甘孜藏区高血压、脑卒中事件现状调查及相关性分析

目的了解甘孜藏区脑卒中及其重要危险因素高血压的发病现状,为探索高原地区脑卒中防治方式提供依据。方法采用分层随机抽样的方法,抽取四川省甘孜州康定、德格、甘孜、理塘及巴塘五县居民和农牧民进行问卷调查,收集人口学特征、高血压、脑卒中患病史等信息,并进行统计学分析。结果共调查该地区5049人,其中男性2453人,占48.6%;女性2596人,占51.4%。高血压总患病率为23.4%,脑卒中患病率为1894/10万,两者相关性具有统计学意义,且均随年龄增大而增高。结论四川甘孜藏区的高血压、脑卒中患病率较高,与当地独特的地理气候条件、生活方式和落后的卫生条件有关,急需加强防治工作。     

脑卒中后抑郁症的临床研究

目的 :探讨脑卒中后抑郁症的临床特点。方法 :回顾分析 12 9例脑卒中后抑郁症患者的一般情况、病变部位和抑郁的关系。结果 :抑郁发生率为 39.81% ,轻、中、重度分别占 12 .6 5 %、19.4 4 %、7.72 %。临床表现以中度抑郁为多见。前半球比后半球病变更易发生抑郁 ,大脑左前部较其它部位容易发生抑郁。结论 :病变部位影响脑卒中后抑郁症的发生     

非风湿性房颤和风湿性房颤所致心源性脑卒中的对比研究

目的:对比分析非风湿性房颤和风湿性房颤所致心源性脑卒中的临床表现和影像学特点。方法:回顾经临床证实非风湿性房颤(A组)和风湿性房颤(B组)所致的176例心源性脑卒中患者的临床表现及影像学检查结果,进行对比分析。结果:A组男性、高龄、患高血压病和冠心病者明显多于B组(P<0.05);A组60.3%和B组65.0%患者存在多发梗死灶,梗死灶主要分布于颈内动脉系统的大脑中动脉供血区和内分水岭区。结论:非风湿性房颤和风湿性房颤所致心源性脑卒中患者在性别、年龄和高血压或冠心病的患病率上存在差异,而在颅内梗死灶分布规律上基本一致。     

Serum uric acid and risk of stroke: a dose-response meta-analysis

The relationship between serum uric acid and risk of stroke is still controversial. Therefore, we conducted a meta-analysis based on the cohort study to explore the relationship between serum uric acid and risk of stroke, and further illuminate whether there is a linear or non-linear relationship between them. We manually searched the database including Cochrane, PubMed, Embase, Web of Science, and selected cohort studies focusing on the relationship between serum uric acid and stroke risk. Random effect model was used for statistical analysis. Twenty-one cohort studies involving 818,098 participants were included. The pooled relative risk for the high-vs-low categories was 1.22 (95% CI: 1.15–1.30). In addition, there was a non-linear dose-response relationship between uric acid and stroke risk. Serum uric acid was in the range of 3–5 mg/dl, with the lowest risk of stroke. In conclusion, high serum uric acid level increases the risk of stroke, with a non-linear dose-response relationship.     

缺血性脑卒中相关危险因素的病例对照研究

目的评价传统与新型相关危险因素与缺血性脑卒中发病风险的关系。方法采用病例对照研究方法,在华东地区选择401例缺血性脑卒中病例,其中脑血栓形成158例,腔梗243例。和442例正常对照组人群。用问卷调查和体检的方式对缺血性脑卒中相关因素进行收集和分析。结果单因素分析显示:BMI,脑血管病家族史,既往史中的TIA、高血压、糖尿病、冠心病、肾脏疾病,目前血压值(包括收缩压和舒张压),血常规中的白细胞数、中性粒细胞比例,生化指标中的血糖、TG、HDL-C值均提示能增加缺血性脑卒中的发病风险(P0.05)。Logistic回归分析显示:TIA史、高血压、糖尿病、冠心病等既往史能显著增加缺血性脑卒中的患病风险。结论缺血性脑卒中需要采取综合干预措施。新的危险因素不容忽视。影响疾病发生发展的其它危险因素尚需要进一步探讨。     

Tai chi for upper limb rehabilitation in stroke patients: the patient’s perspective

Introduction: This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke.

Methodology: Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted.

Results: Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons.

Conclusion: This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits.

• IMPLICATIONS FOR REHABILITATION

• Tai chi was perceived as a good way of integrating various skills learned during rehabilitation.

• Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions.

• Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi.

     

The association between migraine and juvenile stroke: a case-control study

BACKGROUND: Several studies suggest an association between migraine and juvenile stroke. Because of some shortcomings, we designed another case-control study of a homogenous group of patients with juvenile cerebral ischemia. This study is part of a larger German epidemiological research project on the association of migraine with cerebrovascular disease. METHODS: We enrolled 160 consecutive patients under the age of 46 years with first-ever ischemic stroke or transient ischemic attack and 160 strictly sex- and age-matched controls. Patients suffering from arterial dissection, brain hemorrhage, cranial sinus thrombosis, lacunar stroke, or from migrainous infarction were excluded. Migraine was diagnosed according to the criteria of the International Headache Society by the same 2 independent interviewers. For analyzing the data, nonparametric statistical methods including odds ratio and 95% confidence interval were used. RESULTS: Migraine was a significant risk factor for juvenile stroke for the total sample with an odds ratio of 2.11 (confidence interval, 1.16 to 3.82). The odds ratio was even higher in the subgroup under the age of 35 (3.26) and in the female subgroup (2.68). We found migraine to be independent from other vascular risk factors, from etiology, and from the territory of stroke. CONCLUSION: We can confirm the findings of previous studies showing a significant association between migraine and juvenile stroke in women. Furthermore, our data suggest migraine to be an even more significant risk factor for patients under the age of 35 and to be independent from other vascular risk factors.     

脑卒中急性期吞咽障碍的临床影像评价

目的:探讨脑卒中急性期吞咽障碍的临床及影像学检查的表现,分析脑卒中部位与吞咽障碍发生类型的关系。方法:首次发病的急性脑卒中患者62例,根据不同病变部位分为单侧大脑半球组、双侧大脑半球组、脑干与小脑组及多发性卒中组。入院后3d内完成临床吞咽功能评估;入院7d进行吞咽X线荧光透视检查(VFSS);记录分析吞咽障碍的类型和脑卒中的病变部位。结果:入院3d内临床吞咽评定4组患者中有29例(46.8%)存在吞咽困难,其中脑干及小脑组发生吞咽困难的百分率明显高于其他组(P0.05);于7d时VFSS检测11例能完成,其中单侧大脑半球组3例、双侧大脑半球组2例,多出现口腔期困难;脑干及小脑组2例,多出现咽期困难;多发卒中组4例,口腔期和咽期均受影响。吞咽异常表现类型为唇闭合无力、舌运动减弱、误吸及环咽肌功能不全、吞咽反射延迟、喉上抬差、会厌谷和/或梨状窝滞留、喉渗透等。结论:脑卒中后吞咽障碍的临床评定可明确吞咽口阶段的生理状态,VFSS可明确咽阶段及有无误吸。为避免吞咽困难所致的并发症及预防或治疗吞咽困难,需尽早完成吞咽评定,且可以节省患者总体费用及加快改善预后。     

脑卒中患者偏瘫肩痛症状的质性研究

目的探索脑卒中患者偏瘫肩痛症状的真实体验、影响因素及症状结局。方法选取2016年3—6月于上海市阳光康复中心住院的16例脑卒中后偏瘫肩痛患者,采用描述性质性研究方法进行半结构式访谈,并以Colaizzi七步分析法分析资料。结果研究提炼出四大主题:患者对于偏瘫肩痛的认识不足、偏瘫肩痛症状体验呈多样性、偏瘫肩痛影响因素复杂、偏瘫肩痛后果严重。结论脑卒中患者对偏瘫肩痛症状认识片面、对症状的关注普遍缺乏,医务人员进行症状管理时应避免偏瘫肩痛诱因和加重因素,及时为患者提供信息支持并积极处理疼痛,提高其对症状的自我管理能力。     

脑卒中后抑郁状态的相关因素分析

Theconcomitantdepressionafterstrokecaninfluencethestateofillnessandrecoveryoffunctiondisorder．Itsmechanismisnotclearnow．Wetookaclinicalstudyon１２１strokepatientsfromJanuary２００１toDecember２００１，reportedasfollowed．１Subjectsandmethods１．１SubjectsAllthe１２１patientswerein－patientpatientsofdepartmentofneurologyofourhospital，including７４malesand４７females，＜４０yearsold：４cases，４１～５０yearsold：１５cases，５１～６０yearsold：４５cases，６１～７０yearsold：３２cases，７１～…     

脑卒中急性期中医护理方案的多中心临床研究

[目的]通过对脑卒中急性期中医护理方案的临床验证,确定中医护理方案的临床疗效,为进一步优化中医护理方案奠定基础。[方法]选择脑卒中急性期病人216例,按照预先制定的中医护理方案进行辨证施护,并进行健康指导。在病人出院时进行临床疗效、病人满意度、方案实用性评价。[结果]216例病人总有效率达87.0%。病人对健康指导满意度为100.0%。91.2%的责任护士认为本护理方案的实用性较强。[结论]中医综合治疗方案介入脑卒中急性期康复治疗,能更有效地促进病人多方面能力的康复,提高病人的生存质量。     

中风防治灵治疗急性缺血性脑卒中的临床研究

目的 :探讨中风防治灵治疗急性缺血性脑卒中的疗效。方法 :2 48例急性缺血性脑卒中患者随机分为治疗组 12 4例和对照组 12 4例。2组均静滴复方丹参注射液 ;治疗组加服中风防治灵胶囊 5粒 ,对照组加服维脑路通片 0 .3g。 2组均每日 3次 ,15日为 1个疗程。结果 :治疗组临床疗效显著优于对照组 (87.10 %和 6 9.35 % ,P<0 .0 5 ) ,治疗组治疗后血液流变学各指标较治疗前和对照组治疗后明显下降 (P<0 .0 5或 P<0 .0 1)。结论 :中风防治灵可明显改善缺血性脑卒中患者的血液流变性 ,疗效可靠     

综合康复治疗对脑卒中后不同程度吞咽障碍的影响

目的:探讨综合康复治疗对脑卒中后不同程度吞咽障碍患者的临床疗效.方法:脑卒中患者124例采用洼田饮水试验进行吞咽障碍程度评定,分为轻度组58例、中度组50例和重度组16例,3组均给予吞咽功能训练、电刺激及针刺等综合康复治疗,治疗前后进行电视透视吞咽功能检查(VFSS)、美国国立卫生院卒中量表(NIH-SS)、Hamilton抑郁量表(HAMD)及吞咽障碍特异性生活质量量表(SWAL-QOL)评定,并将吞咽障碍的严重程度与NIHSS、HAMD及SWAL-QOL评分进行相关性分析.结果:治疗4周后,轻度和中度组VFSS评分较治疗前明显提高(P＜0.01),轻度及中度组痊愈率及总有效率均显著高于重度组,且轻度组痊愈率更高于中度组(P＜0.01,0.05),2组总有效率比较差异无统计学意义.吞咽困难的严重程度与NIHSS评分无明显相关性(r=-0.103,P＞0.05),与HAMD评分有弱相关性(r=-0.562,P＜0.05),与SWAL-QOL评分有高度相关性(r=-0.715,P＜0.05).结论:综合康复治疗对脑卒中后轻、中度吞咽障碍疗效显著,重度吞咽障碍患者其吞咽功能的恢复较慢.     

帕金森病患者血脂表达情况的研究

目的:研究帕金森病(PD)患者血脂表达情况,探讨血脂水平对PD患者发生脑卒中的影响。方法:回顾性纳入PD患者、急性脑梗死患者及同期健康体检者各161例,分别为PD组、脑梗组及对照组。比较3组的血脂包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平及其他因素;以PD组、脑梗组为因变量对2组有统计学差异的变量进一步采用二分类Logistic回归方法分析。结果:PD组TG、LDL-C水平显著低于对照组及脑梗组(均P0.05),HDL-C水平高于脑梗组(P0.05);PD组的高血压病、糖尿病患病人数比例低于脑梗组(P0.05)。二分类Logistic回归分析显示:高水平的HDL-C、低水平的LDL-C、高血压病、糖尿病病史可能与PD人群中脑卒中发生相关。结论:PD患者TG、LDL-C水平低于健康人和脑梗死患者,HDL-C水平高于脑梗死患者。高水平的HDL-C、低水平的LDL-C可能与PD人群中脑卒中发生相关。     

急性缺血性脑卒中静脉溶栓预后的 多因素联合预测模型研究

目的:探讨通过建立多因素联合预测模型的方法预测急性缺血性脑卒中(AIS)患者使用阿替普酶静脉溶栓治疗后的远期临床预后。方法:通过使用回顾性研究的方法,分析118例接受阿替普酶静脉溶栓治疗的AIS患者的临床资料;通过溶栓后90 d的改良Rankin量表(mRS)分为预后良好组(mRS评分0～2分)和预后不良组(mRS评分3～6分);使用多因素Logistic回归的方法分析影响AIS患者阿替普酶溶栓后90 d神经功能预后的因素,并通过多因素Logistic回归方法计算联合预测值Y;采用ROC曲线验证Logistic回归模型的诊断效度。结果:纳入预后良好组56例(47.46%),纳入预后不良组62例(52.54%)。与预后良好组相比,预后不良组大脑中动脉高密度征的比例及基线美国国立卫生院脑卒中量表(NIHSS)评分分值增高、Alberta卒中项目早期CT(ASPECTS)评分降低、溶栓后出血率较高(均P0.05);多因素Logistic回归分析结果显示ASPECTS评分和基线NIHSS评分为影响静脉溶栓远期预后的因素(P0.001);两者通过多因素Logistic回归方法计算的联合预测值Y的ROC曲线下面积为0.740,敏感度为60.70%、特异度为74.19%;优于单独使用ASPECTS评分(AUC=0.672、敏感度=82.10%、特异度=48.39%)和基线NIHSS评分(AUC=0.693、敏感度=75.00%、特异度=59.68%)作为单因素预测AIS溶栓患者预后的效果。结论:在AIS患者溶栓前的基线指标中,大脑中动脉高密度征、ASPECTS评分、基线NIHSS评分等可作为预测AIS溶栓治疗患者90 d预后的预测因素。通过建立多因素Logistics回归模型计算的联合变量Y对患者预后的预测效能更高。     

阿托伐他汀治疗急性缺血性脑卒中患者早期神经功能恶化和短期转归的最佳剂量研究

目的探讨阿托伐他汀治疗急性缺血性脑卒中患者早期神经功能恶化(END)和短期转归的最佳剂量。方法将128例急性缺血性卒中患者随机分为正常组(阿托伐他汀20 mg/d)与增高组(阿托伐他汀40 mg/d)。主要转归指标为治疗1周内早期神经功能恶化和治疗1个月时评价的转归良好(改良Rankio量表评分0~2分),次要指标为治疗1个月时美国国立卫生研究院卒中量表(NIHSS)评分和不良事件。结果治疗1周时,正常组和增高组分别发生12例(18.75%)和4例(6.25%)END,正常组发生率显著高于增高组(P=0.033)。治疗1个月时,正常组的转归良好比例为59.38%,显著低于增高组的79.69%(P=0.013)。2组患者在治疗期间均未发生导致阿托伐他汀减量或停药的明显肝脏损害、肌肉毒性等不良事件。结论应用大剂量阿托伐他汀(40 mg/d)较应用常规阿托伐他汀(20 mg/d)治疗急性缺血性脑卒中效果更确切,可显著改善患者神经功能水平,调节血脂水平,且安全性好。