卒中单元病房综合治疗对脑卒中患者生存质量的影响

目的：研究卒中单元病房中综合治疗对脑卒中患者生活质量的影响。方法：随机抽取卒中单元病房的脑卒中患者176例为康复组、神经内科脑卒中患者84例为对照组，均采用常规药物治疗和护理，康复组同时配合运动疗法，语言训练、心理康复及健康教育。治疗前和治疗8周后采用Spitzer生活质量指数量表（QLI）和Barthel指数（BI）量表评定患者生活质量，并采用Zung氏抑郁自评量表评定患者抑郁状态。结果：治疗后QLI总分及各分项得分、BI指数得分康复组均明显高于对照组（P〈0．01），抑郁状态的发生率明显低于对照组（P〈0．01）。结论：采用卒中单元病房综合治疗脑卒中能明显改善患者的ADL，减少抑郁状态的发生，提高生活质量。     

早期康复对脑卒中后运动及认知功能的影响

目的研究早期康复对脑卒中后运动及认知功能的影响.方法107例脑卒中偏瘫患者随机分为康复组（51例）和对照组（56例）,均进行神经内科常规药物治疗,康复组加以正规早期康复治疗.两组患者分别在进入课题研究时和3个月后测试Bathel指数（BI）、Fugl-Meyer评定（FMA）分、简明精神状态检查（MMSE）分.结果治疗3个月后,康复组BI、FMA、MMSE积分均较治疗前改善（P＜0.05）;对照组BI、FMMS积分也较治疗前改善（P＜0.05）;BI、FMMS、MMSE积分在两组间有显著性差异（P＜0.05）.结论正规早期康复对脑卒中患者3个月后的运动及认知功能后遗症有明显的改善作用.     

早期康复对脑卒中后焦虑、抑郁症状的影响

目的 观察早期康复对脑卒中后焦虑、抑郁症状的影响。方法 137例脑卒中偏瘫患者分为康复组（70例）和对照组（67例），均进行神经内科常规药物治疗，康复组患者同时接受早期康复治疗；对两组患者分别于治疗前和治疗3个月后进行Bathel指数（BI）、Fugl—Meyer运动量表（FMMS）、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）测试。结果 治疗3个月后，康复组患者的HAMD、HAMA、BI和FMMS、评分与治疗前有显著性差异（P〈0．05～0．01），与对照组治疗后亦有显著性差异（P〈0．05）；对照组的BI、FMMS评分与治疗前有显著性差异（P〈0．05）；康复组抑郁发生率22．86％，焦虑发生率5．71％，对照组分别为40．30％和16．42％．两组间有显著性差异（PG0．05）。结论 早期康复对脑卒中患者的焦虑及抑郁症状有明显的改善作用。     

急性脑卒中早期综合康复疗效观察

[摘要]目的观察早期综合康复对急性脑卒中患者的疗效。方法80例急性脑卒中患者随机分为康复组和对照组各40例，给予神经内科常规治疗，康复组在此基础上进行早期综合康复治疗；治疗前和治疗1个月后，采用美国国立卫生研究院卒中量表（NIHSS）、Fugl—Meyer评定量表（FMA）和Barthel指数（BI），评定两组患者的神经功能、肢体运动功能与日常生活活动能力。结果治疗前，两组患者的NIHSS、FMA及BI评分差异无显著性意义（P〉0．05）；治疗1个月后，康复组患者的各项评分均明显高于对照组（P〈0．01）。结论早期综合康复治疗能促进急性脑卒中患者神经功能的恢复，提高其生活质量。     

卒中单元的疗效及卫生经济学评价

目的：探讨卒中单元对脑卒中患者的疗效及卫生经济学评价．为脑血管病的治疗制订最佳策略。方法：将研究对象分为卒中单元组和普通病房组，疗效观察指标为病死率、平均住院时间、肺感染发生率、治疗前后NIHSS评分、BI评分、改良Rankin评分。采用成本-效果及增量分析进行卫生经济学评价。结果：①出院时卒中单元组各项评分改善程度明显优于普通病房组（P〈0．05）；②卒中单元组患者的病死率、肺感染率、平均住院时间明显低于普通病房组（P〈0．05）；③卒中单元组与普通病房组的人均住院费用差异无显著性意义（P〉0．05），但在药费、康复治疗、各项检查费用方面比较，差异有显著性意义（P〈0．05）；④NIHSS评分每减少1分，BI评分每增加1分，MRS评分每减少1分，卒中单元组所需的花费均较普通病房组少。结论：卒中单元能明显促进脑卒中患者神经功能恢复，强调病因学检查，降低病死率和肺感染率，在提高患者疗效上更为经济。     

氟西汀配合康复训练治疗脑卒中后抑郁的临床研究

目的：观察氟西汀配合康复训练治疗脑卒中后抑郁的临床疗效。方法：87例脑卒中后抑郁患者分为康复组45例和对照组42例,均每日口服氟西汀20 mg,康复组患者同时配合康复治疗;分别于治疗前后对2组进行Barthel指数（BI）、Fugl-Meyer运动量表（FMMS）、Zung抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）检测。结果：治疗3个月后,2组SDS、HAMD评分与治疗前比较减分明显,BI、FMMS评分明显上升（均P〈0.01）;2组间比较康复组显示更明显（P〈0.05）。抑郁状态比较,康复组SDS及HAMD总有效率明显高于对照组（77.8%、78.6%与60.0%、52.4%,P〈0.05和0.01）。结论：氟西汀配合康复训练治疗脑卒中后抑郁有明显的临床疗效。     

急性期康复对脑梗死患者预后的影响

目的：探讨急性缺血性脑卒中患者在急性期接受康复治疗的安全性和有效性以及对预后的影响。方法：急性脑梗死患者146例，其中82例收治卒中单元病房（康复组），64例收治普通病房（对照组）。两组患者用药相同，对康复组患者给予规范的早期康复治疗措施发病24h、治疗后21天各按ESS评分1次，发病3个月时用Barthel指数评定日常生活能力，观察并发症的发生情况．结果：康复组患者的ESS评分、Barthel指数积分显著较对照组为佳（P〈0．01），卒中后并发症明显减少（P〈0．05）：结论：急性期康复治疗能明显促进脑梗死患者各项功能的恢复，改善预后。     

二甲医院卒中单元的运作与效果评价

目的通过在二甲医院建立和运作康复卒中单元，以探讨脑血管病的卒中单元管理模式及效果研究。方法将病情稳定、Barthel指数（BI）评分低于39分的1040例脑卒中患者分别在康复卒中单元病房（观察组）和普通病房（对照组）进行为期7d的相关治疗，运用BI、Fugl-Meyer评估（FAM）以及汉密尔顿抑郁量表（HAMD）对患者日常生活能力、肢体运动功能以及抑郁和焦虑程度进行评定，比较患者的综合康复疗效。结果治疗前BI FMA HAMD在两组之间均无显著性差异（P〉0．05），治疗后对照组以及观察组与其治疗前相比均有显著性差异（P〈0．05），观察组与治疗组相比也有显著性差异（P〈0．05）。结论两组患者的治疗有效，但是康复卒中单元的效果更明显，康复卒中单元是二甲医院实施脑血管病治疗更好的管理模式。     

基层医院卒中单元的卫生经济学评价

目的：应用卫生经济学指标评价基层医院卒中单元的价值。方法：将238例卒中患者随机分为卒中单元治疗组（治疗组）和普通病房组（普通组）。治疗组按照自行设计的卒中单元病房管理模式并参照《中国脑血管病防治指南》实行规范化治疗,普通组按照传统方法进行治疗,分别于入院时、出院时进行神经功能缺损评分（NIHSS）、生活自理能力评定Barthel指数（BI指数）评分,并进行成本-效益分析。结果：治疗组NIHSS评分改善明显高于普通组（P〈0.05）,BI指数积分升高明显高于普通组（P〈0.05）,成本-效益分析显示治疗组优于普通组。结论：在基层医院实施卒中单元管理模式,卒中患者病情改善优于传统治疗,卫生经济学分析显示成本-效益比高,值得推广。     

多学科整合治疗模式——卒中单元治疗脑卒中的应用研究

目的探讨多学科整合治疗模式——卒中单元对脑卒中的治疗价值。方法采用随机平行对照设计，观察卒中单元试验组与普通病房治疗对照组在脑卒中的病死率、并发症发生率、美国国立卫生院卒中量表（NIHSS）评分、Barthel Index（BI）评分、住院时间和费用等方面的差异。结果治疗前试验组与对照组在脑卒中的发病危险因素、诊断、NIHSS及BI评分方面比较差异均无统计学意义（均P〉0．05）；治疗后试验组的NIHSS改善91.3％（73例），高于对照组71．3％（57例）；治疗后试验组BI改善93．8％（75例），优于对照组75．0％（60例），差异均有统计学意义（均P〈0．05）。2组在住院时间和费用等方面比较差异均无统计学意义（均P〉0．05）。结论多学科整合治疗模式是脑卒中有效的治疗方式。     

Preventable stroke and stroke prevention

Stroke is a major cause of death and disability in the world. The main causes of stroke are atherothromboembolism and cardiogenic embolism. The main causal and treatable risk factors for atherothromboembolic ischemic stroke are increasing blood pressure (BP), increasing cholesterol, cigarette smoking and diabetes; and the main risk factors for cardiogenic ischemic stroke are atrial fibrillation (AF) and ischemic heart disease. Strategies to reduce the incidence of stroke include prevention of first-ever and recurrent stroke, and treatment of patients with acute stroke to reduce death and disability. The two main strategies of stroke prevention are the 'population' (or 'mass') approach and the 'high risk' approach. The 'population' approach aims to reduce stroke by lowering the prevalence and mean level of causal risk factors in the community, by means of public education and government legislation. The 'high risk' approach aims to reduce stroke by identifying individuals at high risk of stroke, and lowering their risk by means of optimal medical therapies. Level 1 evidence from randomized controlled trials indicates that effective treatments for high risk patients include control of causal risk factors (lowering BP, lowering blood cholesterol), antithrombotic therapy (antiplatelet therapy with aspirin, clopidogrel, or the combination of aspirin and dipyridamole for patients in sinus rhythm, and anticoagulation with warfarin or ximelagatran for patients in AF) and, where appropriate, carotid revascularization for patients with severe carotid stenosis.     

Life experiences after stroke among Iranian stroke survivors

DALVANDI A., HEIKKILÄ K., MADDAH S.S.B., KHANKEH H.R. & EKMAN S.L. (2010) Life experiences after stroke among Iranian stroke survivors. International Nursing Review 57 , 247–253 Background: Stroke is a major cause of disability worldwide. It is a life‐threatening and life‐altering event, which leaves many physical and mental disabilities, thus creating major social and economic burdens. Experiencing a stroke and its aftermath can be devastating for patients and their families. In Iran, many services are not available for those who lack property; this may result in many difficulties and long‐term problems for stroke survivors and their family members who are usually the main caregivers in Iranian cultural. Despite its effect on their lives, little is known about how the survivors perceive stroke in the Iranian context, therefore, knowing more about this process may enhance problem identification and problem solving. Aim: To illuminate how stroke survivors experience and perceive life after stroke. Method: A grounded theory approach was recruited using semi‐structured interviews with 10 stroke survivors. Findings: The survivors perceived that inadequate social and financial support, lack of an educational plan, lack of access to rehabilitative services, physical and psychological problems led them to functional disturbances, poor socio‐economical situation and life disintegration. The core concept of life after stroke was functional disturbances. Conclusions: The study shows the need to support the stroke survivors in their coping process with their new situation by providing appropriate discharge plans, social and financial support, social insurances and training programmes for the stroke survivors and their families.     

Pediatric stroke

Stroke is rare in children but leads to significant morbidity and mortality. Emergency department physicians are likely to be the first to evaluate children suffering strokes and it is, therefore, important for them to recognize common presenting features and risk factors for pediatric stroke. This review describes the epidemiology, clinical presentations, stroke types, associated risk factors, evaluation, treatment, and prognosis of pediatric stroke. Further research is needed on the acute and preventative treatments of pediatric stroke because merely applying our knowledge of stroke in adults to children is insufficient.     

卒中单元治疗缺血性脑卒中的成本-效果分析

目的采用成本-效果分析评价卒中单元对脑卒中患者临床神经功能缺损评分及日常生活活动能力的影响.方法研究对象为2001-12/2003-01住院的急性缺血性脑卒中患者.随机进入卒中单元和普通病房,共285例.观察指标是住院时间、生活能力评价(BI)、神经功能评价(NIHSS)、社会功能评价(OHS),住院花费.经SPSS 10.0统计,分析卒中单元的成本-效果.结果卒中单元组较普通病房组神经功能缺损每减少1分,少花费509.91元;卒中单元组较普通病房组残障等级每减少1级,少花费720.88元;卒中单元组较普通病房组日常生活能力评分每多提高5分,少花费42.6元.结论卒中单元每提高患者的一个功能单位,所需的花费较普通病房患者少,卒中单元在改善患者结果上更为经济.     

Ischemic stroke

Atherosclerosis in the large carotid and cerebral vessels resulting in insufficient blood supply to the brain is the most common cause of ischemic stroke. Certain risk factors (ie, male sex and advanced age) cannot be changed. However, others (ie, hypertension, hyperlipidemia, and smoking) may be modified. Dr Bundlie describes the present state of research on preventing a first stroke by controlling these risk factors.