巨刺疗法联合运动想象对卒中患者肢体功能恢复影响

目的：观察巨刺疗法联合运动想象对卒中患者肢体功能恢复的影响。方法将80例卒中后单侧肢体功能障碍患者随机分为2组。治疗组40例,予巨刺疗法联合运动想象治疗;对照组40例,单纯予巨刺疗法治疗。2组均以4周为1个疗程,连续治疗3个疗程后,采用 Fugl －Meyer 运动功能评分（FMA）评定患者运动功能,改良 Barthel 指数（MBI）评定患者日常生活活动能力,改良爱丁堡斯堪的那维亚评分（MESSS）进行神经功能缺损程度评定,并采用 MESSS 评分进行疗效比较。结果治疗组总有效率95．0％,对照组总有效率82．5％,2组总有效率比较差异有统计学意义（P ＜0．05）;2组治疗后 FMA、MBI 及 MESSS 评分与本组治疗前比较差异均有统计学意义（P ＜0．05）,FMA、MBI 评分升高,MESSS 评分降低,且治疗组改善均优于对照组（P ＜0．05）。结论巨刺疗法联合运动想象可以明显促进卒中后肢体功能障碍患者肢体功能恢复,疗效确切,二者联合相辅相成具有协同作用。     

Aligned acupuncture at muscle regions plus cutaneous needle for upper limb spasticity after stroke: A multicenter randomized controlled trial

Objective： To evaluate the clinical efficacy of aligned acupuncture at the muscle regions plus cutaneous needle for post-stroke upper limb spasticity. Methods： By adopting a design of multicenter randomized controlled clinical trial, 488 patients with post-stroke upper limb spasticity were randomized into a treatment group and a control group, 244 in each group. In addition to rehabilitation training, the treatment group received aligned acupuncture at the muscle regions plus cutaneous needle therapy and the control group received conventional Western medicine. After successive 3-week treatments, the clinical efficacy, spasticity degree of the upper limb, joint function, and neurological defect degree were evaluated in the two groups. Results： The total effective rate was 93.4% in the treatment group versus 61.5% in the control group, and the difference was statistically significant （P 〈 0.05）. The upper-limb spasticity degree, joint function, and neurological defect degree were improved significantly in both groups after intervention （P〈0.05）, and the improvements in the treatment group were more significant than those in the control group （P〈0.05 or P〈0.01）. Conclusion： Aligned acupuncture at the muscle regions plus cutaneous needle therapy is effective in treating post-stroke upper limb spasticity.     

针刺对脑卒中后认知功能障碍相关机制研究进展

脑卒中后认知功能障碍的干预方法多样,主要有认知功能训练、药物治疗、针刺干预等。大量临床实践已证实针刺对卒中后认知功能障碍的恢复具有一定的疗效。本研究搜集近几年关于针刺对脑血流、对神经细胞内部结构以及相关分子生物学等的影响,并从以上几方面将针刺治疗脑卒中后认知功能障碍部分作用机制做简单阐述;提出目前针刺治疗本病的问题及展望。     

脑卒中急性期并发抑郁症88例临床分析

目的探讨脑卒中急性期并发抑郁状态的临床特点和治疗原则。方法回顾分析88例脑卒中急性期并发抑郁状态患者的主要临床特点,并观察百优解治疗2、4周时的疗效。结果脑卒中急性期并发抑郁状态的发生率为26.0%(132/507),其中多次卒中患者抑郁状态的发病率(46.9%)明显高于首次发病的患者(21.0%)(P<0.01)。病灶主要位于左半球的例数是右半球的2.95倍(65/22)。位于半球前部的例数是后部的1.90倍(57/30)。入组的88例,轻度抑郁68例(77.3%),中度抑郁14例(15.9%),重度抑郁6例(6.8%)。百优解结合心理治疗2周时汉密尔顿抑郁量表(HAMD)评分较治疗前有显著下降(P<0.05);4周时HAMD评分较2周时进一步下降(P<0.01)。结论脑卒中急性期抑郁状态发生率较高,多次卒中患者更加明显,病灶多位于左半球及半球的前部。积极抗抑郁治疗不但能使抑郁症状得到很大地改善,而且能促进卒中后神经功能的恢复。     

脑卒中后抑郁早期干预对神经功能康复的影响

目的：探讨脑卒中后抑郁早期干预对神经功能康复的影响。方法：将96例脑卒中后抑郁患者随机分为治疗组50例和对照组46例;两组均进行常规原发病治疗和康复训练,治疗组同时进行药物治疗和心理治疗。经HAMD量表评定抑郁状态,分别于治疗前及治疗后第1、2、3、4周进行评定。结果：治疗组与对照组对比分析,HAMD量表评定均有明显改善,差异有统计学意义（P〈0．01）。结论：抑郁早期干预不仅能有效改善脑卒中后抑郁患者心境,同时可降低卒中患者的致残率。促进神经功能康复。     

小卒中的预后预测因素

小卒中以症状轻微、快速恢复和不易致残为特点,但一部分小卒中患者是卒中复发的高危人群,并且可导致残疾、认知损害和情绪异常.早期预测小卒中患者的预后,筛查卒中复发和致残的高危人群并给予合适的治疗,可预防卒中复发和改善患者预后.文章就小卒中患者预后的预测因素进行综述.     

Animal models of CNS disorders

There is intense interest in the development and application of animal models of CNS disorders to explore pathology and molecular mechanisms, identify potential biomarkers, and to assess the therapeutic utility, estimate safety margins and establish pharmacodynamic and pharmacokinetic parameters of new chemical entities (NCEs). This is a daunting undertaking, due to the complex and heterogeneous nature of these disorders, the subjective and sometimes contradictory nature of the clinical endpoints and the paucity of information regarding underlying molecular mechanisms. Historically, these models have been invaluable in the discovery of therapeutics for a range of disorders including anxiety, depression, schizophrenia, and Parkinson's disease. Recently, however, they have been increasingly criticized in the wake of numerous clinical trial failures of NCEs with promising preclinical profiles. These failures have resulted from a number of factors including inherent limitations of the models, over-interpretation of preclinical results and the complex nature of clinical trials for CNS disorders. This review discusses the rationale, strengths, weaknesses and predictive validity of the most commonly used models for psychiatric, neurodegenerative and neurological disorders as well as critical factors that affect the variability and reproducibility of these models. It also addresses how progress in molecular genetics and the development of transgenic animals has fundamentally changed the approach to neurodegenerative disorder research. To date, transgenic animal models\have not been the panacea for drug discovery that many had hoped for. However continual refinement of these models is leading to steady progress with the promise of eventual therapeutic breakthroughs.     

中医综合康复治疗偏瘫痉挛状态的临床分析

目的：探讨偏瘫痉挛状态采取中医综合康复治疗的效果。方法：对脑卒中偏瘫痉挛状态的患者采用中医综合康复治疗。结果与结论：中医综合康复治疗偏瘫痉挛状态有较好疗效。     

脑卒中失语症患者常见的心理特点及护理干预

目的探讨脑卒中失语病人的心理特点,采取适当的护理干预措施,观察对脑卒中失语患者康复疗效的改善。方法选取52例脑卒中后造成失语症的患者,随机分为干预组和对照组。对照组给予常规康复训练,干预组在常规训练的基础上给予个性化沟通、音乐治疗、强化支持系统等护理干预措施。疗程为2个月,在治疗前后分别用Zung氏抑郁自评量表、波士顿BDAE失语症诊断量表、Barthel指数、MMSE量表评估两组患者的抑郁程度、语言功能、日常生活活动能力及认知功能。结果干预组与对照组相比,除日常生活活动能力组间比较P〉0．05,其余3组均p〈0．05。结论通过有效的护理干预措施可以有效减轻脑卒中失语症患者的卒中后抑郁,改善其语言功能和认知功能。     

急性脑梗死规范化治疗的临床评估

目的实施急性脑梗死规范化治疗,观察其临床疗效、降低病死率、并发症发生率及平均住院费用的效果,为急性脑梗死规范化治疗的推广提供依据.方法采用病例历史对照研究,对2004年7月～2005年7月符合纳入标准的急性脑梗死患者实施规范化治疗组成规范化治疗组,2003年6月～2004年6月同条件的已实施常规治疗的患者为对照,分别登记患者治疗前后美国国立卫生院神经功能缺损评分(National Institutes of HealthStroke,NIHSS)、格拉斯哥昏迷评分(Glasgow-Pittsburgh Coma Scale,GCS)、日常生活行为能力Barthel指数,院内并发症发生率、院内病死率、平均住院费用等指标,进行统计分析比较两组差别.结果与常规组相比,规范组治疗后可显著降低患者NIHSS,提高Barthel指数,降低住院期间并发症的发生,尤其是肺部感染,院内病死率亦有显著降低(8.2%vs15.2%),住院期间平均费用规范组较常规组节省2000元左右,两组比较有显著性差异(P＜0.05).结论急性脑梗死规范化治疗可显著改善患者预后,降低病死率,降低住院费用,值得在基层医院大力推广.