目的 探讨经颅磁刺激技术联合神经肌肉激活技术对脑卒中患者康复预后的影响.方法 采用前瞻性研究,选取2021年1月至2022年6月邢台市第三医院接诊的120例脑卒中患者作为研究对象,根据随机数字表法将其分为对照组和观察组,每组各60例.对照组接受神经肌肉激活技术治疗,观察组接受经颅磁刺激技术联合神经肌肉激活技术治疗.对比两组蒙特利尔认知评估量表(MoCA)评分、Berg平衡量表和Tinetti量表评分、上肢Fugl-Meyer量表(FMA-UE)和改良Bar-thel指数(MBI)评分、汉语失语成套测验(ABC)评分、吞咽困难严重程度量表(FEDSS)和渗漏-误吸量表(PAS)评分.结果 治疗后,两组抽象思维、定向力、语言、记忆、视结构技能、集中与注意力、执行功能以及MoCA总分均高于治疗前,且观察组上述认知功能评分均高于对照组,差异均有统计学意义(P＜0.05).治疗后,两组Berg平衡量表和Tinetti评分均高于治疗前,且观察组Berg平衡量表和Tinetti评分均高于对照组,差异均有统计学意义(P＜0.05).治疗后,两组FMA-UE、MBI评分均高于治疗前,且观察组FMA-UE、MBI评分均明显高于对照组,差异均有统计学意义(P＜0.05).治疗后观察组信息量、理解能力、数数、流畅度、命名、复述以及总分均明显高于对照组,差异均有统计学意义(P＜0.05).治疗后,两组FEDSS、PAS评分均低于治疗前,且观察组FEDSS、PAS评分均明显低于对照组,差异均有统计学意义(P＜0.05).结论 脑卒中患者通过经颅磁刺激技术联合神经肌肉激活技术治疗,可明显提升认知功能和平衡功能,改善上肢运动功能和日常生活活动能力,提高患者语言表达能力,改善吞咽功能,值得临床推广使用.

Objective:To analyze the effect of intermittent oral to esophageal tube feeding combined with swallowing training on nutritional status and prognosis of patients with dysphagia.Methods:One hundred and six patients with dysphagia in the Third Hospital of Xingtai City from January 2019 to May 2020 were divided into control group (53 cases, continuous indwelling nasal feeding + swallowing training) and study group (53 cases, intermittent oral to esophageal tube feeding + swallowing training) by a random digital table, and all patients were treated for 4 weeks. The swallowing function, nutritional status [including body mass index (BMI), triceps skinfold thickness (TSF), arm circumference (AC), total protein (TP), prealbumin (PA), albumin (ALB)] before treatment and after treatment were compared between the two groups. The clinical effect, the incidences of complications and adverse events during treatment and prognosis were compared.Results:There were statistically significant differences in swallowing function grades between the two groups before and after treatment (P<0.05), and there was a statistically significant difference between the two groups after treatment (P<0.05). After treatment, BMI, TSF, AC, serum TP, PA, ALB levels in the study group were higher than those before treatment, which were higher than those in the control group, with statistically significant differences (P<0.05). There was a statistically significant difference in the grading of clinical effect between the two groups after treatment (P<0.05), and the total effective rate in the study group was higher than the control group (P<0.05). The incidences of aspiration pneumonia, electrolyte disturbance and complications were lower than those of the control group, with statistically significant differences (P<0.05). There was no statistically significant difference in the incidences of adverse events between the two groups (P>0.05). NIHSS score of the study group was lower than that of the control group, and BI score was higher than that of the control group, with a statistically significant difference (P<0.05).Conclusion:Intermittent oral to esophageal tube feeding combined with swallowing training can significantly improve the swallowing function and nutritional status of patients with dysphagia, enhance clinical effect, reduce complications and improve the prognosis.

目的:研究脑卒中吞咽障碍伴顽固性呃逆患者,在针灸治疗的前提下给予经口间歇胃管治疗,观察患者呃逆缓解情况.方法:以2020年5月至2021年5月为研究时段,择取我院60例脑卒中吞咽障碍伴顽固性呃逆患者,将其均分后以对照组和观察组命名,每组30例.对照组采用单纯穴位针灸进行治疗,观察组在穴位针灸治疗的基础上同时停留置管予以经口间歇胃管营养法,对比两组患者呃逆症状控制效果.结果:治疗后观察组呃逆症状缓解有效率为93.33％,明显高于对照组,差异具有一定实际研究意义,P＜0.05.结论:在治疗脑卒中吞咽障碍伴顽固

目的 ：分析对急性重症脑卒中患者采取期床旁康复训练对患者神经功能恢复情况的影响。方法 ：研究资料为一年时间内我院治疗的 80 例急性重症脑卒中患者，通过计算机随机分组的方法分成每组患者 40 人的参照组和研究组，对照组患者采取常规治疗措施，研究组患者采取常规治疗措施的基础上增加使用早期床旁康复训练，对比两组患者治疗前后神经功能评分、运动功能评分、生活自理能力评分以及治疗期间两组患者并发症发生概率。结果 ：研究组患者治疗后的神经功能评分、运动功能评分、生活自理能力评分均明显优于参照组患者，差异分析结果，P ＜ 0.05，研究组患者治疗过程中并发症发生概率低于参照组患者，差异分析结果，P ＜ 0.05。结论 ：对急性重症脑卒中患者采取早期床旁康复训练的措施可以有效改善患者的神经功能以及运动功能，提高患者预后生活自理能力和预后生活质量，且治疗过程中并发症频率较低，值得将其推广使用。

目的 ：研究对脑梗死吞咽功能障碍的患者实施早期康复治疗的效果。方法 ：于我院脑梗死后出现吞咽障碍患者中随机抽取 68 例，分为 2 组，对照组采取常规治疗，观察组采取早期康复治疗，对比两组治疗效果。结果：（1）对照组治疗有效率 24 例（70.58%）。观察组治疗有效率 32 例（94.11%）。2 组对比，差异显著（P ＜ 0.05）。（2）对照组 VFSS（3.56±0.71）分，FOIS（5.10±0.62）级。观察组 VFSS（7.49±0.68）分，FOIS（5.94±0.68）级。2 组对比，差异显著（P ＜ 0.05）。（3）对照组营养不良 2例（5.88%），吸入性肺炎 2 例（5.88%），鼻黏膜损伤 4 例（11.76%），合计 8 例（23.53%）。观察组未出现营养不良、吸入性肺炎，鼻黏膜损伤 1 例（2.94%），合计 1 例（2.94%）。2 组对比，差异显著（P ＜ 0.05）。结论 ：对脑梗死吞咽障碍的患者给予早期康复治疗可有效提高临床疗效，促进患者吞咽功能和进食能力的恢复，有利于预防并发症，具有较高临床价值。

目的 ：研究对脑卒中偏瘫患者实施针灸和生物反馈治疗对恢复和预后的影响。方法 ：于我院脑卒中偏瘫患者随机抽取 74 例，对照组给予针灸治疗，观察组联合给予生物反馈治疗，对比两组恢复和预后效果。结果 ：观察组 BI 指数（68.29±6.45）分，FMA（68.62±8.49）分，明显高于对照组。观察组 SDSS（7.14±1.12）分，SF-36（70.45±4.72）分，均优于对照组。2 组对比，差异显著（P ＜ 0.05）。结论 ：对脑卒中偏瘫患者给予生物反馈治疗联合针灸治疗有利于恢复患者肢体功能和生活能力，从而恢复社会功能以及生活质量，回归正常生活，改善预后效果。

目的 探讨血清S100β、胱抑素C(CysC)及白细胞介素-8(IL-8)水平与脑小血管病(Cerebral small vessel disease,CSVD)患者认知功能障碍的相关性.方法 选取2017年1月～2020年1月邢台市第三医院107例CSVD患者根据蒙特利尔认知评估(MoCA)评分分为认知功能障碍组(CI组,42例)和无认知功能障碍组(non-CI组,65例).对比两组血清S100β、CysC及IL-8水平差异,分析血清S100β、CysC、IL-8水平与MoCA评分的相关性,探讨各指标对认知功能障碍的诊断价值.结果 WML+LI组血清S100β、CysC及IL-8水平显著高于WML组和LI组,CI组患者血清S100β、CysC及IL-8水平明显高于Non-CI组(P<0.05).CI组患者血清S100β、CysC、IL-8水平与MoCA评分均呈显著负相关(P<0.05).血清S100β、CysC、IL-8水平升高是CSVD患者发生认知功能障碍的独立危险因素(P<0.05).血清S100β、CysC、IL-8及联合检测诊断CSVD伴认知障碍的受试者工作特征曲线(ROC)曲线下面积(AUC)为0.855、0.828、0.867、0.942.结论 血清S100β、CysC、IL-8表达与CSVD患者认知障碍有关,联合检测可为认知功能障碍的诊断提供参考.

Objective To study the effect of modified compulsory exercise therapy on upper limb function and activity of daily living (ADL) of stroke patients with hemiplegia. Methods We selected 120 stroke hemiplegic patients in our hospital from June,2015 to June,2016.120 patients were randomly divided into two groups:modified mandatory exercise therapy for the A group of 60 people;the use of neurophysiological therapy(Bobath)and exercise re-learning of the traditional therapy for the B group of 60 people. The patients were evaluated according to the simplified upper limb motor function rating scale,simple upper limb functional examination scale and improved Barthel index. Serum hs-CRP,Hcy and Lp levels were examined before and after treatment.Results There was no significant difference in FMA,STEF and MBI scores between group A and group B before treatment(P>0.05).There were significant differences in scores of FMA,STEF and MBI between the two groups after treatment(P<0.05)(P<0.05).There was significant difference in FMA,STEF and MBI scores between group A and group B after treatment(P<0.05).Serum hs-CRP, Hcy and Lp levels were decreased significantly after treatment in both groups(P<0.05),the effect in group A was better than the effect in group B(P< 0.05). Conclusion Improved mandatory exercise therapy can significantly improve the upper limb function and ADL of stroke patients with hemiplegia,thus patients can take care of themselves and reduce their psychological stress.

Objective It is to explore the effect of Chinese drug for tonify qi and activate the blood on dyskinesia at recov -ery period after ischemic storke with syndrome of qi deficiency and blood stasis and its effect on the levels of S 100 beta and Hcy.Methods 140 patients with dyskinesia at recovery period after ischemic storke with syndrome of qi deficiency and blood stasis were randomly divided into 2 groups,the control group(n=70)was treated with western medicine,additionally the ob-servation group was treated with Chinese drug for tonify qi and activate the blood.The scores of traditional Chinese medicine (TCM)syndrome, Fugl-Meyer motor scale, Barthel index, Berg balance scale, walking ability and the levels of muscle strength,S100 beta and Hcy before and after treatment were observed and the recent curative effects were evaluated in both groups.Results After treatment the scores of TCM symptoms such as hemiplegia,hypesthesia,shortness of breath and so on and the levels of S100 beta and Hcy were significantly lower than those before treatment (P<0.05),and the scores of every index in the observation group were significantly lower than those in the control group(P<0.05);the level of muscle strength and the scores of Fugl-Meyer motor scale,Barthel index,Berg balance scale and walking ability were significantly improved(P<0.05),and the improvements of every index in the observation group were significantly better than those in the control group (P<0.05).Conclusion Chinese drug for tonify qi and activate the blood can effectively relieve clinical symptoms, improve muscle strength and body motor function,improve the quality of daily life, and help to down-regulate the levels of S100 and Hcy in the patients with dyskinesia at recovery period after ischemic storke with syndrome of qi deficiency and blood stasis.

脑卒中是危害公众健康的常见疾病,随着脑卒中知识的日益普及和医疗技术的不断进步,近年来脑卒中病死率得到控制,但70%~80%的存活者会以残疾状态生存.以运动功能障碍为表现的偏瘫是脑卒中后残疾的常见症状,重度偏瘫不但影响患者的生活自理能力,还会降低患者的生存质量,故如何提升脑卒中重度偏瘫患者的步行能力已经成为众多医师关注的课题.步行训练是针对偏瘫患者肢体障碍问题设计的动作训练,有大量研究[1-2]证实,强化早期步行训练能够改善脑卒中中度偏瘫患者肢体运动功能,提升步行能力.本研究探讨了强化早期步行训练对脑卒中重度偏瘫患者康复效果的影响,现将结果报告如下.

目的：探讨分析脑瘫患儿应用核心稳定性训练对其运动功能的影响。方法随机将70例脑瘫患儿分成病例数各35例的研究组与对照组，每组患儿均予以常规康复训练，在此基础上，研究组患儿加施核心稳定性训练，借助于粗大运动功能量表在治疗前后对两组患儿运动功能进行对比评价。结果经过半年的治疗，两组患儿粗大运动功能均所有改善，其中研究组改善情况明显比对照组好（P＜0.05）。结论对于脑瘫患儿基于常规康复训练加施核心稳定性训练，有利于其运动功能的改善，具有应用推广价值。

银杏叶提取物含有多种药用成分，其中黄酮类、萜内酯类为银杏叶的主要活性成分，其可以抗氧化，清除自由基作用、改善微循环、改善血液流变学特性的作用、减轻脑水肿、抑制细胞凋亡等，对脑出血后的神经元起到保护作用，且早期用药效果较好。本文对银杏叶提取物在脑出血的应用进展做了一综述。

Objective To explore the effect of interventional therapy on recurrence of cerebral infarction in patients with anxiety and depression after cerebral infarction.Methods Ninety-two patients with anxiety and depression after cerebral infarction were divided into treatment group and control group,42 cases each.The treatment group was treated with Diana God and Prozac.Control group did not receive interventional therapy.The recurrence rate of cerebral infarction,functional health level,and anxiety and depression improvement were observed after 3 years in two groups.Results In the treatment group,the recurrence rate was lower(P<0.05),the functional health level was higher(P<0.01),and the levels of anxiety and depression were lower compared to control group(P<0.01) after three years.The levels of anxiety and depression were lower after three years both in two groups(P<0.01,P<0.05).Conclusion Interventional therapy of anxiety and depression can effectively prevent the recurrence of cerebral infarction in patients with cerebral infarction complicated with anxiety and depression,improve functional health level and relieve the symptoms of anxiety and depression.

随着社会的不断发展,单纯治病、维持生命已不是脑卒中后治疗的主要目的,而及时康复、提高患者自理能力、提高生存质量,才是最终目的.我们观察到,要做好中重度脑血管病患者的康复工作,家庭参与训练则显得极为重要.

目的:探讨急性脑卒中后中重度偏瘫患者康复的新途径。方法:中重度偏瘫患者200例,分为治疗组和对照组各100例,均予药物治疗,治疗组接受互动模式治疗,于治疗前、1个月、3个月、6个月、12个月时用N IHSS、FM A、B I量化评定,统计并发症发病率。结果:两组对比,治疗组3个月时各指标改善最快(P<0.01),B I 6个月、1 a时仍有改变。治疗组并发症明显低于对照组。结论:医患互动模式对中重度偏瘫患者的康复有重要作用。

Objective To investigate the effect of Doctor-patient Interaction Model on hemiplegia after acute stroke.Methods 200 cases with mderate to severe hemiplegia were divided into treatment group and the control group with each 100 cases according to whether their family supporting rehabilitation.Cases in treatment group received interaction model rehabilitation.They were assessed with National Institutes of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA),Barthel Index(BI)10 d,1 month,3 months,6 months,12 months after rehabilitation,and the Geriatric Depression Scale(GDS)1 year after rehabilitation.Results The scores in all the assessment of the cases in the treatment group improve mostly 3 month after rehabilitation(P<0.01),while the BI improved 6-12 month after rehabilitation(P<0.01).The incidence of depression reduced 18% compared with that of the control group(P<0.01).Conclusion Doctor-patient interaction can improve the outcome of patients with moderate to severe hemiplegia.

Objective:To observe the effectiveness comprehensive rehabilitation on patients of severe cerebrolvascular disease and brain injury.Methods: Select 80 cases of sever cereebrolvascular disease and sever brain injure in contrast to 50 cases of non-compmhensiv rehabilitation,estimate GCS、NIHSS、FMA、ADLboth of them in various time,and so as to severe cerebrolvascular disease and brain injury.Results: Some important indicators improved significantly after comprehensive rehabilitation therepy,the GCS proved more significantly in 1month(P<0.01),NIHSS、FMA、ADL improved more significantly in 3,3,6 month(P<0.05),ADL proved better slowly in 12 monlh(P<0.05).NIHSS、ADL proved more signmcan ficantly in 3,6 month between brain injury and severe cerebrolvascular disease(P<0.01),so as to GCS、NIHSS、FMA、ADL proved significantly in other times(P<0.05).Conclusion:The effect of comprehensive rehabilitation group in some subjcts were better than the other group.

Objective:To investigate the effects of systematic treatment model with subjects for ACVD patients. Methods:TO establish perfect network of Systematic Treatment model with subgerts.7202 patients in hospital were eligible for the criteria that the patients were admitted with ACVD. Of all patients,4089 were made was treatment group from June,2000 to June2005(Systematic Treatment model with subgerts);3113 were made as control group from June, 1995 to June,2000(conventional therapy).Parameters observed were at NIHSS,BI,OHS,Inhospital days,mortality, complicantion and six months appraise of physical disabilities at discharge.Parameters were analyged by SPPS Windows 10,0 softwere. Results: The treatment group NIHSS-4.59±4.68,BI 29.53±24.40,OHS-1.29±0.95;The control group NIHSS-1.97±2.17,BI 16.94±21.41,OHS-0.84±1.09.It were significantly different between the two groups(P0.0001.Curative rate was raised 31.92% , morality was reduced12.77%,complications was reduced 12.52%,the disability was reduced 31.92%.Conehlsion Systematic Treatment model with subjects(STMSACVD) may improve obviously curative rate, reduce complication, reduce mortality of the patients and decrease the disability, increase the life level of patients. It is a perfect treatment model that fit to our national conditions.

探讨中老年急性脑血管病早期高血糖调治范围及调治方法.方法:年龄40～80岁,发病在48小时之内的急性脑血管病3544例病人被随机分入治疗组和对照组.每组1772例.治疗组依据急性脑血管病早期高血糖调治技术,应激性高血糖恒定在7.00～7.50mmol/L,糖尿病性高血糖稳定在MBGC+1.50～2.00mmol/L.采用8点法和5点法监测血糖,指导胰岛素用量.对照组采用常规治疗方法.观察临床疗效和预后状况.结果:发病后第10、30天,CSS临床疗效评分,治疗组在基本治愈、显效、好转及总有效方面均明显高于对照组(P＜0.01),而在无效或恶化以及死亡方面明显低于对照组(P＜0.01).对照组极易发生低血糖,缺血灶扩大,肢体瘫痪加重及混合性卒中,且预后较治疗组差(P＜0.01).结论:中老年急性脑血管病后应激性高血糖者血糖调治在7.00～7.50mmol/L,糖尿病性在MBGC+1.50.～2.00mmol/L,可以获得更好的临床疗效.8点法和5点法可以很好地监测血糖水平,指导胰岛素应用.

[Objective] To explore the ranges and the methods of modulating hyperglycemia following ACVD early stage. [Methods] The 5316 patients with ACVD were randomly divided into treatment group, control groupl and 2. According to the level that the blood glucose concentration(BGC) increased after ACVD in treatment group, insulin was early used to modulate hyperglycemia and YiQi mixed preparation modulating glucose added. BGC was monitored with the 8+ periods and 5+ periods. Conventional therapy was used in control group 1 or 2.The changes were observed in respects of clinical effect and prognosis. [Results] On admission 10- or 30-days, it was more obviously raised that the healing rate, clear effect, improvement and total healing efficiency were evaluated with CSS in treatment group compared with control group 1 and 2 (P ＜0.01). It was more obviously lowered that the incidence of nullity or exacerbation and mortality were abserved in treatment group, compared with control group 1 and 2 (P ＜0.01). The prognosis was aggravated in control groups. [Conclusions] The clinical better healing effect is obtained when the stress hyperglycemia is modulated to 7.00～7.50 mmol/L and the diabetic to MBGC+1.50-2.00 mmol/L.BGC was better monitored with the 8+ periods and 5+ periods. The satisfying BGC target is maintained by means of this technology of modulating hyperglycemia.