鉴于慢性阻塞性肺疾病(COPD)的气流受限特点是进行性发展，而且不能完全可逆，同时COPD带来沉重的社会经济负担，成为劳动力丧失和死亡的重要原因之一。因而近年来国外一些学者主张早期干预COPD，并且提出许多理由，诸如早期干预COPD可以减少症状，减少动态过度充气，改善肺功能，提高生命质量等。然而，必须看到COPD的早期干预是一项很艰难的系统工程，有许多问题需要大家认真思考和讨论，尤其是在我国这个问题尤为重要和复杂。故愿就我国COPD的早期干预问题谈一些不成熟的看法，以就正于同道。
目的:观察神经保护剂及早期干预联合应用对重症新生儿高胆红素血症神经行为预后的影响。方法:将2007年1月至2008年6月收治重症新生儿高胆红素血症患儿67例随机分为常规治疗组和综合治疗组2组。 常规治疗组按照新生儿黄疸干预推荐方案,给与对症治疗;药物治疗;蓝光治疗;周围血管法同步换血等常规治疗。综合治疗组在常规治疗基础上,同时给与新生儿抚触1天2次和神经保护剂神经节苷脂20mg/d×10天,并在经抢救治疗进入恢复期后,按照《0～3 岁早期干预大纲》采用医院和家庭相结合的方式从视,听,触,运动等各方面给予早期干预至6月龄。两组患儿均在6月龄采用北京－Gesell婴幼儿发育诊断量表进行智能测试,比较各组发育商(DQ)。同时对两组后遗症发生机率比较。结果:患儿6月龄时,综合治疗组与常规治疗组在大运动,语言,个人 社交及适应性4个能区均有显著差异(Plt;0.01),精细动作能区有明显差异(Plt;0.05),差别有统计学意义。综合治疗组与常规治疗组后遗症发生率比较(Plt;0.05),差异有统计学意义。结论:急性期神经保护剂及早期干预联合应用可促进重症新生儿高胆红素血症患儿的智能发育,减少神经行为后遗症的发生。
Objective To explore the preventive effectiveness of early physiotherapy on arm lymphedema after modified radical mastectomy for breast cancer. Methods A total of 206 patients who underwent modified radical mastectomy for breast cancer in The First Affiliated Hospital of Henan University from June 2014 to June 2016, enrolled in this randomized controlled clinical trial. Then these patients were randomly divided into intervention group and control group equally. Patients in the control group received routine treatment, and the patients in the intervention group began to use the air pressure pump combined with the microwave physiotherapy on the second day after the radical surgery. The incidences of limb lymphedema in 6 months and 1 year after operation between the 2 groups were compared, and the influencing factors of arm lymphedema were explored. Results The clinical data of 195 patients were analyzed at end, including 99 patients of the intervention group and 96 patients of the control group. ① There were statistical significance in the incidences of arm lymphedema in 6 months and 1 year after operation between the 2 groups (P<0.05), that incidences of arm lymphedema in the intervention group were both lower than those of the control group at the2 time points [6 months after operation: 2.0% (2/99)vs. 9.4% (9/96); 1 year after operation: 5.1% (5/99) vs. 17.7% (17/96)]. ② The results of non-conditional logistic regression analysis shown that, age (OR=1.45, P=0.008), tumor location (OR=1.72, P<0.001), TNM stage (OR=2.01, P=0.033), the number of invasive axillary lymph nodes (OR=1.15, P=0.005), and postoperative radiotherapy (OR=1.23, P=0.016) were the influencing factors of arm lymphedema after modified radical mastectomy for breast cancer, patients with age older than 60 years, tumor position at the outside area, stage Ⅲ of TNM, the number of invasive axillary lymph nodes >5, and patients received radiotherapy after operation had high risk of arm lymphedema. Conclusion Early physiotherapy can effectively prevent the occurrence of arm lymphedema after modified radical mastectomy for breast cancer, and early physiotherapy should be performed for patients with high risk of arm lymphedema.
The Chinese Guideline for Rehabilitation of Cerebral Palsy (hereinafter referred as Guideline) is the first evidence-based guideline for rehabilitation of cerebral palsy, which was compiled by Chinese experts from different fields in 2015. The Guideline suggests that the diagnosis of cerebral palsy needs to meet four essential conditions and two reference conditions. Although the cerebral palsy can be diagnosed according to the Guideline, there is still the question that whether there is a clear age definition and standardized prediction methods for early diagnosis and accurate prediction of cerebral palsy. The Guideline does not give a clear definition of age and standardized prediction methods. There is no international unified understanding or specific recommendations as well. Recently, Dr Iona Novak and other experts have pointed out that the historical viewpoint of the latent or silent period (before the age of 12-24 months) has already been outdated, because cerebral palsy or " high risk of cerebral palsy” can be accurately predicted before the corrected age of 6 months and it is possible to accurately predicte whether it is cerebral palsy or " high risk of cerebral palsy” before the corrected age of 6 months. They proposed a standardized assessment program for early diagnosis. This article introduces and discusses the relevant descriptions of the Guideline and the latest international understanding of early diagnosis and intervention of cerebral palsy.