PNF技术联合火针平衡阴阳法治疗老年脑卒中后肩手综合征的疗效

目的 探讨本体感受神经肌肉促进疗法(PNF)技术联合火针平衡阴阳法治疗老年脑卒中后肩手综合征(SHSAS)的疗效。方法 100例老年SHSAS患者随机分为两组各50例,对照组采用常规治疗,观察组采用常规治疗+PNF技术联合火针平衡阴阳法治疗,均治疗4 w,于治疗4 w时评估两组治疗效果,比较两组治疗前及治疗4 w时的疼痛程度[视觉模拟评分(VAS)]、日常生活活动能力[改良Barthel指数(MBI)评分]及上肢运动功能[简化Fugl-Meyer上肢运动功能评分(FMA)]。结果 观察组治疗4 w时治疗总有效率明显高于对照组(P<0.05);两组治疗4 w时,两组FMA评分均较治疗前明显升高,且观察组明显高于对照组,VAS均较治疗前明显降低,且观察组明显低于对照组(P<0.05);两组治疗4 w时MBI评分均较治疗前明显升高,且观察组明显高于对照组(P<0.05)。结论 老年SHSAS患者采用PNF技术联合火针平衡阴阳法治疗效果显著,可有效减轻疼痛,促进上肢运动功能恢复,改善日常生活活动能力。     

高压氧联合电针治疗脑卒中50例疗效分析

目的探讨脑卒中病人的康复治疗方法及其疗效.方法将100例脑卒中病人随机分为治疗组和对照组各50例,两组均接受常规神经内科治疗,治疗组接受高压氧联合电针治疗,对照组接受高压氧治疗.采用简化Fugy-Meyer(FMA)运动功能评分法和神经功能缺损程度评分标准(NFD)及Bethel指数(MBI)评分法进行功能评定.结果治疗组FM、BI及神经功能缺损程度评分与对照组相比均有统计学意义(P＜0.01).结论高压氧联合电针能有效提高脑卒中病人的康复.     

脊髓损伤伴糖尿病患者的康复治疗体会

目的探讨脊髓损伤伴糖尿病患者最佳的康复治疗方法。方法选择2017年6月—2018年5月在该院康复科进行治疗的78例脊髓损伤伴糖尿病患者作为康复治疗对象。采取随机数字表法,分为对照组和观察组。对照组脊髓损伤伴糖尿病患者采取常规的康复治疗方法,观察组脊髓损伤伴糖尿病患者对康复治疗方法加以优化。从患者血糖检测结果、运动功能和感觉功能评分3方面对康复效果进行分析比较。结果在血糖检测结果方面,观察组脊髓损伤伴糖尿病患者空腹血糖和餐后2 h血糖检测结果低于对照组。在运动功能和感觉功能评分方面,观察组评分结果均高于对照组。以上比较,均差异有统计学意义(P0.05)。结论对脊髓损伤伴糖尿病患者的康复治疗方法加以优化,康复效果更为显著。     

调跷通督益髓法针刺对不完全性脊髓损伤患者膀胱功能及运动功能障碍的影响

目的分析调跷通督益髓法针刺对不完全性脊髓损伤患者膀胱功能及运动功能障碍的影响。方法 50例不完全性脊髓损伤患者按随机数表法分为两组各25例。对照组接受综合康复训练,观察组在对照组疗法基础上加用调跷通督益髓法针刺治疗。观察两组治疗前后膀胱功能、日常生活能力及运动、感觉功能障碍等。结果治疗前两组残余尿量、安全压力下膀胱容量、日排尿次数对比差异无统计学意义(P0.05);治疗后与对照组相比,观察组残余尿量、日排尿次数显著减少(P0.001),安全压力下膀胱容量显著增高(P0.01);治疗前两组美国脊髓损伤委员会(ASIA)运动评分(MS)、ASIA感觉指数评分(SIS)、改良Barthel指数(MBI)评分对比差异无统计学意义(P0.05);治疗后与对照组相比,观察组MS、SIS、MBI评分显著增高(P0.001);治疗前两组盆底肌肌力等级对比无统计学差异(P0.05);治疗后与对照组相比,观察组盆底肌肌力等级较高(P0.05)。结论调跷通督益髓法针刺治疗利于改善不完全性脊髓损伤患者盆底肌肌力与膀胱功能,缓解运动、感觉功能障碍,提升日常生活能力。     

针灸结合康复治疗干预时机对不同程度脊髓损伤患者神经功能恢复的影响

目的 探讨针灸结合康复治疗干预时机对不同程度脊髓损伤患者神经功能恢复的影响.方法 通过观察2008～2010年我院住院治疗的90例不同程度脊髓损伤患者,根据其针灸结合康复治疗干预时机不同分为早期治疗组、晚期治疗组、对照组.针灸采用电针治疗,取受损脊髓节段上、下端督脉经穴及夹脊穴,上肢瘫痪加肩臑、臂偶、曲池、外关、手三里、合谷等穴,下肢瘫痪加髀关、伏兔、足三里、阳陵泉、三阴交、太溪、太冲等穴,大、小便障碍加肾俞、次髎、膀胱俞、气海、关元等穴,每天1次,每10次一疗程;康复治疗采用标准统一的训练方法.采用改良的Bathel指数(MBI)和功能独立性评定表(FM)分别于治疗前及治疗3个月后予以评定.结果 经治疗后,患者的运动、感觉功能和大、小便控制能力均有明显改善,早期治疗组总有效率86.67%;晚期治疗组中总有效率73.33%.早期治疗组BMI和FM与治疗前后比较数值变化具有显著性意义(均P＜0.05).晚期治疗组BMI和FM与治疗前后数值变化具有显著性意义(均P＜0.05).早期治疗组与晚期治疗组分别与对照组MBI和FM比较,均较对照组得分高,说明针灸与康复治疗干预对于脊髓损伤后神经功能恢复具有较好的临床治疗价值;早期治疗组与晚期治疗组治疗前与治疗后MBI和FM有差异;早期治疗组与晚期治疗组MBI和FM有差异,早期治疗组较晚期治疗组高,说明脊髓损伤患者早期进行针灸及康复治疗有利于其神经功能的恢复及生活活动功能力的提高.而早期治疗组与晚期治疗组患者针灸及康复治疗前MBI及FM评分比较,差异均无统计学意义(P>0.05).结论 脊髓损伤患者在早期进行针灸结合康复治疗有利于其经功能恢复,减少并发症,提高患者的日常生活活动能力.     

不同部位急性脑梗死康复治疗的效果

目的探讨不同部位急性脑梗死患者康复治疗的效果。方法选择符合条件的142例急性脑梗死患者,按病变部位分为三组,A观察组(一侧皮层单个病灶,24例)、B观察组(一侧基底节单个病灶,24例)、C观察组(一侧脑干单个病灶,24人)。各组内分别设条件对应的A对照组(23例)、B对照组(24例)、C对照组(23例)。各组均有一侧上下肢功能障碍。且肌力≤Ⅲ级。对照组均接受常规的药物治疗,观察组接受常规药物治疗及康复治疗。入院治疗前、治疗后2 w、4 w分别作Fugl-Meyer运动功能评定(FMA)、Fugl-Meyer平衡功能评定(FM-B)、日常生活活动能力(ADL)评定用Barthel指数(MBI)。结果各观察组与对照组相比在治疗后不同时间FMA、FM-B及MBI评分有显著差异(P0.01)。各观察组内治疗后不同时间FMA、FM-B及MBI评分有显著差异(P0.05)。各观察组间在治疗前FMA、FM-B及MBI评分无显著差异(P0.05),治疗后2 w、4 w时上述评分均有显著差异(P0.05),其中A观察组FMA、FM-B及MBI评分与B观察组及C观察组相比差异显著(P0.05),而B观察组与C观察组相比上述指标差异无统计学意义(P0.05)。结论康复治疗可有效地改善患者的预后;持续的康复治疗获益更大;不同部位的急性脑梗死康复治疗的效果可能不同。     

早期高压氧联合康复治疗对老年高血压脑出血患者神经功能恢复及预后的影响

目的探讨早期实施高压氧联合康复治疗对老年高血压脑出血(HICH)患者神经功能恢复及预后的影响。方法老年HICH患者300例,随机数字表法分为研究组和治疗组各150例,研究组采用常规治疗联合早期高压氧和康复治疗,治疗组采用常规治疗+早期高压氧方法,采用美国国立卫生研究院卒中量表(NIHSS)、欧洲卒中评分量表(ESS)、简易智能精神状态检查量表(MMSE)评估两组神经及运动功能变化,采用格拉斯哥预后评分(GOS)标准评估治疗情况。采用中文版Nasreddine检查表(MOCA)评价患者的认知功能,按照Fugl-Meyer运动功能评分评估患者的肢体运动情况,采用日常生活活动能力(ADL)量表评价两组日常活动能力。对比分析治疗30 d后神经功能恢复情况,治疗6个月后预后情况。结果治疗30 d后,研究组NIHSS、ESS评分均低于治疗组,MMSE评分高于治疗组(P<0.01);治疗6个月后,研究组认知功能、运动功能、日常生活活动能力评分均明显高于治疗组,GOS评分显示研究组预后良好率明显高于治疗组(均P<0.01)。结论早期高压氧联合康复治疗具有缓解老年HICH患者昏迷情况,促进患者神经及日常运动功能恢复,改善预后、提高生存质量。     

高压氧结合现代康复治疗对脑卒中早期患者功能恢复的影响

目的对高压氧结合现代康复治疗对脑卒中早期患者功能恢复的影响进行分析和探讨。方法选取我院2014年1月~2015年2月收治的脑卒中早期患者94例,随机分为观察组和对照组,常规治疗基础上,观察组患者接受高压氧结合现代康复的治疗,对照组患者接受现代康复治疗,对比患者功能恢复情况。结果观察组患者Fugl-Meyer运动功能评分法(FMA)、Barthel指数(MBI)、神经功能缺损程度评分均显著优于对照组患者,组间比较,差异有统计学意义(P0.05)。结论高压氧结合现代康复治疗对于脑卒中早期患者功能的恢复有着积极的促进作用。     

经颅直流电刺激结合感觉训练对卒中后感觉障碍及手功能的疗效分析

目的探讨经颅直流电刺激(tDCS)结合感觉训练对卒中偏身感觉障碍患者感觉功能及手功能的康复疗效。方法回顾性连续纳入2019年7月至2020年1月在首都医科大学宣武医院康复医学科住院治疗的卒中偏身感觉障碍患者30例,均为初发卒中,病程3个月内。根据治疗方式的不同,将30例患者分为试验组和对照组,各15例。两组患者均接受常规药物治疗、偏瘫运动治疗及感觉功能训练,感觉训练2次/d, 30 min/次,5 d/周。在感觉功能训练前,试验组另进行阳极tDCS治疗,对照组患者给予tDCS假刺激,即电刺激仪仅进行正常显示,无刺激电流输出;均2次/d, 20 min/次,5 d/周。疗程均为2周。记录两组患者基线资料以及治疗前后的上肢感觉、上肢运动、日常生活能力评分[Fugl-Meyer运动功能(FMA)量表感觉、运动评分,改良Barthel指数(MBI)评分],并进行组间比较。基线资料包括性别、年龄、病程、卒中类型(脑梗死或脑出血)、病变部位(左半球、右半球)。结果 (1)两组患者性别、年龄、病程、病变性质和病变部位的差异均无统计学意义(均P0.05)。(2)两组患者治疗前后FMA感觉评分比较,组别及时间交互效应的差异有统计学意义(F=235.71,P0.01)。试验组治疗前和治疗后FMA感觉评分分别为(5.9±1.8)、(10.5±1.6)分,对照组治疗前后FMA感觉评分分别为(6.1±1.8)、(8.7±1.6)分。两组患者治疗前FMA感觉评分的差异无统计学意义(P=0.84);治疗2周后,试验组FMA量表上肢感觉评分高于对照组,组间差异有统计学意义(P0.01)。两组患者治疗后FMA感觉评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P0.01)。(3)两组治疗前后FMA运动评分比较,组别及时间交互效应的差异有统计学意义(F=1 713.93,P0.01)。试验组治疗前和治疗后FMA运动评分分别为(13±4)、(41±5)分,对照组治疗前后FMA运动评分分别为(14±4)、(36±3)分。两组患者治疗前FMA运动评分的差异无统计学意义(P=0.54);治疗2周后,试验组FMA运动评分优于对照组,组间差异有统计学意义(P0.01)。两组患者治疗后FMA运动评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P0.01)。(4)两组患者治疗前后MBI评分比较,组别及时间交互效应的差异有统计学意义(F=412.33,P0.01)。试验组治疗前和治疗后MBI评分分别为(18±8)、(60±16)分,对照组治疗前后MBI评分分别为(15±6)、(44±8)分。两组患者治疗前MBI评分的差异无统计学意义(P=0.16);治疗后,试验组MBI评分高于对照组,组间差异有统计学意义(P0.01)。两组患者治疗后MBI评分均高于本组治疗前,治疗前后的差异均有统计学意义(均P0.01)。结论经tDCS结合感觉训练可以改善卒中患者的感觉功能和偏瘫侧手功能,提高日常生活能力,但本研究结果有待于进一步验证。     

综合应用神经发育疗法对脑卒中病人运动功能的影响

目的探讨综合应用神经发育疗法的康复治疗对脑卒中病人运动功能的影响。方法将98例恢复期脑卒中病人随机分为康复组(50例)和对照组(48例),两组接受相同药物治疗。其中康复组,以Bobath法为主,配合Brunnstrom法、本体感觉神经肌肉促通法(PNF)的综合康复运动治疗,采用改良Barthel(MBI)指数对日常活动能力(ADL)进行评定、应用Fugl-Meyer(FMA)评分,Brunnstrom分级评定运动功能。结果康复治疗4周后与治疗前相比,康复组和对照组MBI评分、FMA评分均显著提高,Brunnstrom分级显著改善,差异有统计学意义(P0.05)。并且康复治疗4周后,康复组与对照组相比,MBI评分、FMA评分均显著提高,Brunnstrom分级显著改善,差异有统计学意义(P0.05)。结论综合应用神经发育疗法能够显著改善脑卒中病人ADL及运动功能,康复运动治疗有助于促进脑卒中病人肢体运动功能的恢复,提高生活质量,改善临床预后。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treatment of patients with thromboangiitis obliterans with cyclophosphamide.

This report describes a small, nonrandomized trial of cyclophosphamide in the treatment of patients with advanced thromboangiitis obliterans (TAO) with modest results. The rationale of the treatment was based on the immunopathogenesis of the disease, ie, autoimmune vasculitis of peripheral arteries. Twelve male patient volunteers with TAO were included for the trial. Diagnosis was based on the history of chronic smoking or tobacco chewing, clinical features of ischemia of peripheral vessels, radioarteriography showing arterial block, and characteristic histopathologic changes of affected arteries. Cyclophosphamide (400 mg) was given intravenously daily to the patients for 7 days followed by daily oral administration of 100 mg cyclophosphamide for another 7 weeks. Clinical conditions of the patients started to improve during the third week of the treatment and maximum benefit was noticed at the end of the treatment. There was significant decrease of intermittent claudication and twentyfold increase of claudication distance as well as relief of rest pain. Before starting treatment 6 patients had developed ulcers on their affected limbs; these healed completely in 2, partially healed in another 2, and showed no improvement in the remaining 2, who never stopped smoking. However, immunosuppressive therapy failed to show any improvement of arterial block, as evidenced by radioarteriography and any significant increase of skin temperature over the affected limbs. Nevertheless, histopathologic studies of biopsies taken from the diseased arteries after completion of therapy showed decreased influx of lymphocytes and plasma cells in the thrombi as well as in the arterial walls in comparison to the biopsies taken before the start of treatment. During the treatment the degree of immunosuppression was monitored by blood leukocyte and lymphocyte counts, which were kept between 4,000/mm3 and above 3,000/mm3 and not less than 500/mm3, respectively, indicating modest immunosuppression and no serious complications. All patients were followed up for 1 year. Only 2 patients, who resumed smoking, had relapse.