Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Creatine Kinase is mandatory, and lastly’ acute kidney injury needs to be treated urgently. Also, reducing the risk of infection is one of the management objectives to achieve recovery.

Considerations for exerkine research focusing on the response to exercise training

García-Hermoso and colleagues1 recently published a systematic literature review and meta-analysis on exercise training-induced changes in exerkine concentrations in type 2diabetes mellitus patients,providing a contemporary view on how exerkines respond to exercise training.That review prompted us to highlight 2 additional considerations that should be taken into account when studying the response of exerkines to exercise training.Firstly,whether exerkines can exhibit discordant responses to acute exercise compared to exercise training,and secondly,the need to consider the residual effects of the most recent exercise bout.

Subsequent bilateral acute carpal tunnel syndrome due to tophaceous infiltration:A case report

BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.

Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent

Background:Acute mountain sickness(AMS)is the mildest form of acute altitude illnesses,and consists of nonspecific symptoms when unacclimatized persons ascend to elevation of≥2500 m.Risk factors of AMS include:the altitude,individual susceptibility,ascending rate and degree of pre-acclimatization.In the current study,we examined whether physiological response at low altitude could predict the development of AMS.Methods:A total of 111 healthy adult healthy volunteers participated in this trial;and 99(67 men and 32 women)completed the entire study protocol.Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude(500 m).Heart rate,blood pressure(BP)and pulse oxygen saturation(SpO2)were recorded prior to and during the last minute of exercise.The ascent from 500 m to 4100 m was completed in 2 days.AMS was defined as≥3 points in a 4-item Lake Louise Score,with at least one point from headache wat 6–8 h after the ascent.Results:Among the 99 assessable subjects,47(23 men and 24 women)developed AMS at 4100 m.In comparison to the subjects without AMS,those who developed AMS had lower proportion of men(48.9%vs.84.6%,P<0.001),height(168.4±5.9 cm vs.171.3±6.1 cm,P=0.019),weight(62.0±10.0 kg vs.66.7±8.6 kg,P=0.014)and proportion of smokers(23.4%vs.51.9%,P=0.004).Multivariate regression analysis revealed the following independent risks for AMS:female sex(odds ratio(OR)=6.32,P<0.001),SpO2 change upon exercise at low altitude(OR=0.63,P=0.002)and systolic BP change after the ascent(OR=0.96,P=0.029).Women had larger reduction in SpO2 after the ascent,higher AMS percentage and absolute AMS score.Larger reduction of SpO2 after exercise was associated with both AMS incidence(P=0.001)and AMS score(P<0.001)in men but not in women.Conclusions:Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent.Such an association was more robust in men than in women.Trial registration:Chinese Clinical Trial Registration,ChiCTR1900025728.Registered 6 September 2019.

The Analysis of Wall Shear Stress Modulated by Acute Exercise in the Human Common Carotid Artery with an Elastic Tube Model

Assessment of the magnitude and pattern of wall shear stress(WSS)in vivo is the prerequisite for studying the quantitative relationship between exercise-induced WSS and arterial endothelial function.In the previous studies,the calculation of the WSS modulated by exercise training was primarily based upon the rigid tube model,which did not take non-linear effects of vessel elastic deformation into consideration.In this study,with an elastic tube model,we estimated the effect of a bout of 30-minute acute cycling exercise on the WSS and the flow rate in the common carotid artery according to the measured inner diameter,center-line blood flow velocity,heart rates and the brachial blood pressures before and after exercise training.Furthermore,the roles of exerciseinduced arterial diameter and blood flow rate in the change of WSS were also determined.The numerical results demonstrate that acute exercise significantly increases the magnitudes of blood flow rate and WSS.Moreover,the vessel elastic deformation is a non-negligible factor in the calculation of the WSS induced by exercise,which generates greater effects on the minimum WSS than the maximum WSS.Additionally,the contributions of exercise-induced variations in blood flow rate and diameter are almost identical in the change of the mean WSS.

Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic

BACKGROUND There are two known types of exercise-induced acute renal failure.One is the long-known myoglobinuria-induced acute renal failure due to severe rhabdomyolysis,and the other is the recently recognized non-myoglobinuria-induced acute renal failure with mild rhabdomyolysis.Exercise-induced acute renal failure was first reported in 1982.Non-myoglobinuria-induced acute renal failure is associated with severe low back pain and patchy renal vasoconstriction,and it is termed post-exercise acute renal failure because it usually occurs hours after exercise.It is also called acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise(ALPE).AIM To makes a significant contribution to medical literature as it presents a study that investigated a not-widely-known type of exercise-induced acute renal failure known as ALPE.METHODS We performed a database search selecting papers published in the English or Japanese language.A database search was lastly accessed on September 1,2022.The results of this study were compared with those reported in other case series.RESULTS The study evaluated renal hypouricemia as a key risk factor of ALPE.The development of ALPE is due to the sum of risk factors such as exercise,hypouricemia,nonsteroidal anti-inflammatory drugs,vasopressors,and dehydration.CONCLUSION In conclusion,hypouricemia plays a key role in the development of ALPE and is often associated with anaerobic exercise.The development of ALPE is a result of the cumulative effects of risk factors such as exercise,hypouricemia,NSAIDs,vasopressors,and dehydration.

Demystifying roles of exercise in immune response regulation against acute respiratory infections:A narrative review

The benefits of physical activity and exercise,especially those classified as moderate-to-vigorous activity(MVPA),have been well-established in preventing non-communicable diseases and mental health problems in healthy adults.However,the relationship between physical activity and exercise and the prevention and management of acute respiratory infection(ARI),a global high-burden disease,has been inconclusive.There have been debates and disagreements among scientific publications regarding the relationship between exercise and immune response against the causative agents of ARI.This narrative review aims to explore the theory that sufficiently explains the correlation between exercise,immune response,and ARI.The potential root causes of discrepancies come from research associated with the“open window”hypothesis.The studies have several limitations,and future improvements to address them are urgently needed in the study design,data collection,exercise intervention,subject recruitment,biomarkers for infection and inflammation,nutritional and metabolism status,and in addressing confounding variables.In conclusion,data support the clinical advantages of exercise have a regulatory contribution toward improving the immune response,which in turn potentially protects humans fromARI.However,the hypothesis related to its negative effect must be adopted cautiously.

Effects of music and video on perceived exertion during high-intensity exercise

Background: Dissociative attentional stimuli(e.g., music, video) are effective in decreasing ratings of perceived exertion(RPE) during low-tomoderate intensity exercise, but have inconsistent results during exercise at higher intensity. The purpose of this study was to assess attentional focus and RPE during high-intensity exercise as a function of being exposed to music, video, both(music and video), or a no-treatment control condition.Methods: During the first session, healthy men(n = 15) completed a maximal fitness test to determine the workload necessary for high-intensity exercise(operationalized as 125% ventilatory threshold) to be performed during subsequent sessions. On 4 subsequent days, they completed 20 min of high-intensity exercise in a no-treatment control condition or while listening to music, watching a video, or both. Attentional focus, RPE,heart rate, and distance covered were measured every 4 min during the exercise.Results: Music and video in combination resulted in significantly lower RPE across time(partial η~2= 0.36) and the size of the effect increased over time(partial η~2= 0.14). Additionally, music and video in combination resulted in a significantly more dissociative focus than the other conditions(partial η~2= 0.29).Conclusion: Music and video in combination may result in lower perceived exertion during high-intensity exercise when compared to music or video in isolation. Future research will be necessary to test if reductions in perceived exertion in response to dissociative attentional stimuli have implications for exercise adherence.

Correlation between blood pressure changes and AMS, sleeping quality and exercise upon high-altitude exposure in young Chinese men

Background: Excessive elevation of arterial blood pressure(BP) at high altitude can be detrimental to our health due to acute mountain sickness(AMS) or some AMS symptoms. This prospective and observational study aimed to elucidate blood pressure changes induced by exposure to high-altitude hypoxia and the relationships of these changes with AMS prevalence, AMS severity, sleep quality and exercise condition in healthy young men.Methods: A prospective observational study was performed in 931 male young adults exposed to high altitude at 3,700 m(Lhasa) from low altitude(LA, 500 m). Blood pressure measurement and AMS symptom questionnaires were performed at LA and on day 1, 3, 5, and 7 of exposure to high altitude. Lake Louise criteria were used to diagnose AMS. Likewise, the Athens Insomnia Scale(AIS) and the Epworth Sleepiness Scale(ESS) were filled out at LA and on day 1, 3, and 7 of exposure to high altitude.Results: After acute exposure to 3,700 m, diastolic blood pressure(DBP) and mean arterial blood pressure(MABP) rose gradually and continually(P【0.05). Analysis showed a relationship with AMS for only MABP(P【0.05) but not for SBP and DBP(P】0.05). Poor sleeping quality was generally associated with higher SBP or DBP at high altitude, although inconsistent results were obtained at different time(P【0.05). SBP and Pulse BP increased noticeably after high-altitude exercise(P【0.05).Conclusions: Our data demonstrate notable blood pressure changes under exposure to different high-altitude conditions: 1) BP increased over time. 2) Higher BP generally accompanied poor sleeping quality and higher incidence of AMS. 3) SBP and Pulse BP were higher after high-altitude exercise. Therefore, we should put more effort into monitoring BP after exposure to high altitude in order to guard against excessive increases in BP.

Effects of different flui replacements on serum HSP70 and lymphocyte DNA damage in college athletes during exercise at high ambient temperatures

Purpose：The aim of this study was to investigate the effects of flui replacement by water or sports drinks on serum heat shock protein 70（HSP70） levels and DNA damage during exercise at a high ambient temperature.Methods：Ten male college athletes with an athletic career ranging from 6 to 11 years were recruited from Yonsei University.The subjects ran on a treadmill at 75% of heart rate reserve during 4 different trials：thermoneutral temperature at 18℃（T）,high ambient temperature at 32℃ without flui replacement（H）,high ambient temperature at 32℃ with water replacement（HW）,and high ambient temperature at 32℃ with sports drink replacement（HS）.During each condition,blood samples were collected at the pre-exercise baseline（PEB）,immediately after exercise（IAE）,and60 min post-exercise.Results：Skin temperature significant y increased during exercise and was significant y higher in H compared to T and HS at IAE.Meanwhile,serum HSP70 was significant y increased in all conditions at IAE compared to PEB and was higher in H compared to T at the former time point.Significant y increased lymphocyte DNA damage（DNA in the tail,tail length,tail moment） was observed in all trials at IAE compared to PEB,and attenuated DNA damage（tail moment） was observed in HS compared to H at IAE.Conclusion：Acute exercise elevates serum HSP70 and induces lymphocyte DNA damage.Fluid replacement by sports drink during exercise at high ambient temperature can attenuate HSP response and DNA damage by preventing dehydration and reducing thermal stress.

Isometric exercise promotes arteriogenesis in rats after myocardial infarction

Isometric exercise(IE)is a promising intervention of noninvasive revascularization in patients with acute myocardial infarction(AMI).This study aimed to investigate the impact and mechanisms of IE training on arteriogenesis in AMI.Male Sprague-Dawley rats were randomly assigned into the sham-operation group(SO),myocardial infarction(MI)group,and 13 IE subgroups treated according to training intensity,frequency,duration,or monocyte chemoattractant protein-1(MCP-1),or/and fibroblast growth factor-2(FGF-2)inhibitors for eight weeks.Our results demonstrated that the IE group achieved superior improvement compared with the MI group in terms of left ventricular ejection fraction(LVEF),myocardial infarction size(MIS),arterial density(AD),monocytes(MNCs),smooth muscle cells(SMCs),endothelial cells(ECs),relative collateral blood flow(RCBF),MCP-1,and FGF-2 at the endpoint.Positive correlations between MCP-1 and MNCs,MNCs and FGF-2,FGF-2 and SMCs,SMCs and AD,as well as AD and RCBF were observed.This study demonstrated that with MI of 100%load 20 times daily for eight weeks,the arteriogenesis was improved,which may be attributed to the recruitment of MNCs and SMCs in remote ischemic myocardium caused by increases in MCP-1 and FGF-2 expression.

Too hard to die:Exercise training mediates specific and immediate SARS-CoV-2 protection

Several mechanisms may explain how exercise training mechanistically confers protection against coronavirus disease 2019(COVID-19).Here we propose two new perspectives through which cardiorespiratory fitness may protect against severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).Physical exercise-activated adenosine monophosphate(AMP)-activated protein kinase(AMPK)signaling induces endothelial nitric oxide(NO)synthase(eNOS),increases NO bio-availability,and inhibits palmitoylation,leading to specific and immediate SARS-CoV-2 protection.AMPK signaling also induces angiotensin 1-7 release and enhances eNOS activation thus further mediating cardio-and renoprotection.Irisin,a myokine released from skeletal muscles during aerobic exercise,also participates in the AMPK/Akt-eNOS/NO pathway,protects mitochondrial functions in endothelial cells,and antagonizes renin angiotensin system proinflammatory action leading to reductions in genes associated with severe COVID-19 outcomes.Collectively,all the above findings point to the fact that increased AMPK and irisin activity through exercise training greatly benefits molecular processes that mediate specific,immediate,and delayed SARS-CoV-2 protection.Maintaining regular physical activity levels is a safe and affordable lifestyle strategy against the current and future pandemics and may also mitigate against obesity and cardiometabolic disease syndemics.Move more because a moving target is harder to kill.

有氧运动预适应改善骨髓间充质干细胞治疗急性心肌梗死的效果

背景:干细胞疗法是急性心肌梗死后恢复受损心肌组织的替代治疗策略,运动预适应可诱导机体产生内源性心脏保护效应,然而两者联合应用的疗效及机制尚不清楚。目的:探讨运动预适应联合骨髓间充质干细胞对急性心肌梗死大鼠治疗效果的影响及其可能机制。方法:70只雄性SD大鼠随机分为假手术组、模型组、干细胞治疗组、运动预适应组和联合干预组。运动预适应组和联合干预组于造模前进行8周跑台有氧运动,然后通过结扎冠状动脉前降支制作急性心肌梗死模型,干细胞治疗组和联合干预组于造模后隔天尾静脉注射骨髓间充质干细胞(1×10^(9)L^(-1),1 mL),治疗4周后,利用递增负荷跑台运动实验评估运动能力,超声心动图检测心脏结构与功能;分离左心室,2,3,5-氯化三苯基四氮唑染色评估心肌梗死面积,Masson染色检测胶原容积分数,CD31免疫组织化学染色检测心肌毛细血管密度,TUNEL染色检测心肌细胞凋亡情况,免疫印迹法检测基质细胞衍生因子1、CXC趋化因子受体蛋白4、肿瘤坏死因子α、白细胞介素10和血管内皮生长因子蛋白表达量。结果与结论:①干预疗效:与假手术组比较,模型组运动能力、左心室射血分数、左心室缩短分数、CD31阳性细胞率下降(P<0.05),心肌梗死面积、胶原容积分数和心肌细胞凋亡率增加(P<0.05)。与模型组比较,干细胞治疗组运动能力无显著差异(P>0.05),运动预适应组和联合干预组运动能力提高(P<0.05);干细胞治疗组、运动预适应组、联合干预组左心室射血分数、左心室缩短分数、CD31阳性细胞率升高(P<0.05),心肌梗死面积、胶原容积分数、心肌细胞凋亡率降低(P<0.05)。与干细胞治疗组比较,联合干预组运动能力、左心室射血分数、左心室缩短分数、CD31阳性细胞率增加(P<0.05),心肌梗死面积、胶原容积分数、心肌细胞凋亡率降低(P<0.05)。②蛋白表达:与假手术组比较,模型组肿瘤坏死因子α表达升高(P<0.05),白细胞介素10和血管内皮生长因子表达下降(P<0.05)。与模型组比较,干细胞治疗组和联合干预组CXC趋化因子受体蛋白4表达升高(P<0.05),干细胞治疗组、运动预适应组和联合干预组肿瘤坏死因子α表达下降(P<0.05),白细胞介素10和血管内皮生长因子表达增加(P<0.05)。与干细胞治疗组比较,联合干预组肿瘤坏死因子α表达降低(P<0.05),CXC趋化因子受体蛋白4、白细胞介素10和血管内皮生长因子表达升高(P<0.05)。结果表明:运动预适应可增强急性心肌梗死大鼠骨髓间充质干细胞治疗的效果(抑制心脏重塑、改善心功能、延缓心力衰竭进程),其机制与促进干细胞归巢、抑制炎症反应以及促进血管新生有关。

急性心肌梗死患者心脏运动康复依从动机的质性研究

目的探究急性心肌梗死(acute myocardial infarction,AMI)行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者心脏运动康复的依从动机,为提升患者运动康复参与及行为改变提供建议和依据。方法采用描述性质性研究,通过目的抽样法选取2021年7月至2022年1月在上海某三级甲等医院复诊的29例AMI患者进行半结构式深度访谈,其中18例来源于心脏康复中心、11例来源于随访门诊。采用内容分析法整理访谈资料。结果共提炼3个主题和9个亚主题:患者的运动体验(康复获益感、风险感知),患者的心理状态(悲观、恐惧、积极心态)和社会支持(家庭依恋及支持、专业指导及支持、同伴交流及支持、物理资源及支持)。结论护理人员应重视AMI行PCI治疗患者的运动体验、心理状态及社会支持情况,以提高患者心脏运动康复依从动机。

心脏康复治疗对急性心肌梗死PCI术后心肌微循环、运动能力及生活质量的影响

目的探讨心脏康复治疗对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后心肌微循环、运动能力及生活质量的影响。方法选择2021年9月至2022年6月于邯郸市第一医院接受治疗的AMI手术治疗患者120例,采用随机数字表法分为试验组(n=63)和对照组(n=57)。对照组给予术后常规治疗,试验组在对照组基础上联合心脏康复治疗。比较两组患者的临床疗效、心肌微循环灌注情况、左室射血分数(LVEF)、6 min步行试验(6MWT)、生理健康总评分(PCS)、心理健康总评分(MCS)及心脏并发症发生情况。结果试验组患者治疗总有效率远高于对照组(85.71%vs.70.18%),组间差异具有统计学意义(P<0.05)。两组患者治疗前心肌微循环灌注水平相比,差异无统计学意义(P>0.05)。治疗后两组患者心肌微循环灌注升高,差异有统计学意义(P<0.05),且试验组升高水平较对照组更显著(P<0.05)。治疗后两组患者LVEF、6MWT升高,差异有统计学意义(P<0.05),且试验组升高水平较于对照组更显著(P<0.05)。治疗后两组患者MCS、PCS评分升高,差异有统计学意义(P<0.05),其中试验组升高水平较对照组更显著(P<0.05)。治疗期间的心脏不良反应主要包括:心绞痛、心力衰竭和心律失常,两组不良反应发生率比较,有统计学差异(P<0.05)。结论在AMI患者PCI术后,心脏康复治疗具有较好疗效,可有效改善患者心肌微循环、运动能力及生活质量水平。

择时穴位贴敷结合坐式偏瘫复原操对急性缺血性脑卒中偏瘫患者的临床观察

目的探讨择时穴位贴敷结合坐式偏瘫复原操对急性缺血性脑卒中偏瘫患者的效果。方法将120例急性缺血性脑卒中偏瘫患者用随机数字表法,按1∶1∶1∶1的比例随机分成4组,A组为常规治疗组、B组在常规治疗的基础上加用择时穴位贴敷、C组为常规治疗的基础上加用择时坐式偏瘫复原操锻炼、D组在常规治疗的基础上加用择时穴位贴敷和坐式偏瘫复原操,各30例。4组患者分别于治疗前、治疗1周后和治疗2周后采用中风病中医证候评分量表、中风专用生活质量量表(SS-QOL)、简式Fugl-Meyer评分量表(FMA)、改良Barthel指数(MBI)进行评定。结果4组患者治疗1周后、治疗2周后与治疗前相比较,各项评分均明显改善(P<0.05),且D组各项评分优于A、B、C组(P<0.05)。结论择时穴位贴敷结合坐式偏瘫复原操锻炼,能显著提高急性缺血性脑卒中偏瘫患者的日常生活活动能力、运动功能和生活质量。

急性运动对负性情绪信息有意遗忘的影响

目的:探究急性运动是否可作为一种干预手段作用于大学生负性情绪信息的有意遗忘,以及情绪材料的性质和时间耦合对这一过程的影响。方法:将102名大学本科女生随机分为编码前运动组、编码后运动组和对照组,以10 min中等强度持续运动为运动干预方式,采用项目法有意遗忘范式,以低唤醒负性词、高唤醒负性词和中性词为记忆材料,比较不同组别被试在自由回忆正确数、再认的辨别力指数d’及相对应的有意遗忘效应值上的差异。结果:编码前运动组在再认任务中的有意遗忘效应值显著高于对照组,主要体现在编码前运动组忘记指令词语d’显著低于对照组,编码后运动组的自由回忆正确数呈现出低于编码前运动组和对照组的趋势。结论:编码前运动通过提升个体对信息的抑制控制能力促进有意遗忘的执行,编码后运动则通过干扰记忆巩固过程降低整体回忆表现。提示急性运动可提升个体主动抑制负性情绪信息记忆编码的能力,而在经历负性情绪事件后进行的急性运动能够帮助个体更快遗忘相关负性信息。

奥塔戈运动在老年急性脑卒中患者中的应用效果

目的:探讨奥塔戈运动在老年急性脑卒中患者中的应用效果。方法:回顾性选取2022年6月—2023年6月广州市第一人民医院急诊科收治的83例老年急性脑卒中患者为研究对象。根据护理方法的不同将其分为对照组(41例)和观察组(42例)。对照组给予常规护理,观察组在对照组基础上给予奥塔戈运动。比较两组干预前后认知功能、运动功能及平衡能力,干预后依从性及满意度。结果:干预后,两组定向力、记忆、语言、回忆及注意和计算评分均升高,观察组定向力、记忆、语言、回忆及注意和计算评分均高于对照组,差异有统计学意义(P<0.05)。干预后,两组上肢简易Fugl-Meyer运动功能量表(FMA)、下肢FMA、Holden步行功能分级量表(FAC)及Berg平衡量表(BBS)评分均升高,观察组上肢FMA、下肢FMA、FAC及BBS评分均高于对照组,差异有统计学意义(P<0.05)。观察组遵医治疗、定期复查及生活管理依从率和干预方法、服务态度及症状改善满意度均高于对照组,差异有统计学意义(P<0.05)。结论:奥塔戈运动用于老年急性脑卒中患者中,有助于改善患者认知功能,提高运动功能和平衡能力,可获得较高的依从性及满意度。

急性心肌梗死患者PCI术后锻炼行动自我效能的影响因素分析

目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后锻炼行动自我效能的影响因素。方法:选取2021年12月—2023年12月某院通过PCI成功植入冠状动脉支架的103例AMI患者,收集相关临床资料。单因素及多重线性回归分析影响AMI患者PCI术后锻炼行动自我效能的因素。结果:单因素分析显示,不同性别、文化程度、婚姻状况、医疗保险、居住地点、家庭平均月收入、支架植入数、吸烟史AMI患者PCI术后锻炼行动自我效能评分比较,差异无统计学意义(P>0.05);年龄≥60岁、焦虑、抑郁的AMI患者PCI术后锻炼行动自我效能评分低于年龄<60岁、无焦虑、无抑郁患者,锻炼行为各阶段评分呈行动阶段>意向阶段>前意向阶段,差异有统计学意义(P<0.05)。多重线性回归分析显示,锻炼行为阶段、焦虑、抑郁是AMI患者PCI术后锻炼行动自我效能的影响因素(P<0.05)。结论:锻炼行为阶段、焦虑、抑郁与AMI患者PCI术后锻炼行动自我效能密切相关。

护理迷你临床演练评估结合客观结构化临床考试教学模式对本科急诊护理实习生的培训效果

目的观察护理迷你临床演练评估(Nursing-Mini-CEX)结合客观结构化临床考试(OSCE)教学模式在本科急诊护理实习生护理培训中的应用效果。方法选取2023年7—11月郑州大学第一附属医院老院区75名本科急诊护理实习生作为对照组,接受常规教学模式;选取同期东院区75名本科急诊护理实习生作为观察组,接受Nursing-Mini-CEX结合OSCE教学模式。观察两组入科、出科时理论及急救技能考核成绩、学习积极主动性(ALS)评分、评判性思维能力测量表(CTDI-CV)、岗位胜任能力。结果出科时,观察组理论知识、操作技能得分均高于对照组(P<0.05);出科时,观察组ALS量表、CTDI-CV量表及岗位胜任能力量表中各项评分均高于对照组(P<0.05)。结论在本科急诊护理带教管理中,Nursing-Mini-CEX结合OSCE教学模式有助于提升实习生出科成绩,增强其学习主动性和评判性思维能力,并可通过多站点的迷你情景模拟演练和评估强化其岗位胜任能力,在临床带教中具有一定应用价值。