脑卒中后三级康复干预研究：家庭访视对脑梗死出院患者运动功能和日常生活能力的影响

目的：了解定期家庭访视方式对脑梗死出院患者日常生活能力及运动功能的影响，评估脑卒中后三级康复干预的实用性。方法：将2001-10／2003-10福建医科大学附属第一医院神经内科160例出院脑梗死患者按出院顺序随机分成家庭访视组与对照组各80例。定期家庭访视内容包括对家庭康复环境的布置和改造指导、康复训练指导、日常生活能力训练指导、心理康复指导和疾病康复相关知识的认知教育，对照组不作家庭访视。访视频度前3个月每周1次，3个月后每半个月1次，每次一两个小时，共访视1年。治疗前后采用Fugl-Mever运动功能评分方法(FMA)及改良的Barthel指数评估两组患者的运动功能及日常生活活动(ADL)能力。结果：两组治疗前上肢运动功能、下肢运动功能和FMA总分相差不明显(P均&;gt;0.05)，1年后两组上述3种因子评分均明显高于治疗前，同时访视组治疗后各项FMA(上肢因子、下肢因子、总分)评分也明显高于对照组(P均&;lt;0.01～0.05)；两组治疗前ADL分项评估差异无显著性意义(P均&;gt;0.05)。治疗后两组ADL在排尿、排便、修饰、用厕、进食、转移、活动(步行)、穿衣、上下楼梯、洗澡等分项评分明显高于治疗前(P均&;lt;0.05)。同时家庭访视组治疗后ADL(修饰、用厕、进食、转移、活动步行、洗澡等)分项评分也均明显高于对照组(P均&;lt;0.01～0.05)。结论：定期家庭访视是脑卒中病后三级康复干预的有效方法，可明确提高脑梗死出院患者运动功能及日常生活能力，有益于回归社会。     

早期康复护理在颅脑损伤患者中的应用

目的 探讨早期康复护理对颅脑损伤患者康复的作用.方法 选取颅脑损伤患者92例,随机分为观察组和对照组,每组46例.对照组给予常规护理,观察组在常规护理的基础上给予早期康复护理.观察两组患者治疗前后肢体残损程度及日常生活活动能力(ADL).结果 两组患者治疗后FMA评分及ADL评分均明显高于治疗前(P＜0.01);并且观察组治疗后FMA及ADL评分明显高于对照组(P＜0.05).结论 早期康复护理能明显改善颅脑损伤患者的神经功能、肢体运动功能及日常生活能力,对提高患者生存质量、促进康复有积极意义.     

视频激励对脑卒中患者康复效果的影响

目的观察个性化视频对脑卒中患者康复效果的影响。方法选择在本院成功康复的脑卒中患者为对象制作视频。将60例脑卒中患者分为观察组和对照组,两组均接受常规治疗,观察组增加播放视频。30 d后以简式Fugl-Meyer运动功能评定量表(Fugl-Meyer ssessment,FMA)和日常生活活动能力(activities of daily living,ADL)评分评价患者的运动功能和日常生活能力,同时评价患者的从医性和对医护人员的信任度。结果两组的FMA和ADL评分均明显高于治疗前(P0.05),而观察组显著高于对照组(P0.05);观察组从医性和对医护人员的信任度明显高于对照组(P0.05)。结论个性化视频对脑卒中患者的康复有明显的促进作用。     

具体指导下的家庭康复治疗对脑卒中偏瘫患者疗效的影响

目的观察具体指导下的家庭康复治疗对脑卒中偏瘫患者运动功能及日常生活活动（ADL）能力的影响。 方法将52例脑卒中偏瘫患者随机分为康复组和对照组。康复组患者出院时由治疗师制定详尽的家庭康复计划，并对其家属进行康复知识培训；出院后康复组患者严格按照康复计划进行家庭康复训练（期间由患者家属给予协助）,并定期到医院接受评估指导。对照组患者出院后未给予上述系统家庭康复训练，仅让其自行在家进行康复训练。于出院时、出院后3个月和6个月时采用Fugl-Meyer运动功能评分（FMA）、改良Barthel指数(MBI)对2组患者运动功能、ADL能力进行评定。 结果出院后3个月和6个月时，2组患者FMA评分及MBI评分均较出院时显著改善，且康复组改善幅度明显优于对照组(P<0.05)；康复组出院后6个月时,其FMA、MBI评分与出院后3个月时比较，差异均有统计学意义(P<0.05)，而对照组差异无统计学意义(P&rt;0.05)。 结论具体指导下的家庭康复治疗可显著促进脑卒中偏瘫患者运动功能和ADL能力恢复，是一种行之有效的脑卒中康复治疗手段。     

随访对脑出血穿刺术患者治疗依从性及功能恢复的影响

目的 探讨家庭访视对脑出血穿刺引流术患者治疗依从性与运动功能及生活能力的影响.方法 将176例脑出血穿刺术的患者按出院顺序分成家庭访视组(89例)与对照组(87例).家庭访视组为脑出血穿刺术出院患者定期提供医疗护理支持服务,出院后4个月,每周1次,4个月后每15天1次,每次1～2 h,疗程为1年.对照组按临床常规护理,家庭访视组不定期到患者家里对患者进行康复训练指导及患者到医院接受相关治疗,疗程为1年,访视前后评估2组患者的治疗依从性、运动功能(FMA)及日常生活能力(ADL).结果 对2组治疗依从性、FMA、ADL进行统计学分析,差异均有统计学意义.结论 家庭访视可提高脑出血穿刺引流术患者的治疗依从性与肢体运动功能及生活能力.     

康复精细化管理对脑卒中偏瘫患者上肢功能及日常生活活动能力的影响

目的:探讨康复精细化管理对脑卒中偏瘫患者上肢功能和日常生活活动能力(ADL)的影响。方法:脑卒中偏瘫患者48例随机分为2组各24例,2组均采用常规的康复治疗和护理,对照组采取随意安排床位及常规的病床管理,观察组根据患者偏瘫个体化特点安排病房病床、病床配套设备、相应精细化处置方法等,并安排康复护士进行24h康复护理巡回。结果:干预1个月后,2组FMA各项评分均较治疗前有所提高,但差异无统计学意义;干预3及6个月后,2组FMA各项评分均较治疗前明显提高(均P0.01)。观察组的屈肌协同能力评分在干预1、3及6个月时均明显高于对照组(均P0.01),观察组的伴协同运动和脱离协同运动评分在干预后6个月均明显优于对照组(均P0.05)。干预6个月后,2组BI评分均较治疗前明显提高(均P0.05),且观察组高于对照组(P0.05)。结论:康复精细化管理有利于促进脑卒中偏瘫患者ADL及部分上肢运动功能的提高。     

随访对脑出血穿刺术患者治疗依从性及功能恢复的影响

目的探讨家庭访视对脑出血穿刺引流术患者治疗依从性与运动功能及生活能力的影响。方法将176例脑出血穿刺术的患者按出院顺序分成家庭访视组(89例)与对照组(87例)。家庭访视组为脑出血穿刺术出院患者定期提供医疗护理支持服务,出院后4个月,每周1次,4个月后每15天1次,每次1～2h,疗程为1年。对照组按临床常规护理,家庭访视组不定期到患者家里对患者进行康复训练指导及患者到医院接受相关治疗,疗程为1年,访视前后评估2组患者的治疗依从性、运动功能(FMA)及日常生活能力(ADL)。结果对2组治疗依从性、FMA、ADL进行统计学分析,差异均有统计学意义。结论家庭访视可提高脑出血穿刺引流术患者的治疗依从性与肢体运动功能及生活能力。     

早期康复对脑梗死患者运动功能和日常生活活动能力的影响

目的评价早期康复治疗改善脑梗死患者Fugl-Meyer和ADL评分的效果。方法选取82例脑梗死患者按照不同疗法将其纳入A组(41例)与B组(41例)。A组给予常规药物治疗,B组予以常规药物治疗联合早期康复治疗,对比两组的神经功能(NIHSS评分)、运动功能(Fugl-Meyer评分)、日常生活活动能力(ADL评分)以及总体疗效。结果两组治疗后的NIHSS评分均低于本组治疗前,且B组低于A组,P0.05;两组治疗后的Fugl-Meyer评分与ADL评分均高于本组治疗前,且B组均高于A组,P0.05;B组的总有效率(92.7%)高于A组(75.6%),P0.05。结论早期康复治疗脑梗死的效果满意,可明显改善患者的神经功能、运动功能以及日常生活活动能力。     

社区康复对脑卒中患者肢体功能和日常生活活动能力的影响

目的探讨社区康复对脑卒中患者肢体运动功能和日常生活活动（ADL）能力的影响。 方法60例脑卒中患者分成康复组和对照组,每组30例。康复组由同一康复医师进行评估并制定康复治疗计划,同时指导患者进行系统、规范的社区康复训练,对照组给予常规健康教育。2组均于入组后第1天（治疗前）和治疗3个月后（治疗后）采用简化Fugl-Meyer运动功能量表（FMA）和改良巴氏指数（MBI）评定患者的肢体运动功能和ADL能力。 结果治疗前,2组患者的FMA评分和MBI评分差异均无统计学意义（P＞0.05）;治疗后,2组患者的FMA评分和MBI评分与本组治疗前比较,均有明显改善（P＜0.05）,且康复组的FMA评分和MBI评分较对照组治疗后改善更为显著,差异均有统计学意义（P＜0.05）。 结论社区康复训练对脑卒中患者肢体的运动功能和ADL能力具有良好的促进作用。     

家庭康复治疗对脑卒中偏瘫患者日常生活能力及运动功能的影响

目的 :探讨家庭康复治疗对脑卒中偏瘫患者日常生活能力 (ADL)及运动功能的影响。方法 :脑卒中偏瘫患者 12 8例随机分成 2组各 6 4例 ,2组住院期间进行药物和康复治疗 ,出院后康复组仍坚持正规家庭康复指导 ,对照组仅进行自我锻炼。出院时及出院 8周后进行Brunnstorm运动功能测评及Barthel指数评分。结果 :8周后 2组Barthel指数及偏瘫肢体的运动功能均有改善 ,其改善幅度康复组明显优于对照组 (P <0 .0 5 )。结论 :脑卒中患者出院后仍进行正规的家庭康复指导 ,能明显提高ADL及肢体的运动功能。     

Recurrence of tuberculosis after hip replacement 58 years after primary infection

The paper presents the case of a 73-year-old patient with a history of tuberculosis of the hip in childhood who received an Exeter total hip prosthesis. Tuberculosis recurred 58 years after primary infection and 9 years after THA. The authors analyzed the available literature, which described only a few case reports, because Mycobacterium tuberculosis infections of a joint implant after THA are extremely rare. They are frequently the result of local reactivation of the pathogen or, less commonly, an overlooked diagnosis of tuberculosis at the time of endoprosthesis implantation. Proper diagnostic work-up of infection is particularly difficult because synovial fluid cultures are usually negative. In addition, a coexisting Staphylococcus aureus infection may obscure the clinical presentation. In post-THA patients, complete anti-TB treatment is recommended. Particular caution should be observed in patients from regions with high TB morbidity or with a history of pulmonary and operated joint tuberculosis.     

The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest

IntroductionTreatment with hypothermia has been shown to improve outcome after cardiac arrest (CA). Current consensus is to rewarm at 0.25–0.5 °C/h and avoid fever. The aim of this study was to investigate whether active rewarming, the rate of rewarming or development of fever after treatment with hypothermia after CA was correlated with poor outcome.MethodsThis retrospective cohort study included adult patients treated with hypothermia after CA and admitted to the intensive care unit between January 2006 and January 2009. The average rewarming rate from end of hypothermia treatment (passive rewarming) or start active rewarming until 36 °C was dichotomized in a high (≥0.5 °C/h) or normal rate (<0.5 °C/h). Fever was defined as > 38 °C within 72 h after admission. Poor outcome was defined as death, vegetative state, or severe disability after 6 months.ResultsFrom 128 included patients, 56% had a poor outcome. Actively rewarmed patients (38%) had a higher risk for poor outcome, OR 2.14 (1.01–4.57), p < 0.05. However, this effect disappeared after adjustment for the confounders age and initial rhythm, OR 1.51 (0.64–3.58). A poor outcome was found in 15/21 patients (71%) with a high rewarming rate, compared to 54/103 patients (52%) with a normal rewarming rate, OR 2.61 (0.88–7.73), p = 0.08. Fever was not associated with outcome, OR 0.64 (0.31–1.30), p = 0.22.ConclusionsThis study showed that patients who needed active rewarming after therapeutic hypothermia after CA did not have a higher risk for a poor outcome. In addition, neither speed of rewarming, nor development of fever had an effect on outcome.     

法洛四联症患儿体肺侧枝栓塞术并根治术的术后护理

法洛四联症是一种常见的发绀型先天性心脏病，在发绀型心脏病中居首位，存在肺动脉狭窄、室间隔缺损、主动脉骑跨、右心室肥厚4种畸形，根据病情可选择姑息术和根治术。重症患者体肺侧枝循环形成，术后渗血概率高，易并发低心排综合征、灌注肺等严重并发症。     

Psychotherapy of bereavement after homicide

The author presents guidelines for the assessment and initial treatment of bereavement after a homicide. Early interventions include nonverbal techniques applied in individual and group therapy. Because patients are over-whelmed and reactive, initial treatment strategy is supportive and focuses on reestablishing resiliency rather than on preexisting vulnerabilities (ambivalence, guilt, repression, denial). Adjustment to homicidal dying is lifelong, and therapist and patient should acknowledge that change may be limited.     

中耳乳突手术后治疗中耳内窥镜的应用

目的 探讨乳突根治术后耳内窥镜换药与常规换药相比是否具有优势.方法 2003年3月-2008年10月对89例共89只耳行开放式乳突根治术患者按随机数字表法随机分为试验组及对照组,试验组45例45只耳采用耳内窥镜换药,对照组44例44只耳常规换药;分别观察试验组和对照组的干耳人数及干耳的时间,计算干耳率及干耳的平均时间....     

Gastrointestinal blood loss after diflunisal and after aspirin: effect of ethanol.

Fecal blood loss was evaluated in normal subjects with 51Cr-labeled red cells. In a double-blind parallel study in 10 subjects, 250 mg diflunisal twice daily did not significantly increase blood loss in two consecutive treatment periods, while 750 mg acetylsalicylic acid (ASA) 4 times daily did so. In a double-blind crossover study in 2 subjects, diflunisal, 250 mg twice daily again did not significantly affect fecal blood loss during a 4-day treatment period, and there also was no significant effth diflunisal during two additional treatment days. ASA, 600 mg 4 times daily, induced an increase in blood loss and this effect was significantly enhanced by the addition of alcohol. The difference between treatments in the way they interact with alcohol was also statistically significant.