针刺结合功能训练对社区脑卒中患者日常生活能力的影响

目的 探索规范针刺结合功能训练治疗对社区脑卒中患者日常生活能力的影响.方法 将长宁区三个社区176例脑卒中患者根据区域随机分成康复组和对照组,根据病程划分为软瘫期(Brunnstrom Ⅰ、Ⅱ)、痉挛期(BrunnstromⅢ、Ⅳ)、恢复期(BrunnstromⅤ、Ⅵ)和后遗症期;康复组在常规内科治疗的基础上给予规范的针刺结合功能训练治疗,对照组仅给予一般的常规内科治疗,分别在治疗后2个月末和5个月末采用改良Barthel指数评定量表进行日常生活能力的评定.结果 规范针刺结合功能训练社区康复治疗5个月后,两组患者的日常生活能力评分均提高,康复组与对照组相比具有显著性差异(P＜0.01).结论 规范针刺结合功能训练的社区康复治疗能促进脑卒中患者的日常生活能力的恢复.     

规范三级康复治疗中不同时期患者神经功能改善规律分析

目的探索规范的三级康复治疗后,卒中偏瘫患者神经功能的改善规律.方法卒中52例患者在脑梗塞和脑出血二个层次上区组随机化分成康复组和对照组,康复组给予规范的三级康复治疗,对照组不给于规范的三级康复治疗,但是一般的常规内科治疗同治疗组,分别于入选时,发病后第一个月月末、第三个月月末和第六个月月末采用临床神经功能缺损程度评分标准进行评测.结果康复组在入选后各阶段的评分明显低于对照组(P＜0.001),康复组各阶段神经功能评分积分差值明显高于对照组(P＜0.01);患者自身神经功能各阶段之间的相互比较,发现康复组的各组比值明显较对照组为小(P＜0.001),另外,从各阶段二组患者神经功能变化的线图上可以看出,康复组在入选后各阶段的积分明显低于对照组,积分下降的趋势明显快于对照组,早期尤为明显.结论规范三级康复治疗早期能够加速患者的恢复进程,后期康复治疗仍有利于患者神经功能的改善,但是速度变慢,然而相对于对照组功能恢复仍然较为明显.     

急性脑卒中患者三级康复治疗6个月综合功能恢复的临床分析

目的:探讨急性脑卒中患者进行三级康复治疗6个月综合功能的恢复。方法:196例急性脑卒中偏瘫患者随机分成两组,康复组和对照组,按照三级康复方案,一级康复(<28d).两组均住院进行早期康复治疗;二级康复(>28d),康复组在康复机构或医院继续治疗,对照组自行在家训练;三级康复(>3个月),康复组在家或社区进行康复治疗。结果:康复组治疗后6个月临床神经功能缺损、运动功能评分及改良巴氏指数评分均优于治疗前及对照组(P<0.01,P<0.05)。结论:急性脑卒中患者三级康复治疗综合功能恢复明显,可明显降低患者的依赖程度,提高生存质量。     

早期康复对髋臼后壁粉碎骨折术后功能的影响

背景：髋臼骨折的治疗是近年创伤骨科领域的热点问题，临床上因忽视康复治疗而影响治疗效果的现象屡见不鲜，规范的康复治疗是髋臼骨折治疗不可或缺的重要组成部分。 目的：观察早期康复治疗对髋臼后壁粉碎骨折患者术后肢体功能的影响。 方法：选取河北医科大学第三医院骨科收治的髋臼后壁粉碎性骨折患者40例，男36例，女4例；年龄23~61岁，平均35.3岁；随机分为康复组和对照组，每组20例。行重建钢板内固定后，康复组早期进行规范康复治疗，对照组自行遵医嘱进行功能锻炼。患者均于术后3，6，12个月进行随访，采用改良Merle d’Aubigne和Postel评分系统对患者髋关节功能进行评估。 结果：术后3，6，12个月康复组患者Merle d’Aubigne和Postel评分均大于对照组(13.10±2.05，11.20±2.80；14.50±1.32，13.00±2.10；15.80±1.36，14.25±1.74，P < 0.05)。提示早期进行规范康复治疗有助于髋臼后壁粉碎骨折患者肢体功能恢复。     

急性缺血性脑卒中早期康复和针刺治疗效果

目的 观察早期康复和针刺治疗对急性脑梗死偏瘫患者运动功能的影响.方法 急性脑梗死患者120例随机分为4组,一般药物治疗为对照组、早期针刺组、早期康复组和早期康复加针刺组.以Barthel 指数评分 (BI)等观察指标分析治疗前后的变化,了解不同分组的临床疗效.结果 在3、6个月时,各组与对照组比较均具有显著性差异,P<0.05,而针刺加康复组有显著性差异(P<0.01),6个月时患者的日常生活活动能力(ADL)BI较3个月时增加值各组间差异无统计学意义.结论 急性脑卒中患者应积极开展早期康复治疗和针刺治疗,二者合用是促进脑卒中康复的有效方法.3个月内是急性脑卒中患者的最佳治疗时机.     

正规康复治疗对脑卒中患者P300的影响

目的研究正规康复治疗对脑卒中患者P300的影响,为脑卒中患者认知功能的康复提供临床依据.方法按照统一的入选条件选取2001年10月～2002年2月在本院住院的脑卒中患者60例为研究对象,随机分成康复组和对照组,康复组在脑卒中后3～7 d开始康复治疗,为期1个月.对照组未给予康复治疗,治疗前后进行P300检查.结果康复组在康复后与对照组及在康复后与康复前相比,P300的潜伏期明显缩短,波幅明显增高(P＜0.01).结论正规康复治疗可以明显改善脑卒中患者的认知功能.     

康复护理在脑卒中急性期的应用研究

现将我院２０００年１月～２０００年１０月收治发病后３天内急性脑卒中患者，经实施早期康复护理（康复组）的疗效与不实施早期康复护理（对照组）患者的疗效予以比较分析，探讨早期康复护理对急性脑卒中治疗的临床意义。1 临床资料 所选病例均经头颅ＣＴ或ＭＲＩ证实，患者无明显精神障碍和意识障碍。康复组脑出血１９例，脑梗死３１例，发病年龄４５．３±１５．１岁；对照组脑出血１７例，脑梗死３３例，发病年龄６１．２±1４．１岁。根据１９９５年全国第４届脑血管病学术会议制定的《临床神经功能缺损程度评分》及病情严重程度评定分…     

脑卒中后遗症病人康复护理效果评价的研究

目的 探讨脑卒中后遗症病人康复护理效果.方法 129例脑卒中后遗症患者分为康复组(67例) 和对照组(62例) ,康复组患者住院接受康复护理,对照组门诊随访.对2组患者分别于入选时和入选后3 个月进行Barthel指数(BI)测试;对康复组分别于入选时和入选后3 个月进行并发症,如压疮、呼吸道感染、泌尿系感染、口腔感染的检查.结果 治疗3 个月后, 康复组患者 BI 评分明显上升,有显著性差异(P＜0.05);康复组患者并发症明显下降,有显著性差异(P＜0.05).结论 康复护理显著降低脑梗死后遗症病人并发症的发生,提高日常生活能力.     

全髋置换后康复干预时间与效果的比较

背景：观察全髋置换后康复干预开始时间对临床效果的影响。 方法：回顾性分析2000-07/2008-03湘南学院附属医院骨科收治的行全髋关节置换后康复治疗的患者165例,根据置换后行康复治疗时间的不同分为3组,早期康复组(n=56)：男27例,女29例;年龄44~79岁,置换前患髋Harris评分为(47.4±1.3)分,全髋置换后3 d行康复治疗。中期康复组(n=63)：男37例,女26例;年龄48~80岁,置换前Harris评分(45.6±2.1)分,全髋置换4~21 d后行康复治疗。延迟康复组(n=46)：男24例,女22例;年龄47~81岁,置换前Harris评分(46.3±1.5)分,全髋置换21 d后行康复治疗。3组按统一制定的康复训练计划实施功能锻练。于置换前,置换后1,2,3个月行Harris评分比较。 结果：行康复治疗的患者165例均进入结果分析。置换前3组髋关节Harris评分差异无显著性意义(P > 0.05);康复治疗后,置换后1个月Harris评分早期康复组平均(89.1±6.3)分,中期康复组平均(60.1±3.7)分,延迟康复组平均(54.6±3.5)分,早期康复组得分高于中期康复组及延迟康复组(P < 0.05)。置换后2个月Harris评分早期康复组平均(90.1±4.3)分,中期康复组平均(85.7±5.3)分,延迟康复组平均(69.8±3.8)分,早期康复组、中期康复组与延迟康复组之间相比,差异有显著性意义(P < 0.05)。置换后3个月Harris评分早期康复组平均(94.8±2.3)分,中期康复组平均(92.2±3.2)分,延迟康复组平均(90.5±3.1)分,3组之间相比,差异无显著性意义(P > 0.05)。 结论：早期系统康复治疗有利于全髋置换后髋关节功能的恢复。     

传统与新型抗精神病药治疗精神分裂症疗效及诊治费用的比较

目的　了解传统与新型抗精神病药治疗精神分裂症患者的疗效及治疗费用情况。方法将 6 0 0例精神分裂症患者按门诊病历号分为两组 ,奇数为传统抗精神病药组 (服用氯丙嗪、氟哌啶醇等 ,折合氯丙嗪的平均剂量为 4 5 0～ 6 0 0mg/d) ,偶数为新型抗精神病药组 (服用氯氮平 4 5 0～ 6 0 0mg/d、利培酮 4 6mg/d、奥氮平 17 5mg/d)。分别在治疗前及治疗后 2 ,8,12 ,5 0周末采用简明精神病评定量表、临床大体印象表和副反应量表进行评定 ;调查两组患者家庭在一年中因诊治该患者所需的直接、间接和隐性费用。结果　 (1)有效率 :传统药组为 70 7% ,新型药组为 70 3% (P >0 0 5 ) ;(2 )诊治费用 :传统药组的总费用为 (10 372 81± 6 86 2 2 )元 ,直接费用为 (2 795 5 5± 84 6 2 4 )元 ,间接费用为(5 712 32± 977 13)元和隐性费用为 (2 0 36 2 5± 881 6 2 )元 ,均多于新型药组 [分别为 (5 196 4 0±4 5 1 6 4 )元、(380 5 2 2± 989 2 2 )元、(12 5 5 4 1± 5 0 3 13)元和 (15 8 4 9± 2 2 71)元 ],差异均有显著性 (P <0 0 5或P <0 0 1)。结论　新型抗精神病药的疗效与传统抗精神病药相似 ,但较后者更经济 ,更适合大多数患者。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.