本文關(guān)鍵詞： 廢用綜合征 維西醫(yī)結(jié)合康復(fù)護(hù)理干預(yù) 關(guān)節(jié)活動(dòng)度 便秘　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:選取在養(yǎng)老福利院療養(yǎng)的日常生活活動(dòng)能力FIM量表評(píng)分低于54分長(zhǎng)期臥床廢用綜合征患者,通過(guò)調(diào)查分析廢用綜合征患者的一般情況,并采用維西醫(yī)結(jié)合康復(fù)護(hù)理干預(yù)對(duì)長(zhǎng)期臥床廢用綜合征關(guān)節(jié)攣縮的患者進(jìn)行干預(yù),探討其對(duì)肌力、肌張力、關(guān)節(jié)活動(dòng)度、運(yùn)動(dòng)功能、30秒站立堅(jiān)持時(shí)間、日常生活活動(dòng)能力、生活質(zhì)量、便秘等的療效。方法:選擇長(zhǎng)期居住在烏魯木齊市兩所養(yǎng)老福利院,因各種原因造成的長(zhǎng)期臥床,低運(yùn)動(dòng)而發(fā)生的肌肉萎縮及關(guān)節(jié)攣縮的日常生活活動(dòng)能力得分采用FIM量表評(píng)分低于54分的廢用綜合征患者作為研究對(duì)象,對(duì)其進(jìn)行廢用綜合征一般情況、肌力、肌張力、關(guān)節(jié)活動(dòng)度、30s站立堅(jiān)持時(shí)間、運(yùn)動(dòng)功能、日常生活活動(dòng)能力等基線情況進(jìn)行問(wèn)卷調(diào)查并分析。將80例廢用綜合征患者按照隨機(jī)數(shù)字法分為實(shí)驗(yàn)組40例與對(duì)照組40例,實(shí)驗(yàn)組進(jìn)行維西醫(yī)結(jié)合康復(fù)護(hù)理干預(yù),對(duì)照組進(jìn)行常規(guī)的診療及康復(fù)護(hù)理,并對(duì)干預(yù)前、干預(yù)4周后,追蹤期結(jié)束8周后的指標(biāo)(肌力及肌張力、關(guān)節(jié)活動(dòng)度、30s站立堅(jiān)持時(shí)間、運(yùn)動(dòng)功能、日常生活活動(dòng)能力、生活質(zhì)量等的得分)進(jìn)行療效評(píng)價(jià)。結(jié)果:1.基線結(jié)果:(1)廢用綜合征患者的基線資料:80例廢用綜合征患者的平均年齡為(69.25±7.80)歲,其中男性為50例,女性為30例;自理程度:完全不自理者33例,部分不自理者47例。(2)實(shí)驗(yàn)組和對(duì)照組患者在干預(yù)前的基線資料的比較,兩組患者性別、年齡、廢用綜合征病程等一般情況經(jīng)統(tǒng)計(jì)學(xué)處理,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。2.干預(yù)前后實(shí)驗(yàn)組和對(duì)照組的變化:(1)實(shí)驗(yàn)組患者在肌力,肩關(guān)節(jié)、肘關(guān)節(jié)(屈)、腕關(guān)節(jié)、髖關(guān)節(jié)、膝關(guān)節(jié)(屈)、踝關(guān)節(jié)等關(guān)節(jié)活動(dòng)度,運(yùn)動(dòng)功能,日常生活活動(dòng)能力,30s站立堅(jiān)持時(shí)間,生活質(zhì)量等得分在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組肌張力在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的得分的比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)對(duì)照組患者在肌力,肩關(guān)節(jié)、肘關(guān)節(jié)(屈)、腕關(guān)節(jié)關(guān)節(jié)活度,運(yùn)動(dòng)功能,日常生活活動(dòng)能力等得分在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)外,其余的均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(3)干預(yù)前實(shí)驗(yàn)組和對(duì)照組患者均有不同程度的便秘癥狀,用手微振動(dòng)護(hù)理方法干預(yù)后,實(shí)驗(yàn)組無(wú)一例出現(xiàn)便秘癥狀,對(duì)照組有17例(43.6%)出現(xiàn)便秘癥狀。兩組患者便秘發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=20.775,P0.05)。3.實(shí)驗(yàn)組和對(duì)照組患者各指標(biāo)的比較:(1)肌力和肌張力得分的比較:實(shí)驗(yàn)組和對(duì)照組在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的肌力得分的比較,干預(yù)前無(wú)統(tǒng)計(jì)學(xué)差異,干預(yù)4周后、追蹤期結(jié)束8周后肌力的比較,其差異具有統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)驗(yàn)組肌力的提高比對(duì)照組較好。實(shí)驗(yàn)組和對(duì)照組在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的肌張力得分的比較,除了追蹤期結(jié)束8周后的左上肢肌張力和右下肢肌張力得分的比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)外,其余的均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組和對(duì)照組在肌張力的改變沒(méi)有明顯差異。(2)肩關(guān)節(jié)、肘關(guān)節(jié)、腕關(guān)節(jié)關(guān)節(jié)活動(dòng)度得分的比較:實(shí)驗(yàn)組和對(duì)照組患者在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后關(guān)節(jié)活動(dòng)度得分的比較,除了追蹤期結(jié)束8周后肩關(guān)節(jié)(屈、外展)關(guān)節(jié)活動(dòng)度的比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)外,其余的均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組和對(duì)照組患者在肩關(guān)節(jié)、肘關(guān)節(jié)、腕關(guān)節(jié)活動(dòng)度的變化不太明顯。(3)髖關(guān)節(jié)、膝關(guān)節(jié)、踝關(guān)節(jié)的關(guān)節(jié)活動(dòng)度得分的比較:實(shí)驗(yàn)組和對(duì)照組患者在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后關(guān)節(jié)活動(dòng)度的比較,除了干預(yù)前髖關(guān)節(jié)、膝關(guān)節(jié)、踝關(guān)節(jié)關(guān)節(jié)活動(dòng)度的比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)驗(yàn)組和對(duì)照組患者在干預(yù)4周后、追蹤期結(jié)束8周后的髖關(guān)節(jié)(屈、伸、外展、內(nèi)收、內(nèi)旋、外旋),膝關(guān)節(jié)(屈、伸)踝關(guān)節(jié)(背屈、跖屈、內(nèi)翻、外翻)關(guān)節(jié)活動(dòng)度的比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)后髖關(guān)節(jié)、膝關(guān)節(jié)、踝關(guān)節(jié)關(guān)節(jié)活動(dòng)度的改善,實(shí)驗(yàn)組患者關(guān)節(jié)活動(dòng)度明顯優(yōu)于對(duì)照組。(4)日常生活活動(dòng)能力、生活質(zhì)量、30s站立堅(jiān)持時(shí)間、運(yùn)動(dòng)功能得分的比較:實(shí)驗(yàn)組和對(duì)照組在干預(yù)前、干預(yù)4周后、追蹤期結(jié)束8周后的運(yùn)動(dòng)功能、日常生活活動(dòng)能力、生活質(zhì)量、30s站立堅(jiān)持時(shí)間的比較,干預(yù)4周后的生活質(zhì)量、30s站立堅(jiān)持時(shí)間和追蹤期結(jié)束8周后的運(yùn)動(dòng)功能、日常生活活動(dòng)能力、生活質(zhì)量、30s站立堅(jiān)持時(shí)間得分的比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)外,其余無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)果表明,在追蹤期結(jié)8周后,實(shí)驗(yàn)組在日常生活活動(dòng)能力、運(yùn)動(dòng)功能、生活質(zhì)量、30s站立堅(jiān)持時(shí)間的得分的改善情況明顯高于對(duì)照組的得分。(5)干預(yù)前、干預(yù)4周后和追蹤期結(jié)束8周后,兩組排便次數(shù)的比較,差異有統(tǒng)計(jì)學(xué)意義(t=-1.537、15.275、18.458,P0.05)。隨著干預(yù)時(shí)間的推移,排便次數(shù)增加。實(shí)驗(yàn)組緩解便秘的效果優(yōu)于對(duì)照組。結(jié)論:維西醫(yī)結(jié)合康復(fù)護(hù)理干預(yù)方法對(duì)廢用綜合征患者肌力,關(guān)節(jié)活動(dòng)度,運(yùn)動(dòng)功能,日常生活活動(dòng)能力,生活質(zhì)量,30s站立堅(jiān)持時(shí)間,便秘等指標(biāo)有明顯療效,日常生活逐漸趨向自理,可以解決自己最基本的日常生活活動(dòng)。肌力,關(guān)節(jié)活動(dòng)度和生活質(zhì)量得到明顯的提高,減輕便秘效果較好,并且治療效果可以維持較長(zhǎng)時(shí)間,沒(méi)有復(fù)發(fā)及不良反應(yīng)發(fā)生,安全、經(jīng)濟(jì)、方便、快速有效。維西醫(yī)結(jié)合康復(fù)護(hù)理方法可以讓廢用綜合征患者生活去向自理,提高患者的生活質(zhì)量,值得推廣到養(yǎng)老護(hù)理領(lǐng)域
[Abstract]:Objective: to select the score below 54 long-term bedridden patients with disuse syndrome in ADL FIM nursing old-age welfare institute, through the investigation and analysis of the general situation of disuse syndrome, and the use of medicine in Weixi rehabilitation nursing intervention intervention in bedridden disuse syndrome joint contracture patients, to explore the the muscle strength, muscle tension, joint activity, motor function, 30 seconds standing time to adhere to the quality of life, activities of daily living, and the effect of constipation. Methods: long-term residence in Urumqi City old-age welfare institute, bedridden due to a variety of causes, muscle atrophy and joint contracture and the occurrence of low motion ADL scores using FIM score less than 54 points of disuse syndrome patients as the research object, carries on the disuse syndrome in general, muscle strength, muscle tension, joint. Mobility, 30s standing time to adhere to motor function, analysis, questionnaire survey and ADL baseline. 80 patients with disuse syndrome were randomly divided into experimental group 40 cases and 40 cases in the control group, the experimental group were given rehabilitation nursing intervention combined with medicine control group Sulawesi, treatment and rehabilitation the routine nursing, and the intervention before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the index (muscle strength and muscle tension, joint activity, 30s insisted on standing time, motor function, activities of daily living, quality of life score) for clinical evaluation. Results: 1. baseline results: (1) disuse syndrome: 80 cases of patients with baseline data of disuse syndrome patients for the average age (69.25 + 7.80) years old, including 50 cases of male, female 30 cases; degree of self-care: no self-care in 33 cases, 47 cases were not part of themselves. (2) the experimental group and the control group patients in the stem Comparison of baseline data pre of the two groups of patients with gender, age, duration of disuse syndrome in general statistically, there was no statistically significant difference (P0.05), with comparable changes in the experimental group and the control group before and after the intervention of.2.: (1) patients in the experimental group in muscle strength, shoulder joint, elbow joint (flexion), wrist, hip, knee, ankle joint (flexion) joint activity, motor function, activities of daily living, 30s standing time to adhere to the quality of life score, before intervention, after 4 weeks of intervention, the follow-up period was more than the end of 8 weeks, the differences were statistically significant (P0.05). The muscle tension of experimental group before intervention, after 4 weeks of intervention, compared with follow-up of 8 weeks after the end of the score, the difference was not statistically significant (P0.05). (2) patients in the control group in the muscle, shoulder joint, elbow joint, wrist joint (flexion) joint activity, motor function, activities the daily life ability score in intervention Before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of comparison, the difference was statistically significant (P0.05), the rest were not statistically significant (P0.05). (3) before the intervention group and the control group of patients had different symptoms of constipation, hand micro vibration nursing intervention, the experimental group there were no symptoms of constipation, 17 cases in the control group (43.6%). Two groups of patients with symptoms of constipation constipation were compared, the difference was statistically significant (2=20.775, P0.05).3. experimental group and control group in each index: (1) comparison of muscle strength and muscle tension scores of the experimental group and control group before intervention, after 4 weeks of intervention, comparison of follow-up end strength score after 8 weeks before the intervention, no significant difference after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the comparison of strength, the difference was statistically significant (P0.05), the experimental group than the control group improved muscle force experiment is better. And the control group Group before intervention, after 4 weeks of intervention, comparison of follow-up end muscle tension scores after 8 weeks, in addition to differences in the follow-up period of 8 weeks after the end of the left upper limb muscle tension and right lower limb muscle tension scores was statistically significant (P0.05), the rest were not statistically significant (P0.05). No obvious the difference in muscle tension changes in experimental group and control group. (2) the shoulder joint, elbow joint, wrist joint activity score comparison: the experimental group and the control group of patients before intervention, after 4 weeks of intervention, the follow-up period end compare joint activity score after 8 weeks, in addition to the end of the 8 week follow-up period after the shoulder joint (flexion, abduction) there was a significant difference between the joint activity (P0.05), the rest were not statistically significant (P0.05). The experimental group and the control group in the patients with shoulder joint, elbow joint, wrist movement change is not obvious. (3) of hip joint, knee joint. The ankle joint. 鍔ㄥ害寰楀垎鐨勬瘮杈，

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