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目的探讨白脉软膏按摩治疗脑卒中后上肢痉挛的临床疗效。方法采用随机对照研究,将90例脑卒中后上肢痉挛患者随机分为两组,两组同时都给予常规康复治疗,其中治疗组45例,同时配合白脉软膏按摩治疗,每日两次,每次用药5g,每次按摩时间20~30min,治疗前、治疗2周、治疗4周、治疗6周均采用改良的Ashworth痉挛评定量表(MAS)、简化Fugl-Meyer量表、改良Barthel指数(MBI)对两组患者上肢的痉挛、运动功能、日常生活活动能力(ADL)进行评估。结果常规治疗合并白脉软膏按摩组治疗6周与常规治疗组相比,可明显减轻上肢痉挛程度,MAS评分、FMA评分、MBI评分相比差异均具有显著性意义(2.20±0.11 vs.2.44±0.16,P0.05;37.20±2.36 vs.20.49±3.08,P0.05;79.56±2.04 vs.59.78±3.26,P0.05)。结论在常规康复治疗基础上运用白脉软膏按摩,可明显改善脑卒中患者上肢痉挛,并提高患者的上肢运动功能及ADL能力。 相似文献
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邓盼墨 《临床小儿外科杂志》2011,10(1):59-61
胆道闭锁(Biliary Atresia)是导致婴幼儿终末期肝病的最常见原因,也是目前儿童肝移植的第一位适应症.该疾病以肝内外胆道的纤维闭塞性病变为特点,常迅速引起胆汁性肝硬化而导致患儿死亡,患儿平均生存时间仅19个月[1].法国巴黎Bicetre医院小儿外科曾对271例行Kasai手术或其变异术式的胆道闭锁患儿进行了长达20年的随访,结果仅有63例(23%)患者带自体肝脏长期生存,而其中的61例肝穿刺活检提示存在不同程度的肝硬化表现[2]. 相似文献
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目的 总结先天性食管狭窄诊断和治疗体会,提出最佳的诊断、治疗方法.方法 回顾我院1990至2009收治的15例先天性食管狭窄临床资料,对临床表现(症状、体征、发病年龄等),诊断方法(UGI、胃镜等)进行分析.将患儿分为手术组与非手术组,比较两组治疗过程和预后情况(饮食状况、并发症等).结果 15例先天性食管狭窄患儿,男9例,女6例.发病年龄(10±5.5)个月(0~3岁9个月).主要临床表现为反复进食后呕吐.GI检查发现狭窄段位于食管下段者9例,位于中下段者6例.7例仅行胃镜辅助下食管扩张术,手术治疗8例,其中6例行狭窄段食管切除+端端吻合术,1例行狭窄段肌层切开+胃底折叠术,1例行狭窄段全层切开、纵切横缝+胃底折叠术.术后病理诊断2例为气管软骨异位型,1例为狭窄局部炎性假瘤形成,5例为肌层增厚型.术后4例出现吻合口狭窄,2例出现胃食管反流,1例伴发术侧膈膨升.结论 上消化道钡剂造影(UGI)是诊断首选方法,电子胃镜可作为诊断及辅助治疗的手段.治疗方法建议首选食管扩张术,对扩张2~3次以上无效者进行手术探查.下段狭窄者应行胃底折叠术避免术后并发胃食管反流.Abstract: Objective The aim of this study was to find an optimal procedure of diagnosis and treatment for congenital esophageal stenosis (CES). Methods From 1990 to 2009, 15 CES patients were treated in our hospital. Demographical, clinical, pathological and radiological data were collected retrospectively. Patients were further divided into surgery group and non-surgery group. Outcomes and complications were studied to identify the indication and timing for operation. Results The age of presentationof of these 15 patients (9 boys and 6 girls) were 10± 5. 5 months (1 day ~ 41months).Vomiting was the most significant and common symptomign. UGI were performed in all the 15 patients. 9 patients had stenosis in lower esophagus and 6 in mid-lower esophagus. In surgery group, 6patients underwent surgical resection; the remaining 2 patients underwent Heller myotomy esophagomyotomy and stricturoplasty, respectively. Tracheobronchial remnants were found in 2 patients and submucosal thickening were found in 5 patients. Inflammatory pseudotumor was found in the rest 1patient. The frequency of esophageal anastomotic stricture, gastroesophageal reflux and diaphragmatic erentration were 44.4 % (4/9), 22. 2 % (2/9) and 11.1% (1/9), repectively. Conclusions UGI is the first choice for the diagnosis of CES, while electronic gastroscope can play an alternative role. Esophageal dilatation could be the first therapy for CES, and operation is indicated when outcome dilatation fails. 相似文献
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目的 分析卒中后偏瘫患者的膈肌功能,并探讨其与卒中病程以及吞咽、呼吸、运动、平衡功能和日常生活能力的相关性。
方法 本研究为前瞻性研究,连续纳入首次卒中后单侧偏瘫的患者,记录患者的一般资料,洼田饮水试验、主观呼吸功能障碍程度量表、Fugl-Meyer运动功能评定量表(Fugl-Meyer motor function assessment scale,FMA)、Berg平衡量表(Berg balance scale,BBS)、改良Barthel指数(modified Barthel index,mBI)。采用超声测定膈肌功能,包括平静呼吸时的膈肌活动度以及用力呼吸状态下的膈肌活动度和膈肌增厚率。比较整体和不同瘫痪侧患者偏瘫侧和健侧的膈肌功能,分别比较左侧偏瘫和右侧偏瘫患侧的膈肌功能和健侧的膈肌功能。分析瘫痪侧的膈肌功能与病程、洼田饮水试验、主呼吸功能障碍程度量表、FMA、BBS、mBI等指标的相关性
结果 研究共纳入45例卒中患者,其中左侧偏瘫27例(60.00%),右侧偏瘫18例(40.00%)。在整体患者中,用力呼吸状态下,偏瘫侧膈肌活动度(31.69±15.18 mm vs. 40.24±14.66 mm,P<0.001)及膈肌增厚率(34.99%±23.70% vs. 48.13%±21.98%,P<0.001)低于健侧。用力呼吸状态下,左侧偏瘫患者的偏瘫侧膈肌活动度(30.13±12.64 mm vs. 44.10±12.95 mm,P<0.001)和膈肌增厚率(41.20%±23.42% vs. 54.63%±21.08%,P =0.004)较健侧低;右侧偏瘫患者的偏瘫侧膈肌增厚率(25.67%±21.47% vs. 38.37%±20.07%,P =0.005)较健侧低。用力呼吸状态下,右侧偏瘫患者的偏瘫侧膈肌增厚率低于左侧偏瘫患者(P =0.029)。右侧偏瘫患者的健侧膈肌活动度(P =0.028)及膈肌增厚率低于左侧偏瘫患者(P =0.012)。卒中患者平静呼吸状态下,偏瘫侧膈肌活动度与FMA(r =0.362,P =0.015)呈正相关;用力呼吸状态下,偏瘫侧膈肌活动度与洼田饮水试验(r =0.298,P =0.047)、主观呼吸功能障碍程度量表(r =0.437,P =0.003)、FMA(r =0.330,P =0.027)、BBS(r =0.370,P =0.012)、mBI(r =0.321,P =0.031)呈正相关,偏瘫侧膈肌增厚率与病程(r =-0.298,P =0.047)呈负相关。
结论 卒中后偏瘫侧膈肌功能较健侧下降,右侧偏瘫患者双侧膈肌功能较左侧偏瘫患者更差。卒中患者膈肌功能与病程呈负相关,与吞咽功能、呼吸功能、肢体运动功能、平衡能力及日常生活能力呈正相关。 相似文献
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