中风康复护理的相关研究

对中风康复护理的相关研究进展进行综述,阐述了中风康复护理研究的临床指导意义,提出了有效的、实用的康复护理策略,为护理人员在临床工作中选择适宜的方法提供参考依据。     

运动灸配合反射抑制模式治疗脑卒中后痉挛性瘫痪疗效评价

目的评价运动灸配合反射抑制模式对脑卒中后痉挛性瘫痪患者肌张力的改善作用。方法纳入合格受试者90例,采用随机数字表法,随机分成3组,试验组(A组,30例)采用运动灸配合反射抑制模式治疗;对照组(B组,30例)采用运动灸治疗;对照组(C组,30例)采用反射抑制模式治疗。观察指标为改良Ashworth评分、临床神经功能缺损评分(NDS)及日常生活能力量表(ADL)。结果 3组治疗结束后及随访期间,组间NDS评分、ADL评分比较差异均有统计学意义(P0.05);3组治疗后各关节均有所改善,但是A组肘关节、膝关节改善均优于B组和C组。各组急性期总有效例数最高,其次为恢复期,后遗症期;A组急性期总有效例数远高于B组、C组,恢复期和后遗症期例数差别不大。结论运动灸配合反射抑制模式对改善脑卒中痉挛性瘫痪的神经功能缺损程度、日常生活能力方面均优于单一疗法,而且对急性期患者效果更为明显。     

从腰夹脊穴论治中风后平衡功能障碍针刺思路探析

平衡功能障碍是中风后常见后遗症,增加了患者跌倒的风险及患者的病痛和负担,延缓了康复的进程,影响功能的恢复。针刺治疗是治疗中风后平衡功能障碍的重要方法,临床多以脏腑辨证和经络辨证为基础,多采用头皮针、体针、芒针等方法,虽取得一定疗效,但仍存在相应的局限性,缺乏现代学理论依据;本文从经络辨证和现代医学核心肌群理论出发,选取处于腰部核心肌群的夹脊穴,既可以通督脉、调摄膀胱经之背俞穴,入络脑室,从而达到整体治疗、调整阴阳的目的,又可以松解神经,进而缓解肌痉挛,降低肌张力,提高平衡功能。最后提出以针刺腰部夹脊穴治疗中风后平衡功能障碍,期待在临床治疗中取得更好的效果。     

原发性脑出血临床分析

目的探讨原发性脑出血临床并发症、血清酶和血糖变化与生存率的关系。方法筛选病例均经CT定性及定量检查,临床观察主要指标为：（1）并发症;（2）血清酶类;（3）空腹血糖;（4）预后情况。结果（1）临床主要并发症。消化道出血死亡17例（44.74%）;肺部感染死亡29例（30.53%）;尿路感染死亡19例（19.19%）;电介质紊乱死亡18例（18.37%）;肾功能损害死亡26例（29.89%）;脑疝死亡11例（91.67%）;症状性癫痫死亡5例（83.33%）;代谢性酸中毒死亡4例（40%）;代谢性碱中毒死亡6例（31.58%）;昏迷死亡32例（58.18%）;呼吸功能衰竭死亡30例（69.77%）。（2）血清酶类异常情况：251例中ALP值轻度升高者42例（16.73%）;ALT及AST值轻度升高分别为23、61例（9.16%、24.30%）。（3）空腹血糖值〉7.0mmol/L97例（38.65%）。251例出血患者经治疗死亡者64例（25.50%）,其中高血压患者死亡58例（27.88%）;血压正常者死亡6例（13.95%）。结论重视和加强对原发性脑出血的防治研究,以降低患者的发病率、致残率、复发率及死亡率。     

急性脑卒中180例临床病因分析

目的探讨急性脑卒中的临床特点。方法回顾性分析2005年8月—2010年7月我科收治的180例急性脑卒中患者的临床资料。结果出血性卒中67例,缺血性卒中113例;高血压、心脏病为常见诱因;动态发病以出血性脑卒中常见,静态发病以缺血性卒中常见;CT显示脑卒中好发部位为基底节区。结论急性脑卒中患者有其自身临床特点,治疗高血压、糖尿病、心脏病对预防此病有积极意义。     

拮抗肌侧取穴针刺结合现代康复训练疗法治疗中风后痉挛

目的探讨拮抗肌侧取穴针刺结合现代康复训练疗法治疗中风后痉挛的疗效。方法研究以前瞻性的研究方法,采用随机对照、多中心研究对针刺联用现代康复训练疗法治疗中风后痉挛的技术方法进行规范化研究。治疗组采用针刺结合现代康复训练相结合,对照组采用现代康复训练疗法。结果经简化Fugl-M eyer运动评分、Ashworth痉挛评定、ADL日常能力评定,治疗组和对照组各项评分均较本组治疗前有所改善,差异有统计学意义（P〈0.01）;治疗组各项指标改善程度明显优于对照组,两组比较,差异均有统计学意义（P〈0.01）。治疗组的临床疗效明显优于对照组。结论拮抗肌侧取穴针刺结合现代康复训练疗法治疗中风后痉挛能明显地抑制痉挛,有提高肢体功能、提高患者生活质量的作用。针刺联用现代康复训练疗法具有操作简便、安全性高、疗效可靠等特点,值得临床推广应用。     

针对性评估与干预在吞咽困难患者中的应用

目的探讨针对性评估与干预在急性脑卒中吞咽障碍患者疗效的作用。方法将101例吞咽障碍的急性脑卒中患者随机分为观察组51例和对照组50例。对照组采用常规的护理评估与干预方法,采用洼田饮水试验进行评估;观察组借鉴香港医院的吞水测试和吞糊测试进行评估。比较两组患者吞咽障碍疗效、吸入性肺炎发生率、留置胃管的病例数、平均拔管时间。结果经护理干预后,观察组吞咽障碍疗效优于对照组（Z=4．433,P〈0．01）,住院期间吸入性肺炎的发生率和留置胃管的例数少于对照组（x2=5．156,P〈0．05）,平均拔管时间较对照组明显缩短（t=56．877,P〈0．01）,差异均有统计学意义。结论针对性评估与干预比传统的评价方法更优良。     

Syndrome des anticorps antiphospholipides et nécrose hypophysaire

Antiphospholipid syndrome (APS) is an acquired thrombotic disorder. It mainly occurs with systemic disease or as a primary disorder. All organs may be involved by thrombosis, but to date the most common endocrine manifestation is chronic adrenal insufficiency. Very few cases of hypopituitarism with primary APS have been reported. We report the case of a 27-year-old woman, victim of a stroke leading to double vision and intracranial hypertension. Magnetic resonance imaging showed a macro-adenoma with hemorrhage of a suprasellar lesion. Hormone assessment showed hyper prolactinemia with positive anticardiolipin antibody. Our case is the second reported associating APS with apoplexy. We discuss the clinical, biological and radiological features observed in our case. We conclude that APS should be searched for whenever a history of adenoma with apoplexy is found associated with recurrent thrombosis.     

Primary central nervous system lymphoma mimicking pituitary apoplexy: case report

Lymphoma involving the pituitary gland is very rare and usually results from metastatic spread of systemic lymphoma. We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third nerve palsy and bitemporal hemianopsia. Imaging suggested a pituitary macroadenoma, with spontaneous necrosis, extending into the suprasellar region, compressing the optic chiasm and invading the right cavernous sinus. The patient underwent transsphenoidal resection which revealed a vascular, firm tumor. An aggressive decompression of the optic chiasm was performed with complete resolution of both visual fields and third nerve palsy. Final pathology showed B cell lymphoma. Systemic work-up including bone marrow aspiration and CSF studies showed no other foci of lymphoma, and the patient was HIV-negative. Chemotherapy with methotrexate, vincristine, procarbazine, and dexamethasone was administered for primary CNS lymphoma. This is an uncommon diagnosis of which the clinician should be aware in order to tailor surgical intervention and provide early institution of proper therapy.