目的:初步探讨温泉水中太极对老年慢性非特异性下腰痛患者疼痛及睡眠质量的干预疗效.方法:选取老年慢性非特异性下腰痛患者74 例为研究对象,随机分为治疗组(水中太极训练)和对照组(核心肌力训练)各 37 例.对照组采取核心肌力训练方案,治疗组采取水中太极治疗方案.所有患者干预治疗均为3 次/w,每次间隔1d,持续训练8w为1 个疗程.采用简式McGill疼痛问卷(SF-MPQ)、睡眠日记、匹兹堡睡眠质量指数(PSQI)观察两组患者治疗前后疼痛及睡眠质量的改善程度.结果:治疗前,两组SF-MPQ、睡眠日记、PSQI各维度及总评分比较,差异无统计学意义(P＞0.05);治疗后,两组患者SF-MPQ评分疼痛评级指数、视觉疼痛评分、现有疼痛强度评分与治疗前比较,差异具有统计学意义(P＜0.05);组间比较,治疗组上述三项评分与对照组比较均下降明显,差异具有统计学意义(P＜0.05);两组患者睡眠日记评分比较,治疗后睡眠质量均有不同程度改善,治疗组在总睡眠时间、睡眠效率与对照组比较均改善明显,差异具有统计学意义(P＜0.05);两组患者PSQI评分比较,治疗组在睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物和日间功能方面与对照组比较均改善明显,差异具有统计学意义(P＜0.05).结论:温泉水中太极对老年慢性非特异性下腰痛患者疼痛及睡眠质量有较好的临床疗效.

Aim To investigate the effect of dendrobium officinale polysaccharide（DOP） on Janus kinase（JAK）/signal transducer and activator of transcription 3（STAT3） signaling pathway in brain tissue of ischemic stroke rats. Methods The rat model of middle cerebral artery occlusion was established by thread embolism. SD rats were randomly divided into model group, DOP low dose（25 μg/g） group, DOP medium dose（50 μg/g） group, DOP high dose（100 μg/g） group and edaravone group, with 12 rats in each group; Another 12 SD rats were set as sham operation group. After drug intervention, the neurological deficit of rats in each group was scored by Longa grading method. The cerebral infarction in rats was detected by triphenyltetrazolium chloride staining. Hematoxylin-eosin staining was used to observe the pathological changes of hippocampal nerve tissue in rats. Enzyme-linked immunosorbent assay was used to detect the levels of inflammatory cytokines interferon-γ（IFN-γ）, cyclooxygenase-2（COX-2） and interleukin-6（IL-6） in rat brain. Western blot was used to detect the expression level of JAK/STAT3 signaling pathway related proteins in rat brain.Results Compared with the sham operation group, the hippocampal neurons in the model group were shriveled, smaller, degenerated and necrotic, damaged in structure and disordered in arrangement, and the number of them decreased obviously. The whole hippocampal nerve tissue showed obvious pathological damage, and the neurological deficit score, cerebral infarction area, levels of IFN-γ, COX-2 and IL-6 in brain tissue, p-JAK/JAK, p-STAT3/STAT3 increased obviously（P＜0.05）. Compared with the model group, the pathological damage of hippocampal nerve tissue in the drug treatment group was reduced, the neurological deficit score, cerebral infarction area, the levels of IFN-γ, COX-2 and IL-6 in brain tissue, p-JAK/JAK, p-STAT3/STAT3 were all decreased, and there was a dose-dependent relationship among DOP groups（P＜0.05）. Compared with edaravone group, there was no significant change in all indexes of rats in DOP high dose group（P＞0.05）. Conclusion DOP can inhibit the activation of JAK/STAT3 signaling pathway in ischemic stroke rats, reduce the synthesis and secretion of inflammatory cytokines, relieve brain inflammation and repair nerve function.

目的:观察水中太极联合雷火灸治疗老年非特异性下腰痛的临床疗效.方法:74例随机分为治疗组(水中太极联合雷火灸)和对照组(电针疗法),每组各37例,按照治疗方案治疗4周.结果:治疗后RMDQ评分、ODI评分治疗组优于对照组,差异有统计学意义(P＜0.05).总有效率治疗组83.78％,对照组68.57％,差异有统计学意义(P＜0.05).每人总康复总费用治疗组为(1610.83±321.62)元、对照组为(2670.93±441.62)元,总医疗费用、康复费用治疗组低于对照组,差异有统计学意义(P＜0.05).结论:水中太极联合雷火灸治疗NLBP疗效较好.

目的:观察温泉拉格斯圈疗法结合雷火灸治疗寒湿痹阻型膝骨关节炎的临床疗效.方法:选择60例膝骨关节炎患者,随机分为治疗组和对照组.对照组予基础治疗.治疗组在对照组基础上增加温泉拉格斯圈疗法结合雷火灸的治疗,使用WOMAC评分评估功能改善情况,监测关节软骨相关的基质金属蛋白酶、炎性介质等指标.结果:治疗组治疗后疼痛、僵硬、功能三项评分均低于对照组,差异具有统计学意义(P＜0.05).治疗组治疗后MMP-3、IL-1β指标数值低于对照组,差异具有统计学意义(P＜0.05).治疗组治疗后TIMP-1及TGF-β1

Objective To investigate the effect of nimodipine on the neurological function of rats with cerebral infarction based on the X-linked inhibitor of apoptosis protein（XIAP）/second mitochondrial-derived activator of caspase（Smac） pathway. Methods The middle cerebral artery of rats was occluded with suture to induce cerebral infarction model. Then the rats were randomly divided into model group, nimodipine group（10 mg/kg）, AT-406 group（XIAP inhibitor, 7 mg/kg）,union group（nimodipine combined with AT-406）, with 12 rats in each group, another 12 rats were set as sham operation group. After grouping and the intervention of the respective drug administration,Zea Longa grading method was used to score the neurological deficit of rats in each group. Morris water maze experiment was used to evaluate the learning and memory function of rats in each group by comparing the number of times of crossing the original platform. TTC staining was used to detect the cerebral infarction status of rats in each group.TUNEL staining was used to evaluate the apoptosis of hippocampal neurons in each group. Kits were used to detect the levels of serum pro-inflammatory factors cyclooxygenase-2（COX-2） and Interleukin-18（IL-18） of rats in each group. Western blotting was used to detect the expression of apoptosis-related proteins [B-cell lymphoma-2（Bcl-2）、Bcl-2-associated X protein（Bax）]and XIAP/Smac pathway-related proteins（XIAP, Smac） in rat brain tissues of each group. Results Compared with the sham operation group, the number of times of crossing the original platform and the expression levels of Bcl-2 and XIAP in the brain tissue of the model group reduced significantly（P ＜ 0.05）, the neurological deficit score, cerebral infarction area, hippocampal neuron apoptosis ratio, serum COX-2 and IL-18 levels, and Bax and Smac expression levels in brain tissue increased significantly（P ＜ 0.05）. Compared with the model group and the union group respectively, the number of times of crossing the original platform and the expression levels of Bcl-2 and XIAP in the brain tissue of the nimodipine group increased（P ＜ 0.05）, the neurological deficit score, cerebral infarction area, hippocampal neuron apoptosis ratio, serum COX-2 and IL-18 levels, and Bax and Smac expression levels in brain tissue reduced（P ＜ 0.05）. Compared with the model group and the union group respectively, the number of times of crossing the original platform and the expression levels of Bcl-2 and XIAP in the brain tissue of the AT-406 group reduced（P ＜ 0.05）, the neurological deficit score, cerebral infarction area, hippocampal neuron apoptosis ratio, serum COX-2 and IL-18 levels, and Bax and Smac expression levels in brain tissue increased（P ＜ 0.05）. Conclusion Nimodipine can up-regulate the expression of XIAP and down-regulate the expression of Smac, thereby inhibiting the occurrence and development of inflammation, reducing hippocampal neuronal apoptosis in rats with cerebral infarction, enhancing the learning and memory ability of rats, and improving their neurological function.

Objective:To investigate water exercise therapy's effect on lower limb function rehabilitation in patients with the first stroke.Method:160 patients with the first stroke and lower limb dysfunction who received rehabilitation treatment in the Geriatric Hospital of Hainan, China, from May 2020 to June 2021 were randomly divided into two groups, the control group, and the hydrotherapy group. Each group comprises 80 cases in each group. The control group received conventional drug therapy and traditional rehabilitation training, while the hydrotherapy group received underwater exercise training in combination with the routine group treatment plan. The National Health Center Stroke Scale (NIHSS), the modified Rankin scale (MRS), the limb motor function score table (Fugl-Meyer assessment, FMA), Functional Walking Scale (functional ambulation category scale, FAC), Berg Balance Scale (BBS) and the modified Barthel index (MBI) were respectively used to evaluate the neurological function, lower limb motor function, walking function, balance function and daily living ability before and after treatment.Result:There was no significant difference in NIHSS, MRS, FMA, FAC, BBS, and MBI scores between the two groups before treatment (P > .05). However, after 8 weeks of treatment, there was a significant difference in FMA, FAC, BBS, and MBI scores between the two groups (P = .00035). The FMA scores in control group was 16.60 ± 4.49, while 21.45 ± 2.96 after treatment. The FAC scores in control group was 1.45 ± 0.68, while 1.95 ± 0.783 after treatment.Conclusion:Early water exercise training in hemiplegic patients with the first stroke can significantly enhance the balance ability, walking ability as well as limb coordination of patients.

目的:采用ICF康复组合(ICF-RS)评价非特异性下腰痛(nonspecific low back pain,NLBP)患者的功能状况,初步分析水中太极治疗NLBP的康复疗效.方法:74例NLBP患者随机分配入治疗组(水中太极)和对照组(核心肌力训练),每组各37例.按照预定的治疗方案进行为期8周的集中康复训练,通过ICF-RS评估NLBP患者的功能改善情况.结果:NLBP患者存在明显身体功能障碍的类目依次为:b152情感功能、b280痛觉、b455运动和耐受能力、b710关节活动能力、b730肌肉力量;存在明显活动与参与功能障碍依次为:d230进行日常事务、d410改变身体基本姿势、d415保持一种身体姿势、d640做家务、d660帮助别人、d710基本的人际交往、d770亲密关系、d850有报酬的就业、d920娱乐与休闲.2组NLBP患者治疗前后通过ICF-RS进行疗效评估,2组患者治疗后30条类目中14条明显改善(b152、b280、b455、b710、b730、d230、d410、d415、d640、d660、d710、d770、d850、d920),治疗组改善类目评分均较对照组改善明显,具有显著性差异(P＜0.05).结论:水中太极对NLBP痛患者有明显的临床疗效.ICF-RS可以用于评估NLBP患者的功能状况,指导康复治疗和进行疗效评价.

近年来,国内围绕国际功能、残疾和健康分类(Interna-tional Classification of Functioning,Disability and Health,ICF)临床应用方面的研究逐年增多[1-3],而《国际功能、残疾和健康分类(ICF)专家共识》的发表[4],又推动了 ICF及其核心组合如康复组合(ICF rehabilitation set,ICF-RS)的临床应用及标准的编制[5-6].本文仅就ICF及ICF-RS在国内的应用作一介绍,旨在进一步推动ICF及ICF-RS在国内临床的应用及研究.

目的 探讨安宫牛黄丸联合常规治疗对急性脑梗死恢复期患者的临床疗效.方法 100例患者随机分为对照组和观察组,每组50例,对照组给予常规治疗(阿司匹林、阿托伐他汀、康复运动训练),观察组在对照组基础上加用安宫牛黄丸,疗程14d.检测临床疗效、Fugl-Meyer评分、NIHSS评分、血流量指标(Vm、PI)、血管内皮细胞因子(NO、ET-1、AngⅡ)、不良反应发生率变化.结果 观察组总有效率高于对照组(P＜0.05).治疗后,2组Fugl-Meyer评分、Vm、NO升高(P＜0.05),NIHSS评分、PI、ET-1、AngⅡ降低(P＜0.05),以观察组更明显(P＜0.05).2组均无明显不良反应.结论 安宫牛黄丸联合常规治疗可改善急性脑梗死恢复期患者肢体功能、脑血流灌注量,其机制可能与改善血管内皮功能有关.

以腹痛为首发表现的Trousseau综合征少有报道。本文报告了1例以腹痛为首发表现且合并脾梗死的Trousseau综合征患者临床资料，并结合文献复习进行分析讨论。Trousseau综合征累及颅脑导致的急性缺血性脑卒中事件可出现进展性神经功能缺损症状，因此临床医师需要提高对该疾病的认识，及时诊治，以免贻误病情。

目的 探讨多巴丝肼联合普拉克索治疗老年帕金森病的疗效.方法 选取自2018年1月至2020年9月海南省干部疗养院收治的140例老年帕金森病患者为研究对象.将患者随机分为常规组与观察组,每组各70例.常规组采用单纯多巴丝肼治疗,观察组在常规组基础上加用普拉克索治疗.比较两组的治疗总有效率,治疗前后的统一帕金森病评定量表(UPDRS)评分、实验室指标水平.结果 观察组治疗总有效率显著高于常规组,差异有统计学意义(P<0.05).治疗后,两组患者的UPDRS评分均低于治疗前,且观察组低于常规组,差异均有统计学意义(P<0.05).治疗后,两组患者的5-羟色胺和脑源性神经营养因子水平均高于治疗前,且观察组高于常规组;两组患者的S100β水平低于治疗前,且观察组低于常规组;差异均有统计学意义(P<0.05).结论 多巴丝肼联合普拉克索治疗老年帕金森病可有效提高缓解效果,控制病情进展.

目的 分析白细胞计数/平均血小板体积(white blood cell count to mean platelet volume ratio,WMR)与急性脑梗死(acute cerebral infarction,ACI)患者近期预后的关系.方法 招募2015年9月—2019年12月就诊于我院神经内科的ACI患者134例,收集所有患者临床基线资料、NHISS评分及实验室检测指标及出院后30 d内预后情况,根据患者预后情况,分为预后不良组(n=26)及预后良好组(n=108),分析两组患者临床资料之间的差异,通过ROC曲线评估WMR等临床指标对ACI患者近期预后不良的诊断价值,应用COX比例风险回归模型分析WMR与ACI预后不良的相关性.结果 ①预后不良组患者LDL-C、WBC、MPV、WMR及NIHSS评分水平显著高于预后良好组(P<0.05);(②WMR预测ACI近期预后不佳的价值最高,曲线下面积(AUC)(95％CI)为0.86(0.79～0.93),显著高于其他指标,差异具备统计学意义;③COX比例风险回归模型发现,MPV、NIHSS评分、WMR是ACI患者近期预后不良的独立危险因素,三者危险比(HR)(95％CI)分别为1.04(1.01～1.15)、1.61(0.84～3.11)及1.62(0.61～4.34).结论 WMR是潜在的预测ACI患者近期预后不佳的标记物,其水平升高与ACI预后不良密切相关.

目的 探讨帕金森病患者的吞咽障碍与肺部感染的相关性及炎性因子水平变化.方法 选择海南省干部疗养院于2015年9月至2019年12月期间收治的帕金森病患者120例作为研究对象,根据是否发生吞咽障碍分为吞咽障碍组(n=85)与非吞咽障碍组(n=35).观察所有研究对象肺部感染发生情况及病原菌分布情况,是否合并吞咽障碍肺部感染和炎性因子水平变化.结果 120例帕金森病患者中,发生肺部感染患者47例,发生率为39.17％.肺部感染患者分离病原菌48株,其中分离出革兰阴性菌29株,分离出革兰阳性菌19株.吞咽障碍组肺部感染率(49.41％)高于非吞咽障碍组(14.28％),差异有统计学意义(P<0.05).吞咽障碍组血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平高于非吞咽障碍组,差异有统计学意义(P<0.05).结论 帕金森病患者吞咽障碍发生率较高,且与肺部感染密切相关,且吞咽障碍患者血清IL-1β、IL-6和TNF-α水平明显升高.

目的 探讨胞二磷胆碱联合尼麦角林治疗急性脑梗死的效果及对胰岛素样生长因子1(IGF-1)、β肌动蛋白(β-actin)、心型脂肪酸结合蛋白(H-FABP)水平的影响.方法 选取海南省老年病医院2017年6月至2019年6月收治的急性脑梗死患者84例,随机分为观察组和对照组,各42例.两组患者均予急性脑梗死的基础治疗(包括抗凝、溶栓、抗血小板、调血脂等),并予注射用尼麦角林静脉滴注,观察组患者加用胞二磷胆碱注射液静脉滴注,均连续治疗2周.结果 观察组总有效率为90.48％,明显高于对照组的73.81％(P<0.05);治疗后,观察组患者的美国国立卫生研究院卒中量表(NIHSS)评分明显低于对照组,简易智力状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分均明显高于对照组,IGF-1水平明显高于对照组,β-actin、H-FABP水平均明显低于对照组,健康调查简表(SF-36)中生理职能、情感职能、躯体功能、社会功能评分均明显高于对照组(P<0.05);观察组与对照组不良反应发生率相当(16.67％比9.52％,P>0.05).结论 胞二磷胆碱联合尼麦角林治疗急性脑梗死,能改善患者的认知功能、血清生化指标,提高生活质量.

目的 探讨胞磷胆碱联合Rood技术治疗老年脑卒中的临床疗效及对患者日常生活能力的影响.方法 选取医院2017年9月至2019年9月收治的老年脑卒中患者92例,按随机数字表法分为观察组和对照组,各46例.两组患者均予脑卒中常规治疗,并予Rood技术治疗,观察组患者加服胞磷胆碱钠片.两组均连续治疗4周.结果 观察组总有效率为86.96％,明显高于对照组的69.56％(P<0.05);治疗后,观察组患者的美国国立卫生研究院卒中量表(NIHSS)评分明显低于对照组,简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分及Fugl-Meyer评分、Barthel指数评分均明显高于对照组(P<0.05)、神经元特异性烯醇化酶(NSE)、S100β蛋白、碱性髓鞘蛋白(MBP)水平均明显低于对照组(P<0.05);观察组与对照组不良反应发生率相当(17.39％比10.87％,P>0.05).结论 胞磷胆碱联合Rood技术治疗老年脑卒中,能改善神经缺损状态,降低脑损伤血清标志物水平,改善日常生活能力.

Objective: To analyse the correlation of 5-HTTLPR gene polymorphism and PTSD in Li and Han nationalities of Hainan Province. Methods: Essen trauma inventory (ETI), clinician administered post-traumatic stress disorders scale, (CAPS), tower of Hanoi (TOH), wsiconsin card sorting test (WCST), trail making test (TMT) and wechsler adult intelligence scale revised China (WAIS-RC) were used to investigate patients with PTSD and healthy volunteers (control group). PCR and PPGE were used to detect the polymorphism of 5-HTTLPR gene and analyze its correlation with PTSD. Results: The ETI score, total PTSD score and TMT time of Li nationality patients with PTSD were significantly higher than those of Han nationality patients with PTSD, and the IQ of comprehension and operation in WAIS-RC was significantly lower than that of Han nationality patients with PTSD (P HTTLPR genotype in Li nationality and Han nationality patients with PTSD were significantly higher than those of LL genotype, and the perception, calculation and block diagram in WAIS-RC were significantly lower than those of LL genotype patients (P Conclusions: The SS genotype can increase the risk of PTSD in Li nationality and Han nationality people in Hainan. LL genotype is associated with PTSD of Li and Han nationalities in Hainan, and is an important protective factor for PTSD of Li and Han nationalities in Hainan.

针对脑卒中患者居家养老问题,探讨卒中单元的应用.通过海南省干部疗养院(海南省老年病医院)的实践,我们从卒中单元的管理机制、信息化平台建设、团队建设、服务内容、培训内容以及保障措施方面讨论了卒中单元的具体实施,提出卒中单元在脑卒中患者居家养老服务的应用是具有优越性的,可以改善卒中患者医疗管理模式,丰富脑卒中患者居家养老服务的内涵,提高康复护理疗效和患者生活质量,提升医养结合居家养老的品质.

Objective To investigate the ffects of butylphthalide combined with edaravone on neurological function and vascular endothelial function in patients with acute cerebral infarction(ACI). Method 96 patients with ACI were randomly divided into combined group (n=48) and edaravone group (n=48) by envelope method. Edaravone group was given intravenous drip of 60mg·d-1×4w edaravone on the basis of routine treatment. The combined group was treated with butylphthalide 0.2g·d-1×4w on the basis of edaravone group. Before treatment, after 1w, 2w and 4w treatment National Institutes of Health Stroke Scale (NIHSS), whole blood viscosity, whole blood viscosity, plasma viscosity and hematocrit and other blood rheology indexes, and plasma nitric oxide (NO) and endothelin-1 (ET-1), vascular endothelial growth factor (VEGF) and other vascular endothelial function indexes level of the two groups were measured, adverse reaction rate and 28d mortality rate of two groups were calculated and compared. Results Compared with edaravone group, after 1w, 2w and 4w treatment NIHSS score, blood rheology index and plasma ET-1 and VEGF levels of the combine group were decreased, while the plasma NO level of the combine group was increased (P<0.05). Compared with before treatment, after 1 w, 2w and 4w treatment NIHSS score, blood rheology index and plasma ET-1 and VEGF levels of the combine group were decreased, while the plasma NO level of the combine group was increased; And after 2w and 4w treatment NIHSS score, blood rheology index and plasma ET-1 and VEGF levels of th edaravone group were decreased, while the plasma NO level of the edaravone group was increased (P<0.05). The 28d mortality rate of the combine group was 2.08% (1/48), which was lower than the 16.67% (8/48) that of edaravone group (P<0.05). There were no statistically significant differences in liver and kidney damage, digestive tract reaction, headache and dizziness and other adverse reactions rated in the two groups (P>0.05). Conclusion Butylphthalide combined with edaravone in the treatment of ACI can effectively improve the nerve function, vascular endothelial function and short-term prognosis, and its safety is good, therefore, Clinical application value .

In recent years, with the increase of natural disasters, wars, and terrorist incidents, etc., there are more and more researches on post-traumatic stress disorder (PTSD).This paper bases on the definition, pathogenic mechanism and related gene research of post-traumatic stress disorder.Mechanism, reviews the research status of post-traumatic stress disorder to improve people's understanding of post-traumatic stress disorder, and prospect for future research.

目的 观察瑞舒伐他汀钙胶囊联合阿司匹林肠溶片和氯吡格雷片治疗老年急性脑梗死的临床疗效及安全性.方法 将74例老年急性脑梗死患者随机分为对照组和试验组,每组37例.对照组予以瑞舒伐他汀钙每次10 mg,qd,口服+阿司匹林每次100 mg,qd,口服;试验组在对照组治疗的基础上,予以氯吡格雷每次75 mg,qd,口服.2组患者均治疗28 d.比较2组患者的临床疗效,血清脂蛋白α和高敏C反应蛋白(hs-CRP)水平,颈动脉斑块指标,以及药物不良反应的发生情况.结果 治疗后,试验组和对照组的总有效率分别为94.59％(35例/37例)和78.38％(29例/37例),差异有统计学意义(P＜0.05).治疗后,对照组和试验组的脂蛋白α分别为(24.15±8.32)和(16.01±7.89)U·mL-1,hs-CRP分别为(5.67±1.34)和(2.81±1.20) mg·L-1,颈动脉内中膜厚度分别为(1.07±0.20)和(0.79±0.18)mm,斑块面积分别为(0.67±0.09)和(0.38±0.10)cm2,斑块数量分别为(2.43±0.22)和(2.08±0.17)个,差异均有统计学意义(均P＜0.05).试验组发生的药物不良反应主要有恶心、呕吐、出血和血压异常升高,对照组发生的药物不良反应主要有恶心、呕吐、出血和皮疹.试验组和对照组的总药物不良反应发生率分别为27.03％和21.62％,差异无统计学意义(P＞0.05).结论 瑞舒伐他汀钙胶囊联合阿司匹林肠溶片和氯吡格雷片治疗老年急性脑梗死的临床疗效确切,其有助于降低血清脂蛋白α和hs-CRP水平,稳定动脉硬化斑块,且不增加药物不良反应的发生率.