發(fā)布時(shí)間：2018-05-13 12:49

  本文選題：關(guān)節(jié)炎 + 類風(fēng)濕��； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 觀察運(yùn)動(dòng)干預(yù)期間類風(fēng)濕關(guān)節(jié)炎(RA)患者關(guān)節(jié)功能狀態(tài)、健康狀況評(píng)估問卷(HAQ)評(píng)分、疾病活動(dòng)度等指標(biāo)的變化,為運(yùn)動(dòng)療法提供理論依據(jù),同時(shí)為指導(dǎo)RA患者開展�？瓶祻�(fù)提供基礎(chǔ)。 方法 1.選取60例來自浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院門診和住院的RA患者,隨機(jī)分成治療組和對(duì)照組。專業(yè)康復(fù)醫(yī)生和治療組RA患者采取“一對(duì)一”康復(fù)模式進(jìn)行為期3個(gè)月的運(yùn)動(dòng)康復(fù)治療。 2.觀察RA患者治療前后的疾病活動(dòng)指標(biāo)、雙手肌力、四肢主動(dòng)關(guān)節(jié)活動(dòng)度(AROM)和HAQ評(píng)分。 3.分析RA患者疾病活動(dòng)指標(biāo)及關(guān)節(jié)功能變化與生活質(zhì)量的關(guān)系。 結(jié)果 1.3個(gè)月后治療組和對(duì)照組RA患者的晨僵時(shí)間、患者總體評(píng)估(PGA)、28個(gè)關(guān)節(jié)壓痛計(jì)數(shù)(TJC28)、28個(gè)關(guān)節(jié)腫脹計(jì)數(shù)(SJC28)、血沉(ESR)、C反應(yīng)蛋白(CRP)、28個(gè)關(guān)節(jié)疾病活動(dòng)度評(píng)分(DAS28)、雙手平均握力均有改善,差異有統(tǒng)計(jì)學(xué)意義；治療組患者的雙手平均握力、PGA和DAS28評(píng)分比對(duì)照組患者改善更顯著,差異有統(tǒng)計(jì)學(xué)意義。 2.治療組RA患者AROM有不同程度改善,部分關(guān)節(jié)改善程度有統(tǒng)計(jì)學(xué)意義。對(duì)照組RA患者左側(cè)腕關(guān)節(jié)AROM的背伸和橈偏在治療后變小,其中橈偏治療前后差異有統(tǒng)計(jì)學(xué)意義；對(duì)照組患者其余AROM雖有好轉(zhuǎn),但差異無統(tǒng)計(jì)學(xué)意義。 3.兩組RA患者治療前后HAQ總評(píng)分改善顯著,且治療組患者的改善程度優(yōu)于對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義。治療組RA患者HAQ評(píng)分中的進(jìn)食、行走、抓握和活動(dòng)這四個(gè)單項(xiàng)測(cè)評(píng),3個(gè)月后改善差異有統(tǒng)計(jì)學(xué)意義；相比之下,對(duì)照組RA患者的單項(xiàng)測(cè)評(píng)改善差異則無統(tǒng)計(jì)學(xué)意義。 結(jié)論 1.藥物能控制RA病情,但隨著病程進(jìn)展,缺乏功能鍛煉的RA患者會(huì)出現(xiàn)AROM下降。 2.在藥物有效控制RA病情的基礎(chǔ)上結(jié)合運(yùn)動(dòng)療法,能有效改善患者的肌力和AROM。 3.隨著四肢關(guān)節(jié)功能的恢復(fù),RA患者生活質(zhì)量提高,自我狀況評(píng)估改善。
[Abstract]:Purpose To observe the changes of joint function, health assessment questionnaire (HAQ) score and disease activity in patients with rheumatoid arthritis (RA) during exercise intervention, and to provide theoretical basis for exercise therapy. At the same time, to guide RA patients to carry out specialized rehabilitation to provide the basis. Method 1. Sixty RA patients from the first affiliated Hospital of Zhejiang University Medical College were randomly divided into treatment group and control group. Professional rehabilitation doctors and RA patients in the treatment group were treated with one-to-one rehabilitation mode for 3 months. 2. The index of disease activity, the muscle strength of hands, the range of active joint motion of limbs and the HAQ score were observed before and after treatment in RA patients. 3. Objective: to analyze the relationship between disease activity index, joint function and quality of life in RA patients. Result 1.After 3 months, the morning stiffness time of RA patients in treatment group and control group, the overall assessment of PGAA, TJC28, SJC28, ESR, DAS28 and DAS28, the average grip strength of both hands were improved. The average grip strength and DAS28 scores in the treatment group were significantly improved than those in the control group. 2. In the treatment group, AROM of RA patients was improved to some extent, and the degree of partial joint improvement was statistically significant. In the control group, the dorsal extension and radial deviation of AROM in the left wrist became smaller after treatment, and the difference between the two groups before and after radial deviation was statistically significant, while the other AROM in the control group was improved, but the difference was not statistically significant. 3. The total score of HAQ was significantly improved in the two groups before and after treatment, and the improvement degree of the treatment group was better than that of the control group, and the difference was statistically significant. In the HAQ score of RA patients in the treatment group, there were significant differences in food intake, walking, grip and activity after 3 months, but there was no significant difference between the control group and the control group. Conclusion 1. Drugs can control the condition of RA, but with the progression of the disease, the AROM of RA patients with lack of functional exercise will decrease. 2. On the basis of effective control of RA, combined with exercise therapy, the patient's muscle strength and AROM can be effectively improved. 3. With the recovery of joint function in extremities, the quality of life and self-assessment of RA patients improved.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R593.22

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