运动疗法干预慢性心力衰竭患者30例

为观察运动疗法对慢性心力衰竭患者血压、心率、运动耐力的影响。对本钢医院内科住院的心力衰竭患者30例进行步行锻炼干预。结果心力衰竭患者经步行锻炼干预2个月后静息心率、收缩压、舒张压明显下降,而60min步行距离明显增加。说明长期有规律的进行步行锻炼可降低慢性心力衰竭患者的静息心率、血压,并可明显地提高运动耐量。     

两种呼吸训练对老年慢性心力衰竭病人运动耐力及睡眠质量影响的比较研究

目的:比较两种呼吸训练对老年慢性心力衰竭病人睡眠质量及运动耐力的影响.方法:按照随机数字表法将2017年3月—2018年1月心内科病房收治的慢性心力衰竭病人分为观察组和对照组,对照组给予深呼吸训练,观察组给予快吸慢呼训练,训练12周.比较两组病人训练前后运动耐力及睡眠质量.结果:截至2018年1月共入组150例病人,观察组75例,失访12例,实际纳入研究63例,对照组75例,失访15例,实际纳入研究60例.两组病人一般资料比较差异无统计学意义(P>0.05),具有可比性.观察组病人6 min步行距离、用力肺活量、第一秒用力呼气量、最大自主呼吸通气量均高于对照组,静息心率低于对照组,差异有统计学意义(P<0.05);训练前两组病人匹兹堡睡眠质量指数(PSQI)评分及运动耐力比较差异无统计学意义(P>0.05).训练12周后,观察组病人睡眠质量、入睡时间、睡眠时间、催眠药物、日间功能障碍评分及PSQI总分均低于对照组,差异有统计学意义(P<0.05);两组病人睡眠效率及睡眠障碍评分比较差异无统计学意义(P>0.05).结论:缩唇腹式呼吸训练较深呼吸训练更能提高老年慢性心力衰竭病人运动耐力及睡眠质量.     

示范性教育联合快慢呼吸训练对慢性心力衰竭患者运动耐力和功能锻炼依从性的影响

目的探讨示范性教育联合快慢呼吸训练对慢性心力衰竭患者运动耐力和功能锻炼依从性的影响。方法选取2016年12月至2017年12月收治的192例慢性心力衰竭患者为研究对象,随机将其等分为研究组和对照组,对照组实施常规护理,研究组实施示范性教育联合快慢呼吸训练。比较两组患者运动耐力和功能锻炼依从性。结果干预后1,3个月研究组静息心率、6 min内步行距离、第1 s用力呼气量、最大自主分钟通气量均优于对照组(P 0. 05);研究组患者功能锻炼依从性优于对照组(P 0. 05)。结论慢性心力衰竭患者应用示范性教育联合快慢呼吸训练可有效提高其功能锻炼依从性,改善患者运动耐力,具有临床应用价值。     

运动疗法干预慢性心力衰竭患者30例

为观察运动疗法对慢性心力衰竭患血压、心率、运动耐力的影响。对本钢医院内科住院的心力衰竭患30例进行步行锻炼干预。结果心力衰竭患经步行锻炼干预2个月后静息心率、收缩压、舒张压明显下降，而60min步行距离明显增加。说明长期有规律的进行步行锻炼可降低慢性心力衰竭患的静息心率、血压，并可明显地提高运动耐量。     

快吸慢呼训练对COPD稳定期患者运动耐力及肺功能的影响

目的探讨快吸慢呼训练对COPD稳定期患者运动耐力及肺功能的影响。方法采用便利抽样法选取2016年4月—2016年12月在某三甲医院呼吸科住院的90例COPD稳定期患者作为研究对象,采用随机数字表法随机将其分为观察组(n=45)与对照组(n=45)。对照组采用常规治疗及护理,观察组在常规护理基础上增加快吸慢呼训练,于干预前、干预12周后,分别测量患者6min步行距离、Borg呼吸困难评分及肺功能情况。结果经过快吸慢呼训练干预后,观察组6min步行距离明显增加,呼吸困难程度明显改善,FVC、FEV1、FEV1/FVC等肺功能指标明显增高,时间差异前后对比有统计学意义(P 0. 05);干预后观察组与对照组相比,观察组6min步行距离明显增加、呼吸困难程度明显改善、FVC、FEV1、FEV1/FVC等肺功能指标明显增高,组间差异有统计学意义(P 0. 05)。结论快吸慢呼训练有助于改善COPD稳定期患者运动耐力、呼吸困难程度及肺功能。     

慢性心力衰竭患者吸气肌训练效果的Meta分析

目的 评价吸气肌训练在慢性心力衰竭患者中的应用效果。方法 计算机检索Cochrane Library、PubMed、Web of Science、EMBASE、中国生物医学文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关吸气肌训练应用于慢性心力衰竭患者的随 机对照试验。经筛选文献,提取资料与评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果 最终纳入9篇文献,共505例患者。Meta分析结果显示,吸气肌训练能改善慢性心力衰竭患者的第1秒用力呼气量、用力肺活量和最大自主分钟通气量［WMD＝0.37,95%CI（0.25,0.48）,P<0.001;WMD＝0.48,95%CI（0.37,0.58）,P<0.001;WMD＝11.26,95%CI（10.25,12.27）,P<0.001］,提高患者的6 min步行距离［WMD＝43.11,95%CI（34.48,51.74）,P<0.001］,缓解患者的呼吸困难［WMD＝-0.83,95%CI（-1.31,-0.35）,P<0.001］,降低患者的静息心率［WMD＝-4.69,95%CI（-9.18,-0.21）,P=0.04］,提高患者的生活质量［WMD＝-23.61,95%CI（-26.61,-20.61）,P<0.001］。结论 吸气肌训练可有效地改善慢性心力衰竭患者的肺功能,提高患者的6min步行距离,缓解患者的呼吸困难,降低患者的静息心率,提高患者的生活质量。由于涉及本研究评价指标的纳入研究数量较少且部分评价指标间存在异质性,故未来仍需多中心、高质量、大样本的研究进一步评价吸气肌训练在慢性心力衰竭患者中的应用效果。     

基于“手机新媒体”的健康教育模式对社区慢性阻塞性肺疾病患者的效果研究

目的观察基于"手机新媒体"的健康教育模式应用于社区慢性阻塞性肺疾病患者中的效果。方法将102例慢性阻塞性肺疾病患者根据随机数字表分为观察组和对照组各51例。对照组给予常规健康教育与随访,观察组在常规健康教育与随访基础上采取基于"手机新媒体"的健康教育模式,比较两组患者肺功能和运动耐力。结果干预6个月后观察组第一秒用力呼气容积、用力肺活量以及第一秒用力呼气容积与用力肺活量的百分比优于对照组,深吸气量及6 min步行距离优于对照组,差异有统计学意义(P<0.05)。结论基于"手机新媒体"的健康教育模式可提高社区慢性阻塞性肺疾病患者肺功能和运动耐力。     

肺功能训练对心力衰竭患者活动耐受力的影响研究

目的探究在心力衰竭患者中开展肺功能训练对其机体活动耐受力的影响,并为该类患者的临床优质服务积累经验。方法选取2010年7月~2012年6月我院心内科收治的48例心力衰竭者,设为对照组,实施常规心内科护理;选取2012年7月~2014年我院心内科收治的50例心力衰竭患者,设为实验组,在常规心内科护理的基础上开展肺功能训练。2组患者在入院时及干预后第2w末,分别记录两组患者6 min步行试验前后的心率及收缩压值,并比较两组患者6 min步行距离。结果干预前两组的心率及收缩压值差异无统计学意义(P0.05);干预后训练组的心率及收缩压值均低于对照组,差异具有统计学意义(P0.05);训练组干预后的心率及收缩压值较干预前低,差异有统计学意义(P0.05);干预前后对照组心率及收缩压值差异无统计学意义(P0.05)。两组在干预前的6min步行距离差异无统计学意义(P0.05);干预后第2 w末,训练组6 min步行距离数值较对照组高,差异具有统计学意义(P0.05)。结论肺功能训练应用于心力衰竭患者,能改善其心肺功能状况,并提高机体活动耐受力,有利于患者病情预后转归,值得在临床上进一步推广。     

健康教育及康复锻炼对慢性阻塞性肺疾病稳定期患者心肺功能的影响

目的 探讨健康教育结合规律锻炼是否可以改善慢性阻塞性肺痰病(COPD)稳定期患者的心肺功能,提高运动耐力.方法 对38例COPD稳定期患者实施健康教育及规律锻炼.实施教育及锻炼前后,分别对患者进行呼吸困难自我感党评定(采用改良的Brog量表)、静息肺功能检查、6min步行试验(6MWT)及心肺运动试验(CPET),评价教育及锻炼前后上述参数的变化.结果 健康教育及康复训练后,Brog呼吸困难评分较训练前未见明显改善(P>0.05);第1秒用力呼气容积/用力肺活量(FEV1/FVC)及第1秒用力呼气容积与训练前比较未见明显差异(P>0.05);患者6MWT距离增加(P<0.01);CPET中最大功率增加(P<0.01),最大功率下通气量增加(P<0.05)、呼吸储备下降(P<0.05)、呼吸困难指数上升(P<0.05),最大功率下千克摄氧量、氧脉、心率、心率储备较训练前未见明显差异(P>0.05).结论 健康教育结合规律锻炼,能提高COPD稳定期患者心肺功能及运动耐力.     

呼吸功能锻炼对缓解期慢性阻塞性肺疾病患者的影响

目的探讨呼吸功能锻炼对缓解期慢性阻塞性肺疾病老年患者生存质量和肺功能的影响。方法对30例慢性阻塞性肺疾病患者，给予呼吸肌功能锻炼和宣教，观察期6个月。比较患者干预前后生活质量评分、第1秒用力呼气容积（FEV1）和占用力肺活量的比值（FEV1/FVC）、6min步行距离和体质量指数的变化。结果6min步行距离和生活质量评分干预前后有改善（P〈0．05），第1秒用力呼气容积（FEV1）和占用力肺活量的比值（FEV1／FVC）以及体质量指数有一定程度的改善，但无统计学意义（P〉0．05）。结论呼吸功能锻炼能明显改善缓解期慢性阻塞性肺疾病患者的生活质量。临床实施中，护士要指导患者掌握正确的方法，及时督促，使患者有较好的医嘱依从性，以达到理想的效果。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.