Objective:To explore the efficacy of early hyperbaric oxygen therapy combined with Schuell language training on patients with aphasia after stroke，and to analyze its influence on the activity function of language center.Methods:A total of 176 patients with aphasia after stroke admitted to the Department of Rehabilitation of Xuzhou Central Hospital from March 2021 to March 2022 were selected as research objects，and were divided into control group and observation group by random number table method，with 88 cases in each group. The control group received Schuell language training，while the observation group was additionally treated with hyperbaric oxygen therapy. The efficacy of the two groups were analyzed by observing the degree of neurological impairment，cognitive function，and language center activity function in both groups before and after treatment，with National Institutes of Health Stroke Scale（NIHSS），Montreal Cognitive Scale（MoCA），and Boston Diagnostic Aphasia Scale（BDAE）.Results:After all courses of treatment，the total effective treatment rate of the observation group was 88.64%（78/88），which was significantly higher than that of the control group（73.86%，65/88），and the difference was statistically significant（ P<0.05）. Before treatment，there was no significant difference in NIHSS，MoCA，and language center activity function score between the two groups（ P>0.05）. Compared with those before treatment，the NIHSS scores of the two groups were decreased，and the scores of MoCA and language center activity function were increased；furthermore，after treatment，the NIHSS score of the observation group was lower than that of the control group，and the scores of MoCA and various language center activity function were higher than those of the control group，with statistically significant differences（ P<0.001）. Conclusion:Early hyperbaric oxygen therapy combined with Schuell language training can improve the overall efficacy on patients with aphasia after stroke，and reduce the degree of neurological impairment，thus improving the cognitive function and language center activity function.

目的 分析进食评估问卷调查工具-10(EAT-10)联合容积-黏度测试(V-VST)在老年急性缺血性脑卒中(AIS)后吞咽功能障碍筛查中的效能.方法 2018年3月-2021年3月在徐州市中心医院康复科诊治的98例老年AIS患者,进行卒中后吞咽功能障碍筛查,以视频透视吞咽功能检查(VFSS)方法为标准,采用Kappa 一致性检验分析比较EAT-10和V-VST单独筛查和联合筛查的灵敏度、特异度和准确度.结果 98例AIS患者经VFSS检查确诊51例吞咽功能障碍患者,EAT-10筛查共检出42例阳性,检出率为42.86％,V-VST筛查共检出47例阳性,检出率为47.96％,EAT-10联合V-VST筛查共检出48例阳性,检出率为48.98％;与VFSS检查标准诊断相比,Kappa值分别为0.614、0.796、0.857;EAT-10、V-VST筛查以及两者联合筛查AIS后吞咽功能障碍的敏感度分别为72.55％、78.43％、90.20％,特异度分别为89.36％、93.62％、95.74％,准确率分别为80.61％、89.79％、92.86％.讨论EAT-10联合V-VST筛查AIS后吞咽功能障碍,可有效提高检测灵敏度和特异性,降低漏诊率及误诊率.

Objective:To explore the effect of addition and subtraction of Huatantongluo decoction combined with rehabilitation training in dysphagia (intermingled phlegm and blood stasis syndrome) after acute cerebral infarction.Methods:Ninety-four patients with dysphagia after acute cerebral infarction in Rehabilitation Department of Xuzhou Central Hospital from July 2018 to January 2020 were randomly divided into experimental group and control group, with 47 cases in each group. The control group was given routine drug treatment+rehabilitation training, and the experimental group was treated with addition and subtraction of Huatantongluo decoction on the basis of the control group. The symptom scores of the traditional Chinese medicine before and after treatment, swallowing function scores before and after treatment, clinical effect and the incidences of adverse reactions were compared between the two groups.Results:After treatment, the main symptom scores, secondary symptom scores, the traditional Chinese medicine symptom total scores of the two groups were decreased, and the scores of the experimental group was lower than those of the control group, the differences were statistically significant (P<0.05). After treatment, the total swallowing function scores of the two groups were increased, and the score of the experimental group was higher than the control group, the differences were statistically significant (P<0.05). The clinical effect distribution difference between the two groups was statistically significant, and the total effective rate of the experimental group was higher than that of the control group, the difference was statistically significant (P<0.05). There was no significant difference in the incidences of adverse reactions between the experimental group and the control group (P>0.05).Conclusion:For patients with dysphagia after acute cerebral infarction (intermingled phlegm and blood stasis syndrome) treated with addition and subtraction of Huatantongluo decoction combined with rehabilitation training can ameliorate the traditional Chinese medicine symptom scores, can restore the swallowing function of patients, enhance the clinical efficacy, and it is safe.

目的:探讨碘海醇和硫酸钡作为电视荧光放射技术吞咽功能检查(VFSS)对比剂在卒中后吞咽障碍患者误吸诊断中的应用价值及安全性.方法:脑卒中患者164例,随机分为硫酸钡组和碘海醇组各82例.硫酸钡组采用硫酸钡作为对比剂,碘海醇组采用碘海醇作为对比剂.观察2组误吸发生率、VFSS后吸入性肺炎的发生率.结果:2组稀对比剂口通过时间、稀对比剂咽通过时间、稠糊状对比剂口通过时间、稠糊状对比剂咽通过时间相比较差异均无统计学意义(P>0.05).2组口咽腔滞留、反流、隐匿性误吸、自主清除等发生率相比较差异均无统计学意义(P>0.05).硫酸钡组吸入性肺炎发生率高于碘海醇组,差异有统计学意义(P<0.05).结论:采用碘海醇做对比剂行VFSS对脑卒中吞咽困难患者误吸诊断具有良好诊断价值,且可降低吸入性肺炎的发生率.

目的 评价药物治疗联合心理治疗对脑卒中后抑郁患者的价值.方法 自2018年3月～2019年3月,选取本院收治的脑卒中患者共52例,将患者进行随机分组,分别分为观察组和对照组,对照组采取常规治疗手段,并给予药物治疗,观察组在对照组的基础上联合心理治疗,对比两组患者的焦虑、抑郁评分情况.结果 治疗后观察组的焦虑度(37.5±5.6)分,抑郁度(34.6±3.0)分,低于对照组的焦虑度(53.4±5.3)分,抑郁度(51.8±3.2)分(P＜0.05).结论 在脑卒中后抑郁的治疗中,药物治疗联合心理治疗有效改善患者的心理状态,并大幅提升治疗效果,提高患者的生活质量,治疗效果显著,值得临床推广.

目的:监测小儿急性淋巴细胞白血病(ALL)大剂量甲氨蝶呤(MTX)化疗期间血药浓度变化,并探讨血药浓度与不良反应的关系.方法:226例ALL患儿接受大剂量MTX治疗(3 g/m2),记录其给药后不同时间血药浓度变化,并根据MTX 48 h血药浓度(c48 h)分级方法,比较不同MTX血药浓度分级患儿不良反应发生情况.结果:在所有血药浓度监测时间点内,MTX给药后0.5 h时血药浓度最高,12～24 h MTX消除速率最高,此后持续下降,患儿MTX给药后72 h血药浓度即降至(0.05±0.01)μmol/L.226例患儿共发生不良反应174例次,其中肝功能异常、消化道反应发生率最高,分别为30.09％、21.68％％.c48 h分级一级者不良反应发生率最低,其次为二～四级者,五～六级者不良反应发生率最高,差异有统计学意义(P<0.05).Spearman相关性分析示,c48 h分级与不良反应发生率呈正相关(r=0.617,P<0.05).结论:大剂量MTX给药后患儿血清MTX血药浓度持续下降,但患儿不良反应发生率仍较高且与MTX血药浓度密切相关,持续监测MTX血药浓度并适时调整CF解救方案,有助于确保治疗效果、降低不良反应发生风险.

Objective To explore the cognitive impairment of stroke survivors using magnetic resonance spectra (MRS) and the Loewenstein occupational therapy cognitive assessment (LOTCA),and to analyze their correlation and their clinical significance.Methods Thirty stroke survivors diagnosed with cognitive impairment using the mini-mental state examination formed a cognitive impairment group.Another 30 stroke survivors without cognitive impairment served as stroke controls,while a third group of 30 healthy counterparts were the normal controls.All were assessed using magnetic resonance imaging and the LOTCA and the results were correlated.Results The average LOTCA total score and sub-scores of the impaired group were significantly lower than those of the other two groups.The average LOTCA total scores and the orientation and spatial perception,apparent motion and thinking operation sub-scores of the stroke control group were also significantly lower than those of the normal control group,though their average visual perception and motor praxis scores were not.The average levels of N-acetyl aspartate and creatine (NAA and Cr) in the bilateral hippocampus of the cognitively impaired group were significantly lower than among the controls,while their choline and creatine (Cho/Cr) levels were significantly higher.The average NAA/Cr and Cho/Cr levels in the bilateral hippocampus of the stroke control group were similarly significantly lower and higher than among the healthy controls.The average NAA/Cr levels in the left and right hippocampus were weakly to moderately correlated with the total LOTCA scores and the LOTCA sub-score for attention (r=0.376-0.661 and r=0.396-0.691 respectively).The average value of Cho/Cr in the left hippocampus showed weak to moderate negative correlation with the LOTCA total scores (r=-0.368-0.619),but not with the attention scores.The value of Cho/Cr in the right hippocampus had weak to moderate negative correlation with the LOTCA total score and with the orientation,visual perception,visuo-motor organization and thinking operations sub-scores (r=-0.391-0.632),but no obvious correlation with the scores for spatial perception,motor praxis or attention.Conclusion MRS can be used to assess the cognitive impairment of stroke survivors.MRS and LOTCA scores are closely correlated.MRS combined with LOTCA can evaluate cognitive dysfunction more comprehensively and objectively.

Objective To explore the correlation between Magnetic Resonance Spectroscopy and Mini-Mental State Ex-amination in the assessment of cognitive impairment patients after stroke , and analyze their clinical significance. Methods According to MMSE score,selected 30 stroke patients with cognitive impairment (cognitive impairment group),30 stroke patients without significant cognitive impairment (stroke group), and 30 healthy volunteers (healthy group). The gender,age,educational level and duration were matched in the three groups. All the cases were examined with MMSE and MRS testing. Results The MMSE score of cognitive impairment group was lower than that of stroke group and healthy group(P<0.01), and the MMSE score of stroke group was lower than healthy group (P<0.01). The NAA/Cr in bilateral hippocampus regions of cognitive impairment group was less than the stroke group and the healthy group (P<0.01), the NAA/Cr of stroke group was lower than the healthy group (P<0.01), the Cho/Cr of cognitive impairment group was higher than the stroke group and the healthy group (P<0.01). And the Cho/Cr of stroke group was higher than healthy group (P<0.01). The MMSE scores of cognitive impairment group and stroke group had positive correlation with NAA/Cr in bilateral hippocampus regions (r=0.364~0.681,P<0.05),and had negative correlation with Cho/Cr (r=-0.391~-0.559,P<0.05). Conclusion MRS and MMSE have relative consistency, combining MRS and MMSE can assess vascular cognitive impairment more objectively and comprehensively.