冠心病患者的系统性心肺康复护理

目的分析系统性心肺康复护理对冠心病患者心肺功能及生活质量的影响。方法选取2019年1月—2020年1月在本院就诊的124例冠心病患者为研究对象,根据康复期护理方案分为对照组58例和观察组66例。对照组患者给予常规护理方案,观察组患者给予系统性心肺康复护理干预。比较2组患者心肺功能[无氧阈(AT)、峰值氧脉搏、峰值氧摄取量、二氧化碳通气当量斜率(VE/VCO2)、6 min步行试验(6MWD)]、生活质量及护理满意度。结果观察组患者干预后AT、峰值氧脉搏、峰值氧摄取量及6WMD均高于对照组患者,VE/VCO2低于对照组,差异有统计学意义(P 0.01)。2组患者干预后生活质量各维度评分均较干预前显著改善(P 0.01),且观察组生理职能、社会功能、活力、情感职能、精神健康及总体健康评分均显著高于对照组(P 0.01)。观察组患者对护理的总满意率为98.48%,显著高于对照组患者的86.20%(P 0.01)。结论冠心病患者康复期间应用系统性的心肺康复护理干预安全、有效,能改善患者心肺功能、运动耐力,提高患者生活质量。     

男性非小细胞肺癌合并慢性阻塞性肺疾病患者运动耐量、通气效率特点临床研究

目的:观察男性非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者运动耐量及通气效率特点。方法:将32例男性NSCLC患者根据是否合并COPD分为NSCLC合并COPD组(NSCLC-COPD组,n=12)和未合并COPD组(NSCLC-non COPD组,n=20),以同期行心肺运动试验(CPET)的健康体检者为对照组(n=20)。所有NSCLC患者在肺切除术前完成症状限制性最大负荷运动测试,对CPET结果进行比较分析。结果:与对照组比较,NSCLC-non COPD组与NSCLC-COPD组的峰值摄氧量(VO_2peak)、峰值摄氧量/预计值(VO_2peak/pred%)、峰值公斤摄氧量(peak VO_2/kg)、无氧阈(AT)均下降(均P0.05),二氧化碳通气当量斜率(VE/VCO_2slope)、二氧化碳通气当量最低值(VE/VCO_2nadir)均上升(均P0.05),且NSCLC-COPD组VE/VCO_2slope、VE/VCO_2nadir均高于NSCLC-non COPD组(P0.05)。与对照组和NSCLC-non COPD组相比,NSCLC-COPD组在测试的不同状态下(静息、热身、无氧阈时、峰值时)VE/VCO_2均上升(P0.05)。而与对照组相比,NSCLC-non COPD组在无氧阈时、峰值时VE/VCO_2的上升才有显著性差异(均P0.05)。NSCLC-COPD组潮气末二氧化碳分压(P_(ET-)CO_2)四个阶段均低于对照组(P0.05),在峰值运动时,与NSCLC-non COPD组比较有显著性差异(P0.05)。结论:与健康人群比较,NSCLC患者运动耐量减损,且合并COPD的NSCLC患者整个运动阶段通气效率显著下降,单纯肺癌患者未见此特点。CPET可为NSCLC-COPD患者肺切除术前的风险评估提供依据。     

低负荷抗阻训练对老年人体适能的影响

目的 探讨低负荷抗阻训练对老年人体适能的影响。方法 选择2020年6月1日—2021年5月31日就诊于北京协和医院康复医学科门诊的老年人。采用随机数字表法将老年人随机分为中等强度有氧训练组（有氧训练组）、标准负荷抗阻训练组（标准负荷组）和低负荷抗阻训练组（低负荷组）3组。分别在患者第1次训练前和完成12周训练后采用盲法收集其基本信息、心肺耐力（峰值功率、峰值摄氧量）、心/肺功能改善情况[峰值心率、峰值心率预计值、峰值运动时分钟通气量（minute ventilation,VE）、无氧阈时二氧化碳通气当量]、肌肉力量（肌力）改变情况、肌氧饱和度改善情况等，比较训练前后各组指标的差异性。结果 共纳入患者90例，每组各30例。3组患者的年龄、性别、身高、体重、体质量指数比较，差异均无统计学意义（P>0.05）。训练前后各组组间心肺耐力、心/肺功能、肌力、肌氧相关指标比较，差异均无统计学意义（P>0.05）。除心功能相关指标（峰值心率、峰值心率预计值）和静息肌氧水平外，其他肺功能、心肺耐力、肌力、肌氧下降至谷值时间3组组内训练前后比较，差异均有统计学意义（P<0.05）。除峰...     

有氧联合抗阻运动对2型糖尿病患者的效果

目的评价个体化有氧运动联合抗阻运动对2型糖尿病(T2DM)患者血糖水平、心肺耐力、身体成分、生活质量的影响。方法 2016年9月至2017年12月,T2DM患者120例随机分为对照组(n=40)、有氧组(n=40)和联合组(n=40)。3组均行常规药物治疗、健康宣教和饮食指导,有氧组根据心肺运动试验结果进行个体化有氧训练,联合组在有氧组的基础上增加抗阻训练。治疗前和治疗3个月后,测定患者血糖水平、心肺耐力、身体成分和生活质量。结果两运动组治疗后空腹血糖、糖化血红蛋白、胰岛素抵抗指数、峰值运动负荷、无氧阈、峰值摄氧量、代谢当量、氧脉搏、二氧化碳通气当量斜率、脂肪质量、瘦体质量、生活质量评分均较治疗前改善(t2.422, P 0.05),联合组空腹血糖、糖化血红蛋白、胰岛素抵抗指数、峰值运动负荷、瘦体质量、生活质量总分优于有氧组(P 0.05)。结论联合抗阻训练较单纯有氧训练能更有效降低T2DM患者血糖水平,增加瘦体重,提高生活质量,但对提高心肺耐力无明显优势。     

轻中度哮喘患者与健康人的运动耐量对比研究

目的 :比较轻中度哮喘患者与健康人的运动心肺功能 ,研究运动对哮喘患者肺功能的影响 ,探讨轻中度哮喘患者提高运动耐量的可行性。方法 :采用负荷递增运动方案 ,对 2 0例轻中度哮喘患者及 2 0例健康志愿者进行了运动心肺功能试验。运动前后测一秒钟用力呼气容积 (FEV1 )、用力肺活量 (FVC)、最大呼气中段流量 (FEF 2 5 %- 75 % )、最大呼气末段流量 (FEF 75 % - 85 % )、呼气流量峰值 (PEF)等 ,运动中监测心率 (HR)、每分钟氧耗量(VO2 )、每分钟二氧化碳排出量 (VCO2 )、每分钟通气量 (VE)、氧脉搏 (O2 pulse)、呼吸频率 (BF)等。结果 :运动后 ,哮喘组与正常对照组的FVC、FEV1 、PEF、FEF 2 5 %— 75 %、FEF 75 %— 85 %均有所改善 ,有统计学意义 (P <0 .0 5) ,但两组在改善的差值上无显著意义 (P >0 .0 5)。哮喘患者的最大作功、最大氧耗量 (VO2max)、最大二氧化碳排出量 (VCO2max)、最大每分钟通气量 (VEmax)均显著低于健康人 (P <0 .0 5) ,无氧阈提前出现。结论 :轻中度哮喘患者的运动能力低于健康人 ,但通过小负荷运动可改善肺功能     

心肺康复治疗对冠心病患者心肺功能及生活质量的影响

目的：观察心肺康复训练对冠心病患者心肺功能和生活质量的影响。方法：冠心病患者116例随机分为观察组和对照组各58例。2组均给予常规内科药物治疗,观察组在此基础上给予系统的心肺康复训练。结果：治疗1个月后,观察组的无氧阈（AT）、峰值氧脉搏及峰值氧摄取量均明显高于对照组（P＜0．05）,二氧化碳通气当量（VE/VCO2）斜率明显低于对照组（P＜0．05）;观察组SF-36各项评分均较治疗前及对照组明显提高（P＜0．05）,对照组治疗前后比较差异无统计学意义;2组SAS和SDS评分均较治疗前明显降低（P＜0．05）,且观察组更低于对照组（P＜0．05）。结论：对冠心病患者实施系统心肺康复治疗,可明显改善患者的肺功能,提高患者的运动耐力和生活质量,改善患者的心理状况。     

心肺康复治疗对冠心病患者心肺功能、SAS及SDS评分的影响

目的探究分析心肺康复治疗对冠心病患者心肺功能及焦虑自评量表(SAS)、抑郁自评量表(SDS)评分的影响。方法随机选取该院在2013年1月至2016年1月收治的178例冠心病患者为研究对象,并将其分为观察组和对照组,其中对照组患者采用常规药物治疗,观察组患者采用心肺康复治疗,观察并对比分析两组患者的焦虑抑郁评分及心肺功能变化情况。结果治疗后,观察组患者的SAS评分(30.25±4.31)分和SDS评分(30.31±3.51)分明显优于对照组(P0.05);观察组患者的无氧阀(AT)(15.74±1.03)mL·kg~(-1)·min~(-1)、二氧化碳通气当量斜率(VE/VCO_2斜率)、峰值氧脉搏(12.34±2.02)mL/bpm及峰值氧摄取量(24.58±4.79)mL·kg~(-1)·min~(-1)指标明显高于对照组(P0.05),且观察组患者的生活质量评分显著高于对照组,两组比较差异有统计学意义(P0.05)。结论心肺康复训练在冠心病治疗中具有显著的应用价值,能够有效改善患者的焦虑抑郁状态,改善心肺功能,有助于提高生活质量,值得临床推广应用。     

不同运动方式训练对慢性肾脏病患者运动功能的影响

目的探究有氧运动和有氧运动联合抗阻训练对慢性肾脏病(CKD)患者肌力、心肺耐力等运动功能的影响。方法 2015年7月至2016年8月,CKD患者60例随机分为对照组(n=20)、有氧运动组(n=20)和有氧联合抗阻训练组(n=20)。有氧运动组以50%峰值摄氧量(VO2peak)踏功率自行车,每次30 min。有氧运动联合抗阻训练组在有氧运动组基础上,进行弹力带抗阻训练。每周3次,共12周。比较三组间训练前后上下肢一次最大重复负荷(1 RM)、心肺运动试验(CPET)、手臂弯曲试验(ACT)、30秒坐站试验(CS-30)和6分钟步行试验(6MWT)的差异,并监测训练前后患者血肌酐(sCr)和肾小球滤过率(e GFR)的变化。结果训练前三组间各指标均无显著性差异(F1.841,P0.05)。训练后,有氧运动组和有氧联合抗阻训练组在各指标方面均改善(t2.162,P0.05),且优于对照组(t2.132,P0.05);有氧联合抗阻训练组在上肢1 RM、下肢1 RM、VO_(2peak)、ACT、CS-30和6MWT方面均优于有氧运动组(t2.081,P0.05)。结论有氧运动可改善CKD患者运动功能,联合抗阻训练效果更好。     

耐力训练结合肌力训练对慢性阻塞性肺疾病患者运动耐力及生存质量的影响

目的:研究耐力训练结合肌力训练对慢性阻塞性肺疾病(COPD)患者肺功能、肌力、运动耐力以及生存质量(QOL)的影响。方法:选择符合入选标准的COPD患者45例,随机分为,耐力训练组、肌力训练组和混合训练组(耐力与肌力训练相结合)各15例。三组均接受常规药物的治疗,在此基础上,分别进行耐力训练、肌力训练和耐力联合肌力训练12周,每周3次。干预前、后分别对3组受试者的肺功能、肌力、心肺运动功能、6min步行距离(6MWD)和QOL进行评估。结果:干预前,3组间各项指标比较差异均无显著性意义(P0.05)。干预12周后,3组的肌力、VO2max、最大功率、力竭时间、6MWD和SGRQ得分较治疗前均有明显提高,组内比较差异均有显著性意义(P0.05);干预12周后组间比较,3组的肌力、6MWD和SGRQ得分差异均有显著性意义(P0.05);组间两两比较显示:肌力训练组和混合训练组的各肌群肌力优于耐力训练组(P0.05),但是肌力训练组和混合训练组除胸大肌的肌力外,其余差异均无显著性意义(P0.05);混合训练组6MWD及SGRQ得分优于耐力训练组和肌力训练组(P0.05)。结论:耐力训练结合肌力训练改善COPD患者的运动耐力和肌力,进而改善患者的QOL,为COPD患者临床治疗制定合理的运动方案提供依据。     

适量抗阻运动对慢性心功能不全患者血清PTH、DA、ALD水平和心功能、运动耐力与生活质量的影响

目的研究适量抗阻运动对慢性心功能不全患者血清甲状旁腺激素(PTH)、多巴胺(DA)、醛固酮(ALD)水平和心功能、运动耐力与生活质量的影响。方法选取我院2014年4月—2016年4月90例慢性心功能不全患者,根据心脏康复运动方法的不同均分为抗阻运动组与对照组,对照组在常规药物治疗基础上给予步行锻炼辅助治疗,抗阻运动组在常规药物治疗基础上给予适量抗阻运动,均持续12周。比较两组治疗前后PTH、儿茶酚胺、肾素-血管紧张素系统指标水平,并评价两组治疗前后心功能、运动耐力与生活质量改善情况。结果两组治疗后PTH较治疗前显著降低,DA较治疗前显著升高,差异均有统计学意义(P0.01);治疗后,抗阻运动组PTH显著低于对照组,DA显著高于对照组,差异均有统计学意义(P0.05或P0.01)。两组治疗后血管紧张素Ⅰ(ANG-Ⅰ)、血管紧张素Ⅱ(ANG-Ⅱ)、ALD水平均较治疗前显著降低(P0.01),且抗阻运动组治疗后ANG-Ⅰ、ANG-Ⅱ、ALD水平均显著低于对照组(P0.01)。两组治疗后左心室收缩末期内径、左心室舒张末期内径较治疗前显著降低,左心室射血分数(LVEF)、心搏出量(CO)较治疗前显著升高,差异均有统计学意义(P0.01);治疗后,抗阻运动组LVEF、CO显著高于对照组(P0.05)。两组治疗后最大负荷、6 min步行距离较治疗前显著增加,明尼苏达心功能不全生命质量量表(minnesota living with heart failure questionnaire, MLHFQ)评分较治疗前显著降低,差异均有统计学意义(P0.05或P0.01);抗阻运动组治疗后最大负荷、6 min步行距离显著大于对照组(P0.05),MLHFQ评分显著低于对照组(P0.01)。结论常规药物治疗基础上辅以适量抗阻运动可以抑制慢性心功能不全患者PTH、ALD分泌,促进DA合成,对心功能、运动耐力与生活质量也具有不同程度改善作用。     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.