目的:针对脑卒中后偏瘫患者采用康复护理,观察对这类患者的预后作用。方法:选择2020年1月至2021年1月至我院治疗的脑卒中后偏瘫患者,共200例,随机分成各100例的对照组和观察组,对照组采用常规护理法,观察组采用康复护理。对比两组患者的运动评分、RMS和iEMG评分、NISSS和Barthel评分、治疗情况。结果:护理之后,上下肢总分分值观察组明显高于对照组,P < 0.05,差异具有统计学意义。通过精心的治疗与护理,观察组的肱二头肌、腕屈肌、髋关节屈肌群iEMG值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,观察组的肱二头肌、腕屈肌、髋关节屈肌群RMS值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,两项评分明显更优的是观察组,两组对比,P < 0.05,差异具有统计学意义。护理后对照组以及观察组的治疗总有效率分别为94%、51.00%,观察组的治疗总有效率明显高于对照组,P < 0.05,差异具有统计学意义。结论:针对脑卒中后偏瘫患者采用康复护理可以明显提升患者的肌肉能力,改善运动能力,同时有效提升治疗效果以及生活能力。 Objective: To observe the effect of rehabilitation nursing on the prognosis of patients with hemiplegia after stroke. Methods: 200 patients with hemiplegia after stroke treated in our hospital from January 2020 to January 2021 were selected and randomly divided into the control group and the observation group with 100 cases in each group. The control group was given routine nursing, and the observation group was given rehabilitation nursing. The motor score, RMS and iEMG score, nisss and Barthel score, and treatment of the two groups were compared. Results: After nursing, the total score of upper and lower limbs in the observation group was significantly higher than that in the control group, P < 0.05, the difference was statistically significant. Through careful treatment and nursing, the iEMG scores of biceps brachii, flexor carpi and flexor hip in the observation group were significantly higher than those in the control group, P < 0.05, with statistical significance. After nursing, the RMS value of biceps brachii, flexor carpi and flexor hip of the observation group was significantly higher than that of the control group, P < 0.05, with statistical significance. After nursing, the two scores were significantly better in the observation group, compared with the two groups, P < 0.05, the difference was statistically significant. After nursing, the total effective rates of the control group and the observation group were 94% and 51%, respectively. The total effective rate of the observation group was significantly higher than that of the control group, P < 0.05, with statistical significance. Conclusion: For patients with hemiplegia after stroke, rehabilitation nursing can significantly improve the muscle ability of patients, improve motor ability, and effectively improve the treatment effect and life ability.
目的:针对脑卒中后偏瘫患者采用康复护理,观察对这类患者的预后作用。方法:选择2020年1月至2021年1月至我院治疗的脑卒中后偏瘫患者,共200例,随机分成各100例的对照组和观察组,对照组采用常规护理法,观察组采用康复护理。对比两组患者的运动评分、RMS和iEMG评分、NISSS和Barthel评分、治疗情况。结果:护理之后,上下肢总分分值观察组明显高于对照组,P < 0.05,差异具有统计学意义。通过精心的治疗与护理,观察组的肱二头肌、腕屈肌、髋关节屈肌群iEMG值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,观察组的肱二头肌、腕屈肌、髋关节屈肌群RMS值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,两项评分明显更优的是观察组,两组对比,P < 0.05,差异具有统计学意义。护理后对照组以及观察组的治疗总有效率分别为94%、51.00%,观察组的治疗总有效率明显高于对照组,P < 0.05,差异具有统计学意义。结论:针对脑卒中后偏瘫患者采用康复护理可以明显提升患者的肌肉能力,改善运动能力,同时有效提升治疗效果以及生活能力。
神经内科护理,康复护理,脑卒中后偏瘫,预后观察
Wei Liu, Fang Li, Mengyu Liu, Changhe Shan, Chun Wu, Yixiang Chen*
Chinese People’s Liberation Army Xiamen Special Service Convalescent Center, Xiamen Fujian
Received: Feb. 4th, 2021; accepted: Feb. 23rd, 2021; published: Mar. 4th, 2021
Objective: To observe the effect of rehabilitation nursing on the prognosis of patients with hemiplegia after stroke. Methods: 200 patients with hemiplegia after stroke treated in our hospital from January 2020 to January 2021 were selected and randomly divided into the control group and the observation group with 100 cases in each group. The control group was given routine nursing, and the observation group was given rehabilitation nursing. The motor score, RMS and iEMG score, nisss and Barthel score, and treatment of the two groups were compared. Results: After nursing, the total score of upper and lower limbs in the observation group was significantly higher than that in the control group, P < 0.05, the difference was statistically significant. Through careful treatment and nursing, the iEMG scores of biceps brachii, flexor carpi and flexor hip in the observation group were significantly higher than those in the control group, P < 0.05, with statistical significance. After nursing, the RMS value of biceps brachii, flexor carpi and flexor hip of the observation group was significantly higher than that of the control group, P < 0.05, with statistical significance. After nursing, the two scores were significantly better in the observation group, compared with the two groups, P < 0.05, the difference was statistically significant. After nursing, the total effective rates of the control group and the observation group were 94% and 51%, respectively. The total effective rate of the observation group was significantly higher than that of the control group, P < 0.05, with statistical significance. Conclusion: For patients with hemiplegia after stroke, rehabilitation nursing can significantly improve the muscle ability of patients, improve motor ability, and effectively improve the treatment effect and life ability.
Keywords:Neurology Nursing, Rehabilitation Nursing, Hemiplegia after Stroke, Prognosis Observation
Copyright © 2021 by author(s) and Hans Publishers Inc.
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脑卒中是世界性致残率最常见的一种疾病,早期康复可明显减少患者出现残疾的情况或是减轻残疾程度。脑卒中俗称“中风”,在临床上十常见,由于疾病发病突然,常常容易造成患者脑神经功能的损伤,出现半身无法动弹、口眼歪斜等情况,且有明显局限神经症状,如对侧三瘫,即对侧偏瘫、偏身感觉障碍、偏盲症状,所以可以说多数脑卒中的患者多数有偏瘫的情况,致残率高,对患者的生活能力、运动力有严重影响 [
选择2020年1月至2021年1月至我院治疗的脑卒中后偏瘫患者,共200例,随机分成各100例的对照组和观察组,对照组采用常规护理法,观察组采用康复护理。对比两组患者的运动评分、RMS和iEMG评分、NISSS和Barthel评分、治疗情况。
对照组:常规护理。包括病情的监测、稳定生命体征,所有患者接受合理健康饮食指导,根据患者自身情况行常规治疗。
观察组:开展有效的康复护理:① 康复训练时间的选择。患者接受康复时需要及早进行。当患者的生命体征平衡且病情未再次恶化就需要快速开展康复训练。通常来说,出血性的早期介入最理想时间是当患者的生命体征稳定了48~96 h后开始,如果患者是缺血性的可在24~48小时内后开展 [
① 采用Fugl-Meyer对患者进行运动评分,即FMA法。采用该方法对患者上下肢的运动功能能力进行判断,分数高代表运动能力好。
② 采用表面肌电图-sEMG参数,检测患者的肌肉RMS和iEMG能力,对患者的神经肌肉功能以有康复的效果进行判断定。肌肉收缩的能力和数值为正比例关系。
③ 采用NISSS表,即改良爱丁堡与斯堪的那维亚卒中量表,对患者的功能障碍进行判断,该量表共七项内容,14分为总分:功能障碍十分严重——10分、功能障碍中等——5~9分、功能障碍较轻——< 4分。并使用改良Bathel指数对患者的生活能力进行判断,该量表一共十项,总分满分为100,分数高代表生活能力好。
④ 采用神经功能缺损评价评估患者治疗效果,并统计两组患者的治疗效果。
数据分析所选用软件为SPSS 22.0。通过 x ¯ ± s 标准差来进行数据计量分析,卡方检验进行数据计数分析,用t检验来开展数据对比,若P小于0.05,则表示差异具备统计学价值。
开展护理前,患者上下肢,分值P > 0.05,差异不具有统计学意义;护理之后,上下肢总分分值观察组明显高于对照组,P < 0.05,差异具有统计学意义,详见表1:
组别 | n | 上肢 | 下肢 | 总运动积分 | |
---|---|---|---|---|---|
观察组 | 治疗前 | 100 | 19.14 ± 7.35 | 12.64 ± 9.52 | 30.81 ± 16.83 |
治疗后 | 27.34 ± 7.61 | 20.27 ± 6.95 | 46.58 ± 14.53 | ||
对照组 | 治疗前 | 100 | 17.26 ± 11.22 | 12.04 ± 8.04 | 28.21 ± 19.21 |
治疗后 | 29.44 ± 10.91 | 14.61 ± 8.04 | 45.03 ± 19.23 | ||
t | 25.8941 | ||||
P | 0.000 |
表1. 两组患者护理前后FMA分值变化
两组患者的iEMG值在护理前,各项肌肉的评分值P > 0.05,差异不具有统计学意义;通过精心的治疗与护理,观察组的肱二头肌、腕屈肌、髋关节屈肌群iEMG值分值明显高于对照组,P < 0.05,差异具有统计学意义,详见表2:
组别 | n | 肱二头肌 | 腕屈肌 | 髋关节屈肌群 | |
---|---|---|---|---|---|
观察组 | 治疗前 | 100 | 82.98 ± 19.21 | 53.341 ± 17.82 | 55.54 ± 15.41 |
治疗后 | 114.23 ± 28.41*# | 77.92 ± 19.81*# | 80.14 ± 17.22*# | ||
对照组 | 治疗前 | 100 | 80.32 ± 17.56 | 52.25 ± 20.41 | 53.43 ± 14.24 |
治疗后 | 92.23 ± 10.72# | 65.82 ± 21.82# | 62.24 ± 13.53# |
表2. 两组患者的iEMG值比较
*与对照组相比,P < 0.05,差异具有统计学意义;#组间对比,P < 0.05,差异具有统计学意义。
两组患者的RMS值在护理前,各项肌肉的评分值P > 0.05,差异不具有统计学意义;通过精心的治疗与护理,观察组的肱二头肌、腕屈肌、髋关节屈肌群RMS值分值明显高于对照组,P < 0.05,差异具有统计学意义,详见表3:
组别 | n | 肱二头肌 | 腕屈肌 | 髋关节屈肌群 | |
---|---|---|---|---|---|
观察组 | 治疗前 | 100 | 28.22 ± 6.22 | 20.81 ± 8.01 | 24.32 ± 7.12 |
治疗后 | 54.51 ± 10.33*# | 42.14 ± 11.22*# | 44.32 ± 11.21*# | ||
对照组 | 治疗前 | 100 | 29.62 ± 6.52 | 20.11 ± 3.74 | 22.21 ± 4.36 |
治疗后 | 48.81 ± 6.21# | 30.42 ± 5.66# | 31.21 ± 5.43# |
表3. 两组患者RMS值变化对比
*与对照组相比,P < 0.05,差异具有统计学意义;#组间对比,P < 0.05,差异具有统计学意义。
护理之前,观察组及对照组患者的NISSS、Barthel评分P > 0.05,差异不具有统计学意义。通过护理后,两项评分明显更优的是观察组,两组对比,P < 0.05,差异具有统计学意义。详见表4:
组别 | n | NISSS | Barthel | ||
---|---|---|---|---|---|
干预后 | 干预前 | 干预后 | |||
观察组 | 100 | 8.12 ± 1.83 | 4.95 ± 1.21* | 44.24 ± 11.26 | 66.82 ± 11.07* |
对照组 | 100 | 7.94 ± 1.22 | 3.33 ± 1.41 | 43.87 ± 11.33 | 52.23 ± 10.31 |
表4. 干预前后两组患者NISSS、Barthel评分情况比较
注:与对照组相比较,*P < 0.05。
通过护理,对照组以及观察组的治疗总有效率分别为94%、51.00%,观察组的治疗总有效率明显高于对照组,P < 0.05,差异具有统计学意义。详见表5:
组别 | n | 基本痊愈 | 进步 | 无变化 | 恶化 | 总有效率 |
---|---|---|---|---|---|---|
观察组 | 100 | 42 (42.00%) | 52 (52.00%) | 4 (4.00%) | 0 (0.00%) | 94.00% |
对照组 | 100 | 31 (3100%) | 20 (20.00%) | 27 (27.00%) | 25 (25.00%) | 51.00% |
χ 2 | 6.331 | 10.254 | 11.225 | 23.361 | 20.331 | |
P | <0.05 | <0.05 | <0.05 | <0.05 | <0.05 |
表5. 两组患者治疗情况比较
脑卒中是临床常见神经类系统的疾病。经济在不断发展,人们生活节奏也在不断加快,且工作压力进一步提升,脑卒中患者的发病率也随之增加,而且发病年龄不断年轻化,多数患者在发病后存在不同程度神经功能的损伤而引发系列并发症。其中,最常见的一种并发症为偏瘫,出现偏瘫后对患者生活质量造成极大影响。根据临床研究得知,采取合理、科学的干预,可有效帮助患者恢复功能,并进一步提高预后的效果 [
偏瘫康复机制除了取决血管以及脑组织病变的恢复之外,并依赖中枢神经系统可塑性。功能再训练可使感受器接受传入的神经冲动,促进大脑功能可塑性发展而丧失功能的重新恢复,所以中枢神经功能重组重要条件 [
康复干预需要重视对患者的肢体进行按摩,特别是患者患肢的手、脚处等,有效改善血液循环,消除肿胀并有效缓解疼痛,预防出现静脉炎及压疮,帮助恢复肢体功能 [
本次研究显示,护理之后,患者上下肢总分分值观察组明显高于对照组,P < 0.05,差异具有统计学意义。通过精心的治疗与护理,观察组的肱二头肌、腕屈肌、髋关节屈肌群iEMG值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,观察组的肱二头肌、腕屈肌、髋关节屈肌群RMS值分值明显高于对照组,P < 0.05,差异具有统计学意义。护理后,两项评分明显更优的是观察组,两组对比,P < 0.05,差异具有统计学意义。护理后对照组以及观察组的治疗总有效率分别为94%、51.00%,观察组的治疗总有效率明显高于对照组,P < 0.05,差异具有统计学意义。
可见,针对脑卒中后偏瘫患者采用康复护理可以明显提升患者的肌肉能力,改善运动能力,同时有效提升治疗效果以及生活能力。
刘 薇,李 芳,刘梦玉,单长鹤,吴 春,陈艺香. 神经内科护理中康复护理对脑卒中后偏瘫患者的预后观察分析 Observation and Analysis of Rehabilitation Nursing in Neurology Nursing on Prognosis of Patients with Hemiplegia after Stroke[J]. 护理学, 2021, 10(02): 47-52. https://doi.org/10.12677/NS.2021.102008