高压氧联合GM1及康复治疗急性脑梗死疗效观察

目的探讨高压氧(HBO)联合GM1(单唾液酸四己糖神经节苷脂,商品名申捷)及康复治疗急性脑梗死的治疗效果。方法 107例急性脑梗死患者随机分为两组,治疗组54例,对照组53例,均应用常规药物及GM1和康复训练治疗,治疗组联合高压氧治疗(HBOT),治疗20 d,比较两组患者的疗效。结果治疗前两组患者神经功能缺损评分差异无统计学意义(P0.05),高压氧治疗20 d后,治疗组神经功能缺损评分及有效率均较对照组改善明显(P0.05)。结论 HBO联合GM1及康复治疗急性脑梗死可明显降低脑梗死患者神经功能缺损程度,促进运动功能恢复,疗效明显优于只用药物及康复治疗,且成本低,安全可靠。     

针刺对急性脑梗死患者运动功能的影响

目的 探讨早期康复结合组合针刺疗法对急性脑梗死患者运动功能的影响.方法 85例急性脑梗死患者随机分成治疗组43例和对照组42例,均接受常规药物治疗及早期康复训练,治疗组在此基础上加用组合针刺,分别于治疗前及治疗后各评定1次.结果 治疗后两组患者的Fugl-Meyer Assessment(FMA)、修订Barthel指数(MBI)和欧洲脑卒中评分量表(ESS)评分均有提高(P<0.05),但治疗组疗效优于对照组(P<0.05).结论 早期康复结合组合针刺疗法可改善急性脑梗性死患者的运动功能.     

康复治疗对帕金森病运动功能障碍的影响

目的探讨提高帕金森病运动功能障碍的有效治疗方法。方法60例患者分为康复组(40例)和常规组(20例),2组按常规服用美多巴等药物,康复组并综合应用神经生理与神经发育疗法进行康复训练。治疗前后对2组患者进行Barthel指数和Webster评定,比较疗效。结果治疗1个月,康复组运动功能改善明显,与常规组比较差异有显著性(P<0.05)。结论康复治疗联合药物对帕金森病患者运动功能的恢复有较好的疗效。     

针刺配合康复训练改善脑梗死患者运动功能及日常生活能力的疗效对比

目的 评价脑梗死患者在药物治疗基础上采用针刺配合康复训练对运动功能及日常生活能力的改善作用。方法 选择天津市第一医院收治的病例148例脑梗死患者，分为治疗组和对照组，两组均进行神经内科治疗，治疗组在此基础上施针刺配合康复训练的综合疗法。治疗前后分别进行中风病症状积分．肢体运动功能(FMA)和日常生活功能巴氏指数(MBI)的统计，综合评价其疗效。结果 两组患者治疗前各项评分差异无显著性意义(P&;gt;0．05)，综合疗法治疗脑梗死有效率为9l％，疗效明显优于对照组(70％)(P&;lt;0．01)，中风病症状积分，FMA和MBI积分均有明显改善，且治疗组优于对照组。结论 针刺配合康复训练可提高治疗脑梗死的疗效，有利于肢体功能状态的改善，提高生活自理能力。     

早期综合康复治疗对脑梗死患者疗效的影响

目的探讨早期综合康复治疗对脑梗死患者功能恢复的影响。方法将62例急性脑梗死患者随机分为综合康复组及对照组。综合康复组患者采用综合措施（包括药物治疗、Bobath疗法、PNF疗法、双乳突法低频电刺激及电动床站立训练等）治疗，对照组则采用药物、Bobath及PNF疗法进行干预。于治疗前及治疗30d后分别评价2组患者神经功能缺损程度、平衡功能、运动功能及ADL能力。结果2组患者经治疗后其神经功能缺损积分均明显减少，平衡功能、运动功能、ADL能力积分均明显增加，差异均具有统计学意义（P〈0．05）；并且综合康复组患者上述各项指标的改善幅度均明显优于对照组，组间差异亦有统计学意义（P〈0．05）。结论早期综合康复治疗对脑梗死患者疗效具有显著促进作用。     

高压氧联合针刺运动疗法治疗急性脑梗死的疗效分析

目的探讨高压氧(HBO)联合针刺运动疗法治疗急性脑梗死的疗效。方法 129例急性脑梗死患者随机分为治疗组和对照组,两组均按急性脑梗死常规药物治疗并配合针刺运动疗法,治疗组同时加用高压氧,治疗开始及治疗30 d后对两组患者进行神经功能缺损程度评分和临床疗效评定。肢体运动功能(FMA)及日常生活活动能力采用改良Barthel Index(MBI)评定。结果两组患者治疗前各项评分差异无统计学意义(P>0.05),高压氧治疗30 d后,联合疗法治疗急性脑梗死有效率95.4%,疗效明显优于对照组。结论高压氧联合针刺运动疗法可提高急性脑梗死的疗效,有利于肢体功能的改善,对减轻脑痉挛,预防挛缩畸形及提高患者日常生活能力有促进作用。     

针刺联合康复训练治疗脑梗死偏瘫临床研究

目的:观察针刺疗法结合康复训练对脑梗死后偏瘫患者的临床疗效。方法:选择本院150例生命体征稳定、神经病学体征不再进展的急性脑梗死患者,随机分为针刺组、康复组、针刺康复组各50例,分别采用针刺治疗、康复训练治疗、针刺联合康复治疗,治疗6周后比较三组临床疗效及梗死灶体积、中风评分、神经功能缺损程度积分指标改善情况。结果:针刺康复组总有效率98%,高于针刺组84%及康复组82%;在缩小梗死灶体积、降低中风评分和神经缺损程度积分方面,针刺康复组显著优于针刺组、康复组(P<0.05)。结论:针刺联合康复训练能有效改善脑梗死后神经功能缺损程度,疗效显著,可作为脑梗死偏瘫较佳疗法。     

综合康复干预对急性脑梗死患者功能恢复的影响

目的观察综合康复干预对急性脑梗死患者的运动功能、日常生活能力的影响。方法 110例急性脑梗死患者随机分为康复组与对照组,对照组采用药物治疗,康复组采用综合疗法,包括药物治疗、运动疗法、神经肌肉电刺激等。治疗前及治疗4周后分别采用简化Fugl-Meyer评定(FMA)、改良Barthel指数(MBI)进行评价,根据"临床神经功能缺损程度评分"评定临床疗效。结果所有患者治疗后的FMA、MBI评分均较治疗前改善,康复组优于对照组(P<0.05)。康复组治疗有效率为75%,对照组为56%(P<0.05)。结论综合康复干预能促进急性脑梗死患者的肢体运动功能、日常生活活动能力的恢复。     

超早期康复训练与特殊护理对急性脑梗死患者心身功能恢复的影响

目的探讨超早期康复训练与特殊护理对急性脑梗死患者心身功能恢复的影响。方法选择150例急性脑梗死患者,超早期康复护理组、早期康复护理组和晚期康复护理组各50例,超早期康复护理组在生命体征稳定、神经症状不再进展24小时后进行肢体功能康复训练;早期康复护理组在神经症状不再进展、生命体征稳定72小时后进行肢体功能康复训练;以病程3～4周的脑梗死恢复期为晚期康复护理组开始康复训练。康复训练前、后1个月、3个月3组患者均进行日常生活活动能力、HAMA焦虑量表和HDRS抑郁量表的评定。结果 3组患者康复护理治疗1个月和3个月时日常生活活动能力评分均显著提高,HAMA焦虑量表和HDRS抑郁量表评分则明显下降。超早期康复护理组和早期康复护理组疗效明显优于晚期康复护理组,且超早期康复护理组疗效亦明显优于早期康复护理组(P<0.05)。结论超早期介入康复训练与特殊康复护理,对急性脑梗死患者提高肢体功能,改善焦虑及抑郁状态,降低致残率,提高生活质量有积极的意义。     

康复护理对脑梗死患者吞咽和肢体功能的影响

目的 :探讨早期康复护理对脑梗死患者吞咽和肢体功能的影响。方法 :93例脑梗死患者随机分为常规组和训练组 ,训练组在常规治疗的基础上配合早期康复护理和康复训练 ,并分别观察 2组患者吞咽及运动功能恢复状态。结果 :训练组总有效率为 77.4 % ,与常规治疗组 4 7.5 %比较差异有显著性 (P <0 .0 1) ;肢体运动功能比较 ,康复组明显优于常规组 (P <0 .0 1)。结论 :早期康复护理 ,指导患者开展康复训练能明显促进脑梗死患者吞咽及肢体功能的恢复。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.