Fast-track surgery in laparoscopic radical prostatectomy: basic principles

Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase. The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer. Twenty-five patients each were randomized in the study groups to verify if a fast-track regimen could be transferred into clinical routine. The perioperative data, early complications, hospital stay as well as readmission rate were analyzed. The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group. The overall complications were significantly less in the fast-track procedure. The readmission rate was low and not significant. Patients receiving an LRPE benefit from a suitable fast-track concept. The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate. Thus, fast-track concepts might contribute to saving resources in the long term. However, more evidence based on larger prospective trials is needed to achieve optimal quality of life for patients perioperatively.     

芪独合剂改善缺血性脑卒中恢复期患者神经缺损程度、颈动脉粥样硬化、血管内皮生长因子临床研究

摘 要 目的:探讨芪独合剂改善缺血性脑卒中恢复期（气虚血瘀、络脉痹阻证）患者的临床效果，探讨其对患者神经缺损程度、颈动脉粥样硬化、血管内皮生长因子的影响。方法:将110例缺血性脑卒中恢复期患者采用随机数字表法分为对照组和观察组，每组55例。对照组患者给予常规西药治疗，观察组患者在对照组基础上加用芪独合剂口服，1个月为1个疗程，连续用药2个疗程。观察两组治疗的临床效果，评价神经功能缺损程度、运动功能、日常生活能力变化，检测颈动脉内膜中层厚度(IMT)、斑块面积、大脑中动脉血流速度，监测血管内皮生长因子（VEGF)水平变化。结果:观察组、对照组的有效率分别为90.91%（50/55）、76.36%（42/55），以观察组有效率明显升高（P＜0.05）；观察组患者治疗后的神经功能缺损程度较对照组明显减轻，治疗1个月、治疗2个月的NIHSS评分显著低于治疗前及对照组（P＜0.05）；观察组患者治疗后的运动功能、日常生活能力改善优于对照组，FMA评分、Barthel指数评分均显著高于对照组（P＜0.05）；观察组患者治疗后的颈动脉粥样硬化改善优于对照组，斑块IMT厚度、斑块面积均显著小于对照组（P＜0.05）；观察组患者治疗后的脑血流改善优于对照组，Vm、Vd、Vs均显著高于对照组（P＜0.05）；观察组患者治疗1个月、治疗2个月的VEGF水平显著高于治疗前及对照组（P＜0.05）。结论:芪独合剂能有效提高运动功能、日常生活能力，改善颈动脉粥样硬化程度，增加脑血流量，促进新生血管形成，从而促进受损神经功能的修复。     

电针 点穴 推拿联合功能锻炼治疗颅脑损伤后康复期患者的效果

目的分析电针、点穴、推拿联合功能锻炼治疗颅脑损伤后康复期患者的效果。方法采用随机平行对照法对我院2014-09—2015-10治疗的113例颅脑损伤后康复期患者进行分组,对照组56例给予常规功能锻炼治疗,观察组57例在对照组的基础上增加电针、点穴、推拿疗法,观察2组治疗后的临床疗效、运动功能、语言功能及日常生活能力改善效果。结果观察组总有效率(91.23%)高于对照组(76.79%,P0.05);观察组治疗后FMA评分、失语评分及Barthel指数的改善幅度高于对照组(P0.05)。结论在常规功能锻炼的基础上,联合应用电针、点穴、推拿疗法治疗颅脑损伤后康复期患者,通过补中气、舒经络、调气血,能够更为有效地改善运动功能及语言功能,提高日常生活能力。     

体能训练缓解住院恢复期精神病患者焦虑的作用

目的探讨体能训练缓解住院恢复期精神病患者焦虑的作用。方法对62例住院恢复期精神病患者实施体能训练,同时设32例相同患者作为对照组。分别在训练前、训练/观察2周、训练/观察4周时进行汉密顿焦虑量表(HAMA)评定,比较两组及3个时段量表得分。结果研究组和对照组训练前HAMA总分及因子分无统计学差异,研究组训练在2周和4周时,HAMA总分和躯体性焦虑、精神性焦虑得分均低于对照组(P均<0.01),研究组躯体性焦虑、精神性焦虑和HAMA总分训练2周时明显低于训练前(t=3.272,6.218,5.192;P<0.01)、训练4周时明显低于训练2周时(t=5.115,6.517,5.946;P<0.001)。对照组3个时段无统计学差异。结论体能训练能有效缓解住院精神病人的焦虑症状,对改善体质和减少躯体疾病也会有帮助。     

卒中恢复期甲状腺激素水平与认知功能的相关性研究

目的 探讨卒中恢复期患者甲状腺激素水平与认知功能的相关性,为认知功能康复提供参考。 方法 前瞻性连续纳入2018年12月-2020年1月于石家庄市人民医院康复医学科收治的卒中恢复期 患者为研究对象,根据MMSE评分将患者分为认知功能损害组和无认知功能损害组。比较两组甲状 腺激素各项指标水平,包括三碘甲状腺原氨酸（triiodothyronine,T3）、甲状腺素、游离三碘甲状腺原氨 酸（free triiodothyronine,FT3）、游离甲状腺素及促甲状腺激素水平,采用多元线性回归分析甲状腺激 素各项指标水平与MMSE评分的相关性。 结果 最终纳入210例患者,平均年龄59.97±7.12岁,男性138例（65.7%）,其中认知功能损害组146 例,无认知功能损害组64例。认知功能损害组T3、FT3水平低于无认知功能损害组,差异有统计学意 义。多元线性回归分析结果显示,卒中恢复期患者血清T3、FT3水平与MMSE评分呈正相关（β=0.389, P <0.001;β=0.237,P =0.014）。 结论 卒中恢复期患者血清T3、FT3水平越低,提示认知功能损害越重。临床工作中应积极关注卒 中恢复期患者甲状腺激素水平,以尽早给予全面地康复干预。     

Fast-track knee arthroplasty – status and future challenges

BackgroundFast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee arthroplasty.MethodBoth authors searched the contemporary literature on minimally invasive knee arthroplasty and review articles on fast-track surgery aiming to summarize recent developments.ResultsLength of stay after knee arthroplasty is influenced by preoperative risk factors, anaesthetic and surgical techniques, pain, orthostatic intolerance, cognitive function, sleep disturbances, bleeding and anaemia and finally muscle function and rehabilitation.ConclusionsFast-track surgery reduces the length of stay and the morbidity after knee arthroplasty.Clinical relevanceOptimisation of pre-, per- and postoperative pathway for knee arthroplasty reduces morbidity after this type of surgery and results in shorter length of stay.     

整体康复护理对精神分裂症患者恢复期生活质量的影响

目的 分析整体康复护理对精神分裂症患者恢复期生活质量的影响.方法 将70例精神分裂症恢复期患者随机分为研究组与对照组,各35例,对照组采取常规药物治疗与护理,研究组在对照组基础上给予整体康复护理,观察期6个月,以GQOLI-74问卷评价效果,对比和分析两组生活质量改善情况与康复效果.结果 两组治疗与护理后生活质量评分较治疗与护理前明显升高（P＜0.05）,研究组升高较对照组更明显（P＜0.05）;治疗与护理后,两组BPRS评分较治疗与护理前降低,NOSIE评分较治疗与护理前升高（P＜0.05）,研究组升降幅度较对照组更明显（P＜0.05）.结论 整体康复护理应用于精神分裂症恢复期患者,可明显改善患者的生活质量,值得推广应用.     

90例小儿脑瘫康复训练效果分析

目的:探讨脑瘫患儿康复训练的效果和护理方式。方法:对我科1999年10月～2000年12月90例脑瘫患儿进行康复训练及护理指导。结果:使患儿的肢体功能、智力、语言表达和生活自理能力得到一定的提高,家长对脑瘫康复树立了信心。结论:脑瘫患儿的早期康复训练和正确的护理指导,可以有效的改善原有症状,提高生活自理能力和生存质量,使患儿早日回归社会。     

脑塞通丸治疗中风恢复期气虚血瘀兼阴虚证306例临床观察

目的观察脑塞通丸治疗中风恢复期(气虚血瘀兼阴虚证)的临床疗效。方法将409例中风恢复期气虚血瘀兼阴虚证患者随机分为2组。对照组103例予复方丹参注射液治疗,治疗组306例在对照组治疗基础上加用脑塞通丸治疗。2组均治疗12周后统计临床疗效,并观察2组治疗前、治疗4周、治疗8周及治疗后巴氏指数评分(Bathel-Index)、改良Ranking评分、美国国立卫生院神经功能缺损评分(NIHSS)、症状体征总积分、改良Ashworth评分变化及评分下降值情况。结果治疗组总有效率83.99%,对照组总有效率67.96%,2组比较差异有统计学意义(P0.05),治疗组疗效优于对照组。治疗后Bathel-Index评分、改良Ranking评分、NIHSS评分、症状体征总积分及改良Ashworth评分及下降值比较,差异有统计学意义(P0.05),治疗组优于对照组。结论脑塞通丸治疗中风恢复期气虚血瘀兼阴虚证疗效确切,能明显改善临床症状及中医证候积分。     

Early return to sport post maxillofacial fracture injury in the professional athlete: A systematic review

IntroductionTo summarize the current literature on return to sport times post-maxillofacial fracture injury in the professional athlete.Materials and methodsA literature search on six databases for articles relating to maxillofacial fractures, professional athletes, and return to sport times. Study design, clinical data, and author recommendations were analysed.Results17 studies were retrieved. One prospective study returned 17 athletes to competitive rugby union and soccer at 3 weeks post injury without complication. Two large retrospective studies (n = 278) returned patients to sport at approximately 7 weeks without complication. 64% (n = 7) of patients from case based studies returned to sport at 3–14 days, 4 of which utilized protective facemasks. Athletes generally returned to competition earlier for lower grade (3–10 days) compared to higher grade contact sport (21 days at least). 2 articles recommended a 3 months recovery period for combat sports. 8 articles supported the utility of protective facemasks.ConclusionEarly return to sport (<6 weeks) in the professional athlete post maxillofacial fracture injury is achievable. The optimal clinical approach may be to grade the sport according to its impact forces, discuss an early return with reference to the available literature, the potential utility of facemasks, risks of refracture and its operative implications.