• 期刊

Pediatric Intracarotid Sodium Amytal (ISA) Procedure in Determiination of Cerebral Dominance for Language and Memory Function - Preliminary Prport

本研究總共收集了5位罹患複雜性局部癲癇發作的患者，其中4位男孩，1位為女孩。他們的發病年齡由3至11歲不等，發病頻率由一個月數次到一天數十次不等。其中4位患者慣用右手，1位慣用左手。他們的智力均落在正常顳葉，1位位於左側顳葉。瓦達試驗結果顯示有4位患者的語言優勢大腦位於左側大腦半球，1位位於右側大腦半球。在記憶功能方面，除1位患者不管語言或非語言記憶的優勢大腦均位於左側大腦半球外，其患者兩側大腦半球對語言及非語言記憶均有不等程度的管轄能力。因經過兩年以上的抗癲癇藥物治療均無法有效控制痲癇的發作，有4位患者（3位為左優勢大腦，1位為右優勢大腦）接受了痲癇病灶該側的局部顳葉切除術，均為非語言優勢大腦半球的顳葉。手術後患者均未發生失語症與失憶症，可說是間接證明了瓦達試的準確性。此4位患者術後癲癇發作的頻率及嚴重程度均有顯著的降低。

• 期刊

電針在腦幹中風後吞嚥困難之治療經驗

在腦幹中風病人中，吞嚥困難是一極常見的後遺症，一般臨床經驗認為這類病人在吞嚥訓練上比左右大腦中風病人困難，預後也比較差。為了加速吞嚥困難的改善，本研究設計了一套電針吞嚥治療方式，在上廉泉、承漿、風府、和啞門四穴下針，使用低頻疏密波電刺激，配合吞嚥訓練。治療前後以電視螢光攝影吞嚥檢查，分別評估食團形成、舌頭向後功能、吞嚥反射、食物經口咽時間、異物吸入、咽部滲入、和估計每口成功吞入的食物量七項吞嚥功能。此訓練方式嘗試使用於三例腦幹中風合併吞嚥困難病人，結果發現三例在舌頭向後功能、吞嚥反射、和估計每口成功吞入的食物量方面有明顯進步，經口進食量顯著增加，其中一例最後成功拔除鼻胃管。

• 期刊

頭皮電針對中風患者脊髓運動神經元興奮度之影響

The effect of scalp acupuncture with or without electrical stimulation has been used for years on improving the ambulation of stroke patients. However, the mechanism remains unclear. In this study, the changes in spinal motor neuron excitability of stroke patient were measured before and after scalp electroacupuncture. Thirty subjects with first stroke resulting in spastic hemiparesis or hemiplegia were studied. Two scalp acupuncture regions, the motor area and the motor-sensory area of foot, were inserted with a 1.5 inch scalp needle on both sides respectively. Each subject was stimulated with an electric current, from 7 mA to 12 mA at 9.4HZ, for 25 minutes. Two indices of motor neuron excitability, the H/M ratio and the H-recovery time, were calculated before and after the scalp electroacupuncture. In this study, significant prolonged H-recovery time (P＜0.001) and decreased HIM ratio (P＜0.001) were noted after scalp electroacupuncture in non-hemiplegic side. The H/M ratio decreased (P＜0.05) and H-recovery time prolonged (P＜0.001l) significantly in the hemiplegic side also noted. The decrement of HIM ratio on both sides was mainly due to the significant decrease in maximum H-reflex amplitude (P＜0.05), since maximum M –response amplitude was rather constant. It might be concluded the scalp electroacupuncture had the effect of significant decrease in motoneuron excitability in stroke patients.

• 期刊

兒童先天性心臟病患術後之運動心肺功能評估：初步報告

對多數先天性心臟病的兒童而言，其活動空間總是受到限制，影響其正常健康的身心發展。本文即是藉著運動心肺功能測試在探討兒童先天性心臟病患術後運動心肺功能之狀況。 研究結果顯示，受試者肺功能是正常的，運動心電圖不正常比例雖高達53%，但大多數是無症狀，有氧性功能缺損率雖約22%，但無臨床上意義。因此對於先天性心臟病兒童不應過度限制其運動，以期能有較接近正常而健康的身心發展。。

• 期刊

慢性脊髓損傷患者泌尿問題調查

慢性脊髓損傷者日常生活的困擾以泌尿方面的問題為最多。本研究的目的是評估脊髓損傷者在泌尿方面有關問題及困擾的概況，以提供醫政及醫療之參考，並尋求解決的方法。本研究對全省北，中，南，東各區患者共發出835份問卷，回收有效問卷為403份回收率48.26%)，年齡在14至71歲之間平均37.4±10.7歲)，男性343位、女性60位，受傷時間至少六個月以上，其中89.8%為受傷一年以上。問卷內容包含基本資料．脊髓損傷狀況及泌尿相關問題。結果發現1)泌尿方面的困擾以失禁滲尿最多60.5%)，其次為解不乾淨50.1%)；2)有46.1%的病患認為泌尿問題己達困擾日常生活的程度；3)有24.3%的病患可以用正常的方式解尿;4)32.3%的患者需要他人協助才能完成解尿;5)解尿姿勢以坐姿最多56．3%)。以脊髓損傷狀況來看，排尿的能力和殘存的運動功能有關。

• 期刊

中老年從事網球運動者心肺功能之追蹤研究

本研究目的是評估打網球可否延緩中老年人心肺功能的衰退，研究中有20位中老年打網球者自願參與。其中男性15位，平均年齡66±4歲52-82歲)；女性5位，平均年齡50±7歲40歲-59歲)。受試者球齡在兩年以上，每週至少從事三次以上的網球運動，每次運動時間至少30分鐘以上。受試者利用進階式踏車測試，測其攝氧量、二氧化碳呼出量、心搏率及換氣量等生理變數。並依其運動時呼吸氣體變數的變化，決定無氧閥值AnaerobIcThresholdl)。結果顯示網球運動可以明顯延緩中老年人心肺功能的衰退。男性受試者在兩年間最大攝氧量由33.5±11.8ml/kg/min略降至31.0±8.5ml/kg/min，女性受試者由27.7±3.7ml/kg/min略升至29.0±4.8m1/kg/min，但是統計上未呈明顯差異，此結果表示受試者的最大攝氧量在兩年中無明顯衰退。在無氧閥值時受試者的攝氧量、氧脈及工作率亦無明顯退步。本研究証實網球運動可以延緩中老年人心肺功能的衰退，是一項值得推廣的耐力性運動。

• 期刊

頸髓損傷後肺功能之追蹤

Traumatic cervical cord injury with quadriplegia generally causes respiratory dysfunction. A total of 50 cervical cord injured patients were collected for study of their pulmonary function. They were divided into two groups. Twenty-six cases with complete motor paralysis below lesion site (Frankel A or B) were placed in Group A, the other 24 cases with incomplete motor function (Frankel C or D) were placed in Group B. Pulmonary function test was done by using spirometer at 1 month, 6 months and 12 months following cervical cord injury. The pulmonary function was significantly worse in Group A than in Group B. Lesion level was found to be correlated with pulmonary function in Group A. The lower the injury cord, the better the pulmonary function. Furthermore, there was a significant difference in pulmonary function between lesion site above and below C5. The forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), peak expiratory flow (PEF) and mid maximal expiratory flow (MMEF) were around 33% of predicted normal value in patients with C6 or C7 lesion, but only around 25% of predicted normal value in those with C5 or above C5 lesion. In Group B, however, we failed to find any significant difference according to different lesion level. The effect of time on pulmonary function was ,determined by one way ANOVA. The FVC, FEV1, PEF and MMEF increased during the first year following cervical cord injury in both Group A and B. However, the improvement was shown statistically significant only during the first 6 months after injury. As for the amount of improvement attained during the time period studied, there was no significant difference between Group A and Group B.

• 期刊

麻醉殘餘氣體對恢復室護理人員乎衡能力之影響

The purpose of this study is to investigate whether the waste anesthetic gas has influence on the standing balance of nurses working at the recovery room. The experimental group consisted of 26 nurses at the recovery room and the control group was 25 nurses in the ordinary ward. The sway index, anterior-posterior and lateral maximal sway distance of center of pressure were recorded before and after working eight hours under the following four conditions: 1. eye opened with stable plateform, 2. eye closed with stable plateform, 3. eye opened with tilting plateform, 4. eye closed with tilting plateform. Besides, the accuracy of tracing moving target in three different velocity were also tested. There were significant differences in the balance control (t-test p＜0.05) between the two groups under the condition of I, 2, 3, and low velocity tracing target, but no significant difference in the morning sway index difference between the two groups after three days of consecutive testing. The conclusion of this study is that the trace anesthetic gas exhaled by patient had significant influence on the standing balance of nurses working at recovery room. Yet, no accumulating effect was noted. It is suggested that the air quality in the operation and recovery room should be improved.

• 期刊

靜態持住姿勢肌群作用與共作用程度研究

搬運容易造成下背痛，表面肌電圖常被用來驗證腰椎力學模式之預測能力，也有研究利用它來評佔下背痛患者的肌群功能。本研究在探討搬運時相關肌群的個別與相互作用程度，並篩選搬運因子，作為臨床上評估搬運能力之檢查項目。四十位無背痛經驗的自願者參與本實驗，其中男性26位，女性14位，每位受試者隨機接受四種搬運因子(膝關節角度、髖關節角度、搬運物水平距離典重量)的測試，使用表面肌電設備同時收集八個搬運相關肌群右側的肌電訊號。結果顯示四種搬運因子對八個肌群的作用程度，均會產生顯著的影響;另外，四種搬運因子對腹部、背部、上肢與下肢的肌群，也有明顯不同的共作用程度。在有顯著的搬運變項與檢查的安全考量下，最後篩選12項搬運能力檢查項目。從搬運情境肌群作用程度之觀點，本研究證實可繼輯研究正常者與下背痛病患之差異，作為病患復健成效之參考。

• 期刊

脊髓損傷併發膀胱結石及膀胱輸尿管逆流：病例報告

25歲男性病人，民國七十四年因第一腰椎骨折致雙下肢麻痺及神經性膀胱功能障礙。受傷後逐漸恢復到可持雙側腋下拐杖獨立行走，但逼尿肌反射一直沒有恢復，因此長期放置尿道內留置尿管。受傷七年來因反覆尿路感染，經常前往各醫院求診，從未做過泌尿系統影像檢查。來本院檢查時發現有五顆栗子大小膀胱結石及兩側膀胱輸尿管逆流。開刀取出五顆結石共重81克，分析其成分合磷酸氨鎂83%及草酸鈣17%。手術後尿路感染得到控制，然而病人逼尿肌無力，肌電圖顯示尿道外擴約肌收縮力強，且其膀胱輸尿管逆流在膀胱內壓不到20cmH2O即已發生，因此給予留置尿管處置。出院四個月後追蹤檢查仍有膀胱輸尿管逆流，故建議做尿道擴約肌切開手術。手術後六個月追蹤檢查，只發現有短暫性左側輸尿管逆流，解尿後殘尿量少於50ml，也沒有顯影液留在上尿路系統。近六個月來病人只發生過一次尿路感染，目前其健康情況及生活品質得到明顯改善，病人非常滿意。