电动踝关节功能康复仪预防和矫正足下垂的效果观察

目的 评价电动踝关节功能康复仪预防及矫正足下垂的效果.方法 预防组为长期卧床患者168例,随机分为对照组(80例)和实验组(88例).对照组患者采用将患肢踝关节处于功能位并穿夹板鞋的传统护理方法,实验组用电动踝关节功能康复仪(简称康复仪)治疗.比较2组预防足下垂的有效率.矫正组为足下垂患者60例,随机分为对照组(30例)和实验组(30例),对照组采用手法按摩矫正,实验组应用康复仪矫正.比较2组矫正足下垂的有效率和下肢肌容积变化.结果 在预防组中,对照组和实验组预防足下垂的有效率分别为68.7%和97.7%,两者差异有统计学意义(P＜0.01),实验组有效率较高.在矫正组中,对照组和实验组矫正足下垂的有效率分别为60%和83.3%,两者差异有统计学意义(P＜0.05),实验组有效率较高.两组30 d时的下肢肌容积差异有统计学意义(P＜0.01),实验组较高.结论 康复仪比传统护理能更有效地预防和矫正足下垂,可以提高患者的生活质量,减轻护理人员负担.     

预防压疮小型电动中药液涂抹护理仪的研制与应用

目的探讨预防压疮小型电动中药液涂抹护理仪的设计制作及在临床上应用的的效果。方法选择压疮评分12—14分的患者100例,分为对照组50例和实验组50例。对照组采用常规护理措施,实验组采用常规基础预防护理措施结合仪器应用,以压疮发生率及自制皮肤舒适度量表进行评价,比较两组效果。结果实验组压疮发生率为0,预防压疮有效率为100．0％,对照组压疮发生率为8．0％,有效率为92．0％,两组比较差异有统计学意义（x2=4．17,P〈0．05）;实验组皮肤舒适度为100．0％,高于对照组的皮肤舒适度66．0％,两组比较差异有显著统计学意义（x2=20．48,P〈0．05）。结论仪器能有效预防压疮,提高患者皮肤舒适度,值得临床推广应用。     

自制多向踝关节矫正器应用于脑脊髓病变患者踝关节挛缩的疗效

目的观察自制多向踝关节矫正器对脑脊髓病变偏瘫患者踝关节挛缩的临床疗效。方法将178例脑脊髓病变偏瘫患者随机分为观察组与对照组各89例，对照组除常规治疗和护理外，由专职康复护士对患者的踝关节行被动、主动运动及按摩护理。观察组患者在此基础上，另外加穿自制多向踝关节矫正器，调节足踝于功能位。比较两组踝关节挛缩发生情况。将发生踝关节挛缩的59例患者再随机分为对照组29例与观察组30例，对照组进行常规康复训练，观察组外加用多向踝关节矫正器矫正，比较两组对踝关节挛缩的矫正效果。结果预防踝关节挛缩，观察组踝关节挛缩发生率低于对照组（P〈0．01）；矫正踝关节挛缩，观察组疗效优于对照组（P〈0．05）。结论早期使用多向踝关节矫正器，能有效地预防踝关节挛缩的发生，对已发生的踝关节挛缩矫正效果显著。     

防足下垂牵引装置的设计及应用

目的探讨防足下垂牵引装置在预防长期卧床伴下肢主动运动功能缺陷患者足下垂中的作用。方法采用治疗型的弹力袜、弹性绷带、羊羔毛、软魔术贴等材料,制作预防足下垂的装置并应用于临床。结果18例采用防足下垂牵引装置患者在住院期间未发生1例足下垂。人院时患者肢体功能评分为（56．78±16．45）分,出院时为（66．11±9．89）分,入院时和出院时比较,t=一2．06,P〈0．05,差异具有统计学意义。结论防足下垂牵引装置可预防长期卧床伴下肢主动运动功能缺陷患者足下垂的发生,而且使用方便,值得临床推广应用。     

定制矫形鞋垫对慢性非特异性下背痛患者下肢生物力学指标的影响

目的 探讨物理治疗结合个体化定制矫形鞋垫调整慢性非特异性下背痛(LBP)患者下肢生物力学后，患者症状与功能恢复情况，为临床治疗提供参考依据。 方法 选取非特异性LBP患者60例，按随机数字表法分为实验组和对照组，每组患者30例。实验组在物理治疗的前提下穿戴定制矫形鞋垫，对照组仅给予物理治疗。2组患者接受常规康复治疗，包括康复教育（含康复训练中错误动作的纠正、日常生活中错误姿势的纠正和正确姿势的学习）、超短波、干扰电、手法松动、牵拉和运动训练，每日1次，连续治疗2周。实验组患者在常规康复治疗的基础上，根据患者个体足底生物力学的改变针对性地制作并穿戴定制矫形鞋垫。于矫正前、矫正2周后（矫正后）以及实验组佩戴6个月后（随访时）评估2组患者的疼痛程度和功能状态，并于治疗前和随访时行下肢生物力学指标测量。 结果 于矫正前、矫正2周后（矫正后）以及实验组佩戴6个月后（随访时）评估2组患者的疼痛程度和功能状态，并于治疗前和随访时行下肢生物力学指标测量。随访时，对照组左侧下肢立姿跟骨休息位、胫骨扭转与组内矫正前比较，差异均有统计意义（P<0.05）；实验组左侧下肢立姿跟骨休息位、胫骨扭转、前足外翻与组内矫正前比较，差异均有统计意义（P<0.05），且其胫骨扭转、前足外翻与对照组随访时比较，差异均有统计学意义（P<0.05）。随访时，对照组右侧下肢立姿跟骨休息位与组内矫正前比较，差异有统计意义（P<0.05）；实验组右侧下肢立姿跟骨休息位、胫骨扭转、前足外翻与组内矫正前比较，差异均有统计意义（P<0.05），且其胫骨扭转、前足外翻与对照组随访时比较，差异均有统计学意义（P<0.05）。随访时，实验组患者长短腿差值为（2.51±2.63）mm，与组内矫正前和对照组矫正后比较，差异均有统计学意义（P<0.05）。 结论 定制矫形鞋垫可矫正慢性非特异性LBP患者部分下肢生物力学异常,减轻腰部疼痛。     

自制防足下垂固定器在下肢功能障碍患者中的应用效果

目的：为肢体瘫痪患者设计防足下垂固定装置,以防止患者长期足下垂引起肢体废用性萎缩,并探讨其对患者的康复效果。方法防足下垂固定器由放置下肢及足部的T型凹槽及覆盖在上面的海绵两部分组成。将108例下肢瘫痪患者按照随机数字表法随机分为对照组53例和研究组55例,对照组患者按常规护理,研究组患者在常规护理基础上使用防足下垂固定器。1个月后比较两组患者的Maryland足部功能评分和下肢简式Fugl-Meyer运动功能评分（仰卧位）。结果治疗前,两组Maryland足部功能评分和Fugl-Meyer 运动功能评分差异均无统计学意义（ P＞0．05）。治疗1个月后,研究组Maryland足部功能评分为（90．85±3．02）分,对照组为（83．50±2．43）分,差异有统计学意义（t＝12．52, P＜0．05）;研究组下肢简式Fugl-Meyer运动功能评分为（30．90±2．14）分,对照组为（22．13±2．26）分,差异有统计学意义（t＝19．75,P＜0．05）。结论防足下垂固定器有利于患者下肢功能康复,可有效替代护理人员手工固定,适合下肢瘫痪患者使用。     

自制踝足矫形带对脑卒中偏瘫患者下肢运动功能的影响

目的：观察自制踝足矫形带对脑卒中偏瘫患者下肢运动功能的影响。方法：60例脑卒中偏瘫患者随机分为观察组和对照组各30例。2组患者常规治疗相同,对照组在此基础上进行步态训练;观察组在此基础上佩戴自制踝足矫形带同时进行步态训练。治疗后分别采用综合痉挛量表（CSS）评定踝关节痉挛,Berg平衡量表（BBS）评定平衡功能,Fugl-Meyer运动评分量表中下肢部分（FMA）评定下肢运动功能和步速。结果：治疗3周后,2组患者患侧CSS较治疗前显著降低（P<0.01）,且观察组更低于对照组（P<0.01）;2组患者BBS、FMA及步速均显著高于治疗前（P<0.01）,且观察组更高于对照组（P<0.05,0.01）。结论：自制踝足矫形带联合康复训练能有效降低脑卒中偏瘫患者的踝关节痉挛,矫正足下垂内翻,改善平衡功能,增加步速和提高下肢运动功能。     

人工关节置换术后踝足部早期主动运动的效果

目的探讨早期足踝关节主动运动对患者疼痛和下肢肢体周径的影响,评价其在人工关节置换术后功能锻炼中的作用。方法选择42例人工关节置换患者,随机分为对照组和实验组,各21例,对照组术后按常规护理,实验组术后在常规护理基础上加踝关节主动运动。比较两组术后患肢肢体肿胀及术后患者疼痛情况。结果术后第2,3,5,7天实验组患肢肢体周径和疼痛程度均低于对照组,差异有统计学意义（P〈0．05）。结论早期踝关节主动运动能改善患者肢体肿胀,有助于减轻患者的疼痛,改善患者的生活质量。     

间歇性梯度充气预防脑出血患者下肢深静脉血栓的效果

目的探讨间歇性梯度充气（IPC）在脑出血患者急性期预防下肢深静脉血栓（DVT）的效果。方法连续收集院神经科住院的急性脑出血患者148例,随机分为实验组（72例）和对照组（76例）,实验组采用常规护理联合IPC预防DVT,对照组采用常规护理方法,观察两组患者DVT的发生率。结果实验组DVT发生率11．1％,对照组DVT发生率17．1％,两组比较差异有统计学意义（x^2=4．036,P〈0．05）。结论常规护理联合IPC在预防DVT方面优于常规护理,而且无相关并发症发生,可用于脑出血患者急性期DVT发生的预防。     

CPM对预防下肢骨折术后患者深静脉血栓形成的影响

目的探讨CPM下肢功能训练对预防下肢骨折患者深静脉血栓形成的影响。方法将268例下肢骨折患者随机分为CPM实验组（134例）和对照组（134例）两组进行对比，CPM实验组应用CPM装置进行训练，对照组不使用CPM，只由专业医务人员指导，鼓励患者主动、被动功能训练，观察两组预防深静脉血栓形成的效果。结果CPM实验组在预防患者下肢深静脉血栓形成明显优于对着组（P〈0．05）。结论下肢骨折术后患者患者应用CPM装置有利于预防深静脉血栓形成。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.