体外膈肌起搏联合肺康复训练对脑卒中亚急性期患者肺功能和膈肌功能的影响

目的 探讨体外膈肌起搏联合肺康复训练对脑卒中亚急性期患者肺功能和膈肌功能的影响。方法 选取2021-08—2022-10于南京医科大学附属南京医院诊治的脑卒中亚急性期患者80例,采用随机数字表法分为实验组（40例）和对照组（40例）。实验组采用体外膈肌起搏联合肺康复训练治疗,对照组仅采用肺康复训练治疗。所有患者均治疗3周,比较2组治疗前后肺功能、膈肌功能相关指标。结果 治疗3周后,2组第1秒用力呼气容积（FEV1）[(2.07±0.45)L比（2.63±0.41）L,(2.11±0.47)L比（2.42±0.33）L]、用力肺活量（FVC）[(2.31±0.46)L比（2.77±0.38）L,(2.35±0.39)L(2.56±0.31)L]、FEV1/FVC[(81.41±7.55)%比（89.25±6.43）%,(81.29±6.87)%比（85.12±5.32）%]、峰值呼气流量[（1.81±0.23）L/s比（3.15±0.57）L/s,(1.78±0.44)L/s比（2.54±0.41）L/s]、最大自主通气量[（61.78±7.49）L/min比（78.69±5.69）L/...     

流感疫苗对缺血性脑卒中的保护作用及其机制研究进展

脑卒中已经成为影响我国居民期望寿命的主要因素之一,是致死和致残的主要原因,日益增长的脑卒中负担已经成为重大的公共卫生问题.其中脑卒中的主要类型为缺血性卒中,约占脑卒中发病率和患病率的69. 6％和77. 8％ [1].鉴于我国脑卒中负担较重,做好对脑卒中的一级和二级预防减少脑卒中的发病率尤为重要.已知脑卒中的危险因素有...     

56例缺血性脑卒中急性期患者经颅多普勒检测的临床分析

目的 研究急性缺血性脑卒中患者经颅多普勒(TCD)超声检测的动态变化,探讨其变化规律在临床上的意义.方法 选择56例单侧大脑中动脉(MCA)缺血性脑卒中患者于入院即刻、第2、4、7、14、28天进行TCD动态检测分析,记录各血管频谱波形情况及平均血流速度(Vm)、脉动指数(PI).结果 入院即刻TCD检测发现异常率较高,且患侧VmMCA降低,VmACA升高,分别与自身健侧及对照组比较差异有统计学意义(P<0.05).与正常对照组VmMCA{66.51[56.64,71.43]cm/s}比较,主干闭塞组{23.45[7.55,38.72]cm/s}、深穿支闭塞组{52.53[45.56,66.93]cm/s)、皮层支闭塞组{38.44[31.67,52.45]cm/s}VmMCA均明显降低,差异有统计学意义(P<0.05).动态观察发现治疗后患侧VmMCA明显增高,均较入院即刻比较差异有统计学意义(P<0.05);PIMCA值逐渐增高,与入院即刻及对照组比较差异有统计学意义(P<0.05).结论 TCD检测在缺血性脑卒中急性期的早期诊断中具有较高价值.     

外泌体microRNA对缺血性脑卒中调控机制的研究进展

<正>缺血性脑卒中(cerebral ischemia, CI)是全球第二大死亡原因,也是导致残疾的主要原因。随着人口老龄化社会的到来,其发病率明显上升,给家庭、社会带来了巨大的精神、物质负担^[1]。CI是由动脉粥样硬化、高血压病、血脂异常、糖尿病等多种危险因素引起的^[2]。缺血性脑卒中一旦发生可立即导致离子平衡破坏、代谢衰竭和脑细胞中一般蛋白质合成减少,继而诱发梗死灶周围去极化、兴奋性毒性、氧化应激、     

尤瑞克林对缺血性脑卒中的辅助作用分析

目的 探讨尤瑞克林治疗缺血性脑卒中的辅助作用。方法 选择河南省直第三人民医院2017-04—2018-10收治的缺血性脑卒中患者100例。随机分为常规治疗组和尤瑞克林治疗组各50例,常规治疗组采取常规调脂、抗血小板聚集等药物治疗,尤瑞克林治疗组则采取常规调脂、抗血小板聚集等药物+尤瑞克林治疗。比较2组疾病疗效、神经功能恢复50%的时间、生活自理能力改善时间,治疗前后患者MRS评分、ADL评分、NIHSS评分,以及不安全事件。结果 尤瑞克林治疗组疾病疗效、神经功能恢复50%的时间、生活自理能力改善时间、MRS评分、ADL评分以及NIHSS评分相比较常规治疗组更好,P0.05。尤瑞克林治疗组和常规治疗组不安全事件相似,P0.05。结论 常规调脂、抗血小板聚集等药物+尤瑞克林治疗缺血性脑卒中效果好。     

长期卧床脑卒中患者呼吸肌训练对肺康复的临床观察

目的观察肺功能呼吸肌训练对脑卒中患者呼吸功能的疗效。方法回顾分析2017-2019年郑州大学第二附属医院确诊为脑卒中并伴有运动功能障碍的患者90例,随机分为对照组45例,行药物治疗加常规肢体康复训练,观察组45例,在对照组治疗基础上行呼吸肌功能训练,比较2组动脉血气分析、肺功能通气功能测定、肺部感染率。结果观察组动脉血气分析、肺功能通气功能测定、肺部感染率均显著优于对照组(P0.05)。结论脑卒中患者在药物治疗加常规肢体的康复训练,联合呼吸肌功能的训练,对患者的动脉血气分析、肺功能通气功能测定、肺部感染率等方面具有显著疗效,可提高患者的生存生活质量。     

经颅超声联合溶栓治疗对急性缺血性脑卒中患者血管再通的作用

目的探讨经颅超声联合溶栓治疗对于急性缺血性脑卒中患者血管再通的作用。方法收治的40例急性缺血性脑卒中患者随机分为经颅超声组和溶栓治疗组,2组患者均给予尿激酶溶栓治疗,经颅超声组患者在此基础上给予经颅超声治疗,采用经颅多普勒超声、美国国立卫生所脑卒中量表(NIHSS)于治疗前、治疗后2h、治疗后24h评估患者,并于治疗后3个月评价患者预后良好改良Rankin评分≤2分的发生率,治疗后采用CT评估患者并发脑出血情况。结果经颅超声组患者治疗后2h、24h血管再通率分别为45.0%、55.0%,显著高于溶栓治疗组的15.0%、20.0%再通率(P0.05);治疗后2h、治疗后24h经颅超声组NIHSS评分分别为(10.6±2.8)分、(10.1±2.6)分,显著低于溶栓治疗组(13.9±3.3)分、(13.1±3.2)分的NIHSS评分(P0.05);经颅超声组预后良好发生率为65.0%,显著高于溶栓治疗组20%(P0.05);2组患者脑出血发生率差异无统计学意义(P0.05)。结论在传统尿激酶溶栓治疗的基础上给予经颅脉冲超声治疗,能够显著提高血管再通率,改善患者预后,值得临床推广应用。     

缺血性脑血管病丘脑皮质通路损害的CT与体感诱发电位对比分析

报告了１６例缺血性脑血管病ＣＴ、ＳＥＰ结果。体征与ＣＴ表现符合率３１％，体征与ＳＥＰ表现符合率８１％，两者有显著差异（Ｐ＜０．０５）。３例内囊区单发梗塞灶的病人，分别出现Ｐ２２Ｎ３０成分异常、Ｎ２０Ｐ２５成分异常、Ｐ２２Ｎ３０和Ｎ２０Ｐ２５成分均异常。提示当临床表现与ＣＴ不符时，ＳＥＰ波幅的异常可做为判断丘脑皮质通路完整性的敏感指标以及提供了皮层下损害时感觉与运动分离的ＳＥＰ诊断价值     

缺血性脑卒中的皮质脊髓束的病理生理与干预研究

缺血性脑卒中是危害人类健康的常见疾病之一,具有高致死率和高致残率.近年来其发病率逐年上升,且有年轻化趋势.缺血性脑卒中急性发作后遗留的肢体运动功能障碍严重影响患者的生活质量,并且还影响患者其他功能的康复,给社会和家庭带来沉重负担.近年来的研究表明,皮质脊髓束作为大脑支配肢体随意运动的关键通路,其在脑卒中后继发的病理变化及重塑,可能在神经功能的恢复中占有重要地位,这就为缺血性脑卒中的恢复期及后遗症期治疗提供了新的思路.     

Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial

Abstract

Purpose:

No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia.

Methods:

Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15?minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1?second (FEV₁). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity.

Results:

Our results showed that changes between the pre- and post-test values of FVC (F?=?12.50, P?=?0.02) and FEV₁ (F?=?12.81, P?=?0.01) (P?<?0.05) in the ITG were significantly (P?<?0.05) greater. Changes in EMG activation of the diaphragm (F?=?13.75, P?=?0.003) and external intercostal (F?=?14.33, P?=?0.002) (P?<?0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P?<?0.05) greater than those in patients of the RMTG and the CG at post-test.

Conclusions:

Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.     

The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke

Abstract

Background:

Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke.

Objective:

The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke.

Method:

A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n?=?16) or a Control Group (n?=?15). The intervention included 12?weeks of PFMT.

The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire.

Results:

Thirty participants (median age: 68 years; interquartile range: 60–74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P?<?0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant.

Conclusion:

The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.     

不同步行训练法对脑卒中偏瘫患者预后的影响

目的观察不同步行训练法对脑卒中偏瘫患者预后的影响及临床疗效。方法选取2012-03—2013-03收治的脑卒中偏瘫患者140例为对象,随机分为3组,A组采用常规的步行训练方法,B组采用辅助工具步行训练法,C组采用减重步行训练法。结果 3组患者治疗前FMA和MBL评分差异无统计学意义,治疗后评分均显著上升。治疗后C组FMA和MBL评分分别为31.92±3.31和48.79±5.01,且评分在3组患者中最高。3组治疗前ASS、FAC和FIM评分差异无统计学意义;治疗后C组ASS评分为1.69±0.53,为3组中最低;FAC和FIM评分中,C组为3组中最高。3组患者在接受治疗后其步行距离均有显著提高,C组MWS在治疗前为(12.62±3.35)m/min,治疗后(78.92±8.92)m/min;TUGT从(28.92±11.62)s加速到(12.92±5.72)s,C组测定结果为3组患者中最快;治疗后3个月后A组MWS和TUGT均比B组快,差异有统计学意义(P0.05)。结论采用减重步行训练法有利于提高脑卒中偏瘫患者的步行运动能力,提高患者的生活质量,有利于患者的预后。     

Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized controlled trial

Background: Patients with stroke generally have diminished balance and gait. Mobilization with movement (MWM) can be used with manual force applied by a therapist to enhance talus gliding movement. Furthermore, the weight-bearing position during the lunge may enhance the stretch force.

Objectives: This study aimed to compare the effects of a 4-week program of MWM training with those of static muscle stretching (SMS). Ankle dorsiflexion passive range of motion (DF-PROM), static balance ability (SBA), the Berg balance scale (BBS), and gait parameters (gait speed and cadence) were measured in patients with chronic stroke.

Methods: Twenty patients with chronic stroke participated in this study. Participants were randomized to either the MWM (n = 10) or the SMS (n = 10) group. Patients in both groups underwent standard rehabilitation therapy for 30 min per session. In addition, MWM and SMS techniques were performed three times per week for 4 weeks. Ankle DF-PROM, SBA, BBS score, and gait parameters were measured after 4 weeks of training.

Results: After 4 weeks of training, the MWM group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, SBA, BBS, and cadence showed greater improvement in the MWM group compared to the SMS group (p < 0.05).

Conclusions: This study demonstrated that MWM training, combined with standard rehabilitation, improved ankle DF-PROM, SBA, BBS scores, and gait speed and cadence. Thus, MWM may be an effective treatment for patients with chronic stroke.     

临床路径在脑卒中患者健康教育中的应用研究

目的 探讨临床路径在脑卒中患者健康教育中的应用效果.方法 将300例住院脑卒中患者随机分为2组,各150例,对照组给予常规健康教育,试验组应用临床路径实施健康教育,分别在入院时及出院时评价2组患者的疾病相关知识得分、日常生活活动能力评分.结果 干预前2组患者基线均衡,出院时试验组患者的疾病相关知识得分为89.30±5.27,对照组为71.08±6.01,试验组日常生活活动能力评分85.19±9.58,对照组74.87±8.97,差异有统计学意义（P〈0.05）.结论 应用临床路径对脑卒中患者实施健康教育可以提高其疾病知识掌握水平,提高日常生活活动能力.     

应用临床护理路径对脑卒中患者实施健康教育的效果评价

目的探讨临床护理路径在脑卒中患者健康教育中的实施效果。方法 200例脑卒中病人随机分为观察组和对照组各100例,对照组采用传统健康教育方法,观察组应用临床护理路径模式实施健康教育。采用ADL(日常生活活动能力)评分对2组病人入院时和出院前予以评定,出院时对2组病人派发满意度调查表进行问卷调查比较。结果 2组病人在入院首日的ADL评分无明显差异(P>0.05);出院时,观察组的ADL评分显著高于对照组(P<0.05);护理满意度调查明显高于对照组(P<0.05),2组差异有统计学意义。结论应用临床护理路径对脑卒中病人实施健康教育,能提高患者对护理工作的满意度,减少患者并发症和后遗症的发生率,明显提高了患者的生活自理能力,促进患者早日康复,提高其生活质量。     

Reduced cortical arousability to nocturnal apneic episodes in patients with wake-up ischemic stroke

Study objectivesSleep breathing disorders (SBD) have been linked to wake-up stroke (WUS). Respiratory arousals have an important role in responding to danger during sleep, yet currently no studies have investigated respiratory arousability in WUS. In this study, we used a clinical tool to predict low respiratory arousal threshold (ArTH), and then compared respiratory arousability in patients with WUS and non-WUS.MethodsWe enrolled 119 patients with acute ischemic stroke and assigned them into WUS (n = 34) and non-WUS (n = 85) groups. All participants underwent polysomnography (PSG) during the acute phase of stroke. The respiratory ArTH predictive tool assigns one point for each of the following: apnea-hypopnea index (AHI) < 30/h, nadir oxygen saturation (SaO₂) > 82.5%, and fraction of hypopneas > 58.3%. An ArTH score ≥2 represents low respiratory ArTH.ResultsOur results reconfirmed the association between moderate-to-severe sleep apnea syndrome and WUS (OR 2.879, 95% CI 1.17–7.089, p = 0.021). Significantly fewer participants with obstructive sleep apnea (AHI ≥ 5/h) had low respiratory ArTH in the WUS group than in the non-WUS group (34.8% vs. 68.1%, respectively, p = 0.008). High respiratory ArTH was independently associated with WUS (OR 5.556, 95% CI 1.959–15.761, p = 0.001).ConclusionsThe correlation between SBD and WUS suggests that sleep apnea might induce acute physiological changes that trigger the onset of stroke. We show that reduced respiratory arousability is associated with WUS, and hypothesize that reduced cortical capability to generate respiratory arousal may have a role in triggering stroke during sleep.     

呼吸湿化治疗联合咳痰机对脑卒中合并吞咽困难患者咳痰的影响

目的 探讨呼吸湿化治疗联合咳痰机对脑卒中合并吞咽困难患者咳痰的影响。方法 将80例研究对象按住院时间顺序分为对照组(41例)和治疗组(39例),治疗组采用呼吸湿化治疗仪进行呼吸道湿化治疗6h后用无创气道咳痰机辅助排痰; 对照组采用传统的翻身、拍背、雾化、吸痰等常规辅助排痰措施; 观察2组患者治疗结束后总的排痰量、血氧饱和度(SpO₂)、呼吸频率(R)、心率(HR)、口干例数和肺部感染发生率。结果 治疗组患者的排痰量和血氧饱和度显著高于对照组,呼吸频率、心率、口干和肺部感染发生率均显著低于对照组(P<0.05)。结论 呼吸湿化治疗和无创气道咳痰机联合应用能够有效清理患者呼吸道分泌物,提高患者血氧饱和度,促进患者咳痰,降低患者脑卒中相关性肺炎的发生率。     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

视觉反馈结合MOTOmed智能运动训练系统对脑卒中患者平衡以及步行能力的疗效观察

目的 观察视觉反馈结合MOTOmed智能运动训练系统治疗对脑卒中患者平衡以及步行能力的影响。方法 将脑卒中30例患者随机分为观察组和对照组各15例,2组均进行常规康复治疗以及MOTOmed智能运动训练系统训练,观察组在进行MOTOmed智能运动训练系统训练时引导并督促患者将仪器显示器上显示的两侧对称性尽量都保持在50%,直到训练结束; 对照组在进行MOTOmed智能运动训练系统训练时遮蔽显示器上的对称性显示。结果 治疗3周后2组Berg平衡量表(BBS)评分、简式Fugl-Meyer下肢运动功能评定量表(FMA)评分以及起立步行实验(TUGT)评分均较治疗前明显提高(P<0.05),且观察组3项评分均高于对照组(P<0.05)。MOTOmed智能运动训练系统中的患侧对称性所占比、训练距离以及训练强度也较对照组有了明显的进步(P<0.05)。结论 视觉反馈结合MOTOmed智能运动训练系统通过患者自身的参与以及自我调整可以更好地提高患者的平衡及步行能力。