RESUMO
Objective: To observe the clinical efficacy of row needling at the Governor Vessel on the head for poststroke insomnia, analyze the changes of sleep structure, serum amino acid neurotransmitters, vascular endothelial cell function and cognitive function, in order to explore the mechanism of this therapy.Methods: A total of 41 patients with poststroke insomnia were included in an observation group and treated with row needing at the Governor Vessel on the head; 33 patients with poststroke insomnia were included in a control group and given routine acupuncture treatment. The patients in both groups were treated consecutively for one month. The efficacy was observed and the changes of related indicators were compared. Results: After treatment, the efficacy of the observation group was better than that of the control group (P<0.05). The sleep latency in the observation group was shorter than that in the control group (P<0.05); the total sleep duration, deep sleep duration, light sleep duration and rapid eye movement sleep duration in the observation group were significantly longer than those in the control group (P<0.05); the total waking duration and the waking times over 5 min were significantly less than those in the control group (P<0.05). The serum glutamic acid, γ-aminobutyric acid, calcitonin gene-related peptide, brain-derived neurotrophic factor, nerve growth factor and nitric oxide levels were significantly higher than those in the control group (P<0.01). The tumor necrosis factor-α, interleukin-6, bradykinin, and endothelin-1 levels were lower than those in the control group (P<0.01). The Pittsburgh sleep quality index score in the observation group was lower than that in the control group (P<0.01), and the mini-mental state examination score was higher than that in the control group (P<0.05). Conclusion: Row needling at the Governor Vessel on the head can effectively improve the sleep structure, cognitive function, and sleep quality of patients with poststroke insomnia. The possible mechanisms are regulating serum amino acid neurotransmitters and improving the function of vascular endothelial cells.
RESUMO
Objective:To evaluate the safety and effectiveness of Tiandan Tongluo capsule in the treatment of cerebral infarction (CI) in convalescence (stoke involving meridians and collaterals due to wind-phlegm-static blood obstructing vessels), with Naoshuantong capsule as a control. Method:A total of 352 convalescent patients with CI differentiated into stoke involving meridians and collaterals due to wind-phlegm-static blood obstructing vessels in traditional Chinese medicine (TCM) were included in this multi-center, randomized, double-blind, single-simulated, Naoshuantong capsule-controlled clinical trial, which lasted from 28 December, 2016 to 12 April, 2019. After being randomized into an experimental group and a control group at a ratio of 3∶1, patients in the experimental group were provided with oral Tiandan Tongluo capsule, five capsules per time, three times per day, whereas those in the control group received both Naoshuantong capsule simulator, two capsules per time, three times per day, and Naoshuantong capsule, three capsules per time, three times per day, for 12 successive weeks. The patients were followed up until 180 days after onset. The Barthel activities of daily living (ADL) index (BI) score was used as the primary outcome, and the secondary outcomes included neurological deficit score [assessed with National Institutes of Health Stroke Scale (NIHSS)], modified Rankin scale (mRS), TCM syndrome score, and proportion of patients with new vascular events. The changes in laboratory indexes and the incidence of adverse reactions during treatment were observed. Result:Among the 389 cases enrolled, 30 dropped out, with the drop-out rate being 7.71%. There were 374 cases included in the full analysis set and 377 in the safety set. The comparison with the control group revealed that the total BI score and the percentage of BI score ≥ 75 in the experimental group were increased, but the difference was not statistically significant. The percentage of mRS score ≤ 2 within 180 days after onset in the experimental group obviously elevated in contrast to that of the control group (<italic>P</italic><0.05). As demonstrated by TCM syndrome score analysis, the markedly effective rate in the experimental group was significantly higher than that in the control group (<italic>P</italic><0.05). During the trial, the incidence rates of new vascular events in the experimental group and the control group were 0.00% and 1.09% (one case), respectively, exhibiting no statistically significant difference between the two groups. Conclusion:Tiandan Tongluo capsule and Naoshuantong capsule both produce definite therapeutic effects in the treatment of CI in convalescence (stoke involving meridians and collaterals due to wind-phlegm-static blood obstructing vessels). Compared with Naoshuantong capsule, Tiandan Tongluo capsule better alleviates neurological deficit, promotes neural functional recovery, and improves TCM syndrome score, without inducing severe adverse reactions.
RESUMO
Objective] To observe the use of large-connecting-meridians therapy(agitate blood) for the treatment of two cases of Guillain-Barre syndrome for clinical efficacy. [Method] Two cases of Guillain-Barre syndrome differentiation apply the principlesfrom yin to yang,from yang to yin,according to the meridians order, sequentially taking acupuncture, once daily treatment, continuous treatment for 5 days, rest for two days, surrounded by a continuous course of treatment, continuous treatment of four cycles. [Results] After stomach deficiency syndrome type of patients treated, appetite and sprint of improvement,the muscle gradually was full, muscle strength increased significantly, while blood cells and cerebrospinal fluid protein level were restored to normal range;After stagnation context type of patient treated,numbness feeling relieved a little, numbness narrowed, cerebrospinal fluid protein level was reduced to normal level;two cases of Guillain-Barre syndrome after treatment achieved better results.[Conclusion]Large-connecting-meridians method can be applied not only to stroke, used in Guillain-Barre syndrome can also get good results.
RESUMO
Objective To observe the effect of digital acupressure plus mechanical sputum expectoration on the rehabilitation of patients with stroke-associated pneumonia. Method Forty-six patients with stroke-associated pneumonia were randomized into a treatment group of 22 cases and a control group of 24 cases. The treatment group was intervened by digital acupressure plus mechanical sputum expectoration, while the control group was by mechanical sputum expectoration alone. The simplified version of Clinical Pulmonary Infection Score (CPIS), Fugl-Meyer assessment scale, and modified Barthel Index (BI) were adopted for evaluation before and after intervention. Result After treatment, CPIS, Fugl-Meyer and BI scores were changed significantly in both groups (P<0.01). There were significant differences in comparing the CPIS, Fugl-Meyer and BI scores between the two groups after intervention (P<0.05). After intervention, the two groups showed a negative correlation between CPIS score and Fugl-Meyer score, as well as between CPIS score and BI score. Conclusion Digital acupressure plus mechanical sputum expectoration can effectively improve the pulmonary symptoms in patients with stroke-associated pneumonia, benefiting the rehabilitation of the post-stroke patients.
RESUMO
Objective To investigate the effects of prescription of nourishing blood and stretching of stoke (PNBSS) on the levels of TXB2 and 6-Keto-PGF1αin serum of patients with acute ischemic cerebrovascular disease (AICD);To discuss its action mechanism in AICD treatment. Methods Ninety patients with AICD were randomly divided into trial group and control group, 45 cases in each group. The control group received western routine treatment, while the trail group received the western routine treatment plus PNBSS, one dose per day, for one week. Rating scale of neurologic deficit was employed to evaluate treatment effectiveness. Venous blood was collected before the treatment and on the 3rd and 7th days of treatment. Levels of TXB2 and 6-Keto-PGF1αin serum were detected respectively. Results The score of neurologic deficit of post-treatment in two groups apparently decreased compared with baseline (P<0.01), and score of neurologic deficit in trial group on 7th day was lower than that of control group (P<0.05). The total effective rate in trial group was 93.3%, which was apparently higher than that of control group (84.4%). The level of TXB2 in serum and ratio of TXB2/6-Keto-PGF1α (T/P) in two groups on 3rd and 7th days remarkably decreased compared with baseline (P<0.01), while the level of 6-Keto-PGF1α in two groups on 3rd and 7th days was higher than that of baseline (P<0.01). Meanwhile, the level of TXB2 and ratio of T/P in two groups on 7th day were apparently lower than that of 3rd day (P<0.01), and the level of 6-Keto-PGF1αon 7th day was higher than that of 3rd day (P<0.01). The level of TXB2 in serum and ratio of T/P on 3rd and 7th days in trial group were apparently lower than that of control group (P<0.01, P<0.05), while the level of 6-Keto-PGF1α on 3rd and 7th days in trial group was apparently higher than that of control group (P<0.01, P<0.05). Conclusion One of the mechanisms of PNBSS for AICD appears to inhibit overavtivity of thrombocyte, and regulate the misadjustment of ratio of T/P.
RESUMO
Objective To explore the association of post stroke depression (PSD) with the scale of stroke deficit and serum brain-derived neurotrophic factor levels in the elderly.Methods A total of 150 elderly stroke patients from the department of neurology of our hospital were recruited from August 2010 to September 2013.Patients were assessed by the Hamilton depression rating scale (HAMD),the National Institutes of Health Stroke Scale (NIHSS),and the Activitics of Daily Living Scale (ADL).In addition,serum BDNF levels were determined by ELISA.Results 42.0% of the 150 elderly patients suffered depression after stroke (63/150).There were significant differences in neurological function impairment and ADL scores between the PSD group and the non-PSD group [(14.72±4.06) vs.(5.51±1.93) and (40.63±17.06) vs.(79.66±29.31),t=18.49 and 9.47,respectively,P<0.0001 for both].HAMD and NIHSS scores showed positive correlations with the degreeof depression (r=0.998 and 0.962,P=0.0012 and 0.0375,respectively).ADL scores and serum BDNF levels decreased as the degree of depression increased,and were negatively correlated with the degree of depression (r=-0.985 and-0.995,P=0.0149 and 0.0049,respectively).Conclusions The degree of post-stoke depression is positively correlated with the scale of neurological dysfunction and negatively correlated with the activities of daily living scale and serum BDNF levels in the elderly.The primary disease should be properly treated,and improvement in brain metabolism and micro circulation should be attempted to alleviate neurological dysfunction.In addition,rehabilitation therapy should be performed early in elderly stroke patients in order to improve physical activity and self-care ability,thus reducing the degree of disability and depression.
RESUMO
Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10% from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10% was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0%.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)% vs.(17 ±7)%, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.
RESUMO
Objective To explore the effect of community comprehensive intervention on stroke-prevention-related knowledge, belief and behavior of hypertensive patients. Methods The community-based comprehensive interventions were done to 77 hypertensive patients, with the measures including archives establishment, hypertension-phased management, regular follow-up and multi-mode health education. The stroke-prevention-related knowledge, belief and behavior of them were assessed by the stroke-preventing knowledge questionnaire (SPKQ), champion′s health belief model scale (CHBMS) and (stroke-prevention behavior questionnaire,SPBQ) before and after the intervention. Results Their knowledge on daily-life and pre-stroke symptoms and part of their behaviors (health duty, physical exercises and stress management after the intervention were superior, as compared to the pre-intervention (P0.05). Conclusion The community-based intervention can improve parts of stroke prevention knowledge and health behavior among hypertensive patients. The intervention needs to be modified based on ecological models of health promotion and health belief model.
RESUMO
Objective To investigate the incidence and pathogenic spectrum of nosocomial infections in stroke patients in Chinese medicine hospital during convalescence ,and to provide references for clinical treatment and infection control .Methods The retro‐spective study was performed on 827 stoke patients in the hospital from January 2013 to May 2015 .The cultivation and identifica‐tion of pathogenic bacteria were carried out according to the clinical laboratory operating procedures .The result of drug susceptibili‐ty test were interpreted by CLSI 2013 .Results The incidence rate of the nosocomial infection was about 14 .39% .The most com‐mon infection site is lower respiratory tract ,followed by urinary tract infection .The bacterial strain separation rate are as follows :Escherichia coli(23 .3% ) ,Pseudomonas aeruginosa(17 .3% ) ,baumanii(14 .3% ) ,Klebsiella pneumoniae(11 .3% ) ,Staphylococcus aureus(10 .5% ) .The resistance rate of Gram‐Negative bacillus to aminoglycoside antibiotics is relatively low .Conclusion Treat‐ment and rehabilitation in a stoke unit with characteristic features in traditional Chinese medical hospital plays an important role in suppressing and delaying the occurrences of nosocomial infection and bacterial resistance .However ,we must raise the awareness of hospital infection management .Moreover ,strengthening the management of antibiotics use and paying attention to the pathogenic bacteria distribution and drug‐resistant bacterial detection ,are of great significance for the hospital infection control .
RESUMO
Because the rehabilitation process is too long and its effect is non-significant, stroke patients are prone to showing over-reli-ance on their families, being unconfident in their abilities, and they usually miscommunicate with medical staff, in fact, the reason why they have these problems is that they didn't manifest appropriate ego states, so they couldn't communicate with families and medical staff healthi-ly, which is extremely unfavorable for stroke rehabilitation. So-called ego state is individual mentality and corresponding behavior patterns. This paper used ego state concept in transactional analysis theory to describe the change of stroke patients' ego states, and analyze the com-munication patterns among patients, medical staffs and families, in order to assist patients to be aware of their own ego states, and present them properly, develop healthy communication, and promote the rehabilitation of the disease in the end.
RESUMO
@#Because the rehabilitation process is too long and its effect is non-significant, stroke patients are prone to showing over-reliance on their families, being unconfident in their abilities, and they usually miscommunicate with medical staff, in fact, the reason why they have these problems is that they didn't manifest appropriate ego states, so they couldn't communicate with families and medical staff healthily,which is extremely unfavorable for stroke rehabilitation. So-called ego state is individual mentality and corresponding behavior patterns.This paper used ego state concept in transactional analysis theory to describe the change of stroke patients' ego states, and analyze the communication patterns among patients, medical staffs and families, in order to assist patients to be aware of their own ego states, and present them properly, develop healthy communication, and promote the rehabilitation of the disease in the end.
RESUMO
ObjectiveTo observe the effect of the nine points for hemiplegia plus MOTOmed exercise training system on the lower-extremity function of the patients with post-stroke hemiplegia.MethodForty-five patients with post-stroke hemiplegia were randomized into 3 groups, 15 each.Group A was intervened by regular acupuncture treatment, group B was by the MOTOmed training system, and group C was by the nine points for hemiplegia during the exercise training by the MOTOmed system in addition to the regular acupuncture treatment. The National Institute of Health Stroke Scale (NIHSS) and Fugl-Meyer (FMA) scale were adopted for evaluation and comparison before intervention and after 4-week intervention.ResultBefore intervention, there were no significant differences in comparing the function of lower extremity among the three groups (P>0.05);after 4-week intervention, the observation indexes were improved in the three groups, and the improvement in group C was the most significant (P<0.05), and it was significantly different from that of group A and B at the corresponding time point (P<0.05). ConclusionThe nine points for hemiplegia plus MOTOmed exercise training can effectively improve the lower-extremity function in the patients with post-stroke hemiplegia.
RESUMO
Objective To compare the effects of 3 kinds of gait training methods on stroke patients. Methods 60 patients were divided into 3 groups, and received routine gait training, assistance and partial body weight supported treadmill training (PBWSTT) respectively. They were assessed with 10-meter Maximum Walking Speed (MWS), Timed Up and Go Test (TUGT), Functional Independence Measure (FIM) and Fugl-Meyer Assessment (FMA) before, 1 and 3 months after training. Results MWS, TUGT, FIM and FMA all improved in 3 groups, ranked as assistance group, routine gait training group, and PBWSTT group after training. The PBWSTT group improved the best. Conclusion PBWSTT is more effective on walking after stroke.
RESUMO
There are many co-morbid conditions that are associated with obstructive sleep apnea (OSA). Though a causative relationship between OSA and some of the co-morbidities is well established or strongly associated, many risk factors of OSA (age, male gender and obesity) are also known risk factors especially for cardiovascular diseases. Other important co-morbid conditions associated with OSA are neurocognitive dysfunction and, erectile dysfunction. Recently there are reports that ocular manifestations are associated with OSA. It is expected that more co-morbidities will be reported in OSA as the research in this area progresses.
RESUMO
Objective To observe the clinical effects of ambroxol on acute stroke-associated pneumonia (SAP).Methods From July 2011 to December 2012,a total of 82 patients with strokeassociated pneumonia (SAP) admitted to our hospital were selected and randomly divided into ambroxol group (n=43,treated with ambroxol in combination with antibiotic therapy) and control group (n =39,treated with antibiotic therapy).The defervescence time,hospitalization time,antibiotic use time,C-reactive protein level,blood oxygen partial pressure,bacterial clearance rate and the total effective rate were compared between the two groups.Results The defervescence time,hospitalization time,antibiotic use time were shorter in ambroxol group than in control group [(3.1 ± 0.8)d vs.(3.8±1.1)d,(11.7±3.7)d vs.(13.6±4.9)d,(5.4±1.7)dvs.(6.6±2.1)d,t=18.60,22.80,23.50,P=0.014,0.008,0.011,repectively].Bacterial clearance rate and the total effective rate were higher in ambroxol group than in control group [90.7% vs.74.4%,93.0% vs.74.4%,x2 =3.86,5.34,P=0.05,0.02].There were no significant differences in changes of C-reactive protein level and blood oxygen partial pressure between two groups before and after treatment (all P>0.05).Conclusions Ambroxol is an effective treatment for acute stroke associated pneumonia,which can shorten antibiotic use time and duration of symptoms and remove bacteria effectively.
RESUMO
Objective To observe the value of procalcitonin (PCT ) in the diagnosis ,treatment and prognosis judgement of stoke-associated pneumonia(SAP) .Methods The serum procalcitonin ,hs-CRP and clinical pulmonary infection scores (CPSI) of two groups were detected :SAP group(including 27 patients of stoke-associated pneumonia) and control group(including 31 healthy ob-jects) .Results The CPSI ,hs-CRP and serum concentration of PCT in SAP group were significantly higher than control group (P<0 .01) ,and decreased significantly when get better after treatment .The serum concentration of PCT in SAP group was significantly higher than control group(P<0 .01) .In SAP group ,the serum concentration of PTC was positively associated with CPSI scorers . Moreover ,the results of ROC analysis showed that the cut-off of serum procalcitonin for the diagnosis of SAP was 0 .9 ng/mL .The sensitivety was 88 .6% and the specifity was 79 .3% ,which was superior to hs-CRP .Conclusion The serum concentration of PCT in SAP patients is higher and it is associated with the prognosis .It might be a better clinical marker for the diagnosis and prognosis of SAP .
RESUMO
Resistin is a recently discovered polypeptide hormone.Studies have shown that resistin is closely associated with atherosclerosis by promoting inflammatory response and adhesion of vascular endothelial cells,transformation from macrophages to foam cells,vascular smooth muscle cell proliferation and migration,increasing plaque instability,as well as promoting carbohydrate and lipid metabolism disorders,etc.Resistin can promote the occurrence and development of ischemic cerebrovascular disease.It may become a potential biological marker and intervention target.
RESUMO
@#ObjectiveTo explore the effect of cluster needling of scalp acupuncture combined with rehabilitation(Tang's Approach) on the spasticity after stroke.Methods39 stroke patients with spasm were divided into observation group and control group. The observation group received anti-spasm acupuncture combined with rehabilitation therapy, while the control group received baclofen combined with rehabilitation therapy. Spasm and activities of daily living(ADL) and therapeutical effect were assessed with the Modified Ashworth Scale and Barthel Index.ResultsThere was no significant difference between the two groups (P>0.05). ConclusionTang's Approach has the same effect as baclofen to improve the spasm after stroke without serious side-effect.
RESUMO
OBJECTIVE: To evaluate the reorganization of descending motor pathways of trunk muscles in stroke patients. METHOD: Nine patients with unilateral hemispheric stroke were enrolled. Their mean age was 56 years. Transcranial magnetic stimulation (TMS) was applied to unaffected and affected motor cortices in turn and bilateral electromyographic recordings were made from rectus abdominis, external oblique abdominal, and 4 th and 9 th thoracic erector spinae muscles during resting. The onset latency and peak-to-peak amplitude of motor evoked potential (MEP) were measured for each muscle on both sides. RESULTS: Stimulation of the unaffected hemisphere evoked contralateral responses in all patients. Ipsilateral responses were more common in TMS of affected hemisphere. Ipsilateral but not contralateral MEPs were obtained in TMS of affected hemisphere. CONCLUSION: These results demonstrated that the variable availability of bilateral crossed and uncrossed corticomotorneuronal projections among patients could be related with the inconstant occurrence of trunk weakness after unilateral hemispheric stroke.
Assuntos
Humanos , Vias Eferentes , Potencial Evocado Motor , Músculos , Reto do Abdome , Acidente Vascular Cerebral , Estimulação Magnética TranscranianaRESUMO
@#ObjectiveTo observe effects of early rehabilitation and hyperbaric oxygen treatments on stroke patients.Methods80 patients were randomly divided into rehabilitation group (40 cases) and control group (40 cases). Patients in rehabilitation group were treated with rehabilitation and hyperbaric oxygen treatments; patients in control group were treated only with hyperbaric oxygen treatment. The activities of daily living (ADL) were assessed by modified Barthel index (MBI), and the cognition function was measured by mimi-mental state examination (MMSE).ResultsAfter treatment the scores of MMSE and MBI of two groups increased (P<0.05) and scores of rehabilitation group were higher than that of control group (P<0.05); the process of scores in rehabibilitation group were obviously superior to that in control group (P<0.001).ConclusionEarly rehabilitation and hyperbaric oxygen treatments can obviously improve cognition function and ADL of stroke patients.