脑卒中术后肩手综合征患者的康复护理对患者肢体功能的影响
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摘要
目的探讨脑卒中术后肩手综合征(SHS)患者的康复护理对其肢体功能的影响。方法选取本院2016年1月～2017年12月收治的182例脑卒中后SHS患者为研究对象,将患者随机分为对照组和观察组,每组各91例。对照组给予神经内科常规神经营养治疗和常规护理,观察组给予神经内科常规营养治疗和康复护理。干预前和干预4周后,采用FMA量表评估患者上肢关节被动活动范围、上肢运动能力和腕手关节运动功能;采用Ashworth痉挛评分评定患肢肌群张力,Barthel指数评价患者日常生活活动能力;评价患者肩关节活动度并对正中神经运动和感觉传导电位进行测定。结果两组SHS患者干预前FMA、Ashworth、Barthel及肩关节活动度评分均无显著差异(P>0.05);观察组干预后FMA、Barthel评分较干预前显著增高(P<0.05),且显著高于对照组(P<0.05);观察组干预后Ashworth和肩关节活动度评分较干预前显著降低(P<0.05),且显著低于对照组(P<0.05);两组SHS患者干预前正中神经运动、感觉传导速度和波幅均无显著差异(P>0.05);观察组干预后正中神经运动、感觉传导波幅较干预前显著增高(P<0.05),且显著高于对照组干预后水平(P<0.05)。结论康复护理能够有效提高脑卒中后SHS患者患肢运动功能,增加肩关节活动度,降低肌张力,修复周围神经运动和感觉电位幅度,提高患者生活活动能力。
Objective To investigate the effect of rehabilitation nursing on limb function after stroke in patients with SHS.Methods We selected 182 patients with post-stroke SHS who were admitted to our hospital from January 2016 to December 2017 as subjects. The patients were randomly included in the control group and the observation group, with 91 cases in each group. The control group was given routine neurotrophic therapy and routine nursing in neurology department. The observation group was given routine neurotrophic therapy and rehabilitation care in neurology department. Before and 4 weeks after the intervention, the range of passive motion of upper extremity joints, upper extremity exercise ability and wrist joint function were assessed with FMA scale; Muscle tension was assessed with Ashworth score; Barthel index was used to evaluate the activities of daily living activities of patients; The patient′s shoulder joint activity measures the median nerve motor and sensory conduction potential.Results There was no significant differences in the scores of FMA, Ashworth, Barthel and shoulder motion before SHS intervention in the observation and control groups(P>0.05). The FMA and Barthel scores of patients in observation group after intervention were significantly higher than the levels before the intervention(P<0.05), and were also significantly higher than the scores of patients in the control group after intervention(P<0.05). The shoulder motion and Ashworth scores of patients in observation group after intervention were significantly lower than the levels before the intervention(P<0.05), and were also significantly lower than the scores of patients in the control group after intervention(P<0.05). There was no significant differences in conduction velocity and wave amplitude of motor and sensory fiber of median nerve between the observation group and control group before the intervention(P>0.05). The wave amplitude of motor and sensory fiber of median nerve in observation group after intervention were significantly higher than the levels before the intervention(P<0.05), and were also significantly higher than the amplitude in the control group after intervention(P<0.05).Conclusion Rehabilitation care effectively improves the motor function of limbs, improve the mobility of shoulder joints, reduce muscle tension, repair the amplitude of peripheral nerve and improve the ability of life activities of SHS patients.
Objective To investigate the effect of rehabilitation nursing on limb function after stroke in patients with SHS.Methods We selected 182 patients with post-stroke SHS who were admitted to our hospital from January 2016 to December 2017 as subjects. The patients were randomly included in the control group and the observation group, with 91 cases in each group. The control group was given routine neurotrophic therapy and routine nursing in neurology department. The observation group was given routine neurotrophic therapy and rehabilitation care in neurology department. Before and 4 weeks after the intervention, the range of passive motion of upper extremity joints, upper extremity exercise ability and wrist joint function were assessed with FMA scale; Muscle tension was assessed with Ashworth score; Barthel index was used to evaluate the activities of daily living activities of patients; The patient′s shoulder joint activity measures the median nerve motor and sensory conduction potential.Results There was no significant differences in the scores of FMA, Ashworth, Barthel and shoulder motion before SHS intervention in the observation and control groups(P>0.05). The FMA and Barthel scores of patients in observation group after intervention were significantly higher than the levels before the intervention(P<0.05), and were also significantly higher than the scores of patients in the control group after intervention(P<0.05). The shoulder motion and Ashworth scores of patients in observation group after intervention were significantly lower than the levels before the intervention(P<0.05), and were also significantly lower than the scores of patients in the control group after intervention(P<0.05). There was no significant differences in conduction velocity and wave amplitude of motor and sensory fiber of median nerve between the observation group and control group before the intervention(P>0.05). The wave amplitude of motor and sensory fiber of median nerve in observation group after intervention were significantly higher than the levels before the intervention(P<0.05), and were also significantly higher than the amplitude in the control group after intervention(P<0.05).Conclusion Rehabilitation care effectively improves the motor function of limbs, improve the mobility of shoulder joints, reduce muscle tension, repair the amplitude of peripheral nerve and improve the ability of life activities of SHS patients.
引文
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[9] 范茂华,潘翠环,陈艳,等.冷热交替漩涡浴对脑卒中后肩手综合征Ⅰ期的疗效观察[J].中国康复理论与实践,2015,21(10):1202-1205.
[10] 唐朝正,陈昌成,丁政,等.基于镜像神经元理论的动作观察在脑卒中后肩手综合征疼痛康复中的应用[J].中国康复医学杂志,2016,31(2):145-147.
[11] Nouri M,Barré P,Vesvard D,et al.Association of physiotherapy under continuous brachial plexus analgesia and shoulder arthrographic-distension for treatment of resistant shoulder-hand syndrome[J].Ann Fr Anesth Reanim,2014,33(5):326-329.
[12] 卢红玉,庞全瑭,郭光远,等.红外/红光局部照射联合综合康复治疗肩手综合征的疗效观察[J].中华物理医学与康复杂志,2015,37(5):375-377.
[2] 贾红娥,许涛,郭铁成,等.局部振动治疗脑卒中后肩——手综合征的疗效观察[J].中华物理医学与康复杂志,2014,36(12):939-941.
[3] Peng L,Zhang C,Zhou L,et al.Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system:a systematic review and meta-analysis[J].Clin Rehabil,2018,32(4):429-439.
[4] 刘结梅,黄国志,刘健,等.早期康复治疗对脑卒中后肩手综合征及上肢运动功能的影响[J].山东大学学报(医学版),2014,52(S2):59-61.
[5] 张晓莉,唐朝正,贾杰,等.中西医治疗脑卒中后肩手综合征现状分析[J].中国康复医学杂志,2015,30(3):294-297.
[6] 薛利凤,苗玉新,徐胜东,等.浮针联合红外照射疗法治疗老年脑卒中后肩手综合征的临床疗效[J].中国老年医学杂志,2016,36(11):2743-2744.
[7] Zheng J,Wu Q,Wang L,et al.A clinical study on acupuncture in combination with routine rehabilitation therapy for early pain recovery of post-stroke shoulder-hand syndrome[J].Exp Ther Med,2018,15(2):2049-2053.
[8] 朱昌娥,余波,张雯,等.肌肉振动治疗配合常规康复对脑卒中后肩——手综合征的临床效果观察[J].中国康复医学杂志,2017,32(8):902-906.
[9] 范茂华,潘翠环,陈艳,等.冷热交替漩涡浴对脑卒中后肩手综合征Ⅰ期的疗效观察[J].中国康复理论与实践,2015,21(10):1202-1205.
[10] 唐朝正,陈昌成,丁政,等.基于镜像神经元理论的动作观察在脑卒中后肩手综合征疼痛康复中的应用[J].中国康复医学杂志,2016,31(2):145-147.
[11] Nouri M,Barré P,Vesvard D,et al.Association of physiotherapy under continuous brachial plexus analgesia and shoulder arthrographic-distension for treatment of resistant shoulder-hand syndrome[J].Ann Fr Anesth Reanim,2014,33(5):326-329.
[12] 卢红玉,庞全瑭,郭光远,等.红外/红光局部照射联合综合康复治疗肩手综合征的疗效观察[J].中华物理医学与康复杂志,2015,37(5):375-377.