脑出血继续出血及其影响因素探讨(附410例分析)

脑出血是卒中最严重的一种类型,脑出血患者急性期的高病死率可能与脑出血继续出血有关,继续出血可使血肿进一步增大,导致临床症状的进行性恶化甚至死亡。脑出血继续出血目前国内报道较少。现总结我院1995～1998年410例脑出血住院患者的临床资料,以探讨脑出血继续出血的时间、发生率及其影响因素。1　资料和方法1.1　一般资料　男292例,女118例。年龄36～81岁,平均(64.1±10.8)岁。均符合全国第四次脑血管病学术会议制定的脑出血诊断标准[1]。出血部位:壳核176例,丘脑183例,桥脑18例,小脑22例,脑叶11例。出血量9.2～74.5ml,平均38.1ml。1.2　…     

大面积脑梗塞30例临床分析

大面积脑梗塞因发病突然,症状危重,临床表现及预后酷似脑出血,致残率及死亡率均较高,已日益引起临床医生的关注。现将我院１９９５年８月～１９９７年８月收治的大面积脑梗塞３０例分析报道如下。临床资料１．一般资料３０例均经颅脑ＣＴ检查确诊为大面积脑梗塞,并随...     

大面积脑梗塞30例临床分析

现将我院1995年8月～1997年8月收治的大面积脑梗塞30例分析报道如下。1 临床资料1.1 一般资料 30例均经颅脑CT检查确诊为大面积脑梗塞。并随机抽出同期30例非大面积脑梗塞为对照组。大面积脑梗塞组:年龄52岁～75岁,平均65.8岁。性别:男18例,女12例。其中有动脉硬化病     

全球健康发展新趋势大盘点

整个人类的健康状况是有一定发展趋势的,这个趋势随医学技术、生存环境,饮食结构的改变而改变。几十年前,肺结核是绝症,如今吃药就能解决。解放初期,吸血虫病、麻风病、霍乱横行,现在有的已经非常少见。2009年,疾病又有什么变化趋势,医疗技术会朝哪个方向发展?让我们来做个盘点。     

阻塞性睡眠呼吸暂停低通气综合征患者脑血管自动调节潜力分析

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑血管的自动调节能力.方法 选择济南市第四人民医院神经科自2007年2月至2009年5月就诊或住院的OSAHS患者76例,根据患者呼吸暂停低通气指数(AHI)和夜间最低血氧饱和度(LSaO2)分为轻、中、重度OSAHS组,选择同期有打鼾史的健康体检者32例作对照组,利用多导睡眠仪监测睡眠相关指标及不同时段血压,通过经颅多普勒超声(TCD)检测结合倾斜实验、屏气实验评价患者脑血管的CO2反应性和自动调节能力.结果 与对照组比较,OSAHS组患者AHI较高、LSaO2较低、微觉醒指数(MI)较高,暂停时收缩压增高,S1占睡眠时间的百分比增高、S3+4占睡眠时间的百分比降低,差异均有统计学意义(P＜0.05).与对照组和轻度OSAHS组比较,中、重度OSAHS组患者呼吸抑制指数(BHI)降低、由卧位至立位平均动脉压恢复90%所用时间(TMAP)增加;与对照组比较,OSAHS组患者血管运动反应性(VMR)降低、由卧位至立位脑血流速度(CBFV)恢复90%所用时间(TCBFV)增加,差异均有统计学意义(P＜0.05).中重度OSAHS患者卧立位时血压、平均CBFV的差异均有统计学意义(P＜0.05),立位血压和平均CBFV之间呈正相关关系(r=0.384,P=0.005).结论 OSAHS患者尤其是中重度患者脑血管调节功能受损,卒中风险可能增加.导致OSAHS患者脑血管调节受损的主要因素为夜间低氧血症、高碳酸血症、血压波动及睡眠结构紊乱.

Abstract：

Objective To evaluate the cerebral autoregulation in patients with obstructive sleep apnea-hypopnea syndrome (OASHS) using transcranial Doppler (TCD)-CO2 test and head-upright tilt test (HUTT) from the aspects of nocturnal hypoxemia/hypercapnia and sleep structure. Methods Seventy-six patients with OSAHS visiting our hospital from February 2007 to May 2009 were chosen in our study and divided into severe OSAHS group (n=26), moderate OSAHS group (n=29) and mild OSAHS group (n=21) according to the apnea-hypopnea index (AHI), and the lowest oxygen saturation (LSaO2); 32 healthy controls, having snore history, were adopted too. Polysomnography monitor was used for night-7-h sleep monitoring and blood pressure monitoring; sleep-related indicators and blood pressure at different times were analyzed. Cerebrovascular reactivity was calculated in terms of the breath-holding index (BHI) and vascular motor reactivity (VMR) by TCD-CO2 test; Changes of cerebral blood flow velocity (CBFV), blood pressure (Bp), and the time from squatting-to-tilt position for the mean arterial pressure (TMAP) and the CBFV (TCBFV) returning to ＞90% of baseline levels were detected by HUTT to assess the cerebral pressure-autoregulation. Results The AHI, microarousal index (MI) and the percentages of S1 in the non-rapid eye movement sleep period in the severe, moderate and mild OSAHS groups were all significantly higher than those in the control group (P＜0.05); the LSaO2 and the percentages of S3+4 in the non-rapid eye movement sleep period in all the OSAHS groups were significantly lower than those in the control group (P＜0.05); no significant difference in blood pressure before apnea was noted between the OSAHS groups and the control group (P＞0.05), however, the systolic blood pressure while apnea in all the OSAHS groups was significantly higher than that in the control group (P＜0.05). As compared with the controls and mild OSAHS group (1.89±0.36, 1.75±0.41), severe and moderate OSAHS groups (0.71 ±0.17, 1.12±0.23, respectively) showed significantly decreased BHI (P＜0.05); As compared with the controls (0.68±0.11), and the mild, moderate and severe OSAHS groups (0.20±0.04, 0.34±0.07 and 0.55±0.17, respectively) showed significantly decreased VMR (P＜0.05); TMAP in the moderate and severe OSAHS groups was significantly longer than that in the controls and mild OSAHS group (P＜0.05); TCBFV in the mild, moderate and severe OSAHS groups was significantly longer than that in the controls (P＜0.05). Significant difference on the levels of Bp and CBFV during tilt was noted between the moderate and severe OSAHS groups (P＜0.05); Pearson analysis showed a linkage between Bp and CBFV changes (r=0.384, P=0.005). Conclusion Cerebrovascular autoregulation is impaired in patients with OSAHS, especially in the moderate and severe groups, which may increase the risk of stroke. The major risk factors for cerebrovascular autoregulation in patients with OSAHS are night hypoxemia, hypercapnia, blood pressure fluctuation and severe sleep disorders.     

颜色能影响健康

大自然的各种色彩使人产生各种感觉,并可陶冶人的情操。不同的颜色使人产生不同的情绪,从而引起人的心境发生变化。近年来,各国科学家和心理学家对颜色进行了深入细微的研究,并且得出了"颜色能影响健康"的结论。试     

人工智能医疗器械在卒中诊疗中的伦理探讨

人工智能(artificial intelligence,AI)医疗器械在卒中诊疗中的应用越来越广泛,一方面可以辅助提高卒中诊疗的效率,另一方面也存在一些潜在的伦理问题,包括卒中患者的知情同意、隐私安全性、数据全面性、算法科学性、诊断准确性和主体责任划分等.AI医疗器械在卒中诊疗中的伦理问题对策包括以下2个方面:①伦理...     

甲状腺肢端病骨显像一例

患者女，55岁．1998年10月无明显诱因出现心慌、怕热多汗、乏力等症状．6个月后因甲状腺明显肿大．当地医院诊断为“甲亢”给予“他巴唑”治疗1年，停药后甲亢复发。2000年10月在当地医院行甲状腺次全切除手术，术后甲亢症状缓解．但半年后出现双眼突出、流泪、双手足肿胀，服用泼尼松30mg/d1个月．效果不佳。入院后体格检查：双眼突     

复发性脑梗死的危险因素分析

[目的]研究与复发性脑梗死有关的危险园子。[方法]收集2002、8-2004、7在山东省立医跣神经内科住院的573例急性脑梗死病人，依据文献将573例急性脑梗死患者分为复发组和初发组。对2组患者的临床表现及炎症参数（血白细胞、C-反应蛋白）、平均血小板体积、红细胞、凝集参数（D-二聚体、纤维蛋白原、凝血酶原时间）、血脂、血糖、血压采用Chi-square test，independent-sample t test和logistic多因素逐步回归法来评价进展性中风的危险因子。[结果]在573例病人中。172例（25．6%）为复发性脑梗死。病情的复发与白细胞（t=-5．950，P〈0．001）、平均血小板体积（t=-7．116，P〈0．001）、C-反应蛋白（t=-3．420，P〈0．001）、血糖增高（t=-8．27，P〈0．001）吸糖尿病史明显相关（x^2=11．85，P〈0．005）。[结论]复发性脑梗死与白细胞数、慢性炎症和糖尿病有关。控制慢性炎症如白细胞教、平均血小板体积、C-反应蛋白和血糖可以减少复发性脑卒中。