床资料，包括：人口学特征、既往病史、入院时及发病14 d美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分及入院时日间嗜睡量表[爱波沃斯嗜睡量表（Epworth Sleepiness Scale，ESS）]评分等，回顾性评估患者发病前一个月的ESS评分，分析其与患者基线特点、入院NIHSS评分、入院ESS评分、发病14 d NIHSS评分、发病14 d与发病时NIHSS评分差值（△NIHSS）之间的相关性。根据发病前ESS评分将患者分为嗜睡组和无嗜睡组，比较两组入院时NIHSS、发病14 d NIHSS、△NIHSS及入院时ESS评分的差异。　　结果共纳入106例急性缺血性卒中患者。结果显示：①发病前ESS评分与入院时NIHSS评分、发病14 d NIHSS评分及入院时ESS评分呈正相关，Pearson相关系数分别为0.199、0.276及0.407，P值分别为0.041、0.004及＜0.001；发病前ESS评分与△NIHSS评分呈负相关，Pearson相关系数为-0.189，P=0.042；②嗜睡组28例，非嗜睡组78例，嗜睡组入院时NIHSS、发病14 d NIHSS及入院时ESS评分明显高于非嗜睡组，P值分别为0.033、0.043和＜0.001。嗜睡组△NIHSS评分明显低于非嗜睡组，P=0.046。　　结论发病前存在日间嗜睡的患者在发生急性缺血性卒中后，入院时及发病14 d病情更加严重，短期预后更差，并且卒中后日间嗜睡程度会加重。

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