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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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    电针调控L1CAM表达在阿尔茨海默病神经保护中的作用

    杨学花卫哲周赞华易浩...
    193-198页
    查看更多>>摘要：目的 观察电针干预对阿尔茨海默病小鼠学习记忆能力及神经细胞粘附分子L1(L1CAM)表达的影响。 方法 采用随机数字表法将30只雄性APP/PS1小鼠分为模型组、电针组及非穴组，每组10只小鼠，另取10只C57BL/6小鼠纳入对照组。电针组小鼠给予电针刺激百会、肾俞穴，电刺激频率50 Hz，连续波，电流强度1 mA，每天刺激1次，连续干预14 d；非穴组小鼠在百会、肾俞穴附近给予电针刺激，其它操作均与电针组相同；模型组、对照组小鼠均继续常规饲养，未给予电针等特殊处理。于干预后采用Morris水迷宫实验检测各组小鼠行为学改变，选用Western blot技术检测各组小鼠海马组织中L1CAM、PTEN及p53蛋白表达水平。 结果 与对照组Morris水迷宫定位航行实验结果比较，模型组在第1，2，3，4，5天时的逃避潜伏期均显著延长(P<0.05)。与模型组结果比较，电针组在第2，3，4，5天时逃避潜伏期均显著缩短(P<0.05)。与模型组比较，电针组L1CAM蛋白表达量明显上调(P<0.05)，PTEN及p53蛋白表达量均显著下调(P<0.05)。与电针组比较，非穴组在第2，3，4，5天时逃避潜伏期均明显延长(P<0.05)，L1CAM蛋白表达量下调(P<0.05)，PTEN及p53蛋白表达量均显著上调(P<0.05)。通过相关性分析发现，实验小鼠逃避潜伏期与L1CAM表达水平呈负相关性(P<0.05)，与p53、PTEN表达水平呈正相关性(P<0.05)。 结论 L1CAM参与实验小鼠学习记忆过程，电针穴位可改善AD小鼠学习记忆功能，其作用机制可能与促进海马组织中L1CAM蛋白表达、抑制PTEN及p53蛋白表达有关。 Objective To observe any effect of electroacupuncture on the expression of L1 cell adhesion molecule (L1CAM) in mice modeling Alzheimer′s disease (AD) and also any effect on learning and memory. Methods Thirty male APP/PS1 mice were randomly divided into a model group, an electroacupuncture (EA) group, and a no acupuncture (NA) group, each of 10. All the animals were modeled as AD. Ten C57BL/6 mice served as a control group. The mice in the EA and NA groups were given continuous 50Hz EA at a current intensity of 1mA at and near the Baihui (GV20) and Shenshu (BL23) acupoints, respectively, once a day for 14 days, while the other two groups were not given any EA. The mice in the model and control groups continued to be routinely fed without any special treatment such as electroacupuncture. After the intervention, any behavioral changes were evaluated by using a Morris Water Maze, and the expression of L1CAM, PTEN and p53 protein in the hippocampus of each group was detected using western blotting. Results Compared with the control group, the escape latency in positioning navigation experiments was significantly longer in the model group on the first 5 days of Morris Water Maze testing. Compared with the model group, the escape latency was significantly shorter in the EA group on days 2 to 5 of the Morris Water Maze testing, and the expression of L1CAM had increased significantly in the electroacupuncture group compared with the model group while PTEN and p53 expression had decreased significantly. The average escape latency of the NA group was significantly longer than that of the model group on days 2 to 5 of the Morris Water Maze testing. The average L1CAM expression in the NA group had decreased significantly, and the expression of PTEN and p53 protein had increased significantly more than in the EA group. The escape latency was negatively correlated with L1CAM expression but positively correlated with p53 protein and PTEN expression. Conclusion L1CAM is involved in learning and memory processes, at least in mice. Electroacupuncture can improve the learning and memory of mice modeling Alzheimer′s, which may be due to its promoting the expression of L1CAM and inhibiting the expression of PTEN and p53.

    阿尔茨海默病电针L1CAMMorris水迷宫

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    朗读治疗法同步远程言语康复对脑卒中后失语症患者语言能力和生活质量的影响

    甘莉杨馨李利娟王磊...
    199-204页
    查看更多>>摘要：目的 观察朗读治疗法(ORLA)同步远程言语康复对卒中后失语症(PSA)患者疗效和生活质量的影响。 方法 选取脑卒中后恢复期失语症患者42例，采用计算机中心数表法随机分成住院组、线上1组和线上2组，每组患者14例。3组患者均在接受常规康复治疗的基础上开展失语症常规多模态语言治疗和ORLA。住院组于康复治疗室完成常规多模态语言治疗和ORLA，线上1组和线上2组则在家中通过腾讯会议视频软件完成常规多模态语言治疗和ORLA。常规多模态语言治疗3组患者均每日1次，每周治疗5 d，连续治疗4周，但住院组和线上2组每日治疗30 min，线上1组每日治疗1 h。ORLA 3组患者均每日1次，每周治疗5 d，连续治疗4周，但住院组和线上2组每日治疗1 h，线上1组每日治疗30 min。于干预前和干预4周后(干预后)采用西方失语症成套测验(WAB)、中国康复研究中心汉语标准失语症检查量表(CRRCAE)和中文版脑卒中失语症生活质量量表(SAQOL-39)分别评估3组患者的言语功能、朗读能力和生活质量。 结果 3组患者干预后WAB量表的AQ、阅读、复述、口语流畅度、信息量、听理解、命名评分与组内治疗前比较(线上1组干预后的信息量评分除外)，差异均有统计学意义(P<0.05)；线上2组和住院组干预后WAB量表的AQ、阅读、流畅度、命名评分均显著优于线上1组干预后，差异均有统计学意义(P<0.05)。3组患者干预后的朗读和生活质量评分与组内治疗前比较，差异均有统计学意义(P<0.05)。住院组和线上2组干预后的朗读评分均显著优于线上1组干预后的(76.43±27.35)分，差异均有统计学意义(P<0.05)。线上1组和线上2组干预后的生活质量评分均显著优于住院组干预后的(111.64±14.91)分，差异均有统计学意义(P<0.05)。 结论 中、高强度的ORLA同步远程言语康复可显著改善脑卒中后失语症患者的言语能力、朗读能力和生活质量。 Objective To observe any effect of long-distance application of Oral Reading for Language with Aphasia (ORLA) training on patients with post-stroke aphasia. Methods A total of 42 stroke survivors with aphasia were randomly divided into an inpatient group, and two online groups, each of 14. All three groups had their routine rehabilitation treatment supplemented with ordinary multimodal language therapy and ORLA. The inpatient group completed the routine in the rehabilitation treatment room, while the online groups completed it at home using Tencent video conferencing software. The conventional multimodal language therapy was conducted once daily, 5 days a week for 4 weeks. For the inpatient group and online group 2 the daily session lasted 30 minutes, while for the online 1 groups the daily length was doubled. The ORLA therapy was also conducted once daily, 5 days a week for 4 weeks, for the inpatient group and online group 2 the daily session lasted 1h, while for the online 1 groups the daily length was 30min.The speech function, reading ability and life quality of the three groups were evaluated before and after the intervention using the Western Aphasia Battery, the Chinese Standard Aphasia Examination Scale and the Chinese version of the Stroke Aphasia Quality of Life Scale. Results After treatment, the average aphasia quotient (AQ), reading, naming and quality of life scores in all three groups had improved significantly compared with those before treatment. And related language ability scores (such as retelling, fluency, information volume, listening comprehension, etc.) had also improved significantly in all three groups. However, the average AQ, reading, and oral fluency scores of the inpatient group and online group 2 were significantly higher than those of online group 1. Significant improvement was also observed in the reading aloud and life quality of all three groups, but the average improvement in reading aloud was significantly greater in the inpatient group and in online group 2 compared to online group 1. The average life quality of the online groups was significantly superior to that of the inpatient group. Conclusion Medium- and high-intensity ORLA synchronous remote speech rehabilitation can significantly improve the speech ability, reading ability and life quality of aphasic stroke survivors.

    脑卒中朗读治疗法远程康复脑卒中后失语症

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    节律性听觉刺激引导下的上肢摆动训练对脑卒中患者步行能力的影响

    于利国章志超王博刘金明...
    205-209页
    查看更多>>摘要：目的 探讨节律性听觉刺激(RAS)引导下的上肢摆动训练对脑卒中患者步行能力的影响。 方法 选取80例脑卒中患者，采用随机数字表法分为观察组和对照组，每组40例。2组患者均接受常规康复治疗，包括神经肌肉促进技术、肌力训练、平衡功能及步态训练，观察组患者在此基础上，接受RAS引导下的上肢摆动训练，每日1次，每次20 min，每周5 d，连续6周。分别于治疗前和6周的治疗结束后(治疗后)，采用Holden步行功能分级、Fugl-Meyer量表下肢部分(FMA-LE)、Berg平衡量表(BBS)、稳定极限维持范围及时间测试、10 m步行测试(10MWT)计时等指标对2组患者的平衡功能和步行能力进行评估和比较。 结果 治疗后，观察组患者的Holden步行功能分级[(3.67±0.57)分]、FMA-LE[(26.32±3.63)分]、BBS[(52.14±2.33)分]、10MWT[(26.56±6.98)s]、稳定极限维持范围时间[(3767.83±765.27)s]及范围[(6.82±1.06)mm2]均较对照组同时间点明显改善(P<0.05)。 结论 RAS引导下的上肢摆动训练可以改善脑卒中患者的步行能力，提高步行稳定性、步速及平衡功能。 Objective To explore any effect of upper limb swing training guided by rhythmic auditory stimulation (RAS) on the walking ability of stroke survivors. Methods Eighty stroke survivors were randomly divided into an observation group and a control group. Both groups received conventional rehabilitation treatment, including neuromuscular facilitation, muscle strength training, balance training and gait training, but the observation group was additionally provided with RAS-guided upper limb swing training for 20min once a day, 5d per week for 6 weeks. Before and after the intervention, balance and lower limb function were quantified in both groups using Holden′s walking function classification, the Fugl-Meyer lower extremity motor function scale (FMA-LE), the Berg Balance Scale (BBS) and the 10m walk test (10MWT). Limits of stability were also quantified. Results After the treatment, the average Holden, FMA-LE and BBS scores, as well as the average 10MWT time were significantly better in the observation group than in the control group. The average stability limits and their maintenance were also superior. Conclusion RAS-guided upper limb swing training can improve the gait, walking ability, walking stability, walking speed and balance of stroke survivors.

    脑卒中节律性听觉刺激上肢摆动训练步行

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    动态失稳训练对脑卒中患者姿势控制能力、平衡与步行功能的影响

    马联杰顾旭东李岩傅建明...
    210-215页
    查看更多>>摘要：目的 观察动态失稳训练对脑卒中患者姿势控制、平衡与步行功能的影响。 方法 采用随机数字表法将40例脑卒中患者分为对照组和观察组，每组20例。所有患者均接受常规康复治疗，观察组在此基础上给予动态失稳训练，对照组增加相同时长的常规康复治疗。治疗前、治疗8周后(治疗后)，采用表面肌电图(sEMG)检测2组患者双侧股直肌、股二头肌、竖脊肌的表面肌电信号，包括预期姿势调节(APAs)阶段的激活时间和激活强度，补偿姿势调节(CPAs)阶段的激活强度。采用Berg平衡量表(BBS)、Fugl-Meyer运动功能量表(FMA)下肢部分、GaitWatch步态分析系统评估患者的平衡与步行能力。 结果 与对照组治疗后比较，观察组患侧股直肌[(－71.68±2.64)s]、股二头肌[(－90.07±3.65)s]和健侧股二头肌[(－84.31±5.74)s]、竖脊肌[(－67.29±5.04)s]APAs阶段的激活时间提前较多(P<0.05)，患侧股直肌[(9.90±0.77)]、竖脊肌[(10.18±0.72)]APAs阶段的激活强度较高(P<0.05)。2组患者治疗后CPAs阶段各肌群的激活强度组间比较，差异无统计学意义(P>0.05)。观察组治疗后BBS评分[(48.80±3.52)分]、下肢FMA评分[(29.20±2.42)分]、步幅[(71.25±4.81)cm]、步速[(70.20±5.00)cm/s]改善优于对照组(P<0.05)。 结论 动态失稳训练联合常规康复训练能进一步改善脑卒中患者的姿势控制能力，促进平衡与步行功能恢复，提高下肢运动功能。 Objective To observe any effect of dynamic motor instability training on the balance and postural control of stroke survivors. Methods Forty stroke survivors with poor balance were randomly divided into a control group and an observation group, each of 20. In addition to routine rehabilitation, the observation group was given 20 minutes of dynamic motor instability training, 5 days a week for 8 weeks, while the control group underwent routine rehabilitation for the same length of time. Before and after the intervention, surface electromyogram of the rectus femoris, biceps femoris, and erector spinae were recorded during perturbation. Activation time and the intensity of the anticipatory and complementary postural adjustments (APAs and CPAs) were also observed. Balance and lower limb motor functioning were assessed using the Berg balance scale (BBS), the Fugl-Meyer lower extremity assessment (FMA-LE), and GaitWatch analysis. Results After the treatment the average activation time of the rectus femoris, biceps femoris in the affected side and those of the biceps femoris [(-84.31±5.74)s] and erector spinae in the intact side in APAs were all significantly shorter in the observation group than in the control group, while the average activation intensity of the rectus femoris and erector spinae was significantly greater. There was no significant difference in the activation intensity of each muscle group in CPAs after the treatment. After the intervention the average BBS score, FMA-LE score, stride length and walking speed of the observation group all were significantly better than the control group′s averages. Conclusions Supplementing traditional rehabilitation training with dynamic motor instability training can further improve the posture control of stroke survivors and promote recovery of their balance and walking ability.

    脑卒中姿势控制平衡功能表面肌电图

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    体外冲击波联合本体感觉神经肌肉促进技术对卒中后足下垂患者下肢运动功能的影响

    林少平瞿代虎黄玲李奕凝...
    216-221页
    查看更多>>摘要：目的 观察体外冲击波联合本体感觉神经肌肉促进(PNF)技术对卒中后足下垂患者下肢运动功能的影响。 方法 将入选的36例脑卒中足下垂患者按随机数字表法分为冲击波组、PNF组和联合治疗组三组，每组12例。冲击波组只接受体外冲击波治疗，PNF组只接受PNF技术治疗，联合组同时接受体外冲击波和PNF技术治疗，体外冲击波冲击压力强度2.5 bar，频率10 Hz，每块肌肉冲击2000次，每周2次，共治疗4周；PNF技术治疗每周不少于3次，每次30 min，共治疗4周。分别于治疗前和治疗4周后(治疗后)，采用改良Ashworth分级(MAS)、踝关节主动活动度、足偏角、10 m步行时间(10 MWT)和下肢Fugl-Meyer运动功能量表(FMA)对3组患者的肌张力及下肢运动功能等指标进行治疗效果评定。 结果 ①治疗后，PNF组和冲击波组分别出现8例和9例的小腿肌张力下降，联合治疗组12例患者张力均出现下降；PNF组、冲击波组和联合治疗组治疗后的肌张力评分分别为(1.25±0.62)、(1.17±0.58)和(0.33±0.49)分，均较组内治疗前[PNF组(1.92±0.67)分、冲击波组(1.83±0.83)分和联合治疗组(1.75±0.62)分]明显改善(P<0.05)，且联合治疗组较另2组改善更为明显(P<0.05)。②PNF组和冲击波组治疗前后的踝关节主动活动度差异均无统计学意义(P>0.05)，而联合治疗组治疗前后对比，差异有统计学意义(P<0.05)。③治疗后，3组患者的10 m步行时间及下肢FMA评分均有不同程度的改善，与组内治疗前比较，PNF组差异有统计学意义(P<0.05)，冲击波组差异无统计学意义(P>0.05)，联合治疗组差异有统计学意义(P<0.01)。④3组患者治疗后的足偏角[PNF组(32.4±5.7)°、冲击波组(29.9±4.6)°、联合治疗组(20.9±5.9)°]较组内治疗前[PNF组(40.3±6.4)°、冲击波组(39.0±5.6)°、联合治疗组(38.7±7.4)°]均有明显改善(P<0.01)，且联合治疗组的改善程度明显优于PNF组和冲击波组(P<0.01)。 结论 体外冲击波联合PNF技术可有效改善脑卒中后足下垂患者的下肢运动功能。 Objective To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop. Methods Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed. Results After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups. Conclusion Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop.

    体外冲击波本体感觉神经肌肉促进技术足下垂下肢运动功能

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    脑机接口联合运动想象训练对缺血性脑卒中患者上肢功能恢复的影响

    陈晓娟纳金花马晓红金俏...
    222-225页
    查看更多>>摘要：目的 观察基于运动想象的脑机接口(BCI)训练对缺血性脑卒中患者上肢运动功能恢复的影响，并分析患者运动诱发电位(MEP)潜伏期、中枢运动传导时间(CMCT)与上肢运动功能间的相关性。 方法 采用随机数字表法将46例缺血性脑卒中伴上肢运动功能障碍患者分为脑机组及对照组，每组23例。2组患者均给予常规康复干预，脑机组在此基础上给予基于运动想象训练的脑机接口治疗，对照组则辅以腕指被动屈伸训练。于治疗前、治疗4周后分别采用上肢Fugl-Meyer运动功能量表(FMA-UE)、功能独立性量表(FIM)及上肢动作研究量表(ARAT)对2组患者肢体功能进行评定；同时检测2组患者MEP潜伏期及CMCT，并对患者上肢功能评分与MEP、CMCT进行相关性分析。 结果 治疗前脑机组、对照组患者FMA-UE、FIM、ARAT评分、MEP潜伏期及CMCT组间差异均无统计学意义(P>0.05)；治疗后2组患者FMA-UE评分[分别为(41.22±13.09)分和(32.23±15.49)分]、FIM评分[分别为(82.96±13.58)分和(73.32±18.56)分]、ARAT评分[分别为32.00(20.00，41.00)分和21.00(3.00，38.25)分]、MEP潜伏期[分别为(22.84±0.88)ms和(23.61±1.32)ms]及CMCT[分别为(10.26±1.09)ms和(11.26±1.49)ms]均较治疗前明显改善，并且脑机组上述指标改善情况亦显著优于对照组水平(P<0.05)；另外本研究还发现患者FMA-UE、FIM及ARAT评分与CMCT及MEP潜伏期具有负相关性。 结论 基于运动想象的BCI训练可显著改善缺血性脑卒中患者MEP潜伏期、CMCT值及上肢运动功能，并且FMA-UE、FIM及ARAT评分与MEP潜伏期、CMCT值具有负相关性。

    缺血性脑卒中上肢运动功能障碍脑机接口运动想象训练运动诱发电位

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    虚拟现实训练联合芳香疗法对养老院阿尔茨海默病患者的影响

    孙志成王彤顾晓美马金霖...
    226-231页
    查看更多>>摘要：目的 探讨虚拟现实(VR)训练联合芳香疗法对养老院阿尔茨海默病(AD)患者的康复效果。 方法 选取养老院AD患者50例，按随机数字表法分为观察组和对照组，每组患者25例。2组患者均给予常规康复干预，观察组在此基础上增加VR训练同步芳香疗法，VR训练和芳香疗法均每周3次，每次45 min，连续干预6个月。于干预前和干预6个月后(干预后)评估2组患者的认知功能[ MMSE和AD认知功能评估量表(ADAS-cog)]、精神行为症状[AD病理行为评定量表(BEHAVE-AD)]、日常生活活动(ADL)能力(日常生活活动能力评估量表)、运动功能[包括"起立-行走"记时测试(TUGT)、30 s坐椅站立试验(30sCST)、30 s手臂弯曲试验(30sACT)和坐椅前伸试验(CSRT)]和生活质量[老年性痴呆生活质量量表(QOL-AD)]评估。 结果 干预后，对照组患者的MMSE、ADAS-cog和ADL评分与组内干预前比较，均显著改善，差异均有统计学意义(P<0.05)；观察组患者的MMSE、ADAS-cog、BEHAVE-AD和ADL评分与组内干预前比较，亦显著改善(P<0.05)，且均优于对照组干预后，差异均有统计学意义(P<0.05)。干预后，2组患者的TUGT、30sCST、30sACT和CSRT测试结果与组内干预前比较，均显著改善，差异均有统计学意义(P<0.05)，且观察组干预后的上述指标亦优于对照组干预后，差异均有统计学意义(P<0.05)。干预后，对照组的QOL-AD评分为(26.28±3.27)分，与组内干预前比较，差异有统计学意义(P<0.05)；观察组的QOL-AD评分为(29.47±4.16)分，与组内干预前和对照组干预后比较，差异均有统计学意义(P<0.05)。 结论 VR训练联合芳香疗法可显著改善养老院AD患者的认知功能、精神行为症状、日常生活活动能力、运动功能和生活质量，值得在养老机构的AD患者中推广和应用。 Objective To explore any effects of combining virtual reality training with aromatherapy in caring for Alzheimer′s disease patients in a nursing home. Methods Fifty nursing home residents with Alzheimer′s were divided at random into an observation group and a control group, each of 25. Both groups received routine rehabilitation, while the observation group was additionally given 45 minutes of virtual reality training combined with aromatherapy, 3 times a week for 6 months. Both groups′ cognition was then evaluated using the MMSE and an Alzheimer′s cognition assessment scale (ADAS-cog). Psycho-behavioral symptoms were quantified using the Alzheimer′s disease pathological behavior scale (BEHAVE-AD). Motor functioning was quantified using the timed up and go test (TUGT), the 30-second sit-to-stand test (30sCST), the 30-second arm curl test (30sACT) and the sit-and-reach test (CSRT). Ability in the activities of daily living (ADL) and life quality were quantified using the activity of daily living scale and of the quality of life scale for Alzheimer′s disease (QOL-AD) before and after the intervention. Results After the intervention the average MMSE, ADAS-cog, BEHAVE-AD and ADL scores of both groups had improved significantly, with the average improvement in the observation group significantly greater than that in the control group. The TUGT, 30sCST, 30sACT and CSRT results of both groups were also significantly better, with those of the observation group again significantly superior, on average, to the control group′s results. The average QOL-AD score in the observation was significantly improved after the intervention, and was then significantly better than the control group′s average. Conclusions Virtual reality training combined with aromatherapy can significantly improve the cognition, psycho-behavioral symptoms, activity in daily living, motor functioning and life quality of Alzheimer′s patients in a nursing home. It is worthy of promotion and application in nursing homes.

    虚拟现实训练芳香疗法养老院阿尔茨海默病医养结合

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    重复经颅磁刺激对中晚期帕金森病患者睡眠及血浆食欲素-A含量的影响

    李学陈思远吴少璞古祺...
    232-235页
    查看更多>>摘要：目的 观察重复经颅磁刺激(rTMS)对中晚期帕金森病(PD)患者睡眠及血浆食欲素-A含量的影响，并探讨血浆食欲素-A含量变化与患者睡眠障碍改善情况的相关性。 方法 采用随机数字表法将102例中晚期PD患者分为观察组及对照组，每组51例。2组患者均常规给予抗PD药物治疗，观察组在此基础上辅以高频rTMS治疗，磁刺激部位为左侧前额叶背外侧皮质区(DLPFC)，对照组则给予假rTMS治疗。2组患者均每日治疗1次，每周治疗5 d，连续治疗4周。于治疗前、治疗4周后分别采用匹茨堡睡眠质量指数(PSQI)、REM睡眠行为异常问卷-香港版(RBDQ-HK)、Epworth嗜睡量表(ESS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和PD生活质量量表(PDQ-39)对2组患者睡眠情况、焦虑-抑郁程度及生活质量等进行评定，同时采集2组患者清晨空腹静脉血，检测对比其血浆食欲素-A含量。 结果 治疗后观察组患者PSQI、RBDQ-HK、ESS、HAMA、HAMD及PDQ-39评分[分别为(8.02±3.01)分、(16.58±6.91)分、(7.27±4.03)分、(13.51±2.86)分、(9.61±1.28)分和(45.72±16.58)分]均明显低于治疗前及同期对照组水平(P<0.05)，血浆食欲素-A含量[(1.86±0.39)ng/ml]则明显高于治疗前及同期对照组水平(P<0.05)；对照组治疗后上述指标均较治疗前无显著变化(P>0.05)。通过相关性分析发现，治疗后患者血浆食欲素-A含量与RBDQ-HK及ESS评分均具有显著负相关性(r值分别为－0.548和－0.526，均P<0.05)，与PSQI评分则无显著相关性(r＝－0.123，P>0.05)。 结论 rTMS能显著改善中晚期PD患者失眠、RBD及EDS症状，缓解焦虑、抑郁等负性情绪和生活质量，提高患者血浆食欲素-A水平，其RBD及EDS症状改善可能与提高体内食欲素-A含量有关。

    帕金森病重复经颅磁刺激睡眠食欲素-A

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    滚筒作业训练对颈6脊髓损伤患者体位性低血压及日常生活能力的影响

    孙宁赵合欢叶婷王亚囡...
    235-237页
    查看更多>>摘要：目的 观察滚筒作业训练对颈6脊髓损伤患者体位性低血压(OH)及日常生活能力的影响。 方法 采用随机数字表法将40例颈6脊髓损伤患者分为观察组及对照组，每组20例。2组患者均给予常规康复干预，观察组在此基础上辅以滚筒作业训练，每次训练持续约20 min，每周训练5 d，连续训练8周。于治疗前、后对比2组患者晨起卧床时血压值、起立床最大维持角度及此时血压值，并比较2组患者在轮椅坐位状态下OH不适感消失时间，同时记录、比较2组患者上肢功能性伸展测试(FRT)距离、日常生活能力及工具性日常生活能力评分。 结果 治疗后2组患者晨起卧床时血压值、起立床至最大角度时血压值(对照组舒张压除外)、起立床最大维持角度、坐位下上肢功能性伸展测试结果及日常生活能力、工具性日常生活能力评分均较治疗前明显改善(P<0.05)；并且观察组在站起立床至最大角度时血压值、OH不适感消失时间、日常生活能力评分及工具性日常生活能力评分均显著优于对照组水平(P<0.05)。 结论 滚筒作业训练可改善颈6脊髓损伤患者OH症状，提高患者基础性日常生活能力及工具性日常生活能力，该疗法值得临床推广、应用。

    脊髓损伤滚筒训练体位性低血压日常生活能力

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    基于心肺运动试验的个体化运动康复疗法对老年稳定期慢性阻塞性肺疾病患者的影响

    张倩倩刘志刚刘锦娟丁瑞阳...
    238-242页
    查看更多>>摘要：目的 探讨基于心肺运动试验的个体化运动康复疗法对老年稳定期慢性阻塞性肺疾病(COPD)患者的影响。 方法 选取老年稳定期COPD患者120例，按照随机数字表法将其分为试验组和对照组，每组60例。2组患者均给予药物和常规康复治疗，试验组增加基于心肺运动试验制订的个体化运动康复疗法。治疗前、治疗3个月后(治疗后)，采用Borg评分评估2组患者的呼吸困难程度，记录第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)、最大摄氧量(VO2max)、无氧阈(AT)、心率(HR)、心脏指数(CI)，采用6 min步行距离(6MWD)测定患者的最大步行距离，评估康复疗效。 结果 治疗前，2组患者的Borg评分、心肺功能指标、6MWD比较，差异无统计学意义(P>0.05)。治疗后，2组患者的Borg评分、心肺功能指标、6MWD均较组内治疗前改善(P<0.05)。试验组治疗后Borg评分[(2.38±0.45)分]、FEV1[(3.65±1.31)%]、FVC[(64.09±12.10)%]、FEV1/FVC[(61.98±11.34)%]、VO2max[(19.62±4.06) ml/kg/min]、AT[(669.25±133.82) ml/min]、HR[(96.52±20.59)次/分]、CI[(3.98±1.17) L/min/m2]、6MWD[(315.25±60.12)m]、总有效率(58.33%)均高于对照组(P<0.05)。 结论 基于心肺运动试验的个体化运动康复疗法，可以缓解老年稳定期COPD患者的呼吸困难症状，改善心肺功能，提高运动耐力和康复疗效。 Objective To explore any effect of following an individualized exercise program on the cardio-pulmonary health of elderly persons with stable chronic obstructive pulmonary disease (COPD). Methods A total of 120 elderly COPD patients were randomly divided into an experimental group and a control group, each of 60. Both groups were given medication and routine rehabilitation treatment for 3 months, but the experimental group also followed an individualized exercise program based on the cardiopulmonary exercise test. Before and after the treatment, Borg scoring was used to assess the subjects′ degree of dyspnea. Forced expiratory volume (FEV1), forced vital capacity (FVC), maximum oxygen uptake (VO2max), anaerobic threshold (AT), heart rate (HR) and a heart index (CI) were also recorded. The 6-minute walk test (6 MWD) was administered to evaluate the rehabilitation effect. Results There were no significant differences in the average Borg scores, cardiopulmonary function indexes or 6MWD distances between the two groups before treatment. After the treatment significant improvement was observed in all of the measurements in both groups, but at that point all of the experimental group′s averages were better than those of the control group. Conclusion Individualized exercise based on the cardiopulmonary exercise test can alleviate the symptoms of dyspnea in elderly COPD patients, improve their cardiopulmonary functioning and exercise endurance and improve the rehabilitation effect.

    心肺运动试验个体化运动康复疗法慢性阻塞性肺疾病稳定期

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