卒中后合并脑心综合征患者的便秘症状评分的调查

目的：调查卒中后合并脑心综合征（CCS）患者的便秘症状评分现况。方法：39例卒中后合并CCS患者（卒中＋CCS组）接受了“便秘症状及疗效评估问卷”评估,并与54例同期住院未合并CCS脑卒中患者（卒中对照组）比较。结果：卒中＋CCS组住院期间功能性便秘（CIC）发生率明显高于卒中对照组（64．10％比24．07％,P〈0．01）,同时卒中＋CCS组的便秘症状总分及各分项评分均明显高于卒中对照组[总分：（14．47±4．61）分比（10．25±3．17）分,P〈0．01）]。结论：卒中后合并脑心综合征患者常常患有功能性便秘,且便秘症状评分严重,后者也可能是脑心综合征发病诱因之一。     

驻长沙军队老年干部脑卒中患病率和危险因素调查分析

目的:了解驻长沙军队男性老年干部脑卒中患病率及其危险因素。方法:采用整群抽样问卷调查方法,对2012年1～6月在湖南省长沙市解放军163医院体检或住院的军队男性老年(60岁以上)干部4217例进行调查并检测血糖、血脂、C反应蛋白(CRP)等相关指标,分析脑卒中的发生情况;采用非条件Logistic回归法进行相关危险因素分析。结果:驻长沙军队老年干部脑卒中患病率为20.3%,脑卒中的相关危险因素为吸烟(OR=2.859)、糖尿病家族史(OR=2.163)、高CRP水平(OR=1.834)、肥胖(OR=1.506)、高龄(OR=1.120),P均<0.01。结论:驻长沙军队男性老年干部脑卒中患病率较高,其危险因素是吸烟、有糖尿病家族史、高C反应蛋白水平、肥胖和高龄。     

北京市房山区韩村河镇居民脑卒中流行病学调查

目的初步了解北京市房山区韩村河镇50岁以上本市户籍人口脑卒中的流行现状,为制定相应的防治和干预措施提供科学依据。方法采用随机整群抽样的方法,对韩村河镇6个自然村818名50岁以上本市户籍居民进行脑卒中患病情况进行调查,由培训过的医师收集调查对象的相关信息。结果韩村河镇脑卒中患病率为19．30％。男性患病率为24．30％,显著高于女性（14．56％）,差异有统计学意义（X性别^2=12．20,P〈O．01）。不同年龄、职业间脑卒中患病率比较,差异有统计学意义（X年龄^2=58．13X职业^2=29．70,P均〈0．01）,其中70-75岁、未就业者发病率最高（分别为38．24％、34．39％）,且随着年龄的升高,该地区脑卒中患病率有增高的趋势。不同地区、文化程度、婚姻状况间脑卒中患病率比较,差异无统计学意义∞地Ⅸ。=8．15,X文化^2=1．94,X婚姻^2=2．73,P均〉0．05）。结论韩村河地区50岁以上居民脑卒中患病率明显高于其他地区,男性、70-75岁、未就业者患病率较高,有必要针对性地做好这一地区的脑卒中防控工作。     

跑台运动训练对脑缺血大鼠神经功能恢复的影响

目的：探讨跑台运动训练对脑缺血大鼠神经功能恢复的影响。方法：36只成年雄性SD大鼠被随机分为假手术组、模型组、运动组,各12只。采用改良zea—Longa线栓法制备大鼠大脑中动脉闭塞（MCAO）模型;运动组大鼠于MCAO模型成功后2d开始进行跑台运动训练;通过修订的神经功能评分（mNSS）观察大鼠神经功能恢复情况并观测大鼠体重变化情况,通过氯化四唑（TTC）染色观察大鼠脑梗死体积。结果：模型组和运动组大鼠造模后神经功能逐渐恢复,运动组大鼠造模后14d、28d神经功能评分优于模型组[14d：（8．17±1．03）分比（9．42±1．62）分,P〈0．05;28d：（6．25±0．97）分比（8．17±1．70）分,P〈0．01];与模型组相比,运动组大鼠体重于造模后7d、14d和28d明显增加（P〈0．05或〈0.01）;造模后28d,运动组大鼠脑梗死体积与模型组大鼠相比明显减小[（26．50±0．448）％比（29．45±0．639）％,P〈0．01]。结论：跑台运动训练可以促进大鼠神经功能和体重恢复,减小大鼠脑梗死体积,有利于脑缺血大鼠的康复。     

澳大利亚悉尼西南区内镜下胃造瘘术在脑卒中后吞咽功能障碍患者中的应用分析

目的 探讨脑卒中后吞咽功能障碍患者经皮内镜下胃造瘘术(PEG)术前各种因素与术后死亡之间的关系,评估放置PEG管的必要性.方法 52例入组患者,详细记录了PEG前各种参数及术后生存情况,并分析病例的死亡时间特点.对术前和术后的肺炎以及消化道出血情况进行比较分析.结果 52例患者随访期内总共死亡16例,其中15例(93.4％)在术后3个月内死亡.年龄和美国麻醉师协会(ASA)评分显示与死亡有独立相关性,P值分别为0.026及0.001.PEG管置放前后吸入性肺炎发生率(50.0％比34.6％)及上消化道出血的发生率(5.8％比7.7％)比较,差异无统计学意义.结论 放置了PEG管后多数死亡病例是在短期内(3个月)出现.年龄、ASA评分与卒中患者放置PEG管后的死亡风险相关.PEG并不能降低卒中患者吸入性肺炎及消化道出血的发生率.     

Motor vehicle accidents: How should cirrhotic patients be managed?

Motor vehicle accidents (MVAs) are serious social issues worldwide and driver illness is an important cause of MVAs. Minimal hepatic encephalopathy (MHE) is a complex cognitive dysfunction with attention deficit, which frequently occurs in cirrhotic patients independent of severity of liver disease. Although MHE is known as a risk factor for MVAs, the impact of diagnosis and treatment of MHE on MVA-related societal costs is largely unknown. Recently, Bajaj et al demonstrated valuable findings that the diagnosis of MHE by rapid screening using the inhibitory control test (ICT), and subsequent treatment with lactulose could substantially reduce the societal costs by preventing MVAs. Besides the ICT and lactulose, there are various diagnostic tools and therapeutic strategies for MHE. In this commentary, we discussed a current issue of diagnostic tools for MHE, including neuropsychological tests. We also discussed the advantages of the other therapeutic strategies for MHE, such as intake of a regular breakfast and coffee, and supplementation with zinc and branched chain amino acids, on the MVA-related societal costs.     

脑血管病危险因素在神经内科门诊患者中的知晓率调查分析

目的了解神经内科门诊缺血性脑血管疾病患者对导致脑血管病的主要危险因素的知晓情况,为脑卒中筛查工作提供依据。方法2013年2～7月,对1389例神经内科患者进行问卷调查,测量身高、体重、腰围、臀围、血压,同时测定空腹血脂、空腹血糖。并进行脑血管意外危险因素知晓率的流行病学调查。结果l389例神经内科门诊患者中,高血压病患病率55．6％,知晓率32．6％;糖尿病患病率46．2％,知晓率22．8％;高脂血症患病率82．6％,知晓率43．5％;肥胖患病率57．5％,知晓率33．0％;冠心病患病率67．1％,知晓率32．7％。其中35~44岁年龄（青壮年）组患者对患高血压病、糖尿病、高脂血症、肥胖和冠心病的知晓率更低,分别为8．7％、0、15．4％、9．4％、3．6％,与其他年龄组比较,差异有统计学意义。结论各年龄组患者的高血压病、糖尿病、冠心病、高血脂、肥胖的患病率均较高;对脑血管病的主要危险因素知晓率均较低;以35～44岁组的知晓率最低。对35～44岁组患者加强血脂、血压、血糖筛查,提高知晓率,对降低脑卒中的发病率具有重要意义。     

Sleepiness,driving, and motor vehicle accidents: A questionnaire-based survey

In Switzerland, the prevalence of an excessive daytime sleepiness (EDS) in drivers undergoing a driving capacity assessment is currently not known. In this study, private and professional drivers were evaluated by means of a paper-based questionnaire, including Epworth Sleepiness Scale, Berlin Questionnaire, and additional questions to sleepiness-related accidents, near-miss accidents, health issues, and demographic data.Of the 435 distributed questionnaires, 128 completed were returned. The response rate was 29%. The mean age of the investigated drivers was 42.5 years (20–85 years). According to the Epworth Sleepiness Scale, 9% of the participants are likely to suffer from excessive daytime sleepiness. An equal percentage has a high risk for obstructive sleep apnea syndrome based on the Berlin Questionnaire. 16% admitted an involuntary nodding off while driving a motor vehicle. This subset of the participants scored statistically significant higher on the Epworth Sleepiness Scale (p = 0.036). 8% of the participants already suffered an accident because of being sleepy while driving. An equal number experienced a sleepiness-related near-miss accident on the road. The study shows that a medical workup of excessive daytime sleepiness is highly recommended in each driver undergoing a driving capacity assessment. Routine application of easily available and time-saving assessment tools such as the Epworth Sleepiness Scale questionnaire could prevent accidents in a simple way. The applicability of the Berlin Questionnaire to screen suspected fatal sleepiness-related motor vehicle accidents is discussed.