
Objective To explore the effect of intravascular low-energy He-Ne laser irradiation on blood(ILIB) for serum neuron-specific enolase(NSE) and neural function recovery in acute cerebral infarction(ACI) patients.Methods 42 cases with ACI were randomly assigned into A group and B group:Their basic treatments of two group were similar.Based in the treatments,the ILIB therapy was added to A group for 10 days.The serum NSE and neural function deficit were determined on the 3rd day and 14th day after onset respectively.In addition,21 healthy people were as controls.Results On the 3rd day after onset,the levels of serum NSE of A and B group were obviously higher than those of control group (P 0.001) ,but the serum NSE and neural function deficit between the A group and B group weren't difference markedly(P0.05)。On the 14th day after onset,the serum NSE of two groups all reduced( P 0.001 ),the neural function deficit was significantly decreased,too(P0.001).The change of A group was greater than that of B group (P0.05).Conclusion It is suggested that the IILB can improve the repair of neural tissues and recovery of neural function for ACI patients.
Objective To study the mechacism of electro magnetic field on regeneration of peripheralinjured nerve.Methods The left sciatic nerves of 60 adult Wistar rats were crushed with forceps to form the experimental animal models.Then,they were equally divided into treatment group and control group:The treatment group received the electro magnetic field treatment,control group without magnetic treatment.At various stages after operation,the motor nerve conduction velosity of sciatic nerve and its histology in two groups were detected.Results It showed that the electromagnetic field accelerated the course of Wallerian degeneration,Schwann's cell proliferation,regeneration of axon,myelin recovery of motor nerve conduction velosity of sciatic nerve.Conclusion The study suggests that the electromagnetic field could promote the regeneration and functional recovery of peripheral injured nerve,its mechanism may be through the modulation and promotion of many links of nerve regeneration process.
Objective To observe the kill effect of hyperthermia combined with anti-cancer drugs(mitomycin,vindesine,cisplatin) on human lung adenocarcinoma cell lines(D6).Methods Experimental objects were divided into four groups:Control group,hyerthermia group,chemotherapy group and chemohyperthermia group.Dynamic change of cell proliferation was detect by cell growth curve and clone formation assay;Cell cycle and apoptosis were test by flow cytometry;Cell morphology was observed by electron microscope;Ag-NOr3 in nucleus was determined by multi-function image analysis system.Results After treatment,the dynamic change of cell proliferation all was obviously inhibited in chemotherapy group,hyperthermia group,particularly in the chemohyperthermia group.Of cell cycle,the blockage in S-phase was found at 24 hours after chemohyperthermia group,it reached 88.18%,small apoptotic peak was also presented.There found obvious cell damage and cell vacuolation after 24 hours of chemotherapy or chemohyperthermia treatment.Even as cell disruption to typic apoptosis was appeared in chemohyperthermia group.While the Ag-NOR3 in nucleus appeared black granules,nuclei got yellow under the electron microscope.Conclusion The study suggests that the hyperthermia combined with anti-cancer drugs has a kill effect for treating the human lung adenocarcinoma cells.
Objective To study the inhibitory mechanism of oral adriamycin magnetic fluid combined with extracorporeal magnetic field therapy for implanted gastric tumor in rats.Methods Rat models of implanted gastric tumor were duplicated with Walker-256 tumor cells and divided into three groups: targeting group, non-targeting group and control group. The therapeutic effects including general condition of rats,rate of tumor growth,rats survival duration,histopathology of implanted tumor were evaluated and compared among three groups.Results Compared with the control group, the growth of implanted gastric tumor of rats in targeting group was obviously slower.The inhibitory rate of tumor weight and volume was 78.08% and 82.52% respectively (χ2=27.96,P<0.01). The rats survival duration was markedly prolonged, the prolonged rate was 286.38%(χ2=7.54,P<0.01).Remarkable histopathologic change in the implanted gastric tumor was found.Conclusions The study shows that the targeting therapy of the adriamycin magetic fluid combined with extracorporeal magnetic field has significant inhibitory effects for implanted gastric tumor in rats. It provides an experimental evidence for further clinical application too.
Objective To investigate the effect of intravascular He-Ne laser irradiation on blood(ILIB) for leukocyte adhesion function(LAF) and serum soluble intercellular adhesion molecule-1(sICAM-1) in cerebral infarction(CT) patients. Methods 30 CI cases were treated with drug treatment(group A);other 36 cases,based on the drug treatment,received the ILIB therapy(group B) once a day for 10 times.another 40 healthy subjects were as control group.The LAF and sICAM-1 concentrations were measured before treatment and after the 5th and 10th day of treatment. Results The LAF and sICAM-1 concentrations in CI patients were obviously higher than those of control group(t=16.50~17.94,P<0.001).In group A,the LAF and sICAM-1 concentrations were significantly decreased in the 10th day after treatment(t=3.18,P<0.01;t=3.96,P<0.001),but,in group B,they presented on the 5th and 10th day after ILIB treatment(t=4.48~12.72,P<0.001).However,these parameters of group B were obviously lower than those of group A in the same stage(t=2.67~7.81,P<0.01 or 0.001).While the effective rate(72.22%) of group B was higher than that of group A(46.67%)(χ2=4.48,P<0.05). Conclusion These findings indicate that the ILIB therapy can decrease the LAF and sICAM-1 concentrations in CI patients and it is one of those mechanisms for treating CI patients probably.
目前在较大的综合医院中理疗科的建制没有了,今后也将不会再有理疗医师.中华医学会理疗学分会1984年被改名为"物理康复学会”,以后又改称为"物理医学与康复学会”,1978年创刊的<中华理疗杂志>也将被合并于<中华物理医学与康复杂志>(名为合并,实为取消).一些物理康复专家们称"理疗学是康复之下的,理疗是康复医学的一部分”.他们这样作是"顺应学科发展潮流的”,"是与国际接轨的”.面对我国理疗学科的危亡,我们必须负起历史责任,为学科说话,为我国的实际发言.
在肝脏创伤或肝脏手术,以及各种导致肝脏完全或部分缺血再灌注中,可以引起肝脏的缺血,再灌注损伤[1].在此期间,肝细胞的功能和结构均会受到损害.为了保护肝脏的功能和结构,设计了本实验,报道如下.
Objective To evaluate the efficacy of intravascular He-Ne laser irradiation on blood(ILIB) comprehensive treatment on rediation encephalopathy.Methods 39 patients with radiation encephalopathy were treated with ILIB,50 min/per time, once a day for two courses of treatment, based on the drug therapy.35 cases were only treated with drug therapy as control group.After 3 months,the efficacy in both groups was evaluated and compared.Results In ILIB group ,3 cases were cured and the total effective rate was 74%.But the total effective rate in control group was only 40%.There was obvious difference in both groups(P0.05).Conclusion It is suggested that ILIB combined with drug treatment can obtain better efficacy in the treatment of radiation encephalopathy.
本实验采用动物模型,测定CO中毒致昏迷大鼠高压氧(HBO)治疗前后大脑组织中超氧化物歧化酶(SOD)和丙二醛(MDA)含量,探讨CO中毒昏迷时大脑组织SOD及MDA的变化及HBO对二者的影响。 材料和方法 健康雄性Wistar大鼠80只,体重280~320 g由中国医科大学实验动物部提供,随机分成5组,每组16只,正常对照组(C组),CO染毒组(CO组),CO染毒HBO治疗1次组(HBO1组),CO染毒HBO治疗3次组(HBO3组),CO染毒常压氧治疗1次组(NBO1组)。 CO中毒模型建立:参照Ischiropoulos[1]的方法,将大鼠放入自制染毒瓶中,充入CO气体,使鼠吸入浓度3~4 mg/L的CO气体40~60 min至昏迷。 HBO治疗:染毒后20 min将大鼠放入48 cm×48 cm实验动物用高压氧舱内,在0.2 MPa下吸纯氧60 min。HBO1组治疗1次,HBO3组每天在同一时间连续治疗3 d。HBO治疗:染毒后20 min将大鼠置高压氧舱内0.1 MPa吸纯氧60 min。C组不染毒不治疗,随机分入C组后即处死;CO组染毒后10 min处死。断头取脑,分离出大脑组织保存于-70℃待测。 标本测定:大脑样品按20%(重量/体积)比加入pH7.2磷酸盐缓冲液,匀浆离心取上清液。用羟氨氧化法测定SOD含量;硫代巴比妥酸比色法测MDA;用Lowery法测蛋白含量。SOD单位为NU/g protein,MDA单位为μmol/g protein。统计学分析:单因素方差分析,若有意义,则进一步用两两比较的q检验。
慢性前列腺炎是青、中年男性的多发病。近十余年来,随着性病发生率的逐年提高,慢性前列腺炎的发病率不断上升,由于该病病原复杂,病情时轻时重,且易反复发作,给治疗带来困难。我们采用体外射频加口服中成药前列舒乐冲剂治疗慢性前列腺炎270例,取得较满意的疗效,报道如下。 资料和方法 270例均为门诊患者,年龄20~65岁,平均33.1岁;病程2个月~10年,平均1.4年;已婚216例,未婚54例;均有不同程度的会阴部疼痛、尿道刺激症状,部分患者伴神经衰弱和性功能减退。直肠指诊:前列腺局部压痛,腺体大小、硬度不等。实验室检查:前列腺液镜检,白细胞>10个/HP,卵磷脂小体减少。前列腺液细菌培养,确认为细菌性前列腺炎122例,非细菌性前列腺炎148例。红外线热像图检查:阴茎根部及阴囊两侧见片状或团状热区,与周围区域温差为0.5~1.0℃。B超检查:前列腺大小约4 cm×3 cm×2 cm,包膜回声增强,内部光点不均匀,部分病例有硬结征象。 射频组270例,采用珠海产ERFH-200体外射频机治疗,频率13.56 MHz,波长22.1 m,输出功率55~75 W。嘱患者排净大小便,仰卧于绝缘床上,耻骨联合水平腹、背部各置一直径18 cm的圆形电极板,距离皮肤8~10 cm,射频最大输出功率600 W,维持输出功率在60%~80%,操纵台屏幕显示40℃左右。每次治疗时间1.0~1.5 h,间隔3 d1次,5次为1疗程。疗程结束后1周复查前列腺液镜检,红外热像及前列腺B超图像,以决定是否再进行下一疗程。治疗期间,同时服用“通淋化浊,活血消肿”的中成药前列舒乐冲剂4 g/次,每天3次,连服1个月。对照组104例患者口服前列舒乐冲剂4 g/次,每天3次,连服1个月。 疗效标准 治愈:症状完全消失,前列腺液镜检白细胞(-),卵磷脂小体+++~++++,细菌培养转阴,红外线热像图及B超检查正常;显效:前列腺液镜检白细胞<10个/HP,卵磷脂小体+++~++++,细菌培养转阴,红外线热像图及B超检查接近正常;好转:症状部分缓解,前列腺液镜检白细胞>10个/HP,卵磷脂小体>+,细菌培养仍阳性或转阴,红外线热像图及B超检查有好转;无效:症状及各项指标均无变化。
资料和方法 根据美国风湿病学会膝骨关节炎诊断标准(ACR),确诊为膝骨关节炎的住院患者60例,共110个膝关节。按功能障碍(测量膝关节活动范围取俯卧位,伸0度,屈曲150度)[1]分为Ⅰ级:膝关节时有疲劳或沉重感,日常活动无疼痛,但从坐位到站位需用手支撑,检查无功能障碍,有晨僵感;Ⅱ级:各种活动开始和长距离步行时有轻度疼痛,或步行时常有疼痛,休息后消退,上下楼需扶栏杆,晨僵感明显,关节活动稍受限(膝屈曲135度);Ⅲ级:负重和活动时剧烈疼痛,安静时减轻或仍有疼痛,单腿站立需要扶持,下蹲困难伴晨僵感,关节活动明显受限(膝屈曲100度),关节肿胀,并可有变形。随机分为矿泥组30例56个关节,男8例,女22例;年龄41~60岁27例,>60岁3例;病程<1年3例,~5年15例,>5年12例;双膝26例,单膝4例;功能分级Ⅰ级5例,Ⅱ级19例,Ⅲ级6例。非矿泥组30例54个关节,男9例,女21例;年龄41~60岁26例,>60岁4例;病程<1年4例,~5年13例,>5年13例;双膝24例,单膝6例;功能分级Ⅰ级5例,Ⅱ级20例,Ⅲ级5例。 矿泥组治疗以46~52℃矿泥,按常规方法制作相应泥型敷于膝部,包以毛巾被保温。每天1次,15 min。同时配合39℃矿泉水全身浸浴,每天1次,15 min,24次为1疗程。治疗后每天指导患者进行膝关节以不加重疼痛为度的保持放松康复训练及等长收缩训练2次,每次10~15 min[2]。非矿泥组以温泉水全身浸浴和放松康复训练及等长收缩训练方法同矿泥组。同时每天进行碘化钾直流电导入,膝关节对置,10~20 mA,每天1次,20 min,24次为1疗程。上述治疗均每周6次,共2个疗程,治疗均由专护负责,专职医生负责疗效评定。 疗效标准 临床治愈:疼痛消失,膝关节活动度正常,膝关节肿胀消失;显效:膝关节活动时偶有疼痛,膝关节活动度较治疗前恢复>30%,膝关节肿胀明显减轻(周径较治疗前减少10%);好转:膝关节活动时疼痛,膝关节活动度较治疗前恢复20%,上下楼需扶栏杆,关节肿胀有所减轻(周径较治疗前减少5%);无效:症状和体征无变化。
资料和方法 1996年6月~1999年9月在本院住院确诊为慢性盆腔炎患者168例,治疗分为两组。观察组108例,年龄19~43岁,平均31岁;病程1~48个月;均有不同程度的下腹坠胀疼痛和腰骶部疼痛,或伴有白带增多甚至脓性白带;6例性交痛,月经不规则,淋漓不净25例,伴继发性不孕17例。妇科检查,宫颈有举痛,子宫压痛,附件有不同程度的增粗、增厚,压痛或盆腔包块。实验室检查,白带白细胞增多,无特异性致病菌。B超检查示盆腔积液29例,盆腔炎性包块58例。对照组60例,应用抗生素并口服中药治疗。 两组均应用抗生素1周,其种类及剂量相同。观察组加用中药灌肠及超短波治疗。灌肠药方:金银花60 g,当归、丹参、香附、红藤、蒲公英各30 g,桃仁、制乳没各10 g,上述中药浓煎取液150 ml左右,温度30~40℃,纱布过滤后装入输液瓶中备用,用一次性滴管插入肛管作保留灌肠,灌肠后即行超短波治疗,采用上海产LDTCD31型超短波电疗机,频率40.68 MHz,Ⅱ号软电极下腹部对置,间隙4 cm,热量,每日1次,20 min,10次为1疗程。对照组加服中药治疗,10 d为1疗程。 疗效标准 痊愈:症状及体征完全消失,白带正常,B超检查示正常盆腔;显效:症状消失,体征明显改善,白带正常,B超示附件增粗程度明显减轻,或盆腔包块明显缩小,盆 腔积液消失;好转:症状好转,体征有所改善,白带接近正常,B超示附件增粗程度有所减轻或盆腔包块有所缩小,盆腔积液消失;无效:症状及体征均无改善,B超无变化。
眶神经痛46例均为门诊患者,男27例,女19例;年龄17~65岁,平均38岁;病程3 h~50 d,平均23 d;眶上神经痛34例,眶下神经痛12例;疼痛位于右眼25例,左眼21例;患者初期表现为颜面稍感不适,继而上或下眼眶内深部疼痛,多偏内侧,指压眶内深部则疼痛剧烈,伴偏头痛,一般9~12时和14~17时发作,严重时伴恶心呕吐。35例经药物、封闭及针灸治疗后复发。对照组38例为同期门诊患者,其性别、年龄、疼痛性质及程度与中频电穴位治疗组无显著差异。两组患者均经眼科与神经内科确诊。 治疗组采用北京产K8832-T电脑多功能治疗仪,选用硅橡胶电极1.5 cm×2.0 cm二对,患者取仰卧位,电极下衬一层湿绒布垫,将其中一对中的一个电极置攒竹穴位,另一电极置阳白、鱼腰穴位,再将另一对电极中的一个置四白穴位,另一电极置太阳穴位,电极均为并置,选用3号处方(中频频率10 kHz,低频频率0.125~150 Hz,正弦波),电流指数6,强度为耐受量,每日1 次,20 min,并同时配合口服维生素B1、B12及ATP等药物。对照组肌肉注射维生素B2、B12,并口服消炎痛、泼尼松及ATP等药物,两组均治疗10 d为1疗程,1疗程后判定疗效。 疗效标准 痊愈:眼眶部疼痛及压痛消失,1个月内无复发;显效:眼眶部疼痛及压痛消失,用眼刺激时间稍长则出现眼眶部疼痛不适;好转:眼眶部压痛及疼痛明显减轻;无效:治疗后无变化。 治疗组痊愈43例,显效2例,好转1例,痊愈率93%,总有效率100%;对照组痊愈29例,显效1例,好转6例,无效2例,痊愈率82%,总有效率95%。两组痊愈率比较,χ2=5.006,P<0.05,差异有显著性。中频电穴位刺激并营养神经类药物的联合应用治疗眶神经痛的疗效,明显优于单纯药物治疗眶神经痛的疗效,并经随访6~12个月,疗效稳定,均未复发。
急性附睾炎患者132例,年龄17~31岁;病程平均2.8 d;均有附睾剧烈疼痛并肿大,大多数伴有高热等全身症状;长期留置尿管18例,尿路感染77例,尿道扩张术后发病9例,合并慢性前列腺炎6例,膀胱镜检查术后5例;白细胞数9.5~22.8×109/L,中性粒细胞0.75~0.94;尿细菌培养阳性105例,其中大肠杆菌92例,葡萄球菌4例,肠球菌6例,变形杆菌3例。 治疗分为两组,超短波组82例,采用上海产LDTCD-31A型超短波治疗机,频率40.68 MHz,波长7.37 m,功率200 W,板状电极200 mm×150 mm×2,腰骶部对置,间隙2 cm,微热量,每日1次,15 min,7次为1疗程,同时每日静滴青霉素800万U,甲硝唑250 ml。对照组50例,采用硫酸镁局部冷敷,静滴青霉素800万U,甲硝唑250 ml,7日为1疗程。分别于治疗1~2周后评定疗效。 疗效标准 临床治愈:附睾疼痛完全消失,附睾大小、质地恢复正常,白细胞数4.0×109/L;显效:附睾疼痛消失,附睾肿大明显缩小,有触痛;好转:症状、附睾大小及触痛有一定改善。 超短波组治疗1个疗程65例,2个疗程17例,平均治疗(8.2±1.5)次,临床治愈65例,显效11例。对照组治疗1个疗程32例,2个疗程18例,平均治疗(9.4±3.0)次,临床治愈32例,显效9例,好转2例。两组临床治愈率和治疗7次的临床治愈率,差异均有显著性,χ2=5.50和5.87,均P<0.05,超短波组疗效明显优于对照组。观察表明,超短波并静滴抗生素治疗急性细菌性附睾炎,具有缩短疗程和疗效高等特点。
近年来,国内外进行了许多有关磁场生物学效应的基础和应用研究,磁场的治疗作用已逐步引起重视。大量研究证明, 磁场对高血压和冠心病等心血管疾病有一定的治疗作用,并从不同角度探讨了磁场治疗心血管疾病的作用机制和疗效。为了促进磁场治疗心血管疾病研究的发展,对近几年发表的有关文献综述如下。 1.磁场对心脏机能的影响 Kazakova等在研究恒磁场对家兔的血流动力学影响时发现,0.4 T恒磁场置于心前区30 min,每日1次,共7 d,结果显示恒磁场对健康家兔的心率、每搏量和心输出量无显著影响,但对心功能不全的家兔有很好的治疗作用,使心率趋向于正常,每搏量和心输出量增加,心功能得到改善[1]。Ramon等采用心脏前后异名极放置磁头的方法研究了脉冲磁场(频率10 Hz,磁感应强度6 mT)对离体犬心脏功能的影响,实验结果显示峰值为10 mT的脉冲磁场作用于犬心脏5 min后心率轻度加快,心肌收缩力逐渐加强[2]。Orlov等报告,60例稳定性心绞痛患者随机分成3组,每组20例,分别采用磁感应强度为8 mT、频率为10 Hz的脉冲磁场,抗心绞痛药物,脉冲磁场(同前)加抗心绞痛药物的方法治疗心绞痛,观察结果显示单纯脉冲磁场疗法对稳定性心绞痛有显著的治疗作用,而且磁场能增加抗心绞痛药物的效能[3]。Vasileva等采用磁感应强度为10 mT的低频电磁场(f=50 Hz,τ=20 μs,t=20 min)治疗23例患有频发性期前收缩儿童,通过对临床和生化有关指标的研究发现,心前区磁疗能显著降低患者期前收缩的发生率,其作用机制与细胞内Ca2+ 增加和Mg2+-ATP酶活性增强,血栓素的产生减少,红细胞磷脂合成的改变,红细胞携氧能力的增强和血液粘稠度的降低有关[4]。Mouchawar等对超强脉冲磁场(频率10 Hz,磁感应强度16 mT,时间1~60 min)作用于犬心前区诱发犬心律失常的研究表明,11只体重17~26 kg的实验犬发生心律失常的平均临界磁感应强度为12 T[5],这说明治疗剂量的磁场对心脏传导系统的影响不显著。细胞色素C是心肌能量代谢的一个重要环节,Nossol等的研究显示,300 microT~10 mT的恒磁场作用于心肌20 min后,细胞色素C氧化酶的活性显著增加,10~50 mT的恒磁场对细胞色素C氧化酶活性的影响弱于300 microT~10 mT,超出300 microT~50 mT磁场强度范围时,细胞色素C氧化酶活性的改变不明显[6]。
资料和方法 本组为1985年10月至1996年12月在本院住院的良性前列腺增生症患者(BPH)3 086例,按国际前列腺症状评分(IPSS)以及有关专科和B超检查确诊。患者年龄50~54岁207例,55~59岁516例,60~64岁919例,65~69岁1 020例,70岁以上424例,平均66.8岁;病程4年以内714例,5~9年1 448例,10~14年715例,15年以上209例,平均8.2年;根据IPSS症状标准评分0~35分,分成3个等级[1];轻度0~7分1 577例占51.4%,中度8~19分1 194例占38.6%,重度20~35分315例占10.1%。 采用昆明安宁温泉,该矿泉属重碳酸钙、镁、高热型淡温泉[2]。饮用法:每日饮煮沸过的泉水1 000~2 500 ml,分3~5次饮完,水中不加其他物质。浸浴法:全身或半身浸浴,水温37~44℃,每次20~45 min,每日2~3次,每次间隔4~6 h,20日为1疗程,饮疗和浴疗期间不作其他治疗。 疗效标准 显效:临床症状消失,B超检查前列腺组织前后径缩小2 cm以上,残余尿量基本恢复正常;好转:临床症状基本消失或明显减轻,B超检查前列腺组织前后径缩小2 cm以下,残余尿量减少;无效:临床症状较入院时有所减轻或无变化,B超检查前列腺组织和残余尿量无明显变化。
资料和方法 慢性前列腺炎患者70例,治疗分为两组。观察组35例,年龄25~58岁,平均33.6岁;病程6个月~12年,平均4.6年。对照组35例,年龄24~60岁,平均34.2岁;病程6个月~10年,平均4.3年。全部病例均符合下列诊断标准两项以上:①有前列腺或尿路感染史;②触诊前列腺肿大、不平整、质硬,有局限性压痛;③前列腺液镜检白细胞数≥10个/HP,卵磷脂小体减少(每高倍视野50%以下或极少);④前列腺液细菌培养有致病菌生长。两组资料差异无显著性。两组患者的症状、体征及实验室检查结果见表1。
材料和方法 菌种来自本室检出的标本,先用杭州产营养肉汤进行纯增菌培养24 h,混匀后用法国吉尔森微量移液器吸取10 μl接种于另一5.0 ml定量肉汤管内,每菌种接种两管,一管置于磁管中曝磁,另一管作对照。用6个直径37 mm,厚度7 mm,内径18 mm的铁氧永磁体异名吸合粘贴成42 mm高的磁管,中心磁场强度0.15 T。磁管内壁与培养试管间隙2~3 mm。同时做细菌生化,此反应是根据各菌种的特性有选择地进行。选用浙江军区后勤部卫生防疫检验所生产的各种发酵管,每一菌种接种两套,一套置于磁管中曝磁,另一套作对照。最后将实验与对照各组管一同置于(36.0±0.5)℃培养箱内24 h,第2 d取出用血细胞计数板计算白色念珠菌(以下称真菌)数目,然后用上海产722型分光光度计以540 nm波长比浊。由于葡萄球菌和大肠杆菌微小不便计数,只做比浊测量其吸光度,吸光度的大小与均匀分布于液体中的菌体微粒呈正比[1],其优点是简便、快速,可重复多次然后取平均值。生化反应发酵试验到48 h后得出结果。
资料和方法 烧伤植皮术后患者42例,男31例,女11例;年龄21~30岁15例,31~40岁11例,41~50岁10例,>50岁6例;烧伤面积约70%1例,50%1例,15%~45%25例,<15%15例;烧伤部位:多部位35例,上肢5例,下肢2例。大面积烧伤植皮后患者全身浸浴,小面积的局部浸浴,水温的选择可根据是增生期或静止期而定。增生期一般时间短,瘢痕局部色红,肿胀,发硬,水温可给低温25~32℃或不感温33~35℃。静止期一般时间较长,瘢痕色暗红,水温可给温水浴36~38℃或热水浴≥39℃。水浴时间10~20 min,20次为1疗程,一般2~3个疗程。矿泉水浴与普通水浴比较:42例均经两种水浴后进行比较。 威海矿泉库尔洛夫公式为:M 19.19,T 75℃,Br 33 mg(Cl 98.65)/(Na 66.38 Ca 29.44) 疗效标准 显效:症状明显减轻,皮肤基本恢复正常;好转:症状减轻,皮肤变薄;无效:治疗1疗程无改善。
肢体慢性淋巴水肿30例(30条肢体),男16例,女14例;年龄15~72岁;病程3~20年;下肢28例,上肢2例;炎症性12例,创伤性18例。根据国际淋巴协会的标准,Ⅰ级10例,水肿为非凹陷性,患肢抬高后水肿可大部分消退,无纤维化样皮肤损害;Ⅱ级20例,水肿为非凹陷性,患肢抬高后水肿部分消退,皮肤有中度纤维改变。30例均行核素淋巴显像,提示显影延迟,淋巴回流不畅。以膝关节为中心测量,膝上20 cm患肢周径平均大于健侧6 cm,膝下15 cm患肢周径平均大于健侧7 cm;以肘关节为中心,分别于上下10 cm处测量,患肢周径肘上平均大于健侧4 cm,肘下平均大于健侧3 cm。 采用自制椭圆形透明密闭舱,利用气泵产生压缩气体,经分流系统作用产生正压与负压。治疗时患者取坐位,患肢置入舱内,舱内的气压变化由压力表显示。设定正压为12~18 kPa,充气时间30 s;负压为-6~-8 kPa,抽气时间10 s。每日治疗1~2次,每次15~20 min,10次为1疗程,疗程间休息1~2 d,共治疗6个疗程。每次治疗前于患肢表面涂擦75%酒精生姜浸出液,间歇期穿医用压力袜。 经治疗6个疗程,Ⅰ级10例均达显效,周径与健肢相同,核素淋巴显像通畅,皮肤松软,沉重感消失;Ⅱ级20例,显效12例,改善7例,周径大于健肢2 cm,踝部仍有肿胀,核素淋巴显像较前有进步,皮肤变软,沉重感减轻;无效1例,因丹毒复发。经半年随访均无丹毒复发。 肢体慢性淋巴水肿病变早期,物理疗法是首选方法,早期淋巴管壁内皮细胞间隙还未完全堵塞,有的尽管淋巴有堵塞,但不完全[1]。对于肢体局部淋巴管施以压迫并进行反复按摩,有利于较大幅度地引起组织间的变化,提高了淋巴管的自主节律收缩,促进淋巴液的回流。在治疗方法上采用了正压压力大时间长,负压压力小时间短的交替作用,使淋巴管被动压缩和扩张,真正达到按摩作用,更有利于组织间液回流。通过改革密闭舱内橡胶袖口装置[2],患者可根据自己的耐受力移动肢体位置既可调节舱内气压,缓解了气压骤升骤降的矛盾,又不影响淋巴回流,达到治疗目的。