健康人压痛阈特点的初步研究

摘要 目的：通过测量健康正常人的压痛阈值,分析中国人压痛阈特点，比较个体间及个体内压痛阈差异。 方法：一名施测者使用手持式压力测痛仪对37例健康正常受测者全身共12个部位进行压痛阈测量。这些受测点分布于身体两侧不同的组织如骨突、肌肉处。对每个受测点测量三次取平均值并分析不同个体之间以及个体内各受测点之间的压痛阈差异。 结果：不同个体间压痛阈差异具有显著性意义（P<0.05）；女性压痛阈值低于男性（P<0.05）；同一个体不同部位压痛阈差异具有显著性意义（P<0.05），但双侧对称部位压痛阈的差异则无显著性意义（P>0.05）。脊旁肌的压痛阈较高而骨突处的压痛阈较低。 结论：进行临床疼痛评估时在选择参照点以及结果分析中应重视压痛阈在个体间以及个体内的差异。分析压痛阈的影响因素以及建立适用于中国人群的压痛阈正常参考值是今后研究的任务。     

小面积探头测量人体压痛阈影响因素及正常参考值调查

目的:分析0.1 cm2小面积探头用于压痛阈测量的影响因素,并计算其正常参考值。方法:以武汉某校男女各50名健康在校大学生为受试者,采用0.1 cm2探头的压力测痛仪,选定右侧前臂两个测痛点,测量两处皮脂厚度、压痛痛觉和耐痛阈值,然后分析影响压痛阈的因素并计算其正常参考值。结果:女性受试者两测痛点处压痛阈值比男性低(P<0.001);各测痛点压痛阈值与测痛点处皮脂厚度(P<0.05)呈正相关;纳入受试者测痛点1处压痛阈值低于测痛点2(P<0.001);通过计算得到不同性别受试者两测痛点处压痛阈值95%正常参考值。结论:0.1 cm2探头用于压痛阈测量受到性别、测痛点深部组织结构及皮脂厚度的影响;本研究所得的正常参考值可为今后0.1 cm2探头用于临床压痛测量提供一定参考。     

简式中文版Oswestry功能障碍指数评定下背痛患者的信度及效度分析

目的研究简式中文版Oswestry功能障碍指数(SCODI)评定腰骶部慢性骨筋膜间隔综合征(LCCS)所致下背痛(LBP)患者手术疗效的信度及效度。 方法共选取140例LCCS所致LBP患者，根据其病情给予腰骶部切开减压术治疗。于术前、术后采用SCODI、Roland-Morris功能障碍问卷量表(RDQ)及目测类比评分法(VAS)对患者进行评定，并对SCODI的信度及效度进行分析，其中信度分析指标包括：①Spearman-Brown折半信度；②内部一致性Cronbach′s α系数，重测信度内部相关系数（ICC）。效度分析指标包括：Spearman相关系数（分析效标效度）及因子分析（分析构架效度），并与RDQ、VAS及世界卫生组织国际功能、残疾与健康分类（ICF）核心要目进行相关性分析。 结果信度分析：SCODI量表Spearman-Brown折半信度系数为0.746，Cronbach′s α系数为0.884，重测信度ICC为0.907，提示量表信度理想；效度分析：SCODI量表KMO值为0.82，术前与RDQ、VAS、ICF核心要目的Spearman相关系数分别为0.783，0.945和0.865，术后分别为0.880，0.915和0.548，提示SCODI量表效标效度及结构效度理想。 结论SCODI量表评定LCCS所致LBP患者具有较好的信度及效度，可作为决策腰痛功能障碍患者是否需要手术以及评定手术疗效的重要参考指标。     

中文版儿童作业疗法认知功能动态评定量表信度和效度的初步研究

目的确定中文版儿童作业疗法认知功能动态评定量表（DOTCA-Ch）的信度和效度,为其临床应用提供理论依据。 方法将英文版DOTCA-Ch翻译成中文。选取佳木斯市某小学109名学生,分别用中文版DOTCA-Ch和中国-比内智力测验法进行评定。以中国-比内智力测验法作为校标分析校标效度,采用因子分析方法进行结构效度分析,采用组内相关系数（ICC）分析方法进行测量者内信度和测量者间信度分析,应用Cronbach α系数进行内部一致性检验。 结果内部一致性检验：DOTCA-Ch总Cronbach α系数为0.8920,测量者内总ICC为0.991,测量者间总ICC为0.989。在旋转后的因子负荷阵中,各领域在一个公因子中有较高负荷。将采用中国-比内智力测验法所得智商与DOTCA-Ch评分进行相关性分析,6岁组智商与总分的相关系数为0.872,11~12岁组智商与总分相关系数为0.870。 结论中文版DOTCA-Ch具有良好的信度和效度,可以作为一种有效测量工具来评定儿童认知功能。     

手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度研究

目的探讨手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中的信度。 方法以2009年2月至11月在复旦大学附属儿科医院康复中心接受康复治疗的28例3岁以上的痉挛型脑瘫患儿为研究对象，采用手持式肌力测定仪（HHD）标准化操作方法测定患儿下肢髋、膝、踝等部位肌群的肌力，任意选取20例患儿在接受第1次HHD测定后休息10 min，再由同一测试者进行重复测试，通过比较前后测试结果间的相关性来确定HHD的重测信度；在非同一天任意选取15例患儿在接受第1次HHD测定后休息10 min，再由不同测试者进行重复测试，通过比较前后测试结果间的相关性来确定HHD的不同测试者间信度。 结果HHD在测定痉挛型脑瘫患儿下肢肌群时有良好的重测信度（ICC值在0.74～0.97之间）和不同测试者间信度（ICC值在0.63～0.97之间），其中髋屈曲、足跖屈和膝伸展肌群的重测信度最高（ICC值在0.94～0.97之间），髋屈曲、足背屈的不同测试者间信度最高（ICC值在0.90～0.97之间）。 结论采用标准化的测试方法，手持式电子肌力测定仪在痉挛型脑瘫儿童下肢肌力测定中具有良好的重测信度和不同测试者间信度，可以良好地评价脑瘫患儿的下肢肌力。     

语言行为评估量表的信度与效度研究

目的初步验证语言行为评估量表的信度与效度。 方法由同一名检测人员采用语言行为评估量表对20例言语障碍患者进行重复评估，间隔时间为2周，分析该量表的重测信度；对235例言语障碍患者进行评估，分析该量表的结构效度。 结果①语言行为评估量表2次重复测量的相关系数r=0.723，P=0.05；同一次测量各条目间一致性检验，Cronbach α=0.819；②主成分分析和因素分析的结果提示语言行为评估量表存在3个因子：接受性言语、交流性言语、描述性言语，累积方差贡献率为83.067%。 结论语言行为量表具有良好的信度和效度，可用于言语障碍患者言语能力的评估，为言语康复训练提供参考。     

中文版剑桥前瞻性记忆测量表的信度和标准效度研究

目的探讨中文版剑桥前瞻性记忆测试（C-CAMPROMPT）用于评估中国脑损伤患者的各种信度和标准效度。 方法按程序将英文版剑桥前瞻性记忆测试（CAMPROMPT）翻译成中文。30例“正常人”作为信度组和39例临床观察发现存在记忆功能障碍的脑损伤患者作为效度组入选本研究。采用相关分析、Cronbach α系数法分析量表的重测信度、测试者间信度、复本信度、同质性信度及标准效度。 结果信度测试的相关系数和Cronbach α系数为0.697~0.951。效度分析结果显示，C-CAMPROMPT总分和基于事件任务得分与Rivermead行为记忆测试(RBMT）各领域得分呈正相关，基于时间任务与中文版Stroop字-颜色测试（C-SCWT）回溯性记忆任务得分呈负相关。 结论C-CAMPROMPT具有良好的信度和效度，可用于临床评估中国脑损伤患者的前瞻性记忆功能。     

简体中文版Oswestry功能障碍指数评定社区康复治疗腰椎间盘突出症的信度及效度分析

目的研究简体中文版Oswestry功能障碍指数（SCODI）评定社区综合康复治疗腰椎间盘突出症（LDH）的疗效及信度、效度，为全面推广社区综合康复治疗LDH提供参考依据。 方法共选取在社区接受康复治疗的LDH患者165例，根据其病情程度给予相应康复治疗。于治疗前及治疗3个月后，分别采用SCODI、Roland-Morris功能障碍问卷（RMDQ）及目测类比评分（VAS）对患者进行评估；并对SCODI量表的信度及效度进行分析，其中信度分析指标包括内部一致性Cronbach′s α系数、重测信度内部相关系数（ICC）；效度分析指标包括Spearman相关系数（分析效标效度）及因子分析（分析构架效度），并对SCODI评分及RMDQ、VAS结果进行相关性分析。 结果不同程度病情LDH患者经社区相应康复治疗后，发现上述各量表评分均较治疗前明显改善，提示社区综合康复治疗能有效改善LDH患者病情，促进生活质量提高；本研究还同时发现SCODI量表在评价LDH患者疗效方面具有较好的信度及效度，其结果与RMDQ、VAS评分具有明显相关性。 结论社区综合康复治疗能显著改善LDH患者病情，促进生活质量提高；采用SCODI量表评定LDH患者疗效具有良好的信度及效度，可作为康复疗效评价指标之一，为全面推广社区综合康复治疗LDH提供参考依据。     

激痛点针刺治疗慢性腰肌筋膜疼痛综合征的临床治疗效应研究

目的:评价激痛点针刺对慢性腰肌筋膜疼痛综合征病人主客观功能障碍指标的临床治疗效应及不良反应。方法:60名慢性腰肌筋膜疼痛综合征病人被随机分配到针刺组和对照组。针刺组30名病人在腰臀部肌筋膜激痛点上接受针刺治疗,而对照组30名病人在腰臀部疼痛部位上接受低强度感觉阈经皮电刺激安慰性对照治疗。两组各接受每周一次,共4周的治疗。两组病人分别在治疗前后进行临床评估,内容包括测量视觉模拟评分(visual analogue scale,VAS)和功能障碍(Roland-Morris dysfunction questionnaire,RDQ)水平以及客观的压力疼痛阈值(pressure pain threshold,PPT)和腰部活动范围(range of motion,ROM)。结果:各项主观(VAS、RDQ)和客观(PPT、ROM)指标在针刺后均显示有显著改善,而对照组在治疗后仅有主观症状的显著改善,并且两组间比较仍显示针刺组主观症状改善显著优于对照组。除了针刺后酸痛反应,没有观察到其他显著不良反应。结论:激痛点针刺对于改善慢性腰肌筋膜疼痛病人的疼痛症状和功能性表现均具有积极的治疗效应,是治疗慢性腰肌筋膜疼痛综合征的一种有效方法。     

四种上肢功能评定量表用于脑卒中患者的信度研究

目的探讨脑卒中偏瘫患者Fugl-Meyer量表上肢运动功能测试部分(U-FMA)、Wolf运动功能测试量表(WMFT)、组块测试(BBT)及九孔柱测试 (NHPT)间不同评定次数的重测信度和不同评价者间的组间信度。 方法选取18例脑卒中患者,2 h内应用上述4种量表对每例患者进行2次评定,每次评定均由2名受过专业训练的评定员分别进行。 结果U-FMA的重测信度组内相关系数（ICC）为0.988,组间信度ICC为0.959;WMFT的计时均数和计时中位数重测信度ICC分别为0.996和0.393,组间信度ICC均为1.000;WMFT的动作质量等级评分均数重测信度ICC为0.989,组间信度ICC为0.977;BBT患手计数及患手与健手差值的重测信度ICC分别为0.975和0.982;NHPT患手计时及患手与健手计时差值的重测信度ICC分别为0.937和0.936,组间信度ICC均为1.000。 结论U-FMA、WMFT、BBT及九孔柱测试均具有良好的重测信度和组间信度,适用于脑卒中患者手部功能的临床评价。     

Systolic pressure variation and pulse pressure variation during modifications of arterial pressure

OBJECTIVE: This study was performed to investigate the effect of vasopressor therapy on systolic pressure variation (SPV) and pulse pressure variation (PPV) compared to experimentally measured left ventricular stroke volume variation (SVV). DESIGN AND SETTING: Prospective study in a university laboratory. SUBJECTS: Twelve anesthetized and mechanically ventilated pigs. INTERVENTIONS: Increase in mean arterial pressure (by 100%) using phenylephrine and decrease (by 38%) using adenosine. MEASUREMENTS AND RESULTS: SPV and PPV were calculated and compared to SVV derived from aortic blood flow measurements. SPV was significantly affected by changes in arterial pressure [4.6% (1.5) vs. 6.3% (2.1), p[Symbol: see text]<[Symbol: see text]0.05, increased vs. decreased arterial pressure], whereas PPV did not change during modifications of arterial pressure. During baseline conditions and decreased afterload, correlation with SVV was good both for SPV (r[Symbol: see text]=[Symbol: see text]0.892 and r[Symbol: see text]=[Symbol: see text]0.859, respectively) and for PPV (r[Symbol: see text]=[Symbol: see text]0.870 and r[Symbol: see text]=[Symbol: see text]0.871, respectively) (all p[Symbol: see text]<[Symbol: see text]0.001). Correlation with SVV was only moderate during increased arterial pressure (r[Symbol: see text]=[Symbol: see text]0.683 for SPV and r[Symbol: see text]=[Symbol: see text]0.732 for PPV, p[Symbol: see text]<[Symbol: see text]0.05). CONCLUSION: For guiding fluid therapy in patients under vasopressor support, PPV seems superior to SPV.     

Effect of positive end-expiratory pressure on intra-abdominal pressure

Massive elevation of intra-abdominal pressure (IAP) causes renal, cardiovascular, and respiratory dysfunction. Positive end-expiratory pressure (PEEP) markedly increases the detrimental effect of IAP on the cardiovascular system. The purpose of this study was to determine the effect of PEEP on IAP. In 15 patients requiring mechanical ventilation, IAP was measured, after 15-minute equilibration intervals, at PEEP levels of 0, 5, 10, and 15 cm H2O. Parametric analysis with multiple paired t tests and nonparametric analysis with Spearman's rho and Kendall's tau tests were used to determine correlation between PEEP and IAP. All patients were male. The mean age was 39 years (range, 18-77). Ten patients had just had laparotomy. No correlation was found between PEEP and IAP. We conclude that PEEP of 15 cm H2O or less has no effect on IAP, and we discuss the clinical implications.     

Intracranial pressure. Intracranial pressure monitoring

Based on the data on the current literature, the authors present the basic physiological and pathophysiological aspects of measurement of intracranial pressure and discuss indications for its monitoring and clinical value.     

Plasma osmotic pressure and oncotic pressure

Water distribution in the body fluid is controlled by osmotic pressure and oncotic pressure of plasma. Lower plasma osmotic pressure induces intracellular edema, while lower plasma oncotic pressure induces extracellular edema. The increase in osmo-active substance in plasma induces increase in plasma volume (or extracellular fluid), and then results in extracellular edema.     

Quantification of pressure relief using interface pressure and tissue perfusion in alternating pressure air mattresses

OBJECTIVE: To examine whether the interface pressure (IP) relief provided by alternating pressure air mattresses (APAMs) is matched with maintenance of tissue perfusion over the points of contact by measuring transcutaneous oxygen and carbon dioxide (tcPO2, tcPCO2). DESIGN: Comparative analysis of 2 APAMs with a 2-parameter continuous time-based method for quantifying pressure relief (PR) and transcutaneous gas measurement for assessing tissue perfusion. SETTING: Rehabilitation research facility in a university hospital. PARTICIPANTS: Eleven able-bodied adult postgraduate student volunteers. MAIN OUTCOME MEASURES: Two full-replacement APAM systems were used. For each mattress the mean maximum and minimum interface pressures; mean peak air pressures in the mattresses; interface pressure durations below 30, 20, and 10 mmHg over a 60-minute period; mean maximum tcPCO2 and minimum tcPO2; and mean area under the tcPO2 and tcPCO2 curves were measured for each subject. RESULTS: IP on the sacrum was held below thresholds of 30, 20, and 10 mmHg longer on a 2-cell, low pressure system than on a 3-cell, high pressure system (p < .001). Integrated over time, tcPO2 levels also indicated that the 2-cell system retained oxygen levels closer to the unloaded baseline than did the 3-cell system (p < .01). tcPCO2 levels did not rise significantly (p > 0.1) compared with the baseline measurement in both mattresses. CONCLUSIONS: PR was sensitive to the design of the APAM, especially its inflation pressure, cycle time, and inflation sequence. If future trials demonstrate that PR values and transcutaneous blood gas measurements correlate significantly with the clinical incidence of pressure sore formation, then this technique may prove useful in assessing the effectiveness of alternating pressure support surfaces.     

The effects of NG-nitro-L-arginine methyl ester on systolic pressure, diastolic pressure and pulse pressure according to the initial level of blood pressure

The objective of this study was to re-examine whether the effect of the nitric oxide synthesis inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), on blood pressure depends on peripheral vascular tone. The effects of L-NAME (10 mg/kg, i.v.) on diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP) and heart rate (HR) were studied in pithed rats. Sal-pithed rats received 0.9% NaCl, 10 microl/kg/min. Vascular tone was step-wise increased with 3, 10 and 30 microg/kg/min intravenous phenylephrine infusion (LPhe-pithed, MPhe-pithed and HPhe-pithed rats respectively). L-NAME elicited vasopressor responses in all the animals studied. L-NAME increases in SBP and DBP in Sal-pithed rats were significantly smaller than the ones obtained in phenylephrine infused rats. The increases in DBP elicited by L-NAME were greater in LPhe-pithed rats compared with those of MPhe-pithed and HPhe-pithed rats (i.e. the step-wise rises in DBP obtained with phenylephrine were inversely related to the increases in DBP produced by L-NAME); however, the increases in SBP were similar between these experimental groups. The PP increased during L-NAME-induced pressor responses in phenylephrine-infused rats. l-NAME increases in PP showed the following order: Sal-pithed < LPhe-pithed < MPhe-pithed < or = HPhe-pithed rats. HR was not modified by L-NAME. In conclusion, the vasopressor responses produced by L-NAME in pithed rats are influenced by the pre-existing vasomotor tone in complex form. We did not find a simple positive correlation between the vascular tone or level of arterial pressure, and the magnitude of the diastolic and systolic pressor responses elicited by L-NAME. Interestingly, the increase in PP induced by l-NAME was greater in accordance with the increasing value of baseline arterial pressure. NO synthesis inhibition in the arterial endothelium may possibly explain the increase in PP caused by L-NAME, as resulting from the reduction in proximal conduit artery compliance.     

Effects of relaxation of inspiratory muscleson ventilator pressure during pressure support

OBJECTIVE: During pressure support ventilation (PS), an abrupt increase in ventilator pressure above the pre-set level is considered to signify expiratory muscle activity. However, relaxation of inspiratory muscles may also cause the same phenomenon, and this hypothesis has not been explored. The aim of this study is to examine the cause of this increase in ventilator pressure, during PS, in critically ill patients. DESIGN: Retrospective study. SETTING: In a university intensive care unit. METHODS: Fifteen patients instrumented with esophageal and gastric balloons, and in whom airway pressure (P (aw)) during PS exhibited an acute increase above the pre-set level towards the end of mechanical inspiration were retrospectively analyzed. For each breath, the time of the rapid increase in P (aw) was identified (t (Paw)) and, using the transdiaphragmatic (P (di)) and gastric (P (ga)) pressure waveforms, related to: (1) the end of neural inspiration (peak P (di)) and (2) the time at which P (ga) started to increase rapidly after the end of neural inspiration indicating expiratory muscle recruitment. RESULTS: The t (Paw) was observed 32+/-34ms after the end of neural inspiration, well before (323+/-182ms) expiratory muscle recruitment (identified in eight patients). There was a significant linear relationship between the rate of rise of P (aw) after t (Paw) and the rates of decline of P (di) and inspiratory flow. CONCLUSION: We conclude that, during PS ventilation, the relaxation of inspiratory muscles accounts for the acute increase in P (aw) above the pre-set level, in addition to the contribution made by the occurrence of expiratory muscle activity.     

Positive end-expiratory pressure increases intraocular pressure in cats

BACKGROUND AND METHODS: The purpose of the present study was to examine the effect of various levels of positive end-expiratory pressure on intraocular pressure in cats. Fourteen healthy adult cats (2.6 to 3.7 kg) without evidence of ocular disease were anesthetized with pentobarbital, paralyzed, and placed on mechanical ventilation. Direct continuous measurements of heart rate (HR), mean arterial pressure (MAP), CVP, CSF pressure, and intraocular pressure were recorded at zero end-expiratory pressure, and at 5, 10, and 15 cm H2O positive end-expiratory pressure, applied in random order. MAIN RESULTS: There were no significant changes in pHa, Paco2, HR, MAP, hematocrit, and temperature. Intraocular pressure increased significantly from 17 (during zero end-expiratory pressure) to 20 mm Hg at 10 cm H2O positive end-expiratory pressure; at 15 cm H2O positive end-expiratory pressure, intraocular pressure increased significantly to 21 mm Hg. CVP and CSF pressure increased significantly in parallel with intraocular pressure at 5, 10, and 15 cm H2O positive end-expiratory pressure. CONCLUSIONS: We speculate that similar responses occur in man, and may be undesirable in patients with already increased intraocular pressure, when higher levels of positive end-expiratory pressure are used.     

Heel pressure ulcers and ankle brachial pressure index

There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.