针灸推拿联合常规康复疗法在老年神经根型颈椎病患者康复治疗中的应用疗效

目的：分析老年神经根型颈椎病患者采用常规康复疗法联合针灸推拿在康复治疗中的效果及应用价值。方法：回顾性分析2017年1月~2019年1月收治的100例老年神经根型颈椎病,根据治疗方法不同分为对照组和观察组,各50例。对照组行常规康复疗法,观察组行针灸推拿联合常规康复疗法,观察并比较两组患者中医证候积分、疼痛评分、治疗效果及复发情况。结果：治疗前,两组中医证候积分和疼痛评分比较,差异均无统计学意义（P＞0.05）;治疗后,两组中医证候积分和疼痛评分均明显降低,且观察组低于对照组,差异有统计学意义（P＜0.05）。观察组治疗总有效率高于对照组,复发率低于对照组,差异有统计学意义（P＜0.05）。结论：老年神经根型颈椎病在常规康复治疗的基础上加针灸推拿,可有效减轻疼痛等症状,改善颈椎功能,减少复发率。     

针灸联合身痛逐瘀汤治疗神经根型颈椎病气滞血瘀证的临床效果

目的探讨针灸联合身痛逐瘀汤治疗神经根型颈椎病气滞血瘀证的临床效果。方法将60例神经根型颈椎病气滞血瘀证患者按照治疗方式分为对照组与观察组,各30例。对照组在常规药物治疗基础上给予针灸治疗,观察组在对照组基础上给予身痛逐瘀汤治疗。比较两组的临床效果。结果治疗后,两组的各临床症状评分及总分均升高,VAS及NPQ评分均降低,且观察组优于对照组(P<0.05)。观察组的治疗总有效率高于对照组(P<0.05)。结论针灸联合身痛逐瘀汤治疗神经根型颈椎病气滞血瘀证的临床效果显著。     

整脊手法配合加味葛根汤治疗神经根型颈椎病疗效观察

目的：观察整脊手法与加味葛根汤联合治疗神经根型颈椎病的临床效果。方法：将60例神经根型颈椎病患者随机分为治疗组和对照组各30例。治疗组采用整脊手法配合加味葛根汤治疗,对照组采用整脊手法治疗。比较两组临床疗效及疼痛评分。结果：治疗组治疗总有效率为96.7%,高于对照组的73.3%,差异具有统计学意义（P＜0.05）。两组治疗前疼痛评分比较无显著性差异（P＞0.05）;治疗组治疗后疼痛评分低于对照组,差异具有统计学意义（P＜0.05）。结论：整脊手法配合加味葛根汤治疗神经根型颈椎病能有效改善患者颈椎失稳的病况,有效恢复颈椎生理曲度,同时缓解颈部周围组织对神经根部的压迫,改善临床症状。     

针刺联合井穴点刺放血治疗神经根型颈椎病疗效观察

目的：观察针刺联合井穴点刺放血治疗神经根型颈椎病的临床疗效。方法：将90例神经根型颈椎病患者随机分为观察组45例与对照组45例。对照组予以中医针刺治疗,观察组在此基础上加用井穴点刺放血治疗,观察2组治疗前后的临床症状与体征,比较2组临床疗效。结果：观察组治疗有效率为93.33%,对照组有效率为71.11%,2组比较差异有统计学意义（P〈0.05）;2组症状积分治疗后与治疗前比较,均有改善,但治疗后观察组症状积分显著低于对照组（P〈0.05）。结论：针刺与井穴点刺放血联合治疗神经根型颈椎病可更好缓解患者的症状,消除疼痛,在临床上具一定的参考价值。     

软组织微创配合牵引下整脊对神经根型颈椎病的镇痛止麻效果

目的观察软组织微创配合牵引下整脊对神经根型颈椎病的镇痛止麻效果。方法选60例合格的神经根型颈椎病患者,随机分为软组织微创配合牵引下整脊治疗组及软组织微创配合单纯牵引对照组各30例。牵引下整脊及单纯牵引各治疗9次,软组织微创治疗3次。分析治疗前后及随访3个月后两组颈肩臂疼痛、颈部压痛及麻木症状体征积分的变化。结果两组治疗后及随访3个月后症状体征积分均有改善(P<0.05),治疗组的症状体征积分改善优于对照组(P<0.05)。结论软组织微创配合牵引下整脊在减轻神经根型颈椎病颈肩臂疼痛、颈部压痛及麻木症状方面疗效显著,操作安全。     

雷火灸热敏穴治疗颈型颈椎病颈痛的效果研究

[目的]观察雷火灸热敏穴对颈型颈椎病颈痛的干预效果和不良反应,评价其安全性和有效性,为临床选择有效的规范化干预方案提供依据。[方法]将90例病人按照随机数字表法分为对照组和干预组,各45例。对照组给予艾灸经验穴治疗,干预组先探查出颈型颈椎病病人的热敏穴,再施以雷火灸,每天治疗1次,连续治疗5次后观察疗效。[结果]干预组总有效率为100.0%,对照组总有效率为91.1%,两组疗效比较差异有统计学意义(P0.05)。治疗3次后干预组数字疼痛量表评分(NRS)及NPQ颈痛量表评分均优于对照组(P0.05)。[结论]雷火灸热敏穴治疗颈型颈椎病具有较好的临床疗效。     

针灸治疗神经根型颈椎病76例临床观察

目的：观察针灸治疗神经根型颈椎病的疗效。方法：将149例确诊为神经根型颈椎病的患者随机分为治疗组和对照组,其中治疗组76例,采用针灸配合TDP照射治疗,对照组73例,采用牵引治疗。并分别观察两组患者症状评分。结果：治疗组总显效率86.84%,对照组75.35%（P〈0.05）。治疗组痊愈率28.95%,对照组16.44%（P〈0.05）。结论：针灸治疗神经根型颈椎病有效,优于对照组,结果有统计学意义。     

穴位点按联合背景音乐在神经根型颈椎病牵引护理中的应用

[目的]探讨穴位点按联合背景音乐对神经根型颈椎病牵引效果的影响。[方法]将100例神经根型颈椎病行牵引治疗的病人随机分为对照组和观察组,每组50例,对照组给予牵引治疗及牵引常规护理,观察组在牵引治疗及常规护理的基础上联合运用穴位点按及背景音乐,观察两组干预后病人疼痛评分、症状体征和功能状态积分、改善指数。[结果]观察组干预后疼痛评分、症状体征和功能状态积分、改善指数明显优于对照组,经比较差异有统计学意义(P0.01)。[结论]穴位点按联合背景音乐能缓解疼痛,提高神经根型颈椎病改善指数、增强神经根型颈椎病牵引疗效。     

平衡针结合颈夹脊穴治疗神经根型颈椎病效果观察

目的:观察平衡针结合颈夹脊穴治疗神经根型颈椎病的临床效果。方法:选取2016年8月~2017年8月于我院就诊的神经根型颈椎病患者86例为研究对象,随机分为对照组和观察组,每组43例。两组均给予推拿治疗,观察组给予平衡针结合颈夹脊穴治疗,对照组给予常规针灸治疗,观察两组患者疼痛情况及颈椎病恢复情况。结果:两组治疗前,各疼痛评分、症状、体征、工作生活能力、手的功能评分及总评分比较,差异无统计学意义,P0.05;治疗后,观察组PRI、VAS、PPI等疼痛评分均明显低于对照组,P0.05;两组手的功能评分治疗后均明显升高,但两组间评分比较无显著性差异,P0.05;两组症状、体征、工作生活能力评分及总评分治疗后均明显升高,且两组间比较差异显著,P0.05。结论:平衡针结合颈夹脊穴治疗神经根型颈椎病疗效显著,可有效改善患者颈肩痛及上肢疼痛,促进患者恢复。     

针刺配合穴位注射对神经根型颈椎病镇痛时效性的临床研究

目的：探讨针刺配合穴位注射对神经根型颈椎病镇痛时效性的临床研究。方法：神经根型颈椎病患者90例，随机分为针刺组、注射组及综合组各30例，针刺组采用针刺颈夹脊、风池、曲池、肩髑等穴，注射组取复方当归注射液及葡萄糖注射以上穴位。综合组联合2种方法治疗，治疗前后均采用MPQ疼痛询问量表（MPQ）评分。结果：治疗后0．5、2及6h时3组患者临床症状与治疗前比较均明显缓解，MPQ评分明显下降（P〈0．05）。综合组及时缜痛时效明显优于针刺组及注射组，针刺组与注射组比较则差异无显著性意义。结论：针刺配合穴位注射治疗神经根型颈椎病疗效显著，临床实用性强、可行性较好。     

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.