醒脑开窍针刺联合核心肌群训练对缺血性脑卒中偏瘫患者下肢运动功能的影响

目的探究醒脑开窍针刺联合核心肌群训练对缺血性脑卒中偏瘫患者下肢运动功能的影响。方法选取某院2018年5月至2019年7月108例缺血性脑卒中偏瘫患者,根据治疗方案不同分组,各54例。对照组采用核心肌群训练,观察组采用醒脑开窍针刺联合核心肌群训练。对比两组治疗前后简化Fugl-Meyer运动功能量表(FMA)、Berg平衡量表(BBS)、神经功能缺损评分量表(NDS)、Barthel指数评分量表(BI)评分。结果治疗后观察组FMA、BBS评分高于对照组(P0.001);治疗后观察组NDS评分低于对照组,BI评分高于对照组(P0.001)。结论醒脑开窍针刺联合核心肌群训练应用于缺血性脑卒中偏瘫患者,可改善神经功能缺损、下肢运动功能及平衡能力,提高生活质量。     

针刺联合运动想像疗法对脑卒中偏瘫患者肢体功能的影响

目的观察针刺联合运动想象疗法对脑卒中偏瘫患者肢体功能的影响。 方法共选取120例脑卒中偏瘫患者,将其分为针刺组、运动想象组及治疗组,均给予常规康复治疗,针刺组在此基础上给予针刺治疗,运动想象组则辅以运动想象治疗,治疗组则给予针刺及运动想象联合治疗。于治疗前及治疗3个疗程后,分别采用Fugl-Meyer运动功能评分（FMA）、改良Barthel指数（MBI）及神经功能缺损程度评分（NFDS）对3组患者肢体运动功能、日常生活活动能力及神经功能恢复情况进行评定。 结果3组患者分别经3个疗程治疗后,发现其FMA、MBI及NFDS评分均较治疗前明显改善（P＜0.01）;并且以治疗组上述指标的改善幅度较显著,明显优于针刺组及运动想象组（P＜0.01）;针刺组与运动想象组治疗后上述指标组间差异仍无统计学意义（P＞0.05）。 结论针刺联合运动想象疗法治疗脑卒中偏瘫患者具有协同疗效,能进一步减轻患者神经功能缺损,促进肢体功能恢复,提高生活质量,该联合疗法值得临床推广、应用。     

头针配合促通技术治疗脑卒中偏瘫患者的临床疗效

目的:观察头针配合促通技术对恢复期缺血性脑卒中偏瘫患者肢体功能的影响。方法:恢复期缺血性脑卒中偏瘫患者45例,随机分为A、B、C 3组各15例。A组针刺健侧顶颞前斜线(运动区)治疗;B组采用Brunnstrom促通技术训练;C组两项结合治疗。治疗前后均进行神经功能缺损评分(NIHSS)评定临床疗效;简式Fugl-Meyer运动功能(FMA)和Barthel指数(BI)积分评定上下肢运动功能和ADL。结果:治疗21 d后,FMA及BI积分与治疗前比较3组均有明显提高(P0.01),其中FMA积分,B、C组上肢高于A组(P0.05);A、C组下肢高于B组(P0.05);BI积分,C组高于A、B组(P0.01)。3组临床疗效比较,C组基本痊愈率及总有效率均明显高于A、B组(40.0%与13.3%、13.3%;86.7%与73.3%、66.7%,P0.01)。结论:头针配合促通技术治疗能够有效提高恢复期缺血性脑卒中偏瘫患者的肢体运动功能和ADL,降低致残率。     

个体化桥式运动强化训练对脑卒中偏瘫患者的影响

目的：探讨个体化的桥式运动强化训练对脑卒中偏瘫患者肢体运动功能、平衡能力和ADL能力的影响。方法：对80例发病2-12周内的脑卒中偏瘫患者，随机分成常规运动治疗组（Ａ组）和个体化桥式运动强化训练组（Ｂ组），两组的常规内科治疗相同，分别于入组时、治疗８周末，采用简化Fugl-Meyer运动功能评分、Fugl-Meyer平衡功能评分和改良Barthel指数进行评定。结果：治疗８周后B组的各项评分明显高于A组（Ｐ＜0.05）。结论：个体化桥式运动强化训练较常规运动治疗能更显著地改善脑卒中偏瘫患者肢体运动功能、平衡能力和日常生活活动能力。     

个体化主动康复对脑卒中偏瘫患者运动功能和日常生活活动能力的影响

目的：探讨个体化主动运动康复治疗对早期及恢复期脑卒中偏瘫患者肢体运动功能和日常生活活动能力的影响。方法：对60例发病2—12周的脑卒中偏瘫患者,随机分组成个体化主动运动康复治疗组（A组）和单一被动运动康复对照组（B组）,两组的常规内科治疗相同,分别于入组时、治疗8周末,采用临床神经功能缺损程度量表、简化Fugl-Meyer运动功能量表、功能独立性评定表（FIM）进行评定。结果：治疗8周后A组的各项评分明显高于B组（P〈0.0001）。结论：个体化主动运动康复治疗较单一的被动运动康复能更明显地改善早期及恢复期脑卒中偏瘫患者肢体运动功能和日常生活活动能力。     

全桥运动训练方案在脑卒中偏瘫病人早期康复中的应用

[目的]探讨全桥运动训练方案对脑卒中偏瘫病人肢体运动功能、平衡功能及日常生活活动能力(ADL)能力的影响。[方法]将60例首次发病的脑卒中偏瘫病人随机分成常规运动治疗组(A组)和全桥运动方案训练组(B组),A组采用常规的双桥、单桥运动训练,B组在常规训练基础上对桥式运动增加了内容、时间和次数上的变化。在治疗前和治疗4周时由专人用简化Fugl-Meyer量表(FMA)评定运动功能、Berg平衡量表(BBS)评定平衡功能、改良Barthel指数(MBI)评定日常生活活动能力。[结果]两组治疗后各项功能均有明显提高,但B组评分增加幅度明显高于A组(P<0.05)。[结论]全桥运动训练方案较常规运动治疗能显著改善脑卒中偏瘫病人运动功能、平衡功能及日常生活活动能力。     

头穴丛刺、被动运动结合运动想象治疗早期脑卒中偏瘫患者的临床疗效观察

目的 研究头穴丛刺、被动运动结合运动想象对早期脑卒中偏瘫患者的运动功能、日常生活活动（ADL）能力、神经功能等方面的影响。方法将90例早期脑卒中患者按人院的先后顺序分为头针组（A组）29例，被动运动结合运动想象组（B组）30例，头针、被动运动结合运动想象组（C组）31例。3组患者均接受神经内科的常规治疗，A组同时给予头穴丛刺法治疗，B组接受运动想象与被动运动训练，C组也给予头穴丛刺法治疗，且在留针期间进行被动运动和运动想象训练。治疗前及治疗12周后，对患者运动功能、ADL能力和神经功能进行评定。结果治疗12周后，C组Fugl-Meyer运动评分、改良巴塞尔指数（MBI）评分和临床神经功能缺损评分上与A、B组比较，差异均具有统计学意义（P〈0．01）；A组与B组各项评分比较，差异无统计学意义（P〉0．05）。结论头穴丛刺、被动运动结合运动想象治疗早期脑卒中偏瘫患者，疗效优于单纯头穴丛刺治疗，也优于运动想象结合被动运动治疗。     

强制性运动疗法治疗脑卒中偏瘫的临床应用

目的探讨强制性运动疗法对脑卒中偏瘫引起肢体瘫痪的影响。方法将40例脑卒中伴肢体偏瘫患者分成治疗组和对照组分别进行强制性运动疗法训练与常规康复训练,同时接受相同的常规药物治疗。应用简式Fugl-Meyer评分法和Barthel指数评分。结果治疗组训练前后两组Fugl-Meyer评分及Barthel指数评分比较差异有统计学意义,治疗组明显比对照组提高。结论强制性运动疗法在促进脑卒中偏瘫肢体运动功能恢复及提高日常生活能力方面显著优于常规运动康复,对脑卒中急性期肢体瘫痪治疗是有效和可行的。     

平衡针刺及功能训练治疗脑卒中后肩手综合征

目的:探讨平衡针刺结合功能训练对脑卒中后肩手综合征(SHS)的作用。方法:脑卒中偏瘫并发SHS患者64例,随机分为3组,A组21例采用常规康复训练治疗;B组21例取偏瘫、肩痛及升提穴平衡针刺治疗;C组22例按A、B组方案综合治疗。结果:治疗2周后,采用简化Fugl-Meyer(FMA)及简易上肢功能检查量表(STEF)评定上肢及手的功能,3组患者均较治疗前明显提高,C组明显优于A、B组(均P0.05),A、B组间比较差异无统计学意义;疼痛状况(PPI)评分,3组比治疗前均明显下降,C组低于A、B组(均P0.05);A、B组间比较差异无统计学意义。结论:平衡针刺结合功能训练可提高脑卒中后SHS的治疗效果,加快患者上肢功能的恢复。     

肌电生物反馈疗法结合部分减重平板运动疗法对脑卒中恢复期患者下肢运动功能的影响

目的:观察肌电生物反馈疗法结合部分减重平板运动疗法对脑卒中偏瘫患者下肢运动功能的影响。方法:脑卒中恢复期偏瘫患者40例随机分为治疗组和对照组各20例。两组患者均给予常规神经内科治疗、综合康复治疗及部分减重平板运动疗法,治疗组加用AM-800神经功能重建仪进行下肢肌电生物反馈疗法,共治疗4周。治疗前后进行功能评估,评估项目包括临床神经功能缺损评分、Fugl-Meyer评定、功能独立性评定(FIM量表)。结果:经治疗后,两组患者神经功能缺损评分均有下降,FIM量表得分及Fugl-Meyer下肢得分均上升,其中治疗组相比对照组神经功能缺损评分下降更显著,Fugl-Meyer下肢得分上升更显著(P均<0.05)。结论:肌电生物反馈疗法结合部分减重平板运动疗法,能有效改善脑卒中患者下肢运动功能,并可降低患者神经缺损程度。     

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.