早期康复护理对脑卒中患者肢体运动功能的影响

目的探讨早期康复护理介入对脑卒中偏瘫患者肢体运动功能的影响。方法将200例脑卒中偏瘫患者分为康复组100例和对照组100例,康复组在常规治疗护理的基础上,从患者入院第1天开始即设计良好的肢体位置,进行患肢按摩和肢体的被动活动。对照组按传统的脑血管病治疗护理方法,患者肢体处功能位,急性期卧床静养限制活动。结果两组患者经1个月的治疗和康复护理后,康复组患侧上下肢体运动功能改善程度明显高于对照组(P<0.01)。结论早期康复护理介入能明显改善患肢运动功能和ADL能力。     

急性脑卒中偏瘫早期康复护理探讨

目的：探讨急性脑卒中偏瘫早期康复护理的疗效。方法：将164例急性脑卒中偏瘫患随机分为两组,康复组76例进行系统的康复护理;对照组88例未进行康复护理。采取简式Fugl-Meyer运动功能评分,改良Barthel指数于初期、末期（6周）评定两组患。结果：早期康复组患肢运动功能、日常生活活动能力均明显提高,两组差异有高度显性（P＜0.001)。结论：早期康复护理可明显促进患肢运动功能恢复,降低致残率,提高日常生活能力。     

早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的：探讨早期脑卒中偏瘫的康复护理的疗效。方法：将134例脑卒中偏瘫患分为两组，67例采用药物与康复训练同步进行为康复组，67例采用单纯药物治疗及未经指导的自我锻炼为对照组，采用简式Fugl-Meyer运动功能评分，改良Barthel指数为初期，末期评定，结果：7周后两组进行评评，康复组患肢运动，日常生活能力比对照组明显提高，结论：早期康复护理训练可促进患肢功能恢复，降低致残率。     

早期康复护理干预对脑卒中偏瘫患者日常生活活动能力的影响

目的:探讨早期康复护理干预对脑卒中偏瘫患者日常生活活动能力(ADL)的影响。方法:将118例脑卒中偏瘫患者随机分为康复组和对照组各59例,对照组按神经内科护理常规进行护理,康复组由责任护士按护理程序实施系统化早期康复护理干预,包括基础护理、心理护理、早期患肢康复锻炼、语言功能锻炼、吞咽功能锻炼、日常生活能力训练。采用Barthel指数对两组患者干预前后ADL进行评定比较。结果:两组干预后Barthel指数均较干预前明显升高(P<0.01),康复组干预后Barthel指数明显高于对照组(P<0.01)。结论:早期康复护理干预能提高脑卒中偏瘫患者ADL,降低致残率,改善生活质量。     

早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的探讨早期脑卒中偏瘫的康复护理的疗效。方法将134例脑卒中偏瘫患者分为两组,67例采用药物与康复训练同步进行为康复组,67例采用单纯药物治疗及未经指导的自我锻炼为对照组。采用简式Fugl-Meyer运动功能评分,改良Barthel指数为初期、末期评定。结果7周后两组进行评价,康复组患肢运动、日常生活能力比对照组明显提高。结论早期康复护理训练可促进患肢功能恢复,降低致残率。     

脑卒中偏瘫患者早期康复护理研究

目的 探讨脑卒中偏瘫患患肢功能早期康复护理的重要性。方法 将201例脑卒中偏瘫患分为常规护理组（n=100)和加强护理组（n=101)。加强护理组在常规治疗护理的基础上，从患入院第1天开始即设计良好的肢体位置，进行患肢按摩和肢体的被动活动及主动运动训练。结果 两组患经1个月的治疗护理后，加强护理组患侧上下肢体运动功能改善程度明显高于常规护理组（P＜0．01）。结论 早期康复护理可使脑卒中患受损的肢体功能得到良好的恢复。     

康复护理对脑卒中偏瘫病人功能恢复的影响

[目的]探讨康复护理对脑卒中偏瘫病人功能恢复的影响。[方法]将80例脑卒中偏瘫住院病人随机分为康复组40例和对照组40例。康复组在常规护理的同时进行早期康复训练,对照组给予常规护理及未经指导的自行锻炼。分别于入院4周和12周进行测评。运动功能采用Fugl-Meyer运动功能积分法测评,日常生活能力(ADL)用Barthel指数评分。[结果]入院4周及12周两组病人得分比较,康复组明显高于对照组(P<0.01)。[结论]早期康复护理可提高病人的日常生活能力和肢体运动功能。     

康复护理对脑卒中偏瘫病人功能恢复的影响

[目的]探讨康复护理对脑卒中偏瘫病人功能恢复的影响.[方法]将80例脑卒中偏瘫住院病人随机分为康复组40例和对照组40例.康复组在常规护理的同时进行早期康复训练,对照组给予常规护理及未经指导的自行锻炼.分别于入院4周和12周进行测评.运动功能采用Fugl-Meyer运动功能积分法测评,日常生活能力(ADL)用Barthel指数评分.[结果]入院4周及12周两组病人得分比较,康复组明显高于对照组(P＜0.01).[结论]早期康复护理可提高病人的日常生活能力和肢体运动功能.     

良肢位在防治早期脑卒中偏瘫患者并发症中的作用

目的：探讨良肢位在防治早期脑卒中偏瘫患者并发症中的作用。方法：将100例脑卒中偏瘫患者随机分为康复组和对照组各50例,两组均接受4周神经内科常规药物、物理因子、运动作业等康复治疗及常规护理,康复组自入院当天起保持良肢位,对照组取自然体位。比较两组4周后并发症发生情况。结果：4周后康复组并发症明显少于对照组（P〈0．05）。结论：良肢位的摆放是降低脑卒中偏瘫患者并发症的有效方法。     

康复护理对脑卒中偏瘫病人功能恢复的影响

[目的]探讨康复护理对脑卒中偏瘫病人功能恢复的影响.[方法]将80例脑卒中偏瘫住院病人随机分为康复组40例和对照组40例.康复组在常规护理的同时进行早期康复训练,对照组给予常规护理及未经指导的自行锻炼.分别于入院4周和12周进行测评.运动功能采用Fugl-Meyer运动功能积分法测评,日常生活能力(ADL)用Barthel指数评分.[结果]入院4周及12周两组病人得分比较,康复组明显高于对照组(P＜0.01).[结论]早期康复护理可提高病人的日常生活能力和肢体运动功能.     

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.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.