步态训练机器人对脑卒中偏瘫患者步行功能的影响

目的观察Lokomat步态训练机器人对脑卒中偏瘫患者下肢运动功能、步态及关节活动度的影响。方法 80例脑卒中偏瘫患者(病程<3个月)分为对照组(n=40)和干预组(n=40)。干预组应用Lokomat步态训练机器人进行干预,对照组采用常规康复治疗。于治疗前和治疗10周后分别评定患者Fugl-Meyer评分、步频、步长、步速及髋膝关节活动度。结果治疗前两组各项指标无显著性差异(P>0.05);治疗后干预组各项指标均优于对照组(P<0.05)。结论 Lokomat步态训练机器人介入可进一步提高偏瘫患者下肢运动功能。     

肌电生物反馈对脑卒中偏瘫患者步行能力的影响

目的:探讨肌电生物反馈治疗(EMGBF)对脑卒中偏瘫患者胫前肌肌力、下肢运动功能及步行能力的影响。方法:选取病程小于6个月的首次脑卒中偏瘫患者35例,随机分成EMGBF组和对照组。EMGBF组患者共17例,年龄(61.90±10.35)岁,采用常规康复训练结合EMGBF;对照组患者共18例,年龄(55.12±9.92)岁,进行常规康复训练,治疗4周。分别于治疗前后采用踝背屈主动关节活动度(AROM)、改良Ashworth量表、胫前肌肌力、Berg平衡量表(BBS)、简化Fugl-Meyer运动量表下肢功能评分(FMA-L)和10m步行速度测定,评估患者的步行能力。结果:两组患者治疗前,各评估方法之间的差异均无显著性意义(P0.05),具有可比性。治疗4周后,EMGBF组和对照组各评估结果均有明显改善,与治疗前比较差异均有显著性意义(P0.05);但EMGBF组患者的踝背屈AROM、前肌肌力、BBS、FMA-L和步速改善情况优于对照组(P0.05);两组肌张力变化差异无显著性意义(P0.05)。结论:在常规康复训练的基础上,加用EMGBF能更有效地改善脑卒中偏瘫患者踝背屈障碍,促进偏瘫侧下肢功能及步行能力的恢复。     

下肢康复机器人结合康复训练对脑卒中偏瘫患者下肢肌力及平衡功能的影响

目的探究下肢康复机器人结合康复训练在脑卒中偏瘫患者中的应用价值。方法选取2017年9月至2019年1月某院收治的脑卒中偏瘫患者86例,按随机数表法分为两组,各43例。对照组实施常规康复训练,观察组在对照组基础上行下肢康复机器人训练。对比两组治疗前后下肢肌力、平衡功能及下肢运动功能。结果两组治疗前腘绳肌、股四头肌评分、Fugl-Meyer运动功能量表(Fugl-Meyer assessment,FMA)、Berg平衡量表(Berg balance scale,BBS)评分比较,差异无统计学意义(P0.05);观察组治疗后腘绳肌、股四头肌评分与FMA、BBS评分均高于对照组,差异有统计学意义(P0.05)。结论脑卒中偏瘫患者实施下肢康复机器人结合康复训练能够有效提升其下肢肌力,利于恢复平衡功能与下肢运动功能。     

头颈部训练对偏瘫患者平衡及下肢运动功能的影响

目的:观察头颈部训练对偏瘫患者平衡及下肢运动功能的影响。方法:脑卒中偏瘫患者60例,随机分成观察组和对照组各30例。2组均进行常规康复训练,观察组增加头颈部训练,治疗前后采用徒手肌力测定(MMT)对躯干及偏瘫侧髋的屈、伸肌群进行评定,Fugl-Meyer平衡功能量表及运动功能量表(FMA)分别评定平衡及下肢运动功能。结果:治疗6周后,观察组患者躯干及患侧髋的屈、伸肌群肌力分级与对照组比较差异无统计学意义。治疗2、4及6周后,2组Fugl-Meyer平衡功能量表及FMA评分均较治疗前显著提高(P0.01),治疗2周后,观察组的Fugl-Meyer平衡功能量表评分更高于对照组(P0.05),FMA评分比较差异无统计学意义,治疗4周及6周后,观察组Fugl-Meyer平衡功能量表和FMA评分均显著高于对照组(P0.01)。结论:头颈部训练能有效提高偏瘫患者平衡及下肢运动功能。     

下肢康复机器人对改善脑卒中偏瘫患者下肢肌力及运动功能障碍的临床研究

目的:观察下肢康复机器人训练对早期脑卒中偏瘫患者下肢肌力及运动功能的影响。方法:将50例发病6个月内的脑卒中患者随机分为试验组和对照组,每组25例。在常规康复训练的基础上,对照组给予MOTOmed智能运动系统训练,每次30min,每周5次,共治疗8周;试验组给予下肢康复机器人训练,每次30min,每周5次,共治疗8周。治疗前及治疗8周后采用徒手肌力量表(MMT)评估下肢肌力,采用简式Fugl-Meyer运动量表(FMA)评估下肢运动功能,采用下肢康复机器人数据反馈系统评估下肢肌力。结果:治疗前两组患者的一般资料、MMT评估、Fugl-Meyer评估、机器人客观数据评估差异均无显著性意义(P0.05),治疗后两组MMT评估、Fugl-Meyer评估、机器人客观数据评估差异均有显著性意义(P0.05),且试验组均优于对照组(P0.01)。结论:下肢康复机器人结合常规康复治疗能有效地改善早期脑卒中偏瘫患者下肢肌力及运动功能障碍。     

MOTOmed虚拟情景训练对痉挛型脑瘫患儿肌张力及关节活动度的影响

目的 观察MOTOmed虚拟情景训练对痉挛型脑瘫患儿肌张力及关节活动度的影响.方法 选取痉挛型脑瘫患儿54例,按随机数字表法将其分为治疗组和对照组,治疗组28例,对照组26例,2组均给予常规康复治疗,治疗组在此基础上采用MOTOmed虚拟情景训练.治疗前及治疗后,采用改良Ashworth量表(MAS)评定患儿下肢内收肌、胭绳肌及腓肠肌的肌张力,并利用关节量角器对其内收肌角、腘窝角及足背屈角进行测量.结果 治疗后,治疗组和对照组内收肌、腘绳肌及腓肠肌的肌张力均显著低于组内治疗前(均P＜0.05),与对照组比较,治疗组内收肌、胭绳肌及腓肠肌的肌张力评分[(2.75±0.52)分、(1.93±0.47)分、(2.89±1.32)分]低于对照组[(3.04±0.34)分、(2.31 ±0.55)分、(3.58±1.63)分](均P ＜0.05).2组内收肌角、腘窝角及足背屈角的角度均大于组内治疗前(均P＜0.05),治疗组内收肌角、胭窝角及足背屈角的角度[(99.82±20.30)°、(131.07±12.05)°、(79.46±6.57)°]均大于对照组[(90.96±17.83)°、(123.46±14.41)°、(83.85±10.13)°](均P＜0.05).结论 MOTOmed虚拟情景训练可有效降低痉挛型脑瘫患儿的肌张力,增加其关节活动度.     

功能性运动训练对脑卒中偏瘫患者下肢肌力和肌张力的影响

目的:观察功能性运动训练在脑卒中偏瘫患者下肢肌力康复中的疗效和对肌力、肌张力的影响。方法:将脑卒中偏瘫患者100例,随机分为治疗组50例和对照组50例,2组基本治疗相同;对照组对偏瘫下肢进行抗痉挛模式训练,治疗组对偏瘫下肢进行功能性运动训练,2组治疗均为40 min/次,1次/天,5.5 d/周,总共治疗4周。治疗前后分别采用徒手肌力检查(MMT)、改良Ashworth痉挛分级(MAS)、下肢Fugl-Meyer运动功能评分(FMA)和改良Bathel指数(MBI)等评价2组患者下肢的肌力、肌张力、运动功能和日常生活能力,并进行比较。结果:治疗前2组患者下肢MMT分级、MAS分级、FMA下肢运动积分和MBI评分组间差异均无统计学意义(P>0.05)。治疗后,治疗组下肢MMT分级、FMA和MBI评分均有明显改善,与对照组差异有统计学意义(P<0.05),肌张力在治疗前后却无明显改变(P>0.05)。结论:功能性运动训练能明显改善脑卒中偏瘫下肢的肌力和日常生活功能,对下肢肌张力无不良影响。     

偏瘫患者膝关节等速评定与训练的临床研究

目的研究偏瘫患者膝关节等速训练的临床效果。方法首次发病脑卒中后偏瘫患者90例,按照等速训练时膝关节屈曲范围分为0-30°组、30°-60°组和60°-90°组,应用德国ISOMED2000型等速肌力训练系统进行股四头肌和腘绳肌向心性收缩训练。评定股四头肌痉挛指标;膝关节屈/伸膝肌力比值(Flexor/Extensor,F/E)变化;应用Fugl-Meyer法评定下肢运动功能。结果各组表示痉挛程度的被动阻力力矩在治疗前后差异无统计学意义(P0.05),显示锻炼并没有增加肌张力;治疗前后F/E值差异在0-30°和30°-60°组有统计学意义(P0.05),此两组膝关节稳定性均有好转,60°-90°组差异无统计学意义(P0.05);0-30°组Fugl-Meyer评定中下肢运动积分、下肢平衡计分在治疗前、后差异有统计学意义(P0.05),在30°-60°组和60°-90°组差异无统计学意义(P0.05)。结论本研究显示在膝关节屈曲0-30°股四头肌及腘绳肌的向心性肌力锻炼可有效增加偏瘫患者患侧膝关节的功能,提高日常生活能力。     

康复机器人对手足口病恢复期并下肢瘫痪患儿的康复疗效

目的:研究康复机器人对手足口病恢复期并下肢瘫痪患儿的康复疗效。方法:选取我院2013年3月至2016年3月60例手足口病恢复期并下肢瘫痪患儿为研究对象,按照就诊号先后随机分为对照组与观察组,每组30例。对照组给予常规康复训练,观察组在常规康复训练基础上,采用下肢康复机器人辅助步行训练。比较6周后两组下肢肌力、平衡能力、关节活动度、步态参数、下肢运动能力。结果:干预6周后,观察组髋关节屈曲肌力评级、膝关节伸展肌力评级、Berg平衡量表评分(Berg balance score,BBS)、髋关节活动度、膝关节活动度、步长、步速、Fugl-Meyer下肢运动功能评分(Fugl-Meyer assessment,FMA)分别为3.08±0.62,3.18±0.60,50.36±7.92,23.17°±3.45°,26.39°±4.31°,(51.27±14.83)cm,(64.72±14.38)m/min,(23.14±5.39)分,均显著高于对照组的2.80±0.58,2.85±0.63,45.89±8.12,20.65°±4.63°,22.96°±4.74°,(44.65±12.91)cm,(58.01±12.46)m/min,(20.27±3.62)分(均P<0.05)。结论:采用康复机器人辅助步行训练,可以增强手足口病并下肢瘫痪患儿下肢肌力,改善平衡能力与关节活动度,建立正确步行模式,促进下肢运动能力恢复。     

振动训练对脑卒中偏瘫患者下肢肌张力和运动功能的影响

目的:研究振动训练对脑卒中患者偏瘫下肢肌张力和运动功能的影响。方法:将60例脑卒中偏瘫患者随机分为治疗组(n=30)和对照组(n=30)。两组均给予常规肢体功能康复训练,治疗组加振动训练。8周后,比较两组患者改良Ashworth量表(Ashworth Scale,MAS)评分、简化Fugl-Meyer量表(FuglMeyer assessment,FMA)评分、踝关节背屈主动和被动关节活动度(active and passive range of motion,A-ROM和P-ROM)评分。结果:与治疗前相比,治疗组踝关节背屈A-ROM与P-ROM显著增加(P0.05);与对照组相比,治疗组MAS评分显著减少(P0.05),FMA评分、A-ROM和P-ROM评分均显著增加(P0.05)。结论:常规肢体功能康复训练配合振动训练能更有效改善脑卒中患者偏瘫下肢的肌张力和运动功能。     

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.     

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.