目的 对脑卒中后失能综合评估量表进行汉化及信效度检验,探索该量表在国内的临床适用性.方法 采用Brislin双人直译-回译法、专家评议、预调查对量表进行文化调适,便利抽取203名脑卒中患者进行调查,对中文版量表进行项目分析,并验证其重测信度、评定者间信度、内容效度、效标关联效度.结果 脑卒中后失能综合评估量表重测信度相关性分析结果显示相关系数为0.988;评定者间信度Kappa系数为0.846(95％置信区间为0.793～0.899),P<0.001;各条目内容效度指数均在0.833～1.000之间,量表内容效度指数为0.935;以改良Rankin量表为标准,效标关联效度系数为0.896.结论 中文版脑卒中后失能综合评估量表具有良好的信效度,可作为我国临床脑卒中失能评估工具.

目的:观察高频重复经颅磁刺激(rTMS)、脑仿生电刺激及其序贯治疗脑外伤持续植物状态(PVS)患者的临床疗效.方法:入组的脑外伤PVS患者予常规药物及康复治疗,并随机分为3组:rTMS组(24例),予高频rT-MS治疗;脑仿生电组(23例),予脑仿生电治疗;rTMS与脑仿生电联合组(简称联合组,26例),先高频rTMS治疗后立即给脑仿生电刺激治疗.分别在治疗前、治疗6周后应用昏迷恢复量表修订版(CRS-R)评估患者意识状态,查脑电图(EEG)、脑干听觉诱发电位(BAEP)、体感诱发电位(SEP).结果:治疗4周后,3组CRS-R评分较治疗前均有明显提高(均P<0.05),联合组CRS-R评分均高于脑仿生电组、rTMS组(均P<0.05).治疗后,3组患者EEG、BEAP、SEP分级整体均较治疗前明显改善(均P<0.05),联合组较脑仿生电组、rTMS组明显改善(P<0.05).治疗后,3组患者BEAP、SEP潜伏期较治疗前均有显著降低(P<0.05),联合组BEAP、SEP潜伏期均低于脑仿生电组、rTMS组(P<0.05).结论:高频rTMS、脑仿生电刺激治疗均可以有效改善脑外伤PVS患者的意识及其脑电生理,且二者序贯治疗的效果优于单一治疗.

Objective:To explore the effect of core muscle training on the balance and walking function of stroke patients.Methods:100 stroke patients who were treated in our hospital from November 2019 to April 2020 were selected as the research objects. According to the order of patients' treatment, they were divided into control group and intervention group, 50 cases in each group. The control group was given the conventional training method, and the intervention group was given core muscle training on the basis of routine training. Before treatment, 3 weeks and 6 weeks after treatment, Berg Balance Scale (BBS) and functional ambulation classification (FAC) were used to evaluate the curative effect of the two groups.Results:Before treatment, there were no statistically significant differences in the scores of BBS and FAC between the two groups (all P>0.05); after 3 weeks and 6 weeks of treatment, the scores of BBS and FAC in the intervention group were significantly better than those in the control group (all P<0.05). Conclusion:Core muscle training can improve the ability of posture maintenance, balance function, and walking ability of stroke patients.

目的:观察持续植物状态(PVS)患者采取脑电仿生电结合醒脑开窍针法刺激后弥散张量成像(DTI)、动脉质子自旋标记(ASL)变化,为临床治疗PVS提供可行性方案.方法:按照随机数字表将90例PVS患者分为3组:脑仿生电刺激组(仿生电组)、醒脑开窍针法组(针刺组)和脑电仿生电刺激结合醒脑开窍针法组(联合组)3组,各30例.仿生电组在常规治疗的基础上,采用脑电仿生电刺激治疗,主电极置于天柱穴和完骨穴,每次治疗为连续刺激99min,间歇30min,再刺激99min,每日1次,连续治疗30d;针刺组在常规治疗的基础上,采用醒脑开窍针法治疗,每日1次,连续治疗30d;联合组在常规治疗的基础上,接受脑电仿生电刺激结合醒脑开窍针法治疗,连续治疗30d.选用昏迷恢复量表修订版(CRS-R)疗效评分量表记录评估开始治疗前1d及结束治疗后1d的意识障碍变化,并观察记录DTI额枕束各向异性分数(FA)和ASL丘脑、额叶感兴趣区脑血流(CBF)值.结果:3组CRS-R量表评分、FA值、CBF值分比较,治疗前3组间差异无显著性意义(P＞0.05);3组治疗后较治疗前差异均有显著性意义(P＜0.05),针刺组与仿生电组治疗后比较,差异无显著性意义(P＞0.05);针刺组、仿生电组与联合组治疗后比较,联合组较针刺组、仿生电组差异有显著性意义(P＜0.05).结论:脑电仿生电刺激结合醒脑开窍针法可显著提高临床促醒疗效,在一定程度上可改善脑影像结构和血流量.

目的 观察醒脑开窍针法联合脑电仿生电刺激对持续性植物状态(PVS)患者的促醒作用及其对血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)的影响.方法 选取90例符合PVS诊断标准的患者,分层后采用随数字法分为3组:针刺组、仿生电组和联合组.3组均接受常规治疗后,针刺组接受醒脑开窍针法,仿生电组接受脑电仿生电刺激,联合组接受脑电仿生电刺激加醒脑开窍针刺法治疗,疗程为1个月.3组分别于治疗前及治疗结束后1天采用CRS-R量表评分,并观察对比3组患者血清中TNF-α及IL-6水平的变化.结果 联合组治疗后的CRS-R评分明显高于其他两组,联合组对PVS患者的促醒作用优于针刺组和仿生电组,差异有统计学意义(P＜0.05);经过治疗后,3组IL-6、TNF-α水平均有所下降,且联合组下降明显低于其他两组,差异均有统计学意义(P＜0.05).结论 醒脑开窍针法联合脑电仿生电刺激治疗对PVS患者的促醒作用明显优于单一治疗,而且可明显减轻炎症反应,降低血清中IL-6及TNF-α的水平.

Objective:To compare the effects of two methods of tracheal extubation for persistent vegetative state (PVS) with tracheotomy and intubation.Method:One hundred and twenty-three PVS patients with tracheotomy and intubation were recruited from Guangdong 999 Brain Hospital.They were randomly assigned to observation group and control group.Observation group was given self-made sealing sleeve to plug the endotracheal intubation completely.If patients breathed normally in 48 hours,the tracheotomy cannulas would be extubated.Control group was replaced with metal tracheal cannulas that would be plugged directly after 1 week.If breathing normally in 48 hours,patients would be given extubation.The heart rate,respiration,blood oxygen saturation and different gender,the course of disease,the tracheal tube indwelling time,extubation time,extubation success rate and complication rates of two groups were recorded.Result:Extubation time:①The difference in extubation time between the two groups was statistically significant (P＜0.05);②When the course of disease was 4-12 weeks,the difference of extubation time was more obvious(P＜0.05);③For the patients with traumatic brain injury or cerebral hemorrhage,extubation time also showed more obvious difference(P ＜ 0.05).For extubation success rate and complication rates,there was no statistical difference between the two groups (P ＞ 0.05).Conclusion:There was no statistical difference in safety,success rate,complication rate between two groups.At the same time,observation group had the shorter extubation time,especially in the patients with 4-12 weeks of course of disease,or with traumatic brain injury,cerebral hemorrhage or ischemia anoxic encephalopathy.

Objective:To study the effect of electroencephalograph bionic electric stimulating the points of Wangu(GB 12), Tianzhu(BL 10)and Neiguan(PC 6)on the auditory evoked potential(BAEP)and somatosensory evoked potential(SEP)in persistent vegetative state(PVS)patients.Methods:According to random number table method, 60 PVS patients were assigned to electroencephalograph bionic electrical stimulation group(bionic electric group, n=30)and routine treatment group(routine group, n=30). The routine group was given conventional treatment, including basic management, hyperbaric oxygen therapy, stimulating drugs and sensory stimulation, etc.. The bionic electric group received electroencephalograph bionic electrical stimulation therapy on the basis of conventional treatment. The working electrodes were placed on GB 12 and BL 10, and the auxiliary electrodes were placed on PC 6.Each treatment lasted 99 minutes, 30 minutes rest between each treatment.30 days as a therapeutic course. The change of consciousness disturbance was recorded by PVS efficacy assessment scale and the SEP and BAEP were examined by electrical evoked potentiometer on the day before and after the treatment respectively.Results:The total effective rate of the bionic electrical group was 86.67%, which was better than that of normal group(60.00%), and there was significant difference between the two groups(P<0.05). The SEP and BAEP were improved obviously in bionic electrical group, and the efficacy was better than that of routine group(P<0.05).Conclusion:The electroencephalograph bionic electric stimulating GB 12, BL 10 and PC 6 can enhance the effect of promoting revival, and improve the SEP and BAEP in PVS patients to some extent.

随着优质护理服务的持续全面开展，护理岗位设置成为提升优质护理服务又一新思路，根据卫生部印发《医院实施优质护理服务工作标准（试行）》，建立护士岗位责任制，探索实施护士的岗位管理［1］，试行护理岗位设置，用以实现护理人力资源的科学利用，提高优质护理服务质量及管理效率的提高。