目的探讨运动疗法联合踝足部感觉输入对老年脑卒中偏瘫后直立位静态平衡及日常生活活动能力的影响。方法选择老年脑卒中后偏瘫患者150例,采用随机数字表法随机分为观察组75例与对照组75例。两组入院后均接受常规运动疗法。对照组在治疗...目的探讨运动疗法联合踝足部感觉输入对老年脑卒中偏瘫后直立位静态平衡及日常生活活动能力的影响。方法选择老年脑卒中后偏瘫患者150例,采用随机数字表法随机分为观察组75例与对照组75例。两组入院后均接受常规运动疗法。对照组在治疗室接受常规运动疗法治疗后增加常规下肢肌力训练;观察组在治疗室接受常规运动疗法治疗后增加踝足部感觉输入训练。两组疗程均为6 w。观察并比较两组干预前、干预3 w和干预6 w平衡功能、直立位静态平衡、步行能力和日常生活活动能力变化。结果两组干预3 w和干预6 w Berg平衡量表(BBS)评分较干预前明显增加(P<0.05);观察组干预3 w和干预6 w BBS评分明显高于对照组(P<0.05)。两组干预3 w和干预6 w运动轨迹长度(WL)和外周面积(CIRCUA)较干预前明显降低(P<0.05);观察组干预3 w和干预6 w WL和CIRCUA明显低于对照组(P<0.05)。两组干预3 w和干预6 w Holden步行能力Ⅲ~Ⅳ级较干预前明显增加(P<0.05);观察组干预3 w和干预6 w Holden步行能力Ⅲ~Ⅳ级明显高于对照组(P<0.05)。两组干预3 w和干预6 w Barthel指数(BI)评分较干预前明显增加(P<0.05);观察组干预3 w和干预6 w BI评分明显高于对照组(P<0.05)。结论运动疗法联合踝足部感觉输入对老年脑卒中偏瘫后患者效果良好,可改善患者直立位静态平衡及日常生活活动能力,且可改善患者步行能力。展开更多
The mechanism of orthodeoxia (OD), or decreased partial pressure of arterial o xygen (PaO2) from supine to upright, a characteristic feature of hepatopulmonary syndrome (HPS), has never been comprehensively elucidated...The mechanism of orthodeoxia (OD), or decreased partial pressure of arterial o xygen (PaO2) from supine to upright, a characteristic feature of hepatopulmonary syndrome (HPS), has never been comprehensively elucidated. We therefore investi gated the intrapulmonary (shunt and ventilation-perfusion <<VA/Q>> mismatching) a nd extrapulmonary factors governing PaO2 in 20 patients with mild to severe HPS (14 males, 6 females; 50 ±3 years old SE) at upright and supine, in random orde r. We set out a cutoff value for OD, namely a PaO2 decrease ≥5%or ≥4mmHg (are a under the receiver operating characteristic curve, 0.96 each). Compared to sup ine, 5 patients stowed OD (PaO2 change, -11%±2%, -7 ±1 mm Hg, P < .05) wit h further VA/Q worsening (shunt +low VA/Q mode increased from 19%±7%to 21% ±7%of cardiac output <<QT>>, P < .05), as opposed to 15 patients who did not (+ 2%±2%, +1 ±1 mm Hg) with VA/Q improvement (from 20%±4%to 16%±4%of QT, P < .01). Cardiac output was significantly lower in OD patients in both positio ns. Changes in extrapulmonary factors at upright, such as increased minute venti lation and decreased QT, were of similar magnitude in both subsets of patients. In conclusion, our data suggest that gas exchange response to OD in HPS points t o a more altered pulmonary vascular tone inducing heterogeneous blood flow redis tribution to lung zones with prominent intrapulmonary vascular dilatations.展开更多
文摘目的探讨运动疗法联合踝足部感觉输入对老年脑卒中偏瘫后直立位静态平衡及日常生活活动能力的影响。方法选择老年脑卒中后偏瘫患者150例,采用随机数字表法随机分为观察组75例与对照组75例。两组入院后均接受常规运动疗法。对照组在治疗室接受常规运动疗法治疗后增加常规下肢肌力训练;观察组在治疗室接受常规运动疗法治疗后增加踝足部感觉输入训练。两组疗程均为6 w。观察并比较两组干预前、干预3 w和干预6 w平衡功能、直立位静态平衡、步行能力和日常生活活动能力变化。结果两组干预3 w和干预6 w Berg平衡量表(BBS)评分较干预前明显增加(P<0.05);观察组干预3 w和干预6 w BBS评分明显高于对照组(P<0.05)。两组干预3 w和干预6 w运动轨迹长度(WL)和外周面积(CIRCUA)较干预前明显降低(P<0.05);观察组干预3 w和干预6 w WL和CIRCUA明显低于对照组(P<0.05)。两组干预3 w和干预6 w Holden步行能力Ⅲ~Ⅳ级较干预前明显增加(P<0.05);观察组干预3 w和干预6 w Holden步行能力Ⅲ~Ⅳ级明显高于对照组(P<0.05)。两组干预3 w和干预6 w Barthel指数(BI)评分较干预前明显增加(P<0.05);观察组干预3 w和干预6 w BI评分明显高于对照组(P<0.05)。结论运动疗法联合踝足部感觉输入对老年脑卒中偏瘫后患者效果良好,可改善患者直立位静态平衡及日常生活活动能力,且可改善患者步行能力。
文摘The mechanism of orthodeoxia (OD), or decreased partial pressure of arterial o xygen (PaO2) from supine to upright, a characteristic feature of hepatopulmonary syndrome (HPS), has never been comprehensively elucidated. We therefore investi gated the intrapulmonary (shunt and ventilation-perfusion <<VA/Q>> mismatching) a nd extrapulmonary factors governing PaO2 in 20 patients with mild to severe HPS (14 males, 6 females; 50 ±3 years old SE) at upright and supine, in random orde r. We set out a cutoff value for OD, namely a PaO2 decrease ≥5%or ≥4mmHg (are a under the receiver operating characteristic curve, 0.96 each). Compared to sup ine, 5 patients stowed OD (PaO2 change, -11%±2%, -7 ±1 mm Hg, P < .05) wit h further VA/Q worsening (shunt +low VA/Q mode increased from 19%±7%to 21% ±7%of cardiac output <<QT>>, P < .05), as opposed to 15 patients who did not (+ 2%±2%, +1 ±1 mm Hg) with VA/Q improvement (from 20%±4%to 16%±4%of QT, P < .01). Cardiac output was significantly lower in OD patients in both positio ns. Changes in extrapulmonary factors at upright, such as increased minute venti lation and decreased QT, were of similar magnitude in both subsets of patients. In conclusion, our data suggest that gas exchange response to OD in HPS points t o a more altered pulmonary vascular tone inducing heterogeneous blood flow redis tribution to lung zones with prominent intrapulmonary vascular dilatations.
