目的 探讨延续性健康指导联合预见性干预对慢性脑卒中患者脑功能影响。方法 选取2019年6月—2020年6月我院收治的慢性脑卒中患者118例,使用随机数字表法将其分为两组,对照组进行预见性干预,研究组进行延续性健康指导联合预见性干预。比较两组效果、神经运动功能、不良反应。结果 研究组效果大于对照组(P＜0.05);研究组神经运动功能大于对照组(P＜0.05);研究组不良反应少于对照组(P＜0.05)。结论 慢性脑卒中护理中,延续性健康指导联合预见性干预效果较好,值得应用。

Objective To investigate the effects of continuous health guidance and combined predictive intervention on cerebral function in patients with chronic stroke. Methods A total of 118 patients with chronic stroke admitted to our hospital from June 2019 to June 2020 were selected and divided into two groups using the random number table method. The control group received predictive intervention, and the study group received continuous health guidance combined predictive intervention. The effects, neuromotor functions and adverse reactions of the two groups were compared. Results The effect of the study group was greater than that of the control group (P<0.05). The neuromotor function of the study group was higher than that of the control group (P<0.05). The adverse reactions in the study group were less than those in the control group (P<0.05). Conclusion In the nursing of chronic stroke, the effect of continuous health guidance combined with predictive intervention is good, and it is worth applying.

目的 探讨大黄穴位贴联合直肠指力刺激在脑卒中后便秘患者的应用效果。方法 本研究选择2019年1月—2019年12月间我院收治的脑卒中后便秘患者90例,随机分成A组(大黄穴位贴组),B组(直肠指力刺激组),C组(大黄穴位贴联合直肠指力刺激组)三组,每组30例。记录三组患者便秘治疗有效率,采用Wexner便秘评分系统评估三组患者治疗前后的便秘程度并进行自身前后对比。结果 三组干预前后Wexner评分采用自身配对非参数秩和检验,差异有统计学意义(P＜0.05)。三组干预前后差值采用Kruskal-Wallis H检验结果差异有统计学意义(H=26.211,P＜0.05),经过两两对比,差异有统计学意义(P＜0.05)。值得注意的是,干预后C组Wexner评分下降。干预后C组患者的有效率高于其他两组,有效率结果为C组(90%)＞B组(80%)＞A组(53.5%),差异有统计学意义(P＜0.05)。结论 相较于单一应用大黄穴位贴或直肠指力刺激,大黄穴位贴联合直肠指力刺激治疗效果更好,可有效降低便秘发生率,提高病人生活质量。

Objective To explore the effect of rhubarb acupoint application combined with rectal finger force stimulation in patients with constipation after stroke. Methods In this study, 90 patients with post-stroke constipation admitted to our hospital from January 2019 to December 2019 were randomly divided into group A (rhubarb acupoint application group), group B (rectal finger force stimulation group) and group C (rhubarb acupoint application combined with rectal finger force stimulation group), 30 cases in each group. The effective rates of constipation treatment in the three groups were recorded, and the Wexner constipation scoring system was used to evaluate the degree of constipation before and after treatment among three groups. Results The Wexner scores of the three groups before and after treatment were analyzed by self-paired non-parametric rank sum test, and the differences were statistically significant (all P<0.05). The difference among the three groups before and after treatment using Kruskal-Wallis H test was statistically significant (H=26.211, P<0.05), and after pairwise comparison, the differences were statistically significant (P<0.05). It was worth noting that the Wexner score of group C dropped significantly after treatment. The effective rate of treatment in group C was significantly higher that those in the other two groups. The result showed effective rate of group C (90%)＞ group B (80%)＞group A (53.5%), the difference was statistically significant (P<0.05). Conclusion Compared with the single treatment of rhubarb acupoint application or rectal finger force stimulation, the combined treatment had better efficacy, which reduced incidence of constipation and improved the quality of life of patients.

目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 对首发短暂性脑缺血发作(TIA)及缺血性轻型卒中的患者进行认知功能分析,评估其认知损害程度及常见的认知损害领域,以便制定早期的认知功能康复计划,减少痴呆的发生。方法 纳入起病10天内的首发TIA及缺血性轻型卒中患者,完善MMSE和MoCA评分,把MMSE评分正常者划分为MoCA正常组和MoCA异常者,比较两组的认知功能损害程度及损害领域。结果 纳入142例患者,MMSE正常者113例,其中MoCA正常组83例,MoCA异常组30例。两组的认知功能比较,在视空间/执行功能、命名、注意力、计算、延迟记忆、定向力等方面的差异有统计学意义(P＜0.05),在言语流畅、抽象思维方面的差异无统计学意义(P＞0.05)。结论 TIA/轻型卒中患者存在多方面不同程度的认知功能损害,临床上需重视对该类患者的认知筛查,及时了解患者认知功能的变化,以便给予及时的诊断和治疗。

Objective To analyze the cognitive impairment among the paitents with TIA and minor ischemic stroke for the first attack. Making a recovery plan in early time by eveluating the degree and domains of the cognitive impairment, so as to reduce the prevelance of dimentia. Methods Patients with TIA and minor ischemic stroke for the first attack in 10 days were included. MMSE and MoCA were completed, we sorted out the normal MMSE patients and divided them into MoCA normal group and MoCA abnormal group, compared the cognitive function between the two groups. Results 142 patients were included. Among them 113 patients' MMSE were normal, in which MoCA normal group were with 83 patients and MoCA abnormal group with 30 patients. There were significant differences between them in visuospatial and executive function, naming, attention, caculation, delay memory and orientation(P＜0.05), while no significant difference in language fluency and abstraction(P＞0.05). Conclusion Cognitive impairment of TIA/minor ischemic stroke patients was in different degree, so we should pay more attention to their cognitive function and give them an in-time diagnosis and treatment.

目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨健康教育路径联合集束化护理模式在预防脑卒中患者便秘的效果观察。方法 随机选择神经外科收治的脑卒中患者120例,分为实验组与对照组,各60例,其中对照组给予常规护理,而实验组在常规护理基础上应用健康教育路径联合集束化护理模式。比较两组患者便秘发生率、便秘措施落实率、患者满意度、及患者入院前后的健康教育知识知晓率的比较。结果 实验组便秘发生率明显低于对照组,便秘护理评估率,护理措施落实率,病人满意度明显高于观察组,患者入院后的健康教育知识知晓率明显升高(P<0.05),具有统计学意义。结论 健康教育路径联合集束化护理模式能有效的降低脑卒中患者便秘发生率,提高预防便秘发生护理措施落实率,提高患者满意度,提高患者舒适度。

目的 探讨长期吸烟史对高危脑卒中患者口服阿司匹林二级预防效果的影响。方法 将2012年8月—2014年8月医院口服阿司匹林二级预防的高危脑卒中患者115例作为研究对象,根据有无吸烟史分为无吸烟史组(34例)和吸烟史组(81例),其中36例吸烟时间≥20 a(长期吸烟史组)、45例吸烟时间1～19 a(短期吸烟史组)。随访12个月,测定血小板颗粒膜蛋白(GMP-140)、D-二聚体(D-D)、纤维蛋白原(FIB)、组织型纤溶酶原激活物(t-PA)、血小板膜糖蛋白CD61、CD62p,记录1年阿司匹林抵抗和临床终点事件发生率。结果 长期吸烟史组治疗前后GMP-140、D-D、FIB、CD61、CD62p高于短期吸烟史组和无吸烟史组,t-PA低于短期吸烟史组和无吸烟史组,且短期吸烟史组和无吸烟史组组间比较,差异有统计学意义(P＜0.05);长期吸烟组阿司匹林抵抗发生率和临床终点事件发生率分别为33.33%、30.56%,高于无吸烟史组的8.82%、8.82%,差异有统计学意义(P＜0.05),其余组组间比较差异无统计学意义(P＞0.05)。结论 长期吸烟史会使脑卒中患者存在血栓前状态,增加阿司匹林抵抗和临床终点事件的发生几率。

Objective To explore effects of long-term smoking on secondary prevention for oral aspirin in high-risk stroke patients. Methods A total of 115 high-risk stroke patients who orally took aspirin for secondary prevention in our hospital from August 2012 to August 2014 were selected as the study subjects. According to smoking or not, they were divided into non smoking history group (34 cases) and smoking history group (81 cases). Among them, 36 cases whose smoking time was ≥ 20 years were included in the long-term smoking history group, and 45 cases whose smoking time was 1 to 19 years were included in the short-term smoking history group. The patients were followed up for 12 months. The platelet granule membrane protein (GMP-140), D-dimer (D-D), fibrinogen (FIB), tissue plasminogen activator (t-PA), platelet membrane glycoprotein CD61 and CD62p were determined. The incidence rates of 1-year aspirin resistance and clinical outcome events in the three groups were recorded. Results Before and after treatment, GMP-140, D-D, FIB, CD61 and CD62p in long-term smoking history group were higher than those in short-term smoking history group and non smoking history group while T-PA was lower, and there were significant differences between short-term smoking history group and non smoking history group (P<0.05). The incidence rates of aspirin resistance and clinical outcome events in long-term smoking history group (33.33%, 30.56%) were higher than those in non smoking history group (8.82%, 8.82%)(P<0.05), but there was no significant difference among other groups (P>0.05). Conclusion Long-term smoking history will cause prethrombotic state in stroke patients and increase the incidence rates of aspirin resistance and clinical outcome events.

目的 观察镜像视觉反馈和改良强制性运动治疗对脑卒中偏瘫患者上肢功能的影响。方法 前瞻性纳入2013年12月—2016年10月在我院收治的、临床资料完整的脑卒中偏瘫患者117例,随机将患者分4组:A组30例,B组29例,C组28例和D组30例,所有患者均接受常规综合康复治疗,连续治疗4周。在常规综合康复治疗的基础上,B组和C组分别增加镜像视觉反馈训练和改良强制性运动治疗,D组则同时另加镜像视觉反馈和改良强制性运动治疗。主要观察指标包括治疗前、后的Fugl-Meyer量表(FMA)、上肢功能测试(upper extremity function test, UEFT)和改良Barthel指数(MBI)的评分。结果 4组患者治疗后的FMA、UEFT和MBI评分分别为:A组(26.37±3.44)、(43.30±3.46)、(56.27±4.76),B组(29.17±2.82)、(45.41±3.40)、(58.72±4.48),C组(29.46±3.16)、(45.71±2.37)、(58.82±3.89),D组(31.93±2.74)、(48.83±3.57)、(62.17±4.51),与治疗前组内相比,配对t检验显示差异有统计学意义(P＜0.05);单因素方差分析发现,D组明显优于A、B、C 3组,差异有统计学意义(P＜0.05);B、C 2组均优于A组,差异有统计学意义(P＜0.05);B、C 2组间比较,差异无统计学意义(P＞0.05)。结论 在常规综合康复训练基础上,单独联合镜像视觉反馈或改良强制性运动治疗均能改善脑卒中偏瘫患者上肢运动功能和日常生活自理能力,但同时联合应用两种疗法,疗效更佳。

Objective To investigate the effects of mirror visual feedback (MVF) and modified constraint-induced movement therapy (mCIMT) on upper extremity function in post-stroke hemiplegics. Methods 117 patients with hemiplegia post-stroke were collected prospectively from December 2013 to October 2016, and randomly divided into the following four groups: group A (n=30), group B (n=29), group C (n=28) and group D (n=30). All patients were trained with conventional comprehensive rehabilitation therapy for four weeks, while the group B and group C were respectively trained with MVF and mCIMT based on conventional comprehensive rehabilitation therapy. Finally, the group D was simultaneously trained with MVF and mCIMT. The investigation duration was set as four weeks for all groups. The Fugl-Meyer Assessment (FMA) score, Upper Extremity Function Test (UEFT) score, and Modified Barthel Index (MBI) score were used as main index of clinical effects. Results After treatment, the scores of FMA, UEFT and MBI were respectively (26.37±3.44),(43.30±3.46),(56.27±4.76) in group A, (29.17±2.82), (45.41±3.40), (58.72±4.48) in group B, (29.46±3.16), (45.71±2.37), (58.82±3.89) in group C, (31.93±2.74), (48.83±3.57), (62.17±4.51) in group D.Comparing with the scores before treatment, the paired-sample t test showed that there were significant differences (P<0.05). The single factor variance test showed that the scores of the group D were significant better than those scores in group A, group B and group C (P<0.05); furthermore the scores of the group B and group C were significant better than the group A (P<0.05). However, there were no difference at those scores between the group B and group C (P＞0.05). Conclusion Based on conventional comprehensive rehabilitation, single combined with MVF or mCIMT may significantly improve the function of upper limb and activities of daily living (ADL) in post-stroke patients with hemiplegia. However, simultaneous combined with MVF and mCIMT will be more effective than the single one.

目的 观察和研究功能锻炼和心理护理对中风后肩手综合征老年患者功能康复的影响,以及对运动功能、日常生活活动能力的影响。方法 选取2015年6月—2017年2月收治的中风后肩手综合征老年患者60例为研究对象,随机法分为干预组与对照组,各30例。干预组在给予内科常规治疗及护理的同时,采用功能锻炼心理干预等方法进行处理;对照组仅进行内科的常规治疗及护理。运动功能则采用Fugl-Meyer评分法(FMA)进行评分,而日常生活活动能力采用改良Barthel指数(MBI)进行评分。并比较两组患者干预前后焦虑、抑郁水平。结果 干预组FMA评分以及MBI评分均高于对照组,差异有统计学意义(P<0.05)。干预后干预组患者焦虑、抑郁评分低于对照组,两组比较差异有统计学意义(P<0.01)。结论 采用功能锻炼和心理护理能提高中风后偏瘫患者的运动功能以及日常生活活动能力,缓解或消除患者焦虑抑郁等负性情绪,效果明显,值得推广应用。

Objective To observe and study of functional exercise and psychological nursing for stroke shoulder hand syndrome after the influence of the elderly patients with functional rehabilitation, and the influence on motor function and ability of daily life activities. Methods 60 cases of elderly patients with apoplexy after apoplexy were selected from June 2015 to February 2017. They randomly were divided into two groups: intervention group and control group, each with 30 cases. The intervention group was treated with functional exercise psychological intervention with giving routine treatment and nursing care as the same time. The control group only conducted routine treatment and nursing care. The exercise function was rated by the Fugl-Meyer scoring method (FMA), while the improved Barthel index (MBI) was used to score the daily activities. The anxiety and depression levels were compared between the two groups. Results The FMA score of the intervention group and MBI score were higher than that of the control group, and the difference was statistically significant(P<0.05). The anxiety and depression scores of the intervention group were lower than those in the control group, and the difference between the two groups was statistically significant(P<0.01). Conclusion The functional exercise and psychological care may improve movement function in patients with hemiplegia after stroke, and daily life activities ability, alleviate or eliminate negative emotions, including anxiety depression. It is worth promoting.

目的 探讨急性卒中合并医院获得性肺炎患者的病原学特点及药物敏感性情况。方法 回顾性分析116例急性卒中合并医院获得性肺炎患者临床资料,记录其病原菌分布特点;分析检出率最高的三种病原菌耐药情况。结果 ①此次入组的116例受试患者呼吸道分泌物样本中共分离出160株病原菌,其中革兰阳性菌50株(31.3%),革兰阴性菌88株(55.0%),真菌22株(13.8%);肺炎克雷伯菌、绿铜假单胞菌及金黄色葡萄球菌为分布构成比最大的前三位病原菌,构成比分别为17.5%、15.6%和12.5%;②三种常见病原菌均对万古霉素及利奈唑胺药物敏感性较高,可达100.0%;左氧氟沙星对金黄色葡萄球菌敏感性较高,但肺炎克雷伯菌及绿铜假单胞菌等革兰阴性菌对其耐药性较强;头孢唑林对肺炎克雷伯菌及绿铜假单胞菌敏感性较高。结论 急性卒中合并医院获得性肺炎患者多以革兰阴性菌为常见病原菌,肺炎克雷伯杆菌、铜绿假单胞菌及金黄色葡萄球菌最多见;病原菌对常见抗菌药物存在不同程度耐药性,需引起临床重视,根据病原学分析结果科学合理使用抗菌药物以提升治疗效果。