目的:探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者CT平扫(non-contrast computed tomography,NCCT)Alberta卒中项目早期CT评分(Alberta stroke program early computed tomography score,ASPECTS)与CT灌注成像(CT perfusion,C...目的:探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者CT平扫(non-contrast computed tomography,NCCT)Alberta卒中项目早期CT评分(Alberta stroke program early computed tomography score,ASPECTS)与CT灌注成像(CT perfusion,CTP)梗死核心体积不匹配的影响因素及预后特征。方法:回顾性分析2019年10月—2023年8月449例行NCCT及CTP评估的前循环大血管闭塞型AIS患者的临床及影像资料。采用RAPID软件自动计算NCCT-ASPECTS和CTP梗死核心体积。“NCCT-CTP不匹配”定义为低NCCT-ASPECTS、小梗死核心体积(low ASPECTS and small ischemic core volume,LASC)(NCCT-ASPECTS<6分,CTP梗死核心体积<70 mL)以及高NCCT-ASPECTS、大梗死核心体积(high ASPECTS and large ischemic core volume,HALC)(NCCT-ASPECTS≥6分,CTP梗死核心体积≥70 m L)。采用血管内取栓治疗(endovascular thrombectomy,EVT)后90 d随访基线改良Rankin量表(mRS)评分0~2分定义预后良好。采用多因素逻辑回归分析NCCT-CTP不匹配的独立影响因素。结果:449例AIS患者中有145例出现NCCT-CTP不匹配,其中52例(35.9%)患者血管内取栓治疗(endovascular thrombectomy,EVT)后获得良好预后。多因素逻辑回归分析结果提示,影像评估前接受静脉溶栓(intravenous thrombolysis,IVT)(OR=1.833;95%CI:1.205~2.790,P=0.005)、更高的基线NIHSS评分(OR=1.055;95%CI:1.028~1.083,P<0.001)是AIS患者出现NCCT-CTP不匹配的独立影响因素。NCCT-CTP不匹配亚组分析提示,LASC患者卒中发病至基线影像检查的时间间隔大于HALC患者[306(219,482)min vs.125(63,307)min;P=0.004]。LASC患者EVT术后出血性脑梗死发生率高于HALC患者(66.9%vs.33.3%;P=0.021)。结论:约35%的NCCT-CTP不匹配患者可从EVT中获益。影像评估前接受IVT以及更高的基线NIHSS评分是出现NCCT-CTP不匹配的独立影响因素。展开更多
目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验...目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验证集与测试集。训练/验证集用于模型参数拟合,比较不同损失函数以优选模型,并采用精确率、召回率及平均精度(mean average precision,mAP)评估模型的检测效能;测试集用于独立评估模型的诊断效能。将MRI DWI图像与NCCT图像进行配准,并在NCCT图像上标记病灶。以DWI-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)为金标准,在测试集中分别计算模型及医师对ASPECTS各脑区梗死灶检出的敏感度、特异度及准确度,通过McNemar检验比较模型与医师的诊断效能差异。采用组内相关系数(intra-class correlation coefficient,ICC)与加权Kappa检验评估模型及医师CT-ASPECTS与金标准DWI-ASPECTS之间的一致性,并通过Bootstrap自助抽样法对两者的一致性系数进行差异性检验。结果共纳入急性缺血性卒中患者275例,其中训练/验证集250例,测试集25例。改进的YOLOv5深度学习模型在训练/验证阶段的性能最佳:精确率为0.824,召回率为0.810,mAP@0.5为0.785。测试集中,模型病灶检测效能的比较结果显示,模型组的总体准确度(96.00%vs.91.11%)及特异度(98.74%vs.94.70%)优于医师组(均P<0.001);模型组敏感度有高于医师组的趋势(75.93%vs.64.81%),但差异无统计学意义(P=0.288)。在各脑区的亚组分析中,模型组在M6脑区的准确度高于医师组(98.00%vs.84.00%,P=0.039)。模型组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.669,P<0.001;加权κ=0.447,P<0.001)较医师组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.452,P=0.010;加权κ=0.247,P=0.054)有提高趋势;Bootstrap分析显示,模型组与医师组加权κ的差异具有统计学意义(P=0.044)。结论本研究构建的目标检测模型可在急性缺血性卒中患者的NCCT图像上实现急性小面积梗死灶的自动检测,有助于减少漏诊、提高影像诊断效率,为临床提供可靠的辅助工具。展开更多
The motor relearning program can significantly improve various functional disturbance induced by ischemic cerebrovascular diseases. However, its mechanism of action remains poorly understood. In injured brain tissues,...The motor relearning program can significantly improve various functional disturbance induced by ischemic cerebrovascular diseases. However, its mechanism of action remains poorly understood. In injured brain tissues, glial fibrillary acidic protein and neurofilament protein changes can reflect the condition of injured neurons and astrocytes, while vascular endothelial growth factor and basic fibroblast growth factor changes can indicate angiogenesis. In the present study, we induced ischemic brain injury in the rhesus macaque by electrocoagulation of the M1 segment of the right middle cerebral artery. The motor relearning program was conducted for 60 days from the third day after model establishment. Immunohistochemistry and single-photon emission CT showed that the numbers of glial fibrillary acidic protein-, neurofilament protein-, vascular endothelial growth factor- and basic fibroblast growth factor-positive cells were significantly increased in the infarcted side compared with the contralateral hemisphere following the motor relearning program. Moreover, cerebral blood flow in the infarcted side was significantly improved. The clinical rating scale for stroke was used to assess neurological function changes in the rhesus macaque following the motor relearning program. Results showed that motor function was improved, and problems with consciousness, self-care ability and balance function were significantly ameliorated. These findings indicate that the motor relearning program significantly promoted neuronal regeneration, repair and angiogenesis in the surroundings of the infarcted hemisphere, and improve neurological function in the rhesus macaque following brain ischemia.展开更多
The purpose of the present study was to evaluate the effects of a trunk exercise program on the gait and muscle activity in stroke patients. The participants of this pilot study included six hemiplegic stroke patients...The purpose of the present study was to evaluate the effects of a trunk exercise program on the gait and muscle activity in stroke patients. The participants of this pilot study included six hemiplegic stroke patients. The outcomes were surface electromyography (sEMG) and spatiotemporal gait parameters. In analysis of sEMG, no statistically difference was found between pre- and post-training of Maximal Voluntary Isometric Contraction (MVIC) in rectus abdominis and external abdominal oblique muscle, but it tended to increase. However, the gait parameter significantly increased in walking speed, walking cycle, and affected stride length in stroke patients. These results suggest that the trunk exercise program may in part improve the gait of chronic stroke patients.展开更多
目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因...目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因型检测,根据检测结果分为GG组(n=136)与GA/AA组(n=88),GG组基因型为野生型(ALDH2*1/*1),GA/AA组基因型为基因突变杂合子型(ALDH2*1/*2)与纯合子型(ALDH2*2/*2)。比较两组临床资料Alberta卒中操作早期急性卒中分级CT(Alberta stroke program early CT score,ASPECT)评分、美国国立研究院卒中量表(National Institutes of Health Stroke scale,NIHSS)评分及Barthel指数(Barthel index,BI)。结果两组性别、年龄、体重指数、同型半胱氨酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及高血压病史、吸烟史、饮酒史占比比较差异均无统计学意义。GG组ASPECT评分、BI均高于GA/AA组,NIHSS评分低于GA/AA组,差异有统计学意义(P<0.05)。结论ALDH2基因型与急性缺血性脑卒中严重程度有关,ALDH2基因突变型患者急性缺血性脑卒中严重程度更严重。展开更多
Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effect...Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group （true acupuncture at right Waiguan （SJ5）） and sham point group （sham acupuncture）. Results of functional magnetic resonance imaging revealed activation in right parietal lobe （Brodmann areas 7 and 19）, the right temporal lobe （Brodmann area 39）, the right limbic lobe （Brodmann area 23） and bilateral oc-cipital lobes （Brodmann area 18）. Furthermore, inhibition of bilateral frontal lobes （Brodmann area 4, 6, and 45）, right parietal lobe （Brodmann areas 1 and 5） and left temporal lobe （Brodmann area 21 ） were observed in the true point group. Activation in the precuneus of right parietal lobe （Brodmann area 7） and inhibition of the left superior frontal gyrus （Brodmann area 10） was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex （Brodmann area 5） is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.展开更多
目的系统分析脑卒中患者照顾者准备度干预方案的相关研究,识别干预的具体内容、结局指标和干预效果,以期为医护人员开展相关干预提供参考。方法以范围综述报告规范(PRISMA-ScR)为方法学指导,计算机检索中国知网、万方数据库、维普网、...目的系统分析脑卒中患者照顾者准备度干预方案的相关研究,识别干预的具体内容、结局指标和干预效果,以期为医护人员开展相关干预提供参考。方法以范围综述报告规范(PRISMA-ScR)为方法学指导,计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据、CINAHL、PubMed、Embase、Web of Science、Cochrane Library国内外数据库,检索时限为建库至2024年2月7日。结果共纳入17篇文献,干预方案制定的依据包括问题解决法、赋权教育、ADOPT模式、时机理论等10种理论;干预人员包括护士主导进行干预、多学科协作干预、社会工作者进行个案管理;干预方法主要采用健康教育手册、PPT讲解、技能示范、互联网宣教平台、电话或微信等形式一对一和(或)团体对照顾者进行讲解。干预内容包括疾病管理、照顾技能、康复锻炼、并发症预防、患者及照顾者情绪管理等内容;干预时长由2周~1年,每次干预时间15~60 min;结局指标涉及对患者、照顾者、信息化干预工具的评价3个方面。结论目前脑卒中患者照顾者准备度干预具有综合性、个性化的特点。未来研究应积极应用“互联网+护理服务”,并根据脑卒中患者功能障碍程度及照顾者需求制定科学、合适的干预方案。展开更多
目的:探究血清中程序性细胞死亡因子4(programmed cell death 4,PDCD4)蛋白水平与急性缺血性脑卒中(acute ischemic stroke,AIS)患者的神经功能缺损和预后的相关性。方法:回顾性连续纳入2023年6月—2024年3月南通大学第二附属医院神经...目的:探究血清中程序性细胞死亡因子4(programmed cell death 4,PDCD4)蛋白水平与急性缺血性脑卒中(acute ischemic stroke,AIS)患者的神经功能缺损和预后的相关性。方法:回顾性连续纳入2023年6月—2024年3月南通大学第二附属医院神经内科诊治的110例AIS患者作为研究对象,根据美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)将患者分为轻度神经功能缺损(n=70)和中重度神经功能缺损(n=40)。采用改良Rankin量表(modified Rankin scale,mRS)将患者分为预后良好组(n=69)和预后不良组(n=41)。收集各组患者的人口学资料(年龄、性别、糖尿病病史等)及临床检验指标(中性粒细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值等)。采用酶联免疫吸附法测定血清PDCD4蛋白浓度,并分析其与NIHSS评分、mRS评分及炎症指标的相关性。使用Logistic回归分析模型推断AIS患者中重度神经功能缺损和预后不良发生的危险因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线来评估血清PDCD4蛋白水平对预测AIS患者神经功能缺损程度及预后情况的有效性。结果:AIS患者中,中重度神经功能缺损及预后不良者血清PDCD4蛋白水平显著高于轻度神经功能缺损及预后良好者。血清PDCD4水平与NIHSS评分、mRS评分、降钙素原、超敏C反应蛋白、中性粒细胞/淋巴细胞比值呈正相关。排除混杂因素的干扰后,PDCD4蛋白水平仍是AIS患者的独立危险因素。ROC曲线显示,血清PDCD4蛋白水平对AIS患者神经功能缺损程度和预后情况均有较高的预测价值。结论:在中重度神经功能缺损及预后不良的AIS患者中,血清PDCD4蛋白水平显著升高,且可作为预测AIS患者神经功能缺损程度及预后的独立指标。展开更多
Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alber...Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alberta Stroke Program Early Computed Tomographic Scores(ASPECTS),between 3 and 5.Despite EVT,these patients have a higher rate of mortality and unfavourable outcomes at 3 months,delayed recovery or secondary deterioration.6 The long-term outcomes for these patients remain largely uncertain and unexplored.Recently,the SELECT-2,TESLA and TENSION trials have reported 1-year follow-up outcomes.展开更多
文摘目的:探讨急性缺血性脑卒中(acute ischemic stroke,AIS)患者CT平扫(non-contrast computed tomography,NCCT)Alberta卒中项目早期CT评分(Alberta stroke program early computed tomography score,ASPECTS)与CT灌注成像(CT perfusion,CTP)梗死核心体积不匹配的影响因素及预后特征。方法:回顾性分析2019年10月—2023年8月449例行NCCT及CTP评估的前循环大血管闭塞型AIS患者的临床及影像资料。采用RAPID软件自动计算NCCT-ASPECTS和CTP梗死核心体积。“NCCT-CTP不匹配”定义为低NCCT-ASPECTS、小梗死核心体积(low ASPECTS and small ischemic core volume,LASC)(NCCT-ASPECTS<6分,CTP梗死核心体积<70 mL)以及高NCCT-ASPECTS、大梗死核心体积(high ASPECTS and large ischemic core volume,HALC)(NCCT-ASPECTS≥6分,CTP梗死核心体积≥70 m L)。采用血管内取栓治疗(endovascular thrombectomy,EVT)后90 d随访基线改良Rankin量表(mRS)评分0~2分定义预后良好。采用多因素逻辑回归分析NCCT-CTP不匹配的独立影响因素。结果:449例AIS患者中有145例出现NCCT-CTP不匹配,其中52例(35.9%)患者血管内取栓治疗(endovascular thrombectomy,EVT)后获得良好预后。多因素逻辑回归分析结果提示,影像评估前接受静脉溶栓(intravenous thrombolysis,IVT)(OR=1.833;95%CI:1.205~2.790,P=0.005)、更高的基线NIHSS评分(OR=1.055;95%CI:1.028~1.083,P<0.001)是AIS患者出现NCCT-CTP不匹配的独立影响因素。NCCT-CTP不匹配亚组分析提示,LASC患者卒中发病至基线影像检查的时间间隔大于HALC患者[306(219,482)min vs.125(63,307)min;P=0.004]。LASC患者EVT术后出血性脑梗死发生率高于HALC患者(66.9%vs.33.3%;P=0.021)。结论:约35%的NCCT-CTP不匹配患者可从EVT中获益。影像评估前接受IVT以及更高的基线NIHSS评分是出现NCCT-CTP不匹配的独立影响因素。
文摘目的基于改进的YOLOv5深度学习模型,构建在CT平扫(non-contrast CT,NCCT)上自动检测急性小面积梗死灶的目标检测模型。方法回顾性纳入2018年1月—2023年12月于扬州大学附属医院就诊的急性缺血性卒中患者,按10∶1的比例随机分为训练/验证集与测试集。训练/验证集用于模型参数拟合,比较不同损失函数以优选模型,并采用精确率、召回率及平均精度(mean average precision,mAP)评估模型的检测效能;测试集用于独立评估模型的诊断效能。将MRI DWI图像与NCCT图像进行配准,并在NCCT图像上标记病灶。以DWI-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)为金标准,在测试集中分别计算模型及医师对ASPECTS各脑区梗死灶检出的敏感度、特异度及准确度,通过McNemar检验比较模型与医师的诊断效能差异。采用组内相关系数(intra-class correlation coefficient,ICC)与加权Kappa检验评估模型及医师CT-ASPECTS与金标准DWI-ASPECTS之间的一致性,并通过Bootstrap自助抽样法对两者的一致性系数进行差异性检验。结果共纳入急性缺血性卒中患者275例,其中训练/验证集250例,测试集25例。改进的YOLOv5深度学习模型在训练/验证阶段的性能最佳:精确率为0.824,召回率为0.810,mAP@0.5为0.785。测试集中,模型病灶检测效能的比较结果显示,模型组的总体准确度(96.00%vs.91.11%)及特异度(98.74%vs.94.70%)优于医师组(均P<0.001);模型组敏感度有高于医师组的趋势(75.93%vs.64.81%),但差异无统计学意义(P=0.288)。在各脑区的亚组分析中,模型组在M6脑区的准确度高于医师组(98.00%vs.84.00%,P=0.039)。模型组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.669,P<0.001;加权κ=0.447,P<0.001)较医师组CT-ASPECTS与金标准DWI-ASPECTS的一致性(ICC 0.452,P=0.010;加权κ=0.247,P=0.054)有提高趋势;Bootstrap分析显示,模型组与医师组加权κ的差异具有统计学意义(P=0.044)。结论本研究构建的目标检测模型可在急性缺血性卒中患者的NCCT图像上实现急性小面积梗死灶的自动检测,有助于减少漏诊、提高影像诊断效率,为临床提供可靠的辅助工具。
基金supported by the Combined pecific Foundation of Department of Science and Technology of Yunnan Province and Kunming Medical University,No.2008CD037
文摘The motor relearning program can significantly improve various functional disturbance induced by ischemic cerebrovascular diseases. However, its mechanism of action remains poorly understood. In injured brain tissues, glial fibrillary acidic protein and neurofilament protein changes can reflect the condition of injured neurons and astrocytes, while vascular endothelial growth factor and basic fibroblast growth factor changes can indicate angiogenesis. In the present study, we induced ischemic brain injury in the rhesus macaque by electrocoagulation of the M1 segment of the right middle cerebral artery. The motor relearning program was conducted for 60 days from the third day after model establishment. Immunohistochemistry and single-photon emission CT showed that the numbers of glial fibrillary acidic protein-, neurofilament protein-, vascular endothelial growth factor- and basic fibroblast growth factor-positive cells were significantly increased in the infarcted side compared with the contralateral hemisphere following the motor relearning program. Moreover, cerebral blood flow in the infarcted side was significantly improved. The clinical rating scale for stroke was used to assess neurological function changes in the rhesus macaque following the motor relearning program. Results showed that motor function was improved, and problems with consciousness, self-care ability and balance function were significantly ameliorated. These findings indicate that the motor relearning program significantly promoted neuronal regeneration, repair and angiogenesis in the surroundings of the infarcted hemisphere, and improve neurological function in the rhesus macaque following brain ischemia.
文摘The purpose of the present study was to evaluate the effects of a trunk exercise program on the gait and muscle activity in stroke patients. The participants of this pilot study included six hemiplegic stroke patients. The outcomes were surface electromyography (sEMG) and spatiotemporal gait parameters. In analysis of sEMG, no statistically difference was found between pre- and post-training of Maximal Voluntary Isometric Contraction (MVIC) in rectus abdominis and external abdominal oblique muscle, but it tended to increase. However, the gait parameter significantly increased in walking speed, walking cycle, and affected stride length in stroke patients. These results suggest that the trunk exercise program may in part improve the gait of chronic stroke patients.
文摘目的探讨乙醛脱氢酶2(aldehyde dehydrogenase 2,ALDH2)基因型多态性与急性缺血性脑卒中严重程度的关系。方法选取2022年3月至2023年9月于北京市昌平区医院神经内科住院的224例急性缺血性脑卒中患者作为研究对象,所有患者均行ALDH2基因型检测,根据检测结果分为GG组(n=136)与GA/AA组(n=88),GG组基因型为野生型(ALDH2*1/*1),GA/AA组基因型为基因突变杂合子型(ALDH2*1/*2)与纯合子型(ALDH2*2/*2)。比较两组临床资料Alberta卒中操作早期急性卒中分级CT(Alberta stroke program early CT score,ASPECT)评分、美国国立研究院卒中量表(National Institutes of Health Stroke scale,NIHSS)评分及Barthel指数(Barthel index,BI)。结果两组性别、年龄、体重指数、同型半胱氨酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及高血压病史、吸烟史、饮酒史占比比较差异均无统计学意义。GG组ASPECT评分、BI均高于GA/AA组,NIHSS评分低于GA/AA组,差异有统计学意义(P<0.05)。结论ALDH2基因型与急性缺血性脑卒中严重程度有关,ALDH2基因突变型患者急性缺血性脑卒中严重程度更严重。
基金the State Plan for Development of Basic Research in Key Areas(973 Program)in China,No.2006CB504505,2012CB518504the Key Subject Construction Project of"211 Engineering"III Stage of Guangdong Province in Chinathe Guangdong Provincial"College Students’Innovative Experiment Plan"Project in China,No.1212112038
文摘Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group （true acupuncture at right Waiguan （SJ5）） and sham point group （sham acupuncture）. Results of functional magnetic resonance imaging revealed activation in right parietal lobe （Brodmann areas 7 and 19）, the right temporal lobe （Brodmann area 39）, the right limbic lobe （Brodmann area 23） and bilateral oc-cipital lobes （Brodmann area 18）. Furthermore, inhibition of bilateral frontal lobes （Brodmann area 4, 6, and 45）, right parietal lobe （Brodmann areas 1 and 5） and left temporal lobe （Brodmann area 21 ） were observed in the true point group. Activation in the precuneus of right parietal lobe （Brodmann area 7） and inhibition of the left superior frontal gyrus （Brodmann area 10） was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex （Brodmann area 5） is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.
文摘目的系统分析脑卒中患者照顾者准备度干预方案的相关研究,识别干预的具体内容、结局指标和干预效果,以期为医护人员开展相关干预提供参考。方法以范围综述报告规范(PRISMA-ScR)为方法学指导,计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据、CINAHL、PubMed、Embase、Web of Science、Cochrane Library国内外数据库,检索时限为建库至2024年2月7日。结果共纳入17篇文献,干预方案制定的依据包括问题解决法、赋权教育、ADOPT模式、时机理论等10种理论;干预人员包括护士主导进行干预、多学科协作干预、社会工作者进行个案管理;干预方法主要采用健康教育手册、PPT讲解、技能示范、互联网宣教平台、电话或微信等形式一对一和(或)团体对照顾者进行讲解。干预内容包括疾病管理、照顾技能、康复锻炼、并发症预防、患者及照顾者情绪管理等内容;干预时长由2周~1年,每次干预时间15~60 min;结局指标涉及对患者、照顾者、信息化干预工具的评价3个方面。结论目前脑卒中患者照顾者准备度干预具有综合性、个性化的特点。未来研究应积极应用“互联网+护理服务”,并根据脑卒中患者功能障碍程度及照顾者需求制定科学、合适的干预方案。
文摘目的:探究血清中程序性细胞死亡因子4(programmed cell death 4,PDCD4)蛋白水平与急性缺血性脑卒中(acute ischemic stroke,AIS)患者的神经功能缺损和预后的相关性。方法:回顾性连续纳入2023年6月—2024年3月南通大学第二附属医院神经内科诊治的110例AIS患者作为研究对象,根据美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)将患者分为轻度神经功能缺损(n=70)和中重度神经功能缺损(n=40)。采用改良Rankin量表(modified Rankin scale,mRS)将患者分为预后良好组(n=69)和预后不良组(n=41)。收集各组患者的人口学资料(年龄、性别、糖尿病病史等)及临床检验指标(中性粒细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值等)。采用酶联免疫吸附法测定血清PDCD4蛋白浓度,并分析其与NIHSS评分、mRS评分及炎症指标的相关性。使用Logistic回归分析模型推断AIS患者中重度神经功能缺损和预后不良发生的危险因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线来评估血清PDCD4蛋白水平对预测AIS患者神经功能缺损程度及预后情况的有效性。结果:AIS患者中,中重度神经功能缺损及预后不良者血清PDCD4蛋白水平显著高于轻度神经功能缺损及预后良好者。血清PDCD4水平与NIHSS评分、mRS评分、降钙素原、超敏C反应蛋白、中性粒细胞/淋巴细胞比值呈正相关。排除混杂因素的干扰后,PDCD4蛋白水平仍是AIS患者的独立危险因素。ROC曲线显示,血清PDCD4蛋白水平对AIS患者神经功能缺损程度和预后情况均有较高的预测价值。结论:在中重度神经功能缺损及预后不良的AIS患者中,血清PDCD4蛋白水平显著升高,且可作为预测AIS患者神经功能缺损程度及预后的独立指标。
基金Shenyang Science and Technology Bureau(22-321-33-55,L190082,L230149).
文摘Several randomised controlled trials(RCTs)1–5 have established 3-month efficacy and safety of endovascular thrombectomy(EVT)in treating patients with acute ischaemic stroke(AIS)with a large infarct core and low Alberta Stroke Program Early Computed Tomographic Scores(ASPECTS),between 3 and 5.Despite EVT,these patients have a higher rate of mortality and unfavourable outcomes at 3 months,delayed recovery or secondary deterioration.6 The long-term outcomes for these patients remain largely uncertain and unexplored.Recently,the SELECT-2,TESLA and TENSION trials have reported 1-year follow-up outcomes.
