早期物理治疗对急性脑卒中患者功能预后的影响

目的：探讨早期物理治疗对急性脑卒中患者功能预后的影响。方法：选择８２例急性脑卒中患者,随机分为早期物理治疗组和对照组,治疗组采用Ｂｏｂａｔｈ法和运动再学习法相结合的方法进行训练,对照组不实施物理治疗,任其自然恢复。结果：治疗组Ｆｕｇｌ－Ｍｅｙｅｒ和功能独立性测量得分,治疗前后比较有显著提高（Ｐ〈０．０１）,对照组的上、下肢运动功能和功能独立方面的评分也有一定提高,但改善的程度不如对照组,两组间差异     

早期康复对脑卒中患者功能恢复的影响

目的 :探讨早期康复对急性脑卒中患者功能预后的影响。方法 :在患者生命体征稳定 ,神经病学体征不再进展后 48小时选择 1 0 9例急性脑卒中患者 ,随机分为早期康复组和对照组。其中早期康复组 58例 ,采用Bobath法和运动再学习法相结合的方法进行训练 ;对照组 51例 ,仅进行一次性康复指导。采用临床神经功能缺陷程度评分、简式Fugl Meyer运动评分 (FMA)和改良巴氏指数 (MBI)在治疗前后进行康复评价。 结果 :临床神经功能缺陷程度评分、上下肢FMA和MBI入选时两组无显著差异 (P >0 .0 5) ,出院时两组均较入选时明显改善 (P <0 .0 1 ) ,早期康复组较对照组改善程度更大 (P <0 .0 5)。结论 :早期康复可促进功能恢复 ,对脑卒中患者预后有良好影响     

早期综合康复治疗对急性脑卒中患者功能预后的影响

目的 :探讨早期综合康复治疗对急性脑卒中患者功能预后的影响。方法 :12 3例急性脑卒中患者随机分为康复组和对照组 ,康复组在采用常规药物治疗的同时 ,脑梗死患者于病后 3天、脑出血患者于病后 1周 ,在生命体征稳定、病情无进行性加重时即介入综合康复治疗 (包括肢体功能锻炼、理疗、针灸 ) ,采用电话形式进行随访。神经功能缺损用神经功能缺损程度评分标准评分 ,日常生活活动能力 (ADL)用Barthel指数评分。结果 :经治疗 1个月后两组患者神经功能缺损程度明显减少 ,ADL明显提高 ,与入院时比较有显著差异 (P <0 .0 1) ,康复组改善更明显 ,与对照组比较差异有显著性 (P <0 .0 5 )。其疗效持续至 1年 ,两组仍有显著差异。结论 :急性脑卒中患者进行早期综合康复治疗 ,能明显改善患者神经功能缺损及ADL得分 ,有效地提高患者生活自理能力 ,而且有一定的远期效果。     

体温控制治疗影响脑卒中患者的近期功能预后

目的:观察设定条件下轻度降低体温72h对脑卒中患者功能预后的影响。方法:选择2001-06/2003-06北京市隆福医院神经内科急性脑卒中患者64例。随机分为治疗组32例,男20例,女12例,缺血性脑卒中26例,出血性脑卒中6例;年龄43～74岁;对照组32例,男23例,女9例;缺血性脑卒中25例,出血性脑卒中7例;年龄45～77岁。两组患者均应用常规药物治疗,并根据残疾状况给予适当的运动康复。治疗组患者给予肌松合剂使患者维持于亚冬眠状态。采用电恒温降温毯使肛温恒定在35.5～36.0℃,维持24～72h;复温采用自然缓慢法,每4～6小时回升1℃。全部患者在入组时及1周后和30d后分别进行爱丁堡-斯堪的纳维亚神经功能缺损评分检查,最高分为45分,最低分为0分,积分越大缺损程度越严重;采用Barthel指数进行日常生活活动评价,共包括10项内容,正常最高分为100分,严重不良最低分为0分。结果:64例患者均进入结果分析。①神经功能缺损评分改良值:治疗1周后治疗组明显高于对照组犤(6.35±4.92)分,(1.21±1.02)分,t=2.864,P<0.01犦。治疗30d后治疗组也明显高于对照组犤(12.85±5.87)分,(9.84±3.94)分,t=2.958,P<0.01犦。②Barthel指数评分:治疗1周后治疗组高于对照组犤(54.28±8.38)分,(49.76±7.31)分,t=2.206,P<0.05犦。治疗30d后治疗组也明显高于对照组犤(86.72±7.94)分,(67.34±8.63)分,t=2.812,P<0.01犦。结论:早期轻度低温可以明显改善神经功能缺损程度,提高日常生活活动能力,并且近期预后较好。     

体温控制治疗影响脑卒中患者的近期功能预后

目的：观察设定条件下轻度降低体温72h对脑卒中患者功能预后的影响。方法：选择2001-06／2003-06北京市隆福医院神经内科急性脑卒中患者64例。随机分为治疗组32例，男20例，女12例，缺血性脑卒中26例．出血性脑卒中6例；年龄43～74岁；对照组32例，男23例，女9例；缺血性脑卒中25例，出血性脑卒中7例；年龄45～77岁。两组患者均应用常规药物治疗，并根据残疾状况给予适当的运动康复。治疗组患者给予肌松合剂使患者维持于亚冬眠状态。采用电恒温降温毯使肛温恒定在35．5～36．0℃，维持24～72h；复温采用自然缓慢法，每4-6小时回升1℃。全部患者在入组时及1周后和30d后分别进行爱丁堡-斯堪的纳维亚神经功能缺损评分检查，最高分为45分，最低分为0分，积分越大缺损程度越严重；采用Barthel指数进行13常生活活动评价，共包括10项内容，正常最高分为100分，严重不良最低分为0分。结果：64例患者均进入结果分析。①神经功能缺损评分改良值：治疗1周后治疗组明显高于对照组[（6．35&;#177;4．92）分，（1．21&;#177;1．02）分，t=2．864，P〈0．01]。治疗30d后治疗组也明显高于对照组[（12．85&;#177;5．87）分，（9．84&;#177;3．94）分，t=2．958，P〈0．01]。②Barthel指数评分：治疗1周后治疗组高于对照组[（54．28&;#177;8．38）分，（49．76&;#177;7.31）分，t=2．206，P〈0．05]。治疗30d后治疗组也明显高于对照组[（86．72&;#177;7．94）分，（67.34&;#177;8．63）分，t=2．812，P〈0．01]。结论：早期轻度低温可以明显改善神经功能缺损程度，提高日常生活活动能力，并且近期预后较好。     

The prognosis of the outcome of the inflammatory process in chronic bronchitis]

The authors relate the data on the leading part fibrosoformation plays in the disease outcome in patients with certain pulmonary chronic illnesses. The levels of free and bound hydroxyproline and hyaluronidase activity served as diagnostic criteria for processes of fibrosoformation. Based on the data obtained a method of predicting chronic bronchitis (CB) was devised. Thus, the two-fold rise of hyaluronidase activity as compared to normal and the index of fibrosing (the ratio of free to bound hydroxyproline) exceeding 1 suggest an unfavourable course of CB accompanied by the enhancement of fibrosoformation. Meanwhile if hyaluronidase activity increases 2-fold and more and the index of fibrosing is less than 1, the prognosis of inflammatory process may be favourable. Based on the clinical data, the significance of prognosis was proved in 93% of cases.     

The use of the kallikrein-kininogen system indices in the prognosis of the development of hemorrhagic erysipelas]

A number of the kallikrein-kinin system parameters (kallikrein, prekallikrein, total arginine esterase activity, alpha 1 protease inhibitor, and alpha 2 macroglobulin) were measured in 59 patients with erythematous erysipelas and in 51 ones with hemorrhagic erysipelas over the course of the disease. Marked activation of the blood kallikrein-kinin system was seen in all the patients during the initial period of the disease, manifesting by elevated levels of kallikrein, total arginine esterase activity, alpha 1 protease inhibitor, alpha 2 macroglobulin, and a lowered prekallikrein concentration. In erythematous erysipelas the peak of activation was recorded in the first days of the disease, whereas in hemorrhagic condition it was observed during the second week of erysipelatous inflammation. Different patterns of changes in the kallikrein-kinin system over the course of the disease permit using one of its parameters, kallikrein activity, for the prediction of the development of local hemorrhagic syndrome in erysipelas patients already during the earliest (prehemorrhagic) stage of the condition.     

白质疏松对脑卒中预后的影响

随着影像学的发展,关于白质疏松的研究越来越多,但对其发病机制、病理基础及临床意义目前尚不完全清楚。有些研究认为白质疏松的形成是一个连续的缺血性疾病的过程,开始是影像学上无症状的小缺血病灶,逐渐发展可能出现脑梗死,白质疏松是否可预测脑卒中的发生,预测脑卒中的发展结果,目前对此观点尚缺乏系统研究。脑部出现白质疏松的患者可能会存在认知、步态和排尿方面的障碍,发生脑卒中后,这些临床症状可能会阻碍神经功能缺损恢复,而且由于白质疏松的损害部位集中在白质区域,可能也会影响脑卒中患者的预后,影响患者生存率和再卒中率。     

Meaning perspective transformation following stroke: the process of change

Purpose.?Transformative Learning in an educational theory that posits that individuals learn and grow when their meaning perspectives (frames of reference for interpreting an experience based on knowledge, feelings, values and beliefs) are reformulated following a critical event. This theory has become quite influential in the exploration of adaptation to chronic illness. This study explored whether the change that occurs following stroke follows a process similar to transformative learning.

Method.?Grounded Theory approach was used to explore changes in meaning perspective among 12 people who were members of stroke support organisations, had a stroke at least 1 year prior to the study and described themselves as viewing life positively following stroke. Constant comparison analysis of interviews with these individuals was used to explore their experience following stroke.

Results.?Meaning perspective transformation occurred with four factors contributing to transformation: triggers, support, knowledge and choices to action. A substantive grounded theory of the process of meaning perspective transformation following stroke is presented, which illustrates the interaction of these contributing factors in initiating and facilitating the transformation process.

Conclusion.?Transformative learning can offer insight into how people who have experienced stroke learn, rebuild competence and re-engage in valued activities.     

脑卒中患者临床表现与预后的关系

目的　探讨脑卒中病人某些临床表现与预后的关系。方法　对我院 1997年 5月至 2 0 0 4年 4月收治的 189例脑卒中患者的临床表现与预后进行统计分析。结果　发现脑卒中患者中伴有意识障碍、视乳头水肿、双侧瞳孔不等大、应激性溃疡、抽搐者预后极差 ,与不伴有意识障碍、视乳头水肿、双侧瞳孔不等大、应激性溃疡、抽搐者对比有显著差异 (P均 <0 .0 1)。头痛、高血压、发热、电解质紊乱、肝肾功能不全对预后影响不大 ,与无头痛、高血压、发热、电解质紊乱、肝肾功能不全者对比无显著差异 (P均 >0 . 0 5 )。结论　脑卒中的预后与某些临床并发症有密切关系 ,并发症越多、越重 ,预后越差。     

Functional recovery in young stroke patients.

Thirty young stroke patients were retrospectively assessed for levels of activities of daily living and of basic functional movements. Scores upon admission, discharge, and follow-up were compared in order to evaluate course of rehabilitation and functional outcome. Mean length of stay in the rehabilitation ward was 87 +/- 17 days, and duration of follow-up was 31 +/- 8 months. Multivariate analysis of covariance confirmed significant improvements during hospitalization, in transfer, standing, sitting and walking abilities (F = 3.5, p less than 0.02), as well as in activities of daily living (F = 4.7, p less than 0.01). Further improvement during the follow-up period was observed for standing and walking abilities (F = 10.2, p less than 0.001) only. No fatalities occurred among the patients during the study period. Eighty-one percent of the patients resumed their previous or other jobs six months after discharge. We conclude that for young stroke patients admitted to a rehabilitation ward shortly after the event, prognosis in terms of survival and functional outcome is favorable, and independent of precipitating factor, age, sex, or side of weakness.     

Negotiating the informed-consent process in developing countries: a comparison of Swaziland and Pakistan

Protecting the rights of research participants when conducting studies within an international context presents many challenges. The purpose of this article was to compare and contrast the process of obtaining informed consent in two very different countries - Swaziland and Pakistan. Major aspects of the informed-consent process presented included identification of gatekeepers, seeking permission from officials, negotiating with these officials and Institutional Review Board (IRB) committees in regard to the type of data to be collected, and explaining informed consent to participants in the field. Data for this article is based upon qualitative research of collaboration between nurses and healers in Swaziland and from a variety of studies completed in Pakistan. These studies demonstrate the inadequacy and complexity of applying western-based concepts of informed consent to developing countries.     

Contribution of cerebral angiography to the prognosis of juvenile stroke

46 patients (aged 13 to 40 years) suffering from ischaemic cerebrovascular disease were investigated by means of complete 4-vessel angiography. 40 of these patients were re-examined after a mean follow-up period of 57 months. The aim of the study was to investigate possible connections between the angiographic data and the clinical condition some years later. In the 37 patients who were not subjected to surgical treatment prognosis was not significantly different in cases with, and those without stenoses/occlusions in the craniocervical vessels. However, patients suffering from severe stenoses/occlusions had a significantly worse prognosis than patients with stenoses of a mild degree. The clinical course in patients with stenoses/occlusions localized in the vertebro-basilar system was significantly more favourable than the course of the disease in patients with similar changes in the carotid system. There was a trend towards a worse clinical picture at the end of the follow-up period in cases with degenerative alterations in the small intracranial arteries. The difference in prognostic value of cerebral 4-vessel angiography in cases of stroke in the young, as opposed to the findings in older patients is discussed.     

实验室有关指标对脑卒中预后的影响

目的探索脑卒中急性期实验室相关指标是否为预后的独立预测因素。方法对346例脑卒中患者于入院时或次日清晨测定白细胞（WBC）、血小板（PLT）、血细胞比容（HCT）、血浆纤维蛋白原（FIB）、空腹血糖（FPG）、高敏C反应蛋白（hs-CRP）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、白蛋白（Alb）、钾离子（K＋）、钠离子（Na＋）等指标,并收集可能与预后相关的其他临床资料,随访6个月末的死亡、残疾和独立生存等结局。分别作单因素分析和多因素Logistic回归分析。结果 FPG[比值比（OR）=1.964,P=0.011]、FIB（OR=1.726,P=0.032）和Alb（OR=0.435,P=0.049）是死亡/残疾的独立预测因素。脑卒中部位、年龄、脑损伤体积、脑卒中量表评分也与脑卒中预后密切相关。结论应激时的高水平FPG、FIB危及脑卒中患者预后,Alb是保护因素。监测FPG、FIB变化,密切关注营养状态对改善脑卒中近期预后、降低死亡/致残率有重要意义。