目的 观察音乐治疗对脑卒中后认知障碍患者认知功能、运动功能和日常生活活动能力的影响.方法 选取2020年12月至2022年7月北京博爱医院脑卒中后认知障碍的患者48例,随机分为对照组(n = 24)和试验组(n = 24).两组均给予神经内科常规药物治疗、护理和康复治疗,试验组在此基础上增加音乐治疗,共8周.干预前后采用洛文斯顿作业疗法认知评定成套测验(LOTCA)分析认知功能的变化,采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)评价运动功能和日常生活活动能力.结果 对照组脱落6例.治疗前后,试验组LOTCA总分和FMA评分差值均大于对照组(t＞2.665,P＜0.05);两组MBI评分差值无显著性差异(P＞0.05).结论 音乐治疗可以提高脑卒中后认知障碍患者认知功能和运动功能.

目的 探讨中国北方汉族人群β分泌酶-1(β-amyloid cleaving enzyme,BACE1)基因启动子区甲基化程度与散发性阿尔茨海默病(sporadic Alzheimer's disease,SAD)发病的关系及机制.方法 分析BACE1基因启动子区CpG岛,随机选取35名SAD患者、33名轻度认知障碍(mild cognitive impairment,MCI)患者和22名正常人,进行BACE1基因启动子区甲基化程度的测定,比较各组甲基化差异;构建报告基因质粒,转染细胞,测定荧火虫荧光素酶的活性(LAF)和海肾荧光素酶的活性(LAR),相对荧光素酶活性(RLA,RLA=LAF/LAR)来表示启动子质粒的转录活性.分别用血清剥夺、Aβ25-35、S-腺苷甲硫氨酸(S-adenosyl-L-methionine,SAM)及5-脱氧杂氮胞苷(5-aza-2'-de-oxycytidine,5-aza-CdR)处理,检测不同处理后质粒的荧光素酶活性.结果 BACE1(-407至+60)启动子区有23个甲基化位点.其中大多数CpG位点甲基化程度很低,平均甲基化率小于10％.基因启动子区平均甲基化率与年龄存在负性线性相关.Aβ25-35干预增加SY5Y细胞中BACE1启动子质粒的转录活性约20％;SAM干预明显降低BACE1启动子质粒的转录活性.血清剥夺及5-aza-CdR干预下的RLA与非处理组相比均无显著性差异(P>0.05).结论 BACE1基因甲基化程度的改变与SAD发病有明显相关性.SAM可以通过诱导甲基化抑制基因的转录活性,从而影响淀粉样蛋白分泌酶的活性,进一步导致AD发病.

目的 观察不同模式重复经颅磁刺激(rTMS)联合氟西汀治疗卒中后抑郁(PSD)的临床效果.方法 选取中国康复研究中心北京博爱医院2020年1月至2021年11月收治的PSD患者60例,按照随机数字表法分为低频治疗组、高频治疗组和对照组,每组各20例.分别给予1、5 Hz的rTMS及假刺激14 d,三组同时予以氟西汀20 mg/d、常规药物治疗及康复治疗28 d.于治疗前、治疗第7、14、28天,比较三组汉密尔顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NHISS)、改良Barthel指数(MBI)、简易精神状态检查量表(MMSE)评分变化及不良反应.结果 整体分析显示,三组HAMD评分时间、组间、交互作用比较,差异有统计学意义(P＜0.05).进一步两两比较,组内比较:低、高频治疗组治疗第7、14、28天HAMD评分低于同组治疗前,对照组治疗第14、28天HAMD评分低于同组治疗前,差异有统计学意义(P＜0.05).组间比较:治疗前,各组HAMD评分比较,差异无统计学意义(P＞0.05).治疗后,低、高频治疗组HAMD评分低于对照组,差异有统计学意义(P＜0.05).治疗第28天,三组NHISS评分低于治疗前,MBI、MMSE评分高于治疗前,差异有统计学意义(P＜0.05).治疗第28天,三组NHISS、MBI评分比较,差异有统计学意义(P＜0.05).其中,低、高频治疗组NHISS评分低于对照组,MBI评分高于对照组,差异有统计学意义(P＜0.05).对照组和低频治疗组在治疗过程中未出现不良反应,高频治疗组有3例患者治疗后出现轻中度短暂性头痛,休息后自行缓解.结论 rTMS联合氟西汀治疗和氟西汀单独治疗均能改善PSD患者的情绪、减轻神经功能缺损,提高日常生活活动能力和认知水平;联合治疗起效更快,疗效更显著,且磁刺激停止后疗效仍可持续,不良反应小.

目的:探讨脑损伤后致左侧空间忽略患者的注意捕捉效应.方法:本研究对右侧大脑半球损伤伴左侧忽略的患者及健康被试各20例,分别进行神经心理学背景测试及关联性注意捕捉效应测试,观察左侧空间忽略患者与健康被试之间注意捕捉效应的差异,分析影响关联性注意捕捉效应强度的因素.结果:①与健康对照组相比,左侧空间忽略组的数字捕捉正确率明显降低(P<0.01).②健康对照组:无论干扰刺激颜色与目标刺激颜色是否一致,左侧视野出现干扰刺激时的数字捕捉正确率均明显低于右侧视野出现干扰刺激时(P<0.01);无论干扰刺激在目标刺激的左侧或右侧,当干扰刺激颜色与目标刺激颜色一致时,数字捕捉正确率低于干扰刺激颜色与目标刺激颜色不一致时(P<0.01,0.05).③左侧空间忽略组:无论干扰刺激颜色与目标刺激颜色是否一致,右侧视野出现干扰刺激时的数字捕捉正确率均低于左侧视野出现干扰刺激时(P<0.05);左侧视野出现的干扰刺激颜色与目标刺激颜色一致或不一致时,对数字捕捉正确率的影响差异无统计学意义,而右侧视野出现的干扰刺激颜色与目标刺激颜色一致时,数字捕捉正确率低于颜色不一致时(P<0.05).结论:左侧空间忽略患者的注意功能下降,但无论对于健康受试者或者左侧空间忽略患者,符合目标刺激颜色特征的干扰刺激均能够增强非随意性地注意捕捉效应.

目的 探讨Pusher综合征的临床特点、康复评定和治疗.方法 报道1例女性患者并进行文献综述.结果 患者存在中度同侧深感觉障碍,左侧空间忽略和失用.白质病变迅速发展.康复4周后,对侧倾斜量表评分从2.5分降为0.75分;手功能恢复为辅助手.结论 Pusher综合征患者脑白质变性发展较快,身体运动功能恢复较慢,需要更长时间接受全面、早期、规范康复治疗.正确的运动疗法和体感刺激等对于患者功能恢复非常重要.

目的 调查慢性病患者医学伦理观念及参与药物临床试验意愿,并分析其特点及相关影响因素.方法 2020年12月,选取北京博爱医院内科门诊的慢性病患者318例,采用自制医学伦理问卷对患者的医学伦理观念和参与药物临床试验的意愿进行访谈式调查.结果 病程、地域、文化程度对慢性病患者医学知识关注度、患者权益和责任认知度有影响.多因素Logistic回归分析显示,治疗满意度、医生信任度与患者参与药物临床试验的意愿相关(P<0.05).患者首先关注药物临床试验的安全性,其次是疗效.结论 关注和保护慢性病患者的医疗权益,提高医生信任度,加强临床试验相关知识宣传,可增强慢性病患者参与药物临床试验的意愿.

目的 分析卒中后听觉失认的临床特点、诊治和康复.方法 回顾性分析2016年1月至2018年8月4例以听觉失认为首发症状的脑卒中住院患者.结果 4例患者均以听觉障碍起病,并发肢体运动功能障碍、言语障碍等,既往有一次或多次脑血管病史,检查后确诊为卒中后听觉失认.经综合康复,所有患者运动功能恢复良好,可独立步行,日常生活活动能力改善,部分患者环境音辨别改善,但言语听理解能力改善不明显.结论 卒中后听觉失认临床少见,预后不良,应全面评估,有针对性地行言语感知训练,并加强非语言交流方式训练,提高交流实用性.

2020年初暴发的新型冠状病毒肺炎疫情迅速蔓延,疫情不断升级,成为全球关注的突发公共卫生事件.依据公共卫生伦理学的基本原则,对这次公共卫生行为中的"限制出行""隔离""戴口罩"等防控措施进行了思考和解读,分析这些防控措施的公共卫生伦理依据,并指出一些措施的不足之处,以便指导卫生组织更加科学合理地制定和实施公共卫生防控措施,做到科学防治、精准施策.并就公共卫生伦理学如何在公共卫生事件中发挥更大作用提出了建议.

目的 探讨视神经脊髓炎谱系疾病的临床特点与康复预后.方法 回顾分析2016年1月～2018年10月中国康复研究中心北京博爱医院收治的7例诊断明确的视神经脊髓炎谱系疾病患者的临床资料,分析其临床特征及障碍点,观察日常生活活动(ADL)能力变化,比较康复预后情况.结果 7例患者分别表现出不同程度的肢体运动功能障碍、感觉障碍、尿便障碍、视力异常以及情绪障碍,ADL均需介助.经系统、规范化康复治疗,患者功能障碍明显改善,ADL能力明显提高(P＜0.01).结论 早期、积极的康复治疗能减轻患者的功能障碍,提高ADL能力.

目的 运用ICF核心分类组合脑卒中(综合版)评价脑卒中康复患者的功能、结构、活动和参与、环境因素,并探讨其相互关系.方法 2012年7月至2014年6月,来自全国57个医疗中心的首发脑卒中住院患者2822例,采用ICF核心分类组合脑卒中(综合版)进行评定.对各类目以及不同类目之间的关系进行分析.结果 步态、肌肉力量、随意运动控制、驾驶、做家务、就业是患者困难较大的前几位类目;环境因素中,建筑物相关的用品和技术、个人室内外移动和运输用的用品和技术、劳动和就业的服务、体制和政策等是影响患者的前几位障碍因素.功能与活动和参与正相关(r=0.712,r=0.694,P<0.001);活动和参与的活动表现与能力表现高度正相关(r=0.877,P<0.001);环境因素中的障碍因素与活动和参与的活动表现正相关(r=0.308,P<0.001).结论 ICF核心分类组合脑卒中(综合版)可以作为一个新的康复评价体系应用于脑卒中患者,有助于开展更实用、更有效的康复.

ABSTRACT Objective: The purpose of this study was to compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) applied at different frequencies to the contra-lesional hemisphere to optimize the treatment of post-stroke non-fluent aphasia. Method: Patients with post-stroke non-fluent aphasia were divided randomly into four groups: a high-frequency rTMS (HF-rTMS) group (10 Hz), a low-frequency rTMS (LF-rTMS) group (1 Hz), a sham stimulation group, and a control group. All groups received the standard treatment (consisting of drug therapy, conventional physical exercises, and speech training); in the HF-rTMS and LF-rTMS, this was supplemented with magnetic stimulation that targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed prior to, immediately after, and at 2 months post-treatment by the Chinese version of the Western Aphasia Battery (WAB). Results: When measured immediately post-treatment, as well as at 2 months post-treatment, the LF-rTMS group exhibited a more marked improvement than the HF-rTMS group in spontaneous speech, auditory comprehension, and aphasia quotients (AQ). Compared to the control group, the HF-rTMS cohort exhibited significant improvement at 2-months post-treatment in repetition and AQ. Conclusions: LF-rTMS and HF-rTMS are both beneficial to the recovery of linguistic function in patients with post-stroke non-fluent aphasia. LF-rTMS produced immediate benefits that persisted long-term, while HF-rTMS only produced long-term benefits. In addition, the benefits produced with LF-rTMS were more marked than those produced by HF-rTMS.

目的 探讨缺血缺氧性脑病恢复期患者综合康复治疗的效果.方法 回顾性分析2014年1月至2016年12月收治28例缺血缺氧性脑病恢复期患者的一般资料、康复评定方法和主要问题点、康复治疗手段及功能评分.结果 经康复治疗,患者简易精神状态检查评分、Fugl-Meyer评定量表运动评分和平衡评分、Holden步行分级以及改良Barthel指数分级改善(Z>2.588,P<0.05).结论 综合康复治疗能改善缺血缺氧性脑病恢复期患者认知功能、运动功能、步行和日常生活活动能力.

Objective To investigate the clinical and rehabilitation treatment of hypertrophic olivary degeneration(HOD)secondary to brainstem hemorrhage.Methods The clinical data of one patient with HOD secondary to pontine hemorrhage was retrospectively analyzed. In addition to the disability of the primary disease,involuntary jitter of the right limb gradually presented and aggravated.The patient re-ceived physical therapy,occupational therapy,acupuncture,hydrotherapy and medication.Results After one and a half-month rehabilitation and treatment,the patient improved from standing unsteadily and unable to walk to standing and walking independently.The score of Berg Balance Scale improved from 28 to 38,and the score of modified Barthel Index improved from 70 to 80.The involuntary jitter of the right limb was relieved.Conclusion The symptoms and disabilities of HOD secondary to pontine hemorrhage can be relieved by medication and rehabilitation,and the activities of daily living can be improved.

Objective To explore the etiologies,characteristics of functional disorders,effects of rehabilitation care and prognostic factors of adult hypoxic-ischemic encephalopathy.Methods Retrospective analysis was performed for clinical data of 91 patients with hypoxic-ischemic encephalopathy admitted to Department of Neurological Rehabilitation,Beijing Charity Hospital of China Rehabilitation Research Center,from August 2012 to December 2016.The etiologies and manifestations of functional disorders were summarized;the characteristics of injuries and the improvement in functional disorders as the result of rehabilitation care were analyzed by comparison.Results The etiologies were carbon monoxide poisoning in 21 patients,sudden respiratory and cardiac arrest in 13 patients,surgical accidents in 13 patients,respiratory circulatory failure in 9 patients,asphyxia in 8 patients,cerebrovascular accidents in 8 patients,brain trauma in 6 patients,electric injury in 4 patients,intoxication in 3 patients,allergic shock in 3 patients,hyperglycemic keto-acidic coma in 1 patient,amniotic fluid embolism in 1 patient,and heat stroke in 1 patient.Among the patients,58 (63.7％) received emergency CPR,21 (23.1％) received tracheal intubation,and 29 (31.9％) received tracheal incision.The complicated functional disorders were symptomatic epilepsy in 21 (23.1％) patients,cognitive dysfunction in 81 (89.0％);motor dysfunction in 75 (82.4％) patients;simple pyramidal tract injury in 42 (46.2％) patients,simple extrapyramidal system injury in 11 (12.1％) patients,and both pyramidal tract and extrapyramidal system injuries in 22 patients (24.2％).The mini-mental state examination (MMSE) score was 13.09±10.87 and 16.21±11.13 before rehabilitation and after rehabilitation,there was significant difference (t=3.741,P=0.001).The activities of daily living (ADL) score was 13.09±10.87 and 16.21±11.13 before rehabilitation and after rehabilitation,there was significant difference (t=5.287,P＜0.001).The ambulation score was 1.36±1.76 and 1.66±1.83 before rehabilitation and after rehabilitation,there was significant difference (t=3.466,P=0.001).The balance disturbance score was 5.30±4.97 and 6.26±4.96 before rehabilitation and after rehabilitation,there was significant difference (t=-5.91,P＜0.01).Conclusion Patients with hypoxic-ischemic encephalopathy typically present injuries of cortex,pyramidal system,extrapyramidal system,and cerebellar system,with the manifestations of cognitive and motor dysfunctions,dysarthria,and emotional disorder.Comprehensive rehabilitation care could improve the patient's cognitive function,ambulation,balance function,and ADL.

This article showed the work pattern of rehabilitation assessment, and made assessment of a patient who suffered from bilat-eral hemiplegia and pseudobulbar paralysis caused by multiple cerebral apoplexy. Finally, the special characteristics of rehabilitation treat-ment for a patient with bilateral paralysis were summarized.

Objective To explore the rehabilitation for chorea after bilateral thalamus hemorrhage. Methods A case was reviewed. Re-sults The score of Fugl-Meyer Assessment of balance increased from 0 to 7, the modified Barthel Index increased from 25 to 50, and the co-ordination of movement improved significantly after rehabilitation treatment. Conclusion Early comprehensive rehabilitation may reduce the chorea movement, improve the activities of daily living and balance for chorea after bilateral thalamus hemorrhage.

Objective To observe the effect of comprehensive rehabilitation on POEMS syndrome during sequel period. Methods Two cases of POEMS syndrome with multiple peripheral nerve injury as the main manifestation received physical therapy, occupational therapy, acupuncture, surface electromyography biofeedback and other comprehensive rehabilitation treatment. Results After treatment, the muscle strength, trunk balance, standing balance ability, activities of daily living (ADL) improved. The score of Berg Balance Scale increased from 18 to 28 in the first case, the modified Bathel Index increased from 55 to 70 in the second case. Conclusion Comprehensive rehabilitation can improve the function of patients with POEMS syndrome during sequel period, and surface electromyography biofeedback plays an im-portant role.

Respiratory dysfunction is a significant part of disorders associated with stroke. Stroke could impair respiratory center or mo-tor pathway, leading to alter breath pattern or reduced respiratory muscle strength. Pneumonia secondary to stroke and stroke-associated sleep apnea are common respiratory disorder, which are adverse to the prognosis of stroke. Clinical routine physical examination is basic evaluation of respiratory function. Attention should be paid especially in breath pattern, respiratory muscle volume and muscle tone. Multi-ple quantitative assessments include arterial blood gas analysis, sleep apnea monitoring, dynamical, imaging and electrophysiological tests. Rehabilitation can be used to improve the inspiratory muscle strength, endurance and cough effectiveness, reduce sleep apnea hypoventila-tion, enhance the cardiorespiratory fitness, finally improve the quality of life in stroke patients.

Objective To explore the characteristics and rehabilitation treatment methods of young ischemic stroke combined with con-genital myopathy. Methods The clinical data of one young patient with ischemic stroke combined with congenital myopathy was retrospec-tive analyzed, and its pathological feature and rehabilitation treatment methods were also analyzed. Results The etiology may be artery dis-section mural thrombus fell off. Conclusion The etiology of young ischemic stroke should be clear diagnosed, and the intensity of rehabilita-tion training need attention.

1病历摘要 患者男性，41岁，主因“左侧肢体活动不利5月余”以“脑出血恢复期”收入院。5月余前活动时无明显诱因突发左侧肢体活动不利，上肢不能持物，不能保持坐位，无明显头痛、呕吐及肢体抽搐，伴有二便失禁。送至当地医院，测血压200/140mmHg。头CT检查示右侧基底节区脑出血，出血量约120ml，行去骨瓣减压及血肿清除术。术后3~4d意识转清，能够认识家人，无明显自发言语，左侧肢体活动不能，2个月后，患者病情逐渐稳定，床旁肢体被动活动及针灸等康复训练治疗。但患者一直呈嗜睡状态，唤醒后可回答简单问题，左侧肢体不能活动。病后曾数次出现突发四肢抽搐，双眼上翻，口吐白沫，呼之不应，考虑为癫痫发作，给予丙戊酸钠抗癫痫治疗。目前患者仍呈轻度嗜睡状态，左侧肢体活动不能，坐位平衡不能维持，日常生活大部分依赖他人帮助，既往高血压病史10余年，最高200/140mmHg，平素未规律监测及口服药物控制，有睡眠呼吸暂停病史。