目的 观察低频电刺激治疗对脑卒中偏瘫疗效,并分析其对患者周围神经电生理学与形态学的影响。方法 选取本院94例脑卒中偏瘫患者,以数字表法随机分为两组,各47例,对照组接受基础康复治疗,实验组予以早期综合康复治疗(于对照组基础上进行低频电刺激治疗),比较两组治疗前后Berg平衡量表(BBS)评分、Fugl-Meyer运动功能(FMA)评分、关节(腕与踝)主动活动范围(AROM)、周围神经电生理学[感觉神经传导速度(SCV)、运动神经传导速度(MCV)、动态肌电图]与形态学[腕横纹正中神经(MN)横截面积(CSA)、宽度(W)以及厚度(T)]。结果 实验组治疗后BBS评分、上肢与下肢FMA评分高于对照组(P＜0.05),腕与踝AROM大于对照组(P＜0.05);实验组治疗后腓总神经与胫神经SCV、MCV高于对照组(P＜0.05),肱二头肌与腓肠肌协同收缩率均低于对照组(P＜0.05);两组治疗前后MN的CSA、T比较无差异(P＞0.05),实验组治疗后MN的W大于对照组(P＜0.05)。结论 低频电刺激联合早期综合康复治疗可有效提高脑卒中偏瘫患者平衡能力、关节活动度及上下肢功能,改善周围神经电生理学与形态学,减轻周围神经损伤。

Objective To observe the curative effect of low frequency electrical stimulation treatment on stroke hemiplegia, and analyze its influences on peripheral nerve electrophysiology and morphology of patients. Methods A total of 94 patients with stroke hemiplegia in the hospital were randomly divided into two groups by number table method, 47 cases in each group. The control group was given basic rehabilitation treatment, while experimental group was given early comprehensive rehabilitation treatment (low frequency electrical stimulation on basis of control group). The scores of Berg Balance Scale (BBS) and Fugl-Meyer assessment (FMA), joint (wrist, ankle) active range of motion (AROM), peripheral nerve electrophysiology [sensory conduction velocity (SCV), motor conduction velocity (MCV), dynamic electromyogram (EMG) ] and morphology [cross-sectional area (CSA) of carpal transverse median nerve (MN), width (W), thickness (T)] before and after treatment were compared between the two groups. Results After treatment, scores of BBS, upper and lower limbs FMA in experimental group were higher than those in control group (P<0.05), AROM of wrist and ankle was larger than that in control group (P<0.05). After treatment, SCV and MCV of common peroneal nerve and tibial nerve in experimental group were higher than those in control group (P<0.05), while co-contraction rates of biceps and gastrocnemius muscles were lower than those in control group (P<0.05). Before and after treatment, there were no differences in CSA and T of MN between the two groups (P>0.05). After treatment, W of MN in experimental group was greater than that in control group (P<0.05). Conclusion Low-frequency electrical stimulation combined with early comprehensive rehabilitation therapy may effectively increase the balance ability, joint range of motion and upper and lower limb function of stroke patients with hemiplegia, improve peripheral nerve electrophysiology and morphology, and reduce peripheral nerve injury.

目的 探讨老年急性缺血性脑卒中并发肺部感染患者的临床特征和相关危险因素。方法 采用回顾性研究方法,选择2017年7月— 2019年10月深圳市第二人民医院神经内科收治的1 113例老年急性缺血性脑卒中患者,其中卒中并发肺部感染患者(108 例)纳入感染组,未并发肺部感染患者(1 005例)纳入对照组。以单因素对比分析两组患者的临床资料,采用 Logistic多因素回归分析方法分析合并肺部感染的高危因素。结果 单因素分析提示两组年龄(尤其是高龄患者)、住院天数、房颤、脑梗死史、慢性肺疾病、吞咽困难、言语不清、意识障碍差异有统计学意义(P <0.05)。多因素 Logistics 回归分析显示,高龄(≥80岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍与老年急性缺血性脑卒中并发肺部感染密切相关。结论 老年急性缺血性脑卒中并发肺部感染的独立危险因素主要是高龄(≥80 岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍,临床应高度重视。

Objective Objective To investigate the clinical characteristics and risk factors of elderly patients with acute ischemic stroke complicated with pulmonary infection. Methods A retrospective study was conducted on 1 113 elderly patients with acute ischemic stroke admitted to the department of neurology, Shenzhen Second People's Hospital from July 2017 to October 2019. Among them, 108 patients with stroke complicated with pulmonary infection were included in the infection group and 1 005 patients without concurrent pulmonary infection were included in the control group. The clinical data of the two groups were analyzed by single factor comparison, and the risk factors for pulmonary infection were analyzed by logistic multiple factor regression analysis. Results Single factor analysis showed there were statistically significant differences between the two groups in age (especially elderly patients), length of stay in hospital, atrial fibrillation, history of cerebral infarction, chronic pulmonary disease, dysphagia, slurred speech, and disturbance of consciousness (P <0.05). Multi-factor logistic regression analysis showed that old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech, and disturbance of consciousness were closely related to pulmonary infection in elderly patients with acute ischemic stroke. Conclusion The independent risk factors of acute ischemic stroke complicated with pulmonary infection in the elderly mainly include old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech and disturbance of consciousness, which should be paid more attention to clinically.

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 观察四通道FES对脑卒中患者下肢运动功能的影响,为其临床应用及推广提供依据。方法 将入组的49例脑卒中患者随机分为四通道FES组(17例)、单通道FES组(16例)和对照组(16例),三组患者均进行(除电刺激)综合康复训练,四通道FES组模仿正常人行走时肌肉收缩的时序刺激患侧下肢的股四头肌、胫骨前肌、腓肠肌及腘绳肌。单通道FES组患者仅在迈步时刺激患侧下肢的胫骨前肌,而股四头肌、腓肠肌、腘绳肌三块肌肉仅作安慰刺激。对照组患者在上述四块肌肉处做安慰刺激(即仅在这四处肌肉贴电极片,但没有电流)。治疗时间为每周5次,持续2周共10次,在治疗前、治疗后1周、治疗后2周分别进行患侧下肢运动功能评定及平衡功能评估。结果 组内前后比较:两组患者治疗前、治疗后一周、治疗后两周下肢功能(FMA)及平衡功能(Berg)逐步提高(P＜0.05)。组间比较:治疗后一周三组差异无统计学意义(P＞0.05);治疗后两周三组有统计学意义,经过两两比较发现,只有四通道组与对照组之间差异有统计学意义(P＜0.05),其他两组之间均无统计学意义。结论 应用基于正常行走模式四通道FES治疗可以改善患者的下肢功能及平衡功能。

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 探讨STAF评分(the score for the targeting of atrial fibrillation,STAF)对心源性脑卒中(cardioembolism, CE)的预测价值,以辅助急性缺血性卒中患者病因学分型。方法 本研究为回顾性病例研究,连续入选2009年1月—2010年12月在暨南大学附属第一医院神经内科住院的急性缺血性卒中患者。所有患者严格按照STAF评分标准进行评分,按TOAST(the trial of org 10172 in acute stroke treatment,TOAST)病因学分型标准进行分型,采用SPSS 13.0软件进行统计分析,采用受试者工作特征曲线(receiver operator characteristic,ROC)来评判STAF评分对CE的预测价值。结果 共收集317例患者,其中CE 37例(11.67%)。STAF≥5提示为CE的灵敏度为89%,特异度为91%。结论 STAF评分对CE的预测有较好的作用价值,可辅助急性缺血性卒中病因学分型。

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 探讨急性脑卒中患者颈动脉粥样硬化斑块的超声形态学表现以及探讨不同超声形态学表现的诊断价值。方法 对所有入选受检者进行多层螺旋CT或磁共振(MRI)检查、常规颈动脉超声检查、彩色多普勒血流显像(CDFI)、超声造影技术(CEUS)的影像学资料进行回顾性分析;所入选病例组患者在发病2天内完成上述影像学检查,对照组受检者也在2天内完成上述影像学检查。结果 常规超声发现病例组颈动脉斑块45处、对照组11处;CDFI发现病例组颈动脉斑块远端血流频谱改变35例、对照组11例;超声造影发现颈动脉斑粥样硬化斑块处毛细血管现象病例组15例、对照组2例。斑块表面形态以及内部回声分布情况两项结果与对照组比较差异有统计学意义。结论 脑卒中患者与无症状颈动脉硬化受检者的斑块超声声像图中,斑块表面形态以及内部回声分布两项指标具有明显的鉴别诊断意义。提示表面不光整、内部回声分布不均匀的斑块导致急性脑卒中的可能性较大。