早期持续康复护理对脑卒中恢复期患者认知功能及神经功能的影响

目的:探讨早期持续康复护理对脑卒中恢复期患者认知功能及神经功能的影响。方法:选取2018年10月1日～2020年10月1日收治的80例脑卒中恢复期患者,根据入院先后顺序分为对照组和观察组各40例,对照组给予常规护理干预,观察组在对照组基础上实施早期持续康复护理;比较两组认识功能[采用蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)]、神经功能[采用神经功能缺损程度评分量表(NIHSS)、格拉斯哥-庇斯布赫昏迷分度表(G-PCS)]。结果:干预后,观察组MoCA、MMSE、NIHSS、G-PCS评分均优于对照组(P0.01)。结论:早期持续康复护理干预能够提高恢复期脑卒中患者的认知功能,促进脑神经功能的恢复,对改善远期疗效具有积极意义,值得临床借鉴与推广。     

针灸联合康复功能锻炼对脑卒中恢复期痉挛状态及神经功能缺损的影响

目的:探讨针灸联合康复功能锻炼改善脑卒中恢复期患者痉挛状态及神经功能缺损的临床效果。方法:选择2017年2月-2019年2月我院康复科收治的100例符合纳入标准的脑卒中恢复期患者为研究对象,采用随机数字表法将患者分为研究组和对照组,每组50例。两组患者均给予康复科常规治疗措施,对照组患者采用康复功能锻炼,研究组患者在对照组基础上加用针灸治疗,共治疗8周。比较两组患者痉挛改善效果、治疗前后的肢体运动功能、神经功能缺损程度及日常生活能力。结果:治疗后研究组有96.00%的患者痉挛状态得到改善,对照组有80.00%的患者痉挛状态得到改善(P<0.05);治疗后研究组患者肢体功能评分(FMA)及改良Ashworth评分(MAS)评分低于对照组,研究组患者神经功能缺损(NIHSS)及日常生活能力(Barthel指数)评分均优于对照组,差异均有显著性(P<0.05)。结论:对脑卒中恢复期患者采用针灸联合康复功能锻炼,能够有效改善痉挛状态,提高肢体运动功能,促进神经功能修复。     

穴位按摩结合康复护理对脑卒中恢复期患者神经功能缺损及日常生活能力的影响

目的探讨穴位按摩结合康复护理对脑卒中恢复期患者神经功能缺损及日常生活能力的影响。方法收集入院的50例脑卒中恢复期患者随机分为2组,对照组患者给予常规护理,实验组患者则加施穴位按摩结合康复护理,比较2组患者临床神经功能缺损程度评分(CNS)、Barthel指数评分以及不同护理后的有效情况。结果护理后,2组患者CNS评分较护理前均显著下降,且实验组较对照组下降更更明显,差异具有统计学意义(P0.05);护理后,2组患者Barthel指数较护理前均显著下降,且实验组降低更显著(P0.01);实验组患者总有效率显著高于对照组(P0.01)。结论穴位按摩结合康复护理能改善缺血性脑卒中患者神经功能缺损,改善患者CNS评分,有效的促进肢体功能康复,提高日常生活自理能力,具有临床上推广使用价值。     

脑卒中后抑郁对早期神经功能康复的影响

目的研究脑卒中后抑郁(PSD)对早期神经功能康复的影响。方法根据汉密尔顿抑郁量表(HAMD)标准将64例初发脑卒中患者分为抑郁组和非抑郁组进行研究,4周后比较简式Fugl-Meyer(FMA),Barthel指数(BI),临床神经功能缺损程度(CNS),认知功能(MMSE)量表的评分。结果抑郁组和非抑郁组比较CNS评分无显著性差异(P>0.05),而FMA和BI、MMSE评分有显著性差异(P<0.05和P<0.01)。结论PSD对患者早期日常生活活动能力(ADL)、认知功能及运动功能的恢复有明显的负面影响。临床上应重视PSD的早期防治。     

早期康复治疗对脑卒中神经功能重建的影响

目的:探讨对脑卒中患者进行早期康复治疗的方法及其对患者神经功能重建的影响。方法:将180例具有中度以上神经功能缺损的脑卒中患者随机分为康复组和对照组各90例,2组均接受神经内科常规药物治疗,康复组同时接受早期康复治疗。于治疗前、治疗后1个月评定2组神经功能缺损程度、肢体运动功能(FMA评分)及日常生活活动能力(Barthel指数)。结果:康复组神经功能缺损程度评分、FMA评分及Barthel指数的改善均明显优于对照组(P<0.05)。结论:脑卒中患者的早期康复治疗,能帮助患者改善运动功能,促进神经功能恢复,提高患者ADL能力。     

氟西汀对脑卒中后非抑郁患者神经功能康复的影响

目的：了解氟西汀对脑卒中后非抑郁患神经功能康复的影响。方法：60例脑卒中后非抑郁患按入院时间分为治疗组（30例）对照组（30例），除脑卒中后常规的药物治疗和康复训练指导外，治疗组加用氟西汀20mg/d，分别在治疗前，治疗后30，60d用汉密抑郁量表（HAMD），汉密顿焦虑量表（HAMA），MESS，ADL评价患的情绪和神经功能。结果：发现治疗组在30d时ADL改善与对照组在统计学上有显差异（P＜0．05），在60d时MESSS和ADL的改善与对照组在统计学上有显性差异（P＜0．05），而两组在治疗前、治疗30,60d,HAMD、HAMA评分均无显性差异（P＞0．05）。结论：氟西汀能够改善卒中后非抑郁患的神经功能，其机制的确与抗抑郁作用无关，可能是氟西汀能提高突触间隙5－羟色胺（5－HT）的浓度，促进5－HT突触的传递作用，来改善神经运动功能，促进脑损伤后神经功能的恢复。     

帕罗西汀对脑卒中后抑郁及神经功能康复的影响

目的观察分析抗抑郁剂帕罗西汀对脑卒中后抑郁(PSD)及神经功能康复的影响。方法对60例PSD患者随机分为治疗组(31例),对照组(29例)。两组均在神经内科治疗脑卒中的同时,给予心理疏导,治疗组加服帕罗西汀20mg/d8周。结果治疗前、治疗4周组间评分无显著差异,治疗8周组间评分治疗组较对照组均显著下降(P<0.01)。结论帕罗西汀治疗PSD疗效肯定、副作用小、耐受性好,并能促进卒中后神经功能的康复。     

穴位按摩结合康复护理对脑卒中恢复期病人神经功能缺损及日常生活能力的影响

[目的]探讨穴位按摩结合康复护理对脑卒中恢复期病人神经功能缺损及日常生活能力(ADL)的影响。[方法]将2008年5月—2010年5月住院的166例脑卒中恢复期病人随机分为康复组和对照组。给予康复组病人穴位按摩、康复护理,对照组病人进行常规护理。分别于入组时和1个月后进行神经功能缺损及ADL评分。[结果]1个月后康复组在神经功能缺损、ADL等方面明显优于对照组,差异有统计学意义(P<0.01)。[结论]穴位按摩结合康复护理可促进病人神经缺损功能和日常生活能力的恢复,提高病人生活质量。     

综合康复护理干预对脑卒中患者抑郁及神经功能康复的影响

目的 研究综合康复护理干预对脑卒中患者抑郁及神经功能康复的影响.方法 选择某院2018年1月至2019年1月收治的120例脑卒中患者为研究对象,采用随机数字表分为常规组(常规护理)和实验组(综合康复护理)各60例,对比两组康复效果.结果 实验组护理后的抑郁情绪明显改善,评分低于常规组,差异有高度统计学意义(P<0.01...     

睡眠健康教育对脑卒中失眠患者康复的影响

目的 探讨睡眠健康教育对脑卒中失眠患者睡眠质量和生存质量(quality of life,QOL)的影响.方法 70例住院脑卒中失眠患者按住院号奇偶顺序分为两组,单号为教育组(n=35),双号为对照组(n=35).两组患者均给予常规护理、康复训练及每晚口服酒石酸唑吡坦片10 mg,观察组同时实施规范的睡眠健康教育.在入院时及入院后2个月采用匹兹堡睡眠质量指数量表(pittsburgh sleep qualily index,PSQI)、世界卫生组织生存质量评定量表简表(world health organization quality of life,WHOQOL)及日常生活能力(activites of daity living,ADL)量表对睡眠质量、QOL及ADL进行评定.结果 入院2个月后,教育组PSQI 7因子评分低于对照组(P＜0.01),QOL评分高于入院时及对照组(P＜0.05),平均住院天数和平均住院费用明显低于对照组(P＜0.01).结论 系统规范的睡眠健康教育可提高脑卒中失眠患者对治疗及康复的依从性,改善睡眠质量和生活质量,缩短住院天数,减少住院费用.     

Lesion characteristics, NIH stroke scale, and functional recovery after stroke

OBJECTIVE: We examined the relationships between the National Institute of Health Stroke Scale (NIHSS) and physical, cognitive, and social participation outcomes across subpopulations of stroke survivors on the basis of cortical involvement and lesion lateralization. DESIGN: Families in Recovery from Stroke Trial participants were classified with respect to lesion lateralization (n = 274) and cortical involvement (n = 158). NIHSS scores (average 13 days after stroke) were used to predict Physical Performance Test times (PPT), limitations in activities of daily living (Augmented Barthel Index (ABI)), Instrumental Activities of Daily Living (IADL), cognitive function, depressive symptoms (Center for Epidemiologic Studies Depression scale [CES-D]), and productive, recreational, self-care, and social role activities 3 and 6 mos later. We compared the relationship between NIHSS and each outcome in stroke subgroups classified by lesion lateralization and cortical involvement. RESULTS: NIHSS predicted physical performance, activities of daily living, and IADL independence. The association between NIHSS and both PPT and IADLs was less steep for patients with cortical lesions than for patients with exclusively subcortical lesions. NIHSS predicted physical performance, activities of daily living, or IADLs similarly for right- and left-hemisphere strokes, but hemisphere modified the association between NIHSS and CES-D and cognitive measures. CONCLUSIONS: The NIHSS may predict outcomes in subpopulations of stroke survivors with subcortical lesions better than in patients with cortical involvement. NIHSS predicted CES-D in patients with right-sided lesions but not in those with left-sided lesions. In contrast, NIHSS had little association with cognitive outcomes among patients without left-side involvement.     

Reliability and validity of functional balance tests post stroke

OBJECTIVE: To contribute to the reliability and validity of a series of functional balance tests for use post stroke. DESIGN: Within-session, test-retest and intertester reliability was tested using the kappa coefficient and intraclass correlations. The tests were performed three times and the first and third attempts compared to test the within-session reliability. The tests were repeated a few days later to assess test-retest reliability and were scored simultaneously by two physiotherapists to assess the intertester reliability. To test criterion-related validity the tests were compared with the sitting section of the Motor Assessment Scale, Berg Balance Scale and Rivermead Mobility Index using Spearman's rho. SETTING: Stroke physiotherapy services of six National Health Service hospitals. PARTICIPANTS: People with a post stroke hemiplegia attending physiotherapy who had no other pathology affecting their balance took part. Thirty-five people participated in the reliability testing and 48 people took part in the validity testing. MAIN OUTCOME MEASURES: The following functional balance tests were used: supported sitting balance, sitting arm raise, sitting forward reach, supported standing balance, standing arm raise, standing forward reach, static tandem standing, weight shift, timed 5-m walk with and without an aid, tap and step-up tests. RESULTS: The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. Intraclass correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r = 0.32-0.74 p < 0.05), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r = 0.26 and 0.19 respectively). CONCLUSION: These functional balance tests are reliable and valid measures of balance disability post stroke.     

百莲汤治疗失眠症68例临床观察

目的探讨百莲汤治疗失眠症的疗效及安全性。方法将68例失眠症患者随机分为研究组34例,给予口服中药百莲汤治疗,对照组34例给予艾司唑仑治疗,疗程均为6w。于治疗前及治疗第1、2、4、6w末采用汉密尔顿焦虑量表、疗效总评量表评定临床疗效,药物副反应量表评定不良反应。结果两组治疗前后汉密尔顿焦虑量表、疗效总评量表、副反应量表评分差异均无显著性（P〉0．05）。结论百莲汤治疗失眠症疗效与艾司唑仑相当。     

针灸联合中药养阴熄风通络汤治疗中风病的临床疗效观察

目的观察针灸与养阴熄风通络汤联合用于中风病的临床治疗效果。方法选择110例某院中风病患者,依照随机数表法将其分为对照组和试验组,对照组给予常规药物治疗,试验组则在对照组基础之上采用针灸和养阴熄风通络汤,治疗时长为4个疗程,观察两组患者在治疗前后的神经功能缺损评分、中医证候积分、Fugl-Meyer下肢运动功能量表评分及血液流变学指标变化,并对比临床疗效、不良反应差异。结果经治疗后,对照组的总有效率为72.7%,比试验组的90.9%低(P<0.05);两组治疗4个疗程后神经功能缺损评分、中医证候积分、全血黏度高切、低切及血浆黏度比入院时均明显下降,Fugl-Meyer评分明显上升,且试验组治疗4个疗程上述指标均优于对照组,差异具有统计学意义(P<0.05);不良反应方面两组差异无统计学意义(P>0.05)。结论针灸联合中药养阴熄风通络汤治疗中风病疗效明显,可明显减轻神经损伤及临床症状,调整机体血液流变学。     

郁康宁丸对脑卒中后抑郁及神经功能康复的作用

BACKGROUND：Poststrokedepression（PSD）directlyaffectsqualityoflifeandneuralrehabilitation．EffectoftraditionalChinesemedicineisfavorable．OBJECTIVE：Toobservetheimpactofyukangningonqualityoflifeandneuralrehabilitation．UNIT：InternalDepartmentofTraditionalChineseHospitalofPuyangSUBJECTS：１６６patientswithconfirmeddiagnosisandwithouthistoryofmentaldisorderwererandomlydividedintotwogroups，studygroupandcontrolgroup．Studygroupconsistedof５２malesand３２females，aged３０－７９ye…     

Clinical and cognitive predictors of swallowing recovery in stroke

This retrospective study determined whether specific neurological features were associated with initial and final swallowing outcomes in acute stroke patients. A chart review of 65 acute stroke patients suggested that certain clinical and neurocognitive behaviors were associated with swallowing outcomes. Hemispatial neglect was significantly associated with initial nonoral dietary intake, whereas aphasia was not associated with swallowing outcome. Results from the initial clinical swallowing evaluations suggested that the presence of at least four of six clinical features (cough after swallow, voice change after swallow, abnormal volitional cough, abnormal gag reflex, dysphonia, and dysarthria) were associated with poor initial and final swallowing outcomes. Whether specific lesion location, size, or a combination of clinical neurological deficits are associated with poor initial and final swallowing outcomes is unclear. Prospective studies are warranted for further investigation of these relationships.     

西药联合中药消溃平汤剂治疗消化性溃疡的疗效观察与护理

目的 探讨中药消溃平汤剂治疗胃及十二指肠溃疡疗效及护理措施.方法 随机将85例消化性溃疡患者分为治疗组53例和对照组32例.两组均服用奥美拉唑、阿莫西林、克拉霉素,治疗组另加服中药消溃平汤剂.疗程4周.疗程结束后比较两组治疗有效率、复发率及幽门螺杆菌(Hp)根除率.结果 两组治愈有效率、复发率、Hp根除效果均有统计学意义(P＜0.05).结论 中药消溃平汤剂联合西药治疗胃及十二指肠溃疡比单用西药在加速溃疡面愈合,增强对Hp的根除作用,减少复发有显著的协同作用.护理上指导患者正确服食汤药有助于药效发挥.     

Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke

Purpose.?To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients.

Method.?Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60?min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop.

Results.?Functional electric stimulation (FES) resulted in a 26.3% (p?<?0.001) improvement of walking speed measured with 10-m walkway, whereas the improvement in the control group was only 11.5% (p?<?0.01). The FES group also showed significantly greater improvements compared to control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl–Meyer scores, and the maximum value of the root mean square (RMS_max), which reflects the capacity of the muscle output.

Conclusions.?These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.     

心理干预对脑卒中后抑郁神经功能康复的影响

目的：探讨心理干预对脑卒中后抑郁状态及神经功能康复的影响。方法：将80例脑卒中后抑郁患者随机分成观察组和对照组,观察组采取心理干预加常规护理,对照组单用常规护理方法。采用汉密顿抑郁量表（HAMD）、神经功能缺损评分（NFA）、日常生活活动能力（ADL）测定,分别对两组患者进行疗效评价。结果：3个月的干预后,观察组患者HAMD及NFA均明显低于对照组;ADL评分则明显高于对照组（均P〈0.05）。结论：心理干预不仅有助于改善脑卒中后抑郁患者的抑郁状态,而且对神经功能的康复有促进作用。