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La enfermedad vascular cerebral (EVC) es una patología caracterizada por un déficit neurológico súbito, secundario a oclusión o ruptura de un vaso sanguíneo cerebral; se divide en isquémica o infarto cerebral (IC) y hemorrágica. La EVC es reconocida como la primera causa de discapacidad y la quinta causa de muerte en México, registrándose cerca de 170 mil casos nuevos al año. Existe amplia evidencia que demuestra una reducción en los desenlaces negativos, como muerte y discapacidad, al realizar intervenciones rápidas, incluyendo la administración de trombolisis intravenosa con rt-PA (activador tisular de plasminógeno recombinante) y trombectomía mecánica. La coordinación multidisciplinaria del equipo de salud y los cuidados efectivos de enfermería, son vitales durante todas las etapas de atención de la EVC. Esta revisión da a conocer un panorama general del manejo del infarto cerebral e identificar las intervenciones indispensables del profesional de enfermería realiza durante las etapas prehospitalarias, pretrombolisis, durante trombolisis y postrombolisis.
Cerebralvascular disease (CVD) is a pathology characterized by a sudden neurological deficit secondary to occlusion or rupture of a cerebral blood vessel; it is divided into ischemic or cerebral infarction (CI) and hemorrhagic. CVD is recognized as the first cause of disability and the fifth cause of death in Mexico, with nearly 170,000 new cases registered each year. There is ample evidence that shows a reduction in negative outcomes, such as death and disability, with rapid interventions, including the administration of intravenous thrombolysis with rt-PA (recombinant tissue plasminogen activator) and mechanical thrombectomy. Multidisciplinary coordination of the health care team and effective nursing care are vital during all stages of CVD care. This review provides an overview of the management of cerebral infarction and identifies essential nursing interventions during the prehospital, prethrombolysis, during thrombolysis, and postthrombolysis stages.
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Humans , Male , Female , Nursing , Thrombolytic Therapy , Cerebral Infarction , StrokeABSTRACT
Ischemic cerebrovascular disease (ICVD) is the most common type of nervous system disease in clinical practice in China at present. It is the important leading cause of death after heart disease and tumors. Ischemic cerebrovascular disease has a high rate of occurrence and mortality. It is easy to cause problems such as limb dysfunction, language disorders, nerve dysfunction, etc. It has a great negative effect on the quality of life of patients, and seriously affects the quality of their lives. Although the current research on the treatment of the disease has achieved certain results, single therapies can only treat some key parts of the disease and cannot completely reverse the whole process. At present, thrombolysis, antiplatelet aggregation, degradation of plasma fibrin, anticoagulation, and hemodilution are mainly used in clinical treatment. It is critical to select appropriate treatment methods based on the pathological characteristics of patients to improve efficacy and prognosis. In this review, the research progress in therapies for ischemic cerebrovascular disease was reviewed, both at home and abroad.
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Abstract: Cerebral venous thrombosis (TVC) is a potentially devastating state that occurs in young adults, especially women. Less frequent subtype of cerebral vascular disease (EVC), represented only 0.5% in EVC patients. Headache is the most common symptom common. It requires an accurate diagnosis since the pathophysiology and treatment differ from the arterial EVC. The understanding of the risk factors is the key to the prognosis of the TVC. Objective: To determine the prevalence, the main clinical, radiological findings and prognosis of TVC in Neurological Intensive Care Unit. Material and methods: Retrospective, longitudinal and analytical study of an observational nature. All patients admitted to the Neurological Intensive Care Unit of the National Institute of Neurology and Neurosurgery (INNN) with the diagnosis of TVC from January 2010 to July 2019 confirmed by venous phase computed tomography (vein CT) and/or vein were considered MRI (vein MRI), which will have clinical information and cabinet studies, as well as, the evolution, treatment and prognosis at hospital discharge. Results: Of a total of 14 patients, with an average age of 33 years of age. Of which 85.72% (n = 12) were women and 14.28 (n = 2) were men. Headache occurred 50% of cases. The main predisposing cause for TVC was the use of oral contraceptives in 6 patients (42.85%) and puerperium in three patients (21.42%). The delay in diagnosis was an average of 48 hours. The imaging method used for diagnosis in 64.28% of those with computed tomography in venous phase and in 37.71% with vein magnetic resonance. The upper longitudinal sinus was the most affected in 50% of cases. The average stay in the Intensive Care Unit (ICU) was seven days, where 100% of patients received anticoagulation. Three patients (21.4%) developed intracranial hypertension who underwent decompressive craniectomy between the second and fifth day of stay. The days of mechanical ventilation on average were seven days. With an average hospital stay of 20 days. Mortality at hospital discharge was 21.42%. Conclusions: TVC is less frequent than ischemic stroke or intracerebral hemorrhage. The spectrum of the clinic is broad, with pivotal headache. The confirmation of the diagnosis must be performed with CT vein and/or RM vein. The therapeutic intervention within the acute phase is aimed at the recanalization of the thrombosed sinus or sinuses and the prevention of complications; anticoagulation with low molecular weight heparin is the first-line treatment, which has shown an impact on the prognosis of patients. We must keep in mind that thrombolysis and thrombectomy are an option in treatment. In the case of decompressive craniectomy, it is indicated only in cases of malignant venous infarctions. The results after TVC are generally favorable, they also depend on the patient's factors, such as sex and the specific risk factors of women.
Resumo: Trombose venosa cerebral (TVC) é um estado potencialmente devastador que ocorre em adultos jovens, especialmente mulheres. Subtipo menos frequente do acidente vascular cerebral (AVC), representou apenas 0.5% nos pacientes com AVC. Cefaléia é o sintoma mais comum. Exige um diagnóstico preciso, pois a fisiopatologia e o tratamento diferem da AVC arterial, e a compreensão dos fatores de risco é a chave para o prognóstico da TVC. Objetivo: Determinar a prevalência, os principais achados clínicos, radiológicos e prognósticos da TVC na unidade de terapia intensiva neurológica. Material e métodos: Estudo retrospectivo, longitudinal e analítico de natureza observacional. Todos os pacientes admitidos na unidade de terapia intensiva neurológica do Instituto Nacional de Neurologia e Neurocirurgia (INNN) com diagnóstico de TVC de janeiro de 2010 a julho de 2019 confirmados por tomografia computadorizada de fase venosa (Veno-TC) e/ou veno ressonância magnética (veno-RM), que contaram com informações clínicas e estudos de gabinete, bem como a evolução, tratamento e prognóstico na alta hospitalar. Resultados: Do total de 14 pacientes, com idade média de 33 anos. Dos quais 85.72% (n = 12) eram mulheres e 14.28 (n = 2) eram homens. A cefaléia ocorreu em 50% dos casos. A principal causa predisponente para TVC foi o uso de contraceptivos orais em 6 pacientes (42.85%) e puerpério em 3 pacientes (21.42%). O atraso no diagnóstico foi em média de 48 horas. O método de imagem utilizado para o diagnóstico em 64.28% daqueles com tomografia computadorizada na fase venosa e em 37.71% com veno ressonância magnética. O seio sagital superior foi o mais acometido em 50% dos casos. A permanência média na unidade de terapia intensiva (UTI) foi de 7 dias, onde 100% dos pacientes receberam anticoagulação. Três pacientes (21.4%) desenvolveram hipertensão intracraniana submetidos a craniectomia descompressiva entre o segundo e o quinto dia de internação. Os dias de ventilação mecânica foram em média 7 dias. Com internação média de 20 dias. A mortalidade na alta hospitalar foi de 21.42%. Conclusões: A TVC é menos frequente que o AVC isquêmico ou hemorragia intracerebral. O espectro da clínica é amplo, tendo como sintoma principal cefaléia. A confirmação do diagnóstico deve ser realizada com veno TC e/ou veno RM. A intervenção terapêutica na fase aguda visa à recanalização do seio ou seios trombosados e à prevenção de complicações; a anticoagulação com heparina de baixo peso molecular é o tratamento de primeira linha que demonstrou um impacto no prognóstico dos pacientes. Devemos ter em mente que trombólise e trombectomia são uma opção no tratamento. No caso da craniectomia descompressiva, é indicado apenas em casos de infartos venosos malignos. Os resultados após o TVC são geralmente favoráveis, também dependem de fatores do paciente, como sexo e fatores de risco específicos da mulher.
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Resumen: OBJETIVO: Evaluar el índice leuco-glucémico (ILG) como marcador pronóstico de mortalidad y complicaciones en pacientes con enfermedad vascular cerebral de tipo isquémico aterotrombótico. MATERIAL Y MÉTODO: Estudio prospectivo efectuado en pacientes con enfermedad vascular de tipo isquémico aterotrombótico durante la fase aguda del infarto, que ingresaron entre enero y diciembre de 2017 al servicio de Medicina Interna del Hospital General Ticomán. Se recolectaron datos clínicos y de laboratorio, incluyendo glucemia y leucograma al ingreso, a partir de los cuales se calculó el ILG y se evaluó su valor pronóstico, así como su relación con las escalas de NIHSS y Rankin y con la mortalidad a 21 días. RESULTADOS: Se incluyeron 72 pacientes. Los pacientes con mayor número de complicaciones durante la hospitalización tuvieron valores superiores de ILG (p = 0.02). Se obtuvo un valor ≥ 900 como punto de corte; los pacientes con valores superiores tuvieron tres veces mayor probabilidad de complicaciones durante la hospitalización (razón de momios = 3.02; IC95%: 1.03 a 9.9; p = 0.04), por lo que el índice leuco-glucémico constituyó un predictor significativo. CONCLUSIONES: El índice leuco-glucémico se relacionó con mayor severidad de enfermedad vascular cerebral en las escalas de NIHSS y Rankin, además, se asoció con complicaciones intrahospitalarias.
Abstract: BACKGROUND: The glycemia and the determination of serum leukocytes on admission have demonstrated prognostic importance in patients with ischemic cerebral vascular disease (CVD). The leuko-glycemic index (ILG) is recently studied as a prognostic marker, but knowledge about its value is lacking. OBJECTIVE: To evaluate the leuko-glycemic index (ILG) as a prognostic marker of mortality and complications in patients with atherothrombotic ischemic stroke. MATERIAL AND METHOD: A prospective study was conducted on patients with atherothrombotic ischemic vascular disease during the acute phase of the infarction, who were admitted to the Internal Medicine Department of the Ticoman General Hospital from January to December 2017. Clinical and laboratory data were collected, including glycemia and leukogram at admission, from which the ILG was calculated and its prognostic value was evaluated, as well as its relationship with the NIHSS and Rankin scales and/or with the 21-day mortality. RESULTS: There were included 72 patients. Patients with a higher number of complications during hospitalization had higher ILG values (p = 0.02). A value ≥ 900 was obtained as a cut-off point; patients with higher values presented a three times higher probability of complications during hospitalization (odds ratio: 3.02, CI95%: 1.03 to 9.9, p = 0.04), so the ILG was a significant predictor. CONCLUSIONS: Leuko-glycemic index was associated with greater severity of cerebral vascular disease in the NIHSS and Rankin scales, and was associated with intrahospital complications.
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Objective@#To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD).@*Methods@#Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.@*Results@#(1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05).@*Conclusions@#There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance.
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To explore the regularity of traditional Chinese medicine(TCM) prescriptions for cardio-cerebrovascular diseases,the core drug groups with common therapeutic effects on cerebrovascular diseases represented by stroke and cardiovascular diseases represented by coronary artery disease were extracted,and their consistency and difference in the treatment of different diseases were analyzed.A total of 388 Chinese patent medicines were collected for the treatment of cerebrovascular diseases,cardiovascular diseases and cardio-cerebrovascular diseases.The dominant and recessive patterns of Chinese patent medicines in clinical use were found by "frequency analysis","compatibility analysis" and "network analysis" respectively.According to the findings of the three parts,Salviae Miltiorrhizae Radix et Rhizoma,Chuanxiong Rhizoma,Carthami Flos and Astragali Radix have a high frequency of use in the treatment of brain disease,heart disease and both,with frequent combined medication.Data mining confirmed the core drug combinations for the treatment of cerebral and cardiac vascular diseases,so as to reveal the similarities and differences in the drug use of Chinese medicine for these diseases,and provide a basis for the rational use of traditional Chinese medicine in clinical practice.This analysis also defines a new direction for the future development of prescription combinations for different indications of cerebral and cardiac diseases.
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Humans , Cardiovascular Diseases , Drug Therapy , Cerebrovascular Disorders , Drug Therapy , Data Mining , Drugs, Chinese Herbal , Therapeutic Uses , Medicine, Chinese Traditional , PrescriptionsABSTRACT
Objective To explore the correlation and consistency between thromboelastograpby(TEG)and traditional coagulation tests(CCTs)in ischemic cerebral vascular disease(ICVD).Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled.Patients' TEG parameters(R value,K value,Angle value,MA value,CI value and G value)and CCTs parameters(PT,APTT,TT,and FIB)were collected and analyzed retrospectively.The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters,and Kappa(κ)to explore the consistency in determining the coagulation status of the patients.The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs,and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.Results(1)PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value,MA value and G value.TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value.(2)PT and MA values,PT and G values,FIB and MA values,FIB and G values were accordant in valuing the hypoxic state of ICVD patients.(3)PLT and Angle values,PLT and MA values,PLT and CI values,PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values,FIB and MA values,FIB and CI value,and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients.(4)For detecting TT＞20 s,the AUC of K value and Angle value were 0.648,0.651,respectively;For detecting FIB＞4 g/L,the AUC of Angle value and MA value were 0.717 and 0.747,respectively; For detecting PLT＞ 300× 109/L,the AUC of MA value was 0.808(all P＜0.05).Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD Patients.The TEG parameters have good predictive value in evaluating the abnormal results of CCTs,but cannot replace the CCTs.Combination of these two methods can better reflect the coagulation status of patients,so as to afford assistance.
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China is in the "high death zone" of the world cerebrovascular disease (CVD) map. The prevention and treatment of ischemic CVD (ICVD) have become the top priority in clinical practice. It has been demonstrated that acupuncture therapy has a positive role in bettering clinical symptoms of ICVD patients. Findings of recent experimental studies displayed that electroacupuncture (EA) intervention is effective in reducing the cerebral infarcted volume and cellular injury, promoting proliferation, migration and differentiation of nerve stem cells, facilitating the regeneration of nerve tissue, bettering dysneuria and limb locomotor ability, etc. in ICVD rats, which are closely associated with its effects in regulating different intracellular signaling pathways. In the present study, we review the progress of recent experimental studies on the underlying mechanisms of EA in improving ICVD from six major signaling pathways including Notch, mitogen-activated protein kinases (MAPK)/ extracellular signal regulated protein kinases (ERK), phosphatidy linositol-3-kinase (PI 3 K)/ protein kinase B (Akt), Janus kinase-signal transducer and activator of transcription (JAK-STAT), erythropoietin-producing hepatocyte receptor (Eph)/Ephrin, nuclear factor of kappa B (NF-κB) and their compositions, which may provide new therapeutic targets for acupuncture treatment of ICVD. More attention should be paid to the comparison of the efficacy of acupuncture of different acupoint combinations (traditional acupoint formulas) in relieving ICVD.
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Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals.Our study was designed to explore MRI features and site-specific factors of ischemic WMCs.Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed.Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations.Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions.We found that lesion distribution differed significantly across five cerebral areas,with lesions being predominant in the frontal lobe and parieto-occipital area.To explore WMCs risk factors,after adjusting for gender,diabetes mellitus,and hypertension,only age (P＜0.01),creatinine (P=0.01),alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs.Age (P＜0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016).In conclusion,MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area.The infratentorial area was least affected by WMCs.Typically,age-related WMCs were observed in the frontal lobes,while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.
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Brain magnetic resonance imaging (MRI) of the elderly often reveals white matter changes (WMCs) with substantial variability across individuals.Our study was designed to explore MRI features and site-specific factors of ischemic WMCs.Clinical data of consecutive patients diagnosed with ischemic cerebral vascular disease who had undergone brain MRI were collected and analyzed.Multi-logistic regression analysis comparing patients with mild versus severe WMCs was performed to detect independent associations.Analyses of variance (ANOVAs) were used to detect regionally specific differences in lesions.We found that lesion distribution differed significantly across five cerebral areas,with lesions being predominant in the frontal lobe and parieto-occipital area.To explore WMCs risk factors,after adjusting for gender,diabetes mellitus,and hypertension,only age (P＜0.01),creatinine (P=0.01),alkaline phosphatase (ALP) (P=0.01) and low-density lipoprotein cholesterol (LDL-C) (P=0.03) were found to be independently associated with severe WMCs.Age (P＜0.001) was strongly associated with WMCs in the frontal lobe while hypertension was independently related to lesions in the basal ganglia (P=0.048) or infratentorial area (P=0.016).In conclusion,MRI of WMCs showed that ischemic WMCs occurred mostly in the frontal lobe and parieto-occipital area.The infratentorial area was least affected by WMCs.Typically,age-related WMCs were observed in the frontal lobes,while hypertension-related WMCs tended to occur in the basal ganglia and infratentorial area.
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Se realizó un estudio descriptivo y transversal de 45 cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular, atendidos en la Sala de Rehabilitación Integral del Policlínico Universitario Luis Augusto Turcios Lima del municipio y provincia de Pinar del Río, desde julio hasta diciembre de 2015, con vistas a caracterizar a dichos cuidadores según variables de interés para la investigación. En la serie prevalecieron los cuidadores de 50-59 años de edad (53,3 por ciento), del sexo femenino (44,4 por ciento), con nivel educacional preuniversitario (37,8 por ciento), con lazos de parentesco (71,1 por ciento) y con un tiempo en esta labor entre 7-9 meses (40,0 por ciento). El parentesco existente entre el cuidador y la persona cuidada es un factor importante que influye en gran medida en la experiencia del cuidado
A descriptive and cross-sectional study of 45 caregivers of aged hemiplegic adults with cerebrovascular disease, assisted in the Comprehensive Rehabilitation room of Luis Augusto Turcios Lima University Polyclinic in Pinar del Río municipality and province, was carried out from July to December of 2015, with the aim of characterizing this caretakers, according to variables of interest for the investigation. In the series the caregivers of 50-59 years of age (53,3 percent), the female sex (44,4 percent), preuniversity educational level (37,8 percent), family relationship (71,1 percent) and with a period in this activity among 7-9 months (40,0 percent) prevailed. The existent family relationship between the caregiver and the sick elderly is an important factor that influences greatly in the experience of the care
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged , Caregivers , Stroke , Hemiplegia , Primary Health Care , Epidemiology, Descriptive , Cross-Sectional Studies , Frail ElderlyABSTRACT
Objective To investigate the distribution of age and relationship of ESR with HCT.Methods The HCT,age and ESR datas of the patients which all ages were above 40 years were Collected,then count the mean and standard deviation x±s with different groups of HCT,t test was made to identify the significance of difference.Results HCT:The levels of hct in males was 0.47±0.26 in higher groups of HCT,0.39±0.27 in normal groups and 30.01 ±3.59 in lower groups.The levels of HCT in fe-males was 0.42±0.17 in higher groups,0.30±0.36 in normal groups,0.27±0.45 in lower groups;Age:The average age in males was 57.41±10.62 years in higher HCT groups of patients,67.23 ±12.75 in lower hct groups,there were significantly difference between them.The avarage age in females was 60.70 ± 11.60 in higher HCT groups of patients,61.60 ± 12.40 in lower HCT groups,there were no significantly difference between them.ESR:The levels of ESR in males was (3.95 ±3.26)mm/h in higher HCT groups,(61.61±40.04)mm/h in lower HCT groups;The ESR in females was (28.26±28.62)mm/h in higher HCT groups, (60.20±43.71)mm/h in lower HCT groups,there were significantly difference between different groups included both males and femals.Conclusion When the HCT were decreased,the age and ESR were increased in males,the ESR were also increased but had no relationship with ages in females.Conjuction the age and ESR,it could improve the prevention and monitoring in heart-brain blood disease through the HCT.
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Objective To investigate the effect of Tianqi Jiangtang capsules combined with metformin on blood viscosity, cognitive disorder in elderly patients with type 2 diabetes mellitus complicated with cerebral microvascular lesions.Methods 76 patients with type 2 diabetes mellitus complicated with cerebral microvascular lesions were divided into the observation group and the control group according to odd and even numbers, 38 cases in each group.The observation group were given Tianqi Jiangtang capsules combined with metformin while the control group were received metformin alone.The clinical curative effect, adverse reactions were compared between the two groups.The total score of TCM symptoms, blood glucose, blood lipid, high-sensitivity C reactive protein(hs-CRP), hemorheology and Mini Mental State Examination(MMSE)scores were determined before and after treatment.Results The total effective rate in the observation group(89.47%)was significantly higher than that in the control group(71.05%)(P< 0.05);After treatment, the total score of TCM symptoms, FPG, 2 h PG, hs-CRP, TC, TG, LDL-C, whole blood viscosity at high shear, whole blood viscosity at low shear, plasma viscosity and hematocrit were significantly lower than those before treatment, while MMSE scores were significantly higher(P< 0.05), and the above indexes in the observation group after treatment were significantly better than those in the control group(P< 0.05).There were no significant adverse reactions in the 2 groups.Conclusion Tianqi Jiangtang Capsules combined with metformin is safe and effective in the treatment of elderly patients with type 2 diabetes mellitus complicated with cerebral microvascular lesions.It can significantly improve lipid metabolism and hemorheology, reduce blood viscosity, and alleviate cognitive disorder.
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Objective To analyze the related risk factors of pathological changes of cardiocerebral vascular in type 2 diabetes mellitus (T2DM) patients with hypertension.Methods 100 patients with T2DM were selected as the research subjects.According to the presence of hypertension,they were divided into control group (without hyper tension) and observation group (hypertension),50 cases in each group.The incidence of pathological changes of cardiocerebral vascular in the two groups was compared,and the risk factors of pathological changes of cardiocerebral vascular were analyzed.Results In the control group,the pathological changes of cardiocerebral vascular in 16 cases,the incidence rate was 32.0％.In the observation group,the pathological changes of cardiocerebral vascular in 33 cases,the incidence rate was 66.0％.The incidence rate of the observation group was significantly higher than the control group,there was statistically significant difference (x2 =10.427,P ＜ 0.05).The age,smoking,diet,exercise,fat metabolic disorders,diabetes,glycemic control,diabetic complications between the two groups had statistically significant differences (all P ＜ 0.05).Conclusion Complicated with hypertension will increase the pathological changes incidence of cardiocerebral vascular in patients with T2DM at a certain extent.The age,smoking,diet,exercise,lipid metabolic disorders,diabetes,glycemic control,diabetic complications are related risk factors to hypertension induced the pathological changes of cardiocerebral vascular in patients with T2DM.
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El adulto mayor hospitalizado con dependencia total a causa de la Enfermedad Vascular Cerebral (EVC), que se determina como crónica y degenerativa, está incapacitado para la realización de las actividades básicas de la vida diaria, por lo cual requiere la atención continua de un familiar denominado cuidador primario quien le brinda apoyo en diferentes aspectos. De ahí, que el cuidador primario se afecte en los ámbitos físico, mental y social. En este sentido, se visualiza la figura de cuidador primario como el sujeto-objeto de investigación. OBJETIVO. Determinar las repercusiones en los ámbitos personal, familiar y social del cuidador primario que brinda atención a un adulto mayor con EVC. MÉTODO. Se realizó un estudio usando la técnica de investigación cualitativa, fenomenológica, exploratoria, descriptiva. Se eligió a 6 cuidadores primarios cuyo familiar adulto mayor (AM) presentara dependencia total a causa de EVC. Se les aplicó la Entrevista en Profundidad. Los resultados se analizaron de acuerdo con el instrumento: Análisis de contenido de tipo temático. RESULTADOS. Se encontró, a través de la codificación libre en el texto de las entrevistas, 3 categorías y 9 subcategorías. 1. Cambio en la vida del cuidador: a) Disminuyen sus ingresos económicos, debido a que el cuidador primario dedica el mayor tiempo al cuidado del AM, por ello abandona parcial o totalmente su actividad remunerada; b) Deja de cuidar su salud, al priorizar la atención del AM en detrimento de la propia, presenta alteraciones del sueño, fatiga, alimentación inadecuada lo cual impacta negativamente en su salud; c) Deja de socializar con familiares y amigos, la permanencia en el hospital hasta por 36 horas continuas aísla al cuidador primario de su contexto familiar. 2. Enseñanza y aprendizaje: a) Fuentes de adquisición de nuevos conocimientos, el cuidador primario aun cuando cuente con conocimientos previos para el cuidado, no está capacitado de manera formal para el desempeño de las actividades que debe desarrollar en el hospital, aprende observando, preguntando a otros cuidadores o profesionales y por ensayo y error, lo cual le genera angustia. No existe un programa que capacite al cuidador primario para brindar la atención adecuada al AM; b) Cuidando en el hospital, el cuidado en el hogar difiere en gran medida del cuidado en el hospital, sus actividades son de apoyo al personal de salud debido a que el cuidador primario no recibe una enseñanza formal para el cuidado, lo cual le genera estrés, además de que pudiera representar un riesgo para el AM; 3) La vida en el hospital: a) Percepción del cuidado, el cuidador primario reconoce que el personal médico brinda atención de calidad al AM, no así lo refiere del personal de enfermería, ya que en sus discursos evidencia que no le capacitan para el desempeño de sus actividades, además de percibir maltrato o tardanza para la atención, por otro lado, justifica lo anterior debido a que el personal es insuficiente y los pacientes numerosos; b) Vigilancia en el hospital, con base en los discursos se observó que la relación cuidador primario-personal de vigilancia es complicada porque éstos se apegan rigurosamente a la normatividad del hospital descuidando las normas morales y el trato digno a que tienen derecho los cuidadores primarios; c) Actividades del cuidador primario en el hospital, son las acciones físicas de cuidado, acompañamiento y organización de los relevos, sin embargo, la principal es la de acompañar al AM, aunque el cuidador primario puede ser un colaborador del equipo de salud; d) Espacio de socialización, la permanencia constante del cuidador primario en el hospital, convierte este sitio en el espacio de socialización, en el que convive con otros pacientes y sus familiares, personal de salud y otras personas creando nuevos vínculos para compartir experiencias y ayuda mutua. CONCLUSIÓN. Los resultados obtenidos sugieren que el cuidador primario es un colaborador fundamental para la atención del AM hospitalizado, de ahí que es necesario implementar en los planes de estudio de la Licenciatura en Enfermería un área de formación en la cual se contemple al cuidador primario como persona vulnerable que debe recibir atención al igual que su paciente y la enseñanza formal que le capacite para atender las necesidades del AM, por otro lado, es preciso establecer programas para incluirle en un plan de atención y salud básica.
The older adult hospitalized with total dependence because of Cerebral Vascular Disease (CVD) , which is determined as chronic and degenerative, is unable to perform basic activities of daily life, which requires continuous care of a family called primary caregiver who provides support in different aspects. Hence, the primary caregiver affect on the physical, mental and social fields. In this sense, the figure of primary caregiver as the subject-object research is displayed. OBJECTIVE. Determine the impact on personal, family and social areas of the primary caregiver who provides care to an older adult with CVD. METHOD. A study was conducted using qualitative research technique, phenomenological, exploratory, descriptive study was conducted. 6 primary caregivers whose family AM present total dependence because of CVD was chosen. It was applied in-depth interview. The results were analyzed according to the instrument: analysis of thematic content. RESULTS. It was found through the free coding in the text of the interviews, 3 and 9 sub-categories. 1. Change in the caregiver's life: a) reduce their income, because the primary caregiver spends more time taking care of AM, thus partially or totally abandon their remunerated activity; b) Stop health care, prioritizing the attention of AM detriment of their own, presents sleep disturbances, fatigue, inadequate food which negatively impacts on their health; c) Stop socializing with family and friends, stay in the hospital for up to 36 continuous hours isolates the primary caregiver of the family context. 2. Teaching and learning: a) Sources of acquiring new knowledge, the primary caregiver even when it has prior knowledge care is not formally trained to carry out the activities to be developed in the hospital, learns by watching, asking other caregivers or professionals and by trial and error, which generates anxiety. There is a program that enables the primary caregiver to provide adequate attention to AM; b) Taking care in hospital, home care differs greatly from hospital care, their activities are supportive health personnel because the primary caregiver does not receive a formal education for care, which generates stress, and that could pose a risk to the AM; 3) Life in the hospital: a) Perception of care, the primary caregiver recognizes that medical personnel providing quality care to AM, not so concerned nursing staff, since in his evidence speeches that do not train you for the performance of its activities, in addition to perceived abuse or delay for attention, on the other hand, justifies the above because the staff is insufficient and many patients; b) Monitoring in the hospital, based on the speeches was observed that the primary-care staff monitoring relationship is complicated because they are strictly adhere to the regulations of the hospital neglecting moral standards and fair treatment they are entitled to primary caregivers ; c) Activities of the primary caregiver in the hospital, are the physical actions of care, support and organization of the relays, however, the principal is to accompany the AM, although the primary caregiver can be a partner of the health team; d) Space socialization, constant permanence of the primary caregiver in the hospital, makes this site in the space of socialization, which coexists with other patients and families, health workers and others creating new links to share experiences and help mutual. CONCLUSION. The results suggest that the primary caregiver is a key partner for the attention of AM hospitalized, hence need to be implemented in the curricula of Nursing a training area in which the primary caregiver as a vulnerable person is contemplated which should receive attention as patient education and formal training enabling them to meet the needs of AM, on the other hand, we must establish programs to include him in a care plan and basic health.
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Humans , Aged , Caregivers , Stroke , Functional Status , HospitalizationABSTRACT
Objective To investigate the effects of stress hyperglycemia on prognosis in patients with severe cerebral vascular diseases.Methods A retrospective analysis was conducted.416 patients with severe cerebral vascular diseases confirmed by radiological imaging admitted to intensive care unit (ICU) of Guangdong General Hospital from December 2013 to June 2015 were enrolled.According to the values of randomise blood glucose (RBG) and glycosylated hemoglobin (HbA1c) and diabetes history,the patients were divided into euglycemia group (RBG ＜ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history),diabetes group (RBG ≥ 11.1 mmol/L,HbA1c ≥ 0.065,with diabetes history),and stress hyperglycemia group (RBG ≥ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history).The nosocomial infection rate,the length of ICU stay and 28-day mortality were compared among the three groups.Survival analysis was performed using Kaplan-Meier method,and multivariate Cox proportional hazard model was used to estimate the risk of death.Results Among 416 patients,there were 40 cases with stress hyperglycemia,46 with diabetes and 330 with euglycemia,with the incidence of stress hyperglycemia of 10.81％ (40/370).The nosocomial infection rates in the stress hyperglycemia group and diabetes group were significantly higher than those of the euglycemia group [55.00％ (22/40),52.17％ (24/46) vs.18.79％ (62/330),both P ＜ 0.01],and the length of ICU stay was significantly longer than that of the euglycemia group (days:16.53 ± 6.26,15.79 ± 8.51 vs.9.23 ± 4.29,both P ＜ 0.01).No significant differences in nosocomial intection rate and length of ICU stay were found between stress hyperglycemia group and diabetes group (both P ＞ 0.05).The 28-day mortality rate in stress hyperglycemia group was significantly higher than that of diabetes group and euglycemia group [47.50％ (19/40) vs.26.09％ (12/46),10.30％ (34/330),P ＜ 0.05 and P ＜ 0.01].It was showed by Kaplan-Meier survival analysis that 28-day cumulative survival rate in stress hyperglycemia group was significantly lower than that of euglycemia group and diabetes group (log-rank =6.148,P =0.043).It was showed by Cox death risk analysis that stress hyperglycemia was the risk factor of death in patients with severe cerebral vascular disease [hazard ratio (HR) =1.53,95％ confidence interval (95％CI) =1.04-1.26,P =0.001].Conclusion The patients with stress hyperglycemia may have a higher 28-day mortality and a poorer prognosis compared with those with diabetes and normal blood glucose in severe cerebral vascular diseases.
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Objective To investigate the clinical significance of plasma lipoprotein-associated phospholipase A2 (LP-PLA2) determination in patients with ischemic cerebral stroke(ICS).Methods 124 patients with ICS (ICS group)admitted to Dongfeng Huaguo Hospital in Shiyan City from Jan.2011 to June.2014 and 50 patients with hemorrhagic stroke (hemor-rhagic group)were as the research objects,and 50 healthy controls at the same time were as the control group,compared the plasma Lp-PLA2 levels between the three groups,and compared carotid artery atherosclerotic plaque and plasma Lp-PLA2 levels in patients with different severity of ICS.Results The levels of plasma Lp-PLA2 of the patients of the ICS group,the hemorrhage group and the control group were 58.4±9.6 g/L,30.5±9.2 g/L and 18.7±8.3 g/L,respectively.There were significant differences between the groups (F = 16.741,P = 0.000).The level of plasma Lp-PLA2 of the patients of the plaque group was higher than that of the non-plaque group (66.3 ±9.7 g/L vs 54.1±10.3 g/L,t=5.775,P =0.000),and the unstable plaque group was higher than that of the stable plate group (72.4±9.5 g/L vs 62.8±10.1 g/L,t=4.797,P =0.000).The plasma Lp-PLA2 level of patients with light,medium,heavy ICS were 48.4± 9.2 g/L,60.9 ± 9.6 g/L and 74.5±10.3 g/L,respectively,and the difference was statistically significant between the three groups (F = 13.629,P =0.000).The plasma levels of Lp-PLA2 were positively correlated with NIHSS scores in patients with ICS (r=0.716,P <0.05).Lp-PLA2 in diagnosis of ICS area under the ROC curve was 0.904,the optimal critical value was 45.2 μg/L,the sen-sitivity and specificity were 81.5% and 80.2%.Conclusion The determination of plasma LP-PLA2 has a good effect in di-agnosis of ICS,the plasma level of ICS can be responsed the severity of the patients and the stability of atherosclerotic plaque.
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Objective To investigate and analyze if there is association between ischemic cerebral vascular disease (ICVD)and the time factor of dentition defect or not by the way of questionnaire.The investigation and analy-sis will provide the theoretical basis and reference in order to study the relationship between oral disease and brain functional disease as well as ICVD.Methods 159 elderly patients who diagnosed definitely as brain functional dis-ease and dentition defect or oral prosthesis at the same time were selected.The oral condition and cerebral vascular disease history were recorded and analyzed.Results There were only 27 individuals who had teeth missing without ICVD,accounted for 16.98%.The rest of 132 individuals who had both teeth missing and ICVD accounted for 83.02%.The number of individuals who lose back teeth was larger than the number of that who suffered from ICVD (χ2 =32.360,P <0.01).The longer length of time that losing teeth took,the bigger risk that patients suffered from ICVD.Spearman rank correlation analysis result was r =0.437,P <0.01.It meaned that time was another factor. Conclusion There is certain association between the length of lacking teeth and ICVD.Missing back teeth has a bigger effect on ICVD than missing front teeth.Furthermore,the longer time that losing teeth takes,the higher risk that patients suffer from ICVD.However,it is not clear how the length of time effects ICVD.Further study is still needed.
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Objective: To explore the acute effect of air pollution on mortality for patients with cardio cerebral vascular disease and to provide the basis for disease prevention and control. Methods: The Mortality for patients with cardio cerebral vascular disease from 2001-01 to 2009-12 was from Tianjin Centers for Disease Control and Prevention, the meteorological and air pollution data were from Tianjin meteorological bureau and Tianjin environmental monitoring station respectively. The Single and multiple generalized additive model (GAM) extended poisson regression analysis was performed to calculate the relationship between air pollution and cardio-cerebral vascular disease mortality by controlling the time trends, weather, the day of week and air population. Results: Results: Single GAM analysis indicated that when the effect of SO2, NO2 and PM10 in the air reached the maximum in the day, the RR values for the mortality in patients with cardio-cerebral vascular disease increased 1.13%[95%CI (0.76-1.51)%], 0.78% [95%CI ( 0.41-1.15)%] and 0.61% [95%CI ( 0.51-0.71)%] respectively; when the average concentration of SO2, NO2 and PM10 increasing 10μg/m3 per day, after 0-5 days, the RR values for the mortality elevated 0.70% [95%CI (0.47-0.94)%], 0.51% [95%CI (0.27-0.74)%] and 0.16% [95%CI (0.06-0.27)%] respectively. Multiple GAM analysis presented that when SO2, NO2 and PM10 increasing 10 μg/m3 per day, the RR values for the mortality elevated 0.77% [95%CI (0.58-0.97)%], 0.41% [95%CI (0.05-0.78) %] and 0.38% [95%CI (0.12-0.64%)%] respectively. Conclusion: The air pollution could increase the mortality risk in patients with cardio-cerebral vascular disease, it is necessary to establish the prevention system in order to decrease the mortality risk in those patients.
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Objective To evaluate the effect of atorvastatin on human carotid plaque by high resolution nuclear magnetic resonance imaging(MRI 3. 0T). Methods Forty patients with carotid artery plaque were treated with atorvastatin at the dose of 20 mg daily for one year. Changes of the artery plaques were observed by MRI,and the levels of blood lipoproteins and C reactive protein( hs-CRP)were detected. Results After the treatment with atorvastatin for 6 months and 1 year,the number and average thickness of plaques were reduced. One year after the treatment,average thickness of stable plaques dropped from (2. 41±0. 54)mm to(2. 17±0. 49)mm,and the size of the unstable plaques decreased from(2. 38±0. 89)mm to(2. 01± 0. 32)mm,with significant differences(P﹤0. 05). The levels of TC,TG,LDL-C and Hs-CRP were significantly decreased(P﹤0. 05)and the level of HDL-C was increased. Conclusion High resolution nuclear magnetic resonance( MRI3. 0T)can clearly display the components of the atherosclerotic plaque and the degree of artery stenosis. Atorvastatin exerts a significant effect on carotid plaque by promoting the regression of the carotid atherosclerosis plaque.