RESUMO
Objective:To investigate whether the fluctuation of blood pressure variability (BPV) before carotid endarterectomy (CEA) is related to postoperative cerebral perfusion changes in patients with carotid artery stenosis.Methods:A prospective observational cohort study was performed. Forty-seven patients with carotid artery stenosis accepted CEA in Department of Neurosurgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University from January 2019 to December 2022 were chosen. Patients' blood pressure was closely monitored 3 d before surgery (4 times/d) to obtain their BPV (the maximum △, based on the maximum absolute differences between systolic or diastolic blood pressures measured continuously during the observation period). At the same time, the changes of cerebral perfusion 3 d after surgery were monitored (criteria of cerebral hyperperfusion: newly-appeared delirium and hyperactivity after anesthesia resuscitation or intracranial hemorrhage found by imaging examination; criteria of cerebral hypoperfusion: newly-appeared speech and motor function deficits or aggravation of original cerebral ischemia symptoms after anesthesia resuscitation, or new-found cerebral infarction by imaging examination). Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of BPV before CEA in postoperative cerebral perfusion changes.Results:In these 47 patients, 9 patients (19.1%) had postoperative cerebral perfusion changes: 2 had neurological deficits due to postoperative cerebral infarction, and the other 7 had short-term postoperative delirium or focal neurological deficits (returned to normal after appropriate adjustment of blood pressure). Area under the ROC curve (AUC) of BPV before CEA in predicting postoperative cerebral perfusion changes was 0.876 ( P=0.001, 95% CI: 0.775-0.977). These 47 patients were divided into high BPV group ( n=16) and low BPV group ( n=31) according to the optimal index threshold (27.00), and the statistics showed that significant difference in incidence of cerebral perfusion changes after CEA was noted between the 2 groups ( P<0.05); incidence of postoperative cerebral perfusion changes in the high BPV group was 15.5 times higher than that in the low BPV group ( RR=15.500, P<0.001, 95% CI: 2.120-113.320). Conclusion:BPV before CEA in patients with carotid artery stenosis can well predict the occurrence of postoperative cerebral perfusion changes.
RESUMO
Objective To evaluate the therapeutic effect of acupuncture combined with rehabilitation training on children with cerebral palsy. Methods A total of 68 children with cerebral palsy who met the inclusion criteria were randomly divided into two groups, 34 in each group. The control group was treated with Bobath therapy combined with Vojta therapy for rehabilitation training, while the observation group was treated with acupuncture on the basis of the control group. Both groups were treated for 12 weeks. Modified Ashworth method was used to assess the muscular tension of lower limbs, the gross motor function scale was used to assess the gross motor function, and the Fugl-Meyer motor function evaluation method was used to evaluate the limb motor function of children. And the serum levels of vascular endothelial growth factor and creatine kinase brain isoenzyme (CK-BB) were detected by ELISA. Results After treatment, the muscle tension score (1.3 ± 0.3 vs. 1.7 ± 0.4, t=4.108) in the observation group was significantly lower than that in the control group, while the GMFM score (55.7 ± 13.7 vs. 37.8±11.4, t=5.881) significantly higher than that in the control group (P<0.01). The serum VEGF (145.67 ± 19.78 ng/L vs. 171.35 ± 22.54 ng/L, t=4.993) in the observation group were significantly lower than those of the control group (P<0.01). The levels of CK-BB (71.46 ± 17.62 U/L vs. 95.76 ± 19.65 U/L, t=5.368) in the observation group were significantly lower than those of the control group (P<0.01). The total effective rate was 94.1% (32/34) in the observation group and 73.5% (25/34) in the control group. There were significant differences between the two groups (χ2=5.314, P=0.021). Conclusions Acupuncture combined with rehabilitation training can improve the muscle tension and gross motor function of children with cerebral palsy, reduce the levels of VEGF and CK-BB in serum of children with cerebral palsy, and improve the clinical effect.
RESUMO
<p><b>OBJECTIVE</b>To observe the clinical effect of acupuncture at Baihui(GV 20) and Shenting(GV 24) combined with rehabilitation for post-stroke cognitive impairment(PSCI).</p><p><b>METHODS</b>Fifty patients with PSCI were randomly assigned to an observation group and a control group,25 cases in each one. In the control group,basic treatment and regular rehabilitation were applied. In the observation group,acupuncture at Baihui(GV 20) and Shenting(GV 24) and the same therapies as the control group were used for continuous four weeks,once a day and five times a week. Mini-mental state examination(MMSE) and Montreal cognitive assessment(MoCA) were observed before and after treatment in the two groups.</p><p><b>RESULTS</b>After treatment,the scores of MMSE and MoCA were improved apparently(both<0.05),with better results in the observation group(both<0.05).</p><p><b>CONCLUSIONS</b>Acupuncture at Baihui(GV 20) and Shenting(GV 24) combined with basic treatment and regular rehabilitation can obviously improve the cognitive function of PSCI,and the effect is superior to that of basic treatment and regular rehabilitation.</p>