目的 探索缺血性脑卒中患者溶栓前血压管理和预后的相关性，并分析溶栓前血压管理考虑颅内外血管状态的必要性。 方法 计算机检索PUBMED数据库，并辅以其他检索，对所有涉及溶栓前血压的文献进行整理，并根据“溶栓类型、是否进行溶栓前血压管理、是否进行溶栓前血管评估”对文献进行分类，对其溶栓后的症状性颅内出血率进行分析对比。 结果 大多数静脉溶栓文献无血管评估的数据，其出血率波动于较高水平；进行了血管评估，而未提及血压管理或虽未进行血压管理，但所有患者的血压符合指南中对于血压的要求的文献也呈现了较高的出血率；有1篇进行了血管评估的动脉溶栓文献没有症状性颅内出血事件发生。 结论 当前证据表明现有的溶栓前血压管理模式还不够完善，这也在一定程度上可以解释目前较高的溶栓后症状性出血率。合理的溶栓前血压管理模式有待进一步探索。溶栓前血压管理考虑颅内外血管状态，根据血管病变程度对溶栓前血压进行分级管理可能会成为一个较佳的血压管理模式。
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
A stroke unit means organized inpatient stroke care. The available evidence shows that stroke unit is the most effective treatmeat in stroke care. The definition, classification and the essential components of stroke unit have been explained in this article to help better understanding on it.
Objective To provide references to control the cost of stroke inpatients by analysing pertinent factors of stroke inpatients. Methods According to the models of Anderson and Newnan, univariable analysis and multivariable statistical analysis were applied to a number of factors including predisposing factors, enabling factors, and needs factors in 1 969 stroke inpatients of two third level first-class hospitals in Chongqing. Results Among the 1 969 stroke inpatients, 64% had a history of hypertension, and 50% exhibited hypertension during their stay in hospital. Expenditure on medication consumed the highest costs (51%). Length of stay was the most important factor affecting inpatient expense, additional factors were number of surgical operation, nurse type, Rankin score, number of complications etc. Conclusions Complex measures focusing on hypertension to prevent and control of stroke are recommended. Reducing unnecessary stay in hospital and appropriate prescribing are important methods to reduce cost of stroke inpatients.
Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of abdominal apoplexy, arousing clinic doctors’ attention to this disease. Methods Two hundred and thirty-two domestic cases with abdominal apoplexy were analyzed retrospectively and related literatures in and abroad were reviewed. Results Abdominal apoplexy occured mainly patients aged 45 to 70 years in China and 50 to 59 years abroad. It was more common in women than in men, and male to female ratio was 1 to 1.4 in China and 1 to 2.5 abroad. There were various etiological factors to this disease. It was usually abrupt, with complicated clinical manifestation. The main symptoms were abdominal pain and hemorrhagic shock with nauseat, vomiting and diarrhea. Preoperative diagnosis rate of abdominal apoplexy was very low, literatures showed only 1.7% in China and 2.3% abroad. There was no particular evaluation approach. Abdominal cavity puncture, combined with CT, ultrasound, MRI and selective abdominal angiography helped to raise diagnosis rate. Overall postoperative mortality was 7.3%. In 7.8% cases, no bleeding site could be found during laparotomy, and the mortality rate was 41.2%. Conclusion Abdominal apoplexy is rarely seen in clinic with low preoperative diagnosis rate and poor prognosis. The first choice management is exploratory laparotomy, and the key is to ligate ruptured vessels.
In China, there are more than 2 million new strokes annually, and the disability-adjusted life-years due to stroke were higher than any other disease. With aging of the population, inadequate control of vascular risk factors such as hypertension, and uneven distribution of specialized stroke care, the burden of stroke will continue to increase. Despite improved health care quality in China, the availability of specialized stroke care varies across the country, especially in rural areas. Stroke prevention, management and research face unique and severe challenges due to rough terrain and economic underdevelopment in Southwest China. In the future, efforts should be made to provide more balanced availability of specialized stroke care services across China, promote generalization of evidence-based practice, and carry out more high-quality research to improve outcomes of stroke patients, with special attention to the rural population and Southwest China.