综合性卒中单元治疗115例脑出血患者的疗效观察

目的探讨综合性卒中单元对脑出血患者预后的影响。方法随机选择2002-06～2004-12入住我院神经科常规病房的56例脑出血患者为对照组,选择2005-01～2007-07入住我院综合性卒中单元的59例脑出血患者为病例组,比较2组患者相关临床指标。结果2组患者的中国卒中量表、日常生活能力量表、改良Rankin量表评分值差异均有统计学意义(P<0.05),住院期间的感染率及病死率也有明显差别。结论脑出血患者可从综合性卒中单元的管理模式中取得更好疗效。     

软通道微创穿刺引流与内科保守治疗高血压性脑出血的临床疗效比较(附80例报道)

目的比较软通道微创穿刺引流与内科保守治疗高血压脑出血的临床疗效。方法将80例高血压脑出血患者随机分为对照组与观察组,42例对照组予以内科保守治疗,38例观察组患者行软通道微创穿刺引流治疗。比较两组住院期间的病死率、再出血率和出院后半年日常生活能力。结果观察组与对照组患者住院期间病死率分别为5.56%和11.90%(P0.05),观察组低于对照组(P0.05);两组再出血率分别为28.95%和28.57%,差别无统计学意义(P0.05);治疗后半年的日常生活能力评定优良率,观察组的致残率为59.52%,显著低于对照组76.31%,差别具有统计学意义(P0.01)。结论软通道微创治疗高血压脑出血可显著减少住院期间病死率,降低致残率,改善患者预后,提高生活质量。     

选择性动脉溶栓治疗急性脑梗死的对照研究

目的评价选择性动脉溶栓治疗急性脑梗死的疗效和安全性。方法2003年1月～2005年5月期间对25例急性脑梗死患者进行选择性动脉溶栓,同期选择年龄、病情相匹配的无溶栓的对照患者25例,同时采用卒中登记方法收集选择性动脉溶栓患者及同期无溶栓的对照患者的临床、实验室及影像学等资料,前瞻性随访所有患者6个月的预后。结果溶栓组和对照组1个月末的病死率分别为4%和4%,6个月末的病死率分别为4%和4%;溶栓组和对照组1个月末残疾率分别为16%和40%,6个月末的残疾率分别为4%和24%。溶栓组并发脑出血2例(8%),其中症状性脑出血1例(4%);对照组未发生症状性脑出血。结论选择性动脉溶栓治疗急性脑梗死患者有效和安全。     

脑出血后缺血性脑损害的临床研究

目的　探讨脑出血后继发缺血性脑损害、脑梗死的发生 ,并将我院 1997年 7月～ 2 0 0 1年 3月住院的 15 7例脑出血患者进行分析。方法　对 15 7例脑出血患者及随机抽取同期 5 0例住院脑梗死患者 ,于入院当日、术后第 5天及第 2 8天复查头部CT ,并将手术组和非手术组于入院当日、第 10天、第 2 8天进行神经功能缺评分 ,并将两组进行比较。结果　 4周后 15 7例脑出血患者脑梗死占 2 8.6 6 % ,对照组 2 % ,两组对比有显著性差异 (P <0 .0 1)。结论　脑出血后不仅有出血性损害 ,同时还存在缺血性脑损害 ,并可导致脑梗死的发生     

卒中单元对急性脑卒中患者近期预后的影响

目的 探讨卒中单元对急性脑卒中患者近期预后的影响.方法 196例急性脑卒中患者(脑出血59例,脑梗死137例)随机分为卒中单元组(101例)和普通病房组(95例),并进行相应的治疗.比较两组治疗后与治疗前美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)的差值及疗效,以及并发症的发生率.结果 与治疗前比较,卒中单元组治疗后NIHSS评分降低(12.6± 5.5)分,普通病房组降低(8.9 ±4.1)分;卒中单元组BI升高24.3±14.8,普通病房组升高15.1±10.6;两组间差异有统计学意义(均P<0.05).卒中单元组基本痊愈率、总有效率、并发症发生率及病死率(27.7%、97.0%、10.9%及2.0%)与普通病房组(15.8%、88.4%、23.2%及8.4%)比较差异均有统计学意义(均P<0.05).结论 卒中单元能明显改善急性脑卒中患者的近期预后.     

血肿穿刺引流治疗脑出血手术时机对病死率的影响

目的探讨血肿穿刺引流治疗脑出血手术时机对病死率的影响。方法选择我院2011-01—2012-01收治的86例脑出血患者为观察对象,随机分成观察组与对照组,观察组行超早期手术,即在患者发病7h内进行手术,平均（4.62±1.36）h;对照组行早期手术,即在患者发病后7～24h内进行手术,平均（17.34±2.45）h。观察组49例,对照组37例,2组患者一般资料比较,差异无统计学意义（P〉0.01）。比较2组患者术后病死率。结果观察组病死率6.12%,对照组18.92%,观察组明显低于对照组,差异有统计学意义（P〈0.01）。结论对脑出血患者进行超早期穿刺引流能尽早减轻血肿周围脑组织损伤,从而减少并发症,降低病死率。     

ANCA、ACA与脑卒中发病关系的研究

1资料和方法脑卒中患者81例中,男54例、女27例,年龄38~74岁,平均59·9岁;其中脑梗死53例,脑出血28例。所有患者均经头颅CT证实。同时期献血员100名作为对照。抗中性粒细胞胞浆抗体(ANCA)采用间接免疫荧光法测定。抗心磷脂抗体(ACA)采用ELISA法测定。计数资料的组间比较采用卡方检验,显著水平设为0·05。2结果81例脑卒中患者中,血清ANCA阳性41例(50·6%),而对照组为2例(2·0%),两组间比较差异有统计学意义(P<0·01)。脑梗死组ANCA阳性率为50·9%(27/53),脑出血组为50·0%(14/28),两组ANCA阳性率均显著高于对照组(P<0·01),但两组…     

微创血肿清除治疗对脑出血后神经功能恢复和经济支出的影响

目的 探讨微创血肿清除对脑出血后神经功能恢、住院天数和经济支出的影响.方法 将74例脑出血患者随机分为微创治疗组和常规治疗组,在发病后1、3、6个月3个时间点,采用美国国立卫生院卒中评分(NIHSS)、改良Barthel指数(MBI)、临床痴呆分级量表(CDR)和汉语失语检查表(ABC) 分别对神经功能、日常生活能力、痴呆程度及语言功能进行评分,同时观察患者住院期间的经济支出.结果 1、3、6个月时,微创组NIHSS 评分、MBI指数、ABC评分均高于常规治疗组(P＜0.05).在3、6个月时,微创组CDR分级较常规治疗组低 (P<0.05).微创组住院天数和住院期间经济支出均少于常规治疗组(P＜0.05).结论 微创血肿清除对脑出血患者神经功能恢复具有一定促进作用,且住院天数和住院期间经济支出均较少.     

亚低温治疗重症脑梗死的疗效观察

目的 :探讨亚低温技术治疗重症脑梗死的临床效果。方法 :30例住院的重症脑梗死患者 ,分为治疗和对照两组 ,在给予抗脑梗死治疗的同时 ,治疗组加用亚低温技术 ,治疗后 7天、2 1天分别进行神经功能缺损评分 ,和病死率等一起进行分析。结果 :治疗 7天与 2 1天后 ,治疗和对照两组的评分分别为 30 .4 5± 5 .86 ,34.1 4± 5 .37( P=0 .0 5 ) ;和 2 1 .92± 2 .4 6 ,2 6 .82± 1 .99( P<0 .0 5 ) ;病死率分别为 2 0 %和 2 6 % ( P>0 .0 5 )。结论 :亚低温技术可以明显改善重症脑梗死患者的神经功能和预后。     

微创多靶点引流血肿清除术治疗重型高血压脑出血的临床观察

目的　探讨重型高血压脑出血的有效治疗方法。方法　采用微创多靶点引流血肿清除术治疗了 5 6例患者 ,同时选择与之相匹配的、同期住院的、只行内科治疗的重型高血压脑出血患者 6 0例作对照。结果　治疗组的总有效率 (78.5 7% )及BarthelIndexes (BI) (83.94± 16 .2 7分 )均明显高于对照组 (P <0 .0 1) ,并且其病死率 (16 .0 7% )明显低于对照组 (P <0 .0 5 )。结论　微创多靶点引流清除血肿术是一种抢救重型高血压脑出血的有效治疗方法。     

急性脑血管病规范化治疗方案与结果

目的 :介绍急性脑血管病规范化治疗方案和实践的初步结果。方法 :选择上海市 18家三级和二级医院神经科推广该方案的临床治疗效果 ,比较病死率 ,住院时间和各种特殊治疗的临床疗效。结果 :规范化治疗后 ,上海市 18家医院 ( 1998年 6月～ 2 0 0 0年 5月 ) 6743例脑梗死 ,总病死率 4 92 % ,较规范化治疗前下降 18 3 % ;脑出血 192 4例 ,较规范化治疗前下降 3 5 9% ,住院时间从平均3 7 3d下降到 2 5 7d ,缩短 3 1 1%。特殊规范治疗显示 ,静脉溶栓治疗改善 14d神经功能和 2 1dADL ;抗凝治疗改善 14、2 1d神经功能和 2 1dADL ;降纤治疗改善 14d神经功能和 2 1dADL ,但各种治疗均未改善第 90天的ADL。结论 :规范化治疗可以降低脑卒中的急性期病死率 ,改善近期神经功能和ADL ,但尚不能改变远期ADL结果。     

Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany

BACKGROUND: Telemedical networks are a new approach to improve stroke care in community settings. We aimed to assess the effects of a stroke network with telemedical support in Germany on quality of care, according to acute processes and long-term outcome. METHODS: Five community hospitals without pre-existing specialised stroke care were included in a network with telemedical support by two academic hospitals. In a non-randomised, open intervention study, five community hospitals without specialised stroke care served as the control group, matched individually to the network hospitals by predefined characteristics. Stroke patients admitted consecutively to one of the participating hospitals between July 7, 2003, and March 31, 2005, were included in the study. Patients in network and control hospitals were assessed in the same manner and were followed up for vital status, living situation, and disability at 3 months. Poor outcome was defined by death, institutional care, or disability (Barthel index <60 or modified Rankin scale >3). Predefined indicators for quality of acute stroke care were achieved. FINDINGS: A total of 5696 patients with a sudden, non-convulsive loss of neurological function who were diagnosed with having suspected stroke were admitted to the ten hospitals participating in the study. After exclusion, 3122 were included in the final analysis, of whom 1971 (63%) were treated in the network hospitals. All indicators related to quality of acute stroke care were more commonly met in the network than in the control hospitals. After 3 months, 44% of patients treated in network hospitals versus 54% treated in control hospitals had a poor outcome (p<0.0001). In multivariate regression analysis, treatment in network hospitals independently reduced the probability of a poor outcome (odds ratio 0.62, 95% CI 0.52-0.74; p<0.0001). INTERPRETATION: Telemedical networks with academic stroke centres offer new and innovative approaches to improve acute stroke care at community level for stroke patients living in non-urban areas.     

Data bank project for acute stroke patients]

Stroke is the second cause of death within major adult disease and the first cause of functional disability for elderly in Japan. The diffusion rate of MRI is the highest in the world. Even though, there is only few evidence for stroke management has been reported from Japan. It is necessary to make a data bank of acute stroke patients as infrastructure making evidence for standardization of stroke management. We made Japan standard stroke registry study supported by ministry of health and welfare for 3 years. We completed computerized registry system and accumulated about 8,000 acute stroke cases from 45 stroke center hospitals. This system is also functioning as a stroke database for each hospital. From the analysis of the distribution of stroke subtype, the incidence of atherothrombotic infarction and cardiogenic embolism was similar to lacunar infarction as shown in Fig. 1. Furthermore, the 38% of ischemic stroke patients admitted within 3 hours. Thrombolytic therapy was performed in 15% of the patients who admitted within 3 hours and their initial severity were NIHSS 6-29. The outcome of the patients treated with thrombolytic therapy was significantly better than those without it. These data indicate that the stroke data bank should be useful tool to make verification of the guideline and planning of clinical trial for EBM.     

森田疗法在轻-中度急性缺血性卒中治疗中的应用研究

目的 探讨森田疗法对轻-中度急性缺血性卒中患者康复、住院时间、住院费用的影响.方法 将NIHSS评分为＜15分的70例中度脑卒中患者随机分为两组,分别给予森田疗法与常规疗法联合治疗(心理干预组20例)和单用常规疗法治疗(未心理干预组50例).比较两组患者入院时和出院前的NIHSS、mRS、BI、住院天数、住院费用上的差别.结果 与常规治疗相比,对轻-中度急性缺血性卒中用森田疗法进行心理治疗可以使患者平均住院天数明显缩短[心理干预组:(10.5士2.7)d,未心理干预组:(15.4±2.1)d,(P＜0.05)],平均住院费用降低[心理干预组:(14 885.5士3 687.5)元,未心理干预组:(22 773.4±4 221.7)元,(P＜0.05)],而对△NIHSS、△mRS、△BI评分无明显影响.结论 对脑卒中患者进行心理干预,可以缩短其住院时间、减少住院费用、促进康复.     

中国急性缺血性脑卒中治疗现状

目的 按照国家和国际治疗指南,评估中国缺血性脑卒中急性期患者的治疗状况.方法 2006年7月1日至11月30日在全国62家医院前瞻性地收集诊断为新发急性脑卒中(脑梗死和脑出血)的所有成人(≥15岁)病例的治疗用药数据.结果 筛查了13 038例患者,其中符合入组标准的6416例,缺血性脑卒中74.5%(4783例),缺血性脑卒中患者从发病到医院时间平均为20.0 h(3.8～59.0 h),发病3 h内到医院的有1019例(21.3%),溶栓治疗只有1.9%(91/4783例),用神经保护剂和中药治疗的分别为75.9%和83.1%,抗血小板治疗的有80.5%,23.5%的脑卒中患者既未得到溶栓治疗,也未得到阿司匹林治疗.结论 目前中国缺血性脑卒中治疗现状喜忧参半:阿司匹林的应用虽然与指南存在差距,但是基本达到西方的应用水平;临床过多使用神经保护剂和中药,而确实有效的溶栓治疗却远远不够,脑卒中发生以后到医院的时间明显长于国外.     

Hospitalization of patients with cerebrovascular diseases in Poland in 1979-1981 and 1986-88.]

Hospitalization and death indices of patients admitted with cerebrovascular diseases were analysed on the basis of statistical cards filled by hospitals in a sample of 10% in patients in all Polish hospitals in the years 1979-1981 and 1986-1988. In these years a 40% rise was noted of the hospitalization indices and a 22% rise in the death rated caused by these diseases. On the other hand, the hospital death rate decreased from 32.2% to 27.9%. Higher hospitalization indices were found for males and for the urban population. The death rates and intrahospital mortality were higher for women but the standardized death rates, with the exception of oldest age group, were higher for men. A cause for concern is the rise of hospitalization indices for men and women and death rates in men aged 40-59 years which may indicate lowering of the age of threatening stroke.     

Survival following stroke. A prospective population-based study of 438 hospitalized cases with prediction according to subtype, severity and age

In a prospective population-based study analyses were performed to estimate the survival prognosis following stroke, in relation to age of the patient as well as to subtype, severity and occurrence of the stroke diagnosis. The statistical technique of stepwise regression analysis was used to discriminate the isolated importance of these factors on survival outcome. A total of 438 patients, consecutively admitted to the Department of Neurology during the period Feb. 1st 1986-September 30th 1987 were followed 15 days, 3, 6, and 12 months after the acute stroke. The one-year survival rate was 75% compared with 93% for a control group matched for age, sex, residence and calendar year. Mortality after stroke occurred predominantly within the first 3 months, after 3 months survival prognosis was no different from that of the general population. Statistical analysis identified 2 factors that gave significant isolated prediction on survival outcome. These factors were in order of importance age and severity of stroke diagnosis, whereas sex, subtype and occurrence of stroke were of no discriminative value.     

高血压脑出血的微侵袭手术治疗——前瞻随机多中心研究

目的比较高血压脑出血微侵袭手术治疗的疗效.方法11个医院应用前瞻、随机、对照的研究方法,内科组105例,微侵袭外科组144例,比较高血压脑出血内科治疗与微侵袭外科治疗近期(1个月)和远期随访(6个月).结果近期疗效外科组明显好于内科组(P＜0.001);近期死亡率在两组间无差别内科组近期死亡12例,死亡率11.4%,外科组近期死亡13例,死亡率9.0%(P=0.471).远期疗效外科组明显好于内科组(P=0.006);远期死亡率外科组低予内科组内科组远期死亡7例,死亡率7.5%,外科组远期死亡4例,死亡率3.1%(P=0.013).结论高血压性脑出血微侵袭手术治疗的疗效肯定.     

我国卒中医疗机构分级水平现况调查

目的 明确我国接诊卒中患者的医疗机构卒中医疗资源配置情况及水平。      

Regional disparities in acute and post-acute care of stroke patients in France, 2015

Objective

The aim of this study was to assess regional variations of the hospital management of stroke patients during acute and post-acute phases in France in 2015.