ABSTRACT
Acute ischemic stroke has become one of the important causes of death and disability in human beings, especially in elderly patients. Intravenous thrombolysis with alteplase is an important treatment. However, there are many underlying diseases and poor overall conditions in elderly patients, which increase the risk of intracranial hemorrhage. Intracranial hemorrhage transformation makes the patient′s condition worse, which is the most serious complication of alteplase intravenous thrombolysis, and also one of the important reasons for the low treatment rate of alteplase intravenous thrombolysis in elderly patients. Therefore, we need to pay close attention to the occurrence mechanism and risk factors of intracranial hemorrhage transformation after alteplase intravenous thrombolysis in elderly patients, so as to reduce the risk of intracranial hemorrhage transformation, improve the prognosis and reduce the risk of morbidity and mortality.
ABSTRACT
Objective:To investigate the effectiveness and safety of early combined with tirofiban in the treatment of elderly patients with acute ischemic stroke after intravenous thrombolysis with alteplase.Methods:Elderly (60-75 years old) patients with acute ischemic stroke received intravenous alteplase thrombolysis in the Department of Neurology, Traditional Chinese Medicine Hospital of Huangdao District, Qingdao from January 2018 to May 2020 were enrolled prospectively. According to whether tirofiban is combined or not, they were divided into tirofiban group and non-tirofiban group. Tirofiban was pumped intravenously 2 h after intravenous thrombolysis, first 0.4 μg/(kg·min) for 30 min, then 0.1 μg/(kg·min) for 24 h. The efficacy endpoints included National Institutes of Health Stroke Scale (NIHSS) score at 7 d after treatment and modified Rankin Scale (mRS) score at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. The safety endpoints included the incidence of hemorrhagic transformation, symptomatic intracranial hemorrhage (sICH) and mortality within 90 days after onset.Results:A total of 124 patients with acute ischemic stroke were enrolled. The median age was 68 years (range, 60-75 years). There were 73 males (58.9%) and 51 females (41.1%). There were 62 patients (50%) in the tirofiban group and 62 (50%) in the non-tirofiban group. The median baseline NIHSS score was 14. Hemorrhagic transformation occurred in 7 patients (5.6%), of which 2 were sICH (1.6%). The follow-up at 90 d after onset showed that 68 patients (54.8%) had a good outcome, 56 (45.2%) had a poor outcome, of which 4 (3.2%) died. The NIHSS score at 7 d after treatment (5.52±4.79 vs. 7.35±3.80; t=2.357, P=0.020) and the rate of good outcome at 90 d after onset (64.5% vs. 45.2%; χ2=4.689, P=0.030) in the tirofiban group were significantly better than those of the non-tirofiban group, and there were no significant differences among the incidence of hemorrhagic transformation (4.8% vs. 6.5%; P=1.000), sICH (1.6% vs. 1.6%; P=1.000), and 90 d mortality (3.2% vs. 3.2%; P=1.000). Conclusion:After intravenous thrombolysis with alteplase, the early combined treatment with tirofiban in elderly patients with acute ischemic stroke can significantly improve the efficacy and outcome, and will not increase the risk of hemorrhagic transformation, sICH and death.
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Objective To compare the effectiveness of botulinum toxin type A ( BTXA) and ethyl alcohol ( EA) in treating lower extremity spasticity after stroke. Methods This was a randomized, case-control study. A to-tal of 92 eligible stroke survivors completed the study. They were randomly divided into a BTXA group of 48 and an EA group of 44 according to a random number table. The gastrocnemius, soleus and posterior tibial muscles of the af-fected limb were chosen as injection sites. The BTXA group was injected with 50 to 200 IU of BTXA ( at 50 U/ml) at one to four sites in each muscle, with a total injection dose of less than 600 U. The EA group was injected with less than 10 ml of 50% EA (0.1 to 0.5 ml at each site). Before and 2, 4 and 12 weeks after the injection, both groups were evaluated using the modified Ashworth scale (MAS), a 3 m timed up and go test (TUG), a timed 10 meter walk ( 10m-WT) and each was asked to assess their pain level using a visual analogue scale ( VAS) . Any adverse re-actions were also observed. Results Two weeks after the injection, the average MAS score of both groups had im-proved significantly compared to that before the injection. The average improvement in the BTXA group was signifi-cantly less than in the EA group. No significant differences were found in other measurements. After four weeks the average MAS score of the BTXA group was still significantly different from that before injection or from 2 weeks previ-ously, but the EA group now showed no significant difference from before the injection. The average TUG, 10m-WT and VAS scores of both groups had improved significantly compared to those of the earlier time points. Twelve weeks after the injection, the average MAS, TUG, 10m-WT and VAS scores of the BTXA were still significantly improved compared to before the injection, but in the EA group only the average score VAS reading was significantly improved. There were then significant differences between the two groups in all of the measurements. Conclusions Both BTXA and EA can relieve muscle spasticity. Both take effect within 2 weeks, but the former has fewer side effects than the latter and a longer duration of therapeutic effect.
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Objective To investigate the clinical characteristics and therapeutic plan of Miller Fisher syn-drome( MFS) complicated with Guillain-Barrésyndrome( GBS) .Methods The clinical data of one patient of MFS complicated with GBS was reviewed retrospectively,and analysis combined with literature review was given.Results The patient had infectious history before the onset of MFS and GBS.Clinical manifestations included MFS triad,bulbar paralysis,bilateral facial paralysis,protein-cell dissociation of cerebrospinal fluid and neurogenic damages in electro-myography.Plasm exchange and adrenocortical hormones treatment were effective.Conclusion MFS complicated with GBS is an independent disease which is different from MFS or GBS.It has its distinct clinical features which should apply appropriate treatment.
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Objective To investigation the rule of TCM syndrome differentiation on vascular dementia,and to guide clinic therapy.Methods The vascular dementia TCM syndrome differentiation scale (SDSVD) was used for TCM syndrome differentiation of 60 cases of vascular dementia.Results The Vascular dementia has such TCM syndromes:deficiency of kidney-essence accounting for 28.3％,turbid phlegm blocking the clear orifices accounting for 23.3％,obstruction of collaterals by blood stasis accounting for 21.7％,liver Yang adverse rising accounting for 10.0％,fire-heat prosperous accounting for 8.3％,metabolic waste in viscera accounting for 8.3％.QI and blood paucity accounting for 3.3％.Conclusion The Vascular dementia has a clear TCM syndrome regularity,the syndromes of deficiency of kidney-essence accounting,turbid phlegm blocking the clear orifices,and obstruction of collaterals by blood stasis are the top three syndromes.
ABSTRACT
To study the cause and mechanism of vascular dementia.The author considers kidney deficiency and sputum stasis is the cause and mechanism of vascular dementia,so the treatment of notifying kidney to supplement marrow,activating blood circulation and removing sputum,accompanied by opening orifices medicines should be adopted.
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Objective To study the relationship between stabilization of patients with carotid artery atherosclerosis plaques and different traditional Chinese medicine (TCM)syndromes.Methods 60 patients with carotid artery atherosclerosis plaques were undertaken TCM syndrome differentiation and carotid Color Doppler ultrasonography tested.Results The cases of insufficiency of kidney essence and insufficiency of vital energy and blood had occupied a larger ration in stabilization carotid artery atherosclerosis plaques; while sputum and blood stasis locking collaterals syndrome and blood stasis due to Qi deficiency syndrome had statistical significance in unstabilization carotid artery atherosclerosis plaques.Conclusion Different TCM syndromes had different stabilization of carotid artery atherosclerosis.Sputum and blood stasis locking collaterals syndrome and blood stasis due to deficiency syndrome are unstable.These two syndromes are high risk syndromes of carotid artcry atherosclerosis plaques.