Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

Medical Direct Cost of Hospital Admission for Cerebrovascular Accident on Medical Recovery at the Sylvanus Olympio Teaching Hospital of Lomé

Objectives: Appreciate the Medical direct cost for cerebrovascular accident on medical recovery at the Sylvanus Olympio Teaching Hospital of Lomé. Patients and method: This was a prospective and cross study that took place from 01st October 2015 to 31st July 2016 in the medical recovery Unit of Sylvanus Olympio Teaching Hospital of Lomé. Results: Of the 91 stroke patients surveyed, the average age was 55.1 years;the sex-ratio (Men/women) was 1.3 and only 8.8% of patients had benefited from INAM (National Institute of Health Insurance) granting of benefits. The proportion of ICVA was 73.6% compared to 26.4% for the MCVA. The average overall cost of granting benefits of a CVA patient was 312,245 FCFA for an average stay of 18.6 days. This cost was 399.115 FCFA in MCVA for an average stay of 19.0 days against 281.130 FCFA in ICVA for an average stay of 16.1 days. Conclusion: CVAs on the one hand inflict losses of national productivity by its handicap, and a heavy economic burden for both patients and their families on the other hand, by its high cost of granting of benefits;Hence there is the need for assistance of all kinds by national and international health actors.

RESEARCH ON SEQUELAE OF CEREBROVASCULAR ACCIDENT TREATED BY THREE DIFFERENT NEEDLING TECHNIQUES

One hundred and sixty cases of sequelae of cerebrovascular accident (CVA) wererandomly divided into three groups: The temporal point group (TG), 58 cases; the scalp acupuncturegroup(SG), 52 cases; the body acupuncture group(BG), 50 cases. It was shown that after 30 treat-ments the curative effects were significantly different (P【0. 01) among the three groups. The effectin TG was better than those in SG and BG. There was no difference in curative effects between SGand BG. It is indicated that all the three needling techniques can improve encephalic blood flow in pa-tients. It seems that the effects of the three needling techniques are as follows: TG】SG】BG.

Predictors of a Cerebrovascular Accident in a Population of Systemic Sclerosis Patients Followed at a Large Academic Center with a Dedicated Scleroderma Center

Aim: The aim of this study is to describe the clinical characteristics of patients with a diagnosis of systemic sclerosis who later suffer a stroke and to identify associations for this relationship. Background: Prior studies have showed an increased risk of cardiovascular disease among patients with chronic inflammatory disorders, with chronic inflammation leading to atherosclerosis believed to be the culprit. Systemic sclerosis (SSc) is a chronic inflammatory disease characterized by diffuse fibrosis of the skin and internal organs. Previous studies have suggested a possible link between systemic sclerosis and macrovascular complications such as stroke. Methods: This is a retrospective chart review of patients treated within the University of Pennsylvania Health System from October 2015 to April 2019 with a diagnosis of SSc. Using ICD10 codes, we identified a cohort of SSc patients who suffered a stroke. Information regarding demographics and stroke risk factors were gathered from the charts of patients with a diagnosis of both SSc plus stroke and compared to a control group of randomly selected patients with SSc who never suffered a stroke. Continuous variables were conveyed using a mean plus a standard deviation. A two-sample t-test was used to compare the two groups of patients. Qualitative variables were compared using a two-tailed Fisher’s exact test. Results: Based on a large cohort of SSc patients (n = 2080) followed between October 2015 and April 2019, we identified 36 SSc patients who developed a subsequent stroke (1.7% of cohort). When looking at risk factors for stroke in SSc patients, we identified hypertension and atrial fibrillation to be associated with the diagnosis of stroke in such patients. Specifically, 28 of the 36 patients with both SSc and stroke also had a diagnosis of hypertension while in the control group, only 17 of 36 patients had hypertension. Atrial fibrillation was seen in 9 of 36 patients with both SSc and CVA while it was seen in only 2 of 36 patients in the control group. Conclusions: This case control study demonstrated that the presence of hypertension and atrial fibrillation had a statistically significant association with the diagnosis of CVA in patients with SSc.

Acupuncture combined with Buyang Huanwu decoction in the treatment of sequelae of cerebrovascular accident:a systematic review and meta-analysis

Background:Cerebrovascular accident has high morbidity,high disability,and high mortality,possibly causing several serious sequelae and bringing a heavy burden to the patient,the family,and the society.Buyang Huanwu decoction,a classic ancient prescription of traditional Chinese medicine,and acupuncture are often used in combination to treat the sequelae of cerebrovascular accident.In the present study,we systematically evaluated the clinical efficacy and safety of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident.Methods:Relevant randomized controlled trials of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident were comprehensively retrieved from electronic databases from inception to May 8,2020,including PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure,WanFang Data,and China Science and Technology Journal Database.The main outcomes of clinical efficacy,degree of nerve function impairment,daily self-care capacity,Fugl-Meyer locomotor function score,life quality score,and occurrence of adverse reactions were subjected to meta-analysis.Results:The 28 randomized controlled trials included 2,341 patients with the sequelae of cerebrovascular accident.Systematic review and meta-analysis indicated that compared with acupuncture alone,its combined treatment with Buyang Huanwu decoction significantly increased clinical efficacy(RR=1.19,95%CI(1.14,1.23),P<0.001),improved nerve function impairment(WMD=−4.89,95%CI(−8.25,−1.53),P=0.004),promoted daily self-care capacity(WMD=15.87,95%CI(11.22,20.51),P<0.001),strengthened Fugl-Meyer locomotor function(WMD=20.89,95%CI(13.79,27.98),P<0.001),enhanced physical functioning(WMD=16.99,95%CI(6.01,27.96),P<0.001)and mental health(WMD=16.91,95%CI(9.14,24.69),P<0.001)in terms of life quality score(SF-36 scale)of patients with sequelae of cerebrovascular accident,with few adverse reactions.Conclusion:Compared with acupuncture alone,its combination with Buyang Huanwu decoction had better comprehensive effects on sequelae of cerebrovascular accident without obvious adverse reactions.

Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation

The purpose of this study was to demonstrate an application of Rasch analysis to identify differences in disability profiles resulting from traumatic brain injury (TBI) and cerebral vascular accident (CVA) and to examine outcome differences between the two groups following post-hospital residential rehabilitation. Participant data were collected from 32 facilities in 16 states. From 2990 neurologically impaired individuals with consecutive admissions from 2011 through 2017, 874 met inclusion criteria: TBI (n = 687) or CVA (n = 187), 18 years or older, minimum length of stay of one month, and maximum chronicity of 1 year. Participants were evaluated at admission and discharge on the Mayo Portland Adaptability Inventory-Version 4 (MPAI-4). Rasch analysis was performed to establish item reliability, construct validity and item difficulty. A Repeated Measures Multivariate Analysis of Covariance (RM MANCOVA) determined group differences and improvement from admission and discharge. Rasch Analysis demonstrated satisfactory construct validity and internal consistency (Person reliability > 0.90, Item reliability > 0.98 for admission and discharge MPAI-4s). Both groups showed significant improvement on the MPAI-4 (p 0.0005). The TBI group was more impaired on the adjustment scale at both admission and discharge (p 0.001). Rasch analysis identified two distinct impairment patterns. CVA participants exhibited deficits characteristic of focal impairment while the TBI group presented with deficits reflective of diffuse impairment. Rehabilitation was shown to be beneficial in reducing disability following neurologic injury in both groups. Importantly, Rasch Analysis accurately produced unique disability profiles that differentiated the treatment groups. This unique statistical technique offers a promising prescriptive hierarchical model for guiding neurological rehabilitation treatment.

颞浅动脉-大脑中动脉分支吻合术治疗闭塞性脑血管疾病的临床效果

目的探讨颞浅动脉-大脑中动脉分支吻合术(STA-MCA)治疗闭塞性脑血管疾病的临床效果。方法纳入我院收治的74例闭塞性脑血管疾病患者,根据随机数字表法分为观察组与对照组,每组37例。对照组患者采用保守治疗,观察组患者采用STA-MCA治疗。术后随访3个月,观察2组治疗前和治疗后第3天、1个月、3个月的脑血流指标(大脑前动脉脑血流量、达峰时间),记录2组患者治疗前和治疗后第3天、1个月改良Rankin评分,统计治疗后血管重建情况和并发症发生情况。结果2组患者治疗后1个月、3个月的大脑前动脉脑血流量均提高,达峰时间均缩短,且观察组患者大脑前动脉脑血流量高于对照组,达峰时间短于对照组,差异有统计学意义(P<0.05)。与治疗前比较,2组患者治疗后1个月改良Rankin评分均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后1个月血管重建为0级、1级的比例低于对照组,2级、3级比例高于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后3个月血管重建为0级、1级比例低于对照组,3级比例高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗后并发症总发生率比较,差异无统计学意义(P>0.05)。结论STA-MCA治疗闭塞性脑血管疾病的临床效果良好,有利于改善脑血流指标,促进神经功能恢复和血管重建,安全可靠。

脑卒中患病影响因素的研究现状

随着脑卒中的发病率逐年升高,给社会、家庭和患者带来了巨大的痛苦、经济压力和社会负担,因而加强其疾病因素的分类、研究和预警,对降低发病率和死亡率具有重要意义。因此,本文从不可控因素(年龄、性别、遗传、环境等)、疾病因素(高血压、糖尿病、高血脂、冠心病、偏头痛等)、个人因素(生活习惯、心理因素、睡眠因素等)、其他因素等方面对脑卒中发病的影响因素进行综述,以期为脑卒中的预防、治疗和护理提供依据。

基于FMEA模型的预见性护理在脑血管介入术患者中的应用

目的研究基于失效模式和效应分析(FMEA)模型的预见性护理在脑血管介入术患者中的应用效果。方法前瞻性选取2021年1月至2023年12月在陕西省第二人民医院拟接受脑血管介入术治疗的102例患者作为研究对象,按随机数表法分为观察组和对照组各51例,对照组患者采用常规护理,观察组患者在对照组护理的基础上采用基于FMEA模型的预见性护理。持续护理至患者出院,比较两组患者的置管时间、卧床时间、住院时间以及ICU入住情况;分别于术前、出院时,比较两组患者的D-二聚体(D-D)、超敏C反应蛋白(hs-CRP)水平;出院时采用自制调查问卷调查两组患者和护理满意度;出院时,统计分析两组患者并发症发生情况,并采用生活质量评价量表(SF-36)评估两组患者术后生活质量恢复情况。结果观察组患者的置管时间、卧床时间、住院时间、ICU入住率分别为(4.67±0.78)d、(3.63±1.74)d、(9.67±1.45)d、3.92%,明显短(低)于对照组的(6.39±1.24)d、(5.53±1.26)d、(13.39±2.25)d、21.57%,差异均有统计学意义(P<0.05);术前,两组患者D-D、hs-CRP比较差异均无统计学意义(P>0.05);出院时,观察组患者的D-D、hs-CRP水平分别为(0.29±0.15)mg/L、(3.48±0.45)mg/L,明显低于对照组的(0.57±0.44)mg/L、(6.97±1.40)mg/L,差异均有统计学意义(P<0.05);出院时观察组患者对护理的总满意度为94.12%,明显高于对照组的80.39%,差异有统计学意义(P<0.05);出院时,观察组患者的并发症总发生率为5.88%,明显低于对照组的29.41%,观察组患者SF-36各项得分明显高于对照组,差异均有统计学意义(P<0.05)。结论基于FMEA模型的预见性护理可显著降低脑血管介入术后患者的并发症发生率,促进改善患者临床结局,提升患者护理满意度。

Aspirin interruption before neurosurgical interventions:A controversial problem

Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.

Information-motivation-behavioral guided nursing for stroke patients with pulmonary dysfunction:A randomized controlled trial

BACKGROUND Patients with stroke frequently experience pulmonary dysfunction.AIM To explore the effects of information-motivation-behavioral(IMB)skills modelbased nursing care on pulmonary function,blood gas indices,complication rates,and quality of life(QoL)in stroke patients with pulmonary dysfunction.METHODS We conducted a controlled study involving 120 stroke patients with pulmonary dysfunction.The control group received routine care,whereas the intervention group received IMB-model-based nursing care.Various parameters including pulmonary function,blood gas indices,complication rates,and QoL were assessed before and after the intervention.RESULTS Baseline data of the control and intervention groups were comparable.Post-intervention,the IMB model-based care group showed significant improvements in pulmonary function indicators,forced expiratory volume in 1 sec,forced vital capacity,and peak expiratory flow compared with the control group.Blood gas indices,such as arterial oxygen pressure and arterial oxygen saturation,increased significantly,and arterial carbon dioxide partial.pressure decreased significantly in the IMB model-based care group compared with the control group.The intervention group also had a lower complication rate(6.67%vs 23.33%)and higher QoL scores across all domains than the control group.CONCLUSION IMB model-based nursing care significantly enhanced pulmonary function,improved blood gas indices,reduced complication rates,and improved the QoL of stroke patients with pulmonary dysfunction.Further research is needed to validate these results and to assess the long-term efficacy and broader applicability of the model.

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.

重症脑血管病患者早期气管切开的护理关键要素探究

目的 分析重症脑血管病患者在针对早期气管切开时的护理要素。方法 本研究便利选取2021年10月—2023年5月济南市济阳区中医院收治的91例行早期气管切开的重症脑血管病患者为研究对象。依据护理方法分为两组,对照组(n=45)采用常规护理模式,观察组(n=46)采用综合护理模式,比较两组患者的生活质量、并发症发生情况和护理满意度。结果 护理前,两组患者生活质量评分比较,差异无统计学意义(P>0.05);护理后,观察组生活质量评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为4.35%,低于对照组的20.00%,差异有统计学意义(χ^(2)=5.244,P<0.05)。观察组护理总满意度为97.83%,高于对照组的82.22%,差异有统计学意义(χ^(2)=4.587,P<0.05)。结论 针对重症脑血管病患者早期气管切开时采用综合护理可以提高患者的生活质量,减少患者并发症发生,进一步提高患者的满意度。

综合性康复疗法治疗脑血管意外偏瘫的临床疗效评价

目的分析脑血管意外偏瘫患者使用综合性康复疗法的临床疗效。方法方便选择宁津县人民医院于2021年8月—2023年6月收治的106例脑血管意外偏瘫患者作为研究对象,以随机数表法分为对照组和观察组,每组53例。对照组采用常规康复疗法,观察组采用综合性康复疗法,对比两组临床疗效、肢体运动功能评分、日常生活能力评分、神经功能缺损程度评分。结果治疗后,观察组临床总疗效(94.34%)高于对照组(79.25%),差异有统计学意义(χ^(2)=5.267,P<0.05);观察组肢体运动功能评分、日常生活能力评分、神经功能缺损程度评分均优于对照组,差异有统计学意义(P均<0.05)。结论综合性康复疗法对于提升脑血管意外偏瘫的临床疗效具有重要作用,且可以提升患者肢体运动功能、日常生活能力,改善神经功能缺损问题。

血清Hcy及FGF-23预测血液透析治疗尿毒症合并高血压患者并发心脑血管事件的价值

目的分析血清同型半胱氨酸(Hcy)、成纤维细胞生长因子-23(FGF-23)预测血液透析治疗尿毒症合并高血压患者并发心脑血管事件的价值。方法回顾性分析,选取2019年2月至2022年12月在黄石市中医医院收治的98例行血液透析治疗的尿毒症合并高血压患者的临床资料,其中男58例、女40例,年龄53~76(64.18±5.39)岁;另收集患者血清Hcy、FGF-23等临床资料,随访1年。统计随访期间患者发生心脑血管事件情况,采用t检验、χ^(2)检验及logistic回归分析影响血液透析治疗尿毒症合并高血压患者心脑血管事件发生的因素,并绘制受试者操作特征曲线(ROC)分析Hcy与FGF-23预测其发生心脑血管事件的价值。结果98例行血液透析治疗的尿毒症合并高血压患者中,有37例(37.76%)出现心脑血管事件,其余61例(62.24%)未出现心脑血管事件。两组患者性别、年龄、体质量指数、吸烟史、饮酒史、心率、高血压病程、收缩压、舒张压、降压药物使用种类、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、前白蛋白、转铁蛋白、尿素氮、肌酐、尿酸、血清丙氨酸转氨酶、γ-谷氨酰转移酶、血钙、血磷、总尿素清除指数、血甲状旁腺素、左室射血分数比较,差异均无统计学意义(均P>0.05);心脑血管事件组透析龄、血白蛋白、低密度脂蛋白胆固醇、尿白蛋白排泄率、红细胞分布宽度、Hcy、FGF-23均高于非心脑血管事件组[(4.83±0.81)年比(4.39±0.58)年、(36.33±5.08)g/L比(32.66±5.39)g/L、(3.59±0.75)mmol/L比(3.25±0.35)mmol/L、(38.77±4.43)mg/24 h比(35.54±4.41)mg/24 h、(15.59±2.19)%比(13.21±1.16)%、(18.82±2.31)μmol/L比(14.46±2.20)μmol/L、(189.71±32.69)ng/L比(154.59±27.68)ng/L],估算肾小球滤过率(eGFR)低于非心脑血管事件组[(40.56±7.12)ml/min/1.73m2比(46.37±6.23)ml/min/1.73 m2],差异均有统计学意义(t=3.126、3.388、3.043、3.509、7.303、9.333、5.683、4.239,均P<0.05)。logistic多因素回归分析显示,透析龄、Hcy、FGF-23、eGFR水平是影响血液透析治疗尿毒症合并高血压患者心脑血管事件发生的因素(均P<0.05)。ROC分析结果显示,Hcy、FGF-23及二者联合预测血液透析治疗尿毒症合并高血压患者发生心脑血管事件的灵敏度分别为71.68%、76.57%、78.04%,特异度分别为78.59%、74.31%、89.36%,曲线下面积(AUC)分别为0.768、0.745、0.886。结论血清Hcy、FGF-23水平与血液透析治疗尿毒症合并高血压患者并发心脑血管事件有关,Hcy、FGF-23处于高水平时心脑血管事件发生风险更高,二者联合预测血液透析治疗尿毒症合并高血压患者并发心脑血管事件效能较高。

中医情志护理在脑血管局部麻醉介入患者术中的效果观察

目的 探究脑血管局部麻醉介入术者的护理,分析中医情志护理效果。方法 选择2022年6月至2023年8月阳春市中医院脑病科进行脑血管局部麻醉介入术患者100例为研究对象,随机分为两组,对照组50例,采用术中常规护理,观察组50例,采用术中中医情志护理,统计患者的负性情绪、并发症、疼痛评分、舒适度、满意度,实施比较分析。结果 护理后对照组负性情绪、并发症总发生率、疼痛评分高于观察组,差异有统计学意义(P <0.05)。护理后观察组舒适度评分、满意度高于对照组,差异有统计学意义(P <0.05)。结论 脑血管局部麻醉介入术中施以中医情志护理,效果显著,负性情绪、术后并发症减少,疼痛症状减轻,舒适度及满意度提高,应用价值显著。

细节干预联合优质护理对脑血管意外后遗症患者生活质量、负面情绪的影响

目的探讨针对脑血管意外后遗症患者,采用细节干预联合优质护理的效果。方法抽取2021年5月—2023年5月江苏省无锡市康复医院收治的80例脑血管意外后遗症患者作为研究对象,依据随机数表法将其分为干预组和对照组,各40例,其中对照组给予常规护理干预措施,干预组给予细节干预+优质护理干预,采用焦虑(SAS)和抑郁(SDS)自评量表评价患者的心理状态,采用SF-36量表评估患者治疗后的生活质量,比较两组患者护理满意度。结果护理前两组患者的SAS、SDS评分比较,差异无统计学意义(P>0.05),护理干预后两组患者的SAS、SDS评分均降低,且干预组的SAS、SDS评分低于对照组,差异有统计学意义(P<0.05);护理前两组患者的生理功能、生理职能、躯体疼痛、活力评分比较,差异无统计学意义(P>0.05),干预后两组患者的生理功能、生理职能、躯体疼痛、活力评分均降低,且干预组的以上维度评分均高于对照组,差异有统计学意义(P<0.05);干预组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论脑血管依赖后遗症,在治疗过程中联合细节干预、优质护理,可显著提高治疗的效果,帮助病人减轻负面情绪,提高生活水平,应用价值显著。

侧卧位直接前路全髋关节置换治疗伴有偏瘫的股骨颈骨折的近期疗效观察

目的观察侧卧位直接前路(direct anterior approach,DAA)人工全髋关节置换手术治疗脑血管意外患者偏瘫侧股骨颈骨折的近期疗效。方法回顾性分析亳州市人民医院骨科2018年1月—2020年8月收治的因脑血管意外而致偏瘫侧肢体发生股骨颈骨折的患者57例,按入院后不同治疗分为DAA组和后外侧入路组。DAA组29例采用侧卧位DAA人工全髋关节置换手术治疗,男性15例,女性14例;年龄57~70岁,平均68.3岁;道路交通伤9例,摔伤15例,高处坠落伤5例。后外侧入路组28例采用常规后外侧入路人工全髋关节置换手术,男性14例,女性14例;年龄63~69岁,平均66.6岁;道路交通伤9例,摔伤14例,高处坠落伤5例。观察记录两组患者伤口长度、手术时间、术中失血量、住院时间,术后3、7d疼痛视觉模拟评分(visual analogue scale,VAS),术前及术后1、3、6、16个月随访时髋关节功能评分、手术并发症等,评定侧卧位DAA入路髋关节置换对偏瘫侧肢体股骨颈骨折治疗的安全性和有效性。结果患者均顺利完成手术,DAA组较后外侧入路组切口长度短[(9.32±2.23)cm vs.(11.1±2.43)cm]、手术时间长[(79.3±8.9)min vs.(72.2±8.7)min]、术中出血量少[(181.6±34.2)mL vs.(211.3±42.2)mL]、住院天数少[(7.3±1.3)d vs.(8.9±1.5)d],比较差异有统计学意义(P<0.05)。术后3、7d两组VAS比较差异有统计学意义(Z=-2.357,P=0.018;Z=-2.576,P=0.010)。患者均门诊随访8~16个月,DAA组患者术后1、3个月随访髋关节评分显著优于后外侧入路组(P<0.05),但术后6、16个月两组数据差异无统计学意义(P>0.05)。DAA组2例患者伤口渗液,其余伤口正常愈合;所有患者正常活动均无脱位,无深部组织及假体感染。后外侧入路组患者1例术后2个月假体感染,4例患者术后3个月内活动时脱位。末次随访两组患者X线片未见假体松动现象。结论侧卧位DAA全髋关节置换手术治疗因脑血管意外致偏瘫侧肢体股骨颈骨折创伤小,住院时间短,术后恢复快,值得临床推广应用。

临床护理路径在脑血管病介入患者中的应用效果观察

目的:探讨临床护理路径在脑血管病介入患者护理中的应用效果。方法:选择2020年1月—2021年12月于扬州市江都人民医院进行脑血管病介入治疗的200例患者,以随机数表法分为对照组(n=100,常规护理)与观察组(n=100,临床护理路径干预),比较两组治疗时间及成本,采用焦虑/抑郁自评量表(SAS/SDS)评价患者干预前后负性情绪,出院前采用自制调查问卷评估患者满意度,并统计两组并发症发生率。结果:观察组术前等候时间、住院时间均短于对照组,医疗成本小于对照组(P<0.05)。干预后,两组SAS、SDS评分较干预前均降低,且观察组均低于对照组(P<0.05)。观察组并发症发生率为4.00%,低于对照组的19.00%(P<0.05)。观察组健康教育、服务态度、沟通能力、工作计划、专业能力评分均高于对照组(P<0.05)。结论:对脑血管病介入手术者采用临床护理路径干预能有效改善治疗情况,降低医疗成本,可减轻患者负性情绪,降低并发症风险,提升护理质量,并可提高患者满意度。

卵巢癌并发急性缺血性脑卒中患者的急救护理

总结1例卵巢癌患者并发急性缺血性脑卒中的护理体会。针对患者脑卒中症状不典型、需短时间明确诊断和启动溶栓治疗等问题,护士及时启动快速反应团队、主导多学科合作;溶栓期间加强出血风险监测及管理;新辅助化疗期间重点防范梗死;进行分阶段康复训练,促进肢体康复。经过精心护理,顺利出院。后续及时、足量完成化疗择期行手术治疗,随访3个月,患者状况良好。