个性化康复理念在改善脑卒中偏瘫患者康复效果及治疗态度中的效果观察

目的 观察实施个性化康复对脑卒中偏瘫患者康复效果和治疗态度的影响.方法 将220例脑卒中偏瘫患者随机分为2组,对照组和观察组各110例.对照组采用常规护理,观察组则采用个性化康复护理措施,干预前及干预后3个月采用脑卒中影响量表(SIS)对2组患者生存质量、康复治疗态度进行评价,比较组间差异.结果 2组患者的SIS量表力气、ADL、移动能力、情绪、参与项及总分较干预前均显著提高(P＜0.05);干预后除记忆与思维项外,观察组患者力气、ADL、移动能力、手功能、情绪、参与项及总分均显著高于对照组(P＜0.05);干预后观察组患者治疗态度显著优于对照组(P＜0.05).结论 实施个性化康复能有效提高脑卒中偏瘫患者的康复效果,改善患者的治疗态度.     

药熨配合中医推拿促进脑卒中偏瘫患者肢体康复的效果观察

目的探讨药熨配合中医推拿促进脑卒中偏瘫患者肢体康复的效果。方法将108例脑卒中偏瘫患者随机分为对照组与干预组,每组各54例,对照组患者按脑卒中常规治疗和偏瘫肢体康复护理,干预组患者在对照组基础上采用药熨配合中医推拿康复护理。4周后观察两组患者偏瘫肢体康复效果。结果对照组患者偏瘫肢体康复总有效率为70.4%,干预组为94.4%,两组比较,P<0.05,差异具有统计学意义。结论药熨配合中医推拿可有效促进脑卒中患者偏瘫肢体功能恢复,值得临床推广应用。     

等速训练结合作业疗法对偏瘫侧上肢功能的康复效果

目的：研究等速训练结合作业疗法对偏瘫患者偏瘫侧上肢功能的康复疗效。方法：脑卒中偏瘫患者30例,非随机分为实验组和对照组各15例。对照组给予磨砂板、滚筒、插孔等一般作业疗法;实验组在一般作业疗法基础上给予肩关节等速运动训练。对照组和实验组采用上肢Fugl—Meyer量表(FMA)和Brunnstrom分级进行评定。结果：实验组与对照组经过4周治疗后,两组患者偏瘫侧上肢功能均较治疗前明显提高,实验组治疗效果显著高于对照组(P<0.05)。结论：等速训练结合作业疗法可以显著促进脑卒中偏瘫患者上肢功能,可能为脑卒中的康复治疗提供一种有效的方法。     

四肢康复中药热奄包在脑卒中后偏瘫肢体肿胀患者中的应用

目的观察四肢康复中药热奄包在脑卒中后偏瘫肢体肿胀患者中的应用效果。方法通过随机数字表将92例脑卒中偏瘫后肢体肿胀患者分为观察组和对照组各46例。对照组接受常规治疗与康复训练,观察组在对照组基础上予四肢康复中药热奄包热敷疗法,干预前和干预后4周采用运动功能评定量表评分法评价运动功能并观察干预效果。结果干预后总有效率观察组89.13%,对照组69.57%,两组比较差异有统计学意义(P0.05);干预前两组运动功能评定量表评分差异无统计学意义,干预后观察组运动功能评定量表评分(53.05±14.05)分,对照组(46.28±13.35)分,观察组评分高于对照组,两组比较有统计学意义(P0.05)。结论采用四肢康复中药热奄包热敷疗法可有效改善脑卒中后偏瘫肢体肿胀,降低肢体畸形挛缩,提高患者生存质量。     

家庭成员辅助干预对脑卒中偏瘫患者功能康复的影响

目的探讨家庭成员辅助干预对脑卒中偏瘫患者功能康复的影响.方法将60例脑卒中偏瘫患者随机分成观察组和对照组(每组30例),在常规药物和康复治疗的同时,观察组实施家庭成员辅助干预康复训练,治疗前及治疗后均进行Brunnstorm运动功能测评及Barthel指数评分.结果治疗28天后两组Barthel指数及偏瘫肢体运动功能均有改善,其改善幅度,观察组明显优于对照组.结论在脑卒中偏瘫患者康复治疗中,家庭成员积极合理辅助干预对患者运动功能的康复尤其是日常生活能力(ADL)的提高起到促进作用.     

运动想象疗法在脑卒中偏瘫患者康复护理中的应用

目的观察运动想象疗法对脑卒中偏瘫患者运动功能恢复的影响。方法按入院顺序单双号将100例患者分为观察组与对照组各50例,两组均给予药物治疗、常规康复治疗及常规康复护理。观察组再给予为期6周的运动想象疗法干预。结果两组患者干预后运动功能及日常生活自理能力比较均有统计学意义(P0.05),但观察组效果较对照组更显著(P0.05)。结论运动想象疗法对脑卒中偏瘫患者运动功能及日常生活能力恢复有明显的辅助作用。     

日常生活活动训练对脑卒中偏瘫患者的康复疗效

目的探讨作业疗法中日常生活活动训练对脑卒中偏瘫患者康复疗效的影响。方法 50例脑卒中偏瘫患者分成治疗组(n=27)和对照组(n=23),治疗组进行物理治疗和作业疗法中日常生活活动训练,对照组单纯进行物理治疗。疗程6个月。采用改良Barthel指数(MBI)和Brunnstrom分级进行评定。结果治疗后,治疗组MBI优于对照组(P<0.05),Brunnstrom分级无显著性差异(P>0.05)。结论日常生活活动训练可提高偏瘫康复效果。     

脑卒中偏瘫患者的家庭康复干预

目的探讨家庭康复干预措施对脑卒中偏瘫患者肢体运动功能恢复的作用.方法对60例脑卒中偏瘫患者中的30例出院后施以康复干预(干预组),与其余30例出院后不给予干预的惠者(对照组)进行比较.结果干预组肢体运动功能、日常生活能力均明显高于对照组,差异有显著性.结论家庭康复干预能明显促进脑卒中偏瘫患者肢体运动功能的恢复.     

认知行为干预对脑卒中后偏瘫患者早期肢体康复的影响

目的:探讨认知行为疗法对脑卒中偏瘫患者早期肢体康复的干预效果。方法:选择2014年5月~2016年5月72例脑卒中后偏瘫患者并随机等分为对照组和观察组,对照组行常规护理措施;观察组在常规护理基础上进行认知行为干预。采用日常生活活动量表和运动功能简化评估表对脑卒中后偏瘫患者进行调查,比较两组患者日常生活能力及肢体活动能力。结果:干预后观察组患者日常生活活动评分及肢体活动能力评分明显高于对照组(均P0.05)。结论:认知行为干预对脑卒中后偏瘫患者早期肢体康复有促进作用,能够提高患者的日常生活能力和肢体活动能力。     

24 h姿势管理在脑卒中偏瘫病人康复护理中的应用

[目的]探讨24 h姿势管理在脑卒中偏瘫病人康复护理中的应用效果。[方法]选取2018年6月—2018年12月在山西省汾阳医院康复医学科住院的68例脑卒中病人作为研究对象,采用随机数字表将病人随机分为对照组和试验组。对照组采用传统运动疗法和作业疗法的康复技术进行治疗,试验组在对照组基础上实行24 h姿势管理。于干预前和干预后6个月采用肢体运动功能Fugl-Meyer量表(FMS)、功能独立性(FIM)量表及Barthel指数对两组病人进行测评。[结果]两组病人干预后FMS、FIM量表及Barthel指数得分均高于干预前,且试验组干预后3项指标得分均高于同期对照组,两组比较差异均有统计学意义(P0.05)。[结论]在传统运动疗法和作业疗法基础上实施24 h姿势管理,可提高脑卒中偏瘫病人的肢体运动功能及独立性,增强病人的日常生活活动能力。     

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.     

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.     

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.     

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.