握力测量的研究进展

通过PubMed检索1954～2009年的有关文献,对握力评定的测量工具、测量方法、影响握力值的因素、握力耐力相关研究以及握力测量的信度研究进行综述。结果发现,握力测量受多种因素影响,在临床实践中需要采取标准化测量方法及过程,以得到更为准确的结果。     

两种标准化的握力测试方式对健康青年握力测试结果的影响

目的比较美国手部疗法协会和国民体质测定标准手册所推荐两种标准化的握力测试方式对健康青年握力测试结果的影响。方法采用Dynamometer G100型握力器,用两种方法分别测量32名右利手健康青年左手和右手的握力,各测试3次,取平均值。结果采用美国手部疗法协会标准测试方式所测得的左、右手的握力小于国民体质测定标准测试的左、右手的握力(P<0.05)。结论两种标准化测试方式有显著差异。建议临床研究握力需统一测试方式,并建议采用美国手部疗法协会推荐的测试方式。     

稳定期慢性阻塞性肺疾病病人握力水平现状及其影响因素分析

[目的]调查稳定期慢性阻塞性肺疾病(COPD)病人握力水平,并探讨其影响因素。[方法]采用一般资料调查表、握力器、身体成分分析仪等对96例稳定期COPD病人进行相关检测。[结果]稳定期COPD病人握力水平较同龄正常老年人低,性别、年龄、吸烟史以及呼吸困难指数对握力水平有影响;控制变量年龄、性别后,握力水平与疾病相关指标[第一秒用力呼气容积占预计值的百分比、6min步行距离、体重指数、多因素分级系统(BODE)指数以及呼吸困难指数]相关(P0.05或P0.01),性别、年龄、6min步行距离可以解释握力水平的38.8%的变异量。[结论]稳定期COPD病人握力水平较正常老年人群低,其与疾病相关指标有一定相关性,临床工作者可参考握力测试结果快速评估病人的功能状态。     

维持性血液透析病人握力下降现状及影响因素分析

目的:了解维持性血液透析(MHD)病人握力下降情况及其影响因素.方法:采用便利抽样法选取某血液透析培训基地的198例MHD病人作为研究对象,应用一般情况调查表、握力测试器、Fried衰弱表型(FP)、透析客观营养评价法(OSND)对病人进行调查,应用单因素Logistic回归分析和多因素Logistic回归分析探索MHD病人握力下降的影响因素.结果:MHD病人握力水平为(23.11±9.26)kg,其中男性为(26.66±9.55)kg,女性为(18.40±6.33)kg,握力下降率为42.4％(84/198).多因素Logictic回归分析表明男性、透析不充分、营养不良、衰弱和活动量下降是MHD病人握力下降的主要危险因素(模型似然比χ2=150.560,P<0.001).结论:MHD病人握力水平不佳,男性病人更易发生握力下降,临床应加强病人透析充分性指标、营养情况和衰弱状态的监测,鼓励病人进行一定强度的运动.     

握力在维持性血液透析患者营养评定中的应用

目的测量血液透析患者的握力及相关因素,分析握力与其他营养指标之间的关联。方法测量109例血液透析时间大于3个月,非急性炎症、活动性肝脏病、肿瘤及恶液质患者握力,采用生化指标、人体测量指标、主观综合评估量表方法全面评价患者的营养状态,并与握力测量的结果进行比较。结果握力作为营养指标,与传统意义上的营养指标尤其是前白蛋白、C反应蛋白及炎症指标存在显著相关（P〈0.05）。多因素回归分析显示,年龄、性别是影响握力的主要因素。结论握力作为营养指标,测量快捷、准确,与其他营养指标密切相关,值得在血液透析患者的临床实践和研究中进一步推广和应用。     

恶性肿瘤患者握力的影响因素分析

目的探讨恶性肿瘤患者握力的影响因素,以期为握力在恶性肿瘤患者营养评估中的应用奠定基础。方法采用横断面调查研究方法,收集广西省某三级甲等医院肿瘤内科156例恶性肿瘤患者的临床资料,并测量其握力水平、人体测量学指标及实验室指标,使用营养风险筛查-2002(Nutritional Risk Screening-2002,NRS2002)进行营养风险评分,Pearson相关分析握力与营养相关人体测量学指标、实验室指标及NRS2002营养评分的相关性,采用多元线性回归分析恶性肿瘤患者握力的影响因素。结果 Pearson相关分析结果显示,恶性肿瘤患者握力水平与身高、体质量、体质指数、臂围、小腿围、血清白蛋白、血红蛋白、血肌酐呈正相关(P0.05),与NRS2002营养评分呈负相关(P0.05);多元线性回归分析结果显示,性别、年龄、血清白蛋白及NRS2002营养评分进入回归方程,共解释总变异的66.7%(P0.05)。结论性别、年龄、血清白蛋白及NRS2002营养评分情况是恶性肿瘤患者握力的影响因素。     

ICU老年机械通气患者握力现状与影响因素分析

目的 调查ICU老年机械通气患者握力现状,并探讨其影响因素。 方法 便利选取2020年1月—12月浙江省某三级甲等医院ICU收治的218例老年机械通气患者作为调查对象,采用一般资料调查表、电子握力器、营养风险评估量表2002对其进行横断面调查。采用多元线性回归分析老年机械通气患者握力的影响因素。 结果 ICU老年机械通气患者的握力为（13.8±4.7） kg。多元线性回归分析显示,性别、年龄、运动方式、镇静药物使用时间、营养风险评估量表2002评分是影响其握力的主要因素（P<0.05）。 结论 ICU老年机械通气患者的握力较低,女性、高龄、既往不运动、镇静药物使用时间>5 d、营养风险评估量表2002评分≥3分的机械通气患者握力较低。护理人员应加强其握力的动态评估,控制相关影响因素。     

长期卧床高龄老年人握力的重测信度

目的 探讨长期卧床80岁以上高龄老年人握力的重测信度.方法 对20例卧床时间超过1年的80岁以上老年人取卧姿,采用JAMAR握力器分别测试其左、右手的握力.第1次测试结束7 d后,在同一时间段由同一测试者重复测试1次.结果 左于握力和右手握力的组内相关系数(ICC)分别为0.985和0.970.结论 长期卧床高龄老年人的握力测试具有较高的重测信度.     

138例住院老年慢性病病人握力及其影响因素的调查分析

[目的]探讨我国老年慢性病病人握力的状况,并分析其影响因素。[方法]运用一般资料调查表、CAMRY-1000电子握力计、中文版Tilburg衰弱指标对某老年医院138例老年慢性病病人进行调查。[结果]老年慢性病病人的握力为(19.54±8.9)kg。多元逐步回归分析显示,影响老年慢性病病人握力的因素有躯体衰弱、运动状况、文化程度、三酰甘油含量、血红蛋白5项,可解释握力总变异量的49.8%。[结论]老年慢性病病人握力水平相对较低,对老年慢性病病人进行握力测量,可以筛查肌肉力量下降,进而发现衰弱问题,通过提早干预,预防不良结局发生。     

《护理学报》第6期继续教育思考题

正1作者卢婷等探讨恶性肿瘤患者握力的影响因素,以期为握力在恶性肿瘤患者营养评估中的应用奠定基础。结果显示恶性肿瘤患者握力的影响因素主要有:A性别B年龄C血清白蛋白D臂围E NRS2002营养评分2作者罗文平等研究报道,采用校院合作共建《外科护理学》游戏库进行教学可提高护生:A理论知识B临床应变能力C人际沟通能力D评判思维能力E团队合作能力3作者彭红等对肝癌术后患者灵性健康的影响因素进行分     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.