逍遥散加味治疗脑卒中后情感障碍98例

目的 观察逍遥散加味治疗脑卒中病人情感障碍的临床疗效。方法 将98例脑卒中后情感障碍的病人随机分为两组治疗组在常规治疗的基础上予以心理、抗抑郁焦虑药物、逍遥散加味治疗，对照组采用西医常规治疗。病人治疗前后进行抑郁自评量表（SDS）、焦虑自评量表（SAS）、汉密顿抑郁量表（HAMA）、脑卒中量表（CSS）的测定并进行对比分析。结果 两组治疗后各量表积分均较治疗有明显下降（P〈0．01），且治疗组明显优于对照组（P〈0．05）。结论 逍遥散加味配合西药治疗脑卒中后的情感障碍临床疗效确切。     

中西医治疗脑卒中后情感障碍138例

目的观察中西医治疗脑卒中后情感障碍的临床疗效。方法将138例符合入选标准的病人随机分为治疗组87例与对照组51例。治疗组根据辨证分型，每日服用中药1剂，早晚分服，每周服用5剂；对照组服用氟西汀片20mg，每日1次，或氯氮平片25mg，每日3次，两组均以8周为1个疗程，治疗1个疗程后进行疗效评定。结果治疗组总有效率为79，31％；对照组总有效率为45．10％，两组比较具有统计学意义（P〈0．01）。结论中医辨证分型治疗脑卒中后情感障碍不仅避免西药的副作用，而且疗效稳定可靠。     

早期干预脑卒中后情感障碍对患者预后的影响

脑卒中患者情感障碍的发生率较高 ,据报道抑郁状态发生率为 2 0 %～ 6 0 %,焦虑为 19%～ 40 %。我们对 2 42例急性脑卒中早期出现情感障碍患者采取干预措施并观察其预后。现报告如下。资料与方法 :本组男 134例 ,女 10 8例 ;平均年龄 (6 1.0±7.10 )岁。原发病为脑出血 114例 ,脑梗死 12 8例 ,符合第四届全国脑血管病会议制定的诊断标准和《中国精神障碍分类与诊断标准》(第三版 ) ,且经头颅 CT或 MRI检查证实诊断 ,排除痴呆、感觉性失语、耳聋、意识障碍等所致的情感障碍 ,病前无抑郁、焦虑症史。情感障碍类型为抑郁 115例 ,焦虑 12 7例…     

老年脑卒中后抑郁障碍的临床对比分析

目的 评价老年脑卒中患者抑郁障碍的发病率、病变部位、神经功能缺陷程度、病程及相关危险因素。方法 应用老年抑郁自评量表(SD)对老年脑卒中及中年脑卒中两组病人进行抑郁评估及加拿大神经功能缺陷量表(CNS)对两组病人进行神经功能缺陷评估，并通过脑CT、MRI及危险因素合并情况对两组病人的病变部位与抑郁发生相关性进行对比。结果 老年脑卒中抑郁障碍的发病率为58.82％明显高于中年人(41．55％)，老年女性更高(68．57％)。额叶、颞叶、基底节病变及多发性脑梗死抑郁发病率明显增高，与神经功能缺陷程度及恢复的时间相关，相关危险因素多抑郁发生率高。结论 老年脑卒中后抑郁障碍与病变部位、神经功能缺陷程度、病程、相关危险因素密切相关。     

早期干预脑卒中后情感障碍对患者神经功能康复及日常生活能力的影响

目的探讨早期干预脑卒中后情感障碍对患者神经功能康复及日常生活能力的影响。方法采用抑郁自评量表（SDS）、焦虑自评量表（SAS）对157例急性脑卒中患者进行筛查,其中出现抑郁、焦虑患者为58例,将58例抑郁/焦虑患者随机分成两组,治疗组患者入院时即应用抗抑郁/焦虑药物治疗,2周、4周及8周后,采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、神经功能缺损评分量表及日常生活能力Barthel指数进行效果评定,并与对照组进行比较。结果治疗组的各项评分均优于对照组,差异均有统计学意义（P〈0.05）。结论早期干预脑卒中后情感障碍可促进患者神经功能康复及日常生活能力提高。     

脑卒中急性期抑郁焦虑障碍多因素分析

目的研究脑卒中急性期抑郁焦虑障碍的发生情况及其相关因素.方法采用脑血管病诊断标准、CCMD-3诊断标准中关于脑器质性精神障碍的诊断标准以及相关量表(SDS、SAS、HAMD、HAMA、DNF、ADL和伴发疾病量表)和一般情况调查表,对109例观察对象调查、评估和诊断.根据诊断分组,并比较分析脑卒中急性期抑郁焦虑的相关因素.结果脑卒中急性期抑郁焦虑障碍51例(46.79%),相关性因素有既往情感障碍病史或家族史、内向个性与神经功能缺损程度、日常生活能力、伴发疾病、家庭关系及近期负性生活事件等7个因素.结论脑卒中急性期情感障碍因素,主要为生物学因素和社会心理学因素两大类.     

脑卒中假性球麻醉患者情感障碍的类型及饮食的干预

目的：研究脑卒中患合并假性球麻痹时情感障碍的类型、伴有吞咽困难患饮食的护理方法及饮食的干预对日常生活能力（ADL）的影响。方法：58例伴有吞咽困难的患随机被分为观察组（27例）和对照组（28例），观察组除积极采用康复程序训练外，早期介入饮食干预，对照组则单纯采用康复训练。结果：58例患均有不同程度的情感障碍，其中抑郁69％（40／58），痴呆19％（11／58）；出现吞咽困难55例，其中重度18例（32．7％），中度21例（38．18％），轻度16例（29．1％）；第1次发病25例，第2次发病21例，第3次发病9例。发病次数越多，吞咽困难程度越高，且出现时间越早（P＜0．01）。康复训练结束出院时两组Barthel指数较康复开始时明显提高（P＜0．01），但观察组的提高幅度优于对照组，两组间有显性差异（P＜0．01）。结论：脑卒中必须早期预防与治疗，对伴有吞咽困难的患应早期介入饮食干预，以提高康复训练的效果，同时应注重心理康复。     

老年脑卒中患者睡眠障碍的临床分析

老年睡眠障碍是卒中后的常见继发症状，不仅影响患者的神经功能恢复，还会加重那些引起脑卒中危险因素如高血压、糖尿病等疾病的症状，而且有损于身心健康、生活质量。虽然临床上发病率较高，但未受到临床医生的广泛重视，为了加强对卒中患者睡眠障碍的认识及干预治疗，现分析如下。     

老年脑卒中的临床与相关因素分析

随着人口老龄化和医疗科学技术的发展,老年脑卒中的诊断率及早期治愈正在逐年提高,老年脑卒中后致残高,严重影响老年人的生活质量,给家庭和社会带来巨大的精神和经济负担。为此本文将2001年12月～2002年12月期间因脑卒中住大华医院病房进行诊治的老年病历作一回顾性分析。材料和方法收集2001年12月～2002年12月在大华医院住院进行诊治的老年脑卒中共109例。脑出血病人需除外由外伤,血管畸形或脑部手术损伤等因素引起的病例。老年脑卒中的诊断,均按《内科治疗常规》犤1犦,并具有头颅CT或MRI证实。本文着重讨论其发病类型、性别、年龄、危险…     

Alcoholism and Affective Disorder

From January to November 1980, 421 consecutive new patient admissions to a large alcohol treatment facility were interviewed and diagnosed using the Affective Disorder Section of the Research Diagnostic Criteria. The patient population was divided into two groups based on the presence of an affective disorder diagnosis. The groups identified at the highest risk for concurrent affective disorder among alcoholic inpatients were females ages 20 through 30 and not presently married individuals. Implications of these findings are further discussed.     

Risk of Stroke in Patients with ESRD

Background and objectives

This study aimed to determine absolute and excess stroke risks in people with ESRD compared with the general population.

Design, setting, participants, & measurements

This cohort study used data linkage between the Australia and New Zealand Dialysis and Transplant Registry and hospital and death records for 10,745 people with ESRD in New South Wales from 2000 to 2010. For the general population, Australian Institute of Health and Welfare hospital usage records and Australian Bureau of Statistics census data were used. Rates and standardized incidence rate ratios of hospitalization with a stroke were calculated.

Results

People with ESRD had 640 hospitalizations with stroke in 49,472 person-years of follow-up (1294 per 100,000 person-years), and people in the general population had 338,392 hospitalizations with stroke (212 per 100,000 person-years), an incidence rate ratio of 3.32 (95% confidence interval, 3.31 to 3.33). Excess risk was greater for women (incidence rate ratio, 5.14; 95% confidence interval, 5.11 to 5.18) than men (incidence rate ratio, 2.52; 95% confidence interval, 2.51 to 2.54; P for interaction <0.001) and decreased with age. People ages 35–39 years old with ESRD had an 11 times increased risk of stroke (incidence rate ratio, 11.08; 95% confidence interval, 9.41 to 13.05), and risk in people ages ≥85 years old increased 2-fold (incidence rate ratio, 2.04; 95% confidence interval, 1.87 to 2.23; P for interaction <0.001). Excess risk was greater for intracerebral hemorrhage (incidence rate ratio, 4.18; 95% confidence interval, 4.11 to 4.26) than ischemic stroke (incidence rate ratio, 3.43; 95% confidence interval, 3.40 to 3.45; P for interaction <0.01).

Conclusions

People with ESRD have a substantially higher risk of stroke, particularly women and young people, and hemorrhagic stroke. Future work could investigate effective and safe interventions for primary and secondary prevention of stroke in people with ESRD.     

Nutritional Status in Patients with Acute Stroke

ABSTRACT By measuring three anthropometric variables (relative weight, triceps skinfold thickness and arm muscle circumference) and three circulating proteins (albumin, transferrin and prealbumin), nutritional status was assessed in 100 consecutive patients with acute stroke. On admission to hospital, two or more indicators showed subnormal values for 16%; this was associated with the female sex, high age and a history of atrial fibrillation. At discharge, 22% had two or more subnormal indicators. Poor nutritional status during the hospital stay appeared to be related to infections, the male sex, the intake of cardiovascular drugs and high age. Fewer of the patients with two or more subnormal nutritional indicators were able to return home than of the patients with none or one subnormal nutritional indicator. We conclude that undernutrition is not uncommon at the onset of stroke and that certain risk groups for the development of undernutrition during hospital stay can be identified.     

艾司西酞普兰在治疗抑郁症中的应用

艾司西酞普兰结合高亲和力和低亲和力两种蛋白位点,故起效比其它选择性5-羟色胺回收抑制剂为快,效果优于西酞普兰和帕罗西汀,与舍曲林、文拉法辛和安非他酮效果相似,本文对艾司西酞普兰在治疗抑郁症中的作用作一综述。     

Aids and Orthoses in Patients with Stroke Consequences

The presence of alterations in the muscular tone and in the normal motorial synergies at an articular level causes interferences in the functional recovery of patients with stroke consequences. In the rehabilitative field there are some aids that are useful to replace the compromised functions and to make the patient as autonomous as possible in the common movements of the everyday life. The orthoses are used mainly in two cases: to prevent and/or to contain myofascial retractions (spasticity passive component) and to improve the neuromuscolar control of movement through integration of a partially or totally insufficient function. Hemiparesis patients mainly show synergy alteration of the heel muscles and especially of the peroneus, with the consequent tendency of equinism-supination deviation. Analysis of literature shows a scientific validation especially in the use of dynamic orthoses of legs, the most known being the ankle-foot-orthoses.     

卒中后运动障碍的康复

运动功能障碍是卒中患者的常见症状 ,严重影响患者的生活质量。因此 ,进行积极、及时的康复治疗十分重要。文章介绍了卒中康复的理论基础、时机、方法和注意事项。     

Recurrent Stroke Incidence and Etiology in Patients with Embolic Stroke of Undetermined Source and Other Stroke Subtypes

Aims: This study aimed at clarifying the incidence of recurrent stroke and its etiology in patients with embolic stroke of undetermined source (ESUS) and other stroke subtypes in both the acute and chronic periods. Methods: A total of 645 patients who were admitted with acute ischemic stroke (IS) between March 2015 and August 2019 were enrolled. Among them, 511 patients with ESUS, cardioembolism (CE), large artery atherosclerosis (LAA), or small vessel disease (SVD) were analyzed in this study. After discharge, 391 patients who visited the outpatient clinic were followed up until August 2020. The outcome was stroke recurrence. Results: In the acute admission, recurrence rates were 7.6%, 8.1%, 18.8%, and 2.2% in patients with ESUS, CE, LAA, and SVD, respectively, and there were significant differences between the groups. The subtype of recurrence was almost identical to that of the index stroke. In the outpatient clinic, the annual recurrence rates were 4.4%, 4.3%, 6.0%, and 2.9% in ESUS, CE, LAA, and SVD, respectively, and no difference was observed. Subtypes of recurrence in outpatients with ESUS included ESUS, intracerebral hemorrhage (ICH), and SVD. Patients with ESUS and SVD had a higher risk of ICH during follow-up. Conclusions: Although the risk of recurrence was comparable between patients with ESUS and CE and intermediate between patients with LAA and SVD, in the acute admission unit, the risk in outpatients was similar among all subtypes. ESUS was the most recurrent stroke subtype in outpatients with ESUS. The risk of hemorrhagic stroke was significant in patients with SVD and ESUS.     

Monosomy 7 in Two Patients with a Myeloproliferative Disorder

Clinical and laboratory data are presented for two patients with a dyshaematopoietic disorder, and monosomy 7 in their bone marrow cells. The first patient, a 55-year-old woman, had been treated with chlorambucil for an ovarian carcinoma. After 4 years an oligoblastic myeloid leukaemia was diagnosed and she later died with an acute transformation of the disease. The second patient, a 21-year-old male, has had a dyserythropoietic anaemia with transient pancytopenia for over 5 years without any signs of malignancy. The possible relationship between therapy, the monosomy 7 and the other bone marrow abnormalities is briefly discussed. From an analysis of the data of these and comparable cases in the literature it appears that loss of chromosome No. 7 material is often associated with erythropoietic disorders such as erythroid hyperplasia and erythraemia. The reduction or absence of the Colton blood group antigens found in our patients and in a few other monosomy 7 cases also points to an abnormality of the red cell line.     

Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus

Objective The underlying pathophysiology varies according to stroke subtype. However, stroke heterogeneity among patients with systemic lupus erythematosus (SLE) remains unstudied. We hypothesized that the contribution of SLE to stroke might vary according to its subtype and investigated the associations of SLE and various stroke subtypes. Methods Diagnostic codes and electronic medical records were used to identify 70 patients with SLE who developed acute cerebral infarction or intracerebral hemorrhaging at four tertiary referral hospitals between 2008 and 2018. Intracerebral hemorrhaging was classified as lobar or deep, while cerebral infarction was classified according to the SSS-TOAST criteria. Physician notes were used to identify SLE activity, and their prevalences were compared among stroke subtypes. Outcomes were collected from the patients'' medical records. Results The most common stroke subtype in patients with SLE was that of undetermined causes (31%), followed by small artery occlusion (16%), cardioaortic embolism (13%), other causes (11%), lobar hemorrhaging (10%), deep hemorrhaging (10%), and large artery atherosclerosis (9%). Stroke onset occurred during a period of high SLE activity in 21 patients (30%). The proportion of patients with high SLE activity varied according to stroke subtype (p=0.039) and was highest for cerebral infarction with undetermined causes. Stroke recurrence or death was observed in 40% of patients within 5 years after the initial stroke onset. Conclusion The contributions of SLE to stroke varied significantly according to the stroke subtype. Given the unfavorable prognosis, close stroke subtype-specific observation by rheumatologists and stroke specialists is recommended after stroke events.