首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 171 毫秒
1.
目的确切了解脑卒中后中枢性面瘫闭目乏力的发生率,探讨其发生机制。方法观察1年内所有起病7d内人院的脑卒中患者。使用美国国立卫生院脑卒中量表(National Institute of Health stroke scale,NII-ISS)中第4项面瘫评分及日本面瘫评分(Japan facial score,jrs)进行面瘫评估,使用拉力测量器测量双侧眼轮匝肌的闭目力量差值。比较中枢性面瘫者伴与不伴闭目乏力两组的临床资料。结果共收集病例914例,中枢性面瘫者伴闭目乏力且头颅MRI显示脑干无病灶者共40例,发生率为4.4%。脑卒中后中枢性面瘫伴闭目乏力者的双眼闭目力量差值随时间延长而递减(F=36.049,P〈0.01),而不伴闭目乏力者双眼闭目力量无差异。伴闭目乏力者的责任病灶在右侧大脑半球的比例较不伴闭目乏力者高(72.50%郴32.01%,x^2=32.95,P〈0.01)。两组的责任病灶的性质、分布部位、体积、Alberta卒中计划早期CT评分、有双侧病灶的比例均无差异。责任病灶分布在右侧大脑半球、年龄、性别以及是否有脑干病变这四项因素作为Cox回归的协变量,对中枢性面瘫闭目乏力的持续时间均无影响。结论脑卒中后中枢性面瘫伴闭目乏力的发生率达4.4%,其发生机制可能与右侧大脑半球受损有关。  相似文献   

2.
脑卒中患者临床神经功能缺损程度评分的信度与效度   总被引:2,自引:0,他引:2  
目的 评价脑卒中患者临床神经功能缺损程度评分的信度和效度.方法 222例急性脑卒中患者,分别由不同评定者于入院当天、入院第14天、发病后第90天对同一例脑卒中患者进行临床神经功能缺损程度评分.重测信度与评定者间信度用Kappa值表示,分半信度、内部一致性信度用Croubach α值表示.同时效度、预测效度采用Spearman相关分析.结构效度采用因子分析的方法,其中脑梗死患者根据英国牛津郡社区脑卒中项目(OCSP)分型评定3种不同梗死类型的临床神经功能缺损程度评分的结构效度.结果 所有条目重测信度均>0.6,评定者间信度中条目"步行能力"为0.542,分半信度0.911,Cronbach α值为0.886,不同评定方式间信度显示"上肢肌力"、"手肌力"的信度分别为0.393、0.386.其与NIHSS评定结果呈正相关(均P=0.000),不同OCSP分型患者神经功能缺损程度评分与NIHSS评分结果均相关,且与发病后90 d的Barthel指数和改良Rankin评分均相关.结论 临床神经功能缺损程度评分内部一致性信度较高,其与NIHSS有同时效度,对脑卒中预后有预测效度;对部分前循环梗死患者的结构效度最好,可以用来评定椎-基底动脉系统的脑卒中,但并不敏感.  相似文献   

3.
目的 探讨发病6~9 h动脉溶栓治疗对美国国立卫生研究院卒中量表(National I nstitutes o f H ealth Stroke Scale,NIHSS)<5分的急性缺血性卒中患者的治疗效果。 方法 回顾86例发病距接受治疗的时间6~9 h的急性缺血性卒中(NIHSS<5分)患者资料,比较选择 性尿激酶动脉溶栓和口服阿司匹林2种治疗方法的发病7 d和90 d效果。 结果 与口服阿司匹林组相比,选择性动脉溶栓组患者发病7 d的Barthel指数(Barthel index,BI)较对 照组明显改善(81.3±7.9 vs 54.5±9.3,P =0.034),改良Rankin量表(modified Rankin Scale,mRS)评 分<3分的患者比例明显增加(88.4% vs 48.8%,P =0.028);但在90 d后,两组患者的BI及mRS之间没 有显著差异。 结论 对急性轻型缺血性卒中6~9 h积极的动脉尿激酶溶栓治疗可以促进患者的早期恢复。  相似文献   

4.
脑卒中后吞咽障碍196例临床分析   总被引:3,自引:0,他引:3  
目的探讨吞咽障碍与脑卒中患者预后的相关性,旨在提高对卒中后吞咽障碍的重视。方法选择住院的397例急性脑卒中患者为研究对象,入院后48h内完成标准吞咽评估(standardized swallowing assessment,SSA)。观察急性卒中后吞咽障碍发生率、误吸发生率、1个月内获得性肺炎发生率。按SSA分为吞咽障碍组和无吞咽障碍组。6个月后完成改良Rankin量表(mRS)评分、Barthel指数(BI)评分、NIHSS评分。比较2组预后情况。结果 397例卒中患者中196例吞有咽障碍(49.37%),其中误吸112例,6个月后45例仍存吞咽障碍,8例仍需胃管饮食。无吞咽障碍组BI评分、NIHSS评分分别高于、低于吞咽障碍组(P<0.05),预后良好率高于吞咽障碍组(P<0.05)。结论卒中后吞咽障碍发生率较高,吞咽障碍影响脑卒中患者预后。  相似文献   

5.
目的探讨椎-基底动脉系统脑梗死患者不同时间窗重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗的临床疗效。方法回顾性分析50例椎-基底动脉系统脑梗死患者临床资料,按溶栓治疗时间窗分为4.5 h组和4.5~9 h组,每组25例。比较两组患者神经功能缺损量表(national institutes of health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分、改良Rankin量表(modified Rankin scale,mRS)评分及脑出血发生率。结果与治疗前相比较,治疗后14 d、30 d、90 d时4.5 h组和4.5~9 h组NIHSS评分和BI评分均显著升高,组间比较差异显著(P0.05)。治疗前及治疗后14 d、30 d、90 d,两组患者NIHSS评分和BI评分比较均无统计学差异(P0.05)。治疗后90 d,两组患者mRS评分比较无统计学差异(P0.05)。4.5 h组和4.5~9 h组BI评分脑出血发生率分别为4.0%(1/25)、8.0%(2/25),组间比较差异无统计学意义。结论椎-基底动脉系统脑梗死患者发病9 h内应用rt-PA静脉溶栓治疗是安全有效的。  相似文献   

6.
目的观察注射用丹参多酚酸治疗中度急性缺血性脑卒中的有效性和安全性。方法采用多中心、随机、双盲、平行对照临床研究方法。以美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分为6~22分的急性缺血性卒中患者为对象,将其随机分为研究组和对照组。两组患者均给予常规基础治疗,研究组在基础治疗上加用注射用丹参多酚酸静脉滴注,每日1次,每次130 mg,对照组在基础治疗上给予等量生理盐水,两组均连续治疗14 d。在用药后第14 d、第30 d和第90 d评估NIHSS评分、Barthel指数评分,以治疗后30 d、90 d时改良Rankin量表评分(modified Rankin scale,mRS)评估预后(0~2分为预后良好),根据患者不良事件进行安全性评估。结果共纳入1529例脑卒中患者,其中研究组1021例,对照组508例。研究组和对照组在治疗后第14 d、第30 d和第90 d的NIHSS评分、Barthel指数组间差异均有统计学意义(均P0.05),治疗后30 d、90 d研究组预后良好率高于对照组,组间差异有统计学意义(P0.05)。研究组与对照组不良事件发生率差异无统计学意义(P0.05)。结论注射用丹参多酚酸用于治疗中度急性脑卒中有效且安全,在连续治疗2周后其疗效优于基础治疗。  相似文献   

7.
目的观察阿托伐他汀钙联合羟乙基淀粉注射液治疗急性脑分水岭梗死(ACWI)的疗效。方法 100例ACWI患者,随机、单盲分为治疗组、对照组(n=50),对照组给予常规治疗,治疗组在常规治疗的基础上加用阿托伐他汀钙和羟乙基淀粉注射液治疗14天,治疗后第7、14天采用美国国立卫生院脑卒中量表(NIHSS)予以评分,并在治疗后3、6个月采用改良的Rankin评分(mRS)及Barthel指数(BI)进行远期疗效评价。结果治疗后第7、14天治疗组NIHSS评分明显低于对照组(P0.05)。治疗后3、6个月治疗组BI、mRS明显优于对照组(P0.05)。治疗后6个月治疗组82.61%患者临床结局良好,优于对照组的62.22%(P0.05)。未见明显不良反应。结论阿托伐他汀钙联合羟乙基淀粉注射液治疗ACWI安全、有效。  相似文献   

8.
目的评估后循环脑梗死患者的预后并分析影响预后的相关因素。方法对274例经头颅MRI确诊且资料完整的后循环脑梗死(PCCI)患者进行随访,评估残障量表(mRS)、Barthel指数(BI)以了解患者的预后情况,并分析预后相关因素。结果274例后循环梗死患者中,无残障或轻度残障(mRS0~3分)占87.6%,严重残障(mRS4—5分)占9.9%,死亡占2.6%。mRS评估的多因素回归分析显示发病至就诊时间、入院时美国国立卫生院卒中量表(NIHSS)评分、既往卒中史、高同型半胱氨酸(Hcy)(P〈0.05)与预后相关。结论后循环梗死患者的总体预后良好,病死率低。发病至就诊时间长、入院时NIHSS评分高、既往有卒中史者、伴高同型半胱氨酸血症者预后不良。  相似文献   

9.
目的观察Trevo支架用于前循环急性缺血性脑卒中取栓术的临床疗效及安全性。方法回顾江门市中心医院2018-01—12采用Trevo支架行前循环急性缺血性脑卒中动脉取栓术的12例患者的临床资料,采用改良脑梗死溶栓试验(mTICI)、美国国立卫生研究院卒中量表(NIHSS)、Barthel指数、改良Rankin量表(mRS)等综合评估治疗效果及安全性。结果经过1~3次取栓后,10例患者mTICI达到2b~3级再通。术后1例出现脑出血,另1例出现大面积脑梗死病情加重,其余患者治疗后临床症状较前不同程度改善。12例患者入院时NIHSS评分(12.4±4.6)分,出院时为(7.6±5.7)分,差异有统计学意义(t=-2.4645,P=0.0314)。12例患者出院时Barthel指数(65.8±26.9)较入院时(42.1±17.2)增加(t=-2.8021,P=0.0172)。术后90 d随访mRS 0~2分8例(66.7%)。结论 Trevo支架取栓治疗前循环急性缺血性脑卒中临床安全、有效。  相似文献   

10.
目的:探讨脑梗死中枢性面瘫并闭目乏力的相关危险因素。方法通过对2011—2012年入住我院神经内科的442例脑梗死患者的临床数据进行回顾性研究,对各种数据进行单因素卡方检验。结果与患者闭目乏力相关的因素为病灶位置,NHISS评分。结论脑卒中责任病灶在右侧大脑半球或靠近顶叶者易出现中枢性面瘫并闭眼乏力,且其神经功能缺损程度较严重。  相似文献   

11.
内科并发症对急性脑卒中患者预后的影响   总被引:7,自引:0,他引:7  
目的 研究内科并发症对急性脑卒中患者功能恢复和卒中后死亡的影响。方法 对 5 32例急性脑卒中患者出院时 BI、m RS和出院时减少的 NIHSS百分数进行评估 ,并记录其病死率。分析有、无内科并发症两组患者预后的差别。结果  (1)有并发症的患者出院时减少的 NIHSS百分数低于无并发症者 (P<0 .0 1) ,出院时和出院后6月的日常生活能力差于后者 (P<0 .0 1) ,残疾指数也高于后者 (P<0 .0 1) ;(2 )有并发症者较无并发症者病死率高(P<0 .0 1)。结论 卒中后内科并发症不仅影响急性脑卒中患者的功能恢复 ,而且影响卒中后病死率。  相似文献   

12.
13.
BACKGROUND: Aims of the study: to identify with echo color Doppler ultrasound of the supra-aortic vessels and transcranial color-coded duplex sonography (TCCD) various patterns of vessel occlusion within 3 h from stroke onset, to compare each group defined at the admission with clinical findings and outcome, and to study the recanalization process, independent of therapy. METHODS: We enrolled 89 consecutive patients (mean age 68.9 years). Ultrasound evaluation was done within 3 h from stroke onset, and was repeated at 3-6 and 24-36 h, at day 5, and at 3 months. At admission, patients were divided into the following groups: internal carotid artery occlusions and stenoses (<50%, 50-69%, > or =70%, near occlusion), middle cerebral artery stenoses and occlusions, tandem occlusions and T occlusions. Vascular recanalization in each group was evaluated. Subgroups were compared for NIH Stroke Scale (NIHSS) and the outcome measures mortality, Barthel index (BI) and modified Rankin scale (mRS). Favorable outcome was defined as mRS < or =2 and BI > or =90. RESULTS: Each subgroup differed significantly for baseline NIHSS (p < 0.0001), 3-month mortality (p = 0.0235), BI at day 5 (p = 0.0458) and mRS at 3 months (p = 0.0028), even after adjustment for treatment. T and tandem occlusions were the subgroups with the highest NIHSS scores and the poorest outcomes, and the same subgroups had the worst recanalization rates. CONCLUSIONS: TCCD in the acute setting of stroke patients allows identification of the presence and site of clots, prediction of outcome and study of the dynamic process of vessel recanalization, in both the acute phase and follow-up.  相似文献   

14.
ObjectivesTo evaluate the effect of remote ischemic postconditioning (RIPostC) on the prognosis of acute ischemic stroke(AIS) patients and investigate the mediating role of autonomic function in the neuroprotection of RIPostC.Materials and Methods132 AIS patients were randomized into two groups. Patients received four cycles of 5-min inflation to a pressure of 200 mmHg(i.e., RIPostC) or patients’ diastolic BP(i.e., shame), followed by 5 min of deflation on healthy upper limbs once a day for 30 days. The main outcome was neurological outcome including the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel index(BI). The second outcome measure was autonomic function measured by heart rate variability(HRV).ResultsCompared with the baseline, the post-intervention NIHSS score was significantly reduced in both groups (P<0.001). NIHSS score was significantly lower in the control group than intervention group at day 7.[RIPostC:3(1,5) versus shame:2(1,4); P=0.030]. mRS scored lower in the intervention group compared with the control group at day 90 follow-up(RIPostC:0.5±2.0 versus shame:1.0±2.0;P=0.016). The goodness-of-fit test revealed a significant difference between the generalized estimating equation model of mRS and BI scores of uncontrolled-HRV and controlled-HRV(P<0.05, both). The results of bootstrap revealed a complete mediation effect of HRV between group on mRS[indirect effect: −0.267 (LLCI = −0.549, ULCI = −0.048), the direct effect: −0.443 (LLCI = −0.831, ULCI = 0.118)].ConclusionThis is the first human-based study providing evidence for a mediation role of autonomic function between RIpostC and prognosis in AIS patients. It indicated that RIPostC could improve the neurological outcome of AIS patients. Autonomic function may play a mediating role in this association.Trial registrationThe clinical trials registration number for this study is NCT02777099 (ClinicalTrials.gov Identifier)  相似文献   

15.
Clinical interpretation and use of stroke scales   总被引:4,自引:0,他引:4  
No single outcome measure can describe or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials, including the National Institutes of Health stroke scale (NIHSS), the modified Rankin scale (mRS), the Barthel index (BI), the Glasgow outcome scale (GOS), and the stroke impact scale (SIS). Several scales have been combined in stroke trials to derive a global statistic to better define the effect of acute interventions, although this composite statistic is not clinically tenable. In practice, the NIHSS is useful for early prognostication and serial assessment, whereas the BI is useful for planning rehabilitative strategies. The mRS and GOS provide summary measures of outcome and might be most relevant to clinicians and patients considering early intervention. The SIS was designed to measure the patient's perspective on the effect of stroke. Familiarity with these scales could improve clinicians' interpretation of stroke research and their clinical decision-making.  相似文献   

16.
目的 探讨青年卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后临床预后不良的危险因素.方法 回顾性、连续性纳入胜利油田中心医院2018年1月至2019年12月收治的首次发病并接受rt-PA静脉溶栓的青年卒中患者114例.根据发病90 d mRS评分,将青年卒中患者分为预后良好组(90 d mRS评分0~2分...  相似文献   

17.
目的探讨增强型体外反搏(enhanced external counterpulsation,EECP)对急性缺血性卒中患者临床治疗效果及预后的影响,为缺血性卒中患者的康复治疗提供进一步的临床证据。方法选取急性期缺血性卒中住院患者共171例,随机分为EECP治疗组87例,对照组84例,治疗组予常规治疗加上36 h的EECP治疗,对照组予常规治疗,分别比较两组在入院第1天、EECP治疗后、第3个月的美国国立卫生研究院卒中量表(NIHSS)及改良Rankin量表(mRS)的差别。结果与对照组比较,治疗组在36次EECP治疗后及第3个月的NIHSS评分下降更明显,有统计学差异,(治疗后:44.1%vs.31.5%;第3个月:55.6%vs.40.5%),P值均小于0.05;与对照组比较,发病第3个月,治疗组mRS的评分下降更明显(45.5%vs.30.5%),预后良好者的比率明显升高,差异有统计学意义,P值均小于0.05。结论 EECP治疗可以有效改善急性缺血性卒中患者神经功能缺损症状,促进康复,改善预后。  相似文献   

18.
目的 探讨血清胱抑素C(Cystatin C,Cys C)水平对接受血管内治疗的急性缺血性脑卒中患者预后的预测价值。方法 回顾性分析125例接受血管内治疗的急性缺血性脑卒中患者的临床资料,记录相关病史及实验室检验指标水平; 对所有符合血管内治疗标准的急性缺血性脑卒中患者依据美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)进行神经功能缺损评分; 出院3个月后依据改良Rankin量表(modified rankin scale,mRS)对所有患者进行神经功能评分,依据mRS评分分为2组,mRS评分≤2分为预后良好组,mRS评分>2分为预后不良组,分别比较2组患者的一般资料和手术治疗,并采用Logistic 回归分析确定接受血管内治疗的急性缺血性脑卒中患者预后的不良因素,用受试者工作特征(Receiver operator characteristic,ROC)曲线评估Cys C水平对接受血管内治疗的急性缺血性脑卒中患者的预后不良的预测价值。结果 预后良好组59例,预后不良组66例。预后不良组APTT(Activated partial thromboplastin time,APTT)、入院时Cys C水平、入院时NIHSS评分和年龄较预后良好组高(P<0.05)。多因素Logistic回归分析结果显示入院时NIHSS评分、入院时血清Cys C水平、接受静脉溶栓和APTT水平是接受血管内治疗的急性缺血性卒中患者预后不良的独立危险因素。入院时血清Cys C水平对接受血管内治疗的急性缺血性卒中预后不良的诊断界值为1.005,其敏感度为62.1%,特异度为71.2%,准确度为66.4%。结论 入院时血清Cys C水平对接受血管内治疗的急性缺血性脑卒中患者的不良预后有良好的预测价值,血清Cys C水平越高,预后越差。  相似文献   

19.
目的 评价急性脑梗死患者的红细胞分布宽度(RDW)和神经功能评分的关系及其对患者短期(3个月)预后的判断价值。方法 收集本院神经内科急性发病的脑梗死患者90例作为研究组(均为非溶栓患者),同时把本院神经内科急性入院的眩晕症、血管性紧张性头痛等就诊的非脑梗死患者53例作为对照组; 对入组患者进行常规、血常规及血生化检查,同时对入组脑梗死患者的行美国国立卫生研究院卒中量表(NIHSS)评分,并根据NIHSS水平进行分组:轻度、中度和重度; 对2组患者一般临床资料进行比较,同时比较2组患者及NIHSS不同评分组的RDW值的差异,评价RDW和NIHSS评分的相关性。对入组的脑梗死患者进行脑梗死发生后3个月随访,评定患者的改良Ranking量表(mRS)评分情况,对mRS评分进行分组,即预后良好组(mRS≤2)和预后不良组(mRS>2分),比较2组的RDW值,同时采用多因素Logistic分析其预后不良的危险因素。结果 脑梗死组的RDW较对照组明显增高(P<0.01); RDW的中位值随着神经功能缺损程度的加重而增高(P<0.05); 相关性分析显示RDW与NIHSS评分呈正相关(r=0.335 P=0.001); 预后不良组的RDW较预后良好组明显增高(P<0.01); 多因素Logistic分析显示高RDW、NIHSS及2型糖尿病是急性脑梗死患者短期不良预后的危险因素。受试者工作特征(ROC)曲线图显示RDW对急性脑梗死患者不良预后预测的最佳界值为14.2%(敏感度,72.8%; 特异性,68.6%; 准确性,71.2%)。结论 急性脑梗死患者早期的RDW对评估患者的严重性及短期预后有一定价值。  相似文献   

20.
目的 探讨急性卒中后肺炎对卒中近期预后的影响.方法 对上海交通大学附属第六人民医院金山分院神经内科自2008年1月1日至2010年6月30日住院治疗的急性卒中患者进行前瞻性研究观察,比较肺炎组与非肺炎组入院时和入院后21 d神经功能缺损程度(NIHSS)、残障程度(mRS)及日常生活能力(BI),比较2组患者其他并发症发生率、病死率、住院时间及治疗费用.结果 (1)人院后21 d,市炎组NIHSS改善程度明显低于非肺炎组[改善值-(1.04±1.20)vs(1.37±2.48)],但差异无统计学意义(P=0.663);mRS、BI改善程度明显低于非肺炎组[改善值-(0.12±0.33)vs-(0.64±0.82);3.00±6.55 vs 14.70±19.45],差异均有统计学意义(P<0.05).(2)肺炎组其他并发症发生率、病死率明显高于非肺炎组(80.0%vs19.0%;16.7%vs2.5%),差异均有统计学意义(P<0.05).(3)肺炎组住院时间明显长于非肺炎组[(35±17)dvs(23±11)d],住院总费用及药物费用均明显高于非肺炎组[(8509±4425)元vs(4867±1648)元;(4089±2709)元vs(2168±795)元],差异均有统计学意义(P<0.05).结论 急性卒中后肺炎是导致卒中病死率增加、近期临床预后不良、住院时间延长、医疗费用增加的重要因素.
Abstract:
Objective To study the influence of acute post-stroke pneumonia on short-term prognosis of acute stroke. Methods A prospective, observational study of inpatients with acute stroke,admitted to our hospital from January 1, 2008 to June 30, 2010, was carried out. All the selected patients were divided into pneumonia group and non-pneumonia group. Neurological deficit (NIHSS), disability (modified Rankin Scale, mRS) and activity of daily living (Barthel Index, BI) between these 2 groups were compared on the day of admission and the 21st day of admission; the incidence of other complications, the mortality rate, the hospital length of stay (LOS), and the total costs of hospitalization and drugs between these 2 groups were compared. Results The improvement (NIHSS) in pneumonia group (-[1.04±1.20]) was less significant than that in non-pneumonia group (-[1.37±2.48]), but their differences were not statistically significant (P=0.663); the improvement (mRS and BI, respectively) in pneumonia group (-[0.12±0.33], 3.00±6.55) was obviously less significant than that in non-pneumonia group (-[0.64±0.82], 14.70±19.45, P<0.05). The incidences of other complications and mortality rate in pneumonia group were significantly higher than those in non-pneumonia group (80.0% vs. 19.0%, 16.7%vs. 2.5%, P<0.05). As compared with those in patients of pneumonia group, patients of non-pneumonia group had shorter LOS[(23±11) d vs. (35±17) d, P<0.05], less total costs ofhospitalization[(4867±1648)$ vs. (8509±4425)$, P<0.05] and less drug costs [(2168±795)$ vs. (4089±2709)$, P<0.05].Conclusion Acute post-stroke pneumonia was an important factor that leads to increased acute stroke mortality rate, poor short-term clinical prognosis, prolonged LOS and increased treatment costs.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号