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。

目的 回顾性分析CT血管成像(CTA)在急诊出血性脑卒中患者中,在病因诊断、病程进展评估中的应用。方法 89例头颅平扫初诊急性出血性脑卒中病人,行CTA检查,通过后处理技术,对各种出血原因进行影像学特征分析,并根据图像特征评估血肿的稳定性,在24小时内复查CT平扫了解出血的发展。结果 89例急诊脑出血患者,CTA检查中83例病因明确,并采取相应的临床处理。5例(5.6%)病因不明确,以蛛网膜下腔出血患者为主,需临床进一步全面检查。1例患者不配合造影检查失败。CT平扫发现不稳定血肿22例,复查血肿增大16例,准确率72.2%。CTA判断血肿内持续出血患者14例,复查13例患者有血肿增大,准确率为92.8%。结论 CT平扫只能评估血肿的稳定性,而CTA出现血肿内高密度影时,高度提示血肿内出血仍在持续。急诊医生可通过CTA对脑出血患者进行病因的分析、病程的预估、及时诊断、定位,对指导治疗及手术方式有重要作用。

Objective To retrospectively analyze the value of computed tomographic angiography (CTA) on etiological diagnosis and progression evaluation in patients with emergent hemorrhagic stroke. Methods Eighty-nine patients with preliminary diagnosis of acute hemorrhagic stroke underwent CTA, then various bleeding causes were analyzed by post-processing.The stability of hematoma was evaluated according to the image features.Follow-up CT in 24 h were performed to show the development of hemorrhage. Results In 89 cases of patients with emergent cerebral hemorrhage, 83 cases had made clear diagnosis according to CTA, then the patients received specialized clinical management.The causes of hemorrhage were not clear in 5 cases (5.6%), and subarachnoid hemorrhage was found in the most of these patients, requiring further examination.Twenty-two cases of unstable hematoma were found by CT scan, and hematoma enlarged in 16 cases in follow-up scan, with an accuracy of 72.2%.Fourteen patients were diagnosed as persistent bleeding hematoma by CTA, among them 13 patients showed hematoma enlargement, with an accuracy of 92.8%. Conclusions CT scan can only evaluate the stability of the hematoma, but the CTA high density in the hematoma strongly suggests persistent bleeding in the hematoma.Emergency doctors can analyze the cause of cerebral hemorrhage, assess the progression of disease, timely diagnose, locate the bleeding point by CTA, and there is important value in guidance of treatment and surgical methods.

目的 观察清化血浊中药对大动脉粥样硬化型(LAA)缺血性脑卒中患者的临床疗效。方法 将105例发病24 h内符合标准的大动脉粥样硬化型缺血性脑卒中患者,随机分为观察组52例和对照组53例,对照组予以西医综合治疗,观察组在西医综合治疗的基础上加用清化血浊中药(化浊和血颗粒),疗程为14 d。两组患者分别于治疗前及治疗后7 d、14 d评定NIHSS评分;治疗前及发病1个月后分别测定mRS评分,以判定临床转归;治疗前及治疗后14 d分别采集空腹血测定低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋浓度。结果 清化血浊中药可降低大动脉粥样硬化型缺血性脑卒中患者治疗后7 d及14 d的NIHSS评分(P<0.05)、增加好转率且不增加患者复发、死亡及出血性转化,并能降低患者血低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋白。结论 清化血浊中药可减低大动脉粥样硬化型缺血性脑卒中患者的神经功能缺损,促进神经功能恢复,提高临床良好转归, 且不增加出血性转化。

目的 探究词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍的疗效。方法 将我院收治的200例脑卒中伴有构音障碍患者按照随机数字表法平均分为干预组与对照组。两组患者均接受临床基础治疗、常规PT、0T、理疗和中医药治疗,在此基础上干预组给予词联导航训练法结合针灸、环喉按摩等综合的康复方案进行康复护理和治疗,观察疗效以及不良反应发生情况。结果 干预组(90%)的临床疗效优于对照组(76%),差异有统计学意义(P＜0.05);生活质量评价干预组高于对照组,差异有统计学意义(P＜0.05);不良反应发生情况干预组(6%)与对照组(7%)接近,差异没有统计学意义(P＞0.05)。结论 词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍方法安全、疗效显著,可以提升患者的生活质量。

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th 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 three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

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.