运动想象疗法对脑卒中上肢运动康复分析

目的分析运动想象疗法对脑卒中后患者上肢运动功能康复效果的影响。方法随机选取2016年7月至2018年7月本院收治的脑卒中患者60例,然后平均分成两组,采用SPSS 21.0将入组患者按先后序列号(1～60)随机分为2组:一组常规康复干预组(30例),一组常规康复干预基础上运动想象疗法组(运动想象疗法组,30例),统计分析两组患者的上肢FMA、MAS、MBI评分、ARAT评分、WHOQOL-BREF评分。结果和干预前相比,两组患者干预后的上肢FMA、MAS、MBI评分均显著升高(P0.05);干预后和常规康复干预组相比,运动想象疗法组患者的上肢FMA、MAS、MBI评分均显著升高(P0.05),但干预前两组患者的上肢FMA、MAS、MBI评分之间的差异均不显著(P0.05)。运动想象疗法组患者的ARAT抓、握、捏、粗大动作评分均显著高于常规康复干预组(P0.05),WHOQOL-BREF生理、心理、环境领域及社会关系评分均显著高于常规康复干预组(P0.05)。结论运动想象疗法能够有效改善脑卒中后患者上肢运动功能康复效果。     

抬高患肢和被动运动对脑卒中肩手综合征患者康复效果的影响

目的探讨采取抬高患肢和被动运动训练对脑卒中后肩手综合征患者康复效果的影响。方法将160例脑卒中后肩手综合征患者分为观察组和对照组,各80例。对照组采用常规护理和康复训练;观察组实施抬高患肢及被动运动,连续4周后评价效果。采用Brunnstrom偏瘫上肢功能评价量表、Fugl-Meyer手指运动功能评定表和Barther指数(MBI)进行评价。结果两组患者治疗后上肢功能分级、手指运动功能及ADL评分与治疗前比较有显著改善(均P0.01),观察组效果显著优于对照组(均P0.01)。结论抬高患肢和被动运动训练可有效促进脑卒中患者的手部功能恢复,进而提高日常生活能力。     

运动想象结合头针治疗在偏瘫患者步态训练中的作用

目的探讨在常规康复训练基础上结合运动想象和头针治疗对偏瘫患者步态恢复的影响。方法选择28例病情稳定且病程〉3个月的脑卒中偏瘫患者,分为综合治疗组（10例）、头针组（9例）和运动想象组（9例）。三组患者均进行常规康复训练,综合治疗组行头部针刺后留针,在进行运动想象及步态训练时进行间歇运针;头针组行头针治疗,拔针后进行步态训练;运动想象组在步态训练前进行运动想象训练。分别在治疗前、治疗6周、治疗12周时测定6m最快折返速度、患侧与健侧步长差、患侧负重时间、步态评分以及rugl-Meyer运动功能评定（下肢部分）。结果三组患者的6m最快折返速度及患侧负重时间都明显改善。在治疗12周时综合治疗组步态评分为（15．24±3．78）分,与运动想象组的（11．12±4．13）分和头针组的（10．87±3．12）分比较差异有统计学意义（P〈0．05）。结论在常规康复训练中联合应用运动想象和头针治疗能更有效地促进脑卒中偏瘫患者的步态恢复,提高步行能力。     

想象足背屈训练对脑梗死偏瘫患者下肢功能恢复的影响

目的探讨想象足背屈训练对脑梗死偏瘫患者下肢运动功能恢复的促进作用。方法将58例脑梗死下肢偏瘫患者随机分为干预组(30例)和对照组(28例),两组患者均接受常规康复治疗,干预组在此基础上进行连续5周的想象足背屈训练。结果治疗后干预组患者Brunnstrom分期、FMA和MBI评分显著优于对照组(均P<0.01)。结论想象足背屈训练有效促进患者下肢运动功能的恢复及日常生活活动能力的改善。     

缺血性脑卒中偏瘫患者实施早期康复训练的护理体会

目的探讨早期康复护理对缺血性脑卒中偏瘫患者神经和运动功能恢复的效果。方法随机将60例缺血性脑卒中偏瘫患者分为2组,各30例。常规组实施常规护理,观察组联合实施早期康复训练护理。观察2组在实施护理前和护理3个月后神经(CNS)及肢体运动功能(FMA)评分。结果 2组干预后CNS、FMA评分均优于干预前,且干预后观察组CNS、FMA评分改善情况均优于对照组,差异均有统计学意义(P0.05)。结论对缺血性脑卒中偏瘫患者实施早期康复训练护理,可促进神经和运动功能的恢复,提高患者生活质量。     

Efficacy of foot dorsiflexion-centered motor imagery training on lower limb function of poststroke hemiplegic patients

目的 探讨想象足背屈训练对脑梗死偏瘫患者下肢运动功能恢复的促进作用.方法 将58例脑梗死下肢偏瘫患者随机分为干预组(30例)和对照组(28例),两组患者均接受常规康复治疗,干预组在此基础上进行连续5周的想象足背屈训练.结果 治疗后干预组患者Brunnstrom分期、FMA和MBI评分显著优于对照组(均P＜0.01).结论 想象足背屈训练有效促进患者下肢运动功能的恢复及日常生活活动能力的改善.     

运动想象疗法结合康复训练治疗脑卒中偏瘫疗效分析

目的:研究运动想象疗法结合康复训练对脑卒中偏瘫患者运动功能、日常生活活动能力的影响.方法:特46例脑卒中偏瘫患者随机分为两组,治疗组采用常规神经内科药物治疗及康复训练,对照组在治疗组基础上增加想象运动疗法,将两组治疗后运动功能及日常生活活动能力进行比较.结果:两组治疗后运动功能评分比较,差异有显著性意义.结论:应用运动想象疗法结合康复训练对脑卒中偏瘫患者运动功能及日常生活活动能力的恢复有较好疗效.     

抬高患肢和被动运动对脑卒中肩手综合征患者康复效果的影响

目的 探讨采取抬高患肢和被动运动训练对脑卒中后肩手综合征患者康复效果的影响.方法 将160例脑卒中后肩手综合征患者分为观察组和对照组,各80例.对照组采用常规护理和康复训练;观察组实施抬高患肢及被动运动,连续4周后评价效果.采用Brunnstrom偏瘫上肢功能评价量表、Fugl-Meyer手指运动功能评定表和Barther指数（MBI）进行评价.结果 两组患者治疗后上肢功能分级、手指运动功能及ADL评分与治疗前比较有显著改善（均P＜0.01）,观察组效果显著优于对照组（均P＜0.01）.结论 抬高患肢和被动运动训练可有效促进脑卒中患者的手部功能恢复,进而提高日常生活能力.     

低频脉冲电疗联合康复训练对脑卒中后肩手综合征的疗效观察

目的 探讨低频脉冲电疗联合康复训练治疗脑卒中后肩手综合征(shoulder-hand syndrome,SHS)的临床疗效.方法 选取收治入院的86例SHS患者,随机分为观察组(43例)和对照组(43例).对照组按脑卒中指南进行内科治疗和常规康复训练,观察组在对照组治疗的基础上加用低频脉冲电疗,2周后比较两组患者的VAS评分、Fugl-Meyer评定量表(Fugl-Meyer assessment,FMA)和改良Barthel指数(Modified Barthel Index,MBI)评分.结果 治疗后,两组患者VAS评分均明显下降,而FMA和MBI评分均显著升高(P<0.05);观察组治疗后的VAS评分显著低于对照组,FMA和MBI评分显著高于对照组(P<0.01).结论 低频脉冲电疗联合康复训练可显著改善卒中后SHS患者的上肢运动功能,缓解肩部疼痛,提高日常生活能力.     

应用康复教育光碟指导脑卒中偏瘫患者肩关节功能锻炼

目的探讨应用康复教育光碟指导脑卒中偏瘫患者肩关节功能锻炼的效果。方法将65例康复治疗的脑卒中偏瘫患者按照时间顺序分为对照组(n=33)与观察组(n=32),对照组接受康复训练治疗,观察组在观看康复教育光碟示范下行康复训练治疗。比较两组患者肩关节半脱位发生率及康复训练依从率,并采用Fugl-Meyer评分法(FMA)评定两组患者上肢运动功能。结果康复训练2个月后观察组肩关节半脱位发生率、康复训练依从率、上肢FMA评分与对照组比较,差异有统计学意义(P<0.05,P<0.01)。结论观看康复教育光碟可激发患者的康复欲望,提高上肢运动功能,减少脑卒中偏瘫肩关节半脱位的发生率,促进患者康复。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.