急诊科护士创伤后应激反应与正念及应对方式的关系研究

目的 调查急诊科护士创伤后应激反应现状及其影响因素,为临床制订有效的预防和干预对策,以促进护士心理健康提供参考.方法 采用事件影响量表、正念注意觉知量表和简易应对方式量表对重庆市22所医院的571名急诊科护士进行调查.结果 急诊科护士事件影响量表总分0～88分,中位数28;达到创伤后应激障碍亚临床以上水平的护士占65.3％.事件影响量表总分与正念和积极应对呈负相关,与消极应对呈正相关(P＜0.05,P＜0.01).Logistic回归分析显示,正念是急诊科护士创伤后应激反应的保护因素,消极应对是危险因素(均P＜0.01).结论 急诊科护士创伤后应激反应水平较高;可通过提高正念水平、完善应对方式等,降低急诊科护士创伤后应激反应水平.     

臂丛神经损伤的显微外科治疗

目的：回顾性分析应用显微外科技术治疗臂丛神经损伤的疗效。方法：从１９８４年５月至１９９４年５月共治疗臂丛神经损伤患者１０５例，手术方法包括神经松解术、神经直接缝合术、神经移植术和神经转移术。结果：５４例经１年以上随访，功能恢复优良率达５８．２５％。结论：临床资料表明，（１）开放性臂丛损伤应尽早修复，而闭合性的可保守治疗观察３～６个月；（２）当神经断裂时应尽量利用近端残留的神经根或干优先修复远端重要的神经束，同时，即使长度超过１０ｃｍ的神经段移植亦可获得较好的效果；（３）术后要作长期的随访观察，以便检查术后功能恢复情况和决定是否需要采取其他补救措施。     

臂丛神经损伤的治疗

1988年1月～1993年12月治疗臂丛神经损伤56例。由于损伤情况不同,采取了电刺激疗法及包括神经松解、神经移植和神经移位等手术方法。经复查总结,资料完整者48例,其效果较满意。本文提出了电刺激疗法在臂丛损伤治疗中的作用。讨论了手术时机的选择,手术禁忌,臂丛合并其它神经损伤的发生及诊治。强调对臂丛损伤树立完整治疗观念的必要性。     

臂丛神经损伤后顽固性肺不张病因分析及防治

目的探讨外伤后臂丛神经损伤致顽固性肺不张的病因及防治措施。方法对11例臂丛神经损伤后顽固性肺不张发病原因及治疗进行分析。结果本组10例治愈,1例肺不张并发肺感染,全身多脏器功能衰竭死亡。结论暴力外伤后致臂丛神经损伤,特别是全臂丛神经损伤后致顽固性肺不张多由于相关辅助吸气肌如胸锁乳突肌、胸大肌、前锯肌、斜方肌和背阔肌对应支配的神经损伤,及并发肋骨、锁骨、肩胛骨骨折致疼痛,造成胸廓活动度降低,呼吸活动受限,排痰困难,支气管阻塞,形成顽固性肺不张。对此类患者应采取全面积极的预防和治疗措施可降低肺不张等肺部并发症的发生率和死亡率。     

氨哮素延缓臂丛神经损伤后骨骼肌萎缩的机理研究

目的 探讨氨哮素对臂丛神经损伤后骨骼肌萎缩的延缓作用及其机制。方法 建立大鼠一侧臂丛神经损伤模型，技术后服药的不同分成两组。（１）氨哮素组：术后灌服氨哮素（１０ｍｇ／ｋｇ．ｄ＾－１），６只大鼠。（２）对照组：术后灌服等量蒸馏水，７只大鼠。术后６周取两组手术侧的肱二头肌，观察萎缩肌肉的肌湿重、总蛋白含量的变化；用ＴＵＮＥＬ法检测凋亡肌细胞的百分率，并用免疫组化法检测肌萎缩时Ｆａｓ、Ｃａｓｐａｓｅ－８ｐ２１的表达。结果 （１）氨哮素组：失神经侧的臂围明显大于对照组失神经侧，两组差异有显著性意义（ｔ＝５．４９，Ｐ〈０．０１）。肌湿重和总蛋白含量也明显高于对照组（ｔ＝７．５４，Ｐ〈０．０１；ｔ＝３．８１，Ｐ〈０．０５）。（２）肌细胞凋亡率：氨哮素组：萎缩肌肉内肌细胞的凋亡程度明显轻于对照组，两组差异有显著性意义（Ｔ＝８     

臂丛神经损伤晚期屈肘功能重建的治疗进展

臂丛神经损伤在早期行神经移植 (位 )功能无恢复 ,或因严重的臂丛根性撕脱伤致肱二头肌瘫痪 ,屈肘功能丧失 ,利用肌肉移植 (位 )恢复屈肘功能一直是临床研究的重点。它是晚期臂丛神经损伤重建屈肘功能必须采用而且非常有效的方法。Ｋａｒｄ[1] 认为游离或带蒂肌肉移植可应用于年龄较大或外伤超过6个月的患者。1　动力肌的切取传统的肌肉移植是在直视下切取肌肉。在供区留下长的 ,从美容角度不能接受的疤痕 ,而使患者对临床效果的满意度下降。为了解决这一问题 ,近年来逐渐兴起应用内窥镜切取供肌 ,取得良好效果。Ｄｏｉ等[2 ] 报道 :应用内…     

分娩性臂丛神经损伤危险因素的病例对照研究

目的：明确分娩性臂丛神经损伤的危险因素并提出预防措施。方法：采用病例对照研究，按1：4配对，共收集了出生在1988年至2001年的26个病例和104个对照婴儿，对两组计数资料和计量资料分别进行统计学处理，用条件Logistic回归分析其危险因素。结果：胎儿的出生体重，Apgar评分，分娩方式，母亲的活产次数，第一产程活跃期和第二产程持续时间，胎方位，有无抢救史，是否合并其它产伤等方面，病例组与对照组之间的差异均有显著性意义（P＜0．05），趋势卡方检验表明，随着分娩方式（手术产，自然分娩，产钳助产）级别的增加，发生臂丛神经损伤的可能性也增加（P＜0．001），经条件Logistic回归分析确定巨大儿（出生体重4000g)，产钳辅助分娩，胎方位为枕横位或枕后位是分娩性臂丛神经损伤的危险因素，结论：出生体重是分娩性臂丛神经损伤最强的危险因素，分娩方式与出生体重，胎方位之间均有协同作用，在分娩方式中，手术分娩是其保护因素。     

臂丛神经损伤的核磁共振诊断及影像特点

目的：用前瞻性的方法探讨核磁共振用于臂丛神经损伤的诊断价值及影像特点。方法：对３３例臂丛神经损伤的病例作ＭＲＩ检查。以手术探查所见和体感诱发电位结果作为标准。结果：ＭＲＩ诊断椎管内部分的神经损伤准确度是９１％，椎管外部分是８８％。臂丛神经损伤时的ＭＲＩ主要征象是神经根缺失或者疤痕化、创伤性脊膜囊肿、脊髓变形、脊髓移位及“黑线征”。ＭＲＩ还可以比较清楚地显示臂丛神经的椎管外部分。结论：ＭＲＩ是唯一可用以诊断椎管内外部分臂丛神经损伤的影像学方法。     

心里干预对臂丛神经损伤病人情绪状态的影响

臂丛神经损伤是周围神经损伤中最严重的损伤之一，可造成患的严重残疾。受伤后大部分患需要3～6个月的观察，以确定损伤的部位、范围、恢复情况及手术方式。由于生理解剖的特点，臂丛神经损伤后治疗较困难，疗效也不甚理想。病人由于生活能力下降，常出现以焦虑、抑郁症状为主的严重不良反应。因此，帮助病人摆脱残疾和痛苦，恢复自信，达到生活自理是医护人员努力的目标。通过对我科自2005年7月4日至2006年4月1日住院的20例臂丛神经损伤患进行心理干预，均取得满意效果。     

Social Support and Coping Strategies in Patients with Traumatic Brachial Plexus Injury

Background

Emotional and social characteristics may influence rehabilitation and recovery after traumatic brachial plexus injury.

Purposes

We sought to investigate if traumatic brachial plexus injury patients have different levels of social support and employ distinct coping strategies from uninjured control subjects. In addition, we studied which coping strategies are more commonly used among traumatic brachial plexus injury patients.

Methods

Questionnaires for social support (Interpersonal Support Evaluation List and Social Support Questionnaire) and coping strategies (Brief-Coping Orientation to Problems Experienced) were administered to traumatic brachial plexus injury patients and an age- and sex-matched volunteer cohort (without brachial plexus injury).

Results

There were no differences in interpersonal support (mean [SD] = 26.0 [8.6], 26.5 [6.8]), number of persons available for emotional support, and satisfaction with support between traumatic brachial plexus injury patients (n = 36) and volunteers (n = 43). The following coping strategies were more common among traumatic brachial plexus injury patients: active coping, self-distraction, denial, behavioral disengagement, venting, planning, self-blame, and acceptance.

Conclusion

Patients with traumatic brachial plexus injury have similar levels of social support as healthy volunteers but are more likely to use an array of coping strategies. Surgeons and other clinicians should be aware of coping strategies favored by patients, particularly the potential for behaviors detrimental to recovery such as behavioral disengagement, self-blame, and denial. This work will inform future investigations into the influence of social support and coping strategies on clinical outcomes after traumatic brachial plexus injury.

     

Nerve Transfers for Traumatic Brachial Plexus Injury: Advantages and Problems

In recent years nerve transfers have been increasingly used to broaden reconstructive options for brachial plexus reconstruction. Nerve transfer is a procedure where an expendable nerve is connected to a more important nerve in order to reinnervate that nerve. This article outlines the experience of the Scottish National Brachial Plexus Injury Service as our use of nerve transfers has increased. Outcomes have improved for reconstruction of the paralysed shoulder using transfer of the accessory nerve to the suprascapular nerve. Medial pectoral to musculocutaneous nerve transfer has proved reliable for restoration of elbow flexion for patients with C5,6 and C5,6,7 injuries. Problems with nerve transfers include morbidity in the donor nerve territory, co-contraction, and pre-existing injury to the donor nerve. There is a balance of risks in these procedures which should be weighed up in individual cases.     

Validity and Reliability of Prognosis Brachial Plexus Injury Score for Traumatic Brachial Plexus Injury

BackgroundBrachial plexus injury (BPI) is a peripheral nerve injury that results in severe functional impairment and disability. Even after prompt treatment, predicting the prognosis of BPI is not easy as it involves various factors. An objective and valid scoring system would aid clinicians in informing families and anticipating problems related to the recovery of BPI. Prognosis BPI (PRO-BPI) score, a new prognostic score to predict the outcome of traumatic BPI (TBPI), was developed in 2019 by Suroto and Rahman. This study aimed to evaluate its validity and reliability.MethodsRetrospective cohort analysis was conducted for 111 BPI patients. A serial assessment of Disabilities of the Arm, Shoulder and Hand (DASH) score and PRO-BPI score was done. Validity analysis was done by assessing Spearman correlations between PRO-BPI score and other scoring systems (DASH, Michigan hand outcomes, and 36-item short form survey score [SF-36]). Internal structure consistency using Cronbach’s alpha and test-retest reliability were measured for reliability analyses. A p-value was considered significant if < 0.05.ResultsA total of 96 male and 15 female patients were included in our study with a mean age of 27.9 ± 10.6 years. Most of the patients (56.75%) had a poor prognosis based on the scoring system (average, 14.38 ± 3.98). Major contributors of this low score were the persistent pain (score 1 in 57.7% patients) and initial pain scale score (score 1 in 31.5% patients). Validity test showed that 6 parameters were all valid (p < 0.01). Reliability testing was done using Cronbach’s alpha and found acceptable internal consistency (α = 0.767). Test-retest reliability was high. Moderate correlations were observed between the measures.ConclusionsPRO-BPI score is a valid and reliable scoring system in predicting the prognosis of TBPI.     

护理本科生临床实习压力源及应对方式调查分析

目的 探讨护理本科生(护生)临床实习不同时期压力源及应对方式,寻找影响应对方式的因素.方法 采用自行设计的个人资料问卷、护生压力源问卷和简易应对方式问卷对进入临床实习的90名护生进行调查.结果 "毕业分配情况"一直是护生的首要压力源;"带教教师对护生的态度"是临床实习前期和中期的第2位压力源,后期的第3位压力源;"自我价值感"是护生临床实习前期和中期的第3位压力源.临床实习中护生不同时期消极应对与常模比较,差异有统计学意义(均P<0.01);专业喜好影响护生的应对方式(P<0.05).结论 护生临床实习不同时期面对的主要压力源不同,临床实习中护生的应对方式较积极,但受个人资料中相关因素影响.教师应根据这些特点,在临床实习的不同时期有针对性地为护生提供适时、有效的指导和帮助,促进她们的身心健康,提高教学效果.     

Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury

Background  

Patients with incomplete recovery from obstetric brachial plexus injury (OBPI) usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less emphasis has been placed on the more subtle ones, such as those of the coracoid process. The purpose of this retrospective study is to determine the relationship between coracoid abnormalities and glenohumeral deformities in OBPI patients. We hypothesize that coracoscapular angles and distances, as well as coracohumeral distances, diminish with increasing glenohumeral deformity, whereas coracoid overlap will increase.     

C_7神经根移位治疗臂丛损伤术中胸背神经电生理检测的意义

目的探讨术中肌电生理检测对预测C7神经根移位术中胸背神经损伤程度的价值。方法7例全臂丛神经根性撕脱伤患者,均行健侧C7神经根移位术,术中切断C7之前分别刺激健侧臂丛上、中、下干,以及C7神经根各束支,采用肌电仪记录背阔肌动作电位波幅(Amp),了解各神经对背阔肌的支配权重。结果干部刺激后,背阔肌复合肌肉动作电位Amp在上、中、下干分别为(2.26±1.17)mv,(3.47±1.48)mv及(2.67±1.21)mv,中干与上、下干之间均存在统计学差异(P<0.05),而C7各股束支中,后股总体Amp为(4.14±1.94)mv,明显高于前股(2.08±1.24)mv(P<0.01),且后股内侧Amp最大,为(3.97±1.53)mv,大于后股外侧(2.87±1.41)mv(P<0.05)。背阔肌支配权重在臂丛干部,以中干(41.30%±2.56%)为大,而中干又以中干后股(66.90%±1.72%)、后股内侧(38.37%±1.65%)为大。结论术中电生理检测可以较精确定位背阔肌的支配神经来源,对合理选择C7神经根移位术式、提高C7神经根移位术式安全性具有重要的临床指导意义。