Effects of penehyclidine hydrochloride in small intestinal damage caused by limb ischemia-reperfusion

AIM:To investigate the protective effect of penehyclidine hydrochloride post-conditioning in the damage to the barrier function of the small intestinal mucosa caused by limb ischemia-reperfusion(LIR) injury. METHODS:Male Wistar rats were randomly divided into three groups(36 rats each) :the sham-operation group(group S) ,lower limb ischemia-reperfusion group(group LIR) ,and penehyclidine hydrochloride postconditioning group(group PHC) .Each group was divided into subgroups(n=6 in each group) according to ischemic-reperfusion time,i.e.immediately 0 h(T1) ,1 h(T2) ,3 h(T3) ,6 h(T4) ,12 h(T5) ,and 24 h(T6) .Bilateral hind-limb ischemia was induced by rubber band application proximal to the level of the greater trochanter for 3 h.In group PHC,0.15 mg/kg of penehyclidine hydrochloride was injected into the tail vein immediately after 3 h of bilateral hind-limb ischemia.The designated rats were sacrificed at different time-points of reperfusion;diamine oxidase(DAO) ,superoxide dismutase(SOD) activity,myeloperoxidase(MPO) of small intestinal tissue,plasma endotoxin,DAO,tumor necrosis factor-α(TNF-α) ,and interleukin(IL) -10 in serum were detected in the rats. RESULTS:The pathological changes in the small intestine were observed under light microscope.The levels of MPO,endotoxin,serum DAO,and IL-10 at T1-T6,and TNF-αlevel at T1-T4 increased in groups LIR and PHC(P<0.05) compared with those in group S,but tissue DAO and SOD activity at T1-T6 decreased(P<0.05) .In group PHC,the tissue DAO and SOD activity at T2-T6,and IL-10 at T2-T5 increased to higher levels than those in group LIR(P<0.05) ;however,the levels of MPO,endotoxin,and DAO in the blood at T2-T6,and TNF-αat T2 and T4 decreased(P<0.05) . CONCLUSION:Penehyclidine hydrochloride post-conditioning may reduce the permeability of the small intestines after LIR.Its protection mechanisms may be related to inhibiting oxygen free radicals and inflammatory cytokines for organ damage.

Osteoarthritis action alliance consensus opinion-best practice features of anterior cruciate ligament and lower limb injury prevention programs

AIM To identify best practice features of an anterior cruciate ligament(ACL) and lower limb injury prevention programs(IPPs) to reduce osteoarthritis(OA).METHODS This consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubM ed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading(Me SH) and keywords for terms:(1) ACL OR "knee injury" OR "anterior cruciate ligament";(2) "prevention and control" OR "risk reduction" OR "injury prevention" OR "neuromuscular training"; and(3) meta-analysis OR "systematic review" OR "cohort study" OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.RESULTS The best practice features of an IPP have the following six components:(1) lower extremity and core strengthening;(2) plyometrics;(3) continual feedback to athletes regarding proper technique;(4) sufficient dosage;(5) minimal-to-no additional equipment; and(6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement.Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.CONCLUSION Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.

Changing paradigms in lower extremity reconstruction in war-related injuries

Background: Ballistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue coverage have brought about a paradigm shift in the management of lower extremity wounds during the last decade with an increased emphasis on limb salvage.Methods: A literature-based study was conducted to analyze reconstructive modalities based on the location, depth, and severity of wounds, as well as mechanism of injury, concomitant vascular injuries and open fractures, choice of flap, timing of definitive reconstruction, and complications.Results: Extremity injuries account for over 60% of injuries in the recent conflicts in Iraq and Afghanistan, with the majority secondary to explosive devices. The severity of these injuries is profound compared with civilian registries, and conventional injury scoring systems have failed to accurately predict outcomes in combat trauma. The mainstay of treatment is serial debridement, negative pressure therapy, fracture stabilization, and treatment of concomitant injuries by the forward medical teams with subsequent definitive reconstruction after transport to an advanced military treatment facility. Autologous reconstruction with free tissue transfer and pedicled flaps remains the primary modality for soft tissue coverage in limb salvage. Adjunct innovative modalities, such as external tissue expansion, dermal substitutes, and regenerative matrices, have also been successfully utilized for limb salvage.Conclusion: Lower extremity injuries account for the vast majority of injuries in modern warzones. Explosive devices represent the most common mechanism of injury, with blast impact leading to extensive soft tissue injuries necessitating complex reconstructive strategies. Serial debridement, negative pressure therapy, and autologous reconstruction with free tissue transfer and pedicled flaps remain the mainstay of treatment in recent conflicts.

Ischemic preconditioning produces more powerful anti- inflammatory and cardioprotective effects than limb remote ischemic postconditioning in rats with myocardial ischemia-reperfusion injury

Background Both ischemic preconditioning （IPC） and limb remote ischemic postconditioning （LRIPOC） have been shown to possess significantly different cardioprotective effects against the myocardial ischemia reperfusion injury （IRI）, but no study has compared the anti-inflammatory effects of IPC and LRIPOC during myocardial IRI process. We hypothesized that IPC and LRIPOC would produce different anti-inflammatory effects in an in vivo rat model with myocardial IRI.

Scientific evidence is just the starting point: A generalizable process for developing sports injury prevention interventions

Background: The 2 most cited sports injury prevention research frameworks incorporate intervention development, yet little guidance is available in the sports science literature on how to undertake this complex process. This paper presents a generalizable process for developing implementable sports injury prevention interventions, including a case study applying the process to develop a lower limb injury prevention exercise training program(Footy First) for community Australian football.Methods: The intervention development process is underpinned by 2 complementary premises:(1) that evidence-based practice integrates the best available scientific evidence with practitioner expertise and end user values and(2) that research evidence alone is insufficient to develop implementable interventions.Results: The generalizable 6-step intervention development process involves(1) compiling research evidence, clinical experience, and knowledge of the implementation context;(2) consulting with experts;(3) engaging with end users;(4) testing the intervention;(5) using theory; and(6)obtaining feedback from early implementers. Following each step, intervention content and presentation should be revised to ensure that the final intervention includes evidence-informed content that is likely to be adopted, properly implemented, and sustained over time by the targeted intervention deliverers. For Footy First, this process involved establishing a multidisciplinary intervention development group, conducting 2targeted literature reviews, undertaking an online expert consensus process, conducting focus groups with program end users, testing the program multiple times in different contexts, and obtaining feedback from early implementers of the program.Conclusion: This systematic yet pragmatic and iterative intervention development process is potentially applicable to any injury prevention topic across all sports settings and levels. It will guide researchers wishing to undertake intervention development.

Mechanism of the protective effects of noninvasive limbs preconditioning on myocardial ischemia-reperfusion injury

Background This study aimed at assessing the effect of noninvasive limb preconditioning on myocardial infarct size, and determining whether nitric oxide and neurogenic pathway play an important role in the mechanism of acute remote ischemic preconditioning （IPC）.Methods Forty Wistar rats were randomly divided into four experimental groups. In Group I , the rats underwent 30-minute occlusion of the left anterior descending coronary artery, and 120-minute reperfusion. In Group PL, the rats underwent four cycles of 5-minute occlusion and reperfusion of both hind limbs using a tourniquet before the experiment was continued as in Group I. In Group PL-N and Group PL-,, we administered L-nitro-arginine methyl ester （L-NAME） 10 mg/kg or hexamethonium chloride 20 mg,/kg intravenously, 10 minutes before IPC. Infarct size as a percentage of the area at risk was determined by triphenyhetrazolium chloride staining.Results There were no statistically significant differences in mean arterial pressure and heart rate among these groups at any time point during the experiment （ P〉0. 05 ）. The myocardial infarct size （IS） was decreased significantly in Group PL and Group PL-U compared with Group I , and the IS/AAR was 34. 5%± 7.6%, 35.9%±8.6% and58.5%±8.5%, respectively （P〈0.05）. The IS/AAR was 49.1%±6.5% in Group PEN, and there was no significant difference compared with Group I （P〉0. 05 ）.Conclusions Noninvasive limb IPC is effective in protecting the myocardium from ischemia reperfusion injury. Nitric oxide plays an important role in the mechanism of acute remote IPC, in which the neurogenic pathway is not involved.

Finite element modeling and injury criteria investigation for the lower leg of the Chinese human body under impact loads

The widely used human body injury criteria were established based on the biomechanical response of the EuroAmerican human body,without considering the differences in anthropometry and injury characteristics among different races,particularly the Chinese human body which typically has the smaller body size.The absence of such race specific design considerations negatively influences the injury prevention capability for these populations,and weakens the applicability of injury criteria.To resolve these issues,this study aims to develop a lower leg finite element model of a 50th percentile Chinese male.The model is built based on the medical images of an average size Chinese male with detailed ankle ligaments and lower leg muscles modeled.Data from sixty experiments available in the literature are used to validate its biofidelity.Using the validated model,the lower leg model is subjected to combined axial compression and bending loads to evaluate its injury criteria.Compared with a typical Euro-American human body mode,the Chinese lower leg presents reduced mechanical tolerance,and the revised tibia index may be an appropriate injury criteria for the Chinese lower leg.Additionally,the validated model reproduces the pedestrian lower leg fracture in a domestic accident.

围手术期间歇性充气加压对重度颅脑损伤患者下肢深静脉血栓形成的预防效果

目的分析重度颅脑损伤(TBI)患者围手术期应用间歇性充气加压对下肢深静脉血栓的预防效果。方法选取2021-01—2022-12菏泽市立医院收治的70例重度TBI患者为研究对象,分为对照组、研究组各35例,对照组接受常规下肢深静脉血预防性干预,研究组增加间歇性充气加压。比较2组下肢深静脉血栓发生率、干预前后静脉血流流速及干预7 d后下肢肿胀情况。结果研究组发生下肢深静脉血栓1例(2.86%),对照组6例(17.14%),研究组发生率低于对照组(P<0.05);干预前2组下肢各血管静脉流速对比无统计学差异(P>0.05),干预后2组股静脉、髂外静脉、股深静脉、腘静脉流速较干预前均明显提升,研究组流速快于对照组(P<0.05);对照组、研究组轻度+无肿胀占比差异有统计学意义(P<0.05)。结论间歇性充气加压可有效预防肢深静脉血栓,原因可能在于间歇性充气加压可改善下肢血管静脉流速,建议重度TBI患者围术期应用。

踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

目的观察踝关节智能柔性牵伸在下肢痉挛脊髓损伤患者中的应用效果。方法2021年6月至2024年5月,北京博爱医院脊髓损伤患者28例,随机分为对照组和试验组,各14例。两组均接受常规康复治疗,在此基础上,对照组予以手法牵伸治疗,试验组给予踝关节智能牵伸系统训练,共8周。治疗前后分别采用改良Ashworth评定量表(MAS)、踝关节背屈角、临床痉挛指数、腓肠肌内侧头表面肌电最大均方根值和足大趾振动觉阈值(VPT)进行评定。结果治疗后,试验组MAS分级(χ^(2)=10.378,P=0.035)、踝关节背屈角(Z=-3.306,P<0.001)、临床痉挛指数(t=4.101,P=0.001)和腓肠肌内侧头被动背屈时的最大均方根值(Z=-3.296,P<0.001)均改善,试验组MAS分级(χ^(2)=11.418,P=0.022)、踝关节背屈角(Z=-1.986,P=0.047)、腓肠肌内侧头被动背屈时的最大均方根值(Z=-2.297,P=0.021)均优于对照组。足大趾VPT虽有所改善,但组内和组间比较均无显著性差异(P>0.05)。结论踝关节智能柔性牵伸可改善脊髓损伤患者下肢肌痉挛,有改善足部本体感觉的趋势。

虚拟现实技术对不完全脊髓损伤患者下肢功能的影响

目的探讨虚拟现实技术(VR)对不完全脊髓损伤患者下肢运动功能、平衡能力、躯干控制能力及步行能力的影响。方法选自郑州大学第一附属医院康复医学科2022年1月至2023年12月治疗的46例不完全脊髓损伤患者,采用随机数字法分成治疗组、对照组,各23例。两组接受相同的康复治疗,治疗组在此基础上增加VR 30 min,对照组在常规康复治疗的基础上继续康复训练30 min,每周5 d,疗程8周。治疗前及治疗8周后,分别采用脊髓损伤下肢功能量表(ASIA)、Berg平衡量表(BBS)、躯干控制测试量表(TCT)、Holden功能性步行量表(FAC)对患者下肢运动能力、平衡能力、躯干控制能力及步行能力进行评定。结果两组治疗前ASIA、BBS、TCT、FAC评分比较,差异无统计学意义(P>0.05);两组治疗后ASIA、BBS、TCT、FAC评分比治疗前提高,且治疗组高于对照组(P<0.05)。结论基于VR的康复治疗能改善不完全脊髓损伤患者的下肢功能,提高其平衡能力、躯干控制能力和步行能力。

山地户外运动鞋对人体下肢落地冲击的影响研究

为探讨山地户外运动鞋对人体下肢落地冲击的影响,以光学三维动态捕捉系统与Kistler三维测力台实时采集并对比被试者穿着高缓震户外运动鞋与无缓震户外运动鞋完成山地户外运动常见落地动作时下肢的地面反作用力数据与下肢关节运动学参数。结果发现,穿着高缓震户外运动鞋与无缓震户外运动鞋落地时,人体下肢地面反作用力存在显著性差异:穿着高缓震户外运动鞋时下肢落地的地面反作用更小,对下肢的冲击与损伤更小;穿着高缓震户外运动鞋与无缓震户外运动鞋落地时人体下肢关节的活动度、触地角度、最小角度、最大角速度、出现时间均不存在显著性差异,但穿着无缓震户外运动鞋时下肢关节的活动度小于高缓震户外运动鞋,表明穿着无缓震户外运动鞋落地时下肢的损伤风险更大。

大众跑者跑步相关损伤危险因素的前瞻性研究

目的:通过前瞻性研究调查大众跑者跑步相关损伤(RRI)的危险因素,为RRI的预防和治疗提供理论依据。方法:采集95名健康大众跑者的生理和跑步训练等基本信息、人体测量学因素、身体能力因素和跑步生物力学因素,随后进行4个月的跟踪随访,依据观察期内的损伤情况将受试者分为损伤组和健康组。通过卡方检验或独立样本t检验确认两组间基线指标的差异,将有统计学意义(P<0.05)的变量纳入Logistic回归模型进行分析。结果:36名跑者在观察期内报告了46例RRI,损伤发生率为38%,其中膝关节损伤最为常见(26.7%);与健康组相比,损伤组存在较小的静态Q角(健康组7.42°±6.90°,损伤组11.03°±10.17°,P=0.042)、跑步着地时刻躯干前倾角(健康组94.24°±4.52°,损伤组91.89°±4.55°,P=0.016)和小腿地面夹角(健康组100.94°±3.44°,损伤组99.41°±3.33°,P=0.037),以及更大的跑步离地时刻小腿地面夹角(健康组53.23°±3.19°,损伤组54.70°±3.09°,P=0.031);Logistic回归分析显示跑步着地时刻小腿地面夹角减小(OR=0.853,P=0.039)和离地时刻小腿地面夹角增大(OR=1.222,P=0.014)可能增加RRI的损伤发生风险。结论:(1)在大众跑者中,RRI发生率较高,损伤部位以下肢膝、踝关节和足部为主。跑步着地时刻和离地时刻小腿更加垂直于地面可能是导致大众跑者RRI损伤风险增加的潜在因素;(2)静态Q角和跑步着地时刻躯干前倾角度在损伤组和健康组之间存在差异,但未发现其与损伤风险之间的关系,因此可能不是导致大众跑者RRI风险增加的潜在因素。

下肢康复机器人联合IPC对脑损伤后肢体运动功能障碍患者下肢深静脉血栓预防效果

目的探讨下肢康复机器人联合间歇充气加压装置(IPC)对脑损伤后肢体运动功能障碍患者下肢深静脉血栓形成(DVT)的预防效果。方法通过便利抽样法选取本院2020年12月—2021年12月住院的脑损伤后肢体运动功能障碍患者90例,根据治疗方法的不同将其分为对照组和观察组,每组45例。对照组给予常规康复训练及IPC治疗,观察组在对照组基础上给予下肢康复机器人治疗,两组均在治疗3月后进行效果评价,比较两组临床疗效、美国国立卫生研究院卒中量表(NIHSS)评分、改良Barthel指数(MBI)评分、凝血-纤溶系统指标、下肢深静脉血流动力学参数、DVT发生率。结果观察组临床总有效率高于对照组(P<0.05)。观察组治疗后NIHSS评分低于对照组(P<0.05),观察组治疗后MBI评分高于对照组(P<0.05)。观察组治疗后D-二聚体(D-D)、纤维蛋白降解产物(FDP)均低于对照组,观察组治疗后凝血活酶时间(APTT)、凝血酶原时间(PT)均高于对照组(P<0.05)。观察组治疗后下肢腘静脉、股静脉、髂外静脉平均血流速度(Vm)均高于对照组(P<0.05)。观察组DVT发生率低于对照组(P<0.05)。结论下肢康复机器人联合IPC可有效改善脑损伤后肢体运动功能障碍患者神经功能及下肢血液流动速度,提高日常生活能力,纠正血液高凝状态,降低DVT发生率,值得借鉴。

退变性半月板损伤与下肢力线的相关性研究

目的 比较退变性内侧半月板损伤与外侧半月板损伤之间下肢力线差异,探究半月板损伤与下肢力线之间的关系。方法 收集2019年3月至2022年3月经关节镜手术治疗的退变性半月板损伤患者90例,其中男性45例,女性45例;年龄40~59岁,中位年龄52岁。内侧半月板损伤组47例,外侧半月板损伤组43例。在全长片上测量髋-膝-踝角(HKA角)并比较两组间差异。结果 内侧半月板损伤组与外侧半月板损伤组患者性别、年龄、下肢侧别、体质量指数、损伤部位、损伤类型差异无统计学意义。内侧半月板损伤组HKA角为(177.20±2.46)°,外侧半月板损伤组为(181.05±3.13)°,两组差异有统计学意义(P<0.01)。结论 退变性内侧半月板损伤与外侧半月板损伤之间HKA角存在差异,下肢力线与退变性半月板损伤存在关联。

应用VHD型预定制矫形鞋垫预防海军新兵下肢过劳性损伤:一项随机对照研究

目的探讨VHD型预定制矫形鞋垫是否可以降低海军新兵下肢过劳性损伤(LLOI)的发生率。方法选取参加入伍训练的400名男性海军新兵,随机分配至试验组(n=200)和对照组(n=200)。在入伍训练期间,试验组穿着VHD型预定制矫形鞋垫,对照组不穿鞋垫。1周后进行问卷调查,对出现不良反应的新兵的矫形鞋垫进行重新塑形。12周后通过问卷调查和体格检查收集新兵健康资料。主要研究结果为新兵入伍训练期间LLOI的发生率,次要研究结果为新兵参加入伍训练发生LLOI的类型、因LLOI损失的训练时间、穿着矫形鞋垫的舒适度评分和不良反应。结果试验组和对照组基线测量数据差异无统计学意义(P>0.05)。共发生76例LLOI,其中试验组24例(12%)、对照组52例(26%)。最常见的LLOI类型为足底筋膜炎。试验组因LLOI损失的训练时间共为51 d(2.12 d/人),对照组则为123 d(2.37 d/人)。试验组穿着矫形鞋垫1周和12周后舒适度评分分别为(3.76±1.87)和(2.03±1.74)分;不良反应发生率分别为18%(36/200)和5%(10/200),最常见的不良反应为足弓疼痛。结论VHD型预定制矫形鞋垫可降低新兵LLOI的发生率,减少因LLOI导致的训练时间损失,穿着舒适性较好,不良反应较少。

下肢骨折患者术后发生急性肾损伤的危险因素及其预后状况分析

目的探讨下肢骨折患者术后发生急性肾损伤(AKI)的危险因素及其预后状况。方法分析2016年1—12月首都医科大学附属北京积水潭医院收治的613例下肢骨折手术患者的临床资料,根据术后是否发生AKI将研究对象分为AKI组(术后发生AKI,36例)和非AKI组(术后未发生AKI,577例)。采用单因素分析和多因素logistic回归分析探讨下肢骨折患者术后发生AKI的独立影响因素。分析下肢骨折术后发生AKI患者的预后。结果单因素分析结果显示,AKI组患者的年龄、髋部及大腿骨折比例、术中出血量、住院时间、尿素氮、血肌酐水平均大于非AKI组,膝部及小腿骨折比例、足踝骨折比例、血红蛋白、白蛋白、肾小球滤过率(eGFR)、前白蛋白水平均低于非AKI组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄≥61.0岁、术中出血量≥60.0 ml、住院时间≥12.0 d、术前血肌酐≥79.0μmol/L是下肢骨折患者术后发生AKI的独立危险因素(P<0.05)。本研究中,发生术后AKI的下肢骨折患者36例,发生率为5.87%。AKI组有3例患者进行了血液净化治疗,其中2例患者摆脱透析,顺利出院,但术后随访1年发现其肾功能并未恢复至术前基线水平;另外1例高龄(78岁)患者最终抢救无效死亡;其余33例患者均未进行血液净化治疗,术后2~3周,肾功能恢复至术前基线水平。结论高龄、术中出血量多、住院时间长、术前血肌酐水平高是下肢骨折患者术后发生AKI的独立危险因素。

不同类型排球鞋对运动员下肢关节损伤的影响

本文对排球运动中常发生的下肢关节损伤展开相关研究。选取15名排球运动员作为受试者,选用鞋中底硬度(邵氏硬度)分别为40、50、60,厚度分别为22、25、28 mm的排球鞋,对受试者慢跑时的主观舒适性、跳跃拦网动作时的生物力学指标进行分析,探究不同类型排球鞋对运动员下肢关节损伤的影响。结果表明,中底厚度为22 mm的排球鞋舒适度最好,硬度为40的排球鞋主观评价最好,也更能起到预防损伤的作用;触地起跳阶段,不同中底硬度排球鞋对下肢关节活动度的影响较小;落地阶段,鞋中底硬度增加,髋关节屈曲活动度显著减小,穿着硬度为40的排球鞋时踝关节外旋活动度显著小于硬度为60的排球鞋。

胫骨横向骨搬移治疗下肢血栓闭塞性脉管炎的临床研究

目的分析胫骨横向骨搬移(TTBT)治疗下肢血栓闭塞性脉管炎(TAO)效果,及其对血清内皮损伤因子、疼痛因子的影响。方法选择2017年7月至2022年6月石家庄平安医院收治的下肢TAO患者92例为研究对象,根据手术方式不同将92例下肢TAO患者分为TTBT组和对照组,每组46例。对照组接受置管溶栓及球囊扩张术,TTBT组接受TTBT治疗。观察并比较两组皮肤温度恢复时间、皮肤颜色恢复时间,以及术前、术后半年患肢踝肱指数(ABI)、间歇性跛行距离,血清血管内皮生长因子(VEGF)、低氧诱导因子1α(HIF-1α)、血管性血友病因子(vWF)及血栓素B2(TXB2)等内皮损伤因子,血清5-羟色胺(5-HT)、P物质(SP)、去甲肾上腺素(NE)等疼痛因子水平。结果TTBT组皮肤温度恢复时间、皮肤颜色恢复时间分别为(10.36±1.32)、(5.07±0.53)d,短于对照组的(12.45±1.50)、(6.28±0.65)d,差异均有统计学意义(P<0.05)。术后半年,TTBT组患肢ABI、间歇性跛行距离分别为0.86±0.11、(2546.52±258.28)m,大于对照组的0.77±0.09、(2103.06±226.23)m,差异均有统计学意义(P<0.05)。术后半年,TTBT组血清VEGF、HIF-1α、vWF、TXB2水平分别为(36.87±3.98)ng/L、(2.64±0.29)ng/L、(149.97±17.62)%、(140.38±17.62)ng/L,低于对照组的(44.09±4.82)ng/L、(3.17±0.34)ng/L、(186.50±21.08)%、(178.95±20.11)ng/L,差异均有统计学意义(P<0.05)。术后半年,TTBT组血清5-HT、SP、NE水平分别为(0.24±0.03)μmol/mL、(1.51±0.17)pg/mL、(60.37±6.41)ng/mL,均低于对照组的(0.31±0.05)μmol/mL、(1.87±0.21)pg/mL、(75.25±9.17)ng/mL,差异均有统计学意义(P<0.05)。结论TTBT治疗下肢TAO可重建下肢远端侧支循环,保护血管内皮,改善局部缺血状况,促进患者皮肤恢复,增强患者运动功能,降低疼痛因子、内皮损伤因子水平。

星状神经节阻滞对下肢止血带缺血再灌注损伤及术后镇痛的影响

目的:探讨星状神经节阻滞对下肢止血带缺血再灌注损伤及术后镇痛的影响。方法:在徐州医科大学附属医院麻醉科2020年2月~2022年6月收治的所有下肢损伤手术患者中选取60例为研究对象,采用随机数字表法分为对照组(n=30)与观察组(n=30)两组,观察组采用星状神经节阻滞法进行神经阻滞,对照组患者不进行神经阻滞。分别对比两组患者上止血带前(T0)、止血带充气10 min(T1)、止血带充气30 min(T2)止血带充气60 min(T3)、止血带充气90 min(T4)、松止血带后10 min(T5)、松止血带后30 min(T6)、松止血带后60 min(T7)心率(HR)情况、丙二醇(MDA)、超氧化物歧化酶(SOD)以及炎性因子肿瘤坏死因子(TNF)-α和白细胞介素8(IL-8)表达水平、术后镇痛情况以及术后并发症(术后出血、术后发热以及肺不张)发生率。结果:两组患者T0、T6、T7时刻HR相比差异无统计学意义(P>0.05),T1~T5时刻,观察组的HR明显低于对照组,差异有统计学意义(P<0.05),;两组患者T0时刻MDA、SOD、TNF-α和IL-8相比差异无统计学意义(P>0.05),T7时刻观察组SOD明显高于对照组,MDA、TNF-α和IL-8均低于对照组,差异均有统计学意义(P<0.05);观察组患者的首次镇痛药物服用时间长于对照组患者,48 h镇痛泵使用次数少于对照组患者,差异有统计学意义(P<0.05);观察组患者并发症发生率(3.33%)低于对照组(26.66%),差异有统计学意义(P<0.05)。结论:在对于下肢止血带缺血再灌注损伤患者的治疗中,运用星状神经节阻滞的方法能有效减轻止血带为患者所带来的疼痛,避免脏器损伤,减轻缺血再灌注损伤出现的可能,提高疾病的预后效果,运用效果显著。

电针联合功能性电刺激在促进不完全性脊髓损伤患者下肢运动功能中的应用

目的:观察电针联合功能性电刺激在不完全性脊髓损伤中的应用效果。方法:将90例不完全性脊髓损伤患者随机分为对照组(n=45)与观察组(n=45),对照组采用功能性电刺激治疗,观察组联合电针治疗。观察2组肌力、下肢运动评分、下肢感觉评分、脊髓损伤步行指数Ⅱ(WISCIⅡ)、改良Ashworth量表(MAS)等级、步态参数、临床疗效及治疗安全性。结果:观察组总有效率高于对照组(P<0.05);治疗后,观察组肌力、下肢运动评分、下肢感觉评分、WISCIⅡ、MAS等级、步态参数均优于对照组(均P<0.05)。2组均未发生严重不良事件。结论:电针联合功能性电刺激治疗不完全性脊髓损伤疗效显著,能够促进下肢运动功能恢复。