以微信平台为基础打卡监督对烧伤患者居家康复效果的影响

目的:本研究探讨以微信平台为基础打卡监督对烧伤患者居家康复效果的影响,旨在为烧伤患者多极化健康管理方式提供参考依据.方法:选取2021年1月至2021年12月在本院进行烧伤治疗的患者78例,随机将患者分成对照组和观察组,每组39例.对照组烧伤患者接受常规的持续护理干预,观察组烧伤患者在接受常规持续性护理干预基础上联合应用以微信平台为基础的打卡监督.结果:经过6 m的居家康复治疗干预后,观察组烧伤患者的焦虑程度明显低于对照组(P<0.05);观察组患者治疗依从率明显高于对照组(P<0.05);观察组烧伤患者生活质量显著高于对照组.结论:以微信平台为基础打卡监督对烧伤患者居家康复具有显著的促进效果,可以降低患者的焦虑情绪,提升其治疗依从性及生活质量.     

磁敏感加权成像在高血压性脑出血患者诊断中的应用

目的:探讨磁敏感加权成像(Susceptibility Weighted Imaging,SWI)在高血压性脑出血(hypertensive cerebral hemorrhage,HICH)患者诊断中的应用价值.方法:选择2018年2月至12月本院收治的60例HICH患者,均行SWI序列及核磁共振弥散加权成像(Magnetic resonance imaging diffusion weighted imaging,MRI-DWI)扫描,并以手术结果为对照,分析SWI序列扫描、MRI-DWI序列扫描诊断HICH患者病灶分布情况的准确率与图像质量.结果:经手术结果明确60例HICH患者中共检测出94处病灶.与MRI-DWI序列诊断HICH患者病灶分布的准确率相比,SWI序列诊断病灶分布的准确率更高(P<0.05).经Kappa一致性度量,SWI序列和MRI-DWI序列诊断HICH患者的病灶分布与手术结果的一致性均较好(Kappa>0.8,P<0.01);SWI序列与MRI-DWI序列诊断HICH患者中病灶分布情况的呼吸伪影评分、运动伪影评分、冈上肌边缘的清晰和锐利度评分、影像的总体质量评分都比较高(P>0.05).结论:两种序列诊断HICH患者病灶分布情况的图像质量相当,但SWI序列诊断准确性更高,和手术结果的一致性也更好.     

Curative Effect of the Whole Course of Comprehensive Intervention Therapy of Schizophrenia

目的 观察全病程综合干预治疗对精神分裂症患者的临床疗效.方法 将300例精神分裂症患者随机分为干预组和对照组各150例,对照组采用常规药物治疗,干预组在此基础上采取全病程综合干预治疗,两组于治疗开始,半年,1年,2年时采用阳性和阴性综合征量表(PANSS)、社会功能缺陷筛选量表(SDSS)、康复状态量表(MRSS),药物副反应量表(TESS),对患者的治疗、康复疗效、生存质量、用药安全性进行全方位综合评定对比.结果 干预组的PANSS、SDSS、MRSS、TESS量表指标在治疗各阶段明显优于对照组,差异有统计学意义(P＜0.001).结论 对精神分裂症患者采用全病程综合干预治疗,能明显提高患者治疗效果,改善社会功能,减轻药物副作用,提高依从性,降低复发率,提高患者生存质量,全面促进患者康复.     

综合干预对社区首发精神分裂症患者康复效应观察

目的 观察综合干预疗法对社区首发精神分裂症患者康复的影响.方法 研究对象60例,均在入院治疗的当日给予抗精神病药物口服,同时实施心理干预、技能训练、健康教育、职业训练、中途宿舍入住活动、家庭干预等综合疗法,个性化的组合治疗.患者连续综合治疗的时间均为半年,并于治疗前后采用社会功能缺陷筛选量表(SDSS)、阴性症状量表(SAPS)、阳性症状量表(SANS)及Morningside康复量表(MRSS),对综合干预前后整体的病情转归情况进行评定.结果 综合干预后患者社会功能缺陷、阳性症状与阴性症状以及病情的康复评定分数显著降低,干预前后比较均具有非常显著性差异(P＜0.01).结论 综合干预疗法,对社区首发精神分裂症患者身心及社会功能的康复具有良好的促进作用.     

心理干预对老年脑卒中患者合并抑郁焦虑的康复效果及生活质量影响

目的:探讨心理干预对改善老年脑卒中合并焦虑抑郁患者的负性心理情绪和生活质量的效果。方法:选取我院2016年1月至2017年12月于我院接受治疗的120例脑卒中合并焦虑抑郁患者的临床资料,采用随机数字表法将患者随机分为干预组和对照组,给予对照组常规药物治疗,干预组在常规药物治疗的基础上实施心理康复干预治疗,观察并比较两组患者心理干预前后焦虑(SAS)和抑郁(SDS)自评量表评分、汉密尔顿焦虑量表评分(HAMA)和汉密尔顿抑郁量表评分(HAMD)情况。结果:治疗12周后,两组患者SAS、SDS、HAMA、HAMD评分均显著低于治疗前;治疗后干预组患者SAS(t=-8.735,P0.001)、SDS(t=-8.868,P0.001)、HAMA(t=-7.615,P0.001)、HAMD(t=-4.905,P0.001)评分均显著低于对照组患者;治疗后干预组患者康复依从性与对照组比较具有显著统计学差异(χ~2=9.887,P=0.007)。结论:对脑卒中抑郁焦虑患者,实施心理康复干预能够有效改善患者抑郁焦虑症状,提高患者康复依从性。     

中西医结合治疗88例老年人脑卒中患者的心理干预

目的 结合中西医治疗法和心理干预观察老年人脑卒中患者的临床疗效.方法 选择88例老年人脑卒中患者,分为观察组和对照组,各44例,观察组采用中西医结合治疗,并进行心理干预;对照组采用神经内科常规治疗和护理.结果 观察组患者康复情况明显大于对照组.结论 治疗脑卒中采用中西医治疗和心理干预有很好疗效,促进患者康复.     

早期康复护理干预与急性脑梗塞患者NIHSS评分及C反应蛋白的关系

目的 探讨早期康复护理和脑卒中患者神经功能NIHSS评分以及C反应蛋白的关系.方法 选取2012年1月至2014年12月在我院住院的急性脑梗死患者150例,包括73例男性和77例女性.随机分为早期康复护理干预组和对照组.早期康复护理组和对照组均接受神经内科常规治疗及常规护理.康复护理组除接受神经内科常规治疗及常规护理外,再分阶段由神经科医师、康复医师和护士进行早期康复护理,分别于治疗前、治疗第14天和第30天对患者的神经功能缺损程度采用NIHSS评分及C反应蛋白含量的测定.结果 与对照组相比较,康复护理组干预前两者NIHSS评分无统计学差异(P＞0.05),康复护理组第14天和第30天NIHSS评分均显著降低(P＜0.05).且对照组和康复护理组两组第14天和第30天与干预前比较,均显著降低(P＜0.05).与对照组相比较,康复护理组干预前两者C反应蛋白含量无统计学差异(P＞0.05),康复护理组第14天和第30天C反应蛋白含量均显著降低(P＜0.05).且对照组和康复护理组两组第14天和第30天与干预前比较,均显著降低(P＜0.05).结论 早期康复护理可显著降低急性脑梗死患者NIHSS评分及C反应蛋白的含量,为急性脑梗死患者的临床护理提供理论依据.     

多因素干预提高脑卒中患者康复效果的研究

目的 研究采用多因素干预提高老年脑卒中患者康复效果的方法.方法 对82例患者随机分组,对治疗组进行综合评估,制定针对性的干预计划,进行分阶段康复,建立家庭支持联合"心理防御"等多因素干预模式及方法.对照组常规进行康复治疗,将两组患者进行对照研究.结果 实施多因素干预后,患者的潜在和可改变危险因素明显降低,临床疗效显著提高(p＜0.01).结论 对老年脑卒中患者病后实施多因素干预措施,是控制危险因素,降低复发,提高康复效果的有效治疗方法.     

心理干预结合早期康复锻炼对股骨颈骨折患者髋关节功能康复和焦虑抑郁情绪的影响

目的:探讨心理干预结合早期康复锻炼对股骨颈骨折患者髋关节功能康复和焦虑抑郁情绪的影响。方法:选取我院2016年5月至2017年5月收治的80例股骨颈骨折患者作为研究对象,根据随机数字表法分为两组,分别为对照组(40例)和观察组(40例),对照组患者在临床上给予早期康复锻炼干预,观察组患者在对照组的基础上实行心理干预治疗,两组患者均干预半个月,对比两组患者髋关节功能康复(采用Harris髋关节功能量表)及焦虑抑郁情绪评分,详细记录其心理状态改善和干预满意度的变化情况。结果:干预前,两组患者的焦虑及抑郁程度组间无显著差异(P0.05);两组患者干预后抑郁及焦虑程度均降低(P0.05),且观察组的降低幅度显著高于对照组(t=8.527,15.721;P0.001);经干预后,观察组髋关节疼痛程度及活动度、关节功能的评分均显著高于对照组,两组相比差异具有统计学意义(t=4.478,11.090,2.779;P0.01);观察组患者抑郁症状治疗总有效率显著高于对照组,差异具有统计学意义(χ~2=5.165,P0.05);观察组患者焦虑症状治疗总有效率明显高于对照组(χ~2=5.000,P0.05);观察组干预治疗满意度显著高于对照组(χ~2=7.314,P0.01)。结论:对股骨颈骨折患者,采取心理干预结合早期康复锻炼其疗效确切,能有效地控制患者的焦虑抑郁情绪,改善其心理状态及髋关节功能康复情况,提高对干预的满意度,促进医患关系,具有良好的积极意义。     

eCASH 策略下的综合性护理对 AECOPD 合并呼吸衰竭气管插管患者的影响

目的:探讨基于患者为中心的舒适化浅镇静策略(Early comfort using analgesia,minimal sedatives and maximal humane care,eCASH)的综合性护理对慢性阻塞性肺疾病急性加重(Acute exacerbations of chronic Tool,CPOT)评估两组患者的镇静镇痛效果;统计干预期间两组患者谵妄、意外拔管、气道损伤等并发症情况.结果:观察组机械通气、ICU治疗、住院等时间短于对照组,并发症发生率低于对照组(P<0.05);干预后观察组Ramsay评分、CPOT评分低于对照组(P<0.05).结论:eCASH策略的综合性护理干预能减少AECOPD合并呼吸衰竭气管插管患者并发症,改善患者镇静镇痛效果,且能加速患者康复.obstructive pulmonary disease,AECOPD)合并呼吸衰竭气管插管患者的影响.方法:选取2020年8月至2021年8月我院AECOPD合并呼吸衰竭气管插管患者103例,以入院顺序分组,对照组51例为常规护理,观察组52例为常规护理+eCASH策略的综合性护理.记录两组患者干预期间康复进程(通气时间、ICU治疗时间、住院时间);干预前后采用Ramsay镇静评分、重症监护疼痛观察工具(Critical care Pain Observation Tool,CPOT)评估两组患者的镇静镇痛效果;统计干预期间两组患者谵妄、意外拔管、气道损伤等并发症情况.结果:观察组机械通气、ICU 治疗、住院等时间短于对照组,并发症发生率低于对照组(P＜0.05);干预后观察组Ramsay 评分、CPOT 评分低于对照组(P＜0.05).结论:eCASH 策略的综合性护理干预能减少AECOPD 合并呼吸衰竭气管插管患者并发症,改善患者镇静镇痛效果,且能加速患者康复.     

四肢恶性骨肿瘤的不同保肢重建方法

背景：目前保肢手术已经成为四肢恶性骨肿瘤的规范治疗方式,其目的是不但要提高患者的生存率,而且要保存良好的肢体功能。 目的：就四肢恶性骨肿瘤人工关节置换及同种异体骨移植等各种保肢方式进行综述。 方法：由第一作者应用计算机检索PubMed数据库1992年1月至2012年10月及中国期刊网全文数据库1994年1月至2012年12月有关四肢恶性骨肿瘤保肢治疗的文章,英文检索词为“malignant bone tumor,salvage treatment, allograft bone graft, prosthesis and microwave”,中文检索词为“恶性骨肿瘤,保肢治疗,大段异体骨,肿瘤假体,微波灭活治疗”。排除重复性研究及Meta分析,共保留31篇文献进行综述。 结果与结论：①对于四肢特别是关节周围的恶性骨肿瘤,大多采用人工关节置换、大段同种异体骨移植以及微波灭活治疗。②大段同种异体骨移植后并发症发生率较高,微波灭活治疗技术有新的进展,进一步的研究仍在进行当中。③瘤段骨灭活再植以及乙醇灭活治疗多适用于基层医院。     

Teratogen-induced limb defects

Limb abnormalities are one of the most common and visible phenotypic effects of several human teratogens. The specific effects are different for most teratogens and include effects on limb morphogenesis (thalidomide, warfarin, phenytoin, valproic acid) and the effect of vascular disruption on a limb that had formed normally (misoprostol, chorionic villus sampling, and phenytoin). Either duplication (preaxial polydactyly of hands and feet) or deficiency (absence of thumb) is a common effect of thalidomide; no other human teratogen identified to date has this effect on the developing limb. Procedures during pregnancy, including chorionic villus sampling and dilation and curettage, produce defects of vascular disruption. For common exposures, such as alcohol and cocaine, it has been difficult to confirm objectively the exposure during embryogenesis and to ascribe specific limb defects that are produced. The molecular basis for the limb defects produced by the recognized human teratogens remains unknown.     

Nail-gun limb injuries

We present four cases and a review of the literature regarding nail-gun related limb injury. Nail guns have significant potential to cause limb and other major injuries. In most cases improper use of the nail-gun is the single most important factor in causing such types of injuries. Treatment of these injuries requires careful assessment of the limb and the type of nail involved in order to enable safe extraction. We recommend the introduction of training in the workforce to encourage awareness of the danger of such devices. We also emphasize the continuing requirements for improved workplace safety and adequate safety equipment when working with such dangerous devices.     

Organogenesis of the limb skeleton and the limb joints in the human embryo

The development of the skeleton and limbs joints of embryo and fetus of 5.5-9 weeks has been studied. The organogenesis of the anlages of bones is completed by the end of the embryonal period, when every of them can be identified clearly according to there characteristic features of anatomic structure. The linear size of the anlages of bones are changed in fetus period. The structures are proximal grow quicker. In connection this the qualitative ratio between the elements stylopodium, zeugopodium, autopodium is changed gradually while growing. In the embryonal period the cartilaginous anlages of bones separated each other densely cellular avascular interzones. Since the beginning of fetus period the synovial cavity is formed. The synovial cavity formation in time coincides with morphofunctional differentiation muscles of limbs and there innervation.     

Reacting while moving: influence of right limb movement on left limb reaction

An experiment was designed to determine whether the activation of a muscle group (flexors or extensors) used to produce an ongoing movement of one limb influenced the reaction time and associated initiation of elbow flexion or extension movements of the contralateral limb. Right-handed participants in the bimanual groups were asked to produce a pattern of flexion/extension movements defined by a sine wave (period = 2 s, amplitude = 16°) with the right limb. While performing the right limb movement, participants were instructed that they were to react as quickly as possible by making a flexion or extension movement with their left limb when the cursor they were using to track the sine wave changed color. Participants in the unimanual groups performed the left limb reaction time task but were not asked to make right limb movements. The reaction time stimulus occurred once in each trial and was presented at one of six locations on one of the six cycles comprising the sinusoidal waveform. Participants performed 7 blocks of 6 test trials. Reaction time was calculated as the time interval between the color change of the cursor and the initiation of the response with the left limb. Movement time was calculated as the interval of time between the initiation of the response and the left limb cursor crossing the upper or lower boundary line. Mean reaction of the left limb was significantly influenced by the concurrent type of movement (flexion/extension) of the right limb. Reaction times were shorter on trials in which both limbs were initiating movement with homologous muscles as compared to trials in which the limbs were initiating movement with non-homologous muscles. No differences were detected when the stimuli were presented during the ballistic phase of the right limb movement, and no differences at any position were detected for the unimanual groups. This result is consistent with the notion that neural crosstalk can influence the time required to react to a stimulus but this influence occurs when contralateral muscles are activated.     

Stability of phantom limb phenomena after upper limb amputation: a longitudinal study

Amputees may experience stump pain (SP), phantom limb (PL) sensations, pain, and/or a general awareness of the missing limb. The mechanisms underlying these perceptions could involve nervous system neuroplasticity and be reflected in altered sensory function of the residual limb. Since little is known about the progression of post-amputation sensory phenomena over time, we longitudinally evaluated the stability of, and relationships among: 1) subjective reports of PL sensations, pain, awareness, and SP, 2) stump tactile and tactile spatial acuity thresholds, and 3) use of a functional vs. a cosmetic prosthesis in 11 otherwise healthy individuals with recent unilateral, traumatic upper-extremity amputation. Subjects were evaluated within 6 months and at 1-3 years after amputation. Processing of tactile sensory information from the stump remained stable over the study time period. PL awareness was frequent, stable over time, intense, and occurred with or without PL sensations. Functional prosthetic use correlated with stable vividness of PL awareness whereas subjects who used a cosmetic prosthesis had less vivid PL awareness at follow-up. Initial SP correlated with follow-up SP, the initial PL pain correlated with follow-up PL pain but neither initial nor follow-up SP appear to be related to follow-up PL pain after accounting for initial PL pain intensity. Neither limb temperature nor prosthesis-use correlated with the initial vs. follow-up change in PL pain intensity. These data provide evidence that PL pain described 1-3 years after an amputation is not related in any simple way to peripheral sensory function, SP, or limb temperature; and PL awareness but not PL pain may be influenced by the frequent use of a functional prosthesis.     

Disinhibition of upper limb motor area by voluntary contraction of the lower limb muscle

It is well known that monosynaptic spinal reflexes and motor evoked potentials following transcranial magnetic stimulation (TMS) are reinforced during phasic and intensive voluntary contraction in the remote segment (remote effect). However, the remote effect on the cortical silent period (CSP) is less known. The purpose of the present study is to determine to what extent the CSP in the intrinsic hand muscle following TMS is modified by voluntary ankle dorsiflexion and to elucidate the origin of the modulation of CSP by the remote effect. CSP was recorded in the right first dorsal interosseous while subjects performed phasic dorsiflexion in the ipsilateral side under self-paced and reaction-time conditions. Modulation of the peripherally-induced silent period (PSP) induced by electrical stimulation of the ulnar nerve was also investigated under the same conditions. In addition, modulation of the CSP was investigated during ischemic nerve block of the lower limb and during application of vibration to the tibialis anterior tendon. The duration of CSP was significantly shortened by phasic dorsiflexion, and the extent of shortening was proportional to dorsiflexion force. Shortening of the CSP duration was also observed during tonic dorsiflexion. In contrast, the PSP duration following ulnar nerve stimulation was not altered during phasic dorsiflexion. Furthermore, the remote effect on the CSP duration was seen during ischemic nerve block of the lower limb and the pre-movement period in the reaction-time paradigm, but shortening of the CSP was not observed during tendon vibration. These findings suggest that phasic muscle contraction in the remote segment results in a decrease in intracortical inhibitory pathways to the corticospinal tract innervating the muscle involved in reflex testing and that the remote effect on the CSP is predominantly cortical in origin.