认知治疗对脑卒中后抑郁症的影响

目的了解认知治疗对脑卒中后抑郁患者的影响。方法 84例患者随机分为研究组和对照组各42例。研究组口服盐酸氟西汀,同时给予认知治疗,对照组单纯口服盐酸氟西汀,两组疗程均为8周。治疗前、治疗后2周、4周、8周进行汉密尔顿抑郁量表(HAMD)评分,疗效依据HAMD减分率评定,生活质量评价采用生活质量综合评定问卷(GQOLI-74)评定。结果治疗8周末研究组有效率高于对照组(χ2=0.01,P0.05)。研究组焦虑/抑郁因子分在治疗4周低于对照组(t=2.37,P0.05),第8周低于对照组(t=2.56,P0.05),治疗第8周时研究组睡眠障碍因子分低于对照组(t=2.61,P0.05)。治疗后研究组心理功能评分高于对照组(t=4.02,P0.01),社会功能评分高于对照组(t=3.68,P0.01)。结论认知治疗有助于提高患者抑郁症的治疗效果,减轻患者的焦虑/抑郁情绪,改善患者的睡眠。在一定程度上能提高患者的生活质量。     

佩戴腕托对脑卒中后偏瘫手功能康复的影响

目的 观察在注射A型肉毒毒素(BTX-A)和电刺激的基础上,佩戴腕托对脑卒中患者偏瘫上肢活动的效果。 方法 2016年1月至2018年12月,脑卒中上肢痉挛性偏瘫患者52例,均接受BTX-A注射治疗,注射2 d后行伸指肌群电刺激。A组(n = 26)在刺激时佩戴腕托,B组(n = 26)不佩戴。于治疗前(T0)、治疗2周后(T1)、治疗4周后(T2)、治疗12周后(T3)采用改良Ashworth量表(MAS)、积木盒障碍测试(BBt)、上肢动作研究量表(ARAT)进行评定。 结果 治疗后,两组MAS、BBt、ARAT评分均提高(F_时间 > 118.32, P < 0.001),A组BBt、ARAT各时间点评分均优于B组( F_组别 > 31.26, P < 0.001; F_交互 = 10.65,P < 0.001)。 结论 佩戴腕托能进一步提高BTX-A注射后电刺激对脑卒中患者偏瘫手的疗效。     

经外耳皮肤电刺激迷走神经对脑梗死偏瘫患者上肢运动功能恢复的影响

摘要 目的：探讨经外耳皮肤电刺激迷走神经（transcutaneous vagus nerve stimulation, t-VNS）对脑梗死偏瘫患者上肢运动功能的影响。 方法：将确定入组的42例脑梗死患者随机分配至试验组（t-VNS+常规治疗）及对照组（sham-t-VNS+常规治疗）。入组0天进行基线评定,入组后21天进行治疗后的评价。评定内容包括上肢Fugl-Meyer评分（Fugl-Meyer assessment, FMA）、Wolf运动功能测试（Wolf motor function test,WMFT）、功能独立性评定（functional independence measurement,FIM）。同时治疗过程中及治疗后观察可能出现的副作用。 结果：治疗前两组患者的上肢FMA、WMFT、FIM评分均无显著性差异（P＞0.05）。治疗21天后,两组上肢FMA、WMFT、FIM评分均较治疗前提高（P＜0.05）,并且试验组指标优于对照组（P＜0.05）。治疗过程中及治疗后未出现明显的不良反应。 结论：t-VNS对脑梗死偏瘫患者上肢运动功能恢复的具有促进作用,并且无明显副作用。     

A型肉毒毒素联合本体感觉训练在脑卒中后偏瘫患者中的应用研究

目的研究A型肉毒毒素联合本体感觉训练在脑卒中后偏瘫患者中的应用效果。方法将某院收治的64例脑卒中后偏瘫患者根据随机数表法原则分成甲组32例,乙组32例,甲组实施常规康复治疗,乙组实施A型肉毒毒素联合本体感觉训练,观察两组患者的肢体功能恢复情况及日常生活能力改善情况。结果治疗后,两组的徒手肌力评定法(MMT)评分、Holden功能性步行分级(FAC)评分、Berg平衡量表(BBS)评分及Fugl-Meyer运动功能评测表(FMA)评分均所有上升,且乙组上升的更明显,差异均有统计学意义(P<0.05);两组的日常生活能力评分量表(ADL)评分均有所上升,且乙组的ADL评分较甲组高,差异有统计学意义(P<0.05)。结论A型肉毒毒素联合本体感觉训练,通过A型肉毒毒素改善脑卒中后偏瘫患者的肌张力,解除痉挛,配合本体感觉训练促进肢体功能恢复,促进患者的康复进程。     

渐进式康复训练对脑卒中偏瘫患者功能恢复与日常生活能力的影响

目的探讨渐进式康复训练对脑卒中偏瘫患者功能恢复及心理状况的影响。方法选取2016年1月至2018年1月我院收治的脑卒中偏瘫患者400例为研究对象,采用整群抽样法将其均分为对照组和观察组,对照组给予常规护理干预,观察组在对照组基础上实施渐进式康复训练干预,干预前后,分别采用运动功能评定量表(FM)与改良版Barthel指数评分评价两组干预前后的运动功能康复与日常生活能力。结果观察组的FM与Barthel指数评分均显著高于对照组,差异有统计学意义(P <0. 05)。结论对脑卒中偏瘫患者实施渐进式康复训练干预,可显著改善其肢体功能障碍,提升患肢运动功能康复效果和日常生活自理能力,促进疾病康复进程,值得推广。     

Relationship between β-amyloid protein 1-42, thyroid hormone levels and the risk of cognitive impairment after ischemic stroke

BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure are affected by many factors,and the ability of evaluating the progress of patients with PSCI is insufficient.Therefore,it is necessary to find sensitive markers for predicting the progress of patients and avoiding PSCI.Recent studies have shown thatβ-amyloid protein 1-42(Aβ1-42)and thyroid hormone levels are closely related to PSCI,which may be the influencing factors of PSCI,but there are few related studies.AIM To investigate the relationship between serum levels of Aβand thyroid hormones in acute stage and PSCI and its predicted value.METHODS A total of 195 patients with acute cerebral infarction confirmed from June 2016 to January 2018 were enrolled in this study.Baseline data and serological indicators were recorded to assess cognitive function of patients.All patients were followed up for 1 year.Their cognitive functions were evaluated within 1 wk,3 mo,6 mo and 1 yr after stroke.At the end of follow-up,the patients were divided into PSCI and non-PSCI according to Montreal cognitive assessment score,and the relationship between biochemical indexes and the progression of PSCI was explored.RESULTS Compared with patients with non-PSCI,the levels of Aβ1-42,triiodothyronine(T3)and free thyroxin were lower in the patients with PSCI.Repeated measures analysis of variance showed that the overall content of Aβ1-42 and T3 in PSCI was also lower than that of the non-PSCI patients.Further analysis revealed that Aβ1-42(r=0.348),T3(r=0.273)and free thyroxin(r=0.214)were positively correlated with disease progression(P<0.05),suggesting that these indicators have the potential to predict disease progression and outcome.Cox regression analysis showed that Aβ1-42 and T3 were important factors of PSCI.Then stratified analysis showed that the lower the Aβ1-42 and T3,the higher risk of PSCI in patients who were aged over 70,female and illiterate.CONCLUSION Aβ1-42 and T3 have the ability to predict the progression of PSCI,which is expected to be applied clinically to reduce the incidence of PSCI and improve the quality of life of patients.     

Hip surveillance in Tasmanian children with cerebral palsy

Background:   Children with cerebral palsy (CP) are at risk of hip subluxation. Over time, subluxation can lead to dislocation, deformity and pain. Hip surveillance in the form of an X-ray and clinical examination of this 'at risk group' can identify early subluxation. Early subluxation can be treated, preventing hip dislocation in many cases. Hip surveillance in CP commenced in Tasmania in 1992.
Aims:   To audit the hip surveillance data to date, perform a literature review to understand the emerging evidence for prevention and management of hip subluxation in CP and update hip surveillance guidelines.
Methods:   New guidelines were written and distributed, and an audit of the previous 12 years performed by review of medical files and X-rays.
Results:   Two hundred and eighteen children had been involved in the hip surveillance programme. Fifteen cases of dislocation were recorded in this time. The incidence of subluxation and surgery, as well as the gross motor function classification system (GMFCS) level, was recorded.
Conclusion:   Data from Tasmania showed a similar incidence of hip subluxation according to GMFCS level, and frequency of different surgical interventions as other recent audits. Some children with minor subluxation improved without orthopaedic intervention once weight bearing occurred, which had not before been appreciated. Migration percentage alone is not adequate to fully describe the outcome of hip subluxation. More appropriate measures of outcome in terms of quality of life for children with CP need to be developed.     

儿童交替性偏瘫一例

目的了解儿童交替性偏瘫(AHC)的诊断及治疗方法的合理选择。方法介绍我院收治的1例难治的儿童交替性偏瘫患儿的临床特点,检索国内外10年内的相关文献。结果本病的临床特点为反复发作性的偏瘫,睡眠后缓解,可有其他发作性症状,如发作性肌张力障碍、眼球运动异常和认知障碍等。氟桂利嗪是最常用的药物,托吡酯片、阿立哌唑也可用于治疗本病。结论本病是一种罕见的神经系统发作性疾病,临床表现多样,容易误诊,目前没有标准的治疗方法。     

脑血管病导致残障后康复护理的早期干预

目的:对脑血管病残障及早进行康复护理,以期达到减轻病残、提高患者生活质量、减轻家庭及社会负担.方法:采用床上体位摆放、变换体位、肢体功能锻炼、按摩等,及早对患者进行残障肢体功能康复训练.结果:通过早期进行康复护理干预,减轻了病残损害程度,促进了患者肢体功能恢复,提高了患者的生活质量.结论:给患者进行早期正确的康复训练,可明显提高肢体功能恢复,降低残障程度.     

人工关节置换治疗偏瘫侧股骨颈骨骨折分析

目的分析采用人工关节置换治疗偏瘫下肢股骨颈骨折的疗效。方法18例偏瘫侧股骨颈骨折采用全髋关节置换8例,双动型人工股骨头置换10例,进行回顾性分析。结果18例患者均安全渡过围手术期,全部病例均获随访,优15例,占83%,良3例,占17%,无差的病例。结论人工关节置换是治疗偏瘫侧股骨颈骨折的积极、可靠的治疗方法。