脑卒中患者主要居家照顾者负荷及影响因素的研究

目的了解脑卒中主要居家照顾者的负荷水平及其影响因素。方法选择上海市社区脑卒中患者180例,调查患者的基本情况和功能独立性水平,调查主要照顾者的人口社会学资料、照顾相关资料、应对资源与负荷。对数据进行单因素分析和多元回归分析。结果主要居家照顾者负荷平均分为48.83±8.05。不同的文化程度、家庭经济情况、慢性病情况、每天照顾时间、照顾任务、陪伴患者时间、照顾意愿、自我效能、健康相关生活质量以及患者功能独立程度不同,主要照顾者的负荷差异有统计学意义(P<0.05)。以负荷总分为应变量,所有因素为自变量进行多元逐步回归,,照顾者健康相关生活质量、脑卒中患者的功能独立程度进入回归方程(P<0.001)。结论居家照顾脑卒中患者给其照顾者带来了较重的负荷。应充分重视提高患者的功能独立性水平,给予照顾者多方面的社会支持,提高其自我效能。     

Lateral pelvic displacement during gait: abnormalities after stroke and changes during the first month of rehabilitation

OBJECTIVES: To measure the amplitude and symmetry of lateral pelvic displacement (LPD) in patients with acute hemiparetic stroke; to assess the relationship between LPD and walking speed; and to quantify changes in LPD during 1- and 4-week intervals in the early stages of gait rehabilitation. DESIGN: LPD amplitude and symmetry were measured in stroke patients on admission to acute rehabilitation, 1 week later, and at 4-week follow-up. Performance was compared with sex-, height-, and age-matched control subjects. SETTING: Urban geriatric inpatient rehabilitation facility in Australia. PARTICIPANTS: Fifteen patients with a single-hemisphere stroke, confirmed by computed tomography, were compared with the data from 12 control subjects. Patients' FIM trade mark instrument scores ranged from 54 to 124. INTERVENTION: Gait rehabilitation involved twice-daily individual physical therapy sessions of 45 to 60 minutes, 5 days a week, incorporating whole and part practice, mental rehearsal, verbal feedback on performance, manual guidance, and strengthening techniques. MAIN OUTCOME MEASURES: Three-dimensional motion analysis of LPD amplitude and symmetry; and preferred walking speed over 10m. RESULTS: Compared with controls, stroke patients initially showed increased amplitude of LPD, with no difference in LPD symmetry. A statistically significant linear relationship existed between walking speed and amplitude of LPD (r=-.53; P=.04), yet not between walking speed and symmetry (r=-.41, P=.13). Amplitude and symmetry values remained consistent during the 4-week period of rehabilitation. CONCLUSIONS: These results provide baseline LPD values for patients with acute hemiparetic stroke and demonstrate the relationship between LPD and walking speed. Change in LPD during inpatient rehabilitation was not uniform or predictable, particularly during longer periods. This highlights the need for therapists to regularly reassess each patient during the early rehabilitation phase after stroke, especially given that individual differences can be marked.     

Late motor recovery is influenced by muscle tone changes after stroke

OBJECTIVES: To evaluate the time course of motor recovery in a poststroke period ranging from 2 to 6 months and its correlation with both the severity of motor deficit and the muscle tone disturbances (flaccidity or spasticity) of the affected limbs. DESIGN: Prospective cohort study. SETTING: A comprehensive rehabilitation hospital. PARTICIPANTS: Forty consecutive stroke patients (21 men, 19 women) with first ischemic stroke who met the inclusion criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Change in motor deficit as evaluated by the Adams Hemispheric Stroke Scale. RESULTS: Stepwise regression analysis indicated that the most significant factors influencing motor recovery were the time elapsed since stroke and muscle tone. CONCLUSIONS: Rehabilitation of stroke patients is more effective in the first months after the event rather than later, considering the significant correlation observed between motor recovery and time elapsed since stroke. Flaccid patients appear to need 3 months or more before reaching the final plateau, because motor recovery occurs later and/or proceeds more slowly, whereas outcomes for spastic patients with spasticity appears to occur in the first months after stroke.     

CTA示大脑内静脉不对称与急性前循环缺血性脑卒中患者功能康复的关系

【目的】探讨CT血管造影（CTA）时大脑内静脉（ICV）不对称显影与急性缺血性脑卒中（AIS）患者功能康复情况的关系。【方法】回顾性分析98例AIS并行静脉组织纤维蛋白溶酶原激活物（tPA）溶栓治疗患者的临床资料。患者tPA溶栓3个月后采用改良Rankin量表进行评分,按得分高低分为康复较好组和康复较差组,对比两组患者的年龄、性别、吸烟、高血压、糖尿病等与血管疾病相关的危险因素,以及两组NIHSS评分和溶栓后的CTA影像资料是否有统计学差异,并采用多因素分析其中的独立危险因素。比较CTA影像、NIHSS评分及CTA＋NIHSS评分对患者康复情况评估的特异性、敏感性。【结果】康复较差组患者的平均年龄高于康复较好组、溶栓前NIHSs评分更高、卒中发作24h后NIHSS评分变化更小、溶栓后d2双侧ICV不对称例数更多,差异均有统计学意义（均P〈0．05）。tPA治疗前高NIHSS评分（P=0．041）、24h内NIHSS评分变化,J、（P=0．027）及d2双侧ICV不对称比例多（P=0．031）是预示溶栓后康复较差的独立危险因素。CTA评估的敏感性为83％,高于NIHSS的72％;NIHSS评分的特异性为79％,高于CTA的75％;CTA联合NIHSS评估的特异性和敏感性分别为87％和92％,较单独采用CTA或NIHSS评估的特异性敏感性更高,但差异均没有统计学意义（均P〈0．05）。【结论】AIS患者溶栓后d2双侧ICV不对称较多可以作为预测AIS患者溶栓治疗康复较差的指标,且CTA影像结合NIHSS评分进一步提高了患者康复情况预测的准确度。     

Convergent Validity and Responsiveness of the SULCS

Objective

To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.

老年人脑血管功能分析与卒中危险度评估

目的:分析和评估老年人的脑血管功能、卒中危险度、危险因素暴露状况,描述其人群分布特征。方法:以现况研究设计,整群抽取社区人群中>60岁及60岁以上的老年人群1827人,进行卒中危险因素调查和脑血管血液动力学指标(CVHI)检测。描述卒中危险因素暴露、CVHI检测指标及其积分值的人群分布特征,评估卒中危险度。结果:高血压病、心脏病、肥胖和吸烟的暴露率在男性分别为41.1%、9.4%、1.8%和86.1%,在女性分别为49.6%、13.6%、3.7%和0.46%,上述因素及多项CVHI在男、女组间均有显著差异(P<0.05);高血压病和心脏病的暴露率、收缩压水平随年龄增长而上升,体质量指数(BMI)和CVHI积分值随年龄增长而下降(P<0.01);卒中危险度上升至5倍、7倍和14倍者男性分别为11.3%、11.5%、8.5%,女性分别为17.7%、11.9%、9.9%。结论:老年人的卒中危险因素暴露存在年龄和性别分布差异,高血压暴露率最高,约1/3左右的老年人脑血管功能明显受损,卒中风险明显上升。     

Schlaganfallprävention beim Vorhofflimmern – Umsetzbarkeit von Studienergebnissen in der Praxis

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