硬膜外神经阻滞麻醉分娩镇痛方式对产程的影响

目的探讨硬膜外阻滞麻醉分娩镇痛方式对产程进展及分娩的影响。方法我院2011-06-2012-03采用硬膜外神经阻滞麻醉分娩镇痛的496例产妇作为观察组,未采用任何分娩镇痛方法的496例产妇作为对照组。分别观察2组产程进展及对分娩结局、如新生儿评分、产后出血情况等的影响。结果观察组第一产程短于对照组,第二产程长于对照组,2组缩宫素使用差异有统计学意义（P〈0.01）,分娩方法、产后出血量、新生儿评分2组差异无统计学意义（P〉0.05）。结论硬膜外神经阻滞麻醉用于分娩镇痛效果确切良好,对母婴无不良影响,安全有效。     

神经肌肉电刺激对卒中后吞咽障碍治疗作用的研究

目的 应用视频透视吞咽检查（video fluoroscopy swallowing study,VFSS）方法从吞咽运动学变化方 面研究神经肌肉电刺激（neuromuscular electrical stimulation,NMES）对卒中患者吞咽障碍的治疗作用。 方法 将卒中后吞咽障碍患者随机分为研究组和对照组,研究组给予NMES治疗,对照组给予假 刺激,治疗均为每次20 mi n,5次/周,持续4周。同时所有患者均进行吞咽常规训练。治疗前后均行 VFSS,获取3 ml液态钡食、10 ml液态钡食、半固体钡食及固体钡食4种食团吞咽的Rosenbek渗透-误吸 量表（penetration-aspiration scale,PAS）评分、咽传递时间（pharyngeal transit time,PTT）、咽延迟时间 （pharyngeal delayed time,PDT）、舌骨向前最大幅度、舌骨向上运动最大幅度、喉向前最大幅度及喉向 上运动最大幅度。对比两组治疗前后PAS量表评分及上述吞咽运动学参数的变化。 结果 研究共纳入43例患者,其中研究组23例,对照组20例。治疗后,两组患者4种食团吞咽时PAS评 分均较治疗前下降,PTT、PDT较治疗前缩短（均P＜0.05）。治疗前和治疗后,研究组在各食团吞咽时 PAS评分及PTT、PDT较对照组差异均无显著性。治疗前,两组间舌骨向前、向上运动,喉向前、向上运 动的最大幅度差异均无显著性;治疗后,研究组食团吞咽时舌骨向上运动、喉向上运动的最大幅度 均较对照组显著增大（均P＜0.05）,但两组舌骨向前、喉向前运动差异无显著性。 结论 NMES和常规吞咽康复训练均可改善卒中患者的吞咽功能。NMES更能提高喉-舌骨复合体的向 上运动。     

椎管神经阻滞麻醉分娩镇痛对分娩方式及新生儿评分的影响

目的 探讨在孕妇进行分娩时使用椎管神经阻滞麻醉方法进行镇痛的效果及对新生儿评分的影响.方法 选择2013-01-2013-03在我院住院待分娩的72位产妇,随机分为2组,每组36位.一组为实验组,在临产前采用椎管神经阻滞麻醉镇痛,另外一组为对照组,即临产前不采用椎管神经阻滞麻醉方式.在孕妇分娩的全程认真观察,并予以相应的处理.结果 产前实验组与对照组中产妇的年龄、体质量、身高、身体状况、头盆评分、心率、胎心等均无明显差异.分娩时与对照组相比,无论是疼痛程度、心率、血压还是剖宫产率均有明显差异.2组间器械助产、产后出血以及新生儿窒息的发生均无明显差异.结论 椎管神经阻滞麻醉分娩镇痛较安全,并可有效减轻产妇的痛苦,剖产率也有明显降低,对新生儿未产生不良影响,值得各医院临床推广.     

肌间沟神经阻滞联合阿片类镇痛药对术后镇痛的影响

目的探究肌间沟神经阻滞联合阿片类镇痛药术后镇痛的效果。方法选取我院2011-03—2014-06住院60例上肢骨折手术患者作为研究对象,随机分为实验组和对照组,对照组采取单次肌间沟麻醉,实验组在对照组的基础上加入芬太尼,根据患者手术后疼痛程度来评定镇痛的效果、麻醉起效时间及不良反应。结果患者均无明显不良反应发生,2组麻醉起效时间比较,差异无统计学意义(P>0.05);2组患者术后镇痛效果比较,实验组明显优于对照组,差异有统计学意义(P<0.01)。结论肌间沟神经阻滞联合阿片类镇痛药物具有良好的术后镇痛效果,可缓解患者疼痛,且无明显不良反应,安全性高,具有较高的临床应用价值。     

开颅手术应用罗哌卡因神经阻滞麻醉对血流动力学的影响分析

目的分析开颅手术应用罗帕卡因神经阻滞方案对患者血流动力学的影响。方法选取2013-01—2015-01于我院择期进行开颅手术的80例患者为研究对象,随机分为对照组与观察组,每组各40例。观察组采用罗帕卡因神经阻滞方案,对照组不作神经阻滞,仅作常规麻醉,比较2组麻醉不同时间点血流动力学的变化,采取视觉模拟评分表(VAS)评估患者疼痛程度,记录麻醉并发症。结果 2组麻醉不同时间点,平均动脉压及心率变化对比差异均无统计学意义(P0.05);观察组并发症发生率为27.5%,与对照组的72.5%对比差异有统计学意义(P0.05);术后2h、6h观察组VAS评分均低于对照组,2组对比差异有统计学意义(P0.05)。结论在开颅手术中采用罗哌卡因神经阻滞复合靶控输注方案,可保持患者手术期间血流动力学的稳定性,减轻术后早期疼痛感,降低术后并发症发生率,值得推广。     

镜像运动康复机器人对卒中亚急性期手运动功能障碍的康复效果研究

目的 探讨镜像运动模式康复机器人对卒中亚急性期手运动功能障碍患者的康复效果。 方法 选取2020年6-8月于上海第三康复医院连续收治的卒中亚急性期患者为研究对象,采用信 封法将患者随机分为观察组和对照组,两组均予常规康复治疗,观察组在此基础上予康复机器人手 套治疗,共治疗4周。在两组治疗前后分别进行手功能评估,包括Fugl-Meyer上肢运动功能评定（Fugl- Meyer assessment upper extremity,FMA-UE）、FMA-UE手部评分、箱盒测试（box and block test,BBT）、 上肢动作研究测试（action research arm test,ARAT）、改良Barthel指数（modified Barthel index,MBI）, 以及患侧手握力和捏力。 结果 本研究最终纳入40例患者,两组各20例。治疗前和治疗后两组间各项指标评估结果比较,差 异均无统计学意义。治疗后组内比较结果显示,对照组MB（I P=0.049）高于治疗前,观察组FMA-UE评 分（P =0.024）与FMA-UE手部评分（P =0.046）高于治疗前。两组各指标进步程度比较结果显示,观察 组FMA-UE评分（P =0.038）与FMA-UE手部评分（P =0.048）差值均高于对照组。 结论 镜像康复机器人对卒中亚急性期患者的手运动功能改善具有促进作用,可以作为一种辅助 治疗技术应用于临床。     

缺血性卒中患者急性期认知障碍研究

目的 探讨缺血性卒中患者急性期认知障碍的特点。 方法 本研究为前瞻性研究,连续选取2011年3月～2012年6月广州市第一人民医院神经内科住院的 急性缺血性卒中患者220例为病例组,同时在社区、体检中心、患者家属中收集健康对照者146例为 对照组,采用蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）、简易精神状态检查量表 （Mini-Mental State Examination,MMSE）对研究对象进行测评,依据MMSE和MoCA总分将病例组分为4 个亚组,A组（MMSE＜26分,MoCA≤23分）93例,B组（MMSE得分在26～27分,MoCA≤23分）36例,C组 （MMSE≥28分,MoCA≤23分）24例,D组（MMSE、MoCA得分均正常）67例,评估各亚分组认知功能下降 的情况。 结果 缺血性卒中急性期患者的MMSE总分（25.07±3.99）,MoCA总分（17.70±5.77）均较正常对照 组的MMSE总分（27.73±1.89）和MoCA总分（23.96±3.44）下降（P＜0.05）。病例组和对照组MoCA各 亚项比较,命名项目比较差异无显著性［病例组3（2,3）,对照组3（2,3）,P =0.159］。MoCA各亚项目 病例组的A组｛视空间和执行功能［1（0,2）］、命名［2（1,3）］,记忆［1（0,2）］、注意力［3（2,5）］、 语言［0（0,0）］、抽象［0（0,1）］、定向力［4（3,5）］｝、B亚组｛视空间和执行功能［1（1,2）］、命 名［2（1,3）］,记忆［2（0,3）］、注意力［5（4,6）］、语言［0（0,0）］、抽象［1（1,2）］、定向力［6（5, 6）］｝均较对照组｛视空间和执行功能［4（3,5）］、命名［3（2,3）］,记忆［3（2,4）］、注意力［6（5, 6）］、语言［2（1,2）］、抽象［2（1,2）］、定向力［6（6,6）］｝下降（P＜0.05）,C组患者在视空间和 执行功能［2（1,3.75）］、语言［0（0,0）］、记忆［2（1,3）］3个分项得分与对照组｛视空间和执行功 能［4（3,5）］,语言［2（1,2）］,记忆［3（2,4）］｝比较差异均具有显著性（P＜0.05）。 结论 急性期缺血性卒中患者存在认知受损的表现,其认知受损可累及多个认知域,而在MMSE不 能识别的轻度认知障碍患者中则以视空间和执行功能异常、语言障碍和记忆下降为主要临床表现。     

轻型缺血性卒中后认知障碍与脑动态功能连接状态改变的功能磁共振成像研究

目的 探索轻型缺血性卒中后有认知障碍（cognitive impairment,CI）患者和无认知障碍（no cognitive impairment,NCI）患者脑动态功能连接（functional connectivity,FC）状态的变化。 方法 选择2014年12月1日-2016年5月31日首都医科大学附属北京天坛医院神经病学中心就诊的 轻型急性缺血性卒中患者为研究对象,对所有患者进行神经心理学评估和多模态MRI检查,分为CI 组（15例）和NCI组（11例）,同时招募年龄、性别均匹配的志愿者作为健康对照（healthy control,HC）组 （29例）。基于静息态功能头颅MRI影像,利用动态功能网络连接方法构建一系列随时间变化的FC网络, 然后通过聚类方法划分为多个具有代表性的动态FC状态（分别为模块化连接状态、强连接状态、局 部连接状态和稀疏连接状态）,比较HC组、CI组与NCI组的FC动态特征（各状态的时间比例、驻留时间 及各状态间的转换次数）差异,并在两个时间点（基线和3个月随访期）探索CI组与NCI组动态FC状态 的变化。 结果 HC组、CI组和NCI组在基线和随访期各连接状态的时间比例差异均无统计学意义。基线CI组 和NCI组在稀疏连接状态的驻留时间比HC组更低,三组差异有统计学意义（P =0.035）,但两两比较 的结果均未通过Bonferroni校正;而在随访期,各连接状态的驻留时间差异均无统计学意义。纵向比 较中,与基线相比,CI组随访期在模块化连接状态的时间比例明显下降（P =0.035）,在稀疏连接状 态的时间比例明显上升（P =0.025）,在模块化连接状态的驻留时间明显降低（P =0.012）;而NCI 组 在两个时间点各连接状态的时间比例和驻留时间差异均无统计学意义。对于转换次数,所有组间的 差异均无统计学意义。 结论 轻型缺血性卒中患者急性期较对照人群有局部连接状态增多而稀疏连接状态减少的趋势, 但差异未达统计学意义;对于有认知障碍的轻型缺血性卒中患者,发病3个月时模块化连接状态和 稀疏连接状态均较急性期显著恢复;动态功能网络能够客观反映大脑功能的变化。     

Effects of Exergame on Patients' Balance and Upper Limb Motor Function after Stroke: A Randomized Controlled Trial

Background: Stroke is a major cause of motor incapacity in adults and the elderly population, requiring effective interventions capable of contributing to rehabilitation. Different interventions such as use of exergames are being adopted in the motor rehabilitation and balance area, as they act as motivating instruments, making therapies more pleasurable. Objective: The aim of this study was to investigate the effects of exergame on patients’ balance and upper limb motor function after stroke. Methods: This study is a randomized controlled trial. Thirty-one participants of both genders, mean age of 76 years, were assigned to the experimental or control groups; the experimental group (n = 16) underwent exergame rehabilitation using Motion Rehab AVE 3D, and the control group (n = 15) underwent conventional physiotherapy. Both EG and GC sessions happened twice a week, for 30 minutes each, over a 12 weeks period, resulting in 24 sessions. All sessions were composed of similar exercises, with same purpose and elapsed time (5 minutes). Instruments applied to verify inclusion criteria were a sociodemographic questionnaire and clinical aspects and a Mini-Mental State Examination. At baseline and after 12 weeks of intervention, the Modified Ashworth Scale, the Fugl-Meyer Assessment, and the Berg Balance Scale were used. Results: In both groups, patients obtained significant improvement from baseline values in all analyzed variables (shoulder, elbow, and forearm; wrist; hand; and balance) (P < .001). In the intergroup comparison, there were significant differences between the 2 groups for changes in values from preintervention to postintervention of shoulder, elbow and forearm (P = .001), and total (P = .002). Conclusion: Exergame rehabilitation in poststroke patients can be an efficient alternative for restoring balance and upper limb motor function and might even reduce treatment time.     

Evaluation of the Modulation Effects Evoked by Different Transcutaneous Auricular Vagus Nerve Stimulation Frequencies Along the Central Vagus Nerve Pathway in Migraine: A Functional Magnetic Resonance Imaging Study

ObjectivesTranscutaneous auricular vagus nerve stimulation (taVNS) is a promising treatment option for migraines. This study aims to investigate the modulation effects of different taVNS frequencies along the central vagus nerve pathway in migraineurs.Materials and methodsTwenty-four migraineurs were recruited for a single-blind, crossover magnetic resonance imaging (MRI) study. The study consisted of two taVNS MRI scan sessions, in which either 1-Hz or 20-Hz taVNS was applied in a random order. Seed-based static and dynamic functional connectivity (FC) analyses were performed using two key nodes of the vagus nerve pathway, the nucleus tractus solitarius (NTS) and the locus coeruleus (LC).ResultsStatic FC (sFC) analysis showed that 1) continuous 1-Hz taVNS resulted in an increase of NTS/LC–occipital cortex sFC and a decrease of NTS-thalamus sFC compared with the pre–1-Hz taVNS resting state, 2) continuous 20-Hz taVNS resulted in an increase of the LC–anterior cingulate cortex (ACC) sFC compared with the pre–20-Hz taVNS resting state, 3) 1-Hz taVNS produced a greater LC-precuneus and LC–inferior parietal cortex sFC than 20 Hz, and 4) 20-Hz taVNS increased LC-ACC and LC–super temporal gyrus/insula sFC in comparison with 1 Hz. Dynamic FC (dFC) analysis showed that compared with the pre-taVNS resting state, 1-Hz taVNS decreased NTS–postcentral gyrus dFC (less variability), 20-Hz taVNS decreased dFC of the LC–superior temporal gyrus and the LC–occipital cortex. Finally, a positive correlation was found between the subjects’ number of migraine attacks in the past four weeks and the NTS-thalamus sFC during pre-taVNS resting state.Conclusions1-Hz and 20-Hz taVNS may modulate the sFC and dFC of key nodes in the central vagus nerve pathway differently. Our findings highlight the importance of stimulation parameters (frequencies) in taVNS treatment.     

Effects of a 4-Week Self-Ankle Mobilization with Movement Intervention on Ankle Passive Range of Motion,Balance, Gait,and Activities of Daily Living in Patients with Chronic Stroke: A Randomized Controlled Study

Goal

To compare the effects of a 4-week self-ankle mobilization with movement training program with those of self-ankle mobilization with movement with a 10° inclined board in patients with chronic stroke.

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

ObjectiveChronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. MethodsWe enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. ResultsThe median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). ConclusionThis is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.     

Tales from the Trips: A Qualitative Study of Timely Recognition,Treatment, and Transfer of Emergency Department Patients with Acute Ischemic Stroke

Background and Objectives: Acute Ischemic stroke (AIS) is a time-sensitive emergency and patients frequently present to, and are transferred from emergency departments (EDs). We sought to evaluate potential factors, particularly organizational, that may influence the timeliness of interfacility transfer for ED patients with AIS. Methods: We conducted semistructured interviews at 3 EDs that routinely transfer AIS patients. A structured interview guide was developed and piloted prior to use. Staff were asked about perceived facilitators and barriers to timely and high quality emergency care for patients with AIS who require transfer. Each interview was audio recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to build a list of themes and subthemes, and identify supporting quotes. Results: We interviewed 45 ED staff (administrative staff, nurses, and physicians) involved in acute stroke care. We identified 4 major themes influencing the execution of interfacility transfers of AIS patients: (1) processes, (2) historical experiences; (3) communication; and (4) resources. Pre-existing protocols that standardized processes (eg, autoacceptance protocols) and reduced unnecessary communication, combined with direct communication with the neurology team at the comprehensive stroke center, and the flexibility and availability of human and physical resources (eg, staff and equipment) were commonly cited as facilitators. Lack of communication of clinical and operational outcomes back to transferring ED staff was viewed as a lost opportunity for process improvement, interorganization relationship building, and professional satisfaction. Conclusions: ED staff view the interfacility transfer of AIS patients as highly complex with multiple opportunities for delay. Coordination through the use of protocols and communication pre- and post-transfer represented opportunities to facilitate transfers. Staff and clinicians at transferring facilities identified multiple opportunities to enhance existing processes and ongoing communication quality among facilities involved in the acute management of patients with AIS.     

A Double-Blind,Sham-Controlled,Pilot Study to Assess the Effects of the Concomitant Use of Transcranial Direct Current Stimulation with the Computer Assisted Cognitive Rehabilitation to the Prefrontal Cortex on Cognitive Functions in Patients with Stroke

Objective

To examine the synergistic effects of both computer-assisted cognitive rehabilitation (CACR) and transcranial direct current stimulation (tDCS) on cognitive function in patients with stroke.

Methods

The current double-blind, sham-controlled study enrolled a total of 11 patients who were newly diagnosed with stroke. The patients of the tDCS group (n=6) completed sessions of the Korean computer-assisted cognitive rehabilitation program five times a week for 30 minutes a session during a mean period of 18.5 days concomitantly with the anodal tDCS over the bilateral prefrontal cortex combined with the CACR. The patients of the control group (n=5) also completed sessions of the sham stimulation during a mean period of 17.8 days. Anodal tDCS over bilateral prefrontal cortex (F3 and F4 in 10-20 EEG system) was delivered for 30 minutes at an intensity of 2 mA. Cathode electrodes were applied to the non-dominant arm. All the patients were evaluated using the Seoul Computerized Neuropsychological Test (SCNT) and the Korean Mini-Mental State Examination.

Results

Mann-Whitney U test revealed a significant difference between the two groups. The patients of the tDCS group achieved a significant improvement in the post/pre ratio of auditory continuous performance test and visual continuous performance test on the SCNT items.

Conclusion

Our results indicate that the concomitant use of the tDCS with CACR to the prefrontal cortex may provide additional beneficial effects in improving the cognitive dysfunction for patients with stroke.