ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
Stroke has a high disability rate, with patients often experiencing varying degrees of motor function impairment. Some patients also have concurrent cardiovascular diseases, leading to varying degrees of cardiopulmonary dysfunction. Formulating exercise prescriptions tailored to stroke patients, selecting appropriate assessment methods, and determining suitable exercise intensity are significant clinical concerns. However, there is a lack of definitive conclusions on how to formulate precise exercise prescriptions based on the assessment of cardiopulmonary and motor functions. This paper reviews the determination of post-stroke exercise loads and current research on stroke and cardiopulmonary fitness, aiming to provide a basis for the precise formulation of exercise prescriptions for stroke patients.
Objective To learn if appropriate methods and clinically relevant outcomes were used by analyzing methods of outcome assessment in Chinese acute stroke trials. Method Randomised and quasi-randomised controlled trials on acute stroke published before March 2003 in 6 Chinese neurological journals were included. Types of outcome measures, blinding of outcome assessment, duration of follow up, statistical methods used for data analysis and the significance of the results were evaluated. Types of outcomes were classified as death and four levels: ① Pathology. ② Impairment. ③ Disability. ④ Handicap/quality of life. Results Two hundreds and ten trials were included in this analysis. 57% of the trials used outcomes in pathology level, 77% in impairment level, 12% in disability level and none in the quality of life level. No dichotomous data was analyzed for disability measures. Only 16% of the trials reported number of death but few of them designed death as an outcome measure. Duration of follow up ranged from 3h to 3 years (median 17 d, interquartile range 14-30 d). Most trials did not assess outcomes blindly. Results in 95% of the trials were favorable to the tested interventions. Conclusions In Chinese acute stroke trials, outcome measures used were mainly in pathology and impairment levels and very few trials used functional outcome or death. Blinding of outcome assessment was not commonly used. The average duration of follow up was short.
Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength, functional walking ability and dynamic balance in post-stroke patients. Methods PubMed, Ovid Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in post-stroke patients. The retrieval time was from inception to October, 2022. Endnote X9 software was used to manage the literature. Cochrane Manual 5.1.0 was used for quality assessment, and RevMan 5.4 software was used for meta-analysis. Results A total of 20 randomized controlled trials were included in the study, with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention, with a total of 1448 study subjects. Meta-analysis results showed that the differences in knee flexion peak torque [mean difference (MD)=5.85 N·m, 95% confidence interval (CI) (4.84, 6.85) N·m, P<0.00001], knee extension peak torque [MD=9.09 N·m, 95%CI (4.83, 13.36) N·m, P<0.0001], Time Up Go test [MD=–4.70 s, 95%CI (–6.68, –2.72) s, P<0.00001], 10-meter walking test [MD=–4.71 s, 95%CI (–9.12, –0.31) s, P=0.04], Fugl-Meyer Lower Extremity Motor Function Assessment score [MD=6.61, 95%CI (3.52, 9.70), P<0.0001], and Berg Balance Scale score [MD=5.61, 95%CI (0.91, 10.31), P=0.02] were statistically significant. Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients, but there is still no strong evidence of improvement in motor function and balance.
ObjectiveTo explore the differences of rehabilitation clinical characteristics between youth stroke patients and middle and old age stroke patients, to provide references for secondary prevention and personalized rehabilitation treatment for youth stroke.MethodsFrom May 2016 to October 2019, stroke inpatient in the Department of Rehabilitation Medicine of Huashan Hospital of Fudan University were included. Patients were divided into youth group and middle and old age group according to their age. The clinical characteristics of the two groups during the rehabilitation period were analyzed.ResultsA total of 271 patients were included, including 70 in the youth group and 201 in the middle and old age group. The proportion of patients with hypertension (85.07% vs. 71.43%), diabetes (34.83% vs. 17.14%) and infection (20.90% vs. 8.57%) in the middle and old age group were higher than those in the youth group (P<0.05). The proportion of patients with hemorrhagic stroke (71.43% vs. 32.84%), history of stroke surgery (54.29% vs. 13.43%), epilepsy secondary to stroke (31.43% vs. 4.48%) and overweight/obesity (57.14% vs. 42.79%) in the youth group were higher than those in the middle and old age group (P<0.05). There was no significant difference in the proportion of gender, cognitive impairment, and thinness between the two groups (P>0.05). Among patients whose disease course was within 1 month at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05). The scores of Berg Balance Scale (Z=−2.493, P=0.013) and Barthel Index (Z=−2.527, P=0.012) in the youth group were higher than those in the middle and old age group. Among patients whose disease course was between 1 month and 3 months at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs and Barthel Index between the two groups (P>0.05). The scores of Berg Balance Scale in the youth group were higher than those in the middle and old age group (Z=−2.004, P=0.045). Among patients whose disease course was more than 3 months at the time of admission, there was no significant difference in the scores of Berg Balance Scale, Barthel Index, and Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05).ConclusionsFor youth stroke patients, weight control is very important, and it is necessary to pay close attention to whether there are seizures. In the case of patients with stable vital signs in the early stage of the disease, more active rehabilitation treatment can be given.
ObjectiveTo explore the application effect of the new in-hospital blood glucose management model for patients with stroke and diabetes mellitus during the epidemic of coronavirus disease 2019.MethodsA total of 120 patients with stroke and diabetes mellitus who were admitted to Mianyang Central Hospital and were consulted by the Department of Endocrinology between October 1st 2019 and April 12th 2020 were recruited. Patients who used the traditional consultation model for blood glucose management between October 1st 2019 and January 19th 2020 were classified as the control group (60 cases). Patients who were managed by the virtual ward of remote blood glucose management combined with the video consultation mode between January 20th 2020 and April 12th 2020 were classified as the observation group (60 cases). The basic conditions, the time to reach target blood glucose, the completion time of the consultation, the accuracy of blood glucose related data, the satisfaction rate of the consultation, the rate of reaching target blood glucose, the incidence of hypoglycemia, the blood glucose fluctuation (standard deviation of blood glucose level, maximum blood glucose fluctuation range), the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, and average hospitalization expenses of the two groups were compared.ResultsThere was no significant difference in the basic conditions between the two groups of patients (P>0.05). The time to reach target blood glucose [(5.38±2.16) vs. (8.18±2.63) d], completion time ofthe consultation [(4.33±1.51) vs. (17.97±3.23) h], incidence of hypoglycemia (6.67% vs. 21.67%), standard deviation of blood glucose level [(2.16±0.34) vs. (2.52±0.34) mmol/L] and maximum blood glucose fluctuation range [(5.72±1.36) vs. (6.34±1.51) mmol/L] of the observation group were lower than those of the control group, the accuracy rate of blood glucose related data (100.00% vs. 83.33%), satisfaction rate of the consultation (93.33% vs. 73.33%) and rate of reaching target blood glucose (88.33% vs. 70.00%) of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, or average hospitalization expenses between the two groups of patients (P>0.05).ConclusionDuring the epidemic of coronavirus disease 2019, the combined video consultation model of remote blood glucose virtual ward for patients with stroke and diabetes mellitus has a good application effect, which has certain feasibility and clinical promotion value.
ObjectiveTo evaluate the value of stroke volume variation (SVV) and intrathoracic blood volume index (ITBVI) to predict fluid responsiveness in mechanically ventilated septic shock patients with spontaneous breathing. MethodsA prospective observational study was conducted in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University. Fluid resuscitation data was collected in septic shock patients who received PiCCO monitoring from June 2013 to June 2014. Transpulmonary thermodilution data were collected before and after fluid resuscitation, including cardiac index (CI), SVV, ITBVI, and central venous pressure (CVP). Seventeen patients were defined as responders by an observed increase of≥15% in the cardiac index (CI) after fluid resuscitation, 12 patients were defined as non-responders. Pearson correlation between changes of CI (ΔCI) and SVV, ITBVI, CVP was established. Area under the receiver operating characteristic (ROC) curve of SVV, ITBVI and CVP was calculated for predicting fluid responsiveness. ResultsBaseline CI and ITBVI were significantly lower in the responders (P < 0.05).There was no significant difference in baseline SVV between the responders and the non-responders (P > 0.05). A significant correlation was found between baseline ITBVI andΔCI (r=-0.593, P < 0.001), but no significant correlation between SVV andΔCI (r=0.037, P=0.847) or CVP andΔCI (r=0.198, P=0.302). The area under ROC curve of SVV, ITBVI and SVV for predicting fluid responsiveness was 0.640 (P=0.207), 0.865 (P=0.001), and 0.463 (P=0.565), respectively. The cut-off value of ITBVI for predicting fluid responsiveness was 784 mL/m2 with a sensitivity of 100.0% and a specificity of 70.6%. ConclusionIn mechanically ventilated septic shock patients with spontaneous breathing, ITBVI may be a valuable indicator in predicting fluid responsiveness compared with SVV.
Stroke is a severe disease with high incidence, high recurrence, high disability, and high mortality rates. China has the highest prevalence of stroke in the world, where it is a leading cause of death and disability for adults. There is a struggling way to prevent and control stroke to reduce the disease burden. This review summarizes the temporal trends and characteristics of stroke in China, with an aim to provide baseline reference for stroke prevention and treatment in China. There was an increase in the incidence and prevalence of stroke in China in the past 15 years. The incidence, prevalence, mortality, and disability-adjusted life years of stroke in China were higher than those in developed countries such as the United Kingdom, the United States, and Japan. High-quality studies and standardized diagnosis and treatment are needed to overcome challenges in stroke prevention and treatment in China.
Objective To study the application effect of Snyder hope theory combined with Satir model in the rehabilitation therapy of young and middle-aged patients with stroke. Methods A total of 224 young and middle-aged patients with stroke admitted to Zhongshan Hospital of Fudan University between August 2018 and August 2020 were divided into four groups (control group, Satir group, Snyder group, and combined group) according to the random number table method by taking admission time as sequence. All patients were given rehabilitation training on the basis of conventional treatment, and the Satir group was given group guidance of Satir model, the Snyder group was given hope therapy based on Snyder hope theory, and the combined group was given intervention combined Snyder hope theory with Satir model. All patients were continuously treated for six weeks. The scores of Herth Hope Index (HHI), Self-perceived Burden Scale (SPBS), exercise rehabilitation willingness questionnaire, Health Promoting Lifestyle Profile Ⅱ (HPLP Ⅱ), and Simplified Coping Style Questionnaire (SCSQ) were compared among the four groups before and after intervention. Results There were 53, 52, 54, and 52 patients enrolled in the control group, the Satir group, the Snyder group, and the combined group, respectively. The differences among the four groups in basic information such as sex, age, and type of stroke and the scores of the above scales before intervention were not statistically significant (P>0.05). After intervention, the total scores of HHI scale (27.65±6.34, 30.54±6.85, 32.79±7.12, 35.08±7.63), scores of exercise rehabilitation willingness (39.85±8.16, 40.52±7.93, 40.17±8.25, 43.81±7.46), total scores of HPLP Ⅱ scale (149.87±26.08, 159.32±26.73, 165.89±28.01, 173.18±28.54), and scores of positive coping style of SCSQ scale (19.65±5.08, 22.46±5.29, 25.04±4.91, 28.45±5.12) of the four groups significantly increased compared with those before intervention (P<0.05), while the total scores of SPBS scale (27.35±4.92, 23.74±5.02, 25.16±4.98, 21.49±5.27) and scores of negative coping style of SCSQ scale (4.83±1.25, 3.71±1.02, 3.94±1.08, 4.13±0.96) significantly decreased compared with those before intervention (P<0.05); the scores of HHI scale, exercise rehabilitation willingness, HPLP Ⅱ scale, and positive coping style of SCSQ scale of the combined group were higher than those of the other three groups (P<0.05), while the score of SPBS scale was lower than that of the other three groups (P<0.05). Conclusions Snyder hope theory combined with Satir model for rehabilitation therapy of young and middle-aged patients with stroke can help to improve the hope level, reduce the self-perceived burden, and improve the exercise rehabilitation willingness, health behaviors and coping styles. In addition, it is of great significance for promoting the rehabilitation of patients.