全面康复:勃起功能障碍治疗的新目标

5型磷酸二酯酶(PDE5)抑制剂有效改善勃起功能障碍(ED)患者的勃起功能。枸橼酸西地那非的应用范围不断扩展,肺动脉高压已成为新的适应证。临床研究发现,西地那非能改善多种血管性疾病患者的内皮功能。在ED领域的研究进展包括:动物实验发现,西地那非可以改善海绵体内皮功能,增强磷酸化内皮型一氧化氮合酶(eNOS)蛋白表达,逆转缺血或缺氧导致的海绵体内压(ICP)降低。临床研究证实,西地那非可以使50%以上ED患者阴茎勃起恢复到最充分的硬度(4级勃起);使50%以上保留神经的根治性前列腺切除术后患者勃起功能康复,自发产生足以性交的勃起;使ED患者的自尊心、自信心和性关系满意度等社会心理功能恢复正常。从勃起功能到社会心理功能的全面恢复可能成为今后ED治疗的新目标。     

老年髋部骨折术后患者康复需求程度与康复状况调查

目的了解老年髋部骨折术后患者康复需求程度、需求满足度与康复状况的关系.方法上门随访82例老年髋部骨折术后患者家庭康复现状和康复需求情况.结果康复需求10个维度中他人支持、康复信息及功能训练指导位居前3位;需求程度与生理功能、躯体功能和社会功能有关(P＜0.05,P＜0.01);与髋关节功能评分中的疼痛程度、上楼梯、穿鞋袜和行走距离4个方面有关(P＜0.05,P＜0.01).结论出院后定期给予针对性的康复训练指导和健康教育是患者迫切的需求;康复需求程度高者,相应需求满足率低,其生活质量及髋关节功能恢复应成为干预的重点.     

关节镜技术的历史与新进展

现代的关节镜从膀胱镜演变而来，创伤小，适用广泛。近年膝关节镜技术在半月板病变处理上有逆行全切法等新方法，交叉韧带重建、软骨移植成为研究热点；关节镜技术除应用于肩关节及其它小间隙关节，还开展治疗弹响髓等关节外应用；个性化康复锻炼提高了手术疗效。     

Cardiac rehabilitation and return to work after coronary artery bypass surgery

The work situation of 66 male patients who underwent elective coronary artery bypass surgery (CABS) and who had been randomly allocated to receive cardiac rehabilitation (group R) was compared with the work situation of 59 similar patients allocated to receive only standard care (group H). The follow-up time was one year. The proportions of subjects working in groups R and H were 26% and 20% (p=ns) before the CABS, 45% and 34% (p=ns) 6 months and 56% and 38% (p=ns) 12 months after the CABS, repectively. The increase in proportion of subjects who worked was significant in both groups at both 6 and 12 months after the CABS (p<0.05 for all changes). The increases were not significantly different between the whole groups, but in patients younger than 55 years of age, return to work was more frequent in group R than in group H (at 12 months 60% vs. 35%, p for the difference in change=0.02). Stepwise logistic regression analysis of the factors influencing return to work showed that a patient's judgement of his own working capacity as good 6 months after CABS (odds ratio (OR) 8.5, confidence interval (CI) 2.3–32.0), functional class 16 months after the CABS (OR 6.7, CI 1.8–24.5), his desire to work (OR 6.4, CI 1.6–26.0) and absence from work of less than 3 months before the CABS (OR 4.9, CI 1.2–20.2) were significant positive predictors of return to work 1 year after the CABS.     

卒中急性期病人中医综合康复护理效果观察

[目的]探讨中医综合康复护理对卒中急性期病人神经功能缺损及日常生活能力（ADL）的影响。[方法]选择2004年9月-2006年9月在3家协作医院住院的卒中急性期238例病人为研究对象，随机分为实验组和对照组，两组药物治疗基本相同。实验组按中医综合康复护理方案进行护理．对照组采用卒中护理常规进行护理。对入选的病人在入院第1周内和4周后进行神经功能缺损及ADL的评定。[结果]4周后实验组在临床神经功能缺损、ADL等方面明显优于对照组，差异有统计学意义（P〈0．01）。[结论]中医综合康复护理可促进肢体的功能恢复，提高病人的ADL。     

Evaluation of stroke rehabilitation by randomized controlled studies: a review

In all, 22 reports of 20 randomized, controlled rehabilitation studies were evaluated. In 18 of these, the design of the trial was parallel, with a cross-over format being employed in the remaining 2 instances. Seven studies related to intensive rehabilitation during the early post-acute period. In six others, specific techniques--sometimes associated with traditional physiotherapy procedures--were compared: biofeedback, perceptual retraining, and amphetamine treatment. Eight experiments evaluated speech therapy in aphasia. Frequently, methodological considerations limited the interpretation of the results. The review showed that: 1) as regards activities of daily life and motor function, differences as between rehabilitation in stroke units on the one hand and non-rehabilitation or rehabilitation in medical wards on the other, were detected in relatively few quality studies and remained particularly inconclusive insofar as life in the home environment was concerned; 2) rehabilitation for aphasia and perceptual dysfunction proved effective for at least several months after acute stroke; 3) in general, examination of the reports cited revealed no differences in the effects of biofeedback and perceptual retraining vs conventional physiotherapy; 4) rehabilitation, whether administered by specialists or amateur caregivers purpose-trained by specialists, proved equally effective for aphasia. These conclusions constitute a valuable basis for the development and evaluation of modern rehabilitation programs for stroke patients.     

Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates.

Sixty-three women participated in a study in Calgary, Alberta to assess the rate of arm recovery and factors affecting it up to one year after axillary node dissection for breast cancer. Outcomes included objective measures of swelling, mobility, and strength, and subjective assessments of pain (at rest and with movement) and stiffness. Approximately 42% of women had residual impairment of at least one type one year after surgery, the most common problems being pain (16%) and reduced grip strength (16%). Except for lymphedema, measurements one year after surgery showed little change from measurements at 6 months, suggesting that the shorter follow-up may be appropriate for assessing the long term effects of axillary dissection. Lymphedema was the only sequela which increased over time. The results provide parameter estimates for designing studies to evaluate the role of physiotherapy after axillary dissection.     

58例脊髓损伤合并轻中度肾积水的临床分析

目的探讨脊髓损伤（SCI）肾积水的临床表现特点、发病机理和最佳治疗途径。方法对58例轻、中度脊髓损伤肾积水患者进行回顾性分析，观察肾积水缓解所需的治疗时间和复发情况。结果留置尿管、间歇导尿加药物、综合疗法3种治疗方法所需的治疗时间无差异；其中有效56例（96．55％）；3个月内复发28例（48．28％）；逼尿肌反射亢进合并括约肌痉挛（DSD）的复发率（57．14％）高于逼尿肌反射亢进者（28．57％）和低下者（14．29％）；肾积水复发与患者不能坚持治疗有关。结论SCI肾积水的病程隐匿且易复发；长期坚持间歇导尿和药物治疗能有效预防肾积水的复发。