亚低温对创伤性脑损伤患者脑脊液髓鞘基本蛋白的影响

目的 探讨亚低温对创伤性脑损伤患者脑脊液髓鞘基本蛋白(MBP)水平的影响.方法 36例重型颅脑损伤患者,随机分为亚低温治疗组及常温治疗组,在不同时间点评价颅内压变化、GOS预后,通过酶联免疫吸附实验(ELISA)分析治疗各时间点脑脊液MBP的变化,综合分析亚低温对重型颅脑损伤患者的影响.结果 两组比较,治疗1d脑脊液MBP浓度差异无统计学意义[分别为(24.95±2.07)、(26.72±2.43)μg/L,t=2.36,P＞0.05].在治疗7、14 d亚低温治疗组比常温治疗组脑脊液MBP浓度明显降低,差异均有统计学意义[(12.41±0.74)、(19.54±1.38)μg/L,t=19.86,P＜0.05;(7.85±0.32)、(13.51±1.46)μg/L,t=16.89,P＜0.05].而颅内压监测显示,两组治疗1d颅内压变化差异无统计学意义,在治疗7、14 d颅内压变化差异均有统计学意义[(19.0±2.1)、(26.0±2.6)mm Hg,t=8.94,P＜0.05;(13.0±1.8)、(19.0±1.6)mm Hg,=10.43,P＜0.05].两组预后比较差异有统计学意义(Z=-2.82,P＜0.05);亚低温治疗组预后良好率明显高于常温治疗组(P＜0.05),但在病死率方面差异无统计学意义(P＞0.05).结论 亚低温治疗可能通过减少MBP降解来稳定中枢神经系统髓鞘,达到脑保护作用,从而改善重型颅脑损伤患者的预后.     

亚低温辅助治疗重型颅脑外伤患者82例

目的探讨亚低温在治疗重型颅脑外伤中的应用价值。方法对连续收治的160例重型颅脑外伤患者,随机分为亚低温治疗组（n=82）和常温组（n=78）,观察两组的治疗效果。结果随访6个月,亚低温组20例轻度残疾、正常生活,24例中残,16例重残,9例植物生存,13例死亡;对照组10例轻度残疾、正常生活,18例中残,16例重残,14例植物生存,20例死亡;两组比较有统计学差异（P〈0．05）,亚低温组的治疗效果优于常温组。结论亚低温有显著的脑保护作用,能降低重型颅脑外伤患者的死残率,改善预后。     

亚低温治疗对重型颅脑损伤患者免疫功能的影响

目的 研究33 ℃～35 ℃亚低温治疗对重型颅脑损伤患者免疫功能的影响.方法 将41例入选的重型颅脑损伤患者(GCS评分≤8分)随机分为亚低温治疗组和常温治疗组.亚低温组20例,伤后24 h内采用亚低温治疗,使直肠温度控制在33 ℃～35 ℃,维持5 d;常温治疗组21例,采用传统的物理及化学方法使直肠温度控制在36.5 ℃～38.0 ℃,其他治疗两组完全相同.分别在入院后第1、3、5、7 天检测两组患者血清免疫球蛋白水平和淋巴细胞转化率的动态变化.结果 亚低温治疗组与常温治疗组两组患者的免疫球蛋白水平和淋巴细胞转化率在第1天、第3天、第5天和第7 天均差异无统计学意义(P＞0.05).结论 5 d时间内33 ℃～35 ℃的亚低温治疗不会明显抑制重型颅脑损伤患者的免疫功能.     

亚低温对颅脑损伤后血清S-100β蛋白含量影响的实验研究

目的　观察亚低温治疗对颅脑损伤后患者血清S - 10 0 β蛋白含量变化的影响 ,揭示亚低温保护脑的可能机制。方法　 4 6例重型颅脑损伤患者随机分成常温治疗组和亚低温治疗组 ,分别予以常温治疗和亚低温治疗。两组均于伤后 6h、2 4h、3d、7d等各时间点测定血清S - 10 0 β蛋白含量 ,并与 10名健康成年人正常对照组血清S - 10 0 β蛋白含量比较 ,观察亚低温治疗后颅脑损伤患者血清S - 10 0 β蛋白含量的变化。 结果　①伤后各时间点两组颅脑损伤患者血清S - 10 0 β蛋白含量明显高于正常对照组 (P <0 0 1) ,但两组间S - 10 0 β蛋白含量在伤后 6h无显著性差异 (P >0 0 5 )。②亚低温治疗后各时点亚低温治疗组血清S - 10 0 β蛋白含量低于常温治疗组 ,且差异有统计学意义 (P <0 0 1) ,而且出院时预后也较常温治疗组为佳。结论　亚低温治疗能够降低颅脑损伤患者血清S - 10 0 β含量 ,其脑保护作用可能与亚低温能减轻S - 10 0 β蛋白介导的损伤性脑细胞炎症反应有关     

亚低温治疗重型颅脑损伤86例效果观察及护理

目的：探讨亚低温治疗重型颅脑损伤患者的效果及护理方法。方法：将172例重型颅脑损伤术后患者随机分为常温组和亚低温组各86例。常温组给予脱水、利尿、止血、抗炎、护脑等常规治疗,亚低温组在此基础上采用亚低温治疗。观察两组的治疗效果及并发症发生率,并给予精心护理。结果：亚低温治疗组病死率、重残率均低于常温组,良好率高于常温组（P〈0．05）;两组并发症发生率比较无显著性差异（P〉0．05）。结论：亚低温治疗重型颅脑损伤是一种安全有效、便于实行的治疗方法,值得临床推广应用。在亚低温治疗期间做好基础护理、正确使用电脑控温水毯、严密监测患者生命体征及颅内压的变化、加强呼吸道的护理,能够降低颅脑损伤患者的高颅压情况,改善其预后,提高其生存质量。     

亚低温方法抗重度颅脑损伤作用的临床研究

目的　探讨亚低温方法抗重度颅脑损伤的作用机制。方法　对 34例重度颅脑损伤患者 (Gcs≤ 8)随机分为亚低温治疗组 (16例 )和常温治疗组 (18例 )。分别测定 2 4h内血中丙二醛 (MDA)和脑脊液中 β 内啡呔 (β Ep)含量。结果　亚低温组患者伤后 2 4h血清中MDA含量及脑脊液中 β Ep含量均明显低于常温组 ,差异具有显著性 (P <0 .0 1)。结论　亚低温方法可以使重度颅脑损伤患者急性期内有害物质生成减少 ,从而减轻了脑损伤 ,是临床救治重度颅脑损伤的一种重要方法。     

亚低温对重型颅脑损伤后高颅压及凝血异常影响的临床研究

目的探讨亚低温对重型颅脑损伤后高颅压及凝血异常的影响。方法将 46例重型颅脑损伤患者随机分为亚低温治疗组及常温对照组。亚低温治疗组于伤后 2 4小时内行亚低温治疗 ,余治疗同对照组 ,肛温控制在 32～ 35℃。监测生命体征、颅内压以及入院时、入院后 1～ 3天静脉血的D dimer浓度。结果亚低温治疗组病死率 2 6 .1 % ,良好率 47.8% ;对照组病死率 47.8% ,良好率 2 1 .7% ,有显著性差异。亚低温治疗组伤后 3天内颅内压 (ICP)显著下降 (P <0 .0 5) ,而 3天后无显著差异 (P >0 .0 5) ;伤后早期D dimer显著下降 (P <0 .0 5)。结论亚低温治疗可提高重型颅脑损伤患者的生存质量 ,降低病死率 ,降低颅脑损伤后早期的高颅压 ,延缓脑水肿的形成并可改善颅脑损伤后的凝血异常。     

硫酸镁治疗急性重型颅脑损伤的疗效分析

目的研究硫酸镁对急性重型颅脑损伤的临床治疗效果。方法51例急性重型颅脑损伤患者随机分为硫酸镁治疗组(n=25)和对照组(n=26),观察临床效果,并对治疗后第7天脑水肿带、第10天GCS、伤后半年COS和死亡率等指标进行统计学分析。结果两组第7天脑水肿带、第10天GCS评分、半年后COS评分比较均有统计学意义(P＜0．05)。结论早期硫酸镁治疗急性重型颅脑损伤能减轻脑水肿、促进清醒及改善预后。     

围术期亚低温治疗重型颅脑损伤的临床观察

目的通过对重型颅脑损伤患者术中进行亚低温治疗后的疗效观察，探讨围术期亚低温疗法对此类患者的脑保护作用及临床意义。方法56例重型颅脑损伤患者（GCS评分3—8分）随机分为亚低温治疗组和对照组。亚低温组患者伤后入手术室行亚低温治疗，脑温控制于32℃～35℃；对照组行常温治疗。治疗过程中观察两组患者的颈动脉和颈静脉血气、电解质变化、颅内（ICP）和脑组织氧分（PbtO2）PEA压、心率、呼吸等生命体征。对两组患者的预后情况进行GOS评分。结果亚低温治疗组患者的脑氧摄取（CEO2）和脑动静脉氧压差（A—VDO2）均明显低于对照组，差异均有统计学意义（t分别=14．89、10、19，P均〈0．05）；亚低温治疗组患者的高ICP于术后3、7d明显低于对照组，差异均有统计学意义（t分别=2．79，6．89，P均〈0．05）；亚低温治疗纽患者的PbtO2于术后3d起就明显高于对照组患者，差异均有统计学意义（t分别=4．11、6．90，P均〈0．05）；经GOS预后评分，亚低温治疗组患者中恢复良好67．86％（19／28）与对照组39．28％（11／28）比较，差异有统计学意义（X^2-3．42，P〈0．05）；死亡率为14．29％（4／28），与对照组32．14％（9／28）比较，差异有统计学意义（X^2=4．41，P〈0．05）。结论围术期亚低温治疗能降低脑外伤后升高的ICP，提高PbtO2,具有明显的脑保护作用，能有效改善重型颅脑损伤患者的预后．无严重并发症.     

亚低温治疗重症脑血管病疗效观察

目的 观察亚低温治疗重症脑血管病的疗效。方法 62例重症脑血管病患者,随机分为亚低温组和对照组,亚低温组应用冰毯机将患者肛温控制在34－35℃达48h,并于治疗前,治疗开始后第2天、第5天、第7天对两组患者进行格拉斯哥昏迷评分（glasgow coma scale,GCS),同时于治疗前,治疗开始后第2周、第4周、第12周进行神经功能缺损评分,监测患者生命体征,记录治疗中出现的副反应及死亡率。结果 治疗组30例患者治疗前及治疗后2d,5d,7GCS分别为7．60、8．35、13．39、14．27;对照组相应数值分别为7．52、8．16、9．40、10．8;治疗组治疗前及治疗后2周、4周、12周神经功能缺损评分分别为45．27、35．79、17．36、14．12;对照组相应数值分别为45．52、37．46、29．70、25．35;治疗组与对照组死亡率分别为7．33％和28．12％（P＜0．05）。两组治疗后第5天、第7天GCS相比较,治疗组明显好于对照组（P＜0．05）;两组治疗后第4周、第12周神经功能缺损评分相比较治疗组也明显好于对照组（P＜0．05）。治疗组出现明显副反应。结论 亚低温治疗能有效保护重症脑血管病患者的脑细胞、降低死亡率、改善脑卒中患者的预后。     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

Satisfaction with medical rehabilitation in patients with orthopedic impairment

OBJECTIVE: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN: Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING: Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION: Usual rehabilitation care.Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION: unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.     

Persistence with antimuscarinic therapy in patients with overactive bladder

Overactive bladder (OAB) is a chronic condition, which impacts patients' health and quality of life. The primary symptoms of OAB are distressing and may interfere with work, psychosocial and sexual functioning. OAB also is associated with increased risk of urinary tract infections, fractures from falls, skin infections and depression. Patient's concerns about the effects of incontinence on lifestyle highlight the need to restore continence. The mainstay of treatment is antimuscarinic drug therapy, which may often produce only modest reductions in OAB symptoms and may be accompanied by bothersome adverse effects, leading to poor adherence to prescribed medications. Successful treatment of OAB depends on persistence with the prescribed medication, and efficacy and tolerability are key influencers of persistence. New antimuscarinic agents are now available for treating OAB that significantly improve symptoms of incontinence, urgency and frequency with few adverse effects. An improved efficacy and tolerability profile should result in greater patient satisfaction and persistence with therapy during long-term therapy.