阳气在人体生命活动中发挥主导地位,正如《黄帝内经》云"阳气者,精则养神,柔则养筋".纤维肌痛综合征(FMS)以周身弥漫性疼痛为主要症状,常伴失眠、抑郁、认知功能受损等神志异常表现,病机为阳气失调.针灸作为中医学的瑰宝,具有通调阳气、扶阳祛邪的作用,在治疗FMS上具有一定的优势.基于《黄帝内经》重阳理论探讨针刺治疗FMS的选穴,可为临床治疗提供参考.

目的 比较头针运动疗法与体针治疗急性期腰椎间盘突出症的疗效差异.方法 60例患者随机分为头针组与体针组各30例.头针组采用针刺头部特定条带进行治疗,选取顶中带、顶枕带中1/3、顶颞前斜带上1/5(单侧病变取病变对侧,两侧病变取双侧)、顶颞后斜带上1/5(单侧病变取病变对侧,两侧病变取双侧)、顶枕带下.体针组采用针刺肾俞(双)、大肠俞(双)、委中(患侧)、承山(患侧)治疗.于治疗前后评估两组视觉模拟量表(VAS)、Osuestry功能障碍指数量表(ODI)的评分差异.结果 头针组总有效率为93.33％,高于体针组的83.33％(P＜0.01);两组治疗第2周、第4周后VAS与ODI评分均较治疗前下降(P＜0.01),组间比较头针组评分明显优于体针组(P＜0.01).结论 头针运动疗法治疗急性期腰椎间盘突出症可减轻患者疼痛,改善腰腿部功能障碍,提高患者生活质量,疗效优于常规体针治疗.

目的 基于R软件探讨谷世喆教授针灸治疗抑郁症的取穴配伍经验.方法 选取2015年1月至2020年11月于北京中医药大学国医堂谷世喆教授门诊就诊的抑郁症患者病历资料、总结谷世喆教授经验的专著《知针知药》、谷世喆教授发表于中国知网的论文中的相关医案,应用Microsoft Office Excel 2019对谷世喆教授的针灸处方构建资料数据库,采用R软件进行描述性分析、Apriori关联规则分析和层次聚类分析.结果 谷世喆教授治疗抑郁症使用穴位86个,共计1601次,使用次数排前7位的穴位为膻中、四神聪、百会、内关、神门、印堂、天枢.使用频次最高的经脉为任脉,选穴部位多在经络的四根、三结之处,配伍时讲究根结相引、标本相应.脏腑辨证以清心安神为主,重视肝胆、脾胃的调节.关联分析得到常用穴位组合为内关-天枢-膻中、行间-侠溪-膻中、建里-中脘-天枢、建里-膻中-中脘.聚类分析结果显示,谷世喆教授对抑郁症辨证论治的思路为益气养阴、健脾宁心、清心安神、疏肝利胆.结论 谷世喆教授针灸治疗抑郁症以膻中为主穴,辨证论治以益气养阴、健脾宁心、清心安神、疏肝利胆为主要思路.

目的:探析谷世喆教授治疗颈型颈椎病的用穴特点、取穴规律和组方特色.方法:运用Excel 2019创建谷世喆教授治疗颈型颈椎病针灸处方库,使用R语言对其进行频次分析,运用Apriori算法对腧穴进行关联规则分析,应用Gephi软件对针灸处方进行社区聚类分析.结果:纳入病例共101首针灸处方,谷世喆教授治疗颈型颈椎病用穴共64个,总频次1 107次,使用最多的腧穴为颈百劳,其次是肩中俞、天柱、合谷和风池.阳经穴位使用频率高达70.37％,使用频次最多的经脉为足太阳膀胱经.关联规则分析结果显示,治疗颈型颈椎病腧穴配伍以颈百劳-天柱-肩中俞最为常见.社区聚类结果显示,形成了 3个稳定的腧穴群组,分别为:肝俞-肾俞-膈俞-大肠俞;膻中-百会-印堂-安眠;肩中俞-天柱-风池.结论:通过数据挖掘分析得出谷世喆教授针刺治疗颈型颈椎病注重阳经选穴、颈项局部选穴和腰背部选穴相结合,体现了谷教授治疗颈椎病"温阳通气,形神同调"的学术思想.

目的:采用网络药理学方法探讨泻心通腑汤治疗失眠伴抑郁的依据,预测泻心通腑汤治疗失眠伴抑郁的作用机制.方法:通过数据库检索,得到失眠、抑郁的疾病基因及泻心通腑汤中活性成分的作用靶点;并筛选出泻心通腑汤的中药活性成分在治疗失眠伴抑郁过程中所涉及的功能及通路,最终构建"中药-活性成分-靶点-通路"网络.结果:通过网络药理学方法得到泻心通腑汤中50种活性成分可与失眠伴抑郁的191个疾病靶点相关联,KEGG富集分析得到通路124条.结论:泻心通腑汤治疗失眠伴抑郁可能是通过多靶点、多成分起到作用,而其中PI3 K/AKT信号通路为泻心通腑汤治疗失眠伴抑郁最有可能起作用的通路.

目的 探讨针药结合干预围绝经期抑郁患者的临床疗效.方法 回顾性分析2017年3月至2018年4月上海市第七人民医院传统医学科收治的120例围绝经期伴初发轻、中度抑郁患者的临床资料,根据治疗方法不同分为药物治疗组和针药结合组,各60例.其中,药物治疗组给予疏肝解郁胶囊和莉芙敏片治疗,针药结合组给予宁神方联合电针治疗.治疗12周后,比较两组患者的临床疗效,治疗前后的血清性激素[雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、孕酮(P)]水平、神经递质[去甲肾上腺素(NE)、5-羟色胺(5-HT)、多巴胺(DA)、γ-氨基丁酸(GABA)]水平、汉密顿抑郁量表17项(HAMD-17)评分.结果 针药结合组的总有效率高于药物治疗组[90.00％(54/60)比75.00％(45/60)](P<0.05).治疗前后血清性激素指标(E2、FSH、LH、P)、神经递质指标(NE、5-HT、DA、GABA)、HAMD-17评分的主效应差异有统计学意义(P<0.05),两组间血清性激素指标、神经递质指标、HAMD-17评分的主效应差异有统计学意义(P<0.05),各指标组间和时点间无交互作用(P>0.05).结论 针药结合能够明显升高围绝经期抑郁患者的性激素水平、神经递质水平,改善抑郁症状.

目的:评估改良式气压治疗对脑卒中后并发肩手综合征Ⅰ期患者上肢运动功能和肩关节活动度的影响.方法:将60例符合病例选择标准的脑卒中后并发肩手综合征Ⅰ期患者随机分入改良式气压治疗组(30例)和传统气压治疗组(30例).比较治疗前以及治疗4周后2组的上肢简化Fulg-Meyer运动功能积分以及肩关节活动度,比较治疗4周后2组的治疗有效率.结果:2组治疗4周后的Fugl-Meyer运动功能积分均较治疗前显著增加(P＜0.05),且改良式气压治疗组的Fugl-Meyer运动功能积分改善较传统气压治疗组更为显著(P＜0.05).2组治疗4周后的肩关节活动度均较治疗前显著改善(P＜0.05),其中改良式气压治疗组的肩关节前屈、外展和内旋活动度改善较传统气压治疗组更为显著(P＜0.05,P＜0.01,P＜0.05).治疗4周后,改良式气压治疗组的治疗有效率显著高于传统气压治疗组(分别为83.3%和56.7%,P＜0.01).结论:改良式气压治疗相较于传统气压治疗,可明显改善脑卒中后并发肩手综合征Ⅰ期患者的上肢运动功能和肩关节活动度,值得在临床上推广应用.

目的 探讨以团队为基础的教学(team-based Learning,TBL)结合以问题为基础的教学(problem-based Learning,PBL)法在康复护理教学中的应用方法及效果.方法 便利抽样法选择2017年在某三级甲等医院实习的护理本科生60名为研究对象,按随机数字表将其分为对照组和观察组各30名,对照组采取传统教学法,观察组采用TBL结合PBL教学法进行教学,评价并比较两组护生培训后的理论 、技能考核成绩 、对教学效果的评价及主动学习时间.结果 培训后,观察组学生的理论与技能考核成绩 、对教学效果的评价及主动学习时间均高于或优于对照组学生,差异均有统计学意义(均P<0.05).结论 TBL结合PBL教学法的应用,有利于提高教学效果和学生的自主学习能力.

目的 探讨中西医结合全程护理模式在脑卒中患者中的应用方法及效果.方法 便利抽样法选取2016年4-9月在上海市某三级甲等医院神经内科-神经康复科住院的150例脑卒中患者为研究对象,按随机数字表法将其分为观察组和对照组各75例,分别给予中西医结合全程护理和常规护理,干预时间均为6个月,评价并比较两组患者的运动功能、日常生活活动能力、并发症及满意度情况.结果 干预前,两组患者Fugl-Meyer运动功能评定量表(FM)及日常生活活动能力(the bar-thel index of activities dailyliving,简称Barthel指数)量表评分的差异均无统计学意义(均P>0.05);干预后3、6个月,观察组患者的FM、Barthel指数及满意度评分均高于对照组患者,并发症的发生率均低于对照组患者,差异均有统计学意义(均P<0.05).结论 采用中西医结合全程护理模式对脑卒中患者进行干预,有利于降低患者并发症的发生率,提高患者功能康复水平和满意度,值得临床推广应用.

目的 探讨改良式气压治疗在脑卒中肩手综合征(shoulder-hands syndrome,SHS)Ⅰ期患者中的应用效果.方法便利抽样法选取2015年1月至2017年6月在上海市第七人民医院神经康复科住院的60例脑卒中S H SⅠ期患者为研究对象,按随机数字表法将分为观察组和对照组各30例,分别采用改良式气压治疗和传统气压治疗,治疗时间均为4周,评价并比较治疗前后两组患者患侧上肢的疼痛评分、手部肿胀程度、上肢简化Fulg-Meyer运动功能评分(Fulg-Meyer assessment,FMA)及肩关节活动度(range of motion,ROM).结果治疗前,两组患者的VAS评分、手部肿胀程度、FMA评分及ROM的差异均无统计学意义(均P>0.05);治疗后,两组患者的VAS评分、手部肿胀程度、FMA评分及ROM均优于治疗前,且观察组优于对照组,差异均有统计学意义(均P<0.05).结论应用改良式气压治疗有利于减轻SHSⅠ期患者的疼痛,提高上肢运动功能,值得临床推广应用.

[目的]探讨耳穴埋豆疗法对慢性阻塞性肺疾病Ⅲ级急性加重期失眠病人的疗效.[方法]将78例慢性阻塞性肺疾病Ⅲ级急性加重期失眠病人随机分为两组,每组39例,干预组在抗感染、平喘治疗的基础上加用耳穴埋豆疗法,取穴肺、脾、神门、肾、交感、内分泌、脑点穴.将磁疗贴对准敏感点贴于耳穴,每日按压2次或3次,每次3 min~5 min,双耳交替,2 d换贴1次,3次为1个疗程,共治疗3个疗程;对照组则在抗感染、平喘治疗基础上给予艾司唑仑1 mg睡前口服.治疗3个疗程后应用匹兹堡睡眠质量指数量表进行评价,观察病人夜间实际睡眠时间、入睡时间、睡眠潜伏期.[结果]治疗3个疗程后,干预组夜间实际睡眠时间、入睡时间、睡眠潜伏期评分高于治疗前及对照组(P<0.05).[结论]耳穴埋豆疗法能改善慢性阻塞性肺疾病病人睡眠质量,且无不良反应.

Objective To study the application effect of traditional Chinese medicine fumigation in preven-ting deep vein thrombosis of lower limbs of the stroke patients in rehabilitative period.Methods By con-venience sampling,60 cases were selected and divided into observation group and control group,with 30 cases in each group.The observation group was applied with Traditional Chinese medicine fumigation prescription choose Buyang Huanwu Decoction,while the control group received routine nursing,The color Doppler ultrasonography was used to monitor the incidence of deep vein thrombosis and the changes of hemorheology before and after the treatment.Results Before intervention,there was no statistical signifi-cance of incidence of deep vein thrombosis and the changes of hemorheology found between two groups (all P>0.05).After intervention,the indexes of incidence of deep vein thrombosis and the changes of hemo-rheology in observation group were better than which in control group (all P<0.05).Conclusions Tradi-tional Chinese medicine fumigation can prevent the formation of lower extremity deep vein thrombosis of convalescence cerebral apoplexy patients effectively.

Objective To explore the application effect of self-efficacy theory based rehabilitation nursing plan for stroke patient during the upper extremity function recovery stage .Methods By convenience sampling ,60 cases were selected and randomly divided into observation group and control group ,with 30 cases in each group .The control group received routine recovery nursing and treatment ,while the observation group was applied with self-efficacy theory based recovery nursing plan on the basis of conventional method .The scores of simplified Fugl-Meyer assessment (FMA) scale ,FMA-UE ,general self-efficacy scale (GSES) and Barthel index were compared between two groups .Results Before intervention ,no statistical significance of self-efficacy score ,FMA-UE and Barthel found between two groups (all P > 0 .05) .Three weeks after intervention ,the GSES ,FMA-UE and Barthel index were improved (all P < 0 .05) ,and the observation group was better than that of control group (all P < 0 .05) .Conclusion The recovery nursing plan based on the self-efficacy theory has certain help for improving the upper limb movement function and the activities of daily living of the stroke patients .

近年来,随着医疗技术水平的不断提高,卒中患者致死率逐年下降;然而,卒中患病率和致残率却逐年升高.卒中后认知障碍是卒中常见并发症之一,而认知障碍显著影响卒中患者的预后.音乐疗法是一项新的康复治疗技术,旨在通过音乐调节神经兴奋性和人体内循环,从而发挥治疗作用,帮助恢复患者的认知功能.本文对音乐影响认知功能的机制、音乐疗法的国内外进展、音乐疗法在卒中认知康复中的临床应用以及存在的问题进行综述.

ABSTRACTIn recent years, more attention has been paid to function rehabilitation and how to reduce the complications with increasing successful rate in the treatment of acute phase stroke. Shoulder hand syndrome after stroke is an important complication which affects the limb function rehabilitation of the patients. Therefore, early prevention, treatment and nursing are very important. In this paper, the mechanism of shoulder hand syndrome, its Chinese and western medicine treatment and rehabilitation nursing are summarized.

Obj ective To observe the effect of the discharging rate on ischemia-reperfusion inj ury in bladder of patients with acute urinary retention.Methods By Convenience sampling,90 cases were randomly divided into ob-servation group A,observation group B and control group,with 30 cases in each group.Three different rates were set when discharging,and the urinary sample on before urination (T1),during urination (T2),600ml (T3),800 ml (T4)and 0.5h after urination (T5)were collected.According to the rate of discharging on acute urinary reten-tion.Clinical efficacies of 3 groups were observed,RBC、WBC in urine were observed before(T1)and after voiding (T2,T3,T4,T5).The isomorphic red blood cell,white blood cell,number of epithelial cells,heart rate and blood pressure were measured and compared among three groups of patients.Results The isomorphic red blood cell, white blood cell,number of epithelial cells at T2,T3 and T4 in observation group were less than which in control group(P<0.01).The heart rate and blood pressure in observation groups had no statistical significance(P>0.05). Conclusion It is better to keep the discharge rate at 150ml/min,and the initial urination volume of 400 ml after acute urinary retention which can reduce the damage of bladder histocyte.

目的：比较2种不同的酒精棉球燃火罐方式对拔罐疗法的效果。方法选取2012年1月～10月在本院门诊中医治疗室行拔罐疗法的患者80例为研究对象，随机分为实验组和对照组。实验组采取手工制作血管钳夹紧直径约2.5 cm的酒精棉球燃罐，对照组采取普通医用酒精棉球燃罐，分别比较2组患者燃罐后火罐的吸罐成功率和罐斑颜色。结果实验组燃罐后火罐的吸罐成功率及启罐时紫红色罐斑患者均明显高于对照组（P<0.01）。结论手工制作血管钳夹紧直径适宜的酒精棉球燃罐方式可迅速提升罐内温度，增加罐内负压，从而提高拔罐疗法的临床疗效。

目的 观察止血带分次放气对股骨内固定术患者缺血再灌注损伤的保护效果.方法 便利抽样选择2010年10月至2012年10月在上海市第七人民医院接受股骨下段骨折行限期切开复位内固定术的患者90例,采用信封法将其随机分为观察A组、B组和对照组各30例,观察A组采用5 min内三段式分次放气的方法,观察B组采用10 min内三段式分次放气的方法,对照组采用传统方法设定一次性放气.分别于再灌注后1 min(T1)、5 min(T2)、10 min(T3)、30 min(T4)测定患者血浆丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)的浓度.结果 观察A组及观察B组与对照组相比,T1至T4各时间点血浆MDA与SOD含量差异均有统计学意义(均P＜0.01);观察B组T1至T4四个时间段的血浆MDA浓度均低于观察A组、血浆SOD含量均高于观察A组,差异均有统计学意义(均P＜0.01).结论 止血带分次放气的方法对止血带诱发的肢体缺血再灌注损伤具有一定的保护作用.

Objective To investigate the application of mode based on clinical training base of infusion room in training of rotary new nurses , so as to find more effective , standardized , and practical training methods for the future.Methods Established a training assessment team , developed theory, hands-on training and simulation scenario training program , conducted training in stages , implemented the assessment of related theory, operational skills and overall quality , and satisfaction on rotary new nurse was evaluated by nurses and patients monthly .Results All of the new nurses in the infusion room can timely completed the training program, and the difference was statistically significant in the assessment of theory [(91.4 ±6.3) vs (85.5 ± 5.7)], operation[(93.1 ±5.4) vs (87.6 ±6.7)], first aid [(90.7 ±5.6) vs (84.7 ±5.2)], and the overall quality of evaluation [(94.8 ±4.2) vs (90.1 ±3.9)] between those new nurses and rotary new nurse in 2011 ( t =5.00 , 4.60 , 4.14 , 5.91;P <0.01 ) . After the training , nurses and patients'satisfaction rate respectively was 98.1% and 99.1%, while that in 2011 respectively was 85.5% and 86.9%, and the differences were statistically significant (t =4.379,8.791;P<0.05).Conclusions Rotary new nurses can comprehensively improve their overall quality through the clinical training base mode of infusion room , and that can establish a good nursing personnel reserve for the clinical specialist nursing posts .

目的探讨门诊输液病人对于输液滴速的依从性及影响依从性的相关因素。方法选择来本院输液的病人500例,并填写调查表,通过调查表内容总结出病人的滴速依从性及影响依从性的主要相关因素。结果 500例门诊输液病人中358例表示在一定的情况下会自行调节输液滴速,主要受病人年龄、性别、学历、既往输液经历、对医学存在认识误区及外界环境等因素影响。结论正确的输液滴速对于输液效果起至关重要的作用,通过调查了解病人输液滴速依从性及相关影响因素后,有助于护士采取一定的措施增强病人的输液滴速依从性,从而促进输液安全。