Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

Evolving of treatment options for cerebral infarction

In this editorial,we comment on a recent article which addressed the therapeutic effect of aspirin plus edaravone in patients with cerebral infarction(CI).Herein,we outline the progress in therapy of CI.Apart from thrombolysis,aspirin is the most effective treatment for CI.Edaravone,a free radical scavenger,reduces endothelial cell damage and delays neuronal cell death.Aspirin plus edaravone mitigates damage to brain tissue by different mechanisms,thereby expediting the reinstation of neurological function.However,the nephrotoxic effect of edaravone,along with gastrointestinal bleeding associated with aspirin,may restrict this combination therapy.Although clinical studies have demonstrated the efficacy of thrombolytic therapy and mechanical thrombectomy,patients receiving these treatments experience modest efficacy and many adverse events.Moreover,interest in exploring natural medicines for CI is increasing,and they appear to have a high potential to protect against CI.The evolution of therapeutic strategies is expected to improve clinical outcomes of patients with CI.

Magnetic resonance imaging combined with serum endolipin and galactagoglobin-3 to diagnose cerebral infarction in the elderly with diabetes mellitus

BACKGROUND Magnetic resonance imaging(MRI)combined with serum endothelin and galactagoglobin-3(Gal-3)can improve the clinical diagnosis of diabetes mellitus complicated with cerebral infarction.AIM To analyze the clinical value of MRI combined with serum endolipin and Gal-3 for the diagnosis of cerebral infarction in the elderly with diabetes mellitus.METHODS One hundred and fifty patients with acute cerebral infarction hospitalized between January 2021 and December 2023 were divided into two groups according to comorbid diabetes mellitus,including 62 and 88 cases in the diabetic and nondiabetic cerebral infarction groups.Serum samples were collected to detect the expression of serum endolipoxins,and Gal-3,and cranial MRI was performed at admission.Differences between the two groups were compared to analyze the diagnostic value of these parameters.RESULTS Serum endolipin and Gal-3 expression were higher in the diabetic cerebral infarction group(P<0.05).The arterial wall area,vessel area,normalized wall index,and lumen stenosis rate were higher in the diabetic cerebral infarction group,while the rate of arterial lumen moderate and severe stenosis was 48.39% higher(36.36%,P<0.05).The percentage of large(29.03%)and multiple infarcts(33.87%)in the diabetic cerebral infarction group was higher(13.64% and 20.45%),and the incidence rate of lacunar infarcts was lower(37.10%vs 65.91%)(P<0.05).The total incidence of arterial plaque in patients in the diabetic cerebral infarction group was 96.77% higher(69.32%),while the incidence of necrotic lipid core plaque was 58.06%higher(26.14%)(P<0.05).Receiver operating characteristic curve analysis was performed to assess the diagnosis utility of these techniques.MRI in combination with serum endoglin and Gal-3 had the highest area under the curve,the Yoden index,sensitivity and specificity(P<0.05).CONCLUSION The expression of serum endolipin and Gal-3 in elderly patients with diabetes mellitus with cerebral infarction showed an elevated trend,and the degree of luminal stenosis was severe.MRI predominantly revealed large and multiple infarct foci.This combined index examination can improve the clinical diagnosis of diabetes mellitus combined with cerebral infarction.

Therapeutic effect and psychological impact of aspirin plus edaravone on patients with cerebral infarction

BACKGROUND Cerebral infarction(CI)is characterized by a high prevalence,disability,and mortality.Timely or improper treatment greatly affects patient prognosis.AIM To explore the drug efficacy of aspirin plus edaravone and to explore their effect on quality of life(QOL),anxiety and depression in CI patients.METHODS We retrospectively analyzed the records of 124 CI patients treated between June 2019 and February 2021 who were assigned to an observation group(OG)(combination therapy of aspirin and edaravone,65 patients)or a control group(CG)(aspirin monotherapy,59 patients).The therapeutic effects,pre-and posttreatment National Institutes of Health Stroke Scale(NIHSS)scores,activities of daily living,degree of cognitive impairment,protein levels of glial fibrillary acidic protein(GFAP),neuron-specific enolase(NSE)and S-100B,occurrence of adverse reactions,and serum high-sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6 and tumor necrosis factor(TNF)-αwere evaluated,detected and compared between the two groups.Finally,posttreatment QOL,anxiety,and depression were assessed by the Medical Outcomes Study 36-Item Short Form Health Survey Scale,Self-rating Depression Scale(SDS),and Self-rating Anxiety Scale(SAS),respectively.RESULTS Compared with the CG,the OG had markedly better therapeutic effects,greater improvements in activities of daily living,and better alleviation in cognitive dysfunction after treatment,as well as lower posttreatment NIHSS scores and serum NSE,GFAP,S-100B,hs-CRP,IL-6,and TNF-αlevels;the OG was similar to the CG in terms of adverse reactions but was better than the CG in terms of posttreatment QOL;and the OG also had lower SDS and SAS scores than the CG after treatment.CONCLUSION Aspirin plus edaravone had a good curative effect on CI.It can reverse cranial nerve damage in patients,improve neurological function and prognosis,and alleviate inflammation,anxiety,and depression;thus,it is considered safe and worthy of clinical application.

Application Effect of Early Rehabilitation Nursing in Elderly Cerebral Infarction Patients with Dysphagia

Objective:To observe the application effect of early rehabilitation nursing in elderly cerebral infarction patients with dysphagia.Methods:120 cases of elderly cerebral infarction patients with dysphagia were divided into 60 cases in the control group and 60 cases in the observation group by the double-blind method,and conventional nursing and early rehabilitation nursing were implemented respectively.Swallowing function,quality of life,adverse events,and nursing satisfaction were compared before and after nursing care.Results:After nursing,the swallowing function score of the observation group(1.01±0.18 points)was lower than that of the control group,and the quality of life score(160.63±9.95 points)was higher than that of the control group(P<0.05);the incidence rates of aspiration and aspiration pneumonia in the observation group(5.00%and 3.33%)were lower than that of the control group(P<0.05);the total nursing satisfaction of the observation group(98.33%)was higher than that of the control group(P<0.05).Conclusion:Early rehabilitation nursing can reduce the degree of dysphagia in elderly patients with cerebral infarction,reduce the incidents of aspiration and aspiration pneumonia,and improve the quality of life,with high nursing satisfaction.

The Effect of Different Hyperbaric Oxygen Treatment Time Windows on Neurological Function and Prognosis in Acute Cerebral Infarction

Objective:To observe the effects of different hyperbaric oxygen treatment time windows on the prognosis and neurological function of acute cerebral infarction.Method:160 patients with acute cerebral infarction admitted to Xiangyang Central Hospital in Hubei Province were randomly divided into four groups,each with 40 cases,using a random number table method.According to the 2017 guidelines for the treatment of cerebral infarction,the control group received routine treatment for acute cerebral infarction;On the basis of the control group,patients in Group A received hyperbaric oxygen therapy within 48 hours of onset;Group B patients receive hyperbaric oxygen therapy within 3-6 days of onset;Group C patients receive hyperbaric oxygen therapy within 7-12 days of onset.Observe the efficacy,recurrence,and neurological function recovery of four groups of patients after treatment.Result:There was no statistically significant difference in the National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)scores among the four groups before treatment(P>0.05).There were statistically significant differences in NIHSS and BI scores between 14 and 30 days after treatment and before treatment(F=16.352,27.261,11.899,28.326,P<0.05).At 14 and 30 days after treatment,the NIHSS score in Group A decreased compared to the control group,Group B,and Group C,while the BI score increased compared to the control group,Group B,and Group C,with statistical significance(P<0.05).There was no statistically significant difference in NIHSS and BI scores between Group C and the control group after treatment(P>0.05).After 30 days of treatment,the total effective rate of Group A was higher than that of the control group and Group C,and the difference was statistically significant(X2=6.135,P<0.05).The one-year recurrence rate of Group A and Group B is lower than that of Group C and the control group,and the difference is statistically significant(X2=8.331,P<0.05).There was no statistically significant difference in adverse reactions among the four groups(P>0.05).Conclusion:Patients with acute cerebral infarction who receive hyperbaric oxygen therapy within 48 hours can improve neurological function and reduce the recurrence rate.The efficacy of receiving hyperbaric oxygen therapy within 7-12 days of onset is equivalent to that of not receiving hyperbaric oxygen therapy.

Analysis of the Effect of Limb Rehabilitation Therapy Combined with Transcranial Magnetic Stimulation Therapy on Muscle Activity in Patients with Upper Limb Dysfunction After Cerebral Infarction

Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.

The Prognostic Value of Red Cell Distribution Width in Critically Ill Cerebral Infarction Patients:A Retrospective Cohort Study

Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.

A Case of Acute Upper Gastrointestinal Bleeding in Liver Cirrhosis Complicated by Acute Cerebral Infarction and Acute Myelitis

Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.

Edaravone administration and its potential association with a new clinical syndrome in cerebral infarction patients:Three case reports

BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone.Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions.Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction,clinicians’knowledge is the key element in recognizing this phenomenon.

Value of Tongue Color Combined with Sublingual Microcirculation in Predicting the Severity of Mild to Moderate Acute Cerebral Infarction

Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.

探讨NLR、PLR、hs-CRP、Hb、D-D与ACI非溶栓治疗后出血性转化的相关性分析

目的 探讨急性脑梗死患者(ACI)非溶栓治疗前血清中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、超敏C反应蛋白(hs-CRP)、血红蛋白(Hb)、D-二聚体(D-D)与治疗后出血性转化(HT)的相关性,以期为临床预防ACI非溶栓治疗后发生提供指导依据。方法 本研究病历组(设为转化组)共纳入80例样本,选取自2015年1月至2019年12月在吉林大学第一医院检验科接受非溶栓治疗后并出现HT的ACI患者,根据HT严重程度等级化分1级、2级、3级、4级,各严重程度患者分别为27例、22例、18例、13例。选取50例在接受非溶栓治疗后未出现HT的ACI患者作为对照(非转化组)。比较各组的血清NLR、PLR、hs-CRP、Hb、D-D表达水平差异,并通过Spearman秩相关检验分析NLR、PLR、hs-CRP、Hb、D-D与HT严重程度的相关性。并采用ROC曲线分析NLR、PLR、hsCRP、Hb、D-D对ACI患者HT的预测作用。结果 转化组的血清NLR、PLR、hs-CRP、D-D表达水平均高于非转化组,Hb的表达水平低于非转化组(均P<0.05)。1级、2级、3级、4级患者的血清NLR、PLR、hs-CRP、D-D表达水平依次上升,Hb表达水平依次降低,差异有统计学意义(P<0.05),且组间两两比较,差异有统计学意义(P<0.05)。ACI非溶栓治疗后HT严重程度与血清NLR、PLR、hs-CRP、D-D均呈正相关(r值分别为:0.729、0.692、0.601、0.578,均P<0.05),与Hb呈负相关(r值为:-0.678,P<0.05)。ROC曲线分析显示,NLR的AUC值为0.896[95%CI(0.737~0.962)]、PLR的AUC值为0.775 [95%CI(0.626~0.917)]、hs-CRP的AUC值为0.840 [95%CI(0.712~0.948)]、Hb的AUC值为0.782 [95%CI(0.493~0.914)]、D-D的AUC值为0.725 [95%CI(0.403~0.852)]。结论 ACI患者的NLR值、PLR值、hs-CRP、Hb、D-D表达水平与其在非溶栓治疗后发生HT存在相关性,临床上可将这些指标作为预测HT风险。

基于CiteSpace可视化分析国内脑梗死与炎症的研究热点与趋势

目的运用CiteSpace 6.2 R3软件分析国内近10年来“脑梗死”“炎症”的研究现状与热点趋势。方法检索中国知网(CNKI)、维普、万方3个中文文献数据库相关文献,用CiteSpace知识图谱直观展示对发文量、作者、机构、关键词等信息进行分析。结果纳入相关文献997篇,得到9个关键词聚类,年发文量呈上升趋势,发文量最多的作者是以刘建勋为代表的研究团队(7篇),发文量最大的机构是河南中医药大学(16篇),研究热点在于神经炎症、针刺、丁苯酞、外泌体、细胞焦亡、静脉溶栓等方向。结论本研究利用知识图谱直观展示了近10年“脑梗死”“炎症”的研究现状与热点趋势,以期为“脑梗死”与“炎症”之间的相关性研究前沿提供新的视角参考。

血清ESM-1、E-cad对ACI-LAA溶栓后HT的预测价值

目的 探讨血清内皮细胞特异性分子-1 (ESM-1)、E-钙黏连蛋白(E-cad)对大动脉粥样硬化型脑梗死(ACI-LAA)溶栓后出血转化(HT)的预测价值。方法 选取2020年1月至2022年12月新疆医科大学第一附属医院收治的110例ACI-LAA患者,根据是否发生HT分为HT组和non-HT组。对比两组基础资料及血清ESM-1、E-cad水平。采用ROC曲线分析ESM-1、E-cad预测ACI-LAA患者发生HT的价值。结果 HT组患者NIHSS评分高于non-HT组,梗死面积大于non-HT组(P <0.05),HT组患者血清ESM-1、E-cad水平也高于non-HT组(P<0.05)。Logistic回归分析显示,梗死面积大、NIHSS评分高、血清ESM-1和E-cad水平升高是ACI-LAA患者发生HT的危险因素(P<0.05)。ESM-1联合E-cad预测ACI-LAA患者发生HT的曲线下面积为0.859,预测灵敏度为84.6%,特异度为72.6%。结论 血清ESM-1和E-cad水平与ACI-LAA患者HT密切相关,可作为早期预测发生HT的参考指标。

急性脑梗死外周血中Circ-BBS9的表达水平及临床意义

目的:检测急性脑梗死(ACI)中环状RNA-BBS9的表达水平,探讨其作为ACI早期诊断潜在生物标志物的可能性。方法:随机选取2021年1月至12月收治的34例ACI患者作为病例组,41例非ACI患者作为对照组,收集一般资料并采血行生信分析,筛选出差异性最大的Circ RNA作为目的基因,分析两组一般资料和目的基因表达水平与ACI发生的相关性;运用ROC曲线分析目的基因诊断ACI的价值。结果:病例组的男性占比、年龄、高血压病史率、冠心病病史率、吸烟史占比、饮酒史占比、血压水平均高于对照组(P<0.05)。差异性最大的Circ RNA为Circ-BBS9。病例组的Circ-BBS9表达水平低于对照组(P<0.05)。性别、年龄、高血压患病史、冠心病患病史、吸烟史、饮酒史、血压水平以及Circ-BBS9表达均是ACI发生的相关影响因素(P<0.05),其中Circ-BBS9表达水平与ACI发生呈负相关(P<0.05),其他因素与ACI发生呈正相关(P<0.05)。Circ-BBS9具有诊断ACI的价值。结论:Circ-BBS9是急性脑梗死发病的保护因素,Circ-BBS9的表达水平是影响ACI发生的独立因素,外周血检测Circ-BBS9具有预测ACI发病的潜在价值。

颈动脉超声参数分析对ACI患者动脉斑块性质及预后不良的预测价值

目的研究急性脑梗死(ACI)患者颈动脉超声参数,分析其对患者动脉斑块性质及预后不良的预测价值。方法采取回顾性研究,选择2020年10月至2023年10月中国人民解放军陆军第八十一集团军医院和张家口市第一医院收治的106例完成3个月随访的ACI患者临床资料作为研究对象。根据患者术后斑块病理检查结果进行分组,将易损斑块患者临床资料纳入易损斑块组(n=42),将稳定斑块患者临床资料纳入稳定斑块组(n=64);根据患者术后3个月时改良Rankin量表(mRS)评分评估患者预后,将评分≤2分患者临床资料纳入预后良好组(n=76),将评分>2分患者临床资料纳入预后不良组(n=30);统计患者颈动脉超声参数[斑块体积、斑块厚度、标准化管壁指数(NWI)、灰阶中位数(GSM)]及基线资料。采用受试者工作特征(ROC)曲线分析颈动脉超声参数对ACI患者颈动脉斑块性质及预后的预测价值;采用二元logistic回归分析ACI患者发生预后不良的危险因素。结果易损斑块组NWI水平高于稳定斑块组,GSM低于稳定斑块组(P<0.05),2组斑块体积、斑块厚度比较差异无统计学意义(P>0.05)。绘制ROC曲线,结果显示,NWI、GSM水平及联合检测评估ACI患者斑块性质的AUC均>0.70,有一定预测价值,其中联合检测最高。预后不良组NIHSS评分、NWI高于预后良好组,GSM水平低于预后良好组,合并高脂血症、糖尿病患者占比高于预后良好组(P<0.05);二元logistic回归分析结果显示,NIHSS评分高、合并高脂血症、合并糖尿病及NWI高水平是ACI患者预后不良的危险因素(OR>1,P<0.05),GSM高水平是ACI患者预后不良的保护因素(OR<1,P<0.05);绘制ROC曲线,结果显示,NWI、GSM水平及联合检测评估ACI患者预后不良的AUC均>0.70,有一定预测价值,其中联合检测最高。结论ACI患者颈动脉超声参数能够有效评估动脉斑块性质,预测预后不良风险,临床可针对预后不良风险较高者采取针对性干预,以改善患者预后。

ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性

目的探讨急性脑梗死(ACI)溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性。方法选取2018年12月至2022年12月于新疆维吾尔自治区人民医院接受治疗的患者148例为观察组,同时健康体检正常者148例为对照组,均采用实时荧光定量PCR法检测血清miR-379-5p表达水平并对比。根据血清miR-379-5p表达水平情况将观察组进行亚分组,根据中位数分为高表达组和低表达组,对比观察组中高表达组和低表达组一般资料、缺血再灌注损伤水平,采用Pearson分析ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性。结果观察组miR-379-5p表达水平(1.09±0.24)较对照组miR-379-5p表达水平(1.88±0.21)低(t=30.137,P<0.01)。根据观察组miR-379-5p表达水平中位数分组分为高表达组74例(miR-379-5p表达水平≥1.10)和低表达组74例(miR-379-5p表达水平<1.10);高表达组溶栓后NIHSS评分、血清晚期氧化蛋白产物(AOPP)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、单核细胞趋化蛋白-1(MCP-1)水平较低表达组低,血清过氧化物歧化酶(SOD)水平较低表达组高(P<0.05);Pearson相关性分析显示:miR-379-5p表达水平与溶栓后NIHSS评分、血清AOPP、MDA、TNF-α、CRP及MCP-1水平(r=-0.465,P<0.05;r=-0.273,P<0.05;r=-0.429,P<0.05;r=-0.486,P<0.05;r=-0.320,P<0.05;r=-0.273,P<0.05)呈负相关,与血清SOD水平呈正相关(r=-0.465,P<0.05)。结论ACI溶栓患者miR-379-5p表达水平与缺血再灌注损伤的相关性,上调miR-379-5p水平有助于减轻ACI静脉溶栓后缺血再灌注损伤。

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.

血清VEGF、FGF、PLGF水平变化与ACI患者NIHSS评分关系及临床意义

目的:探讨血清血管内皮生长因子(VEGF)、成纤维细胞生长因子(FGF)、胎盘生长因子(PLGF)水平变化与急性脑梗死(ACI)患者美国国立卫生院卒中量表(NIHSS)评分关系及临床意义。方法:选取2021年4月-2022年8月我院收治的129例ACI患者为研究对象,根据入院时NIHSS评分将患者分为轻度组(46例)、中度组(58例)、重度组(25例)。比较三组入院时血清VEGF、FGF、PLGF水平,比较不同脑梗死灶体积、不同预后患者入院时血清VEGF、FGF、PLGF水平,分析入院时血清VEGF、FGF、PLGF水平与梗死灶体积、NIHSS、改良Rankin量表(mRS)评分的相关性及联合诊断价值,并分析其危险度。结果:入院时血清VEGF、FGF、PLGF水平比较:轻度组<中度组<重度组(P<0.05),小梗死灶<中梗死灶<大梗死灶(P<0.05);入院时,预后不良患者血清VEGF、FGF、PLGF水平比预后良好患者高(P<0.05);入院时血清VEGF、FGF、PLGF水平与梗死灶体积、NIHSS评分、mRS评分均呈正相关(P<0.05);入院时血清VEGF、FGF、PLGF水平联合预测ACI患者预后不良的AUC大于各单独指标(P<0.05);入院时血清VEGF、FGF、PLGF高水平患者预后不良的危险度是低水平的4.566、4.025、3.331倍(P<0.05)。结论:血清VEGF、FGF、PLGF水平与ACI患者NIHSS评分密切相关,可作为临床诊断病情、评估预后的有效指标。

Analysis of mental health status and related factors in patients with acute cerebral infarction

BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.