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目的:观测中风后遗症患者球结膜微循环及血管内皮功能指标,为临床治疗和预后分析提供资料。方法:选择首次中风,一年后仍存在偏瘫、失语等后遗症患者38例,男28例,女10例,年龄50-60岁;其BrumslromⅣ级左右,BDAE评定分级3级-2级、Bathel’s Index 40分左右;正在进行功能锻炼、针灸等康复治疗。另选年龄、性别与之匹配的同期健康体检者30例作为对照。采用XW型微循环检测系统观察两组人群球结膜微血管直径、血流状态及白色微小血栓;并抽取所有受检者空腹肘静脉血液,放免法测定血浆内皮素-1(ET-1)水平,硝酸还原酶法测定血清一氧化氮(NO)水平,并计算ET/NO比值。结果:中风后遗症患者中微动脉纤细、微静脉瘀曲较多见,占81.58%(31/38),血流呈粒流-粒缓流状态者占65.79%(25/38),高于对照人群的16.67%(5/30)和6.67%(2/30);中风后遗症患者17例(44.74%)见到白色微小血栓,对照人群仅见1例(3.33%);差异均有统计学意义(P<0.01)。中风后遗症患者ET-1水平明显高于对照人群(82.54±11.76ng/L vs 51.96±8.75ng/L,P<0.05);NO水平却较对照人群稍低(45.33±12.80μmol/L vs50.23±18.65μmol/L,P>0.05);中风后遗症的ET/NO也大于对照组(1.82±0.23vs 1.03±0.12,P<0.05)。结论:部分中风后遗症患者存在微循环障碍,内皮功能不稳定可能是其重要原因之一;临床应加强防范其二次中风的危险。
Objective: To observe the conjunctival microcirculation and vascular endothelial function in patients with stroke sequelae, and to provide information for clinical treatment and prognosis analysis. Methods: There were 38 cases of sequelae such as hemiplegia and aphasia after one year. There were 28 males and 10 females, aged 50-60 years. The Brumslrom Ⅳ grade and BDAE grade 3 to 2 were evaluated. Bathel’s Index 40 minutes or so; ongoing functional exercise, acupuncture and other rehabilitation. Another 30 healthy subjects who were matched for age and sex during the same period were taken as control. The diameter of conjunctiva microvessel, blood flow state and white microthrombosis were observed by XW microcirculation system. Fasting elbow venous blood was collected from all the subjects, and plasma ET-1 level was determined by radioimmunoassay. Nitric acid reductase method was used to determine serum nitric oxide (NO) level and ET / NO ratio was calculated. Results: Stenosis of arterioles and venules were more common in patients with stroke sequelae, accounting for 81.58% (31/38) and 65.79% (25/38) in flow-granular-flow state, which were higher than those in control 16.7% (5/30) and 6.67% (2/30) of the population, 17 (44.74%) patients with stroke sequelae and 1 control (3.33%) patients with white micro thrombus respectively. The differences were statistically significant P <0.01). The level of ET-1 in stroke sequelae was significantly higher than that in control subjects (82.54 ± 11.76ng / L vs 51.96 ± 8.75ng / L, P <0.05), while the level of NO was slightly lower than that in control subjects (45.33 ± 12.80μmol / L vs50.23 ± 18.65μmol / L, P> 0.05). The ET / NO of stroke sequelae was also higher than that of the control group (1.82 ± 0.23 vs 1.03 ± 0.12, P <0.05). Conclusion: Some patients with stroke sequelae have microcirculation disturbance and unstable endothelial function may be one of the important reasons. Clinical risk should be strengthened to prevent secondary stroke.