神经—肌腱滑行练习对轻中度腕管综合征患者的效果研究

发布时间：2017-12-26 19:10

本文关键词：神经—肌腱滑行练习对轻中度腕管综合征患者的效果研究　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的汉化波士顿腕管量表并检验其信效度；描述腕管综合征(Carpal Tunnel Syndrome, CTS)患者的患病现状；分析CTS患者疾病严重程度的影响因素；评价以神经-肌腱滑行练习为核心的护理干预对改善轻中度CTS患者病情的效果。方法本研究分三个阶段进行。第一阶段为国外量表的引进及汉化,通过研究国内外文献,了解目前CTS干预效果评价工具的现状,对相关评价工具进行比较和分析；经原作者同意,将波士顿腕管量表(Boston Carpal Tunnel Questionnaire, BCTQ)引进并汉化,检验其信效度,从而形成中文版的BCTQ。第二阶段为基线调查,以一般资料调查表、CTS疾病资料调查表、肌电图仪作为研究工具,调查上海市华山医院手外科门诊的CTS患者199例,了解CTS患者的患病现状并分析该病严重程度的影响因素。第三阶段为干预性研究,选择符合第三阶段纳入标准且愿意参加本研究的轻中度CTS患者42例,以随机数字表法随机分成干预组和对照组,每组各21例。两组研究对象在人口社会学资料和CTS疾病相关资料等方面的差异无统计学意义(P0.05)。对照组接受CTS知识的健康教育,干预组在此基础上给予神经-肌腱滑行练习,为期3个月,干预方式包括集中培训、个体指导、电话咨询及随访、短信服务。以中文版BCTQ得分、SF-36生活质量量表得分,电生理指标正中神经远端动作电位潜伏期(Distal Motor Latency,DML)作为评价指标,于干预后1个月、2个月、3个月分别进行干预效果的评价。结果第一阶段结果：①形成的中文版BCTQ共19个条目,包括两个维度,即症状严重程度维度和功能状况维度。②量表的Cronbach's a系数为0.90-0.947；内容效度各条目的CVI值为0.9-1.0,全部条目的平均CVI为0.95；量表各维度得分与量表总分之间的相关系数分别为0.9190.01)和0.9440.01)；因子分析按两个维度分别进行,第一个维度提取2个公因子解释总变异的66.7%,第二个维度提取1个公因子解释总变异的73.25%。第二阶段基线调查结果：①199例(共345只手)CTS患者中左手患病24例,右手患病29例,双手均患病146例；病程平均为(3.88±5.37)年；主要症状为麻木、刺痛、夜间麻醒、肌肉萎缩、疼痛。②CTS患者DML平均值为(7.06±5.59)ms；左手患病24例,DML平均值为(7.50±6.99)ms；右手患病29例,DML平均值为(5.43±1.10)ms;双手患病146例,DML平均值为(7.32±5.83)ms。③不同职业人群中农民的病情最严重,其次为蓝领、白领、家庭主妇；不同职业人群中蓝领的患病人数最多,其次为白领、农民、家庭妇女。④单因素分析结果显示：不同职业、文化程度、病程、生活习惯、家务负担的患者,其DML值差异有统计学意义(P0.05)。⑤患者一般资料和疾病资料的多元线性回归结果显示,影响患者病情严重程度的因素有文化程度和家务负担,可解释患者疾病严重程度44.4%的变异。第三阶段干预研究结果：①干预3个月后干预组DML值明显低于对照组(P0.05)。②重复测量方差分析的结果显示,干预组BCTQ症状严重程度维度得分低于对照组(P0.05),多元方差分析的结果显示,干预后1个月BCTQ症状严重程度维度得分干预组与对照组差异无统计学意义(P0.05)；干预后2个月、3个月干预组BCTQ症状严重程度维度得分低于对照组,差异有统计学意义(P0.05)。③重复测量方差分析的结果显示,干预组BCTQ功能状况维度得分低于对照组(P0.05),多元方差分析的结果显示,干预后1个月、2个月BCTQ功能状况维度得分干预组与对照组差异无统计学意义(P0.05)；干预后3个月干预组BCTQ功能状况维度得分低于对照组,差异有统计学意义(P0.05)。④重复测量方差分析的结果显示,干预前后两组患者生活质量差异无统计学意义(P0.05),但是干预组生活质量上升趋势明显优于对照组。结论中文版BCTQ具有良好的信度和效度,适宜在我国CTS患者中使用。CTS病情严重程度与文化程度、家务负担、职业环境有关。针对CTS疾病严重程度的影响因素,以神经-肌腱滑行练习为核心的护理干预能有效缓解轻中度腕管综合征患者的症状、改善手部功能。
[Abstract]:The purpose of the finished Boston carpal tunnel questionnaire and test its reliability and validity; description of carpal tunnel syndrome (Carpal Tunnel, Syndrome, CTS) prevalence situation of patients; analysis of factors affecting the disease severity of CTS patients; to evaluate nerve tendon gliding exercises nursing intervention as the core to improve the effect of patients with mild to moderate CTS. Methods this study was carried out in three stages. The first stage is the introduction of Chinese and foreign scale, through the literature research at home and abroad, study the current evaluation tool CTS intervention, the evaluation tools were compared and analyzed; with the consent of the original author, the Boston carpal tunnel scale (Boston Carpal Tunnel Questionnaire, BCTQ) is introduced and finished, test the validity to form a Chinese version of BCTQ. The second stage is baseline survey, with general information questionnaire, CTS disease data questionnaire and electromyography instrument as the research tool. We investigated 199 cases of CTS patients in the hand surgery outpatient clinic of Huashan Hospital of Shanghai, understand the prevalence of CTS, and analyze the influencing factors of the severity of the disease. The third stage is an intervention study. 42 patients with mild or moderate CTS who are willing to participate in the study are selected according to the third stage criteria. They were randomly divided into intervention group and control group by random number table, 21 cases in each group. There was no significant difference between the two groups in the data of population sociology and CTS disease related data (P0.05). The control group received health education of CTS knowledge, and the intervention group was given nerve tendon exercise for 3 months on the basis of the intervention group. The intervention included centralized training, individual guidance, telephone consultation and follow-up, and short message service. The scores of Chinese version BCTQ score and SF-36 quality of life scale, electrophysiological indicators, Distal Motor Latency (DML) of median nerve action potential were used as evaluation indexes. Intervention effects were evaluated at 1 months, 2 months and 3 months after intervention. Results the results of the first stage were: (1) the Chinese version of BCTQ was made up of 19 items, including two dimensions, the dimension of symptom severity and the dimension of functional status. The Cronbach's scale a coefficient is 0.90-0.947; the content validity CVI value is 0.9-1.0, the average CVI of all entries is 0.95; scores and total scale correlation coefficient between 0.9190.01 and 0.9440.01) respectively); factor analysis in two dimensions. The first dimension extraction, 2 common factors explain 66.7% of the total variation, the second dimensions extracted 1 factors explain 73.25% of the total variation. The second stage baseline survey results were as follows: (1) among 199 cases (345 hands), 24 cases were left hand disease, 29 cases were right hand disease, 146 cases were both hands, and the average duration was (3.88 + 5.37) years. The main symptoms were numbness, tingling, night awakening, muscle atrophy and pain. CTS was the most common symptom in all patients. (2) the average DML value of CTS patients was (7.06 + 5.59) MS; 24 cases of left hand disease, DML mean value (7.50 + 6.99) MS; 29 cases of right hand disease, DML mean value (5.43 + 1.10) MS; 146 cases of both hands, DML average value (7.32 + 5.83) Ms. (3) farmers in different occupational groups are the most serious, followed by blue collar, white collar and housewives. The number of blue collar workers is the largest among different occupational groups, followed by white collar, farmers and family women. (4) univariate analysis showed that the DML value of patients with different occupations, educational level, course of disease, living habits and household burdens was statistically significant (P0.05). (5) multiple linear regression analysis of general information and disease data showed that factors influencing the severity of illness were educational level and housework burden, which could explain the variation of disease severity by 44.4%. The results of the third stage intervention study: (1) after 3 months of intervention, the DML value of the intervention group was significantly lower than that of the control group (P0.05). The results of the repeated measures analysis of variance showed that the intervention group than in the control group BCTQ symptom severity score (P0.05), multivariate analysis of variance showed that 1 months BCTQ symptom severity scores after the intervention group and the control group had no significant difference (P0.05); after 2 months and 3 months the intervention group BCTQ symptom severity score lower than the control group, the difference was statistically significant (P0.05). The results of the repeated measures analysis of variance showed that the intervention group than in the control group BCTQ function score (P0.05), multivariate analysis of variance showed that 1 months after the intervention, 2 months BCTQ function score of the intervention group and the control group had no significant difference (P0.05); the intervention group at 3 months BCTQ function score lower than the control group, the difference was statistically significant (P0.05). (4) the results of repeated measures analysis showed that there was no significant difference in the quality of life between the two groups before and after intervention (P0.05), but the quality of life in the intervention group was significantly better than that in the control group. Conclusion the Chinese version of BCTQ has good reliability and validity, and is suitable for the use of CTS patients in China. The severity of CTS was related to the degree of education, the burden of housework, and the occupational environment. According to the factors influencing the severity of CTS disease, the nursing intervention based on neuro tendon slide exercise can effectively relieve symptoms and improve hand function in patients with mild to moderate carpal tunnel syndrome.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.6

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