石家庄市社区居民脑卒中危险因素调查分析

目的调查石家庄市部分社区40岁以上居民脑卒中高危人群分布及危险因素暴露情况,为建立脑卒中防控干预措施提供依据。方法采取随机抽样调查的方法对石家庄社区40岁及以上常住居民进行现场问卷调查、评估、分级,将调查数据进行统计分析。结果 2633居民接受了调查,其中有脑卒中低危1561人,中危638人,高危373人,排在前3位的危险因素分别是高血压(31.9%)、运动减少(21.5%)及肥胖(21.2%),男性居民吸烟率明显高于女性,而女性在血脂异常及运动减少者明显多于男性。结论高血压、运动减少和肥胖是脑卒中高危人群中主要的危险因素,应作为重点进行干预。     

上海市浦东新区某社区老年脑卒中高危人群筛查结果分析

目的了解上海市浦东新区三林社区老年脑卒中高危人群危险因素暴露情况及其人群分布特征,为制定老年脑卒中高危人群防治策略提供依据。方法于2015-2017年采取整群抽样方法对浦东新区三林社区65岁及以上常住户籍人口开展现场询问调查和相关的体格检查,进行血脂、空腹血糖、糖化血红蛋白、同型半胱氨酸、心电图检测,以筛查缺血性脑卒中高危人群及其危险因素。结果 2015-2017年筛查居民总数为9195人,筛查出脑卒中高危人群1504人,高危人群比例为16.78%,有短暂性脑缺血发作史或者卒中史535人(5.82%),危险因素≥3项的高危人群969人(10.54%)。1504名高危人群中危险因素暴露率从高到低依次为高血压、超重、高血脂、糖尿病、卒中史、吸烟史、家族史、缺乏运动、房颤。969例危险因素≧3的高危人群中,女性糖尿病、高血脂暴露率高于男性,男性吸烟率、超重高于女性。参加筛查的社区人群中,高Hcy血症的检出率为53.72%。男性检出率为63.8%,女性为45.7%,差异有统计学意义。结论三林地区65岁以上人群高危人群检出率与上海其他地区相似;高血压、超重、高血脂是暴露率最高的三项危险因素。男性和女性某些危险因素暴露情况有差异。高同型半胱氨酸血症在高龄、男性人群检出率高。应结合不同人群的危险因素发生情况实施定期随访管理,以达到预防脑卒中的目的。     

脑卒中3年生存和复发的社区干预效果

目的近20年来,脑卒中是中国人群的主要死亡原因,其发病率随着脑卒中危险因素的增加呈上升趋势。本研究旨在评价初发脑卒中患者3年生存和复发的社区干预效果。方法1991～2000年选择北京2个人口约50 000人的社区分别作为干预和对照社区。采取的综合干预措施包括高危人群管理和社区人群健康教育。对初发脑卒中3年生存和复发的社区干预效果进行评价。结果3年内干预社区736例患者中有41．85%的死亡,而对照社区818例患者中有40．34%的死亡;干预社区223例患者中有26人(11．66%)复发〔RR=0．74,95% CI为(0．61,0．89),P= 0．002〕,对照社区250例患者中有52人(20．80%)复发〔RR=0．61,95% CI为(0．46,0．81),P=0．001〕,2个社区的复发率间差别有显著性意义。对照社区比干预社区脑卒中死亡率下降了26%,尤其是出血性脑卒中下降了39%,同时复发率下降了42%。结论社区干预对预防脑卒中,尤其是出血性脑卒中的复发,改善脑卒中生存是有效的。     

脑卒中高危人群高血压病新型管理模式探索

目的建立脑卒中高危人群的高血压病新型健康促进模式,并探索该模式对乐山社区脑卒中高危人群高血压病的干预效果。方法建立由神经内科专业人员参与的监控管理、社区直接管理、患者及家庭组成的高血压病长程监控管理体系,并筛查出159例伴高血压病的脑卒中高危人群,给予个性化的健康教育和干预方案。结果该新型高血压病管理模式能有效提高脑卒中预防中的高血压病管理效果,平均收缩压下降23.7 mmHg、舒张压下降11.4 mmHg。经干预后血压控制率从9.4%提高到70.4%。高血压病患者的知晓率、用药率、控制达标率、依从性、控盐、运动等均明显提高。结论该新型健康促进模式是脑卒中预防的有效措施,能降低脑卒中高危人群的血压水平,减少高危人群的脑卒中发病率,应加强社区的脑卒中知识教育。     

上海脑卒中急性期死亡的流行病学研究

目的:报告上海市区人群脑卒中急性期死亡的监测结果。方法:在上海市选取社区人群共９１ ４２８人进行长达４年的脑卒中疾病监测。结果:４年共发现脑卒中７７８例,其中急性期死亡２７７例。脑出血与脑梗死病死率分别为６０．３%与２２．５%。男性发病率与死亡率均高于女性。两类脑卒中的死亡率均随着年龄的增大而上升。急性期死亡者生存天数在０~２ｄ的频数分布累计为５０．９%。结论:随着年龄的增大,脑卒中死亡率上升,男性死亡率高于女性,脑出血死亡率和病死率高于脑梗死。     

综合性干预对社区高血压患者血压和人群脑卒中发病、死亡的影响

目的研究综合性干预对社区高血压患者血压和人群脑卒中发病、死亡的影响.方法1997～2000年对长沙市35岁以上社区人群中的部分高血压患者进行综合性防治,并监测1996～2000年干预和对照社区人群脑卒中发病和死亡情况.结果干预社区高血压患者收缩压人均下降了4.25mmHg、舒张压人均下降了1.16mmHg(P＜0.01),且不论男女,人均血压均有不同程度的下降;综合干预使干预社区脑卒中发病率下降约50%.结论综合性干预能降低社区高血压患者血压水平,为脑卒中社区防治的有效手段.     

体检人群劲动脉超声筛查结果及脑卒中危险因素分析

目的解体检人群中脑卒中发病风险,筛选高危人群,并分析相关危险因素,为脑卒中的预防提供依据。方法以2015-04—2016-06我院256例体检者为研究对象,进行常规体格检查和劲动脉超声筛查,包括双侧颈总动脉、颈内动脉、颈外动脉等,记录颈动脉粥样硬化斑块检出情况,并对性别、年龄、高血脂、高血压、肥胖等危险因素进行分析。结果年龄≥60岁患者斑块形成率为11.76%,高于年龄60岁的4.10%,差异有统计学意义(P0.05);男性斑块形成率为11.02%,高于女性的3.88%,差异有统计学意义(P0.05);Logistic回归分析显示,年龄、高血脂、高血压、肥胖为脑卒中的危险因素(P0.05)。结论老年人群脑卒中发病率较高,男性较女性发病率高,发生率与、高血脂、高血压、肥胖等危险因素有关。     

脑卒中前期的社区综合干预及效果评价

目的评价社区综合干预对脑卒中前期高危人群的预防效果。方法选取2010-08—2012-08在我市某社区卫生服务中心筛选出的356例高危人群为研究对象。根据随机对照原则分为研究组(干预组)和对照组(常规干预组),随访3a,比较2组研究对象干预前、后收缩压、舒张压、空腹血糖、LDL-C、基础疾病变化,记录2组发病率和病死率,评估社区综合干预对脑卒中高危人群的预防效果。结果研究组干预前后高血压、糖尿病、心血管疾病患者基本保持稳定,差异无统计学意义(P0.05),对照组干预前后高血压、糖尿病、心血管疾病患者增加明显,差异有统计学意义(P0.05);干预后研究组发病率降低53.8%,对照组发病率增高18.5%,差异有统计学意义(P0.05);干预后研究组病死率降低40%,对照组病死率增加33.3%,2组间差异有统计学意义(P0.05)。结论社区综合干预可有效改善脑卒中高危人群高血压、高血糖、高血脂,明显降低脑卒中高危人群发病率和病死率,对预防脑卒中的发生具有重要意义。     

脑卒中危险因素早期筛查与高危个体处理

目的探讨脑血管功能检测技术对脑卒中高危人群的筛查与处理,以期降低该病的发病率。方法选择2015年9月至2016年9月本院体检中心筛选的6703例脑卒中高危人群作为研究对象,通过评估脑卒中危险因素、药物治疗等一系列干预措施预防脑卒中的发生。结果干预后脑卒中的可控制危险因素有所减少,缺乏体育锻炼、肥胖、血脂异常及吸烟的发生率分别由25.3%、15.6%、13.8%、12.0%降低至18.4%、13.4%、12.5%、9.2%,差异有统计学意义(均P0.05)。同时个体对高血压、糖尿病、缺乏体育锻炼、肥胖、房颤或心脏瓣膜病、血脂异常、吸烟等风险因素的知晓率明显提高,分别由71.0%、44.8%、58.9%、49.7%、38.3%、58.7%、50.9%提升至96.0%、84.2%、97.5%、89.3%、81.8%、88.7%、94.0%,差异有统计学意义(均P0.05)。对高危个体干预后脑卒中发病率仅为0.4%。结论对体检人群进行脑卒中危险因素早期筛查与干预,可有效地降低发病率。     

上海市青浦区居民脑卒中死亡特征和早病死概率分析

目的分析上海市青浦区居民脑卒中死亡特征和早病死概率情况,为制定脑卒中有效预防控制措施提供依据。方法对2017年上海市青浦区心脑血管急性事件登记报告的339例脑卒中死亡病例进行统计分析。结果 2017年上海市青浦区户籍居民脑卒中死亡率为70. 53/10万,标化死亡率为20. 01/10万;男性死亡率为75. 29/10万,标化死亡率22. 16/10万;女性死亡率为65. 92/10万,标化死亡率17. 84/10万。30～69岁年龄组男性早死亡率和早病死概率(25. 91/10万和0. 94%)均高于女性(8. 34/10万和0. 34%),差异有统计学意义(P 0. 05)。死亡率随年龄的增长而呈上升趋势,死亡病例主要集中在60岁及以上年龄组,占全部死亡病例的93. 80%。脑卒中死亡前3位的疾病类型为脑梗死(非腔隙性) I63例(47. 49%)、脑卒中不分型I64例(25. 96%)、脑内出血I61例(24. 78%)。结论脑卒中是影响农村社区人群健康的重要公共卫生问题。随着人口老龄化形势严峻,应重视男性和老年人脑卒中高危人群的筛查和干预工作,从而降低脑卒中对居民健康和生活的影响。     

社区≥50岁人群高血压与卒中防治知识、态度和行为的调查

目的 了解50岁以上社区人群高血压与卒中防治知识、态度、行为（Knowledge,Attitude,Practice,KAP）状况。方法 在北京崇文和石景山地区,选择各约5万自然人群的社区,按照整群随机抽样的方法,对1352名年龄≥50岁的非卒中人群中进行卒中危险因素与卒中防治KAP水平的调查。结果 崇文组和石景山组除了在文化程度方面崇文组高于石景山组,差异有统计学意义外（P<0.01）,性别、年龄以及血压水平的差异均无统计学意义。知晓高血压诊断标准者崇文组高于石景山组,差异有统计学意义（P<0.01）。知晓高血压可引起脑出血和脑梗死者均在90%左右,并且石景山组高于崇文组,差异有统计学意义（P<0.05）。认为有必要经常测量血压者均在80%以上,差异没有统计学意义（P>0.05）。曾经测量过血压者两组均在90%以上,石景山组高于崇文组,差异有统计学意义（P<0.01）。两组的高血压患者能按医嘱治疗高血压者均超过85%。结论 社区≥50岁人群高血压患病率居高不下,继续广泛开展和加强高血压与卒中防治知识的宣传教育十分必要。     

Ischaemic strokes: management in first six hours.

Cerebrovascular disease (CVD) or stroke is one of the foremost causes of high morbidity and mortality for many nations of the world, posing a major socio-economic challenge in the occupational and neuro-rehabilitational programmes of the 'stroke-survivors'. For example, in USA alone it has been estimated that a sum of 3261 million dollars is spent as direct cost for treatment, in addition to 4104 million dollars as indirect costs, consequent on economic losses of 'stroke victims'. Thus, the new concept in stroke pathophysiology and strategies for stroke prevention have assumed global importance. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15% of urban population is hypertensive (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many other reasons such as patient's compliance in taking medicine and poor followup in clinical practice that may lead to failure in reducing stroke mortality. In subjects, who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin is well established in prevention of stroke. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight. Associated conditions like diabetes mellitus etc. should also be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base stations for these surveys, because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.     

Perioperative stroke as a predictor of mortality and morbidity in patients undergoing CABG

Perioperative stroke is a devastating neurological complication of Coronary Artery Bypass Grafting surgery (CABG). It results in significantly increased rates of mortality and morbidity and presents a significant financial burden to our healthcare system. It has not, however, been studied in a large population based sample. We aim to investigate the role of perioperative stroke as an independent risk factor for in-hospital mortality and morbidity following CABG, and to review trends in the early outcomes of CABG from the years 1999 to 2011. We hypothesize that perioperative stroke is an independent risk factor for in-hospital mortality and morbidity following CABG. We analyzed data from the 1999–2011 Nationwide Inpatient Sample, identifying patients who underwent CABG using ICD-9 and CCS codes. We excluded patients below the age of 18 and above the age of 100, and patients undergoing concomitant heart and/or vascular procedures. Analysis on our sample of 668,627 patients yielded an overall rate of perioperative stroke, mortality, and morbidity of 1.87%, 2.13%, and 49.07%, respectively. Along with age, risk category, gender, and other postoperative outcomes, perioperative stroke was found to be a strong predictor of mortality and morbidity, leading to more than a 5-fold risk of death and morbidity. From our study, we conclude that perioperative stroke remains a serious adverse outcome of CABG and is an independent predictor of mortality and morbidity. While rates of stroke and mortality are decreasing, morbidity continues to trend upwards. This study emphasizes the importance of prevention and early intervention in patients at risk for perioperative stroke.     

二级医院参与社区防治脑卒中的实践研究

目的将二级医院的资源用于社区卫生,创立可推广的防治脑卒中的应用、管理模式。方法与全社区卫生服务中心建立双向转诊制度;培训社区医生,提高社区医生防治脑卒中的技术水平;二级医院医生进入社区与居民进行直接的脑卒中防治知识宣教,提高社区居民防治脑卒中知识的知晓率。结果双向转诊解决了社区脑卒中病人看病难、住院难问题;卒中溶栓病例逐年增加。全区14家社区医院医生对脑卒中防治知识的合格率从培训前的20.8%、49.4%提高到培训后的84.8%、96.6%。接受宣教的社区居民对脑卒中防治知识的知晓率明显提高。社区医生和社区居民对二级医院医生下社区举措的欢迎度分别达到100%。上海市松江区近三年脑卒中的首次发病和死亡呈控制趋势。结论利用二级医院资源指导社区防治脑卒中的方法,具有控制地区脑卒中发病和死亡率作用,可能是具有推广应用价值的防控卒中的模式。     

Quantitative and qualitative evaluation tool in planning stroke treatment strategies: the “Safe implementation of treatments in stroke Monitoring Study (SITS MOST)” registry

A decade ago, stroke was the first leading cause of morbidity and mortality in Croatia. Nowadays, we record reduction in stroke incidence, as well as stroke consequences—invalidity and mortality. These are due to long-term planned actions in the field of public health as well as actions performed by professional organizations. Today, we can be satisfied with improvement in that field, but there are still things we can improve, at the first place improvement of the emergency medicine network due to Croatian-specific topographical characteristics to reduce onset-to-door time. In this paper, we evaluated results from 11 Croatian hospitals in the period 11/2005–11/2012. To find out about the past and present state in applying thrombolytic therapy in Croatia and to plan further actions in light of new studies and efforts in Europe and in the world, all with the aim of improvement in stroke prevention and acute treatment resulting in reduction of stroke morbidity, mortality and symptomatic intracerebral hemorrhage as well as better functional outcome. Our results have shown that we improved stroke treatment in the last decade, but further actions should be performed to raise public stroke awareness and to improve emergency medicine network as well as in hospital protocols.     

Awareness of warning symptoms and risk factors of stroke in the general population and in survivors stroke.

Awareness among the general population of the risk factors and warning symptoms of stroke is essential for preventative purposes and for immediate effective treatment. The aim of the present study was to assess the awareness, among the general population and stroke survivors, of the risk factors and warning symptoms of stroke, to develop an educational strategy for its prevention and immediate effective treatment. Six hundred and sixty stroke patients (370 male, 290 female) and 4000 people from the general population who accompanied the patients (2800 male, 1200 female) were interviewed, using three sets of questionnaires, on the risk factors and warning symptoms of stroke. Poor knowledge or awareness of the risk factors and warning symptoms of stroke was found in both groups. Both groups suggested educational programs for stroke using printed information, audiovisual programs and community survey programs using simple and understandable information for the prevention and immediate effective treatment of stroke. Poor awareness of stroke contributes to a delay in the arrival of patients in hospital emergency departments for immediate effective treatment. Multifaceted programs regarding stroke, including printed information, audiovisual programs and stroke service programs, are advocated by both patients and the general population to improve stoke treatment and prevention.     

北京市社区卫生服务中心医务人员卒中相关知识调查及干预研究

目的 调查社区医务人员对卒中相关知识的认知情况。对社区医务人员进行卒中相关知识培训干预效果进行评价。方法 选取北京市丰台区方庄卫生服务中心作为研究现场。全体医务人员进行干预前基线调查。使用统一的问卷式调查表。调查内容包括：（1）社区医务人员的性别、年龄、文化程度等一般资料;（2）卒中相关知识,包括卒中危险因素的认识、卒中高危人群的干预、卒中的防控相关知识、卒中的早期症状识别及转诊知识。对全体医务人员进行上述卒中相关知识培训。培训结束后进行再次问卷调查。对调查前后的卒中知识认知情况进行比较以评价干预效果。结果 共有50名社区医务人员参与研究。（1）社区医务人员对卒中危险因素知晓率为66%～100%,培训后的知晓率为94%～100%。对高血压、糖尿病、肥胖等危险因素的防控知识的知晓率为70%～96%,培训后的知晓率为92%～100%。（2）对卒中高危人群的知晓率为84%～100%,培训后的知晓率为98%～100%。对卒中高危人群进行社区干预的知晓率为86%～96%,培训后的知晓率为94%～98%。对卒中防控知识的知晓率为90%～100%,培训后的知晓率为94%～100%。（3）对卒中早期症状识别知晓率为82%～96%,培训后的知晓率为94%～100%,对发生卒中早期症状转诊的知晓率为88%～98%,培训后为96%～100%。结论 目前北京市社区医务人员对卒中的危险因素、早期症状识别、卒中高危人群的社区干预及卒中防控等相关知识存在一定程度的认识不足。经过一定学时的相关知识培训后上述知识的知晓率得到明显提高。需要定期对社区医务人员加强卒中相关知识培训。     

The impact of ageing on stroke subtypes, length of stay and mortality: study in the province of Teruel, Spain

BACKGROUND AND PURPOSE: During the last three decades, there have been important advances in the diagnosis and treatment of stroke leading to a decline in mortality rates in western countries. However, the longer life expectancy and the higher proportion of elderly people in the structure of the population may partially counteract this positive trend in stroke-related mortality. The purpose of this study was to analyse the impact of a high ageing index of the population on stroke-related variables such as stroke subtypes, length of hospital stay and mortality from stroke. METHODS: We analysed the data of 1850 consecutive patients with first-ever stroke retrieved from a prospective registry over a period of 8 years (1994-2001) in the province of Teruel, Spain, with two public hospitals in the catchment area. The mean age was 75.5 years (SD: 9.4) and the sex was male in 62% of cases. The variables included in the study were vascular risk factors, stroke subtypes, fatality rate, length of stay and mortality. Mortality was assessed from 1990 to 2000. RESULTS: Arterial hypertension and atrial fibrillation were the most frequent risk factors, with an observed high frequency of cardioembolic stroke. The mean 28-day case fatality rate was 16.6%, ranging from 11.9% in 1994 to 23.4% in 1999. We found complications in 38% of patients, especially in the elderly. Fatality occurred in 20.3% of elderly subjects (65 or over) in comparison to 7.25% for those younger (Relative risk: 2.8; 95% CI: 1.475.3). Crude mortality rates were higher than for the general population in Spain and ranged from 169 in 1991 to 139/100,000 in 2000 with higher rates for women. However, the age-adjusted mortality rate to the standard European population was 56.6/100,000 (95% CI: 4664) in 1999, which was similar to that found in Spain (61/100,000). CONCLUSIONS: The impact of ageing on case fatality and mortality by stroke was substantial. Whereas mortality by stroke stabilized after decreasing in our province and in Spain in the last decade, fatality rates have significantly increased in our province because of the high proportion of elderly people and to the high rate of post-stroke complications.     

Neurologic Complications of Chronic Kidney Disease

Chronic kidney disease (CKD) is an increasing problem worldwide and is now being recognized as a global health burden particularly for cardiovascular and cerebrovascular events. The incidence of stroke increases in the presence of CKD with a 3-fold increased rate reported in ESRD. Atrial fibrillation (AF) increases the risk of stroke in CKD. There is conflicting observational evidence regarding benefit of anticoagulation in CKD for prevention of stroke in AF as risk of bleeding is high. Overall, anticoagulant in CKD may be beneficial in appropriate patients with meticulous monitoring of international normalized ratio (INR). Neurological manifestations related to electrolyte disorders, drug toxicity, and uremia are common in CKD. Appropriate drug dosing, awareness of potential side effects of medications, prompt diagnosis, and treatment are essential in preventing long-term morbidity and mortality.     

Current status of stroke epidemiology in Greece: A panorama

Although strokes have been documented since about 3 millennia, they remain today as one of the leading causes of mortality, as well as of subsequent serious long-term physical and mental morbidity, among patients in many different countries all over the world. Greece presents an increase in mortality rates according to World Health Organization, and this fact underlines the need for early diagnosis and treatment, as well as, the need to implement effective prevention strategies for strokes. This review makes an effort to describe the current status of stroke epidemiological features, as well as to present the risk factors prevalent in Greece. The incidence rate is 261–319/100,000 based on the recent population based registry. Stroke appears to be more prevalent in men than in women, and the mean age of stroke onset in Greece is at 70 years of age. Hypertension, atrial fibrillation, dyslipidaemia and diabetes mellitus are the major risk factors of stroke in the Greek population, while smoking is the most commonly documented modifiable risk factor in young adults with ischemic stroke. Similar to other parts of the world, ischemic stroke is the most common stroke type. The 28-day case fatality rate for men and women was 26.5%. The mean in-hospital cost per stroke patient was 3624.9 € and the mean rehabilitation cost of outpatients with stroke was 5553.3 €, while the cost proportion of hemorrhagic stroke is higher when compared to ischemic stroke. Stroke is a devastating condition with recognized challenges in identifying effective prevention programs. In Greece, limited data exists regarding the epidemiology of strokes. As a result, the need to conduct new studies and researches across the country is well documented.