早期综合康复疗法对脊髓损伤患者的康复效果
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摘要
目的探讨早期综合康复疗法对改善脊髓损伤(SCI)患者功能康复及生活质量的效果。方法 2016年6月至2017年8月诊疗的SCI患者44例,早期使用糖皮质激素、甘露醇减轻水肿,预防损伤加重,稳定生命体征,辅助微循环药物、营养脑神经药物等基础治疗;同时给予情志护理、按摩、运动与作业康复疗法,并辅助传统中药与电针疗法的早期综合康复疗法。分析患者治疗前与治疗3个月后脊髓功能情况。结果治疗3个月后,患者美国SCI学会(ASIA)分级明显优于治疗前(U=7. 215,P <0. 01),其中治疗前E级为0,治疗后为84. 09%;患者功能独立性测量(FIM)、日常生活活动量表(Barthel指数)、Berg平衡量表(BBS)及健康调查简表(SF-36)(生理功能、躯体疼痛、总体健康、活力、社会功能、精神健康)评分均明显高于治疗前(P均<0. 01);治疗期间,患者并发症发生率为9. 09%。结论早期综合康复疗法治疗SCI患者,能明显改善患者的运动感觉功能、日常生活能力及躯干平衡能力,提高患者的生活质量,并发症少,安全可靠。
Objective To explore the effects of early comprehensive rehabilitation therapy on functional rehabilitation and quality of life in patients with spinal cord injury( SCI). Methods Forty-four SCI patients were selected from June 2016 to August 2017 and treated with glucocorticoids and mannitol to alleviate edema,preventing injury from aggravating and stabilizing vital signs and supplement microcirculation drugs,nutritional brain nerve drugs. At the same time,they were given emotional care,massage,exercise and homework rehabilitation therapy assisted by the early comprehensive rehabilitation therapy of traditional Chinese medicine and electro-acupuncture therapy. Monitoring of spinal cord function before and 3 months after treatment was performed. Results After 3 months of treatment,American Spinal Injury Association( ASIA) grades significantly improved compared with those before treatment( U = 7. 215,P < 0. 01),and ASIA grade E increased significantly( 84. 09% vs 0,P < 0. 01). The scores of functional independence measurement( FIM),Barthel index,Berg balance scale( BBS) and quality of life( physiological function,body pain,general health,vitality,social function and mental health) were significantly higher than those before treatment( all P < 0. 01). During the treatment period,the incidence of complications was 9. 09%. Conclusion Early comprehensive rehabilitation therapy can obviously improve the motor and sensory function,daily life ability and trunk balance,and can increase the quality of life of SCI patients with safety,reliability and fewer complications.
Objective To explore the effects of early comprehensive rehabilitation therapy on functional rehabilitation and quality of life in patients with spinal cord injury( SCI). Methods Forty-four SCI patients were selected from June 2016 to August 2017 and treated with glucocorticoids and mannitol to alleviate edema,preventing injury from aggravating and stabilizing vital signs and supplement microcirculation drugs,nutritional brain nerve drugs. At the same time,they were given emotional care,massage,exercise and homework rehabilitation therapy assisted by the early comprehensive rehabilitation therapy of traditional Chinese medicine and electro-acupuncture therapy. Monitoring of spinal cord function before and 3 months after treatment was performed. Results After 3 months of treatment,American Spinal Injury Association( ASIA) grades significantly improved compared with those before treatment( U = 7. 215,P < 0. 01),and ASIA grade E increased significantly( 84. 09% vs 0,P < 0. 01). The scores of functional independence measurement( FIM),Barthel index,Berg balance scale( BBS) and quality of life( physiological function,body pain,general health,vitality,social function and mental health) were significantly higher than those before treatment( all P < 0. 01). During the treatment period,the incidence of complications was 9. 09%. Conclusion Early comprehensive rehabilitation therapy can obviously improve the motor and sensory function,daily life ability and trunk balance,and can increase the quality of life of SCI patients with safety,reliability and fewer complications.
引文
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[8] Muir SW,Berg K,Chesworth B,et al. Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People:A Prospective Study[J]. Phys Ther,2008,88(4):449-459.
[9]欧禹萍.夹脊电针疗法联合康复训练对不完全性脊髓损伤后双下肢运动功能的影响[J].四川中医,2018,36(2):183-185.
[10]陈怡欣,刘遂心,周莉,等.心理康复治疗对脊髓损伤患者的康复效果研究[J].医学临床研究,2016,33(10):2071-2073.
[11]刘浩,刘四文,贾延兵,等.重复经颅磁刺激在不完全性脊髓损伤运动功能康复中的应用进展[J].中国康复医学杂志,2017,32(1):121-124.
[12]赵海容.运动再学习疗法在不完全性下颈段脊髓损伤患者BADL康复中的应用[J].中国药物与临床,2016,16(11):1699.
[13]周皓,陈燕,赵正恩,等.作业治疗对脊髓损伤患者生活满意度的影响[J].华西医学,2017,32(2):196-199.
[14]任宏巍,孟红梅.中药与督脉电针联合高压氧治疗对脊柱骨折伴脊髓损伤患者的疗效分析[J].检验医学与临床,2017,14(5):618-620.
[15]陈荣良,杜伟斌,全仁夫,等.针刺夹脊穴及督脉穴对急性脊髓损伤神经传导通路影响的研究[J].中国中医急症,2016,25(4):619-622.
[16]胡可慧,常有军,杨廷彦,等.肌电生物反馈联合康复训练对脊髓损伤患者运动功能及功能独立性的影响[J].中国康复,2016,31(6):450-452.
[17]黄亚琴,李竹,王盾.脊髓损伤肌痉挛康复治疗的研究进展[J].医学综述,2016,22(5):935-939.
[18] Hollis ER 2nd,Ishiko N,Yu T,et al. Ryk controls remapping of motor cortex during functional recovery after spinal cord injury[J]. Nat Neurosci,2016,19(5):697-705.
[19]王振涛.夹脊电针疗法联合自拟元胡止痛方治疗不完全性脊髓损伤后神经病理性疼痛疗效观察[J].现代中西医结合杂志,2017,26(28):3107-3110.
[2]李佳诺,孙忠人,郭玉怀,等.电针对脊髓损伤大鼠相关因素影响的实验研究进展[J].针灸临床杂志,2016,32(5):81-84.
[3] Truchon C,Fallah N,Santos A,et al. Impact of Therapy on Recovery during Rehabilitation in Patients with Traumatic Spinal Cord Injury[J]. J Neurotrauma,2017,34(20):2901-2909.
[4]孙祥耀,海涌.脊髓损伤非手术治疗的研究进展[J].中国骨与关节杂志,2016,5(6):437-443.
[5] Ditunno JF Jr. American spinal injury standards for neurological and functional classification of spinal cord injury:past,present and future. 1992 Heiner Sell Lecture of the American Spinal Injury Association[J]. J Am Paraplegia Soc,1994,17(1):7-11.
[6] Hamilton BB,Laughlin JA,Fiedler RC,et al. Interrater reliability of the 7-level functional independence measure(FIM)[J]. Scand J Rehabil Med,1994,26(3):115-119.
[7] Sarker SJ,Rudd AG,Douiri A,et al. Comparison of 2 extended activities of daily living scales with the Barthel Index and predictors of their outcomes:cohort study within the South London Stroke Register(SLSR)[J]. Stroke,2012,43(5):1362-1369.
[8] Muir SW,Berg K,Chesworth B,et al. Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People:A Prospective Study[J]. Phys Ther,2008,88(4):449-459.
[9]欧禹萍.夹脊电针疗法联合康复训练对不完全性脊髓损伤后双下肢运动功能的影响[J].四川中医,2018,36(2):183-185.
[10]陈怡欣,刘遂心,周莉,等.心理康复治疗对脊髓损伤患者的康复效果研究[J].医学临床研究,2016,33(10):2071-2073.
[11]刘浩,刘四文,贾延兵,等.重复经颅磁刺激在不完全性脊髓损伤运动功能康复中的应用进展[J].中国康复医学杂志,2017,32(1):121-124.
[12]赵海容.运动再学习疗法在不完全性下颈段脊髓损伤患者BADL康复中的应用[J].中国药物与临床,2016,16(11):1699.
[13]周皓,陈燕,赵正恩,等.作业治疗对脊髓损伤患者生活满意度的影响[J].华西医学,2017,32(2):196-199.
[14]任宏巍,孟红梅.中药与督脉电针联合高压氧治疗对脊柱骨折伴脊髓损伤患者的疗效分析[J].检验医学与临床,2017,14(5):618-620.
[15]陈荣良,杜伟斌,全仁夫,等.针刺夹脊穴及督脉穴对急性脊髓损伤神经传导通路影响的研究[J].中国中医急症,2016,25(4):619-622.
[16]胡可慧,常有军,杨廷彦,等.肌电生物反馈联合康复训练对脊髓损伤患者运动功能及功能独立性的影响[J].中国康复,2016,31(6):450-452.
[17]黄亚琴,李竹,王盾.脊髓损伤肌痉挛康复治疗的研究进展[J].医学综述,2016,22(5):935-939.
[18] Hollis ER 2nd,Ishiko N,Yu T,et al. Ryk controls remapping of motor cortex during functional recovery after spinal cord injury[J]. Nat Neurosci,2016,19(5):697-705.
[19]王振涛.夹脊电针疗法联合自拟元胡止痛方治疗不完全性脊髓损伤后神经病理性疼痛疗效观察[J].现代中西医结合杂志,2017,26(28):3107-3110.