全程健康教育在首次住院青年脑卒中患者护理管理中的应用

目的探讨全程健康教育在首次住院青年脑卒中患者护理管理中的应用效果。方法选取首次住院治疗的青年脑卒中患者230例,在治疗原发病和康复训练的同时,分别在入院时、急性期、康复期、出院前、出院后实施有针对性的全程健康教育。结果实施全程健康教育后,青年脑卒中患者的复发率降低,脑卒中相关知识掌握情况和对护理的满意度提高(P0.01)。结论对首次住院青年脑卒中患者实施全程健康教育科学、有效,可作为脑卒中护理工作的一种制度化、常规化的干预措施在临床推广应用。     

首次突发脑梗塞患者就医时间及其影响因素分析

目的 探讨影响首次突发脑梗塞患者就医时间的影响因素,为脑卒中高危人群的预防保健教育提供理论依据。 方法 对315例首次突发脑梗塞患者的就医时间进行调查,分析其文化程度、首发症状及对脑卒中疾病知识的了解等因素对患者发病后选择就医时间的影响。 结果 315例患者平均就医时间为34.79h,6h内就医者65例(20.64%),文化程度、首发症状轻重及对脑卒中疾病知识的了解程度等对患者选择就医时间均有影响。 结论 早期在社区实施对高危人群的预防保健教育,对降低患者伤残率有非常重要的意义。     

首次卒中患者家属脑卒中预防知识及行为调查

目的 了解首次脑卒中患者家属对脑卒中一级预防知识、行为及其相关危险因素的知晓度,为制定针对性的健康教育计划提供理论依据.方法 运用我科自行设计的脑卒中一级预防知识及行为问卷对在我院确诊并行住院治疗的首次脑卒中患者的家属进行调查.结果 患者家属的脑卒中一级预防知识的总知晓率34.3％;患者家属的脑卒中一级预防知识水平与年龄、居住地及文化程度密切相关(P＜0.01).结论 患者家属的脑卒中一级预防知识知晓率低,预防行为与其年龄、学历及居住地密切相关.     

早期心理护理干预对急性脑梗死患者心理状态改变的影响

目的:探讨早期心理护理干预对急性脑梗死患者心理状态改变的影响。方法:将首次发病的急性期脑梗死患者120例随机分为对照组和观察组各60例,对照组采用常规护理,观察组在常规护理的基础上加早期心理护理干预;观察两组治疗前后焦虑、抑郁程度(采用汉密顿焦虑/抑郁量表评价)、对脑卒中相关知识的知晓率(采用自制脑卒中知识调查问卷)、遵医行为、自我管理能力、是否坚持规律运动等。结果:与护理前比较,两组焦虑量表评分及抑郁量表评分明显减低(P0.05);护理后,观察组焦虑量表评分及抑郁量表评分较对照组明显减低(P0.05),脑卒中相关知识的知晓率、遵医行为、自我管理能力、是否坚持锻炼的比例较对照组明显升高(P0.01,P0.05)。结论:根据脑梗死患者的心理状态改变,采取有针对性的早期心理护理是进行脑梗死患者护理的有效措施。     

医护人员对急性缺血性脑卒中患者早期活动的知识和态度现况调查

目的 调查专科医务人员对急性缺血性脑卒中患者早期活动知识和态度的现况与影响因素。方法 选择来自江苏省4个城市的6所三级医院、3所二级医院的253名医护人员进行调查。结果 医务人员对急性缺血性脑卒中患者早期活动知识、态度的平均得分分别为(68.51±9.16)分和(68.19±8.66)分,知识与态度呈正向直线相关。多元线性回归分析结果显示：医院级别、专科工作年限、早期活动知识培训是医务人员对急性缺血性脑卒中患者早期活动知识和态度的影响因素。结论 医务人员对急性缺血性脑卒中患者早期活动的知识水平需要进一步提升,早期活动态度不够积极,能够意识到早期活动的益处,但过分担忧早期活动的潜在风险,需要通过加强相关知识培训与资源下沉,提升知识与态度水平,促进早期活动的实施。     

脑卒中早期识别与急救知识现状调查与影响因素分析

目的调查患者及家属脑卒中早期识别与急救相关知识的知晓情况,并分析其影响因素。方法采用方便抽样法,于2016年11—12月借助康复助手微信公众号,对上海市6家医院共1 904名患者及家属进行脑卒中早期识别与急救相关知识的调查。结果患者及家属对脑卒中识别与急救相关知识知晓率低,单因素分析显示,年龄越小、女性、教育程度越高、脑力劳动者和接触过脑卒中者,其脑卒中早期识别和急救相关知识水平越高(P0.05);多因素分析显示,其水平与性别、教育程度、职业、脑卒中接触史有关(R~2=0.143,F=78.984,P0.05)。患者及家属对脑卒中预警症状的知晓率为23.7%,部分知晓为74.5%;对脑卒中识别方法和溶栓时间窗的知晓率仅略高于10%;获取脑卒中知识的途径主要为电视(53.6%)和网络(54.7%)。结论在医院内对患者及家属开展脑卒中早期识别与急救相关知识的健康教育势在必行,且应重点加强对男性、低学历、体力劳动、未接触过脑卒中者的教育,进一步促进脑卒中院前急救的有效落实。     

脑卒中早期识别与急救知晓现状与影响因素分析

目的调查患者及家属脑卒中早期识别与急救相关知识的知晓情况,并分析其影响因素。方法采用方便抽样法,于2016年11—12月借助康复助手微信公众号,对上海市6家医院共1 904名患者及家属进行脑卒中早期识别与急救相关知识的调查。结果患者及家属对脑卒中识别与急救相关知识知晓率低,单因素分析显示,年龄越小、女性、教育程度越高、脑力劳动者和接触过脑卒中者,其脑卒中早期识别和急救相关知识水平越高(P0.05);多因素分析显示,其水平与性别、教育程度、职业、脑卒中接触史有关(R~2=0.143,F=78.984,P0.05)。患者及家属对脑卒中预警症状的知晓率为23.7%,部分知晓为74.5%;对脑卒中识别方法和溶栓时间窗的知晓率仅略高于10%;获取脑卒中知识的途径主要为电视(53.6%)和网络(54.7%)。结论在医院内对患者及家属开展脑卒中早期识别与急救相关知识的健康教育势在必行,且应重点加强对男性、低学历、体力劳动、未接触过脑卒中者的教育,进一步促进脑卒中院前急救的有效落实。     

脑卒中三级预防健康教育方案的设计与应用

目的评价脑卒中三级预防健康教育方案对患者健康知识及遵医行为的影响。方法成立脑卒中三级预防健康教育工作小组,设计健康教育方案及专科护士培训方案,对脑卒中高危患者实施一级预防健康教育,对脑卒中发病患者实施二级预防健康教育,对脑卒中后遗症患者实施三级预防健康教育。结果实施脑卒中三级预防健康教育后,提高了脑卒中高危患者及患者对脑卒中相关知识知晓率(P0.01),同时改善了患者的行为依从性(P0.01)。结论脑卒中三级预防健康教育能提高患者疾病相关知识掌握程度,增强行为依从性,达到了患者主动采取正确的行为方式,预防脑卒中的发病、致残、复发的目的。     

健康教育对脑卒中患者遵医行为和生活方式的影响

目的:探讨健康教育对脑卒中患者遵医行为及生活方式的影响.方法:对首次发病住院的47例脑卒中患者应用自制的入院评估表进行评估,评估内容包括对所患疾病相关知识的了解,既往史及用药情况,有无不良生活行为,并建立健康档案.由专人给予有针对性的健康教育,每周强化1次,出院后采取电话随访和门诊复诊指导,每2周1次,于发病后3个月评估患者的疾病知识,遵医用药情况及不良生活行为,并与干预前进行比较.结果:干预后的脑卒中患者在了解疾病知识、遵医用药及改变不良生活行为方面明显提高(P＜0.05).结论:健康教育可以有效提高脑卒中患者的遵医行为、改变不良生活方式,增加相关疾病知识.     

患者对脑卒中早期症状知晓情况的调查分析

目的了解甘肃省脑卒中住院患者对脑卒中发病早期症状知晓情况。方法采取问卷调查的方法,对甘肃省10 家不同级别的省、市、县级医院的神经内科、神经外科2010 年收治的脑卒中住院患者1100 例进行调查。结果各个年龄段患者对脑卒中早期症状的知晓率均普遍较低。结论甘肃省脑卒中患者缺乏对早期发病症状的了解,应加大宣传力度使更多的患者能够早期就诊,减少致残率及病死率。     

甘肃省脑卒中患者对卒中及康复认知现状调查

目的了解脑卒中患者对卒中危险因素、早期症状、康复知识的认知情况。方法分层随机抽取甘肃省10 家不同级别医院1043 例神经内外科住院的脑卒中患者,采用自行设计的问卷进行调查。结果脑卒中患者对卒中各种危险因素中,知晓率最高的为高血压(61.55%), 全部危险因素知晓率为6.42%; 防治方法中, 合理饮食知晓率最高(56.18%), 其次为戒烟戒酒(52.92%);早期症状中,偏侧肢体发麻知晓率最高(53.88%),其次为头痛头晕(50.14%),视物模糊、恶心呕吐、舌部发硬等症状的知晓率均低于30%;60%患者对康复相关知识完全不了解,22%不清楚是否需要康复治疗;无论家庭月收入高低,约80%脑卒中患者在治疗期间选择药物治疗,进行康复的比率不足30%。结论对脑卒中危险因素、早期症状、康复知识的普及应引起医务人员的高度重视,健康教育和康复知识的宣传需要进一步加强。     

Stroke prevention in diabetes and obesity

Stroke is an important cause of morbidity and mortality, and is an economic burden. Diabetes and obesity are two important modifiable risk factors for stroke. Patients with diabetes have a higher incidence of stroke and a poorer prognosis after stroke. Risk-factor modification is the most important aspect of prevention of stroke in diabetes and obesity. This includes lifestyle modifications and different therapeutic modalities to control conditions, such as diabetes, hypertension, dyslipidemia and arrhythmia. Recent landmark studies have shown the beneficial effects of statins in diabetic patients even with close to normal or normal low-density lipoprotein cholesterol. Obesity, which is a risk factor for diabetes, hypertension and hyperlipidemia has been shown to be an independent risk factor for stroke. Increased leptin, dysregulation of adipocyte proteins, increased insulin resistance and C-reactive protein may be factors involved in the increased incidence of cardiovascular morbidity and mortality directly related to obesity. Visceral fat is a much bigger health risk than subcutaneous fat. Lifestyle interventions and pharmacotherapeutic agents have been used to manage obesity. In morbidly obese patients, surgical intervention seems to be the best method of treatment with a long-lasting favorable metabolic outcome. In the 21st Century, with the advanced medical knowledge and the therapeutic modalities available, it should be possible to reduce the incidence of stroke associated with diabetes and obesity.     

东莞外来务工人员脑卒中知识认知水平的调查分析

目的:了解东莞外来务工人员对脑卒中知识的认知水平。方法:2012年7月至2013年6月按照多阶段随机抽样原则,在东莞市不同企业抽取年龄18-60岁的外来务工人员发放问卷5000份,调查内容包括被调查者的一般情况、脑卒中的预防、识别、诊疗、知识来源途径,各项内容采用描述性分析及x~2检验。结果:回收有效问卷4657份(93.14%)。脑卒中危险因素中高血压的知晓率排第一,其次为糖尿病、高脂血症,其他危险因素知晓率低;脑卒中临床症状知晓率以"突发肢体麻木或无力"排第一,其次为"不醒人事"、言语不清;就诊方式有2567人选择立即"120"急救,只有343人知道脑卒中需到神经内科就诊;最常见的信息来源途径为亲朋介绍,其次是卫生宣传;在人群分层分析上,家庭成员中有卒中患者、高教育程度者及青年务工人员的脑卒中预防、识别和诊疗知识认知水平明显高于低教育程度者、中年务工人员(P0.05)。结论:东莞外来务工人员脑卒中知识认知水平比低,尤其是低教育程度者和中年务工人员,需加强通过电视、网络、报纸等多媒体途径宣传脑卒中知识,可降低该人群脑卒中的发病率、死亡率和致残率。     

Stroke intervention

As current stroke therapies are refined and newer promising methodologies brought on line, the rapid, accurate diagnosis of stroke syndromes will become more important. The emergency department is in a unique and vital position for providing early diagnosis, for organizing and activating an interdisciplinary team to rapidly assess the stroke patient, and for establishing protocols for therapy. The emergency physician has an important role in increasing general awareness and in helping to educate the public about risk factors and early symptoms of various stroke syndromes. Nursing and emergency personnel must also be made increasingly aware of the desirability of early recognition of stroke and of new therapeutic measures. Stroke patients should no longer be considered of moderate to low priority, as has often been the case in the past. With an aggressive approach in dealing with risk factors, education in early recognition of symptoms, and new and promising interventional therapies, morbidity and mortality from this often catastrophic disease may be dramatically reduced.     

卒中健康管理门诊的建立与实践效果研究

目的探讨开展卒中健康管理门诊的效果。方法便利抽样法选取2018年11月至2019年5月上海市某三级甲等医院收治的脑卒中患者288例为研究对象,按其住院号末位数字的奇偶数分为门诊管理组和电话随访组。电话随访组给予常规电话随访,门诊管理组通过卒中健康管理门诊就诊.健康管理师根据患者住院期间建立的健康管理档案,评估患者高危因素的管控情况,提供专业健康管理服务。比较两组患者疾病知识掌握、自我行为管理、复诊率、服药依从性及卒中合并症(高血压和高血糖)的发生情况及卒中复发率。结果门诊管理组疾病知识掌握、自我行为管理、复诊率均优于电话随访组,合并.症发生情况及卒中复发率低于电话随访组,差异均有统计学意义(均P<0.05)。结论开展卒中健康管理门诊能提高患者疾病知识掌握程度、复诊率,改善患者自我行为管理能力.提高服药依从性及降低合并症的发生,从而降低卒中复发风险。     

Stroke: epidemiology, risk factors, and genetics

Stroke constitutes a major global challenge for health policy and healthcare economics. Reducing stroke burden requires extensive knowledge of risk factors and, if applicable, preventive control. Risk factors may be categorized in non-modifiable biological factors, such as age, gender, race/ethnicity; proatherosclerotic/prothrombotic factors (hypertension, diabetes, dyslipidaemia, other serologic and haemostasis factors); cardiac comorbidity (CAD, CHF, atrial fibrillation); lifestyle factors, which play an increasing role, e.g. smoking, physical inactivity, alcohol consumption. These traditional risk factors are extended by rapidly growing efforts in elucidating genetic backgrounds for stroke. Genetic polymorphisms of functionally or pathophysiologically important proteins are investigated in the setting of case-control-studies for their role as candidate genes. Meta-analyses have corroborated the association of the factor V-Leiden arg506gln, MTHFR-C677T, and ACE-insertion-deletion polymorphisms with stroke. Current population-based, genome-wide linkage analyses face high expectations for identifying new genetic risk factors.     

Stroke: strategies for primary prevention

Stroke is a leading cause of morbidity and mortality in North America. Primary prevention of stroke includes lifestyle modifications and measures to control blood pressure, cholesterol levels, diabetes mellitus, and atrial fibrillation. Lowering blood pressure in patients with hypertension prevents both hemorrhagic and ischemic stroke (relative risk reduction, 35 to 45 percent). Observational studies suggest that higher cholesterol levels are associated with an increased risk of ischemic stroke, and treatment with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) may reduce the risk of fatal and nonfatal stroke by 25 percent. Although high-quality evidence linking tighter glucose control with stroke reduction is lacking, good glucose control and aggressive treatment of hypertension and hyperlipidemia in patients with diabetes mellitus are recommended. The risk of stroke in patients with atrial fibrillation and the role of anticoagulation depend on factors such as age and the presence of comorbid conditions. Controversy exists about the roles of angiotensin-converting enzyme inhibitors and aspirin in the primary prevention of stroke.     

FAST Stroke Prevention Educational Program for Middle School Students: pilot study results.

This pilot study evaluated the effects of FAST Stroke Prevention Educational Program for Middle School Students, a 2-month stroke prevention educational program targeted to middle school students. The FAST program focused on improving knowledge of stroke signs and symptoms; risk factors; treatment-seeking behaviors (call 911); overall attitude toward stroke, including perceived self-efficacy in identifying stroke warning signs and dealing with a stroke victim; stroke risk-reduction behaviors; and other risk factors for stroke, such as hypertension and diabetes. The FAST program evaluation consisted of a pretest, an educational intervention, immediate posttest, and a long-term posttest at 2 months. A convenience sample of 72 students with a mean age of 13.25 years was used. After obtaining school, parental, and student consent, the FAST program was implemented by the school nurse, health teachers, and research nurses. Results indicated significant increases in knowledge of stroke risk factors and warning signs and in attitudes of self-efficacy among middle school students that were sustained from pretest to long-term posttest; data supported the effectiveness of this novel intervention. Additional research using a variety of educational strategies and a longer time frame of intervention is recommended to further expand use of this program.     

Migraine in Patients With Stroke and Antiphospholipid Antibodies

SYNOPSIS
The association between migraine and antibodies against antiphospholipids is controversial. We investigated the prevalence and the clinical feature of migraine in patients with ischemic stroke and antiphospholipid antibodies. Data were obtained from the medical records of 162 consecutive patients with ischemic stroke over a 2-year period. Ten patients with antiphospholipid antibodies were prospectively identified. A history of migraine was present in 6 of these patients and in only 5 of the 152 patients with negative results for antiphospholipid antibodies (chi-square=47.68; P <.0001). In the former, migraine had been for a long time the only clinical problem before the occurrence of the ischemic stroke. These findings suggest that migraine is frequent and can be an early and a prominent symptom in the antiphospholipid antibodies syndrome. Further studies are needed to fully elucidate the association of migraine and antiphospholipid antibodies. A better knowledge of this association could allow an early identification of patients at high risk of stroke.     

青年卒中临床特点及危险因素分析

目的：探讨青年卒中患者的临床特点和危险因素。方法：回顾性纳入青年卒中患者146 例与同期入院 的中老年卒中患者628 例,分析2 组临床特点及主要危险因素暴露情况。结果：青年卒中组脑出血和男性患 者比例均明显高于中老年组（P＜0.05）。从危险因素的暴露率看,2 组最高的均为高血压,且差异无统计学 意义（P＞0.05）;青年卒中组吸烟、饮酒、肥胖、血脂代谢异常、高同型半胱氨酸血症、高尿酸血症的比例均明 显高于老年卒中组（均P＜0.05）。从患者对主要危险因素的干预情况看,青年卒中组高血压患者服用降压 药物比例明显偏低（P＜0.05）。结论：青年男性较女性更容易发生卒中,出血性卒中在青年中发病率明显高 于中老年;吸烟、饮酒、肥胖、血脂代谢异常、高同型半胱氨酸血症、高尿酸血症等危险因素对青年卒中的发 生影响更大;青年高血压人群不良生活方式及对降压治疗重视不够可能是导致卒中发生的原因之一。