经颅直流电刺激调节迷走神经兴奋性对脑卒中后吞咽障碍的效果

目的 研究经颅直流电刺激(tDCS)调节迷走神经兴奋性对卒中后吞咽功能障碍的疗效。方法 2020年9月至2021年2月,本院康复科卒中后吞咽障碍患者28例随机分为对照组和tDCS组,各14例。两组均行吞咽功能训练,tDCS组行迷走神经tDCS,对照组行迷走神经假刺激。治疗前后,采用改良曼恩吞咽能力评估量表(MMASA)和澳大利亚治疗结局量表(AusTOMs)吞咽功能评分进行评定。结果 治疗后,两组MMASA评分(|t| > 5.593, P < 0.001)和AusTOMs吞咽功能评分(|Z| > 2.121, P < 0.05)均提高,tDCS组优于对照组(|t| = 2.439, |Z| = 2.079, P < 0.05)。结论 tDCS调节迷走神经兴奋性可促进卒中后吞咽功能障碍恢复。     

脑卒中后吞咽障碍患者肠内营养素应用的临床观察

目的：探讨肠内营养混悬液对脑卒中后吞咽障碍患者的营养支持作用。方法：将60例脑卒中后吞咽障碍患者随机分为观察组和对照组各30例,观察组经鼻饲管或胃造瘘管推注肠内营养混悬液总蛋白纤维低聚果糖(TPF-FOS)及自制匀浆膳;对照组经鼻饲管或胃造瘘管给予家庭自制匀浆膳。分别评估2组患者治疗前后的各项相关生化和躯体营养指标。结果：治疗14d后,观察组白蛋白浓度、前白蛋白浓度较治疗前及对照组治疗后明显提高（P＜0.05）。结论：肠内营养混悬液TPF-FOS能够改善患者的营养状态,有助于患者的神经功能全面康复。     

Post-stroke depression among stroke survivors attending two hospitals in Kampala Uganda

Background

The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere.

Methods

In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD.

Results

Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD.

Conclusion

There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient''s inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.     

维生素B1联合帕罗西汀治疗卒中后抑郁症的临床疗效

目的:探讨维生素B1与帕罗西汀联合治疗卒中后抑郁症(PSD)的临床疗效。方法:PSD患者60例随机分为联合组和对照组各30例。2组均给予帕罗西汀治疗,联合组在此基础上给予维生素B1治疗,疗程8周。于治疗前及治疗开始后2、4、8周时分别使用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评估疗效,采用不良反应量表(TESS)评估不良反应。结果:2组治疗第2周末疗效差异无统计学意义(P0.05);第4、8周末联合组的HAMD、SDS评分较对照组下降(P0.05),疗效优于对照组(P0.05)。TESS评分差异无统计学意义(P0.05)。结论:维生素B1联合帕罗西汀治疗PSD较单用帕罗西汀疗效显著,且不会增加不良反应。     

MFI-20应用于脑卒中后疲乏(PSF)的诊断价值

目的 探索多维疲乏目录（Multidimensional Fatigue Inventory,MFI-20）对脑卒中后疲乏（post-stroke fatigue,PSF）的诊断价值。方法 采用方便抽样法抽取328例脑卒中患者作为研究对象,以疲乏严重度量表（Fatigue Severity Scale,FSS）结果为诊断标准,评估MFI-20诊断PSF的效能。结果 328例患者中,136例使用FSS诊断PSF（41.5%）,153例应用MFI-20诊断PSF（46.6%）。以FSS为标准,MFI-20对PSF的诊断符合率为91.8%,Kappa值为0.833,灵敏度为96.3%,特异度为88.5%,阳性预测值为85.6%,阴性预测值为97.1%。MFI-20诊断PSF的ROC曲线下面积为0.924。结论 MFI-20具有良好的诊断价值,其多维的特点与PSF的复杂性相契合,可作为PSF的诊断工具。     

The prevalence and management of central post-stroke pain at a hospital in Zimbabwe

BackgroundCentral post-stroke pain (CPSP) is a poorly diagnosed chronic pain. It is under-treated and usually mismanaged.ObjectiveTo establish the prevalence of CPSP and its management in stroke clinics at a tertiary hospital.MethodsThis was a cross-sectional design with stroke patients and health professionals from the stroke clinic at the tertiary hospital in Zimbabwe.ResultsOut of 166 stroke survivors, 8% had CPSP. Younger age (<60 years) was significantly associated with CPSP (P<0.003). Pain characteristics of CPSP were hyperaesthesia (10, 71%), electric shocks (9, 64%), temperature allodynia (9, 64%) and allodynia (12, 86%). Ten health professionals participated in the study: one (10%) reported using Douleur Neuropathique 4 (to diagnose neuropathic pain) and two (20%) reported using sensory tests. Four patients (44%) were on paracetamol (acetaminophen) and on weak opiates such as codeine. None of the patients were on anticonvulsants or antidepressants. Two medical doctors (50%) used weak opiates as second-line management. Five patients (36%) reported receiving a combination of massage, stretching, general exercise and moist heat or cryotherapy.ConclusionThe prevalence of CPSP in the study group is within international range. There is a need for appropriate management and use of tests and outcome measures for diagnosis of CPSP.