复发性脑梗死TOAST卒中分型危险因素的分析

目的探讨脑梗死复发的相关危险因素及与缺血性卒中分型的关系。方法回顾分析544例脑梗死患者的危险因素,比较复发与初发脑梗死两组患者不同TOAST分型中危险因素的差异。结果 544例脑梗死患者中,复发性脑梗死264例。在TOAST分型中,复发组最多亚型的患者是大动脉粥样硬化,此分型患者高血压病、糖尿病、脂代谢紊乱等危险因素要显著高于初发患者。结论高血压病、糖尿病、脂代谢紊乱等危险因素容易导致大动脉粥样硬化型卒中复发。     

组织化卒中管理模式对脑卒中患者临床疗效的影响

目的研究组织化卒中管理模式对脑卒中患者临床疗效的影响。方法自2002年1月至2006年12月的脑卒中患者共2637例,随机进入组织化卒中病房(研究组)和普通神经科病房(对照组),比较两组的病死率、未愈率、好转率、治愈率。结果研究组病死率、未愈率、好转率、治愈率分别为2.00%、0.90%、74.94%和22.16%;对照组则为3.26%、1.02%、74.01%及21.71%。研究组的病死率较对照组明显减少(P<0.05),而研究组与对照组的未愈率、好转率、治愈率比较差异无统计学意义(P>0.05)。结论组织化卒中管理模式对减少脑卒中患者病死率较普通神经科病房更具有优越性。     

卒中单元对急性脑卒中治疗的效果评价

目的 通过对急性脑卒中患者的临床神经功能缺损及日常生活能力评分分析卒中单元的治疗效果及经济学评价。方法 对进入卒中单元（n=32例）和普通病房（n=32例）急性脑血管病患者进行住院期间神经功能评分、生活能力评价（BI）、住院费用及病人和陪护者工资损失进行分析,并经SPSS11．5统计软件来分析卒中单元的经济效益。结果 卒中单元较普通病房组神经功能缺损每减少1分,少花费707．51元,较普通病房日常生活能力评分能提高5分,少花费33．23元。结论 卒中单元能明显降低脑卒中患者的神经功能缺损提高日常生活能力,但所需的花费较普通病房患者少,卒中单元在改善患者结果上更为经济。     

Dysphagia in stroke patients

Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non-dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review.     

Magnesium in stroke treatment

Magnesium is involved in multiple physiological processes that may be relevant to cerebral ischaemia, including antagonism of glutamate release, NMDA receptor blockade, calcium channel antagonism, and maintenance of cerebral blood flow. Systemically administered magnesium at doses that double physiological serum concentration significantly reduces infarct volume in animal models of stroke, with a window of up to six hours after onset and favourable dose-response characteristics when compared with previously tested neuroprotective agents. Small clinical trials have reported benefit, but results are not statistically significant in systematic review. A large ongoing trial (IMAGES) will report in 2003-4 and further trials are planned.     

Dysphagia in acute stroke

A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke. The site of the present lesion and of any previous stroke was determined clinically and was confirmed by computed tomography of the brain or necropsy in 40 cases. Of 41 patients who had dysphagia on admission, 37 had had a stroke in one cerebral hemisphere. Only seven patients showed evidence of lesions in both hemispheres. Nineteen of 22 patients who survived a stroke in a hemisphere regained their ability to swallow within 14 days. Dysphagia in patients who had had a stroke in a cerebral hemisphere was associated in this study with a higher incidence of chest infections, dehydration, and death.     

缺血性卒中的脑血管影像学特点及与卒中进展的关系

目的 分析急性缺血性卒中的脑血管影像学特点,探讨进展性卒中的发病机制.方法 回顾性分析147例缺血性脑卒中患者的血管影像学(DSA、CTA)资料,观察有无脑供血动脉的狭窄、狭窄的位置、程度,根据神经功能是否恶化分为进展性卒中和非进展性卒中两组,对两组的血管影像学资料进行比较.结果 147例缺血性脑卒中患者有72例(48.98%)存在脑血管狭窄,其中单发狭窄47例(31.97%),多发狭窄25例(17.01%);27例(18.37%)出现卒中进展.进展性卒中与非进展性卒中相比,大脑中动脉狭窄、基底动脉狭窄及多发动脉狭窄的差异有显著性 (P<0.01).结论 大脑中动脉狭窄、基底动脉狭窄及颅内外动脉多发狭窄是缺血性卒中神经功能恶化的重要危险因素,可作为进展性卒中发生的预测指标之一.     

急性缺血性脑卒中病人医院感染与卒中复发风险研究

目的研究急性缺血性脑卒中(acute ischemic stroke, AIS)病人医院感染与脑卒中复发之间的关系。方法采用队列研究, 收集121例AIS病人基本资料, 随访收集病人卒中复发情况。Cox回归分析医院感染是否为脑卒中复发的独立危险因素。结果121例AIS病人中医院感染的发生率为19.8%(95%CI: 0.127~0.269), 卒中复发率为26.4%(95%CI: 0.185~0.343), 医院感染导致卒中复发的HR为6.485(95%CI: 2.984~14.091)。结论AIS病人医院感染可能是卒中复发的一个独立风险因素。     

应用卒中单元理念综合治疗脑卒中疗效评价

目的 评价应用卒中单元的理念,早期康复介入中西药并用综合治疗脑卒中的疗效.方法 选择270例急性脑卒中病例,将近年采用早期康复介入、中西药并用等综合治疗组(150例)与往年应用常规治疗的对照组(120例)进行疗效对比分析.结果 综合治疗组平均住院天数低于对照组(P＜0.05),治疗后神经功能缺损较对照组明显改善(P＜0.01);综合治疗组病死率显著低于对照组(P＜0.05).结论 应用卒中单元理念综合治疗急性脑卒中,对其神经功能恢复,降低病死率及致残率,提高生存质量,具有一定的意义.     

醒后卒中的影像学研究进展

我国最新居民致残和致死调查报告显示,卒中发病率高居首位,虽然近几年卒中致死率较前下降,但是因为疾病的致残性及后续康复带来的巨大社会支出,对卒中的探索及相关研究依然刻不容缓。急性缺血性卒中（acute ischemic stroke,AIS）占所有卒中的85%,醒后卒中（wake-up stroke,WUS）又占其中的20%左右。因在睡眠中发病,故具体发病时间不详。事实上,很多患者疾病发生在醒来前的很短时间,但治疗上却错失了溶栓或血管内治疗的机会,最终导致预后不良。目前针对WUS发病时间的研究越来越多,其中通过影像学手段推测WUS的发病时间指导其治疗尤为热门。本文对WUS的近期影像学研究进展作一综述。     

缺血性中风病机探析

中风病的致病原因,历代多有争议,现在“风、火、痰、瘀、气、虚”等病因被广大学者认同,但多强调气血逆乱.对于基本病机,观点不一,试参照历代医家对本病的病机认识,结合现代医学,探求缺血性中风病病因病机.     

中医特色卒中单元对缺血性脑卒中患者生活质量的影响

目的：观察中医特色卒中单元对缺血性脑卒中患者生活质量的影响。方法将70例患者随机分为治疗组和对照组。2组均采用卒中单元常规治疗,即降颅压、抗血小板聚集、脑保护、神经细胞营养剂和西医对症治疗,以及西医心理治疗、语言康复、肢体功能康复。治疗组予中医特色卒中单元———在组织管理上,参照正规卒中单元医疗模式的实施形式,结合自身实际情况整合最有效的中医资源,强调团队合作,明确工作任务;在治疗措施上,除了对患者实施脑卒中的上述西医常规治疗外,给予中医学的经典方药、中医心理疗法、养生保健指导、传统康复技术。2组按此方案治疗28 d。结果治疗28 d 后,治疗组在神经功能缺损程度（NIHSS）评分、Barthel 指数（BI）评定、抑郁自评量表（SDS）上均优于对照组,2组比较,P ＜0.05。结论中医特色卒中单元对缺血性脑卒中患者生活质量的提高具有良好的效果。     

The role of genetics in stroke

Stroke is a leading cause of death and disability in developed countries. While both modifiable and non-modifiable risk factors are acknowledged, studies have shown that these may account for just 50% of stroke risk and that other factors, including genetic ones, may be important. Over recent years family history, twin and candidate gene studies have supported this and various mendelian stroke syndromes have now been identified in humans. This article provides an up-to-date summary of the common single gene disorders associated with stroke as a principle manifestation, including their genetic basis, pathogenesis, presentation and suggested management. Often these disorders present with stroke at a young age; this article provides a practical approach to the management and investigation of a young stroke patient.     

卒中后抑郁的发生与卒中位置次数病灶个数的关系探讨

目的 探讨卒中后抑郁的发生与卒中位置、次数、病灶个数的关系.方法 选择120例急性脑卒中患者,在患者发病2周时,采用汉密尔顿抑郁量表(HAMD) 进行评分,分为卒中后抑郁组(post-stroke depression,PSD)和非PSD组.计算PSD的发生率,并比较2组患者的脑卒中的发病次数、发病部位,了解卒中位置与PSD发生的相关性.结果 PSD总的发生率为38.3%,其中轻度抑郁12例(26.09%),中度抑郁为24例(52.17%),重度抑郁10例(21.74%);卒中次数越多、卒中病灶个数越多,越容易发生PSD(P<0.05);从卒中位置来看,抑郁组和无抑郁组的卒中位置左侧明显高于右侧和双侧;多病灶患者PSD的临床发病率要高于单病灶患者.结论 卒中后抑郁的发生与卒中位置有关,与卒中次数、病灶个数呈正相关.     

Management of stroke

This article outlines the current evidenced based practice for stroke care. It outlines many of the recommendations in the National Clinical Guidelines for Stroke published by the Royal College of Physicians. It also covers all aspects of multidisciplinary stroke care from initial assessment and acute treatment to rehabilitation strategies and management of complications. The article concludes with an examination of the latest evidence for secondary prevention of cerebrovascular disease.