Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many...Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).展开更多
目的:研究口服布洛芬治疗极低出生体质量儿动脉导管未闭(PDA)及与脑出血的相关性。方法:选取90例PDA极低出生体质量儿作为研究对象,根据治疗方案分为观察组和对照组,各45例,其中对照组口服吲哚美辛,观察组口服布洛芬。统计2组疗效、脑...目的:研究口服布洛芬治疗极低出生体质量儿动脉导管未闭(PDA)及与脑出血的相关性。方法:选取90例PDA极低出生体质量儿作为研究对象,根据治疗方案分为观察组和对照组,各45例,其中对照组口服吲哚美辛,观察组口服布洛芬。统计2组疗效、脑出血发生率及治疗前后心脏功能左心室射血分数(LVEF)、左心室舒张末期容量(LVEDV)、左心室收缩末期内径(LVESD),脑血流动力学参数大脑前动脉(ACA)、中动脉(MCA)的舒张末期流速(Vd)、阻力指数(RI);采用logistic分析PDA极低出生体质量儿脑出血发生风险。结果:观察组治疗总有效率95.56%,与对照组91.11%比较差异无统计学意义(P>0.05);治疗后2组LVEDV、LVESD、LVEF均低于治疗前(P<0.05),2组间比较差异无统计学意义(P>0.05);治疗后观察组MCA、ACA的Vd高于对照组,RI低于对照组(P<0.01),观察组脑出血发生率低于对照组(P<0.05)。logistic回归分析显示,胎龄长、出生体质量高、出生1 min Apgar评分高、布洛芬治疗是PDA极低出生体质量儿脑出血保护因素,呼吸暂停、宫内窘迫、机械通气、母亲大出血、滞产是PDA极低出生体质量儿脑出血危险因素(P<0.05~P<0.01)。结论:口服布洛芬治疗PDA极低出生体质量儿效果确切,能改善心室重构,稳定脑血流,降低脑出血发生率。PDA极低出生体质量儿脑出血与呼吸暂停、宫内窘迫、机械通气等多种因素有关,应积极行颅脑超声检查并动态观察,以进一步减少脑损伤。展开更多
文摘Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
文摘目的:研究口服布洛芬治疗极低出生体质量儿动脉导管未闭(PDA)及与脑出血的相关性。方法:选取90例PDA极低出生体质量儿作为研究对象,根据治疗方案分为观察组和对照组,各45例,其中对照组口服吲哚美辛,观察组口服布洛芬。统计2组疗效、脑出血发生率及治疗前后心脏功能左心室射血分数(LVEF)、左心室舒张末期容量(LVEDV)、左心室收缩末期内径(LVESD),脑血流动力学参数大脑前动脉(ACA)、中动脉(MCA)的舒张末期流速(Vd)、阻力指数(RI);采用logistic分析PDA极低出生体质量儿脑出血发生风险。结果:观察组治疗总有效率95.56%,与对照组91.11%比较差异无统计学意义(P>0.05);治疗后2组LVEDV、LVESD、LVEF均低于治疗前(P<0.05),2组间比较差异无统计学意义(P>0.05);治疗后观察组MCA、ACA的Vd高于对照组,RI低于对照组(P<0.01),观察组脑出血发生率低于对照组(P<0.05)。logistic回归分析显示,胎龄长、出生体质量高、出生1 min Apgar评分高、布洛芬治疗是PDA极低出生体质量儿脑出血保护因素,呼吸暂停、宫内窘迫、机械通气、母亲大出血、滞产是PDA极低出生体质量儿脑出血危险因素(P<0.05~P<0.01)。结论:口服布洛芬治疗PDA极低出生体质量儿效果确切,能改善心室重构,稳定脑血流,降低脑出血发生率。PDA极低出生体质量儿脑出血与呼吸暂停、宫内窘迫、机械通气等多种因素有关,应积极行颅脑超声检查并动态观察,以进一步减少脑损伤。
