目的:探讨早期康复治疗对中青年脑卒中患者肢体运动功能恢复等影响。方法：从我院选取中青年脑卒中患者90例作为实验对象，分为实验组和观察组各45例，两组同时接受相同常规治疗并给予早期康复介入，并对其进行患侧上肢和下肢功能评定量表（ Fugl-Meyer, FMMS），以及患者日常生活活动能力（Modified Barthel Index,MBI）评定。实验组给予进一步强化康复运动治疗，以加速提高患者康复速率；2周结束时对实验组和观察组再次进行评估，比较2组患者治疗前后组内和组间治疗疗效。结果：早期康复2周后，实验组FMMS量表上肢评分为(29.82±15.43)分，观察组上肢评分为(21.33±11.98)分，组间存在统计学差异（P=0.005）。实验组FMMS量表下肢评分为(21.18±8.97)分，观察组下肢评分为(15.40±7.40)分，实验组得分高于观察组且两组间存在显著统计学差异（P=0.002）；随访1个月后实验组上下肢功能呈持续改善趋势，且两组间差异具有显著统计学意义。实验组MBI量表评分为(35.56±18.93)分，高于对照组（28.56±14.68）分，但未见统计学意义；1个月后两组间差异具有显著统计学意义（P＜0.001）。结论：研究表明，早期康复治疗对改善中青年脑卒中患者肢体功能和日常生活活动能力具有显著康复效果。

Objective:Exploring the impact of early rehabilitation therapy on the recovery of limb motor function and other aspects in young and middle-aged stroke patients. Methods: Ninety young and middle-aged stroke patients were selected from our hospital as experimental subjects and divided into two groups, namely the experimental group and the observation group, with 45 cases in each group. Both groups received the same conventional treatment and early rehabilitation intervention simultaneously, and were evaluated using the Fugl-Meyer Motor Scale (FMMS) for the affected upper and lower limbs, as well as the Modified Barthel Index (MBI) for activities of daily living. The experimental group received further intensive rehabilitation exercise therapy to accelerate the rehabilitation rate. At the end of 2 weeks, both groups were reassessed, and the therapeutic effects within and between the two groups before and after treatment were compared. Results: After 2 weeks of early rehabilitation, the FMMS upper limb score in the experimental group was (29.36±15.27) points, while that in the observation group was (25.18±11.99) points, with no statistically significant difference observed between the groups. The FMMS lower limb score in the experimental group was (20.93±8.93) points, higher than that in the observation group (15.40±7.40) points, with a significant statistical difference between the two groups (P=0.002). The MBI score in the experimental group was (33.22±15.96) points, higher than that in the control group (28.56±14.68) points, but no statistical significance was observed. Conclusions: Our study indicates that early rehabilitation therapy has certain effects on upper limb function and activities of daily living in patients, particularly demonstrating significant rehabilitation effects in improving lower limb functional recovery in young and middle-aged stroke patients.

       脑卒中后认知障碍（PSCI）是脑卒中患者常见的并发症，严重影响患者的生活质量和社会功能。近年来，随着认知储备理论的发展和早期干预理念的普及，PSCI的早期干预模式逐渐成为研究热点。文章综述了PSCI早期干预模式的研究现状与进展，包括干预的理论基础、具体措施及未来发展方向，以期为临床实践和科研提供参考。

       Post-stroke cognitive impairment（PSCI）is a common complication among stroke patients．It seriously affects the patients’ quality of life and social functions．In recent years，with the development of the cognitive  reserve theory and the popularization of the concept of early intervention，the early intervention model for PSCI has gradually become a research hotspot．This article reviews the current research status and progress of the early intervention model for PSCI，including the theoretical basis of the intervention，specific measures，and future development directions，aiming to provide  references for clinical practice and scientific research．

       目的   探讨优化护理路径在急性缺血性脑卒中介入手术中的应用及效果。方法   采用随机对照研究，纳入2024年1月—2025年1月收治的112例急性缺血性脑卒中取栓患者，观察组（56例）实施优化介入护理路径，对照组（56例）采用常规护理。结果   观察组患者的满意度评分、医护满意度评分均优于对照组（P＜0.05）；观察组的术前等待时间、患者自进入介入室至股动脉穿刺时间、手术时间、住院费用、并发症发生率、差错事故发生率也优于对照组（P＜0.05）。结论   通过标准化术前准备、术中多学科协作及术后康复衔接，优化护理路径可显著提升急性缺血性脑卒中治疗时效性（缩短急性脑卒中患者从进入医院到开始静脉溶栓给药的时间至黄金时间窗内），改善患者神经功能预后。

       Objective  To explore the application and efficacy of an optimized nursing pathway in endovascular therapy for acute ischemic stroke（AIS）．Methods  A randomized controlled trial was conducted，enrolling 112 AIS patients undergoing mechanical thrombectomy from January 2024 to January 2025．Patients were randomly assigned to either the observation group（n=56），which received the optimized interventional nursing pathway，or the control group（n=56），which  received  routine nursing care．Results  Patient satisfaction score，medical staff satisfaction score，and postoperative favorable  recovery  rate in observation group were better than those of control group（P＜0.05）．Additionally，the observation group  showed  significant improvements in preoperative waiting time，time from entering the operation room to femoral artery puncture，surgical duration，hospitalization costs，complication incidence rate，and medical error incidence rate（P＜0.05）．Conclusions  By standardizing preoperative preparations，implementing intraoperative multidisciplinary collaboration，and enhancing postoperative  rehabilitation coordination，the optimized nursing pathway significantly improved the timeliness of thrombectomy treatment（shortening door-to-needle time to reach the golden time window）and enhanced neurological functional prognosis in AIS patients，demonstrating substantial clinical applicability．

目的 探究本体感觉神经肌肉促进疗法（PNF）技术与居家远程康复治疗对缺血性脑卒中患者凝血功能、平衡状态的影响。方法 选择2023年1月—2024年1月在宁乡市中医医院择期治疗的60例缺血性脑卒中患者为研究对象。按照患者选择的治疗方案进行分组, 观察组接受PNF技术联合居家远程康复指导治疗, 对照组接受常规居家远程康复指导治疗。记录疗效、凝血功能、神经功能缺损症状。结果 凝血功能方面,观察组治疗后活化部分凝血酶时间（APTT）、凝血酶原时间（PT）高于治疗前, 二聚体（D-D）、纤维蛋白原（FIB）低于治疗前,组间比较差异有统计学意义（P<0.05）。与对照组相比, 观察组的APTT、PT、D-D、FIB指标相近,组间比较差异无统计意义（P>0.05）。治疗后, 观察组平衡功能（BBS）评分比治疗前高, 组间比较差异有统计学意义（P<0.05）。观察组BBS评分、FMA评分、肌力等级更高, 组间比较差异有统计学意义（P<0.05）。结论 PNF技术+居家远程康复指导治疗可作为缺血性脑卒中患者治疗的有效手段。联合治疗后凝血功能、平衡状态、肢体功能状况、肌力明显改善, 可见联合治疗对于减轻患者病情尤为明显。

Objective To explore the effects of proprioceptive neuromuscular facilitation（PNF）and home-based remote rehabilitation on coagulation function and balance function in patients with ischemic stroke．Methods From January 2023 to January 2024, 60 patients with ischemic stroke were selected from our hospital．The patients were divided into two groups according to the treatment plan chosen by themselves．The patients in the observation group received PNF technology combined with home-based remote rehabilitation guidance, while the patients in the control group received routine home-based remote rehabilitation guidance．The curative effect, coagulation function and neurological deficit were recorded．Results After treatment, activated partial thrombin time（APTT）and prothrombin time（PT）were significantly higher, D-dimer（D-D）and fibrinogen（FIB）were significantly lower in the observation group than those before treatment（P<0.05）．Compared with the control group, the APTT, PT, D-D and FIB of the observation group were similar, and there was no significant difference between the two groups（P>0.05）．After treatment, the Berg Balance Scale score of the observation group was higher than that before treatment, and there was significant difference between the two groups（P<0.05）．The Berg Balance Scale score, Fugl-Meyer Assessment score and muscle strength grade of observation group were higher than those of control group（P<0.05）．Conclusions PNF combined with home-based remote rehabilitation can be used as an effective method for the treatment of patients with ischemic stroke．The coagulation function, balance, extremity function and muscle strength were significantly improved after combined treatment, which indicated that the combined treatment was especially effective in relieving the patients’ symptoms．

目的 探讨作业疗法结合经皮神经电刺激对脑卒中后肩痛的疗效。方法 选取2020年6月—2023年6月在肇庆市第一人民医院治疗的60例脑卒中后肩痛患者为研究对象,随机分为观察组和对照组各30例。其中,观察组进行作业疗法结合经皮神经电刺激;对照组单纯进行作业疗法。记录患者治疗前及治疗4周后的视觉模拟疼痛评分（VAS）,改良Barthel指数（MBI）和汉密顿抑郁量表评分（HAMD）,并对记录进行检验和t检验。结果 观察组和对照组的治疗效果比较差异有统计学意义（P=0.019）,观察组治疗有效率（93.33%）高于对照组（63.33%）;治疗前两组患者的VAS（P=0.536）和HAMD（P=0.558）分值比较差异无统计学意义,治疗后其VAS（P=0.049）及HAMD（P=0.023）分值均较治疗前下降,且观察组下降幅度分别为（2.23±1.14）分和（4.47±3.06）分,均高于对照组的（1.27±0.98）和（1.33±1.35）,组间比较差异有统计学意义;治疗前两组患者的MBI分值比较差异无统计学意义（P=0.216）,治疗后其MBI分值均较治疗前提高,且观察组提高幅度（21.87±10.25）较对照组（12.00±13.58）更显著,组间比较差异有统计学意义（P=0.003）。结论 作业疗法结合经皮神经电刺激可缓解脑卒中肩痛,改善患者日常生活能力和心理精神状态,减少抑郁的发生。

Objective To explore the therapeutic effect of occupational therapy combined with transcutaneous electrical nerve stimulation（TENS） on shoulder pain after stroke．Methods Sixty patients with post-stroke shoulder pain who were treated in the First People’s Hospital of Zhaoqing from June 2020 to June 2023 were selected as the study subjects and randomly divided into an observation group and a control group,with 30 cases in each group．Among them,the observation group received occupational therapy combined with TENS,while the control group received occupational therapy alone．This study recorded the Visual Analogue Scale（VAS）,modified Barthel Index（MBI）,and Hamilton Depression Rating Scale（HAMD）of patients before and after 4 weeks of treatment,and conducted the and t-test analysis．Results The test analysis showed a significant difference in treatment effectiveness between the observation group and the control group（P=0.019）,with the observation group having a significantly higher treatment effectiveness rate（93.33%）than the control group（63.33%）;t-test analysis showed that there was no statistically significant difference in VAS（P=0.536）and HAMD（P=0.558）indicators between the two groups of patients before treatment．However,after treatment,the VAS（P=0.049）and HAMD（P=0.023）indicators decreased compared to before treatment．The observation group had decreased（2.23±1.14）and（4.47±3.06）,respectively,which were significantly higher than the control group’s（1.27±0.98）and（1.33±1.35）,and the inter group differences were statistically significant;before treatment,there was no statistically significant difference in MBI indicators between the two groups of patients（P=0.216）．After treatment,their MBI indicators increased compared to before treatment,and the observation group（21.87±10.25）showed a more significant improvement compared to the control group（12.00±13.58）．The difference between the groups was statistically significant（P=0.003）．Conclusions Occupational therapy combined with TENS can significantly alleviate shoulder pain after stroke,improve daily living ability and psychological state of patients,and reduce the occurrence of depression．

目的 本研究以脑卒中患者为研究对象,通过二代Illumina高通量测序平台对患者的粪便标本进行微生物群落多样性测序。选择物种丰度≥30%的24个门类（Phylum）作为肠道菌群的研究指标,进而研究肠道菌群与脑卒后抑郁（PSD）之间的相关关系。方法 以40位脑卒中患者的24个门类作为特征变量,抑郁组和对照组为二分类目标变量,建立以Logistic回归、随机森林、支持向量机和AdaBoost为基模型的Stacking分类模型。主成分分析方法作为该模型的特征选择方法选择恰当的主成分进行模型训练,通过二分类评价报告（precision、recall、f1-score）、ROC曲线和混淆矩阵等评价指标对其性能进行评价。结果 （1）通过差异性检验分析了两组（抑郁组和对照组）的基线一致（P<0.05）;（2）从Stacking模型融合的角度定量分析了影响脑卒中后抑郁情绪的具体肠道菌群。研究结果可知,放线菌门、拟杆菌门、变形菌门和酸杆菌门在PSD患者中均增加（P<0.001）;厚壁菌门,疣微菌门,绿弯菌门和软壁菌门在PSD患者中降低（P<0.001）。结论 以上菌群是影响脑卒中后抑郁患者情绪的主要影响因素,因此,在临床上通过恰当干预肠道菌群的变化来调节脑卒中后抑郁患者的抑郁水平,这为脑卒中后抑郁情绪的诊断和治疗方案提供科学依据。

Objective In this study,patients with stroke were selected as the research object,and the microbial community diversity of patients' stool samples was sequenced by the second-generation Illumina high-throughput sequencing platform． Twenty four phylum species with 30% species abundance were selected as indicators for the study of gut microbiota,and then the correlation between gut microbiota and post-stroke depression（PSD） was studied．Methods Taking 24 categories of 40 stroke patients as characteristic variables,depression group and control group as dichotomous target variables,a stacking classification model based on Logistic regression,random forest,support vector machine and AdaBoost was established．As the feature selection method of the model,principal component analysis selects the appropriate principal components for model training,and evaluates its performance through dichotomous evaluation reports（precision,recall,f1 score）,ROC curve and confusion matrix．Results The baseline of the two groups（depression group and control group）was consistent（P<0.05）through the difference test．From the perspective of stacking model fusion,the specific intestinal flora affecting post-stroke depression was quantitatively analyzed．The results showed that Actinobacteria,Bacteroidetes,Proteobacteria and Acidobacteria were significantly increased in PSD patients（P<0.001）,while Firmicutes,Verrucomicrobia,Chloroflexi and Tenericutes were significantly decreased in PSD patients（P<0.001）．Conclusions The above microbiota are the main factors affecting the mood of patients with post-stroke depression．Therefore,in clinical practice,we can adjust the depression level of patients with post-stroke depression by properly intervening the changes of intestinal microbiota,which provides a scientific basis for the diagnosis and treatment of PSD．

目的 探讨复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的疗效。方法 选择2019年6月—2023年1月在河南省许昌中医院诊治的79例缺血性脑卒中患者,按照入院就诊顺序采用奇偶法把患者分为联合组40例与传统组39例。传统组给予阿替普酶静脉溶栓治疗,联合组给予复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗,评价与记录联合组与传统组的疗效与安全性及治疗前、治疗14 d后Fugl-Meyer评定量表（FMA）与改良版Banhel评价指数（MBI）、血清β-内啡肽、前列腺素E2（PGE2）水平变化。结果 治疗14 d后联合组的总有效率更高（97.5% vs 82.1%,P<0.05）,并发症发生率更低（5.0% vs 20.5%,P<0.05）。联合组与传统组治疗14 d后的FMA与MBI评分高于治疗前（P<0.05）,联合组治疗14 d后的FMA评分、MBI评分比传统组提高（P<0.05）。联合组与传统组治疗14 d后的血清β-内啡肽、PGE2水平低于治疗前（P<0.05）,联合组治疗14 d后的血清β-内啡肽、PGE2水平低于传统组（P<0.05）。结论 复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中能提高效果,降低患者的肺部感染、尿路感染、静脉血栓、褥疮等并发症发生率,改善患者的运动与日常生活功能,还可降低患者血清β-内啡肽、PGE2水平。

Objective To explore and analysis the efficacy and safety of compound brain peptide ganglioside injection combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. Methods From June 2019 to January 2023,79 patients with ischemic stroke who were diagnosed and treated at Henan Xuchang Traditional Chinese Medicine Hospital were selected as the research subjects．According to the order of admission,the patients were divided into the combination group of 40 cases and the traditional group of 39 cases．The traditional group received intravenous thrombolytic therapy with alteplase,while the combination group received treatment with compound brain peptide ganglioside injection on the basis of the traditional group．The efficacy and safety and changes of the Fugl-Meyer rating Scale（FMA）and modified Banhel Evaluation Index（MBI）,serum β-endorphin,and PGE 2 levels in the combined and traditional groups were evaluated and recorded. Results After 14 days of treatment,the combined group had a higher overall response rate（97.5% vs 82.1%,P<0.05）and a lower complication rate（5.0% vs 20.5%,P<0.05）．FMA scores and MBI scores of the two groups after 14 days of treatment were higher than those before treatment（P<0.05）,and FMA scores and MBI scores of the combined group after 14 days of treatment were higher than those of the traditional group（P<0.05）．The contents of β-endorphin and prostaglandin E2 in two groups after 14 days of treatment were lower than those before treatment（P<0.05）,and the contents of β-endorphin and prostaglandin E2 in combination group after 14 days of treatment were lower than those in traditional group（P<0.05）. Conclusions The combination of compound brain peptide ganglioside injection and alteplase intravenous thrombolysis in the treatment of acute ischemic stroke can improve the treatment effect,reduce the incidence of complications such as pulmonary infections,urinary tract infections,venous thrombosis and bedsores in patients,improve patients' motor and daily life functions,and also reduce patients' serum levels of β-endorphins and prostaglandin E2．

脑卒中是临床常见的急性脑血管疾病,常有偏瘫、肩手综合征、下肢深静脉血栓等后遗症,严重影响患者的生活质量。温针疗法是中医传统的特色疗法,近年来,应用以温针为主的相关疗法治疗脑卒中后遗症的报道越来越多,在临床上得到广泛应用。本文归纳分析了近10年来温针疗法治疗脑卒中后肩手综合征、偏瘫、下肢深静脉血栓三大主要疾病的案例及研究,以期为相关研究与应用提供参考。

Stroke is a common acute cerebrovascular disease in clinical practice,which frequently leaves sequelae like hemiplegia,shoulder-hand syndrome and deep vein thrombosis of the lower extremities,and vastly reduces the quality of life of patients．Warm needling is a characteristic therapy of traditional Chinese medicine．In recent years,there have been more and more reports of warm needling-based related therapies for the treatment of stroke sequelae,and it has been widely used in clinical practice．This article summarizes and analyzes the cases and studies of warm needing therapy in the treatment of shoulder-hand syndrome,hemiplegia and deep vein thrombosis of the lower extremities after stroke in the past 10 years,so as to provide reference for related research and application．

目的 探讨间歇经口至食管管饲法与自创吞咽功能训练联合应用于脑卒中吞咽障碍患者的效果。方法 选取河南大学淮河医院2022年1月—2023年12月收治的50例脑卒中吞咽障碍患者,应用随机数字表法将其分为两组,每组各25例。对照组采取持续留置鼻饲的同时应用自创吞咽功能训练进行训练,观察组采取间歇经口至食管管饲的同时应用自创吞咽功能训练进行训练。对比两组吞咽障碍改善情况、干预前后营养状况指标及生活质量变化,比较两组并发症发生率。结果 观察组总有效率高于对照组（P<0.05）。干预后两组血清总蛋白、白蛋白和血红蛋白水平和体质量指数均升高,观察组高于对照组（P<0.05）。干预后两组生活质量综合评定量表评分升高,观察组高于对照组（P<0.05）。观察组并发症发生率低于对照组（P<0.05）。结论 对脑卒中吞咽功能障碍患者采取间歇经口至食管管饲法与自创吞咽功能训练,能够更有效改善患者吞咽功能,提升其生活质量,且可降低留置饲管营养支持过程中的并发症发生率。

Objective To explore the application effect of intermittent oral to esophageal feeding combined with self created swallowing function training exercises in stroke patients with swallowing disorders．Methods Fifty stroke patients with swallowing disorders admitted to our hospital from January 2022 to December 2023 were selected and divided into two groups by random number table method,both with 25 cases．Control group patients received continuous nasogastric feeding while using solf created swallowing function training exercises for training,while observation group patients received intermittent oral to oesophageal tube feeding and using solf created swallowing function training exercises for training．The improvement of swallowing disorders,changes in nutritional status indicators and quality of life before and after the intervention were compared,and also the frequency of complications．Results The observation group was generally more effective than the control group（P<0.05）．After intervention,the serum total protein,albumin hemoglobin,and BMI levels of both groups of patients increased,with the observation group being higher than the control group（P<0.05）．After the intervention,GQOLI-74 score increased in both groups,and the observation group was higher than the control group（P<0.05）．The complication rate was lower in the observation group（P<0.05）．Conclusions The intervention method of intermittent oral to esophageal tube feeding combined with self created swallowing function training exercises can further improve the swallowing function of stroke patients with swallowing dysfunction,improve their quality of life,and reduce the occurrence of complications during the nutritional support process of feeding tubes．

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．