中国脑卒中的发病与趋势——三大城市的研究结果

分析1991～2000年北京、上海、长沙3城市社区年登记的卒中病例,了解3大城市90年代脑卒中及其亚型的发病率和变化趋势。经年龄标化后北京初发脑卒中的发病率为135．0/10万人年、上海为76．1/10万人年、长沙为150．0/10万人年,其中北京缺血性卒中的发病率最高,其次为上海和长沙;而长沙颅内出血的发生率最高,其次是北京和上海;蛛网膜下腔出血的顺序同脑出血。社区≥50岁的人群总卒中和颅内出血年龄标化后的发病率普遍高于西方国家。从10年变化趋势来看,北京、上海、长沙3大城市颅内出血的年下降率分别为12．0%、4．4%和7．7%,而脑缺血的年增长率除长沙外北京和上海分别为5．0%和7．7%。这种颅内出血减少和缺血性卒中增加的现象反映出中国人群脑卒中危险因素的变化情况。     

蛇毒3号加黄芪干预脑卒中危险因素降低发病率的临床研究

观察蛇毒3号、黄芪注射液对脑卒中危险因素及发病率的影响。应用蛇毒3号加黄芪注射液静脉滴注半月。发现脑卒中危险因素如高血压、高血脂及高粘血症均有明显下降,脑卒中发病率较对照组明显降低（P＜0.01）。提示蛇毒3号加黄芪注射液静滴,能够干预脑卒中危险因素,对降低脑卒中发病率具有重要意义。     

脑卒中患者应激性溃疡的调查及预防

脑卒中患者急性期 ,机体因中枢神经系统的损害而出现一系列应激反应。其中消化道出血是最严重且往往是致死的并发症之一 ,称之为应激性溃疡。为掌握脑卒中患者应激性溃疡的临床特点及防治措施 ,对 1999年 1月～ 2 0 0 2年 5月在我科住院治疗的 165例脑卒中患者 ,应激性溃疡的发生情况进行调查 ,现报告如下。1　资料与方法1.1　病例选择　 1999年 1月～ 2 0 0 2年 5月 ,在我科住院治疗的脑卒中患者共 165例 ,包括脑梗死、脑出血、蛛网膜下腔出血 ,排除发病后 2 4小时内死亡病例及自动出院患者。既往均无消化道出血、消化道溃疡病史。其中 :男…     

北京市和上海市抽样人群脑卒中发病率和危险因素暴露水平比较

目的：对北京和上海两城市抽样人群的脑卒中发病率及危险因素暴露情况进行比较和分析,为脑卒中预防提供参考。方法：在北京市石景山区和上海市奉贤区以整群抽样方法抽取人群中年龄≥40岁者为目标人群（北京2910名,上海5244名）。设计统一的调查表格,对目标人群进行基线调查,并进行脑循环动力学检测,此后随访脑卒中的发病情况。比较和分析两城市脑卒中发病率、危险因素及脑循环动力学综合积分的差异。结果：北京市和上海市高血压病、心脏病、糖尿病、血脂异常、脑卒中家族史、肥胖、吸烟、饮酒因素的暴露率分别为34．64％和21．09％、23．16％和5．53％、10．79％和2．38％、23．02％和2．59％、28．63％和7．70％、26．74％和4．27％、36．8％和33．6％、36．9％和18．5％,地区间各因素暴露率的差异有统计学意义（P〈O．01）。脑卒中发病密度分别为6．29‰和N2．51‰。男女组间各危险因素暴露率、脑循环动力学积分值及脑卒中发病率差异均有统计学意义（P〈0．01）。结论：北京市高血压、心脏病、糖尿病、血脂异常等脑卒中危险冈素暴露率、脑循环动力学损害及脑卒中发病率均显著高于上海市。脑循环动力学损害可能是影响脑卒中发病的重要因素。     

广东省新生儿缺血缺氧性脑病发病率调查及危险因素分析

目的了解广东省新生儿缺血缺氧性脑病（HIE）的发病率及其流行特征，分析有关危险因素。方法以整群抽样的方式收集资料数据等，用多因素Logistic回归分析筛选危险因素。结果广东省HIE发病率为0．92％。产妇心脏病、贫血、流产次数、胎位因素、催产素、胎头吸引、胎膜早破等19项因素为HIE发病的危险因素，怀孕次数、接近分娩的最后一次产检以及较高等级的产检医院为HIE发病的保护因素。羊水不正常、出生体重增加、5min Apgar评分异常、出生皮肤颜色、呼吸、心跳异常、1minApgar评分异常、出生时反射异常、出生第一天神志异常等因素为HIE发病的胎儿、新生儿危险因素。结论避免与HIE发病高度相关的危险因素．关注保护因素．采取积极的预防措施，可相对地减少和预防HIE的发病。     

大庆地区精神分裂症五年发病率调查

按照北京医科大学精神卫生研究所的设计，我们于１９８６～１９９０年对大庆市红岗区进行了精神分裂症发病率的前瞻性调查，调查时限为这五年中每年１月１日至１２月３１日。采用功能性筛查表逐户筛查，与前瞻性报病及回顾性部分补查结合的方法。五年共诊断首次发病的精神分裂症１２５例，平均年发病率０．２２‰，男性为０．２１‰，女性为０．２４‰，城市为０．２４‰，农村为０．１２‰。     

脑卒中后肌痉挛发病情况调查分析

随着MR/CT等影像学的发展及介入技术广泛开展和新型溶栓药物早期利用,卒中的早期诊断率明显提高,病死率明显降低,在挽救了越来越多患者的生命同时,其残存功能并未得到明显改善,致残率仍高居不下;这种高致残率除与卒中损伤部位、损伤程度及早期是否选择有效干预方式有关外,还与病情稳定后痉挛密切相关。卒中后的痉挛给患者造成异常的姿势和异常的运动模式,影响患者的步态和日常生活功能,甚至是痉挛性疼痛,这些都严重制约着患者的康     

脑卒中流行病学调查相关文献复习

脑卒中作为一个全球性的健康问题,是影响伤残调整寿命年第3位的原因。脑卒中造成的死亡和残疾为发展中国家带来了沉重的经济负担。中国作为拥有世界上最多人口的发展中国家,在经历经济迅猛发展的同时,老年人口的数量也在不断增加。流行病学研究显示,脑卒中的发病率随着年龄的增加而增长,脑卒中的病死率从1990至2000年以来逐渐增加,从21世纪初开始逐渐下降,这可能与有效控制脑血管病相关危险因素和急性脑卒中的早期预防密切相关。中国是一个地理环境差异明显的国家,中国人的生活方式在过去的30年中也发生了巨大变化,地理差异和血管危险因素的不断变化决定了中国脑卒中的患病率和亚型。文中就中国脑卒中的决定因素以及潜在方向进行讨论。     

缺血性脑卒中的流行病学研究

据国外研究报道,正常情况下成年女性缺血性脑卒中(ischemic stroke,IS)年发病率为170/10万,男性为212/10万,年平均发病率为0.58%~0.61%;复发率为21.8%~12.9%,其中,伴有房颤的1年脑卒中复发率为10%~20%,发病前和发病后接受过抗血小板治疗的分别为9.0%和6.2%~14.0%。据国内文献统计:缺血性脑卒中发病率为91.3~263.1/10万,年平均发病率为145.5/10万;复发率为8.47%。     

Changes in caregiver burden among informal caregivers of stroke patients in Mongolia

Background: Modern therapeutics and health care improvements prolong stroke patients’ survival; however, the degree of disability remains high. Stroke survivors often require caregivers, particularly in the first year after the onset of the stroke. Longitudinal assessment of and factors associated with caregiver burden (CGB) among caregivers of stroke patients has been scarcely discussed. This study aimed to define the changes in CGB in the first year of caregiving among the caregivers of stroke patients and to identify associated factors.

Methods: A prospective, multi-centered observational study was conducted in nine public hospitals in Mongolia. We used the Montgomery CGB Scale for assessing CGB, and repeated the assessment after 1 year. Stroke patient characteristics were included in the analyses. Multinomial logistic regressions were conducted to analyze changes in CGB.

Results: A paired t-test analysis revealed that demand burden increased (from 12.61 to 11.50, p = 0.034), whereas stress burden decreased (from 10.69 to 11.60, p = 0.016). Although objective burden decreased, the difference was not significant. Factors associated with these changes in CGB were the caregiver’s marital status, the caregiver’s relationship with the patient, financial difficulties, and the patient’s sex and dependency.

Discussion: The information on factors predicting changes in CGB in the first year of caregiving provided in this study suggests that social or financial support can assist in reducing CGB among the caregivers of post-stroke patients.     

帕金森病患者疾病的经济负担及其相关影响因素研究

目的 探讨帕金森病(PD)患者疾病的经济负担及其相关影响因素.方法 对150例PD患者进行问卷调查,了解患者及其家庭的基本资料和2009年有关PD支出的费用(包括直接费用、间接费用).应用Hoehn和Yahr分级(H-Y分级)量表评定PD患者的病情.应用单因素分析和多元线性逐步回归分析判断影响PD患者疾病经济负担的相关因素.结果 PD患者的年平均PD支出为13 576.43元,其中直接费用为12 306.73元(90.6％),间接费用为1269.70元(9.4％);分别占年家庭收入和人均收入的17.9％和48.0％.单因素分析发现,PD患者的门诊次数(x2=6.423,P＜0.05)及家庭月收入(x2=13.718,P＜0.05)对疾病经济负担的影响有统计学意义.多元逐步回归分析显示,PD患者的病情严重程度(t=2.210,P=0.029)、门诊次数(t =2.185,P=0.031)和家庭月收入(t=1.679,P=0.096)为影响PD经济负担的相关因素.结论 PD患者的疾病经济负担较重;而患者的病情严重程度、门诊次数和家庭收入是影响PD经济负担的相关因素.     

不同TOAST亚型脑卒中患者动脉硬化负担分级比较

目的按照TOAST分型标准对急性脑梗死患者进行病因学分型,并评价各类型患者的动脉硬化负担分级。方法选取2014-01—2016-05我院收治的急性脑梗死患者160例,并对其临床资料进行回顾性分析;按照TOAST标准进行病因分型,并根据动脉硬化负担分级对各亚型卒中患者进行分级评价,比较各亚型卒中患者的动脉硬化负担分级。结果 TOAST分型结果:心源性栓塞型(CE)24例(15.38%),大动脉粥样硬化型(LAA)54例(34.62%),小动脉闭塞型(SAO)28例(17.59%),其他明确病因型(ODC)20例(12.82%)及不明原因型(UND)30例(19.23%);动脉硬化负担分级结果:心源性栓塞型患者、大动脉粥样硬化型患者与小动脉闭塞型患者的动脉硬化负担分级程度高于其他明确病因型与不明原因型,差异有统计学意义(P0.05)。结论心源性栓塞型、大动脉粥样硬化型与小动脉闭塞型患者的病因均与血管性因素有关,通过动脉硬化负担分级有利于血管性脑卒中患者的病因诊断。     

The stroke caregiving trajectory in relation to caregiver depressive symptoms,burden, and intervention outcomes

Background: Caregiver depression and burden have a detrimental effect on stroke survivors’ rehabilitation and are contributors to stroke survivors’ hospital readmission and institutionalization. The stroke caregiving trajectory is unique compared to other illnesses, and the effect of length of caregiving on stroke caregiver outcomes is poorly understood. Interventions can improve caregiver outcomes, but the optimal timing of these interventions is unclear.

Objectives: We sought to determine the relationship between: (1) length of caregiving and stroke caregiver depressive symptoms and burden, and (2) length of caregiving and amount of change in depressive symptoms and burden following the Resources and Education for Stroke Caregivers’ Understanding and Empowerment (RESCUE) intervention – an online and telephone problem-solving, education, and support intervention.

Methods: We analyzed retrospective data collected from 72 stroke caregivers who participated in the RESCUE intervention. Outcomes were caregiver depressive symptoms and burden. Data were analyzed using mixed-effects regression analysis.

Results: Baseline depressive symptoms and burden were both negatively related to length of caregiving (p < 0.05). We found significant improvement in caregiver depressive symptoms and burden following an intervention. The interaction between changes in outcomes and length of caregiving was not significant for either depressive symptoms (p = 0.26) or burden (p = 0.10).

Conclusions: This study contributes to the understanding of the relationship between length of caregiving and depression, burden, and intervention outcomes. Clinicians should recognize that the stroke caregiving trajectory can be nonlinear. Routine and repeated clinical assessment of caregiver well-being is needed, along with implementation of interventions when necessary, regardless of how much time has passed since the stroke.     

Temporal trends of stroke in Valle d'Aosta, Italy. Incidence and 30-day fatality rates

The objective of this study was to evaluate temporal changes of stroke in an Italian community by comparing the present incidence rates with those reported in the same area for 1989. The two studies were conducted by the same research group and met almost all the criteria proposed for an “ideal” stroke incidence study. The annual incidence rate per 1000 inhabitants increased (p < 0.01) by 29% from 2.23 (95% CL, 1.96–2.50) in 1989 to 2.89 (95% CL, 2.58–3.20) in 1997. No statistically significant change was found when these rates were adjusted to the 1991 Italian population. The overall incidence rate was 2.40 (95% CL, 2.14–2.66) in 1989 and 2.65 (95% CL, 2.39–2.91) in 1997. The thirty-day case fatality rate declined dramatically (p < 0.001) from 31% (95% CL, 26– 36) to 20% (95% CL, 16–24) between 1989 and 1997. Ageing of the population and better identification of cases could explain the high incidence rate, whereas the decrease of fatality rate may be due to a general improvement in acute care and inclusion of milder cases. Received: 24 August 1999 / Accepted in revised form: 2 December 1999     

The incidence of cases of aphasia following first stroke referred to speech and language therapy services in Scotland

Background: Key to the provision of appropriate services is an understanding of the number of cases in a given population. This study examined the incidence of aphasia following first ever stroke. It was part of a larger study, the Aphasia in Scotland Study, which examined the provision of services for people with aphasia in Scotland.

Aims: The present study examines the incidence of aphasia referred to speech and language therapy services in people who have experienced their first ever stroke. The specific questions addressed were: What is the incidence of aphasia following first ever stroke? What is the percentage of aphasia following first ever stroke? What are the crude figures for aphasia following first ever stroke by age? What are the crude figures for aphasia following first ever stroke by gender? What are the crude figures for aphasia following first ever stroke by severity?

Methods & Procedures: All 14 health boards in Scotland were approached but only 3, NHS Borders, Orkney, and Shetland, were able to provide the level of information required. Respondents were asked to provide information about the age and gender and level of communication need of referred cases over a given year.

Outcomes & Results: Results suggested that the incidence of aphasia following first ever stroke was found to be 54, 57, and 77.5 per 100,000, for NHS Borders, Orkney, and Shetland respectively. This is slightly higher than in other comparable studies. The percentage of new cases of aphasia following a first ever stroke across NHS Borders, Orkney, and Shetland was 19, 22, and 34% respectively. The variability across the three sites is probably a function of the potential effect of small changes in the relatively low numbers. The majority of cases were, unsurprisingly, over 65 years of age but a substantial minority—17% (Shetland), 26% (Borders) and 36% (Orkney)—were below 65 years of age. One third of new cases resulted in severe aphasia. Although the proportions of men and women with aphasia were similar, women tended to be older at the point at which they experienced their first stroke.

Conclusions: The results are discussed in terms the practicalities of this sort of data collection exercise and the implications of the results for service delivery. There is a need for comparable local data collection exercises tied in to current epidemiological studies.     

Incidence and trends of stroke and its subtypes in Changsha,China from 2005 to 2011

During the 1990s no significant changes were found for the high incidence of ischemic stroke (IS) in Changsha, in contrast to the increase observed in Beijing and Shanghai. However, the epidemiological patterns of stroke may change with economic development. This study aimed to examine the characteristics of stroke incidence transition in Changsha from 2005 to 2011. In 2007 two communities with a registered population of about 100,000 were selected and data from stroke patients who presented between 2005 and 2007 were retrospectively collected from January to June 2008. From January to December 2007 a stroke surveillance network was established and stroke patients who presented between 2008 and 2011 were prospectively registered. From 2005 to 2011 the mean annual age-adjusted incidence of first-ever stroke was 168.5/100,000 (95% confidence interval [CI] 159.0–178.0/100,000), with 189.3/100,000 (95% CI 175.1–178.0/100,000) for men and 148.7/100,000 (95% CI 136.0–161.4/100,000) for women. The mean annual age-adjusted incidence of IS, intracranial hemorrhage and subarachnoid hemorrhage was 72.6/100,000 (95% CI 66.3–78.9/100,000), 85.1/100,000 (95% CI 78.3–91.9/100,000) and 9.4/100,000 (95% CI 7.1–11.7/100,000), respectively. During the study period, the age-adjusted incidence of stroke increased at an annual rate of 3.7% (p = 0.001); at 4.2% for men (p = 0.001) and 3.1% for women (p = 0.026). The age-adjusted incidence of IS increased at an annual rate of 3.5% (p = 0.003) but no significant changes were seen for hemorrhagic stroke. Characteristics of stroke incidence transition may reflect underlying changes in risk factors and there is an urgent need to identify these factors and launch appropriate public health campaigns.     

双相障碍不同首选用药间处方方式、不良反应、经济负担、依从性比较

目的比较首选心境稳定剂和首选抗精神病药治疗的双相障碍患者处方方式、不良反应、经济负担及药物治疗依从性等。方法对河北省11个地市39家精神卫生机构中接受心境稳定剂或抗精神病药治疗的240例双相障碍患者,采用自制调查问卷、临床总体印象病情严重程度量表(clinical global impressions scale-severity of illness,CGI-SI)、不良反应量表(treatment emergent symptom scale,TESS)、药物依从性评定量表(medication adherence rating scale,MARS)进行社会人口学、疾病临床特征、处方方式(联合用药情况)、精神类药物花费、不良反应及治疗依从性等方面的调查。结果首选抗精神病药治疗者(抗精神病药组)152例(63.3%),首选心境稳定剂治疗者(心境稳定剂组)88例(36.7%)。抗精神病药组与心境稳定剂组相比,住院患者构成比(90.1%vs.76.1%)、伴有精神病性症状患者构成比(27.0%vs.11.4%)、不良反应发生率(46.1%vs.31.8%)、精神类药物日花费(中位数12.00元vs.8.37元)和总花费(中位数344.61元vs.144.64元)均较高(P0.05)。但两组间药物处方方式、不良反应严重程度、MARS总分无统计学差异(P0.05)。结论河北省双相障碍患者以首选抗精神病药治疗为主,但首选抗精神病药并未减少之后的联合用药,且不良反应发生率及药物经济负担均明显高于首选心境稳定剂治疗者,所以心境稳定剂仍应作为双相障碍主要首选用药。     

The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation

Abstract Stroke is the second most common cause of death in the world. The aim of this study is to estimate stroke’s direct costs and productivity losses in Italy from a societal perspective and to explain cost variability. A prospective observational multicentre cost of illness study was designed. Four hundred and forty-nine consecutive patients admitted because of acute first-ever stroke in 11 Italian hospitals were enrolled. Costs and outcomes were assessed at patients’ enrolment, and at 3, 6 and 12 months after discharge. Overall, social costs in the first six months following the attack were € 11 600 per patient; 53% of this was health care costs, 39% non-health care costs and the remaining 8% productivity losses. Age, level of disability and type of hospital ward were the most significant predictors of six-month social costs. The acute phase counted for more than 50% of total health care costs, leaving the remaining 50% to the post-acute phase, indicating that follow-up should be on the agenda of policy makers also.     

Characteristics of hospitalizations due to acute stroke in the Silesian Province,Poland, between 2009 and 2015

Introduction

The available data on acute stroke (AS) in Poland come mainly from non-representative cohorts or are outdated. Therefore, the current study was done to access the most recent data on AS in the industrial region that covers 12% (4.6 mln) of the country's population.