_美国康复医学进展与中医针灸[精选].pptVIP

Tx – Pharmacotherapy治疗3-药物 - SSRIs and SNRIs like fluoxetine and duloxetine, resp, are often used with the latter being approved for neuropathic pain conditions.抗精神忧郁新药有效。 - Opioids should be avoided as much as possible as their effectiveness is not well proved and dependence/ addiction are serious concerns in CRPS patients. 避免过量鸦片样药物治疗 - Intrathecal baclofen, IV steroids, IVIG, and anticonvulsant medications are all treatments that have been considered and used with variable success, though studies are still lacking. 激素，贝可洛芬， IgG等等，效果有限，疗效有待证明。 Tx – Interventional Approaches介入性治疗 1.Cervical and lumbar sympathetic blocks。 颈，腰丛交感神经节阻断 Tx – Interventional Approaches介入性治疗 Beir blocks with local anesthetics, guanethidine, or other neurolytic agents have been performed with varying success. 局部神经阻断，效果有限。 SCS, pump implantation, and thermocoagulation have also been used to treat patients with CRPS with variable success rates. 吗啡泵等，效果有限。 区域性复杂性疼痛综合征 预后不好，疗效差，因此针灸大有可为。 在美国治疗有效，头针，耳针加体针。 中风的预防急救和治疗 李先生,75岁,患有高血压,高血脂和房纤近十年.平时服用抗高血压和抗血脂药.一天早起晨练,忽然觉得右臂和脸部麻痹,他不以为意,以为睡一觉就会好,第二天醒来,他发现整个右侧身体偏瘫.他被送入院.诊断为缺血性MCA中风.住院卧床二月,回家后因为生活不能自理,请了一位保姆照顾,半年后,依然卧床.他平时除了服用抗高血压和抗血脂药,没有其他治疗. 李先生的问题 没有预防措施 没有紧急治疗 没有康复治疗 没有针灸治疗 没有再次中风预防 美国NIH中风指导大纲 Eligibility for IV treatment with rt-PA尿激酶治疗标准 Age 18 or older.18岁以上 Clinical diagnosis of ischemic stroke causing a measurable neurological deficit.临床诊断为缺血性中风 Time of symptom onset well established to be less than 180 minutes before treatment would begin.中风发作到治疗必须少于180分钟. CT 和/或MRI 排除出血性中风. 0.9 mg/kg (maximum of 90 mg) infused over 60 minutes with 10% of the total dose administered as an initial intravenous bolus over 1 minute. 在60分钟之内静脉点滴0.9 mg/kg (maximum of 90 mg),在头一分钟点滴10%的剂量. 同时控制血压和监控出血. 来源:/guidelines/tpa_guidelines.html T-PA 必须在三小时内注射 A B C D E F Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148 Diabetes No No Yes Yes Yes Yes Cigarettes No No No Yes Yes Yes Prior Atrial Fib. No No No No Yes Yes Prior CVD No No No No No Ye