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针刺对缺血性中风早期康复的作用及针刺时间窗的研究概况
脑卒中是世界上引起人类死亡的第三大病因,仅次于心脏病和肿瘤引起的死亡人数.卒中后1年内大约有29%的患者死亡,这一比例在65岁以上的老年人中更高;卒中是致残的主要原因,31%的卒中存活者在卒中后需要人照顾,20%需要辅助才能行走,16%的存活者需要安置到提供生活照顾的机构;至少1/3的卒中患者有抑郁症[1].
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亚低温对局灶性脑缺血治疗时间窗的实验研究进展
脑血管病是严重威胁人类生命健康的临床常见病,而缺血性脑血管病占其中的70%,大脑中动脉阻塞(MCAO)是临床上常见的局灶性脑缺血性疾病.目前,对于急性MCAO的治疗已经由单纯的药物治疗发展成为神经介入和(或)药物联合治疗.由于急性脑缺血再通后可以级联一系列再灌注损伤,因此,进行MCAO的动物实验研究具有现实的临床意义.什么时间内实施亚低温治疗才能起到大限度的神经保护作用,这涉及到亚低温治疗的时间窗问题.作者对亚低温局灶性脑缺血治疗时间窗的实验研究及临床应用前景综述如下.
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A preliminary study from our research group showed that picroside II inhibited neuronal apop-tosis in ischemic penumbra, reduced ischemic volume, and improved neurobehavioral function in rats with cerebral ischemia. The aim of the present study was to validate the neuroprotective effects of picroside II and optimize its therapeutic time window and dose in a rat model of ce-rebral ischemia. We found that picroside II inhibited cell apoptosis and reduced the expression of neuron-speciifc enolase, a marker of neuronal damage, in rats after cerebral ischemic injury. The optimal treatment time after ischemic injury and dose were determined, respectively, as fol-lows:(1) 2.0 hours and 10 mg/kg according to the results of toluidine blue staining;(2) 1.5 hours and 10 mg/kg according to early apoptotic ratio by lfow cytometry;(3) 2.0 hours and 10 mg/kg according to immunohistochemical and western blot analysis;and (4) 1.5 hours and 10 mg/kg according to reverse transcription polymerase chain reaction. The present ifndings suggest that an intraperitoneal injection of 10 mg/kg picroside II 1.5-2.0 hours after cerebral ischemic injury in rats is the optimal dose and time for therapeutic beneift.
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脑梗死溶栓治疗的临床与基础探索
急性脑梗死的溶栓治疗用之合理,疗效显著;处理不当,后果严重.在国际上,对组织型纤溶酶原激活剂(tissue plasminogen activator, tPA)使用的利弊一直存在争论.紧迫而实际的问题是:如何选择适应证和"治疗时间窗" (therapeutic time window, TTW )?如何减少脑出血并发症? 如何扩大TTW? 以及tPA 本身对神经组织有何利弊?