卒中急性期并发症中西医结合综合方案的临床研究
|
摘要
目的：本项临床研究的目的旨在前期20余年运用中风醒脑液治疗脑卒中的基础上,通过多中心、随机对照的临床观察,对脑卒中急性期并发症(肺部感染、出血性梗死)进行中西医结合综合方案的治疗,以期建立卒中急性期并发症(肺部感染、出血性梗死)的综合方案。
方法：本试验研究的受试对象来源于由成都中医药大学附属医院、都江堰人民医院、川北医学院附属医院、攀枝花中西医结合医院、广元市中医院住院的符合卒中急性期并发肺部感染210例、急性缺血性卒中并发出血性梗死患者100例,分别随机分2组,两组均给予西医基础治疗加中风醒脑液口服,治疗组在上述基础上加用中药复方汤剂鼻饲或口服,50ml, tid,疗程为3～14天不等。观察周期3个月,填写原始病历和CRF表。疗效判定：观察治疗后患者病死率、住院天数、肺部感染症状及体征,总体疗效,NIHSS评分、mRS评分、GCS评分、生活能力、生存质量等。评价治疗后14天、28天的疗效,并观察治疗过程中可能出现的不良反应。利用SPSS20.0软件包对资料进行分析处理。
结果：
1.急性缺血性卒中并发出血性梗死痰热腑实证患者结果
本研究通过急性缺血性卒中并发出血性梗死痰热腑实证治疗组25例,对照组25例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为16.0%、24.0%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,差异具有统计学意义(P<0.05)；生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
2.急性缺血性卒中并发出血性梗死痰湿蒙神证患者结果
本研究通过急性缺血性卒中并发出血性梗死痰湿蒙神证治疗组25例,对照组25例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为24.0%、12.0%,治疗组高于对照组,但两组间的差异无统计学意义：在疗后14天、与疗后28天,在中医证候积分、体征积分,治疗组和对照组进行组间比较,差异具有统计学意义(P<0.05)：生存质量方面,治疗组对于改善患者生存质量,优于对照组,差异具有统计学意义(P<0.05)。
3.卒中急性期并发肺部感染痰热壅肺证患者结果
本研究通过卒中急性期并发肺部感染痰热壅肺证治疗组52例,对照组53例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为11.5%、18.9%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,具有统计学意义(P<0.05)；在疗后14天,治疗组和对照组的GCS评分进行组间比较,差异具有统计学意义(P<0.05)。生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
4.卒中急性期并发肺部感染痰浊蕴肺证患者结果
本研究通过卒中急性期并发肺部感染痰浊蕴肺证治疗组53例,对照组52例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为11.3%、21.2%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,具有统计学意义(P<0.05)；在疗后14天,治疗组和对照组的GCS评分进行组间比较,差异具有统计学意义(P<0.05)。生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
结论：
1急性缺血性卒中并发出血性梗死结论
治疗组能明显缩短急性缺血性卒中并发出血性梗死的住院天数、住院费用；明显改善急性缺血性卒中并发出血性梗死的症状、体征；在显效率、总有效率方面,治疗组优于对照组。
2卒中急性期并发肺部感染结论
治疗组能明显缩短卒中急性期并发肺部感染的住院天数、住院费用；明显改善座中急性期并发肺部感染的症状、体征；在显效率、总有效率方面,治疗组优于对照组。治疗组在降低痰培养阳性率和中性粒细胞百分比方面无统计学意义(P>0.05)。
Objective:The purpose of this clinical study is settle a project which is confirmed by randomized controlled trial (RCT), multicenter observation,to treat the complications of the stroke in the acute phase. This project is connection the western medicine and the Rraditional Chinese Medicine,zhongfengxingnao oral liquid, which has been applied for more than20years.
Method: The subjects of this study are from the inpatients departments of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,the People's Hospital of Dujiangyan, Affiliated Hospital of North Sichuan Medical College, Panzhihua Hospital Integrative Medicine, the Affiliated Hospital of the the Guangyuan Hospital. There are210cases with lung infection and100cases of hemorrhagic infarction.The subjects are randomly diveded into two groups. Both groups were given the same treatments,the western medicine and the zhongfengxingnao oral liquid,however, the treatment group add the Chinese formulaes by nasogastric or ora50ml, tid, the course of14days.Observation period is3month, followed up and finished the origenal record and the CRF tables.Therapeutic efficacy: mortality,the number of days of hospitalization,lung infection syndrome,overall effcts,NIHSS score,(mRS) score, GCS score, life skills, and quality of life. will be observed to evaluate the effect of14days and28days,after treatment,and observe adverse reactions that may occur during the process of treatment. And use SPSS20.0analysis the data.
Results:
1Acute ischemic stroke with hemorrhagic infarction the phlegm heat Fushi patients results
There are25cases in both treatment group and in control group of the study of the acute phase of stroke and issude hemorrhagic infarction phlegm-heat Fu shi syndrome. The results are:the mortality of treat group is16.0%,in the control group is 24.0%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment,there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups, what is more,the treatment group's quality of life is better than the control group,and there is a statistically significant as well.(P<0.05).
2Acute ischemic stroke patients with hemorrhagic infarction phlegm God permit results
There are25cases in both treatment group and in control group of the study of the Acute stroke patients with hemorrhagic infarction phlegm God permit results.The results are:the mortality of treat group is24.0%,in the control group is12.0%,but there is no statistically significant difference between the two groups;After14days treatment and28days treatment, there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups, what is more.the treatment group's quality of life is better than the control group.and there is a statistically significant as well.(P<0.05).
3Acute stroke patients with pulmonary infection in patients with Phlegm obstruct the lung
There are53cases in treatment group and52cases in control group of the study of the Acute stroke patients with pulmonary infection in patients with Phlegm obstruct the lung syndrome..The results are:the mortality of treat group is11.5%,in the control group is18.9%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment,there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups. After14days treatment, there is a statistically significant(p<0.05) of the data in GCS score,what is more.the treatment group's quality of life is better than the control group.and there is a statistically significant as well.(P<0.05).
4Acute stroke patients with pulmonary infection in patients with lung phlegm Yun results
There are53cases in treatment group and52cases in control group of the study of the Acute stroke patients with pulmonary infection in patients with lung phlegm Yun syndrome.The results are:the mortality of treat group is11.3%,in the control group is21.2%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment, there is a statistically significant(p<0.05) of the data in the symptom score in signs points,GOS degree of disability, between two groups. After14days treatment, there is a statistically significant(p<0.05) of the data in GCS score,what is more,the treatment group, s quality of life is better than the control group,and there is a statistically significant as well.(P<0.05).
Conclusions:
1The conclusion of acute ischemic stroke and complication of hemorrhagic infarction
The number of days of hospitalization, hospitalization expenses,has been reduced in the treatment group,besides those,there are significant changes of the syndrome of acute stroke and complication of hemorrhagic infarction,in the treatment group,and the treatment group is better than the in control group,in the remarkable efficiency,total efficiency.
2The conclusions of stroke in the acute phase and with the complication of pulmonary infection
The number of days of hospitalization, hospitalization expenses,has been reduced in the treatment group,besides those,there are significant changes of the syndrome of acute stroke and complication of pulmonary infection,in the treatment group,and the treatment group is better than the in control group,in the remarkable efficiency,total efficiency.However,there is not obvious advantage of treatment group in reducing sputum culture positive rate and the percentage of neutrophils,and we need to expand the sample size for further study.
方法：本试验研究的受试对象来源于由成都中医药大学附属医院、都江堰人民医院、川北医学院附属医院、攀枝花中西医结合医院、广元市中医院住院的符合卒中急性期并发肺部感染210例、急性缺血性卒中并发出血性梗死患者100例,分别随机分2组,两组均给予西医基础治疗加中风醒脑液口服,治疗组在上述基础上加用中药复方汤剂鼻饲或口服,50ml, tid,疗程为3～14天不等。观察周期3个月,填写原始病历和CRF表。疗效判定：观察治疗后患者病死率、住院天数、肺部感染症状及体征,总体疗效,NIHSS评分、mRS评分、GCS评分、生活能力、生存质量等。评价治疗后14天、28天的疗效,并观察治疗过程中可能出现的不良反应。利用SPSS20.0软件包对资料进行分析处理。
结果：
1.急性缺血性卒中并发出血性梗死痰热腑实证患者结果
本研究通过急性缺血性卒中并发出血性梗死痰热腑实证治疗组25例,对照组25例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为16.0%、24.0%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,差异具有统计学意义(P<0.05)；生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
2.急性缺血性卒中并发出血性梗死痰湿蒙神证患者结果
本研究通过急性缺血性卒中并发出血性梗死痰湿蒙神证治疗组25例,对照组25例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为24.0%、12.0%,治疗组高于对照组,但两组间的差异无统计学意义：在疗后14天、与疗后28天,在中医证候积分、体征积分,治疗组和对照组进行组间比较,差异具有统计学意义(P<0.05)：生存质量方面,治疗组对于改善患者生存质量,优于对照组,差异具有统计学意义(P<0.05)。
3.卒中急性期并发肺部感染痰热壅肺证患者结果
本研究通过卒中急性期并发肺部感染痰热壅肺证治疗组52例,对照组53例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为11.5%、18.9%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,具有统计学意义(P<0.05)；在疗后14天,治疗组和对照组的GCS评分进行组间比较,差异具有统计学意义(P<0.05)。生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
4.卒中急性期并发肺部感染痰浊蕴肺证患者结果
本研究通过卒中急性期并发肺部感染痰浊蕴肺证治疗组53例,对照组52例的疗效观察,结果表明：在病死率方面,治疗组和对照组的病死率分别为11.3%、21.2%,对照组高于治疗组,但两组间的差异无统计学意义；在疗后14天、与疗后28天,在中医证候积分、体征积分、GOS残障程度方面,治疗组和对照组进行组间比较,具有统计学意义(P<0.05)；在疗后14天,治疗组和对照组的GCS评分进行组间比较,差异具有统计学意义(P<0.05)。生存质量方面,治疗组对于改善患者生存质量,优于对照组,两者具有统计学意义(P<0.05)。
结论：
1急性缺血性卒中并发出血性梗死结论
治疗组能明显缩短急性缺血性卒中并发出血性梗死的住院天数、住院费用；明显改善急性缺血性卒中并发出血性梗死的症状、体征；在显效率、总有效率方面,治疗组优于对照组。
2卒中急性期并发肺部感染结论
治疗组能明显缩短卒中急性期并发肺部感染的住院天数、住院费用；明显改善座中急性期并发肺部感染的症状、体征；在显效率、总有效率方面,治疗组优于对照组。治疗组在降低痰培养阳性率和中性粒细胞百分比方面无统计学意义(P>0.05)。
Objective:The purpose of this clinical study is settle a project which is confirmed by randomized controlled trial (RCT), multicenter observation,to treat the complications of the stroke in the acute phase. This project is connection the western medicine and the Rraditional Chinese Medicine,zhongfengxingnao oral liquid, which has been applied for more than20years.
Method: The subjects of this study are from the inpatients departments of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,the People's Hospital of Dujiangyan, Affiliated Hospital of North Sichuan Medical College, Panzhihua Hospital Integrative Medicine, the Affiliated Hospital of the the Guangyuan Hospital. There are210cases with lung infection and100cases of hemorrhagic infarction.The subjects are randomly diveded into two groups. Both groups were given the same treatments,the western medicine and the zhongfengxingnao oral liquid,however, the treatment group add the Chinese formulaes by nasogastric or ora50ml, tid, the course of14days.Observation period is3month, followed up and finished the origenal record and the CRF tables.Therapeutic efficacy: mortality,the number of days of hospitalization,lung infection syndrome,overall effcts,NIHSS score,(mRS) score, GCS score, life skills, and quality of life. will be observed to evaluate the effect of14days and28days,after treatment,and observe adverse reactions that may occur during the process of treatment. And use SPSS20.0analysis the data.
Results:
1Acute ischemic stroke with hemorrhagic infarction the phlegm heat Fushi patients results
There are25cases in both treatment group and in control group of the study of the acute phase of stroke and issude hemorrhagic infarction phlegm-heat Fu shi syndrome. The results are:the mortality of treat group is16.0%,in the control group is 24.0%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment,there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups, what is more,the treatment group's quality of life is better than the control group,and there is a statistically significant as well.(P<0.05).
2Acute ischemic stroke patients with hemorrhagic infarction phlegm God permit results
There are25cases in both treatment group and in control group of the study of the Acute stroke patients with hemorrhagic infarction phlegm God permit results.The results are:the mortality of treat group is24.0%,in the control group is12.0%,but there is no statistically significant difference between the two groups;After14days treatment and28days treatment, there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups, what is more.the treatment group's quality of life is better than the control group.and there is a statistically significant as well.(P<0.05).
3Acute stroke patients with pulmonary infection in patients with Phlegm obstruct the lung
There are53cases in treatment group and52cases in control group of the study of the Acute stroke patients with pulmonary infection in patients with Phlegm obstruct the lung syndrome..The results are:the mortality of treat group is11.5%,in the control group is18.9%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment,there is a statistically significant(p<0.05) of the data in the symptom score in signs points, GOS degree of disability, between two groups. After14days treatment, there is a statistically significant(p<0.05) of the data in GCS score,what is more.the treatment group's quality of life is better than the control group.and there is a statistically significant as well.(P<0.05).
4Acute stroke patients with pulmonary infection in patients with lung phlegm Yun results
There are53cases in treatment group and52cases in control group of the study of the Acute stroke patients with pulmonary infection in patients with lung phlegm Yun syndrome.The results are:the mortality of treat group is11.3%,in the control group is21.2%,but there is no statistically significant difference between the two groups; After14days treatment and28days treatment, there is a statistically significant(p<0.05) of the data in the symptom score in signs points,GOS degree of disability, between two groups. After14days treatment, there is a statistically significant(p<0.05) of the data in GCS score,what is more,the treatment group, s quality of life is better than the control group,and there is a statistically significant as well.(P<0.05).
Conclusions:
1The conclusion of acute ischemic stroke and complication of hemorrhagic infarction
The number of days of hospitalization, hospitalization expenses,has been reduced in the treatment group,besides those,there are significant changes of the syndrome of acute stroke and complication of hemorrhagic infarction,in the treatment group,and the treatment group is better than the in control group,in the remarkable efficiency,total efficiency.
2The conclusions of stroke in the acute phase and with the complication of pulmonary infection
The number of days of hospitalization, hospitalization expenses,has been reduced in the treatment group,besides those,there are significant changes of the syndrome of acute stroke and complication of pulmonary infection,in the treatment group,and the treatment group is better than the in control group,in the remarkable efficiency,total efficiency.However,there is not obvious advantage of treatment group in reducing sputum culture positive rate and the percentage of neutrophils,and we need to expand the sample size for further study.
引文
[1]WHO task force on Stroke and other Cerebrovascular disorder. Stroke,1989 recommendations on Stroke prevention, diagnosis,and therapy. Stroke,1989,20:1407-1431.
[2]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(2)：154-160.
[3]hu C. The Third National Survey on the cause of death. Ministry of Health, People's Republic of China. Beijing: Peking Union Medical University Press, 2008.14-52.
[4]Liu M,Wu B,Wang WZ,et al.Stroke in China:epidemiology,prevention,and management strategies[J].Lancet Neuro 1,2007,6:456-464.
[5]黄如训,苏镇培.脑卒中第二版[M]2012.北京：人民卫生出社,2012292-293.
[6]Warlow CP, Dennis MS, Hankey GJ, et al.Stroke—A practical guide to manage-ment.London:Blackwell Science Ltd,1996:485-495.
[7]Davenport RJ. Dennis MS, Wellwood,et al.Complications after stroke [J].Stroke,1996,27:415-420.
[8]Silver FJ Norris jw,Lewis AJ,et alEarly mortality following stroke a prospective review[J].Stroke,1984,15:492-496.
[9]宋建良,诸国嘉,孙新芳,等.脑卒中患者发生支气管-肺医院感染的危险因素[J].中华医院感染学杂志,2003,13(5)：424-426.
[10]Aslanyan S,Weir CJ,Diener HC,et al. Pneumonia and urinary tract infection after acute ischemic stroke:a tertiary analysis of the GAIN international trial [J]. Eur J Neurol,2004,11(]):49-53.
[11]张晓云,张怡,罗晓琼.清金化痰汤加减治疗脑出血急性期并发肺部感染30例临床疗效观察[J].四川中医,2012,30(6)：83-84.
[12]张心中,毕作木.内科危重疾病现代治疗[M].青岛：海洋大学出版社,1994,27-32.
[13]隋邦森.脑血管疾病——MR, CT, DSA与临床[M].北京：人民卫生出版 社,1991：154-155.
[14]Hammer A,Lund A,Hugdahl K.Long-lasting cognitive impairment in unipolar major depression:A 6-month follow-up study[J].Psychiatry Res,2003,118(2):189.
[15]Ogata J, Yutani C, Jmakita M,et aLHemorrhagic infarct of the brain without a repening of the occluded in cardiombolic stroke[J].Stroke,1989,20(6):766-769.
[16]Levine SR, Brott TG.Thrombolysis therapy in cerebrovascular disorders [J].Progcardiovasc Dis,1992,34(4)235-262.
[17]Claus H, Thomas B, Carmen S, et al. Hemorrhagic transformation in cardioembolic cerebral infarction[J].Stroke,1993,24:465-468.
[18]Derex L,Hermier M,Adeleine P,et al.Neurol Neurosurg Psychiatry,2005,76(1):70-75.
[19]陈绍宏,张晓云.逐瘀化痰口服液治疗急性脑出血的临床及实验研究[J].中国中医急症,1995,4(2)：58-62.
[20]陈绍宏,张晓云.中风醒脑口服液治疗急性脑出血的临床研究[J].中国中医急症,2004,13(12)：793.
[21]黄青松,吴建英,肖玮.中风醒脑口服液治疗急性脑梗死25例临床观察[J].中华使用中西医杂志,2008,21(6)：481,483.
[22]李康,张晓云.中风醒脑口服液治疗急性脑梗死疗效观察[J].中国中医急症,2012,21(3)：467-468.
[23]邹薇萌.应用决策树对缺血性中风不同时段证候变化特征的研究[D].北京：北京中医药大学,2012.
[24]刘志斌.急性脑出血中、西医研究概况和中风醒脑口服液治疗急性脑出血的临床研究[D].成都,成都中医药大学,2003.
[25]张乐春.中医治疗中风病证候的临床举隅[J].中华中西医学杂志,2008(4)：51.
[26]曹峰.中风病痰热证病因病机理论研究[D].山东济南,山东中医药大学,2006.
[27]任建询.莱格注射液对脑缺血保护作用于血脑屏障调节机制的实验研究[D].成都,成都中医药大学2005.
[28]刘亮.中风急症临床辨证的文献研究[D].成都中医药大学：2004年.
[29]刘祖发,谭子户.简明中西医结合神经病学[M].北京：科学技术文献出版社,2008：135-146.
[30]李富汉.《金匮·中风》病因初探[J].河南中医,2003,233(5)：3-4.
[31]李大鹏.从中风病病机证治规律看《中医基础理论》“内风”病机学说的缺失[D].黑龙江中医大学：2008.
[32]郝军,田永衍,严世芸.孙思邈“凡中风多由热起”浅析[J].上海中医药大学学报,2011,25(2)：20-22.
[33]王新志,李燕梅,张金生.《内经》论中风病因钩玄[J].北京中医药大学学报,2002,25(3)：15.
[34]万远铁.中风病证治经验[J].中华现代中西医杂志,2005,8(3)：719-721.
[35]石春明.黄竹清脑颗粒对脑出血急性期(痰热腑证)大鼠SOD、MMP-9[D]陕西中医学院,2009.
[36]陈浩彬,谭晓媚.略论张子和攻邪中的扶正观[J].光明中医,2011,10(10)：1987-1988.
[37]赵超蓉.王左教授治疗中风病经验[J].中国中医急症,200817(4)：490-491.
[38]杨龙.头穴丛刺结合康复治疗对脑梗死患者平衡功能影响的临床研究[D].黑龙江中医药大学,2008
[39]孙迎春,郑彩霞,孟红艳.金元医家对中风病的研究及对后世的影响[J].齐鲁杏苑,2009,4：27.
[40]李金梁.中风Ⅰ号治疗气虚血瘀型缺血性中风的药效学实验研究[D].吉林大学,2007.
[41]杨维华.叶天士对中风先兆五因、四症与治疗四法的探讨[J].湖南中医杂志,1993,3：2-4.
[42]韦衮政,李伟伟.补阳还五汤治疗中风探讨[J].时珍国医国药,1999,10(9)：702-703.
[43]姚巧林.中风病的病因病机及历史形成过程[J].中国临床康复,2006,27(10)：131-133.
[44]刘敏,王庆国.中风病中医病因病机学说史略[J].中国中医基础医学杂志,,200612(4)：252-253.
[45]余丽霞.根结部配穴针刺法缺血性脑卒中大鼠的血液粘度和血浆ET-1的影响[D].河南中医学院,2007.
[46]刘耀东,孙丽萍,姬广伟,等.浅议中医危证“脱证”[J].实用心脑肺血管病杂志,2011,19(1)：142.
[47]郭建文,张晓云,兰万成,等.陈绍宏教授”中风核心病机论”[J].天津中医药,2006,23(1)：7-9.
[48]郭建文.急性脑出血治疗的时间窗及中风醒脑口服液干预的临床和细胞培养研究[D].成都中医药大学,2004.
[49]李中良.中风芪红利水饮对中风气虚血瘀水湿停滞证患者血清SOD、MDA含量影响[D].河南中医学院,2005.
[50]陈绍宏.中风病的病因病机心得浅述[C].2009年中华中医药学会内科分会中医内科临床科学研究专题研讨会论文汇编：1-4.
[51]王钦鹏,徐志玉,李晓红.试论《素问·生气通天论》中的养生思想[J].时珍国医国药,2009,20(1)：243-244.
[52]郭建文,刘明洁,何迎春,等.张景岳辨治中风病学术思想浅识[J].中国中医急症,2003,12(2)：159.
[53]林培政,刘亚敏.叶天士《临证指南医案》中风论治特色[J].新中医,2011,33(11)：6-8.
[54]袁利梅,杜同仿.叶天士治疗中风用药规律探析[J].时珍国医国药,2009,20(3)：739-740.
[55]茅晓.王清任“气虚致中”学说及其临床应用[J].山西中医,2002,18(1)：38-39.
[56]王全胜,王晓峰.从津血同源论痰瘀相关学说探析[J].实用中医内科杂志,2005,19(6)：503.
[57]滕晶.中风病病因病机理论探析[J].中华中医药学刊,2007,25(5)：962-963.
[58]祝维峰.缺血性中风痰瘀互结机制的探讨[J].浙江中医学院学报,2000,21(30)：57-58.
[59]顾宁.周仲英教授从瘀热阻窍辨治急性脑出血学术思想探析[C].第四届著名中医药学家学术传承高层论坛选粹.
[60]陈利国,马民,屈援,等.精尿病血瘀证研究进展[J].中华中医药杂志,2005,20(2)：114-116.
[61]史宇广,单书健主编.当代名医临证精华中风专辑[M].北京：中医古籍出版 社,192.
[62]张丽玲,梁卫,马建芳.从痰瘀论治哮喘[J].中国中医基础医学杂志,2007,13(11)：850-851.
[63]姜良铎.中医急诊临床研究[M].北京：人民卫生出版社,142.
[64]贾文魁.古今医家诊治中风经验及发挥[M].北京：人民军医出版社,1999：33.
[65]叶光宏,张晓云.中风醒脑液治疗出血中风的机制探讨[J].中国中医急症,2011,20(3)：389-390,
[66]窦德强,蕲玲,陈英杰.人参的化学成分及药理活性的研究进展与展望[J].沈阳药科大学学报,1999,16(2)：151-152.
[67]Han JA, Hu WY, Sun ZH. Efect of Panax notoginseng Saponin on Ca2+,CaM in craniocerebral injury[J].Chinese Journal of Integrated Traditional and Western Medicine,1999,19:227-229.
[68]纳鑫,汪雪兰,皮荣标.川芎嗪对中枢神经系统的药理作用及其机制的研究进展[J].中药新药与临床药理,2008,19(1)：77-80.
[69]汤湘江,陈洁文,陈朝风.三七皂苷对大鼠海马脑片缺氧损伤的保护作用[J].中药新药与临床药理,1997,8(4)：221.
[70]孔令越,陈汝兴,邹刚.生大黄治疗脑出血大鼠的实验研究[J].辽宁中医学院学报,2003,5(3)272-273.
[71]焦东海.单味大黄活血止血作用的实验研究[J].中成药研究,1983,3(4)：30.
[72]史录文.6种大黄抗超氧负离子自由基活性的研究[J].北京医科大学学报,1993,25(增刊)：103.
[73]高贤钧.中草药钙通道阻滞剂的研究与展望[J].中国中西医结合杂志,1990,10：447.
[74]王鸿利.大黄有效单体止凝恤机理的临床研究[J].中西医结合杂志,1985,(9)：555-557.
[75]龙晓燕.中风醒脑口服液对脑缺血的保护作用[J].药学进展,2000,24(5)299.
[76]高学敏.中药学[M].北京：人民卫生出版社,2004,1513-1542.
[77]龙晓燕,黄国钧,陈绍宏,等.中风醒脑口服液对脑缺血的保护作用[J].药学进展,2000,24(5)：299-301.
[78]李艳青,张晓云.中风醒脑液SD大鼠含药血清对体外培养神经细胞缺血再灌注损伤保护作用的实验研究[J].辽宁中医杂志,2012,39(3)：560-561.
[79]Skene JHP. Axional-growth associated proteins [J]. Annu Rev Neurosci,1989,12:127-156.
[80]Julien JP, Mushynski WE. Neurofilaments inhealth and disease [J].Prog Nucleic Acid Res Mol Biol,1998,61:1-23.
[81]李艳青,谢荃,张晓云.中风醒脑液对体外培养缺血再灌注PC-12细胞GAP-43和NF蛋白表达的影响[J].辽宁中医杂志,2012,39(5)：938-939.
[82]谢荃,李艳青,张晓云.中风醒脑液对大鼠缺血再灌注的保护作用和治疗时间窗[J].辽宁中医杂志,2012,39(5)：946-948.
[83]于白莉,张洪.中风醒脑口服液治疗后循环缺血眩晕疗效观察[J].中国中医急症,2012,21(6)：885-886.
[84]王筠,谢荃,黄斌,等.中风醒脑口服液治疗急性脑出血致脑心综合征临床观察[J].成都中医药大学学报,2010,33(3)27-29.
[85]任继学.悬壶漫录[M].北京：北京科学技术出版社,1990：203-210.
[86]Bamford J,Sandercock P, Dennis M,et al.Classfication and natural history of clinical identifiable subtypes of cerebral infarction.Lancet,1991,337:1521.
[87]Cucchiara B,Messe S,Sansing L,et al.Hematoma growth in oral anticoagulant related intracerebral hemorrhage [J].Stroke,2008,39(11)2993-2996.
[88]Davis SM,Broderick J,Hennerici M,et al.Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage.Neurology,2006,66(8):1175-1181.
[89]曾进胜,黄如训.高血压动脉硬化性混合性中风的实验病理学研究[J].中国神经精神疾病杂志,1992,18(6)：340-342.
[90]黄如训.脑出血合并脑梗塞[J].中国神经精神疾病杂志,1988,14(4)：195-197.
[91]黄如训,曾进胜,苏镇培,等.易卒中型肾血管性高血压大鼠模型[J].中国神经精神疾病杂志,1991,17(2)：257-260.
[92]严石林,陈为,于宏波,等.同病异治的理论基础和意义探讨[J].南京中医药大学学报,2012,28(6)：501-503.
[93]刘丽梅,陈琳,王瑞海,等.病证结合方证相应基础研究的现状[J].中国中医基础 医学杂志,2009,15(5)：334-336.
[94]Fisher M,ADAMS RD. Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction [J]. J Neuropathol Exp Neurol,1951,10(1):92-94.
[95]Ott BR, Zamani A,Kleefileld J, et al. The clinical spectrum of hemorrhagic infarction [J]. Stroke,1985,17(4):630-637.
[96]张晓云,张怡.从痰辨证论治脑梗死后出血性转化的临床观察[J].中国中医急症,2012,21(6)：861-862,877.
[97]于晓东.崔金海应用大黄治疗急性中风病经验[J].河北中医,2006,,28(1)：5-6.
[98]韩瑛,吴晓华,张颖琪.脑梗死后出血相关因素的分析[J].临床神经病学杂志,2004,17(1)：50-51.
[99]Berger C, Fionelli M, Steiner T, et al. Hemorrhagic transformation of ischemic brain tissue:asymptomatic or symptomatic[J].Stroke,2001,32,1330-1335.
[100]Derex Derex L,Hermier M,Adeleine P, et al. Neurol Neurosurg Psychiatry,2005,76(1):70-75.
[101]张晓云,张怡,罗晓琼.清金化痰汤治疗脑出血急性期并发肺部感染30例临床疗效观察[J].四川中医,2012,30(6)：83-84.
[102]易松,张晓云.中西医结合治疗脑卒中急性期并发肺部感染疗效观察[J].中国中医急症,2007,16(11)：1314-1315.
[103]Langhorne P, Stott DJ,Robertson L et al. Medical complications after stroke:a multicenter study Stroke,2000,31:1223-1229.
[104]Ovbiagele B, Hills NK, Saver JL,et al. Frequency and determinats of pneumonia and urinary tract infection durning stroke hospitalization.J Stroke Cerebrovasc Dis,2006,15:209-213.
[105]Upadya A, Thorevska N, Sena KN, et al. Predictors and consequences of pneumonia in criticailly ill patients with stroke. J Crit Care,2004,19:16-22.
[106]Addington W R, Stephens RE, Gilliland KA. Assessing the laryngeal COUsh reflex and the risk of developing pneumonia after stroke:an interhospital comparison. Stroke,1999,30(6):1203-1207.
[107]Heros RC. Early pathnphysiology and treatment summary of the Fifty Decade of the Brain Symposium. Stroke.1994,25:1877-1881.
[108]Perry L, Lova CP. Screening for dysphagia and aspiration in acuterstroke:a systeteatic review. Dysphagia,2001,16(1):7-18.
[109]伏平.重症监护患者医院感染分析[J].中华医院感染学杂志,2000,10(4)：271-272.
[110]耿莉华.医院感染控制指南[M].北京：科学技术文献出版社.2004,420-421.
[111]Hamidon BB,Baymondd AA. Risk factors and complications of acute ischaemic stroke patients at Hosptial University Kebangsaan Malaysia(HUKM).Med J Malysia,2003,58:499-505.
[112]Hanchaiphiboolkul S. Rik factors for early infection after an acute cerebral infatcion. J Med Assoc Thai,2005,88:150-155.
[113]Sellars C, Bowie L, Bagg J,et al. Risk factors for chest infection in acute stroke:a prospective cohort study Stroke,2007,382284-2291.
[114]Kammersgaard LP, Jorgensen HS, Reith J, et al. Early infection and prognosis after acute stroke:the Copenhagen Stroke Study. J Stroke Cerebrovasc Dis,2001,10:217-221.
[115]Weimar C, Ziegler A, Konig IR, et al. Predicting functional outcome and survival after acute ischemic stroke. J Neurol,2001,249:888-895.
[116]Aslanyan S, Weir CJ, Diener HC,et al. Pneumonia and urinary tract infection after acute ischaemic stroke:A teriary analysis of the GAIN international trial. Eur J Neuro 1,2004,11:49-53.
[117]Hospital-acquired pneumonia in adults:diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society. November 1995. Am J Respir Crit Care Med,1996,153:1711-1725.
[118]Katzan IL, Cebul RD, Husak SH,et al. The ffect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology,2003,20:620-625.
[119]Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke:implications for neurological intensive care medicine. Stroke,2003,34:975-981.
[120]Vargas M, Horcajada JP, Obach V,et al. Clinical consequences of infection in patients with acute stroke:is it prime time for further antibiolic trial?. Stroke,2006,37:461-465.
[121]Walter U, Knblich R, Steinhagen V,et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol,2007,254,1323-1329.
[122]Vernino S, Brown RD Jr, Sejvar JJ,et al. Csuse-specific mortality after first cerebral infarction. A population-based study. Stroke,2003,34:1823-1832.
[123]王威,陈路燕,刘建平.脑卒中后肺部感染的危险因素与预后[J].中华医院感染学杂志,2007,17：805-806.
[124]Perry L, Love CP. Screening for dysphagia and aspiration in acute stoke:a systematic review. Dysphagia,2001,16:7-18.
[125]Hinchey JA, Shephard T, Furie K,et al. Formal dysphagia screening prptocols prevent pneumonia. Stroke,2005,36:1972-1976.
[126]Nakajob K, Nkagawa T, Sekizawa K,et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med,2000,247:39-42.
[127]Pittock SJ, Meldrum D, Hardiman O,et al. The Oxfordshire Community Stroke Project classification: correlation with imaging,associated complications, and prediction of outcome in acute ischemic stroke. J Stroke Cerebrovasc Dis,2003,12:1-7.
[128]郑天衡,王少石,陈真理等.早期肠内营养支持对急性期卒中患者免疫功能的影响[J].中国脑血管病杂志,2008,3：356-360.
[129]王少石,郑天衡,陈真理等。早期肠内营养支持对急性卒中尽其预后的影响[J].中华内科杂志,2007,46：366-369.
[130]沈一曼.复方三拗汤吸入治疗儿童急性下呼吸道感染的疗效观察与机制探讨[J].浙江中西医结合杂志,1996,6(3)：142.
[131]柴秀娟.复方三拗汤雾化吸入的药效实验研究[J].浙江中医学院学报,1997,(4)：274-26.
[132]刘兴祥.麻黄的药理作用及其临床应用[J].中西医结合杂志,1989,9(4)：255-256.
[133]吴雪荣.麻黄药理作用研究进展[J].中国中医药现代远程教育,2010,8(5)：173.
[134]王艳红,王珊,王杰.浅谈中药苦杏仁的药理作用及其炮制方法[J].中国药业,1999,8(9)：36.
[135]郭建民,田源洪.中药炮制学[M].北京：中医古籍出版社,2003,156-158.
[136]郭书文,王国华,石克华,等。瓜蒌薤白半夏汤降肺动脉高压的试验研究[J].中国中西医结合杂志,1997,17(7)：23-24.
[137]田德禄.中医内科学[M].北京：人民卫生出版社,2006,94-101,401.
[138]蒋文钧.加服苏杏丹清金化痰汤治疗慢性阻塞性肺疾病疗效观察[J].广西中医药,2011,34(6)：16-17.
[139]张峰,王海明,叶甫澄.加味清金化痰汤治疗老年性肺炎临床观察[J].中国中医急症,2012,21(4)：622-623.
[140]叶惠芬,刘平,陈惠玲,等.中药对广州地区肺炎链球菌抑菌作用研究[J].临床医药实践杂志,2006,15(8)：566-568.
[141]姬广伟,刘耀东,孙丽萍,等.清金化痰汤从肺论治重症脑卒中临床观察[J].中国实用医药,2009,16(4)：177-178.
[142]Donnan GA, Davis SM, Chambers BR,et al. Trial of the streptokinase in severe acute ischemic stroke,Lancel,1995,345:578-579.
[143]Fiorelli M, Bastianello S, von Kummer R,et al. Hemorrhagic transfotmation within 36 hours of a cerebral infarct:relationships with early clinical deterioration and 3-month outcome in the European Cooperatinve Acute Stroke Study I (ECASSI) co hort[J].Stroke,1999,30(11)2280-2284.
[144]Tissue plasminogen activator for acute ischemic stroke.The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group[J].N Engl J Med,1995,333(24):1581-1587.
[145]A. K. Gilligan M,FRACP,R. Markus M,et aL Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke[J].Stroke,2002,33(9):2236-2242.
[146]England TJ,Bath PM,Sare GM,et aLAsynptomatic hemorrhagic transformation of infarction and its relationship with functional outcome and stroke subtype assessment from the Tinzaparin in Acute Ischemic Stroke Trial[J].Stroke,2010,41 (12)2834-2839.
[147]Randomised controlled trial of strep tokinase,aspirin,and combination of both in treatment of acute ischaemic stroke.Multicentre Acute Stroke Trial-Italy (MAST) Group. Lancet,1995,12:1509-1514.
[148]Kidwell CS,Saver JL,Carneado J,et al.Predictors of hemorrhagic transformation in patients receiving intra-arterial thro mbo lysis [J]. Stroke,2002,33(3):717-724.
[149]Hacke W, Kaste M, Fieschic, et al Intraevenous thrombolysis with recombinant tissue palsminogen activator for acute hemischemic stroke the Europe Cooperative A cute Stroke Stud y(EC ASS). JAMA,1995,274(13),1017-1025.
[150]Davalos A,Toni D,Iweins F,et aLNeurological deterioration in acute ischemic stroke:potential predictors and associated factors in the European cooperative acute stroke study(ECASS)I [J]. Stroke,1999,30(12):2631-2636.
[151]Hacke W, Kaste M, Fieschic, et al.Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke(ECASS II).Second European-Australasian Acute Stroke Study Investigators[J].Lancet,1998,352:1245-1251.
[152]Jin R, Yang G, Li G. Molecular insights and therapeutic targets for blood-brain barrier disruption in ischemic stroke:critical role of matrix metalloproteinases and tissue-type plasminogen activator[J].Neurobiol Dis,2010,38:376-385.
[153]伊恋,张克玲,张忠玲.组织型纤溶酶原激活剂在部分中枢神经系统中的作用[J].中国临床神经科学,2012,20(2)：228-232.
[154]Tessalu T, Kulla A, Simisker A, et al. Tissue plasminogen activator and neuroserpin are widely expressed in the human central nervous system [J]. Thromb Haemost,2004,92:358-368.
[155]Benchenane K, Lopez-Atalaya JP, Fernandez-Monreal M, er al. Equivocal roles of tissue-type plasminogen activator in stroke-induced injury[J]. Trends Neurosci,2004,27:155-160.
[156]Lochner JE, Honigman LS, Grant WF, et al. Activity-dependent release of tissue plasminogen activator from the dendritic spines of hippocampal neurons revealed by live-cell imaging[J]. J Neurobio 1,2006,66.564-577.
[157]Shin CY, Kundel M, Wells DG. Rapid, activity-induced increase in tissue plasminogen activator is mediated by metabotropic glutamate receptor-dependent mRNA translation[J]. J Neurosci,2004,24:9425-9433.
[158]Melchor JP, Strickland S. Tissue plasminogen activator in central nervous system physiology and pathology[J].Thromb Hsemost.2005,93:655-660.
[159]Andrew B. McGeachie, Lorenzo A. Cingolani, Yukiko Goda. A stabilizing influence:Integrins in reglution of synaptic plasticity [J].Neutosci Res.2011,70:24-29.
[160]Rebola N, Srikumar BN, Mulle C.Activity-dependent synaptic plasticity of NMDAreceptors [J].J Physiol,2010,588:93-99.
[161]Yepes M, Lawrence DA. New function for an old enzyme:n onhemostatic roles for tissue-type plasminogen activator in the central nervous system[J].Exp Biol Med (Maywood),2004,229:1097-1104.
[162]Pang PT, Teng HK, Zaitsey E, Woo NT, et al.Cleavage of proBDNF by tPA/plasmin is essential for long-term hippocampal plasticity [J]. Science,2004,306:487-491.
[163]Nicole O,Docagne F, Ali C,et al. The proteolytic acyivity of tissue-plasminogen activator enhance NMDA receptor-mediated signaling[J].Nat Med,2001,7:59-64.
[164]Samson AL, Medcalf RL. Tissue-type plasminogen activator:a multifaceted modulator of nruotransmission and synaptic plasticity [J].Neuron,2006,50:673-678.
[165]Zhuo M, Holtzman DM. LiY,Osaka H,et al.Role of tissue plasminogen activator receptor LRP in hppocampal long-term potentiation [J]. Neuron,2006,50:673-678.
[166]Klein T, Bischoff RPhysiology and pathophyiology of matrix metalloproteases[J].Amino Acides,2011,41271-290.
[167]Gasche Y,Soccal PM,Kanemitsu,et al. Matrix metalloproteinases and diseases of the central nervous system with a special emphasis on ischemic brain[J].Front Biosci,2006,11:1289-1301.
[168]Hacke W, Kaste M, Bluhmki E,et al.Thrombolysis with alteplase 3 to 5 hours after acute ischemic stroke[J].N Engl J Med,2008,359:1317-1329.
[169]Lo EH, Broderick JP, Moskowitz MA. tPA and proteolysis in the neurovascular unit[J]. Stroke,2004,35:354-356.
[170]Castellanos M,Leria R,serena J,et al. plasma metalloproteinase-9 concentration predicts hemorrhagic transformation in acute ischemic stroke [J].Stroke,2003,34:40-46.
[171]Montaner J, Alvarez-Sabin J,Molina C,et al.Matrix metalloproteinase expression after human cardioembolic stroke:temporal profile and relation to neurological impairment [J].Stroke,2001,32:1759-1766.
[172]Montaner J, Molina CA,Monasterio J,et al.Matrix metalloproteinase-9 pretreatment level predicts intracranial hemorrhagic complications after thrombolysis in human stroke[J].Circulation,2003,107-598-603.
[173]Ramos-Fernandez M,Bellolio MF, Stead LG. Matrix metalloproteincase-9 as a marker for acute ischemic stroke:a systematic review[J].J Stroke Cerebrovasc Dis,2011,20:47-54.
[174]Rosell A, Lo EH. Multiphasic roles for matrix metalloproteinases after stroke[J].Curr Opin Pharmacol,2008,8:82-89.
[175]Tsuji K, Aoki T,Tejima E,et al. Tissue plasminogen activator promotes matrix metallptroteinase-9 upregulation after focal cerebral ischemia [J]. Stroke,2005,36:1954-1959.
[176]Yepes M,Sandkvist M, Moore EG,et al. Tissue-type plasminogen activator induces opening of the blood-brain barrier via the LDL receptor-related protein[J].J Clin Invest,2003,112:1533-1540.
[177]徐铅辉,楮晓凡.脑梗死后出血性转化的研究进展[J].实用医学杂志,2009,25(22)：3904-3906.
[178]Rosell A, Ortega-Aznar A, Alvarez-Sabin J,et al. Increased brain expression of matrix metalloproteinase-9 after ischemic and hemorrhagic human stroke[J]. Stroke,2006,37,(6):1399-1406.
[179]Rosell A, Cuadrado E, Ortega-Aznar A,et al.MMP-9-positive neutrophil infitraton is associated to blood-brain barrier breakdown and basal lamina type Ⅳ collagen degradation during hemorrhagic transformation after human ischemic stroke[J].Stroke,200839(4):1121-1126.
[180]Asahi M,Asahi K,Wang X,et al.Reduction of tissue plasminogen activator-induced hemorrhage and brain injury by free radical spin trapping after embolic focal cerebral ischemia in rats[J].J Cereb Blood Flow Metab,2000,20(3):452-457.
[181]Levy DE, Brott TG, Haley EC Jr, et al. Factors related to intracranial hematoma formation in patients receiving tissue type plsaminogen activiator for acute ischemic stroke [J].Stroke,1994.25:291-297.
[182]Adams HP, Brott TG,Furlan AT,et al. Guidelins For Thrombolysis Therapy for Acute Stroke:a supplement to the guidelines for the management of patients with ischemic stroke [J]. Circu- lation,1996,94:1167-1174.
[183]Baron JC,Kummer R,del ZOPPO, GJ.Treatment of acute ischemic stroke challenging the concept of a rigid and universal time window[J].Stroke,1995,26:2219-2221.
[184]del Zoppo GJ,Hiqashida RT,Rurian AJ,et aLa phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke.PROACT Investigators.Prolyse in Acute Cerebral Thromboembolism[J].Stroke,1998,29(1):4-11.
[185]Larrue V,von Kummer R,del Zoppo GJ,et al. Hemomhagic transformation in acute ischemic stroke potential contributing factors in the Eurpean Cooperative Acute Stroke Study[J]. Stroke,1997,28:957-960.
[186]Lamue V,von Kumme,Muller A,et al.Risk Factors for severe hemorrhagic transformation in ischemic stroke patient is treated with recombinant tissue plasminogen activator: A secondary analysis of the European-Australasian Acute study(ECASS II)[J]. Stroke,2001,32(2):438-441.
[187]The NINDS tPA Stroke Study Group. Intracerebral hemorrhage after intravenous tPA therapy for ischemic stroke[J].Stroke,1997,28(11):2109-2118.
[188]Hacke W,Kaste M,Fieshic et al. Intravenous thromboylysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The Europe Cooperative Acute Stroke Study(EMCASS),JAMA,1995,274:1017-1025.
[189]Castellanos M,Leria R,Serena J,et al.Plasma celluar-fibronecin concentration predicts hemorrhagic transformation after thrombolytic therapy in acute ischemic stroke [J].Stroke,200435(7):1671-1676.
[190]Cocho D,Borrell M,Montaner Joan,et al.Pretreatment hemostatic markers of symptomatic intracerebral hemorrhage in patients treated with tissue plasminogen activator[J].Stroke,2006,37(4):996-999.
[191]Montaner J,Rermandez-Cadenas I,Molina CA,et al.Safety profile of tissue plasminogen activator treantment among stroke patients carrying a common polymorphism(C-1562T) in the promoter region of the matrix metalloproteinase-9 gene[J].Stroke,2003,34(12):2851-2855.
[192]Bang O Y,Saver J L,Alger J R,et al.Patterns and predictors of blood-brain barrier permeability derangements in acute ischemic stroke[J].Stroke,2009,40(2):454-461.
[193]樊东升.新型强效自由基清除剂依达拉奉治疗急性缺血性卒中——从实验室到临床[J].国际脑血管病杂志,2009,17(1)：1-5.
[194]Meier N,Nedultchev K,Brekenfeld C,et al.Prior statin use,intracranial hemorrhage,and outcome after intraarterial thrombolysis for acute ischemic stroke [J]. Stroke,2009,40(5):1729-1737.
[2]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(2)：154-160.
[3]hu C. The Third National Survey on the cause of death. Ministry of Health, People's Republic of China. Beijing: Peking Union Medical University Press, 2008.14-52.
[4]Liu M,Wu B,Wang WZ,et al.Stroke in China:epidemiology,prevention,and management strategies[J].Lancet Neuro 1,2007,6:456-464.
[5]黄如训,苏镇培.脑卒中第二版[M]2012.北京：人民卫生出社,2012292-293.
[6]Warlow CP, Dennis MS, Hankey GJ, et al.Stroke—A practical guide to manage-ment.London:Blackwell Science Ltd,1996:485-495.
[7]Davenport RJ. Dennis MS, Wellwood,et al.Complications after stroke [J].Stroke,1996,27:415-420.
[8]Silver FJ Norris jw,Lewis AJ,et alEarly mortality following stroke a prospective review[J].Stroke,1984,15:492-496.
[9]宋建良,诸国嘉,孙新芳,等.脑卒中患者发生支气管-肺医院感染的危险因素[J].中华医院感染学杂志,2003,13(5)：424-426.
[10]Aslanyan S,Weir CJ,Diener HC,et al. Pneumonia and urinary tract infection after acute ischemic stroke:a tertiary analysis of the GAIN international trial [J]. Eur J Neurol,2004,11(]):49-53.
[11]张晓云,张怡,罗晓琼.清金化痰汤加减治疗脑出血急性期并发肺部感染30例临床疗效观察[J].四川中医,2012,30(6)：83-84.
[12]张心中,毕作木.内科危重疾病现代治疗[M].青岛：海洋大学出版社,1994,27-32.
[13]隋邦森.脑血管疾病——MR, CT, DSA与临床[M].北京：人民卫生出版 社,1991：154-155.
[14]Hammer A,Lund A,Hugdahl K.Long-lasting cognitive impairment in unipolar major depression:A 6-month follow-up study[J].Psychiatry Res,2003,118(2):189.
[15]Ogata J, Yutani C, Jmakita M,et aLHemorrhagic infarct of the brain without a repening of the occluded in cardiombolic stroke[J].Stroke,1989,20(6):766-769.
[16]Levine SR, Brott TG.Thrombolysis therapy in cerebrovascular disorders [J].Progcardiovasc Dis,1992,34(4)235-262.
[17]Claus H, Thomas B, Carmen S, et al. Hemorrhagic transformation in cardioembolic cerebral infarction[J].Stroke,1993,24:465-468.
[18]Derex L,Hermier M,Adeleine P,et al.Neurol Neurosurg Psychiatry,2005,76(1):70-75.
[19]陈绍宏,张晓云.逐瘀化痰口服液治疗急性脑出血的临床及实验研究[J].中国中医急症,1995,4(2)：58-62.
[20]陈绍宏,张晓云.中风醒脑口服液治疗急性脑出血的临床研究[J].中国中医急症,2004,13(12)：793.
[21]黄青松,吴建英,肖玮.中风醒脑口服液治疗急性脑梗死25例临床观察[J].中华使用中西医杂志,2008,21(6)：481,483.
[22]李康,张晓云.中风醒脑口服液治疗急性脑梗死疗效观察[J].中国中医急症,2012,21(3)：467-468.
[23]邹薇萌.应用决策树对缺血性中风不同时段证候变化特征的研究[D].北京：北京中医药大学,2012.
[24]刘志斌.急性脑出血中、西医研究概况和中风醒脑口服液治疗急性脑出血的临床研究[D].成都,成都中医药大学,2003.
[25]张乐春.中医治疗中风病证候的临床举隅[J].中华中西医学杂志,2008(4)：51.
[26]曹峰.中风病痰热证病因病机理论研究[D].山东济南,山东中医药大学,2006.
[27]任建询.莱格注射液对脑缺血保护作用于血脑屏障调节机制的实验研究[D].成都,成都中医药大学2005.
[28]刘亮.中风急症临床辨证的文献研究[D].成都中医药大学：2004年.
[29]刘祖发,谭子户.简明中西医结合神经病学[M].北京：科学技术文献出版社,2008：135-146.
[30]李富汉.《金匮·中风》病因初探[J].河南中医,2003,233(5)：3-4.
[31]李大鹏.从中风病病机证治规律看《中医基础理论》“内风”病机学说的缺失[D].黑龙江中医大学：2008.
[32]郝军,田永衍,严世芸.孙思邈“凡中风多由热起”浅析[J].上海中医药大学学报,2011,25(2)：20-22.
[33]王新志,李燕梅,张金生.《内经》论中风病因钩玄[J].北京中医药大学学报,2002,25(3)：15.
[34]万远铁.中风病证治经验[J].中华现代中西医杂志,2005,8(3)：719-721.
[35]石春明.黄竹清脑颗粒对脑出血急性期(痰热腑证)大鼠SOD、MMP-9[D]陕西中医学院,2009.
[36]陈浩彬,谭晓媚.略论张子和攻邪中的扶正观[J].光明中医,2011,10(10)：1987-1988.
[37]赵超蓉.王左教授治疗中风病经验[J].中国中医急症,200817(4)：490-491.
[38]杨龙.头穴丛刺结合康复治疗对脑梗死患者平衡功能影响的临床研究[D].黑龙江中医药大学,2008
[39]孙迎春,郑彩霞,孟红艳.金元医家对中风病的研究及对后世的影响[J].齐鲁杏苑,2009,4：27.
[40]李金梁.中风Ⅰ号治疗气虚血瘀型缺血性中风的药效学实验研究[D].吉林大学,2007.
[41]杨维华.叶天士对中风先兆五因、四症与治疗四法的探讨[J].湖南中医杂志,1993,3：2-4.
[42]韦衮政,李伟伟.补阳还五汤治疗中风探讨[J].时珍国医国药,1999,10(9)：702-703.
[43]姚巧林.中风病的病因病机及历史形成过程[J].中国临床康复,2006,27(10)：131-133.
[44]刘敏,王庆国.中风病中医病因病机学说史略[J].中国中医基础医学杂志,,200612(4)：252-253.
[45]余丽霞.根结部配穴针刺法缺血性脑卒中大鼠的血液粘度和血浆ET-1的影响[D].河南中医学院,2007.
[46]刘耀东,孙丽萍,姬广伟,等.浅议中医危证“脱证”[J].实用心脑肺血管病杂志,2011,19(1)：142.
[47]郭建文,张晓云,兰万成,等.陈绍宏教授”中风核心病机论”[J].天津中医药,2006,23(1)：7-9.
[48]郭建文.急性脑出血治疗的时间窗及中风醒脑口服液干预的临床和细胞培养研究[D].成都中医药大学,2004.
[49]李中良.中风芪红利水饮对中风气虚血瘀水湿停滞证患者血清SOD、MDA含量影响[D].河南中医学院,2005.
[50]陈绍宏.中风病的病因病机心得浅述[C].2009年中华中医药学会内科分会中医内科临床科学研究专题研讨会论文汇编：1-4.
[51]王钦鹏,徐志玉,李晓红.试论《素问·生气通天论》中的养生思想[J].时珍国医国药,2009,20(1)：243-244.
[52]郭建文,刘明洁,何迎春,等.张景岳辨治中风病学术思想浅识[J].中国中医急症,2003,12(2)：159.
[53]林培政,刘亚敏.叶天士《临证指南医案》中风论治特色[J].新中医,2011,33(11)：6-8.
[54]袁利梅,杜同仿.叶天士治疗中风用药规律探析[J].时珍国医国药,2009,20(3)：739-740.
[55]茅晓.王清任“气虚致中”学说及其临床应用[J].山西中医,2002,18(1)：38-39.
[56]王全胜,王晓峰.从津血同源论痰瘀相关学说探析[J].实用中医内科杂志,2005,19(6)：503.
[57]滕晶.中风病病因病机理论探析[J].中华中医药学刊,2007,25(5)：962-963.
[58]祝维峰.缺血性中风痰瘀互结机制的探讨[J].浙江中医学院学报,2000,21(30)：57-58.
[59]顾宁.周仲英教授从瘀热阻窍辨治急性脑出血学术思想探析[C].第四届著名中医药学家学术传承高层论坛选粹.
[60]陈利国,马民,屈援,等.精尿病血瘀证研究进展[J].中华中医药杂志,2005,20(2)：114-116.
[61]史宇广,单书健主编.当代名医临证精华中风专辑[M].北京：中医古籍出版 社,192.
[62]张丽玲,梁卫,马建芳.从痰瘀论治哮喘[J].中国中医基础医学杂志,2007,13(11)：850-851.
[63]姜良铎.中医急诊临床研究[M].北京：人民卫生出版社,142.
[64]贾文魁.古今医家诊治中风经验及发挥[M].北京：人民军医出版社,1999：33.
[65]叶光宏,张晓云.中风醒脑液治疗出血中风的机制探讨[J].中国中医急症,2011,20(3)：389-390,
[66]窦德强,蕲玲,陈英杰.人参的化学成分及药理活性的研究进展与展望[J].沈阳药科大学学报,1999,16(2)：151-152.
[67]Han JA, Hu WY, Sun ZH. Efect of Panax notoginseng Saponin on Ca2+,CaM in craniocerebral injury[J].Chinese Journal of Integrated Traditional and Western Medicine,1999,19:227-229.
[68]纳鑫,汪雪兰,皮荣标.川芎嗪对中枢神经系统的药理作用及其机制的研究进展[J].中药新药与临床药理,2008,19(1)：77-80.
[69]汤湘江,陈洁文,陈朝风.三七皂苷对大鼠海马脑片缺氧损伤的保护作用[J].中药新药与临床药理,1997,8(4)：221.
[70]孔令越,陈汝兴,邹刚.生大黄治疗脑出血大鼠的实验研究[J].辽宁中医学院学报,2003,5(3)272-273.
[71]焦东海.单味大黄活血止血作用的实验研究[J].中成药研究,1983,3(4)：30.
[72]史录文.6种大黄抗超氧负离子自由基活性的研究[J].北京医科大学学报,1993,25(增刊)：103.
[73]高贤钧.中草药钙通道阻滞剂的研究与展望[J].中国中西医结合杂志,1990,10：447.
[74]王鸿利.大黄有效单体止凝恤机理的临床研究[J].中西医结合杂志,1985,(9)：555-557.
[75]龙晓燕.中风醒脑口服液对脑缺血的保护作用[J].药学进展,2000,24(5)299.
[76]高学敏.中药学[M].北京：人民卫生出版社,2004,1513-1542.
[77]龙晓燕,黄国钧,陈绍宏,等.中风醒脑口服液对脑缺血的保护作用[J].药学进展,2000,24(5)：299-301.
[78]李艳青,张晓云.中风醒脑液SD大鼠含药血清对体外培养神经细胞缺血再灌注损伤保护作用的实验研究[J].辽宁中医杂志,2012,39(3)：560-561.
[79]Skene JHP. Axional-growth associated proteins [J]. Annu Rev Neurosci,1989,12:127-156.
[80]Julien JP, Mushynski WE. Neurofilaments inhealth and disease [J].Prog Nucleic Acid Res Mol Biol,1998,61:1-23.
[81]李艳青,谢荃,张晓云.中风醒脑液对体外培养缺血再灌注PC-12细胞GAP-43和NF蛋白表达的影响[J].辽宁中医杂志,2012,39(5)：938-939.
[82]谢荃,李艳青,张晓云.中风醒脑液对大鼠缺血再灌注的保护作用和治疗时间窗[J].辽宁中医杂志,2012,39(5)：946-948.
[83]于白莉,张洪.中风醒脑口服液治疗后循环缺血眩晕疗效观察[J].中国中医急症,2012,21(6)：885-886.
[84]王筠,谢荃,黄斌,等.中风醒脑口服液治疗急性脑出血致脑心综合征临床观察[J].成都中医药大学学报,2010,33(3)27-29.
[85]任继学.悬壶漫录[M].北京：北京科学技术出版社,1990：203-210.
[86]Bamford J,Sandercock P, Dennis M,et al.Classfication and natural history of clinical identifiable subtypes of cerebral infarction.Lancet,1991,337:1521.
[87]Cucchiara B,Messe S,Sansing L,et al.Hematoma growth in oral anticoagulant related intracerebral hemorrhage [J].Stroke,2008,39(11)2993-2996.
[88]Davis SM,Broderick J,Hennerici M,et al.Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage.Neurology,2006,66(8):1175-1181.
[89]曾进胜,黄如训.高血压动脉硬化性混合性中风的实验病理学研究[J].中国神经精神疾病杂志,1992,18(6)：340-342.
[90]黄如训.脑出血合并脑梗塞[J].中国神经精神疾病杂志,1988,14(4)：195-197.
[91]黄如训,曾进胜,苏镇培,等.易卒中型肾血管性高血压大鼠模型[J].中国神经精神疾病杂志,1991,17(2)：257-260.
[92]严石林,陈为,于宏波,等.同病异治的理论基础和意义探讨[J].南京中医药大学学报,2012,28(6)：501-503.
[93]刘丽梅,陈琳,王瑞海,等.病证结合方证相应基础研究的现状[J].中国中医基础 医学杂志,2009,15(5)：334-336.
[94]Fisher M,ADAMS RD. Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction [J]. J Neuropathol Exp Neurol,1951,10(1):92-94.
[95]Ott BR, Zamani A,Kleefileld J, et al. The clinical spectrum of hemorrhagic infarction [J]. Stroke,1985,17(4):630-637.
[96]张晓云,张怡.从痰辨证论治脑梗死后出血性转化的临床观察[J].中国中医急症,2012,21(6)：861-862,877.
[97]于晓东.崔金海应用大黄治疗急性中风病经验[J].河北中医,2006,,28(1)：5-6.
[98]韩瑛,吴晓华,张颖琪.脑梗死后出血相关因素的分析[J].临床神经病学杂志,2004,17(1)：50-51.
[99]Berger C, Fionelli M, Steiner T, et al. Hemorrhagic transformation of ischemic brain tissue:asymptomatic or symptomatic[J].Stroke,2001,32,1330-1335.
[100]Derex Derex L,Hermier M,Adeleine P, et al. Neurol Neurosurg Psychiatry,2005,76(1):70-75.
[101]张晓云,张怡,罗晓琼.清金化痰汤治疗脑出血急性期并发肺部感染30例临床疗效观察[J].四川中医,2012,30(6)：83-84.
[102]易松,张晓云.中西医结合治疗脑卒中急性期并发肺部感染疗效观察[J].中国中医急症,2007,16(11)：1314-1315.
[103]Langhorne P, Stott DJ,Robertson L et al. Medical complications after stroke:a multicenter study Stroke,2000,31:1223-1229.
[104]Ovbiagele B, Hills NK, Saver JL,et al. Frequency and determinats of pneumonia and urinary tract infection durning stroke hospitalization.J Stroke Cerebrovasc Dis,2006,15:209-213.
[105]Upadya A, Thorevska N, Sena KN, et al. Predictors and consequences of pneumonia in criticailly ill patients with stroke. J Crit Care,2004,19:16-22.
[106]Addington W R, Stephens RE, Gilliland KA. Assessing the laryngeal COUsh reflex and the risk of developing pneumonia after stroke:an interhospital comparison. Stroke,1999,30(6):1203-1207.
[107]Heros RC. Early pathnphysiology and treatment summary of the Fifty Decade of the Brain Symposium. Stroke.1994,25:1877-1881.
[108]Perry L, Lova CP. Screening for dysphagia and aspiration in acuterstroke:a systeteatic review. Dysphagia,2001,16(1):7-18.
[109]伏平.重症监护患者医院感染分析[J].中华医院感染学杂志,2000,10(4)：271-272.
[110]耿莉华.医院感染控制指南[M].北京：科学技术文献出版社.2004,420-421.
[111]Hamidon BB,Baymondd AA. Risk factors and complications of acute ischaemic stroke patients at Hosptial University Kebangsaan Malaysia(HUKM).Med J Malysia,2003,58:499-505.
[112]Hanchaiphiboolkul S. Rik factors for early infection after an acute cerebral infatcion. J Med Assoc Thai,2005,88:150-155.
[113]Sellars C, Bowie L, Bagg J,et al. Risk factors for chest infection in acute stroke:a prospective cohort study Stroke,2007,382284-2291.
[114]Kammersgaard LP, Jorgensen HS, Reith J, et al. Early infection and prognosis after acute stroke:the Copenhagen Stroke Study. J Stroke Cerebrovasc Dis,2001,10:217-221.
[115]Weimar C, Ziegler A, Konig IR, et al. Predicting functional outcome and survival after acute ischemic stroke. J Neurol,2001,249:888-895.
[116]Aslanyan S, Weir CJ, Diener HC,et al. Pneumonia and urinary tract infection after acute ischaemic stroke:A teriary analysis of the GAIN international trial. Eur J Neuro 1,2004,11:49-53.
[117]Hospital-acquired pneumonia in adults:diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society. November 1995. Am J Respir Crit Care Med,1996,153:1711-1725.
[118]Katzan IL, Cebul RD, Husak SH,et al. The ffect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology,2003,20:620-625.
[119]Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke:implications for neurological intensive care medicine. Stroke,2003,34:975-981.
[120]Vargas M, Horcajada JP, Obach V,et al. Clinical consequences of infection in patients with acute stroke:is it prime time for further antibiolic trial?. Stroke,2006,37:461-465.
[121]Walter U, Knblich R, Steinhagen V,et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol,2007,254,1323-1329.
[122]Vernino S, Brown RD Jr, Sejvar JJ,et al. Csuse-specific mortality after first cerebral infarction. A population-based study. Stroke,2003,34:1823-1832.
[123]王威,陈路燕,刘建平.脑卒中后肺部感染的危险因素与预后[J].中华医院感染学杂志,2007,17：805-806.
[124]Perry L, Love CP. Screening for dysphagia and aspiration in acute stoke:a systematic review. Dysphagia,2001,16:7-18.
[125]Hinchey JA, Shephard T, Furie K,et al. Formal dysphagia screening prptocols prevent pneumonia. Stroke,2005,36:1972-1976.
[126]Nakajob K, Nkagawa T, Sekizawa K,et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med,2000,247:39-42.
[127]Pittock SJ, Meldrum D, Hardiman O,et al. The Oxfordshire Community Stroke Project classification: correlation with imaging,associated complications, and prediction of outcome in acute ischemic stroke. J Stroke Cerebrovasc Dis,2003,12:1-7.
[128]郑天衡,王少石,陈真理等.早期肠内营养支持对急性期卒中患者免疫功能的影响[J].中国脑血管病杂志,2008,3：356-360.
[129]王少石,郑天衡,陈真理等。早期肠内营养支持对急性卒中尽其预后的影响[J].中华内科杂志,2007,46：366-369.
[130]沈一曼.复方三拗汤吸入治疗儿童急性下呼吸道感染的疗效观察与机制探讨[J].浙江中西医结合杂志,1996,6(3)：142.
[131]柴秀娟.复方三拗汤雾化吸入的药效实验研究[J].浙江中医学院学报,1997,(4)：274-26.
[132]刘兴祥.麻黄的药理作用及其临床应用[J].中西医结合杂志,1989,9(4)：255-256.
[133]吴雪荣.麻黄药理作用研究进展[J].中国中医药现代远程教育,2010,8(5)：173.
[134]王艳红,王珊,王杰.浅谈中药苦杏仁的药理作用及其炮制方法[J].中国药业,1999,8(9)：36.
[135]郭建民,田源洪.中药炮制学[M].北京：中医古籍出版社,2003,156-158.
[136]郭书文,王国华,石克华,等。瓜蒌薤白半夏汤降肺动脉高压的试验研究[J].中国中西医结合杂志,1997,17(7)：23-24.
[137]田德禄.中医内科学[M].北京：人民卫生出版社,2006,94-101,401.
[138]蒋文钧.加服苏杏丹清金化痰汤治疗慢性阻塞性肺疾病疗效观察[J].广西中医药,2011,34(6)：16-17.
[139]张峰,王海明,叶甫澄.加味清金化痰汤治疗老年性肺炎临床观察[J].中国中医急症,2012,21(4)：622-623.
[140]叶惠芬,刘平,陈惠玲,等.中药对广州地区肺炎链球菌抑菌作用研究[J].临床医药实践杂志,2006,15(8)：566-568.
[141]姬广伟,刘耀东,孙丽萍,等.清金化痰汤从肺论治重症脑卒中临床观察[J].中国实用医药,2009,16(4)：177-178.
[142]Donnan GA, Davis SM, Chambers BR,et al. Trial of the streptokinase in severe acute ischemic stroke,Lancel,1995,345:578-579.
[143]Fiorelli M, Bastianello S, von Kummer R,et al. Hemorrhagic transfotmation within 36 hours of a cerebral infarct:relationships with early clinical deterioration and 3-month outcome in the European Cooperatinve Acute Stroke Study I (ECASSI) co hort[J].Stroke,1999,30(11)2280-2284.
[144]Tissue plasminogen activator for acute ischemic stroke.The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group[J].N Engl J Med,1995,333(24):1581-1587.
[145]A. K. Gilligan M,FRACP,R. Markus M,et aL Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke[J].Stroke,2002,33(9):2236-2242.
[146]England TJ,Bath PM,Sare GM,et aLAsynptomatic hemorrhagic transformation of infarction and its relationship with functional outcome and stroke subtype assessment from the Tinzaparin in Acute Ischemic Stroke Trial[J].Stroke,2010,41 (12)2834-2839.
[147]Randomised controlled trial of strep tokinase,aspirin,and combination of both in treatment of acute ischaemic stroke.Multicentre Acute Stroke Trial-Italy (MAST) Group. Lancet,1995,12:1509-1514.
[148]Kidwell CS,Saver JL,Carneado J,et al.Predictors of hemorrhagic transformation in patients receiving intra-arterial thro mbo lysis [J]. Stroke,2002,33(3):717-724.
[149]Hacke W, Kaste M, Fieschic, et al Intraevenous thrombolysis with recombinant tissue palsminogen activator for acute hemischemic stroke the Europe Cooperative A cute Stroke Stud y(EC ASS). JAMA,1995,274(13),1017-1025.
[150]Davalos A,Toni D,Iweins F,et aLNeurological deterioration in acute ischemic stroke:potential predictors and associated factors in the European cooperative acute stroke study(ECASS)I [J]. Stroke,1999,30(12):2631-2636.
[151]Hacke W, Kaste M, Fieschic, et al.Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke(ECASS II).Second European-Australasian Acute Stroke Study Investigators[J].Lancet,1998,352:1245-1251.
[152]Jin R, Yang G, Li G. Molecular insights and therapeutic targets for blood-brain barrier disruption in ischemic stroke:critical role of matrix metalloproteinases and tissue-type plasminogen activator[J].Neurobiol Dis,2010,38:376-385.
[153]伊恋,张克玲,张忠玲.组织型纤溶酶原激活剂在部分中枢神经系统中的作用[J].中国临床神经科学,2012,20(2)：228-232.
[154]Tessalu T, Kulla A, Simisker A, et al. Tissue plasminogen activator and neuroserpin are widely expressed in the human central nervous system [J]. Thromb Haemost,2004,92:358-368.
[155]Benchenane K, Lopez-Atalaya JP, Fernandez-Monreal M, er al. Equivocal roles of tissue-type plasminogen activator in stroke-induced injury[J]. Trends Neurosci,2004,27:155-160.
[156]Lochner JE, Honigman LS, Grant WF, et al. Activity-dependent release of tissue plasminogen activator from the dendritic spines of hippocampal neurons revealed by live-cell imaging[J]. J Neurobio 1,2006,66.564-577.
[157]Shin CY, Kundel M, Wells DG. Rapid, activity-induced increase in tissue plasminogen activator is mediated by metabotropic glutamate receptor-dependent mRNA translation[J]. J Neurosci,2004,24:9425-9433.
[158]Melchor JP, Strickland S. Tissue plasminogen activator in central nervous system physiology and pathology[J].Thromb Hsemost.2005,93:655-660.
[159]Andrew B. McGeachie, Lorenzo A. Cingolani, Yukiko Goda. A stabilizing influence:Integrins in reglution of synaptic plasticity [J].Neutosci Res.2011,70:24-29.
[160]Rebola N, Srikumar BN, Mulle C.Activity-dependent synaptic plasticity of NMDAreceptors [J].J Physiol,2010,588:93-99.
[161]Yepes M, Lawrence DA. New function for an old enzyme:n onhemostatic roles for tissue-type plasminogen activator in the central nervous system[J].Exp Biol Med (Maywood),2004,229:1097-1104.
[162]Pang PT, Teng HK, Zaitsey E, Woo NT, et al.Cleavage of proBDNF by tPA/plasmin is essential for long-term hippocampal plasticity [J]. Science,2004,306:487-491.
[163]Nicole O,Docagne F, Ali C,et al. The proteolytic acyivity of tissue-plasminogen activator enhance NMDA receptor-mediated signaling[J].Nat Med,2001,7:59-64.
[164]Samson AL, Medcalf RL. Tissue-type plasminogen activator:a multifaceted modulator of nruotransmission and synaptic plasticity [J].Neuron,2006,50:673-678.
[165]Zhuo M, Holtzman DM. LiY,Osaka H,et al.Role of tissue plasminogen activator receptor LRP in hppocampal long-term potentiation [J]. Neuron,2006,50:673-678.
[166]Klein T, Bischoff RPhysiology and pathophyiology of matrix metalloproteases[J].Amino Acides,2011,41271-290.
[167]Gasche Y,Soccal PM,Kanemitsu,et al. Matrix metalloproteinases and diseases of the central nervous system with a special emphasis on ischemic brain[J].Front Biosci,2006,11:1289-1301.
[168]Hacke W, Kaste M, Bluhmki E,et al.Thrombolysis with alteplase 3 to 5 hours after acute ischemic stroke[J].N Engl J Med,2008,359:1317-1329.
[169]Lo EH, Broderick JP, Moskowitz MA. tPA and proteolysis in the neurovascular unit[J]. Stroke,2004,35:354-356.
[170]Castellanos M,Leria R,serena J,et al. plasma metalloproteinase-9 concentration predicts hemorrhagic transformation in acute ischemic stroke [J].Stroke,2003,34:40-46.
[171]Montaner J, Alvarez-Sabin J,Molina C,et al.Matrix metalloproteinase expression after human cardioembolic stroke:temporal profile and relation to neurological impairment [J].Stroke,2001,32:1759-1766.
[172]Montaner J, Molina CA,Monasterio J,et al.Matrix metalloproteinase-9 pretreatment level predicts intracranial hemorrhagic complications after thrombolysis in human stroke[J].Circulation,2003,107-598-603.
[173]Ramos-Fernandez M,Bellolio MF, Stead LG. Matrix metalloproteincase-9 as a marker for acute ischemic stroke:a systematic review[J].J Stroke Cerebrovasc Dis,2011,20:47-54.
[174]Rosell A, Lo EH. Multiphasic roles for matrix metalloproteinases after stroke[J].Curr Opin Pharmacol,2008,8:82-89.
[175]Tsuji K, Aoki T,Tejima E,et al. Tissue plasminogen activator promotes matrix metallptroteinase-9 upregulation after focal cerebral ischemia [J]. Stroke,2005,36:1954-1959.
[176]Yepes M,Sandkvist M, Moore EG,et al. Tissue-type plasminogen activator induces opening of the blood-brain barrier via the LDL receptor-related protein[J].J Clin Invest,2003,112:1533-1540.
[177]徐铅辉,楮晓凡.脑梗死后出血性转化的研究进展[J].实用医学杂志,2009,25(22)：3904-3906.
[178]Rosell A, Ortega-Aznar A, Alvarez-Sabin J,et al. Increased brain expression of matrix metalloproteinase-9 after ischemic and hemorrhagic human stroke[J]. Stroke,2006,37,(6):1399-1406.
[179]Rosell A, Cuadrado E, Ortega-Aznar A,et al.MMP-9-positive neutrophil infitraton is associated to blood-brain barrier breakdown and basal lamina type Ⅳ collagen degradation during hemorrhagic transformation after human ischemic stroke[J].Stroke,200839(4):1121-1126.
[180]Asahi M,Asahi K,Wang X,et al.Reduction of tissue plasminogen activator-induced hemorrhage and brain injury by free radical spin trapping after embolic focal cerebral ischemia in rats[J].J Cereb Blood Flow Metab,2000,20(3):452-457.
[181]Levy DE, Brott TG, Haley EC Jr, et al. Factors related to intracranial hematoma formation in patients receiving tissue type plsaminogen activiator for acute ischemic stroke [J].Stroke,1994.25:291-297.
[182]Adams HP, Brott TG,Furlan AT,et al. Guidelins For Thrombolysis Therapy for Acute Stroke:a supplement to the guidelines for the management of patients with ischemic stroke [J]. Circu- lation,1996,94:1167-1174.
[183]Baron JC,Kummer R,del ZOPPO, GJ.Treatment of acute ischemic stroke challenging the concept of a rigid and universal time window[J].Stroke,1995,26:2219-2221.
[184]del Zoppo GJ,Hiqashida RT,Rurian AJ,et aLa phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke.PROACT Investigators.Prolyse in Acute Cerebral Thromboembolism[J].Stroke,1998,29(1):4-11.
[185]Larrue V,von Kummer R,del Zoppo GJ,et al. Hemomhagic transformation in acute ischemic stroke potential contributing factors in the Eurpean Cooperative Acute Stroke Study[J]. Stroke,1997,28:957-960.
[186]Lamue V,von Kumme,Muller A,et al.Risk Factors for severe hemorrhagic transformation in ischemic stroke patient is treated with recombinant tissue plasminogen activator: A secondary analysis of the European-Australasian Acute study(ECASS II)[J]. Stroke,2001,32(2):438-441.
[187]The NINDS tPA Stroke Study Group. Intracerebral hemorrhage after intravenous tPA therapy for ischemic stroke[J].Stroke,1997,28(11):2109-2118.
[188]Hacke W,Kaste M,Fieshic et al. Intravenous thromboylysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The Europe Cooperative Acute Stroke Study(EMCASS),JAMA,1995,274:1017-1025.
[189]Castellanos M,Leria R,Serena J,et al.Plasma celluar-fibronecin concentration predicts hemorrhagic transformation after thrombolytic therapy in acute ischemic stroke [J].Stroke,200435(7):1671-1676.
[190]Cocho D,Borrell M,Montaner Joan,et al.Pretreatment hemostatic markers of symptomatic intracerebral hemorrhage in patients treated with tissue plasminogen activator[J].Stroke,2006,37(4):996-999.
[191]Montaner J,Rermandez-Cadenas I,Molina CA,et al.Safety profile of tissue plasminogen activator treantment among stroke patients carrying a common polymorphism(C-1562T) in the promoter region of the matrix metalloproteinase-9 gene[J].Stroke,2003,34(12):2851-2855.
[192]Bang O Y,Saver J L,Alger J R,et al.Patterns and predictors of blood-brain barrier permeability derangements in acute ischemic stroke[J].Stroke,2009,40(2):454-461.
[193]樊东升.新型强效自由基清除剂依达拉奉治疗急性缺血性卒中——从实验室到临床[J].国际脑血管病杂志,2009,17(1)：1-5.
[194]Meier N,Nedultchev K,Brekenfeld C,et al.Prior statin use,intracranial hemorrhage,and outcome after intraarterial thrombolysis for acute ischemic stroke [J]. Stroke,2009,40(5):1729-1737.