目的 探讨良肢位训练联合风险预控急救应用于重症脑卒中的效果。方法 采用回顾性分析,纳入我院2020年3月—2021年3月期间收治的41例重症脑卒中患者为对照组,救治方式为常规救治联合良肢位训练。同时纳入我院2021年4月—2022年4月期间收治的41例重症脑卒中患者为观察组,救治方式为良肢位训练联合风险预控急救。对比2组抢救情况、抢救效果、运动功能。结果 观察组院外吸氧率（46.34%）、院外插管率（34.15%）均高于对照组（17.07%、9.76%）,转入专科治疗时间、发病至入院时间均短于对照组（P<0.05）;干预3 d后,观察组格拉斯哥昏迷量表分值高于对照组,APACHEⅡ评分分值低于对照组（P<0.05）;观察组Fugl-Meyer运动评估、Berg平衡量表分值均高于对照组,NIHSS量表分值低于对照组（P<0.05）。结论 良肢位训练联合风险预控急救应用于重症脑卒中可有效改善抢救情况、提升抢救效果,从而增强运动功能。

Objective To explore the effect of normal extremity position training combined with risk pre-control emergency treatment in severe stroke．Methods Forty-one severe stroke patients from March 2020 to March 2021 included in the control group were retrospective studied,and the treatment method was conventional treatment combined with normal extremity position training．At the same time,41 severe stroke patients from April 2021 to April 2022 were included in the observation group,which the treatment method was the risk pre-control and emergency treatment．The rescue situation,rescue effect and sports function of the two groups were compared．Results Incidences of oxygen inhalation（46.34%）and intubation（34.15%）outside the hospital in observation group were higher than that in control group（17.07%,9.76%）;specialist treatment,onset to admission time were longer in control group（P<0.05）．Glasgow coma scale score in observation group was higher than that in control group,while APACHE Ⅱ score was lower in observation group（P<0.05）,Fugl-Meyer assessment and Berg Balance Scale score were higher,and NIHSS score was lower than control group（P<0.05）．Conclusions Combination of normal extremity position training and risk pre-control emergency treatment in severe stroke treatment can effectively improve the rescue effect,thus enhance the motor function．

目的 评价银杏二萜内酯葡胺注射液（DGMI）联合依达拉奉右崁对急性缺血性脑卒中（AIS）的治疗效果。方法 回顾性分析我院2021年3月—2022年6月收治的86例AIS患者,根据治疗方法不同,分为单药组和联合组,每组43例,2组均予以DGMI治疗,联合组加用依达拉奉右崁醇。对比2组的治疗效果。结果 治疗后,联合组美国国立卫生研究院卒中量表（NIHSS）评分低于单药组（P<0.05）,简易智能精神状态检查量表（MMSE）和Barthel指数（BI）得分高于单药组（P<0.05）;联合组治疗后脑血流动力学指标（Q_min和V_min）高于单药组（P<0.05）,而全血还原黏度、血浆黏度和血小板聚集指数低于单药组（P<0.05）;联合组治疗后血清丙二醛（MDA）、超敏C-反应蛋白（hsCRP）和白细胞介素-6（IL-6）低于单药组（P<0.05）,而超氧化物歧化酶（SOD）高于单药组（P<0.05）;联合组治疗总有效率88.37%,高于单药组的67.44%（P<0.05）,且2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 DGMI联合依达拉奉右崁醇可有效提高AIS患者的神经功能、认知功能及日常生活能力,降低血液高凝状态,改善脑部血流,缓解机体氧化应激及炎症反应,且不良反应发生率较低,安全性良好。

Objective To evaluate the clinical efficacy of diterpene ginkgolides meglumine injection（DGMI）combined with edaravone dextracanthol in the treatment of acute ischemic stroke（AIS）．Methods A total of 86 patients with AIS admitted to our hospital from March 2021 to June 2022 were divided into single drug group and combination group according to different treatment methods,with 43 patients in each group．Both groups were treated with DGMI,and the combination group was added with edaravone dextracanthol．The therapeutic effect,neurological function and adverse reactions of the two groups were compared．Results After treatment,compared with the single drug group,the NIH Stroke Scale（NIHSS）score of the combination group was significantly lower（P<0.05）,and the Mini-Mental State Examination（MMSE）and Barthel index（BI）scores were significantly higher（P<0.05）．After treatment,the cerebral hemodynamic indexes（Q_min and V_min）in the combination group were significantly higher（P<0.05）,while the whole blood reducing viscosity,plasma viscosity and platelet aggregation index were significantly lower（P<0.05）．After treatment,compared with the single drug group,the serum malondialdehyde（MDA）,high sensitive C-reactive protein（hsCRP）and interleukin- 6（IL-6）levels in the combination group were significantly lower（P<0.05）,while the level of superoxide dismutase（SOD）was significantly higher（P<0.05）．The total effective rate of the combination group was 88.37%,which was significantly higher than 67.44% of the single drug group（P<0.05）．The incidence of adverse reaction between two groups was not significant（P>0.05）．Conclusions DGMI combined with edaravone dextracanthol can effectively improve the neurological function,cognitive function and daily living ability of patients with AIS,reduce blood hypercoagulability,improve cerebral blood flow,alleviate oxidative stress and inflammatory reaction,improve the therapeutic effect,without increasing the incidence of adverse reactions,which has good safety．

目的 比较单纯康复训练和在此基础上结合苍龟探穴针法对脑卒中后肩手综合征I期的临床疗效差异。方法 选择响水县人民医院疼痛康复科收治的卒中后出现肩手综合征I期患者60例,按随机数字表法分为治疗组（n=30）和对照组（n=30）。治疗组患者行与苍龟探穴中医针法结合康复训练,先由具备针灸专业主治资格的临床医师对所选取的部分穴位使用苍龟探穴中医传统针法实施治疗后,再由具有5年以上工作经历的康复治疗师实施治疗,而其他患者则单纯接受康复训练,并观察2组患者在治疗前和治疗后的视觉模拟评分（VAS）、肿胀程度、简式上肢运动功能（Fugl-Meyer）评估以及临床疗效。结果 本次研究临床治疗进程中,2组无不良反应情况出现,因疫情和不能配合治疗而出现5例脱落病例（治疗组2例,对照组3例）。①治疗后,2组患者的VAS和肿胀程度评分低于治疗前（P<0.01）,治疗组患者2项评分高于治疗前（P<0.05）;②治疗后,2组患者的Fugl-Meyer评分高于治疗前（P<0.01）,治疗组患者评分高于对照组（P<0.01）;③治疗组的有效率高于对照组,组间比较差异有统计学意义（P<0.05）。结论 苍龟探穴中医传统针法结合康复训练可减少患者水肿和酸痛情况,明显改善患者上肢运动能力,有良好的临床效果。

Objective To compare the clinical efficacy of rehabilitation training alone and the combination of Cangguitanxue acupuncture on post-stroke stage I shoulder-hand syndrome．Methods A total of 60 patients from the Department of Rehabilitation Medicine of Xiangshui County People's Hospital who met the diagnosis（stroke followed by stage I shoulder-hand syndrome）were selected, and they were randomly divided into treatment group（n=30）and control group（n=30）according to the random number table method．Patients in the treatment group underwent a combination of rehabilitation training with the Cangguitanxue acupuncture Chinese medicine acupuncture method, and were first treated by a clinician qualified in acupuncture using the Cangguitanxue acupuncture Chinese medicine traditional acupuncture method on selected acupoints, and then by a rehabilitation therapist with more than five years of experience, while other patients received rehabilitation treatment alone．Results In the clinical treatment process of this study, there were no adverse reactions in the two groups, but there were five cases of dropout due to the epidemic and the inability to cooperate with the treatment（two cases in the treatment group and three cases in the control group）．After treatment, the visual analogue scale（VAS）and swelling degree scores of the two groups were significantly lower than those before treatment（P<0.01）, and the performance of the patients in the treatment group was better than that before treatment（P<0.05）．After treatment, the score of simplified upper limb motor control function（Fugl-Meyer）score in the two groups was significantly higher than that before treatment（P<0.01）, and the score of patients in the treatment group was higher than that of the control group（P<0.01）．The effective rate of the control group was inferior to that of the treatment group, and the difference was statistically significant（P<0.05）．Conclusions The traditional acupuncture method combined with rehabilitation training can significantly reduce edema and soreness in patients, significantly improve upper limb motor ability, and have good clinical effects．

目的 探讨血清心型脂肪酸结合蛋白（H-FABP）、血管生成素-1（Ang-1）在急性大血管闭塞性卒中（AIS-LVO）静脉溶栓桥接支架取栓患者预后中的评估价值。方法 选择2019年1月—2021年5月80例AIS-LVO患者作为研究对象,均接受静脉溶栓桥接支架取栓治疗,检测术前血清H-FABP、Ang-1水平,术后随访90 d将患者分为预后良好组（n=57）与预后不良组（n=23）。结果 两组在高血压、冠心病、心房颤动、急性卒中治疗低分子肝素试验（TOAST）分型、侧支循环、术前H-FABP、术前Ang-1方面存在差异（P<0.05）。多因素 Logistic 回归分析结果显示,高血压、心房颤动、心源性梗死型、侧支循环为0 ~1 级、术前H-FABP≥10.0 ng/L、术前Ang-1<5.25 ng/mL是AIS-LVO静脉溶栓桥接支架取栓患者预后不良的危险因素。术前血清H-FABP预测术后90 d预后不良的AUC为0.728（95%CI：0.368~0.918）,灵敏度、特异度分别为66.68%、58.92%。术前血清Ang-1预测术后90 d预后不良的AUC为0.773（95%CI：0.592~1.129）,灵敏度、特异度分别为70.35%、63.92%。H-FABP联合Ang-1预测术后90 d预后不良的AUC为0.854（95%CI：0.652~0.957）,灵敏度、特异度分别为77.18%、71.82%。结论 静脉溶栓桥接支架取栓治疗AIS-LVO患者的预后受到多种危险因素的影响,其中术前血清H-FABP和Ang-1是具有前景的预后预测因子。

Objective To investigate the prognostic value of serum heart-type fatty acid binding protein（H-FABP）and angiopoietin-1（Ang-1）in patients with acute ischemic stroke-large vessel occlusion（ALS-LVO）undergoing venous thrombolytic bridging stent thrombectomy．Methods A total of 80 patients with ALS-LVO from January 2019 to May 2021 were selected as the study subjects,treated with intravenous thrombolytic bridging stent thrombectomy,and their serum H-FABP and Ang-1 levels were measured before operation．After 90 days of follow-up,the patients were divided into good prognosis group（n=57）and poor prognosis group（n=23）．Results There were significant differences between the two groups in hypertension,coronary heart disease,atrial fibrillation,TOAST classification,collateral circulation,preoperative H-FABP,and preoperative Ang-1（P<0.05）．Multivariate logistic regression analysis showed that hypertension,atrial fibrillation,cardiogenic infarction type,collateral circulation of 0~1 grade,preoperative H-FABP≥10.0 ng/L,preoperative Ang-1<5.25 ng/mL were independent risk factors for poor prognosis of ALS-LVO patients treated with venous thrombolytic bridging stents．The AUC of preoperative serum H-FABP predicting poor prognosis 90 days after operation was 0.728（95%CI：0.368~0.918）,with sensitivity and specificity of 66.68% and 58.92% respectively．The AUC of preoperative serum Ang-1 predicting poor prognosis 90 days after surgery was 0.773（95%CI：0.592~1.129）,with sensitivity and specificity of 70.35% and 63.92% respectively．The AUC predicted by H-FABP combined with Ang-1 for poor prognosis 90 days after operation was 0.854（95%CI：0.652~0.957）,and the sensitivity and specificity were 77.18% and 71.82% respectively．Conclusions The prognosis of patients with ALS-LVO treated with intravenous thrombectomy bridging stent thrombectomy is affected by many risk factors,among which preoperative serum H-FABP and Ang-1 are promising prognostic factors．

目的 评估全身免疫炎症指数（SII）、中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）在区分急性缺血性卒中（AIS）伴发卵圆孔未闭（PFO）与非伴发PFO患者的价值。方法 回顾性分析100例AIS患者的血液和血清指标,计算SII、NLR和PLR,使用Logistic回归及受试者操作特征（ROC）曲线分析3项指标在鉴别AIS伴发PFO与非伴发PFO中的价值。结果 伴发PFO的AIS患者SII、NLR、PLR高于非伴发PFO的AIS患者,其中以SII最为明显（P均<0.05）。单因素Logistic回归显示,中性粒细胞计数、淋巴细胞计数、PLR、NLR、SII与AIS伴发PFO有关（P<0.05）。ROC曲线分析结果,SII、NLR、PLR鉴别AIS伴PFO与非伴PFO患者,最佳阈值分别为476.4、1.99、115.3,曲线下面积分别为0.777、0.767、0.708。结论 SII、NLR和PLR可作为鉴别AIS患者是否伴发PFO的生物标志物,具有潜在临床应用价值。

Objective To evaluate the value of systemic immune-inflammatory index（SII）,neutrophil/lymphocyte ratio（NLR）and platelet/lymphocyte ratio（PLR）in distinguishing acute ischemic stroke（AIS）patients with patent foramen ovale（PFO）and without PFO．Methods A retrospective analysis of blood and serum indicators in 100 AIS patients was conducted,and SII,NLR and PLR indices were calculated．Logistic regression and ROC curve analyses were performed．Results SII,NLR and PLR were significantly higher in PFO patients than in non-PFO patients,with SII being the most significant．Univariate logistic regression showed that Neu,Lym,PLR,NLR,and SII variables were significantly associated with AIS combined with PFO（P<0.05）．ROC curve analysis revealed that the optimal cut-off values for SII,NLR and PLR in distinguishing AIS patients with PFO from those without PFO were 476.4,1.99 and 115.3,respectively,with area under the curve of 0.777,0.767 and 0.708．Conclusions SII,NLR and PLR can serve as biomarkers for identifying AIS patients with PFO,offering potential clinical application value．

目的 探讨个体化肠内营养联合电动起立床训练对老年脑卒中卧床患者器官功能的影响。方法 严格执行纳排标准后前瞻性选取2021年7月—2022年9月期间我院收治的97例老年脑卒中卧床患者作为研究对象,按照随机数字表法分为单一组48例给予脑卒中基础干预,联合组49例给予个体化肠内营养联合电动起立床训练干预,观察2组患者营养状况、肺功能指标以及心功能指标。结果 干预4周后,2组血清前蛋白、血清白蛋白、血红蛋白水平均上升且联合组高于单一组（P<0.05）;2组用力肺活量（FVC）、第1秒用力呼吸容积（FEV₁）、FEV₁/FVC均上升且联合组高于单一组（P<0.05）;联合组左心室收缩期内径、左室舒张末期内径低于单一组,联合组左心室射血分数高于单一组（P<0.05）。结论 个体化肠内营养联合电动起立床训练干预可有效改善老年脑卒中卧床患者营养状况及心肺功能,促进其机体功能的恢复。

目的 探讨脑卒中患者多重耐药菌（MDROs）医院感染风险因素,并进行病原学特点分析。方法 选择2020年1月—2022年12月福建中医药大学附属福鼎医院神经内科病房收治的160例脑卒中患者为研究对象,评估患者的MDROs医院感染发生状况,调查患者的一般资料并进行多因素分析。结果 在160例患者中,发生医院感染20例,分离到病原体26株,其中8例样本为MDROs（研究组,其他归为对照组）,来源于8例患者,占比5.00%,包括耐甲氧西林金黄色葡萄球菌（MRSA）3株,耐碳青霉烯大肠埃希菌（E.coli）2株、耐碳青霉烯肺炎克雷伯菌（KP）1株、全耐药KP1株、耐碳青霉烯PA1株。研究组的美国国立卫生院神经功能缺损（NIHSS）评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、糖尿病、低蛋白血症、置管留置时间、住院时间等与对照组对比差异有统计学意义（P<0.05）。二分类Logistic回归分析显示,上述指标均为导致MDROs医院感染发生的重要因素（P<0.05）。结论 脑卒中患者MDROs医院感染的发生率依然比较高,病原菌多为耐甲氧西林MRSA、耐碳青霉烯E.coli,患者的NIHSS评分、APACHEⅡ评分、糖尿病、低蛋白血症、置管留置时间、住院时间为主要的MDROs感染风险因素。

目的 研究益生菌结合肠内营养(enteral nutrition,EN)干预纠正缺血急性脑梗死(acute cerebral infarction,ACI)患者肠道菌落紊乱的作用及对患者预后的影响。方法 将97例无法自主进食的ACI患者根据治疗方法不同分为观察组(采用益生菌结合EN进行营养支持)和对照组(单纯EN为营养支持)进行治疗,疗程30 d,比较2组肠道菌落生长情况、患者营养水平、临床疗效及预后。结果 治疗后,2组双歧杆菌、肠球菌、大肠杆菌数量先降低后升高,2相邻时间点之间差异显著(P<0.05),2组乳酸杆菌数量持续升高,观察组各时间点之间差异显著(P<0.05),对照组治疗第7 d开始有明显差异(P<0.05),且治疗第7 d后观察组双歧杆菌、肠球菌、大肠杆菌数量高于对照组,差异有统计学意义(P<0.05),治疗第14 d后,观察组乳酸杆菌数量高于对照组,差异有统计学意义(P<0.05);治疗后,观察组体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thinkness,TSF)、上臂肌围(arm muscle circumference,AMC)及血红蛋白(hemoglobin,HB)明显降低(P<0.05),对照组BMI、TSF、AMC、HB、白蛋白(albumin,ALB)及三酰甘油(triglyceride,TG)均明显降低(P<0.05),且观察组BMI、TSF、AMC、HB、ALB及TG高于对照组,差异有统计学意义(P<0.05);观察组治疗过程中腹胀、腹泻发生率低于对照组,差异有统计学意义(P<0.05);治疗后2组APACHEⅡ评明显降低(P<0.05),且观察组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后观察组日常生活活动能力(activities of daily life,ADL)评分高于对照组,ADL分级优于对照组,差异有统计学意义(P<0.05)。结论 益生菌结合EN治疗可有效纠正患者肠道菌落平衡,保护胃肠道功能,从而改善机体营养水平,提高ACI治疗效果,改善患者预后。

目的 探索老龄化形势下广州市白云区西部卒中防治工作的新模式。方法 通过完善组织结构、管理架构、建立稳定高效运行的(1+1+N)紧密型医联体模式,创建优质高效的卒中救治区域联盟,实现高质量的基层首诊,双向转诊,快速响应的卒中绿道急救和全程管理。结果 初步完成构建广州市白云区西部区域性卒中救治中心,区域内卒中患者及时救治,溶栓效率,血管再通等均有显著提升,整体提升白云区西部医疗机构的卒中救治水平。结论 区域性的协同救治是提高卒中救治水平的重要举措。(1+1+N)紧密型医联体模式能提高卒中患者救治率,具有可行性和必要性。

Objective To explore the effectiveness of a new stroke prevention and treatment pattern in the western part of Baiyun District, Guangzhou city, under an aging situation. Method We aim to build a high-quality and efficient stroke treatment regional alliance based on a (1+1+N) compact medical consortium, expecting to improve the overall abilities of stroke treatment in the western part of Baiyun District through high-quality primary care, two-way referrals, rapid response to stroke greenway emergency and full-process management. Results We have initially established a regional stroke treatment center in the western part of Baiyun District, Guangzhou. Stroke patients in that region can be treated in time, and the efficiency of thrombolysis and vascular recanalization have been significantly improved. Conclusion Regional coordinated treatment is an effective measure to reduce the disability and fatality rate of stroke. The (1+1+N) compact medical consortium model can improve the treatment effect in stroke patients, which is feasible and necessary.

目的 探讨脑卒中患者应用NNN-链接延续护理模式对患者生活质量及护理结局影响。方法 将 2019年6月—2020年12月收治的60例患者按纳入研究对象,以NNN-链接为结构框架,从入院到出院后3个月实施NNN-链接延续护理模式,收集延续护理患者护理诊断、护理结局、护理措施及三者的链接,比较延续护理不同阶段脑卒中患者护理结局评分。结果 使用频率最高的护理诊断及NNN-链接分别为生活自理能力缺陷、有跌倒的危险、知识缺乏、营养失调:低于机体需要量、有误吸危险;出院后3个月,从功能健康、健康知识和行为、生理健康Ⅱ、心理社会健康、家庭健康5大领域进行护理结局评分,分值均比出院时第一个月有提高(P<0.05)。结论 NNN-链接延续护理模式能有效提高病人的健康知识与行为,提高照顾者照护能力,降低意外事件发生。