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.     

脑卒中后吞咽障碍的针灸康复思路探析

针刺治疗结合康复训练对促进脑卒中后吞咽障碍患者吞咽功能的恢复、改善生命质量具有重要意义。中医辨证辨经相结合,吞咽功能及时筛查与系统评估相结合,整体察病,对脑卒中后吞咽障碍患者的全面评估及康复治疗有重要的指导意义。可根据吞咽分期五期模式分期论治：认知期阴阳失调,窍闭神匿,治神为本,取之督脉;口腔准备期和口腔期清窍失养,气血阻滞,取之阳明;咽期脉络闭阻,气机不通,辨证取穴;食管期邪实渐去,精血耗伤,故以补为用,取之阳明;辅以康复运动疗法,针灸与康复并举。     

Thrombolysis in acute ischaemic stroke

In conclusion, thrombolysis with rtPA given within six hours of the onset of stroke in carefully selected patients is a safe therapy. However, efficacy has only been demonstrated within three hours after stroke onset. At present, only 6%-12% of all stroke patients are likely to be eligible for thrombolysis. Improved methods for investigating acute stroke, particularly magnetic resonance techniques, may improve the appropriate targeting of this treatment to those patients most likely to benefit. What is certain is that any increasing use of thrombolysis will have major effects on stroke services. The emphasis will have to be on early assessment and referral, if only to reach an imaging facility for a treatment decision to be made.     

Orthostatic haemodynamic responses in acute stroke

Little is known about orthostatic blood pressure regulation in acute stroke. We determined postural haemodynamic responses in 40 patients with acute stroke (mild or moderate severity) and 40 non-stroke control in-patients, at two days ('Day 1') and one week ('Week 1') post-admission. Following a 10-minute supine rest and baseline readings, subjects sat up and blood pressure and heart rate were taken for 5 minutes. The procedure was repeated with subjects moving from supine to the standing posture. Haemodynamic changes from supine data were analysed. On standing up, the control group had a transient significant fall in mean arterial blood pressure on Day 1 but not Week 1. No significant changes were seen on either day when sitting up. In contrast to controls, the stroke group showed increases in mean arterial blood pressure on moving from supine to the sitting and standing positions on both days. Persistent postural hypotension defined as > or = 20 mmHg systolic fall occurred in < 10% of either of the study groups on both days. Sitting and standing heart rates in both groups were significantly faster than supine heart rate on both days. The orthostatic blood pressure elevation is consistent with sympathetic nervous system overactivity which has been reported in acute stroke. Upright positioning as part of early rehabilitation and mobilisation following mild-to-moderate stroke would, therefore, not predispose to detrimental postural reductions in blood pressure.     

急性缺血性脑卒中血压控制原则

急性缺血性脑卒中患者血压变化十分常见，对血压变化的处理原则存在诸多争议，如何正确、规范地处理这些问题有重要的临床意义。作者复习急性脑卒中血压防治指南，旨在阐述急性缺血性脑卒中患者高血压处理原则。     

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。     

联合卒中单元治疗急性脑卒中的临床观察

目的观察在联合卒中单元模式下治疗急性脑卒中的疗效。方法选择同期住院急性脑卒中患者200例,分为A、B两组各100例,A组患者在联合卒中单元病房内治疗,B组普通病房治疗。观察治疗14、90天神经功能缺损评分(NIHSS),Barthel指数(BI)。90天改良Rankin量表(mRS)评分及临床疗效。结果治疗14天后两组NIHSS、BI比较P<0.05,90天后临床有效率A组为92%,B组为89%,P<0.01;生活能力mRS评分有明显改善,P<0.01。结论联合卒中单元病房内治疗急性脑卒中疗效好。     

小鼠血栓栓塞法急性缺血性脑卒中模型的建立

目的 应用7.0 T MR评价可用于分子影像与溶栓治疗研究的急性血栓栓塞脑卒中模型的可控性和可重复性.方法 成年雄性C57BL/6J小鼠24只,随机分为两组栓塞组(n=14)和假手术组(n=10).制备富含纤维蛋白适宜长度的栓子并在显微镜下测量直径.栓塞组经右侧颈外动脉插管至颈内动脉开口处,注入栓子.对照组只注入含有牛血白蛋白的PBS缓冲液.在栓塞后1、3、24 h,应用7.0 T MR分别行MRA、DWI、PWI(ASL技术)和T2WI扫描.24 h后行TTC染色.观察MCA闭塞率、rCBF变化及病灶体积.结果 血栓直径(162±14)μm.栓塞后MRA 1、3、24 h,MCA闭塞率分别为约78.6%、71.4%、57.1%.所有MCA闭塞模型病灶侧皮层rCBF低于对侧.rCBF下降百分比分别为1 h为26%±10%、3 h为26%±15%,与相同时间点对照组间比较rCBF下降差异有统计学意义(P＜0.05).24 h梗塞体积百分比T2WI、TTC分别为30%±4%、30%±16%.对照组未出现MCA闭塞及异常MR信号、TTC染色阴性.结论 成功建立了小鼠急性血栓栓塞脑卒中模型,使用的改良模型构建方案稳定可行.7.0T MR可以对该模型进行多参数评价.     

Doppler diagnosis in cases of acute stroke

Ultrasound techniques are employed increasingly for the evaluation of patients with cerebrovascular disease. We determined the accuracy of carotid Doppler ultrasonography, which incorporated spectral analysis and periorbital directional Doppler assessment, by comparison with conventional or digital-subtraction arteriography in 93 patients (186 vessels). We also reviewed our experience with the Doppler technique in consecutive patients who were admitted to hospital with established carotid-territory stroke. The Doppler technique had a sensitivity of 93% and a specificity of 97% as a screening test for the presence of carotid stenosis, and a high level of precision. The arteriography rate in patients with completed stroke was 40% before the introduction of Doppler ultrasonography but decreased to 24% after its introduction, and to 16% in the last 100 cases. The proportion of cases in whom an underlying cause for stroke could not be identified decreased from 31% of cases to 21% of cases. Extracranial carotid stenosis was implicated in only 22 of the last 100 patients with carotid-territory stroke. Doppler ultrasonography is a valuable diagnostic tool in patients with completed stroke. It aids in the selection of patients for arteriography and provides clues to the pathogenesis of stroke in patients in whom arteriography is inappropriate.