脑卒中病人的心理情绪评估

脑卒中病人最常见的心理情绪变化是抑郁和焦虑，常用的评估量表包括症状自评量表（SCL－90）、Beck抑郁问卷（BDI）、自评抑郁量表（SDS）、抑郁状态问卷（DSI）、汉密顿抑郁量表（HRSD）、焦虑自评量表（SAS）、汉密顿焦虑量表（HAMA）等。各量 表的适用人群和侧重各有不同，使用时主要根据病人完成评估的能力和临床工作人员的需求选择适当的量表。及早发现和评定脑卒中病人的不良心理情绪，并给予及时、合理的心理辅导和药物治疗有利于卒中患的运动功能、认知功能和ADL的恢复。     

脑卒中患者焦虑抑郁情绪及相关影响因素分析

目的 探讨脑卒中患者的焦虑抑郁情绪及相关影响因素,为综合干预提供依据.方法 将86例脑卒中患者设为研究组,抽取同期健康者85名设为对照组,采用自拟一般资料调查表、简明智能状况检查表、症状自评量表、焦虑自评量表、抑郁自评量表、汉密顿焦虑量表、汉密顿抑郁量表、社会支持评定量表、生活事件量表、艾森克个性问卷进行测评分析.结果 研究组症状自评量表、焦虑自评量表、抑郁自评量表、汉密顿焦虑量表评分及汉密顿抑郁量表总分和除体质量外的其他因子分,生活事件量表总分和除正性事件外的其他因子分,艾森克个性问卷除掩饰倾向维度外的其他维度分均显著高于对照组(P＜0.05或0.01);社会支持评定量表评分显著低于对照组(P＜0.05或0.01).研究组不同程度焦虑抑郁情绪检出率均显著高于对照组(P＜0.05或0.01);艾森克个性问卷内外倾维度中间型和神经质维度中间、稳定型检出率显著低于对照组(P＜0.05或0.01),内外倾维度外向型和神经质维度不稳定型检出率显著高于对照组(P＜0.05或0.01).结论 脑卒中患者存在明显的焦虑抑郁情绪.负性生活事件,缺乏亲人和社会支持,不良个性特征等因素可能是脑卒中患者发生焦虑抑郁情绪的危险因素.     

急性冠状动脉综合征病人焦虑、抑郁状况及心理危险因素分析

[目的]了解急性冠状动脉综合征(ACS)与急性胰腺炎(AP)住院病人焦虑、抑郁状况及相关心理危险因素。[方法]应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和自行设计相关心理危险因素调查表,对120例ACS及116例AP住院病人进行问卷调查。[结果]ACS病人焦虑、抑郁发生率明显高于AP病人,家庭因素、经济因素、对病情认知情况、认知干预因素等对心理状态影响更大。[结论]应加强对ACS病人心理干预,给予更多的关爱、照顾和支持,控制焦虑、抑郁症状,改善病人生活质量。     

心理干预对2型糖尿病患者焦虑抑郁情绪的影响

目的了解2型糖尿病患者的心理健康状况,探讨心理干预对其焦虑抑郁情绪的影响。方法将100例糖尿病患者随机分为治疗组和对照组各50例,两组均接受糖尿病常规治疗,治疗组联合心理干预,观察4 w。于治疗前及治疗1 w、2 w、3 w、4 w末采用症状自评量表评定心理健康状况,采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况及心理干预效果,同时检测空腹血糖的变化。结果2型糖尿病患者存在不同程度的心理问题,治疗后两组症状自评量表、汉密顿焦虑量表、汉密顿抑郁量表评分及空腹血糖测定均较治疗前显著下降(P<0.01),但治疗组各时段均较对照组下降显著(P<0.01~0.05)。结论2型糖病患者存在不同程度的心理问题,心理干预能显著缓解其焦虑抑郁情绪,提高原发病疗效,改善生活质量。     

住院冠心病病人的心理状况及其影响因素研究

[目的]探讨住院冠心病病人的心理健康状况及其影响因素.[方法]采用汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)、艾森克成人个性问卷(EPQ)和症状自评量表(SCL-90),对80例住院冠心病病人进行测试.[结果]61%的冠心病病人同时伴有焦虑抑郁症状,36%的冠心病病人存在焦虑症状;冠心病病人的HAMD和HAMA总分受性别、文化程度、病程以及住院次数等因素的影响,SCL-90总分及其因子分明显高于常模,个性中神经质分值与SCL-90总分以及部分因子分呈显著正相关.[结论]冠心病病人存在较为严重的情绪障碍,焦虑抑郁情绪受多种因素的影响.及时有效地实施负性情绪干预对冠心病病人康复起着重要的作用.     

团体心理干预对脑卒中患者情绪及日常生活能力的影响

目的：探讨团体心理干预对脑卒中患者情绪及日常生活能力的影响。方法：60例患者随机分为团体心理干预联合康复干预组和单纯康复干预组（对照组）,每组 30 例。治疗2个月后采用焦虑自评量表、汉密顿抑郁量表、改良Barthel指数评定量表评价患者情绪及日常生活能力变化情况。结果：治疗后2组患者的焦虑自评量表及汉密顿抑郁量表评分均较治疗前下降（P＜0.05）,改良Barthel指数评定量表评分均较前提高（P＜0.05）,且干预组改善程度大于对照组（P＜0.05）。结论：团体心理干预联合康复治疗能够有效改善脑卒中患者的不良情绪,提高患者日常生活能力水平。     

脑卒中患者个性特征生活方式和负性情绪与疾病的相关性对照研究

目的 探讨脑卒中患者的个性特征、生活方式和负性情绪状况,为临床综合治疗提供依据.方法 将116例脑卒中患者设为研究组,抽取同期正常体检者115名设为对照组.采用自拟一般资料调查表统计一般资料,艾森克个性问卷评定人格特征,自拟生活方式调查表测评生活方式,汉密顿焦虑量表及汉密顿抑郁量表评定焦虑、抑郁状况.结果 研究组艾森克个性问卷的精神质、内外倾、神经质维度分均显著高于对照组(P＜0.01),外向、内向性格和情绪不稳定者检出率均显著高于对照组(P＜0.05或0.01);饮食偏咸,不喝牛奶,喜高脂饮食,睡眠无规律或睡眠差,业余生活单调,很少或不锻炼,嗜酒、嗜烟等不良生活方式显著高于对照组(P＜0.01);汉密顿焦虑量表及汉密顿抑郁量表总分和各因子分均高于对照组(P＜0.01),不同程度的焦虑、抑郁情绪检出率均显著高于对照组(P＜0.01).结论 脑卒中患者存在明显的个性缺陷、不良生活方式和焦虑抑郁负性情绪,在综合防治时,除控制其生物病因外,还应改善不良生活方式,调整情绪,加强心理治疗,以利于患者的全面康复.     

首发脑卒中患者心理健康状况调查及心理干预效果评价

目的 探讨首发脑卒中患者的心理健康状况,为针对性地开展心理干预提供依据.方法 对38例首发脑卒中患者采用汉密顿焦虑量表、汉密顿抑郁量表和自编问卷调查患者的心理状况,针对调查结果予以心理干预,内容包括支持心理治疗、认知心理治疗、健康教育.观察4周.于心理干预后采用上述量表再次进行评定,并对评定结果进行对比分析.结果 38例患者中,71.05%存在明显的焦虑抑郁情绪问题,其中36.84%存在焦虑情绪,50.00%存在抑郁情绪;77.14%怕爱人和孩子不关心,68.42%怕成为家人拖累,47.37%担心病治不好,60.53%担心经济负担过重,42.11%怕失去工作或劳动能力.干预后汉密顿焦虑量表和汉密顿抑郁量表评分均显著低于干预前(P＜0.01);干预后自编问卷调查结果较干预前有显著改善(P＜0.05或0.01).结论首发脑卒中患者存在着明显情绪障碍,早期心理干预能显著改善患者焦虑、抑郁情绪,减轻患者心理负担,有助首发脑卒中患者的全面康复.     

急性冠状动脉综合征病人焦虑、抑郁状况及心理危险因素分析

[目的]了解急性冠状动脉综合征（ACS）与急性胰腺炎（AP）住院病人焦虑、抑郁状况及相关心理危险因素。[方法]应用抑郁自评量表（SDS）、焦虑自评量表（SAS）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）和自行设计相关心理危险因素调查表,对120例ACS及116例AP住院病人进行问卷调查。[结果]ACS病人焦虑、抑郁发生率明显高于AP病人,家庭因素、经济因素、对病情认知情况、认知干预因素等对心理状态影响更大。[结论]应加强对ACS病人心理干预,给予更多的关爱、照顾和支持,控制焦虑、抑郁症状,改善病人生活质量。     

康复期脑卒中后焦虑抑郁患者心理干预效果评价

目的 探讨支持性心理治疗和认知疗法对康复期脑卒中后焦虑抑郁患者的效果。 方法 将58例脑卒中后焦虑抑郁患者随机分为干预组和对照组,每组各29例。2组均接受系统的药物治疗和常规康复护理,干预组在此基础上给予支持性心理治疗和认知治疗。于治疗前及治疗2周末采用焦虑自评量表(SAS)评定2组焦虑症状改善情况,汉密顿抑郁量表(HAMD)评估2组抑郁症状改善情况。 结果 干预组干预2周末SAS评分明显低于对照组,HAMD减分率高于对照组。 结论 心理干预能有效改善康复期脑卒中患者的焦虑抑郁情绪,可以显著提高卒中患者的生存质量和生活质量。     

心房颤动抗凝治疗进展

心房颤动是临床上最常见的心律失常,增加卒中风险。华法林抗凝效果虽已受到广泛的肯定,但同时存在出血风险、治疗窗狭窄、需要长期监测国际标准化比率以调整药量等缺点。新型口服抗凝药的应用如达比加群、利伐沙班、阿哌沙班可有效预防卒中及血栓栓塞。经皮左心耳封堵术亦可成为预防心房颤动血栓事件的有效替代治疗方式。     

Hospital-based management of acute ischemic stroke following intravenous thrombolysis

Timely administration of proven therapies remains the primary goal in acute stroke care. Following reperfusion therapy with intravenous thrombolysis, medical and neurological complications may develop in the hospitalized patient with acute ischemic stroke. Medical complications may include deep venous thrombosis, pulmonary embolism, aspiration, systemic infections and neuropsychiatric disturbances. Neurologic complications may include symptomatic intracranial hemorrhage, cerebral edema with elevated intracranial pressure, and post-stroke seizures. Early initiation of preventative strategies and proper management of common complications may improve both short-term and long-term outcomes. Here we review evidence-based management strategies for hospitalized acute ischemic stroke patients following intravenous thrombolysis.     

Diagnosis of stroke in young adults

The cause of stroke in a young adult can usually be ascertained with proper workup. One of the most common causes is atherosclerotic cerebrovascular disease, and cigarette smoking is an important risk factor in young adults. Several types of nonatherosclerotic cerebral vasculopathy can also result in premature cerebral infarction; these include cervicocephalic arterial dissection, nonpenetrating traumatic arterial disease, moyamoya disease, fibromuscular dysplasia, vasculitis, and migraine. Cardiac embolism may play a more important role than was previously thought, and hematologic disorders (eg, sickle cell disease, polycythemia rubra vera, coagulation problems) are known to predispose patients to stroke. A careful history of risk factors and a thorough neurologic and cardiovascular examination followed by adequate testing, including angiography, are essential to diagnosis.     

Reintegration for stroke survivors. Home and community considerations

Plans for home and community re-entry for the stroke patient should begin as soon as medical stability is achieved. The majority of stroke patients will require a comprehensive program of rehabilitation. Patients and their families should be educated about stroke and the impairments associated with it to promote active participation in the rehabilitation process and to solve problems before they happen. The participation of the family and the use of appropriate community health resources for the stroke patient who is in a safe and accessible home and community environment will markedly enhance a successful outcome. A systematic approach is necessary for people with stroke to achieve their optimum functional level and proper reintegration to home and community.     

Obstructive sleep apnea and stroke

Obstructive sleep apnea (OSA) is a common disorder that has been associated with many cardiovascular disease processes, including hypertension and arrhythmias. OSA has also been identified as an independent risk factor for stroke and all-cause mortality. OSA is highly prevalent in patients with transient ischemic attacks and stroke. Routinely screening patients with transient ischemic attacks or stroke for sleep apnea is becoming more common. In stroke patients with OSA, treatment with continuous positive airway pressure may prevent subsequent cardiovascular events and improve neurologic outcomes. This review explores the pathophysiology of the association between OSA and stroke, and the clinical implications of identification and treatment of OSA in patients with stroke.     

脑卒中患者配偶生活质量的调查研究

目的了解脑卒中患者配偶的生活质量,以便在今后的临床护理工作中,对患者配偶进行相应的心理干预,提高患者配偶的生活质量。方法应用生活质量综合评定问卷对118例脑卒中患者配偶及56名已婚正常对照者进行评定。结果脑卒中患者配偶的总体生活质量及躯体功能、心理功能、社会功能、物质生活均较正常者差,其中以心理健康和躯体健康对生活质量的影响最大。结论脑卒中患者配偶的生活质量较正常对照组差,并涉及到心身健康等多个方面。     

早期康复护理干预在预防脑卒中偏瘫病人肩痛的作用

目的 探讨早期康复护理干预对预防脑卒中偏瘫病人肩痛的作用。方法 将101例急性脑卒中偏瘫患者随机分成两组,对照组50例,接受常规治疗与护理;干预组51例,接受常规治疗的同时,给予早期康复护理干预。结果 干预组肩痛的发生程度明显低于对照组。结论 早期康复护理干预能有效减轻脑卒中偏瘫病人肩痛程度的发生(P<0.05)。     

Consensus Statement- Prehospital Care of Exertional Heat Stroke

Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.     

Streamlining stroke care: from symptom onset to emergency department

Prehospital delays in the treatment of stroke patients, including identification of stroke as a medical emergency, represent a significant and preventable obstacle to optimal stroke care. Although patient delay in seeking care represents the greatest barrier to expedient care, delays often exist in the identification, transport, and triage of stroke patients. Public education in recognizing stroke symptoms as warranting immediate care and appropriate training of emergency medical service personnel are essential parts of community-wide, coordinated stroke care. In addition, emergency physicians must be engaged in the effort to limit delays if the rates of patients eligible for thrombolytic therapy are to improve. This review presents the common inadequacies in the prehospital identification and care for stroke patients and discusses changes within the community health care system that can be implemented to improve the critical early stages of stroke management.     

Spasticity After Stroke: An Overview of Prevalence, Test Instruments, and Treatments

ABSTRACT: The objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Recent studies show that spasticity occurs in 20%-30% of all stroke victims and in less than half of those with pareses. Although spasticity may occur in paretic patients after stroke, muscle weakness is more likely to be the reason for the pareses. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. To determine the nature of passive stretch, electromyographic equipment is needed. However, the Modified Ashworth Scale, which measures the sum of the biomechanical and neural components in passive stretch, is the most common instrument used to grade spasticity after stroke. Treatment of spasticity with physiotherapy is recommended, although its beneficial effect is uncertain. The treatment of spasticity with botulinum toxin in combination with physiotherapy is suggested to improve functioning in patients with severe spasticity. A task-specific approach rather than a neurodevelopmental approach in assessing and treating a patient with spasticity after stroke seems to be preferred.