• 대한한의학회지
• /
• 제19권1호
• /
• pp.385-391
• /
• 1998

Stroke is badly demaged for patient, family, society and country. To reduce a sequelae and return rapidly to society, treatment at acute stages is very important. In the research on xiafa(下法;diarrhea technique) used at the acute stages of stroke, the results were as follows. On the treatment of stroke, we are to control qi(氣) For it, sweeting technique(汗法), vomitting technigue(吐法) and diarrhea technique(xiafa ;下法) are used. For treatment on biaoshizheng(標實 reyufushi, 熱鬱腑實) at acute stages, tongfuxiexiafa(通腑瀉下法) is in general use. At acute stages, mental state is very important. Therefore, Xiafa(下法) have to conduct by zangfu(臟腑)'s law. At the acute stages, xiafa(下法) improved a whole body problems by treatment on a constipation and dysuria. We think that xiafa(下法) clinically effect on the cerebral edema and increased intracranial pressure. In the future, experimental study is needed.

• 재활간호학회지
• /
• 제5권1호
• /
• pp.27-37
• /
• 2002

During acute stages of hospitalized stroke patients, family caregivers face many challenges. They often experience emotional distress, social isolation, and financial constraints. However, the burden of caregiving of stroke patients in acute stages has never been studied properly. The purpose of this study was to investigate the factors related to the caregivers' burden with acute stroke. The subjects were 123 acute stroke patients and their caregivers who were admitted to neurology and neurosurgery units at Dan Kook University Hospital in Chung-Nam area. An interview was performed with the use of standardized questionnaire which included data pertaining to the patients/caregivers characteristics, caregiver burden (Modified Zarit's Burden Scale), and social support (Personal Resource Questionnaire). Our results showed that the mean burden score was 3.11, indicating high level of burden. Among the sub-domain scores, financial burden was the highest. In univariate analysis, the factors related to caregiver burdens were: inability to communicate between patients and caregiver(p<.001); low cognitive function of the patients(p<.001); low level of ADL(p<.001); the gender of caregiver(p<.001); the current employment status of caregivers(p<.01); the presence of social support for caregiver(p<.001); and the availability of alternative caregivers(p<.001). In multiple regression analysis, social support for family caregivers (87%), low level of patient's cognition (2%), availability of 2nd caregiver (1%), and gender of caregiver (female, 0.4%) were significant explanatory factors of overall burden. The caregivers' burden in acute stages during hospitalization following stroke was high. Recognition of high levels of caregivers' burden and those relating factors affecting caregiver burden may allow us to develop different nursing strategies to unload the level of burden for caregivers in acute stages of stroke.

• 대한한방내과학회지
• /
• 제31권3호
• /
• pp.612-619
• /
• 2010

Background : Low level laser therapy may be an effective method to protect tissue damage in acute stroke. Recently, series of clinical studies on the basis of animal experiments report efficacy and safety of laser therapy at early stages of acute stroke. Laser promotes mitochondrial ATP synthesis to reduce cell death by ischemic infarction. Objectives : To report possibility of non-invasive laser therapy for acute stroke by reviewing literature about its effectiveness, safety and mechanism. Methods : We searched papers using PubMed and 'Web of Knowledge' of Thomson ISI, using the keywords "Laser Therapy, Low-Level" and "Stroke". Limitations were last 10 years of publications and only in English. Search range includes RCTs, clinical reports, reviews and animal experiments. Papers not matched with inclusion criteria were excluded. Results : A total 223 studies were found, 203 excluded during title and extract screening. After scanning 20 papers the final 2 serial RCTs were selected and analyzed. They reported that transcranial laser therapy led in neuroprotective effect for acute stroke patents. Clinical evaluation factors showed favorable trend and initial safety. Conclusions : Non-invasive laser secured safety of clinical application. It may be a favorable choice for the acute stage of stroke.

• 대한한의학회지
• /
• 제24권1호
• /
• pp.181-189
• /
• 2003

Background : Patient, family, society and country are badly damaged by stroke (CVA : cerebrovascular accident). To reduce sequelae and return rapidly to society, treatment in the acute stage is very important. In many studies on purgation therapy (下法) used in acute stages of stroke, the changes of blood pressure, pulse and so on before and after purgation therapy were reported. However, the changes in the human body according to the day elapsed after defecation were not reported, so study was needed to confirm such changes. Methods : Seventy-six patients were studied. We observed forty-three patients at acute stroke and thirty-three patients at convalescent stroke. To confirm the importance of regular defecation in stroke patients, we analyzed blood pressure according to the day elapsed after defecation. Results : The following result were obtained. 1. In stroke group, compared with the day after defecation, the mean blood pressure of the third day after defecation increased. It increased the most in the acute stroke group. 2. Especially in stroke and acute stroke groups, compared with the second day after defecation, the mean systolic blood pressure of the third day after defecation increased significantly. 3. In the infarction group, compared with the day after defecation, the mean blood pressure of the third day after defecation increased. It increased the most in the acute infarction group. 4. Especially, in the infarction and acute infarction groups, compared with the second day after defecation, the mean systolic blood pressure of the third day after defecation increased significantly. Conclusion : In stroke patients, regular defecation is important, so we think that purgation therapy (下法) is needed in stroke patients over the third day elapsed after defecation. We think that the bowel movement control in acute stroke patients is more important than in convalescent stroke patients.

• 대한응급의학회지
• /
• 제29권5호
• /
• pp.437-448
• /
• 2018

Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

• 한국콘텐츠학회논문지
• /
• 제20권10호
• /
• pp.385-394
• /
• 2020

본 연구는 급성기 뇌졸중 환자의 뇌졸중 후 우울 발생 현황을 파악하고 뇌졸중 후 우울에 영향을 미치는 요인을 규명하기 위해 수행되었다. 연구대상자는 2개 지역병원에서 허혈성 뇌졸중으로 입원 치료 후 상태가 안정되어 퇴원 예정인 20대 이상의 성인 104명을 편의추출 하였다. 뇌졸중 후 우울 측정은 뇌졸중 후 우울척도, 사회적지지는 사회적지지 척도, 뇌졸중 심각도는 미국 국립보건원 뇌졸중 척도, 장애정도는 수정 랜킨 척도를 이용하였다. 연구결과 대상자의 뇌졸중 발병 후 입원기간은 평균 5.9±2.1일이었고 79.8%가 7일 이내였다. 뇌졸중 심각도는 평균 2.4±2.5점이었으며 69.2%가 경증 뇌졸중이었고, 장애정도는 평균 1.6±1.1점이었고 46.2%가 발병 전의 모든 업무와 일상활동 실행이 가능했다. 대상자의 32.7%가 경증 이상의 우울상태였으며, 종교가 없고(p<.004), 장애정도가 심하고(p<.031), 뇌졸중 심각도가 높으며(p<.034), 가족지지가 적을수록(p<.009) 뇌졸중 후 우울을 경험할 가능성이 높은 것으로 나타났다. 이러한 결과를 통해 뇌졸중 환자들에게 발병 초기 단계부터 우울이 나타날 수 있음을 알 수 있다. 따라서 뇌졸중 급성기 단계부터 우울에 대한 지속적인 조기 사정과 종교나 가족지지 등을 포함한 급성기 뇌졸중 후 우울 중재에 대한 간호지침 개발이 필요하다.

• Investigative Magnetic Resonance Imaging
• /
• 제22권2호
• /
• pp.131-134
• /
• 2018

Susceptibility-weighted imaging (SWI) is well known for detecting the presence of hemorrhagic transformation, microbleeds and the susceptibility of vessel signs in acute ischemic stroke. But in some cases, it can provide the tissue perfusion state as well. We describe a case of a patient with hyperacute ischemic infarction that had a slightly hypodense, patchy lesion at the left thalamus on the initial SWI, with a left proximal posterior cerebral artery occlusion on a magnetic resonance (MR) angiography and delayed time-to-peak on an MR perfusion performed two hours after symptom onset. No obvious abnormal signals at any intensity were found on the initial diffusion-weighted imaging (DWI). On a follow-up MR image (MRI), an acute ischemic infarction was seen on DWI, which is the same location as the lesion on SWI. The hypointensity on the initial SWI reflects the susceptibility artifact caused by an increased deoxyhemoglobin in the affected tissue and vessels, which reflects the hypoperfusion state due to decreasing arterial flow. It precedes the signal change on DWI that reflects a cytotoxic edema. This case highlights that, in some hyperacute stages of ischemic stroke, hypointensity on an SWI may be a finding before the hyperintensity is seen on a DWI.

• Korean Journal of Radiology
• /
• 제2권4호
• /
• pp.183-191
• /
• 2001

Objective: To document the signal characteristics of intracerebral hemorrhage (ICH) at evolving stages on diffusion-weighted images (DWI) by comparison with conventional MR images. Materials and Methods: In our retrospective study, 38 patients with ICH underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR). In 33 and 10 patients, respectively, conventional and echo-planar T2^* gradient-echo images were also obtained. According to the time interval between symptom onset and initial MRI, five stages were categorized: hyperacute (n=6); acute (n=7); early subacute (n=7); late subacute (n=10); and chronic (n=8). We investigated the signal intensity and apparent diffusion coefficient (ADC) of ICH and compared the signal intensities of hematomas at DWI and on conventional MR images. Results: DWI showed that hematomas were hyperintense at the hyperacute and late subacute stages, and hypointense at the acute, early subacute and chronic stages. Invariably, focal hypointensity was observed within a hyperacute hematoma. At the hyperacute, acute and early subacute stages, hyperintense rims that corresponded with edema surrounding the hematoma were present. The mean ADC ratio was 0.73 at the hyperacute stage, 0.72 at the acute stage, 0.70 at the early subacute stage, 0.72 at the late subacute stage, and 2.56 at the chronic stage. Conclusion: DWI showed that the signal intensity of an ICH may be related to both its ADC value and the magnetic susceptibility effect. In patients with acute stroke, an understanding of the characteristic features of ICH seen at DWI can be helpful in both the characterization of intracranial hemorrhagic lesions and the differentiation of hemorrhage from ischemia.

• 보건행정학회지
• /
• 제33권4호
• /
• pp.440-449
• /
• 2023

Background: This study aimed to analyze the prehospital process and reperfusion therapy process of acute ischemic stroke in Busan metropolitan area and examine the impact of living arrangement on the early management and functional outcomes of acute ischemic stroke (AIS). Methods: The patients who diagnosed with AIS and received reperfusion therapy at the Busan Regional Cardiovascular Center between September 2020 and May 2023 were selected. We investigated the patients' hospital arrival time (onset to door time) and utilization of 119 emergency ambulance services. Additionally, various time matrices related to reperfusion therapy after hospital were examined, along with the functional outcome at the 90-day after treatment. Results: Among the 753 AIS patients who underwent reperfusion therapy, 166 individuals (22.1%) were living alone. AIS patients living alone experienced significant delays in symptom detection (p<0.05) and hospital arrival compared to AIS patients with cohabitants (370.1 minutes vs. 210.2 minutes, p<0.001). There were no significant differences between the two groups in terms of 119 ambulance utilization and time metrics related with the reperfusion therapy. Independent predictors of prognosis in AIS patients were found to be age above 70, National Institutes of Health Stroke Scale score at admission, tissue plasminogen activator, living alone (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.155-2.760) and interhospital transfer (OR, 1.898; 95% CI, 1.152-3.127). Delay in identification of AIS was shown significant correlation (OR, 2.440; 95% CI, 1.070-5.561) at living alone patients. Conclusion: This study revealed that AIS patients living alone in the Busan metropolitan region, requiring endovascular treatment, face challenges in the pre-hospital phase, which significantly impact their prognosis.

• 대한간호학회지
• /
• 제36권7호
• /
• pp.1232-1241
• /
• 2006

Purpose: The purpose of this study was to examine the effects of cerebral ischemia on Type I(soleus) and Type II(plantaris, gastrocnemius) muscles, and to determine the effects of isometric contraction training by electro- stimulation on Type I and II muscles in cerebral ischemia model rats. Method: Twenty-five male Sprague-Dawley rats were randomly divided into four groups: ST(stroke), STES(stroke+electrostimulation), SH(sham) and SHES (sham+electrostimulation). The ST and STES groups received a transient right middle cerebral artery occlusion operation. The SH and SHES groups received a sham operation. The STES and SHES groups had daily isometric contraction training by electrostimulation(100Hz, 45mA, 7.5V) on hindlimb muscles for 7days. Result: Plantaris and gastrocenmius muscle weight, myofibrillar protein contents of soleus and gastrocnemius, and the muscle fiber cross-sectional area of gastrocnemius in the ST group significantly decreased compared with the SH group. Soleus, plantaris, gastrocnemius muscle weight, myofibrillar protein contents of soleus and gastrocnemius, and the Type I muscle fiber cross-sectional area of soleus and the Type II muscle fiber cross-sectional area of gastrocnemius in the STES group significantly increased compared with the 57 group. Conclusion: Hindlimb muscle atrophy occurs after acute stroke and isometric contraction training by electrostimulation during early stages of a stroke attenuates muscle atrophy of Type I and Type II muscles.