脑卒中吞咽困难22例早期康复训练分析

2005年3月～2006年8月，我们对脑卒中吞咽困难22例，根据吞咽障碍程度实施个体化康复训练，疗效满意。现分析报告如下。 1临床资料 1．1一般情况 22例中，男12例，女10例；年龄（59±11．1）岁。全部病例均经头颅MRI或CT检查确诊为脑卒中，按照1995年全国脑血管病会议诊断标准，吞咽困难诊断明确。全部病例意识清楚、能够配合康复训练。     

急性脑卒中患者合并吞咽困难的临床分析与康复治疗

目的观察急性脑卒中合并吞咽困难患者康复治疗的疗效评定及吸入性肺炎的发生率。方法将168例急性脑卒中合并吞咽困难的患者随机分为康复组和对照组,康复组在对照组应用药物治疗的同时给予综合康复训练治疗。治疗时间为1个月．以治疗前后患者吞咽功能恢复情况及吸入性肺炎的发生率作为观察指标。结果康复组患者吞咽功能恢复情况显著优于对照组,而其吸入性肺炎的发生率显著低于对照组。结论对于急性脑卒中合并吞咽困难的患者早期给予及时、系统的综合康复训练能够有效改善患者的吞咽功能,并显著减少此类患者吸入性肺炎的发生率。     

脑卒中后吞咽困难的评定与康复治疗的研究

目的：通过对脑卒中后吞咽困难患者的评定和康复治疗,研究康复治疗对卒中后吞咽困难的意义。方法：选取60名脑卒中患者,经筛选实验：饮水实验;电视透视检查,分为对照组（30例）和实验组（30例）。对实验组患者进行康复治疗,对照组未给予康复治疗。观察并记录两组脑卒中患者的并发症（呛咳、吸入性肺炎、脱水、营养不良）、住院日、体重及营养状况等情况。结果：实验组脑卒中患者在并发生、住院天数、体重及营养状况方面均优于对照组（P〈0.05）。结论：卒中后吞咽困难的康复治疗对脑卒中患者有益。     

家庭干预对脑卒中患者吞咽困难的效果观察

目的：探讨家庭干预对脑卒中患者吞咽困难康复的影响。方法：将62例脑卒中后吞咽困难的患者,采用随机分组的方法,将观察对象分为干预组和对照组,每组31例。对照组给予常规治疗和康复指导,观察组在此基础上,分别进行家庭干预,比较干预前、干预1周、2周、4周时的干预效果。结果：干预组吞咽困难评分低于对照组（P〈0.05）。结论：家庭干预可促进脑卒中患者吞咽功能的重建。     

洼田试验缩短脑卒中吞咽困难患者留置胃管时间的临床研究

目的 探究洼田试水试验缩短脑卒中吞咽困难患者留置胃管时间.方法 选取神经内科收治的100例脑卒中吞咽困难留置胃管患者,随机分为研究组及对照组,各组50例.对照组患者给予常规医嘱处理,研究组给予洼田饮水试验.比较两组患者临床疗效判定情况及留置胃管拔除时间.结果 研究组患者临床疗效判定总有效率明显高于对照组(P<0.05);研究组患者留置胃管拔除时间明显早于对照组(P<0.05).结论 采用洼田饮水试验治疗脑卒中吞咽困难患者疗效显著,明显缩短留置胃管拔除时间,缩短脑卒中吞咽困难患者的住院时间,减轻病人痛苦,降低患者住院费用,更早恢复患者生活自理能力.     

电针联合早期康复训练治疗脑卒中后的吞咽障碍临床观察

目的探讨电针配合早期康复训练治疗脑卒中后所致吞咽障碍的疗效。方法随机将脑卒中急性期后伴吞咽功能障碍患者88例分为治疗组（n=46）和对照组（n=42）。治疗组患者给予电针和早期康复训练综合治疗,对照组仅予内科常规治疗。结果治疗1月后,治疗组患者吞咽困难改善明显优于对照组,两组比较有显著性差异（P〈0．01）。结论对急性期后脑卒中患者进行电针配合康复训练可改善患者的吞咽功能,减少并发症,提高生活质量。     

高压氧联合针刺治疗缺血性脑卒中合并吞咽困难的疗效观察

目的:观察高压氧联合针刺治疗对脑卒中合并吞咽困难患者的疗效。方法:选取2017年5月至2020年5月南通大学附属建湖医院收治的脑卒中患者160例,采用随机数字表法分为对照组和观察组,每组80例。对照组和观察组患者均采用脑卒中常规药物治疗及高压氧治疗,并进行常规吞咽功能康复训练,观察组在此基础上给予针刺治疗。分别采用标准...     

康复训练对脑卒中后吞咽困难预后影响的研究

目的探讨脑梗死后吞咽困难患者采用康复训练后对吞咽功能预后的影响。方法选择284例脑梗死患者,随机分为康复组和对照组,康复组采用特定的康复治疗,对照组采用一般常规治疗。结果两组患者第28天吞咽障碍分级比较显示,康复组患者吞咽功能的恢复优于常规组。结论对脑梗死吞咽困难患者予以康复治疗后,可促进吞咽功能的重建与恢复,从而提高生活质量。     

吞咽困难的发病原因及治疗研究进展

吞咽是一个复杂的神经肌肉活动,包括口腔、咽、食管阶段,涉及许多肌肉的协调功能。吞咽困难是指食物通过咽部、食管时感到费力,有梗阻感觉,吞咽过程比较长。吞咽困难较易发生在儿童及老年人2个人群中,因为他们吞咽功能的不完善或退化,但主要是见于疾病因素,也可因误食异物所致,其中疾病因素较常见于神经系统及消化系统。吞咽困难可引起吸入性肺炎甚至窒息而危及生命,因此准确的诊断及治疗吞咽困难是必要的,同时为减少病死率及肺炎的发生率,恰当而准确地评估吞咽功能也是必要的。     

中医外治法治疗吞咽困难研究进展

<正>吞咽困难归属祖国医学喑痱喉痹范畴,是脑卒中后延髓麻痹的主要症状之一,临床以发音障碍、语声嘶哑、吞咽困难、饮水呛咳等为主要表现,且多发于中老年人,病情缠绵难愈。中医外治法在治疗吞咽困难中,具有针对性、严谨性等特点,笔者就中医外治法治疗吞咽困难的研究进展作一综述。现报道如下。1针刺针刺治疗是神经内科常用于治疗神经类疾病的方法,通过经络的特殊机理来达到治疗目的,并     

针刺配合功能训练治疗脑卒中后吞咽障碍疗效分析

目的观察针刺配合功能训练治疗脑卒中后吞咽障碍的疗效。方法将脑卒中后伴吞咽障碍的100例患者随机分为对照组和治疗组。对照组采用功能训练治疗;治疗组采用针刺配合功能训练治疗。2周为1疗程,连续治疗2个疗程。2组在治疗前及治疗第14d、28d行吞咽X线电视透视检查（VFFS）和洼田氏评定。结果两组均能改善吞咽障碍,但针刺配合功能训练的疗效优于单纯功能训练（P〈0．05）。结论针刺配合功能训练不仅可以加速患者脑卒中后吞咽障碍的功能康复,提高生活质量,而且副作用小,花费少,可以作为脑卒中后吞咽障碍的常规治疗手段。     

Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

Introduction Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined.Methods A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device.Results After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized.Conclusion We report the use of a new mechanical thrombectomy device 8 h after onset of ischemic symptoms, with substantial subsequent improvement in neurological outcome. In selected cases, use of the Merci Retriever can result in improved outcomes beyond the traditional 6-hwindow used for intraarterial pharmacological thrombolysis.     

Perfusion CT and angio CT in the assessment of acute stroke

In order to evaluate the clinical utility of non-enhanced CT with perfusion and angio CT in the assessment of acute ischaemic stroke, 42 patients with symptoms of acute stroke were examined within the first 6 h from onset of symptoms with non-enhanced CT (NECT), perfusion CT (PCT) and CT angiography (CTA). Maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analysed visually, and after drawing regions of interest (ROIs) in the territory of anterior, middle and posterior cerebral arteries, maximum-intensity projection and volume-rendering images of the cervical and cerebral vessels were created. All patients underwent a control CT or MR examination 24–48 h after the initial examination. Twenty-nine patients developed an area of infarction at control examinations. Significant perfusion abnormalities were found in 27 cases, whilst in two patients the perfusion studies were considered to be normal. All the cases with perfusion abnormalities showed arterial stenoses or occlusions on angio CT. Small infarctions at levels other than the ones selected for perfusion CT, and arteriosclerotic changes, were observed in the two cases with no perfusion abnormalities. In conclusion, combining non-enhanced CT with PCT and CTA is a simple and a very valuable tool in the initial assessment of acute stroke.     

88例缺血性脑卒中患者动脉溶栓治疗回顾性研究

目的 总结动脉溶栓治疗的影响因素,为动脉内溶栓治疗的合理应用提供理论依据.方法 通过回顾我中心88例急性缺血性脑卒中动脉内溶栓治疗住院病例,采集患者病史、起病过程的特点、发病与动脉溶栓的间隔时间、有无出血、是否死亡以及治疗之后(包括治疗后即刻、治疗后24 h)患者主要神经功能的变化过程,我们所选用的神经功能包括肌力、眼震及意识水平.脑血管造影回顾则采集动脉溶栓前后DSA血管形态的异常发现及变化,以及尿激酶用量.此后对上述指标进行整理,统计学处理.结果 本组患者,平均溶栓时间为5.8(5.8±3.3)h;DSA资料丢失20例,造影阴性率为14.7%,血管再通率(部分及完全再通)为36.2%,溶栓后早期(＜24 h)症状加重24例(27.3%).起病后6 h内接受动脉内溶栓的急性缺血性脑卒中患者在治疗后24 h内加重率为31.7%,与6 h以上接受治疗者相比(18.5%)有明显差异(P=0.01);而与年龄、起病特点、溶栓后神经功能评分及血管造影结果及血管再通率间均无统计学差异.结论 在不分辨前后循环所有患者群体内,急性脑缺血性脑卒中的动脉溶栓时间窗可以延长至6 h,却面临更高的早期加重率.所以对于早期加重的原因揭示及有效处理,可以改善动脉溶栓的治疗效果.     

Imaging in acute stroke

Stroke is a syndrome characterized by a sudden neurological deficit caused by intracranial hemorrhage or ischemia. Computed tomography (CT) maintains a primary role in the evaluation of patients with acute stroke. The optimal magnetic resonance imaging (MRI) protocol in acute stroke includes diffusion-weighted imaging (DWI) to show acute ischemic lesion and MR perfusion study to estimate brain perfusion. Careful selection of patients for a thrombolytic therapy is crucial to improve safety and efficacy.     

心肌酶变化对急性脑卒中患者预后的影响

目的：观察急性脑卒中患者心肌酶变化特点及其对预后的影响。方法：观察56例急性卒中患者血清天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、肌酸激酶（CK）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBDH）的变化,比较不同GCS评分组心肌酶学检测结果以及死亡组与存活组心肌酶学检测结果。结果：GCS评分≤8分组心肌酶值增高,与其他2组比较差异有统计学意义（P〈0.05）;死亡组较存活组心肌酶值增高,差异有统计学意义（P〈0.05）;出血性卒中和缺血性卒中组心肌酶值比较差异无统计学意义（P〉0.05）。结论：血清心肌酶变化对急性脑卒中患者病情严重程度及预后有重要的预测价值。     

Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

Introduction The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. Methods We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3–5), or dead (mRS score 6). Results Included in the study were 12 patients (mean age 66±17 years, range 31–88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12–23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Conclusion Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb-IIIa inhibitors may be helpful in preventing reocclusion and in increasing patency rates. This work was presented at the American Society of Interventional and Therapeutic Neuroradiology Third Annual Course and Workshop (Puerto Rico, August 2006).