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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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    高强度间歇运动对自发性高血压大鼠肾脏肾素-血管紧张素系统的影响

    李晓勇刘静万琼易浩...
    673-677页
    查看更多>>摘要：目的 观察高强度间歇运动对自发性高血压大鼠(SHR)血压水平及肾功能的影响，并探讨肾脏肾素-血管紧张素系统(RAS)在其间的作用机制。 方法 采用随机数字表法将20只雄性SHR大鼠分为高血压安静组及高血压运动组，同时选取10只Wistar-Kyoto大鼠纳入正常血压组。正常血压组及高血压安静组大鼠均置于鼠笼内安静饲养，高血压运动组大鼠则给予8周高强度间歇运动干预。于末次运动结束后检测各组大鼠血压水平、肾功能、肾脏一氧化氮(NO)和白细胞介素-6(IL-6)含量以及肾脏血管紧张素转换酶(ACE)、ACE2、血管紧张素1型受体(AT1R)、AT2R和Mas受体(MasR)蛋白表达量。 结果 与正常血压组比较，高血压安静组大鼠血压升高(P<0.05)，肾功能减退(P<0.05)，肾脏NO含量减少(P<0.05)，IL-6含量升高(P<0.05)，ACE和AT1R蛋白表达以及AT1R/AT2R比值升高(P<0.05)，ACE2、AT2R及MasR蛋白表达下降(P<0.05)；与高血压安静组比较，高血压运动组大鼠血压明显下降(P<0.05)，肾功能改善(P<0.05)，肾脏NO含量升高(P<0.05)，IL-6含量降低(P<0.05)，ACE和AT1R蛋白表达以及AT1R/AT2R比值下降(P<0.05)，ACE2、AT2R及MasR蛋白表达显著上调(P<0.05)。 结论 8周高强度间歇运动干预能通过调控肾脏RAS轴对SHR大鼠肾脏发挥保护作用。 Objective To observe any effect of high-intensity interval training on the blood pressure and renal function of Wistar-Kyoto rats modeling spontaneous hypertension (SHR) and to explore the mechanism of the renal renin-angiotensin system′s (RAS′s) role in this process. Methods Twenty male SHR were randomly divided into a sedentary group and an exercise group, each of 10. Another 10 Wistar-Kyoto rats formed a normotensive control group. The rats in the normotensive and hypertensive sedentary groups were fed quietly in their cage, while the hypertensive exercise group performed high-intensity interval training for 8 weeks. After the last exercise, blood pressure, renal function, the kidney levels of nitric oxide and interleukin-6 (IL-6) and the protein expressions of angiotensin converting enzyme (ACE), ACE2, angiotensin type 1 receptor (AT1R), AT2R and Mas receptor (MasR) were measured. Results Compared with the normotensive group, the hypertensive sedentary group showed a significant increase in average blood pressure, IL-6, ACE and AT1R protein and the ratio of AT1R to AT2R. There was a significant decrease in the renal function, the average NO level and the expression of ACE2, AT2R and MasR protein. That group also showed a significant decrease in blood pressure, IL-6, ACE and AT1R protein expression and the AT1R: AT2R ratio compared with the hypertensive sedentary group, but a significant increase in renal function, average NO content and the expression of ACE2, AT2R and MasR protein. Conclusion Eight weeks of high-intensity interval training has a protective effect on the kidneys by regulating the renin-angiotensin system, at least in rats.

    高强度间歇运动自发性高血压大鼠肾脏肾素-血管紧张素系统血压

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    音乐运动疗法联合经颅直流电刺激对帕金森病患者运动及认知功能的影响

    吴少璞李学祁亚伟王恒...
    678-682页
    查看更多>>摘要：目的 观察音乐运动疗法联合经颅直流电刺激(tDCS)对帕金森病(PD)患者运动、平衡及认知功能的影响。 方法 采用随机数字表法将120例PD患者分为对照组、音乐运动组、tDCS组和联合组，每组30例。4组患者均给予常规康复训练，音乐运动组、tDCS组在此基础上分别给予音乐运动训练或tDCS治疗，联合组则辅以音乐运动训练及tDCS联合治疗。于治疗前、治疗4周后分别采用统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、10 m折返运动试验、Berg平衡量表(BBS)、活动平衡信心量表(ABC)及蒙特利尔认知评估量表(MoCA)对4组患者的运动、平衡及认知功能进行评定。 结果 经治疗4周后，发现音乐运动组UPDRS-Ⅲ评分、10 m折返运动计时、BBS评分及ABC评分均明显优于对照组(P<0.05)；tDCS组MoCA各项指标评分及总分均明显优于音乐运动组和对照组(P<0.05)；联合组UPDRS-Ⅲ评分、10 m折返运动计时、BBS评分、ABC评分、MoCA各项指标评分及总分均显著优于对照组、音乐运动组及tDCS组(P<0.05)。 结论 音乐运动训练联合tDCS可进一步改善PD患者的运动、平衡及认知功能，该联合疗法值得临床推广、应用。 Objective To observe any effect of combining music exercise with transcranial direct current stimulation (tDCS) on the motor control, balance and cognition of persons with Parkinson′s disease (PD). Methods A total of 120 PD patients were randomly divided into a control group, a music exercise group, a tDCS group and a combined group, each of 30. All received routine rehabilitation training, while the music exercise, tDCS and combined groups were additionally provided with music exercise therapy, tDCS treatment or both, respectively. Version three of the unified Parkinson′s disease scale (UPDRSIII), a 10m reentry movement test, the Berg balance scale (BBS), the Activity Balance Confidence scale (ABC) and Montreal cognitive assessments were applied before and after 4 weeks of the treatments. Results After the treatment, the average UPDRSIII score and 10m reentry movement time of the music exercise group were significantly lower than in the control group, while the average BBS and ABC scores were significantly higher than the control group′s averages. The tDCS group′s average MoCA scores on all of the items and its total score were significantly higher than those of the music exercise and control groups. The average UPDRSIII score and 10m reentry movement time of the combined group were the lowest after the treatment, and that group′s average BBS, ABC, MoCA and total scores were the highest, significantly better than the other three groups. Conclusion Combining music exercise training with tDCS can effectively improve the motor functioning, balance and cognition of persons with PD.

    帕金森病音乐运动疗法经颅直流电刺激运动功能认知功能

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    阈值压力负荷吸气肌训练对帕金森病患者呼吸肌功能、平衡功能和步行功能的影响

    华玲王志宋达许忠梅...
    683-687页
    查看更多>>摘要：目的 观察阈值压力负荷吸气肌训练对帕金森病患者平衡功能的影响。 方法 采用随机数字表法将帕金森病患者48例分为观察组和对照组，每组24例。对照组给予常规神经内科药物治疗和常规康复训练，观察组在此基础上使用阈值压力负荷训练器进行吸气肌训练。阈值压力负荷吸气肌训练每周训练5 d，连续训练8周。于治疗前和治疗8周后(治疗后)分别对2组患者进行吸气肌功能[包括超声评估膈肌的活动度和厚度，以及最大吸气压(MIP)]、平衡功能[包括躯干损伤量表(TIS)评分、Berg平衡量表(BBS)评分、姿势稳定极限(LOS)和计时起立-行走测试(TUGT)]和步行功能[包括10米步行测试(10MWT)和动态步态指数(DGI)]评定。 结果 治疗后，2组患者的膈肌活动度、厚度和MIP均较组内治疗前均明显改善，差异均有统计学意义( P<0.05)。观察组治疗后的膈肌活动度、吸气末厚度和MIP均显著优于对照组治疗后，差异均有统计学意义(P<0.05)。治疗后，2组患者的TIS评分、BBS评分、LOS和TUGT较组内治疗前均显著改善，差异均有统计学意义(P<0.05)。观察组治疗后的TIS评分、BBS评分、LOS和TUGT均显著优于对照组治疗后，差异均有统计学意义(P<0.05)。治疗后，2组患者的10MWT和DGI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)。观察组治疗后的10MWT和DGI评分均显著优于对照组治疗后，差异均有统计学意义(P<0.05)。相关性分析显示，观察组治疗前、后的MIP差值与其TUGT差值(r＝－0.651)、10MWT差值(r＝－0.501)均呈显著负相关(P<0.01)。 结论 阈值压力负荷吸气肌训练联合常规康复治疗可显著改善帕金森病患者的吸气肌力量、膈肌活动度和厚度，从而进一步地改善患者的平衡功能和步行能力。 Objective To observe any effect of threshold pressure loaded inspiratory muscle training on the balance of persons with Parkinson′s disease (PD). Methods Forty-eight persons with PD were randomly divided into an observation group and a control group, each of 24. Both groups were given conventional neurological drug treatment and conventional rehabilitation training. The observation group additionally completed inspiratory muscle training using a threshold pressure load trainer, 5 days per week for 8 weeks. Before and after the treatment, both groups′ inspiratory muscle functioning was quantified using ultrasound to assess diaphragm mobility and thickness, and maximum inspiratory pressure (MIP). Balance was quantified using Trunk Injury Scale (TIS) scoring, the Berg Balance Scale (BBS), limits of stability (LOS), and the timed up and go test (TUGT). Walking was evaluated using the 10-metre walk test (10MWT) and the Dynamic Gait Index (DGI). Results After the treatment all of the indicators had improved significantly in both groups, on average, but those of the observation group were then significantly better. Correlation analysis showed that the difference in MIP of the observation group before and after treatment was significantly negatively correlated with the TUGT and 10MWT times. Conclusion Threshold pressure loaded inspiratory muscle training combined with conventional rehabilitation therapy significantly improves the inspiratory muscle strength, balance and walking of persons with PD.

    帕金森病阈值压力负荷训练器吸气肌训练膈肌平衡功能

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    Broca失语患者双侧额下回与全脑功能连接的时间变异性研究

    李思静席艳玲凌琛
    688-694页
    查看更多>>摘要：目的 利用静息态功能磁共振成像技术(rs-fMRI)研究脑卒中后Broca失语(BA)患者双侧额下回与全脑功能连接的时间变异性，并比较维、汉语失语症的差异。 方法 纳入维、汉语BA患者30例(患者组)和维、汉语健康者30例(健康组)。采集rs-fMRI图像，经影像数据预处理、剔除不符合要求的研究对象后，将患者组分为维语患者组(9例)和汉语患者组(12例)，将健康组分为维语健康组(13例)和汉语健康组(15例)。进行动态功能连接(dFC)的计算，使用双因素协方差分析获得语种与失语存在交互作用的脑区，并对维、汉语BA患者dFC异常的脑区与语言行为学的相关性进行分析。 结果 双侧额下回与左侧内侧和旁扣带回、右侧中央后回dFC的时间变异性存在交互作用。维语患者组左侧额下回(Broca区)与左侧内侧和旁扣带回dFC的时间变异性低于维语健康组和汉语患者组(P<0.05)，右侧额下回(Broca镜像区)与右侧中央后回dFC的时间变异性低于维语健康组和汉语患者组(P<0.05)；汉语患者组Broca镜像区与右侧中央后回dFC的时间变异性高于汉语健康组和维语患者组(P<0.05)。维语患者组Broca区与左侧内侧和旁扣带回dFC的时间变异性，与口语表达中的流畅度、系列语言、阅读理解中的填空、书写中的系列书写呈正相关(P<0.05)。 结论 静息态下维、汉语BA患者双侧额下回dFC的时间变异性存在差异，其中Broca区与左侧内侧和旁扣带回dFC的时间变异性降低，对于维语BA患者语言功能受损的识别可能有提示作用，而Broca镜像区与右侧中央后回dFC的时间变异性增强可能是汉语BA患者语言网络重组的结果。 Objective To observe the temporal variability of functional connectivity between the bilateral inferior frontal gyrus and rest of the brain in persons with Broca′s aphasia (BA) and to compare the connectivity between Uygur and Chinese aphasics. Methods Thirty Chinese and Uygur BA patients (the patient group) and 30 healthy people speaking Uygur and Chinese (the healthy group) were included. rs-fMRI images were acquired, and the patient group was divided then into a Uygur language patient group (9 cases) and a Chinese language patient group (12 cases). The healthy group was divided into a Uygur language healthy group (13 cases) and a Chinese language healthy group (15 cases). Dynamic functional connectivity (dFC) calculations were performed, and a two-factor analysis of covariance was used to obtain the brain regions in which there was an interaction between language and aphasia and to analyze the correlation between the brain regions with abnormal dFCs and linguistic behavior. Results Interaction between the bilateral inferior frontal gyrus and the left medial and paracentral cingulate gyrus and the right postcentral gyrus dFC was observed to vary. Temporal variability among the Uygur patients was significantly less than among the Uygur healthy and Chinese patient groups. The temporal variability of Broca′s mirror area and the right postcentral gyrus in the Chinese patient group was significantly greater than in the Chinese healthy group or the Uygur patient group. Variability of Broca′s area and the left medial and paracingulate cingulate gyrus in the Uygur patients group correlated positively with oral fluency, reading comprehension and writing. Conclusion There are differences in the temporal variability of the dFC in the bilateral inferior frontal gyrus between Uygur and Chinese BA patients. The lower variability of Broca′s area with the left medial and paracingulate and cingulate gyrus may help to identify impaired language function in BA patients. The enhanced variability of the Broca′s mirror image area with the right postcentral gyrus may be the result of reorganization of the linguistic network in Chinese BA patients.

    双侧额下回动态功能连接Broca失语静息态功能磁共振成像

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    脑卒中吞咽障碍患者预后和住院费用相关性的回顾性研究

    张萍萍李涛王孝文张慧...
    695-701页
    查看更多>>摘要：目的 探讨吞咽障碍与脑卒中患者预后和住院费用之间的相关性。 方法 选取于潍坊市3家公立医院康复科就诊的脑卒中住院患者1370例，根据吞咽造影检查结果，将患者分为吞咽障碍组(499例)和非吞咽障碍组(871例)。收集患者临床资料，包括病案号、年龄、性别、医保类型、卒中类型、病灶部位、Charlson合并症指数(CCI)等。采用二元Logistic回归和多重线性回归模型分析吞咽障碍与肺炎发生情况、改良Rankin量表(mRS)评分、改良Barthel指数(MBI)、住院时长、住院总费用之间的相关性。 结果 本研究纳入脑卒中患者的吞咽障碍发生率为36.42%。校正混杂因素后，吞咽障碍组肺炎的发生风险是非吞咽障碍组的2.417倍[OR＝2.417，95%CI(1.902，3.072)，P＝0.000]。出院时，吞咽障碍患者mRS评分≥3分和MBI<60分的风险分别为3.272倍[OR＝3.272，95%CI(2.508，4.269)，P<0.001]和1.670倍[OR＝1.670，95%CI(1.230，2.268)，P<0.001]。多重逐步线性回归结果显示，吞咽障碍与出院时较高的mRS评分(β＝0.265，P<0.001)、较低的MBI评分(β＝－0.210，P<0.001)、较长的住院时间(β＝0.053，P<0.001)存在显著相关性。从标准化回归系数看，影响住院费用的程度，从大到小的顺序依次为住院时长(β＝0.618)、吞咽障碍(β＝0.147)、MBI评分(β＝－0.416)、肺炎(β＝0.133)、幕上卒中(β＝－0.053)、出血性脑卒中(β＝0.058)、CCI评分(β＝0.039)。其中，吞咽障碍与住院费用存在显著相关性(β＝0.147，P<0.001)。 结论 吞咽障碍会对患者的预后和住院费用产生显著影响，应尽早识别并予以干预，以改善预后、减轻经济负担。 Objective To seek any correlation between and prognosis and hospitalization costs of stroke survivors with dysphagia. Methods The records of 1370 stroke survivors admitted to the rehabilitation departments of 3 public hospitals in Weifang were studied. Of them, 499 (36.4%) were diagnosed with dysphagia and 871 were not. Binary logistic regression and multiple linear regression were employed to analyze the correlation between dysphagia and the occurrence of pneumonia, modified Rankin Scale (mRS) scores, modified Barthel index (MBI) scores, length of stay and total hospitalization cost. Results After adjusting for confounding factors, the risk of pneumonia in the dysphagia group was 2.4 times higher. At discharge, the risk of an mRS≥3 was 3.3 times greater and that of an MBI score <60 was 1.7 times greater with dysphagia. Multiple stepwise linear regression showed that dysphagia was significantly associated with higher mRS scores at discharge, lower MBI scores, and longer hospital stays. The standardized regression coefficients predict that after the length of stay, dysphagia is the strongest predictor of the cost of hospitalisation, followed by ADL ability, pneumonia, supratentorial, haemorrhagic stroke and CCI. Conclusions Dysphagia is a significant predictor of the hospitalization costs of stroke patients. It is recommended to identify and treat dysphagia as early as possible to improve the prognosis of such patients and reduce the economic burden.

    脑卒中吞咽障碍预后负担肺炎

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    中枢间歇Theta节律刺激联合外周磁刺激对脑卒中患者上肢运动功能障碍的影响

    孟莹张春华王海霞梁家彩...
    702-706页
    查看更多>>摘要：目的 观察患侧M1区间歇Theta节律刺激(iTBS)联合外周磁刺激(PMS)对亚急性期脑卒中患者上肢运动功能障碍的影响，并探讨可能的神经机制。 方法 选取45例脑卒中合并上肢功能障碍患者，采用随机数字表法分为联合刺激组、中枢组和对照组，每组15例。3组患者均给予药物(包括调控血压血糖、营养神经、调脂稳定斑块等治疗)及常规康复训练治疗，每次训练时间45 min。在常规康复训练的基础上，联合刺激组加用患侧M1区iTBS联合患肢Erb′s点重复外周磁刺激(rPMS)；中枢组加用患侧M1区iTBS联合患肢Erb′s点rPMS假刺激，假刺激仅将线圈垂直于刺激表面；对照组未接受任何磁刺激。每日1次，每周5 d，共治疗10次。所有45例患者中，仅对照组有1例因患者个人原因退出，未能完成治疗，余44例均完成10次治疗。分别于治疗前和治疗10次后(治疗后)，对患者行患侧拇短展肌的运动诱发电位(MEP)潜伏期及波幅测定；采用上肢Fugl-Meyer运动功能(FMA)评分、改良的Barthel指数(MBI)对3组患者治疗前后的运动功能、日常生活活动(ADL)能力进行评估。 结果 治疗前，联合刺激组、中枢组和对照组患者的MEP潜伏期[(23.55±1.89)、(22.89±1.69)和(23.37±1.48)ms]、波幅[(1.23±0.72)、(1.02±0.43)和(0.99±0.24)mV]以及FMA评分[(21.40±17.13)、(23.00±19.26)和(19.87±19.80)分]及MBI评分[(56.00±21.05)、(58.00±25.62)和(52.00±25.06)分]组间差异均无统计学意义(P>0.05)。治疗后，与组内治疗前比较，3组患者的MEP潜伏期[(20.43±2.06)、(21.25±1.57)和(23.02±1.38)ms]均明显缩短(P<0.05)，波幅[(2.37±0.62)、(1.77±0.63)和(1.22±0.25)mV]均明显增高(P<0.05)；3组患者的FMA评分[(29.10±18.60)、(27.10±21.99)和(21.75±19.94)分]和MBI评分[(69.50±20.47)、(67.50±25.14)和(56.85±26.18)分]亦较组内治疗前明显增加(P<0.05)，且联合刺激组上述指标的改善均明显优于中枢组和对照组(P<0.05)。 结论 中枢iTBS联合PMS可以有效改善亚急性期脑卒中患者的上肢运动功能。

    脑卒中间歇Theta节律刺激外周磁刺激上肢运动功能障碍

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    基于姿势解密技术的手法治疗对脑卒中偏瘫患者步行功能的影响

    赵萍王琛涵王玉阳刘瑶瑶...
    706-709页
    查看更多>>摘要：目的 观察基于姿势解密技术的手法治疗对脑卒中偏瘫患者步行功能的影响。 方法 采用随机数字表法将40例脑卒中偏瘫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，观察组患者在此基础上辅以基于姿势解密技术的手法治疗。于治疗前、治疗3周后对2组患者进行疗效评定，通过测量患侧肩胛骨内上角到胸2棘突的垂直距离评估患者肩高度，通过测量患侧骨盆倾斜角度评估患者骨盆位置变化情况，采用Fugl-Meyer运动功能量表下肢部分(FMA-LE)评估患者下肢运动功能，采用"起立-行走"计时测试(TUGT)评估患者步行能力，应用步态分析系统评测患者步长(患侧)及步频变化情况。 结果 治疗后2组患者患侧肩高度、下肢FMA评分、骨盆倾斜角度、TUGT及患侧步长、步频均较治疗前明显改善(P<0.05)，并且观察组患侧肩高度[(2.85±2.71)mm]、下肢FMA评分[(27.05±3.01)分]、骨盆倾斜角度[(13.35±3.09)°]、TUGT[(15.55±4.40)s]及患侧步长[(48.75±7.66)cm/步]亦显著优于对照组患者。 结论 在常规康复干预基础上辅以姿势解密技术手法治疗，能进一步改善脑卒中偏瘫患者的步行功能。

    姿势解密技术脑卒中偏瘫步行功能

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    电针结合长针骶刺法治疗糖尿病膀胱过度活动症的疗效观察

    姚文平李明田卫杨励...
    710-714页
    查看更多>>摘要：目的 观察电针结合长针骶刺法治疗糖尿病膀胱过度活动症的临床疗效。 方法 采用SAS 9.4软件生成随机序列表，将90例糖尿病膀胱过度活动症患者按照随机序列表分为观察组和对照组，每组45例。2组患者均接受糖尿病基础治疗方案，观察组在基础治疗方案基础上增加电针结合长针骶刺法治疗，每周5次，共治疗4周；对照组在基础治疗方案基础上增加琥珀酸索利那新片(5 mg)口服治疗，每日1次，治疗4周为1个疗程。分别于治疗开始前1周和治疗结束前1周，采用排尿日记卡记录平均每日的白天排尿次数、夜间排尿次数，以及1周内的尿急次数和急迫性尿失禁次数。分别于治疗前和治疗结束后(治疗后)，采用膀胱过度活动症评分(OABSS)、膀胱过度活动症生活质量调查表(OAB-q)、尿流动力学最大尿流率(Qmax)和平均尿流率(Qave)的变化评估2组患者的小便情况、生活质量改善情况和尿流动力学情况。 结果 治疗后，2组患者的平均白天排尿次数和夜间排尿次数、1周内的尿急次数和急迫性尿失禁次数、OABSS评分、OAB-q评分、Qmax和Qave与组内治疗前比较，差异均有统计学意义(P<0.05)，且观察组的白天排尿次数、夜间排尿次数、1周内尿急次数、OABSS评分、OAB-q评分、Qmax和Qave均显著优于对照组(P<0.05)。治疗后，观察组患者的Qmax和Qave分别为(18.02±1.60)和(9.79±1.26)ml/s，分别与组内治疗前[(12.14±1.09)和(7.21±0.95)ml/s]和对照组治疗后[(16.97±1.25)和(8.85±0.96)ml/s]比较，差异均有统计学意义(P<0.01)。 结论 电针结合长针骶刺法能明显减少糖尿病膀胱过度活动症患者的排尿次数，改善患者尿急和急迫性尿失禁等症状，可明显改善尿流率，提高患者生活质量。 Objective To observe the clinical efficacy of combining electroacupuncture with long needle sacral nerve acupuncture in the treatment of diabetic overactive bladder. Methods A total of 90 patients with diabetic overactive bladder were randomly divided into an observation group and a control group, each of 45. In addition to the basic treatment for diabetes, the observation group received electroacupuncture combined with long needle sacral nerve acupuncture 5 times a week for 4 weeks, while the control group was given 5mg of oral solinax succinate once a day as a course of treatment. One week before the beginning of the experiment and one week before its end, urination diary cards were used to record the average number of times of daytime and nighttime urination daily, as well as any urgent urination and urinary incontinence during the week. Bladder overactivity syndrome score (OABSS), the bladder overactivity quality of life questionnaire (OAB-q), maximum urine flow rate (Qmax) and mean urine flow rate (Qave) were employed to quantify urination status, life quality and the urodynamics of the 2 groups before and after the treatment. Results After the treatment, significant improvement was observed in the average weekly incidence of daytime and nighttime urination, of urgent urination and of urinary incontinence. The average OABSS, OAB-q, Qmax and Qave scores improved in both groups, but the experimental group showed significantly better improvement than the control group. Conclusion Electroacupuncture combined with sacral nerve needling can significantly reduce the frequency of urination, relieve the symptoms of urgent urination and incontinence, and improve the rate of urine flow, improving the life quality of patients with diabetic overactive bladder.

    电针糖尿病膀胱过度活动症尿流率

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    快走运动对肌肉减少症患者步行能力和握力以及血清GDF-8和IGF-1的影响

    黄海鹰林萍王琴任谦...
    715-719页
    查看更多>>摘要：目的 观察快走运动训练对肌肉减少症患者步行速度、6 min步行距离(6MWT)、握力以及血清生长分化因子-8(GDF-8)、胰岛素样生长因子-1(IGF-1)的影响。 方法 选取肌肉减少症患者61例入组，按随机数字表法分为观察组(31例)和对照组(30例)。2组患者均给予常规药物治疗，观察组予快走运动(步速100~120步/min，中等强度60%最高心率为靶心率)，对照组予常规散步运动(步速70~90步/min，低强度小于50%最高心率为靶心率)，每次30 min，每周3次，共治疗12周。分别于治疗前和治疗12周后(治疗后)，观察和比较2组患者的握力、步行速度、6MWT、四肢骨骼肌指数(ASMI)以及血清GDF-8、IGF-1的变化。 结果 治疗前，观察组和对照组患者(男性或女性)握力及ASMI的同性别组间差异均无统计学意义(P>0.05)；治疗后，观察组男性和女性患者的握力及ASMI均较组内治疗前明显增高(P<0.05)，且明显优于同性别对照组治疗后(P<0.05)；但对照组治疗前后的握力及ASMI均无明显变化(P>0.05)。治疗后，观察组和对照组患者的步行速度[(0.62±0.04)和(0.59±0.02)m/s]、6MWT[(223.68±14.51)m和(210.03±6.71)m]及血清IGF-1[(178.39±10.25)和(160.47±5.89)μg/L]均较组内治疗前[观察组(0.57±0.05)m/s、(201.23±7.01)m、(145.00±8.85)μg/L；对照组(0.56±0.02)m/s、(200.13±7.16)m、(144.50±8.69)μg/L]明显增高(P<0.05)，且观察组较对照组增高更为明显(P<0.05)；但患者治疗前后血清GDF-8比较显示，观察组明显下降(P<0.05)，而对照组无明显变化(P>0.05)。 结论 快走运动可显著增加肌少症患者的握力和ASMI，明显改善患者的步行能力及血清IGF-1和GDF-8水平。 Objective To observe any effect of fast walking on walking speed, 6-minute walking test (6MWT) time, and on serum levels of growth differentiation factor-8 (GDF-8) and insulin-like growth factor-1 (IGF-1) in patients with sarcopenia. Methods A total of 61 sarcopenia patients were randomly divided into an observation group (n=31) and a control group (n=30). Both groups were given conventional drug therapy. In addition, the observation group underwent 30-minutes of walking at 100-120 steps/min (about 60% of maximum heart rate) three times a week for 12 weeks. The control group also walked, but at 70-90 steps/min (less than 50% of maximum heart rate). Grip strength, walking speed, 6MWT time, skeletal muscle index (ASMI) and serum GDF-8 and IGF-1 were compared before and after the intervention. Results There were no significant differences in grip strength or ASMI between observation group and control group (comparing males with males and females with females) before the experiment. Afterward, grip strength and ASMI in the observation group had increased significantly on average. Both were then significantly higher than the control groups′ averages, which had not changed significantly. Average walking speed, 6MWT time and serum IGF-1 levels had improved significantly in both groups, but the observation group′s average improvement was significantly greater. A significant decrease the average serum GDF-8 level was observed in the observation group, but not in the control group. Conclusion Fast walking can improve the walking of persons with sarcopenia, raise serum IGF-1 levels, and significantly reduce serum GDF-8.

    肌肉减少症步行速度6分钟步行距离血清因子

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    筋膜松弛术联合静态渐进性牵伸治疗创伤后膝关节僵硬的疗效观察

    汪鑫徐珑张振江许亚雄...
    720-722页
    查看更多>>摘要：目的 观察筋膜松弛术联合静态渐进性牵伸治疗创伤后膝关节僵硬的疗效。 方法 采用随机数字表法将60例创伤后膝关节僵硬患者分为观察组、筋膜松弛组及静态牵伸组，每组20例。3组患者均给予常规康复干预，包括肌力训练、关节松动术及物理因子治疗等，筋膜松弛组、静态牵伸组在此基础上分别辅以筋膜松弛术或静态渐进性牵伸治疗，观察组则辅以筋膜松弛术及静态渐进性牵伸联合治疗。于治疗前、治疗4周后分别采用视觉模拟评分法(VAS)、Lysholm膝关节功能评分、改良Barthel指数(MBI)量表对各组患者膝关节疼痛、功能恢复情况及日常生活活动(ADL)能力进行评定，并于上述时间点检测、对比各组患者膝关节主动活动范围(AROM)。 结果 治疗后3组患者膝关节AROM、Lysholm评分均较治疗前明显提高(P<0.05)，疼痛VAS评分均较治疗前明显降低(P<0.05)，观察组MBI评分亦较治疗前明显提高(P<0.05)；通过组间比较发现，治疗后观察组AROM、Lysholm评分均显著优于筋膜松弛组及静态牵伸组(P<0.05)；观察组及筋膜松弛组疼痛VAS评分均显著优于静态牵伸组(P<0.05)。 结论 筋膜松弛术联合静态渐进性牵伸治疗能进一步改善创伤后膝关节僵硬患者的关节活动度及功能，提高生活质量。

    膝关节筋膜松弛术静态渐进性牵伸关节僵硬康复治疗

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