帕金森病抑郁患者双侧额叶的磁共振波谱改变及意义

目的研究帕金森病抑郁(DPD)患者额叶磁共振波谱(1H-MRS)的改变及其临床意义。方法对20例DPD患者、23例PD患者和20名正常对照者的双侧额叶进行~1H-MRS检测,分析3组双侧额叶的N-乙酰基天门冬氨酸(NAA)/肌酸复合物(Cr)和含胆碱化合物(Cho)/Cr值的变化。结果 DPD患者症状首发侧额叶的NAA/Cr值显著低于PD患者(P0.05),Cho/Cr值显著高于PD患者(P0.05)。DPD患者症状首发侧额叶的NAA/Cr和Cho/Cr值与PD患者比较无显著差异。结论~1H-MRS可以检测到DPD患者额叶的代谢改变,有助于DPD的病因诊断及风险预测。     

太极拳运动对帕金森病患者认知功能及健康相关生活质量的影响

目的:探讨太极拳运动对轻度认知障碍帕金森病患者认知功能和健康相关生活质量的影响。方法:将52例轻度认知障碍帕金森病患者随机分为干预组28例和对照组24例。对照组仅接受常规药物治疗和运动建议,干预组在此基础上进行24式杨氏太极拳训练。干预前后采用蒙特利尔认知评估量表(Mo CA)和39项帕金森病生活质量问卷(PDQ-39)进行评定。结果:干预16周后,干预组Mo CA评分较干预前明显提高(P0.05),PDQ-39评分明显降低(P0.05),对照组无显著改变。干预后,干预组Mo CA评分明显高于对照组(P0.05),PDQ-39评分明显低于对照组(P0.05)。结论:太极拳运动对轻度认知障碍帕金森病患者改善认知功能和提高生活质量具有积极意义。     

动态超声弹性成像技术评估帕金森病肌强直程度的临床研究

目的 探讨动态超声弹性成像技术评估帕金森病骨骼肌生物力学特征的价值.方法 选取2019年1月至9月在首都医科大学附属北京天坛医院入院、明确诊断为帕金森病的患者28例作为帕金森病组,选取同期健康志愿者作为健康对照组,共10名.应用超声弹性成像技术完成2组受试者腓肠肌动态弹性检查,记录被动背屈踝关节过程中,关节角度对应的腓...     

慢性阻塞性肺疾病患者社会支持状况及对生命质量的影响

目的：调查慢性阻塞性肺疾病（ＣＯＰＤ）患者社会支持状况,并分析社会支持对其生命质量的影响。方法：６０例ＣＯＰＤ患者和６０例健康者应用个人资源询问表进行社会支持评分,同时对ＣＯＰＤ患者应用ＣＯＰＤ的生命质量问卷作评估。结果：ＣＯＰＤ患者的社会支持评分低于健康对照组（Ｐ＜０．０５）。年龄、病程和通气功能与ＣＯＰＤ患者的社会支持评分呈显著相关（Ｐ＜０．０５）;社会支持评分与ＣＯＰＤ患者的生命质量中生活能力、社会和抑郁症状评分相关性有统计学意义（Ｐ＜０．０５）。结论：加强社会支持有可能提高ＣＯＰＤ患者的生命质量。     

社区护理干预对阿尔茨海默症患者生存质量影响的meta分析

目的 从循证医学的角度评价社区护理干预对老年痴呆患者生存质量的影响。 方法检索中英文数据库,纳入实施社区护理干预措施+常规护理与仅有常规护理比较的随机对照试验(RCT)和半随机对照试验研究,采用ReVMan 5.3统计软件进行meta分析,比较观察组和对照组在简易精神状态量表(mini-mental state examination, MMSE)、日常生活能力量表(activities of daily living, ADL)中评分方面的差异,以加权均数差(weighted mean difference, WMD)为效应量进行合并分析。 结果 共纳入10个RCT和1个半RCT研究,共计914人,观察组461人,对照组453人。观察组认知功能好于对照组[WMD=2.87,95%CI(1.85~3.89),P<0.001],日常生活活动能力好于对照组[WMD=4.90,95%CI(1.04~8.77),P=0.01]。 结论 社区护理干预能改善老年痴呆患者的认知功能,增强患者的日常生活活动能力,提高患者的生活质量。     

Effectiveness of multidisciplinary interventions to improve the quality of life for people with Parkinson's disease: A systematic review

Aims

To conduct a systematic review and critically evaluate the literature on the effectiveness of multidisciplinary interventions to improve quality of life for people with Parkinson's disease.

Methods

An electronic search of the following publication databases was performed for records from 1995 to 2011: CINAHL PLUS (EBSCO), Joanna Briggs Institute, Pubmed, Web of Science (ISI), psycINFO, Scopus and Cochrane library. The keywords used were Parkinson's disease, nursing, allied health, doctor, intervention, quality of life, rehabilitation, multidisciplinary team and their various combinations. Key terms were matched to MeSH subject headings and exploded where relevant to include all subheadings and related terms to each key term used. 1808 articles were initially identified based on our selection criteria and the reference list of these articles was hand searched. Nine studies were included after this sifting process and critiqued by two reviewers.

Results

Three randomised controlled trials and 6 non-randomised cohort studies were included. For these studies the level of evidence ranged from the Scottish Intercollegiate Network (SIGN) level of 1- to 2-. The outcome measures assessed were heterogeneous, including measures of disability of disease, stage of disease and various quality of life measures.

Conclusion

The evidence quantifying positive and sustained effects of multidisciplinary interventions to improve quality of life for people with Parkinson's disease is inconclusive. There has been relative lack of controlled experimentation to quantify therapy outcomes. The studies reviewed were varied and lacked long-term follow-up to quantify retention of the intervention. It is recommended that interventions to improve quality of life are tested in randomised controlled trials using standardised outcome measures, adequately powered samples and longer follow-up periods to assess intervention sustainability.     

健康信念模式为框架的护理干预对老年痴呆患者认知功能障碍及生活质量的影响

目的探讨基于健康信念模式为框架的护理干预对老年痴呆患者认知功能障碍及生活质量的影响。方法选取71例老年痴呆患者,随机分为观察组36例和对照组35例,对照组予以常规护理干预,观察组在对照组基础上实施基于健康信念模式为框架的护理干预,观察并比较2组认知功能评分(MMSE)、生活质量各指标评分及语言能力评分、意外事件发生情况及护理满意度评分。结果干预后观察组MMSE评分高于对照组(P0.05);干预后观察组生活质量各指标评分均高于对照组(P0.05);观察组干预后阅读及听理解能力评分高于对照组(P0.05);观察组意外事件发生率为8.33%,低于对照组的28.57%(P0.05);观察组护理满意度为91.67%,高于对照组的71.43%(P0.05)。结论基于健康信念模式为框架的护理干预可改善老年痴呆患者认知功能、语言能力及生活质量,且意外事件发生率低,护理满意度高。     

心肌疾病患者生活质量与社会支持相关性的研究

目的 研究心肌疾病患者生活质量与社会支持相关性,探讨提高患者生活质量的有效途径.方法 采用生活质量综合评定量表(GQOLI-74)、社会支持评定量表(SSRS),以随机抽样的方法对住院50例心肌疾病患者的生活质量和社会支持情况进行调查,分析两者的相关性,并随机抽取45名健康人作为对照组进行比较.结果 心肌疾病患者生活质量与正常对照组比较差异有统计学意义(P<0.05);心肌疾病患者的社会支持与正常对照组比较差异有统计学意义(P<0.01);社会支持与其生活质量呈正相关关系(r=0.614,P<0.01).结论 心肌疾病患者的生活质量与社会支持密切相关, 护理过程中应该重视社会支持系统对提高心肌疾病患者生活质量的作用,并充分有效利用.     

帕金森病伴不宁腿综合征的现况调查

目的:通过横断面调查帕金森病(PD)合并不宁腿综合征(RLS)的发病率及临床特征。方法:采用病例对照研究,连续选取自2015年10月至2016年1月我院及天坛医院帕金森专病门诊PD患者,分析RLS组、非RLS(NRLS)组的临床相关性,并根据RLS严重程度评分,分为轻、中、重度。同时收集患者发病年龄、病程、有无毒物接触史、UPDRS-Ⅲ评分、改良H-Y分级、贝克焦虑量表(BAI)等临床资料。结果:共收集294例PD患者,合并RLS共87例(29.6%),其中轻度32例、中度36例、重度19例,既往RLS诊治率仅19.5%。RLS组与NRLS组比较,在病程、改良H-Y分级、UPDRS-Ⅲ、BAI等方面差异有统计学意义(P0.05),在发病年龄、文化程度、是否有毒物接触史、PD家族史等方面差异无统计学意义(P0.05)。结论:PD合并RLS存在发病率高、漏诊率高的特点。运动症状较重、病程较长的患者,易合并RLS。     

Timed Up and Go evaluation with wearable devices: Validation in Parkinson's disease

The Timed Up and Go test (TUG) is used to assess individual mobility. It evaluates static and dynamic balance by means of the total time required to complete the test, usually measured by a stopwatch. In recent years tools based on portable inertial measurement units (IMU) for clinical application are increasingly available on the market. More specifically, a tool (hardware and dedicated software) to quantify the TUG test based on IMU is now available. However, it has not yet been validated in subjects with Parkinson's disease (PD). Thus, the aim of this study is to compare measurements from instrumented TUG tests (or iTUG) acquired by an IMU with those obtained using an optoelectronic system (the gold standard) and by a stopwatch, to gain an in-depth understanding of IMU behavior in computing iTUG in subjects with PD. To do this, three TUG test trials were carried out on 30 subjects with PD and measured with all three systems simultaneously. System agreements were evaluated using Intraclass Correlation Coefficient and Bland-Altman plots. The device tested showed excellent reliability, accuracy and precision in quantifying total TUG test duration. Since TUG is a widely used test in rehabilitation settings, its automatic quantification through IMUs could potentially improve the quality of assessments in the quantification of PD gait ability.     

丘脑底核脑深部电刺激术在改善帕金森病核心症状中的应用

目的探讨丘脑底核脑深部电刺激术在改善帕金森病(PD)核心症状中的疗效。方法选取行双侧丘脑底核脑深部电刺激术PD患者20例,采用自身前后对照法在基线和随访结束时(术后12个月)对患者运动症状、认知功能进行评估,观察患者术后不良反应,比较术前、术后日左旋多巴等效计量。结果术前及术后12个月时,服药状态下帕金森病评定量表第3部分(UPDRSⅢ)评分及各亚相评分均明显低于未服药状态(P0.05);术后12个月时,未服药及服药状态下的UPDRSⅢ评分及各亚相评分均明显低于术前(P0.05),服药后各个评分项目的改善率均明显高于术前(P0.05),VFT评分明显低于术前(P0.05),CDT评分明显高于术前(P0.05);术后1年日左旋多巴等效计量均较术前明显减少(P0.01);术后未见颅内出血、电极位置不当、脑脊液漏等并发症。结论双侧丘脑底核脑深部电刺激术能显著改善PD患者运动及认知功能,有效减少药物用量,手术安全性高,治疗效果显著。     

先天性巨结肠术后远期排便功能与生活质量研究

目的了解先天性巨结肠患儿术后远期排便功能及生活质量，为探索社区护理干预模式奠定基础。方法对46例符合要求的先天性巨结肠患儿进行随访，采用访谈法及内容分析法、Heikkinen评分法评价排便功能。结果共发现三个主题类别：排便功能、并发症及生活质量。生活质量包括四个亚主题类别：生活饮食、工作学习、社会交往及性功能。89．1％（41／46）的患儿术后远期排便功能为优良，21．7％（10／46）出现并发症，社会交往明显受影响者占30．4％（14／46）。结论先天性巨结肠患儿术后远期排便功能恢复良好，需要发展社区护理于预促进其生活质量改善。     

家庭功能和社会支持对慢性阻塞性肺疾病患者生存质量的影响

目的了解COPD患者家庭功能、社会支持及生存质量现状及三者之间的关系。方法采用方便抽样的方法,选择2017年6月—2018年9月某三级医院收治的225例COPD患者作为研究对象,应用一般资料调查表、APGAR家庭关怀度指数问卷、社会支持评定量表和WHO生存质量测定量表简表进行调查。采用单因素分析、Pearson相关、多元线性回归分析患者生存质量与社会支持、家庭功能的关系。结果COPD患者的家庭功能评分为(7.03±2.15)分,社会支持评分为(39.43±8.46)分,生存质量评分为(51.91±11.48)分;患者的家庭功能评分、社会支持各维度得分及总分均与生存质量评分呈正相关(P<0.05);家庭功能、社会支持、疾病严重程度是COPD患者生存质量的影响因素(P<0.01)。结论良好的家庭功能和社会支持有利于改善COPD患者的生存质量,建议护理人员鼓励家庭成员给予患者更多的关注,改善患者的社会支持水平,提高患者的生存质量。     

低频与高频rTMS对帕金森病患者运动功能和自主神经功能障碍的影响

目的观察低频与高频重复经颅磁刺激（rTMS）治疗帕金森病（PD）患者运动功能障碍和自主神经功能障碍的效果及安全性。 方法将90例伴自主神经功能障碍的PD患者分为低频组、高频组及假刺激组。治疗组患者分别给予低频1 Hz、高频5 Hz rTMS治疗,假刺激组于相同时间点、相同部位给予假性rTMS治疗。于治疗前、治疗后即刻、7 d、14 d、30 d,采用起立-行走实验时间、统一帕金森病评定量表（UPDRS）和帕金森病自主神经症状量表（SCOPA-AUT）评分作为评定指标。 结果组内比较：高频组和低频组患者治疗后即刻、7 d、14 d、30 d,起立-行走实验时间均较治疗前有所缩短,且差异具有统计学意义（P＜0.05）。低频组UPDRS评分、SCOPA-AUT评分在治疗后7 d、14 d较治疗前降低,差异有统计学意义（P＜0.05）;治疗后即刻和治疗后30 d与治疗前相比,UPDRS评分、SCOPA-AUT评分无明显统计学意义（P＞0.05）。高频组UPDRS评分、SCOPA-AUT评分在治疗后7 d、14 d、30 d均较治疗前降低,差异均具有统计学意义（P＜0.05）。组间比较：与假刺激组比较,低频组、高频组治疗后即刻、7 d、14 d起立-行走实验时间均缩短,差异有统计学意义（P＜0.05）。与假刺激组比较,治疗组UPDRS评分在治疗后7 d、14 d均降低,差异有统计学意义（P＜0.05）;至治疗后30 d时,与假刺激组比较,低频组UPDRS评分不具有统计学意义（P＞0.05）,但高频组UPDRS评分仍低于假刺激组,差异具有统计学意义（P＜0.05）。与假刺激组比较,高频组、低频组患者SCOPA-AUT评分在治疗后7、14 d均明显降低（P＜0.05）;在治疗后30 d,低频组与假刺激组比较,SCOPA-AUT评分差异不具有统计学意义（P＞0.05）;但高频组SCOPA-AUT评分仍低于假刺激组（P＜0.05）。 结论低频及高频rTMS均能有效改善PD患者的运动功能和自主神经功能障碍症状,安全性较好,且高频rTMS治疗可能较低频rTMS治疗作用更强、更持久。     

Measuring quality of life in Parkinson's disease: selection of-an-appropriate health-related quality of life instrument

There is growing awareness of the need to measure quality of life (QOL) in people with Parkinson's disease during routine physiotherapy assessment. This paper highlights why it is important for clinicians to focus particularly on health-related QOL (HRQOL) when assessing people with this disabling and progressive neurological condition, and provides a guide for selection of the most appropriate instruments for measuring HRQOL. Using measures of health utility, health status and wellbeing, physiotherapists can better understand the social, physical and emotional consequences of Parkinson's disease.     

Effect of Age on Substantia Nigra Hyper-echogenicity in Parkinson's Disease Patients and Healthy Controls

Substantia nigra (SN) hyper-echogenicity (SN+) describes an enlargement (>90th percentile) of the area of echogenicity at the anatomic site of the SN in the midbrain detected by transcranial sonography. This ultrasound sign has proven to be a valuable marker supporting the clinical diagnosis of Parkinson's disease (PD). Although there is considerable variation in the extent of echogenic signals at the anatomic site of the SN among PD patients, previous work suggests that SN+ is a stable marker throughout the course of the disease. The present study focused on two aspects: (i) determining whether SN+ values differ between the sides, mirroring the asymmetric character of the disease; and (ii) determining whether age has an influence on SN echogenicity. This cross-sectional study included 300 PD patients and 200 healthy controls. SN+ was measured planimetrically by transcranial sonography. Echogenicity was analyzed separately for onset and non-onset sides, with onset side defined as the SN contralateral to the side of the body that first manifested PD-related motor impairment. Age of the patients and healthy controls at study time was used for correlation. We found that the onset SN+ contralateral to the side of initial motor symptoms was on average 17.6% larger than its counterpart. However, we also found that contrary to the control group, where an increase in age was associated with an increase in size of SN+, age of PD patients was associated with a decline in size of the onset SN+. Furthermore, SN measured at the onset side of PD patients correlated significantly with patient age and Hoehn and Yahr stage, a scale that grades PD severity, although this was not the case for the non-onset side. The present study indicates that changes in SN echogenicity have a different dynamic depending on the onset side of the disease. The age at study time had a significantly negative effect on the size of onset SN+, the effect on the non-onset side was non-significant. We conclude that for appropriate PD analysis, onset SN+ is a more important marker than the average of both sides of SN. Furthermore, we found that among healthy controls, the size of SN+ increases with age.     

社会支持对乳腺癌手术患者生活质量的影响

目的探讨社会支持与乳腺癌手术患者生活质量的关系。方法采用乳腺癌生活质量测定量表FACT-B和社会支持评定量表（SSRS）对78例乳腺癌患者的生活质量和社会支持现状进行测评,并对结果进行分析。结果乳腺癌患者在生活质量的情感状况及功能状况2个领域得分较低,分别为（9．10±3．99）分和（12．81±7．99）分;乳腺癌患者获得的社会支持总分为（36．93±6．42）分,显著高于正常人的社会支持总分（34．56±3．73）分;乳腺癌患者生活质量中的生理状况、社会／家庭状况及情感状况与社会支持总分呈显著正相关。结论社会支持是影响乳腺癌患者生活质量的重要因素,临床护理工作中应重视并充分利用患者的社会支持来源,通过各种干预措施改善和提高患者的生活质量。     

社会支持对乳腺癌手术患者生活质量的影响

目的 探讨社会支持与乳腺癌手术患者生活质量的关系.方法 采用乳腺癌生活质量测定量表FACT-B和社会支持评定量表(SSRS)对78例乳腺癌患者的生活质量和社会支持现状进行测评,并对结果进行分析.结果 乳腺癌患者在生活质量的情感状况及功能状况2个领域得分较低,分别为(9.10±3.99)分和(12.81±7.99)分;乳腺癌患者获得的社会支持总分为(36.93±6.42)分,显著高于正常人的社会支持总分(34.56±3.73)分;乳腺癌患者生活质量中的生理状况、社会,家庭状况及情感状况与社会支持总分呈显著正相关.结论 社会支持是影响乳腺癌患者生活质量的重要因素,临床护理工作中应重视并充分利用患者的社会支持来源,通过各种干预措施改善和提高患者的生活质量.