老年急性脑梗死患者T淋巴细胞亚群的变化及其临床意义

目的探讨老年急性脑梗死患者T淋巴细胞亚群的动态变化及其临床意义。方法用流式细胞仪对 32例老年急性脑梗死患者发病后第 3、7、10、14天的外周血CD3 、CD4、CD8T淋巴细胞进行动态检测。结果老年急性脑梗死发病后第 3、7天外周血CD3 、CD4T淋巴细胞和CD4/CD8比值均较健康对照组低 (P <0 .0 5 ) ,而第 14天的CD3 、CD4T淋巴细胞和CD4/CD8比值与健康对照组相比无显著性差异 (P >0 .0 5 )。结论老年急性脑梗死患者第 3、7天的细胞免疫功能明显降低 ,第 10天开始逐渐恢复 ,第 14天基本恢复正常 ,提示老年急性脑梗死后预防感染的重点时期是在发病后14天之内。     

T淋巴细胞亚群在老年疾病中的变化

T淋巴细胞亚群是人体内主要的细胞免疫系统.目前发现,越来越多的疾病与免疫紊乱相关.为了探讨其与常见的老年疾病的关系,我们检测了我院干部内科56例老年患者的T淋巴细胞亚群结果,并就其临床特点进行了分析,现报告如下.     

桂北地区恶性肿瘤患者外周血T淋巴细胞亚群和淋巴细胞亚群的相关性研究

目的探究桂北地区恶性肿瘤患者外周血T淋巴细胞亚群和淋巴细胞亚群的数值及其临床意义。方法选取184例肿瘤患者,分别设有鼻咽癌组94例,乳腺癌组32例,宫颈癌组36例,肺癌组22例,并选取了40例符合性别年龄区间的健康体检人员作为正常对照组,运用流式细胞仪检测肿瘤各组和正常组的T淋巴细胞亚群表面因子CD3~+、CD4~+、CD8~+细胞绝对计数和CD4~+/CD8~+比值,淋巴细胞亚群表面因子相对计数CD3~+%、CD56~+%、CD19~+%,并进行统计学分析,比较肿瘤组和正常组之间的差异。结果肿瘤组患者T淋巴细胞亚群细胞绝对计数CD3~+、CD4~+、CD8~+和正常组对比有显著差异(P=0.000),CD4~+/CD8~+比值,鼻咽癌有显著差异(P=0.000),乳腺癌(P=0.634)、宫颈癌(P=0.409)、肺癌(P=0.629)差异无统计学意义。淋巴细胞亚群相对计数与正常组对比,乳腺癌、肺癌差异无统计学意义,鼻咽癌CD3~+%(P=0.000)、CD56~+%(P=0.001)有显著差异,CD19~+%差异无统计学意义;宫颈癌CD3~+%(P=0.000)有显著差异,CD56~+%(P=0.094)差异无统计学意义,CD19~+%(P=0.235)差异无统计学意义。结论恶性肿瘤患者免疫功能异常,通过流式细胞仪检测T淋巴细胞亚群、淋巴细胞亚群项目,对患者病情评估、身体免疫情况实时监测、后期治疗指导用药具有一定的临床应用价值。     

老年糖尿病患者淋巴细胞亚群变化

<正>糖尿病作为一种代谢疾病,其发病率已越来越高[1],严重危害人们的健康和生命安全,因此,对于糖尿病的诊断和治疗越来越受到医学界的关注。目前,对于糖尿病的诊断指标除了血糖之外,还有一些如白细胞、白细胞介素等相关免疫指标[2],但指标比较分散,且部分测定方法较为繁琐。我院采用流式细胞仪对老年2型糖尿病患者的细胞进行分类分析,力图寻找不同细胞类型与2型糖尿病之间的相     

脑肿瘤患者外围血T淋巴细胞亚群测定分析

目的：观察脑肿瘤患者外围血淋巴细胞亚群水平变化，进一步了解患者免疫功能状态。方法：采用碱性磷酸酶-抗碱性磷酸酶（APAAP法）桥联酶法技术，对36例颅内肿瘤患者进行T淋巴细胞亚群的CD2^＋、CD4^＋、CD8^＋细胞检测。结果：所查T淋巴细胞亚群CD2^＋、CD4^-细胞水平及CD4^＋、CD8^＋细胞比值均低于正常参考值。结论：表明脑肿瘤患者均有不同程度的细胞免疫功能低下表现．良性肿瘤略低．恶性及颅内转移瘤显低。     

卵巢恶性肿瘤患者T淋巴细胞亚群的改变

通过对临床分组病人的研究，证明卵巢恶性肿瘤患者Ｔ细胞亚群对比发生变化，显示在恶性肿痛患者的Ｔ淋巴细胞免疫功能受到抑制。     

日常生活能力与老年人认知功能的相关性调查

目的 了解日常生活能力与老年人认知功能的相关性,对老年人进行健康指导,提高老年人群的生活质量和生命质量.方法 采用随机抽样方法,对唐山市唐海县2 200名60岁以上的老年人进行问卷调查.结果 日常生活能力有障碍有认知功能障碍的为48.1％,日常生活能力正常有认知功能障碍的为13.8％,差异有统计学意义(P＜0.05).结论 日常生活能力异常的老年人认知障碍发生率高于日常生活能力正常的.     

脓毒症患者早期淋巴细胞亚群动态变化分析

目的:研究脓毒症患者早期淋巴细胞亚群变化与脓毒症患者病程的关系.方法:回顾性分析2006年1月至2008年12月我院收治的脓毒症患者21例的临床资料,动态观察脓毒症患者早期淋巴细胞亚群浓度变化.结果:脓毒症组患者在入院后第一个24小时内CD3+,CD4+,CD4+/CD8+值显著低于正常值,4天内CD3+,CD4+,CD4+/CD8+值逐渐上升,接近于正常值.结论:脓毒症患者病程早期处于免疫系统抑制状态.     

动机性访谈对脑卒中患者日常生活活动能力的影响

目的 ：探讨动机性访谈对脑卒中患者日常生活活动能力康复进程的影响。方法 ：选取天津市某三级甲等医院的脑卒中患者60例,按照时间先后顺序分为实验组及对照组,各组均30例。在科室常规护理的基础上,对实验组进行一对一的为时30-40min的动机性访谈干预,并发放《卒中后日常生活活动锻炼手册》以及为期3个月的电话随访。对照组接受针灸科常规护理及健康教育。采用Barthel指数量表对干预前、出院前2天、出院后1个月、出院后3个月的干预效果进行评价。结果 ：实验组干预后日常生活活动能力得分高于对照组,差异有统计学意义（P〈0.05）。其中,实验组日常生活活动能力得分随时间变化幅度不同,表现为出院前2天得分涨幅达到较高水平,而3个月时得分逐渐趋于平稳。结论 ：动机性访谈可以提高患者的日常生活活动能力,加快患者的康复进程。而3个月时干预的正向效果随着时间发展逐渐削弱,应警惕出现故态复萌现象。     

城市社区高龄老人生存现状调查

目的 了解杭州市部分社区高龄老人的生存现状,为政府及社区制定依托家庭护理和社区护理的养老服务政策提供参考依据.方法 采用便利抽样法选取杭州5个社区80岁及以上的老人为调查对象,使用调查问卷进行面对面调查,实际调查454名,调查率为71.2％.结果 高龄老人文化程度低,女性低于男性(P＜0.05);73.1％的老人与配偶或子女孙辈居住,20.7％的老人独居;高龄老人慢性病患病率高,为87.2％,失能比例高.结论 社区高龄老人慢性病患病率高,失能比例高,政府与社区应加强社区高龄老人的慢性病管理和老年护理工作,有针对性地增加家庭护理内容,给予女性高龄老人、独居老人及失能老人更多的关注与护理,以整体改善社区高龄老人的生存质量.     

中国人四肢瘫日常生活能力评定量表的信度研究

目的研究四肢瘫日常生活能力评定量表评测四肢瘫患者的重测信度及观察者间信度。方法由1位评定者应用四肢瘫日常生活能力评定量表对20例四肢瘫患者进行评定,评定后1周内再次对该患者进行评定;另1位评定者在第1位评定者初次评定后2 d内对该患者进行评定。结果第1位评定者两次评定总分的组内相关系数为0.994(P<0.01);第1位评定者与第2位评定者评定总分的组内相关系数为0.971(P<0.01)。结论四肢瘫日常生活能力评定量表具有良好的重测信度及观察者间信度。     

综合性医院成年住院病人的直接护理时间与自理能力、疾病严重度相关性的研究

目的比较综合性医院不同日常生活自理能力、不同疾病严重度的成年住院病人所需直接护理时间的差异,并探讨各变量之间的相关关系。方法对某综合性医院428例成年住院病人采用Barthel指数评定量表、急性生理功能和慢性健康疾病状况评估系统Ⅱ(APACHEⅡ)评价病人的自理能力和疾病严重度,用自行设计的病人基本护理需求与直接护理时间观测表观察记录成年住院病人24h所需直接护理时间。结果①不同自理能力病人所需直接护理时间不同;②不同疾病严重度病人直接护理时间不同;③直接护理时间与自理能力负相关,与疾病严重度正相关。结论①病人的直接护理时间与自理能力和疾病严重度相关;②科学地测量护理工作量和配备护理人力应考虑到病人的日常生活自理能力和疾病严重度。     

Chiropractic Use and Changes in Health Among Older Medicare Beneficiaries: A Comparative Effectiveness Observational Study

Objective

The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

Methods

Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used—one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

Results

Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

Conclusion

The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.     

Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation

Wu C-Y, Chuang L-L, Lin K-C, Lee S-D, Hong W-H. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living scale in patients with improved performance after stroke rehabilitation.

Objectives

To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation.

Design

Secondary analyses of patients who received stroke rehabilitation therapy.

Setting

Medical centers.

Participants

Patients with stroke (N=78).

Interventions

Secondary analyses of patients who received 1 of 4 rehabilitation interventions.

Main Outcome Measures

Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC₉₀), and MCID on the NEADL score and percentages of patients exceeding the MDC₉₀ and MCID.

Results

The SRM of the total NEADL scale was 1.3. The MDC₉₀ value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC₉₀ and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively.

Conclusions

The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates.     

Predictors of long-term survival after out-of-hospital cardiac arrest: The impact of Activities of Daily Living and Cerebral Performance Category scores

Background

Current focus on immediate survival from out-of-hospital cardiac arrest (OHCA) has diverted attention away from the variables potentially affecting long-term survival.

Aim

To determine the relationship between neurological and functional status at hospital discharge and long-term survival after OHCA.

Methods

Prospective data collection for all OHCA patients aged >18 years in the Jerusalem district (n = 1043, 2008–2009). Primary outcome measure: Length of survival after OHCA. Potential predictors: Activities of Daily Living (ADL) and Cerebral Performance Category (CPC) scores at hospital discharge, age and sex.

Results

There were 52/279 (18.6%) survivors to hospital discharge. Fourteen were discharged on mechanical ventilation (27%). Interviews with survivors and/or their legal guardians were sought 2.8 ± 0.6 years post-arrest. Eighteen died before long-term follow-up (median survival 126 days, IQR 94–740). Six improved their ADL and CPC scores between discharge and follow-up. Long-term survival was positively related with lower CPC scores (p = 0.002) and less deterioration in ADL from before the arrest to hospital discharge (p = 0.001). For each point increment in ADL at hospital discharge, the hazard ratio of death was 1.31 (95%CI 1.12, 1.53, p = 0.001); this remained unchanged after adjustment for age and sex (HR 1.26, 95%CI 0.07, 1.48, p = 0.005).

Conclusions

One-third of the patients discharged from hospital after OHCA died within 30 months of the event. Long-term survival was associated both with better neurological and functional level at hospital discharge and a smaller decrease in functional limitation from before to after the arrest, yet some patients with a poor neurological outcome survived prolonged periods after hospital discharge.     

行为护理在老年脑梗死患者康复过程中的应用价值

【目的】探讨行为护理在老年脑梗死（ACI）患者康复过程中的应用价值。【方法】选择2014年6月至2015年10月本院神经内科收治的105例老年ACI患者为研究对象,采用随机数字表法将其分为对照组和观察组。对照组给予常规护理,观察组在对照组的基础上给予行为护理。干预4周后,比较两组患者干预前后日常生活能力、运动功能和生活质量的差别。【结果】干预前两组患者的日常生活功能评定量表（BI）各维度得分和总分、运动功能评定量表（FMA）评分以及生活质量评分均无明显差别;干预后,两组患者的各项指标均有所提高,且观察组均高于对照组,差异有统计学意义（P〈0．05）。【结论】行为护理在老年ACI患者康复过程中的应用可明显提高患者的运动能力,提高其生活质量。     

Responsiveness of Mobility, Daily Living, and Instrumental Activities of Daily Living Outcome Measures for Geriatric Rehabilitation

Demers L, Desrosiers J, Nikolova R, Robichaud L, Bravo G. Responsiveness of mobility, daily living, and instrumental activities of daily living outcome measures for geriatric rehabilitation.

Objectives

To assess and compare the ability of the Timed Up & Go (TUG) and subscales of the Functional Autonomy Measurement System (SMAF) to detect change in people undergoing geriatric rehabilitation in inpatient geriatric rehabilitation units (GRUs) and day hospitals.

Design

Longitudinal design with repeated measures obtained at admission and discharge from rehabilitation and at 2 follow-up interviews.

Setting

Inpatient and outpatient hospital-based settings.

Participants

Subjects (N=237, age 80±7y) had data at admission and discharge from rehabilitation (changing time frame), and of these, 160 had data at 2 subsequent follow-ups (stable time frame).

Interventions

Not applicable.

Main Outcome Measures

The TUG was used to estimate basic mobility, and subscales of the SMAF were used to estimate general mobility (SMAF-mobility), basic activities of daily living (SMAF-ADL), and instrumental activities of daily living (SMAF-IADL). Professionals' perception of change was used as a criterion.

Results

The TUG generated large values for the standardized response mean (SRM) and Guyatt's responsiveness index in GRUs (.98 and 1.12) and day hospitals (.89 and 1.85). Professionals' perception of change in mobility was explained by a perceptible change in the TUG in day hospitals (15%) but not in GRUs. The SMAF-mobility, SMAF-ADL, and SMAF-IADL were associated with large values of SRM and Guyatt's responsiveness index in GRUs (.97-2.17) and with small to moderate values in day hospitals (.29-.54). Moderate to large portions in the professionals' perceptions of change for mobility (20%, 17%), basic ADLs (10% and 14%), and IADLs (23% and 19%) were associated with the respective change scores of the subscales of the SMAF in both GRUs and day hospitals.

Conclusions

Progress of older adults in the areas of mobility, basic ADLs, and IADLs can be captured using the TUG, SMAF-mobility, SMAF-ADL, and SMAF-IADL in both GRUs and day hospitals. The results support their use in settings of high- and low-intensity rehabilitation, thus suggesting their adequacy for use in these 2 settings.     

家属参与同伴教育配合康复治疗对老年脑卒中患者生活能力的影响

目的探讨家属参与同伴教育配合康复治疗对老年脑卒中患者生活能力的影响。方法将70例老年脑卒中患者随机分为试验组和对照组各35例。试验组除采用常规的治疗、护理措施外,同时配合为期3个月的家属参与同伴教育;对照组仅给予神经内科的常规药物治疗、护理和康复训练治疗。在治疗前及治疗后3个月,采用Barthel指数和Fugl-Meyer运动功能积分法,分别对两组的日常生活能力(ADL)和肢体运动功能进行评定。结果治疗后,试验组ADL和肢体运动功能指标均优于对照组,两组比较差异有统计学意义(P<0.05)。结论家属参与同伴教育配合康复治疗,有利于老年脑卒中患者运动功能的恢复、日常生活能力的提高及健康行为的管理,是一种可行、有效的健康教育形式。