阿司匹林在高血压治疗中的应用与意义

高血压,即使是经过了治疗,仍较正常人有较高的心血管并发症的发生。高血压有关的并发症对患者的生活质量及预后有较大的影响。其首要死亡原因是缺血性事件。阿司匹林是经过大量安慰剂对照、随机临床试验证实、可降低首次心肌梗死及缺血性脑卒中危险的抗血小板药物。近年来有关阿司匹林在防治缺血性心血管病方面的循证医学证据逐渐增多,国内及国际的心血管病防治指南均推荐应用阿司匹林。随着卒中预防领域内几项关键性的临床试验（ESPRIT、CHARISMA及WHS）的公布,美国心脏协会／美国卒中协会写作委员会对2006版指南的内容进行了更新。本文结合新的临床试验的证据,对阿司匹林在高血压治疗中的意义进行了分析,以期能更适当地应用阿司匹林,减少与高血压有关的缺血事件,提高人口的生存质量及寿命。     

阿司匹林在高血压治疗中的应用与意义

高血压,即使是经过了治疗,仍较正常人有较高的心血管并发症的发生。高血压有关的并发症对患者的生活质量及预后有较大的影响。其首要死亡原因是缺血性事件。阿司匹林是经过大量安慰剂对照、随机临床试验证实、可降低首次心肌梗死及缺血性脑卒中危险的抗血小板药物。近年来有关阿司匹林在防治缺血性心血管病方面的循证医学证据逐渐增多,国内及国际的心血管病防治指南均推荐应用阿司匹林。随着卒中预防领域内几项关键性的临床试验（ESPRIT、CHARISMA及WHS）的公布,美国心脏协会／美国卒中协会写作委员会对2006版指南的内容进行了更新。本文结合新的临床试验的证据,对阿司匹林在高血压治疗中的意义进行了分析,以期能更适当地应用阿司匹林,减少与高血压有关的缺血事件,提高人口的生存质量及寿命。     

石家庄市区缺血性心脑血管病级预防中阿司匹林的应用状况初探

调查在河北省石家庄市区冠心病和缺血性脑血管病二级预防中阿司匹林的应用状况。通过对原住院患者随访,对内科门诊、专家门诊和社区门诊患者通过问卷调查,收集服用阿司匹林的有关资料,根据阿司匹林的应用情况,将患者分为两组：1组为服药组：患者规范或不规范服用阿司匹林;2组为未用药组：患者从未服阿司匹林。共1885例,其中缺血性脑血管病925例、冠心病711例、冠心病与缺血性脑血管病并存249例。患者来自住院随访患者567例、内科门诊882例、社区门诊436例。全组1885例患者中,服用阿司匹林组为1226例（占比例为65．1％）,其中,规范服用阿司匹林957例（50．8％）,不规范用药269例（14．3％）,未服用阿司匹林659例（34．9％）。阿司匹林在本调查地区缺血性心脑血管病二级预防中的应用率较高,用药的依从性较好,但和阿司匹林规范化应用的专家共识还有较大的差距。     

老年脑卒中患者自我感受负担影响因素研究及干预策略

调查老年脑卒中患者的自我感受负担现状,分析其相关因素并提出策略.应用一般人口学资料问卷和自我感受负担量表对锦州市某医院106名老年脑卒中患者进行问卷调查,并分析其影响因素.结果显示患者自我感受负担得分为(37.32±5.48)分,处于中等水平.其影响因素是医疗费用的付费方式、生活自理能力和照顾者的健康状况.老年脑卒中患者自我感受负担明显,且受多种因素的影响.因此应采取有效的干预措施,减轻患者的自我感受负担,有利于患者的治疗.     

缺血性脑血管病合并颈部动脉狭窄的高危因素分析

考察缺血性脑血管病患者中动脉狭窄的发生率,探讨动脉狭窄发生的高危影响因素。选取2013年6月~2015年6月我科共收住院经确诊的缺血性脑血管病患者128例。测量并记录动脉狭窄的发生情况(部位、程度,病变类型、特点及分布,侧支循环、Willis环开放)。考察引起动脉狭窄的高危影响因素。动脉狭窄主要因动脉粥样硬化引起,单因素分析结果显示,动脉狭窄的高危因素包括高血压病、糖尿病、脑卒中史、高血脂、吸烟等(P0.05)。经Logistic回归发现,这些因素均与动脉狭窄的发生具有显著性相关(P0.05)。缺血性脑血管病患者多合并有不同程度的动脉狭窄。既往有高血压、高血脂、糖尿病、脑卒中史以及吸烟等均为动脉狭窄发生的高危影响因素。     

急性脑梗死患者超早期急诊溶栓决策延迟的现状及影响因素分析

调查急性脑梗死患者超早期急诊溶栓决策延迟的现状并分析其影响因素。便利抽取2017年3月~9月就诊于大连市某三级甲等医院的208例患者作为研究对象,采用一般资料调查表、疾病相关情况调查表进行调查。结果表明,急性脑梗死患者超早期急诊溶栓决策时间为(31.81±13.08)分钟,仅6.73%的患者决策时间低于15分钟。多元回归显示决策者、此前是否有医护人员向您讲解过疾病的相关知识、是否对脑卒中高危因素进行预防是影响患者决策延迟的主要影响因素(P0.05)。研究结果揭示,应加强健康教育,大范围普及相关知识,以最大限度缩短患者决策就医时间。     

家属对脑卒中患者设立预先指示的态度研究

通过方便取样法,抽取海口市某三级老年病专科医院脑卒中患者家属249名,使用问卷调查法调查家属对脑卒中患者设立预先指示(advance directives,AD)的态度并分析其影响因素。结果显示,在生命终末期治疗的选择上,家属为自己选择的治疗与为患者选择的治疗一致性较差(Kappa=0.249,P0.01)。家属的代理决策结果受多种因素影响。是否有过住院经历、家属代理决策的结果、家属对AD的态度是影响家属对患者设立AD态度的主要因素。     

尿微量白蛋白与急性缺血性脑卒中的关系研究

探讨尿微量白蛋白（MA）与急性缺血性脑卒中（AIS）的关系。选取2012年1月1日～2014年3月31日于大连大学附属新华医院神经内科住院的缺血性脑卒中患者175例为研究对象。分为试验组：A1S患者103例;对照组：非AIS患者72例。比较两组的一般资料和MA阳性率情况。结果试验组的MA阳性率为41．75％,显著高于对照组MA的阳性率20．83％（P〈0．05）。MA与AIS可能有相关性,MA可能是AIS的危险因素。     

进展性脑梗死的形成机制与防治策略

进展性脑梗死是临床上常见的一种缺血性脑卒中,其发病率高,致残率高,预后较差,严重危害患者的生命和健康,成为临床卒中治疗的一大难题。本文结合近年来的有关研究文献,就进展性脑梗死的临床分型、形成机制、可能的危险因素及其防治策略等方面的研究进展作一综合性介绍。     

进展性脑梗死的形成机制与防治策略

进展性脑梗死是临床上常见的一种缺血性脑卒中,其发病率高,致残率高,预后较差,严重危害患者的生命和健康,成为临床卒中治疗的一大难题.本文结合近年来的有关研究文献,就进展性脑梗死的临床分型、形成机制、可能的危险因素及其防治策略等方面的研究进展作一综合性介绍.     

Global cognitive function before,surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors

An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65–79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p’s <.0.0001), but were not significantly different from the contrasting level (all p’s >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.     

高血压患者长期应用阿司匹林应注意的问题

我国高血压患者人数已高达1．6亿。高血压的严重后果是心脑血管血栓性事件（心绞痛、心肌梗死、脑梗死等）发生率的显著增高。大量的证据显示,每天100mg阿司匹林可以有效预防血栓性事件,使心肌梗死的发生率下降1／3,脑梗死发生率下降1／4,心血管疾病病死率下降1／6,国内外指南均明确规定有适应证的高血压患者需终身服用阿可匹林。本文就长期应用阿司匹林应注意的问题做一综述。     

Pregnancy and stroke

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.     

脑卒中诊治观念转变的思考

脑卒中是一种常见病,伴有较高的病死率和致残率。近年来脑卒中诊治方面取得了不少进展,许多有关脑卒中的诊治的观念发生了巨大的转变,如卒中后血压的控制,高血压脑出血的止血治疗,急性脑梗死的溶栓治疗,卒中单元以及卒中的预防等方面。从这些转变中渗透着许多哲学观点,如否定之否定规律,科学假说与理论之间的关系,系统论的应用等。运用哲学的观点认识脑卒中的诊断治疗的转变,对日后的临床和科研有着一定的指导意义。     

Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke

Abstract

Objective: To assess levels of self-efficacy for health-related behaviour change and its correlates in patients with TIA or ischemic stroke.

Methods: In this prospective cohort study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behaviour change and fear, social support and depressive symptoms. Relations between fear, social support, depressive symptoms, cognitive impairment, vascular risk factors and history and demographic characteristics and low-self-efficacy were studied with univariable and multivariable logistic regression.

Results: Median total self-efficacy score at baseline was 4 (IQR 4–5). Older age (OR 1.05, 95% CI 1.01–1.09), depressive symptoms (OR 1.09, 95% CI 1.03–1.16), presence of vascular history (OR 2.42, 95% CI 0.97–6.03), higher BMI (OR 1.15, 95% CI 1.01–1.30), fear (OR 1.06, 95% CI 1.01–1.12) and low physical activity (OR 1.49, 95% CI 1.01–2.21) were significantly associated with low self-efficacy.

Conclusion: Patients with recent TIA or ischemic stroke report high self-efficacy scores for health-related behaviour change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity and fear were correlates of low self-efficacy levels.

Practice implications: These correlates should be taken into account in the development of interventions to support patients in health behaviour change after TIA or ischemic stroke.     

Risk factors for arterial ischemic stroke in childhood

Stroke affects up to 13 of 100,000 children, is more common in boys and African Americans, and is associated with considerable cognitive and psychiatric morbidity, as well as motor disability. Around half are hemorrhagic and half are ischemic. Underlying conditions include sickle cell disease, cardiac abnormalities, chromosomal abnormalities (eg, Down syndrome), and neurocutaneous conditions (eg, neurofibromatosis), but up to half the patients with ischemic stroke have no previously diagnosed condition. Although there is almost certainly an important genetic component to stroke risk, head trauma, infections, drugs and radiation appear to play an etiological role in some patients. The majority of the patients with infarction in an arterial distribution have associated cerebrovascular disease. Vascular pathologies include carotid or vertebrobasilar dissection, intracranial vasculopathy affecting the middle and anterior cerebral arteries, which is often transient, and moyamoya. Intermediate risk factors may include hypertension, hypoxia, and poor nutrition leading, for example, to iron deficiency and hyperhomocysteinemia. Some chronic conditions may directly influence the child's behavior and stroke recurrence risk, although large cohorts and randomized controlled trials will be needed before strategies for modification can be evidence-based.     

Hypercoagulable states and stroke: a selective review

Blood disorders have been implicated in approximately 5% to 10% of ischemic stroke, with an increased frequency in younger patients. Most disorders are associated with an increased thrombotic tendency and, therefore, an increased risk of ischemic stroke. Less commonly, a bleeding diathesis may predispose a patient to intracranial hemorrhage. While many conditions predisposing to thrombosis have been associated with stroke, there are relatively few prospective, epidemiological studies addressing hypercoagulable states and arterial stroke compared with the number of studies on the genetic thrombophilias, which are predominantly associated with venous thrombosis. When ordering tests of coagulation in stroke patients, one should keep in mind whether the results will influence therapy and/or patient outcome. It is generally not advocated to screen all stroke patients for a "hypercoagulable workup". Typically, patients to be screened for coagulation defects will have a prior history of one or more unexplained thromboembolic events. The yield for diagnosing a hypercoagulable state is typically greatest for young stroke patients or those with a family history of thrombosis and who have no other explanations for their stroke (cryptogenic stroke). The yield in typically low in unselected ischemic stroke patients and older patients. Treatment of a first stroke with a documented hypercoagulable state is typically long-term or indefinite duration warfarin, although there is a paucity of clinical trial data supporting this clinical approach.     

德州地区进展性缺血性脑卒中相关危险因素的研究

探讨进展性缺血性脑卒中（SIP）的相关危险因素。选择德州市人民医院1999年～2009年163例SIP患者,首先对18个变量行单因素分析,然后对阳性变量行多因素Logistic逐步回归分析,筛选SIP发生的相关危险因素。高血压史、感染、加拿大卒中量表（CNS）评分、高血糖、TG、纤维蛋白原、脑水肿、颈动脉粥样硬化性狭窄...