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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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    干细胞治疗联合有氧运动对急性心肌梗死大鼠左心室重塑的影响

    乔冰杨进华王晨宇刘静...
    385-390页
    查看更多>>摘要：目的 观察干细胞治疗联合有氧运动对急性心肌梗死大鼠左心室重塑的影响。 方法 采用结扎冠状动脉前降支方法将60只6周龄雄性Wistar大鼠制成急性心肌梗死动物模型，并随机分为模型组、干细胞组、运动组及观察组，同时选取10只健康Wistar大鼠纳入假手术组。干细胞组和观察组大鼠于造模成功后经尾静脉输注骨髓间充质干细胞悬液，运动组和观察组大鼠于造模4周后给予跑台运动干预(每天运动60 min，每周运动5 d，连续运动8周)。于造模4周后及末次训练结束时利用递增负荷运动实验评估大鼠运动能力，于末次训练结束时采用超声成像系统检测大鼠心脏结构及功能，取左心室组织进行Masson染色并计算胶原容积分数，采用实时荧光定量PCR技术检测大鼠心肌脑钠肽(BNP)、β-肌球蛋白重链(β-MHC)、α-MHC mRNA表达量以及α-MHC/β-MHC比值。 结果 与假手术组比较，模型组力竭时间、力竭距离明显缩短，最快跑速、左心室射血分数(LVEF)、左心室缩短分数(LVFS)、α-MHC表达量及α-MHC/β-MHC比值显著降低(P<0.05)，安静时心率、胶原容积分数、BNP和β-MHC表达量显著增加(P<0.05)。与模型组比较，干细胞组力竭时间、力竭距离、最快跑速、安静时心率、BNP、β-MHC、α-MHC和α-MHC/β-MHC比值均无显著变化(P>0.05)，LVEF和LVFS均明显升高(P<0.05)，胶原容积分数显著降低(P<0.05)；观察组力竭时间、力竭距离、最快跑速、LVEF、LVFS、α-MHC表达量和α-MHC/β-MHC比值均明显增加(P<0.05)，安静时心率、胶原容积分数、BNP和β-MHC表达量均明显降低(P<0.05)。与干细胞组比较，观察组力竭时间、力竭距离、最快跑速、α-MHC表达及α-MHC/β-MHC比值均明显增加(P<0.05)，安静时心率、胶原容积分数、BNP及β-MHC表达均明显降低(P<0.05))。 结论 单纯有氧运动或干细胞治疗均可抑制心肌梗死大鼠左心室重塑并改善心功能，两种疗法联用具有协同作用，能进一步增强干细胞治疗效果。 Objective To explore the effect of supplementing stem cell therapy with aerobic exercise in left ventricle remodeling after myocardial infarction. Methods Sixty 6-week-old male Wistar rats had acute myocardial infarction induced by ligation of the anterior descending coronary artery. They were then randomly divided into a model group, a stem cell group, an exercise group and an observation group. Another ten healthy Wistar rats formed a sham operation group. The rats in the stem cell and observation groups were infused with a suspension of bone marrow mesenchymal stem cells through the tail vein. Beginning four weeks later, the exercise and observation groups underwent 60 minutes of aerobic treadmill exercise 5 days per week for 8 weeks. At the beginning and end of the eight weeks the rats′ exercise performance was evaluated using a graded treadmill exercise test. And after the last training session cardiac structure and function were detected using ultrasound imaging. Tissue was then collected from the left ventricles and the collagen volume fractions were calculated. The expression of myocardial brain natriuretic peptide (BNP), heavy chain β-myosin (β-MHC) and α-MHC mRNA was detected using real-time fluorescence quantitative PCRs. Results Compared with the sham operation group, the time and distance to exhaustion shortened significantly in the model group, with a significant decrease in the average maximum running speed, left ventricle ejection fraction (LVEF), left ventricle shortening fraction (LVFS), expression of α-MHC and the α-MHC/β-MHC ratio. There was a significant increase in the average resting heart rate, collagen volume fraction, expression of BNP and β-MHC in the model group. Compared with the model group, there was a significant increase in the average LVEF and LVFS of the stem cell group as well as in the time and distance to exhaustion, maximum running speed, expression of α-MHC and in the α-MHC/β-MHC ratio of the observation group, but a significant decrease in the average collagen volume fraction of the stem cell group compared with the observation group, together with the resting heart rate, collagen volume fraction, the expression of BNP and of β-MHC. Compared with the stem cell group, the observation group showed a significant increase in the average time and distance to exhaustion, maximum running speed, expression of α-MHC and the α-MHC/β-MHC ratio, with a significant decrease in the average resting heart rate, collagen volume fraction, expression of BNP and β-MHC. Conclusion Aerobic exercise or stem cell therapy alone can inhibit left ventricular remodeling and improve cardiac function after myocardial infarction, at least in rats. The combination of the two treatments has a synergistic effect and can further enhance the effect of stem cell therapy.

    有氧运动干细胞疗法急性心肌梗死大鼠心脏重塑

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    经颅直流电刺激对脑卒中患者认知功能及其脑白质纤维完整性的影响

    宋梦涵高呈飞周锐志朱其秀...
    391-396页
    查看更多>>摘要：目的 观察经颅直流电刺激(tDCS)对脑卒中患者认知功能的疗效，并利用磁共振弥散张量成像(DTI)技术观察tDCS对脑白质纤维完整性的影响。 方法 选取脑卒中后认知障碍(PSCI)患者30例，将其分为试验组和对照组，每组患者15例。2组患者均给予基础药物治疗和常规认知训练，试验组在此基础上增加tDCS治疗(每日1次，每次刺激20 min，每周刺激5 d，连续治疗3周)，对照组则增加tDCS假刺激。于治疗前和治疗3周后(治疗后)采用简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评价2组患者的认知功能，其日常生活活动能力采用改良的Barthel指数(MBI)进行评估，同时采用DTI观察PSCI患者脑白质纤维完整性的变化，并采用Pearson检验法对弥散纤维束的FA值与MMSE、MoCA分数进行相关性分析。 结果 治疗后，2组患者的MMSE、MoCA、MBI评分较组内治疗前均显著改善，差异均有统计学意义(P<0.05)，且试验组治疗后的MMSE、MoCA、MBI评分均显著高于对照组治疗后，差异均有统计学意义(P<0.05)。试验组患者治疗后的FA、DA、DR值与组内治疗前和对照组治疗后比较，差异均有统计学意义(P<0.05)。2组患者患侧IFOF的FA值与MMSE评分(r＝0.8447，P<0.0001)和MoCA评分(r＝0.6688，P<0.0001)均呈正相关。 结论 tDCS可以有效地提高脑卒中患者的认知功能、改善日常生活活动能力，其机制可能与tDCS可改善相关脑白质纤维的完整性有关。 Objective To observe any effect of transcranial direct current stimulation (tDCS) on the cognition of stroke survivors and the integrity of their white matter fibers. Methods Thirty persons with post-stroke cognitive impairment (PSCI) were randomly divided into an experimental group (n=15) and a control group (n=15). In addition to basic drug therapy and routine cognition training, the experimental group received 20 minutes of tDCS daily, 5 days per week for 3 weeks, while the control group received sham tDCS stimulation. Before and after the treatment, both groups′ cognitive functioning was evaluated using the mini-mental state examination (MMSE) and the Montreal cognitive assessment scale (MoCA). Their ability in the activities of daily living (ADL) was quantified using the modified Barthel index (MBI). Diffusion tensor imaging (DTI) was employed to observe any changes in the integrity of their white matter fibers. Results The average MMSE, MOCA and MBI scores of both groups had improved significantly after the treatment, but the improvement in the experimental group was significantly greater than among the controls. The average fractional anisotroposy value of the affected inferior fronto-occipital fasciculus in both groups was positively correlated with the group′s average MMSE score and MoCA score. Conclusion tDCS can effectively improve the cognition and functioning in the activities of daily living of stroke survivors. Its mechanism may be related to improving the integrity of the white matter fibers involved.

    脑卒中后认知障碍经颅直流电刺激弥散张量成像脑白质纤维

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    低频重复经颅磁刺激联合虚拟情景互动训练对脑卒中后上肢运动功能恢复的影响

    李泽文郭琛琛刘丽丁懿...
    397-401页
    查看更多>>摘要：目的 观察低频重复经颅磁刺激(rTMS)联合虚拟情景互动训练对脑卒中患者上肢运动功能恢复的影响。 方法 采用随机数字表法将90例脑卒中患者分为伪rTMS组、rTMS组及联合组，每组30例。3组患者均给予基础药物、常规康复及综合护理干预，在此基础上伪rTMS组辅以rTMS假刺激，rTMS组辅以低频(1 Hz)rTMS治疗，联合组则辅以低频(1 Hz)rTMS治疗及虚拟情景互动训练，各组患者均每周治疗5 d。于治疗前、治疗4周后检测3组患者运动诱发电位(MEP)的皮质潜伏期(CL)、中枢运动传导时间(CMCT)，使用表面肌电(sEMG)技术采集患侧肱二头肌、肱三头肌均方根值(RMS)，同时采用美国国立卫生研究院卒中量表(NIHSS)、上肢Fugl-Meyer量表(FMA-UE)及改良Barthel指数(MBI)评定患者神经缺损程度、上肢运动功能和日常生活活动(ADL)能力情况。 结果 治疗后3组患者CL、CMCT、RMS参数及NIHSS、FMA-UE、MBI评分均较治疗前明显改善(P<0.05)，并且rTMS组CL、CMCT、RMS参数及NIHSS、FMA-UE、MBI评分亦显著优于伪rTMS组水平(P<0.05)，联合组CL[(24.01±1.16)ms]、CMCT[(12.15±0.76)ms]、肱二头肌RMS[(8.97±4.33)μV]、肱三头肌RMS[(7.30±2.18)μV]、NIHSS评分[(8.80±2.14)分]、FMA-UE评分[(42.70±8.76)分]及MBI评分[(72.57±9.88)分]均显著优于rTMS组及伪rTMS组水平(P<0.05)。 结论 低频rTMS联合虚拟情景互动训练能有效改善脑卒中患者上肢运动功能及ADL能力，减轻神经缺损症状，该联合疗法值得临床推广、应用。 Objective To observe any effect of combining low-frequency transcranial magnetic stimulation (rTMS) with interactive virtual scenario training on the recovery of upper limb motor function after a stroke. Methods Ninety stroke survivors were randomly divided into a pseudo-rTMS group, an rTMS group and a combination group, each of 30. In addition to basic medication, conventional rehabilitation and nursing care, the pseudo-rTMS, rTMS and combination groups received either sham rTMS treatment, 1Hz rTMS or virtual situational interaction along with 1Hz rTMS 5 days a week for 4 weeks. Before and after the 4 weeks their motor evoked potentials, cortical latency and central motor conduction time were measured, and surface electromyography was applied to the affected biceps brachii and triceps brachii. Meanwhile, the National Institutes of Health Stroke Scale, the Fugl-Meyer upper extremity assessment and the modified Barthel index were employed to assess the degree of neurological deficit, upper extremity motor function and ability in the activities of daily living (ADL). Results After the 4-week intervention, a significant improvement was observed in all of the outcome measurements with all three groups. At that time the average scores of the rTMS group were significantly better than the pseudo-rTMS group′s averages but the average scores of the combination group were significantly better than those of either of the other two groups. Conclusion Repeated application of low-frequency transcranial magnetic stimulation combined with virtual scenario interactive training can effectively improve the upper limb motor function and ADL performance of stroke survivors, and relieve the symptoms of neurological deficit. The combined therapy is worthy of application in clinical practice.

    重复经颅磁刺激虚拟情景互动训练运动再学习神经可塑性

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    小脑间歇性θ短阵脉冲刺激联合物理治疗对脑卒中患者平衡功能和步态的影响

    陈静石明芳陈君张键...
    402-407页
    查看更多>>摘要：目的 观察小脑间歇性θ短阵脉冲刺激(iTBS)联合物理治疗对脑卒中患者平衡功能和步态的影响。 方法 选取脑卒中后偏瘫患者32例，按随机数字表法分为治疗组和对照组各16例。2组患者均接受常规物理治疗，物理治疗前治疗组行健侧小脑iTBS治疗，对照组给予相同部位伪刺激，iTBS每日治疗1次，每次治疗200 s，每周6次，连续治疗3周。于治疗前、治疗3周后和出院3周后(随访时)对2组患者进行疗效评估。主要观察指标包括Berg平衡量表(BBS)评分、动摇总轨迹长和X轴最大动摇径，用于评估2组患者的平衡功能和重心转移能力。次要评估指标有采用10 m步行时间测试(10MWT)和Tinetti步态评估量表(POMA-G)评估2组患者的步行能力；采用简化的Fugl-Meyer下肢运动功能量表(FMA-LE)评估2组患者下肢的运动功能；采用Barthel指数(BI)评估2组患者的日常生活活动能力。 结果 治疗3周后和随访时，对照组患者的BBS评分分别为(41.38±5.33)分和(42.19±5.55)分，较组内治疗前均显著改善(P<0.05)；治疗组患者治疗3周后和随访时的BBS评分、动摇总轨迹长和X轴最大动摇径较组内治疗前和对照组同时间点均显著改善，差异均有统计学意义(P<0.05)。治疗3周后和随访时，对照组患者的POMA-G评分、FMA-LE评分和BI评分较组内治疗前均显著改善(P<0.05)。治疗3周后和随访时，治疗组患者的10MWT、POMA-G评分、FMA-LE评分和BI评分较组内治疗前均显著改善(P<0.05)，且其治疗3周后的POMA-G评分、10MWT和随访时的10MWT和BI评分均显著优于对照组同时间点，差异均有统计学意义(P<0.05)。 结论 小脑间歇性θ短阵脉冲刺激联合物理治疗可有效地改善脑卒中后患者的平衡功能和步态，分析其可能的机制与小脑间歇性θ短阵脉冲刺激可调节小脑-丘脑-大脑皮质环路有关。 Objective To explore any effect of combining intermittent theta-burst stimulation (iTBS) of the cerebellum with physiotherapy on the balance function and gait of stroke survivors. Methods Thirty-two hemiplegic stroke survivors were divided at random into a treatment group and a control group, each of 16. Both groups received conventional physical therapy. Before their physiotherapy sessions the treatment group received iTBS treatment of the cerebellar hemisphere contralateral to the affected cerebral hemisphere, while the control group was given pseudo-stimulation on the same site. The iTBS was given once a day for 200s each time, 6 times a week for 3 weeks consecutively. Before and after the treatment, as well as 3 weeks later, both groups′ balance was evaluated using the Berg Balance Scale (BBS). Their ability to shift their center of gravity, total length of their shaking trajectory, and maximum shaking diameter were also quantified. Walking ability was assessed using 10m walk test (10MWT) times and the Tinetti Gait Assessment Scale (POMA-G). Lower limb motor function was quantified using the relevant Fugl-Meyer assessment (FMA-LE) and the subjects′ ability in the activities of daily living was measured with the Barthel index (BI). Results After the 3 weeks of treatment and at the follow-up the average BBS score of the treatment group had improved significantly more than the control group′s average, as had its total track length and maximum shake diameter. The average POMA-G, FMA-LE and BI scores of the treatment group were also significantly better. Conclusions Combining iTBS with physiotherapy can improve the balance and gait of stroke survivors more effectively than physiotherapy alone.

    间歇性θ短阵脉冲刺激小脑脑卒中平衡步态

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    不同侧小脑半球Theta爆发式经颅磁刺激对健康受试者吞咽调节效应的影响

    王丙琰孟萍萍潘晓娜孙慧...
    408-413页
    查看更多>>摘要：目的 观察间歇性Theta爆发式经颅磁刺激(iTBS)对健康受试者大脑吞咽运动皮质和小脑吞咽运动区兴奋性的影响，并探讨小脑iTBS调节吞咽功能的机制。 方法 采用随机数字表法将44例右利手健康受试者分为优势侧小脑组(15例)、非优势侧小脑组(15例)、对照组(14例)。优势侧小脑组给予优势侧小脑iTBS干预和非优势侧小脑假刺激，非优势侧小脑组给予优势侧小脑假刺激和非优势侧小脑iTBS干预，对照组给予双侧小脑假刺激。iTBS干预前后，分别对受试者双侧大脑和双侧小脑的舌骨上肌群代表区进行单脉冲经颅磁刺激(TMS)测定，观察受试者运动诱发电位(MEP)波幅和潜伏期的变化。 结果 与组内干预前比较，非优势侧小脑组干预后双侧大脑吞咽皮质和刺激同侧小脑的MEP波幅升高(P<0.05)；优势侧小脑组干预后仅刺激同侧小脑的MEP波幅升高(P<0.05)。在MEP波幅与基线相比的百分比变化方面，与对照组干预后同指标比较，非优势侧小脑组刺激双侧大脑皮质和刺激同侧小脑的数值较高(P<0.05)；与非优势侧小脑组干预后同指标比较，优势侧小脑组刺激双侧大脑皮质的数值较低(P<0.05)。3组受试者MEP潜伏期、MEP潜伏期与基线相比的百分比变化，组内及组间比较差异无统计学意义(P>0.05)。 结论 非优势侧小脑半球与优势侧小脑半球iTBS对吞咽相关脑区均有一定的兴奋作用，但二者所兴奋的脑区有所差异。 Objective To observe any stimulatory effect of intermittent theta burst stimulation (iTBS) on the cerebral swallowing cortex and the cerebellar swallowing motor area and to explore the related mechanisms. Methods Forty-four healthy right-handed subjects were divided at random into a dominant cerebellum group (n=15), a non-dominant cerebellum group (n=15) and a control group (n=14). In the dominant cerebellum group, iTBS was administered to the cerebellum of the dominant hemisphere, and the other hemisphere was given sham stimulation. In the non-dominant cerebellum group, it was the opposite. The dominant cerebellum received the sham stimulation. In the control group both hemispheres received sham stimulation. Before and after the stimulation, single-pulse transcranial magnetic stimulation (TMS) was applied to the representative regions of suprahyoid muscles in bilateral brain and cerebellum to observe changes of the latency and amplitude of motor evoked potentials (MEPs). Results After the intervention the MEP amplitude of the bilateral swallowing cortex and the stimulated cerebellum had increased in the non-dominant cerebellum group, with increased MEP amplitude only from the stimulated cerebellum of the dominant cerebellum group. Compared with the control group, the non-dominant cerebellum group showed the greatest improvement in MEP amplitude of the stimulated bilateral cerebral cortex and cerebellum. Improvement in the dominant cerebellum group was significantly smaller. However, there were no significant differences in MEP latency or the percentage change in MEP latency from baseline among the three groups. Conclusions Applying iTBS to either the non-dominant or the dominant cerebellum excites the brain areas related to swallowing, but in different ways.

    吞咽小脑间歇性Theta爆发式经颅磁刺激运动诱发电位

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    体感音乐疗法联合吞咽动画视听反馈训练对脑干卒中后患者吞咽功能和情绪状态的影响

    甘莉杨馨李利娟蒙利娇...
    414-417页
    查看更多>>摘要：目的 观察体感音乐疗法联合吞咽动画视听反馈训练对脑干卒中患者吞咽功能和情绪状态的影响。 方法 采用计算机中心数表法将50例脑干卒中后吞咽障碍患者随机分为对照组和联合组，每组25例。2组患者均接受常规吞咽功能训练，对照组在此基础上增加直接摄食训练，联合组增加体感音乐疗法和吞咽动画视听觉刺激下的摄食训练。治疗前、治疗4周后，采用标准吞咽功能评价量表(SSA) 、Gugging吞咽功能评估表(GUSS)、正负性情绪量表(PNAS)对2组患者的吞咽功能和情绪状态进行评定。 结果 与组内治疗前比较，2组患者治疗4周后SSA评分下降，GUSS和PNAS评分增高(P<0.05)。联合组治疗4周后SSA评分[(22.40±3.06)分]、GUSS评分[(17.56±1.96)分]、PNAS评分[(87.52±9.78)分]均较对照组改善优异(P<0.05)。 结论 在常规吞咽功能训练基础上，增加体感音乐疗法和吞咽动画视听觉刺激下的摄食训练，可显著改善脑干卒中后吞咽障碍患者的摄食功能和情绪状态。 Objective To observe any effect of combining vibroacoustic therapy with audio-visual feedback on the swallowing and the emotional state of persons with a swallowing disorder after a brainstem stroke. Methods Fifty brainstem stroke survivors with dysphagia were randomly divided into a control group and a combination group, each of 25. In addition to routine swallowing function training, the control group received additional direct feeding training, while the combination group was provided with vibroacoustic feeding training and swallowing stimulation from an animated audio-visual presentation. Before and after the treatment, the subjects′ swallowing function was quantified using the Standard Swallowing Assessment (SSA) scale and the Gugging swallowing screen (GUSS). The Positive and Negative Emotions Scale (PNAS) was used to quantify their emotional state. Results After the treatment the average SSA scores of both groups had decreased significantly, while the average GUSS and PNAS scores had increased significantly. The average improvements in all three measures were significantly greater in the combination group than in the control group. Conclusion In addition to routine swallowing function training, feeding training applying vibroacoustics and audio-visual stimulation can significantly improve the feeding function and emotional state of brainstem stroke survivors with dysphagia.

    脑干卒中体感音乐疗法吞咽障碍镜像视觉反馈

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    肘前臂托和传统肩吊带治疗脑卒中后肩关节半脱位的随机交叉研究

    陈汉波吕晓燕铁斌丁丽娟...
    418-422页
    查看更多>>摘要：目的 采用自身随机交叉对照研究方法，分析和比较基于3D打印的肘前臂托(3D法)和传统肩吊带(传统法)对脑卒中后肩关节半脱位(GHS)的即时复位效果。 方法 选取8例符合入组条件的脑卒中后偏瘫伴GHS患者，依次进行2个阶段的佩戴矫形器治疗，每个阶段随机佩戴肘前臂托和传统肩吊带，30 min/次，2个阶段间隔24 h。所有患者检查6次肩关节X线正位片(分别是佩戴前健侧和患侧以及患侧2种矫形器每次佩戴即刻和佩戴30 min后)，分别测量肩峰下缘至肱骨头中心的垂直距离(VD)和水平距离(HD)。2次佩戴结束后，对2种矫形器患者和家属进行满意度问卷调查。 结果 患者佩戴即刻和佩戴30 min后与同一方法佩戴前比较，VD和HD均有明显改善(P<0.05)；但3D法的VD改善更加明显(P<0.01)。VD和HD在佩戴即刻和佩戴30 min后，不同方法之间的差异均有统计学意义(P<0.05)，受试者对肘前臂托(3D法)的满意度更高。 结论 基于3D打印的肘前臂托和传统肩吊带对GHS都具有即时复位效果，但肘前臂托复位效果更明显，患者及其家属的使用满意度更高。 Objective To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke. Methods Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed. Results The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support. Conclusion Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

    3D打印肘前臂托脑卒中肩关节半脱位交叉试验

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    脊髓损伤患者入院合并泌尿系感染危险因素的回顾性研究

    禄熠行孙妙巧吴相波徐沐兰...
    423-428页
    查看更多>>摘要：目的 探讨脊髓损伤(SCI)患者入院合并泌尿系感染(UTI)的危险因素。 方法 回顾性分析空军军医大学第一附属医院康复医学科2017年8月至2022年6月收入院的403例SCI患者资料。按入院时是否合并UTI分为UTI组和非UTI组。分别比较两组患者的性别、年龄、损伤原因、损伤节段、肛门自主收缩情况、发病至入院时间、美国脊髓损伤协会(ASIA)分级、入院体温、合并症(糖尿病、高血压、骨盆骨折、压疮、贫血)、实验室检查结果(血白细胞、尿细菌定量)等相关指标。采用二元Logistic回归分析筛选SCI患者入院时合并UTI的危险因素。 结果 在最终纳入的354例患者中，有62例患者(17.51%)入院时合并UTI。二元Logistic回归分析结果显示，SCI患者入院时合并UTI与肛门自主收缩消失[OR＝3.305，95%CI(1.472，7.421), P＝0.004]、发热[OR＝5.027，95%CI(1.606，15.738)，P＝0.006]、贫血[OR＝2.522, 95%CI(1.309, 4.856), P＝0.006]、血白细胞升高[OR＝3.367, 95%CI(1.641, 6.910), P<0.001]、高尿细菌定量[OR＝5.970, 95%CI(2.753, 12.945),P<0.001]有关。 结论 肛门自主收缩消失、发热、贫血、血白细胞升高、高尿细菌定量是SCI患者入院时合并UTI的独立危险因素，其中发热(腋温≥37.3 ℃)和高尿细菌定量(尿细菌定量≥1266.9个/μl)是风险较高的两个因素。 Objective To explore the risk factors for urinary tract infection (UTI) after a spinal cord injury (SCI). Methods The medical records of 403 SCI patients were analyzed retrospectively. They were divided into UTI group and no-UTI group according to whether they had a UTI at admission. Gender, age, cause of injury, injury level of the spinal cord, voluntary anal contraction, time from injury to admission, American Spinal Injury Association (ASIA) grade, axillary temperature at admission, complications at admission (diabetes, hypertension, fracture of the pelvis, pressure sores or anemia), white blood cell count and urinary bacteria were compared between the two groups. Binary logistic regression was used to highlight the risk factors for a UTI after an SCI. Results Of the 354 patients included in the final analysis, 62 (17.51%) had a UTI at admission. The regression showed that UTI after an SCI was closely related to an inability to voluntarily contract the anus, anemia, elevated white blood cell count and a high level of bacteria in the urine. Conclusions Inability to contract the anus, fever, anemia and an elevated white blood cell count are independent indicators of a UTI after an SCI. A temperature ≥37.3°C is a simple indicator of a concentration of bacteria in the urine ≥1266/μL.

    脊髓损伤泌尿系感染危险因素

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    高强度间歇性训练对老年人血管壁弹性的影响

    庄鑫徐花郑娟吴丽丽...
    429-431页
    查看更多>>摘要：目的 观察高强度间歇性训练(HIIT)对老年人血浆致动脉硬化指数(AIP)和臂踝脉搏波传导速度(baPWV)的影响。 方法 将82例通过社会招募且符合入组标准的老年人按照随机数字表法分为运动组和对照组，每组41例，对照组予以日常运动锻炼指导和健康宣教，运动组在此基础上予以每次40 min(3 min高强度训练与3 min休息的间歇运动5组，10 min的热身与整理活动)、每周3次的HIIT(80%峰值功率)。分别于干预前和12周后(干预后)进行血脂检查换算出2组的AIP，使用全自动动脉硬化检测仪检测2组的baPWV。 结果 干预前，2组研究对象的AIP和baPWV组间差异均无统计学意义(P>0.05)。12周后，运动组的AIP[(0.097±0.059)]较干预前[(0.158±0.759)]明显降低(P<0.05)，且低于同时间点对照组[(0.148±0.093)]，组间差异有统计学意义(P<0.05)。 结论 HIIT可以改善老年人AIP水平，可能对老年人血管壁弹性减退有一定改善作用。

    高强度间歇性训练动脉硬化指数臂踝脉搏波传导速度

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    功能性电刺激联合Vojta反射性翻身疗法对痉挛型脑瘫患儿翻身发育的影响

    简海胜徐光青周平白文芳...
    432-434页
    查看更多>>摘要：目的 观察功能性电刺激联合Vojta反射性翻身疗法对痉挛型脑瘫患儿翻身发育的影响。 方法 选取年龄6月至8月的痉挛型脑瘫患儿80例，按随机数字表法将其分成对照组和治疗组，每组患儿40例。对照组采用单纯的Vojta反射性翻身疗法进行治疗，治疗组在Vojta反射性翻身治疗的基础上增加胸廓主诱发带区域和腹肌区域的功能性电刺激治疗。功能性电刺激治疗每日1次，每次20 min，每周治疗5 d，连续治疗6周。于治疗前和治疗6周后(治疗后)采用粗大运动评价量表(GMFM-88)A区评估2组患儿的粗大运动功能，同时采用改良Ashworth肌张力评估量表(MAS)评估2组患儿上、下肢的肌张力。 结果 治疗后，2组患儿的GMFM-88量表A区评分、上肢MAS评分和下肢MAS评分较组内治疗前均显著改善(P<0.05)，且治疗组患儿治疗后的GMFM-88量表A区评分、上肢MAS评分和下肢MAS评分分别为(39.45±4.91)分、(2.63±0.74)分和(2.67±0.66)分，均显著优于对照组治疗后，差异均有统计学意义(P<0.05)。 结论 在Vojta反射性翻身疗法的基础上增加功能性电刺激可显著改善痉挛型脑瘫患儿的翻身发育和肢体肌张力。

    痉挛型脑瘫Vojta疗法翻身功能性电刺激

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