“四大一支持”综合疗法救治腹部外科危重症的探讨

目的：为探讨有效合理的综合治疗腹部外科危重症的方法，提出“四大一支持”综合疗法，并应用于临床，观察其疗效，方法：采用“四大一支持”综合疗法；（１）短程大剂量山莨菪碱；（２）短程大剂量地塞米松；（３）大剂量抗需氧菌和抗厌氧菌抗生素联合正确应用；（４）大剂量应用腹腔灌洗液清洗腹腔；（５）一支持即完全的代谢营养支持。结果：７５例危重外科病人并发多器官功能障碍２４例，死亡１０例，治愈６５例，结论：“四大一     

对"睡前服氟桂利嗪治疗老年人失眠的体会"的验证

贵刊１９９５年第７期报道“睡前服氟桂利嗪治疗老年人失眠的体会”一文，阅后启发颇大，参照该文的疗法，笔者１９９５年１０月至１９９７年１０月治疗老年人失眠２０例，疗效满意。２０例均为门诊病人。其中男１５例，女５例；年龄５８～８０（平均６８）岁；失眠史３个...     

" 局部使用胰岛素治疗皮肤黏膜溃疡 52例”的验证

我读了《新医学》１９９８年第二期刊登的“局部使用胰岛素治疗皮肤黏膜溃疡５２例”犤１犦一文后，倍受启发。３年来笔者先后用此疗法治疗皮肤黏膜溃疡３４例，其中男１９例，女１５例，年龄１８岁至７０岁，中位年龄３３岁，病程７日至５年，中位病程１９日。口腔溃疡２２例，瘫痪患者臀部或肘部溃疡１２例，溃疡面积为（０．３cm×０．３cm）至（６cm×９cm）。治疗方法同该文，３４例在用胰岛素治疗期间均未用其它药物治疗。结果：口腔溃疡３日至５日全部治愈，臀部或肘部溃疡经１个至２个疗程治愈，未发现不良反应。口腔溃疡反复发作，…     

"肩痛灸"贴敷治疗肩痛

２００２年１月采用“肩痛灸”敷贴疗法用于肩痛的治疗，共计５２例，均取得较满意的疗效，并与口服西药芬必得作对照观察，现报道如下。１对象与方法全组１０２例，分为治疗组５２例，对照组５０例。均为初诊患者。治疗组男２２例，女３０例。年龄３０～７４岁，平均年龄５０．８１岁。病程５d～８年。诊断纳入标准：参照《中医病证诊断疗效标准》。（１）慢性劳损，外伤筋骨，或感受风寒湿邪后所致肩周疼痛。（２）肩关节周围疼痛，外展、外旋功能受限，并转见加重。（３）肩周压痛，外展功能受限。（４）肩周疼痛，以夜间加剧，或因天气…     

"西地碘片治疗小儿急性感染性口炎90例"的验证

读了贵刊１９９８年第６期“西地碘片治疗小儿急性感染性口炎９０例”一文后,启发很大。我们最近１０个月以来先后用此疗法治疗小儿急性感染性口炎６０例;其中男３９例,女２１例;年龄１０日至１３岁;黏膜溃疡４２例,牙龈炎１１例,鹅口疮７例。 随机分为治疗组及对照组各３０例,临床表现、治疗方法及疗效标准见该文［１］。 治疗组用药３日至６日,全部治愈。对照组用药４日至８日治愈１８例（６０％）,好转６例（２０％）,无效 ６例（２％）,总有效率 ８０％,两组痊愈率相比有显著性差异（Ｐ＜０．０５）。 本组疗效说明此疗法…     

手法治疗腰椎间盘突出症30例疗效观察

根据“脊柱生物力学”原理，采用中医传统医学手法，背法，穴位按 压疗法；足经，配合“膊运、滚法、揉拿”等手法治疗腰椎间突出症病人的３０例。结果痊愈１４例，占４６．７％，显效７例，占２３．３％，有效６例，占２０．０％，无效３例，占１０．０％，部民有效率为９９．０％。提示本疗法对治疗腰椎间盘突出症有较好疗效，交对该疗法的治疗机理，特点等进行初步的的探讨。     

颌面部 " 致残 " 术病人的心理状况分析及心理康复护理

“致残”手术使病人的身心受到严重损害，颌面部“致残”术更是一种残酷的、常人难以接受的、又是唯一能达到康复的一种治疗手段。本文对２０００年收治的３例颌面部“致残”患者术前、术后心理进行分析探讨，说明心理康复在临床中的作用。报道如下。１对象与方法１．１对象本组３例，男２例，女１例；年龄４２～５６岁，平均４９．３岁；均为农民。右鼻腔鳞状细胞癌２级侵犯右筛窦及眼眶２例，右鼻腔及右筛窦占位侵入右眶内及前颅底１例。手术方式：颅面联合进路鼻腔、鼻窦、前颅底肿瘤切除术＋右眶内容物剜除术１例，鼻侧切开鼻腔、鼻窦肿…     

加用“腹泻汤”治疗小儿腹泻的疗效观察

目的：为观察中西医结合疗法对小儿腹泻病的疗效。方法：１２０例患儿随机分为３组，以抗生素为主的西药组（４０例）；在西医常规治疗基础上，加用自拟“腹泻汤”治疗的中西医结合组（４０例）及以自拟方“腹泻汤”为主的中药组（４０例）均治疗３天作比较。结果：中西医结合疗法对感染性腹泻的总有效率达９０．９１％，明显优于西药组（总有效率为７８．７９％）及中药组（总有效率为８８．４６％），经统计学分析，Ｐ＜０．０１，有非常显著性差异；单用中药治疗小儿感染性腹泻总有效率达８８．４６％，对非感染性腹泻总有效率也达７８．５７％。结论：腹泻汤在治疗小儿腹泻病中具有抗炎、解痉、健脾、利湿、止泻之功能。值得临床推广使用。     

“三联疗法”治疗急性脑梗死疗效观察

目的：观察“三联疗法”治疗急性脑梗死的临床疗效。方法：治疗组以脉络宁注射液、灯盏花素注射液和精制脑组织液分别静滴治疗１００ 例急性脑梗死患者,对照组用尿激酶、精制蝮蛇抗栓酶以静脉给药治疗６０例急性脑梗死患者。结果：总有效率治疗组与对照组分别为９５０％ 和７８３％ ,治疗组疗效明显优于对照组（Ｐ＜ ００１）。２ 组患者治疗后全血比粘度、血细胞比容及纤维蛋白原含量均较治疗前明显下降（Ｐ均＜ ００１）,但治疗后２ 组血液流变学各项指标比较无明显差异。结论：“三联疗法”治疗急性脑梗死疗效肯定,未发现不良反应     

舌运动功能训练矫治"L"音发音错误

在临床治疗过程中，常见到不同年龄患者发与“L”有关的音节或词句时吐字不清（如来、狼、六、了、力量、来了等）。虽为个别辅音错误引起的吐字不清，却明显影响了患者的工作、学习与生活。近５年对收治的２１例仅有“L”音发音错误的患者资料进行统计分析，并对自行设计使用的矫治方法进行归纳总结，报告如下。１．对象与方法１．１对象１９９７年２月至今所诊治的病人共２１例，男１４例，女７例，年龄５～３５岁，平均１６．３岁。年龄分布情况：５～９岁６例，１０～１４岁４例，１５～１９岁３例，２０岁以上８例。“L”音在音节中…     

早期康复干预对急性心肌梗死患者生活质量的影响

目的：探讨早期康复干预对急性心肌梗死患者生活质量的影响。方法：选择急性心肌梗死无并发症患者136例，分为早期康复组72例，常规康复组64例。早期康复组在入院当天即开始康复锻炼。常规康复组在入院第6天进行康复锻炼，两组康复训练内容基本相同，训练时间为14－15d，两组患者在康复锻炼后第14天采用自制生活质量评价表进行问卷调查。统计学处理采用SPSS V 10．0软件包，行t检验。结果：早期康复组生活质量评分明显高于常规康复组，10项评价指标中有精神、睡眠、食欲、疼痛等9项存在显著性差异（P＜0．01），仅对疾病的认识1项无统计学差异（P＞0．05）。结论：对急性心肌梗死患者进行早期康复干预能促进心脏康复，提高患者生活质量。     

运动训练对大鼠局灶性脑缺血后微血管新生的影响

目的：探讨运动训练对局灶性脑缺血后微血管新生的影响。方法：55只SD大鼠随机分为假手术对照组、模型组、康复组；模型组和康复组动物以线栓法制成大鼠左侧大脑中动脉梗死模型，康复组术后1天开始进行运动训练．每周5天，共4周；其余两组常规饲养。以免疫组织化学法检测血管内皮生长因子（VEGF）、因子表达，测定微血管密度。结果：大鼠大脑中动脉栓塞后，缺血区神经元变性、坏死，VEGF和因子在缺血周边区表达明显增加．经运动训练干预后，VEGF和因子表达大量增加，做血管数目明显增加。结论：运动训练可通过促VEGF表达上调．促进微血管新生。     

康复训练对急性脑梗死大鼠长时程增强的影响

目的:研究康复训练对急性大脑中动脉闭塞大鼠海马CA3区长时程增强(LTP)效应的影响。方法:48只Wistar大鼠采用Longa颈外动脉线栓法制备成大鼠大脑中动脉闭塞模型,并随机分为训练组和对照组,训练组每天进行1 h滚筒、平衡木、转棒及网屏训练。于造摸后3、、7、14及21d时2组分别各取6只大鼠进行行为学评分,利用电生理学方法研究大鼠海马CA3区LTP现象的变化。结果:训练14及21d时,训练组大鼠高频电刺激群体峰电位(PS)增幅比同时点对照组明显增强(P<0.05、0.01);训练组自身21d时与3、7、14d时比较PS增幅明显增强。结论:康复训练能促进大鼠急性脑梗死后海马CA3区突触重塑,从而改善其学习与记忆功能。     

The order of reacquirement of activity of daily living functions in people with spinal cord injury during rehabilitation after initial medical treatment and its affecting factors.

The purpose of this study was to investigate the order of reacquisition of activity of daily living (ADL) functions during inpatient rehabilitation at our spinal cord injury unit following the individual's initial medical care and to investigate what initial medical and biological factors would affect the ADL functions which the individual with spinal cord injury could perform 14 weeks after the beginning of inpatient rehabilitation. Fifty-two patients with spinal cord injuries who were hospitalized in the rehabilitation unit after their initial medical care participated in this study. The participants' ADL abilities were measured using the Barthel Index every four weeks after hospitalization for a period of 26 weeks. The order of reacquisition of ADL functions included in the Barthel Index was analyzed. Multiple regression analysis was performed to analyze the initial medical and biological factors affecting ADL reacquisition 14 weeks after hospitalization. The order of reacquisition of the ADL functions was almost the same in each individual. The multiple regression equations of the Barthel Index score and number of ADL functions after 14 weeks were both significant and the explanatory variables in both equations included the patients' age, complications on the initial stage and traumatic brain injury as an associated injury with spinal cord injury. We concluded that the patient's score on the Barthel Index and what the patient could actually perform 14 weeks after hospitalization could be predicted from the patient's status at hospitalization in the rehabilitation unit. This predictable correlation can contribute to the rehabilitation management for spinal cord injuries.     

14 家三级甲等医院中医医师脑卒中康复知识水平调查

目的了解我国三级甲等(简称“三甲”)医院中医医师对脑卒中康复知识的掌握情况。方法参照“中国脑卒中康复治疗指南”编制问卷,于2012 年5 月对全国12 省市14 家三甲医院共128 名临床中医医师进行问卷调查。结果脑卒中康复基础知识的整体正确率为66.83%;脑卒中康复评价知识的整体正确率为88.77%;脑卒中康复治疗知识的整体正确率为75.12%。结论三级甲等中医院医师对脑卒中康复知识的掌握情况尚显不足,需进一步加强康复知识的专科培训。     

康复训练对脑梗死大鼠梗死灶周围微管蛋白表达的影响

目的研究康复训练对大鼠脑梗死灶周围微管蛋白(tubulin)表达的影响。方法40只Wistar大鼠,采用Longa颈外动脉线栓法制备大鼠大脑中动脉闭塞模型,造模后将大鼠随机分为康复组和造模对照组,每组20只。康复组大鼠每天进行滚筒、平衡木、转棒及网屏训练,时间1h;造模对照组置于普通笼中饲养,不予以康复训练。每组分别于造模后3,7,14和21d4个时间点处死5只大鼠,并取脑组织,采用免疫组织化学方法观察每个时间点脑梗死灶周围tubulin的表达。结果康复组神经功能评分明显低于造模对照组(P<0.05)。2组tubulin阳性细胞于脑缺血3d后即已出现,7～21d有大量表达,14d达高峰;康复组于脑缺血7d和21d,tubulin阳性细胞的表达水平明显高于造模对照组(P<0.05)。结论康复训练能促使中枢神经系统表达较高水平的tubulin。     

The organization of vocational rehabilitation: the structure of success

Focusing on vocational rehabilitation goals provides an understanding of the underlying structural and behavioural factors affecting successful employment outcomes. Two types of vocational centres having contrasting rehabilitation employment orientations are examined. Both types have similar end goals but organizational structures shaping divergent means toward the gainful employment of disabled persons. Utilizing a split sample of 14 vocational rehabilitation programmes in Israel, 7 sheltered and 7 supported programmes, a structured questionnaire of key administrative personnel and employees was generated. Success was based on six consensus measures. Clear differences between administrative, organizational and programme goals emerge, which affect goal priority and source of success measurement. Employing regression models, three keys to success are detected which stress the interplay between internal and external organization reference criteria in affecting success attainment. The results suggest that the organization of vocational rehabilitation has a direct impact on rehabilitation success.     

康复训练对脑梗死大鼠血管内皮生长因子的表达及血管生成的影响

目的研究康复训练对脑梗死大鼠梗死灶周围新生血管情况、血管内皮生长因子（VEGF）和其受体（FLK-1）表达的影响。方法60只Wistar大鼠制备脑梗死模型后，随机分为康复训练组和造模对照组。康复训练组大鼠每天进行1h滚筒、平衡木、转棒及网屏训练，造模对照组置于普通笼中自由活动。每组分别于造模后3，7，14，21和28d采用免疫组织化学法检测梗死灶周围微血管数量（CD34标记）及VEGF和FLK-1的表达。结果（1）康复训练组术后14，21和28d行为学评分明显低于造模对照组（P〈0．05）；（2）康复训练组大鼠脑梗死灶周围CD34阳性微血管数量在脑梗死后21和28d较造模对照组明显增加（P〈0.05）；（3）康复训练组大鼠各时间点梗死灶周围VEGF表达均较对照组明显增加（P〈0．05）；（4）康复训练组大鼠各时间点梗死灶周围FLK-1表达均较造模对照组明显增加（P〈0．05）。结论康复训练可能通过诱导VEGF及其受体的表达，保护神经细胞，并促进血管新生，改善梗死灶周围血液供应，从而促进脑梗死后神经功能的恢复。     

Characteristics of cost outliers who did not benefit from stroke rehabilitation

The purpose of this paper is twofold: 1) to identify stroke patients who generated substantial charges during inpatient rehabilitation, but did not seem to benefit from that experience and 2) to identify factors that can predict which patients will fall into this group using only variables known at admission to rehabilitation. High cost stroke patients during inpatient medical rehabilitation are examined to determine how they differ from low cost patients and to identify a subset who did not appear to benefit from rehabilitation. This paper is based on longitudinal charge data involving 73 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities in 1984. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. Among these 73 stroke patients, charges for inpatient medical rehabilitation amounted to nearly 1.8 million dollars, excluding physician fees and out-of-pocket expenses. Of this total, 57.6% was accured by only 33% of the patients. Fourteen patients, who were both rehabilitation cost outliers and apparent rehabilitation "failures," were identified. Rehabilitation charges for these 14 amounted to $673,232 or 37.5% of the total rehabilitation charges for all 73 patients.     

不同干预方法对局灶性脑缺血大鼠内源性神经干细胞增殖的影响

目的:观察针刺、康复训练、针刺+康复训练对成年局灶性脑缺血大鼠的神经功能缺损评分及内源性神经干细胞(NSCs)增殖的影响。方法:采用线栓法制备大鼠大脑中动脉闭塞(MCAO)模型,并给予针刺、康复训练、针刺+康复训练干预,在缺血损伤后第4、7、14和21天,对大鼠进行神经功能缺损评分,同时应用Brdu免疫组化法观察再灌注损伤后大鼠NSCs增殖情况。结果:康复训练组、针刺组、针刺+康复训练组在术后第4、7、14、21天神经功能缺损评分比较,差异无显著性意义(P0.05);与造模组比较差异有显著性意义(P0.05)。脑缺血后,第4、7、14、21天室管膜下区、缺血边缘区Brdu阳性细胞表达,第7天达高峰;第7天室管膜下区康复训练组和针刺组BrdU阳性细胞数显著高于相同时间段模型组(P0.05),针刺+康复训练组BrdU阳性细胞数显著高于相同时间段康复训练组和针刺组(P0.05);第14天和21天BrdU阳性细胞数在模型组、针刺组、康复训练组和针刺+康复训练组差异未见显著性意义(P0.05)。结论:缺血性脑损伤后诱发内源性NSCs发生增殖。康复训练和针刺可增加局灶性脑缺血大鼠SVZ区内源性NSCs的增殖。