下肢智能反饋訓(xùn)練系統(tǒng)對脊髓損傷患者膀胱功能的影響
發(fā)布時間：2018-07-18 12:15
【摘要】：目的本研究的目的是針對脊髓損傷伴有膀胱功能障礙的患者在采取常規(guī)藥物、理療、膀胱功能訓(xùn)練及護理等基礎(chǔ)上試驗組加用下肢智能反饋訓(xùn)練系統(tǒng)進行治療,觀察分析治療前后兩組間患者膀胱功能有無差別,進而探討下肢智能反饋訓(xùn)練系統(tǒng)對脊髓損傷患者膀胱功能的作用及臨床應(yīng)用價值。方法選擇經(jīng)過磁共振成像(MRI)、臨床表現(xiàn)及相關(guān)檢查確診為脊髓損傷并伴有膀胱功能障礙的40例住院患者,按照隨機化原則和就診時間先后的順序進行相應(yīng)分組,40例符合要求并愿意進行該項試驗的患者中選取20例作為試驗組,另20例患者作為對照組,兩組患者兩組均進行常規(guī)康復(fù)治療,包括:①藥物治療:常規(guī)劑量的營養(yǎng)神經(jīng)藥物,存在尿路感染者,根據(jù)尿培養(yǎng)及藥敏試驗結(jié)果選用相應(yīng)抗生素等;②運動療法和理療:肌力減弱或喪失肢體的主、被動活動,智能運動訓(xùn)練儀、神經(jīng)肌肉電刺激、氣壓治療儀和電動起立床訓(xùn)練,均為一天兩次,每次30分鐘;③膀胱功能的護理:由康復(fù)護理人員教會患者及其家屬定時夾閉導(dǎo)尿管,制定合理的飲水、進食計劃,進行排尿意識的訓(xùn)練,學(xué)會用伐爾沙耳法(Valsalva法)、克萊臺法(Crede法)輔助排尿,同時對患者進行心理護理和健康教育。試驗組在上述常規(guī)康復(fù)治療的基礎(chǔ)上加用下肢智能反饋訓(xùn)練系統(tǒng)進行訓(xùn)練。兩組患者于進行該項試驗治療前及治療四周達(dá)到一個療程后分別進行導(dǎo)尿管膀胱殘余尿測定,通過殘余尿量多少反映膀胱功能狀態(tài)。此外根據(jù)國際脊髓損傷數(shù)據(jù)集下尿路功能基本數(shù)據(jù)集表格記錄并收集各組患者治療前后的尿意、非自主漏尿頻率、膀胱排空方法,進行相應(yīng)比較。最后運用SPSS 17.0統(tǒng)計軟件對上述采集的數(shù)據(jù)進行分析和綜合處理,加以總結(jié)得出結(jié)論。結(jié)果40例患者均配合完成試驗,未有發(fā)生體位性低血壓等不良反應(yīng),兩組患者的性別、年齡經(jīng)過統(tǒng)計分析無明顯差異。試驗組和對照組患者膀胱殘余尿量治療前差異無統(tǒng)計學(xué)意義(P0.05),治療后均減少,且差異有統(tǒng)計學(xué)意義(P0.05);試驗組中有4例恢復(fù)尿意,3例膀胱排空方法發(fā)生改變,5例非自主漏尿頻率發(fā)生改變;對照組有2例恢復(fù)尿意,1例膀胱排空方法發(fā)生改變,2例非自主漏尿頻率發(fā)生改變。美國脊髓損傷協(xié)會(ASIA)損傷程度分級中以上各項觀察指標(biāo)低級患者的恢復(fù)數(shù)目多于高級患者。結(jié)論常規(guī)的藥物治療、運動療法、理療、膀胱功能訓(xùn)練及護理對促進膀胱功能的改善有一定的幫助,而試驗組的數(shù)據(jù)表明在以上治療的基礎(chǔ)上加用下肢智能反饋訓(xùn)練系統(tǒng)能夠進一步恢復(fù)膀胱功能。在整個治療過程中未見患者發(fā)生相關(guān)不良反應(yīng),患者耐受性及適應(yīng)性較好,有較廣闊的應(yīng)用前景。另外膀胱功能有所恢復(fù)的患者中ASIA分級程度低級患者的數(shù)目多于高級患者,兩者似有相關(guān)性,推測ASIA損傷程度分級中低級患者的康復(fù)效果可能優(yōu)于高級患者。
[Abstract]:The purpose of this study was to treat patients with spinal cord injury and bladder dysfunction with conventional medicine, physical therapy, bladder function training and nursing, and the experimental group was treated with the intelligent feedback training system of lower extremity, to observe and analyze the difference of bladder function between the two groups before and after treatment, and then to explore the intelligent feedback of lower extremity. The effect and clinical value of the training system on bladder function of patients with spinal cord injury. Methods 40 hospitalized patients with spinal cord injury and bladder dysfunction diagnosed by magnetic resonance imaging (MRI), clinical manifestation and related examination were classified according to the principle of randomization and the order of time in order. 40 cases were in accordance with the requirements. Among the patients who were willing to carry out the test, 20 cases were selected as the experimental group, the other 20 patients were used as the control group, and the two groups of the two groups were all treated with routine rehabilitation, including: (1) the drug treatment: the conventional dose of nutritional neurodrugs, the presence of urinary tract infection, and the selection of antibiotics according to the results of urine culture and drug sensitivity test; and exercise therapy And physical therapy: muscle strength weakening or loss of the main body, passive activity, intelligent exercise training apparatus, neuromuscular electrical stimulation, air pressure therapy instrument and electric standing bed training, all are two times a day, 30 minutes each time; (3) nursing of bladder function: the rehabilitation nursing staff teach patients and their families to close the catheter regularly and make reasonable drinking water and eating meter. By training the consciousness of urination, we learned to use the VaR Sha ear (Valsalva) and kleis method (Crede) to assist the urination. Meanwhile, the patients were treated with psychological nursing and health education. The experimental group was trained with the lower limb intelligent feedback training system on the basis of the above routine rehabilitation treatment. The two groups were treated before and treated with the treatment. After a course of treatment, the urinary bladder residual urine was measured and the urinary bladder function state was reflected by the amount of residual urine. In addition, the urinary meaning, the frequency of non spontaneous leakage of urine, the method of bladder emptying and the method of bladder emptying were collected and collected according to the basic data set of the urinary tract function of the international spinal cord injury data set. In the end, the data collected above were analyzed and integrated with SPSS 17 statistical software, and the results were summed up. The results of the 40 patients were all matched with the completion of the test. There was no adverse reaction such as postural hypotension. The sex and age of the two groups were not significantly different. There were no statistical significance (P0.05) before the treatment of residual urine (P0.05), and the difference was statistically significant after treatment, and the difference was statistically significant (P0.05). In the experimental group, 4 cases recovered urine meaning, 3 cases of bladder emptying were changed, 5 cases of non autonomic leakage urine frequency changed, 2 cases in the control group were restored to urine meaning, 1 cases of bladder emptying were changed, 2 cases of non autonomic leakage of urinary frequency were changed. The rate of the American Spinal Cord Injury Association (ASIA) is more than that of the advanced patients. Conclusion the routine drug therapy, exercise therapy, physical therapy, bladder function training and nursing are helpful to promote the improvement of bladder function, and the data of the test group show that above On the basis of the treatment, the intelligent feedback training system with lower extremity can further restore the function of the bladder. There is no related adverse reaction in the whole treatment process, the patient's tolerance and adaptability are better, and there is a broad application prospect. In addition, the number of ASIA grade low grade patients in the patients with the bladder function recovery is more than high. There is a correlation between the two groups. It is speculated that the rehabilitation effect of the lower grade patients in ASIA classification is better than that of the advanced patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.2;R49
本文編號：2131873
[Abstract]:The purpose of this study was to treat patients with spinal cord injury and bladder dysfunction with conventional medicine, physical therapy, bladder function training and nursing, and the experimental group was treated with the intelligent feedback training system of lower extremity, to observe and analyze the difference of bladder function between the two groups before and after treatment, and then to explore the intelligent feedback of lower extremity. The effect and clinical value of the training system on bladder function of patients with spinal cord injury. Methods 40 hospitalized patients with spinal cord injury and bladder dysfunction diagnosed by magnetic resonance imaging (MRI), clinical manifestation and related examination were classified according to the principle of randomization and the order of time in order. 40 cases were in accordance with the requirements. Among the patients who were willing to carry out the test, 20 cases were selected as the experimental group, the other 20 patients were used as the control group, and the two groups of the two groups were all treated with routine rehabilitation, including: (1) the drug treatment: the conventional dose of nutritional neurodrugs, the presence of urinary tract infection, and the selection of antibiotics according to the results of urine culture and drug sensitivity test; and exercise therapy And physical therapy: muscle strength weakening or loss of the main body, passive activity, intelligent exercise training apparatus, neuromuscular electrical stimulation, air pressure therapy instrument and electric standing bed training, all are two times a day, 30 minutes each time; (3) nursing of bladder function: the rehabilitation nursing staff teach patients and their families to close the catheter regularly and make reasonable drinking water and eating meter. By training the consciousness of urination, we learned to use the VaR Sha ear (Valsalva) and kleis method (Crede) to assist the urination. Meanwhile, the patients were treated with psychological nursing and health education. The experimental group was trained with the lower limb intelligent feedback training system on the basis of the above routine rehabilitation treatment. The two groups were treated before and treated with the treatment. After a course of treatment, the urinary bladder residual urine was measured and the urinary bladder function state was reflected by the amount of residual urine. In addition, the urinary meaning, the frequency of non spontaneous leakage of urine, the method of bladder emptying and the method of bladder emptying were collected and collected according to the basic data set of the urinary tract function of the international spinal cord injury data set. In the end, the data collected above were analyzed and integrated with SPSS 17 statistical software, and the results were summed up. The results of the 40 patients were all matched with the completion of the test. There was no adverse reaction such as postural hypotension. The sex and age of the two groups were not significantly different. There were no statistical significance (P0.05) before the treatment of residual urine (P0.05), and the difference was statistically significant after treatment, and the difference was statistically significant (P0.05). In the experimental group, 4 cases recovered urine meaning, 3 cases of bladder emptying were changed, 5 cases of non autonomic leakage urine frequency changed, 2 cases in the control group were restored to urine meaning, 1 cases of bladder emptying were changed, 2 cases of non autonomic leakage of urinary frequency were changed. The rate of the American Spinal Cord Injury Association (ASIA) is more than that of the advanced patients. Conclusion the routine drug therapy, exercise therapy, physical therapy, bladder function training and nursing are helpful to promote the improvement of bladder function, and the data of the test group show that above On the basis of the treatment, the intelligent feedback training system with lower extremity can further restore the function of the bladder. There is no related adverse reaction in the whole treatment process, the patient's tolerance and adaptability are better, and there is a broad application prospect. In addition, the number of ASIA grade low grade patients in the patients with the bladder function recovery is more than high. There is a correlation between the two groups. It is speculated that the rehabilitation effect of the lower grade patients in ASIA classification is better than that of the advanced patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.2;R49
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