针刺结合康复训练治疗中风偏瘫不同分期患者的临床疗效研究进展

现代康复学者Bobath通过临床经验的总结指出,中风后患者肢体的运动能力的恢复一般需要经历固定的三个阶段:迟缓期;痉挛时期;相对恢复时期。根据针灸经络理论及Signe Brunnstrom提出的中风偏瘫后机体运动功能恢复的六个阶段的特殊病理过程,灵活采用针刺、放血、点穴推拿以及火针等治疗方法对不同分期的中风偏瘫患者进行治疗,疗效显著。在中风偏瘫的康复治疗过程中常常把传统的中医针刺与现代康复技术积极的结合在一起,对偏瘫患者的功能康复起到了至关重要的作用,本文将对近五年此类文章进行总结。     

杞菊地黄丸联合直流电离子导入香丹注射液治疗围绝经期干眼的临床观察

目的观察杞菊地黄丸联合直流电离子导入香丹注射液治疗围绝经期干眼的临床疗效。方法将80例(160眼)患者按照随机数字表法分为治疗组和对照组各40例,对照组给予玻璃酸钠滴眼液治疗;治疗组在对照组的基础上加用杞菊地黄丸联合直流电离子导入香丹注射液治疗,共治疗30天,观察两组患者泪膜破裂时间(BUT)、泪液分泌量(SⅠT)、角膜荧光素染色(FL)及眼表疾病指数(OSDI)量表评分、主观症状评分和整体症状评分的变化。结果两组主观症状和整体症状评分较治疗前均有改善(P0.01);且治疗组较对照组改善更为明显(P0.05),OSDI评分治疗组降低明显低于对照组(P0.01)。治疗组较对照组BUT、SⅠT明显延长(P0.05)。结论杞菊地黄丸联合直流电离子导入香丹注射液治疗围绝经期干眼可有效延长BUT,促进泪液分泌,促进角膜上皮修复及减轻主观症状。     

精神分裂症患者拒食行为临床分析及护理87例

拒食行为是精神科住院患者常见问题 ,因此 ,精神科的饮食护理更为重要。本文对 1999年 1月～ 2 0 0 0年 12月住院有拒食行为的精神分裂症患者的护理作回顾性研究。现报告如下。1　临床资料1 1　一般资料研究对象均为 1999年 1月～ 2 0 0 0年 12月住我院符合ＣＣＤＭ - 2 -Ｒ精神分裂症诊断标准且有拒食行为的患者 ,排除有躯体疾病的 ,共 87例 ;其中男 47例 ,女 40例 ,年龄 18～47岁 ,平均年龄 ( 3 0 .2 5± 6.3 4)岁 ;病程 3个月～ 6ａ。1.2　结果分析1.2 .1　疾病的类型分布。偏执型精神分裂症 64例 ,紧张型精神分裂症 18例 ,未定型精神分…     

自体混合植骨治疗成人髋臼发育不良髋臼骨缺损

目的探讨全髋关节置换术中自体骨颗粒、骨泥混合植骨治疗成人髋臼发育不良髋臼骨缺损的临床效果。方法对59例(66髋)CroweⅡ~Ⅳ型髋关节发育不良髋臼骨缺损患者在行全髋关节置换术中应用自体骨颗粒、骨泥混合植骨。结果患者均获得随访,时间1~3年。术后6个月患者Harris评分由术前(48.76±7.79)分提高至(92.09±3.61)分,差异有统计学意义(P0.001);其中优56髋,良8髋,可2髋,优良率为96.97%。结论自体骨颗粒、骨泥混合植骨治疗成人髋臼发育不良髋臼骨缺损,手术时间短、出血量少,植骨均可愈合,疗效确切。     

驱动压指导PEEP滴定对机器人辅助根治性前列腺切除术老年患者呼吸功能的影响北大核心CSCD

目的观察驱动压(DP)指导呼气末正压(PEEP)滴定对机器人辅助根治性前列腺切除术(RARP)老年患者呼吸功能的影响。方法选择2020年9月至2021年9月择期全麻下行RARP的老年患者40例,年龄65~80岁,BMI 19~28 kg/m^(2),ASAⅡ或Ⅲ级。将患者随机分为两组:DP指导组(D组)和对照组(C组),每组20例。D组:机械通气后,PEEP从4 cmH_(2)O开始,以1 cmH_(2)O增幅逐渐增加,每个PEEP水平维持4 min,计算并记录4 min内最后1次呼吸循环的DP值,寻找DP最低值,此时对应的PEEP为平卧位时的最佳PEEP。屈氏体位且气腹建立后重复上述操作,滴定屈氏体位气腹下的最佳PEEP,直至手术结束。C组:以5 cmH_(2)O的固定PEEP进行机械通气。记录平卧位最佳PEEP设置完成后(C组固定PEEP通气后)4 min(T_(1))、屈氏体位气腹后滴定的最佳PEEP通气(C组改变体位与建立气腹后)1 h(T_(2))、2 h(T_(3))血气分析结果、气道峰压(Ppeak)、气道平台压(Pplat)、肺动态顺应性(Cdyn),并计算肺泡动脉氧分压差(A-aDO_(2))、氧合指数(OI)、呼吸指数(RI)、死腔/潮气量比值(V_(D)/V_(T)),记录T_(1)、T_(3)、拔管后1 min(T_(4))、术后2 h(T_(5))血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)浓度。记录术后肺部并发症(PPCs)的发生情况。结果与C组比较,D组T_(1)、T_(2)、T_(3)时PaO_(2)、Cdyn、OI明显升高(P<0.05),A-aDO_(2)、RI明显降低(P<0.05),T_(1)、T_(3)、T_(4)、T_(5)时血清IL-6、IL-8、TNF-α浓度明显降低(P<0.05)。两组术中Ppeak、Pplat、PaCO_(2)、V_(D)/V_(T)差异无统计学意义。两组均未发生PPCs。结论最小驱动压指导最佳呼气末正压设置能够改善机器人辅助根治性前列腺切除术老年患者术中呼吸功能,提高患者氧合。     

间歇呼吸暂停联合低水平PEEP通气策略在输尿管软镜手术中的应用

目的 探讨间歇呼吸暂停联合低水平呼气末正压(PEEP)通气策略对输尿管软镜手术患者的影响。方法 选择接受输尿管软镜钬激光碎石术的患者73例,男59例,女14例,年龄25~60岁,BMI 18~28 kg/m²,ASA Ⅰ或Ⅱ级,随机分为三组：呼吸暂停联合低水平PEEP组（P组,n=25）、呼吸暂停组（A组,n=28）和对照组(C组,n=20)。P组术中采用呼吸暂停联合低水平PEEP (5 cmH₂O)通气模式,A组术中采用传统呼吸暂停通气模式,C组术中采用常规通气模式。P组和A组于麻醉诱导前（T0）、插管后10 min（T1）、第1次呼吸暂停前（T2）、最后1次呼吸暂停结束后即刻（T3）和拔管后30 min（T4）时,C组于T0—T1、术者第1次要求呼吸暂停前（T2）、碎石结束后即刻（T3）、T4时记录基本生命体征并抽取桡动脉及颈内静脉血进行血气分析,术后24 h（T5）时抽取颈内静脉血。记录T0—T4时PaCO₂、pH、氧合指数（OI）、脑氧饱和度（rSO₂）、脑氧摄取率（CERO₂）、动脉和颈内静脉血氧分压差（Pa-jvO2）、动脉和颈内静脉血氧饱和度差（Sa-jvO2）;T0、T4—T5时血清肺Clara细胞分泌蛋白(CC16)、静脉血清S100β蛋白含量、静脉血清肌钙蛋白（cTnT和cTnI）、肌红蛋白（Mb）和肌酸激酶同工酶（CK-MB）。记录激光碎石时间和术者满意程度评分。结果 与C组比较,T3时A组PaCO₂明显升高、pH、OI明显降低（P<0.05）。与A组比较,T3时P组PaCO₂明显降低、pH、OI明显升高（P<0.05）。三组不同时点rSO₂、CERO₂、Pa-jvO2、Sa-jvO2、CC16、S100β蛋白、cTnT、cTnI、Mb、CK-MB差异均无统计学意义。与C组比较,P组和A组激光碎石时间明显缩短（P<0.05）,术者满意程度评分明显升高（P<0.05）。结论 间歇呼吸暂停联合低水平PEEP(5 cmH₂O)通气策略可安全地用于输尿管软镜手术,既保留了传统呼吸暂停通气策略的优势,同时减少了其带来的不利影响,是一种更优化的通气策略。     

氯氮平合并脑复康治疗精神分裂症阴性症状对照研究

目的 研究氯氮平合并脑复康治疗精神分裂症阴性症状的疗效。 方法 将62例精神分裂症患者随机分为实验组(31例)和对照组(31例)两组。实验组在服用氯氮平(326.20±50.26mg·d-1)基础上合并脑复康,对照组单一服用氯氮平(336.72±42.86 mg·d-1),两组治疗前后用SANS评分比较。 结果两组剂量问相比无差异(t=1.01,P>0.05),但两组治疗后比较,实验组疗效显著好于对照组(P<0.05)。 结论氯氮平合并脑复康对精神分裂症阴性症状有很好的疗效。     

Experimentally investigating the effect of buccal acupuncture on analgesic time-effect characteristics and monoamine neurotransmitters

Objective

To investigate the analgesic time-effect characteristics and changes in concentrations of rabbit’s hypothalamic 5-hydroxytryptamine (5-HT) and noradrenaline (NE) caused by buccal acupuncture in the rheumatoid arthritis (RA) rabbits, and to reveal the analgesic central mechanism of buccal acupuncture, thereby providing a theoretical basis for the treatment of pain by buccal acupuncture.

Methods

Forty rabbits were randomly divided into a normal group, a model group, a body acupuncture group, and a buccal acupuncture group, with 10 rabbits in each group. No model was established in the normal group, while equal dose of normal saline was injected at the matched site and time point; rabbits in other groups were subjected to the establishment of RA models using egg protein. From the 27th day of the experiment, rabbits in each group received the designated intervention. Rabbits in the normal group and the model group were fixed for 30 min every day using the same method as those in the other groups. In the acupuncture group, Dubi (ST 35) and Zusanli (ST 36) on bilateral hind limbs were selected. Perpendicular needling (using the needles with 0.25 mm in diameter and 25 mm in length) was performed with twirling manipulation for 15 s at intervals of 5 min. The needles were retained for 30 min and acupuncture was performed once a day. In the buccal acupuncture group, the knee point in the buccal acupuncture and needles with a diameter of 0.25 mm and a length of 15 mm were selected. Oblique needling was performed with twirling manipulation for 15 s at intervals of 5 min. The needles were retained for 30 min and acupuncture was performed once a day. The thermal pain thresholds at the 0, 5, 15, 30, 60, 120 and 240 min after the 1st and 10th acupuncture therapy were measured with a PL-200 thermal-inducing pain meter. After the 10th acupuncture therapy, rabbit’s hypothalamus was removed, and the 5-HT and NE concentrations in the hypothalamus at the peak point of the acupuncture pain threshold curve were determined by high performance liquid chromatography (HPLC).

Results

The analgesic effect was obvious at 5 min after buccal acupuncture started, peaked at 30 min, and decreased to the lowest value at 240 min. Rabbits in the body acupuncture group began to show significant analgesic effect at 15 min, which was peaked at 30 min, and began to decline at 60 min. The pain threshold at 240 min was still higher than that at 0 min. Compared with the model group, the concentrations of hypothalamic 5-HT in the buccal acupuncture group and the body acupuncture group was significantly increased, and the between-group differences were statistically significant (both P<0.05). The NE/5-HT ratios in hypothalamus in the buccal acupuncture group and the body acupuncture group were significantly lower than the ratio in the model group, and the differences were statistically significant (both P<0.05); difference in the decrease was statistically significant between the buccal acupuncture group and the body acupuncture group (P<0.05).

Conclusion

The analgesic effect of buccal acupuncture shows an obvious time-dependent curve. It is characterized by rapid onset of pain relief, rapid increase and decline in pain threshold. 5-HT and NE levels in rabbit’s hypothalamus can be affected by buccal acupuncture, with increased 5-HT concentration and reduced NE/5-HT ratio.

     

棘阿米巴性角膜炎2例

棘阿米巴性角膜炎是一种严重的致盲性眼病、近年来,由于角膜接触镜的广泛使用,其发病率在迅速增长[1].本人2011年10月至12月在台湾彰化基督教医院访学期间观察到2例棘阿米巴性角膜炎患者,现报告如下. 病例1:颜某某,女,18岁.以双眼发红、疼痛、畏光流泪,伴视力下降1周于2011年10月25日就诊.病史:患者1周前无明确诱因出现双眼红痛、畏光、流泪伴视力下降,在外院诊断细菌性角膜炎,点消炎眼药水,病情进一步加重,今来本院就诊.