影响0岁~3岁脑瘫患儿康复因素的调查

[目的]了解脑瘫患儿家长脑瘫基本知识、康复情况、依从性等。[方法]选取某医院确诊为小儿脑性瘫痪进行门诊康复治疗的40例和住院的40例共80例患儿家长进行问卷调查。[结果]50%以上的家长不知晓脑瘫是一种什么疾病,60%以上的家长存在一定的自卑心理,80%的家长没有在家里对孩子进行家庭康复治疗及早期干预,表示没有家庭康复的相关内容,没有家庭康复的指导方案,没有相关专业人员在家里进行指导。[结论]3岁以下脑瘫患儿家长基本知识缺乏,没有家庭早期干预和家庭康复指导方案及评价,家长迫切需要科学有效的家庭康复模式。     

脑瘫患儿的康复护理

目的:探讨脑瘫患儿的康复护理措施。方法:本组主要通过对脑瘫患儿系统化的康复护理,包括运动及语言康复护理、心理护理、指导家长掌握一些康复护理训练的基本知识,对患儿进行综合康复护理治疗。结果:大部分脑瘫患儿的肌体功能和生活自理能力、智力及语言表达能力得到一定的提高,家长对脑瘫康复治疗树立了信心。结论:早期系统化康复护理训练及家庭康复指导,使脑瘫患儿提高了生活自理能力和生存质量。     

脑瘫患儿放弃治疗的原因分析与对策

目的 探讨分析脑瘫患儿放弃治疗的原因,并制定针对性的护理对策.方法 对50例在本院门诊确诊的脑瘫惠儿家长进行问卷调查.结果 该病的预后(36%)、经济承受能力(32%)、心理与社会压力(14%)等是脑瘫患儿得不到正规治疗和继续治疗的主要原因.提出做好脑瘫患儿家长的思想工作,帮助其树立正确的心态,参与家庭康复培训等对策.结论 应用家庭康复训练模式对脑瘫患儿实施多层次、全方位的康复治疗,较易得到患儿家属的支持和主动配合,脑瘫患儿的功能改善效果满意,既减轻了患儿家庭的经济负担,又有利于患儿的康复.     

康复训练指导对脑瘫患儿治疗效果的影响

目的探讨对脑瘫患儿家长进行康复训练指导的重要性和必要性.方法采取以集体授课为主、单个指导为辅的方式对患儿家长进行康复训练指导,并鼓励其阅读有关脑瘫康复的书籍.结果大多数患儿家长掌握了简单的家庭训练方法,如仰卧位抬头、翻身训练、坐位训练、四爬位姿势等.结论让患儿家长了解脑瘫的病因、症状及家庭康复训练的重要性,配合治疗师的治疗,可缩短疗程,提高疗效,并在一定程度上减少治疗费用.     

微信公众平台下的家庭康复护理模式在痉挛性脑瘫患儿中的应用

目的 探讨微信公众平台下的家庭康复护理模式应用于痉挛性脑瘫患儿的效果.方法 选取医院2019年4月—2021年3月痉挛性脑瘫患儿91例作为研究对象,按组间基本资料匹配原则分为观察组46例和对照组45例.对照组实施常规家庭康复护理模式,观察组在对照组基础上实施微信公众平台下的家庭康复护理模式.比较两组干预前后运动功能(G...     

家长参与对脑性瘫痪患儿康复疗效的影响

目的探讨家长参与对提高脑性瘫痪（简称脑瘫）患儿综合能力的影响。方法81例脑瘫患儿随机分为综合组和对照组，两组均采用Bobath、Vojta和Rood等神经生理学疗法，综合组同时指导家长进行家庭康复训练，治疗前后采用脑瘫儿童综合功能评定量表进行评定。结果治疗6个月后，两组患儿综合功能较治疗前明显提高（P〈0．01），综合组得分明显高于对照组（P〈0．05）。结论对脑瘫患儿进行康复治疗的同时，指导家长进行家庭康复训练更有利于提高脑瘫患儿的综合能力。     

脑瘫患儿家长对脑瘫的认知评价调查

[目的]了解脑瘫患儿家长对脑瘫这一应激事件的认知评价。[方法]采用自制"脑瘫患儿家长认知评价调查问卷"对70名脑瘫患儿家长进行问卷调查。[结果]57.1%的家长呈消极认知,其中伤害评价的消极认知占64.3%,威胁评价的消极认知占61.4%,挑战评价的消极认知为18.6%。[结论]在对脑瘫患儿家长进行心理护理的过程中,要关注其消极认知评价,从而降低脑瘫患儿家长的心理应激反应。     

痉挛型脑瘫患儿30例的家庭康复护理指导

总结对30例痉挛型脑瘫患儿家长的家庭康复护理指导。家庭康复护理指导内容包括心理指导、睡眠护理、穿脱衣护理、喂养姿势、运动训练、言语训练及癫痫护理。脑瘫患儿经康复治疗和家庭康复护理3月后,康复总有效率0～1岁为75.0%、2～3岁为82.4%、4～6岁为100.0%、>6岁为75.0%。     

324例脑瘫患儿家长不良情绪的现状分析

[目的]分析脑瘫患儿家庭生活现状、患儿家长的不良情绪,为提高患儿家长的心理状态提供理论依据。[方法]采用问卷调查法,选取324例脑瘫患儿及其家长为研究对象,进行描述性研究。[结果]脑瘫患儿病情重、病程长,家长精神压力大,经济负担重。[结论]脑瘫患儿家长的经济负担重、精神压力大,对脑瘫的认识不足,临床应对家长加强脑瘫疾病康复治疗的健康教育工作,同时加强残疾儿童医疗救助,缓解家长的负性情绪,提高患儿的康复效果。     

家庭康复护理对小儿脑瘫的康复影响

目的:探讨家庭康复护理对脑瘫患儿的康复作用。方法:回顾性分析2010年5月～2011年5月到我院就诊的50例脑瘫患儿的临床资料,该组患儿家长均接受了我院家庭康复指导后进行家庭康复护理,包括头部控制训练、坐位、爬行、站立、步行、训练与游戏结合以及饮食护理等,比较患儿家庭康复护理3个月后日常生活能力的变化。结果:患儿家庭康复护理后在大便、小便、修饰、如厕、吃饭等生活能力指标方面的评分均显著高于护理前(P<0.05)。结论:家庭康复护理对于脑瘫患儿日常生活能力的提高具有很好的作用。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.