早期康复护理对脑卒中血肿清除术后病人的影响

目的 探计早期康复护理对脑卒中瘫痪病人行血肿清除术后肢体功能预后的影响。方法 将214例脑卒中瘫痪行血肿清除术后病人随机分为康复组(105例)和对照组(109例)。两组均接受常规护理,康复组在此基础上,待病人生命体征稳定48 h后对其进行早期康复护理,分别于入院时和入院后第20天测评两组病人肢体运动功能、日常生活能力(ADL)。结果入院时两组病人肢体运动功能及ADL比较,差异无显著性意义(P>0.05),入院第20天两组病人各项指标均有明显改善,但观察组显著优于对照组(P<0.01)。结论早期康复护理可改善病人瘫痪肢体运动功能和ADL,对病人预后有良好的作用。     

早期康复心理治疗对初发精神分裂症病人的作用

目的探讨康复心理治疗对延缓精神分裂症病人社会功能缺陷及复发的作用。方法将 2 87例初发精神分裂症病人随机分为对照组 (138例 )和观察组 (14 9例 )。两组均行常规治疗护理 ,观察组在此基础上进行 8周康复心理治疗。于入院时及治疗 8周末 ,用住院精神病病人康复疗效评定量表 (IPROS)及自定约束不良言行标准评定病人近期疗效 ;出院后随访 1年 ,1年后 ,用社会功能缺陷筛选量表 (SDSS)评定病人院外社会功能缺陷情况 ,并比较两组病人复发情况。结果治疗 8周末 ,观察组IPROS总分及各因子分显著低于对照组 (均P <0 .0 1) ;其主要不良言行人均发生次数明显少于对照组 (P <0 .0 5或P <0 .0 1)。 1年后 ,观察组SDSS总均分及第 1、5、6、9、10单项分显著低于对照组 (P <0 .0 5或P <0 .0 1) ,两组 1年内复发率分别为 2 2 .15 %和 4 1.30 % ,对照组显著高于观察组 (P <0 .0 1)。结论早期康复心理治疗可提高初发精神分裂症治疗效果 ,有效减轻病人的社会功能缺陷及减少疾病复发。     

脑卒中病人的康复护理和生活质量研究

为探讨康复护理对脑座病人神经功能恢复和生活质量改善的意义,将96例脑卒中病随机分为康复组和对照组各48例。对照组予一般护理,康复组实施康复护理。3个月后对两组治疗前后进行神经功能及生活质量评价并比较。结果康复组在神经功能缺损程度恢复和生活质量指数改善方面均明显优于对照组,两组比较,差异有显著性意义（P＜0．05）。提示脑卒中病人的康复护理对神经功能的恢复和生活质量的改善具有一定效果。     

知识竞赛在精神分裂症病人健康教育中的应用

将 2 1 6例精神分裂症病人随机分为观察组和对照组各 1 0 8例。对照组采用常规健康教育 ,观察组在此基础上对病人采取知识竞赛的形式进行健康教育 ,时间均为 8周 ,并进行 3个月的随访。分别于健康教育 8周末及随访结束时采用自制问卷对两组病人进行健康教育效果评定。结果观察组评分显著高于对照组 (均P <0 .0 1 )。提示采用知识竞赛的形式进行健康教育能够充分调动精神分裂症病人的积极主动性及学习兴趣 ,有助于强化记忆     

早期康复锻炼对脑外伤病人肢体功能障碍的影响

目的:探讨早期康复锻炼对脑外伤病人肢体功能恢复的影响.方法:将80例脑外伤肢体功能障碍患者随机分为康复组(40例)和对熙组(40例),两组病人在常规神经外科治疗和护理的基础上,早期康复组病人在发病后3个月内进行康复训练,对照组于发病3个月～6个月后接受康复训练.两组均采用Fugl-meyer评分(FMA)评定运动功能,采用Barthe1指数评定日常生活能力(ADL).结果:康复治疗3个月后,两组病人Barthel指数和Fugl-meyer评分均有一定程度的提高,早期康复组明显高于对照组(P＜0.01).结论:脑外伤病人接受康复治疗可以提高肢体运动功能、日常生活能力.早期康复疗效优于晚期康复.     

早期康复护理对PTCA术后病人恢复及并发症的影响

目的探讨早期康复护理对冠心病PTCA术后病人恢复及并发症的影响 ,评价其措施的有效性和安全性。方法将 10 2例急性心肌梗死、不稳定型心绞痛PTCA术后病人随机分为康复组和对照组各 5 1例。康复组实施系统的早期康复活动指导 ,对照组进行常规护理。比较两组活动情况及并发症发生率。结果康复组术后步行距离及上台阶数均显著优于对照组 (均P <0 .0 1) ,心血管事件发生率显著低于对照组 (P <0 .0 5 )。结论早期康复护理可促进PTCA术后病人早期康复 ,降低心血管事件发生率 ,提高其生活质量。     

超早期康复护理防治偏瘫患者肩手综合征效果观察

目的观察超早期康复护理对预防和治疗脑卒中偏瘫患者肩手综合征的作用.方法将238例脑卒中偏瘫患者随机分为康复组(122例)和对照组116例),两组均给予常规药物治疗和护理,康复组在此基础上予超早期康复护理,包括保持功能和做医疗体操和向心性缠绕压迫手指法、冷-温水交替浸泡法、上举患侧上肢、利用意念促使肢体功能恢复等多种康复训练措施.最后根据患者手指肿胀发生率、患手指肿胀程度以及简易手功能检查(STEE)评定康复效果.结果康复组患者肩手综合征发生率显著低于对照组(P<0.01);康复组治疗后较治疗前手指肿胀程度显著减轻(P<0.01);两组治疗后患肢运动功能均较前显著恢复(P<0.05,P<0.01),而康复组更显著(P<0.05).结论超早期康复护理对脑卒中偏瘫患者肩手综合征的预防和治疗具有积极的促进作用.     

脑卒中抑郁患者实施情志护理及穴位疗法的效果观察

目的 探讨脑卒中患者抑郁情绪的中医护理干预效果.方法 将117例脑卒中患者随机分成干预组(52例)和对照组(65例),两组均采用抗抑郁药物治疗,对照组给予常规护理,干预组在此基础上进行情志护理及穴位疗法.分别时两组患者在入院确诊后和治疗20 d采用抑郁自评量表(SDS)进行效果评定.结果 治疗20 d干预组抑郁程度显著低于对照组(P＜0.01).结论 情志护理及穴位疗法可显著改善脑卒中患者抑郁症状,促进疾病的康复,提高患者生活质量.     

健康教育对髋关节置换术后病人ADL的影响

将 4 0例髋关节置换术后 3～ 5d的病人按随机数字表法分为两组 ,各 2 0例。对照组采用常规康复治疗和康复护理 ,观察组在此基础上对病人进行健康教育。于治疗前及治疗 4周用Barthel指数评分进行日常生活活动能力(ADL)评定。结果两组治疗后Barthel指数评分均较治疗前提高 (均P <0 .0 1) ,两组治疗后比较 ,观察组的评分优于对照组 (P <0 .0 1)。提示健康教育对髋关节置换术后病人肢体功能恢复及提高ADL有极大的促进作用。     

含服酸冰块对脑卒中吞咽障碍患者吞咽功能的改善作用

目的探讨早期含服酸冰块对脑卒中吞咽障碍患者吞咽功能的改善作用。方法将76例急性脑卒中后中度吞咽障碍患者按入院日期单双号分为观察组(40例)和对照组(36例)。两组入院后予降低颅内压、改善脑循环,营养脑细胞及吞咽功能基础训练、摄食训练、冰刺激等康复治疗及常规护理。观察组在此基础上早期含服自制酸冰块刺激口咽部。干预4周后采用才藤氏吞咽障碍7级评价法评定效果。结果干预后观察组吞咽障碍改善程度显著优于对照组(P0.01);两组误吸发生率比较,差异有统计学意义(P0.05)。结论早期实施酸冰块刺激口咽部,可有效改善脑卒中吞咽障碍患者吞咽功能,减少误吸发生。     

Recovery of severe sciatica

STUDY DESIGN: A prospective study of patients with acute severe sciatica. OBJECTIVES: To 1) describe the characteristics of patients with acute severe sciatica and the agreement among different diagnostic tests, 2) describe overall recovery during 1 year in terms of perceived disability, and pain, and 3) explore acute-phase predictors of failure to recover at 1 year. SUMMARY OF BACKGROUND DATA: The development of imaging techniques has been very impressive during recent decades. However, different authors have highlighted the prevalence of abnormal images among asymptomatic subjects. These findings increase the difficulty of interpreting the results from the diagnostic techniques used with each individual patient. Furthermore, other clinical and biopsychosocial variables need to be explored for their associations with recovery or failure to recover. This study aimed to explore those associations. METHODS: Consecutive patients admitted to the hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires that included items on demographics, pain, perceived disability, and quality of life. Imaging and blood samples were collected at the first visit, and an electromyogram was taken for sciatica lasting at least 3 weeks. RESULTS: The study included 82 consecutive patients (66% men) with a mean age of 43 +/- 10.3 years. The mean intensity of pain, on a visual analog scale of 0 to 100 (VAS) at Visit 1, was 73. The straight leg raising test was positive in 78% of the patients, with a mean value of 59 degrees +/- 18 degrees. The contralateral straight leg raising test was positive in 20% of the patients. Imaging was positive for disc herniation in 74% and electromyogram was positive in 62% of cases. These two diagnostic tests showed a good to excellent total agreement (58-87%) with the straight leg raising tests and the presence of radiating pain below the knee. The recovery of clinical symptoms and signs was observed mainly within the first 3 months. However, clinical recovery and perceived recovery was not complete in most cases. CONCLUSIONS: In most cases, there was good to excellent agreement among the different diagnostic tests. None of the tests was predictive of recovery. The presence of blood antibodies against 3'LM1 (IgM + IgG) and GD1a (IgM) was significantly associated (P < 0.023) with neurologic symptoms and signs. However, the meaning of these antibodies remains unclear. Only a minority of the patients (29%) had fully recovered after 12 months. Within the 1-year follow-up, one third of the patients had surgery.     

Recovery from pancuronium

The rate at which paralysis from pancuronium could be reversed by neostigmine was monitored in two groups of patients, one elderly and the other young adults. Some patients were found to have prolonged recovery times, and this slow reversal occurred more frequently in the older group of patients. Possible reasons for this are discussed.     

Recovery care facilities

In a world of rapidly changing policies in healthcare and the constant search for value-based medical care, the anaesthesiologist must be aware of new anaesthetic drugs and techniques utilized in daily practice, and most importantly, be updated on the implications of using these techniques in the ambulatory (day-case) setting without compromising patient safety or jeopardizing the physician-patient relationship. The ambulatory surgery movement has led to some of the most substantial changes in anaesthesia, with special emphasis on recovery care when the patient is rapidly brought into contact with their relatives or escorts shortly after emerging from a sedative or anaesthetic state.     

Pharmacodynamics and the Plasma Concentration of Mivacurium during Spontaneous Recovery and Neostigmine-facilitated Recovery

Background: The authors examined the plasma concentrations of the isomers of mivacurium and its pharmacodynamics during spontaneous and neostigmine-facilitated recovery after a mivacurium infusion.

Methods: Sixteen patients receiving nitrous oxide-opioid anesthesia received 0.25 mg/kg mivacurium. Patient response to neuromuscular stimulation was determined using a mechanomyograph. Once T1 had recovered to 25% of its baseline height, a mivacurium infusion was begun and adjusted to maintain 95-99% neuromuscular block. The infusion was discontinued after 90 min and muscle strength allowed to recover either spontaneously or after neostigmine/glycopyrrolate (0.05/0.01 mg/kg). Plasma concentrations of the isomers of mivacurium after discontinuation of the infusion were determined using an HPLC assay. Differences between the groups were determined using a one-way analysis of variance with a Bonferroni-corrected t test or Student t test as appropriate. P Results: Differences in the times for recovery to a train-of-four ratio of 70% did not achieve statistical significance (mean +/- SD, 13.3 +/- 6.0 vs. 16.3 +/- 2.5 min for the neostigmine and spontaneous groups, respectively). Plasma cholinesterase activity decreased significantly from baseline values after administration of neostigmine (5.88 +/- 0.21 vs. 0.43 +/- 0.04 U/ml plasma). Plasma concentrations of the trans-trans isomer were significantly greater in the neostigmine group than in the spontaneous recovery group 5, 6, 8, and 10 min after discontinuation of the infusion. Differences in the plasma concentration of the cis-trans isomer did not achieve statistical significance.