脑血管病患者的康复护理

脑血管病是一组突然起病的脑血液循环障碍性疾病，具有发病率、致残率、病死率高的特点，存活患者中大约3／4有肢体及语言功能障碍，严重影响患者的生存质量，给家庭和社会带来巨大负担。我科对2006年1月至2007年12月收治的262例脑血管病患者在进行积极治疗预防并发症的同时，及早进行康复护理，对减少致残、最大限度地发挥患者的残存功能、提高生存质量方面收到了较好效果，现报告如下。     

教学重演律在探索性药理学实验中的应用

探讨"教学重演律"在探索性药理学实验中的应用,为形成一种新的药理学实验教学模式提供理论基础。     

生理湿润环境对急慢性损伤愈合的临床观察

目的:探讨生理湿润环境对急慢性损伤愈合作用的临床效果.方法:采用多中心协作研究的方法,对59例住院或门诊急慢性损伤患者的创面采用美宝创面速愈贴创造生理湿润环境的方法处理,观察其减轻疼痛、预防控制感染、促进创面愈合和减少瘢痕的作用.结果:进入本次研究的病例59例,其中急性损伤28例,创面愈合时间5d~21d;慢性损伤31例,创面愈合时间7d～45d.收到了较好的止血、止痛、控制感染、促进愈合和减少瘢痕的效果,治愈率100%.结论:生理湿润环境不仅能够促进各种急慢性损伤的愈合,同时具有良好的止痛、止血、预防控制感染和减少搬痕的作用,值得临床推广应用.     

Evaluation of the healing activity of hydrocotyle tincture in the treatment of wounds

The object of this study was to evaluate the healing activity of Cothyline^TM, a new formulation comprising asiaticoside as the main ingredient in combination with antiseptic adjuvants. The study has two parts: (1) a clinical phase involving the observation of patients afflicted with soiled wounds and chronic or recurrent atony which was resistant to the usual treatment, and (2) an experimental phase in which the healing action of Cothyline was evaluated by light and electron microscopic observation of the morphological changes that occurred in scarified guinea pig skin. Treatment of patients with Cothyline completely healed (64%) or improved (16%) the lesions under study. In the animal study, it was shown that changes occurred in the shape and size of the keratohyaline granules, a phenomenon observed during accelerated healing. To the best of our knowledge, this is the first time that the healing action of Cothyline has been demonstrated in an objective and controlled manner. Cothyline has the unique advantage of simultaneously acting as an antiseptic and a cicatrizant; moreover, it affects all four phases of healing. This drug constitutes a new and advantageous approach in the treatment of wounds.     

Does focal destruction of the thoracic aorta wall by Staphylococcus aureus lead to the development of infected aneurysms? An experimental study.

Objective: The infrequency of infected aneurysms suggests that either infection of segments of the aortic wall is uncommon, or that infections do not always lead top infected aneurysm formation. The purpose of the study was to determine whether focal Staphylococcus aureus infection of aortic wall segments leads consistently to the development of infected aneurysms and to evaluate the segments in which infection did not lead to the infected aneurysm formation. Methods: Twenty pigs were inoculated with 0.1 ml of a Staphylococcus aureus inoculum in three segments of the thoracic aorta wall (study group). In another 10 pigs, 0.1 ml of saline solution was injected in three segments of the thoracic aorta wall (control group). Study group: histological abnormalities and bacterial culture of the inoculation sites were evaluated at 10 days (n=5 pigs), 30 days (n=5 pigs), and 90 days (n=10 pigs). Control group: histological abnormalities were evaluated at 10 days (n=5 pigs) and 90 days (n=5 pigs). Results: Study group: infected aneurysms developed in only two animals killed at 30 days. At 90 days, destruction of the elastic tissue, scar tissue and neointima formation were found in all the aortic segments studied. Control group: no significant changes were found in any of the segments evaluated. Conclusion: In our experimental model, acute local infection by S. aureus caused the development of infected aortic aneurysm in only 10% of the animals. In the remaining 90%, healing of the site of infection followed resolution of the infection.     

Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures

Physicians often have to perform a lumbar puncture to ascertain the diagnosis in patients with meningeal signs, because of the serious consequences of missing bacterial meningitis The aim of this study was to derive and validate a clinical rule to predict bacterial meningitis in children with meningeal signs, to guide decisions on the performance of lumbar punctures. Information was collected from records of patients (aged 1 mo to 15 y) consulting the emergency department of the Sophia Children's Hospital between 1988 and 1998 with meningeal signs. Bacterial meningitis was defined as cerebrospinal fluid (CSF) leucocyte count >5 cells μl^?1 with a positive bacterial culture of CSF or blood. The diagnostic value of predictors was judged using multivariate logistic modelling and area under the receiver operating characteristic curves (ROC area). In the derivation set (286 patients, years 1988–1995) the duration of the main complaint, vomiting, meningeal irritation, cyanosis, petechiae and disturbed consciousness were independent clinical predictors of bacterial meningitis. The ROC area of this model was 0.92. The only independent predictor from subsequent laboratory tests was the serum C‐reactive protein concentration, increasing the ROC area to 0.95. Without missing a single case, this final model identified 99 patients (35%) without bacterial meningitis. Validation on 74 consecutive patients in 3 subsequent years (1996–1998) yielded similar results. Conclusion: This prediction rule identifies about 35% of the patients with meningeal signs in whom a lumbar puncture can be withheld without missing a single case of bacterial meningitis. For the individual patient this prediction rule is valuable in deciding whether or not to perform a lumbar puncture.     

重组人生长激素对烧伤患者供皮区愈合的临床评价

目的:探讨重组人生长激素(rhGH)对烧伤患者供皮区愈合的作用。方法:第1部分将28例大面积烧伤患者,随机分为rhGH治疗组和对照组。rhGH组于切削痂手术后(供皮区为头皮)1 d开始每天皮下注射rhGH 9μ,共7 d,对照组未用药。第2部分将35例烧伤患者,随机分为rhGH治疗组和对照组,rhGH组于切削痂手术后(供皮区为大腿)1 d开始每天皮下注射rhGH 9μ,共10～15 d,对照组未用药。观察供皮区愈合时间。结果:rhGH组供皮区愈合时间明显优于对照组(P<0．01)。结论:烧伤病人早期应用rhGH,能加快供皮区愈合,利于反复多次供皮。     

Can we assess healing of surgically treated long bone fractures on radiograph?

Purpose

To determine the frequency and causes for limitations in the radiographic evaluation of surgically treated long bone fractures.