Investigate Targeted Factors to Achieve Prediction Goal in Stroke Convalescence in Terms of Causal Relationships of Prediction Error

Background and Purpose: To investigate target functional independence measure (FIM) items to achieve the prediction goal in terms of the causal relationships between prognostic prediction error and FIM among stroke patients in the convalescent phase using the structural equation modeling (SEM) analysis. Methods: A total of 2992 stroke patients registered in the Japanese Rehabilitation Database were analyzed retrospectively. The prediction error was calculated based on a prognostic prediction formula proposed in a previous study. An exploratory factor analysis (EFA) then the factor was determined using confirmatory factorial analysis (CFA). Finally, multivariate analyses were performed using SEM analysis. Results: The fitted indices of the hypothesized model estimated based on EFA were confirmed by CFA. The factors estimated by EFA were applied, and interpreted as follows: “Transferring (T-factor),” “Dressing (D-factor),” and “Cognitive function (C-factor).” The fit of the structural model based on the three factors and prediction errors was supported by the SEM analysis. The effects of the D- and C-factors yielded similar causal relationships on prediction error. Meanwhile, the effects between the prediction error and the T-factor were low. Observed FIM items were related to their domains in the structural model, except for the dressing of the upper body and memory (p < 0.01). Conclusions: Transfer, which was not heavily considered in the previous prediction formula, was found in causal relationships with prediction error. It is suggested to intervene to transfer together with positive factors to recovery for achieving the prediction goal.

Advantages and Suggestions of Scraping to Promote Rehabilitation of COVID-19 Patients in Convalescence

Objective:To demonstrate the advantages of scraping in helping COVID-19 patients in convalescence,popularize scraping therapy among them and provide basis for the establishment of operation specification.Methods:Discuss the relationship between scraping and epidemic disease by reviewing the relevant scraping theory analysis,summarize the existing clinical studies and propose reference scheme for the treatment of COVID-19 patients in convalescence with respect to the related symptoms proving effective treatment of scraping on patients in convalescence.Results:Ancient healers used scraping to treat pestilence,and there have been many clinical trials and experiments for the treatment of convalescent symptoms related to scraping.Scraping also has the effect of improving immune function and antioxidation,which is feasible for the treatment of convalescent symptoms related to scraping.Conclusion:Scraping can effectively improve the clinical symptoms of COVID-19 convalescent patients,and it can be used as one of the external treatments for convalescent patients.It is recommended to promote scraping among the patients so that they can have self-intervention treatment.

Low-grade fever during COVID-19 convalescence:A report of 3 cases

BACKGROUND Low-grade fever during convalescence is an atypical symptom of coronavirus disease 2019(COVID-19).Reports of such cases are rare,and the mechanism and outcome of low-grade fever during COVID-19 convalescence are not completely clear.We report 3 cases with low-grade fever during COVID-19 convalescence and highlight the main clinical,radiographic,and laboratory characteristics,thereby increasing the level of expertise in the clinical management of COVID-19 during convalescence and facilitating individualized decision-making.CASE SUMMARY We describe 3 patients with COVID-19,two females aged 62 and 66 years and a male 55 years,who had low-grade fever during COVID-19 convalescence.All 3 patients had no other discomfort or comorbidities during low-grade process.Lesions on computed tomography in all 3 patients had resolved during this period.Two patients tested negative on two consecutive severe acute respiratory syndrome coronavirus 2 tests with an interval of at least 24 h between tests.Body temperature in all 3 patients returned to normal after several days without treatment,and fever recurrence was not observed.CONCLUSION Enhancing the knowledge of low-grade fever during COVID-19 convalescence may increase the expertise in the delivery of optimal healthcare services.

Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.

Value of individualized active rehabilitation training for neurological functional reconstruction in the convalescence of cerebral hemorrhage

Objective: To explore the value of individualized active rehabilitation training for neurological functional reconstruction in the convalescence of cerebral hemorrhage. Methods: The rehabilitation programs of 120 patients in the convalescence of cerebral hemorrhage were reviewed and used to divide them into the control group (n=71) who received conventional rehabilitation training and the observation group (n=49) who received individualized active rehabilitation training. The differences in serum contents of nerve injury-related indexes, pituitary-thyroid axis function indexes, neurotransmitters and so on were compared between the two groups of patients before rehabilitation and after 3 months of rehabilitation. Results:Before rehabilitation, there was no statistically significant difference in serum contents of nerve injury-related indexes, pituitary-thyroid axis function indexes and neurotransmitters between the two groups. After 3 months of rehabilitation, serum nerve injury-related indexes NSE, MBP and S100β contents of observation group were lower than those of control group;serum pituitary-thyroid axis function index FT3 content was higher than that of control group whereas FT4 and TSH contents were lower than those of control group;serum neurotransmitters Dny-A, SP and Glu contents were lower than those of control group whereas GABA content was higher than that of control group. Conclusion: The individualized active rehabilitation training can effectively optimize the neurological function and reduce the nerve injury in patients in the convalescence of cerebral hemorrhage, and can help the recovery of disease.

Effect of adjuvant Naoxintong capsule therapy on nerve function and inflammatory stress response in patients in convalescence of cerebral infarction

Objective: To explore the effect of adjuvant Naoxintong capsule therapy on nerve function and inflammatory stress response in patients in convalescence of cerebral infarction. Methods:91 patients with cerebral infarction who were treated in our hospital between September 2015 and October 2017 were selected as the research subjects, and the medication during convalescence was reviewed and used to divide all patients into the control group (n=50) who received conventional western medicine treatment and the Naoxintong capsule group (n=41) who received western medicine combined with Naoxintong capsule treatment. The differences in serum levels of nerve function indexes, inflammatory mediators and oxidative stress indexes were compared between the two groups before convalescence medication (T1) and after 1 month of convalescence treatment (T2). Results: At T1, serum levels of nerve function indexes, inflammatory mediators and oxidative stress indexes were not significantly different between the two groups. At T2, serum nerve function indexes Copeptin and α-HBDH levels of Naoxintong capsule group were lower than those of control group whereas BDNF and IGF-1 levels were higher than those of control group;serum inflammatory mediators hs-CRP, YKL-40, IL-6 and IL-18 levels were lower than those of control group;serum oxidative stress index SOD level was higher than that of control group whereas 8-OHdG and MDA levels were lower than those of control group. Conclusion: Adjuvant Naoxintong capsule therapy can be further optimize the nerve function and relieve the inflammatory stress response in patients in convalescence of cerebral infarction.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACU-MOXIBUSTION OF DIFFERENT ACUPOINT GROUPS IN STROKE PATIENTS IN CONVALESCENCE STAGE

Objective: To observe and compare clinical therapeutic effect of acupuncture and moxibustion at different acupoint groups in stroke patients in the convalescence stage. Methods: Sixty stroke patients were evenly randomized into yin-meridian group and yang-meridian group. On the basis of the treatment with Chinese and Western medicines, these stroke patients of two groups were treated mainly by acupuncture of acupoints of yin meridians such as Jiquan (极泉HT 1), Tongli (通里HT 5), Neiguan (内关PC 6), etc., and those of yang meridians as Jianyu (NFDA1 LI 15), Quchi (曲池 LI 11), Shousanli (手三里LI 10), etc. respectively. After 30 days’ treatment, the therapeutic effect was evaluated by using American National Institutes of Health Stroke Scale (NIHSS), Hamilton Depression (HAMD) Rating Scale, Mini-Mental State Examination (MMSE), Barthel Index and Activities of Daily Living (ADL) Scale. Results: Following treatment, the therapeutic effect of yin-meridian group was significantly superior to that of yang-meridian group in improving stroke patients’ neurological deficits [Level B: 50% (15/30) vs 20% (6/30)] and ADL [Level Ⅱ: 40% (12/30) vs 13.3% (4/30)]. No significant difference was found between two groups in the neurological impairment domains. Conclusion: Acu-moxibustion of acupoints of yin meridians is superior to acupoints of yang meridians in improving stroke patients’ neurological impairment and daily living activities.

Effects of Standardized Rehabilitation on Quality of Life of Stroke Patients at Convalescence and Sequelae Stages

Objective:To explore the effects of standardized rehabilitation on quality of life (QOL) of stroke patients at convalescence and sequelae stages. Method:A total of 251 stroke patients were randomly divided into a standardized rehabilitation group and a control group. The simplified Fugl-Meyer assessment(FMA) scale, the 36-item short-form health survey questionnaire (SF-36) and functional comprehensive assessment (FCA) were administered before as well as after 3, 6 and at 12 months a follow-up study respectively. Statistical analysis was conducted based on the evaluations at 4 testing time points. Result:There was no significant difference in FMA,SF-36 and FCA scores of the two groups before and after 3 months treatments, while FMA,SF-36 and FCA scores of the rehabilitation group were obviously higher than those of the control group either after 6 months treatments or of followup study. Moreover, after 6 months treatments FMA score was apparently higher than the score at the beginning and after 3 months treatments. The FMA, SF36 and FAC scores during the followup visit decreased when compared with scores after 6 months treatments, but increased significantly when compared with the scores at the beginning and after 3 months treatments. Conclusion:Standardized tertiary rehabilitation (STR) at convalescence and sequelae stages can significantly improve motor functions and QOL of stroke patients.

Effect of acupuncture combined with drug therapy on the nerve cytokine secretion and oxidative stress in convalescence of cerebral infarction

Objective: To explore the effect of acupuncture combined with drug therapy on the nerve cytokine secretion and oxidative stress in convalescence of cerebral infarction. Methods: A total of 118 patients in convalescence of cerebral infarction who were treated in the affiliated hospital of our school between August 2014 and December 2016 were divided into control group (n=59) and observation group (n=59) according to the random number table method. Control group received routine drug therapy, and the observation group received acupuncture combined with drug therapy. The differences in serum levels of neurotrophic factors, nerve injury factors and oxidative stress indexes were compared between the two groups before and after treatment. Results: The differences in serum levels of neurotrophic factors, nerve injury factors and oxidative stress indexes were not statistically significant between the two groups before treatment. After treatment, serum neurotrophic factors IGF-1, BDNF and NGF levels of observation group were higher than those of control group;nerve injury factors S-100β, NSE, GFAP and UCH-L1 levels were lower than those of control group;oxidative stress indexes MDA, AOPPs and LHP levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group. Conclusion: Acupuncture combined with drug therapy can effectively optimize the nerve function, reduce the nerve injury and suppress the systemic oxidative stress response of patients in convalescence of cerebral infarction.

参麦注射液辅助西药治疗中风恢复期临床研究

目的:观察参麦注射液辅助西药治疗中风恢复期的临床疗效。方法:按随机数字表法将90例中风恢复期患者分为治疗组与对照组各45例。对照组给予阿司匹林肠溶片、胞二磷胆碱注射液、甲钴胺片等西药对症治疗,治疗组在对照组基础上给予参麦注射液治疗。治疗4周后,比较2组临床疗效、中医证候评分、美国国立卫生院神经功能缺损评分(NIHSS)、肢体运动功能Fugel-Meyer评定量表(FMA)及血清炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤细胞因子-α(TNF-α)]水平。结果:治疗后,治疗组总有效率为95.56%,对照组为82.22%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组中医证候评分、NIHSS评分均较治疗前降低(P<0.05),且治疗组2项评分均低于对照组(P<0.05)。治疗后,2组上、下肢的FMA评分均较治疗前升高(P<0.05),且治疗组上、下肢的FMA评分均高于对照组(P<0.05)。治疗后,2组血清IL-1β、IL-6、TNF-ɑ水平均较治疗前降低(P<0.05),且治疗组上述各项指标均低于对照组(P<0.05)。结论:参麦注射液辅助西药治疗中风恢复期患者疗效显著,可有效减轻机体炎症反应,缓解临床症状,改善神经功能及肢体运动功能。

补阳还五汤治疗脑梗死恢复期患者的临床疗效

目的:探究补阳还五汤治疗脑梗死恢复期患者的临床疗效。方法:按照治疗药物不同将84例气虚血瘀型脑梗死恢复期患者分为中药组和常规组,每组各42例。常规组采用常规药物治疗;中药组联合补阳还五汤辅助治疗。比较两组治疗前、治疗4周后的中医症候积分、神经功能、认知功能、肢体运动能力。结果:治疗4周后,两组患者中医症候积分各维度及总分、血清超敏C反应蛋白(hs-CRP)、血栓调节蛋白(TM)水平均低于治疗前,且中药组低于常规组(P<0.05);两组患者血清脱氢表雄酮(DHEA)、脑源性神经营养因子(BDNF)水平、蒙特利尔认知评估量表(MoCA)评分、Fugl-Meyer运动功能评分(FMA)均较治疗前升高(P<0.05),且中药组高于常规组(P<0.05);血清VEGF水平较治疗前降低(P<0.05),但中药组高于常规组(P<0.05)。结论:补阳还五汤可有效改善脑梗死恢复期患者临床症状,提高DHEA、BDNF水平和认知功能,促进肢体运动恢复。

老年大肠癌病人术后康复期生命质量调查分析

目的:分析老年大肠癌病人术后康复期生命质量及其影响因素。方法:采用便利取样法选取5所综合性医院124例直肠癌术后老年病人作为调查对象,调查其术后康复期生命质量。应用大肠癌病人康复期生命质量问卷对老年病人的身体状况、心理状态、社会功能、症状及副反应和自我总评5个领域进行评价。结果:不同性别、年龄、文化程度、子女情况、居住地、居住方式、家庭人均月收入及不同手术后时间、是否造瘘、是否化疗的老年大肠癌病人康复期生命质量总分比较差异均无统计学意义(P>0.05),唯有目前仍从业组与未从业组老年大肠癌病人生命质量总分比较差异有统计学意义(P<0.01)。结论:当地老年大肠癌病人在术后康复期内的总体生命质量较好,除了“是否仍在从业”因素以外,其他不同个体因素和治疗因素的老年大肠癌病人康复期生命质量无明显差异。

火针联合黄芪桂枝五物汤加减治疗脊髓损伤恢复期的临床效果

目的 观察火针联合黄芪桂枝五物汤加减治疗脊髓损伤恢复期的临床效果。方法 选取2021年12月至2023年10月于广西壮族自治区桂林市中医医院康复医学科及老年病科治疗90例脊髓损伤恢复期患者,按照随机数字表法将其分成火针组、中药组、联合组,每组30例。三组均给予常规基础康复训练,火针组增加火针治疗,中药组增加黄芪桂枝五物汤治疗,联合组增加火针联合口服黄芪桂枝五物汤,三组均持续治疗8周。分别于治疗前后进行美国脊柱损伤协会(ASIA)感觉功能评分量表、ASIA运动功能评定量表、日常生活活动能力评定。结果 治疗后,三组ASIA感觉功能评分量表中轻触觉、ASIA感觉功能评分量表中针刺觉、ASIA运动功能评定量表、改良Barthel指数评分高于治疗前,且联合组高于火针组、中药组(P<0.05)。结论 火针联合黄芪桂枝五物汤能显著改善脊髓损伤恢复期患者的感觉功能、运动功能,以及日常生活活动能力。

脑栓通胶囊联合丁苯酞胶囊治疗脑梗死恢复期患者的效果观察

目的观察脑栓通胶囊联合丁苯酞胶囊治疗脑梗死恢复期患者的效果。方法104例脑梗死恢复期患者随机分为两组。除基础药物治疗外,对照组给予丁苯酞胶囊治疗,观察组给予脑栓通胶囊联合丁苯酞胶囊治疗。比较两组的脑血流动力学参数、神经功能和日常生活能力。结果治疗后,两组的RI、PI、NIHSS评分均较治疗前降低,且观察组低于对照组(P<0.05);两组的Vm、BI评分均较治疗前提高,且观察组高于对照组(P<0.05)。结论脑栓通胶囊联合丁苯酞胶囊能够明显改善脑梗死恢复期患者的脑血流动力学参数、神经功能和日常生活能力。

早期精准化运动在急性缺血性脑卒中偏瘫患者运动康复中的作用研究

目的探索对于急性缺血性脑卒中伴偏瘫患者,采取早期精准化运动康复的效果。方法将2023年1月至2023年12月在黄河三门峡医院就诊的178例急性缺血性脑卒中偏瘫患者,根据康复方式的不同,分为观察组(采用早期精准化康复模式)与对照组(采用常规康复模式),每组各89例。比较两组患者运动能力、生活能力、膝关节和髋关节屈曲伸展活动度、神经功能、希望水平及细胞因子水平。结果干预前,两组患者运动和生活能力评分、膝关节和髋关节屈曲伸展活动度、神经功能、希望水平和细胞因子水平均无显著差异(P>0.05);干预后,两组患者以上指标均改善(P<0.05),且观察组运动和生活能力评分、膝关节和髋关节屈曲伸展活动度、神经功能、希望水平和细胞因子水平均显著高于对照组(P<0.05)。结论早期精准化康复可改善急性缺血性脑卒中伴偏瘫患者的运动能力、生活能力、膝关节和髋关节屈曲伸展活动度、神经功能、希望水平及调节神经损伤相关细胞因子水平。

综合护理干预应用于康复期精神分裂症患者的效果分析

目的:分析综合护理干预应用于康复期精神分裂症患者的效果。方法:选取2020年6月—2022年8月江苏省常熟市第三人民医院收治的康复期精神分裂症患者80例作为研究对象,采用随机数字表法分为参照组与试验组,各40例。参照组实施常规护理干预,试验组实施综合护理干预。比较两组护理效果。结果:干预后,两组社会能力、社会兴趣、个人整洁及总积极因素评分高于干预前,且试验组高于参照组,差异有统计学意义(P<0.05);两组激惹、精神病表现、迟缓、抑郁及总消极因素评分低于干预前,且试验组低于参照组,差异有统计学意义(P<0.05)。干预后,两组日常生活能力、动性和交往情况、社会性活动技能评分高于干预前,且试验组高于参照组,差异有统计学意义(P<0.05)。干预后,两组心理社会评分、动力与精力评分、症状和不良反应评分低于干预前,且试验组低于参照组,差异有统计学意义(P<0.05)。结论:综合护理干预应用于康复期精神分裂症患者的效果显著,能够改善患者社会功能,提高生活质量。

火龙罐综合灸联合耳穴压豆对肝肾亏虚型中风(脑梗死恢复期)后失眠患者的护理效果分析

目的 探讨火龙罐综合灸联合耳穴压豆对肝肾亏虚型中风(脑梗死恢复期)后失眠患者的护理效果。方法 随机选取2022年9月—2023年3月潍坊市中医院脑病康复科收治的30例肝肾亏虚型中风(脑梗死恢复期)后的失眠患者为研究对象,依据随机数表法分为观察组和对照组,每组15例。对照组采用耳穴压豆法护理干预,观察组采用火龙罐综合灸联合耳穴压豆法护理干预,比较两组患者护理后睡眠质量、生活质量及护理满意度。结果 护理后,观察组匹兹堡睡眠质量指数评分低于对照组,差异有统计学意义(P<0.05)。观察组脑卒中专门生活质量量表评分高于对照组,差异有统计学意义(P<0.05)。观察组护理满意度为93.33%,高于对照组,差异有统计学意义(P<0.05)。结论 火龙罐综合灸联合耳穴压豆可以提高患者的睡眠质量,提高生活质量。

穴位贴敷联合吞咽障碍治疗仪治疗脑梗死恢复期吞咽障碍临床研究

目的:观察穴位贴敷联合吞咽障碍治疗仪治疗脑梗死恢复期的临床疗效。方法:将150例脑梗死恢复期患者以随机数字表法分为观察组和对照组各75例。观察组给予穴位贴敷联合吞咽障碍治疗仪治疗,对照组仅给予吞咽障碍治疗仪治疗。评估2组临床疗效、吞咽功能及生活质量。结果:观察组总有效率90.67%,高于对照组78.67%(P<0.05)。治疗后,2组洼田饮水试验(WST)分级均改善(P<0.05),且观察组改善效果优于对照组(P<0.05)。治疗后,2组电视X线透视吞咽功能检查(VFSS)评分、功能性经口摄食量表(FOIS)评分、吞咽障碍特异性生活质量量表(SWAL-QOL)评分均升高(P<0.05),且观察组高于对照组(P<0.05);2组标准吞咽功能评价量表(SSA)评分均降低(P<0.05),且观察组低于对照组(P<0.05)。结论:采用穴位贴敷联合吞咽障碍治疗仪治疗脑梗死恢复期吞咽障碍可有效改善患者吞咽功能及摄食能力,提高患者生活质量及临床疗效。

骨骼肌质量和肌肉力量对缺血性脑卒中患者神经功能的预测效能评价

目的 探讨并评价缺血性脑卒中患者骨骼肌质量和肌肉力量对脑卒中后3个月神经功能预后的预测效能。方法 纳入117例缺血性脑卒中患者,根据脑卒中后3个月的改良Rankin量表(mRS)评分分为预后不良组(54例)和预后良好组(63例),比较两组骨骼肌质量、肌肉力量等相关指标的差异。采用Pearson相关分析骨骼肌质量、肌肉力量与mRS评分之间的相关性,采用logistic回归分析ASM/Ht2、握力与神经功能预后之间的关系,同时应用受试者工作特征(ROC)曲线评估其对神经功能预后的预测效能。结果 与预后良好组相比,预后不良组年龄均数较大、国立卫生研究院脑卒中量表(NIHSS)评分均数较高,合并低肌肉质量的患者比例、合并低肌肉力量的患者比例以及同时合并低肌肉质量与低肌肉力量的患者比例均较高;而ASM/Ht2和握力均数则较低,差异均有统计学意义(t分别=3.55、4.94,χ^(2)分别=7.27、20.35、11.51,t分别=-4.40、-9.56,P均<0.05)。ASM/Ht2、握力与mRS评分呈负相关(r分别=-0.56、-0.74,P均<0.05)。多因素logistic回归分析发现,ASM/Ht2和握力大是神经功能预后不良发生的保护因素(OR分别=0.64、0.54,P均<0.05)。ROC分析显示,握力的曲线下面积(AUC)为0.89,明显大于ASM/Ht2的AUC(0.71),差异有统计学意义(Z=3.05,P<0.05)。结论 脑卒中患者发病早期的骨骼肌质量和肌肉力量均与其康复期神经功能不良预后密切相关。骨骼肌质量和肌肉力量对脑卒中患者神经功能预后均具有较好的预测价值,尤其是握力,其预测效能更优。

森田疗法门诊操作规则的专家意见

森田疗法已诞生100余年,住院森田疗法可操作性强、易掌握,通过4期治疗就可改善许多难治神经症,但更多神经症是在门诊治疗,无法使用住院森田疗法,因此门诊操作专家意见的制定尤为重要。本文结合国内外文献,经国内森田疗法专家多次讨论,起草了第1版门诊森田疗法操作的专家意见,制定门诊三阶段的森田疗法操作规则:病因分析阶段,通过森田疗法理论指导,分析发病因素,提高对治疗依从性,降低抵抗;作业阶段,指导患者投入建设性意义行动,实现顺其自然为所当为原则,达到治疗目的;陶冶性格、充实生活阶段,注重正面信息关注,扩大行动范围、内容,提高适应复杂生活的能力,预防因能力不足导致的复发。该规则为国内门诊森田疗法的推广,使更多神经症等心理疾病患者在门诊就可得到森田疗法治疗奠定基础。