多感觉联合刺激对颅脑损伤昏迷患者的促醒作用

目的 观察多感觉联合刺激促醒治疗措施在颅脑损伤昏迷患者康复护理中的干预效果以及对其并发症的影响。 方法 选取2017年10月至2019年7月于曲靖市第一人民医院康复医学科就诊的颅脑损伤昏迷患者60例,按随机数字表法分为对照组和观察组,每组患者30例。对照组采用常规治疗护理方法,观察组在此基础上增加听觉刺激、触觉刺激、视觉刺激、嗅觉刺激和味觉刺激等多感觉联合刺激干预。记录2组患者的恢复清醒时间和清醒率,以及治疗过程中的并发症发生情况和治疗30 d后患者及其家属的满意度。于治疗前和治疗30 d后（治疗后）对2组患者的神经功能进行评估。 结果 干预后,观察组的恢复清醒时间和清醒率均优于对照组,差异均有统计学意义（P<0.05）。干预后,2组患者的GCS、NDS和NIHSS评分与组内干预前比较,差异均有统计学意义（P<0.05）;且观察组干预后的GCS、NDS和NIHSS评分均显著优于对照组干预后,差异均有统计学意义（P<0.05）。干预后,观察组并发症发生率为16.67%,显著低于对照组的36.67%,差异有统计学意义（P<0.05）;观察组满意度为86.67%,显著高于对照组的63.33%,差异有统计学意义（P<0.05）。 结论 多感觉联合刺激可以促进颅脑损伤昏迷患者恢复清醒,有利于神经功能的恢复,降低并发症的发生率。     

46例颅脑外伤术后持续昏迷患者的护理

江苏省江都市第一人民医院2003年9月～2005年12月，共收治颅脑外伤术后持续昏迷患者46例，现将护理体会报告如下。     

颅脑外伤术后持续昏迷患者的护理

我院2004年1月至2006年11月,共收治颅脑外伤术后持续昏迷患者58例,现将其护理报告如下。     

护理干预对重型颅脑损伤昏迷患者的促醒作用

目的探讨临床综合性呼唤式护理干预对重型颅脑损伤昏迷患者的促醒作用。方法对照组60例患者采用常规性护理方法,研究组60例患者采用综合性呼唤式护理方法,分别对患者治疗前及治疗后10d、20d、30d的格拉斯哥昏迷评分(GCS)和清醒情况进行记录和比较分析。结果两组患者于治疗后经护理GCS评分逐渐升高,治疗后20d和30d时,研究组评分(8.37±2.74,12.50±2.98)明显高于对照组(6.58±2.66,9.02±2.91),差异有统计学意义(P<0.05)。结论采用综合性呼唤式护理方法对于重型颅脑损伤昏迷患者具有较好的临床护理疗效,能够有效提高觉醒率,适合于临床推广应用。     

刺激性康复护理对颅脑损伤致昏迷患者的促醒作用研究

目的:探讨刺激性康复护理对颅脑损伤致昏迷患者的促醒作用及预后的影响.方法:选择格拉斯哥昏迷评分(GCS)≤8分的颅脑损伤昏迷患者64例,随机分为观察组(刺激性康复护理组)及对照组(常规护理组)各32例,对照组采用常规护理方法,观察组在常规护理的基础上,同时给予刺激性康复护理.于住院2个月后比较两组的清醒率、清醒时间及临床疗效.结果:观察组患者昏迷转清醒率较对照组明显增高(P<0.05),清醒时间较对照组明显缩短(P<0.01),临床疗效优于对照组(JP<0.05).结论:刺激性康复护理应用于颅脑损伤患者,能促进患者早日清醒,减少致残率和病死率,改善预后.     

46例颅脑外伤术后持续昏迷患者的护理

江苏省江都市第一人民医院2003年9月~2005年12月,共收治颅脑外伤术后持续昏迷患者46例,现将护理体会报告如下。1临床资料46例患者,男31例,女15例,年龄7~82岁,平均37.6岁。受伤原因为车祸、坠落伤、打击伤。伤后昏迷时间45 min~24 h,平均4.7 h。入院时GCS 3~9分,平均5.7分。术后昏迷时间15~102 d,平均33 d。气管切开17例,套管保留时间18~90 d,平均32.5 d。2结果46例患者中,痊愈及好转30例,自动出院7例,植物生存状态4例,死亡5例。出院患者生活完全自理者12例,部分自理10例,不能自理8例。3护理3.1术后病情观察颅脑外伤开颅术后24 h是颅内血肿…     

110例颅脑外伤伴昏迷患者的急诊气道处理

近年来,颅脑外伤患者随着交通事故的增加而逐渐增多。尤其是伴昏迷的患者病情危急,临床发现很多患者在送达医院急诊时出现不同程度的缺氧,呼吸困难,严重者出现窒息,呼吸停止,失去宝     

颅脑外伤后持续昏迷患者并发湿疹20例的护理

湿疹是多种内外因素所引起的一种瘙痒性皮肤病。其皮损为多形性,如斑、丘疹、丘疱疹、糜烂、渗出、结痂、肥厚及苔藓样变等[１]。本病可发生于全身各处,反复发作,病程迁延。我科从１９９９年８月至 ２０００年４月收治２０例颅脑外伤后持续昏迷的患者,２０例患者并发了程度不一的湿疹,通过药物治疗及全面护理,收到了良好的效果。     

听觉诱导应用于颅脑外伤昏迷唤醒护理的效果分析

目的：探讨采用听觉诱导措施护理颅脑外伤昏迷患者的效果。方法随机选取我院收治的颅脑外伤昏迷患者90例,将其随机分为观察组以及对照组,每组45例。对照组给予常规护理,观察组采取听觉诱导唤醒护理措施。比较两组患者治疗前以及治疗后2、8周、治疗结束时的格拉斯哥昏迷( GCS)评分,治疗后8周以及治疗结束时的脑电图改善情况,治疗8周后的听觉诱发电位( BAEP)变化。结果观察组患者VAP的发生率为48.89%,对照组为75.56%( P<0.05),观察组治疗后的脑电图改善明显优于对照组,观察组治疗8周后的BAEP频率以及反应性变化均明显优于对照组(均P<0.05)。结论听觉诱导治疗方法应用于颅脑损伤后昏迷患者能够显著提高患者的GCS评分,改善其脑电图以及听觉诱发电位的变化,提高治疗效果,值得临床推广应用。     

生长激素治疗烧伤的随机对照试验的系统评价

目的评价生长激素治疗烧伤的有效性和安全性.方法检索中国生物医学文摘数据库、MEDLINE、EMBASE和Cochrane图书馆,收集所有相关随机对照试验,对其逐个进行质量评价,并进行Meta-分析.结果纳入9个高质量研究,共治疗732例患者.①有助于烧伤创面的愈合[WMD-11.25,95%CI(-14.84,-7.66),P＜0.000 01];②有助于供皮区创面的愈合[WMD-1.87,95%CI(-2.28,-1.47),P＜0.000 01];③有助于缩短住院时间[WMD-8.10,95%CI(-10.40,-5.79),P＜0.000 01];④使用生长激素后,患者静息能量消耗有降低的趋势但尚无统计学意义[WMD-0.04,95%CI(-0.08,0.00),P=0.06];⑤生长激素会引起血糖升高[SMD 0.98,95%CI(0.54,1.42),P＜0.000 01],和血胰岛素升高[SMD 0.86,95% CI(0.43,1.30),P=0.000 1];病死率[OR 1.15,95%CI(0.15,8.53),P=0.9]和脓毒血症的发生方面无差异[OR 1.08,95% CI(0.50,2.34),P=0.8]及呼吸机需求方面无差异[OR1.51,95%CI(0.72,3.16),P=0.3].结论目前资料表明烧伤患者在监测和控制好血糖水平的条件下运用生长激素是安全、有效的.     

The Efficacy of Physical Therapy Modalities in Patients With Hemophilia: A Systematic Review of Randomized Controlled Trials With Meta-analysis

ObjectiveTo evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation.Data SourcesSeven databases—PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov—were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia.Study SelectionAfter abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria.Data ExtractionRelevant data were extracted from eligible studies and outcomes were categorized according to the ICF.Data SynthesisUsing Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I² test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead.Results35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model.ConclusionThis systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.     

心理干预治疗癌症患者抑郁症的系统评价

目的系统评价心理干预治疗癌症患者抑郁症的疗效。方法计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库,检索时间从各数据库建库至2009年10月;同时手工检索相关领域的杂志,全面查找符合纳入标准的随机对照试验（RCT）,用RevMan5.0软件进行统计分析。结果共纳入11篇RCT,包括1670例患者。Meta分析结果显示,常规治疗和心理干预联合常规治疗在治疗癌症患者抑郁症得分减少方面差异有统计学意义[SMD=–0.40,95%CI（–0.70,–0.11）],在治疗癌症患者焦虑症得分减少方面差异无统计学意义[SMD=–0.68,95%CI（–1.37,0.01）]。敏感性分析结果显示,心理干预联合常规治疗与常规治疗癌症患者焦虑症得分方面差异有统计学意义[SMD=–0.30,95%CI（–0.52,–0.08）]。结论与常规治疗相比,心理干预联合常规治疗癌症患者可明显改善癌症患者的精神障碍症状,但尚需更多高质量大样本的随机对照试验进一步证实。     

内镜下气囊扩张治疗贲门失弛缓症的系统评价

目的系统评价内镜下气囊扩张治疗贲门失弛缓症的有效性和安全性。方法计算机检索Cochrane图书馆临床对照试验数据库(2007年第1期)、MEDLINE(1978～2007年)、EMbase(1978～2007年)、OVID数据库(1978~2007年)、中国生物医学文献数据库(1978～2007年)、维普中文期刊数据库(1989～2007年)、中国期刊全文数据库(1979～2007年)和万方学位论文数据库(1978～2007年),手工检索相关会议论文集及所获文献的参考文献,全面收集全世界关于内镜下气囊扩张治疗贲门失弛缓症的随机对照试验。按Cochrane协作网推荐的方法进行系统评价。结果共纳入24个RCT,包括1045例患者。Meta分析结果显示:①短期总有效率:内镜下气囊扩张治疗优于内镜下注射肉毒杆菌毒素治疗[OR0.47,95%CI(0.30,0.73);P=0.0007]。②长期总有效率:内镜下气囊扩张治疗优于内镜下注射肉毒杆菌毒素治疗[OR0.31,95%CI(0.13,0.70);P=0.005]。③临床复发率:内镜下注射肉毒杆菌毒素治疗高于内镜下气囊扩张治疗[OR8.88,95%CI(3.31,23.79);P<0.0001]。④副作用及并发症发生率:内镜下气囊扩张治疗高于内镜下注射肉毒杆菌毒素治疗[OR0.14,95%CI(0.04,0.44);P=0.0008];经腹开放性括约肌切开治疗高于内镜下气囊扩张治疗[OR0.15,95%CI(0.05,0.44);P=0.0006]。结论目前的证据表明,内镜下气囊扩张治疗具有较好的长短期疗效,且操作简单方便,不良反应少,建议在临床实践中依患者病情选用。     

Effect of Scraping Therapy on Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveThe purpose of this study was to review the literature on the effect of scraping therapy on chronic low back pain (LBP) from randomized controlled trials (RCTs).MethodsThree English medical electronic databases (PubMed, Embase, and the Cochrane Library) and 2 Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials related to the effects of scraping therapy on chronic LBP were included in this systematic review. Study selection, data extraction, and validation were conducted independently by 2 reviewers. The methodological quality of the studies was evaluated by the Cochrane risk-of-bias tool. RevMan 5.3 software was applied to perform meta-analysis of the data.ResultsTen studies comprising 627 participants were included. Overall, the quality of evidence was moderate owing to a lack of blinding and allocation concealment in some studies and unclear risk of selective reporting. Meta-analysis of 9 RCTs indicated that scraping therapy had a statistically significant effect on pain reduction (standard mean difference = ?0.66, 95% confidence interval [CI], ?0.83 to ?0.49, P < .001). However, if only a single scrape treatment was carried out, the results did not show that scraping was superior to the control group regarding pain relief (mean difference = ?0.35, 95% CI, ?1.23 to 0.53, P = .44). Moreover, the results of 6 RCTs involving 468 participants showed significantly greater improvement in lumbar dysfunction (mean difference = ?10.05, 95% CI, ?13.52 to ?2.32, P < .001). In addition, the results of 5 RCTs involving 393 participants showed a favorably significant effect on the overall efficacy (odds ratio = 4.74, 95% CI, 2.34-9.62, P < .001). As for follow-up effects, meta-analysis of 3 RCTs involving 241 participants showed a promising effect on pain reduction and lumbar function improvement at 1 month and 3 months after the end of treatment, respectively. Only 1 study reported adverse effects, and none were serious.ConclusionScraping therapy may have a therapeutic effect for some individuals with chronic LBP. However, due to the limited amount of research and the low methodological quality of the included studies, additional large-scale, multicenter, high-quality RCTs on relieving pain intensity and improving lumbar dysfunction are still necessary.     

CMH检验和Meta分析在临床试验中心效应分析的应用探讨

目的探讨比较多中心临床随机对照试验中心效应的统计分析方法。方法以一项多中心临床随机对照试验数据为例，运用CMH检验及Meta分析。结果CMH检验显示各中心间效应值一致性检验差异有统计学意义（P〈0．05）而Meta分析的异质性检验结果显示差异无统计学意义（χ^2=12．81，P=0．12），采用固定效应模型，合并后效应值组问差异有统计学意义（Z=3．35，P〈0．05）。结论多中心临床随机对照试验研究中，如果存在分中心组间疗效差异趋势不一致时，可选择Meta分析，再根据Meta分析异质性检验结果，选择适合的模型进行合并后效应值的组问比较，并结合CMH检验给出结论。     

他汀类药物治疗心房颤动随机对照试验的Meta分析

目的评价他汀类药物抗心房颤动（房颤）的疗效。方法采用Cochrane系统评价的方法,计算机检索PubMed、EMbase、EMB Reviews—Cochrane Central Register of Controlled Trials（2007年第3期）、中国生物医学文献数据库、中文科技期刊数据库,中国期刊全文数据库,检索时间截至2007年9月15日,纳入中外文他汀类药物抗房颤的随机对照试验（RCTo由两名评价者独立评价纳入研究质量、提取资料并交叉核对。采用RevMan4．3软件进行Meta分析。结果共纳入5个RCT,包括470例房颤患者。各研究间存在统计学异质性（I^2=66．8％,P=0．02）,故采用随机效应模型进行合并分析,其结果显示,他汀类药物可减少房颤复发,发生率[RR=0．61,95％CI（0．43,0．88）,P=0．008o敏感性分析显示结果稳定性较好,失安全数为52．91。结论他汀类药物可以有效降低房颤的复发和发生率。但本研究中部分文献质量不高,加之有关他汀类药物预防房颤的RCT文献数量较少,总样本量较小,上述结论尚有待开展大样本、随机、双盲对照试验证实。     

血脂康治疗糖尿病肾病的系统评价

目的系统评价血脂康治疗糖尿病肾病（DKD）的疗效和安全性。方法计算机检索Cochrane图书馆临床对照试验资料库（2008年第3期）、MEDLINE（1980～2008．9）、EMbase（1980～2008．9）、CBMdisc（1990～2008．9）、CNKI（1994～2008．9）,手工检索相关文献,按纳入与排除标准选择试验、评价质量,提取资料,并用RevMan 4．2软件对数据进行Meta分析。结果共纳入血脂康治疗糖尿病肾病的9个RCT,8个RCT的方法学质量评价为B级,另1个为C级。Meta分析结果显示：血脂康组在降低DKD患者24h尿蛋白[WMD=-0．87,95％CI（-1．34,-0．41）]、尿微量白蛋白[WMD=-115．39,95％CI（-127．63,-103．15）]及尿蛋白排泄率方面[WMD=-65．46,95％CI（-68．87,-62．12）]均优于常规治疗组;血脂康组在改善DKD患者Scr水平方面[WMD=-5．42,95％CI（-11．06,0．21）]与常规治疗组相似;血脂康组在降低TC[WMD=-1．71,95％CI（-2．39,-1．03）]、TG[WMD=-0．96,95％CI（-1．46,-0．46）]、LDL-C[WMD=-1．01,95％CI（-1．64,-0．38）]以及升高HDL-C[WMD=0．22,95％CI（0．09,0．36）]方面均优于常规治疗组;血脂康在改善FBS方面[WMD=-0．01,95％CI（-0．49,0．47）]与常规治疗组相当,但在改善2h-Bs[WMD=-1．10,95％CI（-1．35,-0．85]、HbA1c方面[WMD=-0．41,95％CI（-0．56,-0．27）]优于常规治疗组。血脂康未见明显不良反应或过敏反应的报道。结论现有的临床证据显示,血脂康能够降低24h尿蛋白、尿微量白蛋白及尿蛋白排泄率,且能调节血脂（降低TC、TG、LDL-C和升高HDL-C）和控制血糖（降低2h-BS和HbA1c）。但由于纳入研究存在选择性偏倚和测量性偏倚的中度可能性,势必影响结果的论证强度,期待更多高质量的随机双盲对照试验提供高质量的证据。     

Pharmacologic Prophylaxis of Stress Ulcer in Non-ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

PurposeAcid-suppressive medications are widely used in non–intensive care unit (non-ICU) patients for stress ulcer (SU) prophylaxis. However, SU prophylaxis in this population is still controversial. The purpose of this study was to systematically evaluate the efficacy and tolerability of these agents for SU prophylaxis in non-ICU patients.MethodsElectronic databases including Cochrane, ClinicalTrials.gov, Ovid-Medline, Embase, Chinese CNKI, and Wanfang Data were systematically searched on July 10, 2019, for randomized controlled trials (RCTs) that evaluated acid-suppressive medications in non-ICU patients. Network meta-analysis and pairwise meta-analysis were performed to calculate odds ratios (ORs) and 95% CIs. A random-effects model was used for generating pooled estimates. The primary outcome was occurrence of SU bleeding, and the adverse drug events (ADEs) were described as the secondary outcome.FindingsA total of 17 RCTs involving 1985 patients were eligible. Meta-analysis results indicated that the occurrence of SU bleeding was significantly decreased with all acid-suppressive medications compared with placebos (gastric mucosa protectants, OR = 0.29 [95% CI, 0.14–0.61]; H2-receptor antagonists, OR = 0.3 [95% CI, 0.18–0.50]; proton pump inhibitors [PPIs]: OR = 0.08 [95% CI, 0.04–0.16]). The occurrence of SU bleeding was significantly decreased with PPIs compared with gastric mucosa protectants (OR = 0.29; 95% CI, 0.12–0.72) and H2-receptor antagonists (OR = 0.28; 95% CI, 0.16–0.48). There was no significant difference between any 2 classes of PPIs on SU bleeding or any 2 acid-suppressive medications on ADEs.ImplicationsPPIs could significantly decrease SU bleeding risk without increasing ADEs than other acid-suppressive medications for SU prophylaxis in non-ICU patients. However, RCTs of high quality were required to confirm the findings of this investigation.     

健康教育对腰痛干预疗效的系统评价和Meta分析

目的:系统评价健康教育对腰痛患者疼痛、功能性活动及生活质量的临床效果。方法:计算机检索EMBASE、Web of Science、PubMed/Medline、The Cochrane Library、VIP、CNKI和WanFang Data数据库,搜索时限从2009年1月~2019年9月。由两名评价员独立筛选文献、提取数据并评价纳入研究的方法学质量,以RevMan 5.3软件进行Meta分析。结果:最终纳入27个研究,共2701例患者。Meta结果显示与对照组相比:①健康教育联合运动疗法在改善腰痛患者疼痛和功能障碍方面具有显著优势,NPRS评分[MD=-1.78,95%CI(-2.67,-0.89),P<0.01]、RMDQ评分[MD=-4.72,95%CI(-7.70,-0.84),P=0.01];②健康教育联合常规治疗在改善疼痛方面并无显著性差异,VAS评分[MD=-0.49,95%CI(-1.04,0.07),P=0.09],但在改善功能障碍方面具有优势,RMDQ评分[MD=-0.97,95%CI(-1.91,-0.02),P=0.04];③加强健康教育在疼痛改善方面具有优势,VAS评分[MD=-0.52,95%CI(-0.93,-0.11),P=0.01]、NPRS评分[MD=-0.41,95%CI(-0.75,-0.08),P=0.01],在改善功能障碍方面均无优势。所有研究在改善生活质量方面均无优势。结论:运动疗法或常规治疗基础上增加健康教育更有利于腰痛患者疼痛缓解,并能更好的改善因腰痛导致的功能障碍。且加强健康教育可能更加有效。受纳入研究数量和质量的限制,以上述结论尚待更多高质量研究予以验证。