120例急性脑卒中患者的早期康复治疗

目的:探讨早期康复介入对急性脑卒中患者的运动功能和日常生活活动(ADL)能力的影响。方法:将120例急性脑卒中患者随机分为康复组和对照组各60例,均接受神经内科常规药物治疗,康复组同时接受早期康复治疗。2组于治疗前、治疗后1个月进行神经功能缺损评分,并以Barthel指数(BI)评定ADL能力。结果:治疗1个月后康复组神经功能缺损评分明显低于对照组(P<0.05),BI评分及BI增加值明显高于对照组(P<0.05及P<0.01)。结论:早期康复治疗可明显提高脑卒中患者的运动功能,降低致残率,提高ADL能力。     

脑卒中患者家属早期参与强化康复治疗的疗效观察

目的:探讨家属早期参与强化康复治疗对急性脑卒中患者神经功能缺损、运动功能及日常生活能力的影响。方法:142例急性脑卒中患者随机分为康复组(88例)及对照组(54例),康复组在常规药物治疗同时,进行家属早期参与强化康复治疗,对照组仅采用常规药物及一般康复治疗。35 d后分别评价2组患者的神经功能缺损评分、Fugl-Meyer的运动功能积分及日常生活活动能力评分。结果:治疗后2组的神经功能缺损评分、Fugl-Meyer的运动功能积分及日常生活能力评分与治疗前比较差异有统计学意义(P<0.01),康复组各指标的改善明显优于对照组(P<0.01)。结论:家属早期参与强化康复治疗能有效改善急性脑卒中偏瘫患者的运动功能,提高生活能力,减少神经功能缺损。     

早期康复治疗对脑卒中神经功能重建的影响

目的:探讨对脑卒中患者进行早期康复治疗的方法及其对患者神经功能重建的影响。方法:将180例具有中度以上神经功能缺损的脑卒中患者随机分为康复组和对照组各90例,2组均接受神经内科常规药物治疗,康复组同时接受早期康复治疗。于治疗前、治疗后1个月评定2组神经功能缺损程度、肢体运动功能(FMA评分)及日常生活活动能力(Barthel指数)。结果:康复组神经功能缺损程度评分、FMA评分及Barthel指数的改善均明显优于对照组(P<0.05)。结论:脑卒中患者的早期康复治疗,能帮助患者改善运动功能,促进神经功能恢复,提高患者ADL能力。     

早期康复对急性脑卒中的临床疗效

目的 :观察早期康复治疗对急性脑卒中患者的临床疗效。方法 :2 0 4例急性脑卒中患者随机分为早期康复组 (A组 )和常规组 (B组 )各 10 2例 ,均常规进行神经内科药物治疗 ,A组同时综合应用Baboth和运动再学习的方法进行训练。结果 :治疗 1个月后神经功能缺损评分减少、ADL依赖程度及临床疗效等比较 ,A组均优于B组(P <0 .0 5或 0 .0 1)。结论 :早期康复治疗对急性脑卒中患者神经功能恢复具有良好的促进作用     

早期康复对急性偏瘫病人118例临床预后的影响

目的 :为了科学地评价早期康复方法能否明显改善急性脑卒中偏瘫病人的运动功能、提高日常生活活动 (ADL)能力、减轻临床神经功能缺损程度 ,从而改善临床疗效。方法 :采用国际公认的Bobath疗法和随机对照临床试验方法进行评价和治疗。结果 :①早期康复组治疗前后比较 ,FMA、MESSS、MBI均有明显改善 (P <0 0 5 ) ,对照组则无显著改变 (P >0 0 5 ) ,两组治疗后比较改善仍明显 (P <0 0 5 ) ;②早期康复组康复的总有效率明显高于对照组 (P <0 0 5 )。结论 :早期应用Bobath疗法治疗急性脑卒中偏瘫病人 ,能显著减轻临床神经功能缺损程度 ,明显提高患肢的运动功能和ADL能力 ,从而改善临床预后 ,降低病人的致残率。     

急性脑卒中患者早期康复的临床研究

目的　对比研究早期康复治疗对脑卒中患者发病早期的神经功能缺损程度、平衡功能、运动功能及日常生活活动能力 (ADL)的影响。方法　 64例急性脑卒中患者随机分为康复组及对照组 ,康复组采用综合疗法 (包括药物治疗、Bobath疗法、PNF疗法及神经肌肉电刺激等治疗 )。对照组采用药物治疗。 2 8d后分别评价两组患者的神经功能缺损程度、平衡功能、运动功能及ADL。结果　所有受试者治疗后神经功能缺损积分均明显减少 ,平衡功能、运动功能、ADL积分均明显增加 ,两组的变化均数相比 ,康复组优于对照组 (P<0 .0 5 )。结论　急性脑卒中患者早期综合康复与药物治疗相比 ,在降低其神经功能缺损积分 ,提高平衡功能、运动功能、ADL的积分上效果更好     

早期康复护理在脑卒中偏瘫患者中的应用效果

目的探讨早期康复训练治疗对脑卒中患者运动功能、日常生活和继发性残疾的影响。方法将156例急性脑卒中患者随机分为康复组及对照组,康复组在采用常规药物治疗的基础上,进行早期综合康复治疗,平均于病后9d开始实施康复护理。对照组仅给予常规药物治疗。35d后评价并比较2组患者的神经功能缺损评分、肢体运动功能评定、日常生活活动能力。结果治疗后2组患者的神经功能缺损评分、肢体运动功能评定、日常生活活动能力评分与治疗前相比,差异具有统计学意义(P0.05),康复组各指标的改善明显优于对照组(P0.05)。结论早期康复治疗能有效改善急性脑卒中偏瘫患者的运动功能,提高生活能力,减少神经功能缺损,值得临床推广应用。     

急性脑卒中的早期床旁康复干预

目的:研究早期综合康复训练和护理指导对急性脑卒中患者发病早期的神经功能缺损程度、平衡功能、运动功能及ADL的影响。方法:58例急性脑卒中患者随机分为康复组和对照组。2组均给予神经内科常规药物治疗,康复组同时给予早期综合康复训练和护理指导。2组患者分别于治疗前、出院前1d进行神经功能缺损程度、平衡功能、运动功能及ADL评估,出院3～6个月进行电话随访评定ADL。结果:2组患者治疗后神经功能缺损积分均减少,平衡功能、运动功能、ADL积分增加(P<0.01)。2组比较,康复组疗效优于对照组(P<0.05)。结论:脑卒中早期采用床旁综合康复干预与单纯采用神经内科常规药物治疗相比,能更显著地改善神经功能缺损,提高平衡、运动功能和ADL。     

早期康复干部对急性脑卒中患者心理与日常生活活动能力的影响

为了探讨早期康复干预对急性脑卒中偏瘫患者心理与生活能力(ADL)的影呐，将123例急性脑卒中患者随机分为两组，早期干预组与对照组。经治疗1—6个月后，采用神经功能缺损(NFI)、ADL量表与抑郁自评量表(SDS)评分。治疗后，两组NFI减少，ADL明显提高，SDS降低，与对照组比较早期干预组改善明显(P&;lt;0．01)。急性脑卒中患者早期进行康复可有效改善患者神经功能缺损与提高患者ADL，减轻心理疾患并有一定远期效果。     

早期康复护理对急性脑血管病患者神经功能及生活能力的影响

目的:探讨早期康复护理对急性脑血管病患者神经功能及生活能力的影响.方法:将70例急性脑血管病患者随机分为康复组和对照组各35例,对照组给予神经内科常规治疗与护理,康复组在对照组基础上进行分阶段早期康复护理.4周末对两组神经功能缺损评分和日常生活活动能力(ADL)评分进行比较分析.结果:治疗后,康复组神经功能缺损评分及ADL评分分别为4.4±1.9分及59.3±6.0分;对照组神经功能缺损评分及ADL评分分别为6.9±2.4分及37.8±4.2分,两组比较均有显著性差异(P<0.05).结论:早期康复护理对急性脑血管病患者神经功能及日常生活活动能力的恢复具有促进作用.     

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.