卒中“疾病全周期”康复

卒中全周期康复包含疾病全周期、分级诊疗全周期、参与人员全周期、不同地域之间全周期等四个方面。卒中全周期模式的提出对提高卒中诊疗水平、实施分级诊疗策略、人员功能定位、消除地区间医疗资源的不平衡提供了建设性意见。疾病全周期能让我们更好地了解卒中不同分期并且给予针对性康复,使患者的功能预后实现最优化。本文就"疾病全周期"康复策略和措施进行阐述。     

卒中单元医疗管理与脑卒中早期康复治疗

目的探讨卒中单元医疗管理与临床脑卒中早期康复治疗效果。方法将452例急性缺血性脑卒中患者随机分为卒中单元治疗组(A组)与传统治疗组(B组)。对A组进行临床早期介入康复治疗的评价。结果卒中单元治疗组比传统治疗组在Brunnstrom分组上疗效明显,A组优于B组(P<0.01)。结论 卒中单元医疗管理模式对急性脑卒中患者介入康复治疗,能明显改善肢体运动功能,疗效显著。     

台大医院脑中风中心

脑中风中心或卒中单元可明显降低卒中患者的死亡率、提高功能恢复、降低住院天数,对于急性卒中患者的监护可提供显著的疗效。台大医院于2002年11月成立卒中中心,提供卒中患者的跨科整合医疗、推展急性卒中团队、卒中的重症治疗、提升血栓溶解与其他特殊治疗、卒中处置的标准作业流程及临床路径、民众及医疗人员卒中继续教育、建立卒中患者登录库、早期康复治疗、卒中患者长期预后随访等,以建构卒中由预防、治疗、监护至长期护理转介及随访的全程规划。     

中国脑血管病防治指南(节选)

第三章 卒中单元 一、概念 卒中单元（stroke unit）是指改善住院卒中患者的医疗管理模式，专为卒中患者提供药物治疗、肢体康复、语言训练、心理康复和健康教育、提高疗效的组织系统。卒中单元的核心工作人员包括临床医师、专业护士、物理治疗师、职业治疗师、语言训练师和社会工作者。基于以上概念，可以将卒中单元概括为以下特点：（1）针对住院的卒中患者，因此它不是急诊的绿色通道，也不是卒中的全程管理，只是患者住院期间的管理。（2）卒中单元不是一种疗法，而是一种病房管理系统。（3）这种新的病房管理体系应该是一种多元医疗模式（muhidisciplinary care system），也就是多学科的密切合作。（4）患者除了接受药物治疗，还应该接受康复治疗和健康教育。但是，卒中单元并不等于药物治疗加康复治疗，它是一种整合医疗（integrated care）或组织化医疗（organized care）的特殊类型。（5）卒中单元体现对患者的人文关怀，体现了以人为本。它将患者的功能预后以及患者和家属的满意度作为重要的临床目标，而不像传统的理念仅强调神经功能的恢复和影像学的改善。     

音乐疗法与卒中患者认知障碍康复的研究进展

近年来,随着医疗技术水平的不断提高,卒中患者致死率逐年下降;然而,卒中患病率和致残率却逐年升高。卒中后认知障碍是卒中常见并发症之一,而认知障碍显著影响卒中患者的预后。音乐疗法是一项新的康复治疗技术,旨在通过音乐调节神经兴奋性和人体内循环,从而发挥治疗作用,帮助恢复患者的认知功能。本文对音乐影响认知功能的机制、音乐疗法的国内外进展、音乐疗法在卒中认知康复中的临床应用以及存在的问题进行综述。     

远程医疗与“周末效应”

<正>1研究介绍1.1研究背景近年来美国卒中死亡率呈逐年下降趋势,但在农村地区其死亡率仍居高不下。远程医疗(telemedicine,TM)的应用可提高偏远地区医疗服务质量及可及性。通过TM指导进行的静脉rt-PA溶栓治疗急性缺血性卒中已被证明是安全的,且其临床结局、并发症及死亡率都与直接前往卒中中心接受治疗的患者相当。有证据表明,就诊日期及时间或可影响卒中结局,患者夜间或周末就诊较工作日工作     

卒中中心建设及质量控制研究进展

卒中中心建设及质量控制是近年来卒中救治领域的热点话题。我国的卒中中心建设通过医疗资源整合,多学科协作,形成了一个集院前识别与转运、急性期救治、早期康复、二级预防、随访宣教、质量检测及改进于一体的区域组织化卒中救治网络,建立了一套标准、高效、规范的卒中救治及质量控制体系,对规范和提升医疗机构卒中诊疗和效率,促进医疗服务质量改进,降低疾病负担起到了重要作用。急救地图建设着眼于如何在急救响应及急性期治疗环节减少包括院前识别、急救派遣等环节的时间延误,我国逐步构建了“国家-省-地级市”三级卒中急救地图体系,建设以地级市为中心的“区域卒中急救地图”。我国卒中急诊绿色通道建设近10年来发展迅速。各级医疗机构通过成立急性卒中诊治多学科团队,就诊流程从串联变并联,开展精细化质量检测及持续改进,借助信息化手段逐步提升效率,有效缩短院内延误,提高了溶栓率,改善了临床疗效。基层医疗机构更为直接面对广大卒中人群,但由于在医疗硬件、人才储备、体制机制等各方面的劣势,打通卒中救治的“最后一公里”困难重重。河南省进行的积极探索值得借鉴参考。卒中单元可以显著改善急性卒中患者的临床结局,其建设涵盖了卒中患者的急性期治疗...     

全科医学与卒中

急性缺血性卒中是我国最常见的卒中类型,且致残率、死亡率高[1-2]。缺血性卒中的治疗包括早期诊治、二级预防和康复治疗等,是一项系统工程,需要各级医疗机构、120急救、康复中心等的协作。随着上海区域医联体的建立,家庭医生签约覆盖率的提升,以及社区医养体系的发展,卒中的分级诊疗和管理逐渐规范,惠及越来越多的社区居民。本文介绍家庭医生对1例轻型卒中患者的院前识别和社区康复管理,为卒中的社区防治提供参考经验。     

影响卒中患者康复疗效的机体因素

<正>卒中是当前老年人发病率及残障率极高的疾病之一。随着医疗的发展,卒中患者的存活率逐步提高,然而远期的生活质量却普遍较差。生活质量及心理健康作为二级预防的主要目标,康复作为卒中后治疗也已被医师和患者认同,当前的疗效不尽人意。生理、社会、功能性因素,包括年龄、性别、社会环境等级、共存病、教育程度、神经功能、卒中严重程度、认知及抑郁,都被认为是卒中康复的主要影响因素,本文就影响卒中患者康复疗效的几个常见机体因素进行综述。     

远程医疗在卒中救治体系中的应用

近20年来,远程医疗在卒中救治领域中的应用方兴未艾,现已逐步趋向成熟.国外相继启动了一系列远程卒中项目,并制定出具体实践指南,而我国的远程卒中发展相对落后,但在新型冠状病毒肺炎疫情期间发挥了重要作用,未来可期.随着近年来我国逐步建立起卒中救治体系,将远程医疗应用于卒中救治体系成为提高卒中患者救治效率的一种新模式,同时远...     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.