苯海拉明在药物诱发痫样脑电图试验中的应用

目的观察苯海拉明在药物诱发试验中癲痫脑电图(EEG)阳性率检出的效果。方法324例临床诊断的癫痫患者,采用开放随机分组对照研究的方法分为苯海拉明组(162例)和水合氯醛组(162例),两组分别进行睡眠诱发EEG检查,观察两组痫样放电率以及非快速动眼(NREM)睡眠痫样放电容易出现的时期。结果苯海拉明组有7例脱落。药物诱发试验：苯海拉明组阳性49例,痫样放电率31.61%;水合氯醛组阳性30例,痫样放电率18.52%。苯海拉明组药物诱发试验痫样放电阳性率比水合氯醛组明显高(χ²=7.26, P<0.01)。NREM睡眠Ⅰ～Ⅱ期痫样放电检出率：苯海拉明组为83.7%;水合氯醛组为63.3%。提示NREM睡眠Ⅰ～Ⅱ期是痫样放电容易出现时期,且苯海拉明组癫痫放电阳性率比水合氯醛组高(χ²=4.22, P<0.05)。结论苯海拉明在癫痫药物诱发试验中可作为首选药物之一。     

山西省智力残疾抽样调查结果分析

目的了解山西省智力残疾的数量、发生率、结构、地区分布、致残原因、需求等。方法采用多阶段抽样方法,全省共抽取22个县(市、区),88个乡(镇、街道),共调查75016人。由经过培训的调查人员按照规定程序进行调查,并填写相关表格。结果本次调查结果显示,智力残疾人数占调查总人数的0.34%,以三、四级为主。男性以青年残疾发生率最高,女性以童年最高。青年组一、二级残疾比例大于其他年龄段。农村智力残疾发生率显著高于城市(P<0.001)。智力残疾主要致残原因是脑疾病、原因不明、遗传、惊厥性疾病、其他外伤。只有43.8%的残疾人群接受过服务和扶助情况,救助项目局限于医疗服务与救助、贫困残疾人救助与服务、康复训练与服务等少数几个方面。不同人群主要康复需求不同。结论山西省智力残疾现状较为乐观,不存在较大性别歧视。扩大残疾人群接受服务和扶助范围,根据不同人群需求提供有针对性措施以及强化农村防残治残工作是今后工作的重点。     

上海市闸北区280 名残疾人生活质量研究

目的调查2009 年上海市闸北区同意接受“居家养护”服务的所有残疾人的生活质量,并分析其影响因素。方法采用中文版健康调查简表(SF-36)进行入户调查。结果闸北区280 名残疾人生活质量总体得分为(59.72±20.03)。不同年龄段、不同残疾类型、不同低保情况的残疾人生活质量平均得分具有非常显著性差异(P<0.01),年龄与生活质量呈负相关(P<0.01),教育程度、低保情况与生活质量呈正相关(P<0.05, P<0.01)。结论上海市闸北区残疾人生活质量较低。     

湖北省视力残疾人的康复现状和需求调查分析

目的:了解湖北省视力残疾人接受康复的情况及康复需求.方法:对湖北省地区符合残疾评定标准的1142例视力残疾患者进行康复现状调查,内容包括①接受康复的项目:医疗服务与救助、辅助器具、康复训练与服务;②康复需求:机构康复,延伸服务、社区和家庭服务等.结果:1142例视力残疾患者中接受过一种或以上康复服务469例(41.1%);对康复形式的需求中机构康复760例(66.6%),延伸服务53例(4.6%),社区和家庭服务329例(28.8%).对康复内容的需求中医疗服务与救助898例(78.6%),辅助器具276例(24.2%),康复训练与服务120例(10.5%).结论:对视力残疾患者应根据不同年龄、不同地区、残疾程度和不同康复需求,在医疗机构和社区内提供相应的康复服务,满足视力残疾患者的康复需求.     

等速-平衡-减重综合康复训练对老年人髋关节置换术后的疗效分析

目的评价等速-平衡-减重综合康复训练对老年人髋关节置换术后患者的短期疗效。方法 50例髋关节置换患者分为康复A组和康复B组,每组25例。康复A组行等速-平衡-减重综合康复训练,康复B组行常规康复训练。于康复前,康复4周、8周、12周行Harris评分及生活质量满意度调查。结果康复8周后,两组Harris评分均较入院时改善(P<0.05),康复A组在康复8周及12周时Harris评分较康复B组改善更明显(P<0.05)。康复12周髋关节功能优良率康复A组优于康复B组(P<0.05)。生活质量满意度调查：两组患者于康复4周、8周、12周时较入院时明显提高（P<0.01）,12周时康复A组优于康复B组（P<0.05）。结论等速-平衡-减重综合康复训练可促进髋关节的功能恢复,提高患者生活质量。     

中国残疾人康复需求与发展研究

目的研究中国残疾人的主要康复需求和康复服务发展状况。方法对第二次全国残疾人抽样调查中康复需求与发展状况的数据进行统计分析,并就2006年至2016年中国残疾人事业发展统计公报有关康复的数据进行分析研究。结果我国残疾人的康复需求主要包括:医疗服务与救助、辅助器具、康复训练与服务、贫困残疾人救助、无障碍设施、信息无障碍和其他康复需求。需求最高的是医疗服务与救助(34.84%)和贫困残疾人救助(33.25%)。不同残疾类别残疾人在康复需求上存在非常显著性差异(χ~2=40322.1,P0.01)。在我国各类残疾中,有约41.46%的残疾人未曾接受过任何服务和救助,接受最多的服务是医疗服务与救助(30.45%),接受最少的是信息无障碍(0.55%)。专家为各类残疾人提供的康复形式建议主要集中在机构康复和社区与家庭服务;专家建议医疗服务作为精神残疾类(68.18%)和视力残疾类(60.28%)的主要康复内容,辅助器具作为听力残疾类(51.67%)的主要康复内容,康复训练与服务作为智力残疾类(57.36%)和言语残疾类(47.06%)的主要康复内容。不同残疾类别残疾人在专家为其提供的康复形式和康复内容上存在非常显著性差异(χ~2=12489.9,χ~2=52528.93,P0.01)。结论中国残疾人的康复需求主要表现为医疗服务与救助、辅助器具、康复训练与服务和贫困残疾人救助,不同类别残疾人康复需求存在差异;残疾人接受最多的是医疗服务与救助;中国残疾人得到的贫困残疾人救助与其需求差距最大;专家为不同类别残疾人建议的康复形式和康复内容存在差异。建议构建国家和地方康复政策支持体系和康复服务治理架构;以残疾人的康复需求为导向,提供精准康复服务;建立综合性康复服务体系,实现人人享有基本康复服务的目标;大力培养专业康复人员,提升康复服务提供能力和水平;运用《国际功能、残疾和健康分类》开展康复科学研究,为促进康复事业发展提供科学支持。     

基于表面肌电图的针刺缓解腓肠肌群疲劳的评价

目的利用表面肌电图评价针刺缓解腓肠肌疲劳的效果。方法20 名男性健康志愿者负重直立提踵,疲劳发生后对腓肠肌局部(承筋穴)针刺15 min(针刺组);4 周后进行第二次测试,疲劳发生后休息15 min(非针刺组)。记录不同状态下表面肌电信号和心率。结果两组运动后腓肠肌表面肌电值与运动前相比升高(P<0.05),针刺组针刺后降低(P<0.05),休息组休息后升高(P<0.05)。两组运动后心率明显升高(P<0.05),针刺/休息后较运动后减慢(P<0.05),降低量无显著性差异(P>0.05)。结论针刺可以缓     

本体感觉神经肌肉促进技术对脑卒中患者平衡功能的影响

目的探讨在社区康复治疗中应用本体感觉神经肌肉促进技术(PNF)对脑卒中患者平衡功能的影响。方法204 例脑卒中患者分为对照组(n=98)和观察组(n=106),对照组接受常规康复治疗,观察组在此基础上应用PNF。治疗前和治疗3 个月后分别采用Fugl-Meyer 下肢运动功能评定(FMA)、Berg 平衡量表(BBS)和静态平衡测定仪进行评定。结果治疗后两组FMA及BBS 评分均较治疗前提高(P<0.05),且观察组高于对照组(P<0.05);在睁眼与闭眼模式下,观察组轨迹长度、轨迹总面积、单位面积轨迹长均较对照组降低(P<0.05)。结论社区康复治疗中应用PNF 可提高脑卒中患者下肢运动功能和平衡功能。     

综合护理干预对老年慢性心力衰竭患者的影响

目的观察综合护理干预对老年慢性心力衰竭患者的影响。方法老年慢性心力衰竭患者80例,分为综合护理干预组(40例)和对照组(40例),两组均接受相应的心内科常规治疗和一般护理;综合干预组在此基础上加用预见性护理、心理护理及运动康复。结果干预组总有效率高于对照组(P<0.05),出院前6 min步行试验长于对照组(P<0.05)。结论综合护理干预有利于老年慢性心力衰竭患者的康复。     

娱乐疗法对脑卒中患者社会交往能力的影响

目的探讨娱乐疗法对脑卒中患者社会交往能力的影响。方法将脑卒中患者分为治疗组28例和对照组30例,在接受常规康复的同时,治疗组接受经个体化设计的娱乐康复活动。分别在治疗前和治疗结束时进行功能独立性评定。结果两组患者治疗后功能独立性评分均有改善(P<0.05),治疗组社会交往能力评分较对照组改善更多(P<0.01)。结论娱乐康复活动有助于提高脑卒中患者社会交往能力。     

Headache and the eye

Because of the inextricable link between the eyes and headaches, ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, eye pain and visual disturbances are often neurologic in origin. Many primary headache disorders have ophthalmic features, and secondary causes of headache frequently involve the visual system. Both afferent and efferent symptoms and signs are associated with headache disorders. Moreover, the frontal or retro-orbital pain of some primary ophthalmic conditions may be mistaken for a headache disorder, particularly if the ophthalmologic examination is normal. This article reviews common ocular conditions that are associated with head pain, and some secondary causes of headache with neuro-ophthalmic neuro-ophthalmic manifestations.     

Acute visual loss

Acute visual loss is not an infrequent presenting complaint to the Emergency Department. The history of visual loss, physical examination of the eye, and indicated laboratory evaluation are keys to making the diagnosis. The etiology of nontraumatic visual loss is diverse, involving vascular, anatomic, infectious, autoimmune, toxicologic, and psychogenic causes. Appropriate treatment, as well as the need for timeliness of ophthalmologic consultation, is described.     

湖南省凤凰县50岁以上人群低视力与盲流行病学调查

【目的】调查分析湖南省凤凰县≥50岁人群低视力与盲的患病率及其病因。【方法】采用分层整群随机抽样的原则,按比例抽取乡镇,然后再按乡镇抽取行政村,根据居民户口簿来确定调查对象;按照WH0制定的低视力及盲标准,由眼科医师作外眼、角膜、前房、虹膜、晶状体、玻璃体及视网膜等详细检查并对所有视力d0．3的患眼进行主要眼病原因诊断。【结果】检录人数为4857人,实际受检人数为4484人,总受检率92．32％。双眼低视力患病率3．81％,双眼盲患病率1．56％;单眼低视力患病率4．53％,单眼盲患病率1．92％。致盲的主要眼病依次为白内障（51．43％）、玻璃体视网膜病（17．14％）、角膜病（5．71％）、葡萄膜病（5．71oA）、青光眼（4．29％）及高度近视（4．29％）等。【结论】凤凰县≥50岁人群中低视力与盲仍然是严重的公共卫生问题。白内障仍然是导致盲和低视力的首位原因。     

Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a dedicated eye casualty.

Emergency care for eye complaints is provided both by accident and emergency (A&E) departments as well as by dedicated eye casualty departments. This study examines the role of each type of department and the quality of eye care provided. Significant differences were found between the accident and emergency department and the eye casualty department in the history, examination and management of eye patients. Most notably, there were significant differences in the quality of the assessment in the two institutions. Overall 19% (19/100) of A&E records had an inadequate history, compared with 2% (1/50) for eye casualty records. Fifty-nine per cent (59/100) of A&E records contained a significant examination omission, compared with only 8% (4/50) of eye casualty records. Most of the omissions related to a failure to perform an adequate, yet simple, ocular examination including failure to record visual acuity. In 44% (44-100) of A&E cases visual acuity was not recorded or recorded incorrectly. In comparison acuity omissions in eye casualty were present in only 4% (2/50) of cases.     

Ocular examination techniques for the emergency department

The purpose of this article is to provide a guide to assist the Emergency Physician in examining the eye. The evaluation of a patient with eye problems consists of a history, visual acuity, pupil examination, external examination, extra ocular movements, visual fields, and color vision. The patient is then examined at the slit lamp. After the slit lamp examination, the fundus and optic nerve is examined with a direct ophthalmoscope and intraocular pressure is measured. Special tests such as a plain film study and computed tomography (CT) scan may be obtained when indicated and, finally, referral to an ophthalmologist can be made for a dilated fundus examination, ultrasound studies of the eye and orbit, and surgical treatment.     

Subacute angle-closure glaucoma as a cause of headache in the presence of a white eye

Three patients, initially diagnosed with headache syndromes, were subsequently found to have subacute angle-closure glaucoma. In each case, the eye appeared grossly normal and there were no visual symptoms. A comprehensive ophthalmologic examination, including gonioscopy, confirmed the diagnosis. Laser iridotomy was curative with complete resolution of head and face pain. Subacute angle-closure glaucoma is an exception to the maxim that a white eye is not the cause of a painful eye.     

Ocular emergencies

Prompt recognition and appropriate treatment of ocular emergencies are essential in the primary care setting when the outcome may depend on timely management. All ocular emergencies, including a penetrating globe injury, retinal detachment, central retinal artery occlusion, acute angle-closure glaucoma, and chemical burns, should be referred immediately to the emergency department or an ophthalmologist. Careful eye examination and simple tests can help primary care physicians make decisions about appropriate treatment and referral. All patients with eye problems should be tested for visual acuity and ocular movements. Confrontation visual field examination, pupillary examination, and direct ophthalmoscopy of both eyes also should be performed. Ocular injury from high-velocity trauma or from chemicals may be easily misdiagnosed. After a chemical burn, thorough eye washing for at least 30 minutes or until the pH of the eye is within physiologic range is critical to prevent further damage. Use of an eye shield is required in patients with a ruptured globe to protect the injured eye and preserve the patient's vision.     

Trauma to the globe and orbit

Trauma to the eye represents approximately 3% of all emergency department visits in the United States. Rapid assessment and examination following trauma to the eye is crucial. A thorough knowledge of potential injuries is imperative to ensure rapid diagnosis, to prevent further damage to the eye, and to preserve visual capacity. This article describes the aspects of the eye examination that merit special attention in the case of trauma. It then discusses the eye injuries most likely to be seen in the emergency department and their appropriate treatment.     

Demographic predictors of eye care utilization among women

BACKGROUND: Visual impairment may be preventable or treatable with timely intervention. Differences in the use of eye care services may play a role in fostering the racial and socioeconomic gap in the burden of visual impairment in the United States. OBJECTIVE: The objective of this study was to examine the frequency of eye examinations in women and how this varies with age, race, marital status, geographic region, profession, education, and income. SUBJECTS AND METHODS: We used logistic regression models to examine data obtained by mailed questionnaires from 39,876 female health professionals participating in the Women's Health Study. RESULTS: Most women (83%) had an eye examination within the past 2 years. The likelihood of having an eye examination in the past 2 years increased with age (odds ratio [OR] = 2.59 for age > or =75 years versus those <50 years; P [trend] <0.0001), higher education (OR = 1.27 for master's degree versus licensed nurse training; P [trend] = 0.0004), and higher household income (OR = 1.85 for > or =$100,000 versus <$10,000; P [trend] <0.0001). Women from the south were less likely to have had an eye examination than those from the west (OR = 0.92; P = 0.03). Compared with whites, Asian/Pacific Islanders were less likely (OR = 0.76; P = 0.02) and blacks more likely (OR = 1.27; P = 0.02) to have had an eye examination within 2 years. CONCLUSIONS: Age, education, income, race/ethnicity, and region of residence were independent predictors of having had an eye examination in the past 2 years. Known medical and ocular problems appeared to explain the association with age but not the other findings, although the clinical significance of these associations was not determined in the present study. Additional research on determinants of eye care-seeking behavior could help in devising new strategies to encourage preventive behaviors, especially among groups at higher risk of visual impairment.