肛肠病手术超前镇痛联合术后局部注射镇痛效果的临床研究

为观察高乌甲素超前镇痛加亚甲蓝长效止痛剂局部注射对肛肠病患者进行术后镇痛的效果,将300例拟行手术治疗的肛肠病患者随机分为A、B、C三组,各100例,镇痛方式：A组术前3h肌肉注射氢溴酸高乌甲素8mg,术后于创面局部点状注射亚甲蓝长效止痛剂（亚甲蓝20mg、2％利多卡因5ml、注射用水10ml的混合液）;B组仅术后于创面局部点状注射亚甲蓝长效止痛剂;C组仅术后口服曲马多缓释片。对比观察三组患者的术后镇痛效果。结果显示,（1）肛门疼痛VAS评分：A组患者术后6～72h几乎无痛。术后6h、24h肛门疼痛VAS评分A组均低于B、c组,P〈0．05或P〈0．01。术后72h肛门疼痛VAS评分A组与B组比较差异无统计学意义,P〉0．05;但A组、B组均明显低于C组,P〈0．01。（2）镇痛效果：A组患者术后6～72h镇痛效果均为优。术后6h、24h镇痛效果A组均明显优于B、c组,P〈0．01。术后72h镇痛效果A组与B组比较差异无统计学意义,P〉0．05;但A组、B组均明显优于C组,P〈0．01。结果表明,高乌甲素超前镇痛加亚甲蓝长效止痛剂局部注射对肛肠病患者进行术后镇痛操作简单,安全,效果满意。     

肩锁关节手术后应用臂丛神经自控镇痛的临床研究

目的研究臂丛神经自控镇痛（PCRA）对围术期肩锁关节骨折脱位手术患者镇痛治疗应激反应的影响。方法45例拟行肩锁关节骨折脱位手术患者,根据不同镇痛方式随机分为三组：A组为对照组,术后根据需要间断肌注哌替啶镇痛;B组术后行PCRA;C组术后行静脉自控镇痛（PCIA）。测定术前、术后24、48h血浆皮质醇、血管紧张素Ⅱ的浓度;监测HR、BP及进行视觉模拟评分（VAS）;测量肩锁关节被动活动度。结果B组及C组术后24h皮质醇、血管紧张素Ⅱ值显著低于A组（P〈0．05）,而B组降低幅度更大,持续时间更长,至术后48hB组仍低于A组（P〈0．05）,而术后48hC组与A组比较差异无统计学意义。B组及C组术后HR、SBP、DBP及VAS显著低于同期A组（P〈0．05）,且B组数值更低（P〈0．01）。B组及C组术后肩锁关节被动活动度显著大于同期A组（P〈0．05）,且B组术后肩锁关节被动活动度更大（P〈0．01）。结论PCRA更能有效地减轻肩锁关节骨折脱位手术患者疼痛,降低患者术后皮质醇、血管紧张素Ⅱ水平,利于患者进行肩锁关节早期功能锻炼,减少术后并发症,有利于患者恢复。     

2型糖尿病肾脏病患者血清脂联素水平变化及分析

目的通过分析血清脂联素（ADPN）在糖尿病肾脏病（DKD）肾损害不同时期的水平变化,探讨其在DKD发生、发展中的可能作用。方法2型糖尿病患者120例,根据24h尿蛋白定量及血肌酐（SCr）水平分为单纯糖尿病组（A组）、微量白蛋白尿组（B组）、大量白蛋白尿组（C组）、肾功能衰竭组（D组）,正常对照组30例（E组）。用酶联免疫吸附法检测各组血清ADPN水平变化。结果血清ADPN水平在A组显著低于E组（P〈0．05）,而在B、C、D组均显著高于E组（P〈0．01）,且随24h尿蛋白定量及肾损害程度的增加依次升高,B、C、D组间有统计学差异（P〈0．01或P〈0．05）。A、B、C、D组肿瘤坏死因子α（TNF-α）水平均较E组显著升高（P〈0．01或P〈0．05）,且随24h尿蛋白定量及肾损害程度的增加依次升高,4组间比较亦有统计学差异（P〈0．01或P〈0．05）。A、B、C、D组血清ADPN水平与TNF-α、24h尿白蛋白定量及SCr呈正相关（r=0．4345、0．5015、0．4644,P〈0．01）,与血糖、甘油三酯呈负相关（r=-0．1849、-0．1793,P〈0．05）。与胆固醇无相关性。结论2型DKD患者血清ADPN水平随。肾损害程度加重而不断升高,且与TNF-α显著相关。提示二者水平变化及相互作用可能在DKD发生发展过程中起重要作用。     

妊娠高血压综合征患者剖宫产术后硬膜外微量泵镇痛对泌乳素的影响

目的探讨妊娠高血压综合征（妊高征）患者剖宫产术后硬膜外微量泵镇痛对泌乳素的影响。方法选择足月正常产妇和足月中、重度妊高征产妇各30例,在硬膜外麻醉下施行剖宫产术,术毕随机分为四组：正常产妇镇痛组（A组）、正常产妇对照组（B组）、妊高征产妇镇痛组（C组）、妊高征产妇对照组（D组）,每组各15例。A组和c组术后采用硬膜外微量泵镇痛,B组和D组术后按需肌肉注射哌替啶。分别于术前、术毕、术后24h、术后48h记录平均动脉压（MAP）和心率,采用放射免疫法测定泌乳素水平,视觉模拟疼痛评分（VAS）评定镇痛效果。结果A组和B组MAP和心率无明显变化,c组和D组术毕、术后24h和术后48hMAP较术前明显降低（P〈0．01）,C组术后24h和术后48h较D组降低更为明显（P〈0．01）。A组和C组术后24h和术后48hVAS评分均明显低于B组和D组（P〈0．01）。术前A组和B组泌乳素水平[（196．45±38．57）、（195．61±36．23）μg／L]高于C组和D组[（161．75±42．66）、（162．26±35．38）μg／L]（P〈0．05）,术后24h和术后48h四组泌乳素水平[A组：（335．28±42．63）、（397．63±40．59）μg/L,B组（288．26±45．47）、（359．74±43．24）μg／L,C组（322．52±50．62）、（391．57±54．52）μg／L,D组（261．34±43．14）、（318．24±43．68）μg／L]均较术前升高（P〈0．05）。术后24h和术后48hA组泌乳素水平高于B组,B组和c组高于D组,差异均有统计学意义（P〈0．05）。四组术后48h泌乳素水平均高于术后24h（P〈0．05）。初乳时间及肠排气时间A组和C组早于B组和D组（P〈0．05）,B组早于D组（P〈0．05）。术后生命体征平稳,无恶心、呕吐、头痛发生。结论妊高征患者剖宫产术后采用布比卡因、芬太尼硬膜外微量泵镇痛效果确切、安全,能促进泌乳素分泌,提高初乳时间。     

中／长链脂肪乳注射液（卡路）在“全合一”营养液中的稳定性研究

目的研究中／长链脂肪乳注射液（卡路）在“全合一”营养液中的稳定性。方法分别将125ml和250ml的卡路添加到1L（A组）和2L（B组）克灵麦液中,同时在两组中添加相同剂量的维生素、电解质、微量元素及不同剂量的20％卡路配制成“全合一”营养液,两组脂肪乳的终浓度均为2．20％而电解质和微量元素的浓度不同。室温放置,分别于0、24、48、72h取样检测,观察两组卡路的乳粒大小、平均粒径、分布及“全合一”营养液的pH值和渗透压。结果两组间脂肪乳的平均粒径在各时间点无显著性差异;两组24h的乳粒计数较新配时显著减少（P〈0．05）;A组72h的乳粒计数较新配时显著增加（P〈0．05）;B组在48h和72h的乳粒计数较A组显著减少（P〈0．05）。两组24、48、72h的pH值较新配时显著降低（P〈0．05）;B组48h较A组pH显著下降（P〈0．05）,但72h较A组显著升高（P〈0．05）。A组24、48、72h的渗透压较新配时显著下降（P〈0．05）,B组24h和48h渗透压较新配时显著下降（P〈0．05）;B组各时段渗透压均较A组显著降低（19〈0．05）。两组的卡路在各时段的各项结果均符合质量标准要求。结论两组的电解质和微量元素浓度不同,在室温条件放置72h后,卡路在“全合一”营养液中的乳粒稳定性仍符合质量标准要求。     

大鼠肝移植后早期血清一氧化氮的变化及其意义

目的探讨大鼠肝移植后早期血清一氧化氮（NO）的变化情况及其意义。方法将SD大鼠随机分成A、B、C三组，进行肝移植．供、受者均为SD大鼠。A组于移植肝恢复血流2h、B组于移植肝恢复血流4h、C组于移植肝恢复血流6h时采取受者的下腔静脉血和左肝叶组织．测定血清丙氨酸转氨酶（ALT）和NO含量．免疫组化法测定移植肝组织中核因子．κB p65亚单位（NF-κB p65）的表达，并观察肝组织病理学变化；每组均于移植肝恢复血流时收集5min的胆汁，测量5min胆汁分泌量。结果A组的5min胆汁分泌量为（3．73±1．11）μl．明显高于B组的（2．35±0．92）μ和C组的（2．23±0．81）μl（P〈0．05）。A组血清ALT含量为（468±36）IU／L．B组为（619±49）IU／L．C组为（820±65）IU／L，A组明显低于B、C组（P〈0．05），B组明显低于C组（P〈0．05）。A组血清NO含量为（14．2±1．5）μmol／L，明显高于B组的（10．5±1．2）μmol／L和C组的（10．3±1．1）μmol／L（P〈0．05）。A组肝组织中NF-κB p65表达阳性细胞百分率为（23．5±1．9）％．B组为（43．8±3．8）％，C组为（48．6±5．1）％．A组明显低于B、C组（P〈0．05）。病理学观察显示．随着移植肝脏再灌注时间的延长，肝组织损伤呈进行性加重。Pearson相关性分析提示．NO与血清ALT水平及NF-κB p65表达呈明显的负相关（r值分别为-0．74和-0．77，P〈0．01）。结论移植肝脏再灌注早期．血清NO下降，NF-κB的活性逐渐增强．移植肝脏的功能和组织损伤呈加重趋势。     

丙泊酚麻醉对急性颅脑外伤手术患者血清S100B的影响

目的研究急性颅脑外伤手术前和手术期间丙泊酚对血清S100B的影响,以评价丙泊酚的脑保护作用。方法急症颅脑外伤手术患者30例。随机分为丙泊酚（A）组和异氟醚（B）组,每组15例。另10例泌尿系统手术的非颅脑损伤患者的血清作空白对照（C）组。酶联免疫吸附法测定C组及A、B组颅脑手术前、手术开始2h、手术结束时血清S100B含量。对急症颅脑外伤手术患者进行格拉斯哥（Glasgow）评分。结果A、B组患者手术前S100B显著高于C组（P〈0．01）;Glasgow评分越低的患者术前S100B越高（r=-0．446,P〈0．05）。手术结束时A组S100B显著低于B组（P〈0．05）。开颅手术2h和手术结束时两组S100B均较术前有升高。结论急性颅脑外伤时患者血清S100B升高,Glasgow评分越低,血清的S100B浓度也越高。提示临床剂量丙泊酚可以抑制血清S100B的升高,减轻继发性脑损害,具有脑保护作用。     

丙酮酸乙酯对重症急性胰腺炎大鼠肠黏膜HMGB1表达的影响

目的探讨丙酮酸乙酯（EP）对大鼠重症急性胰腺炎（SAP）肠组织中高迁移率族蛋白B1（HMGBl）表达的影响，以期为SAP的治疗提供思路。方法雄性Wistar大鼠90只随机分为3组：A组为SAP组；B组为SAP＋EP处理组（EP组）；C组假手术对照组（对照组）。3组动物于术后3，6，12，24，48h取材。测定血淀粉酶（AMY）、D-乳酸、肠组织丙二醛（MDA）含量。通过光学显微镜观察肠组织病理变化及免疫组织化学法观察HMGBl在肠组织中的表达。Western-blot法进行HMGBl检测。结果A，B组AMY和D-乳酸水平明显升高，但B组较A组显著降低（P〈0．05）。A组肠组织中MDA明显高于C组（P〈0．01），B组肠组织中MDA升高幅度较A组小（P〈0．05）。B组较A组肠组织病理损伤明显减轻。A组6h时肠组织HMGBl表达水平显著高于C组，于24h达峰值，且持续至48h（P〈0、01）。B组肠组织HMGBl表达水平均明显低于A组（P〈0．05）。结论SAP时，HMGBl可介导肠黏膜通透性增加。EP能显著抑制HMGBl的表达，改善肠黏膜屏障功能，对SAP肠黏膜损伤有明显的保护作用。     

适时镇痛对腹部术后疼痛患者的影响

目的 探讨上腹部术后疼痛患者肌内注射哌替啶镇痛的时机及效果。方法 将80例上腹部术后患者随机分为A、B、C三组，分别在VAS评分2～3分、4～5分和6～7分时肌内注射哌替啶1次，注射后3、6h再次评分观察镇痛效果，并记录48h内用药次数。结果 肌内注射哌替啶3h和6h后VSA评分三组比较，B组和C组显著高于A组，差异有显著性意义（均P〈0．01）；48h内肌内注射哌替啶2次或≥3次的人数比较，B组和C组显著高于A组（P〈0．05，P〈0．01）。结论 术后VAS评分2～3分时肌内注射镇疼药时机最佳．能有效的缓解疼痛．减少用药次数。     

护患纠纷后护理人员心理状况调查分析

目的 探讨全麻手术术前不同时间留置尿管对患者术后尿管耐受性的影响。方法 将307例全麻开胸手术患者随机分成A组（102例）、B组（104例）、C组（101例），分别在病室（A组）、手术室全麻诱导前（B组）、手术室全麻诱导后（C组）留置尿管，观察置管时及术后（拔除气管导管时，术后3h，术后6h）4个时段患者对尿管的耐受情况。结果 置管时，C组尿管耐受率100％，显著优于B组（59．61％）和A组（23．53％），而B组耐受率显著优于A组（均P〈0．01）。术后，C组拔除气管导管时、术后3h尿管耐受率与A、B组比较，差异有显著性意义（P〈0．05，P〈0．01），而A、B组比较，差异无显著性意义（均P〉0．05）；术后6h，3组间比较，差异无显著性意义（均P〉0．05）。结论 麻醉诱导前留置尿管，患者不适反应轻，术后苏醒期对尿管的耐受性好，是术前留置尿管的最佳时机。     

Induction of Heat Shock Response: Effect on the Rat Liver with Carbon Tetrachloride-induced Fibrosis from Ischemia-reperfusion Injury

n = 56) received no pretreatment except anesthesia, and the heat shock group (group HS, n = 56) were exposed to heat shock (42°C) for 15 minutes. After a 48-hour recovery all rats were subjected to 30 minutes of warm ischemia. Western blotting analysis was employed for heat shock protein (HSP) 72 detection. The adenine nucleotide levels in liver tissue and the liver enzyme levels in serum were measured before and after ischemic intervention (seven animals were used at each of six time point measurements in both groups). HSP72 was induced in group HS at greater intensity than in group C. The survival rate on postoperative day 7 in group C (3/14) was significantly poorer than that in group HS (14/14) ( p < 0.01). The higher survival rate in group HS was accompanied by more rapid recovery of the adenosine triphosphate level and lower serum levels of liver enzymes after reperfusion ( p < 0.01 vs. group C). Heat shock preconditioning induces HSP72 in the rat liver with fibrosis and provides significantly increased tolerance of warm-ischemia reperfusion injury.     

手法加载对慢性下腰痛模型大鼠降钙素基因相关肽和神经生长因子的影响

目的:观察手法加载对慢性下腰痛(chronic low back pain,CLBP)模型大鼠的镇痛效应以及腰大肌组织相关炎性因子表达的影响,探索手法对局部炎性微环境状态的改善情况。方法:选取体质量为340～360 g的SPF级雄性SD大鼠32只,随机分为空白组、假手术组、慢性下腰痛模型组、治疗组,每组8只。模型组大鼠腰椎L4-L6植入外部链接固定系统(external link fixation system,ELFS),假手术组不植入ELFS,仅行切开缝合,空白组不作任何处理,治疗组植入ELFS后,在脊柱两侧用力量为5 N,频率为2 Hz的刺激量进行手法干预,15 min/次,1次/d,连续干预14 d,分别在造模前、干预后第1、3、7、10、14天检测四组大鼠机械刺激反应阈值(paw with drawl threshold,PWT),热刺激反应阈值(paw withdrawl latency,PWL),治疗周期结束后,酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测腰大肌组织中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)和神经生长因子(nerve growth factor,NGF)的浓度值。结果:空白组与假手术组的PWT、PWL在造模后均无显著差异(P0.05);模型成模后,CLBP模型组和治疗组PWT、PWL明显降低(P0.01);手法加载后第1、3天,治疗组的PWT较CLBP模型组改善不明显(P0.05);手法加载后第7天,治疗组与CLBP模型大鼠相比,痛阈值呈现出升高的趋势,但二者相比无统计学意义(P=0.0560.05),至治疗第10、14天,治疗组大鼠的机械痛阈值开始上升,且与CLBP模型大鼠相比有统计学意义,分别为(P0.05,P0.01);手法治疗后第1、3天,治疗组的PWL较CLBP模型组改善同样不明显(P0.05);待第7天比较,治疗组与CLBP模型组的PWL有统计学意义(P=0.0160.05),手法加载对CLBP大鼠热痛觉过敏现象有了改善直到实验结束。CLBP模型组腰大肌中CGRP和NGF含量均高于空白组和假手术组(P0.01),治疗后两者的含量均有明显下降(P0.01)。结论:局部按揉手法加载对CLBP大鼠有镇痛作用,同时可以抑制CLBP大鼠腰大肌组织CGRP、NGF的含量,改善局部炎性微环境状态。     

Effects of moderate endurance exercise on calcium, parathyroid hormone, and markers of bone metabolism in young women

We investigated the short-term (1 hour–3 days) effects of a 45 minute run on calcium, parathyroid hormone, the carboxyterminal propeptide of type I procollagen (PICP), and the immunoactive carboxyterminal telopeptide of type I collagen in serum (ICTP) in young females. Fourteen healthy young women, aged 25.2 ± 0.6 years (mean ± SEM) with regular menstruations, participated. The test was outdoor jogging for 45 minutes at an intensity of 50% of VO_{2 max}. Blood samples were collected 15 minutes before the test and 1, 24, and 72 hours after the test. The measured values were adjusted for changes in plasma volume. A significant decrease of ionized calcium was observed at 1 hour (P < 0.001) and 72 hours (P < 0.05) and a significant increase of parathyroid hormone (PTH) was noted 24 (P < 0.01) and 72 hours (P < 0.05) after the test. A significant decrease of PICP at 1 hour (P < 0.05) was followed by an increase after 24 (P < 0.01) and 72 hours (P < 0.001) and a significant increase in ICTP was noted at 24 and 72 hours (P < 0.05). A strong positive correlation was found between serum levels of PICP and ICTP (r = 0.55–0.84; P < 0.05) throughout the experiment. In conclusion, young females showed biochemical signs of increased bone collagen turnover and altered homeostasis of calcium and PTH after a single bout of moderate endurance exercise. Received: 19 October 1995 / Accepted: 14 June 1996     

Effects of Muscle Architecture on Eccentric Exercise Induced Muscle Damage Responses

There is a need to investigate the role of muscle architecture on muscle damage responses induced by exercise. The aim of this study was to determine the effect of muscle architecture and muscle length on eccentric exercise-induced muscle damage responses. Eccentric exercise-induced muscle damage was performed randomly to the elbow flexor (EF), knee extensor (KE), and knee flexor (KF) muscle groups with two week intervals in 12 sedentary male subjects. Before and after each eccentric exercise (immediately after, on the 1^st, 2^nd, 3^rd, and 7^th days) range of motion, delayed onset muscle soreness, creatine kinase activity, myoglobin concentration and isometric peak torque in short and long muscle positions were evaluated. Furthermore, muscle volume and pennation angle of each muscle group was evaluated before initiating the eccentric exercise protocol. Pennation angle and muscle volume was significantly higher and the workload per unit muscle volume was significantly lower in the KE muscles compared with the KF and EF muscles (p < 0.01). EF muscles showed significantly higher pain levels at post-exercise days 1 and 3 compared with the KE (p < 0.01-0.001) and KF (p < 0.01) muscles. The deficits in range of motion were higher in the EF muscles compared to the KE and KF muscles immediately after (day 0, p < 0.01), day 1 (p < 0.05-0.01), and day 3 (p < 0.05) evaluations. The EF muscles represented significantly greater increases in CK and Mb levels at day 1, 3, and 7 than the KE muscles (p < 0.05-0.01). The CK and Mb levels were also significantly higher in the KF muscles compared with the KE muscles (p < 0.05, p < 0.01 respectively). The KF and EF muscles represented higher isometric peak torque deficits in all the post-exercise evaluations at muscle short position (p < 0.05-0.001) compared with the KE muscle after eccentric exercise. Isometric peak torque deficits in muscle lengthened position was significantly higher in EF in all the post-exercise evaluations compared with the KE muscle (p < 0.05-0.01). According to the results of this study it can be concluded that muscle structural differences may be one of the responsible factors for the different muscle damage responses following eccentric exercise in various muscle groups. Key points

• The upper extremity flexor muscles are more affected by eccentric exercise induced muscle damage, either they are in a shortened or lengthened position.
• Loss of peak torque due to eccentric exercise induced muscle damage is observed at different levels in the joint range of motion where the muscles are lengthened or shortened.
• The workload per unit muscle volume during eccentric contraction is higher in muscles having a longitudinal fiber orientation compared to pennate muscles, which is a possible reason for the increased incidence of muscle damage.

Key words: Muscle damage, pennation angle, eccentric exercise, quadriceps muscle, hamstring muscle, biceps brachii muscle     

A single-bout of one-hour spinning exercise increases troponin T in healthy subjects

Objectives. While long-term endurance exercise is known to increase cardiac biomarkers, only a few studies on short-term exercise and these markers have been reported. The aim of this study was to investigate the acute effects of a one-hour bicycle spinning on cardiac biomarkers in healthy individuals. Design. Serum levels of high-sensitive troponin T (TnT), creatinine kinase MB fraction (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine kinase (CK) and myoglobin were measured at baseline, 1 and 24 hour after one hour of spinning exercise in ten healthy and fit (age 31.0 ± 6.6 years) individuals. Results. TnT doubled one hour post-exercise (All values ≤ 5 – 9.7 ± 6.0 ng/L, p < 0.001). Two individuals had TnT levels above upper reference limit, URL (20.7 and 20.2 ng/L, URL = 12 ng/L). Myoglobin levels increased 72% one hour post-exercise (38 ± 20 – 66 ± 41 mg/L, p < 0.02). TnT and myoglobin levels returned to baseline 24 hour post-exercise. Serum levels of CK-MB, NT-proBNP and CK were not significantly changed. Conclusions. A single-bout of one-hour bicycle spinning transiently increases TnT and myoglobin in healthy subjects. Some subjects even have TnT release above URL. Thus, recently performed exercise also of short duration should be taken into consideration in the evaluation of acute chest pain with release of cardiac TnT.     

Light-emitting diode phototherapy improves muscle recovery after a damaging exercise

The goal of the present study was to determine the effect of light-emitting diode phototherapy (LEDT) at 630 nm on muscle recovery after a damaging eccentric exercise bout. Seventeen healthy young male volunteers, without previous experience with eccentric exercise, were included in a randomized double-blinded placebo-controlled trial. They were divided into a LEDT (n?=?8) and a PLACEBO group (n?=?9). To induce muscle damage, subjects performed 30 eccentric contractions with a load of 100 % of maximal voluntary isometric contraction strength of the elbow flexors of the non-dominant arm. LEDT group subjects received biceps brachii phototherapy (λ 630 nm; total energy density, 20.4 J/cm2) immediately after the exercise bout. The LEDT in the placebo group was aimed at the muscle, but it remained turned off. Isometric muscle strength, muscle soreness, and elbow range of motion (ROM) were measured before and at 24, 48, 72, and 96 h the after eccentric exercise bout and compared between groups. Our results showed that the muscle soreness, muscle strength loss, and ROM impairments were significantly reduced up to 96 h after a damaging eccentric exercise bout for the LEDT group compared with the PLACEBO group. A single LEDT (630 nm) intervention immediately after a damaging eccentric exercise bout was effective in terms of attenuating the muscle soreness and muscle strength loss and ROM impairments.     

Heart Rate Variability Before and After Cycle Exercise in Relation to Different Body Positions

The purpose of this study was to assess the effect of three different body positions on HRV measures following short-term submaximal exercise. Thirty young healthy males performed submaximal cycling for five minutes on three different occasions. Measures of HRV were obtained from 5-min R to R wave intervals before the exercise (baseline) and during the last five minutes of a 15 min recovery (post-exercise) in three different body positions (seated, supine, supine with elevated legs). Measures of the mean RR normal-to-normal intervals (RRNN), the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive differences (RMSSD) and the low-frequency (LF) and the high-frequency (HF) spectral power were analyzed. Post-exercise RRNN, RMSSD were significantly higher in the two supine positions (p < 0. 01) compared with seated body position. Post-exercise ln LF was significantly lower in the supine position with elevated legs than in the seated body position (p < 0.05). No significant difference was found among the three different body positions for post-exercise ln HF (p > 0.05). Post-exercise time domain measures of HRV (RRNN, SDNN, RMSSD) were significantly lower compared with baseline values (p < 0.01) regardless body position. Post-exercise ln LF and ln HF in all three positions remained significantly reduced during recovery compared to baseline values (p < 0.01). The present study suggests that 15 minutes following short-term submaximal exercise most of the time and frequency domain HRV measures have not returned to pre-exercise values. Modifications in autonomic cardiac regulation induced by body posture present at rest remained after exercise, but the post-exercise differences among the three positions did not resemble the ones established at rest.

Key points

• Whether different body positions may enhance post-exercise recovery of autonomic regulation remains unclear.
• The absence of restoration of HRV measures after 15 minutes of recovery favor the existence of modifying effects of exercise on mechanisms underlying heart regulation.
• On the basis of discrepancies in HRV measures in different body positions pre- and post-exercise we argue that the pace of recovery of cardiac autonomic regulation is dependent on body posture.

Key words: Heart rate variability, recovery, exercise     

不同作用方向的整复手法治疗腰椎间盘突出症 临床疗效观察

目的：比较向前方向作用的后伸卷腰扳动定位整复手法和向左右方向作用旋转扳动整复手法治疗腰椎间盘突出症的疗效。方法：腰椎间盘突出症209例,男131例,女78例;年龄20-79岁,其中50岁以上58例。膨出型92例,突出型69例,游离型48例。209例按随机数字表法分为治疗组（107例）和对照组（102例）：治疗组采用牵引治疗仪持续牵引30min后,用后伸卷腰扳动定位整复手法治疗;对照组采用牵引治疗仪持续牵引30min后,用旋转腰部扳动整复手法治疗。隔1d治疗1次,3次为1个疗程。观察患者的症状和体征（包括腰部疼痛与不适、下肢疼痛与麻木、大小便无力与会阴麻木、直腿抬高程度、下肢行走能力、工作生活能力）,并按疗效标准比较两种治疗方法的治疗效果的差异。结果：两组患者均获随访,时间1～6个月,平均3．2个月。治疗1个疗程后,治疗组与对照组的症状与体征各方面较治疗前均有较大改善（P〈O．01）,其中治疗组在腰部疼痛与不适、下肢行走能力方面优于对照组（P〈0．05）。按疗效评定标准：治疗组疗效优于对照组,两组疗效比较差异有统计学意义（P〈0．01）。膨出型治疗组47例,对照组45例,治疗组优于对照组（P〈0．05）;突出型治疗组35例,对照组34例,治疗组比对照组有效率高,但差异无统计学意义（P〉0．05）。游离型治疗组25例,对照组23例,对照组比治疗组有效率高,但差异无统计学意义（P〉0．05）。结论：后伸卷腰扳动定位整复手法比旋转扳动整复手法治疗腰椎间盘突出症的整体疗效满意,但游离型的腰椎间盘突出症选择旋转扳动整复手法更好。     

肱骨髁上骨折3种手术方法的疗效评价

目的：探讨3种手术方法治疗儿童肱骨髁上骨折的临床疗效。方法：肱骨髁上骨折103例,其中男58例,女45例;年龄3～12岁,平均7．4岁。根据手术入路分肘内侧切口（A组）37例,肘外侧切口（B组）35例及肘后侧切口（C组）31例．比较术后肘关节仲屈功能丢失和肘内翻发生情况。结果：随访18个月～8年,平均32个月。发生肘关节伸屈功能丢失：A组6例,B组6例,C组25例,C组的发生率明显高于A、B两组（P〈0．01）。发生肘内翻：A组8例,B组17例,C组7例,B组的发生率明显高于A、C两组（P〈0．05）。结论：3种手术入路治疗肱骨髁上骨折有不同疗效,肘外侧切口肘内翻发生率较高,肘后切口肘伸屈功能明显降低,肘内侧切口效果肯定。     

关节松动术应用于老年桡骨远端骨折术后的临床疗效观察

目的 :探讨关节松动术对老年桡骨远端骨折术后患者腕关节功能、疼痛和握力的影响。方法 :自2015年1月至2016年6月共纳入符合标准的老年桡骨远端骨折患者67例,分为常规锻炼组和关节松动术组。其中常规锻炼组37例,采用常规桡骨远端骨折术后关节功能锻炼方案,男16例,女21例;平均年龄(67.8±3.2)岁(60~72岁);优势侧23例,非优势侧14例;跌倒26例,车祸11例;AO分型:B3型6例,C1型18例,C2型7例,C3型6例。关节松动术组30例,在对照组基础上增加关节松动术治疗,男14例,女16例;平均年龄(67.1±4.0)岁(61~74岁);优势侧21例,非优势侧9例;跌倒25例,车祸5例;AO分型:B3型8例,C1型13例,C2型6例,C3型3例。观察患者术后3个月腕关节的活动度、Gartland-Werley腕关节功能评分、VAS疼痛评分及握力。结果:治疗3个月后,常规锻炼组腕关节VAS评分大于关节松动术组(P0.05)。常规锻炼组和关节松动术组患侧握力均低于健侧,但关节松动术组患侧平均握力高于常规锻炼组(P0.05)。常规锻炼组掌屈、背伸、桡偏平均角度均明显大于观察组(P0.05),而常规锻炼组尺偏角度与关节松动术组差异无统计学意义(P0.05)。治疗后Gartland-Werley各项评分比较中,两组患者在残余畸形、并发症中差异无统计学意义(P0.05),常规锻炼组主观评分、客观评分、总分均明显高于关节松动术组(P0.05);常规锻炼组治疗后腕关节功能Gartland-Werley评分中优21例,良10例,可6例,关节松动术组中优23例,良6例,可1例,两组分布比较差异具有统计学意义(P0.05)。结论:老年桡骨远端骨折术后关节松动术的应用可以提高患者关节活动度,获得更好的腕关节功能。