夹脊低频电刺激对脊髓损伤影响的研究

目的：观察夹脊低频电刺激对脊髓损伤（SCI）患者的疗效。方法：SCI患者112例,随机分为观察组和对照组各56例,2组均进行常规康复治疗,观察组在此基础上加用夹脊低频电刺激治疗。观察2组患者痉挛程度及运动感觉功能变化。结果：治疗90d后,观察组Ashworth、腱反射、阵挛评分均较治疗前及对照组治疗后明显降低（均P〈0．01）,对照组仅腱反射评分较治疗前明显降低（P〈0．01）。2组运动及感觉功能评分均较治疗前明显提高（P〈0．05,0．01）,且观察组更高于对照组（P〈0．05,0．01）。结论：夹脊低频电刺激结合常规康复治疗可明显改善患者痉挛状态、提高运动和感觉功能。     

点穴配合常规康复治疗脑卒中偏瘫疗效观察

目的观察点穴配合常规康复治疗脑卒中偏瘫患者运动障碍的疗效。方法58例脑卒中偏瘫患者随机分为治疗组30与对照组28例；治疗组采用常规康复及点穴治疗；对照组仅接受常规康复治疗，分别于治疗前和治疗后12周采用Fugl-Meyer量表（FMA）评定患者的肢体运动功能，采用改良巴氏指数（MBI）评定日常生活活动能力（ADL）。结果治疗前两组患者的上下肢FMA积分无显著性差异（P〉0．05）；治疗后，治疗组患者的FMA积分较治疗前改善（P〈0．05），且明显优于对照组（P〈0．01），MBI评分高于对照组（P〈0．05）。结论点穴配合常规康复治疗可促进脑卒中患者运动功能的恢复，且效果优于常规康复治疗。     

运动模仿训练对脑卒中后本体感觉障碍及ADL的疗效

目的：观察运动模仿训练对脑卒中患者本体感觉障碍的疗效。方法：30例脑卒中偏瘫伴本体感觉障碍患者，随机分为治疗组（一般康复训练＋运动模仿训练）15例及对照组（一般康复训练）15例。以Fugl—Meyer评定法及改良Barthel指数量表作为观察指标，分别于入院时及治疗8周后进行评估。结果：治疗后治疗组运动积分和四肢本体感觉积分与治疗前比较差异均有显著性意义（P〈0．01），而对照组的运动积分与治疗前比较差异有显著性意义（P〈0．05），但四肢本体感觉积分与治疗前比较差异无显著性意义（P〉0．05）。治疗前，两组患者改良Barthel指数评分比较差异无显著性意义（P〉0．05），治疗后两组患者比较差异有非常显著性意义（P〈0．01）。结论：运动模仿训练对脑卒中偏瘫伴本体感觉障碍患者有良好的治疗作用，且本体感觉障碍的改善又有利用于ADL的提高。     

早期功能训练对脑卒中急性下肢深静脉血栓形成的影响

目的：比较脑卒中后急性下肢深静脉血栓形成（DVT）早期康复治疗与卧床制动对下肢功能影响及并发肺梗死风险的差异。方法：脑卒中并急性下肢深静脉血栓形成患者60例,随机分为观察组和对照组各30例,2组均予常规抗凝及消肿治疗,对照组予卧床、弹力袜支持及患肢抬高治疗7～14d后开始行肢体功能康复,观察组予早期（下肢血栓形成后1～2d）弹力袜支持下行肢体功能康复治疗。比较2组患者3个月内肺梗死的累计发生率和功能恢复情况。结果：2组患者3个月内均无症状性肺梗死病例发生。治疗3个月后,2组患者下肢FMA评分均较治疗前明显升高（P〈0．05,0．01）,且观察组更高于对照组（P〈0．01）;治疗后,2组VAS评分及双侧小腿内踝上缘治疗前后周径差值均较治疗前明显下降（P〈0．05,0．01）,且观察组更低于对照组（P〈0．01）。结论：脑卒中患者急性下肢深静脉血栓形成早期开始康复治疗较卧床治疗患肢功能改善更明显,且不增加肺梗死的发生率。     

早期康复治疗对脑卒中偏瘫患者肢体运动功能的影响

目的：探讨早期康复训练对脑卒中偏瘫患者肢体运动功能的影响。方法：108例脑卒中患者根据康复治疗开始的时间不同分为早期组56例及对照组52例，均按照神经内科常规治疗方案治疗，早期组患者在发病15～30d时即配合康复训练；对照组于发病3～6个月后接受康复训练。2组治疗前及治疗3个月后均进行运动功能评分（FMA）和ADL评分。结果：治疗前，早期组FMA评分明显低于对照组（P〈0．01），ADL评分差异无显著性意义；治疗3个月后，2组FMA评分和ADL评分与治疗前比较均有提高（P〈0．01、0．05），2组间比较，早期组明显高于对照组（P〈0．01）。结论：康复治疗早期介入对降低脑卒中的致残率，减少并发症具有重要意义。     

综合康复治疗对脑卒中患者运动功能障碍的疗效

目的 探讨综合康复治疗对脑卒中患者运动功能障碍的疗效。方法 121例急性脑卒中患者随机分为康复组（59例）与对照组（62例），康复组采用综合康复治疗（运动再学习和Bobath疗法）；对照组给予一般康复治疗，如针灸、理疗。采用临床神经功能缺损评分、改良巴氏指数评分（MBI）、Fugl-Meyer运动功能评分（FMA）在治疗前后对两组患者进行评定。结果 治疗前。两组患者的临床神经功能、FMA和MBI评分无显著性差异（P〉0．05）；治疗后，两组的评分均较治疗前明显改善（P〈0．01），但康复组改善的程度大于对照组（P〈0．05）。结论 综合康复治疗可促进脑卒中患者运动功能的恢复，对预后有良好影响。     

医学训练式治疗对膝关节损伤患者功能障碍的疗效观察

目的：观察医学训练式治疗（MTT）对膝关节损伤后功能障碍患者的疗效。方法：膝关节损伤后功能障碍患者80例,随机分为观察组和对照组各40例,2组均进行系统综合康复治疗,观察组加用MTT治疗。治疗前后评估患者肌力、疼痛程度及步行能力。结果：治疗4周后,2组患者PT、TW、AP及6min步行距离均较治疗前明显提高（均P〈0．05）,且观察组提高较对照组更显著（均P〈0．01）;2组VAS评分较治疗前明显降低（均P〈0．05）,且观察组降低较对照组更显著（P〈0．01）。结论：MTT能有效地改善膝关节损伤功能障碍患者的运动功能和疼痛程度。     

家庭康复计划对脑卒中偏瘫患者运动功能恢复的影响

目的 观察家庭康复计划对脑卒中偏瘫患者运动功能恢复的影响。方法 将64例脑卒中偏瘫患者随机分为康复计划组和对照组各32例，两组患者住院期间均接受系统康复治疗。出院回家后，康复计划组严格按照康复计划所规定的时间和内容进行康复训练．并每2周来康复门诊评估指导一次；对照组在每天训练与否、训练时间和训练内容等方面完全由自己掌握。采用Fugl—Meyer评测法（FMA）及改良Barthel指数（MBI）分别于治疗前、治疗5个月后对两组患者进行评定。结果 治疗5个月后，两组患者的FMA评分和MBI评分均较治疗前显著提高（P〈0．001），但康复计划组的康复效果显著优于对照组（P〈0．001）。结论 家庭康复计划可以明显促进脑卒中偏瘫患者运动功能的恢复。     

强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。     

中西医结合治疗脑卒中后感觉障碍

目的：观察中西医结合综合治疗脑卒中后感觉障碍的临床疗效。方法：脑卒中后感觉障碍患者52例随机分为2组各26例,均给予Bobath法、运动再学习、Rood技术等常规运动及感觉训练,观察组在此基础上增加中药、穴位注射等治疗,治疗前后采用Fugl-Meyer（FMA）法的感觉和运动评分对2组患者进行疗效评价。结果：治疗40d后,2组FMA评分感觉及运动功能积分均较治疗前明显提高（P〈0.01）,且观察组显著高于对照组（P〈0.05,0.01）。治疗后2组临床疗效比较,观察组总有效率明显高于对照组（92.31%、76.92%,P〈0.05）。治疗后,2组血液流变学各项检测指标均较治疗前明显降低（P〈0.05）,2组间比较差异无统计学意义。结论：中西综合治疗不仅有利于感觉功能恢复,而且对提高运动功能及改善血液黏稠度均有良好的作用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.