深度呼吸训练器对下颈段颈髓损伤患者功能恢复的影响

目的:研究深度呼吸训练器(Power-Breathe)增强呼吸肌的肌力、耐力及协调性,改善肺功能,从而改善神经功能、提高日常生活活动能力,促进下颈段颈髓损伤患者整体康复的作用。方法:将60例下颈段颈髓损伤四肢瘫的患者随机分为治疗组和对照组,对照组患者在常规康复治疗基础上,增加常规肺康复训练,包括:训练前护理和传统呼吸功能训练。治疗组在常规肢体康复及肺功能康复治疗的同时,加用深度呼吸训练器训练肺功能。患者均经过为期2个月的康复治疗周期,对患者肺功能、疲劳程度、神经功能(运动功能、感觉功能)及日常生活活动能力进行评估。结果:治疗后两组患者肺功能各项指标(FVC、MVV、MMEF、PEF)、Borg评分、FSAS评分、SCI-FRS评分、感觉评分、运动评分、BI评分均较治疗前有差异(P0.05),表明治疗后患者肺功能及疲劳程度、神经功能(运动、感觉)、日常生活活动能力均较治疗前改善。两组患者治疗前后感觉评分差异无显著性意义(P0.05),表明两组患者感觉功能改善程度大致相同。治疗组患者的肺功能各项指标及Borg评分、FSAS评分、SCI-FRS评分、运动评分、BI评分均较对照组有差异(P0.05),治疗组改善程度优于对照组。结论:深度呼吸训练器可在一定程度上改善患者肺功能,提高运动肌的肌力、耐力和日常生活活动能力,有利于患者整体功能恢复。     

缩唇腹式呼吸联合阻力呼吸训练器对老年慢性阻塞性肺病稳定期患者康复效果和生活质量的影响

目的观察缩唇腹式呼吸联合阻力呼吸训练器对老年慢性阻塞性肺病(COPD)稳定期患者康复效果和生活质量的影响。方法将2017年1~7月我院收治的120例老年COPD稳定期病例纳入研究,按照随机原则分为研究组和对照组各60例,对照组开展缩唇腹式呼吸训练,研究组予以缩唇腹式呼吸联合阻力呼吸训练器方案,比较两组训练前后肺功能[1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、FEV1/预计值(FEV1%pred)]、血气分析[血二氧化碳分压(PaCO_2)与氧分压(PaO_2)]、呼吸肌生理学[最大呼气压(MEP)与最大吸气压(MIP)]、6 min步行距离(6 MWT)、生活质量(SF-36)评分。结果训练后,研究组FEV1、FVC、FEV1/FVC及FEV1%pred均明显高于对照组(P0.05);血PaCO_2明显低于对照组(P0.05),PaO_2、MEP、MIP明显高于对照组(P0.05);6 MWT明显大于对照组(P0.05),SF-36量表中各项内容评分明显高于对照组(P0.05)。结论缩唇腹式呼吸联合阻力呼吸训练器能有效改善老年COPD稳定期患者血气分析,促进肺功能与呼吸功能的恢复,增加患者运动耐力,同时提高其生活质量,具有积极意义。     

变速变负荷运动训练对膝关节功能障碍患者康复疗效的影响

目的:研究膝关节功能障碍患者变速变负荷(VVR)运动训练后膝关节的主动活动度范围(AROM)、股四头肌和股二头肌峰力矩(PT)及Lysholm膝关节功能评定量表(LKSS)评分的变化。方法:将60例膝关节功能障碍患者随机分为变速变负荷训练试验组和对照组,两组患者均接受常规功能训练,变速变负荷运动训练试验组在常规功能训练基础上进行变速变负荷运动训练,两组患者于康复治疗前、治疗8周后分别进行膝关节的主动活动度范围(AROM)、股四头肌和股二头肌峰力矩(PT)、Lysholm膝关节功能评定量表(LKSS)各评定1次。结果:治疗后两组患者膝关节的主动活动度范围(AROM)、股四头肌和股二头肌峰力矩(PT)、LKSS评分均较治疗前有明显改善(P<0.05),但变速变负荷运动训练试验组上述各项参数指标改善幅度均明显优于对照组(P<0.05)。结论:采用VVR下肢肌力测定训练系统对膝关节功能障碍患者进行运动训练不仅有利于膝关节主动活动度、股四头肌和股二头肌峰力矩的恢复,而且还有利于其生存质量的提高;VVR下肢肌力测定训练系统应该结合膝关节功能障碍患者实际病情,制定"个体化康复治疗方案",尽早应用于膝关节功能障碍患者的康复治疗。     

下肢康复机器人对改善脑卒中偏瘫患者下肢肌力及运动功能障碍的临床研究

目的:观察下肢康复机器人训练对早期脑卒中偏瘫患者下肢肌力及运动功能的影响。方法:将50例发病6个月内的脑卒中患者随机分为试验组和对照组,每组25例。在常规康复训练的基础上,对照组给予MOTOmed智能运动系统训练,每次30min,每周5次,共治疗8周;试验组给予下肢康复机器人训练,每次30min,每周5次,共治疗8周。治疗前及治疗8周后采用徒手肌力量表(MMT)评估下肢肌力,采用简式Fugl-Meyer运动量表(FMA)评估下肢运动功能,采用下肢康复机器人数据反馈系统评估下肢肌力。结果:治疗前两组患者的一般资料、MMT评估、Fugl-Meyer评估、机器人客观数据评估差异均无显著性意义(P0.05),治疗后两组MMT评估、Fugl-Meyer评估、机器人客观数据评估差异均有显著性意义(P0.05),且试验组均优于对照组(P0.01)。结论:下肢康复机器人结合常规康复治疗能有效地改善早期脑卒中偏瘫患者下肢肌力及运动功能障碍。     

任务导向性训练结合肌力训练对脑卒中后遗症期偏瘫患者运动功能的影响

目的:探讨任务导向性训练结合肌力训练对脑卒中后遗症期偏瘫患者运动功能的影响.方法:将42例脑卒中后遗症期偏瘫患者随机分为治疗组(21例)和对照组(21例),两组患者均接受常规药物治疗和康复治疗.康复治疗方法:治疗组采用任务导向性训练和肌力训练相结合的运动治疗,对照组采用易化技术.两组患者均于治疗前、治疗6周后进行偏瘫肢体运动功能、ADL能力和移动能力评价.结果:治疗6周后,治疗组患侧下肢FMA评分、MBI评分及EMS评分与对照组比较均有明显提高,差异具有显著性意义(P＜ 0.05).结论:任务导向性训练结合肌力训练有利于提高脑卒中后遗症期偏瘫患者下肢运动功能和ADL能力.     

缩唇腹式呼吸辅以阻力呼吸训练器对COPD稳定期老年病人肺功能和生存质量的影响

[目的]探究缩唇腹式呼吸辅以阻力呼吸训练器对慢性阻塞性肺疾病(COPD)稳定期老年病人肺功能和生存质量的影响。[方法]将2016年4月─2017年3月我院呼吸科收治的58例COPD稳定期病人作为对照组,进行腹式呼吸训练;将2017年4月─2018年3月我院呼吸科收治的58例COPD稳定期病人作为研究组,实施缩唇腹式呼吸辅以阻力呼吸训练器,干预前及干预第2周末对两组病人的肺功能、二氧化碳分压(PaCO_2)及氧分压(PaO_2)、生活质量进行测评。[结果]干预后,研究组病人的肺功能优于对照组,PaCO_2低于对照组,PaO_2高于对照组,生活质量各维度评分高于对照组,差异有统计学意义(P0. 05)。[结论]缩唇腹式呼吸辅以阻力呼吸训练器应用于稳定期COPD老年病人,能改善其肺功能,提高其生存质量。     

肺康复运动训练改善慢性阻塞性肺疾病病人运动能力的研究进展

综述慢性阻塞性肺疾病(COPD)病人运动能力的现状及肺康复运动训练的有效性、COPD病人运动能力的评估方法(耐力评估、肌力评估)、肺康复运动训练的实施方案(耐力运动训练、阻力运动训练、呼吸训练、中国传统运动训练等),旨在为医护人员早期、有效地开展肺康复运动训练提供参考。     

认知行为疗法结合生物反馈训练对冠状动脉搭桥术后患者认知功能效果评价

目的:观察认知行为疗法(CBT)结合生物反馈训练,对行冠状动脉搭桥术后认知功能障碍患者的康复护理效果。方法:纳入80例择期行冠脉搭桥术后认知功能障碍的患者,随机分为试验组(n=40)和对照组(n=40),对照组进行常规康复护理,试验组加用认知行为疗法结合生物反馈训练,比较两组干预前后的蒙特利尔认知功能评估量表(MoCA)评分情况。结果:试验组在命名、注意力、抽象思维、延迟回忆单项评分及总标准分较干预前评分提高(P0.05);对照组的总标准分较干预前提高(P0.05);试验组在注意力、语言、延迟回忆单项评分及总标准分较对照组评分提高(P0.05)。结论:CBT结合生物反馈训练可改善冠脉搭桥术后患者的认知功能,提高康复效果。     

核心肌力训练在胸腰椎骨折功能锻炼中的应用

目的探讨胸腰椎骨折临床功能锻炼中实施核心肌力训练的效果。方法选取我院脊柱科2018年5月至2019年5月接治的92例压缩性胸腰椎骨折手术患者,按照随机数字法将其等分为试验组和对照组,两组均行改良椎弓根内固定术,对照组实施常规康复护理,试验组行核心肌力训练。应用Oswestry功能障碍指数(ODI)、改良日本骨科协会腰痛评分表(M-JOA)评估康复效果、腰椎活动度,比较两组临床疗效。结果治疗前、治疗1周两组ODI评分、M-JOA评分差异无统计学意义(P 0. 05),治疗1,3个月后试验组均明显优于对照组(P 0. 05)。试验组临床疗效优于对照组(P 0. 05)。结论在胸腰椎骨折手术后配合核心肌力训练,可有效缓解疼痛,促进腰椎功能恢复,提高康复效果。     

早期持续康复训练在重症监护病房肝移植术后患者中的应用效果

目的:探讨早期持续康复训练对肝外科重症监护病房(Liver Intensive Care Unit,LICU)肝移植术后患者康复的作用。方法:收集2017年3月至2018年1月在复旦大学中山医院行同种异体原位肝移植术后入住LICU患者43例,分为两组,对照组接受7 d康复训练(n=15),试验组接受持续14 d康复训练(n=28)。康复训练包括包括下肢肌力及平衡功能训练。采用下肢徒手肌力评定(MMT)量表、Berg平衡量表及焦虑自评量表(SAS)评定训练效果。两组患者均在第1次康复训练之前进行首次康复评定;对照组在康复训练后第7天进行第2次评定,试验组则在康复训练后第14天进行第2次评定。结果:试验组患者下肢肌力、平衡功能及焦虑改善情况总体效果优于对照组(P<0.05)。结论:在LICU早期持续康复训练能提高肝移植术后患者下肢肌力及平衡功能,并改善其焦虑状态。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.