带血管蒂皮瓣修复肢体软组织缺损及综合康复42例报告

目的：提高皮瓣转移的成功率与功能康复。方法：对４２例皮瓣转移患者采用了术前、术后的康复治疗,并进行了随访。结果：成功率达９５％,修复的缺损部位的功能恢复满意。结论：综合性康复治疗对提高皮瓣转移术的成功率及降低术后功能障碍是不可或缺的方法     

In vitro measurements of aerodynamic characteristics of an improved tracheostoma valve for laryngectomees

Tracheostoma valves are often required in the rehabilitation process of speech after total laryngectomy. Patients are thus able to speak without using their hands to close the tracheostoma. The improved Groningen tracheostoma valve consists of a “cough” valve with an integrated (“speech”) valve, which closes for phonation. The cough valve opens as the result of pressure produced by the lungs during a cough. The speech valve closes by the airflow produced by the lungs, thus directing air from the lungs into the esophagus at a deliberately chosen moment. An experimental setup with a computer-based acquisition program was developed to measure the pressure at which the cough valve opened and the flow at which the speech valve closed. In addition, the airflow resistance coefficient of the tracheostoma valve was defined and measured with an open speech valve. Both dry air from a cylinder and humid expired air were used. Results showed a pressure range of 1–7 kPa to open the cough valve and a flow range of 1.2–2.7 l/s to close the speech valve. These values were readily attained during speech, while the flow range occurred above values reached in quiet breathing. The device appeared to function well in physiological ranges and was optimally adjustable to an individual setting. No significant differences were measured between air from a cylinder and humid expired air. Findings showed that methods used to obtain results could be employed as a reference method for comparing aerodynamic characteristics of tracheostoma valves. Received: 13 February 1997 / Accepted: 16 September 1997     

河南省大范围白内障复明工作的体会

目的探讨大范围白内障手术复明工作的组织管理和开展复明手术的方法。方法总结河南省：1988—2003年建立全省技术网络、有组织地开展人员培训及大范围白内障手术复明工作的经验。随机抽样调查了新的小切口非超声乳化手术效果。结果15年来各类白内障复明手术累计411886例。抽样调查12566例术后1-2天视力。视力≥0．5者占86．25％，0．8—1．0者占80．44％。每例手术所用时间大多在10—22分钟之间，其中娩核时间8—26秒。术中后囊破裂2．41％，玻璃体脱出1．14％。脱盲率99．12％，脱残率96．86％。结论在一个省范围内，采取适当措施和适用的手术方法，可以提前实现世界卫生组织与防盲协会所提出的“视觉2020”行动纲要的部分目标，先使白内障盲人“享有看见的权力”。     

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services.

The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.     

Rehabilitation in Charles Bonnet syndrome: a review of treatment options

People with vision loss sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinations often causes anxiety for the sufferer and can be difficult for the attending eye care professional to manage. A review of the literature highlighted a range of visual, pharmacological and social management regimes that may alleviate these hallucinations, albeit using small samples in uncontrolled trials. Eye care practitioners should be aware of methods of rehabilitation in Charles Bonnet syndrome that may lead to resolution of the visual hallucinations.     

不同镇痛方式对高龄肺癌手术后恢复的综合分析

【目的】观察3种不同的镇痛方式对高龄肺癌患者行肺叶切除术后康复的影响、镇痛效果及患者对术后镇痛方式的满意程度，以探讨最佳的镇痛方式。【方法】选择60例老年肺癌患者行肺叶切除术（年龄〉60岁），随机分成3组：肌肉注射吗啡镇痛组，静脉自控镇痛组，硬膜外自控镇痛组。连续3d观察患者的镇痛效果、满意程度、术后康复及术后并发症发生率的影响；检测术后3d患者的肺活量动脉血气，连续监测患者的脉搏氧饱和度。【结果】硬膜外自控镇痛组镇痛效果、满意程度明显优于另外两组，低氧血症的发生率及程度明显低于另外两组。硬膜外自控镇痛组的患者术后床上活动的时间明显早于另外两组。并能主动配合医护人员进行肺功能的康复治疗。【结论】老年肺癌患者行肺叶切除术采用硬膜外自控镇痛具有镇痛效果良好，能主动配合医护工作者进行早期肺功能的康复治疗的优越性。     

针刺配合康复训练治疗脑卒中后吞咽障碍的疗效观察

目的观察对比脑卒中后吞咽障碍的疗效；方法针刺配合康复训练；结果治疗组与对照组相比有非常显著的差异；结论针灸配合康复训练治疗脑卒中后的吞咽障碍有显著疗效。     

对男性海洛因依赖者康复训练效果的随访

目的:探索社区康复训练与劳动教养相结合的康复模式对男性海洛因依赖者的治疗效果。方法:以湖南省新开铺劳教大队的50名劳教吸毒人员为对照,对戒毒中心的50名劳教吸毒人员进行为期至少4个月的康复训练。康复训练以海洛因依赖者的需求、所处的康复阶段及接受能力为中心,包括强化戒毒治疗动机、减少吸毒造成的危害、复吸预防等各种技能训练。用成瘾严重度指数和应付方式问卷评估康复训练的疗效,并随访两组在解教后1 a的康复情况。结果:康复训练后海洛因依赖者幻想、退避、自责等不成熟型应付方式分值下降(P<0.01),求助的分值增加(P<0.01)。解教后1 a康复组与劳动教养组的戒断率差异无显著性,但康复训练组在海洛因滥用严重程度、违法犯罪行为和精神健康方面损害显著低于劳动教养组(P<0.05)。结论:劳动教养和社区康复训练都是对吸毒者有效的康复措施,康复训练的作用更大。     

视神经损伤后视觉功能重塑的研究进展

青光眼或其他原因导致的视神经损伤,以及颅脑损伤导致的视觉损伤通常被认为是不可逆的。然而,近年来的研究发现,神经系统具有明显的神经可塑性(neuroplasticity)。人们尝试对神经的可塑性作用机制进行阐明,并通过视觉经验、电流刺激、代偿性眼球运动训练及压力疏导等方法来激活或活化“休眠”细胞及视觉传递,并构建自组织映射模型对视觉重塑效果进行预估。