血友病是一种X染色体连锁的隐性遗传性出血性疾病，患者主要表现为关节、肌肉及深部组织出血，关节出血是血友病患者最常见且具有特征性的临床表现之一。由于血友病患者出血时间长、出血量大，并且出血后血液在关节腔内不能及时吸收是导致血友病患者关节损伤的主要原因[1]。大量研究发现，短波治疗能促进血肿吸收、缓解疼痛，但禁用于有出血倾向的患者[2]。本研究采用脉冲短波治疗血友病伴膝关节出血患者，发现治疗后患者关节功能明显改善，且治疗安全性较好。

Objective To explore the effect of comprehensive rehabilitation care group on the limb function and life quality of patients during cerebral infarction convalescence. Methods Through retrospective analysis in Jul. 2013 to Aug. 2014 in our hospital, comprehensive rehabilitation care group of 60 patients with cerebral infarction conva-lescence as observation group, and 60 cases of routine nursing convalescence of cerebral infarction patients as control group, compared the limb function and the improvement of life quality of the two groups′ patients before and after the nursing intervention . Results The Barthel ADL index score of the observation group after nursing intervention improved significantly higher than that before nursing intervention ( P<0. 05 ) , the score of the control group after nursing inter-vention had no significant increase than that before intervention ( P>0. 05 ) , and the score of the observation group after nursing intervention was significantly higher than that of the control group ( P<0. 05 );the Stroke Specific Quality of Life Scale ( SS-QOL) score of the observation group after nursing intervention was significantly higher than that before nurs-ing intervention ( P<0. 05 ) , the score of the control group after nursing intervention had no significant increase than that before intervention ( P>0. 05 ) , and the score of the observation group after nursing intervention score was significantly higher than that of the control group ( P<0. 05 ) . Conclusions For the limb function and life quality improvement of the patients with cerebral infarction convalescence, the comprehensive rehabilitation nursing intervention group was sig-nificantly better than the conventional nursing. Comprehensive rehabilitation nursing intervention reduce the complica-tions of the patients, improve their ability of daily living, alleviate the disability, reduce the burden of the family and society, and improve the quality of survival comprehensively, thus it is worth further clinical application.

目的 研究成立综合康复护理小组对脑梗死恢复期患者进行综合康复治疗的治疗效果.方法 选取2014年1～12月间在我院康复科住院治疗的60例脑梗死恢复期患者作为研究对象,并随机分为观察组和对照组,各30例.观察组患者在综合康复护理指导小组指导下进行综合康复治疗及护理,对照组患者仅接受常规治疗及护理,比较两组患者治疗3个月后改良Barthel指数评分情况和脑梗死并发症发生情况以评价两组患者的治疗效果.结果 观察组共29例患者完成研究,对照组共28例患者完成研究;观察组患者治疗后改良Barthel指数明显优于对照组,差异有统计学意义(Z=-3.47,P=0.001);观察组并发症发生率为3.45％,明显低于对照组的25.00％,差异有统计学意义(P＜0.05).结论 成立综合康复护理小组对脑梗死恢复期患者进行治疗,可显著提高患者改良Barthel指数,降低患者并发症发生率,提高患者生存质量,值得在临床推广应用.

目的:探讨脑卒中早期认知干预对患者认知功能及日常生活活动能力的影响.方法:按入院顺序随机将80例脑卒中患者分为干预组40例和对照组40例,对照组进行常规药物治疗和康复训练,干预组在对照组基础上进行认知功能训练.比较两组患者在入组时和治疗1个月后的改良Barthel指数(MBI)及简易精神状态量表(MMSE)评分.结果:1个月后,干预组改良Barthel指数(71.75±18.06);MMSE评分分别为(24.62±6.21),与治疗前、对照组比较,差异均有统计学意义(P＜0.05).结论:早期认知干预治疗能改善卒中患者的认知功能,提高日常生活自理能力.

OBJECTIVE To evaluate the role of albumin or prealbumin in diagnosing of ventilator-associated pneumonia(VAP)so as to guide the clinical diagnosis and treatment.METHODS The albumin and prealbumin were collected from 75patients who used mechanical ventilator for more than 48hours,then the patients were divided into the infection group and the non-infection group according to the incidence of VAP,the average value of the albumin or prealbumin was compared between the two groups,finally,the efficacy in diagnosis of VAP was evaluated by using receiver operating characteristic(ROC)curve.RESULTS As compared with the non-infection group,the difference in the albumin or prealbumin of the infection group was significant(P<0.05).The areas under the ROC curve of the prealbumin were 0.639and 0.757,respectively;the optimal cut-off points of albumin and prealbumin in diagnosis of VAP were less than 29.95%g/L and 160g/L,respectively;the sensitivity,specificity,accuracy,and Youden index were 62.9%vs 71.4%,62.5%vs 75.0%,62.7%vs 73.3%,and 0.254vs 0.464,respectively.CONCLUSIONThe albumin and prealbumin have certain value in diagnosis of VAP.

目的:了解氟西汀对脑卒中患者卒中后抑郁、神经功能恢复、日常生活能力(ADL)改善的影响。方法:选择2005年1月至2008年6月在温州市第三人民医院神经内科和康复科住院的急性脑梗死患者80例,均符合全国第四届脑血管病学术会议修订的诊断标准,患者符合中等以上程度的抑郁表现,汉密尔顿抑郁量表(HAMD)评分≥18分,神经功能缺损评分[1](改良爱丁堡-斯堪的纳维亚卒中量表,MESSS)≥16分,随机将患者分为治疗组和对照组各40例。两组都按照神经内科常规治疗和康复治疗,治疗组用氟西汀胶囊(百优解胶囊,美国礼来公司)20mg/d抗抑郁治疗,对照组用茴拉西坦胶囊(100mg/d)作为安慰剂做对照治疗。用MESS、HAMD和ADL量表(简化巴氏指数)对所有病例在治疗前和治疗后6周分别进行评分,评定患者的神经功能缺损、抑郁程度和ADL。结果:治疗前两组间HAMD、MESSS和ADL差异无显著性(P>0.05),治疗后6周两组间HAMD、MESSS和ADL差异有显著性(P<0.01)。结论:氟西汀能缓解急性脑梗死患者的抑郁症状,增强患者对康复的信心和主动性,提高患者的总体康复水平;同时能直接促进急性脑梗死患者的神经功能恢复,从而提高患者的日常生活能力。

目的 观察氟西汀对脑梗死后抑郁患者神经功能缺损及日常生活能力的影响.方法 临床选取急性脑梗死后抑郁患者80例,随机将患者分为治疗组(氟西汀)和对照组各40例,治疗前后分别用改良爱丁堡-斯堪的那维亚脑卒中评分量表(MESSS)、汉密顿抑郁量表(HAMD)和改良巴氏指数量表(MBI)进行评分,评定氟西汀的治疗作用.结果 治疗前两组间HAMD、MESSS和MBI无显著性差异( P＞0.05),治疗后6周两组间HAMD、MESSS和MBI均有显著性差异( P＜0.01).结论 氟西汀能缓解急性脑梗死患者的抑郁症状,促进急性脑梗死患者的神经功能恢复,提高患者的日常生活能力.

目的探讨丁螺环酮对改善脑血管意外(中风)后伴共济失调症状患者日常生活能力的临床疗效。方法选取有共济失调症状的中风患者30例,给予口服丁螺环酮治疗。评定治疗前后分别用日常生活能力量表、共济失调量表得分,并与未服丁螺环酮的对照组(30例)进行比较。结果治疗组治疗后日常生活能力量表、共济失调量表在平衡性和协调性方面都有明显提高(<0.01),与对照组比较差异亦有显著性意义(<0.01)。结论丁螺环酮短期内可有效改善中风后伴共济失调症状患者的日常生活能力。

肩关节疼痛是中风后最常见的并发症之一[1],严重的疼痛很大程度上影响了患者功能的恢复,也是康复治疗的一大障碍.作者对32例患者通过Brunnstrom理论指导下的功能训练进行康复治疗,效果满意.报告如下.

目的:对痉挛的肱二头肌使用不同治疗频率,寻找最佳治疗中风后痉挛的治疗频率。方法:将80例处于BrunnstromⅢ期的患者分成四组,分别对不同组的患者进行3次/d、2次/d、1次/d、1次/2d的肱二头肌的被动手法治疗,比较不同组治疗第2次治疗前、1个月后的肱二头肌肌张力及肘关节伸直角度。结果:2次/d是最合适和有效的治疗频率。结论:对于长期持续的痉挛必须给予长期的康复治疗。

Objective To explore the effect of early pelvis control training on the balance function in patients with hemiplegia. Methods 60 early stroke patients were divided into the treatment group and the control group. The patients in the treatment group accepted the early pelvis control training based on the normal early rehabilitation which was given to the control. They were evaluated with Berg Balance Scale and the Modified Bathel Index before and 2 months after treatment. Results The scores of Berg Balance Scale and the Modified Bathel Index of the treatment group improved more than that of the control group (P0.05). Conclusion The early pelvis control training can improve the balance dysfunction after hemiplegia effectively.