淮南地区急性脑血管病患者的危险因素分析

[目的]探讨脑血管病的流行病学特征以及各种危险因素对不同类型卒中的影响,观察淮南地区人群脑血管病的发病特点.[方法]连续收集从2008年6月至2010年4月首次发病入院且资料完整的急性脑血管病患者773例,其中缺血性684例,出血性89例.分析卒中患者的发病年龄、分型特点及危险因素等.[结果]淮南地区773例首发卒中患者的平均发病年龄为(64.96±11.86)岁,其中出血性卒中组平均年龄显著低于缺血性卒中组(P＜0.001),男性卒中患者的平均发病年龄显著低于女性卒中患者(P＜0.01).缺血性卒中发病高峰年龄为60～79岁,出血性卒中发病高峰年龄为45～64岁,两者有显著性差异(p＜0.001).高血压是出血性和缺血性卒中的首要危险因素,其次为吸烟、饮酒、心脏病和糖尿病史.入院首次血压(收缩压和舒张压),出血性卒中组均显著高于缺血性卒中组(P ＜0.001).高血压史、吸烟史、饮酒史在出血性卒中组出现的频率均高于缺血性卒中组(P＜0.01、P＜0.05、P＜0.01).出血性卒中组血清高密度脂蛋白显著高于缺血性卒中(P＜0.001).本组患者就诊距发病时间＜24 h者出血性卒中约占75.0％～82.4％,缺血性卒中占48.8％～ 57.3％.[结论]淮南地区出血性卒中发病高峰年龄明显小于缺血性卒中,与国内多数报道一致;高血压是导致各类卒中的重要危险因素;血清高密度脂蛋白胆固醇增高、吸烟、饮酒与出血性卒中密切相关.     

The decrease in procarboxypeptidase U (TAFI) concentration in acute ischemic stroke correlates with stroke severity, evolution and outcome

Summary.  Background and objectives:  Procarboxypeptidase U (proCPU, TAFI) concentration in plasma is potentially related to thrombotic tendency, and elevated proCPU levels have been reported in ischemic stroke patients. Improved insight into the role of proCPU in acute ischemic stroke is essential for the development of more adequate therapeutics that may include carboxypeptidase inhibitors. In this study we investigated whether the plasma concentration of proCPU and the proCPU kinetic profile in acute ischemic stroke are related to initial stroke severity, stroke evolution in the subacute phase and long-term stroke outcome. Methods:  Plasma concentration of proCPU was assessed in 136 stroke patients at admission (7.5 h after stroke onset), at 24 h, at 72 h and at day 7 after stroke onset. We evaluated the relation between change in proCPU concentrations and (a) stroke severity (patients with TIA vs. stroke patients, NIHSS score at admission), (b) stroke evolution (stroke progression, infarct volume at 72 h), and (c) stroke outcome (mRS score at month 3). Results:  ProCPU concentration decreased significantly in the first 72 h after stroke onset and thereafter returned to baseline. This biphasic time course, with its nadir at 72 h, was more pronounced in patients with severe stroke, unfavourable stroke evolution in the first 72 h and poor long-term outcome. Conclusions:  The decrease in proCPU concentration in the first 72 h after stroke onset correlates with more severe stroke, unfavourable stroke evolution, and poor long-term stroke outcome.     

Association between stroke knowledge,stroke awareness,and preventive behaviors among older people: A cross‐sectional study

In this cross‐sectional study, we compared preventive behaviors among Thai people aged > 60 years of age, with and without stroke risk, in Chiang Mai Province, Thailand, and examined the associations between stroke knowledge and stroke awareness with preventive behaviors in these two groups (n = 422). Participants completed researcher‐developed tools, including the Personal Demographic Questionnaire, the Stroke Knowledge Questionnaire, the Awareness of Stroke Risk and Severity Questionnaire, and the Stroke Preventive Behavior Questionnaire. The findings revealed a significantly higher mean score of preventive behaviors in older people with stroke risk than in those without risk. For people with stroke risk, stroke knowledge did not result in a significant association with stroke‐preventive behaviors, while stroke awareness did. For those without stroke risk, both stroke knowledge and stroke awareness were significantly associated with stroke‐preventive behaviors. Although the stroke‐preventive behaviors of both groups were performed appropriately, it is necessary for people with stroke risk to maintain preventive behaviors, and for health professionals to regularly assess them for stroke symptoms and encourage people to be proactive about stroke‐preventive behaviors.     

首发脑卒中患者卒中相关知识的调查

目的调查首次发病的脑卒中患者脑卒中相关知识。方法对259例首次发病住院的脑卒中患者问卷调查患者的脑卒中相关知识及其获取知识的途径。结果患者对高血压容易并发脑卒中、脑卒中早期治疗重要性、脑卒中早期常见的偏瘫症状有所了解,缺少脑卒中其他知识如危险因素、高血压病标准等方面的知识。结论需要大力加强脑脑卒中防治知识的教育。     

Neutrophil extracellular traps regulate ischemic stroke brain injury

Ischemic stroke prompts a strong inflammatory response, which is associated with exacerbated outcomes. In this study, we investigated mechanistic regulators of neutrophil extracellular trap (NET) formation in stroke and whether they contribute to stroke outcomes. NET-forming neutrophils were found throughout brain tissue of ischemic stroke patients, and elevated plasma NET biomarkers correlated with worse stroke outcomes. Additionally, we observed increased plasma and platelet surface–expressed high-mobility group box 1 (HMGB1) in stroke patients. Mechanistically, platelets were identified as the critical source of HMGB1 that caused NETs in the acute phase of stroke. Depletion of platelets or platelet-specific knockout of HMGB1 significantly reduced plasma HMGB1 and NET levels after stroke, and greatly improved stroke outcomes. We subsequently investigated the therapeutic potential of neonatal NET-inhibitory factor (nNIF) in stroke. Mice treated with nNIF had smaller brain infarcts, improved long-term neurological and motor function, and enhanced survival after stroke. nNIF specifically blocked NET formation without affecting neutrophil recruitment after stroke. Importantly, nNIF also improved stroke outcomes in diabetic and aged mice and was still effective when given 1 hour after stroke onset. These results support a pathological role for NETs in ischemic stroke and warrant further investigation of nNIF for stroke therapy.     

The impact of stroke on the cost and level of care in nursing homes: a retrospective population-based study

OBJECTIVE: To estimate the impact of incident stroke on nursing home (NH) costs and level of care. SUBJECTS AND METHODS: This retrospective population-based cohort study is part of a larger study that identified all Rochester, Minn, residents with a confirmed first stroke occurring between January 1, 1988, and December 31, 1989. One Rochester resident who had not had a stroke was matched to each person with stroke. Persons with and without stroke were followed up in provider-linked medical records and NH files from baseline (i.e., date of stroke) through December 31, 1994, for evidence of NH use. This study characterized the NH activity of those individuals with any NH activity after baseline (58 persons with major stroke, 36 persons with minor stroke, and 63 persons without stroke) as to NH case mix at first assessment, number of NH days, and per diem Medicaid reimbursement. RESULTS: Characteristics at first NH assessment after baseline revealed that NH residents with major stroke were younger and more disabled and required more services than residents without stroke. Over the full period of follow-up, the mean number of NH days was similar for NH residents with major stroke and those without stroke, yet per diem Medicaid reimbursement was 11% higher for residents with major stroke compared with residents without stroke. Nursing home residents with minor stroke appeared similar to those without stroke with respect to time to admission, characteristics at first assessment, number of NH days, and per diem Medicaid reimbursement. CONCLUSION: Lower incidence and severity of stroke may contribute to lower care needs and per diem cost, but no fewer NH days.     

可穿戴设备在脑卒中危险因素监测及风险预测中的研究进展

对脑卒中危险因素进行早期监控,降低脑卒中发病率,并对脑卒中预测因素进行有效的整合与识别,是脑卒中防治最重要的工作。可穿戴设备及人工智能算法有望成为脑卒中高危人群风险监测及预测的有效解决方案。该文综述了基于可穿戴设备的脑卒中危险因素监测方法、基于人工智能算法的脑卒中预测模型以及手机应用程序在脑卒中风险预测及识别中的应用,为护士开展脑卒中健康管理工作提供可借鉴的依据,并为改进脑卒中防治策略提供参考。     

青年女性缺血性卒中病因分型特点及相关危险因素分析

目的:探讨青年女性急性缺血性卒中患者的病因分型特点和相关危险因素。方法:回顾性分析急性缺血性卒中青年女性患者67例(青年女性卒中组)的临床资料,同时随机抽取老年女性卒中患者(老年女性卒中组)和同期健康体检的青年女性(青年女性对照组)各67例,分析卒中患者的病因分型特点及相关危险因素。结果:①依据中国缺血性卒中(CISS)分型,青年女性卒中组以大动脉粥样硬化(32.84%)和心源性卒中(25.37%)为主。②危险因素方面,青年女性卒中组高血压、糖尿病、高脂血症、动脉粥样硬化斑块阳性患者的比例明显低于老年女性卒中组(均P<0.05),但卒中家族史阳性患者比例高于老年女性卒中组(P<0.05);青年女性卒中组患者高血压、糖尿病、高脂血症、高同型半胱氨酸血症、吸烟、心脏病史、口服避孕药、先兆性偏头痛和卒中家族史阳性患者的比例明显高于青年女性对照组(均P<0.05)。③多因素Logistic回归分析结果显示高血压、糖尿病、高脂血症、高同型半胱氨酸血症和吸烟是青年女性卒中的独立危险因素。结论:青年女性缺血性卒中病因分型构成和相关危险因素与老年女性患者分布不同。早期明确病因分型和发现危险因素有利于青年女性缺血性卒中的防治。     

T ACTICAL E MERGENCY C ARE,M ILITARY AND O PERATIONAL O UT-OF -H OSPITAL M EDICINE

To improve the outcomes of stroke patients, public awareness of stroke must be increased and emergency medical services (EMS) response to stroke calls optimized. Rapid response to stroke is key, as emphasized in the American Stroke Association's “Stroke Chain of Survival,” which consists of four components—rapid recognition of and reaction to stroke warning signs through immediate use of the 9-1-1 system; rapid EMS assessment; priority transport with prenotification of the receiving hospital; and rapid and accurate diagnosis and treatment at the hospital. Neither the risk factors for stroke nor the most common warning signs are adequately known to the public in general, and in particular, to the groups at highest risk for stroke. Effective education through mass media and health care professionals is paramount in increasing the public's awareness of stroke. Whether tools to aid dispatchers and paramedics in stroke diagnosis, assessment, and management can improve stroke patients' outcomes requires further study, as does the value of designated stroke centers. Overall, according stroke the same urgency as acute myocardial infarction, from both the public and the prehospital provider perspectives, might improve stroke patient outcomes.     

Knowledge of stroke symptoms and risk factors among at-risk elderly patients in the UK

Assessing patient knowledge can help healthcare providers in planning measures directed at prevention, early identification and referral of patients. An incorrect understanding of stroke symptoms may delay patients seeking emergency help, thus missing the benefits of acute stroke treatments. Insufficient knowledge about stroke risk factors may affect risk factor control. We conducted a questionnaire-based interview among elderly patients at risk of stroke and assessed their baseline knowledge of stroke symptoms and risk factors. A large proportion were found to have an improper understanding of stroke symptoms and risk factors. Stress was considered the commonest risk factor for stroke. Most patients did not consider themselves to be at further risk of stroke. Further education is needed as part of stroke prevention strategies to remove misconceptions. Improved recognition of stroke symptoms when they occur will help when seeking emergency medical help.     

Cerebral infarction

Diabetes mellitus is the second major risk factor for ischemic stroke. Recent increase in atherothrombotic stroke appears to be related with recent increasing of diabetes. Diabetes is, however, a risk factor not only for atherothrombotic stroke but also for lacunar stroke because there is no difference in prevalence of diabetes between atherothrombotic and lacunar strokes. Diabetes can be a risk factor for cardioembolic stroke as well because the major cause of cardioembolic stroke is atrial fibrillation, and diabetes is a risk factor for stroke in patients with atrial fibrillation. Acute ischemic stroke should be classified into above three subtypes according to the brain and artery imaging as well as cardiac sources of embolism. In hyper-acute patients within 3 hours of onset and without early ischemic signs on CT or ischemic lesions less than one third of the hemisphere on magnetic resonance diffusion-weighted imaging, thrombolytic therapy with alteplase is indicated. In acute stroke patients later than 3 hours of onset, argatroban, heparin, and ozagrel are indicated for atherothrombotic, cardioembolic, and lacunar stroke, respectively. For stroke prevention, total management is required by simultaneous treatments for all risk factors existed. In secondary prevention for stroke, in addition to the more strict control of risk factors antithrombotic therapy is required, that is, antiplatelet therapy is indicated for non-cardioembolic stroke, and anticoagulant therapy is indicated for cardioembolic stroke.     

Evaluating a community‐based stroke nursing education and rehabilitation programme for patients with mild stroke

This study evaluated whether mild stroke patients who received a community‐based stroke nursing intervention had better stroke knowledge, behaviour and self‐efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2‐hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6‐month follow‐up. At the 6‐month follow‐up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self‐efficacy compared with those at baseline. Also, self‐efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6‐month follow‐up; self‐efficacy was correlated with social participation after the 6‐month follow‐up. A community‐based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self‐efficacy.     

脑卒中半失能老年患者复发恐惧的调查研究

目的 调查脑卒中半失能老年患者脑卒中复发恐惧的现状,并分析其影响因素。方法 选取2020年5月—12月在山东省济南市历下区、历城区、市中区、槐荫区和天桥区23个社区的584例脑卒中半失能老年患者为研究对象,采用一般资料调查表、恐惧疾病进展简化量表、简易疾病感知问卷及Barthel指数量表进行调查。结果 脑卒中半失能老年患者脑卒中复发恐惧水平较高,584例脑卒中半失能老年患者恐惧疾病进展简化量表得分为（38.89±7.13）分,≥34分者498例（85.27%）,简易疾病感知问卷得分为（50.12±7.65）分,Barthel指数得分为（43.86±6.16）分。多元线性逐步回归分析显示,年龄、Barthel指数评分、病程、疾病复发次数和疾病感知是脑卒中复发恐惧的影响因素（P<0.05）。 结论 脑卒中半失能老年患者脑卒中复发恐惧处于较高水平,脑卒中患者年龄越小、病程越短、日常生活能力得分越低、疾病复发次数越多、疾病感知越高,其复发恐惧水平越高。护理人员应该根据脑卒中患者复发恐惧的影响因素制订干预对策,提高脑卒中患者对疾病的认知,改善脑卒中患者的生活能力,降低脑卒中半失能老年患者脑卒中复发恐惧感。     

内蒙古自治区7 472例脑卒中发病流行病学特征分析

  目的   分析内蒙古地区缺血性和出血性脑卒中发病流行病学特点及相关因素,为脑卒中高危人群的防治策略制定提供数据支撑。  方法   选取国家脑卒中高危人群筛查和干预项目2020年度内蒙古地区医院7 472例脑卒中患者的数据,对病例基本特征、临床检测指标、实验室检测指标等应用SPSS 22.0统计软件进行χ2检验和t检验,采用多因素logistic回归计算出血性和缺血性脑卒中的比值比（OR）及其95%可信区间（95% CI）。  结果   内蒙古地区脑卒中发病以缺血性为主,占比89.7%,且男性高发。 缺血性脑卒中组糖尿病患病率明显高于出血性脑卒中组,差异有统计学意义（P＜0.01）,而出血性脑卒中组高血压患病率明显高于缺血性脑卒中,差异有统计学意义（P＜0.01）。 单因素分析,缺血性脑卒中组的体质指数（BMI）、血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）及同型半胱氨酸（Hcy）水平明显高于出血性脑卒中组,差异有统计学意义（P＜0.01）,而高密度脂蛋白胆固醇（HDL-C）水平明显低于出血性脑卒中组,差异有统计学意义（P＜0.01）。 缺血性脑卒中组各年龄组BMI均大于出血性脑卒中组,差异均有统计学意义（P＜0.01）。 多因素回归分析显示,相对于出血性脑卒中,缺血性脑卒中的影响因素为年龄、BMI、高TC、低HDL-C、高Hcy、吸烟史和糖尿病;而相对于缺血性脑卒中,出血性脑卒中的影响因素为高血压、蒙古族和饮酒情况。 汉族人群中年龄、BMI、TC、HDL-C、Hcy水平、吸烟（史）和过量饮酒、高血压和糖尿病患病情况等是两类脑卒中的影响因素（P＜0.05）;而蒙古族人群TG、HDL-C及饮酒情况不是发生两类脑卒中的影响因素（P＞0.05）。  结论   内蒙古地区脑卒中发病以缺血性为主,男性高发。糖尿病、BMI、血脂异常（高TC、低HDL-C和高Hcy）和高龄与缺血性脑卒中关系密切。 低龄、高血压、饮酒及蒙古族人群更易发生出血性脑卒中。     

Stroke awareness among Georgia adults: epidemiology and considerations regarding measurement.

BACKGROUND: To design and evaluate interventions for reducing the impact of stroke in Georgia, we assessed knowledge of signs, risk factors, and burden of stroke. METHODS: Adults in Georgia were studied with a random digit dial telephone survey. RESULTS: Answering an unaided question, 39% of 602 respondents named > or =1 stroke warning sign. Awareness was considerably greater when assessed with prompted questions. Most respondents (70%) said they would call 911 if someone had a stroke; almost all (95%) considered stroke an emergency. Risk factor awareness ranged from 97% (previous stroke) to 69% (diabetes). Altogether, 6% reported having had a stroke; 48% reported a stroke in their family. CONCLUSIONS: Georgia adults have low awareness of stroke warning signs. Our findings underscore the importance of conducting an effective educational campaign. Furthermore, a need exists for questions on stroke awareness that approximate more closely the situation in which a person must identify a potential stroke.     

What's the "hyper" in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours

Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset. Guidelines have been established identifying critical elements for hospitals in order to be designated as primary or comprehensive stroke centers. Research studies exploring treatment options for stroke, as well as general care priorities exist in the scientific literature but must be integrated into hospital-based protocols. Recommended interventions are highlighted to assist critical care practitioners in the delivery of care for stroke patients. Coordinated teams using an evidence-based approach can optimize the outcomes of the stroke patient population.     

Stroke: From recognition by the public to management by emergency medical services

To improve the outcomes of stroke patients, public awareness of stroke must be increased and emergency medical services (EMS) response to stroke calls optimized. Rapid response to stroke is key, as emphasized in the American Stroke Association's “Stroke Chain of Survival,” which consists of four components—rapid recognition of and reaction to stroke warning signs through immediate use of the 9-1-1 system; rapid EMS assessment; priority transport with prenotification of the receiving hospital; and rapid and accurate diagnosis and treatment at the hospital. Neither the risk factors for stroke nor the most common warning signs are adequately known to the public in general, and in particular, to the groups at highest risk for stroke. Effective education through mass media and health care professionals is paramount in increasing the public's awareness of stroke. Whether tools to aid dispatchers and paramedics in stroke diagnosis, assessment, and management can improve stroke patients' outcomes requires further study, as does the value of designated stroke centers. Overall, according stroke the same urgency as acute myocardial infarction, from both the public and the prehospital provider perspectives, might improve stroke patient outcomes. PREHOSPITAL EMERGENCY CARE 2002;6:99-106     

急性脑卒中合并不同程度阻塞性睡眠呼吸暂停低通气综合征患者伴发脑心综合征的临床分析

目的探讨急性脑卒中合并不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者发生脑心综合征(CCS)的差异性,为临床监测及干预治疗提供依据。方法收集急性脑卒中合并OSAHS患者471例,其中缺血性卒中伴轻度OSAHS组85例,缺血性卒中伴中度OSAHS组74例,缺血性卒中伴重度OSAHS组68例,出血性卒中伴轻度OSAHS组69例,出血性卒中伴中度OSAHS组83例,出血性卒中伴重度OSAHS组92例。观察各组心电图、心肌酶、肌钙蛋白的变化。结果缺血性脑卒中合并不同程度OSAHS患者发生CCS的比较,差异有统计学意义(χ~2=6.532,P=0.012),其中两两比较差异均有统计学意义(P0.01)。出血性脑卒中合并不同程度OSAHS患者发生CCS的比较,差异有统计学意义(χ~2=12.741,P=0.005),其中两两比较差异均有统计学意义(P0.01)。缺血性卒中合并轻度OSAHS与出血性卒中合并轻度OSAHS患者发生CCS的比较,差异有统计学意义(χ~2=6.972,P=0.010)。缺血性卒中合并中度OSAHS与出血性卒中合并中度OSAHS患者发生CCS的比较,差异有统计学意义(χ~2=9.248,P=0.005)。缺血性卒中合并重度OSAHS与出血性卒中合并重度OSAHS患者发生CCS的比较,差异有统计学意义(χ~2=10.831,P=0.005)。结论急性脑卒中合并OSAHS的患者,随着OSAHS程度的加重,CCS的发生率增加,且出血性卒中合并OSAHS的患者较缺血性卒中合并OSAHS的患者更易导致CCS的发生。     

急性脑卒中患者血糖水平的动态变化

目的:研究急性脑卒中患者起病12h内血糖变化情况及探讨血糖变化程度与脑卒中严重程度、卒中类型和预后的关系。方法:2次测定188例无糖尿病的急性脑卒中患者起病12h内的血糖水平。结果:血糖于急性脑卒中起病12h内开始升高:轻至中度脑卒中患者血糖水平由5.6mmol/L升至6.1mmol/L(P<0.001);重度脑卒中患者血糖水平由6.3mmol/L升至6.8mmol/L(P<0.001);起病7d内死亡患者血糖水平由6.8mmol/L升至7.2mmol/L(P<0.001)。结论:血糖水平在急性脑卒中起病后升高且与脑卒中的严重程度呈正相关。     

卒中后癫痫

癫痫是卒中后常见的并发症，目前对卒中后癫痫的发病机制尚不清楚，认为早发性癫痫可能与脑组织缺血，缺氧，迟发性癫痫与胶质细胞形成有关。对卒中后癫痫以治疗原发病为主，对反复发作和迟发性癫痫应用抗痫药治疗。