不同营养支持方式对肠外瘘患者人体组成改善作用之比较

目的观察不同营养支持方式对肠外瘘患者人体组成的改善作用。方法30例肠外瘘患者分成两组各15例,分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN),观察10d前后患者人体组成及血清胰岛素样生长因子-1(IGF-1)的变化。结果10d后所有患者的体重指数(BMI)与体细胞群(BCM)显著改善,而TEN组患者10d前后BCM增加幅度更明显,分别为(27.5±0.8)kg和(29.0±0.6)kg,Day10与Day0相比,P<0.01。两组患者总体水(TBW)与细胞内水(ICW)均增加,尤其ICW,Day10与Day0相比,TEN组P<0.01;TPN组P<0.05。血清IGF-1在两组患者治疗后均有显著上升,TEN组增加幅度更明显,Day0为(175.0±32.9)ng/ml,Day10为(255.5±34.1)ng/ml,与Day0比较,P<0.01;与TPN组比较,P<0.05。IGF-1的变化与BCM的改善显著正相关(r2=0.16,P<0.05)。结论营养支持治疗能显著改善肠外瘘患者的体细胞群,纠正细胞内、外水的异常分布,而EN作用更明显。     

躯干运动和负重时对足底支撑面侧向横移的姿势控制

目的:本研究假设自主运动命令和姿势控制信号间有冲突,因此设计在附加重物和不同自主任务的同时给予足底一个模拟受滑的干扰(横移)来观察姿势变化并分析其是否受冲突命令或者力学参数的影响.方法:受试者在执行各种不同的自主任务时,随机给予足底支撑面一个左侧或右侧的横移干扰.这些不同的自主任务包括不负重静止站立、静止站立单手负重5kg、负重5kg站立并躯干静止侧屈15°、负重5kg动态地提重物和放重物5项任务.测量和分析下列参数:中心压力的侧位移(COP)、躯干和股部在冠状面上的角位移和腹内压(IAP).结果:干扰离开质量(向右)、始反应超射的幅度、达到终平衡的时间和达到平衡前COP位移的次数都增加,这种情况可以看作是为了再获得平衡的姿势反应效率降低,因此,如果质量的重力效果能对抗干扰,则再获得平衡的反应效率甚至可以被增进.结论:提重和负重是危害姿势反应效率的因素,因为提重和负重改变了重力效果,加大了对躯干的干扰.在动态条件下躯干的运动不是被横移干扰增强就是被横移干扰抵消,并没有显著地影响改变最终平衡位置姿势校正的效应.因此附加任务的同时给一个支持面上的横移干扰,姿势控制的效应可以被抵消.这个减低的效应可以引起脊柱周围结构的负荷增加和增加受伤的危险性.但是,在恰当地放置负重的位置时,反而可以增进躯干控制和协助恢复姿势平衡.     

社会支持对考试应激的影响

目的了解社会支持对考试应激的影响。方法采用焦虑自评量表和社会支持量表分别对７２７个学生考试前１个月、考试期间考试焦虑分数及社会支持情况进行调查，比较分析考试焦虑分数与社会支持因素的关系。结果考试焦虑分数与客观支持、来自同学和老师的主观支持以及社会支持的利用度成反比。结论家长和学校给予学生足够的社会支持，以及让学生参加适当的社会活动，培养他们利用社会支持的能力，有助于让学生减缓考试应激的水平     

失眠症患者心理防御机制与社会支持的相关研究

目的　探讨失眠症患者心理防御特征和社会支持 ,并分析两者的关系。方法　采用心理防御方式问卷 (DSQ )、社会支持评定量表 (SSRS)对失眠症患者和正常健康者各 5 0例进行评定。结果　患者组心理防御方式 (不成熟型、中间型防御因子和掩饰因子的因子分高 ,成熟防御因子分低 )和社会支持 (社会支持总分、主观支持分、对支持利用度低 )与对照组相比差异有显著性 (P <0 .0 5或 0 .0 1) ;相关分析发现 ,患者组不成熟防御机制与SSRS的支持总分、主观支持分、对支持利用度呈负相关 (P均 <0 .0 5 ) ,中间型防御机制与SSRS的主观支持呈负相关 (P <0 .0 5 )。结论　失眠症患者心理防御机制的成熟程度较正常人低 ,社会支持差 ,两者存在一定的关系。     

Semipermeable Hollow Fiber Membranes in Hepatocyte Bioreactors: A Prerequisite for a Successful Bioartificial Liver?

Abstract: Recent studies have shown that liver support systems based on viable hepatocytes can prolong life in animal models of acute liver failure. Now the time has come to elucidate the design characteristics that are essential to construct an efficient bioreactor. The gold standard remains the intact liver. Despite the very high cell density in this organ, individual cell perfusion is guaranteed resulting in low diffusional gradients which are essential for optimal mass transfer. These conditions are not met in bioreactors based on hollow fiber membranes. Moreover, the semipermeable membranes can foul and act as a diffusional barrier between the hepatocytes and the blood or plasma of the recipient. We devised a novel bioreactor for use as a bioartificial liver that does not include hollow fiber membranes for blood or plasma perfusion. The device is based on an integral oxygenator and a nonwoven polyester matrix material for hepatocyte culture as small aggregates. The efficacy of this original design was tested in rats with liver ischemia. Preliminary results show statistically significantly improved survival; life was prolonged 100% compared to the control experiments.     

A Clinical Study for the Durability of Oxygenators on Cardiopulmonary Support

Abstract: Cardiopulmonary support (CPS) requires durability of the oxygenator. The life span of the oxygenator is affected by various clinical factors, including patient condition, perfusion condition, and equipment usage. Predictors for the durability of oxygenators were evaluated clinically in this study. Thirty-two patients, who had undergone CPS during the last 3 years in our institute were assigned to this study. Fifty oxygenators had been used (Capiox SX in 19, CB Maxima in 23, and AL-6000 in 8). Significant predictors for the durability of oxygenators were evaluated by nonparametric survival analysis and proportional hazards regression analysis. Univariate regression analysis revealed 6 significant predictors for the life span of oxygenators. These were the oxygenator type, type of centrifugal pump, acidosis with blood pH less than 7.35, base excess less than -5, blood glutamic-oxaloacetic transaminase (GOT) levels greater than 1,000 IU, and blood lactate dehydrogenase (LDH) levels greater than 3,000 IU. After multivariate analysis, there remained only 2 significant predictors. An oxygenator used with a noncoated CPS system (Capiox SX with Capiox EBS) proved to have a significantly shorter life span than one used with a heparin-coated system (CB Maxima or AL-6000 with CB BP-80) (hazards ratio, 3.588, p = 0.0065). Patient conditions, which revealed acidosis with less than -5 of base excess, significantly shortened the life of the oxygenator (hazards ratio, 3.595, p = 0.0188).     

Experience with the Berlin Heart Assist Device

Abstract: Different mechanical circulatory support systems (MCSS) have been in clinical use since 1987 to keep patients alive by assisting the heart during cardiac recovery after open heart surgery, myocardial infarction, acute graft failure after heart transplantation, or as a bridge to transplantation in heart transplant candidates. Four different hospitals in Germany used the Berlin Heart Assist Device. Up until 1993, there were 22 patients in the "recovery" group; 4 patients were weaned from the system, and only 1 patient was discharged from the hospital. In 112 patients the Berlin Heart Assist Device was implanted for the purpose of a bridge to transplantation, 68 were transplanted and 46 patients left the hospital. It was concluded that patients may be kept alive with this system for weeks and months after any kind of cardiogenic shock. Complete cardiac recovery may be achieved in patients with early posttransplant graft failure. Reliable prediction of outcome in bridge–to–transplantation patients requires further experience and improvement of system components.     

Treatment approaches for clients with a stroke‐affected upper limb: Are we following evidence‐based practice?

Stroke rehabilitation is an area of practice that many occupational therapists encounter during their career. The literature promotes a wide range of management techniques and support devices for people who have a stroke-affected upper limb, but little is known about the validity of those that occupational therapists actually use in practice. A questionnaire was sent to occupational therapists working in Queensland and northern New South Wales facilities (n = 35), in which adults with a stroke were likely to be treated. Eighteen respondents answered questions about the management techniques and support devices used in their facility, and their perception of the benefit of these devices in the reduction of hemiplegic shoulder pain. Results are discussed with reference to evidence-based practice and indicate an urgent need for the collation and dissemination of the best current evidence available for the management techniques and support devices used in this area, as well as further research to extend this evidence.     

慢性阻塞性肺疾病患者家庭支持与自我概念的相关性研究

目的 探讨慢性阻塞性肺疾病(慢阻肺)患者的家庭支持与自我概念的关系。方法 用方便抽样法选取108位慢阻肺患者，应用修订的个人资源问卷、自我概念量表和一般资料问卷分别测定其家庭支持、自我概念水平和一般资料。结果 该组患者家庭支持程度为中到高度，自我概念中度积极；家庭支持与总的自我概念呈中度正相关，与自我概念中的体感、自我一致性、理想自我及道德一伦理一精神自我有显著相关．与体象无关。结论 慢阻肺患者的家庭支持水平越高，其自我概念越积极。