电项针治疗成人缺氧缺血性脑病的临床研究
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摘要
目的:观察电项针对成人急性缺氧缺血性脑病(HIE)患者早期治疗的临床疗效并探讨电项针治疗HIE的作用机制。
方法:将80例符合成人HIE诊断标准的患者根据入院顺序编号,再利用随机数字表将患者分入电项针治疗组和对照组,剔除资料不全者后,电项针治疗组38例,对照组36例。比较两组治疗前后格拉斯哥昏迷量表评分(GCS)和格拉斯哥-匹特兹堡昏迷量表评分(G-PCS)的变化,根据GCS和G-PCS疗效评分标准进行临床疗效评定;比较两组治疗前与治疗后存活的患者的脑电双频指数(BIS),并将电项针治疗组根据G-PCS分组,比较电项针治疗前、治疗中和治疗后的BIS即刻变化;比较不同水平脑氧利用率(O2UCc)患者的预后;比较两组治疗前后的脑氧利用率变化。
结果:
1.电项针治疗组治疗后的GCS及G-PCS较治疗前提高(P<0.05);电项针治疗组与对照组治疗前GCS及G-PCS无差异,治疗后电项针治疗组GCS及G-PCS高于对照组(P<0.05)。
2.以GCS为疗效评定标准,电项针治疗组总有效率为73.7%,对照组为50%(P<0.05);以G-PCS为疗效评定标准,电项针治疗组总有效率为84.2%,对照组为61.1%(P<0.05)。
3.以GCS预测HIE患者死亡预后的ROC曲线下面积为0.868(,P<0.01),以G-PCS预测患者死亡的ROC曲线下面积为0.990 (P<0.01),可靠性优于GCS,其预测HIE患者死亡的cutoff值为11。
4. G-PCS>11分组患者电项针即刻治疗中和治疗后的BIS值高于治疗前(P<0.01,P<0.05),其即刻治疗后的BIS值高于G-PCS≤11分组治疗后的BIS值(P<0.05)。
5.疗程结束后,去除死亡病例,电项针治疗组治疗后的BIS值高于对照组(P<0.05)。
6. O2UCc <25%与O2UCc正常的HIE患者治疗前后O2UCc无明显变化;O2UCc >45%的患者两组治疗后的O2UCc水平均下降,电项针治疗组优于对照组(P<0.01);且电项针治疗组的治疗后O2UCc水平与治疗前比较差异显著(P P<0.01)。
结论:
1.电项针能够提高改善HIE患者神经功能预后,临床疗效确切。
2.电项针能够提高HIE患者的即刻的BIS值,提示电项针能够通过脉冲电流激动上行网状系统而使大脑细胞得到活化,皮质兴奋性增高,具有一定的促醒作用。
3.电项针累加治疗能够提高HIE患者远期的BIS值,提示电项针能通过反复电刺激,形成长期强化作用,使脑干上行网状激活系统至大脑皮质的受损反射弧重建,神经功能恢复,意识水平提高。
4.电项针能使O2UCc升高的HIE患者O2UCc水平降低,提示电项针能够通过改善椎基底动脉循环,及时恢复大脑血流,改善脑组织缺血缺氧状况,降低脑氧利用率,恢复正常脑代谢。
Objective:To observe the clinical effectiveness of the nucha electrical acupuncture on the hypoxic ischemic encephalopathy(HIE) patients, and to investigate the mechanism of the treatment.
Method: 80 HIE patients were assigned numbers by sequence of admission and were divided into nucha electrical acupuncture group and controll group under the table of random number. Excluding incomplete information, the nucha electrical acupuncture group included 38 patients and the control group included 36 patients. To compare the change of Glascow coma scale(GCS) and Glasgow-Pittsberg coma scale(G-PCS)of before and after theray beween two groups , and to assess the effectiveness according to GCS and G-PCS; To compare the Bispectual index (BIS) value of before and after theray beween two groups, and in nucha electrical acupuncture group, to compare the instant change of BIS value before , during and after theray ; To compare the prognosis of HIE patients with different cerebral oxygen utiliation cofficients(O2UCc), and to compare the change of O2UCc before and after theray beween two groups.
Results:1. In nucha electrical acupuncture group, the GCS and G-PCS of adult HIE patients after therapy were higher than that of before therapy; there was no significance about GCS and G-PCS before therapy, and the GCS and G-PCS of nucha electrical acupuncture group was higher than that of control group after therapy.
2.As effectiveness cretirion by GCS , the total effective rate of nucha electrical acupuncture group was 73.7%, that of control group was 50%(P<0.05)..As effectiveness cretirion by G-PCS , the total effective rate of nucha electrical acupuncture group was 84.2%, that of control group was 61.1%(P<0.05).
3. To prognose the death of HIE patients ,the AUC of GCS was 0.868(P P<0.01), The AUC of G-PCS was 0.990 ( P<0.01),the cutoff of G-PCS was 11;
4. In the G-PCS>11 group ,the instant BIS value during and after nucha electrical acupuncture therapy were both significantly higher than before therapy; the instant BIS value after therapy in the G-PCS>11 group were higher than that of the G-PCS≤11 group;
5.excluding death cases ,the BIS value after therapy in the nucha electrical acupuncture group was higher than the control group;
6.There were no manifest change before and after therapy in the patients with O2UCc <25% and normal O2UCc. In the patients with O2UCc >45% ,the O2UCc level after therapy were both decreased , the nucha electrical acupuncture group was better than the control group( P<0.01). In the nucha electrical acupuncture group ,the O2UCc level after therapy was lower insignificantly than before therapy(P<0.01).
Conclusions:
1.The nucha electrical acupuncture therapy can improve neurologica outcome of HIE patients, have exact effect.
2.The nucha electrical acupuncture can increase instant BIS value, it declare that the nucha electrical acupuncture can increase cortical excitability by pulsating current exciting ARAS and has consciousness-promoted effect;
3.The nucha electrical acupuncture can increase long-term BIS value ,it illustrate that long term electrical stimulus on ARAS can form LTP to reconstruct reflex arc and rusume nerve function.
4.The nucha electrical acupuncture lower the O2UCc of the HIE patients with high O2UCc, it illustrate that the nucha electrical acupuncture can improve vertebral-basilar artery circulation ,recover cerebral blood ,improve ischemia and hypoxia status , lower cerebral oxygen utiliation cofficients and recover normal cerebral metabolism.
方法:将80例符合成人HIE诊断标准的患者根据入院顺序编号,再利用随机数字表将患者分入电项针治疗组和对照组,剔除资料不全者后,电项针治疗组38例,对照组36例。比较两组治疗前后格拉斯哥昏迷量表评分(GCS)和格拉斯哥-匹特兹堡昏迷量表评分(G-PCS)的变化,根据GCS和G-PCS疗效评分标准进行临床疗效评定;比较两组治疗前与治疗后存活的患者的脑电双频指数(BIS),并将电项针治疗组根据G-PCS分组,比较电项针治疗前、治疗中和治疗后的BIS即刻变化;比较不同水平脑氧利用率(O2UCc)患者的预后;比较两组治疗前后的脑氧利用率变化。
结果:
1.电项针治疗组治疗后的GCS及G-PCS较治疗前提高(P<0.05);电项针治疗组与对照组治疗前GCS及G-PCS无差异,治疗后电项针治疗组GCS及G-PCS高于对照组(P<0.05)。
2.以GCS为疗效评定标准,电项针治疗组总有效率为73.7%,对照组为50%(P<0.05);以G-PCS为疗效评定标准,电项针治疗组总有效率为84.2%,对照组为61.1%(P<0.05)。
3.以GCS预测HIE患者死亡预后的ROC曲线下面积为0.868(,P<0.01),以G-PCS预测患者死亡的ROC曲线下面积为0.990 (P<0.01),可靠性优于GCS,其预测HIE患者死亡的cutoff值为11。
4. G-PCS>11分组患者电项针即刻治疗中和治疗后的BIS值高于治疗前(P<0.01,P<0.05),其即刻治疗后的BIS值高于G-PCS≤11分组治疗后的BIS值(P<0.05)。
5.疗程结束后,去除死亡病例,电项针治疗组治疗后的BIS值高于对照组(P<0.05)。
6. O2UCc <25%与O2UCc正常的HIE患者治疗前后O2UCc无明显变化;O2UCc >45%的患者两组治疗后的O2UCc水平均下降,电项针治疗组优于对照组(P<0.01);且电项针治疗组的治疗后O2UCc水平与治疗前比较差异显著(P P<0.01)。
结论:
1.电项针能够提高改善HIE患者神经功能预后,临床疗效确切。
2.电项针能够提高HIE患者的即刻的BIS值,提示电项针能够通过脉冲电流激动上行网状系统而使大脑细胞得到活化,皮质兴奋性增高,具有一定的促醒作用。
3.电项针累加治疗能够提高HIE患者远期的BIS值,提示电项针能通过反复电刺激,形成长期强化作用,使脑干上行网状激活系统至大脑皮质的受损反射弧重建,神经功能恢复,意识水平提高。
4.电项针能使O2UCc升高的HIE患者O2UCc水平降低,提示电项针能够通过改善椎基底动脉循环,及时恢复大脑血流,改善脑组织缺血缺氧状况,降低脑氧利用率,恢复正常脑代谢。
Objective:To observe the clinical effectiveness of the nucha electrical acupuncture on the hypoxic ischemic encephalopathy(HIE) patients, and to investigate the mechanism of the treatment.
Method: 80 HIE patients were assigned numbers by sequence of admission and were divided into nucha electrical acupuncture group and controll group under the table of random number. Excluding incomplete information, the nucha electrical acupuncture group included 38 patients and the control group included 36 patients. To compare the change of Glascow coma scale(GCS) and Glasgow-Pittsberg coma scale(G-PCS)of before and after theray beween two groups , and to assess the effectiveness according to GCS and G-PCS; To compare the Bispectual index (BIS) value of before and after theray beween two groups, and in nucha electrical acupuncture group, to compare the instant change of BIS value before , during and after theray ; To compare the prognosis of HIE patients with different cerebral oxygen utiliation cofficients(O2UCc), and to compare the change of O2UCc before and after theray beween two groups.
Results:1. In nucha electrical acupuncture group, the GCS and G-PCS of adult HIE patients after therapy were higher than that of before therapy; there was no significance about GCS and G-PCS before therapy, and the GCS and G-PCS of nucha electrical acupuncture group was higher than that of control group after therapy.
2.As effectiveness cretirion by GCS , the total effective rate of nucha electrical acupuncture group was 73.7%, that of control group was 50%(P<0.05)..As effectiveness cretirion by G-PCS , the total effective rate of nucha electrical acupuncture group was 84.2%, that of control group was 61.1%(P<0.05).
3. To prognose the death of HIE patients ,the AUC of GCS was 0.868(P P<0.01), The AUC of G-PCS was 0.990 ( P<0.01),the cutoff of G-PCS was 11;
4. In the G-PCS>11 group ,the instant BIS value during and after nucha electrical acupuncture therapy were both significantly higher than before therapy; the instant BIS value after therapy in the G-PCS>11 group were higher than that of the G-PCS≤11 group;
5.excluding death cases ,the BIS value after therapy in the nucha electrical acupuncture group was higher than the control group;
6.There were no manifest change before and after therapy in the patients with O2UCc <25% and normal O2UCc. In the patients with O2UCc >45% ,the O2UCc level after therapy were both decreased , the nucha electrical acupuncture group was better than the control group( P<0.01). In the nucha electrical acupuncture group ,the O2UCc level after therapy was lower insignificantly than before therapy(P<0.01).
Conclusions:
1.The nucha electrical acupuncture therapy can improve neurologica outcome of HIE patients, have exact effect.
2.The nucha electrical acupuncture can increase instant BIS value, it declare that the nucha electrical acupuncture can increase cortical excitability by pulsating current exciting ARAS and has consciousness-promoted effect;
3.The nucha electrical acupuncture can increase long-term BIS value ,it illustrate that long term electrical stimulus on ARAS can form LTP to reconstruct reflex arc and rusume nerve function.
4.The nucha electrical acupuncture lower the O2UCc of the HIE patients with high O2UCc, it illustrate that the nucha electrical acupuncture can improve vertebral-basilar artery circulation ,recover cerebral blood ,improve ischemia and hypoxia status , lower cerebral oxygen utiliation cofficients and recover normal cerebral metabolism.
引文
1.吴丽红,何扬子.试论脑髓学说为项针的理论基础[J].辽宁中医杂志,2007,34(11):1621~1622
2.郑路.针刺治疗急性硬膜下血肿术后持续性植物状态[J].中国针灸,2005,25(2):77
3.杜元灏,冀健民.醒脑开窍针法中水沟穴作用探讨[J].中国针灸, 2001, 21(9): 535~536.
4.郭华林,郭杰,陈玲.针刺水沟穴干预治疗急诊抽搐休克[J].中国针灸, 2001, 21(4): 13.
5.裴海涛.针刺“百会透曲鬓”穴对脑缺血再灌注大鼠脑微血管内皮细胞黏附分子1表达的影响[J].中国临床康复, 2005, 9(21): 130~131
6.陈少宁,叶芳,刘维渊.用“平补平泻”手法针刺内关穴对冠心病患者左心功能的影响[J].针灸学报, 1992, (2): 102~112.
7.易受乡,林亚平,严洁,等.针刺内关与缺血预处理对心肌缺血再灌注损伤保护作用的比较[J].中国中医基础医学杂志,2001, 7(8): 56~58.
8.石学敏,傅立新.醒脑开窍针法对实验性脑缺血大鼠心肌超微结构损伤的保护作用[J].中国针灸, 1998, 18(7): 405.
9.孙龙,韦鹏翔.手厥阴经电刺激对脑性昏迷的治疗[J].神经疾病与精神卫生,2007,7(4):308~310
10.牟秋榕.涌泉穴治疗脑病临床体会[J].中国针灸, 1998, 18(2): 106.
11.石学敏,杨兆钢,周继增,等.针刺治疗假性延髓麻痹325例临床和机理研究[J].中国针灸, 1999, 19(18): 491
12.施静,刘晓春,张春,等.电针对脑缺血神经元凋亡影响的形态学研究[J].1998,7(3):391~395.
13.骆仲达,骆仲逵,许能贵,等.电针对局灶性脑缺血大鼠缺血区脑组织神经细胞凋亡及神经生长因子影响的研究[J].针刺研究,2002,27(3):165~169.
14.李荣,郭景春,程介士.督脉穴位电针对暂时性脑缺血所致的神经细胞死亡的影响[J].针刺研究,2003,28(1):10~16.
15.孙忠人,张力,郑美华,等.针刺预处理对全脑缺血大鼠脑组织Bcl-2蛋白表达影响的实验研究[J].中医药学刊,2006,24(11):1976~1977
16. Lim TN, Te J,Hsu CY,et al. Prolongation and enhancement of postischemic C-fosexpression after fasting[J].Stroke,1997,28:412~418.
17.Yamashita K,Wiessener C,Lindholm D,et al.Post-occulusion treatment with BDNF reduces infarct size in a model of permanent occulusion of middle cerebral artery in rat[J].Metab Brain Dis,1997,12(4):271~280.
18.江克文,张瑛,水家祥.电针预处理对新生大鼠缺血缺氧性脑损伤保护.作用的可能机制[J].中国中西医结合杂志,2003,23(12):914~917.
19.张学勤,王利,张勇,等.大鼠脑局部缺血再灌注后C-fos mRNA及C-Fos蛋白的表达[J].首都医科大学学报,2001,22(4):306~309.
20. Sugawara T,Lewen A,Noshita N,et al.Effects of global ischemia duration on neuronal,astroglial,oligdendroglial,and microglial reactions in the vulnerable hippocampal CA1subregion in rats[J].Neuro tramuma,2002,19(1):85.
21. Seri B,Garcia-Verdugo JM,Mcewen BS,et al.Astrocytes give ris to new neurons in the adult mammalian hippocampus[J].Neurosci,2001,21:7153~7160.
22.方燕南,张艳,黄如训,等.电刺激治疗对脑梗死后运动功能及星形胶质细胞活性的影响[J].中国神经精神疾病杂志,2000,26(1):9~11.
23.王聚,赖新生.电针对血管性痴呆模型大鼠海马神经胶质细胞及微血管的影响[J].针刺研究,2003,28(4):251~254.
24.Nakatomi H, Kuriu T,Okabe S,et al.Regeneration of hippocampal pyramidal neurons after ischemic brain injury by recruitment of endogenous neural progenitors[J].Cell,2002,110(4):429~441.
25.曾光伟,张伟宏,吴爱群,等.电针对缺血缺氧新生大鼠脑内神经前体细胞增殖的影响[J].郑州大学学报(医学版),2004,39(6):977~979.
26.Kim EH,Kim YJ,LeeHJ,et al.Acupuncture increases cell proliferation in dentate gyrus after transient global ischemia in gerbils[J].Nurosci Lett,2001,27(1):21~24.
27.李常新,黄如训,陈立云,等.大鼠脑梗死后神经前体细胞的增殖及电针作用的实验研究[J].中国神经精神疾病杂志,2004,30(3):190~193.
28.王廷华,良芳,廖德阳,等.针刺对脑源性神经营养因子在脊髓II板层可塑性中表达的影响[J].神经解剖学杂志,2002,18(1):55~58
29.庄明华,骆建明,刘明发,等.针刺任脉、督脉及膀胱经促进新生儿缺血缺氧性脑病鼠模型脑内神经干细胞增殖[J].中华神经医学杂志,2006,5(7):686~688
30.Yuen ES.Nerve growth factor and the neurotrophic factor hypothesis[J].Brain Dev,1996,18:362~386.
31.Sagot Y.Clinical and molecular aspects of motoneurone[J].Trends Pharmacol Sci,1997,18:330~337.
32.陈英辉,黄显奋.电针对MCAO大鼠皮层神经营养因子表达的影响[J].中风与神经疾病杂志,2000,17(6):139~141.
33.石向群,陆兵勋,米瑞发,等.脑缺血再灌注后脑内脑源性神经营养因子的基因表达与调节[J].卒中与神经疾病,2000,7(1):1~3.
34.张雪朝,孙国杰.针刺对缺血再灌注大鼠海马脑源性神经营养因子mRNA的影响[J].中国神经免疫学和神经病学杂志,2004,11(2):98~101.
35.陈英辉,黄显奋.累加电针对脑缺血大鼠皮层脑源性神经营养因子表达及脑梗塞体积的影响[J].针刺研究,2000,25(3):165~169.
36.李宛青,刘伟,吴爱群,等.电针对新生大鼠缺血缺氧后脑组织CHAT和BDNF表达的影响[J].解剖学研究,2003,25(4):295~297.
37.施静,刘晓春,张静,等.电针对局灶性脑缺血大鼠脑内神经生长因子受体trkA的影响[J].中国组织化学与细胞化学杂志,1999,8(2):132~136.
38.王培东.昏迷与植物状态诊断治疗学[M].北京:人民卫生出版社,2008:26~49
39. Stewart D J,Cernacek P,Costello K B,et al.Elevated endothein-1 in heart failure and loss of normal response to postural change [J].Circulaion, 1992,85(2):510~516
40.姚存姗,孟晓落,伍期专,等.降钙素基因相关肽对鼠局灶性脑梗死的预防和保持作用[J].临床神经病学杂志,2002,15(4):193~195
41.杜权,葛衡江,刘怀琼.心脏停搏复苏后犬脑矢状窦血浆内皮素-1及脑氧代谢变化[J].临床麻醉学杂志,2006,22(2):134~136
42茹伟祥,庞家亮.心源性缺氧缺血性脑病患者血浆内皮素和血浆降钙基因相关肽的研究[J].临床荟萃,2003,18(15):853~854
43. Antoni Davalo MD, et al.Duration of glutamate release after acute ischemic[J]. Stroke ,1997,28(24):708~710
44.沈怡,陆雪芬,胡学强.谷氨酸及其受体在缺氧缺血性脑病中的作用.广州医学院学报[J],28(3):84~87
45.韩玉昆,许植之,虞人杰.新生儿缺氧缺血性脑病[M].北京:人民卫生出版社,2001.42~46.
46. Szabo I,Zoratti M.The giant channel of the in-ner mitochondrial membrane is inhibited by cyclosp-orin A[J].J Biol Chem,1991,266(11):3376.
47. White RJ,Reynolds IJ.Mitochondria accumulate Cafollowing intense glutamate stimulation of cultured rat forebrain neurons[J].J Physiol,1997,498(1):31.
48. Bickler PE,Hansen BM.Hypoxia-tolerant neonatal CA1 neurona:relationahip of survival to evoked g-lutamate release and glutamate receptor-mediated c-aluim changes in hippocampal slice[J].Brain Res DeBrain Res,1998,106(1-2):57~69.
49.赵希敏,综述.丁美修,审校.脑血流量调节的研究进展[J].国外医学生理病理科学于临床分册,2000,20:294~297
50. Zhu C, Qiu L, Wang X, et al. Involvement of apoptosis-inducing factor in neuronal death after hypoxic-ischemia in the neonatal rat brain[J] .J Neurochem ,2003,86:306~317
51.许忠,徐如祥,刘宝松,等.缺血缺氧及再灌注后海马神经元损伤的时间窗特性[J].中国临床康复,2005,9(5):73~75
52. Sharp FR,LuA,TangY,et al.Multiple molecular penumbras after focal cerebral ischemia[J].J Cereb Blood FlowMetab,2000,20:1011.
53. Fridovich I.The biology of oxygen radical[J].Science,1978,201(4359):875.
54. PHAN TG,WRIGHT JH,MARKUS R,et al.Salvaging the ischemic penumbra:more than just reperfusion[J]·Clin Exp Pharmacol Physiol,2002,29(1-2):1~10.
55. MEMEZAMA H,SMITH ML,SIOSJO BK. Penumbral tissue salvaged By reperfusion following middle cerebral artery occlusioin rats [J].Stroke,1992,23(4):552~559.
56. BARON JC.Mapping the ischemic penumbra with PET:implications For acute stroke treatment[J].Cerebrovasc Dis,1999,9(4):193~201.
57. MacG regor DG,A vshalumov MV,Rice M E. Brain edema induced by in vitro ischemia: causal factors and neuroprotection[J].Neu-rochem, 2003, 85(6): 1402~1411.
58. Warach S,LatourLL.Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brainbarrier disruption[J]. Stroke, 2004, 35(1): 2659~2661.
59. MINEMATSU K,FISKER M,LI L,et al.Diffusion and perfusion magnetic responanse imaging studies to evaluate a noncompetitive N-imethyl-D-aspartate ontagonist and reperfusion in experimental stroke in rats[J].Stroke,1993,24:2074~2081.
60.郑艇,张小霓,林财珠.急性等容性血液稀释对脑氧代谢的影响[J].医学综述,2006,12(21):1321~1323
61.Cruz J.Cerebral oxygenation monitoring and management[J].Acta Neurochir,1993,59(Suppl):86 ~90.
62. Dearden N W,Midyley S.Technical considerations in continuouss jugular venous oxygen saturation measurement[J]. AxtNeurochir,1993,59(Suppl):91 ~97.
63.隆云,刘大为.严重脑损伤的颅内压、脑血流监测及目标性治疗[J].中国危重病急救医学,1998,10(4):246~ 248.
64. Kuboyama K,Safar P,Oku K,et al.Mild hypothermia after cardiac arrest in dogs dose not affect postarrest cerebral oxygen uptake delivery mismatching[J].Resuscitation,1994,27(4):231~244.
65.Glbert J.Estimation of cerebral blood flowby cerebral venous oxygen difference[J].J Neurosurg,1989,71(6):790~791.
66.田辉,吴铁军,张连群,等.重症颅脑损伤患者脑氧利用率的临床研究[J].中国危重病急救医学杂志,2004,16(4):223~225
67.诸葛毅,俎德玲,胡金兰.动脉颈内静脉血气监测评价重症患者脑代谢功能[J].中国急救医学,2004, 24(2):139~140
68.郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
69.高晋健,唐文渊.重型颅脑伤患者颈静脉血氧饱和度的监测及其临床意义[J].中国危重病急救医学,1997,9(6):338~ 339.
70.Takasu A, Yage K, Ishiharo S,et al. Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardic arrest[J].Resuscitation,1995,29(8):189~194.
71. Dings J,Meixensberge J,Jager A,et al.Clinical experience with 118 brain tissue oxygen partial pressure catheter probes [J]. Neurosurgery, 1998, 43(2):1082~1095.barrier disruption[J]. Stroke, 2004, 35(1): 2659~2661.
59. MINEMATSU K,FISKER M,LI L,et al.Diffusion and perfusion magnetic responanse imaging studies to evaluate a noncompetitive N-imethyl-D-aspartate ontagonist and reperfusion in experimental stroke in rats[J].Stroke,1993,24:2074~2081.
60.郑艇,张小霓,林财珠.急性等容性血液稀释对脑氧代谢的影响[J].医学综述,2006,12(21):1321~1323
61.Cruz J.Cerebral oxygenation monitoring and management[J].Acta Neurochir,1993,59(Suppl):86 ~90.
62. Dearden N W,Midyley S.Technical considerations in continuouss jugular venous oxygen saturation measurement[J]. AxtNeurochir,1993,59(Suppl):91 ~97.
63.隆云,刘大为.严重脑损伤的颅内压、脑血流监测及目标性治疗[J].中国危重病急救医学,1998,10(4):246~ 248.
64. Kuboyama K,Safar P,Oku K,et al.Mild hypothermia after cardiac arrest in dogs dose not affect postarrest cerebral oxygen uptake delivery mismatching[J].Resuscitation,1994,27(4):231~244.
65.Glbert J.Estimation of cerebral blood flowby cerebral venous oxygen difference[J].J Neurosurg,1989,71(6):790~791.
66.田辉,吴铁军,张连群,等.重症颅脑损伤患者脑氧利用率的临床研究[J].中国危重病急救医学杂志,2004,16(4):223~225
67.诸葛毅,俎德玲,胡金兰.动脉颈内静脉血气监测评价重症患者脑代谢功能[J].中国急救医学,2004, 24(2):139~140
68.郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
69.高晋健,唐文渊.重型颅脑伤患者颈静脉血氧饱和度的监测及其临床意义[J].中国危重病急救医学,1997,9(6):338~ 339.
70.Takasu A, Yage K, Ishiharo S,et al. Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardic arrest[J].Resuscitation,1995,29(8):189~194.
71. Dings J,Meixensberge J,Jager A,et al.Clinical experience with 118 brain tissue oxygen partial pressure catheter probes [J]. Neurosurgery, 1998, 43(2):1082~1095.
85.周晓峰,王晶,赵妍,等.乌司他丁对心肺复苏后大鼠脑组织含水量及CD11b的影响[J].中国现代医生, 2009,47(17):25~37
86.赵瑛,徐运,丁素菊.神经系统疾病治疗学[M].第二军医大学出版社,上海,2009:376~377
87.BERTI R,WILLIAMS A J,VELARDE L C,et al.Effect of the proteasome inhibitor MLN519 on the expression of inflammatory molecules following middle cerebral artery occlusion and reperfusion in the rat[J].Neurotox Res,2003,5(7):505~514.
88. VEMUGANTI R,DEMPSEY R J,BOWEN K K.Inhibition of intercellular adhesion molecule-1 protein expression by antisense oligonucleotides is neuroprotective after transient middle cerebral artery occlusion in rat [J]. Stroke,2004,35(1):179~184
89. SLEVIN M,KRUPINSKI J,KUMAR P,et al.Gene activation and protein expression following ischaemic stroke:strategies towards neuroprotection[J].J Cell Mol Med,2005,9(1):85~102.
90. VILA N.A genetic approach to ischemic stroke therapy[J].Cerebrovasc Dis,2004,17(Suppl 1):63~69
91. FALLON J,REID S,KINYAMU R,et al.In vivo induction of massive proliferation,directed migration,and differentiation of neural cells in the adult mammalian brain[J].Proc Natl Acad Sci USA,2000,97(26):14686~14691.
92. WU P,TARASENKO Y I,GU Y,et al.Region-specific generation of cholinergic neurons from fetal human neural stem cells grafted in adult rat[J].Nat Neurosci,2002,5(12):1271~1278.
93. Jansen EM,Solberg L,Underhill S,et al.Transplantation of fetal neocortex ameliorates sensorimotor and locomotor deficits following neonatal ischemic-hypoxic brain injury in rats[J].Exp Neurol 1997;147(2):487~497
94. Nagai A,Kim WK,Lee HJ,et al.Multilineage potential of stable human mesenchymal stem cell line derived from fetal marrow[J].PloS ONE 2007;2(12):1256~1272
95. Cho YH,Kim HS,Lee KH,et al.The behavioral effect of human mesenchymal stem cell transplantation in cold brain injured rats[J].Acta Neurochir Suppl 2006;99:125~132
96. Park KI.Transplantation of neural stem cells:celluar gene therapy forhypoxicischemic brain injury[J].Yonsei Med J 2000;41(6):825~835
97. Kurimoto Y,shibuki H,Kaneko Y,et al.Transplantation of adult rat hippocampus-derived neural stem cells into retina injured by transient ischemia[J].Neurosci Lett 2001;306(1-2):57
98. Qu T,Brannen CL,Kim HM,et al.Human neural stem cells improve cognitive function of aged brain[J].Neuroreport 2001;12(6):1127~1132
99. Alvearez-Buylla A, Lois C.Neuronal stem cells in the brain of adult vertebrates[J]. Stem Cell , 1995,13:263~272
100.Fukunaga A ,Uchida K, Hara K, et al. Differentiation and angiogenesis of central nerveous system stem cells implanted with mesenchyme into ischemic rat brain[J]. Cell Transplant, 1999,8(4):435~441
101.Chopp M,Li Y.Treatment of neural injury with marrow stromal cells[J]. Lancet Neurol,2002,1(2):92~100.
102.张重功,李轶,马杰,等.化疗后骨髓再生细胞移植治疗大鼠缺氧缺血性脑病的实验研究[J].山西医药杂志,2008,37(9):789~792
103.Asai A, Maekawa M, Akguchi I, et al.Survey of Japanese physicians attitude towards the care of adult patients in persistent vegetative state[J]. J Med Ethics ,1999,25(4):302~308
104. Yokoyama, Kamei Y, Kanno T.Right median nerve electrical comatose patients[J].The society for treatment of coma ,1996,5:117~122
105.韦鹏翔,孙龙,刘四新,等.手厥阴经电刺激对重症脑外伤昏迷患者促醒作用的初步研究[J].北京中医药大学学报,2007,30(10):713~716
106.Kamei Y, Kanno T, Yokoyama T. Analysis of cerebrospinal fluid amine metabolites in vegetative state patients after spinal cord stimulation[J]. The society for Treatment of Coma,1992, 1:29~38.
107.Kamei Y, Kanno T, Yokoyama T. Effect of electrical spin cord stimulation on intracerebral neurotransmitters concentrations in rats[J]. The society for Treatment of Coma, 19921:39~51.
108.Kanno T. Neurostimulation for consciousness disturbance[G].Proceeding of the 2nd Asian congress of neurological surgeons OSAKA, 1998:37~42.
109.刘运生,欧阳珊.神经系统疾病诊断治疗学[M].北京:人民军医出版社,2002:555~556
110.刘晓加,吕四明.临床神经内科急诊学[M].北京,科学技术文献出版社,2009:376~378
111.郭华,陈炅,彭芳.成人急性缺氧性脑病13例临床分析.医学信息手术学分册,2008,21(7):597-599
112.范晨雷,张再强.成人缺血缺氧性脑病的磁共振特征探讨[J].中国急救医学,2004,24(12):923~924
113.王良,余丹.成人重症缺血缺氧性脑病34例CT、MRI分析[J].中国现代医学杂志, 2008,18(13):1889~1893
114.方圻.现代内科学[M].北京:人民军医出版社,1995
115.Gutling E, Gonser A, mhof HG, et al.EEG reactivity in the prognosis of severe head injury [J],Neurology, 1995,45:915~918
116.麦名裕,李秉权.脑干反射在昏迷过程中的价值[J].中国精神病杂志,1984,10(4):1031
117.刘先国,魏东,刘彩琴,等.脑干听觉诱发电位和脑干神经反射对昏迷病人预后判断的价值[J].临床脑电学杂志,2000,9(1):44~45
118.杨伯捷,李盛昌,徐启武,等.多种诱发电位评估急性昏迷病人的预后[J].复旦学报,2001,28(5):416~418
119.邹伟伟,戚志超,刘志群.脑电双频指数在老年患者异氟烷复合诱导中的应用[J].华中医学杂志,2008,32(4):295~296
120. Roscw C, Manberg PJ.Bispectral index monitoring[J]. Anesthesiol Clin North America ,2001,19:947~966
121.Hayes MM, Berg RA, Otto CW.Monitoring during cardiac arrest: are we there yet? [J].Curr Opin Crit Care 2003,9:211~217
122.Daniel M Fatovich, lan G Jacobs, Antonio Celenza, et al. An observational study of bispectral index monitoring for out of hospital cardiac arrest[J]. Resuscitation,2006,69:207~212
123. Febregas N, Gambus PL,Valero R, et al.Can bispectral index monitoring predictrecovery of consciousness in patients with severe brain injure? [J]Anesthesiol, 2004,101(1):43~51
124.周挺,高越,许国根,等.脑电双频指数评估急性脑损伤患者预后的可行性[J].浙江实用医学,2006,11(5):319~320
125.王明山,陈怀龙,张丽娜,等.经皮穴位电刺激对健康受试者脑电双频指数的影响[J].中国中医急症,2007,16(3):267~268
126.刘育勇,李雅兰,蔡明雪,等.电针在甲状腺次全切除术中对脑电双频指数的影响[J].中国中西医结合杂志,2006,26(12):1070~1073
127. Paraskeva A, Melemeni A, Petropoulos G, et al. Needling of the extra 1 point decreases BIS values and preoperative anxiety. Am J Chin Med 2004;32(5)∶789~794
128. Litscher G. Effects of acupressure, manual acupuncture and laser needle acupuncture on EEG bispectral index and spectral edge frequency in healthy volunteers[J]. Eur J Anaesthesiol,2004;21(1)∶13~19
129.张金强,罗应超,伍维贤.生脉注射液对心肺复苏后脑损伤保护作用的研究[J].临床医药实践杂志,2007,16(7):652~653
130. Cormio M,Valaka A B,Robertson C S.Elevated jugular venou oxygen saturation after severe head injury[J].J Neurosurg,1999,90:9 15.
131.李继禄,杨洪菊,郭桂华,等.格拉斯哥昏迷评分动态曲线的记录及临床意义[J].中华创伤杂志,2005,21(9):708~709
132.高维滨,高金立.神经病针灸新疗法[M].北京:人民卫生出版社,2002:144~159
133.于秀,罗立欣.电项针疗法治疗椎-基底动脉供血不足40例观察.实用中医内科杂志,2007,21(7):101-102
134.张圣良.莫新华.“项九针”针法对椎-基底动脉影响的临床研究[J].浙江中医学院学报,2004,28(6):57
135.樊敬峰,吕佩源.突触可塑性相关物质及其在脑缺血后的变化[J].国外医学脑血管疾病分册,2004,12(5):371~374
136申鹏飞,石学敏.针刺对急性期超早期脑梗死患者脑氧代谢的影响[J].光明中医,2009,24(2):303~305.
137.张金强,罗应超,伍维贤.生脉注射液对心肺复苏后脑损伤保护作用的研究[J].临床医药实践杂志,2007,16(7):652~653
138.王拥军.现代神经病学进展[M].北京:科学技术文献出版社,2004:335
139.丁春华,刘焕荣,张少丹,等.针灸治疗幼鼠缺血缺氧性脑病的实验研究[J].中国应用生理学杂志,2005,21(4):400~401
140.赵瑛,徐运.神经系统疾病治疗学[M].江苏,第二军医大学出版社,2009:348~350郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
141.杨续艳,王锐,郭淑颖,等.电项针疗法对大鼠脑缺血再灌注模型脑组织EPO表达的影响[J].2009,25(5):24~26
142.杨续艳,郭淑颖,王锐,等.电项针疗法对大鼠缺血再灌注模型HIF-1α及HIF-1αmRNA表达的影响[J].针灸临床杂志,2009,25(3):33~35
143.刘明发,庄明华,骆建明,等.针刺对新生鼠缺血缺氧性脑损伤皮质Nestin表达的影响[J],中华物理医学与康复杂志,2006,28(7):437~440
2.郑路.针刺治疗急性硬膜下血肿术后持续性植物状态[J].中国针灸,2005,25(2):77
3.杜元灏,冀健民.醒脑开窍针法中水沟穴作用探讨[J].中国针灸, 2001, 21(9): 535~536.
4.郭华林,郭杰,陈玲.针刺水沟穴干预治疗急诊抽搐休克[J].中国针灸, 2001, 21(4): 13.
5.裴海涛.针刺“百会透曲鬓”穴对脑缺血再灌注大鼠脑微血管内皮细胞黏附分子1表达的影响[J].中国临床康复, 2005, 9(21): 130~131
6.陈少宁,叶芳,刘维渊.用“平补平泻”手法针刺内关穴对冠心病患者左心功能的影响[J].针灸学报, 1992, (2): 102~112.
7.易受乡,林亚平,严洁,等.针刺内关与缺血预处理对心肌缺血再灌注损伤保护作用的比较[J].中国中医基础医学杂志,2001, 7(8): 56~58.
8.石学敏,傅立新.醒脑开窍针法对实验性脑缺血大鼠心肌超微结构损伤的保护作用[J].中国针灸, 1998, 18(7): 405.
9.孙龙,韦鹏翔.手厥阴经电刺激对脑性昏迷的治疗[J].神经疾病与精神卫生,2007,7(4):308~310
10.牟秋榕.涌泉穴治疗脑病临床体会[J].中国针灸, 1998, 18(2): 106.
11.石学敏,杨兆钢,周继增,等.针刺治疗假性延髓麻痹325例临床和机理研究[J].中国针灸, 1999, 19(18): 491
12.施静,刘晓春,张春,等.电针对脑缺血神经元凋亡影响的形态学研究[J].1998,7(3):391~395.
13.骆仲达,骆仲逵,许能贵,等.电针对局灶性脑缺血大鼠缺血区脑组织神经细胞凋亡及神经生长因子影响的研究[J].针刺研究,2002,27(3):165~169.
14.李荣,郭景春,程介士.督脉穴位电针对暂时性脑缺血所致的神经细胞死亡的影响[J].针刺研究,2003,28(1):10~16.
15.孙忠人,张力,郑美华,等.针刺预处理对全脑缺血大鼠脑组织Bcl-2蛋白表达影响的实验研究[J].中医药学刊,2006,24(11):1976~1977
16. Lim TN, Te J,Hsu CY,et al. Prolongation and enhancement of postischemic C-fosexpression after fasting[J].Stroke,1997,28:412~418.
17.Yamashita K,Wiessener C,Lindholm D,et al.Post-occulusion treatment with BDNF reduces infarct size in a model of permanent occulusion of middle cerebral artery in rat[J].Metab Brain Dis,1997,12(4):271~280.
18.江克文,张瑛,水家祥.电针预处理对新生大鼠缺血缺氧性脑损伤保护.作用的可能机制[J].中国中西医结合杂志,2003,23(12):914~917.
19.张学勤,王利,张勇,等.大鼠脑局部缺血再灌注后C-fos mRNA及C-Fos蛋白的表达[J].首都医科大学学报,2001,22(4):306~309.
20. Sugawara T,Lewen A,Noshita N,et al.Effects of global ischemia duration on neuronal,astroglial,oligdendroglial,and microglial reactions in the vulnerable hippocampal CA1subregion in rats[J].Neuro tramuma,2002,19(1):85.
21. Seri B,Garcia-Verdugo JM,Mcewen BS,et al.Astrocytes give ris to new neurons in the adult mammalian hippocampus[J].Neurosci,2001,21:7153~7160.
22.方燕南,张艳,黄如训,等.电刺激治疗对脑梗死后运动功能及星形胶质细胞活性的影响[J].中国神经精神疾病杂志,2000,26(1):9~11.
23.王聚,赖新生.电针对血管性痴呆模型大鼠海马神经胶质细胞及微血管的影响[J].针刺研究,2003,28(4):251~254.
24.Nakatomi H, Kuriu T,Okabe S,et al.Regeneration of hippocampal pyramidal neurons after ischemic brain injury by recruitment of endogenous neural progenitors[J].Cell,2002,110(4):429~441.
25.曾光伟,张伟宏,吴爱群,等.电针对缺血缺氧新生大鼠脑内神经前体细胞增殖的影响[J].郑州大学学报(医学版),2004,39(6):977~979.
26.Kim EH,Kim YJ,LeeHJ,et al.Acupuncture increases cell proliferation in dentate gyrus after transient global ischemia in gerbils[J].Nurosci Lett,2001,27(1):21~24.
27.李常新,黄如训,陈立云,等.大鼠脑梗死后神经前体细胞的增殖及电针作用的实验研究[J].中国神经精神疾病杂志,2004,30(3):190~193.
28.王廷华,良芳,廖德阳,等.针刺对脑源性神经营养因子在脊髓II板层可塑性中表达的影响[J].神经解剖学杂志,2002,18(1):55~58
29.庄明华,骆建明,刘明发,等.针刺任脉、督脉及膀胱经促进新生儿缺血缺氧性脑病鼠模型脑内神经干细胞增殖[J].中华神经医学杂志,2006,5(7):686~688
30.Yuen ES.Nerve growth factor and the neurotrophic factor hypothesis[J].Brain Dev,1996,18:362~386.
31.Sagot Y.Clinical and molecular aspects of motoneurone[J].Trends Pharmacol Sci,1997,18:330~337.
32.陈英辉,黄显奋.电针对MCAO大鼠皮层神经营养因子表达的影响[J].中风与神经疾病杂志,2000,17(6):139~141.
33.石向群,陆兵勋,米瑞发,等.脑缺血再灌注后脑内脑源性神经营养因子的基因表达与调节[J].卒中与神经疾病,2000,7(1):1~3.
34.张雪朝,孙国杰.针刺对缺血再灌注大鼠海马脑源性神经营养因子mRNA的影响[J].中国神经免疫学和神经病学杂志,2004,11(2):98~101.
35.陈英辉,黄显奋.累加电针对脑缺血大鼠皮层脑源性神经营养因子表达及脑梗塞体积的影响[J].针刺研究,2000,25(3):165~169.
36.李宛青,刘伟,吴爱群,等.电针对新生大鼠缺血缺氧后脑组织CHAT和BDNF表达的影响[J].解剖学研究,2003,25(4):295~297.
37.施静,刘晓春,张静,等.电针对局灶性脑缺血大鼠脑内神经生长因子受体trkA的影响[J].中国组织化学与细胞化学杂志,1999,8(2):132~136.
38.王培东.昏迷与植物状态诊断治疗学[M].北京:人民卫生出版社,2008:26~49
39. Stewart D J,Cernacek P,Costello K B,et al.Elevated endothein-1 in heart failure and loss of normal response to postural change [J].Circulaion, 1992,85(2):510~516
40.姚存姗,孟晓落,伍期专,等.降钙素基因相关肽对鼠局灶性脑梗死的预防和保持作用[J].临床神经病学杂志,2002,15(4):193~195
41.杜权,葛衡江,刘怀琼.心脏停搏复苏后犬脑矢状窦血浆内皮素-1及脑氧代谢变化[J].临床麻醉学杂志,2006,22(2):134~136
42茹伟祥,庞家亮.心源性缺氧缺血性脑病患者血浆内皮素和血浆降钙基因相关肽的研究[J].临床荟萃,2003,18(15):853~854
43. Antoni Davalo MD, et al.Duration of glutamate release after acute ischemic[J]. Stroke ,1997,28(24):708~710
44.沈怡,陆雪芬,胡学强.谷氨酸及其受体在缺氧缺血性脑病中的作用.广州医学院学报[J],28(3):84~87
45.韩玉昆,许植之,虞人杰.新生儿缺氧缺血性脑病[M].北京:人民卫生出版社,2001.42~46.
46. Szabo I,Zoratti M.The giant channel of the in-ner mitochondrial membrane is inhibited by cyclosp-orin A[J].J Biol Chem,1991,266(11):3376.
47. White RJ,Reynolds IJ.Mitochondria accumulate Cafollowing intense glutamate stimulation of cultured rat forebrain neurons[J].J Physiol,1997,498(1):31.
48. Bickler PE,Hansen BM.Hypoxia-tolerant neonatal CA1 neurona:relationahip of survival to evoked g-lutamate release and glutamate receptor-mediated c-aluim changes in hippocampal slice[J].Brain Res DeBrain Res,1998,106(1-2):57~69.
49.赵希敏,综述.丁美修,审校.脑血流量调节的研究进展[J].国外医学生理病理科学于临床分册,2000,20:294~297
50. Zhu C, Qiu L, Wang X, et al. Involvement of apoptosis-inducing factor in neuronal death after hypoxic-ischemia in the neonatal rat brain[J] .J Neurochem ,2003,86:306~317
51.许忠,徐如祥,刘宝松,等.缺血缺氧及再灌注后海马神经元损伤的时间窗特性[J].中国临床康复,2005,9(5):73~75
52. Sharp FR,LuA,TangY,et al.Multiple molecular penumbras after focal cerebral ischemia[J].J Cereb Blood FlowMetab,2000,20:1011.
53. Fridovich I.The biology of oxygen radical[J].Science,1978,201(4359):875.
54. PHAN TG,WRIGHT JH,MARKUS R,et al.Salvaging the ischemic penumbra:more than just reperfusion[J]·Clin Exp Pharmacol Physiol,2002,29(1-2):1~10.
55. MEMEZAMA H,SMITH ML,SIOSJO BK. Penumbral tissue salvaged By reperfusion following middle cerebral artery occlusioin rats [J].Stroke,1992,23(4):552~559.
56. BARON JC.Mapping the ischemic penumbra with PET:implications For acute stroke treatment[J].Cerebrovasc Dis,1999,9(4):193~201.
57. MacG regor DG,A vshalumov MV,Rice M E. Brain edema induced by in vitro ischemia: causal factors and neuroprotection[J].Neu-rochem, 2003, 85(6): 1402~1411.
58. Warach S,LatourLL.Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brainbarrier disruption[J]. Stroke, 2004, 35(1): 2659~2661.
59. MINEMATSU K,FISKER M,LI L,et al.Diffusion and perfusion magnetic responanse imaging studies to evaluate a noncompetitive N-imethyl-D-aspartate ontagonist and reperfusion in experimental stroke in rats[J].Stroke,1993,24:2074~2081.
60.郑艇,张小霓,林财珠.急性等容性血液稀释对脑氧代谢的影响[J].医学综述,2006,12(21):1321~1323
61.Cruz J.Cerebral oxygenation monitoring and management[J].Acta Neurochir,1993,59(Suppl):86 ~90.
62. Dearden N W,Midyley S.Technical considerations in continuouss jugular venous oxygen saturation measurement[J]. AxtNeurochir,1993,59(Suppl):91 ~97.
63.隆云,刘大为.严重脑损伤的颅内压、脑血流监测及目标性治疗[J].中国危重病急救医学,1998,10(4):246~ 248.
64. Kuboyama K,Safar P,Oku K,et al.Mild hypothermia after cardiac arrest in dogs dose not affect postarrest cerebral oxygen uptake delivery mismatching[J].Resuscitation,1994,27(4):231~244.
65.Glbert J.Estimation of cerebral blood flowby cerebral venous oxygen difference[J].J Neurosurg,1989,71(6):790~791.
66.田辉,吴铁军,张连群,等.重症颅脑损伤患者脑氧利用率的临床研究[J].中国危重病急救医学杂志,2004,16(4):223~225
67.诸葛毅,俎德玲,胡金兰.动脉颈内静脉血气监测评价重症患者脑代谢功能[J].中国急救医学,2004, 24(2):139~140
68.郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
69.高晋健,唐文渊.重型颅脑伤患者颈静脉血氧饱和度的监测及其临床意义[J].中国危重病急救医学,1997,9(6):338~ 339.
70.Takasu A, Yage K, Ishiharo S,et al. Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardic arrest[J].Resuscitation,1995,29(8):189~194.
71. Dings J,Meixensberge J,Jager A,et al.Clinical experience with 118 brain tissue oxygen partial pressure catheter probes [J]. Neurosurgery, 1998, 43(2):1082~1095.barrier disruption[J]. Stroke, 2004, 35(1): 2659~2661.
59. MINEMATSU K,FISKER M,LI L,et al.Diffusion and perfusion magnetic responanse imaging studies to evaluate a noncompetitive N-imethyl-D-aspartate ontagonist and reperfusion in experimental stroke in rats[J].Stroke,1993,24:2074~2081.
60.郑艇,张小霓,林财珠.急性等容性血液稀释对脑氧代谢的影响[J].医学综述,2006,12(21):1321~1323
61.Cruz J.Cerebral oxygenation monitoring and management[J].Acta Neurochir,1993,59(Suppl):86 ~90.
62. Dearden N W,Midyley S.Technical considerations in continuouss jugular venous oxygen saturation measurement[J]. AxtNeurochir,1993,59(Suppl):91 ~97.
63.隆云,刘大为.严重脑损伤的颅内压、脑血流监测及目标性治疗[J].中国危重病急救医学,1998,10(4):246~ 248.
64. Kuboyama K,Safar P,Oku K,et al.Mild hypothermia after cardiac arrest in dogs dose not affect postarrest cerebral oxygen uptake delivery mismatching[J].Resuscitation,1994,27(4):231~244.
65.Glbert J.Estimation of cerebral blood flowby cerebral venous oxygen difference[J].J Neurosurg,1989,71(6):790~791.
66.田辉,吴铁军,张连群,等.重症颅脑损伤患者脑氧利用率的临床研究[J].中国危重病急救医学杂志,2004,16(4):223~225
67.诸葛毅,俎德玲,胡金兰.动脉颈内静脉血气监测评价重症患者脑代谢功能[J].中国急救医学,2004, 24(2):139~140
68.郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
69.高晋健,唐文渊.重型颅脑伤患者颈静脉血氧饱和度的监测及其临床意义[J].中国危重病急救医学,1997,9(6):338~ 339.
70.Takasu A, Yage K, Ishiharo S,et al. Combined continuous monitoring of systemic and cerebral oxygen metabolism after cardic arrest[J].Resuscitation,1995,29(8):189~194.
71. Dings J,Meixensberge J,Jager A,et al.Clinical experience with 118 brain tissue oxygen partial pressure catheter probes [J]. Neurosurgery, 1998, 43(2):1082~1095.
85.周晓峰,王晶,赵妍,等.乌司他丁对心肺复苏后大鼠脑组织含水量及CD11b的影响[J].中国现代医生, 2009,47(17):25~37
86.赵瑛,徐运,丁素菊.神经系统疾病治疗学[M].第二军医大学出版社,上海,2009:376~377
87.BERTI R,WILLIAMS A J,VELARDE L C,et al.Effect of the proteasome inhibitor MLN519 on the expression of inflammatory molecules following middle cerebral artery occlusion and reperfusion in the rat[J].Neurotox Res,2003,5(7):505~514.
88. VEMUGANTI R,DEMPSEY R J,BOWEN K K.Inhibition of intercellular adhesion molecule-1 protein expression by antisense oligonucleotides is neuroprotective after transient middle cerebral artery occlusion in rat [J]. Stroke,2004,35(1):179~184
89. SLEVIN M,KRUPINSKI J,KUMAR P,et al.Gene activation and protein expression following ischaemic stroke:strategies towards neuroprotection[J].J Cell Mol Med,2005,9(1):85~102.
90. VILA N.A genetic approach to ischemic stroke therapy[J].Cerebrovasc Dis,2004,17(Suppl 1):63~69
91. FALLON J,REID S,KINYAMU R,et al.In vivo induction of massive proliferation,directed migration,and differentiation of neural cells in the adult mammalian brain[J].Proc Natl Acad Sci USA,2000,97(26):14686~14691.
92. WU P,TARASENKO Y I,GU Y,et al.Region-specific generation of cholinergic neurons from fetal human neural stem cells grafted in adult rat[J].Nat Neurosci,2002,5(12):1271~1278.
93. Jansen EM,Solberg L,Underhill S,et al.Transplantation of fetal neocortex ameliorates sensorimotor and locomotor deficits following neonatal ischemic-hypoxic brain injury in rats[J].Exp Neurol 1997;147(2):487~497
94. Nagai A,Kim WK,Lee HJ,et al.Multilineage potential of stable human mesenchymal stem cell line derived from fetal marrow[J].PloS ONE 2007;2(12):1256~1272
95. Cho YH,Kim HS,Lee KH,et al.The behavioral effect of human mesenchymal stem cell transplantation in cold brain injured rats[J].Acta Neurochir Suppl 2006;99:125~132
96. Park KI.Transplantation of neural stem cells:celluar gene therapy forhypoxicischemic brain injury[J].Yonsei Med J 2000;41(6):825~835
97. Kurimoto Y,shibuki H,Kaneko Y,et al.Transplantation of adult rat hippocampus-derived neural stem cells into retina injured by transient ischemia[J].Neurosci Lett 2001;306(1-2):57
98. Qu T,Brannen CL,Kim HM,et al.Human neural stem cells improve cognitive function of aged brain[J].Neuroreport 2001;12(6):1127~1132
99. Alvearez-Buylla A, Lois C.Neuronal stem cells in the brain of adult vertebrates[J]. Stem Cell , 1995,13:263~272
100.Fukunaga A ,Uchida K, Hara K, et al. Differentiation and angiogenesis of central nerveous system stem cells implanted with mesenchyme into ischemic rat brain[J]. Cell Transplant, 1999,8(4):435~441
101.Chopp M,Li Y.Treatment of neural injury with marrow stromal cells[J]. Lancet Neurol,2002,1(2):92~100.
102.张重功,李轶,马杰,等.化疗后骨髓再生细胞移植治疗大鼠缺氧缺血性脑病的实验研究[J].山西医药杂志,2008,37(9):789~792
103.Asai A, Maekawa M, Akguchi I, et al.Survey of Japanese physicians attitude towards the care of adult patients in persistent vegetative state[J]. J Med Ethics ,1999,25(4):302~308
104. Yokoyama, Kamei Y, Kanno T.Right median nerve electrical comatose patients[J].The society for treatment of coma ,1996,5:117~122
105.韦鹏翔,孙龙,刘四新,等.手厥阴经电刺激对重症脑外伤昏迷患者促醒作用的初步研究[J].北京中医药大学学报,2007,30(10):713~716
106.Kamei Y, Kanno T, Yokoyama T. Analysis of cerebrospinal fluid amine metabolites in vegetative state patients after spinal cord stimulation[J]. The society for Treatment of Coma,1992, 1:29~38.
107.Kamei Y, Kanno T, Yokoyama T. Effect of electrical spin cord stimulation on intracerebral neurotransmitters concentrations in rats[J]. The society for Treatment of Coma, 19921:39~51.
108.Kanno T. Neurostimulation for consciousness disturbance[G].Proceeding of the 2nd Asian congress of neurological surgeons OSAKA, 1998:37~42.
109.刘运生,欧阳珊.神经系统疾病诊断治疗学[M].北京:人民军医出版社,2002:555~556
110.刘晓加,吕四明.临床神经内科急诊学[M].北京,科学技术文献出版社,2009:376~378
111.郭华,陈炅,彭芳.成人急性缺氧性脑病13例临床分析.医学信息手术学分册,2008,21(7):597-599
112.范晨雷,张再强.成人缺血缺氧性脑病的磁共振特征探讨[J].中国急救医学,2004,24(12):923~924
113.王良,余丹.成人重症缺血缺氧性脑病34例CT、MRI分析[J].中国现代医学杂志, 2008,18(13):1889~1893
114.方圻.现代内科学[M].北京:人民军医出版社,1995
115.Gutling E, Gonser A, mhof HG, et al.EEG reactivity in the prognosis of severe head injury [J],Neurology, 1995,45:915~918
116.麦名裕,李秉权.脑干反射在昏迷过程中的价值[J].中国精神病杂志,1984,10(4):1031
117.刘先国,魏东,刘彩琴,等.脑干听觉诱发电位和脑干神经反射对昏迷病人预后判断的价值[J].临床脑电学杂志,2000,9(1):44~45
118.杨伯捷,李盛昌,徐启武,等.多种诱发电位评估急性昏迷病人的预后[J].复旦学报,2001,28(5):416~418
119.邹伟伟,戚志超,刘志群.脑电双频指数在老年患者异氟烷复合诱导中的应用[J].华中医学杂志,2008,32(4):295~296
120. Roscw C, Manberg PJ.Bispectral index monitoring[J]. Anesthesiol Clin North America ,2001,19:947~966
121.Hayes MM, Berg RA, Otto CW.Monitoring during cardiac arrest: are we there yet? [J].Curr Opin Crit Care 2003,9:211~217
122.Daniel M Fatovich, lan G Jacobs, Antonio Celenza, et al. An observational study of bispectral index monitoring for out of hospital cardiac arrest[J]. Resuscitation,2006,69:207~212
123. Febregas N, Gambus PL,Valero R, et al.Can bispectral index monitoring predictrecovery of consciousness in patients with severe brain injure? [J]Anesthesiol, 2004,101(1):43~51
124.周挺,高越,许国根,等.脑电双频指数评估急性脑损伤患者预后的可行性[J].浙江实用医学,2006,11(5):319~320
125.王明山,陈怀龙,张丽娜,等.经皮穴位电刺激对健康受试者脑电双频指数的影响[J].中国中医急症,2007,16(3):267~268
126.刘育勇,李雅兰,蔡明雪,等.电针在甲状腺次全切除术中对脑电双频指数的影响[J].中国中西医结合杂志,2006,26(12):1070~1073
127. Paraskeva A, Melemeni A, Petropoulos G, et al. Needling of the extra 1 point decreases BIS values and preoperative anxiety. Am J Chin Med 2004;32(5)∶789~794
128. Litscher G. Effects of acupressure, manual acupuncture and laser needle acupuncture on EEG bispectral index and spectral edge frequency in healthy volunteers[J]. Eur J Anaesthesiol,2004;21(1)∶13~19
129.张金强,罗应超,伍维贤.生脉注射液对心肺复苏后脑损伤保护作用的研究[J].临床医药实践杂志,2007,16(7):652~653
130. Cormio M,Valaka A B,Robertson C S.Elevated jugular venou oxygen saturation after severe head injury[J].J Neurosurg,1999,90:9 15.
131.李继禄,杨洪菊,郭桂华,等.格拉斯哥昏迷评分动态曲线的记录及临床意义[J].中华创伤杂志,2005,21(9):708~709
132.高维滨,高金立.神经病针灸新疗法[M].北京:人民卫生出版社,2002:144~159
133.于秀,罗立欣.电项针疗法治疗椎-基底动脉供血不足40例观察.实用中医内科杂志,2007,21(7):101-102
134.张圣良.莫新华.“项九针”针法对椎-基底动脉影响的临床研究[J].浙江中医学院学报,2004,28(6):57
135.樊敬峰,吕佩源.突触可塑性相关物质及其在脑缺血后的变化[J].国外医学脑血管疾病分册,2004,12(5):371~374
136申鹏飞,石学敏.针刺对急性期超早期脑梗死患者脑氧代谢的影响[J].光明中医,2009,24(2):303~305.
137.张金强,罗应超,伍维贤.生脉注射液对心肺复苏后脑损伤保护作用的研究[J].临床医药实践杂志,2007,16(7):652~653
138.王拥军.现代神经病学进展[M].北京:科学技术文献出版社,2004:335
139.丁春华,刘焕荣,张少丹,等.针灸治疗幼鼠缺血缺氧性脑病的实验研究[J].中国应用生理学杂志,2005,21(4):400~401
140.赵瑛,徐运.神经系统疾病治疗学[M].江苏,第二军医大学出版社,2009:348~350郑铮,宿英英.急性脑梗死患者脑氧代谢的初步研究[J].中国脑血管病杂志,2005,2(10):445~448
141.杨续艳,王锐,郭淑颖,等.电项针疗法对大鼠脑缺血再灌注模型脑组织EPO表达的影响[J].2009,25(5):24~26
142.杨续艳,郭淑颖,王锐,等.电项针疗法对大鼠缺血再灌注模型HIF-1α及HIF-1αmRNA表达的影响[J].针灸临床杂志,2009,25(3):33~35
143.刘明发,庄明华,骆建明,等.针刺对新生鼠缺血缺氧性脑损伤皮质Nestin表达的影响[J],中华物理医学与康复杂志,2006,28(7):437~440
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