急性脑卒中早期康复的功能变化与费用的随机对照研究

目的:探讨早期康复对急性脑卒中患者功能变化的影响及相关费用的分析和评价。方法:80例急性脑卒中患者随机分成康复组(40例)和对照组(40例),除进行常规的神经内科治疗外,康复组患者在急性期(病后1个月内,病情稳定48h)至病后6个月进行规范的康复治疗,包括运动疗法、作业疗法和言语治疗等,并对每组患者在入组时、病后3个月和6个月时的功能状况采用改良Barthel和综合功能评定(FCA)进行评测。比较两组在病后3个月和6个月的相关费用,包括直接医疗费用、直接非医疗费用、间接费用等,并进行了成本—效果分析。结果:病后3个月和6个月两组患者的功能状况均有不同程度的改善,其中康复组患者功能改善程度较大,差异有显著性意义(P<0.05)。病后3个月康复组38例的费用总和为$889104.2(23397.5±14176.4),对照组38例的费用总和为$737686.1(19412.8±20897.6),差异有显著性意义(P<0.05);病后6个月康复组38例的费用总和为$1087417.5(28616.2±22009.1),对照组为$901915.2(23734.6±22687.0),差异无显著性意义(P>0.05)。MBI或FCA积分每增加1分在康复组所需的总费用和直接医疗费用相对较低。结论:早期规范的康复治疗可以改善急性脑卒中的功能状况。

经左、右侧上肢外周静脉置入中心静脉导管对置管结局的影响：458例前瞻性随机对照研究

目的比较经左、右侧上肢床旁行经外周静脉置入中心静脉导管（PICC）对置管结局的影响。方法2007年5月至2008年5月在武汉大学中南医院行PICC的患者458例，按随机表分为经左侧置入组（n=230）和右侧置入组（n=228）两组，于置管后即刻行胸部X线检查确认导管头端位置，并随访至导管停止使用时为止。结果右侧置入组出现送管困难的比率明显低于左侧置入组（14．9％比24．8％，P=0．003），导管头端大于40°成角的比率也明显低于左侧置入组（2．2％比23．4％，P=0．000）。两组患者导管头端位于中心静脉部位的到位率差异尤统计学意义（54．4％比53．0％，P=0．538），右侧置入组头端位于上腔静脉近心段的比率明显高于左侧置入组（21．0％比6．6％，P=0．001）；右侧置入组导管头端异位于头臂静脉的比牢明显低于左侧置入组（48．1％比66．7％，P=0．008），异伉于颈内静脉（P=0．859）和锁骨下静脉（P=0．696）的比率与左侧置入组差异无统计学意义。两组患者在导管留置时间（P=0．617）、穿刺血管局部静脉炎发生率（P=0．561）、导管堵塞率（P=0．774）及导管相关感染率（P=0．854）方面差异尤统计学意义，右侧置入组的上肢肿胀发生率明显低于左侧置入组（4．4％比8．3％，P=0．043）。结论经右侧上肢置入PICC的效果优于经左侧上肢，建议临床中置入PICC时优先选择经右侧上肢置管。

Management of liver cirrhosis between primary care and specialists

This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: "ascites", "liver fibrosis", "cirrhosis", "chronic hepatitis", "chronic liver disease", "decompensated cirrhosis", "hepatic encephalopathy", "hypertransaminasemia", "liver transplantation" and "portal hypertension". Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.

The effect of meridian massage on BM,BMI,WC and HC in simple obesity patients:a randomized controlled trial

Objec ve To observe the eff ects of meridian massage on body weight（BW）. body mass index（BMI）,waist circumference（WC） and hip circumference（HC） in pa ents of simple obesity. Methods Fi y-four obesity pa ents were randomized into a massage group（28 patients） and a control group（26 patients） with SAS（statistical analysis software）. The patients in the control group were subjected to diet control and exercise program,while the pa ents in the massage group were subjected to diet control and massage program in combina on with meridian massage. Stomach meridian,spleen meridian,bladder meridian,Guānyuán（关元 CV 4）,Qihǎi（气海 CV 6）,Zhōngwǎn（中脘 CV 12）,Dàhéng（大横 SP 15,both sides）,Tiānshū（天枢 ST 25,both sides）,Zúsānl？（足三里 ST 36,both sides）,Fēnglóng（丰隆 ST 40,both sides） and Ashi points（at positions of fat accumulation） were selected,and the massages were mainly rolling manipulation,acupressure and pressing manipulation. The treatment was carried out 3 times a week for totally 24 times. Clinical therapeutic efficacy,BW,BMI,WC and HC of the patients in the two groups before and after treatment were evaluated. Results The difference in the comparison of therapeutic efficacy after treatment between the two groups was sta s cally significant,and the therapeu c effi cacy in the massage group was be er than that in the control group（P？？0.05）; BW,BWI,WC and HC in the massage group were significantly improved a er treatment in comparison to those before treatment and those in the control group after treatment（P？？0.05）. Conclusion Meridian massage can significantly improve body mass and other related indices of pa ents,improve their life quality,and thus may reduce the morbidity of obesity related diseases.

The Needle-Rolling Therapy for Treatment of Non-organic Chronic Insomnia in 90 Cases

Objective: To evaluate the therapeutic effects of needle-rolling therapy for chronic insomnia. Methods: In the present multi-central randomly controlled clinical study, 180 cases of chronic insomnia were randomly divided into the following two groups, a treatment group (90 cases) treated by the needle-rolling therapy and a control group (90 cases) treated with clonopin. The treatment course for both the two groups was 4 weeks. The therapeutic effects were evaluated based on improvement of the TCM symptoms and the Pittsburgs's sleep-quality index (PSQI). Results: After treatment, there were significant differences between the two groups in the effective rate (P<0.05), and in the total score of PSQI and in the scores of the 4 sub-items, i.e. sleep-quality, sleep-efficiency, hypnotic and daytime function (P<0.05). Although there was no significant difference between the two groups in the effective rate after a 3-month follow-up period, significant differences still existed in the 3 sub-items of sleep-efficiency, hypnotic, and daytime function of the PSQI (P<0.05). Conclusion: As compared with hypnotics of the second generation, the needle-rolling therapy may show better therapeutic effects for chronic insomnia patients.