早期康复治疗对急性脑卒中患者日常生活能力的影响

目的 :探讨早期康复治疗对脑卒中偏瘫患者 1个月后日常生活活动能力的影响。方法 :将 12 9例脑卒中偏瘫患者随机分成康复组 (74例 )和对照组 (5 5例 ) ,进行临床对照性研究 ,两组均常规进行神经内科的药物治疗 ,康复组增加运动疗法和电疗等康复治疗方法 ,对每例患者在进入课题时和 1个月后分别测试ADL能力。结果 :康复组两次Barthel指数分别为 6 .36± 4.93、13.0 0± 4.91,对照组为 7.5 0± 6 .19、11.6 0± 6 .2 6 ;两组前后比较均有高度显著性差异 (P <0 .0 0 1) ;两组的变化均数比较康复组 1个月后ADL恢复优于对照组 (P <0 .0 0 1)。结论 :早期康复治疗对患者 1个月后的日常生活活动能力具有良好的促进作用。     

运动疗法早期干预治疗小儿脑性瘫痪100例疗效分析

目的探讨早期干预对小儿脑性瘫痪(CerebralPal-sy,CP)和中枢协调障碍(Centralcoordinationdisturbance,CCD)康复效果的影响.方法对0～9个月的100例脑性瘫痪患儿和中枢协调障碍患儿进行早期干预,采取以运动疗法为主的综合康复治疗.结果早期干预的患儿经过3～6个月,平均4个月规范化治疗,总有效率达96%,年龄越小正常化率越高.结论对脑性瘫痪患儿早期诊断、早期干预及正规康复方法可以减少残疾发生.     

90例婴幼儿脑性瘫痪康复的临床研究

目的探讨婴幼儿脑性瘫痪不同年龄、不同病情程度、不同康复时间的康复疗效。方法选择 3— 3 6个月的脑瘫儿 90例 ,用前瞻性方法 ,随机将 3— 12个月、13— 2 4个月、2 5— 3 6个月分为 3组。每组 3 0例 ,其中轻、中、重度各 10例 ,分别全面康复治疗 2个月与 3个月 ,对每例行治疗前、后生活自理能力 (ADL)评价 ,将所提高分值百分比进行组间比较 ,做统计学分析。结果婴幼儿CP康复治疗时间 3个月组明显优于 2个月组 ,病情程度一致的各年龄组组间比较康复疗效及各年龄组轻、中、重度CP比较均有显著性差异 (P <0 .0 1)。 3— 12个月组明显优于 2 5 -3 6个月组。结论婴幼儿脑瘫康复治疗 3个月疗效显著。轻、中度脑瘫康复疗效明显 ,轻度脑瘫效果最佳。年龄越小 ,康复效果越好。     

早期干预及综合康复措施对小儿脑性瘫痪的预后影响

目的:探讨早期干预和综合康复治疗在小儿脑性瘫痪临床治疗中的应用价值。方法:选取本院2015年2月-2018年2月期间内接收的110例脑性瘫痪患者,随机分2组,每组55例。分别接受早期干预联合综合康复治疗、仅早期干预。对比治疗效果,以及治疗前后智力及运动水平,并观察发育商情况。结果:观察组治疗总有效率较对照组来说更高,治疗后6个月、12个月时MDI、PDI水平较对照组与治疗前来说均显著增高,语言能力、适应能力、社交能力、精细动作、大运动评分较对照组来说均更高,P<0.05。结论:针对小儿脑性瘫痪患儿可联合早期干预以及综合康复治疗,能够改善患儿智力及运动水平发育情况,促进患儿神经系统的发育,改善预后,临床实用价值较高。     

急性脑卒中瘫痪早期综合康复治疗体会

目的 :探讨急性脑卒中瘫痪早期综合康复治疗的效果。方法 :将 12 0例初发的急性脑卒中瘫痪患者随机分为康复组 60例和对照组 60例 ,康复组在常规药物治疗的同时 ,脑梗死发病后 3d、脑出血病后 7d神志恢复清楚 (GSC≥ 8分 ) ,在生命体征稳定后进行早期综合康复治疗 (包括肢体功能锻炼、理疗、针灸 ) ,疗程 1个月 ;对照组不进行正规综合康复治疗 ,两组分别于治疗前、治疗后 1个月、2个月、3个月用Fugl Meyer运动功能量表 (FMA )和Barthel指数量表 (BI)评分。结果 :治疗前两组的FMA和BI评分差异均无显著意义 (P >0 0 5)。治疗 1个月、2个月及 3个月后康复组FMA和BI评分显著提高 ,与对照组比较差异有显著意义 (P <0 0 5)。结论 :早期综合康复治疗可明显提高患肢运动功能 ,降低致残率 ,提高日常生活能力     

二次住院脑性瘫痪儿童日常生活活动能力分数变化的相关因素

目的分析脑性瘫痪儿童出院后影响患儿日常生活活动能力的相关因素。方法对1999—01／2001—12在中国康复研究中心儿童康复科2次住院的脑性瘫痪儿童40例进行日常生活活动能力评价，与第1次出院前日常生活活动能力分数比较，并对患儿家长进行相关问卷调查。结果①不同年龄患儿第2次住院与第1次出院前日常生活活动能力分数相比，3-5岁降低明显。②重度脑性瘫痪对日常生活活动能力有影响（肢体障碍程度越重，影响就越大，以四肢瘫和双重瘫最明显）。③两次住院间隔时间在两三个月之内日常生活活动能力分数没有显著性变化；大于6个月时差异有显著性。④出院后是否坚持康复训练及家庭社会环境对脑性瘫痪儿童日常生活活动能力均有影响。结论脑性瘫痪儿童日常生活活动能力受年龄、病情严重程度、前后两次住院时间间隔等因素的影响，提示脑性瘫痪儿回归家庭后仍要坚持康复训练。     

全髋置换后康复干预时间与效果的比较

背景:观察全髋置换后康复干预开始时间对临床效果的影响.方法:回顾性分析2000-07/2008-03湘南学院附属医院骨科收治的行全髋关节置换后康复治疗的患者165例,根据置换后行康复治疗时间的不同分为3组,早期康复组(n=56):男27例,女29例;年龄44～79岁.置换前患患髋Harris评分为(47.4±1.3)分,全髋置换后3 d行康复治疗.中期康复组(n=63):男37例,女26例;年龄48～80岁,置换前Harris评分(45.6±2.1)分,全髋置换4-21 d后行康复治疗.延迟康复组(n=46):男24例,女22例;年龄47～81岁,置换前Harris评分(46.3±1.5)分,伞髋置换21 d后行康复治疗.3组按统一制定的康复训练计划实施功能锻练.于置换前,置换后1,2,3个月行Harris评分比较.结果:行康复治疗的患者165例均进入结果分析.置换前3组髋关节Harris评分差异无显著性意义(P>0.05);康复治疗后,置换后1个月Harris评分早期康复组平均(89.1±6.3)分,中期康复组平均(60.1±3.7)分,延迟康复组平均(54.6±3.5)分,早期康复组得分高于中期康复组及延迟康复组(P<0.05).置换后2个月Harris评分早期康复组平均(90.1±4.3)分,中期康复组平均(85.7±5.3)分,延迟康复组平均(69.8±3.8)分,早期康复组、中期康复组与延迟康复组之间相比,差异有显著性意义(P<0.05).置换后3个月Harris评分早期康复组平均(94.8±2.3)分,中期康复组平均(92.2±3.2)分,延迟康复组平均(90.5±3.1)分,3组之间相比,差异无显著件意义(P>0.05).结论:早期系统康复治疗有利于全髋置换后髋关节功能的恢复.     

脑卒中后抑郁治疗效应对运动功能及日常生活自理能力恢复的作用

目的:研究脑卒中后抑郁(post-strokedepression,PSD)的干预治疗对运动功能康复、日常生活自理能力(ADL)的影响。方法:60例PSD患者随机分成3组:对照组给予常规药物治疗,康复治疗组给予药物治疗和早期康复、ADL训练,干预康复治疗组给予药物治疗、早期康复、ADL训练和抗抑郁剂及心理调试干预治疗。结果:干预康复组在治疗后1个月NIHSS(6.90±4.22)分,FMA(74.65±24.12)分,MBI(81.80±21.58)分及HAMD得分(4.75±0.60)分,疗效明显优于对照组(P<0.01)。结论:PSD的治疗,可促进脑卒中后抑郁患者运动功能康复及日常生活自理能力的提高。     

神经元特异性烯醇化酶与新生儿缺氧缺血性脑病及脑性瘫痪的相关性

目的:分析神经元特异性烯醇化酶与新生儿缺氧缺血性脑病临床分度及脑性瘫痪发生的相关性。方法:选择2001-07/2003-07在珠海市人民医院新生儿室住院的110例足月缺氧缺血性脑病患儿。①根据新生儿缺氧缺血性脑病诊断依据和临床分度标准分为3组,轻度组(n=65)、中度组(n=35)、重度组(n=10);选择同期出生足月正常新生儿20例为对照组。用ELISA法测定缺氧缺血性脑病各组患儿血中神经元特异性烯醇化酶的含量并进行比较。②将所有观察患儿均按照新生儿缺氧缺血性脑病的治疗方案进行后续治疗,随机分为3组进行早期干预,干预1组干预时间为满1个月起至24个月;干预2组为满6个月起至24个月岁;干预3组为满12个月岁起至24个月。干预方法采用鲍秀兰教授0～3岁潜能开发指南进行。随访时间为6个月以内每月1次,6个月～12个月每2个月1次,12个月～24个月每3～6个月1次;随诊内容除一般的健康体检外,重点检查有否脑性瘫痪症状,并指导早期干预。对照组及各随访非干预时间按传统喂养和照料。经统计学处理分析神经元特异性烯醇化酶与缺氧缺血性脑病严重程度、脑性瘫痪的相关性。结果:110例缺氧缺血性脑病患儿和20例正常新生儿,均进入结果分析。①轻度缺氧缺血性脑病组血清神经元特异性烯醇化酶与对照组接近,差异无显著性意义[(12.36±4.55),(8.32±2.89)μg/L,P>0.05];中度、重度缺氧缺血性脑病血清神经元特异性烯醇化酶与对照组比较明显升高,差异有显著性意义[(35.45±13.56),(69.98±19.92)μg/L,t=9.354,16.452,P<0.01],缺氧缺血性脑病临床分型与神经元特异性烯醇化酶成正相关(r=0.754,P<0.001)。有过脑性瘫痪早期症状患儿的血清神经元特异性烯醇化酶含量显著高于无脑性瘫痪早期症状患儿,差异有显著性意义[(33.26±20.33),(18.34±9.87)μg/L,t=6.98,P<0.01]。②随访结果:轻度缺氧缺血性脑病组6个月内脑性瘫痪早期症状发生率20%,中度组43%、重度组100%,明显高于对照组,差异有显著性意义(P<0.05)。③干预24个月后,干预1组无脑性瘫痪患儿,干预2组有1例,干预3组有4例,干预3组与对照组比较,差异有显著性意义(P<0.05)。结论:神经元特异性烯醇化酶是新生儿脑损伤及预测早期脑性瘫痪的有效指标。早期干预可以减低脑性瘫痪的发生。     

针刺结合易化技术治疗对脑卒中后肢体功能恢复的影响

目的：评价中西医结合综合康复疗法对脑卒中偏瘫患者运动功能、日常生活活动能力恢复的影响。方法：将58例脑卒中偏瘫者随机分为康复治疗组28例(采用中西医结合康复治疗)，对照组30例(接受康复指导)。治疗前及治疗3个月后，两组分别接受临床神经功能缺损评定、Fud—Meyer(FMA)和修订的Barthel指数评测。结果:经3个月后，康复治疗组临床神经功能缺损、FMA和MBI提高程度比对照组明显，差异均有显著性意义(P&;lt;0．05或0．01)。结论:中西医结合综合康复疗法能显著改善脑卒中后偏瘫患者的运动功能障碍，并有助于日常生活活动能力提高。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.