Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke,assessed by the ABILOCO questionnaire

BackgroundThe identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions.ObjectiveTo investigate which impairment measures would best predict locomotion ability in people with chronic stroke.MethodsIndividuals (n = 115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke.ResultsAge, sex, and time since stroke did not significantly correlate with the ABILOCO scores (−0.07 < ρ < 0.05; 0.48 < p < 0.99). Measures of motor impairments and walking speed were significantly correlated with the ABILOCO scores (−0.25 < r < 0.57; p < 0.001), but only walking speed and strength were kept in the regression model. Walking speed alone explained 35% (F = 55.5; p < 0.001) of the variance in self-reported locomotion ability. When strength was included in the model, the explained variance increased to 37% (F = 31.4; p < 0.001).ConclusionsWalking speed and lower limb strength best predicted locomotion ability as perceived by individuals who have suffered a stroke.     

安徽省淮南市居民脑卒中471例发病危险因素分析

目的评价淮南市脑卒中患者发病危险因素的构成情况。方法选择连续登记住院的淮南市居民脑卒中患者471例,其中缺血性脑卒中362例,出血性脑卒中109例,对已知危险因素进行统计学分析。结果在所有脑卒中患者中,高血压的患病率占首位（缺血性脑卒中为69．3％、出血性脑卒中为77．9％）,是各类脑卒中最重要的危险因素。不同性别脑卒中患者危险因素构成情况有所不同,男性患者吸烟、饮酒问题较女性患者更突出（分别为51．1％、33．2％和5．1％、2．0％）,差异均有统计学意义（X^2=111．81、67．62,均P〈0．01）。糖尿病、心脏疾病、房颤的患病率在女性患者较男性患者更高（分别为37．6％、31．9％、19．3％和22．3％、20．4％、8．8％）,差异均有统计学意义（X^2=13．12、8．09、11．12,均P〈0．01）。高血压、糖尿病患者规律服药仅占40．8％、47．4％。房颤在出血性脑卒中患者中更多见。结论控制血压、血糖仍是本地区脑卒中一级预防和二级预防的重点工作,对不同性别的人群应有针对性地进行个体化健康教育,重视提倡健康的生活方式,从而有效的预防脑卒中的发生。     

多因素干预提高老年脑卒中患者康复效果的研究

目的探讨多因素干预对提高老年脑卒中患者康复的效果。方法对85例患者随机分组,对治疗组进行综合评估,制定针对性的干预计划,进行分阶段康复,建立家庭支持联合“心理防御”等多因素干预模式及方法。对照组常规进行康复治疗,将两组患者进行比较。结果治疗组43例,有效率95．3％,对照组42例,有效率83．3％。实施多因素干预后,患者的潜在和可改变危险因素明显降低,临床疗效明显提高（P〈0．01）。结论对老年脑卒中患者病后实施多因素干预措施,是控制危险因素,降低复发,提高康复效果的有效治疗方法。     

急性脑血管病危险因素累积效应分析

目的 探讨急性脑血管病的代谢紊乱特点并分析相关因素,为急性脑血管病的防治提供依据.方法 对621例急性脑血管病患者(脑梗死341例、脑出血280例)及202例健康体检者(健康对照组)的临床资料进行回顾性分析.621例急性脑血管病患者根据血压、血糖、血脂水平分为代谢综合征组(合并高血压+高血糖+血脂紊乱)、2种危险因素组(合并高血压+高血糖或高血压+血脂紊乱或高血糖+血脂紊乱)、1种危险因素组(合并高血糖或高血压或血脂紊乱)和无危险因素组.结果 341例脑梗死、280例脑出血患者中伴高血压者分别占93.8%(320/341)和92.5%(259/280);伴高血糖者分别占47.8%(163/341)和36.1%(101,280);伴高脂血症者分别占33.7%(115/341)和50.4%(141/280).急性脑血管病患者的基本临床特征为1种危险因素组、2种危险因素组和代谢综合征组收缩压(SBP)及舒张压(DBP)均显著高于健康对照组及无危险因素组,2种危险因素组体质指数(BMI)、空腹血糖(FPG)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)均高于健康对照组及无危险因素组,代谢紊乱的程度可随代谢紊乱组分的增多而相对加重.相关因素分析表明,年龄、BMI、SBP、DBP、FIG、总胆固醇(TC)、TG、LDL-C、高密度脂蛋白胆固醇(HDL-C)为急性脑血管病的独立危险因素.结论 急性脑血管病患者多有代谢紊乱,有效控制各种危险因素有利于防治急性脑血管病.

Abstract：

Objective To investigate the clinical characteristics and related factors of metabolic disorder in acute cerebrevascular disease (ACVD) and to provide clinical basis for intervention of ACVD.Methods The clinical data of 202 healthy individuals (control group) and 621 cases of ACVD (341patients with cerebral infarction and 280 patients with cerebral hemorrhage) was analysed retrospectively.Based on the level of blood pressure,blood glucose and blood fat, 621 cases of ACVD were divided into me tabolism syndrome( MS ) group (hypertension + hyperglycemia + hyperlipidemia),two kinds of risk fatorsgroup (hypertension + hyperglycemia or hypertension + hyperlipidemia or hyperglycemia + hyperlipidemia),one kind of risk factor group (hypertension or hyperglycemia or hyperlipidemia) and no risk fastor group.Results Of the patients with cerebral infarction and cerebral hemorrhage 320 eases(93.8%) and 259 cases (92.5%) had hypertention,163 cases (47.8%) and 101 cases (36.1%) had hyperglycemia, 115 cases (33.7%) and 141 cases (50.4%) had hyperlipidemia, respectively. The blood pressure in one kind of risk factor group, two kinds of risk factors group and MS group was significantly higher than those in control group and no risk factor group,the body mass index (BMI), fasting plasma glucose (FPG),total cholesterol(TG)and low density lipoprotein cholesterol (LDL-C) in two kinds of risk factors group were higher than those in control group and no risk factor group (P <0.05). The age,BMI,blood pressure,FPG,TC,TG,high density lipoprotein cholesterol(HDL-C) and LDL-C had obvious correlation with ACVD. Conclusion ACVD is often combined with various kinds of metabolic disorders risk factors, suggesting that an effective control of metabolic disorders is benefit to intervention of ACVD.     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

老年脑血管意外患者肠内营养支持的疗效

目的观察老年脑血管意外患者的肠内营养支持治疗效果。方法回顾性分析29例老年脑血管意外患者的肠内营养支持治疗效果。第一阶段给予百普素要素营养制剂,第二阶段给予要素营养制剂加低浓度匀浆膳,第三阶段过渡至高热量匀浆膳或口服自然饮食。结果本组患者21例按照上述营养治疗方案在两周左右到达第三阶段,在第一、二营养治疗阶段有5例因伴有严重的肺部感染并继发性多器官功能衰竭死亡,3例因应激性溃疡出血而改为肠外营养。结论较为完善的设计(包括营养液的配置、鼻饲管的选择,供给方式等)可以使老年脑血管意外患者得到合理的、有效的营养支持。     

超声评价缺血性脑血管病患者颈动脉颅外段病变的临床研究

目的 应用超声技术探讨缺血性脑血管病患者颈动脉颅外段动脉粥样硬化严重程度及斑块形成的程度.方法 对102例缺血性脑血管病患者及31例健康人进行彩色血管超声检查,比较其动脉硬化程度.结果 ①缺血性脑血管病患者颈动脉颅外段硬化较严重.②各类型缺血性脑血管病患者斑块发生率(>60%)及狭窄发生率(>40%)均较高.结论 缺血性脑血管病患者颈动脉颅外段动脉粥样硬化较严重,进行颈动脉颅外段超声检测,对缺血性脑血管病患者的临床诊治有重要的参考价值.     

依达拉奉联合维生素B12、叶酸治疗进展性卒中疗效观察

目的 探讨依迭拉奉联合维生素B12、叶酸治疗进展性卒中的疗效.方法 将60例进展性卒中患者随机分为治疗组和对照组各30例,2组患者均未行溶栓治疗.对照组给予脱水、控制脑水肿、活血化瘀、抗血小板聚集等常规治疗.治疗组在常规治疗基础上加用依达拉奉和维生素B12、叶酸治疗.两组于发病48 h 和治疗14 d后分别进行中国卒中...     

急性脑血管意外院前急救的护理体会

目的探讨急性脑血管意外院前急救护理方法及临床价值。方法对166例发生急性脑血管意外患者的临床资料进行回顾性分析,观察疾病预后与院前急救护理的关系。结果呼叫早并进行积极有效的院前急救和护理的患者预后比自行就诊未得到有效现场急救的患者治疗有效率高。结论积极地院前急救护理,可有效阻止疾病的进一步恶化,对提高急性脑血管意外患者入院治疗后的有效率具有重要的意义,应引起急诊科医护人员的高度重视。     

Safety and efficacy of the SeparGate™ balloon-guiding catheter in neurointerventional surgery: Study protocol of a prospective multicenter single-arm clinical trial

BackgroundThe balloon-guiding catheter (BGC) reportedly reduces the number of retrievals and occurrence of distal emboli, achieving superior revascularization results and improved clinical outcomes in acute stroke. This study will aim to examine the efficacy and safety of the new SeparGate™ BGC.DesignThis prospective multicenter single-arm clinical trial will aim to include 128 patients who fulfill its inclusion and exclusion criteria. All patients will receive endovascular interventional therapy with BGC assistance. The primary endpoint will be the immediate surgical success rate, while the secondary endpoint will be product performance. The safety evaluation will include serious adverse events such as puncture site hematoma and bleeding, cerebral vasospasm, vessel dissection, vessel perforation, air embolism, thrombus (acute or subacute), vessel occlusion, distal embolization, infection, adverse reaction to antiplatelet and anticoagulant drugs, intracranial hemorrhage, stroke, death, and device defect.DiscussionThe prospective multicenter trial will provide safety and efficacy information for the SeparGate™ BGC. Its findings will provide a clinical reference for endovascular adjuvant therapy of cerebrovascular disease.Trial registrationChiCTR1800014459.