针刺督脉配合功能训练在脑卒中后偏瘫康复中的应用

目的:观察针刺督脉配合功能训练在脑卒中后偏瘫患者康复中的临床疗效.方法:76例患者随机分为2组各38例,治疗组采用针刺督脉配合康复训练治疗,对照组单纯针刺治疗.3周为1个疗程,1个疗程后进行疗效评定.结果:2组治疗前后FMA评分、Barthel(BI)指数评分经统计学处理均具有非常显著性差异(P＜0.01),组间治疗后比较亦有显著性差异(P＜0.05).结论:针刺督脉配合功能训练在脑卒中后偏瘫患者康复中具有更好的效果,值得临床推广应用.     

语言疗法和作业疗法对脑卒中后运动性失语伴口颜面失用的作用

目的探讨语言疗法结合作业疗法对脑卒中致运动性失语伴口颜面失用的语言康复方法。方法 5 5名脑卒中致运动性失语伴口颜面失用患者随机分为训练组和对照组。用前瞻法对两组进行比较分析 ,训练组患者进行语言康复训练的同时 ,用作业疗法对其进行失用症康复训练 ;对照组只进行语言康复训练。分别于训练前后进行测评。结果训练组口颜面失用现象改善效果优于对照组 (P <0 0 5 ) ;语言表达能力 (复述、说、出声读 )训练组优于对照组 (P <0 .0 5 )。结论脑卒中致运动性失语伴口颜面失用患者在语言康复训练同时 ,运用作业疗法进行口颜面失用的康复训练 ,可明显改善口颜面失用 ,并提高语言表达能力     

灯盏花穴位注射治疗脑卒中偏瘫后上肢痉挛30例临床研究

目的 :探讨治疗脑卒中偏瘫后上肢痉挛的有效治疗方法。方法 :将 60例患者随机分为 2组 ,各 3 0例。治疗组取患肢肩贞、尺泽、内关 3穴注入灯盏花注射液。每周注射 3次 ,1 0次为 1个疗程。共治疗 2个疗程后 ,进行疗效评价。配合每日进行常规康复训练。对照组仅每日进行常规康复训练 ,观察期同治疗组天数。结果 :2组治疗后的痉挛程度有统计学差异 ,P <0 .0 5 ,治疗组抑制痉挛的程度优于对照组。结论 :灯盏花穴位注射治疗具有较为良好的抑制脑卒中偏瘫上肢痉挛的作用 ,具有较好的临床推广应用价值 ,值得进一步深入研究     

药物配合音频电疗及超短波透热综合治慢性盆腔炎疗效分析

目的　研究慢性盆腔炎综合治疗的康复效果及作用机制。方法　将 82例慢性盆腔炎患者随机分为两组 :对照组予药物常规治疗 ;治疗组除上述处理外 ,予音频电疗加高频透热治疗 ,三疗程后观察效果 ,并用病情程度评分量表进行评价。结果　对照组治愈 11例、显效 2 0例、有效 10例 ;治疗组治愈 2 2例、显效 14例、有效 5例。治疗组疗效优于对照组 (P <0 .0 5 ) ;病情程度评分治疗前后差值的均数 :对照组为(9.0 5± 3.0 )分 ,治疗组为 (11.6 3± 3.5 9)分 ,两组比较有统计学意义 (P <0 .0 1) ;平均治愈次数 :治疗组为(14 .86± 5 .91)次 ,少于对照组 (2 1.6 4± 6 .6 5 )次 (P <0 .0 1)。结论　综合治疗对慢性盆腔炎有较高的康复价值 ,整个治疗过程舒适、安全、无创伤、无副作用     

家庭成员辅助干预对急性脑梗死患者运动功能障碍康复的影响

目的探讨家庭成员辅助干预对急性脑梗死所致偏瘫患者运动功能障碍康复的影响。方法选择 60例急性脑梗死偏瘫患者 ,随机分成观察组和对照组 (每组 3 0例 ) ,在常规药物和康复治疗的同时 ,观察组实施家庭成员辅助干预康复训练 ,通过治疗前后Fugl Meyer运动评分 (FMA)、修订的Barthel指数 (MBI)评分的变化对两组患者功能康复进行评价。 结果 8周后两组患者的FMA、MBI评分均较前有明显提高 (P <0 0 0 1) ,观察组更优于对照组 (P <0 0 5 )。结论在急性脑梗死患者康复治疗中家庭成员积极合理辅助干预对偏瘫运动功能康复、尤其是日常生活活动能力的提高起到促进作用。     

功能性电刺激对中风偏瘫患者肢体运动功能康复的影响

目的:观察功能性电刺激合并康复训练对偏瘫患者肢体运动功能的改善作用。方法:将89例中风偏瘫患者随机分组,治疗组47例采用功能性电刺激合并康复训练,对照组42例采用康复训练,2周为1个疗程,治疗1～3个疗程。结果:治疗组有效率及MBI评分均明显优于对照组,差异有显著性(P值均<0.05)。结论:功能性电刺激合并康复训练可促进偏瘫患者肢体运动功能康复,提高运动能力和生活自理能力。     

针刺配合康复训练治疗偏瘫肩痛的疗效观察

目的观察针刺配合康复训练治疗偏瘫肩痛的疗效。方法将 10 0例偏瘫肩痛患者随机分为两组 ,治疗组 5 0例采用针刺配合康复训练 ,对照组 5 0例采用单纯康复训练 ;对两组的疗效进行组间及组内对照分析。结果治疗后 ,两组患者的肩痛程度积分低于治疗前 (P <0 .0 1) ,上肢运动功能达IV级以上者明显增多 (P <0 .0 1) ,但治疗组均优于对照组 (P <0 .0 5 )。结论针刺配合康复训练能有效提高偏瘫肩痛的治疗效果。     

作业训练对不同类型失用现象改善的效果分析

目的：探讨作业疗法（Occupation Threapy,OT)对脑卒中致失用症的治疗效果。方法：30例患者训练前后均经相关的失用症量表评分,日常生活活动（ADL）评分采用改良Barthel指数（BI）进行评定,运用OT的形式,对不同的脑卒中伴有失用症的患者分别采取相应的训练,训练时间2－6个月。结果：患者的失用现象得到明显改善,其中结构性失用和穿衣失用有效率为57．1％和50．0％,意念性失用和意念运动性失用的有效率为80．0％和81．8％,ADL均有不同程度的提高,运动性失用提高98．5％,其余失用提高72．0％左右,结构性失用没有改变,统计学处理有显著性差异（P＜0．05）,结论：通过OT的康复方法训练患者,对患者的失用现象改善和ADL提高有效。     

康复矫形脚托对急性脑卒中偏瘫患者步行功能的影响

目的研究康复矫形脚托对急性脑卒中偏瘫患者步行功能恢复的影响。方法将不具备步行能力的 95例急性脑卒中偏瘫患者随机分成观察组 ( 4 9例 )和对照组 ( 4 6例 ) ,对照组采用常规康复训练程序训练 ,观察组在上述基础上加用康复矫形脚托训练。结果康复训练结束时 ,两组在步行能力和日常生活活动能力上均明显改善 (P <0 .0 1) ,观察组改善程度优于对照组 (P<0 .0 5— 0 .0 1)。结论康复矫形脚托有助于提高急性脑卒中患者的步行能力。     

早期康复治疗对急性脑卒中患者日常生活能力的影响

目的 :探讨早期康复治疗对脑卒中偏瘫患者 1个月后日常生活活动能力的影响。方法 :将 12 9例脑卒中偏瘫患者随机分成康复组 (74例 )和对照组 (5 5例 ) ,进行临床对照性研究 ,两组均常规进行神经内科的药物治疗 ,康复组增加运动疗法和电疗等康复治疗方法 ,对每例患者在进入课题时和 1个月后分别测试ADL能力。结果 :康复组两次Barthel指数分别为 6 .36± 4.93、13.0 0± 4.91,对照组为 7.5 0± 6 .19、11.6 0± 6 .2 6 ;两组前后比较均有高度显著性差异 (P <0 .0 0 1) ;两组的变化均数比较康复组 1个月后ADL恢复优于对照组 (P <0 .0 0 1)。结论 :早期康复治疗对患者 1个月后的日常生活活动能力具有良好的促进作用。     

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.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.