本文選題：水針　切入點(diǎn)：綜合康復(fù)治療　出處：《鄭州大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的:采用水針與常規(guī)康復(fù)結(jié)合療法及常規(guī)康復(fù)療法分別對(duì)腦性癱瘓伴智力障礙的患兒進(jìn)行治療,觀察記錄治療過(guò)程中兩組患兒的智力改善情況及大腦前、中、后動(dòng)脈的血流學(xué)改變,并對(duì)其與療效的關(guān)系進(jìn)行觀察和統(tǒng)計(jì)分析,以綜合評(píng)價(jià)水針治療腦癱智力障礙的臨床療效,探討水針改善腦癱患兒腦血流動(dòng)力學(xué)的作用,以進(jìn)一步明確其作用機(jī)理,為判斷水針治療腦癱伴智力障礙的預(yù)期效應(yīng)提供依據(jù),為治療腦癱智力障礙探索方法,同時(shí)提高水針治療在小兒腦癱康復(fù)治療方面,尤其是在伴有智力障礙患兒治療中的作用和地位。方法:本課題采用隨機(jī)、對(duì)照、平行的研究方法進(jìn)行試驗(yàn),將80例腦癱患兒,隨機(jī)平均分為治療組和對(duì)照組,每組40例。其中,治療組患兒,采用常規(guī)康復(fù)方法與水針間隔交叉治療,對(duì)照組患兒采用常規(guī)康復(fù)治療,不進(jìn)行水針治療。對(duì)兩組腦癱患兒采取相同的康復(fù)治療方案,具體為分別采用運(yùn)動(dòng)療法、語(yǔ)言療法、作業(yè)療法以及引導(dǎo)式教育進(jìn)行綜合的康復(fù)訓(xùn)練治療,治療期間每23天為一個(gè)療程,共計(jì)進(jìn)行3個(gè)療程。治療前后分別從智力發(fā)育指數(shù)、腦血流動(dòng)力學(xué)指標(biāo)、不良反應(yīng)3個(gè)方面進(jìn)行評(píng)定,觀察患兒智力改善情況、治療前后的腦血流動(dòng)力學(xué)變化情況及安全性分析,并于所有療程結(jié)束后的一個(gè)月,進(jìn)行臨床隨訪,隨訪結(jié)束進(jìn)行詳細(xì)、規(guī)范的統(tǒng)計(jì)學(xué)分析,從統(tǒng)計(jì)分析結(jié)果來(lái)客觀的評(píng)價(jià)療效。結(jié)果:1.綜合療效的比較:經(jīng)治療,3療程結(jié)束后,治療組40例患兒,達(dá)到正常化患兒共30例,另有6例患兒效果顯著,3例患兒有效,1例患兒治療無(wú)效,正�；蕿�30/40=75%,總有效率為39/40=97.5%;對(duì)照組40例患兒中,達(dá)到正�；�15例,顯效10例,有效6例,無(wú)效9例,正�；�37.5%,總有效率77.5%;經(jīng)Redit統(tǒng)計(jì)分析P=0.000(P0.05),差異有統(tǒng)計(jì)學(xué)意義。2.癥狀、體征評(píng)分比較:兩組腦癱患兒治療前后分別進(jìn)行MDI評(píng)分、PDI評(píng)分,其中,組內(nèi)自身比較及治療后組間比較,均具有統(tǒng)計(jì)學(xué)差異(p0.05);各療程結(jié)束后與前一療程相比較,比較組內(nèi)大腦前、中、后動(dòng)脈血流動(dòng)力學(xué)參數(shù)的變化,其中Vs,Vm,Vd參數(shù)升高,RI參數(shù)降低,差異有統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論:1.水針治療對(duì)腦癱患兒腦血流有直接影響,腦血流動(dòng)力學(xué)變化具有一定特征性,腦血流加快,血管阻力降低,且血流動(dòng)力學(xué)變化早于形態(tài)學(xué)改變。2.水針結(jié)合綜合康復(fù)治療方法對(duì)于腦癱患兒智力障礙的治療臨床療效肯定,治療組效果優(yōu)于對(duì)照組(P0.05),可以明顯改善患兒的智力障礙狀態(tài)及綜合能力,增強(qiáng)患兒的生活自主能力,為家庭、社會(huì)減輕負(fù)擔(dān)。3.兩組1-2歲患兒的療效均優(yōu)于2歲以上患兒的療效(P0.05),治療組改善更明顯,說(shuō)明治療療效與年齡大小密切相關(guān),年齡越小,療效越好。4.通過(guò)分別分析第1療程末、第2療程末以及第3療程末的治療效果,證明療效與療程的長(zhǎng)短有關(guān),且療程越長(zhǎng)的效果越好。5.治療小兒腦癱的關(guān)鍵在于早期診斷、早期干預(yù)治療,并要持之以恒的堅(jiān)持治療;水針為主的綜合治療方法是安全有效的,無(wú)不良反應(yīng)及毒副作用,值得推廣。
[Abstract]:Objective: using the water needle and the conventional rehabilitation therapy and routine rehabilitation therapy of cerebral palsy children with mental disorders treatment, the two groups were observed during the treatment were recorded the improvement of intelligence and brain before, the change after arterial blood flow, and the relationship with the curative effect of observation and statistical analysis based on the comprehensive evaluation of water injection, the treatment of cerebral palsy with intellectual disabilities to explore the clinical curative effect, improve the water injection in children with cerebral palsy cerebral hemodynamic effects, in order to further clarify its mechanism of action, with intellectual disabilities to determine the intended effect of water injection in treatment of cerebral palsy should provide the basis for the exploration of methods for the treatment of cerebral palsy, mental retardation, and improve water treatment in needle rehabilitation treatment of cerebral palsy in children, especially the role and status in the treatment of children with mental disorders. Methods: This study used a randomized, controlled, parallel study to test 80 cases Children with cerebral palsy were randomly divided into treatment group and control group, 40 cases in each group. The treatment group, the treatment of conventional rehabilitation method and cross water injection interval, the control group were treated with routine rehabilitation treatment, without water needle treatment. Take the same rehabilitation treatment in two groups of children with cerebral palsy, specific respectively. With exercise therapy, speech therapy, occupational therapy and guiding education of comprehensive rehabilitation treatment, during treatment every 23 days for a course of treatment, a total of 3 courses. Before and after treatment respectively from the mental development index, index of cerebral blood flow dynamics, 3 aspects of adverse reactions were evaluated, observed improvement of intelligence. Analysis of cerebral hemodynamic changes and safety before and after treatment, and in all month after the end of treatment, clinical follow-up, follow-up detailed, standardized statistical analysis, from the statistical analysis Objective to evaluate the efficacy results. Results: compared with 1. comprehensive effect: after treatment, 3 after the end of treatment, the treatment group of 40 cases, to achieve normalization of 30 cases and 6 cases of children with significant effect, 3 cases effective, 1 cases ineffective treatment, the normalization rate of 30/40=75%, total efficiency 39/40=97.5%; the control group of 40 cases, 15 cases of normal, 10 cases were markedly effective, 6 cases effective, 9 cases ineffective, the normal rate of 37.5%, the total efficiency of 77.5%; statistical analysis by Redit P=0.000 (P0.05), the difference was statistically significant.2. symptoms, signs score: MDI score, respectively before and after two groups of children with cerebral palsy treatment PDI score, which, within the group itself and the comparison between the two groups after treatment, there was significant difference (P0.05); after the treatment compared with before treatment, were compared within brain before, changes of arterial blood flow mechanics parameters including Vs, Vm, Vd parameters increased RI parameters The number is reduced, the difference was statistically significant (P0.05). Conclusion: 1. water needle therapy has a direct effect on the cerebral blood flow in children with cerebral palsy, with certain characteristics of cerebral hemodynamic changes in cerebral blood flow, accelerate vascular resistance decreased, and the hemodynamic changes in early morphological changes of the.2. water needle combined with comprehensive rehabilitation therapy certainly treatment clinical curative effect for cerebral palsy children with intellectual disabilities, the treatment group is better than the control group (P0.05), can significantly improve the mental state and the comprehensive ability of children, enhance independent living ability, with the family, the efficacy of social burden.3. two group of 1-2 year old children were better than those of children over the age of 2 (P0.05), the treatment group the improvement is more obvious, indicating that the treatment effect and age are closely related, the younger the better curative effect by.4. were analyzed at the end of the first course, at the end of the second course and third course of treatment at the end of the treatment, proof The efficacy and duration on the length of the key, and the longer the duration the better the effect of.5. treatment for children with cerebral palsy is early diagnosis, early intervention, and to persevere adhere to treatment; comprehensive treatment method of water injection is safe and effective, no adverse reactions and side effects, worthy of promotion.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R742.3

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