脑卒中患者自我感受负担现状及其影响因素分析

目的：调查脑卒中患者自我感受负担的现状并分析其影响因素,为提供有针对的护理措施提供依据。方法：采用便利抽样的方法选取天津市某三甲医院110例脑卒中患者为研究对象,采用一般情况调查表、自我感受负担量表对其进行问卷调查。结果：共回收有效问卷102份,102例脑卒中患者自我感受得分为(29.24±4.41)分,各维度得分由高到低为经济负担、情感负担、精神负担。多元回归结果显示,患者对疾病了解程度、患者自理能力、照顾者年龄进入回归方程,共解释32.7%的变异量。结论：脑卒中患者的自我感受负担处于轻中度水平,护理人员应该对住院脑卒中患者尤其是首次住院的脑卒中患者及其家属给予更多的关注,充分发挥护士教育者的职能,做好心理健康指导工作,加强患者和家属对疾病相关知识和康复知识的了解。     

Long-term consequences of young patients undergoing endoscopic sphincterotomy: a cohort study

Background

An estimated 15% of the UK population has gallstones. Gallstones in the biliary tree can result in complications such as cholangitis and pancreatitis, which have high morbidity and mortality rates. To prevent such complications, patients can undergo endoscopic sphincterotomy. In our centre, an initial study was undertaken in 2002 to examine outcomes of endoscopic sphincterotomy in patients under the age of 50 years. The aim of our current project was to examine the long-term outcomes until Nov 30, 2015.

检测昏迷患者在纳洛酮治疗前后血浆β-内啡肽的含量

目的:为了探讨昏迷患者在纳洛酮治疗前后的血浆β-内啡肽(β-EP)的含量。方法:将45例Glasgow-Pittsburgh昏迷量表(G-Pcs)评分小于等于20分的昏迷患者随机分为治疗组和对照组,其中对照组21例给予常规治疗,24例治疗组在常规治疗基础上,给予纳洛酮1.6mg加入0.9％生理盐水100mL,静滴,每日2次,疗程10d;同时观察两组患者治疗前后血浆β-内啡肽(β-EP)含量变化。结果:治疗组治疗后血浆β-EP水平较治疗前明显下降P<0.05,与对照组比较有显著差异P<0.05。结论:β-EP的放射免疫检测为临床提供治疗昏迷方案具有重要价值。     

Gastrointestinal bleeding in patients with acute spinal injuries

Twenty out of 365 patients (5.5 per cent) with acute spinal cord injuries referred to a spinal ward over a $\text{9}\text{1}\text{2}$-year period bled from the gastrointestinal tract.A cause of the haemorrhage was found in 15 patients. Six patients were endoscoped. Most patients had gastroduodenal ulceration but we could not be certain whether this was due to stress or peptic ulceration. We did not confirm that cervical cord lesions were associated with a higher incidence of gastrointestinal bleeding.The 4 patients who died probably represent an ‘inevitable’ mortality in severely ill patients.The role of endoscopy is outlined, the pathogenesis of gastrointestinal ulceration discussed and future management of these patients is suggested.     

“靳三针”对脑卒中偏瘫患者认知功能和日常生活能力的影响：多中心随机对照研究

目的:为"靳三针"疗法治疗中风提供可靠证据.方法:采用多中心随机对照试验(RCT)的方法,将180例缺血性脑卒中偏瘫患者随机分为靳三针组(90例)和常规针刺组(90例).两组均进行神经内科基础治疗,靳三针组采用靳三针疗法,穴取颞三针、足三针、手三针等穴;常规针刺组采用传统针刺法,穴取曲池、环跳、伏兔等,均予针刺治疗,治疗5周.比较两组治疗前后功能综合评定量表(FCA)认知功能评分,简易精神状态检查量表(MMSE)评分以及改良Barthel指数(BI)评分.结果:两组治疗后FCA评分、MMSE评分、BI指数评分,均较治疗前有显著改善(P＜0.01,P＜0.05);治疗后两组FCA评分、MMSE评分、BI指数评分比较,靳三针组改善程度均优于常规针刺组(P＜0.01,P%0.05).靳三针组总有效率为85.4%,常规针刺组总有效率为70.0%,靳三针组优于常规针刺组(P%0.05).结论:靳三针疗法针刺治疗对中风偏瘫患者的认知功能和日常生活活动能力均有明显改善,疗效优于传统针刺方法.     

运动与睡眠对老年缺血性脑卒中患者执行功能的影响

目的探讨运动与睡眠对老年缺血性脑卒中患者执行功能的影响。方法选取经原华北煤炭医学院神经内科确诊的老年缺血性脑卒中患者,采用执行功能缺陷综合征的行为学评价(behavioral assessment of dysexecutivesyndrome,BADS)在患者非急性期(入院10～14 d)对其执行功能的各项指标进行测评。结果经常锻炼的老年患者在找钥匙测验、时间判断测验、动物园分布图测验、修订六元素测验方面的评分及总分高于几乎不锻炼者,差异均有统计学意义(P<0.05);经常参加社区活动的老年患者在转换卡测验、找钥匙测验、时间判断测验、修订六元素测验方面的评分及总分高于几乎不参加者,差异有统计学意义(P<0.05);睡眠质量良好的老年患者在转换卡测验、动作计划测验、修订六元素测验方面的评分高于睡眠质量差者,差异有统计学意义(P<0.05)。结论经常运动的老年患者和睡眠质量好的老年患者其执行功能明显提高或增强。     

通心络胶囊对老年睡眠期陈-施呼吸患者呼吸的影响

目的观察通心络胶囊对老年睡眠期陈-施呼吸（CSR）患者的影响。方法根据多导睡眠图监测（PSG）结果,除外心力衰竭病因者,入选老年睡眠期CSR患者30例,按呼吸暂停低通气指数分为轻度（n=11）、中度（n=9）及重度（n=10）CSR组,均予口服通心络胶囊2粒／次,3次,d,共30d。分析治疗前后PSG指标及症状的变化及与日间嗜睡程度的相关关系。日间嗜睡程度以Epworth嗜睡评分（ESS）评定。结果通心络胶囊治疗前后比较显示,3组中仅重度组呼吸暂停低通气指数显著降低[（37．4±4．3）vs（30．8±4．5）,P〈0．05];3组的日间ESS均有改善（P〈0．05）,轻度组由（8．8±2．0）降低到（6．0＋1．9）,中度组由（10．7±2．1）降至（8．0±2．3）,重度组由（13．4±2．4）降至（10．2±3．0）。相关性分析显示轻度组ESS与微觉醒指数呈正相关（r=0．775,P〈0．05）,而中重度组日间嗜睡评分与最低血氧饱和度呈负相关（分别为r=-0．751,P〈0．05;r=-0．739,P〈0．05）。结论通心络胶囊可改善老年睡眠期CSR者的日间嗜睡症状,可能部分降低重度老年睡眠期CSR的呼吸暂停低通气指数。     

浅谈抚触对早产儿生长发育的影响

目的 探讨抚触对早产儿生长发育的影响.方法 早产儿120例按床号(单双号)分为2组,均按常规护理,抚触组在每天沐浴后按国际通用抚触方法进行抚触.结果 30 d后抚触组早产儿体重、头围比较均有显著性差异(P＜0.01).结论 抚触能促进早产儿的生长发育.     

Imbalance of tissue-type plasminogen activator (t-PA) and its specific inhibitor (PAI-1) in patients with rheumatoid arthritis associated with disease activity

Summary The relationship between plasma fibrinogen, D-dimer (DD), t-PA and PAI-1 and their correlation with disease activity (DA) were studied in 45 patients with rheumatoid arthritis (RA) (group B) to further understand the implication of fibrinolysis in the pathophysiology of RA. The control group constituted 24 healthy subjects (group A). A Stoke index (SI) of DA was assigned to each patient. Patients were divided into two groups: C, minimal-mild DA (SI 1–7); D, moderate-severe DA (SI 8–17). Fibrinogen was elevated in RA correlating positively with SI and CRP. Hypercoagulability counteracted by reactive fibrinolysis was inferred from a 10-fold increase of DD in group B as compared to group A. The relatively lower levels of DD in group D compared to group C and their negative correlation with SI (r_s=–0.45, –0.49, p=0.0006) indicate the tendency of fibrinolysis to decrease with the increase of DA. Significant elevation of t-PA and PAI-1 were found in group B compared to group A. While t-PA progressively decreased with the increase of DA (r_s=–0.45, p=0.0019), a positive relation of PAI-1 to DA was observed (r_s=0.42, p=0.0042). A 2-fold increase of PAI-1/t-PA molar ratio in group D compared to groups A and C as well as its positive correlation with SI (r_s=0.63, p=0.0001) indicate the displacement of balance between t-PA and PAI-1 in favour of the inhibitor with the increase of DA in RA. The involvement of inflammatory mediators in PAI-1/t-PA imbalance was proposed from the relation of fibrinolytic abnormalities with the activity of systemic inflammatory process.     

High prevalence of hidradenitis suppurativa symptoms in axial spondyloarthritis patients: A possible new extra-articular manifestation

Background

Spondyloarthritis (SpA), a chronic inflammatory, rheumatic disease, and hidradenitis suppurativa (HS), a chronic, debilitating, inflammatory skin disease, share several clinical and pathophysiological features, such as the association with inflammatory bowel disease and elevated cytokine levels IL-17 and TNF-α. Recently, SpA was reported to be more prevalent (2.3–28.2%) in patients with HS than in the general population. Conversely, the prevalence of HS in SpA is not exactly known.