目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

经颅磁刺激(TMS)作为一种新兴的非侵入性的神经调控技术,具有安全无痛、操作简单等优点,日益广泛应用于神经康复各领域。本文基于近年来发表的TMS治疗神经系统疾病的研究成果,对TMS在脑卒中后运动障碍、认知障碍和吞咽障碍、脊髓损伤、帕金森、抑郁症中的应用现状和可能机制进行综述。并对当前TMS在神经康复应用中存在的不足和应用前景进行简要总结,以期为TMS在临床和科研中的应用提供理论依据。

Transcranial magnetic stimulation (TMS), as a new non-invasive neuromodulation technique, has the advantages of safety, painless and simple operation, and has been widely used in various fields of neurological rehabilitation. Based on the research results of TMS in the treatment of neurological diseases in recent years, this paper reviewed the application status and possible mechanisms of TMS in the treatment of poststroke dyskinesia and cognitive impairment, spinal cord injury, Parkinson's disease and depressive disorder. The deficiencies and application prospects of TMS in the application of neurological rehabilitation were briefly summarized in order to provide theoretical basis for the application of TMS in clinical and scientific research.

目的 针对胆结石手术患者,评价应用快速康复外科(ERAS)理念辅助护理的实践效果,同时分析其对患者术后并发症以及机体康复情况的影响。方法 选取本院在2019年8月—2020月5月间收治的84例胆结石手术患者为研究对象,采取随机数字表法对纳入患者进行随机分组:实施常规护理干预的患者作为本研究的对照组,实施快速康复外科护理干预的患者作为本研究的干预组;对比术后患者并发症发生情况及恢复情况。结果 干预组患者术后拔管、首次肛门排气、排便及住院时间较对照组均有缩短(P<0.05);且干预组穿孔、感染、胰腺炎等总并发症发生几率低于对照组(2.38% vs 14.28%,P<0.05)。结论 在护理胆结石手术患者中,采取快速康复外科护理干预可有效预防多种术后并发症的发生,并能够有效加快患者术后康复进程,建议推广。

Objective To evaluate the practical effect of assisted nursing with the concept of enhanced recovery after surgery (ERAS) for patients underwent cholelithiasis surgery, and analyze its impact on postoperative complications and physical rehabilitation. Methods Eighty-four patients underwent cholelithiasis operation in our hospital from August, 2019 to May,2020 were selected as the research objects, and the patients were randomly divided into two groups by random number table. The control group was given routine nursing intervention, while the observation group was given nursing intervention based on ERAS.The postoperative complications incidence and recovery of patients were compared. Results Data showed that the postoperative extubation time, first anal exhaust, defecation time and hospitalization time in the observation group were significantly shorter than those in the control group (P<0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (2.38% vs 14.28%, P<0.05). Conclusions In nursing patients undergoing cholelithiasis surgery, ERAS nursing intervention can effectively prevent the occurrence of a variety of postoperative complications, and can effectively speed up the process of postoperative rehabilitation, which is recommended to popularize.

目的 探讨在慢性肾炎中采用厄贝沙坦＋肾炎康复片对肾功能的影响。方法 在我院肾内科2018年3月—2020年8月收治的慢性肾炎患者中随机选取80例,按照抽签法分为2组,对照组(40例)采用厄贝沙坦,研究组在其基础上加用肾炎康复片,对比2组肾功能指标、临床疗效及不良反应。结果 治疗后2组肾功能指标均好转,且研究组血肌酐、尿素氮、24 h尿蛋白量均低于对照组,肾小球滤过率高于对照组(P＜0.05)。2组治疗总有效率对比差异显著(P＜0.05),不良反应对比无差异。结论 在对慢性肾炎的治疗中联用厄贝沙坦及肾炎康复片可有效提高肾功能,疗效显著。

Objective To investigate the effect of irbesartan and Shenyan Kangfu Tablet on renal function in chronic nephritis. Methods A total of 80 patients of chronic nephritis admitted in our hospital from March 2018 to August 2020 were randomly selected and divided into two groups by drawing lots. The control group (40 cases) received irberartan, while the research group added Shenyan Kangfu Tablet on the basis of irberartan. The renal function indexes, clinical efficacy and adverse reactions of the two groups were compared. Results After treatment, renal function indexes in both groups were improved, and serum creatinine, urea nitrogen and 24 h urinary protein levels in the research group were lower than those in the control group, and glomerular filtration rate was higher than that in the control group (P<0.05). The total effective rate was significantly different between the two groups (P<0.05), but there was no difference in adverse reaction rate. Conclusions In the treatment of chronic nephritis, irbesartan combined with Shenyan Kangfu Tablets could effectively improve renal function, and the effect is significant.

目的 分析基于微信平台步行运动训练对慢性充血性心力衰竭(CHF)患者心脏康复水平的影响。方法 本次研究对象来源于梅州市中医医院一内科2020年11月—2021年12月住院的90例CHF患者,根据随机数字表法分组(每组n=45),对比组给予常规药物治疗,观察组在对比组基础上给予基于微信平台步行运动训练治疗,对比两组临床疗效、心脏功能指标、血清NT-proBNP、D-D、6分钟步行距离、日常生活能力评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果 观察组临床总有效率(95.56%)高于对比组(66.67%),观察组治疗后左心室舒张末期内径、左心室收缩末期内径均低于对比组,观察组治疗后左室射血分数高于对比组,观察组治疗后血清NT-proBNP、D-D均低于对比组,观察组治疗后6分钟步行距离、日常生活能力评分均高于对比组,观察组治疗后MLHFQ评分低于对比组,P＜0.05(差异均具有统计学意义)。结论 基于微信平台步行运动训练可有效改善CHF患者心功能,抑制NT-proBNP、D-D高表达,提高日常生活能力、生存质量。

Objective To analyze the effect of walking training through Wechat on cardiac rehabilitation of chronic congestive heart failure (CHF) patients. Methods A total of 90 patients with CHF hospitalized in the First Internal Medicine Department of Meizhou Traditional Chinese Medicine Hospital from November 2020 to December 2021 were enrolled in this study. They were divided into two groups according to the random number table method (45 patients in each group).The control group was given routine drug treatment,and the observation group was given walking training through Wechat on the basis of control group. The clinical efficacy,cardiac function indexes,serum NT-proBNP,D-D levels,6-minute walking distance,ability of daily life (ADL) score and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score were compared between two groups. Results The total clinical effective rate of the observation group (95.56%) was higher than that of the control group (66.67%),the LVEDd and LVESd of the observation group were lower than those of the control group after treatment,the LVEF of the observation group was higher than that of the control group after treatment,the serum NT-proBNP and D-D levels of the observation group were lower than those of the control group after treatment,the 6-minute walking distance and ADL score of the observation group were higher than those of the control group after treatment,and the MLHFQ score of the observation group was lower than that of the control group after treatment,P<0.05 (the difference was statistically significant).Conclusions Walking training by Wechat could effectively improve the cardiac function of CHF patients,inhibit the high expression of NT proBNP and D-D,and improve the ability of daily living and quality of life.

目的 快速康复外科理念在老年前列腺电切术后的应用分析。方法 选取我院2019年1月—2020年10月行前列腺电切术老年患者88例,以随机数字表法分为两组,参照组给予常规护理,研究组给予快速康复外科理念下护理,比较两组患者术后尿管拔除时间、术后首次进食时间、术后首次下床活动时间,并比较两组住院天数、及入院时和出院前生活质量(以ADL评价)评分,术后并发症发生情况。结果 研究组术后尿管拔除、首次进食、首次下床活动时间、住院天数短于参照组,术后并发症发生率低于参照组,差异有统计学意义(P＜0.05);入院时,两组ADL评分比较,差异无统计学意义(P＞0.05)。出院前,两组ADL评分高于入院时,且研究组高于参照组,差异有统计学意义(P＜0.05)。结论 老年患者行前列腺电切术后,给予快速康复外科理念下的护理服务,有利于缩短术后尿管拔除、进食、下床活动时间,也能够提高患者生活质量,减轻并发症影响,缩短住院天数,提高床位周转率,具有较高的护理价值。

目的 探讨规范化康复护理在脊髓型颈椎病前路手术术后功能恢复的影响。方法 将60例行颈椎前路椎间隙减压植骨融合内固定术的患者分为观察组和对照组各30例。对照组实施常规护理,观察组实施规范化康复护理措施。分别在出院时、出院后1、3、6个月进行日本骨科协会脊髓功能JOA评分、颈椎功能残障指数NDI评分、疼痛视觉模拟VAS评分、生活自理能力评分以及记录两组住院时间、术后并发症发生率。结果 手术后观察组与对照组的平均住院时间、术后并发症、术后脊髓功能恢复情况、颈椎功能恢复、生活自理能力的差异有统计学意义(P<0.05);观察组的平均住院时间均低于对照组(P<0.05);术后脊髓功能功能评分、生活自理能力评分均高于对照组(P<0.05);颈椎功能残障指数评分、术后并发症发生率均低于对照组(P<0.05)。结论 规范化康复护理可以促进脊髓型颈椎病行前路手术术后脊髓、颈椎功能的恢复,减少住院时间,减少术后并发症的发生,提高患者生活自理能力,提高生活质量。

Objective To investigate the effect of standardized rehabilitation nursing on functional recovery of cervical spondylotic myelopathy (CSM) after anterior operation. Methods Sixty patients were divided into two groups: observation group (n = 30) and control group (n = 30). Routine nursing was carried out in the control group and standardized rehabilitation nursing measures were carried out in the observation group. At the time of discharge, 1,3,6 months after discharge, the JOA score of spinal cord function of the Japanese Orthopaedics Association, the NDI score of cervical spine disability index, the VAS score of visual analogue of pain, the score of self-care ability of life were taken. The length of hospitalization of the two groups and incidence of postoperative complications were recorded. Results There were significant differences in average hospitalization time, postoperative complications, recovery of spinal cord function, recovery of cervical spine function and ability of living self-care between the observation group and the control group after operation (P<0.05). The average hospitalization time in the observation group was lower than that in the control group (P<0.05), and the scores of spinal cord function and self-care ability after operation were higher than those in the control group (P<0.05). The score of cervical disability index and the incidence of postoperative complications were lower than those of the control group (P<0.05). Conclusion Standardized rehabilitation nursing may promote the recovery of spinal cord and cervical spine function, reduce hospital stay, reduce postoperative complications, improve the self-care ability of patients and improve the quality of life.

目的 分析加速康复外科措施在行腹腔镜辅助结直肠癌根治术治疗患者中的应用价值。方法 2017年6月—2018年8月,选取74例行腹腔镜辅助结直肠癌根治术患者进行研究,按照随机数字表法分为观察组、对照组,对照组实施常规康复外科措施,观察组实施加速康复外科措施,对比两组术后恢复情况、住院情况、应激反应及营养状态。结果 观察组术后首次排气时间、下床活动时间、早期进食时间及导管拔出时间短于对照组(P＜0.05);观察组住院时间、总住院费用少于对照组(P＜0.05);术前两组患者Hs-CRP(超敏C-反应蛋白)、ALB(白蛋白)、PA(前白蛋白)及Hb(血红蛋白)指标比较,差异无统计学意义(P＞0.05)。术后第3 d,观察组Hs-CRP、ALB、PA及Hb指标均优于对照组(P＜0.05)。结论 加速康复外科措施在腹腔镜辅助结直肠癌根治术患者中的开展价值显著。

Objective To analyze the value of accelerated rehabilitation surgery in the treatment of patients undergoing laparoscopic assisted radical resection of colorectal cancer. Methods From June 2017 to August 2018, 74 patients who underwent laparoscopic assisted radical resection of colorectal cancer were enrolled in the study. The patients were divided into observation group and control group according to the random number table method. The group implemented accelerated rehabilitation surgery measures to compare postoperative recovery, hospitalization, and immune function. Results The first exhaust time, the time of getting out of bed, the time of early feeding and the time of catheter extraction were shorter in the observation group than that in the control group(P<0.05). The hospitalization time and total hospitalization cost in the observation group were less than those in the control group(P<0.05). There were no significant differences in Hs-CRP(high-sensitivity C-reactive protein), ALB(albumin), PA(pre-albumin) and Hb(hemoglobin) between the two groups before surgery(P>0.05). On the 3rd day after operation, the indexes of Hs-CRP, ALB, PA and Hb in the observation group were better than those in the control group(P<0.05). Conclusion Accelerated rehabilitation surgery is of great value in the development of laparoscopic assisted colorectal cancer radical surgery.

目的 探讨腰椎间盘手术护理路径对经皮椎管成型下腰椎间盘摘除手术患者腰腿功能康复效果。方法 选择2018年1月—2019年11月住院进行经皮椎管成型下腰椎间盘摘除手术患者60例,按住院时间先后分为对照组和实验组各30例,对照组患者术后按椎间盘摘除手术给患者进行病情观察、腰腿功能康复锻炼、腰围配戴和康复护理知识宣教等护理;实验组患者在实施对照组护理措施基础上按腰椎间盘手术护理路径对患者进行有计划的康复护理知识宣教,按制定的康复护理路径对患者进行个性化康复活动训练指导。术后1周和出院时分别对患者掌握康复护理训练知识、腰椎功能障碍指数(ODI)、服务满意度进行评价。结果 实验组患者在术后首次进行康复训练时间早于对照组,差异有统计学意义(P=0.000 4);掌握康复护理知识得分实验组高于对照组,差异有统计学意义(P=0.002 3);掌握康复训练活动实验组高于对照组,差异有统计学意义(P<0.05);腰椎功能障碍指数(ODI)实验组低于对照组,差异有统计学意义(P<0.05);护理服务满意度实验组高于对照组,结果差异有统计学意义(P<0.05)。结论 椎间盘手术护理路径能促进患者早期进行康复训练,提高患者对腰椎间盘术后康复护理知识和康复训练技能的掌握,降低患者腰椎功能障碍指数,促进术后患者机体功能的康复。

Objective To explore the effect of nursing path of lumbar disc operation on the rehabilitation of lumbar and leg function in patients undergoing percutaneous laminoplasty. Methods From January 2018 to November 2019, 60 patients who were hospitalized for percutaneous laminoplasty were divided into the control group and the experimental group with 30 patients in each group according to the length of stay. The patients in the control group were given nursing care including condition observation, waist and leg function rehabilitation exercise, waist circumference wearing and rehabilitation nursing knowledge propaganda and education after the operation. On the basis of the nursing measures of the control group, patients in the experimental group received the planned rehabilitation nursing knowledge education according to the nursing path of lumbar disc operation, and individualized rehabilitation activity training guidance according to the established rehabilitation nursing path. One week after the operation and at the time of discharge, the patients' mastery of rehabilitation nursing training knowledge, lumbar dysfunction index (ODI) and service satisfaction were evaluated. Results The first time of rehabilitation training in the experimental group was earlier than that in the control group, the results were statistically significant (P=0.000 4); the score of mastering rehabilitation nursing knowledge in the experimental group was higher than that in the control group, the results were statistically significant (P=0.002 3); the experimental group of mastering rehabilitation training activities was higher than that in the control group, the results were statistically significant (P<0.05); lumbar dysfunction index ODI in the experimental group was lower than that in the control group, the results were statistically significant (P<0.05); the satisfaction of nursing service in the experimental group was higher than that in the control group, the results were statistically significant (P<0.05). Conclusion The nursing path of lumbar disc surgery can promote the early rehabilitation training of patients, improve the mastery of postoperative rehabilitation nursing knowledge and rehabilitation training skills of patients, reduce the lumbar dysfunction index of patients, and promote the rehabilitation of patients' body function.

目的 探讨凯格尔(Kegel)锻炼法结合生物反馈电刺激对产后盆底康复管理效果的影响。方法 选取2018年5月—2019年4月在我院妇产科阴道分娩的足月产妇200例,采用随机数字法分为对照组和观察组,每组各100例,对照组单纯给予Kegel锻炼法,观察组给予Kegel锻炼法结合生物反馈电刺激。干预2～3个月,比较两组患者盆底肌肉功能相关指标改善情况,并比较两组患者生活质量的改变。结果 干预后,观察组患者盆底肌Ⅰ类肌纤维肌力恢复正常率为86.0%(86/100),高于对照组的56.0%(56/100),观察组盆底肌Ⅱ类肌纤维肌力恢复正常率为83.0%(83/100),高于对照组的54.0%(54/100),差异均有统计学意义(P<0.05)。且干预后,观察组下腹不适、尿失禁、排尿异常、排便异常及阴道分泌物异常患者低于对照组(P<0.05),性生活质量评分高于对照组(P<0.05)。结论 Kegel锻炼结合生物反馈电刺激可促进盆底肌力,改善尿失禁、盆腔器官脱垂等盆底异常症状,提高患者生性生活质量。

Objective To explore the effect of Kegel exercise combined with biofeedback electric stimulation on the management of postpartum pelvic floor rehabilitation. Methods A total of 200 full-term pregnant women who delivered vaginally in our hospital from May 2018 to April 2019 were randomly divided into two groups: the control group and the observation group, with 100 cases in each group. The control group was only given Kegel exercise method, and the experimental group was given Kegel exercise method combined with biofeedback electrical stimulation. After 2～3 months of intervention, the improvement of pelvic floor muscle function and quality of life of the two groups were compared. Results After intervention, the recovery rate of pelvic floor muscle type I muscle strength in the observation group was 86.0% (86/100), higher than that in the control group (56/100), and the recovery rate of pelvic floor muscle type II muscle strength in the observation group was 83.0% (83/100), higher than that in the control group (54/100). The difference was statistically significant (P<0.05). After the intervention, the patients situations in the experimental group were lower than those in the control group (P<0.05) including abdominal discomfort, urinary incontinence, abnormal urination, abnormal defecation and abnormal vaginal secretion, and the score of sexual quality of life was higher than that in the control group (P<0.05). Conclusion Kegel exercise combined with biofeedback electrical stimulation may promote pelvic floor muscle strength, improve the symptoms of urinary incontinence, pelvic organ prolapse and other pelvic floor abnormalities, and improve the quality of life of patients.