目的探讨丁苯酞序贯治疗急性脑梗死并大脑中动脉血流轻中度增快患者的疗效。方法选取2018年1月至2021年10月武汉科技大学附属孝感医院收治的急性脑梗死并大脑中动脉血流轻中度增快患者92例进行回顾性分析,采用随机数字表法分为研究组和...目的探讨丁苯酞序贯治疗急性脑梗死并大脑中动脉血流轻中度增快患者的疗效。方法选取2018年1月至2021年10月武汉科技大学附属孝感医院收治的急性脑梗死并大脑中动脉血流轻中度增快患者92例进行回顾性分析,采用随机数字表法分为研究组和对照组,对照组给予静脉滴注丁苯酞氯化钠注射液治疗,研究组静脉滴注丁苯酞氯化钠注射液结束后继续口服丁苯酞软胶囊。比较两组患者基线临床资料、血流动力学、神经功能及临床转归。在治疗后90 d随访时采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、日常生活自理能力自评量表(activity of daily living scale,ADL)及改良Rankin量表(mRS)评估临床转归,应用经颅多普勒超声(TCD)评估血流动力学变化。结果共有92例患者按照要求完成所有观察指标,其中研究组48例,对照组44例。两组人口统计学、血管危险因素、实验室检查、NIHSS评分、ADL评分及病变大脑中动脉血流动力学差异均无统计学意义(均P>0.05)。治疗后90 d,研究组患者NIHSS评分[(4.00±1.95)分比(4.91±2.08)分;t=-2.16,P=0.033]、ADL评分[(82.71±9.56)分比(76.25±11.47)分;t=2.94,P=0.004]及转归良好率[70.83%(34/48)比50.00%(22/44);χ^(2)=4.18,P=0.041]较对照组显著改善;研究组患者病变大脑中动脉收缩期峰值血流速度(systolic velocity,Vs)[(152.33±9.58)cm/s比(157.41±11.77)cm/s;t=2.27,P=0.025]及平均血流速度(mean velocity,Vm)[(90.00±8.30)cm/s比(94.45±9.07)cm/s;t=-2.46,P=0.016]较对照组差异均有统计学意义,搏动指数(pulsitility index,PI)[(0.97±1.06)比(1.01±1.21);t=1.69,P=0.093]差异无统计学意义。与转归不良组比较,转归良好组患者出院后NIHSS评分及ADL评分均降低(均P<0.001),且转归良好组患者采用序贯疗法比例更高[60.70%(34/56)比38.90%(14/36);χ^(2)=4.18,P=0.041]。结论丁苯酞序贯疗法治疗急性脑梗死并大脑中动脉血流轻中度增快患者,能改善神经功能缺损,促进神经功能恢复,改善病变血管的血流动力学,并对患者日常生活活动能力有显著改善作用。展开更多
Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the...Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction（stroke group） in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers（control group） were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90（SCL-90）, the social support by the Social Support Rating Scale（SSRS）, and medication adherence by Morisky＇s self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group（P〈0.01）. Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions（including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety） of SCL-90 were significantly higher in the stroke group than those in the control group（P〈0.05, or P〈0.01）. The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group（P〈0.05, or P〈0.01）. Those in the ＂SCL-90 total scores 〉150 group＂ were significantly higher than in the ＂SCL-90 total scores 〈100 group＂ and the ＂SCL-90 total scores between 100 to 150 group＂（P〈0.05, or P〈0.01）. Those in the ＂SCL-90 total scores between 100 to 150 group＂ were significantly higher than in the ＂SCL-90 total scores 〈100 group＂（P〈0.05）. In 90 patients with ischemic stroke, 26（28.89%） patients obtained high medication adherence, 47（52.22%） patients medium medication adherence, and 17（18.89%） patients low medication adherence, respectively. Among these stroke patients, there were 17（50.00%） patients with high medication adherence in the ＂SCL-90 total scores 〉150 group＂, 28（75.67%） patients with medium medication adherence in the ＂SCL-90 total scores between 100 to 150 group＂, and 12（61.16%） patients with low medication adherence in the ＂SCL-90 total scores 〈100 group＂, respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients（P〈0.05 or P〈0.01）. It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.展开更多
文摘目的探讨丁苯酞序贯治疗急性脑梗死并大脑中动脉血流轻中度增快患者的疗效。方法选取2018年1月至2021年10月武汉科技大学附属孝感医院收治的急性脑梗死并大脑中动脉血流轻中度增快患者92例进行回顾性分析,采用随机数字表法分为研究组和对照组,对照组给予静脉滴注丁苯酞氯化钠注射液治疗,研究组静脉滴注丁苯酞氯化钠注射液结束后继续口服丁苯酞软胶囊。比较两组患者基线临床资料、血流动力学、神经功能及临床转归。在治疗后90 d随访时采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、日常生活自理能力自评量表(activity of daily living scale,ADL)及改良Rankin量表(mRS)评估临床转归,应用经颅多普勒超声(TCD)评估血流动力学变化。结果共有92例患者按照要求完成所有观察指标,其中研究组48例,对照组44例。两组人口统计学、血管危险因素、实验室检查、NIHSS评分、ADL评分及病变大脑中动脉血流动力学差异均无统计学意义(均P>0.05)。治疗后90 d,研究组患者NIHSS评分[(4.00±1.95)分比(4.91±2.08)分;t=-2.16,P=0.033]、ADL评分[(82.71±9.56)分比(76.25±11.47)分;t=2.94,P=0.004]及转归良好率[70.83%(34/48)比50.00%(22/44);χ^(2)=4.18,P=0.041]较对照组显著改善;研究组患者病变大脑中动脉收缩期峰值血流速度(systolic velocity,Vs)[(152.33±9.58)cm/s比(157.41±11.77)cm/s;t=2.27,P=0.025]及平均血流速度(mean velocity,Vm)[(90.00±8.30)cm/s比(94.45±9.07)cm/s;t=-2.46,P=0.016]较对照组差异均有统计学意义,搏动指数(pulsitility index,PI)[(0.97±1.06)比(1.01±1.21);t=1.69,P=0.093]差异无统计学意义。与转归不良组比较,转归良好组患者出院后NIHSS评分及ADL评分均降低(均P<0.001),且转归良好组患者采用序贯疗法比例更高[60.70%(34/56)比38.90%(14/36);χ^(2)=4.18,P=0.041]。结论丁苯酞序贯疗法治疗急性脑梗死并大脑中动脉血流轻中度增快患者,能改善神经功能缺损,促进神经功能恢复,改善病变血管的血流动力学,并对患者日常生活活动能力有显著改善作用。
文摘Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction（stroke group） in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers（control group） were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90（SCL-90）, the social support by the Social Support Rating Scale（SSRS）, and medication adherence by Morisky＇s self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group（P〈0.01）. Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions（including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety） of SCL-90 were significantly higher in the stroke group than those in the control group（P〈0.05, or P〈0.01）. The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group（P〈0.05, or P〈0.01）. Those in the ＂SCL-90 total scores 〉150 group＂ were significantly higher than in the ＂SCL-90 total scores 〈100 group＂ and the ＂SCL-90 total scores between 100 to 150 group＂（P〈0.05, or P〈0.01）. Those in the ＂SCL-90 total scores between 100 to 150 group＂ were significantly higher than in the ＂SCL-90 total scores 〈100 group＂（P〈0.05）. In 90 patients with ischemic stroke, 26（28.89%） patients obtained high medication adherence, 47（52.22%） patients medium medication adherence, and 17（18.89%） patients low medication adherence, respectively. Among these stroke patients, there were 17（50.00%） patients with high medication adherence in the ＂SCL-90 total scores 〉150 group＂, 28（75.67%） patients with medium medication adherence in the ＂SCL-90 total scores between 100 to 150 group＂, and 12（61.16%） patients with low medication adherence in the ＂SCL-90 total scores 〈100 group＂, respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients（P〈0.05 or P〈0.01）. It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.
文摘目的探讨急性缺血性卒中患者早期神经功能恶化（early neurologic deterioration，END）的危险因素。方法回顾性纳入急性缺血性卒中患者，收集患者的临床资料和实验室检查结果。根据发病后7d内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分变化分为END组与非END组，END定义为NIHSS评分较基线水平增加≥3分。采用多变量logistic回归分析确定急性缺血性卒中患者END的独立危险因素。结果共纳入328例急性缺血性卒中患者，其中74例（22．6％）发生END，254例（77．4％）未发生END。END组男性、高血压、既往卒中或短暂性脑缺血发作史、脑干或小脑梗死、人院前使用抗高血压药的患者构成比以及人院前收缩压均显著高于非END组（P均〈0．05），白细胞计数、中性粒细胞百分比、低密度脂蛋白胆固醇、空腹血糖、高半胱氨酸、C反应蛋白和纤维蛋白原水平均显著高于非END组（P均〈0．05）。多变量logistic回归分析显示，白细胞计数[优势比（oddsratio，OR）2．126，95％可信区间（confidence interval，CI）1．240～4．325）；P=0．028]、低密度脂蛋白胆固醇（OR2．486，95％CI 1．932～6．021；P=0．036）、高半胱氨酸（OR2．787，95％CI1．194～6．902；P=0．036）和C反应蛋白（OR3．416，95％CI1．552～10．650；P=0．032）较高是急性缺血性卒中患者发生END的独立预测因素。结论白细胞计数、低密度脂蛋白胆固醇、高半胱氨酸和C反应蛋白较高是急性缺血性卒中患者END的独立预测因素。
