俯卧位脊柱手术患者的护理

通过对128例俯卧位脊柱手术护理的总结,阐述这类病人术中的主要护理诊断：焦虑;有潜在的呼吸功能异常的危险;有围手术期体位性损伤的危险;有体液不足的危险;有潜在的损伤的危险。根据护理诊断,在手术护理中正确安置体位,避免体位性损伤;严密观察病人的生命体征变化;注意观察术野的出血情况;保持术中体位稳定。有效提高了手术护理质量。     

阻塞性睡眠呼吸暂停患者的磨牙症研究

目的研究阻塞性睡眠呼吸障碍患者发生磨牙症的情况。方法使用多导睡眠检测技术对381例阻塞性睡眠呼吸暂停低通气综合征患者的磨牙事件进行分析。结果381例阻塞性睡眠呼吸暂停低通气综合征患者中,共有磨牙症患者238例（62.5%）,出现阻塞性睡眠呼吸暂停事件2520次,在阻塞性睡眠呼吸暂停事件末端出现磨牙事件的有1437次（57.0%）。结论阻塞性睡眠呼吸暂停低通气综合征患者常伴有磨牙症。     

剖宫产麻醉穿刺时不同体位对仰卧位综合征发生的影响

目的观察不同体位行腰硬联合麻醉(CSEA)穿刺对剖宫产手术仰卧位综合征发生率的影响。方法随机选择ASA I～II级剖宫产手术患者100例,分为左侧卧位组(L组)和右侧卧位组(R组)。两组均取L2～3椎间隙腰硬联合穿刺,穿刺成功后注入0.75%罗哌卡因1.5 ml。然后向头端置入硬膜外导管3～4 cm,固定导管后嘱产妇平卧。术中监测血压、心率。观察麻醉后胸闷气急、恶心呕吐等症状的发生情况。结果 R组仰卧位综合征各种临床表现的发生率明显高于L组(P<0.05)。结论剖宫产术中患者采用左侧卧位,仰卧位综合征各种临床表现的发生率明显低右侧卧位。左侧卧位法预防仰卧位综合征操作简单,安全有效,值得临床推广应用。     

The use of pressure mapping for seating posture characterisation in children with cerebral palsy

Purpose.?To investigate the feasibility of using pressure mapping for the characterisation of the seated posture of children with cerebral palsy (CP).

Method.?Analysis of pressure mapping readings and video of children seated in a seating system during two assessments: The first assessment involved the pressure mapping of non-disabled children during a standardised protocol, and the second one involved the pressure mapping of children with CP performing daily life activities.

Results.?It was possible to detect periods of activity of the children from pressure readings using the mean variation of pressure. Additionally, several parameters stemming from pressure readings were shown to be successful in assessing the posture of the children. The centre of pressure when positioned relative to the ischial tuberosities, allowed for recognition of ‘adverse postures’ involving pelvic obliquity/medio-lateral trunk flexion or antero-posterior pelvic tilt/trunk flexion-extension, as deviations from the centre point. The angle between the principal axis of the sensors' pressure and the medio-lateral axis of the seat was also proposed to characterise pelvic transverse rotation but could not be tested with the actual protocol.

Conclusions.?Pressure monitoring can be used to assess qualitatively and quantitatively sitting posture of children with CP.     

Detecting destabilizing wheelchair conditions for maintaining seated posture

Purpose: The purpose of this study was to detect and classify potentially destabilizing conditions encountered by manual wheelchair users with spinal cord injuries (SCI) to dynamically increase stability and prevent falls.

Methods: A volunteer with motor complete T11 paraplegia repeatedly propelled his manual wheelchair over level ground and simulated destabilizing conditions including sudden stops, bumps and rough terrain. Wireless inertial measurement units attached to the wheelchair frame and his sternum recorded associated accelerations and angular velocities. Algorithms based on mean, standard deviation and minimum Mahalanobis distance between conditions were constructed and applied to the data off-line to discriminate between events. Classification accuracy was computed to assess effects of sensor position and potential for automatically selecting a dynamic intervention to best stabilize the wheelchair user.

Results: The decision algorithm based on acceleration signals successfully differentiated destabilizing conditions and level over-ground propulsion with classification accuracies of 95.8, 58.3 and 91.7% for the chest, wheelchair and both sensors, respectively.

Conclusion: Mahalanobis distance classification based on trunk accelerations is a feasible method for detecting destabilizing events encountered by wheelchair users and may serve as an effective trigger for protective interventions. Incorporating data from wheelchair-mounted sensors decreases the false negative rate.

• Implications for Rehabilitation

• SCI has a significant impact on quality of life, compromising the ability to participate in social or leisure activities, and complete other activities of daily living for an independent lifestyle.

• Using inertial measurement units to build an event classifier for control the actions of a neuroprosthetic device for maintaining seated posture in wheelchair users.

• Varying muscle activation increases user stability reducing the risk of injury.

     

姿势解密技术治疗粘连期肩周炎疗效观察

目的:观察姿势解密技术治疗粘连期肩周炎的临床疗效.方法:选取30例粘连期肩周炎患者随机分为观察组和对照组各15例.观察组患者给予姿势解密技术治疗,对照组患者给予传统推拿手法.2组患者均于治疗前、治疗1次、治疗4次、治疗结束后1个月进行疼痛视觉模拟评分(VAS)、肌肉压痛阈值(PPT)、肩关节活动度(ROM)、肩关节功能...     

Construction of an artifact to the suitability of sitting posture in children with cerebral palsy and multiple disabilities

Abstract

Introduction: Cerebral palsy (CP) may involve muscle imbalance between the spastic muscles and their antagonists leading to weak postural changes, decreased mobility and chest deformities. Objective: To improve postural condition in children with CP using physiotherapy and assistive technology (AT). Materials and methods: Five children with CP and multiple disabilities and postural changes like scoliosis were included in this study. AT involved the use of low-cost custom made cushion seat and backrest for the wheelchairs to achieve 90° of trunk flexion. This was performed in 10 sessions after the beginning of physiotherapy. As evaluation-intervention tool, photographs were taken at the beginning and end of each session, and then analyzed using software for postural assessment (SAPO). Results: Twenty-five per cent of the participants had an improvement of trunk angulations at the end of the treatment program. Conclusion: The use of AT with physiotherapy treatment proved efficient in the postural alignment of children with CP children in a wheelchair.

• Implications for Rehabilitation

• Wheelchairs are manufactured in standard size, which makes difficult the adaptation of individuals with peculiar postures. Even the most sophisticated, with adjustments and special accessories, not always allow adjustments to shape up properly to deformities in children with cerebral palsy.

• It is hoped that this research will be useful in order to show rehabilitation professionals the ability to minimize the difficulties of keeping children with cerebral palsy and multiple disabilities properly seated in the wheelchair, facilitating posture, movement, breathing and swallowing.

• The construction of these artifacts has the advantage of being low cost, and must pass through stages of adequacy and modeling in order to replace the seat and side of the wheelchair.

     

健康人矢状面照片拍摄法评定头颈姿势的信度研究

目的:探索矢状面照片拍摄法评定头颈姿势的评估者间信度和评估者内部信度.方法:选取27例健康受试者,在左侧耳屏、肩峰及C7棘突处作红色标记,从受试者左侧拍摄其坐位矢状面照片,包括头颈和上胸段.选取头颈角,即耳屏和C7棘突连线和水平线所形成的夹角作为评定头颈姿势的参数.评估方法包括目测观察法和量角尺测量法.两位评估者独立评...     

体位干预预防甲状腺手术体位综合征的临床观察

目的 :探讨体位干预对甲状腺手术体位综合征的影响。方法 :随机将 2 2 8例甲状腺手术患者分成两组 ,对照组 12 0例采用常规的手术体位 ,干预组 10 8例采用改进手术体位。对两组的手术时间、头颈部过伸位的时间及术后两组患者的头痛、恶心呕吐等进行对照。结果 :干预组并不增加手术难度及手术时间 ,但可显著缩短术中头颈部过伸位的时间 ;干预组头痛和恶心呕吐发生率均明显低于对照组 (P <0 0 1)。结论 :体位干预可有效地预防或减轻患者甲状腺术后头痛及恶心呕吐等症状     

新型脊柱手术体位垫在俯卧位手术患者中的应用

目的对俯卧位支架自行设计改进为“新型脊柱手术体位垫”,探讨其应用于俯卧位脊柱手术患者的临床应用效果。方法选取2018年1—12月收治的180例俯卧位腰椎手术患者为研究对象,随机等分为对照组和观察组,对照组使用原有的俯卧位体位垫,观察组使用新型脊柱手术体位垫。比较两组患者的不舒适感和支撑点皮肤的受压状况。结果观察组患者不舒适感低于对照组(P<0.05),受压部位支撑点皮肤的受压状况均优于对照组(P<0.05)。结论新型脊柱手术体位垫应用于俯卧位手术患者,改善患者皮肤发红、水泡的情况,提高患者的舒适感,值得临床推广应用。     

术前体位训练对甲状腺手术体位综合征影响的临床研究

目的:探讨术前体位训练对甲状腺手术体位综合征的影响。方法:将298例甲状腺手术患者随机分为观察组(151例)和对照组(147例)。观察组行术前体位训练,直至患者能坚持体位到手术所需要的时间;对照组术前不进行体位训练。观察患者术中体位舒适度和耐受力情况及术后48h患者头痛、恶心、呕吐情况。结果:术前体位训练组甲状腺手术体位综合征发生率明显低于对照组。结论:术前体位训练可有效预防甲状腺手术体位综合征的发生。     

脑瘫儿童乳牙釉质发育缺陷的临床表现分析

目的:探讨脑瘫儿童乳牙釉质发育缺陷的临床表现特点及可能的发生机制。方法:选择150例脑瘫患儿,检查乳牙釉质发育缺陷的状况,结合胎儿期、围产期、出生后病史,研究釉质发育缺陷的临床表现及可能的发生机制。结果:脑瘫儿童中,乳牙釉质发育缺陷的患病率明显高于正常儿童,男女性别间差异无显著性。缺陷多发生在切牙及第一磨牙,且基本对称发生。釉质发育不全发生最多。结论:脑瘫儿童乳牙的釉质发育缺陷的敏感时期为妊娠的后6个月到出生后1年,其患病率明显高于正常儿童。     

Post-lumbar-puncture headache: The significance of body posture

In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.     

改良角尺在脊髓损伤患者体位护理中的应用

<正>脊髓损伤是指由损伤或疾病等因素引起的脊髓结构和功能的损害,导致损伤水平以下运动、感觉和自主神经功能的障碍[1]。脊髓损伤是一种严重的致残性损伤,可造成截瘫或四肢瘫。高位脊髓损伤,特别是颈髓损伤的急性期获得坐位的耐力多有困难[2]。据报道,在胸6水平以上脊髓损伤患者中,体位性低血压的发     

The effects of smart phone gaming duration on muscle activation and spinal posture: Pilot study

This study investigates changes in the posture angles of the neck and trunk, together with changes in the muscle activation of users, at the start of and at 5, 10, and 15 minutes of smartphone use. Eighteen males participated in this study. Surface electromyography (EMG) and a digital camera were used to measure the muscle activation and angular changes of the neck and trunk of participants during smartphone use for a period of 16 minutes. Neck and trunk flexion significantly increased at 5, 10, and 15 minutes (p < 0.05) in comparison with the neck and trunk flexion of participants at the start of smartphone usage. The EMG activation and 10th%amplitude probability distribution function (APDF) values of the bilateral cervical erector spinae at 5–6, 10–11, and 15–16 minutes of usage (p < 0.05) were also significantly greater than at the start of usage. The EMG activation of the bilateral thoracic erector spinae and lower trapezius was significantly decreased at 5–6, 10–11, and 15–16 minutes of usage (p < 0.05). Smartphone use induced more flexed posture on the neck and trunk than other visual display terminal (VDT) work. Smartphone use also changed posture and muscle activation within a relatively short amount of time, just 5 minutes. Pain after 16 minutes of smartphone use was also observed. Thus, clinicians should consider the influences of smartphone use in posture and muscle activity in evaluation, intervention, and prevention of neck and trunk conditions.     

体位图片解释法在硬膜外麻醉手术患者体位摆放中的应用

目的探讨体位图片解释法在硬膜外麻醉患者体位摆放中的作用。方法收集2008年9月-2009年2月在本院行硬膜外麻醉的患者200例,随机分为观察组和对照组,每组各100例。观察组采用体位图片解释法协助患者摆放麻醉体位,对照组仅采用口述解释法指导患者摆放麻醉体位。比较两组患者硬膜外麻醉体位配合程度和护士解释所需时间。结果两组患者在麻醉体位摆放配合度及护士解释所需时间方面比较,其差异存在统计学意义（均P〈0．05）。其中观察组患者的配合度高于对照组,而护士解释所需的时间则低于对照组。结论体位图片解释法能有效提高患者硬膜外麻醉体位配合程度,缩短护士解释所需时间,从而间接提高手术室护理质量。     

Sitting bodily configuration: A study investigating the intra-tester reliability of positioning subjects into a predetermined sitting posture

Sitting posture predominates in lifestyle and workplace, but quantitative postural designation is limited due to divergence of methodology used in the studies.To date, no study has investigated the upper body’s habitual or a predetermined sitting posture in healthy individuals assessing together pelvis, spine and head. The objectives were (i) assessment of intra-rater reliability of positioning subjects to a lordotic sitting posture and (ii) comparison of habitual sitting posture (HSP) with the lordotic posture. Another objective was to synthesize and propose an improved 3D model for pelvis, trunk and head to assess quantitatively the postural sagittal configuration.A single session test-retest design was employed. After power calculations 25 subjects were recruited. A repeated measure ANOVA revealed significant differences between HSP and the predetermined posture used in the study. Intra-rater reliability was analysed used the intra-class correlation coefficient (ICC) and also standard error of measurement (SEM) and smallest real difference (SRD) were calculated. The ICC values for all angles ranged from 0.85 to 0.98 indicating almost perfect agreement. The SEMs for all angles ranged in degrees from 0.65 to 1.50 and the SRDs from 1.80 to 4.16.This study provides the most specific sagittal measurement of surface spinal curves, head and pelvis position, in reference to a lordotic seated posture. The clinical significance of this study is reinforced by the fact that postural assessment is conducted by body surface evaluation. The results regarding reliability and SEMs established that healthy individuals can be reliably positioned in an upright lordotic sitting posture.     

体位干预在高龄全髋关节置换患者术中压疮的作用研究

目的探讨体位干预在有效评估预防术中压疮应用的效果,解决高龄全髋关节置换患者术中压疮存在的风险、预防治疗及管理方面存在的问题。方法分2组进行比较,针对术前评估、压疮护理,应用循证方法查阅文献资料,进行归纳总结,寻求最佳护理证据。结果 2组比较,P<0.05,差异具有统计学意义。结论应用体位干预,可以科学地指导术前、术中预防压疮的系统管理工作,有效地进行评估,预防术中压疮和指导压疮护理,对人工全髋关节置换患者不同个体进行评估—预防—治疗,提高护理质量,降低压疮护理成本,减少护理纠纷,减轻手术患者术后的痛苦。