探究恢复期脑卒中患者注意力缺陷与平衡控制及跌倒的关系

目的探究恢复期脑卒中患者注意力缺陷与平衡控制及跌倒的关系。方法选取符合入选条件的恢复期脑卒中患者40例,调查受试者的跌倒情况,统计跌倒次数;通过划销测验评价受试者的注意力水平,计算出注意力持续性指数;用Berg平衡量表评价受试者的平衡控制能力。比较注意力持续性指数、Berg评分与跌倒之间的相关性,并比较无跌倒组和跌倒组的注意力持续性指数以及Berg评分有无显著性差异。结果40例受试者中有14例发生过跌倒,跌倒发生率为35%;注意力持久性指数与平衡评分呈正相关(r=0.550,P<0.01),注意力持久性指数与跌倒次数呈负相关(r=-0.458, P<0.01),平衡评分与跌倒次数呈负相关(r=-0.500, P<0.01);无跌倒组的注意力持续性指数和平衡评分明显高于跌倒组(P<0.01)。结论恢复期脑卒中患者跌倒的发生率较高;恢复期脑卒中患者注意力持续性水平与平衡控制能力有关;恢复期脑卒中患者注意力持续性水平减退和平衡控制能力下降均会增加患者的跌倒风险。     

胸段完全性脊髓损伤患者的三维步态分析

目的通过对胸段完全性脊髓损伤(TCSCI)患者配戴交互式步行矫形器(RGO)的三维步态分析,比较分析脊髓损伤(SCI)平面与步行能力之间的关系,探讨重建SCI患者步行能力的量化指标。方法选择在本中心住院且配戴RGO进行步行训练3个月以上的TCSCI患者10例,采用Vicon三维步态分析系统进行步态检测与分析。应用Spearman秩和相关系数对TCSCI患者的不同SCI平面与其步态的运动学和时空参数等的相关性进行统计学检验。结果步频和跨步长分别为(37.4±2.15) 步/min和(91.6±9.09) cm;髋关节摆动角度及髋关节伸展和屈曲时相的角速度分别为(42.57 °±5.43 °)、(20.88 °±2.18 °)/s和(124.75 °±9.31 °)/s。步速(r=0.80,P<0.01)、跨步长(r=0.78,P<0.01)、助行架的压力峰值(r=0.82,P<0.01)、髋关节摆动角度(r=0.77,P<0.01)、助行架的压力均值(r=-0.67,P<0.05)和髋关节伸展的角速度(r=0.75,P<0.05)与SCI平面之间均有显著的相关性。结论TCSCI患者双上肢过度负载和髋关节摆动幅度受限是其步行能力受限的主要原因;降低过度负载的康复训练方法有助于改善重建的步行功能。     

脑卒中患者康复初期应对方式与抑郁的相关性及护理对策

目的探讨脑卒中后住院康复患者入院初期的应对方式与抑郁的相关性。方法对入院1周内,符合入选标准的30例脑卒中康复期患者,以医学应对方式问卷(MCMQ)、抑郁自评量表（SDS）进行评定。结果抑郁组屈服分数明显高于非抑郁组（P<0.01)。两组面对和回避无显著性差异（P>0.05)。SDS评分与屈服评分相关(r=0.416, P=0.003)。结论脑卒中后住院康复患者入院初期抑郁情绪的产生与屈服因子有关。应采取对应的护理措施预防与缓解康复初期患者的不良情绪,提高康复的积极性。     

探讨脑卒中患者患侧负重情况与功能性移动能力的关系

目的探讨脑卒中患者患侧负重情况与功能性移动能力的关系。方法测量36例脑卒中患者患侧负重率及患侧最大负重率,进行“起立-行走”计时测试(Timed "Up and Go" Test, TUGT)及坐立测试(Sit-to-Stand Test)。用Spearman相关性分析方法对患侧负重率小于50%的患者患侧最大负重率与TUGT和坐立测试所用时间的相关性进行统计学分析。结果患侧最大负重率与TUGT所用时间呈负相关(r=-0.605,P<0.01),与坐立测试所用时间呈负相关(r=-0.456,P<0.05)。结论脑卒中患者患侧负重情况与功能性移动能力有高度相关性。     

急性缺血性脑卒中动脉溶栓中血管再闭塞的临床分析

目的:研究急性缺血性脑卒中动脉溶栓后再通动脉出现再闭塞的危险因素和其对预后的影响.方法:回顾性分析我院56例发病3～6 h内的颈内动脉系统急性缺血性脑卒中患者的临床和影像学资料,使用重组组织型纤溶酶原激活剂(rtPA)行动脉溶栓治疗,观察闭塞血管再通和发生再闭塞的情况.结果:血管造影显示颈内动脉闭塞26例,大脑中动脉闭塞30例.动脉溶栓后起初血管再通率为78.6%.再闭塞率为20.5%.稳定再通者3个月时预后良好率(modified Rankin Score 0～2)明显高于发生再闭塞者(80%与33.3%)(P=0.012).对两组患者单因素组间比较差异有统计学意义的变量进行多因素Logistic回归分析显示基线NIHSS评分≥16分(P=0.018)和动脉溶栓后仅获得部分再通(P=0.035)可能是血管再闭塞的独立危险因素.结论:基线NIHSS评分≥16分或动脉溶栓后仅获得部分再通的急性缺血性脑卒中患者易于发生再闭塞,再闭塞者预后不良.     

磁共振血管造影检查在急性缺血性卒中早期诊断中的意义

目的:探讨急性缺血性卒中患者早期进行磁共振血管造影(magnetic resonance angiography,MRA)检查的意义。方法:依据血管病变将145例急性缺血性卒中患者分为2组:大血管闭塞组(n=83)和无大血管闭塞组(n=62)。采用Rankin量表(modified Rankin scale,mRS)评分评价患者的神经功能,比较2组的预后。结果:第3个月和第6个月随访时,大血管闭塞组患者mRS评分显著高于无大血管闭塞组;无大血管闭塞组mRS 0～2分患者所占比例均显著高于大血管闭塞组患者,分别为82.26%(51/62)比28.92%(24/83)和83.33%(50/60)比28.21%(22/78),差异具有统计学意义(P<0.005)。结论:急性缺血性卒中患者早期行MRA检查具有重要意义,可在一定程度上评估患者预后。     

血浆脑钠肽水平与急性缺血性脑卒中预后的相关性研究

目的:探讨血浆脑钠肽(BNP)与急性缺血性脑卒中预后的相关性。方法:急性缺血性脑卒中患者212例,依据住院期间是否死亡分为存活组和死亡组,比较2组相关临床资料,并分析血浆BNP和美国国立卫生研究院卒中量表(NIHSS)评分与预后的相关性。结果:急性缺血性脑卒中患者住院期间的预后死亡率为15.09%(32/212);多因素分析结果显示房颤(OR=3.819)、大面积脑梗死(OR=6.228)、血浆BNP浓度≥280 ng/L(OR=5.191)、NIHSS评分≥13分(OR=3.536)为脑卒中预后死亡的独立危险因素;NIHSS评分≥13分筛查预后的灵敏度、特异度、准确度分别为89.1%、75.0%、87.0%;血浆BNP≥280 ng/L筛查预后的灵敏度、特异度、准确度分别为85.0%、81.3%、84.4%。结论:房颤、大面积脑梗死、血浆BNP水平及NIHSS评分为急性缺血性脑卒中预后死亡的高危因素,其中血浆BNP水平和NIHSS评分可能可作为预后死亡的预测指标。     

中老年缺血性脑卒中患者康复治疗前后的弥散张量成像研究

目的利用磁共振弥散张量成像(DTI)研究中老年脑梗死患者脑白质纤维束各向异性特征和皮质脊髓束(CST)受损与临床预后的关系。方法24 例中老年单侧急性脑梗死患者,依年龄段分为A组(45～59 岁)、B 组(60～74 岁)和C 组(75 岁以上),每组各8 例。患者于发病3 d 内行3.0 T 常规磁共振(MRI)和DTI 检查。于入院时和发病后6 周,分别测量梗死灶和对侧相应正常脑组织的部分各向异性值(FA),同时采用美国国立卫生院脑卒中量表(NIHSS)进行神经功能缺损评分,并运用弥散张量纤维束成像(DTT)显示通过病灶的纤维束特征,评价脑梗死区周边纤维束的情况,并与神经功能缺损程度进行比较。结果各组患者梗死侧FA值均较对侧相应正常脑组织降低(P<0.05),康复治疗6 周后梗死侧的FA值均比入院时增加(P<0.05)。各年龄组患者CST 2 级的NISHH评分均高于CST 1 级(P<0.05)。在同组同一CST 级别的患者发病后6 周NIHSS 评分均低于入院时NIHSS 评分(P<0.05)。结论DTT 可直观显示纤维束走行及与病灶之间的关系,在缺血性脑卒中的早期即可对其损伤情况进行判定,同时也可提示患者的预后,对患者的康复治疗具有一定的指导意义。     

单中心急性前循环大血管闭塞性醒后脑卒中血管内治疗有效性与安全性研究

目的探讨急性前循环大血管闭塞性醒后脑卒中血管内治疗的安全性及有效性。方法收集急性前循环大血管闭塞性缺血性脑卒中患者,以CT血管成像(CTA)证实颈内动脉或大脑中动脉M1段闭塞、Alberta脑卒中项目早期CT(ASPECT)评分≥6分及美国国立卫生研究院卒中量表(NIHSS)评分≥6分为主要入组标准,以术后24 h及术后7 d NIHSS评分评估患者神经功能缺损改善程度,以术后90 d改良Rankin量表(mRS)评分评估患者预后。按发病时间分为醒后卒中组和非醒后卒中组,比较2组基线资料、手术相关特征、术后脑出血率、术后90 d病死率、术后24 h及术后7 d NIHSS评分、术后90 d预后良好患者比例。结果共纳入53例急性前循环大血管闭塞性缺血性脑卒中患者,其中醒后卒中组18例、非醒后卒中组35例。醒后卒中组与非醒后卒中组的年龄、性别构成、脑卒中危险因素、入院NIHSS评分、脑卒中病因学分型、ASPECT评分比较差异均无统计学意义(P均> 0.05)。醒后卒中组术前静脉溶栓患者的比例低于非醒后卒中组(11%vs. 57%,P <0.05),2组的入院至穿刺时间、责任血管...     

围绝经期妇女压力性尿失禁的康复治疗分析

目的探讨围绝经期妇女压力性尿失禁的康复治疗方法。方法选取60例围绝经期压力性尿失禁妇女进行治疗,随机分为A组、B组和C组,每组20例。A组给予盆底锻炼,即Kegel训练;B组联合雌激素局部治疗;C组联合低频电刺激联合生物反馈治疗。结果尿失禁量与Kupperman评分呈正相关(r=0.752,P<0.01)。与治疗前比较,治疗1个月、3个月后Kupperman评分A组、B组、C组均明显降低(P<0.01);治疗1个月后,A组与B组比较差异无统计学意义;C组Kupperman评分明显降低(P<0.01),治疗3个月后进一步降低(P<0.01)。与治疗前比较,治疗1个月、3个月后尿失禁量A组、B组、C组均明显降低(P<0.01);A、B两组比较,尿失禁量治疗1个月、3个月后差异无统计学意义(P>0.05);C组与A、B两组比较,治疗1个月,3个月后尿失禁量明显降低(P<0.01)。结论盆底锻炼、低频电刺激联合生物反馈疗法可以明显减轻围绝经期妇女压力性尿失禁的症状。     

头颈部CT血管造影对急性缺血性脑卒中早期的诊断价值

目的:分析应用头颈部非创伤性血管成像技术(简称CT血管造影)(CT angiography,CTA)实施颈动脉狭窄诊断对于急性缺血性脑卒早期诊断的应用价值.方法:选取2020年5月—2021年5月宁津县人民医院收治的50例疑似颈动脉狭窄急性缺血性脑卒中患者,对入组患者均实施头颈部CTA扫描及颈部血管彩超,对比数字减影血...     

急性缺血性卒中超早期不同梗死部位分型的临床特征及预后

目的研究急性缺血性卒中超早期不同梗死部位分型的临床特征及预后。方法选择发病后6h内完成核磁弥散成像（DWI）的大脑中动脉供血区脑梗死患者87例，根据DWI异常表现分为6型，核磁检查前及发病24h后评估美国国立卫生研究院卒中量表（NIHSS）评分，3月后随访改良的Ranking量表（mRS）评分。结果不同梗死部位分型组间，基线NIHSS评分、梗死体积、病变侧颈内或大脑中动脉的闭塞情况及临床结局均有显著性差异（P〈0．05）。结论急性缺血性卒中超早期不同梗死部位分型同临床症状、血管状况及临床结局都存在密切关系，有助于指导临床治疗及判断预后。     

Statin pre-treatment is associated with lower platelet activity and favorable outcome in patients with acute non-cardio-embolic ischemic stroke

Introduction

Statins reportedly have anti-inflammatory and anti-thrombotic effects aside from cholesterol-lowering. This study aimed to evaluate the effect of pre-existing statin use on platelet activation markers and clinical outcome in acute ischemic stroke patients.

Methods

This prospective study evaluated 172 patients with acute ischemic stroke divided in two groups: patients with pre-existing statin (n = 43) and without pre-existing statin (66 cases with statins initiated post-stroke and 63 without statin treatment). Platelet activation markers (CD62P and CD63) were measured by flow cytometry at different time points after stroke and analyzed with clinical outcome.

Results

The CD62P and CD63 expressions on platelets were significantly lower in the patients with pre-existing statin use compared to the patients without pre-existing statin use on Day 1 post-stroke (p < 0.05). The CD62P expression was significantly lower in the patients with pre-existing statin use on 90 days after the acute stroke (p < 0.05). Patients with pre-existing statin use had lower incidences of early neurologic deterioration (END) than those without treatment (p < 0.05). Among several baseline clinical variables, admission NIHSS score, history of coronary artery disease, and pre-existing statin use were independent predictions of good clinical outcome at three months.

Conclusions

Pre-existing statin use is associated with decreased platelet activity as well as improved clinical outcome and reduced END in patients with acute ischemic stroke.     

Expedited computed tomography perfusion and angiography in acute ischemic stroke: a feasibility study

Background

Acute ischemic stroke diagnosis and treatment are among the most challenging in Emergency Medicine. Perfusion computed tomography (CTP) can increase the sensitivity for detecting ischemic stroke and, especially with the addition of CT angiography (CTA), improve decision-making regarding thrombolytic therapy compared to non-contrast computed tomography (NCCT) alone. However, because acute stroke protocols do not generally include procedures for multimodal imaging, they are not commonly performed. In addition, there is concern that additional studies could delay or preclude therapy in patients otherwise eligible for thrombolytic therapy.

Objectives

To demonstrate the feasibility of perfusion CTP and CTA in addition to NCCT of the brain in the emergency assessment of patients with acute ischemic stroke. Methods: Starting January 2008, multimodal (CTP and CTA) imaging was added to NCCT in the Emergency Department (ED) initial assessment of patients with stroke of ≤ 5 h duration. Over the subsequent 9 months, we measured the time from ED arrival to imaging and to recombinant tissue plasminogen activator (rt-PA) treatment and compared these times to patients evaluated with CT alone.

Results

From January to October 2008, 95 patients had CTP and CTA studies in addition to NCCT for acute ischemic stroke. There were no differences between the average time to CT study or to rt-PA treatment between patients evaluated with multimodal CT imaging and patients assessed with NCCT alone.

Conclusions

Combining CTP and CTA with NCCT is feasible and does not adversely increase the time to CT imaging or rt-PA treatment in patients with acute ischemic stroke.     

高龄非糖尿病急性脑梗死患者入院随机血糖水平与临床结局关系的倾向值评分

目的:探讨入院随机血糖水平与高龄急性脑梗死非糖尿病患者临床结局的关系。方法:连续性纳入2013年1月至2016年6月在南京大学医学院附属泰康仙林鼓楼医院与解放军南京总医院老年医学中心住院治疗年龄≥80岁的急性脑梗死非糖尿病患者。收集患者的临床资料。分别以临床结局(住院期间的病死率)和入院血糖水平为区组和干预变量,采用倾向值评分重新抽取组间协变量匹配的配对样本,并评估入院血糖水平对临床结局的影响。结果:根据临床结局,将患者分为生存组459例,死亡组294例。与生存组比较,死亡组既往卒中史显著降低,而高脂血症、贫血、高血压病、卒中后感染比例及NIHSS评分、C反应蛋白水平与住院时间显著升高(P<0.05);两组间血糖水平差异无统计学意义(P=0.11)。多因素logistic回归分析显示:血糖水平与临床结局无相关性,但NIHSS评分、高血压病史、贫血及卒中后感染是死亡的危险因素(均P<0.05)。倾向值评分匹配分组后结果显示随机血糖水平两组间差异无统计学意义(P=0.48)。结论:急性脑梗死非糖尿病患者入院血糖水平可能并不增加住院死亡风险。     

Circulating endothelial microparticles in acute ischemic stroke: a link to severity, lesion volume and outcome

BACKGROUND: Endothelial membrane microparticles (EMP) in plasma are elevated in several vascular diseases. OBJECTIVES: To test the hypothesis that EMP would be increased in patients with acute ischemic stroke and would correlate with stroke severity, brain lesion volume and outcome. PATIENTS AND METHODS: Forty-one patients were studied and divided into two groups based on the National Institutes of Health Stroke Scale (NIHSS) score: 20 patients with mild stroke (NIHSS score < 5) and 21 patients with moderate-severe stroke (NIHSS score > or = 5). Lesion volume was measured using diffusion-weighted magnetic resonance imaging and discharge outcome was based on the discharge Barthel and Rankin scores. Twenty-three age-matched control subjects were also studied. Using flow cytometry, endoglin-positive EMP: CD105+ CD41a-CD45- (E(+)EMP), specific endothelial EMP expressing VE-cadherin and endoglin: CD105+CD144+ (C(+)EMP), EMP expressing phosphatidylserine: CD105+PS+ CD41a- (PS(+)EMP) and EMP expressing ICAM-1: CD105+CD54+ CD45- (I(+)EMP) were analyzed. RESULTS: Significantly higher PS(+)EMP counts were observed in the group of acute ischemic stroke patients [median 59 (25th-75th percentile: 28-86) MP microL(-1)] relative to the controls [28 (14-36) MP microL(-1)] (P = 0.002). All four EMP phenotypes studied were elevated in the subgroup of moderate-severe stroke patients relative to the controls (all P < 0.05). In the patients with acute ischemic stroke three EMP phenotypes (E(+)EMP, PS(+)EMP and I(+)EMP) correlated significantly with brain lesion volume, with I(+)EMP (P = 0.002) showing the strongest correlation. Admission counts of C(+)EMP (P = 0.0003) and E(+)EMP (P = 0.003) correlated significantly with discharge clinical outcome. CONCLUSIONS: Certain circulating EMP phenotypes may be associated with severity, lesion volume and outcome of acute ischemic stroke. EMP analysis shows promising contribution to understanding stroke pathophysiology.     

阿替普酶静脉溶栓治疗急性脑梗死预后的影响因素分析

目的:分析影响阿替普酶(重组组织型纤溶酶原激活剂,rt-PA)静脉溶栓治疗急性脑梗死预后的因素。方法:接受rt-PA静脉溶栓治疗的46例急性脑梗死患者按治疗后第90日改良Rankin量表(mRS)评分,分为预后良好组(mRS评分0～1分)及预后不良组(mRS评分2～6分),比较两组患者的临床资料,采用Logistic回归分析影响预后的危险因素。结果:预后良好组(19例)与预后不良组(27例)相比,合并房颤率低(P=0.031),溶栓前血糖较低(P=0.001),CT示早期缺血率低(P=0.043),溶栓前美国国立卫生研究院卒中量表(NIHSS)低(P=0.001),发病至溶栓开始的时间短(P=0.001)。Logistic回归分析表明溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是预后的独立预测因素。结论:溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是影响rt-PA静脉溶栓治疗急性脑梗死预后的独立预测因素。     

全脑血管造影未见血管阻塞的急性脑梗死患者的临床预后

目的:探讨起病1周内全脑血管造影(DSA)未见血管阻塞的急性脑梗死患者的临床预后。方法:急性脑梗死患者260例,在发病1周内完成全脑血管DSA和头颅CT、MRI检查,采用NI HSS量表评估入院时病情,改良Rankin量表(mRS)评估患者3个月时的预后,mRS≤2分视为预后良好,并对影响患者预后的危险因素进行多因素logistic回归分析。结果:260例患者中,发病1周内全脑血管DSA正常者96例(37%),其中头颅MRI显示有相应梗死灶93例(97%),发病1周内脑血管自然再通率为18%(46/260)。脑血管DSA未见血管阻塞的患者3个月时预后良好者67例(70%)。多因素logistic回归分析显示,入院时NI HSS评分[OR=0.231(0.080～0.811),P=0.013]、是否为大面积脑梗死[OR=0.171(0.062～0.725),P=0.006]显著影响患者3个月时的预后。结论:起病1周内急性脑梗死患者血管的再通率为18%,DSA检查显示无血管阻塞的患者为37%,其中70%的患者预后良好,入院时的病情及脑梗死面积是影响患者3个月预后的主要因素。     

对急性缺血性脑卒中患者基于多学科协作诊疗干预的效果观察

目的 探讨多学科协作诊疗干预在急性缺血性脑卒中患者中的应用效果。方法 选取2019 年1 月1 日—2020 年6月 30 日某三级甲等医院介入手术室治疗的68 例急性缺血性脑卒中患者,在多学科协作诊疗干预前后时间段分别取样分组,对照组33例和观察组35 例;对照组实施常规措施,观察组在此基础上实施多学科协作诊疗干预;观察比较2组患者入院-溶栓时间、入院-股动脉穿刺时间、转诊时间和待手术时间;术后2组患者的致死率、致残率、神经功能损伤评分及患者就诊满意度。结果 观察组患者的入院-溶栓时间、入院-股动脉穿刺时间、转诊时间和待手术时间均短于对照组（P<0.001）;观察组患者的致残率和神经功能缺损评分均低于对照组（P<0.05）,2组患者致死率差异无统计学意义（P>0.05）;除医疗环境外,观察组对医护服务态度、团队业务能力、护理应急能力及主动性、沟通交流、健康教育和患者需求方面的评分均高于对照组（P<0.001）。结论 对急诊介入手术脑卒中患者实施基于多学科协作诊疗干预,可提高抢救患者的工作效率,改善患者临床救治结局,提高患者就诊满意度。     

Allopurinol as a Preventive Contrivance after Acute Ischemic Stroke in Patients with a High Level of Serum Uric Acid: A Randomized,Controlled Trial

Objectives

To assess the clinical relevance (functional outcome) of a 3-month allopurinol regimen in patients with high serum uric acid (SUA) levels and acute ischemic stroke without considering the changes in SUA levels.

Materials and Methods

In a randomized, double-blind, controlled study, 70 patients (45 females, 25 males) with acute ischemic stroke who had elevated levels of SUA were included. They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol (200 mg/day) regimen versus placebo on their functional outcome, which was evaluated using a modified Rankin scale.

Results

The overall mean age was 68.9 ± 11.33 years (range 27-89). The final favorable functional status (mRS = 0-2) was 23 (65.7%) and 14 (40.0%) in the treated and placebo groups, respectively, which was strongly associated with allopurinol consumption (OR = 4.646, p = 0.014) and age ≤70 years (OR = 0.139, p = 0.005) in patients with ischemic stroke after adjusting for confounders. There was no significant difference in death between allopurinol-treated cases (3; 8.6%) and placebo-treated ones (6; 17.2%; p = 0.278).

Conclusion

Allopurinol treatment was well tolerated and improved the 3-month functional status of patients with acute ischemic stroke who had high levels of SUA without considering the decreasing effect of allopurinol on SUA.Key Words: Acute ischemic stroke, Allopurinol, Xanthine oxidase inhibitor, High serum level of uric acid, Modified Rankin scale, Functional outcome, Survival