三结合康复模式对脑性瘫痪儿童生存质量的影响
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摘要
目的:本课题通过对脑性瘫痪儿童、正常儿童及患有一般疾病儿童的生存质量进行比较,观察脑性瘫痪对儿童生存质量的影响,分析影响患儿生存质量的相关因素;通过观察“三结合康复模式”治疗前后脑性瘫痪儿童生存质量、粗大运动功能(GMFM)及发育商(DQ)的变化,初步探讨“三结合康复模式”对患儿生存质量及病情的影响,为指导临床康复措施的选择及提高脑性瘫痪儿童的生存质量提供依据。
方法:采用病例一对照及自身前后对照的试验设计方法,将确诊为脑性瘫痪的儿童纳入为脑瘫组,将同龄健康儿童纳入为正常对照组,将同龄患有急性上呼吸道感染的儿童纳入为一般疾病对照组,利用PedsQL4.0普适性核心量表测量三组儿童的生存质量,比较三组儿童生存质量的差别,分析脑瘫组儿童生存质量与临床分型、解剖分型、粗大运动功能分级(GMFCS)及智力水平的关系,分析GMFM总分及社会适应DQ与患儿生存质量的相关性;脑瘫组儿童接受现代医学康复、传统医学康复以及家庭医学康复三者相结合的“三结合康复模式”治疗,疗程3个月,观察治疗前后患儿生存质量、粗大运动功能及发育商的变化情况,进行自身前后对照。
结果:本研究脑瘫组儿童80例、正常对照组儿童80例、一般疾病对照组儿童40例,三组儿童的年龄、性别以及儿童父母的年龄、性别、教育程度、家庭收入的差别均无统计学意义;脑瘫组儿童的生存质量明显低于正常对照组及一般疾病对照组儿童,差别有统计学意义(P<0.01);不同临床类型脑瘫患儿生存质量之间的差别无统计学意义;痉挛型四肢瘫患儿与痉挛型双瘫患儿相比较,在生理功能/领域及总体生存质量的差别有统计学意义(P<0.05),在情感功能、社会功能及心理领域的差别无统计学意义;不同GMFCS分级以及不同智力水平患儿的生理功能/领域、社会功能、心理领域及总体生存质量之间的差别有统计学意义(P<0.05),情感功能的差别无统计学意义;脑瘫患儿的GMFM总分、社会适应DQ与其生理功能/领域、社会功能、心理领域及总体生存质量之间存在正性相关(P<0.01),与其情感功能的相关性无统计学意义。“三结合康复模式”治疗3个月后,采用便利抽样方法回访脑瘫患儿32例,治疗有效率为71.9%,治疗前后患儿GMFM坐位得分、站位得分以及总分的差别有统计学意义(P<0.05),治疗后患儿的生存质量有不同程度的提高,差别无统计学意义。
结论:脑瘫组儿童生存质量存在明显的损害;患儿的生存质量与粗大运动功能及智力水平相关,运动功能及智力水平是影响其生存质量的重要因素;“三结合康复模式”治疗可以提高患儿的粗大运动功能,改善患儿的病情,治疗3个月后患儿的生存质量有不同程度的提高。
Objective:To investigate impact of cerebral palsy(CP) on children's quality of life(QOL).Clinical observation of multi-rehabilitation on QOL and condition in children with CP.
Methods:A ease-control and before-after study of the experimental design method.Selected inpatients with CP as the CP group,randomly selected healthy peers from two kindergartens in Nanhai area as the normal-control group,and selected inpatients with acute upper respiratory infection as common-disease-control group.All children were measured by Pediatric Quality of Life Inventory Version 4(PedsQL4.0) to assess their QOL and then compared differences in QOL of children among three groups.Children with CP were also assessed gross motor function by Gross Motor Function Measure(GMFM) and developmental quotient(DQ) by Beijing Gesell Developmental Scale(GDS) before and after treatment.Relationship was analyzed among QOL,clinical classification,anatomical type,condition and intelligence of children with CP.Children with CP were treated by multi-rehabilitation combined of modern medicine,traditional medicine and family medicine in three months and then compared differences in QOL,gross motor function and DQ before and after treatment.
Results:200 children participated in all(80 cases in CP group,80 in normal-control group and 40 in common-disease-control group).There was no significant differences in children' s age and gender,as well as parents' age, sex,educational background and income among three groups.Significant differences in mean scores favoring two control group were found in physical functioning/aspect,emotional functioning,social functioning,psychological aspect and total score(P＜0.01).There was no significant differences in mean scores of PedsQL4.0 in all clinical types of children with CP.Significant differences in mean scores between spastic quadriplegia and spastic diplegia of children with CP were found in physical functioning/aspect and total score(P＜0.01),except emotional functioning,social functioning and psychological aspect.Mean scores of different level of GMFCS(Gross Motor Function Classification System),as well as different level of intelligence in children with CP were found significant differences in physical functioning/aspect,social functioning,psychological aspect and total score(P＜0.05),but with no significant differences in emotional functioning. GMFM total scores and social adaptation DQ of children with CP positive correlated to their physical functioning/aspect,social functioning, psychological aspect and total score(P＜0.01),but with no significant correlation to emotional functioning.After three months treatment of multi-rehabilitation,32 cases of CP were selected by convenience sampling method.12 cases showed significant effect(37.5%),11 cases showed progress(34.4%),and 9 cases had no-effect(28.1%)(total probability of effective is 71.9%).Children's GMFM seat score,station scores and total scores were significant different before and after treatment(P＜0.05).After 3 months rehabilitation there was some improvement in PedsQL4.0-QOL,but with no significant differences.
Conclusion:CP reduces children's QOL in full-scale.QOL positive correlates to gross motor function,as well as level of intelligence of children with CP.Multi-rehabilitation can improve children' s condition and gross motor function.After 3 months rehabilitation,there is no significant improvement in children's QOL.
方法:采用病例一对照及自身前后对照的试验设计方法,将确诊为脑性瘫痪的儿童纳入为脑瘫组,将同龄健康儿童纳入为正常对照组,将同龄患有急性上呼吸道感染的儿童纳入为一般疾病对照组,利用PedsQL4.0普适性核心量表测量三组儿童的生存质量,比较三组儿童生存质量的差别,分析脑瘫组儿童生存质量与临床分型、解剖分型、粗大运动功能分级(GMFCS)及智力水平的关系,分析GMFM总分及社会适应DQ与患儿生存质量的相关性;脑瘫组儿童接受现代医学康复、传统医学康复以及家庭医学康复三者相结合的“三结合康复模式”治疗,疗程3个月,观察治疗前后患儿生存质量、粗大运动功能及发育商的变化情况,进行自身前后对照。
结果:本研究脑瘫组儿童80例、正常对照组儿童80例、一般疾病对照组儿童40例,三组儿童的年龄、性别以及儿童父母的年龄、性别、教育程度、家庭收入的差别均无统计学意义;脑瘫组儿童的生存质量明显低于正常对照组及一般疾病对照组儿童,差别有统计学意义(P<0.01);不同临床类型脑瘫患儿生存质量之间的差别无统计学意义;痉挛型四肢瘫患儿与痉挛型双瘫患儿相比较,在生理功能/领域及总体生存质量的差别有统计学意义(P<0.05),在情感功能、社会功能及心理领域的差别无统计学意义;不同GMFCS分级以及不同智力水平患儿的生理功能/领域、社会功能、心理领域及总体生存质量之间的差别有统计学意义(P<0.05),情感功能的差别无统计学意义;脑瘫患儿的GMFM总分、社会适应DQ与其生理功能/领域、社会功能、心理领域及总体生存质量之间存在正性相关(P<0.01),与其情感功能的相关性无统计学意义。“三结合康复模式”治疗3个月后,采用便利抽样方法回访脑瘫患儿32例,治疗有效率为71.9%,治疗前后患儿GMFM坐位得分、站位得分以及总分的差别有统计学意义(P<0.05),治疗后患儿的生存质量有不同程度的提高,差别无统计学意义。
结论:脑瘫组儿童生存质量存在明显的损害;患儿的生存质量与粗大运动功能及智力水平相关,运动功能及智力水平是影响其生存质量的重要因素;“三结合康复模式”治疗可以提高患儿的粗大运动功能,改善患儿的病情,治疗3个月后患儿的生存质量有不同程度的提高。
Objective:To investigate impact of cerebral palsy(CP) on children's quality of life(QOL).Clinical observation of multi-rehabilitation on QOL and condition in children with CP.
Methods:A ease-control and before-after study of the experimental design method.Selected inpatients with CP as the CP group,randomly selected healthy peers from two kindergartens in Nanhai area as the normal-control group,and selected inpatients with acute upper respiratory infection as common-disease-control group.All children were measured by Pediatric Quality of Life Inventory Version 4(PedsQL4.0) to assess their QOL and then compared differences in QOL of children among three groups.Children with CP were also assessed gross motor function by Gross Motor Function Measure(GMFM) and developmental quotient(DQ) by Beijing Gesell Developmental Scale(GDS) before and after treatment.Relationship was analyzed among QOL,clinical classification,anatomical type,condition and intelligence of children with CP.Children with CP were treated by multi-rehabilitation combined of modern medicine,traditional medicine and family medicine in three months and then compared differences in QOL,gross motor function and DQ before and after treatment.
Results:200 children participated in all(80 cases in CP group,80 in normal-control group and 40 in common-disease-control group).There was no significant differences in children' s age and gender,as well as parents' age, sex,educational background and income among three groups.Significant differences in mean scores favoring two control group were found in physical functioning/aspect,emotional functioning,social functioning,psychological aspect and total score(P＜0.01).There was no significant differences in mean scores of PedsQL4.0 in all clinical types of children with CP.Significant differences in mean scores between spastic quadriplegia and spastic diplegia of children with CP were found in physical functioning/aspect and total score(P＜0.01),except emotional functioning,social functioning and psychological aspect.Mean scores of different level of GMFCS(Gross Motor Function Classification System),as well as different level of intelligence in children with CP were found significant differences in physical functioning/aspect,social functioning,psychological aspect and total score(P＜0.05),but with no significant differences in emotional functioning. GMFM total scores and social adaptation DQ of children with CP positive correlated to their physical functioning/aspect,social functioning, psychological aspect and total score(P＜0.01),but with no significant correlation to emotional functioning.After three months treatment of multi-rehabilitation,32 cases of CP were selected by convenience sampling method.12 cases showed significant effect(37.5%),11 cases showed progress(34.4%),and 9 cases had no-effect(28.1%)(total probability of effective is 71.9%).Children's GMFM seat score,station scores and total scores were significant different before and after treatment(P＜0.05).After 3 months rehabilitation there was some improvement in PedsQL4.0-QOL,but with no significant differences.
Conclusion:CP reduces children's QOL in full-scale.QOL positive correlates to gross motor function,as well as level of intelligence of children with CP.Multi-rehabilitation can improve children' s condition and gross motor function.After 3 months rehabilitation,there is no significant improvement in children's QOL.
引文
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