目的 不同强度穿戴式下肢康复机器人训练对脑卒中患者步行功能、下肢运动功能、平衡功能和功能独立性的影响.方法 2021年11月至2022年12月,北京博爱医院住院脑卒中患者60例,随机分为对照组(n = 20)、观察1组(n = 20)和观察2组(n = 20).所有患者均接受常规治疗,对照组每天接受传统步行训练30 min,观察1组每天接受穿戴式下肢康复机器人训练30 min,观察2组每天接受穿戴式下肢康复机器人训练60 min,共4周.治疗前后采用功能性步行分级(FAC)、Fugl-Meyer评定量表下肢部分(FMA-LE)、Berg平衡量表(BBS)、Rivermead运动指数(RMI)进行评定.结果 观察1组1例脱落,观察2组3例脱落.治疗后,3组FAC、FMA-LE、BBS和RMI评分均显著改善(|Z|>3.448,|t|>8.102,P<0.001),3组间无显著性差异(|H|<4.643,F = 1.454,P>0.05),观察1组的BBS评分改善程度优于对照组(P<0.05),观察2组各项指标改善程度优于对照组(P<0.05).结论 穿戴式下肢康复机器人训练可能有助于改善脑卒中患者的步行功能、下肢运动功能、平衡功能和功能独立性,大强度训练可能更有效.

目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙浓度的变化,探讨血清钙浓度与急性心肌梗死(acute myocardial infarction,AMI)的相关性.方法 选择2019年6-7月首都医科大学附属北京天坛医院心内科病房收治的ACS患者247例.收集患者的临床资料,采集血标本行血清钙等生化指标检测.采用二元logistic回归分析AMI的相关危险因素.结果 247例ACS患者分为两组,不稳定性心绞痛组149例,年龄(62.88±9.91)岁;AMI组98例,年龄(60.21±10.86)岁.AMI组患者的血清钙(2.21±0.11)mmol/L,明显低于不稳定性心绞痛组(2.25±0.09)mmol/L(P<0.001).Logistic回归分析显示,校正性别、心率、血白蛋白、总胆固醇、血磷等混杂因素后,血清钙四分位数(OR 0.591,95％CI 0.399～0.874,P=0.008)、年龄(OR 0.834,95％CI 0.791～0.898,P<0.001)、血红蛋白(OR 1.048,95％CI 1.017～1.079,P=0.002)、低密度脂蛋白胆固醇(OR 2.532,95％CI 1.544～4.151,P<0.001)、GRACE评分(OR 1.129,95％CI 1.092～1.167,P<0.001)是AMI的独立危险因素.结论 与不稳定性心绞痛患者相比,AMI患者表现出较低的血清钙浓度,血清钙水平降低是AMI的独立危险因素.

目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙水平与全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分的相关性.方法 选取2019年6—7月首都医科大学附属北京天坛医院心内科病房收治的ACS确诊患者247例,收集患者的临床资料和GRACE评分,采集血标本测定血清钙等生化指标,所有患者均行冠状动脉造影.分析血清钙与GRACE评分的相关性.结果 根据临床资料和冠状动脉造影结果,将247例患者分为急性心肌梗死组98例及不稳定型心绞痛组149例.与不稳定型心绞痛组比较,急性心肌梗死组血清钙显著降低(P<0.001).根据血清钙的四分位数将患者分为4组:Q1组(≤2.15mmol/L)54例、Q2组(>2.15～2.23mmol/L)59例、Q3组(>2.23～2.30mmol/L)77例和Q4组(>2.30mmol/L)57例.Q3组与Q4组患者的GRACE评分均低于Q1组(P<0.01).根据GRAC评分分为高危组(≤108分)34例,中危组(109～140分)87例,低危组(>140分)126例,发现高危组患者血清钙低于中危组和低危组(P<0.01).Pearson直线相关分析显示,ACS患者的血清钙水平与GRACE评分呈显著负相关(r=-0.246,P<0.001).结论 ACS患者血清钙水平与GRACE评分呈明显负相关,血清钙水平降低对识别高危ACS患者具有重要参考价值.

Objective To investigate the effect of music therapy combined with routine medication and rehabilitation training on motor function of hand of patients with brain injury. Methods 30 brain injury patients with hemiplegia were divided into sound group (n=15) and no-sound group (n=15). Besides routine medication and rehabilitation training, two groups received instrument training, one for open music and the other for closed music, 30 minutes a day for 4 weeks. They were evaluated with Simple Test for Evaluating Hand Function (STEF) and Modified Barthel Index (MBI) before and after training to assess hand function and activities of daily living (ADL) respectively. Re-sults The scores of STEF and MBI improved in both groups after training (P<0.01). The score of STEF was better in the sound group than in the no-sound group (P<0.01) while the score of MBI showed no difference between the two groups (P>0.05). The items as taking metal pieces, taking small balls, and taking small metal rod improved most in the sound group while the items as taking small cubic, taking small metal rod, and taking artificial leather improved most in the no-sound group. The items as dressing oneself, cleaning after defecating and uri-nating, and making up improved most in the two groups. Conclusion Music therapy combined with routine medication and rehabilitation training can facilitate to improve fine movement function of hand of hemiplegic patients, such as movement speed, precision.