缺血性卒中卫生经济学评价模型结构研究

目的 梳理和提炼现有文献中缺血性卒中卫生经济学评价模型的结构和逻辑,为规范我国缺血性卒中经济学评价模型提供参考和支持.方法 系统检索国内外已发表的缺血性卒中卫生经济学评价文献,对现有文献中评价模型的结构特点进行总结和归纳.结果 共纳入20篇国内外缺血性卒中卫生经济学评价文献,其中以决策树与马尔科夫相结合的模型最常见,不...     

缺血性卒中影像学研究

脑卒中是一种突然起病的脑血液循环障碍性疾病,系指脑血管病患者因各种诱发因素导致颅内动脉狭窄、闭塞或破裂所引起的急性脑血液循环障碍,亦称脑血管意外。其临床表现为短暂性或永久性神经功能障碍的症状与体征,分为出血性和缺血性卒中,其中67%～80%患者为急性缺血性卒中,神经功能的康复与脑组织存活程度密切相关。因此,应于高危因素、缺血和出血等可逆性神经功能损伤出现之前明确诊断并及时处理。近年来,CT和     

急性缺血性卒中影像学研究进展

在我国,随着生活水平的不断提高、工作节奏的加快,以及高血压、糖尿病患者的增多,脑血管病的发病率呈现逐年上升趋势。根据2008年公布的第3次全国死因调查结果,我国居民前5位死因依次为脑血管病、恶性肿瘤、呼吸系统疾病、心脏病,以及损伤和中毒。以13亿人口计,全国每年新发病例约为250万例,死于脑血管病者超过150万例,幸存者600～700万例,病残率高达75%。更为严重的     

缺血性卒中影像学研究

脑卒中是一种突然起病的脑血液循环障碍性疾病,系指脑血管病患者因各种诱发因素导致颅内动脉狭窄、闭塞或破裂所引起的急性脑血液循环障碍,亦称脑血管意外。其临床表现为短暂性或永久性神经功能障碍的症状与体征,分为出血性和缺血性卒中,其中67％～80％患者为急性缺血性卒中,     

同型半胱氨酸与缺血性卒中

同型半胱氨酸（Hcv）即2-氨酸-4-巯基丁酸,又名高半胱氨酸,是蛋氨酸（Met）代谢的重要中间产物。1964年,Gibson等率先报告高同型半胱氨酸血症与血管性疾病和血栓形成有关。自1969年Mccully提出高同型半胱氨酸血症是导致动脉粥样硬化的主要因素以来,已有大量研究证实高同型半胱氨酸血症是缺血性卒中的独立危险因子,但近年又有临床试验得出不同结论。笔者拟就同型半胱氨酸与缺血性卒中之间的关系作如下综述。     

同型半胱氨酸与缺血性卒中

同型半胱氨酸(Hcy)即2-氨酸-4-巯基丁酸,又名高半胱氨酸,是蛋氨酸(Met)代谢的重要中间产物。1964年,Gibson等率先报告高同型半胱氨酸血症与血管性疾病和血栓形成有关。自1969年McCully提出高同型半胱氨酸血症是导致动脉粥样硬化的主要因素以来,已有大量研究证实高同型半胱氨酸血症是缺血性卒中的独立危险因子,但近年又有临床试验得出不同结论。笔者拟就同型半胱氨酸与缺血性卒中之间的关系作如下综述。一、同型半胱氨酸代谢特点     

神经经济学研究进展

神经经济学是神经科学、经济学、心理学的交叉学科,系指应用神经科学的方法来分析和解释与人类相关的经济行为,并进一步研究决策的神经学基础。经典的实验模式有爱荷华博弈任务(IGT)、最后通牒游戏(UG)、囚徒困境游戏(prisoner’sdilemma game)等。爱荷华博弈任务要求被试每次从4叠卡片中任选一张,每张卡片均对应相应的收益与亏损,卡片1和2是高风险、高奖赏的选项,为不利选项;卡片3或4是低风险、低奖赏选项,为有利选项,而受试者的实验任务是在未知风险概率的情况下尽可能地获得更高的收益。目前应用于神经经     

干细胞移植治疗缺血性卒中的研究进展及临床相关问题

脑血管病与心脏病、恶性肿瘤构成人类的三大致死性疾病：其中,脯卒中是指由于急性脑循环障碍所致的局限性或全面性神经功能缺损综合征,     

干细胞移植治疗缺血性卒中的研究进展及临床相关问题

脑血管病与心脏病、恶性肿瘤构成人类的三大致死性疾病。其中,脑卒中是指由于急性脑循环障碍所致的局限性或全面性神经功能缺损综合征,也称急性脑血管事件。脑卒中发病率、病死率和病残率逐年升高,生存者中50%～70%遗留严重残疾,给社会和家庭带来沉重负担。现有的治疗措施尚未显示出明显的临床治疗效果,而干细胞移植治疗在动物实验和临床研究中取得的初步成果及其对     

急性缺血性卒中影像学研究进展

在我国,随着生活水平的不断提高、工作节奏的加快,以及高血压、糖尿病患者的增多,脑血管病的发病率呈现逐年上升趋势。根据2008年公布的第3次全国死因调查结果,我国居民前5位死因依次为脑血管病、恶性肿瘤、呼吸系统疾病、心脏病,以及损伤和中毒。以13亿人口计,全国每年新发病例约为250万例,死于脑血管病者超过150万例,     

Pavlov at home and abroad: His role in international physiology

Contemporary science is conducted internationally. This is a comparatively recent phenomenon that developed during the last century, most notably after the second world war. During the first half of the twentieth century, however, I P Pavlov became the first major international physiologist, travelling widely and contributing to major scientific meetings around the world. This paper records and assesses Pavlov's international role, with an especial focus on the International Congresses of Physiology, set in the dynamic context of his domestic position in Imperial Russia and later in the Soviet Union.     

An assessment of guidelines for prevention of ischemic stroke

OBJECTIVE: To compare methods and key management recommendations from recent stroke prevention guidelines. METHODS: Systematic review of guidelines for prevention of ischemic stroke published in English between 1996 and 2001 was conducted, and recommendations were independently abstracted and compared. RESULTS: Among 22 stroke prevention guidelines, information was provided about panel selection in 24%, funding source in 36%, consensus methods in 33%, and quantitative risk/benefit estimates in 38%. Eleven recommended anticoagulation for patients with atrial fibrillation at high risk for stroke, but eight different sets of criteria to identify high-risk patients were proposed. Recommendations regarding carotid endarterectomy for asymptomatic stenosis varied from general endorsement in a setting of low perioperative risk to routinely withholding surgery. All nine relevant guidelines endorsed aspirin in dosages between 50 and 325 mg/day for initial antiplatelet therapy following cerebral ischemia; six also suggested other antiplatelet agents as options for initial therapy. CONCLUSIONS: Current stroke prevention guidelines do not provide adequate methodologic information to permit assessment of their quality, potential bias, and clinical applicability. Management recommendations are relatively consistent but differ in several important areas.     

A systematic review of economic evaluations on stent-retriever thrombectomy for acute ischemic stroke

Background

Our objective was to review economic evaluations on stent-retriever thrombectomy (SRT) added/not added to intravenous (IV) tissue plasminogen activator (t-PA) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO).

Methods

We conducted a systematic review using several electronic databases and searching for studies published from January 2009 to September 2017. Inclusion criteria: any publication type reporting the incremental cost-effectiveness ratio of SRT in people with AIS secondary to LVO. Quality assessment was undertaken with the CHEERS and the Philips’ checklists.

Results

Eight original articles (four from North America/four from Europe) were included; of these, seven were model-based cost-effectiveness studies and one was a study conducted alongside a clinical trial. The perspective was the healthcare system in seven studies, and societal in one. The time horizon was lifetime (minimum 20 years) in all but two studies where it was 1 and 5 years. Overall, studies were rated of good quality (mean score 79%; range 70–90). Data sources, effectiveness outcomes and other input parameters were heterogeneous across studies. In three studies, SRT was dominant (less expensive and more effective). In five studies, SRT was more expensive and generated more quality-adjusted life years but had a high probability (79–100%) to be cost-effective at conventional thresholds.

Conclusion

This review shows that SRT added/not added to IV t-PA is likely to be cost-effective or even dominant, which is consistent with the opinion from several Health Technology Assessment bodies recommending SRT. However, our findings are supported by primary studies with substantial methodological heterogeneity.

     

缺血性卒中与胰岛素抵抗关系的研究进展

缺血性卒中是我国人群的首要致死原因.虽然在过去的30多年里,临床医生已对相应已知的危险因素作了积极的防治,但其发病率仍居高不下,提示尚有诸多未被充分认识和处理的缺血性卒中危险因素.已有越来越多的证据提示胰岛素抵抗可能是这些未知的危险因素中的一种.本文就胰岛素抵抗的基本特点和与缺血性卒中相关的一些证据作一综述.     

Study on frequency and predictors of dementia after ischemic stroke

Abstract.Objective: We studied a large hospitalized cohort of patients aged 55 years and over with acute ischemic stroke to identify the frequency and predictors of poststroke dementia.Methods: A total of 434 consecutive patients with ischemic stroke were enrolled in this study. During admission, the demographic data, vascular risk factors, stroke features, and neurological status information were collected. All subjects were examined by a battery of neuropsychological tests during admission and 3 months after stroke. Logistic regression analysis was used to find the predictors of poststroke dementia.Results: (1) The frequency of poststroke dementia was 27.2%, that of stroke-related dementia was 21.6%, and that of dementia after first-ever stroke was 22.7% 3 months after stroke. (2) Univariate analysis indicated that older age, low educational level ( 6 years), everyday drinking, diabetes mellitus, atrial fibrillation, prior stroke, left carotid territory infarction, embolism, multiple stroke lesions, dysphasia, and gait impairment were more frequent in the patients with poststroke dementia. (3) Multivariate analyses demonstrated that age (OR 1.179, 95%CI 1.130–1.230), low educational level (OR 1.806, 95 %CI 1.024–3.186), everyday drinking (OR 3.447, 95 %CI 1.591–7.468), prior stroke (OR 2.531, 95 %CI 1.419–4.512), atrial fibrillation (OR 3.475, 95%CI 1.712–7.057), dysphasia (OR 5.873, 95 %CI 2.620–13.163), and left carotid territory infarction (OR 1.975, 95%CI 1.152–3.388) were associated with poststroke dementia.Conclusions: The frequency of dementia is about one-forth of patients with ischemic stroke 3 months after stroke. Independent predictors of poststroke dementia include age, low educational level, everyday drinking, prior stroke, dysphasia, atrial fibrillation, and left carotid territory infarction.Abrreviations AD Alzheimers disease - ADL Activity of Daily Living - CI Confidence Interval - CMMS Chinese version of the Mini-Mental State Examination - CT Computed Tomography - DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th edition - FOM Fuld Object Memory Evaluation - IADL Instrumental Activity of Daily Living - IQCODE Informant Questionnaire on Cognitive Decline in the Elderly - MRI Magnetic Resonance Imaging - OR Odds Ratio - POD Pfeiffer Outpatient Disability Questionnaire - RVR Rapid Verbal Retrieve - SD Standard Error - TIA Transient Ischemic Attack     

急性缺血性脑卒中早期康复和针刺治疗效果

目的 观察早期康复和针刺治疗对急性脑梗死偏瘫患者运动功能的影响.方法 急性脑梗死患者120例随机分为4组,一般药物治疗为对照组、早期针刺组、早期康复组和早期康复加针刺组.以Barthel 指数评分 (BI)等观察指标分析治疗前后的变化,了解不同分组的临床疗效.结果 在3、6个月时,各组与对照组比较均具有显著性差异,P<0.05,而针刺加康复组有显著性差异(P<0.01),6个月时患者的日常生活活动能力(ADL)BI较3个月时增加值各组间差异无统计学意义.结论 急性脑卒中患者应积极开展早期康复治疗和针刺治疗,二者合用是促进脑卒中康复的有效方法.3个月内是急性脑卒中患者的最佳治疗时机.     

Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project

The objective was to determine the functional outcome, location of care and economic consequences in the first 3 months after ischemic stroke. As part of the Erlangen Stroke Project, (ESPro) information was collected on patients suffering a first-ever ischemic stroke. Three months after the stroke, location of care, dependence on caregivers and function based on Barthel Index: poor (0-55), moderate (60-90) or good function (95-100) were recorded. Data about health services used were combined with cost estimates for Germany (2000 Euros, undiscounted). Of 491 patients hospitalized, 383 were alive 3 months afterwards, 79% residing in the community. The majority of patients with poor function (60%) were still in institutional care. Patients with good function typically accrued the lowest costs, whether in an institution (17 965) or not (11 032) compared with poorer function who were living in an institution (poor: 26 370; moderate: 28,121), or community (poor: 27,207; moderate: 19,350). Hospitalization and rehabilitation services were the major costs accrued at each level of function. Many patients were left requiring a substantial amount of care and the costs associated with providing institutional care has a major impact on the economic consequences of a stroke.     

缺血性卒中复发危险因素分析及风险评估

目的筛查缺血性卒中复发危险因素并评估复发风险。方法采用Essen卒中风险评分(ESRS)评价176例缺血性卒中患者(首次发作96例、复发80例)复发风险,单因素和多因素逐步法Logistic回归分析筛查缺血性卒中复发危险因素。结果缺血性卒中首次发作组与复发组患者年龄和75岁患者比例、高血压、糖尿病、冠心病、周围血管病、短暂性脑缺血发作或缺血性卒中、饮酒、ESRS评分差异具有统计学意义(均P0.05);首次发作组ESRS评分0分1例(1.04%)、1分8例(8.33%)、2分39例(40.63%)、3分44例(45.83%)、4分4例(4.17%),复发组ESRS评分3分2例(2.50%)、4分20例(25%)、5分37例(46.25%)、6分18例(22.50%)、7分3例(3.75%),组间差异有统计学意义(Z=-11.376,P=0.000)。Logistic回归分析显示,仅ESRS评分3分是缺血性卒中复发的独立危险因素(OR=31.324,95%CI:3.934~249.430;P=0.001)。结论 ESRS评分3分是缺血性卒中复发的独立危险因素,应加强对缺血性卒中复发风险的评估,筛查并控制危险因素是缺血性卒中二级预防的关键。