刺激及其操作条件对电刺激单纤维肌电图的影响

测定了１０只健康家兔在改变刺激电极位置、电流强度、频率时刺激单纤维肌电图（Ｓｔｉｍｕ－ＳＦＥＭＧ）的变化。结果为，电刺激条件和操作技术对Ｓｔｉｍｕ－ＳＦＥＭＧｒ的Ｊｉｔｔｅｒ值有明显影响。为了避免或减少误差，操作时须注意：（１）刺激电极应按解剖标志选择进针点，并在此基础上进一步调整，以便尽可能接近神经干或神经分枝；（２）刺激频率宜控制在５ＨＺ以下；（３）刺激电流应高于３倍阈值；（４）通过改变刺激强     

The Influence of Neuromuscular Electrical Stimulation on the Heart Rate Variability in Healthy Subjects

[Purpose] The purpose of this study was to examine the effect of neuromuscular electrical stimulation (NMES) on heart rate variability (HRV). [Subjects and Methods] Ten healthy subjects participated in the study. All subjects received NMES with a pulse duration of 300 us and frequency of 30 Hz at the vastus lateralis and vastus medialis for 15 minutes. The stimulation intensity was adjusted in the range of 20 to 30 mA. HRV using a pulse oximeter was measured in the sitting position before and after NMES. [Results] After the NMES, all HRV data slightly increased, but there was no significance between before and after data. [Conclusion] We suggest that strengthening exercises using NMES may be undertaken safely.Key words: Neuromuscular electrical stimulation, Heart rate variability, Strengthening exercise     

钙剂的分类及临床选择

介绍钙剂的分类及临床选择 ,并从补钙效力高、毒副作用小、患者乐于接受及价廉易得等方面阐述选用准则。     

Mechanism of Effect of Alpha Adrenergic Stimulation with Norepinephrine on Renal Water Excretion

The present study was undertaken to investigate the mechanism whereby alpha adrenergic stimulation with intravenous norepinephrine results in a water diuresis. Renal perfusion pressure was kept constant in all experiments by adjustment of a suprarenal aortic clamp. In hydropenic anesthetized dogs the intravenous infusion of norepinephrine (0.5 μg/kg per min) was associated with a mean decrease in urinary osmolality from 616 to 126 mosmol/kg (P < 0.001) which increased to 532 mosmol/kg (P < 0.001) after the infusion was discontinued. During the same period of time the mean free water clearance increased from -0.437 to 1.59 (P < 0.001) and then returned to -0.314 ml/min (P < 0.001) after cessation of the infusion. This diuretic effect occurred in both innervated and denervated kidneys and was not associated with an increase in glomerular filtration rate or solute excretion. Systemic arterial pressure increased from 121 to 142 mm Hg during the norepinephrine infusion. Studies were also performed in hypophysectomized animals receiving a constant infusion of either 80 μg/kg per min or 20-40 μU/kg per min of vasopressin. In these animals, intravenous norepinephrine was not associated with changes in either urinary osmolality or free water clearance. The intrarenal administration of norepinephrine, in doses comparable with those reaching the kidneys during the intravenous studies, also resulted in no significant change in either urinary osmolality or free water clearance in hypophysectomized animals receiving 20-30 μU/kg per min of vasopressin. These results thus indicate that the water diuresis associated with intravenous norepinephrine is mediated primarily by suppression of vasopressin release rather than by changes in renal hemodynamics, renal innervation, or an effect of norepinephrine on the water permeability of the tubular epithelium.     

电刺激对脑卒中吞咽障碍康复的效果

目的探讨电刺激对脑卒中吞咽障碍康复的效果。方法将40例脑卒中后吞咽障碍的患者分为治疗组和对照组各20例,均给予常规药物治疗和吞咽功能康复训练,治疗组在此基础上采用电刺激治疗。以吞咽障碍程度分级评分评定疗效。结果两组均能改善吞咽障碍,但治疗组疗效优于对照组(P<0.05)。结论电刺激可提高脑卒中后吞咽障碍的治疗效果。     

Programmed Electrical Stimulation of the Ventricle: An Efficient, Sensitive, and Specific Protocol

A relatively simple and evident ventricular programmed electrical stimulation (PES) protocol was developed, capable of achieving high degrees of sensitivity and specificity. In a series of 481 subjects, 1, 2, and 3 extrasfimuli (ES) were used successively during sinus rhythm and ventricular pacing at two drive cycle lengths, at one or more ventricular sites, together with rapid ventricular pacing, and other maneuvers such as isoproterenol infusion. Three ES were used immediately after two ES at each drive rate, rather than returning after completion of the protocol with two ES. Using the protocol, appropriate arrhythmias could be induced in 88% of all patients with ventricularfibrillation, 84% of all patients with sustained ventricular tachycardia (91% with underlying coronary disease), and 58% of patients with severe nonsus-tained ventricular tachycardia. There were significant differences in inducibility between patients whose ventricular arrhythmias were due to coronary artery disease and other causes. In contrast, sustained ventricular arrhythmias fall ventricular fibrillation) could be induced in only 5% of a control group of control patients, for a specificity of 95%. The protocol described is simpler and more efficient than those that use exhaustive testing of two ES before going to three ES. Three ES during sinus rhythm proved to be the most productive step, with a higher yield ratio (true:false-positives) than two ES or three ES during pacing, especially at fasterrates. Greater efficiency is also achieved by leaving the timing of an extrastimulus just beyond its effective refractory period when an additional extrastimulus is to be added, compared to protocols in which the extrastimulus is moved later in the cycle and then decremented in tandem with the additional extrastimulus. Coupling intervals < 200 msec produced some false-positives, but fewer overall than intervals < 200 msec, and with yield ratios comparable to other protocol steps. The protocol described meets NASPE standardsfor ventricular programmed stimulation protocols, and with its demonstrated specificity and relative simplicity and efficiency may be useful as a model for groups not yet committed to an alternative protocol.     

Effects of Transcutaneous Electrical Nerve Stimulation on Mastectomy Pain,Patient Satisfaction,and Patient Outcomes

PurposeMastectomy is one of the most painful surgical procedures. Postoperative pain guidelines recommend transcutaneous electrical nerve stimulation (TENS) as a reliable non-pharmacological analgesic method. The aim of this study was to investigate the effects of TENS on postoperative pain and outcomes in patients undergoing modified radical mastectomy (MRM).DesignA single-center, single-blind, prospective, randomized-controlled study.MethodsThis single-center, single-blind, randomized-controlled study included a total of 80 patients who underwent MRM at general surgery clinic of a tertiary center were included. The pain management of the patient outcomes were evaluated using the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR).FindingsThe pain levels of the intervention group were lower than the control group. There were significant improvements in the patient outcomes such as mobilization, position, sleep, anxiety, and fear in the intervention group.ConclusionsOur study results suggest that TENS reduces MRM pain. Thus, TENS can be recommended as a useful analgesic method in MRM.     

Vitalstim神经肌肉电刺激对神经源性吞咽障碍的疗效观察

目的观察Vitalstim神经肌肉电刺激治疗神经源性吞咽功能障碍的疗效。方法 82例神经源性吞咽功能障碍患者分为3组:A组采用吞咽行为治疗,B组采用Vitalstim神经肌肉电刺激治疗,C组在吞咽行为治疗的基础上加用Vitalstim神经肌肉电刺激方法。10次为1个疗程。结果 1~2个疗程后,A组总有效率72.7%,B组总有效率82.6%,C组总有效率94.5%。且C组经吞咽X线电视透视检查(VFSS)评分吞咽障碍恢复分值显著高于A组和B组(P=0.000)。结论在吞咽行为治疗的基础上加用Vitalstim神经肌肉电刺激治疗能更好地改善神经源性吞咽障碍患者尤其是假性球麻痹患者的吞咽功能。     

External Electrical Stimulation in the Management of Acute Tachyarrhythmias

For the management of acute tachyarrhythmias various methods of electrical temporary pacing are available which offer advantages over other forms of treatment such as use of antiarrhythmic agents or electrocardioversion. This paper gives a survey of the different pacing methods foverdrive pacing, rapid rate stimulation, overdrive suppression, underdrive pacing and programmed stimulation) and discusses their application, indications, effectiveness and possible complications. (PACE, Vol. 4, November-December, 1981)     

功能性电刺激的原理,设计与应用（一）

本文分三部分阐述功能性电刺激（FES）的基本概念、设计和应用。第一部分讨论电刺激的阈值，募集顺序等概念，第二部分介绍肌内电刺激的安全参数范围，组织损伤，并讨论刺激器的设计。第三部分以C5／C6患者手功能重建为例，阐明功能性电刺激系统的工作原理。     

A Review of the Functional Electrical Stimulation Equipment Market

The market for functional electrical stimulation (FES) equipment for use in rehabilitation is growing as increasingly sophisticated products enter the market each year. Factors that impact the availability of FES equipment include technological limitations, government regulation, reimbursement status, and clinician training. New products have become available in the last decade with many innovative applications available under investigational status. The current availability of FES equipment for selected applications such as therapeutic muscle stimulation, cardiovascular exercise, restoration of function in the lower and upper extremities, respiratory assist, restoration of bladder function, electroejaculation, and scoliosis correction is reviewed. A review of FES equipment for nonneuromuscular applications such as control of epilepsy, cochlear implants, electrotactile stimulation, and systems to enhance wound healing and bone growth is also included. Key manufacturers are identified.     

功能性电刺激研究在中国的回顾、现状与展望

功能性电刺激(FES)是康复领域为瘫痪患者服务的一种常用技术.本文综述了FES研究在中国(包括香港和台湾)的发展历史与现状,重点对FES系统研发情况进行了分析.     

Opportunities and Challenges for the Clinical Utilization of Functional Electrical Stimulation

Clinical applications of electrical stimulation for effecting change in the damaged or disabled nervous system are in their infancy. This technique is extremely powerful, because any neural structure that is electrically excitable can potentially be affected. Although early attempts to apply electrical stimulation were limited by insufficient physiological knowledge and undeveloped technology, developments over the past two decades now provide a strong base for clinical applications. Clinical systems for bladder control and respiration have been in use for many years. Some applications of FES to restore hand function and walking are in multicenter testing, whereas many others are being studied for clinical feasibility at single sites. Applications are focusing on safety and efficacy, as well as on clinical outcome measures to address the issues posed by the regulatory and reimbursement processes. As clinical systems become more routine, issues of multiple system applications will need to be addressed. Present and future applications of functional electrical stimulation may be expected to significantly enhance independence and improve the quality of life for individuals with central nervous system dysfunction.     

低频电刺激治疗脑卒中后吞咽障碍疗效观察

目的观察低频电刺激对脑卒中吞咽障碍的治疗效果。方法将60例脑卒中吞咽障碍患者分为治疗组和对照组各30例,治疗组采用电刺激配合吞咽训练,对照组单纯采用吞咽训练。于治疗前后采用藤岛一郎吞咽疗效进行评估。结果训练后两组疗效均有明显提高(P<0.05),治疗组评分高于对照组(P<0.05)。结论低频电刺激可加强吞咽训练对脑卒中患者吞咽功能的疗效。     

针刺联合经皮神经电刺激治疗肝豆状核变性吞咽困难的临床研究

目的探讨肝豆状核变性患者吞咽困难的有效治疗方案。方法将60例肝豆状核变性合并吞咽困难患者分为3组:A组(针刺+经皮神经电刺激+吞咽功能训练),B组(针刺+吞咽功能训练),C组(经皮神经电刺激+吞咽功能训练),1个疗程15d,共治疗2个疗程。应用洼田饮水试验及标准化床边吞咽功能检查表(SSA)进行疗效评价。结果第1个疗程后A组疗效明显优于B组、C组,A组的两种评分差值明显高于B组、C组(P0.01)。第2个疗程后3组之间饮水试验及SSA评分无显著性差异(P0.05)。结论针刺联合经皮神经电刺激和吞咽功能训练综合治疗能够有效改善肝豆状核变性患者的吞咽功能。     

Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient Satisfaction

Background and AimsThis study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients’ vital signs, and patient satisfaction after inguinal herniorrhaphy.DesignThis study used a randomized controlled design.SettingA state hospital in the west of Turkey.Participants/SubjectsThe study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015.MethodsPatients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients’ vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care.ResultsPain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre–and post–transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05).ConclusionsAfter inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced postoperative pain without a negative impact on vital signs and increased patient satisfaction with nursing care.     

针刺结合颊肌电刺激治疗脑卒中后口腔期吞咽障碍的效果

目的探讨针刺结合颊肌电刺激治疗脑卒中后口腔期吞咽障碍的疗效。方法40 例脑卒中后口腔期吞咽障碍患者随机分为治疗组(n=20)和对照组(n=20)。对照组给予常规内科干预及吞咽训练,治疗组在对照组的基础上加用针刺和颊肌电刺激。于治疗前及治疗20 d 后采用口腔功能评分和洼田饮水试验进行评定。结果治疗前两组间口腔功能评分和洼田饮水试验评级无显著性差异(P>0.05);治疗后两组患者口腔功能评分和洼田饮水试验评级均较治疗前明显改善(P<0.01),治疗组优于对照组(P<0.05)。结论针刺结合颊肌电刺激治疗脑卒中后口腔期吞咽障碍临床疗效满意。