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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    经颅直流电刺激对认知损害模型大鼠学习、记忆功能的影响

    戴有勇严国强石珊杨辉...
    1-5页
    查看更多>>摘要：目的 观察经颅直流电刺激(tDCS)对认知损害模型大鼠学习、记忆能力及海马皮质神经细胞形态的影响，并探讨大鼠认知功能损害行为学特征与海马CA1区颗粒层厚度的相关性。 方法 采用随机数字表法将30只SD大鼠分为观察组、模型组及对照组，每组10只大鼠。通过腹腔注射东莨菪碱将观察组、模型组大鼠制成认知损害动物模型，对照组大鼠则同期注射生理盐水。制模后观察组大鼠给予tDCS干预，模型组、对照组大鼠电极放置方法同观察组，但期间不予电刺激，3组大鼠均连续干预16 d。待干预结束后采用穿梭箱及Morris水迷宫实验检测各组大鼠行为学变化；于制模后第30天时各组大鼠均断头取脑，观察其海马及皮质神经元形态学改变，同时测量海马颗粒层厚度。 结果 干预后观察组被电击次数[(60.5±6.67)次/min]较模型组[(145.8±19.31)次/min]显著减少(P<0.05)，寻找平台时间[(50.4±3.68)s]较模型组[(91.9±3.09)s]显著缩短(P<0.05)，穿越D象限平台次数[(23.3±3.56)次/分]较模型组[(15.3±3.43)次/分]显著增加(P<0.05)。与对照组比较，模型组海马CA1区颗粒层厚度[(93.47±1.07)μm]显著减少(P<0.05)；与模型组比较，观察组海马CA1区颗粒层厚度[(95.17±1.49)μm]明显增加(P<0.05)。经相关性分析发现，实验大鼠海马CA1区颗粒层厚度与被电击次数、寻找平台时间具有负相关性(P<0.05)，与穿越D象限平台次数具有正相关性(P<0.05)。 结论 腹腔注射东莨菪碱能导致大鼠认知功能受损，其受损程度可能与海马CA1区颗粒层厚度具有一定相关性；tDCS可改善认识损害模型大鼠学习、记忆功能，其作用机制可能与促进海马皮质神经元结构恢复、增加海马颗粒层厚度有关。 Objective To observe any effect of transcranial direct current stimulation (tDCS) on learning, memory ability and the morphology of neurons in the hippocampus and cortex of rats with cognitive impairment, and also to seek any correlation between the rats′ behavior and the thickness of the granular layer in the CA1 region of the hippocampus. Methods Thirty Sprague-Dawley rats were randomly divided into an observation group, a model group and a control group, each of 10. Cognitive impairment was induced in the observation and model groups by intraperitoneal injection of scopolamine, while the control group was injected with saline solution over the same period of time. After successful modeling, the observation group was given tDCS, while the model and control groups were connected with electrodes but not given any electrical stimulation. After 16 consecutive days of treatment, behavioral changes of each group were quantified using a shuttle box and a Morris water maze. On the 30th day after the mode-ling, the brains were collected to observe any changes in the morphology of the hippocampal and cortical neurons. The thickness of the hippocampal granular layer was also measured. Results In the observation group the average rate of electrical impulses after the intervention [(60.5±6.67)/min] was significantly less than in the model group [(145.8±19.31)/min], while the time to find a platform was significantly shorter. The rats of the observation group also crossed the D quadrant of the platform significantly more quickly than the model group, on average. Compared with the control group, the granular layer in the CA1 region of the hippocampus [(93.47±1.07)μm] was significantly thinner on average than in the model group but compared with the model group, the observation group had significantly thicker layers [95.17±1.49)μm] on average. The thickness was negatively correlated with the number of shocks and the time to find the platform, but positively correlated with the number of crossings of the platform in the D quadrant. Conclusions The degree of impairment generated by intraperitoneal injection of scopolamine correlates with the thickness of the CA1 granular layer of the hippocampus, at least in rats. tDCS can improve the learning and memory of such rats. Its mechanism may be related to promoting structural recovery of hippocampal cortical neurons and increasing the thickness of the granular layer.

    经颅直流电刺激海马皮质厚度认知损害学习记忆大鼠

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    超短波治疗对脊髓损伤炎症因子和丝裂原活化蛋白激酶通路的影响

    王帅刘佳琳那里苏朋...
    6-11页
    查看更多>>摘要：目的 观察超短波治疗对脊髓损伤(SCI)后炎症因子和丝裂原活化蛋白激酶(MAPK)通路的影响。 方法 将79只Sprague-Dawley(SD)大鼠随机分成对照组(n＝35)、干预组(n＝35)和假手术组(n＝9)。采用Allen′s法对干预组和对照组大鼠行SCI挫压伤造模，假手术组仅暴露脊髓组织，不进行打击。SCI后24 h后，干预组给予无热量超短波治疗，每日1次，每周5次，每次7 min直至取材前。造模成功1 d后和各组对应的取材时间点(提前1 h)，采用SCI行为学评分(BBB)对3组未取材的大鼠进行运动功能评估。造模成功1 d、3 d、7 d后，采用免疫荧光和免疫印迹技术观察3组大鼠损伤区域内炎症因子和MAPK通路的动态变化。 结果 造模成功14 d后，干预组大鼠的BBB评分为(7.30±1.04)分，显著优于对照组造模成功14 d后，差异有统计学意义(P<0.05)。造模成功7 d后，假手术组大鼠脊髓组织炎症因子NOD样受体热蛋白结构域相关蛋白(NLRP3)，白介素-6(IL-6)，白介素-6受体(IL-6R)和肿瘤坏死因子-α(TNF-α)的含量均显著低于对照组和干预组，差异均有统计学意义(P<0.05)；干预组大鼠脊髓组织炎症因子NLRP3、IL-6、IL-6R和TNF-α的含量亦显著低于对照组，差异均有统计学意义(P<0.05)。造模成功7 d后，干预组大鼠损伤区域内锌指蛋白36(TTP)的阳性细胞数量显著高于对照组，差异有统计学差异(P<0.01)。造模成功7 d后，对照组和干预组大鼠损伤区域MAPK通路核心蛋白丝裂原活化蛋白激酶2(MK2)、磷酸化抗体(p-MK2)和TTP蛋白均显著高于假手术组，差异均有统计学意义(P<0.05)。造模成功7 d后，干预组大鼠损伤区域MAPK通路核心蛋白MK2、p-MK2和TTP蛋白与对照组比较，差异均有统计学意义(P<0.05)。 结论 超短波治疗可通过调节MAPK炎症通路来抑制炎症因子的产生，从而促进SCI大鼠运动功能的恢复。 Objective To observe any effect of ultrashortwave (USW) therapy on inflammatory cytokines and the MAPK pathway of rats with a spinal cord injury. Methods Seventy-nine Sprague-Dawley rats were randomly divided into a control group (n=35), an intervention group (n=35) and a sham group (n=9). Allen′s method was used to establish a contusion model of SCI in the rats of the control and intervention groups, while the sham group′s spinal tissues were exposed but not stricken. Beginning twenty-four hours after SCI modeling, the intervention group was given 7min of USW therapy daily, five days a week till the day of sacrifice for sampling the target area of spinal cord for tests. Then, motion function was evaluated using Basso, Beattie and Bresnahan (BBB) scoring. One, three and seven days after the SCI modeling, immunofluorescence and western blotting were employed to observe any changes in inflammatory factors and the MAPK pathway in the lesioned area. Results Fourteen days after the modeling the average BBB score of the intervention group was significantly higher than the control group′s average. Moreover, 7 days after the modeling the average content of the domains containing protein 3 (NLRP3), interleukin-6 (IL-6), IL-6 receptor and tumor necrosis factor-α (TNF-α) in the target area of the spinal cord of sham group showed significantly lower levels than in the other 2 groups. And the levels in the intervention group were significantly lower than in the control group. Seven days after the modeling the number of cells positive for zinc finger protein 36 (TTP) in the lesioned area of the intervention group was significantly greater than among the control group. At the same time the levels of MAPK-activated protein kinase 2 (MK2), phosphorylated-mitogen-activated protein kinase-activated version (p-MK2) and TTP in the control and intervention groups were significantly higher than in the sham group. And there were significant differences between the intervention group and control group in the levels of MK2, p-MK2 and TTP. Conclusion Ultrashortwave therapy can inhibit inflammation by regulating the MAPK inflammatory pathway, promoting the recovery of motion functions, at least in rats.

    脊髓损伤超短波丝裂原活化蛋白激酶通路炎症因子

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    间歇性低氧干预对心肌梗死大鼠AMPKα1/SIRT3通路及心肌能量代谢的影响

    党小红黄传万春晓易浩...
    12-17页
    查看更多>>摘要：目的 探讨间歇性低氧(IH)干预对心肌梗死(MI)大鼠心肌能量代谢的影响及可能作用机制。 方法 采用随机数字表法将21只SD大鼠分为假手术组、心梗组及观察组，将心梗组及观察组大鼠制成左冠状动脉前降支(LAD)闭塞心肌梗死模型。于造模结束1周后假手术组及心梗组大鼠均给予常氧干预，观察组大鼠则给予4周(4 h/d，5 d/周)间歇性低氧干预。于造模后1周、IH干预4周后检测各组大鼠左心室射血分数(LVEF)；于IH干预4周后检测各组大鼠心肌纤维化指数、线粒体结构、ATP含量、腺苷酸活化蛋白激酶(AMPKα1)及Sirtuins蛋白家族成员3(SIRT3)蛋白表达水平。 结果 经IH干预4周后与假手术组比较，心梗组LVEF、线粒体数量、ATP含量、AMPKα1及SIRT3蛋白表达均明显降低(P<0.05)，心肌纤维化指数明显增加(P<0.05)；观察组LVEF明显降低(P<0.05)，心肌纤维化指数明显增加(P<0.05)，线粒体数量、ATP含量、AMPKα1及SIRT3蛋白表达组间差异均无统计学意义(P>0.05)。与心梗组比较，观察组LVEF、线粒体数量、ATP含量、AMPKα1及SIRT3蛋白表达均显著增加(P<0.05)，心肌纤维化指数明显降低(P<0.05)。相关性分析显示大鼠心肌AMPKα1、SIRT3蛋白表达均与LVEF、ATP含量呈正相关(P<0.05)，AMPKα1与SIRT3亦具有正相关性(P<0.05)。 结论 IH干预可通过调控MI大鼠AMPKα1/SIRT3通路促进心肌ATP合成，改善线粒体结构完整性，进而抑制心肌纤维化、增强心功能。 Objective To explore any effect of intermittent hypoxia (IH) on myocardial energy metabolism and its mechanism. Methods Twenty-one male Sprague-Dawley rats were randomly divided into a sham operation group, a myocardial infarction group and an observation group. The latter two groups received occlusion of the left anterior descending coronary artery. The observation group then lived in an hypoxic environment intermittently for 4 hours/day, 5 days/week for four weeks, while the other 2 groups were exposed to a normal level of oxygen. The ejection fraction of the left ventricle (LVEF) was measured at 1 week after the modeling and 4 weeks after the start of the intervention. Also at that point myocardial fibrosis, mitochondrial structure, ATP content, and the protein expressions of adenosine monophosphate-activated protein kinase alpha1 (AMPKα1) and sirtuins protein family member 3 (SIRT3) were assessed in all three groups. Results A significant decrease in the LVEF, the number of mitochondria, ATP content, AMPKα1 and SIRT3 protein were observed in the infarction group compared with the sham group. There was also a significant increase in the myocardial fibrosis index. Moreover, the LVEF decreased significantly and the myocardial fibrosis index had increased significantly in the observation group compared with the sham operation group, though the two groups exhibited no significant differences the number of mitochondria, ATP content, or the expression of AMPKα1 or SIRT3. Compared with the myocardial infarction group, in the observation group there was a significant increase in the LVEF, the number of mitochondria, ATP content, and the expression of AMPKα1 and SIRT3 protein, with a significant decrease in the fibrosis index. AMPKα1 and SIRT3 level were positively inter-correlated and positively correlated with LVEF and ATP content. Conclusions IH intervention can promote ATP synthesis and improve mitochondrial structure by regulating the AMPKα1/SIRT3 pathway, reducing myocardial fibrosis and enhancing cardiac function.

    心肌梗死心脏康复间歇性低氧能量代谢

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    老年急性缺血性脑卒中患者3个月后认知障碍相关因素分析及其预测价值

    邹永明舒睿王娜边际...
    18-23页
    查看更多>>摘要：目的 探讨老年急性缺血性脑卒中患者3个月后认知障碍的相关危险因素及其预测价值。 方法 采用回顾性病例对照研究设计，纳入符合入组条件的老年急性缺血性脑卒中患者898例，排除42例后，最终纳入856例。根据蒙特利尔认知评估量表(MoCA)评分，将其分为脑卒中后非认知功能障碍(PSNCI)组(422例)和脑卒中后认知功能障碍(PSCI)组(434例)。收集患者的一般人口社会学资料、临床相关化验资料，并进行美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、日常生活活动(ADL)能力、汉密尔顿抑郁量表(HAMD)评分。采用SPSS 22.0版统计学软件进行单因素分析、多因素Logistics回归分析和受试者工作曲线(ROC)分析。 结果 2组患者在性别、年龄、高血压、冠心病、痴呆家族史、受教育程度方面比较，差异有统计学意义(P<0.05)。在总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、尿阿尔茨海默病相关神经丝蛋白(AD7c-NTP)水平、NIHSS评分、BI指数、ADL评分方面比较，组间差异有统计学意义(P<0.05)。Logistics回归分析显示，冠心病、尿AD7C-NTP、HAMD评分是老年急性缺血性脑卒中患者3个月后认知障碍的独立危险因素，BI是独立保护因素。尿AD7C-NTP的ROC曲线下面积(AUC)最大(0.875)，cut-off值为2.425，灵敏度为0.937，特异度为0.75，具有较好的预测价值。 结论 年龄、性别、受教育程度、吸烟、饮酒、体重指数(BMI)、冠心病、脑卒中史、痴呆家族史、AD7C-NTP、TC、TG等可能是老年急性缺血性脑卒中患者3个月后认知障碍的危险因素，其中冠心病、尿AD7c-NTP、HAMD评分是独立危险因素，BI是独立保护因素。尿AD7c-NTP对PSCI具有一定的预测价值。 Objective To explore the risk factors for cognitive impairment 3 months after an ischemic stroke and their predictive value. Methods A retrospective case-control study considered the records of 856 elderly patients who had survived an ischemic stroke. All had been evaluated using the Montreal Cognitive Assessment scale (MoCA). They were divided according to their MoCA scores into a group without cognitive impairment (the PSNCI group) and an impaired (PSCI) group. The subjects′ demographic and clinical laboratory data were compiled. All had been assessed using the National Institutes of Health stroke scale (NIHSS), the Barthel Index (BI), and the Hamilton depression scale (HAMD). Univariate and multivariate logistic regressions were evaluated and a receiver operator characteristics (ROC) curve was computed. Results There were significant differences between the two groups in terms of gender distribution, age, hypertension and heart disease history, family history of dementia and education level. Moreover, significant differences were observed in the groups′ average total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), urinary neurofilament protein (AD7c-NTP), NIHSS scores, BIs and ADL scores. Logistic regression showed that a history of heart disease, urinary AD7C-NTP level and HAMD score were significant independent predictors of cognitive impairment 3 months after a stroke. A high BI was an independent protective factor. The area under the ROC curve for urinary AD7C-NTP was the largest (0.875) and had significant predictive value with a cut-off value of 2.43, sensitivity of 0.94 and specificity of 0.75. Conclusion Age, sex, education, smoking, drinking, body mass index, a history of heart disease or stroke, a family history of dementia and elevated AD7C-NTP, TC or TG are risk factors for cognitive impairment after a stroke. A high BI suggests a better prognosis. Urinary AD7c-NTP is a useful predictor of PSCI 3 months after a stroke.

    老年急性缺血性脑卒中认知功能障碍危险因素尿AD7c-NTP预测价值

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    脑卒中失能患者营养不良的影响因素及预测模型分析

    蔡昂李一王留根李和平...
    24-28页
    查看更多>>摘要：目的 探讨脑卒中失能患者营养不良的影响因素和预测模型。 方法 收集符合标准的脑卒中失能患者373例，采集患者的相关信息，根据是否发生营养不良分为营养不良组(271例)和对照组(102例)，进行单因素相关分析和多因素Logistic回归分析，采用受试者工作曲线(ROC)分析相关因素对营养不良的预测价值。 结果 共有271例患者(72.7%)发生营养不良。单因素分析显示，年龄、是否吞咽困难、是否肺部感染、失能评分、进食方式可能与发生营养不良有关(P<0.05)；多因素Logistic回归分析显示，年龄大、肺部感染、吞咽困难、摄入总量少、Barthel指数分值低是脑卒中失能患者营养不良的危险因素(P<0.05)，应用鼻胃管管饲法(NGT)辅助进食的患者发生营养不良的风险远高于应用间歇经口至食管管饲法(IOE)辅助进食的患者(P<0.05)；ROC曲线分析提示，Barthel指数联合吞咽困难预测营养不良能力的曲线下面积(AUC)为0.840，灵敏度为87.8%，特异度为72.5%。 结论 脑卒中失能患者年龄、肺部感染、吞咽困难、进食途径、摄入总量、失能评分是其营养不良的影响因素，Barthel指数联合吞咽困难对是否发生营养不良有较好的预测作用。 Objective To analyze the risk factors for malnutrition among disabled stroke survivors and devise a prediction model. Methods A total of 373 disabled stroke survivors treated in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University in 2021 formed a control group (n=102) and a malnutrition group (n=271) according to their nutritional status. Univariate correlation analysis and multivariate logistic regression were used to analyze the risk factors for malnutrition and their predictive value. Results Age, dysphagia, pulmonary infection, disability score and feeding style were found to be related significantly to the occurrence of malnutrition. Multivariate logistic regression confirmed that age, pulmonary infection, dysphagia, low total intake and a low Barthel index were useful predictors of malnutrition in such persons. Moreover, patients who had received nasogastric tube feeding were at much higher risk of malnutrition than those with intermittent oroesophageal tube feeding. The area under the receiver operating characteristics curve of the Barthel index combined with dysphagia to predict malnutrition was 0.84. The critical value was 0.67 with a sensitivity of 88% and a specificity of 72.5%. Conclusions Age, pulmonary infection, dysphagia, feeding method, total intake and disability score are risk factors for malnutrition in disabled stroke survivors. The Barthel index combined with dysphagia has good predictive power for the occurrence of malnutrition in such persons.

    脑卒中失能营养不良吞咽困难预测模型

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    运用弹性超声动态测量不同肌张力下肌肉硬度的初步研究

    张心培张丽张元鸣飞李涛...
    29-34页
    查看更多>>摘要：目的 运用剪切波弹性成像(SWE)技术测定肱二头肌在被动牵伸过程中的杨氏模量变化，初步探索SWE测量肌肉硬度辅助肌张力定量评定的潜力。 方法 对49例脑卒中患者及30例健康受试者行双侧肘屈肌肌张力MAS评定，根据MAS分级结果分为健康受试者组、患者健侧组、MAS 0级组、1级组及1+级组。在受试者肘关节被动匀速伸直过程中，留取肱二头肌的实时剪切波弹性成像录像，并读取杨氏模量数据。选取6个肘关节位置点，记录各位置点处的瞬时杨氏模量(E X)、计算各位置点较运动起始处的杨氏模量变化值(ΔE)，分别评估E X和ΔE与MAS分级的相关性以及组间差异。 结果 MAS分级越高，肱二头肌杨氏模量越高，并且在肘关节伸直角度增加时其杨氏模量值增加越明显。在1/2关节活动范围(ROM)至全ROM之间可观察到E X及ΔE在MAS 0级与MAS 1级、MAS 0级与MAS 1+级之间的差异有统计学意义(P<0.05)，但MAS 1级与MAS 1+级之间在各个位置点的差异均无统计学意义(P>0.05)。 结论 利用剪切波弹性超声在运动过程中定量、实时测量肌肉硬度与MAS分级有一定的相关性。 Objective To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone. Methods Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1+ group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus (E X) and calculate its change during the movement (ΔE). Those data were correlated with the MAS scores and compared among the groups. Results Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in E X and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1+ groups. There were, however, no significant differences between MAS class-1 and MAS class-1+ . Conclusions MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.

    肌张力剪切波弹性成像杨氏模量改良Ashworth量表

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    网状脊髓束激活对上肢精细运动中预期性姿势调节的影响

    夏楠何畅李飏安韩肖华...
    35-41页
    查看更多>>摘要：目的 观察不同难度的上肢精细任务中预期性姿势调节(APA)的特征变化，并探究网状脊髓束(RST)激活对其APA的影响。 方法 本研究采用了双变量混合设计，包含4种不同测试任务和3中不同任务启动状态。共招募健康右利手男性13例进入测试。受试者须根据耳机中的声音提示随机完成前向触碰、杯状抓握、拇指夹卡片和小指夹卡片四种任务，各10次。每种任务测试中有一半的任务启动提示音为114 dB的白噪音，以诱发惊吓效应激活RST；另一半为80 dB的嘟嘟声，作为常规对照。使用表面肌电记录受试双侧胸锁乳突肌、下斜方肌、背阔肌、腰段竖脊肌以及右侧三角肌、桡侧腕屈/伸肌的全程肌电。并在随后处理中，将肌电时域和频域指标转化为目标肌肉的启动反应时、达峰时间、激活延时、APA或补偿性姿势调节(CPA)幅值等进行不同任务和刺激状态的对比分析。此外，研究中根据胸锁乳突肌(SCM)提前激活与否将114 dB测试任务分别归类为SCM+和SCM－作为不同启动态进行处理。 结果 RST激活后，各任务中运动前反应时与肌肉收缩达峰时间均明显缩短(P<0.01)。SCM+、SCM－和普通状态下的三角肌反应时分别为(106.89±43.78)ms、(136.78±48.74)ms和(168.60±73.17)ms，且两两比较均存在显著区别(P≤0.01)。同一状态下的对侧斜方肌下部和同侧背阔肌APA幅值显著增高(P<0.05)，但肌肉启动时序和前臂肌肉APA/CPA幅值未见显著影响(P>0.05)。小指夹取任务中桡侧腕伸肌预期性肌肉激活延时较触碰任务显著缩短[(－15.39±5.02)ms和(4.45±4.59)ms]，差异有统计学意义(P<0.05)。 结论 不同难度的上肢精细任务中仅桡侧腕伸肌表现出任务特异性的提前激活；RST激活可以导致预期动作提前启动，并加速肌肉收缩和提高部分躯干肌APA幅值，但对前臂肌肉APA/CPA幅值没有显著影响。 Objective To observe any dependence of anticipatory postural adjustment (APA) on the difficulty of fine upper limb tasks and to document any effect of reticulospinal tract (RST) facilitation on APAs during such tasks. Methods The study′s bivariate mixed design involved 4 different tasks and 3 different priming states. Thirteen healthy, male, right-handed subjects were recruited. They were asked to complete the 4 tasks of reaching, grasping a cup, pinching a card using the thumb or using the little finger, respectively for 10 times 1 in response to two different starting cues delivered through an earphone. Half of the trials with each task were initiated with 114dB white noise to startle and activate the reticulospinal tract (RST), while the others were activated with 80dB beeps as a control. Electromyographic signals were recorded from the bilateral sternocleidomastoid (SCM), lower trapezius (LT), latissimus dorsi (LD), lumbar erector spinae and right anterior deltoid muscles and also from the right flexor and extensor carpi radialis muscles (ECR/FCR). In the subsequent processing the electromyographic time domain and frequency domain indicators were converted into a pre-motor reaction time, a time to muscle peak contraction, an activation latency, and APA or compensatory postural adjustment (CPA) amplitude of the tested muscles. These were compared among the different tasks and stimuli. In addition, the 114dB test tasks were classified as two different priming status as SCM+ and SCM- according to whether the sternocleidomastoid muscle (SCM) was activated in advance. Results After RST activation the pre-motor reaction time and the time to peak contraction of all of the muscles were significantly shortened in all of the tasks. The deltoid muscle reaction times in the SCM+ , SCM- and control states were (106.89±43.78)ms, (136.78±48.74)ms and (168.60±73.17)ms, respectively, and those differences are significant. The APA amplitudes of the contralateral LT and ipsilateral LD were significantly greater than normal, but the timing of muscle activation onset and the APA/CPA amplitudes of the ECR/FCR were not affected. The latency in the anticipatory muscle activation of the ECR in the little finger grip task was significantly shorter than that in reaching. Conclusions The extensor carpi radialis show task-specific early activation in fine tasks of the upper limbs with different difficulties. RST activation can lead to early starting of expected actions, accelerate muscle contraction and increase APA amplitude of some trunk muscles, but it has no significant effect on APA/CPA amplitudes in the forearm muscles.

    网状脊髓束预期性姿势调节惊吓反应上肢精细运动

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    改良高强度间歇运动在冠状动脉疾病患者心脏康复中的应用研究

    郅季炘高永成马刚易浩...
    42-47页
    查看更多>>摘要：目的 观察改良高强度间歇运动(HIIT)对冠状动脉疾病(CAD)患者心脏康复的影响并评估其安全性及依从性，为优化CAD患者心脏康复方案提供参考资料。 方法 采用随机数字表法将60例CAD患者分为运动组及对照组，每组30例。2组患者均给予常规心脏康复治疗(包括营养调整、心理疏导及低强度有氧运动等)，运动组患者在此基础上辅以每周2次、共6周改良HIIT干预(以85%~90%最大心率强度持续蹬车30 s后间歇30 s为1个循环，每次重复训练15个循环)。于干预前、干预6周后检测2组患者心肺适能、血压水平、血管功能及身体成分等变化情况，同时评估该改良HIIT方案的安全性及患者依从性。 结果 与干预前比较，干预后运动组患者在递增负荷运动试验中的最大摄氧量及最大功率均明显增加(P<0.05)，血压水平及身体成分指标均明显改善(P<0.05)，积极情绪评分明显升高(P<0.05)，消极情绪及焦虑评分明显下降(P<0.05)，患者对训练的愉悦感较显著。对照组经干预后上述各项指标均无显著变化(P>0.05)。干预期间运动组训练计划完成率(97.4%)较对照组(88.7%)明显升高(P<0.05)，且2组患者均无严重不良反应或心血管相关事件发生。 结论 改良HIIT是CAD患者心脏康复的有效手段，能显著降低心血管疾病风险，同时还具有较高的安全性及患者依从性。 Objective To observe the effect of a modified version of high-intensity interval training (HIIT) on the rehabilitation of persons with coronary artery disease (CAD), and to evaluate its safety and patient compliance. Methods Sixty CAD patients were randomly divided into an exercise group and a control group, each of 30. Both groups were given conventional cardiac rehabilitation (including controlled nutrition, psychological counseling and low-intensity aerobic exercise). The exercise group additionally completed a session of HIIT twice a week for 6 weeks. Each session involved 30s of cycling at 85-90% of the patient′s maximum heart rate followed by 30s rest, repeated 15 times. The cardiorespiratory fitness, blood pressure, vascular function and body composition of both groups were documented before and after the 6 weeks. Compliance was recorded and the safety of the modified HIIT program was evaluated. Results A significant improvement was observed in the maximum oxygen uptake and workload in a graded exercise test among the exercise group. The average blood pressure and body composition improved significantly, as did the average positive mood score and enjoyment of training. There was a significant decrease in negative mood and anxiety scores among the exercise group. No significant differences were observed in the control group. Compliance with the HIIT training program of the exercise group (97.4%) was significantly better than the control group′s compliance (88.7%) with its less strenuous regimen. There were no serious adverse reactions or cardiovascular events during the experiment. Conclusion Modified HIIT is an effective form of cardiac rehabilitation training for CAD. It is safe, and compliance is good.

    高强度间歇运动冠状动脉疾病心脏康复血压身体成分安全性

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    盆底肌训练结合注意力训练对女性压力性尿失禁患者盆底功能的影响

    刘燕平侯燕君陈嘉敏黄国芳...
    48-52页
    查看更多>>摘要：目的 观察盆底肌训练结合注意力训练对女性压力性尿失禁患者盆底功能和尿失禁症状的影响。 方法 选取女性压力性尿失禁患者50例，按照随机数字表法将其分为对照组和实验组，每组25例。对照组进行常规盆底肌训练，实验组在此基础上结合注意力训练。治疗前和治疗6周后(治疗后)，应用盆底表面肌电图评估两组患者的盆底肌表面肌电值，采用国际咨询委员会尿失禁问卷表简表(ICIQ-SF )评估两组患者治疗前后的尿失禁程度变化，用尿失禁生活质量问卷(I-QOL)评估两组患者治疗前后生活质量的变化。 结果 治疗前，两组患者盆底肌表面肌电值、ICIQ-SF评分、I-QOL评分比较，差异均无统计意义(P>0.05)。治疗6周后，实验组盆底肌快速收缩峰值[ (40.7±3.29) μV ]、紧张收缩平均肌电值[ (31.1±5.11)μV ]和耐力收缩平均肌电值[(29.39±2.60) μV ]、ICIQ-SF评分[(3.60±0.88)分]和I-QOL评分[ (84.71±5.14)分]较对照组改善优异，差异有统计学意义(P<0.05)。 结论 盆底肌训练结合注意力训练可以有效改善女性压力性尿失禁患者的盆底功能和尿失禁症状，提高生活质量。 Objective To explore any effect of pelvic floor muscle training and/or attention training on pelvic floor function and women′s symptoms of stress urinary incontinence (SUI). Methods Fifty incontinent women were divided into a control group (n=25) and an experimental group (n=25). Both groups received conventional pelvic muscle rehabilitation training, but the experimental group was additionally provided with attention training for 6 weeks. Before and after the 6 weeks of treatment, both groups were evaluated using surface electromyography of the pelvic floor. The short form of the International Urinary Incontinence Advisory Committee′s urinary incontinence questionnaire (ICIQ -SF) was used to assess the severity of incontinence and quality of life (I-QOL). Results Before the treatment there was no significant difference between the 2 group′s pelvic floor myographs, nor in their average ICIQ-SF and I-QOL scores. After the treatment, however, compared with the control group, significant improvement was observed in experimental group′s peak amplitude during rapid contraction, average EMG in tonic contraction and endurance contraction. Their average ICIQ-SF and I-QOL scores were also better. Conclusion Supplementing pelvic floor muscle training with attention training can effectively improve the urinary continence and the life quality of women with stress urinary incontinence.

    盆底肌训练注意力训练压力性尿失禁盆底功能

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    贴扎对慢性踝关节不稳的男性篮球运动员正向和侧向跳跃时踝关节运动学特征的影响

    姚军威程阳韦俏丽马勇...
    53-60页
    查看更多>>摘要：目的 观察贴扎对慢性踝关节不稳的男性篮球运动员正向和侧向跳跃时踝关节运动学特征的影响。 方法 采用Vicon三维运动捕捉系统和Kistler三维测力台采集29例慢性踝关节不稳的男性篮球二级运动员贴扎与未贴扎条件下的正向和侧向跳跃落地数据，包括受试者未贴扎和贴扎条件下正向跳跃落地动作和侧向跳跃落地动作踝关节触地(TD)前200 ms、TD前150 ms、TD前100 ms、TD前50 ms、TD时、TD后50 ms、TD后100 ms、TD后150 ms和TD后200 ms的背屈/跖屈角度、外翻/内翻角度和外旋/内旋角度，以及背屈/跖屈角速度、外翻/内翻角速度、外旋/内旋角速度。采用Visual 3D三维运动分析软件对所得数据进行建模计算，并采用SPSS 25.0版统计学软件对本研究所得数据进行分析。 结果 正向跳跃落地，受试者贴扎后TD前50 ms和TD的踝关节跖屈角度较未贴扎时分别减少了3.27°和2.70°，TD前50 ms的踝关节内翻角度较未贴扎时减少了2.13°，TD前200 ms和TD前150 ms的踝关节外旋角度较未贴扎时分别减少了2.59°和2.17°，TD后100 ms的落地踝关节外旋角度较未贴扎时减少了1.59°，差异均有统计学意义(P<0.05)。侧向跳跃落地，受试者贴扎后TD前50 ms和TD的踝关节跖屈角度较未贴扎时分别减少了1.94°和3.23°，TD前50 ms和TD的踝关节内翻角度较未贴扎时分别减少了2.86°和2.87°，TD前200 ms和TD前150 ms的踝关节外旋角度较未贴扎时分别减少了0.93°和2.36°，差异均有统计学意义(P<0.05)。正向跳跃落地，受试者贴扎后TD和TD后100 ms的踝关节背屈角速度较未贴扎时分别减少了58.47°/s和28.39°/s，差异均有统计学意义(P<0.05)。侧向跳跃落地，受试者贴扎后TD的踝关节背屈角速度较未贴扎时减少了20.52°/s，踝关节内翻角速度较未贴扎时增加了49.69°/s，差异均统计学意义(P<0.05)；TD后50 ms时，受试者贴扎后的踝关节外翻角速度较未贴扎时减少了30.28°/s，差异亦有统计学意义(P<0.05)。 结论 踝关节贴扎可以改变CAI男性篮球运动员正向和侧向跳跃落地动作时踝关节的角度和角速度，踝关节贴扎可使正向和侧向跳跃落地TD前50 ms和TD的踝关节跖屈和内翻角度减小，使正向跳跃落地TD的踝关节背屈角速度减小，使侧向跳跃落地TD的踝关节角速度增加。 Objective To observe the effect of taping on the kinematic characteristics of the ankle joint during forward and lateral jumps by male basketball players with chronic ankle instability (CAI). Methods A Vicon 3D motion capture system and a Kistler 3D ergometer were used to collect data describing the landing data with or without taping from forward and lateral jumps of 29 male basketball players with CAI. The landing data included the dorsiflexion and plantarflexion angles, valgus and inversion angles and external and internal rotation angles. Dorsiflexion or plantarflexion angular velocity was also recorded along with valgus or inversion angular velocity and external or internal rotation angular velocity 200ms, 150ms, 100ms and 50ms before and after touchdown. The data obtained were modeled using three-dimensional motion analysis software, and then analyzed. Results Taping reduced the ankle plantarflexion in landing from a forward jump by 3.27° 50ms before landing and by 2.70° at touchdown. The ankle inversion angle was reduced 2.13° 50ms before touchdown, while the angle of external rotation decreased by 2.59° 200ms before touchdown and 2.17° 150ms before. Moreover, the angle of external rotation 100ms after landing was reduced by a significant 1.59° compared with that without taping. In lateral jumps taping reduced the average ankle plantarflexion angle by 1.94° 50ms before landing and 3.23° at touchdown compared with no taping. Ankle inversion was reduced significantly by 2.86° 50ms before landing and by 2.87° at touchdown. External rotation was a significant 0.93° less 200ms before landing and 2.36° smaller 150ms before touchdown. In the forward jump landing, taping reduced the average angular velocity of ankle dorsiflexion on landing by a significant 58.5°/s and by 28.39°/s 100ms later. In the lateral jump landings the average ankle dorsiflexion velocity decreased by significant 20.5°/s with taping, but the valgus velocity increased by 49.7°/s compared with no taping. However, 50ms after touchdown the speed of external rotation with taping was 30.3°/s slower than without taping. Conclusions Ankle taping can modify ankle rotation angles and angular velocities during landing from jumps. This is particularly helpful for basketball players with CAI.

    贴扎慢性踝关节不稳踝关节运动学

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