吉兰-巴雷综合征康复治疗的疗效探讨

目的探讨康复治疗对吉兰-巴雷综合征的作用。方法选择吉兰-巴雷综合征患者57例,分为康复组及对照组,2组进行常规药物治疗的同时,康复组同步进行康复针灸治疗,分别于治疗前后进行评定,肌力采用徒手肌力试验Lovett的6级分级法进行评分,ADL用Barthel指数评分。结果康复组肌力的提高明显优于对照组(P<0.05),康复组ADL恢复更显著(P<0.01)。结论进行康复针灸治疗可明显提高吉兰-巴雷综合征患者的肌力和ADL得分,降低致残率,缩短康复时间,提高患者的生活质量。     

社区康复护理对脑卒中后遗症患者的影响

目的观察并分析社区康复护理对脑卒中后遗症患者的影响,探讨社区康复护理的临床价值。方法深圳市龙华新区人民医院白石龙社康中心2011-01—2012-12收治脑卒中后遗症患者70例,依照随机数字表法随机分为2组;对照组35例给予常规护理,干预组35例给予社区康复护理,对比分析2组患者干预前与干预3个月后的肢体运动功能评价结果和日常生活能力评价结果。结果干预3个月之后,干预组患者肢体运动功能评价和日常生活能力评价结果均显著优于对照组,差异有统计学意义(P<0.01)。结论积极有效的社区康复护理干预能够明显改善脑卒中后遗症患者的肢体运动能力和日常生活能力,对加速疾病恢复进程具有重大价值。     

延伸卒中单元对脑卒中患者神经功能及抑郁的影响

目的观察延伸卒中单元(ESU)社区康复模式对脑卒中患者神经功能和卒中后抑郁(PSD)的影响。方法将91例符合入选标准脑卒中患者按居住社区不同分为对照组48例和ESU组43例,ESU组由卒中专家小组和社区卫生机构每月定期进行健康咨询、体格检查、康复指导、心理测评和干预治疗,对照组出院后未进行规范的康复训练和治疗。2组患者于卒中单元治疗出院时、发病6月、12月时采用NIHSS、ADL、HAMD量表进行评价。结果出院时2组HAMD、SSS、ADL评分等基线资料比较无明显差异,发病6月及12月ESU组NIHSS、ADL、HAMD评分均较对照组有改善,中度、重度抑郁病例数减少,无抑郁患者病例数增多,而对照组发病6月时HAMD评分较出院时明显增加,12月时评分较出院时无明显差异,中度、重度抑郁病例数增加。结论 ESU社区康复能有效改善脑卒中患者神经功能,提高患者日常生活能力,改善脑卒中后抑郁。     

应用临床护理路径对脑卒中患者实施健康教育的效果评价

目的探讨临床护理路径在脑卒中患者健康教育中的实施效果。方法 200例脑卒中病人随机分为观察组和对照组各100例,对照组采用传统健康教育方法,观察组应用临床护理路径模式实施健康教育。采用ADL(日常生活活动能力)评分对2组病人入院时和出院前予以评定,出院时对2组病人派发满意度调查表进行问卷调查比较。结果 2组病人在入院首日的ADL评分无明显差异(P>0.05);出院时,观察组的ADL评分显著高于对照组(P<0.05);护理满意度调查明显高于对照组(P<0.05),2组差异有统计学意义。结论应用临床护理路径对脑卒中病人实施健康教育,能提高患者对护理工作的满意度,减少患者并发症和后遗症的发生率,明显提高了患者的生活自理能力,促进患者早日康复,提高其生活质量。     

系列体位支持垫在脑卒中患者康复中的应用

目的 探讨系列体位支持垫对脑卒中患者早期功能恢复及防止各种并发症的作用.方法 选取脑卒中偏瘫卧床患者86例,分为支持垫组和对照组.支持垫组实施康复治疗联合康复体位护理(使用系列体位支持垫),对照组给予康复治疗联合传统护理.干预后3和6周,分别采用Barthel指数(BI)、简化Fusl-Meyer运动功能量表(FMA)进行评定,并进行两组并发症发生率比较.结果 两组患者入选时BI、FMA评分无显著差异.干预3周后,支持垫组的BI评分高于对照组(P<0.05);但两组患者的并发症无显著差异(P>0.05).干预6周后,支持垫组的FMA评分及BI评分提高分均显著高于对照组(P<0.01);并发症发生率较入选时及对照组有显著降低(P<0.01).结论 系列体位支持垫有助于脑卒中卧床患者运动功能的恢复,同时可减少各种并发症.     

系统化康复治疗对脑卒中偏瘫患者功能恢复的影响

目的探讨系统化康复治疗对脑卒中偏瘫患者肢体运动功能和日常生活活动(ADL)能力的影响。方法 84例脑卒中患者随机分为康复组和对照组,分别于治疗前及治疗后60 d对两组患者采用简化Fugl-Meyer量表(FMA)和Barthel指数(BI)来评定患者运动功能及ADL能力。结果治疗前,两组患者的FMA评分和BI评分差异均无显著统计学意义(P>0.05);治疗后,两组患者的FMA评分和BI评分与治疗前比较,均有明显改善(P<0.05)。结论系统化康复治疗对脑卒中偏瘫患者的肢体运动功能和ADL能力的恢复具有显著促进作用。     

早期康复治疗对脑卒中患者肢体功能恢复的影响

目的探讨早期康复治疗对脑卒中患者肢体功能恢复的影响。方法选择2015-05—2016-05在驻马店市中心医院治疗的脑卒中患者100例,随机分为观察组和对照组各50例,对照组给予常规治疗和护理,观察组在常规治疗和护理的基础上给予早期康复治疗,比较2组患者肢体功能恢复情况和日常生活活动能力。结果干预前,2组患者的CCS评分、MBI评分及FMA评分无明显差异(P0.05);干预后2组患者的CCS评分、MBI评分及FMA评分均有所改善(P0.05),干预后2组CCS评分、MBI评分及FMA评分比较差异有统计学意义(P0.05)。结论脑卒中患者采用早期康复治疗有助于改善肢体运动功能和神经功能,促进患者肢体康复,提高日常生活活动能力和自理能力。     

早期康复干预管理模式对急性脑卒中患者神经功能恢复的影响

目的研究急性脑卒中患者进行早期康复干预管理模式对患者神经功能恢复的影响。方法将120例急性脑卒中偏瘫患者随机分成实验组和对照组,实验组患者在生命体征平稳2d后开始进行康复干预治疗,为期1个月,1个月后转为常规治疗,为期1个月。对照组患者在生命体征平稳2d后开始进行神经内科常规康复治疗,为期1个月,1个月后同实验组一样转为常规治疗,为期1个月。2组患者均在生命体征平稳时、康复治疗1个月后以及常规治疗1个月后3个时间段对患者的神经功能进行评测,采用简式Fugl-Meyer运动功能评测法和Barthel指数(MBI)来评定患者的运动功能以及ADL评分。结果在康复治疗1个月以及常规治疗1个月后,2组患者的运动功能及ADL评分均有明显提高,但实验组疗效明显优于对照组(P<0.05)。结论早期康复干预管理模式对于急性脑卒中患者神经系统功能的恢复具有良好的促进作用,能显著提高患者的生活质量。     

社区康复对脑出血偏瘫患者整体功能和生活质量的影响

目的探讨社区康复治疗对脑出血偏瘫患者整体功能和生活质量的影响。方法依据入选标准纳入83例脑出血偏瘫患者,将其按随机数字表随机分为康复组42例和对照组41例,于入组时、治疗后2个月末和5个月末应用功能综合评定量表（FCA）、改良Barthel指数ADL能力评定量表（MBI）和WHO生活质量评定量表（WHOQOL-BREF）中文版对2组患者进行评定。康复组进行功能评定、社区康复治疗和定期随访,对照组只进行同期的随访和功能评定。结果2组患者的FCA评分、ADL能力评分、QOL评分在入组评定时差异无统计学意义（P〉0.05）。康复组治疗后2、5个月末患者的FCA评分、ADL能力评分、QOL评分均较治疗前提高,对照组治疗后5个月末FCA评分、ADL能力评分、QOL评分较治疗前提高（P〈0.01）。康复组患者的FCA评分、ADL能力评分在治疗后5个月末,QOL评分在治疗后2、5个月末较对照组提高（P〈0.01）。结论社区康复治疗对脑出血偏瘫患者功能恢复和生活质量的提高有促进作用。     

早期综合康复干预对脑卒中患者日常生活功能及心理状态的影响

目的探究早期综合康复干预对脑卒中患者生活功能及心理状态的影响。方法选取宝山中西医结合医院因首发脑卒中住院患者200例,随机分为干预组及对照组,都予以脑卒中后常规治疗,在此基础上对干预组进行脑卒中后心理卫生宣教、肢体锻炼心理教育、电话询诊、康复科的脑功能及生物反馈治疗等干预措施。在基线期、3月、6月、12月四个时点比较两组日常社会功能量表(ADL)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)的评分差异。结果 6月及12月末ADL评分干预组好于对照组,差异具有统计学意义(P=0.042,P=0.012);12月末干预组与对照组HAMA评分(7)有统计学差异(P=0.007),而HAMA总分及HAMD总分评分无统计学差异(P=0.169,P=0.494)。结论开展持续整体的综合性早期康复干预可以改善脑卒中患者功能障碍,延缓日常社会功能下降;综合干预措施能够减轻脑卒中患者的焦虑情绪,而对抑郁情绪效果不明显。加强卒中后肢体康复锻炼及心理卫生知识教育,能在一定程度上提高卒中后患者生活质量改善心理状态。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.