Risk Factors Affecting Ischemic Stroke: A Potential Side Effect of Antihypertensive Drugs

Background: Stroke is a worldwide health problem, the world’s second-leading cause of death and third-leading cause of disability. Currently, the majority of stroke patients are ischemic stroke patients. It is necessary to evaluate risk factors to prevent ischemic stroke. Data and Methods: The risk factors for stroke in the previous fiscal year were analyzed. They were divided into nonmodifiable and modifiable factors. The probit and ordered probit models were used in the study, with 59341 and 50542 observations used in the estimation of the models, respectively. Results: Among the nonmodifiable factors, age, gender and cerebrovascular disease history are important risk factors. The history of cerebrovascular diseases is considered to be an especially important factor. Among the modifiable factors, taking antihypertensive drugs and recent large weight change are negative risk factors;however, sleeping well significantly reduces the probability of ischemic stroke. Conclusion: It is very important to ensure that medical personnel know a patient’s history of cerebrovascular diseases for proper treatments. Ischemic stroke might be considered an important side effect of antihypertensive drugs. Limitations: The dataset was observatory. There are various types of antihypertension drugs, and their effects are not analyzed.

Comprehensive therapeutic effect of the stroke rehabilitation unit in a medium-sized comprehensive community hospital

BACKGROUND： Acute stroke unit （stroke care unit） is developing in some domestic large-sized hospitals, but most stroke patients need stroke rehabilitation unit therapy, so setting stroke rehabilitation unit in medium-sized comprehensive community hospital （secondary hospital）, where medical facility is relatively insufficient, is a new pathway to satisfy stroke patients. OBJECTIVE： To observe the comprehensive effect of developing stroke rehabilitation unit based on the facility of secondary hospital and its feasibility. DESIGN： Non-randomized concurrent controlled observation SETTING： Department of Neurology, Beijing Longfu Hospital PARTICIPANTS： Totally 264 stroke reconvalescents who suffered stroke for 7 days and received treatment in the Department of Neurology, Beijing Longfu Hospital during June 2003 to June 2005 were involved in the study. All the involved patients were confirmed by CT or MRI. The patients were scored by using Modified Edinbergh-Scandinavia stroke scale （SSS） 〉 16 points. Written informed consents were obtained from all the patients. The patients were assigned into 2 groups according to the willing of patients and their relatives： （1）treatment group, in which, there were 134 patients, 76 males and 58 females, aged 43 to 74 years; cerebral infarction was found in 116 cases and cerebral hemorrhage in 18 cases;（2） control group, in which, there were 130 patients, 66 males and 64 females, aged 45 to 77 years, cerebral infarction was found in 115 cases and cerebral hemorrhage in 15 cases. There were significant differences in baseline data of the patients between two groups. METHODS： A same basic treatment was conducted in the patients of the two groups. （1） Patients in the treatment group admitted to stroke rehabilitation unit and received comprehensive rehabilitation treatment. The rehabilitation flow-sheet： randomization-letting the patients of treatment group go into the unit-making comprehensive assessment in the initial stage-making therapy plan-talking with patients and their other family members-general rehabilitation-making metaphase assessment-adjusting therapy plan-making final assessment-letting the patients discharge and doing follow-up visits. （2） The patients in the control group admitted to common wards, and they were encouraged to do activities by themselves in the early stage, but did not receive rehabilitation training under the instructions from professional physicians. MAIN OUTCOME MEASURES： The following assessments were conducted on admission and 7 and 28 days after admission： （1） Severity of stroke and motor function： scored as 0 to 45 points by SSS, the higher points, the severer damage. （2）Activities of daily living： Evaluated by Barthel index, 110 points in total, 110 points meant normal, 0 point meant extremely poor. （3）Mental status： evaluated by Hopkin＇s symptom scale with a 5-point scoring. The symptom was scored with low to high points. （4）Cognitive function： Quantification measurement was conducted with LOTCA method. The higher points, the better therapeutic effects. RESULTS： （1） Three cases dropped out and one died in the treatment group, 11 cases dropped out and 4 died in the control group. （2）The neurologic impairment points on 7 and 28 days after therapy in the treatment group were lower than those in the control group separately [7 days：（9.73±6.43） points vs. （12.63± 7.87） points, t =2.28, P〈 0.05;28 days：（7.88±4.81） points vs. （9.84±7.03）points, t =2.04, P〈 0.05]. Barthel index on 7 and 28 days after therapy in the treatment group were higher than those in the control group separately [7 days：（54.28±8.38） points vs. （39.76±7.31） points, t =2.206, P 〈 0.05; 28 days： （89.72±7.94） points vs. （67.34±8.63） points, t =2.812, P 〈 0.01]. （4） Patients were allocated into different age groups based on age and evaluated with LOTCA. Results showed that there were no significant differences among different age groups （P 〉 0.05）. （5） Totally 160 patients in the two groups accomplished the Hopkin＇s test, among them, 94 （58.7%） had different mental disorders; Among the patients with mental disorder, depression, obsessive-compulsive and anxiety were found mostly, being 53.8%, 52.5% and 46.2%, respectively. CONCLUSION： （1） Developing stroke rehabilitation unit therapy in the secondary hospital can obviously improve the motor function and activities of daily living of stroke reconvalescents. （2） More than half of the stroke reconvalescents accompany the symptoms of depression, obsessive-compulsive, anxiety and other mental disorders. （3） The cognitive function of stroke reconvalescents is not related to age.

Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study

Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui（GV20） and Taiyang（EX-HN5）. We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave（Hmax/Mmax）, muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of ＂Deficiency and Excess＂. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.

The Promoting Role of TCM Nursing in the Rehabilitation of Stroke Hemiplegia Patients

Objective: To explore the promoting function of TCM nursing in the rehabilitation of hemiplegia patients with stroke. Methods: 78 stroke hemiplegic patients admitted from April 2022 to April 2024 were randomly divided into a control group of 38 cases who received routine care, and an experimental group of 40 cases who received routine nursing basis plus traditional Chinese medicine nursing;the nursing effects of the two groups of patients were compared. Results: After 12 days of nursing care, the experimental group showed better psychological status [SAS score (21.71 ± 3.21), SDS score (22.18 ± 2.31)], limb motor function, daily living ability, and neurological function [NIHSS score (12.23 ± 2.21)] than the control group, with significant differences in data (P Conclusion: Traditional Chinese medicine nursing for stroke hemiplegia patients is more conducive to promoting rehabilitation than routine nursing.

用AE中的Stroke(描边)特效以及图层遮罩功能制作动态流程示意图

AE界面中,通过添加固态层,并在这个层上绘制出动态的路径,如果在这个路径上添加了Stroke(描边)特效,那么stoke滤镜会自动将路径选定为描边的对象,通过对路径的color(颜色),brush size(笔刷尺寸),brush hardness(笔刷硬度),opacity(不透明度),spacing(间距、绘制连续线段),paint style(绘制类型)等一系列调整,以及设置开始/结束关键帧,就可以实现路径演示的动态特效.

绿道专职护士主导的急性缺血性脑卒中静脉溶栓救治模式的应用

目的探讨绿道专职护士主导的急性缺血性脑卒中(acute ischemic stroke,AIS)溶栓救治模式的应用效果。方法选取2021年3月—2023年2月深圳市某三级甲等综合医院急诊科收治的124例AIS静脉溶栓治疗患者为研究对象。其中2021年3月—2022年2月61例AIS患者为对照组,采用常规救治模式接诊溶栓;2022年3月—2023年2月的63例AIS患者为干预组,采用以绿道专职护士为主导的模式接诊溶栓。比较两组患者入院至完成CT所用时间、溶栓知情同意谈话时间、入院至静脉溶栓开始时间(door to needle time,DNT)、DNT 60min达标率、溶栓前后美国国立卫生院卒中量表(national institute of health stroke scale,NIHSS)评分及患者就诊满意度。结果干预组入院至完成CT检查所用时间、溶栓知情同意谈话时间、DNT均短于对照组,干预组DNT 60min达标率高于对照组,溶栓前后干预组NIHSS评分降幅较对照组大,两组比较,差异具有统计学意义(均P<0.05)。干预组患者就诊满意度高于对照组,两组比较,差异具有统计学意义(P<0.05)。结论以绿道专职护士为主导的AIS静脉溶栓救治模式可有效缩短患者入院至完成CT检查所用时间、溶栓知情同意谈话时间、DNT时间,降低患者NIHSS评分,提高DNT 60 min达标率及患者就诊满意度。

盐酸替罗非班在进展性大动脉粥样硬化型脑梗死患者中的临床应用

目的观察盐酸替罗非班注射液在治疗进展性大动脉粥样硬化型脑梗死患者中的疗效及其安全性。方法选择68例符合进展性大动脉粥样硬化型脑梗死标准的患者,将其随机分成常规治疗组和盐酸替罗非班治疗组,其中常规治疗组给予强化抗血小板及强化降脂药物等治疗,盐酸替罗非班组在加重24 h内给予盐酸替罗非班注射液(100 mL∶5 mg)静脉泵入[前半小时以0.4μg/(kg·min^(-1))速率泵入,半小时后以0.1μg/(kg·min^(-1))速率泵入],记录进展加重后24 h及7 d内2组患者卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分,并记录药物不良反应、有无出血等情况。结果2组患者在治疗后24 h NIHSS评分比较差异无统计学意义(P>0.05)。盐酸替罗非班组和常规治疗组在治疗后7 d NIHSS评分比较差异有统计学意义(P<0.05),mRS评分比较差异有统计学意义(P<0.05)。结论盐酸替罗非班静脉泵入可能改善进展性大动脉粥样硬化型脑梗死患者的早期神经功能缺损症状,其改善机制有待进一步研究。

急性期缺血性中风血瘀证患者中医护理的应用效果观察

目的探索活血化瘀中医护理方案对急性期缺血性中风血瘀证患者的应用效果。方法选择2023年12月—2024年5月中国中医科学院西苑医院脑病科住院的缺血性中风血瘀证患者82例,采用随机信封法分为2组,对照组给予常规治疗及中风急性期中医护理方案,观察组在对照组的基础上,根据患者不同血瘀类型给予理气活血、补气活血、祛痰活血、温阳活血中医护理方案,干预时长为2周,对比干预前后2组中医证候分级量化表得分、美国国立卫生研究院卒中量表(NIHSS)得分、日常生活活动能力(ADL)及血瘀证得分。结果干预结束,2组ADL得分(Z=-2.24,P=0.025)、中医证候分级量化表得分(Z=3.102,P=0.036)、NIHSS得分(Z=2.27,P=0.023)、血瘀证得分(Z=-3.309,P=0.036)比较,差异均有统计学意义。结论活血化瘀中医护理可改善缺血性中风血瘀证患者的血瘀状况、神经功能缺损、日常生活活动能力、中医治疗结局。

Serum cystatin C levels are negatively correlated with post-stroke cognitive dysfunction

Stroke is the leading cause of death and long-term disability worldwide,and cognitive impairment and dementia are major complications of ischemic stroke.Cystatin C (CysC) has been found to be a neuroprotective factor in animal studies.However,the relationship between CysC levels and cognitive dysfunction in previous studies has revealed different results.This prospective observational study investigated the correlation between serum CysC levels and post-stroke cognitive dysfunction at 3 months.Data from 638 patients were obtained from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS).Cognitive dysfunction was assessed using the Mini-Mental State Examination (MMSE) at 3 months after stroke.According to the MMSE score,308 patients (52.9%) had post-stroke cognitive dysfunction.After adjusting for potential confounding factors,the odds ratio (95% CI) of post-stroke cognitive dysfunction for the highest quartile of serum CysC levels was 0.54 (0.30–0.98),compared with the lowest quartile.The correlation between serum CysC and cognitive dysfunction was modified by renal function status.We observed a negative linear dose-response correlation between CysC and cognitive dysfunction in patients with normal renal function (Plinearity = 0.044),but not in those with abnormal renal function.Elevated serum CysC levels were correlated with a low risk of 3-month cognitive dysfunction in patients with acute ischemic stroke,especially in those with normal renal function.The current results suggest that CysC is a protective factor for post-stroke cognitive dysfunction,and could be used to treat post-stroke cognitive dysfunction.The CATIS study was approved by the Institutional Review Boards at Soochow University from China (approval No.2012-02) on December 30,2012,and was registered at ClinicalTrials.gov (identifier No.NCT01840072) on April 25,2013.

三乌胶丸对中风后遗症患者临床疗效及神经功能恢复的影响

目的探讨三乌胶丸对中风后遗症患者临床疗效及神经功能恢复的影响。方法选择2020年3月-2022年9月于中南大学湘雅医院住院治疗的中风后遗症患者106例,随机分为西药组与联合中药组,各53例。西药组使用阿司匹林治疗,联合中药组使用阿司匹林联合三乌胶丸治疗。统计2组临床疗效、中医证候积分、血清细胞因子水平、血液流变学指标、神经功能及生活质量变化。结果治疗4周后,联合中药组总有效率(90.57%,48/53)高于西药组(75.47%,40/53)(P<0.05)。与治疗前比较,治疗4周后2组中医证候积分各项得分、血清S100-β水平、红细胞积压(HCT)、血浆比黏度(PV)、全血低切黏度(WBLSV)、全血高切黏度(WBHSV)及美国国立卫生研究院卒中量表(NIHSS)评分、神经功能缺损(NDS)评分降低,联合中药组低于西药组(P<0.05);治疗4周后2组血清脑源性神经营养因子(BDNF)、内皮衍生超极化因子(EDHF)、一氧化氮(NO)水平及Berg平衡量表评分、Fugl-Meyer运动功能量表(FMA)下肢评分及生活质量各项评分均升高,联合中药组高于西药组(P<0.05)。结论三乌胶丸可缓解中风后遗症患者的中医证候,改善血清细胞因子水平及血液流变学,促进患者神经功能、下肢功能恢复,提高患者生活质量,具有较好的治疗效果。

针药并用对缺血性脑卒中患者血流与神经损伤的影响

目的研究针灸和药物治疗对急性缺血性脑卒中患者大脑中动脉血流量的即刻效应及神经损害程度的影响。方法选取福建医科大学附属泉州第一医院2021年6月至2023年6月收治入院的100例急性缺血性脑卒中患者,采用随机数字表法分为针刺治疗组(35例)、非穴针刺组(32例)、常规药物治疗组(33例)。所有缺血性脑卒中患者入院后均予西医常规治疗,在此基础上,针刺治疗组与非穴针刺组均在入组的第1天未使用药物改善循环的情况下进行首次针灸治疗。三组患者连续治疗14d,观察患者治疗前后的大脑血流动力学指标:大脑中动脉的收缩期峰速(systolic peak velocity,Vs)、舒张期峰速(diastolic peak velocity,Vd)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)及平均血流速度(mean blood flow velocity,MFV);检测患者治疗前后的脑神经损伤标志物水平,并通过美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评估患者的神经功能损伤程度。结果与治疗前比较,治疗后常规药物治疗组和非穴针刺组患者的Vs、MFV水平提高(P<0.05),PI较治疗前显降低(P<0.05);针刺治疗组患者的Vs、Vd、MFV水平均提高(P<0.05);PI、RI较治疗前降低(P<0.05)。三组治疗后比较,针刺治疗组患者的Vs、Vd、PI、RI、MFV改善情况优于非穴针刺组与常规药物治疗组(P<0.05)。针刺治疗组患者首次针刺后的Vs、Vd、PI、RI、MFV均有改善,其改善程度优于非穴针刺组(P<0.05)。三组治疗后,患者的血清S-100β蛋白、心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)、神经元特异性烯醇化酶(neuron specific enolase,NSE)水平显著降低(P<0.05),其中针刺治疗组指标低于非穴针刺组和常规药物治疗组(P<0.05)。与非穴针刺组和常规药物治疗组比较,针刺治疗组在治疗2周后、随访30d后,患者的NIHSS评分更低,差异有统计学意义(P<0.05)。结论早期针刺治疗可改善急性缺血性脑卒中患者的大脑中动脉的血流情况,减轻患者神经损伤的程度。

通窍化瘀汤辅助治疗缺血性脑卒中的疗效及对神经功能的影响

目的 观察通窍化瘀汤辅助治疗缺血性脑卒中的疗效及对神经功能的影响。方法 选取2021年1—12月泉州市中医院收治的缺血性脑卒中患者60例,按照随机数字表法分为中西联合组30例和丁苯酞组30例。在常规治疗基础上,丁苯酞组予丁苯酞软胶囊治疗,中西联合组在丁苯酞组基础上联合通窍化瘀汤治疗,2组均连续治疗30 d。比较2组临床疗效,治疗前后血清学指标[神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)]、血液流变学指标[纤维蛋白原(Fib)、血浆黏度(PV)、血小板聚集率]、美国国立卫生院卒中量表(NIHSS)评分、日常生活活动能力(ADL)评分及不良反应。结果 中西联合组总有效率为93.33%,高于丁苯酞组的70.00%(χ^(2)=5.455,P=0.020)。治疗30 d后,2组血清NSE、Hcy、hs-CRP水平较治疗前降低,血清VEGF水平较治疗前升高,且中西联合组降低或升高的幅度大于丁苯酞组(P<0.05或P<0.01);2组Fib、PV、血小板聚集率较治疗前降低,且中西联合组低于丁苯酞组(P<0.01);2组NIHSS评分较治疗前降低,ADL评分较治疗前升高,且中西联合组降低或升高的幅度大于丁苯酞组(P<0.01);中西联合组与丁苯酞组不良反应总发生率比较差异无统计学意义(3.33%vs.13.33%,χ^(2)=0.873,P=0.350)。结论 通窍化瘀汤在缺血性脑卒中的辅助治疗中具有显著临床效果,可明显改善血管内皮功能和血流动力学,改善患者神经功能和日常活动能力,且安全性较高。

直接抽吸与支架取栓对大脑中动脉闭塞性急性缺血性脑卒中患者治疗效果的比较

目的对比直接抽吸和支架取栓对于大脑中动脉闭塞性急性缺血性脑卒中(acute ischemic stroke,AIS)患者的治疗效果。方法选取我院2018年1月—2021年12月行血管内取栓的大脑中动脉闭塞性AIS患者59例,根据取栓方式的不同分为抽吸取栓组(25例)和支架取栓组(34例),收集并比较两组患者的基本资料、术后血管再通率、穿刺到血管再通时间、术前NHISS评分、术前术后即刻NHISS评分差值(△1 NHISS评分)、术前术后24 h NHISS评分差值(△2 NHISS评分)、血栓逃逸率、实施补救率、术后7 d颅内出血率、术后7 d病死率及术后90 d预后良好率。结果抽吸取栓组患者穿刺到血管再通时间显著短于支架取栓组(t=5.923,P<0.05),两组患者血管再通率、△1 NHISS评分、△2 NHISS评分、血栓逃逸率、实施补救率、术后7 d颅内出血率、术后7 d病死率及术后90 d预后良好率均无显著差异(P>0.05)。结论直接抽吸与支架取栓两种手术方式治疗大脑中动脉闭塞性AIS均效果良好,两种术式患者的血管再通率、神经功能恢复程度及预后相似,但抽吸取栓手术方式的血管再通耗时更短。

手指操联合中医情志护理对恢复期脑卒中患者康复效果评价

目的探讨手指操联合中医情志护理对恢复期脑卒中患者的康复效果,为临床护理实践提供理论指导。方法选取宁晋县中西医结合医院2022年2月—2023年2月90例恢复期脑卒中患者为研究对象,按照组间基线资料均衡可比的原则将其分为对照组和观察组,各45例。对照组患者均给予常规基础护理、康复治疗与锻炼、预防并发症护理等,观察组在对照组基础上给予手指操训练联合中医情志护理。分别于干预前及干预后2周、4周、8周,采用改良Barthel指数量表、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)与Fugl-Meyer运动功能评价量表评价两组患者日常生活活动能力、焦虑评分、抑郁评分及上下肢运动功能评分。采用满意度量表评价两组患者的护理满意程度。结果干预后观察组患者焦虑、抑郁评分低于对照组,上、下肢运动功能评分及Barthel指数评分均高于对照组,两组患者HAMA评分、HAMD评分、Fugl-Meyer评分及Barthel指数比较,组间、不同时间点、组间与不同时间点交互作用差异均有统计学意义(P<0.05)。观察组患者护理满意程度高于对照组,差异具有统计学意义(P<0.05)。结论手指操联合中医情志护理可以有效改善脑卒中患者的焦虑、抑郁状态,提高其日常生活自理能力,促进患者上下肢功能恢复,有利于患者早日康复,从而提高患者的满意度。

红光疗法结合艾灸治疗中风偏瘫的效果及安全性

目的分析红光疗法结合艾灸治疗中风偏瘫的效果及安全性。方法回顾性选取2022年1月—2023年1月金乡县人民医院收治的128例中风偏瘫患者的临床资料,按照治疗方式的不同分为研究组(64例,红光疗法结合艾灸治疗)和参考组(64例,传统康复治疗)。比较两组患者的中医证候积分、自理能力、肢体功能、美国国立卫生院卒中量表(National Institute Health Stroke Scale,NIHSS)评分、并发症发生情况。结果治疗前,两组患者的中医证候积分、自理能力、肢体功能、NIHSS评分比较,差异无统计学意义(P均>0.05);治疗1个月、3个月后,研究组的中医证候积分、自理能力、肢体功能、NIHSS评分优于参考组,差异有统计学意义(P均<0.05)。研究组的并发症发生率为0,低于参考组的9.38%,差异有统计学意义(χ^(2)=4.372,P<0.05)。结论中风偏瘫患者通过红光疗法结合艾灸治疗,能够改善症状评分、自理能力、肢体功能、神经功能,有效降低并发症发生率。

虚拟现实技术及强制性运动疗法对脑卒中偏瘫患者康复效果的影响

目的探讨虚拟现实技术及强制性运动疗法对脑卒中偏瘫患者康复效果的影响。方法选取2021年9月至2022年9月于陕西省榆林市第一医院就诊的脑卒中偏瘫患者80例作为研究对象,按照随机数字表法将其分为对照组和观察组,每组40例。对照组采用常规康复训练,观察组在常规康复训练的基础上加用虚拟现实技术及强制性运动疗法。观察并比较两组患者干预前后关节活动情况(评价指标为肩关节前屈、肩关节内收、肩关节外展与肘关节屈曲活动度)、上肢运动功能[采用简化的上肢运动功能量表(FMA-UE)进行评估]、平衡功能[应用平衡功能评价量表(FMA-B)进行评估]、日常生活活动能力[采用改良Barthel指数(MBI)评分进行评估]及生活质量(包括生理功能、躯体疼痛、总体健康、活力、社会功能、精神健康5个维度)。结果干预后,两组肩关节前屈、肩关节内收、肩关节外展、肘关节屈曲活动度以及FMA-UE、FMA-B、MBI评分和生活质量5个维度评分均较干预前升高(P<0.05);干预后观察组肩关节前屈、肩关节内收、肩关节外展、肘关节屈曲活动度以及FMA-UE、FMA-B、MBI评分和生活质量5个维度评分均高于对照组,差异均有统计学意义(P<0.05)。结论虚拟现实技术及强制性运动疗法对脑卒中偏瘫患者的康复效果明显,可提高关节活动度、上肢运动功能、平衡功能、日常生活活动能力和生活质量。

脑卒中后吞咽障碍的影响因素分析及康复治疗效果研究

目的分析脑卒中后吞咽障碍的影响因素及康复治疗效果,以为临床治疗该病及改善患者预后提供参考。方法选取2021年9月至2022年9月于我院神经内二科住院的111例脑卒中患者为研究对象,根据是否合并吞咽障碍将其分为吞咽障碍组和吞咽正常组。采用洼田饮水试验和容积-黏度吞咽测试(V-VST)完成患者吞咽功能评估;收集患者年龄、性别、美国国立卫生研究院脑卒中量表(NIHSS)评分、病程、后遗症个数等资料。通过单因素及二元Logistic回归分析探讨影响脑卒中患者发生吞咽障碍的因素;并分析脑卒中后吞咽障碍患者的康复治疗效果。结果吞咽障碍86例,吞咽正常25例。单因素分析结果显示,吞咽障碍组和吞咽正常组的年龄、NIHSS评分及后遗症个数比较,差异具有统计学意义(P<0.05)。二元Logistic回归分析结果显示,年龄和后遗症个数是脑卒中患者发生吞咽障碍的独立危险因素(P<0.05)。脑卒中后吞咽障碍患者出院时的洼田饮水试验评分及治疗参数均优于入院时,差异有统计学意义(P<0.05)。结论脑卒中患者的吞咽障碍发生率较高,其与年龄、后遗症个数有关,及时给予此类患者康复治疗,可以改善预后。

血清NETs水平对急性缺血性脑卒中患者阿替普酶桥接机械取栓治疗预后的评估价值

目的探讨血清中性粒细胞胞外诱捕网(NETs)水平对急性缺血性脑卒中(AIS)患者阿替普酶(rt-PA)桥接机械取栓治疗预后的评估价值。方法选取2021年7月至2023年9月喀什地区第一人民医院行rt-PA溶栓桥接机械取栓的103例AIS患者,根据治疗3个月后改良Rankin量表评分分为预后良好组(68例,mRS评分≤2分)和预后不良组(35例,mRS评分>2分)。对比两组一般资料、实验室指标及血清NETs水平,分析血NETs水平、NIHSS评分对AIS患者治疗预后的评估价值。结果预后不良组患者入院NIHSS评分、血清NETs水平明显高于预后良好组(~均P<0.05),预后不良组患者侧支循环(Ⅲ~Ⅳ级)、mTICI分级(2b~3级)占比则低于预后良好组(~均P<0.05)。NETs与NIHSS评分联合预测AIS患者预后不良的曲线下面积为0.854,预测敏感度为80.0%,特异度为77.9%。Logistic回归分析显示,血清NETs水平、入院NIHSS评分、侧支循环建立情况及mTICI分级程度是影响AIS患者治疗预后的危险因素(~均P<0.05)。结论AIS患者治疗预后状况与血清NETs水平有关,NIHSS评分联合血清NETs检测可为早期评估AIS患者rt-PA桥接机械取栓治疗效果提供依据。

丁苯酞联合再灌注方案治疗缺血性卒中的成本效果分析:基于BASTⅢ期试验

目的:基于中国卫生服务体系角度评价丁苯酞对比安慰剂治疗缺血性卒中患者的经济性。方法:基于丁苯酞的Ⅲ期对照试验和已发表的文献数据构建Markov模型,模拟患者终身的质量调整生命年(quality-adjusted life year,QALY)和增量成本效果比(Incremental cost-effectiveness ratio ICER),并进行单因素敏感性分析、亚组分析和概率敏感性分析检验模型的不确定性。结果:研究结果显示,丁苯酞组患者比安慰剂组患者在多获得0.28个QALYs的同时成本增加了2750.66元,ICER值为9700.31元/QALY,小于0.5倍人均GDP,丁苯酞组患者比安慰剂组治疗缺血性卒中更具有经济性。单因素敏感性分析结果显示,对模型结果影响程度最大的4个因素分别是mRS3-5状态的首次住院成本、mRS0-2状态的首次住院成本、贴现率和mRS0-2状态的效用值。亚组分析结果显示,丁苯酞组患者比安慰剂组患者在NIHSS评分4~7、8~14和15~253个亚组中的ICER值分别为16430.66、3146.91和9745.38元/QALY,均小于0.5倍人均GDP。概率敏感性分析结果显示,丁苯酞相较于安慰剂方案在0.5倍人均GDP的阈值下具有经济性的概率为98%。丁苯酞在NIHSS评分4~7、8~14和15~253个亚组中具有经济性的概率分别为84%、97%和87%。结论:在我国0.5倍人均GDP的意愿支付值之下,丁苯酞在接受静脉溶栓和/或血管内再灌注治疗缺血性卒中患者具有经济性。

圣约翰草提取物治疗脑卒中后抑郁临床效果分析

目的 探讨圣约翰草提取物治疗脑卒中后抑郁临床效果。方法 选取2018年12月—2020年12月哈尔滨第五医院收治的卒中患者100例作为研究对象,通过数字随机法分为对照组和观察组,每组50例。对照组采用常规治疗,观察组在对照组的基础上增加圣约翰草提取物治疗。比较两组患者的疗效、心理情绪评分和NIHSS和DHI评分。结果 观察组治疗效果显著高于对照组,差异存在统计学意义(P<0.05);治疗后观察组患者HAMD、HAMA、NIHSS、DHI评分显著低于对照组(P<0.05)。结论 圣约翰草提取物治疗脑卒中抑郁疗效显著,有助于改善抑郁症状以及促进神经功能恢复,值得临床进行应用推广。