膝关节镜术后中西医结合康复训练临床观察

目的:观察中西医结合康复训练对膝关节镜术后膝关节功能恢复的影响,并与单纯CPM机康复训练效果进行比较.方法:膝关节镜术后患者72例,随机分为两组.各36例.实验组实施中西医结合早期康复训练配合CPM机功能锻炼,对照组单纯实施CPM机功能锻炼.结果:治疗组术后2、4周的膝关节HSS功能评分与对照组比较,有显著性差异(P<0.05).结论:膝关节镜术后采用中西医结合康复训练方法配合CPM机锻炼能促进膝关节肿胀消退及减轻患肢疼痛度,促进膝关节早期功能恢复.     

中医手法结合CPM机训练对全膝关节置换术后患膝功能恢复的影响

【目的】探讨中医手法结合持续被动训练机(CPM)训练对全膝关节置换术(total knee arthroplasty,TKA)后患膝功能恢复的影响。【方法】将55例患者随机分为观察组31例和对照组24例,对照组采用常规的早期康复训练,观察组在早期康复训练的基础上给予中医手法结合CPM机训练。2组均从术后第1天开始早期康复训练,观察组于术后第2天开始中医手法治疗,术后第3天开始CPM机训练,各种治疗均至术后第12天结束,疗程共12 d。用美国特种外科医院(HSS)膝关节功能评分量表对2组患者的膝关节在疼痛、行走功能、关节活动度、肌力、屈曲畸形、稳定性、减分项目和总分等方面的评分结果进行比较。【结果】(1)TKA术后12 d,观察组在疼痛、功能、活动度、减分项目和总分方面的改善作用显著优于对照组,差异有统计学意义(P0.05)。在肌力、屈曲畸形、稳定性方面作用相仿,差异无统计学意义(P0.05)。(2)TKA术后12 d,观察组优良率为93.55%,对照组为50.00%。观察组疗效显著优于对照组,2组比较差异有统计学意义(P0.05)。【结论】中医手法结合CPM机训练有利于全膝关节置换术后患膝功能的恢复。     

CPM机在粉碎性髌骨骨折患者术后的应用研究

目的探讨粉碎性髌骨骨折术后给予CPM机功能锻练的疗效。方法选取内蒙古医科大学第二附属医院创伤科行"粉碎性髌骨骨折切开复位内固定术",术后需做康复训练的患者40例,按入院先后顺序随机分为2组:对照组和实验组各20例,实施前均需评估患者病情并做好其心理护理。术后对照组给予自主功能训练;实验组采用CPM机功能锻炼,最后对比两组在做康复训练期间疼痛强度、术后2、4周膝关节活动度(ROM)及3个月后膝关节功能恢复优良率。用量角器测量膝关节活动度,依据VAS、HSS测量疼痛程度及膝关节功能评分,并比较两组膝关节功能恢复的优良率。结果患者术后2、4周膝关节活动度比较:实验组2、4周ROM分别为(76.25±3.78)、(95.93±4.66);对照组为(52.86±3.26)、(73.75±4.97),实验组膝关节活动度大于对照组。比较术后24 h、48 h、72 h疼痛程度:实验组分别为(5.45±0.67)、(3.75±0.62)、(2.05±0.59);对照组为(6.00±5.85)、(5.00±4.52)、(3.00±2.57),实验组疼痛程度小于对照组。结论术后早期患者应用CPM机进行屈伸训练可以促进患肢血液循环和淋巴回流,加速切口及骨质愈合,加快膝关节功能恢复,预防并发症发生,缩短住院时间,节省住院费用,提高患者出院时满意度,CPM机应广泛应用于骨科临床康复训练中。     

CPM结合康复训练在人工全膝关节置换术中的早期应用

目的 研究人工全膝关节置换术(Total Knee Replacement TKR)后早期应用关节持续被动活动器(Continuous Passive Motion CPM)结合康复训练效果,探讨TKR后早期康复治疗的意义及价值.方法回顾分析我科18例20膝TKR后的患者早期应用CPM结合康复训练治疗方法,以膝关节的关节活动度(Range Of MotionROM),HSS评分作为评定标准.结果CPM结合康复训练的早期综合康复治疗方法,18例20膝患者均于术后第5天下地,术后平均ROM为(104.9±11.2)0,伸直均达到00;术后膝关节HSS评分平均为85.3 分.结论 早期应用CPM机结合康复训练可促进关节功能早日康复.     

CPM机对人工全膝关节表面置换术术后膝关节功能康复的影响

目的研究人工全膝关节表面置换术后患者早期应用CPM机辅助康复锻炼对膝关节功能恢复的影响。方法选择2016年9月至2017年12月在郑州大学第一附属医院行人工全膝关节表面置换术的患者97例,根据患者术后康复锻炼方法分为改良CPM组、传统CPM组及未使用CPM组。比较3组患者术前以及术后第14天时膝关节功能的情况。结果术后第14天时3组患者膝关节HSS评分较术前均增加,差异有统计学意义(均P<0.05)。术后第14天时3组患者膝关节HSS评分比较,差异有统计学意义(P<0.05);随后进行组间两两比较,改良CPM组膝关节HSS评分高于传统CPM组与未用CPM组,差异有统计学意义(均P<0.05)。传统CPM组术后14 d膝关节HSS评分与未用CPM组比较,差异无统计学意义(P>0.05)。结论术后早期改良CPM机的使用有助于人工全膝关节表面置换术患者膝关节功能的恢复。     

CPM合用活血止痛汤对膝关节置换术后功能康复的影响

目的:探讨早期进行康复训练对人工全膝关节置换术后功能恢复的作用.方法:对60例人工全骆关节置换术后患者随机分成两组,治疗组予以CPM合用活血止痛汤内服,对照组单用CPM,6周后对两组膝关节功能恢复参照改良膝关节HSS功能评分.结果:两组患者膝关节功能较术前明显改善,治疗组明显优于对照组.结论:CPM合用活血止痛汤对人工...     

早期康复训练及院外延续训练对全膝关节置换术术后功能康复的影响

目的:探讨早期康复训练及院外延续训练对全膝关节置换术术后功能康复情况的影响。方法:将90例行全膝关节置换术的患者随机分为观察组45例,对照组45例,其中观察组在术后1周即行康复训练,患者出院后继续行院外延续训练,对照组在术后3周按照传统方法行康复训练。结果:两组比较,观察组术后膝关节功能恢复情况优于对照组,差异有统计学意义(P<0.05)。患者出院时Barthel指数评分、HSS评分,两组比较,差异无统计学意义(P>0.05),出院后1个月、3个月、6个月,患者Barthel指数评分及HSS评分比较,观察组均高于对照组,差异有统计学意义(P<0.05)。结论:对全膝关节置换术患者实施早期康复训练及院外延续训练,能有效促进患者膝关节肢体功能的恢复,值得临床推广应用。     

老年关节炎患者人工膝关节置换术后功能与变量因素相关性研究

目的探讨老年关节炎(OA)患者人工膝关节置换术(TKA)后功能与变量因素相关性。方法回顾72例行TKA的老年OA患者围手术期及术后临床资料,采用HSS评分对老年人TKA后早期膝关节功能进行评价。结果 72例顺利完成TKA,术后2周与术前比较在关节活动度、HSS评分、关节疼痛、关节功能及活动度差异均有统计学意义(均<0.05),TKA术后2周HSS评分与术前膝关节活动度、术前HSS评分、术前膝关节疼痛、术后早期CPM应用情况(即CPM初始角度)显著正相关(<0.05)。结论影响骨OA患者膝关节功能的因素复杂,作用于骨OA患者的手术治疗前后,影响疗效,并提示预后,明确这些因素可以指导临床治疗。     

舒适护理在创伤性骨折患者中应用价值分析

目的:研究创伤性骨折患者采用舒适护理的临床价值.方法:选取我院收治的94例创伤性骨折患者,随机分为观察组(n=47)和对照组(n=47),其中基础护理对象,定义为对照组,舒适护理对象,定义为观察组.比较护理效果.结果:观察组护理满意度为95.74%,对照组护理满意度为80.85%,P<0.05;护理前,2组VAS疼痛评分、CPM膝关节活动度评分以及HSS膝关节功能评分比较无差异,P>0.05;护理后,观察组VAS疼痛评分、CPM膝关节活动度评分以及HSS膝关节功能评分均明显改善,优于对照组,P<0.05.结论:对创伤性骨折患者采用舒适护理干预措施,护理效果优异,值得借鉴.     

持续被动运动机辅助早期功能锻炼在胫骨平台骨折术后中的应用

目的探讨持续被动运动(CPM)机辅助早期功能锻炼在胫骨平台骨折(FTP)术后中的应用效果。方法行手术治疗的FTP患者78例,随机分为观察组及对照组,各39例。对照组术后予常规膝关节活动和肌肉力量锻炼,观察组术后CPM机辅助早期功能锻炼,观察两组术后1、3及12个月膝关节活动度(ROM)、膝关节功能、胫骨平台内翻角(TPA)与胫骨平台内侧后倾角(PSA)的变化,并比较并发症发生情况。结果观察组术后1、3及12个月ROM及Rasmussen评分均高于对照组(均P<0.05)。术后12个月观察组TPA与PSA均低于对照组(均P<0.05)。观察组术后并发症发生率低于对照组(P<0.05)。结论CPM机辅助早期功能锻炼用于FTP患者术后不仅可提升膝关节活动度,改善膝关节功能,而且可减少FTP患者术后内外髁塌陷程度,减少术后并发症发生。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.