福建省健康大学生111名握力及捏力的测试

背景:正常人握捏力数据为手功能障碍的评估及治疗提供重要参考依据,但到目前为止国内仍缺乏一套大样本的握捏力常模数据.目的:旨在分析健康大学生的握力、捏力正常值,并且探讨握捏力与计量资料之间相互关系.方法:募集111名福建中医药大学二年级学生,男65名,女46名.在同一握力体位下,应用E-link电子握捏力计分别测试学生握力、侧捏、三指捏、指尖捏捏力.同时测量身高、体质量、前臂长度、前臂围度、手宽、手长、手掌厚,分析相互关系.结果与结论:男女利手握捏力均高于非利手(差异10%以内),男性握捏力值均大于女性.男女侧捏与三指捏力无显著差异,均明显高于指尖捏力.握捏力值与国外同龄数据相差较大,尤其是男性.握力体质量比男性74%,女性58%;3种捏握比均低于传统认定正常值30%:男性(14.8%～21.6%)、女性(16.9%～24.3%).左右手握捏力呈高度相关(r=0.680～0.872,P＜0.01),男女性握力及3种捏力之间呈中度相关(r=0.390～0.720,P＜0.01),指尖捏力与人体计量资料不相关,年龄、前臂长与握捏力无关.身高仅与男性握力相关,手掌厚与男性握捏力(除指尖捏力)相关,与女性无关.与握捏力相关的主要计量资料有体质量、前臂围度、手宽、手长,尤其手宽度是预测男女性握力重要指标.     

智能化手功能评定系统用于脑卒中患者手功能评定的可信性分析

摘要 目的：分析智能化手功能评定系统在脑卒中患者手功能评定的信度。 方法：共收集了30例初发单侧脑卒中偏瘫患者,年龄（53.83±2.02）岁,男18例,女12例。应用智能化手功能评定系统测量脑卒中偏瘫手最大握力、捏力和夹指压力,每个项目均测量3次,取最大值作统计学分析;再予以Brunnstrom（手部）,FM-UE运动评测和Barthel指数法评定手功能。 结果：智能化手功能评定系统测定最大握力、捏力及夹指压力结果与其他常用上肢功能评定之间存在直线相关关系,Pearson相关系数为0.670—0.888（P值均小于0.05）;最大握力与FM-UE和Brunnstrom（手部）的相关性优于最大捏力和夹指压力。 结论：智能化手功能评定系统检测出的最大握力、捏力及夹指压力可反映脑卒中患者上肢功能,能对患者上肢功能进行客观、精确和量化的评定。     

男性人体测量指标与体脂含量相关性分析

[目的]探讨男性人体测量指标与体脂含量的相关性.[方法]选取 20～50岁男性 89例为研究对象,根据体重指数分为 3组.应用双能X线进行体脂含量测定.[结果]超重组和肥胖组体脂含量,总体脂肪质量和躯干脂肪质量均高于对照组（P〈0.05）.体脂含量与体重指数（r =0.765）,腰围（r =0.798）,腰围身高比（r =0.809）和腰臀比（r =0.665）均呈正相关（P〈0.01）.以体脂含量为因变量,行多元线性回归显示,腰围身高比（β=93.983,P=0.000,R2=0.654）被引入方程.[结论]男性人体测量指标与体脂含量密切相关,利用简单的人体测量指标推算体脂含量是可行的,但有待流行病学研究进一步证实.     

不同年龄、性别、心率的正常成人Q-T间期的特征分析

目的探讨不同年龄、性别、心率正常成人Q-T间期的特征。方法比较3 062例正常成人心电图的Q-T间期和Q-Tc。结果正常成人的Q-T间期和Q-Tc在18~39、40~59、≥60岁3个年龄组间具有显著差异（P〈0.01）;除18~39岁组外,其他两个年龄组及不分年龄组的Q-T间期有性别差异,女性Q-T间期大于男性（P〈0.01）;分年龄组和不分年龄组的Q-Tc均有性别差异,女性Q-Tc大于男性（P〈0.01）。在不同的心率段Q-T间期和Q-Tc均存在显著差异（P〈0.01）;Q-T间期与心率呈负相关（r=-0.502,P〈0.01）,而Q-Tc与心率呈正相关（r=0.473,P〈0.01）。结论正常成人Q-T间期和Q-Tc间期均受心率的显著影响,年龄和性别对Q-T间期有一定影响。     

不稳定型心绞痛患者心率减速力与冠状动脉病变程度的相关性

目的探讨不稳定型心绞痛（acute myocardial infarction,UAP）患者心率减速力变化特点及其与冠状动脉病变范围及程度的相关性。方法选择2016年9月至2017年1月在安徽医科大学第三附属医院心内科确诊为UAP患者109例,同期非冠心病患者52例作为对照（对照组）行24 h动态心电图检查,应用相应的分析软件对结果进行分析,比较两组间心率减速力的差异。对UAP患者不同心率减速力值范围与冠状动脉病变支数及程度的差异进行比较。分析UAP患者心率减速力与冠脉病变支数、冠脉病变范围及程度的相关性。结果UAP组心率减速力值明显低于对照组[（5.10±1.34）与（6.03±1.40）,t＝-3.775,P〈0.01]。心率减速力〉4.5 ms组患者冠脉病变支数[（1.67±0.77）支]及Gensini评分[（21.37±5.54）分]均少于心率减速力≤ 4.5 ms组[（2.39±0.83）支与（42.69±8.61）分,t值分别是-3.910,-2.277,P均〈0.05]。心率减速力值与冠状动脉病变支数（r＝-0.206,P〈0.01）、Gensini评分（r＝-0.358,P〈0.01）均呈负相关。结论UAP患者心率减速力值减小,心率减速力与UAP患者冠状动脉病变程度及范围密切相关。     

人体坐姿上肢不同拉力负荷时足底的压力分布

背景：足底压力测量技术已广泛应用于生物力学的步态研究,但多数研究都集中在正常行走或穿各种鞋时的步态时间特征和足底压力分布方面。目的：探讨人体坐姿条件下上肢在不同拉力负荷过程中足底压力分布的特征。方法：应用Seat16/53mFLEX足底压力测试系统记录40名健康受试者以坐姿在不同拉力负荷条件下的足底压力分布信号,分析在30%,50%,80%,100%最大随意肌力的拉力负荷下,不同年龄及不同性别受试者足底压力的分布。结果与结论：在不同的拉力负荷下,青年组男性受试者的足底压力值明显大于女性（P〈0.05）,而中年组男性和女性的足底压力值间差异无显著性意义（P〉0.05）。同时,所有受试者均表现出左右足底受力不均一的现象。其中,青年组男性右脚足底压力明显小于左脚,而青年组女性均显示出右脚足底压力大于左脚的情况（P〈0.05）。中年组男性和女性左脚的足底压力在30%～80%最大随意肌力拉力负荷下变化不大,但在100%最大随意肌力拉力负荷下明显减小（P〈0.05）。说明年龄和性别对不同拉力负荷下人体足底压力均有影响。     

腹型肥胖男性糖耐量试验各时点血糖与代谢综合征各组份的相关性

[目的]探讨腹型肥胖男性葡萄糖耐量试验（OGTT）各时点血糖与代谢综合征各组份的相关性.[方法]选取 20～50岁糖耐量正常的男性为研究对象,其中腰围（WC）≥90 cm 36例为腹型肥胖组,WC〈90 cm 31例为对照组,行OGTT并检测血脂、肝肾功能及人体基本参数.[结果]两组间空腹血糖（FPG）和糖负荷后2 h血糖（2hPG）和3 h血糖（3hPG）比较无统计学差异（P〉0.05）,腹型肥胖组糖负荷后 0.5 h血糖（0.5hPG）,1 h血糖（1hPG）和葡萄糖曲线下面积（AUCglu）高于对照组（P〈0.05）.其中 1hPG与WC（r=0.519）,收缩压（SBP）（r=0.456）,舒张压（DBP）（r=0.338）,甘油三脂（TG）（r=0.439）,高密度脂蛋白胆固醇（HDL-C）（r=-0.391）,尿酸（UA）（r=0.418）,AUCglu（r=0.914）和胰岛素抵抗指数（Homa-IR）（r=0.470）相关性最强（P〈0.01）.多元线性回归显示,1hPG与WC、SBP、DBP、TG、HDL-C和UA存在独立相关.[结论]NGT腹型肥胖男性1hPG与多种代谢综合征组份密切相关.因此,在腹型肥胖人群进行OGTT时应更加关注1hPG监测     

等动肌力测试10岁健康儿童肩关节屈伸肌群的发育特征

背景：肩关节是人体最灵活的关节,目前对儿童肩关节肌群发育特征的研究非常少见。目的：通过等动肌力测试分析10岁儿童肩关节屈伸肌群力量的发育特征。方法：运用Kinitech等动测力系统对59名10岁儿童双侧肩关节屈伸肌进行60,120（°）/s两种速度测试。结果与结论：①同一测试速度下同侧同名肌群男女比较,左右肩关节屈伸峰力矩、最大功率值差异均无显著性意义（P〉0.05）。②左肩关节：男性屈肌在120（°）/s速度下的相对体质量峰力矩值高于女性（P〈0.05）,伸肌在60,120（°）/s速度下数值高于女性（P〈0.01或P〈0.05）;男性屈肌在60（°）/s速度下的相对体质量最大功率值高于女性（P〈0.05）,伸肌在60,120（°）/s测试速度下的相对体质量最大功率值高于女性（P〈0.05或P〈0.01）。③右肩关节：男性伸肌在60,120（°）/s速度下的相对体质量峰力矩值高于女性（P〈0.05）;男女屈肌在60,120（°）/s速度下的相对体质量最大功率值差异均无显著性意义（P〉0.05）,男性伸肌在60,120（°）/s速度下的相对体质量最大功率值高于女性（P〈0.01或P〈0.05）。说明10岁儿童男女相比,肩关节屈伸肌群发育无明显差异;自身相比,男女儿童肩关节伸的肌群力量要好于屈肌群,屈伸比在合理范围之内。     

淮南矿区1963例65岁以上老年人高血压、糖尿病患病情况调查分析

[目的]调查淮南矿区65岁以上老年人高血压、糖尿病患病情况。[方法]对1963例65岁以上老年人的健康体检资料进行分析,并对男、女患病率情况进行对比。[结果]淮南矿区65岁以上老年人高血压的患病率男、女相近（P〉0.05）;糖尿病、空腹血糖调节受损（IFG）的患病率男性均高于女性（P〈0.05）,超重、肥胖的患病率、3级高血压患病率男性明显高于女性（P〈0.01）;超重、肥胖者伴高血压者男性明显高于女性（P〈0.01）;高血压合并糖尿病情况女性高于男性（P〈0.05）,高血压合并脑血管病情况男性明显高于女性（P〈0.01）。[结论]社区要更加关注男性高血压和糖尿病的患病情况,以便进行有的放失的社区干预。     

最大握力和捏力检测用于脑卒中患者上肢功能评定的研究

目的：分析最大握力和捏力检测对脑卒中患者上肢功能评定的临床意义。方法：实验组为65—75岁脑卒中患者25例，对照组为同年龄段健康老年人32例。应用E—LINK电子握力和电子捏力计对两组研究对象分别进行双侧最大握力和捏力检测，实验组在同一周内予以MMT、Fugl—Meyer运动评测的上肢部分FIM量表和金子翼简易上肢机能检查等项目的评测。结果：实验组患侧最大握力或捏力与健侧之比（手比率，handratio，HR）与其他临床评定之间存在良好的直线相关关系，Pearson相关系数为0．826—0．980。对应Lovett徒手肌力不同级别，最大握力或捏力HR存在不同的范围和均值。结论：最大握力和3种捏力检测对脑卒中患者上肢功能评定具有不同临床意义．综合各项肌力的检测结果，更有助于对患者上肢功能状态的进行客观、精确、量化和动态的判断。     

膝关节置换术后患者早期夹管和冰敷的护理

目的探讨膝关节置换术后患者早期夹管和冰敷的护理方法。方法选择2009年1月至2011年4月在温州医学院附属第一医院骨科行单膝关节置换手术患者35例为研究对象,按入院先后将其分为观察组和对照组。观察组患者35例,在常规处理的基础上采取早期夹闭引流管和冰敷等措施;而对照组患者20例行常规处理,即置管持续引流。观察两组患者术后引流量、疼痛程度和肿胀情况。结果观察组患者术后6、12、24、48h切口引流量明显少于对照组,差异有统计学意义(P<0.01),且患者术后24、48h疼痛评分和肿胀值均低于对照组,差异有统计学意义(P<0.01)。两组患者术后均未出现严重并发症,痊愈出院。结论 早期夹管和冰敷能有效减少人工全膝关节置换术术后出血,减轻疼痛和肿胀,具有较好的临床应用价值。     

Reliability of Pinch Strength Testing in Elderly Subjects with Unilateral Thumb Carpometacarpal Osteoarthritis

[Purpose] The aim of this study was to examine the test-retest reliability of pinch strength testing in elderly subjects with thumb CMC OA. [Subjects and Methods] A total of 27 patients with unilateral right-thumb CMC OA (mean ± SD age: 81.3 ± 4.7 years) were recruited. Each patient performed three pain-free maximal isometric contractions on each hand on two occasions, one week apart. Three different measurements were taken: tip, tripod, and key pinch strength. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95% limits of agreement (LOA) calculations were performed. [Results] Test-retest reliability of measurements of tip, tripod, and key pinch strength was excellent for the affected side (ICC=0.93, 0.96, and 0.99) and the contralateral thumb (ICC=0.91, 0.92, and 0.94). [Conclusions] The present results indicate that maximum pinch strength can be measured reliably using the Pinch Gauge Dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving pinch strength.Key words: Test-retest, Reliability, Pinch strength     

Effects of the Surface Texture and Weight of a Pinch Apparatus on the Reliability and Validity of a Hand Sensorimotor Control Assessment

Objectives

To investigate the reliability and validity of a modified pinch apparatus devised with 3 surface textures and 2 different weights for clinical application.

Comparison of Heart Rate and Blood Pressure with Toe Pinch and Bispectral Index for Monitoring the Depth of Anesthesia in Piglets

Determining depth of anesthesia (DOA) is a clinical challenge in veterinary medicine, yet it is critical for the appropriate oversight of animals involved in potentially painful experimental procedures. Here, we investigated various parameters used to monitor conscious awareness during surgical procedures and refined the application of noxious stimuli to anesthetized animals. Specifically we used a common stimulus, a compressive toe pinch (TP), to determine physiologic changes that accompanied a positive or negative motion response in isoflurane-anesthetized piglets. A positive response was defined as any reflexive withdrawal, whereas a negative response was defined as the absence of motion after stimulation. We also assessed the utility of the bispectral index (BIS) for its ability to predict a motion response to TP. The average of BIS values over 1 min (BIS_mean) was recorded before and after TP. In piglets with a positive response to TP, heart rate (HR), but not blood pressure (BP), increased significantly, but receiver operating characteristic (ROC) analysis revealed that HR was not a sensitive, specific predictor of TP motion response. Both before and after TP, BIS_mean was a strong predictor of a positive motion response. We conclude that HR and noninvasive BP changes are not clinically reliable indicators of anesthetic depth when assessed immediately after a peripherally applied compressive force as an indicator stimulus; however, BIS_mean and response TP are acceptable for assessing DOA in piglets maintained under isoflurane anesthesia.Abbreviations: BIS, bispectral index; DOA, depth of anesthesia; Et_ISO, end-tidal isoflurane concentration; HR, heart rate; ROC, receiver operating characteristic; TP, toe pinchEnsuring an appropriate depth of anesthesia (DOA) is a clinical and humane imperative for animals undergoing invasive procedures, yet there is a paucity of reliable standardized assessments in broad use in veterinary medicine. Current practice dictates that DOA is determined by evaluating changes in hemodynamic and respiratory variables and, in the absence of neuromuscular blockade, by observable withdrawal movement in response to a noxious stimulus. In research animals, the noxious stimulus is typically a nonstandardized compressive force applied to a toe, and absence of a pedal withdrawal reflex is the metric used to identify when animals are at an appropriate surgical plane of anesthesia prior to incision or invasive procedures.Alternative methods to assess DOA may aid in the refinement of humane animal use in research. Although motor response to stimulation has been the most commonly used parameter to clinically assess depth of sedation and anesthesia in animals, this response may be independent of input from the forebrain and is mediated at the level of the spinal cord.^1,51-53 Alternatively, EEG measures are increasingly being used to measure the depth of sedation, anesthesia, and awareness.⁴³ Because hypnosis and amnesia are difficult to assess in some patients, namely in nonverbal patients such as animals and young human pediatric patients, the possibility of using refined EEG measures to determine the awareness or recall ability of patients is very promising.The ancillary EEG measure that has been researched most extensively is the bispectral index monitor (BIS monitor, Covidien, Mansfield, MA). The bispectral index (BIS) is a parameter derived from the EEG; it is calculated by comparing the patient''s EEG with a database of EEG recordings from sedated and conscious human volunteers that have been matched to observed DOA and drug doses. The proprietary algorithm used to determine BIS takes into account 3 main factors:^37,61,62 1) bicoherence or phase coupling, the amount of waveforms that are in phase together, 2) the power spectrum, the ratio of low- (δ) to high- (β) frequency waves; and 3) the percentage isoelectricity (burst suppression ratio) in the recording.^37,62 These metrics are based on the observation that the conscious mind has an EEG recording that is very random, high-frequency, and low-amplitude, reflecting desynchronized neuronal firing, whereas the unconscious mind has an EEG recording that is low-frequency, high-amplitude, and synchronized. Tailoring anesthetic administration to changes in BIS monitoring has been associated with a decrease in the incidence of intraoperative awareness as measured by postoperative recollection of surgical events.⁴⁴ In addition, the titration of anesthetic regimens to intraoperative BIS monitoring in humans has been associated with decreased time to first spontaneous breathing, eye opening, extubation, time to response to verbal command, and time spent in the postanesthesia care unit.^7,42 Improvements in these short-term outcomes are essential in the research environment, where reliable assessments in high-throughput systems are the desired goal yet difficult to achieve by using large-animal models.BIS monitoring has not been restricted to human patients. In fact, it has been used in dogs, cats, horses, calves, goats, pigs, rabbits, chickens, alpacas, elk, dolphins, and a wild raptor to measure DOA, cerebral dysfunction, and sleep cycles, with varying success depending on species, anesthetic, and stimulus.^{2,4,6,16-20,23,29,37-41,54,56,62} Due to their frequency of use as surgical models in biomedical research, laboratory swine may benefit substantially from the investigation of BIS monitoring. Previous studies evaluating the use of BIS in pigs found varying utility of this modality to measure depth of anesthesia in this species. Overall, BIS decreases with the administration of anesthetics in swine.^{18,23,38,40,41,55,56} Although some investigators found low sensitivity of BIS in predicting response to movement⁴ and poor correlation to a visual analog scale of DOA,²³ others found that BIS correlated well to clinical measures of DOA⁴⁰ and that its utility depended on the dose of anesthetic administered.¹⁸ Changes in heart rate (HR) and blood pressure (BP) in swine did not affect BIS values during abdominal surgery.³⁸ The use of different anesthetic protocols in these studies makes comparisons across them difficult. The age, size, and breed of pigs differed between the studies as well, and the effect of these variables on BIS in pigs is unknown. For these reasons, BIS should be evaluated in pigs of different breeds and ages with different anesthetics.In the present study, our objectives were to examine physiologic responses to a commonly applied compressive toe pinch (TP) without standardized equipment and to relate the motor response to TP and BIS as assessments of hypnosis in piglets. Our hypothesis was that a positive response to TP would correspond to changes in HR, BP, and level of hypnosis as measured by BIS. Outcomes from this study were intended to examine the veracity of concerns regarding the subjectivity of TP as a measure of anesthetic depth. To our knowledge, this study is the first to specifically relate BIS to motion response to noxious stimuli during the use of inhaled volatile anesthetics in swine.     

Comparison of Power Grip and Lateral Pinch Strengths between the Dominant and Non-Dominant Hands for Normal Chinese Male Subjects of Different Occupational Demand

The purpose of this study was to establish handgrip data for right hand dominant normal Chinese subjects. Sixty-four males were studied for their power grip and lateral pinch strengths. They were categorized into non-manual and manual workers. Standardized procedure and instructions were used for handgrip testing. Results showed that both the non-manual and manual workers demonstrated stronger power grip and lateral pinch strengths in their dominant hands. The 10% rule was applicable only for power grip strength of non- manual workers and lateral pinch strength of manual workers. No significant difference was found between the dominant grip strengths in these two groups of subjects. It was recommended that when assessing the progress and outcome of hand rehabilitation, the occupation and demand level of hand use of the patient must be taken into consideration when using the uninjured hand for comparison.     

Measuring Spasticity and Fine Motor Control (Pinch) Change in the Hand After Botulinum Toxin-A Injection Using Dynamic Computerized Hand Dynamometry

ObjectivesTo evaluate change in fine motor hand performance and to investigate the relationship between existing clinical measures and dynamic computerized dynamometry (DCD) after botulinum toxin-A (BTX-A) injections for adults with upper limb spasticity.DesignPretest/posttest clinical intervention study.SettingHospital outpatient spasticity clinics.ParticipantsA convenience sample of adults (N=28; mean age, 51y) with upper limb spasticity after acquired brain injury.InterventionsBTX-A injections for upper limb spasticity management.Main Outcome MeasuresDCD protocol using a piezoelectric pinch meter (termed DCD[pinch]); current clinical upper limb measures: Modified Ashworth Scale, Tardieu Scale, Action Research Arm Test, Michigan Hand Outcomes Questionnaire, and Goal Attainment Scale.ResultsBTX-A produced a significant change on DCD(pinch) and some current clinical measures, with correlations observed between DCD(pinch) and current clinical measures.ConclusionsDCD(pinch) sensitively and objectively assessed the effects of BTX-A on upper limb spasticity during a simulated functionally based pinch and release task.