内热针导热疗法联合臂丛神经阻滞下肩关节松解治疗粘连性肩关节囊炎的临床效果

<正>粘连性肩关节囊炎是临床的常见病、多发病,以肩关节周围疼痛、活动障碍为主要临床表现。目前临床上常用理疗、按摩、拔火罐、针灸等康复治疗,以及肩关节痛点阻滞治疗,但其疗程长,疗效不佳,患者肩关节功能通常不能得到有效改善。臂丛神经阻滞下肩关节松解治疗粘连性肩关节囊炎,虽能有效地缓解肩关节周围的粘连,促进患者肩关节功能恢复[1],但肩关节松解后数天,往往继发肩部肌肉挛缩、疼痛,影响患者肩关节活动,易再次出现肩关节粘连。内热针导热疗法是将内热针置入骨骼肌附着点,连接内热针导热巡检仪,通过松解     

脉络宁复合液颈椎旁神经阻滞术治疗神经根型颈椎病临床观察

目的:探讨使用脉络宁复合液治疗神经根型颈椎病的临床疗效。方法:选择神经根型颈椎病患者60例,随机分为脉络宁复合液组与倍他米松组,每组30例。两组分别使用脉络宁复合液及倍他米松行责任椎体旁神经阻滞术。每周治疗1次,疗程4周,6个月后随访。观察综合疗效,统计分析颈椎病疗效评分及视觉模拟评分(visual analogue scale,VAS)。结果:治疗后6个月脉络宁组与倍他米松组临床疗效及疼痛症状较治疗前差异有统计学意义(P<0.01);脉络宁组优于倍他米松组,两组间疗效比较差异有统计学意义(P<0.05)。结论:脉络宁复合液治疗神经根型颈椎病疗效确切,远期疗效稳定,是治疗神经根型颈椎病的有效方法之一。     

威伐光联合臂丛神经阻滞下手法松解治疗伴糖尿病的肩周炎疗效观察

目的:探讨威伐光照射联合臂丛神经阻滞下手法松解治疗伴有糖尿病的肩周炎临床疗效。方法:将100例经临床确诊为糖尿病合并肩周炎的患者随机分为观察组(采用臂丛神经阻滞下手法松解,威伐光照射治疗)与对照组(仅采用臂丛神经阻滞下手法松解治疗),每组50例,评定治疗前后2组患者肩关节的疼痛、活动范围。结果:2组治疗后与治疗前比较,肩关节疼痛评分显著降低(均P0.01),活动范围显著提高(均P0.01),且观察组评分改善程度均优于对照组(均P0.01)。结论:威伐光联合臂丛神经阻滞下手法松解治疗伴有糖尿病的肩周炎,可明显提高肩周炎患者的疗效。     

臂丛神经阻滞后手法松解治疗粘连性肩周炎

目的探讨臂丛神经阻滞后手法松解治疗粘连性肩周炎的临床疗效。方法选取益阳市第一中医医院收治的粘连性肩周炎患者96例,随机将其分为研究组和对照组各48例。研究组患者采用臂丛神经阻滞后手法松解治疗,对照组患者采用药物封闭治疗,并就两组患者的临床疗效进行比较和分析。结果研究组患者治疗后VAS评分较对照组患者明显改善,临床治愈率和临床总有效率较对照组患者均明显提升,且差异均有统计学意义(P<0.05)。结论臂丛神经阻滞后手法松解治疗对于粘连性肩周炎患者疼痛症状和临床疗效的改善均具有显著的促进作用。     

肌间沟臂丛神经阻滞下手法松解与液压扩张联合治疗肩周炎

肩周炎是以肩部疼痛及肩关节活动障碍为主要特征的中老年常见病,其主要病理特点是:关节囊及部分滑液囊粘连,关节间隙变窄,囊下部皱襞加深。我院自2000年5月以来,对168例肩周炎伴有肩关节活动障碍患者,采用肌间沟臂丛神经阻滞下手法松解与肩关节腔内液压扩张联合疗法,取得满意疗?..     

体外冲击波联合痛点阻滞治疗粘连性肩关节囊炎的效果

<正>粘连性肩关节囊炎,又称肩周炎,是临床的常见病、多发病,目前其发病机理并不完全清楚。临床报道的治疗方法较多,有臂丛或全麻下肩关节松解术[1,2],此方式虽能彻底解除肩关节周围的粘连,但有一定的麻醉和医源性损伤风险;各种物理及手法等保守治疗[3]疗程长,重症患者疗效差;关节镜下松解术[4]只运用于有重度关节挛缩及运动功能障碍者,并不能作为常规治疗手段。肩关节痛点阻滞能快速缓解粘连性肩关节囊炎疼痛症状,松解肩关     

臂丛神经阻滞下松解粘连性肩周炎的系统化康复护理评价

目的：评价臂丛神经阻滞下松解粘连性肩周炎的系统化康复功能锻炼效果。方法：将64例臂丛神经阻滞下松解的粘连性肩周炎患者,随机分成康复组和对照组各32例,对照组予以常规护理,康复组在常规护理的基础上指导患者进行系统化的康复功能锻炼。结果：经过2个疗程共14d的系统化康复功能锻炼,康复组肩部疼痛和肩关节功能改善效果明显优于对照组,2组比较差异具有统计学意义（P〈0．05）。结论：系统化康复功能锻炼能明显改善臂丛神经阻滞下松解的粘连性肩周炎患者的肩关节功能,缩短病程,减轻患者痛苦。     

综合物理疗法治疗肩周炎的疗效观察

目的探讨臂丛神经阻滞下手法松解术配合超短波、电磁场、关节松动术及功能锻炼治疗肩周炎的临床疗效。 方法将240例经临床确诊的肩周炎患者随机分为观察组（采用臂丛神经阻滞下手法松解、患肩超短波治疗、电磁治疗、关节松动术、功能锻炼等物理疗法治疗）与对照组（仅采用臂丛神经阻滞下手法松解疗法）,每组患者120例,评定治疗前、后2组患者肩关节的疼痛、活动范围。 结果2组治疗后肩关节疼痛评分及活动范围较治疗前均有显著提高（P＜0.01）,且观察组评分显著优于对照组（P＜0.01）,差异有统计学意义（P＜0.05）。 结论臂丛神经阻滞下手法松解后配合其它物理疗法,可明显提高肩周炎患者治疗疗效,值得临床借鉴应用。     

臂丛麻醉下不同次数手法松解治疗肩周炎的对比研究

<正>肩周炎又称粘连性肩关节囊炎,是中老年人的一种常见病、多发病。国外文献报道发病率约占肩部疾患的42%[1],国内文献发病率约为8%[2]。临床上各种治疗方法较多,但效果不一,臂丛麻醉下一次性手法松解术常见报道,但一次臂丛麻醉下,在麻醉药还有效的时间内多次手法松解治疗未见报道,笔者运用在臂丛麻醉下,在麻醉药还有效的时间内一次手法松解治疗肩周炎与多次手法松解治疗的疗效进行比较。1资料与方法     

肩关节粘连松解术后气压弹道式冲击波治疗冻结肩的疗效观察

肩周炎是一种中老年人常见疾病,其主要临床特征为肩周疼痛和肩关节活动障碍.冻结肩是由于肩关节周围肌肉、肌腱、滑囊和关节囊等软组织的慢性炎症、粘连引起的以肩关节周围疼痛、功能障碍为主要症状的一组临床表现[1],其治疗方法很多.如物理、针灸等治疗,臂丛神经阻滞下行肩关节粘连松解术是治疗肩周炎冻结肩的有效方法之一,但术后部分患者存在再次粘连,术后恢复较慢等问题.本研究旨在比较臂丛神经阻滞下行肩关节粘连松解术后冲击波治疗与肩胛上神经阻滞治疗冻结肩的疗效差异.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.