维西医结合康复护理干预对废用综合征关节挛缩患者的影响研究

发布时间：2018-01-24 01:51

  本文关键词： 废用综合征 维西医结合康复护理干预 关节活动度 便秘　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:选取在养老福利院疗养的日常生活活动能力FIM量表评分低于54分长期卧床废用综合征患者,通过调查分析废用综合征患者的一般情况,并采用维西医结合康复护理干预对长期卧床废用综合征关节挛缩的患者进行干预,探讨其对肌力、肌张力、关节活动度、运动功能、30秒站立坚持时间、日常生活活动能力、生活质量、便秘等的疗效。方法:选择长期居住在乌鲁木齐市两所养老福利院,因各种原因造成的长期卧床,低运动而发生的肌肉萎缩及关节挛缩的日常生活活动能力得分采用FIM量表评分低于54分的废用综合征患者作为研究对象,对其进行废用综合征一般情况、肌力、肌张力、关节活动度、30s站立坚持时间、运动功能、日常生活活动能力等基线情况进行问卷调查并分析。将80例废用综合征患者按照随机数字法分为实验组40例与对照组40例,实验组进行维西医结合康复护理干预,对照组进行常规的诊疗及康复护理,并对干预前、干预4周后,追踪期结束8周后的指标(肌力及肌张力、关节活动度、30s站立坚持时间、运动功能、日常生活活动能力、生活质量等的得分)进行疗效评价。结果:1.基线结果:(1)废用综合征患者的基线资料:80例废用综合征患者的平均年龄为(69.25±7.80)岁,其中男性为50例,女性为30例;自理程度:完全不自理者33例,部分不自理者47例。(2)实验组和对照组患者在干预前的基线资料的比较,两组患者性别、年龄、废用综合征病程等一般情况经统计学处理,差异无统计学意义(P0.05),具有可比性。2.干预前后实验组和对照组的变化:(1)实验组患者在肌力,肩关节、肘关节(屈)、腕关节、髋关节、膝关节(屈)、踝关节等关节活动度,运动功能,日常生活活动能力,30s站立坚持时间,生活质量等得分在干预前、干预4周后、追踪期结束8周后的比较,差异均具有统计学意义(P0.05)。实验组肌张力在干预前、干预4周后、追踪期结束8周后的得分的比较,差异无统计学意义(P0.05)。(2)对照组患者在肌力,肩关节、肘关节(屈)、腕关节关节活度,运动功能,日常生活活动能力等得分在干预前、干预4周后、追踪期结束8周后的比较,差异有统计学意义(P0.05)外,其余的均无统计学意义(P0.05)。(3)干预前实验组和对照组患者均有不同程度的便秘症状,用手微振动护理方法干预后,实验组无一例出现便秘症状,对照组有17例(43.6%)出现便秘症状。两组患者便秘发生率比较,差异有统计学意义(χ2=20.775,P0.05)。3.实验组和对照组患者各指标的比较:(1)肌力和肌张力得分的比较:实验组和对照组在干预前、干预4周后、追踪期结束8周后的肌力得分的比较,干预前无统计学差异,干预4周后、追踪期结束8周后肌力的比较,其差异具有统计学意义(P0.05),实验组肌力的提高比对照组较好。实验组和对照组在干预前、干预4周后、追踪期结束8周后的肌张力得分的比较,除了追踪期结束8周后的左上肢肌张力和右下肢肌张力得分的比较差异有统计学意义(P0.05)外,其余的均无统计学意义(P0.05)。实验组和对照组在肌张力的改变没有明显差异。(2)肩关节、肘关节、腕关节关节活动度得分的比较:实验组和对照组患者在干预前、干预4周后、追踪期结束8周后关节活动度得分的比较,除了追踪期结束8周后肩关节(屈、外展)关节活动度的比较差异有统计学意义(P0.05)外,其余的均无统计学意义(P0.05)。实验组和对照组患者在肩关节、肘关节、腕关节活动度的变化不太明显。(3)髋关节、膝关节、踝关节的关节活动度得分的比较:实验组和对照组患者在干预前、干预4周后、追踪期结束8周后关节活动度的比较,除了干预前髋关节、膝关节、踝关节关节活动度的比较差异无统计学意义(P0.05),实验组和对照组患者在干预4周后、追踪期结束8周后的髋关节(屈、伸、外展、内收、内旋、外旋),膝关节(屈、伸)踝关节(背屈、跖屈、内翻、外翻)关节活动度的比较差异均有统计学意义(P0.05)。干预后髋关节、膝关节、踝关节关节活动度的改善,实验组患者关节活动度明显优于对照组。(4)日常生活活动能力、生活质量、30s站立坚持时间、运动功能得分的比较:实验组和对照组在干预前、干预4周后、追踪期结束8周后的运动功能、日常生活活动能力、生活质量、30s站立坚持时间的比较,干预4周后的生活质量、30s站立坚持时间和追踪期结束8周后的运动功能、日常生活活动能力、生活质量、30s站立坚持时间得分的比较差异有统计学意义(P0.05)外,其余无统计学意义(P0.05)。结果表明,在追踪期结8周后,实验组在日常生活活动能力、运动功能、生活质量、30s站立坚持时间的得分的改善情况明显高于对照组的得分。(5)干预前、干预4周后和追踪期结束8周后,两组排便次数的比较,差异有统计学意义(t=-1.537、15.275、18.458,P0.05)。随着干预时间的推移,排便次数增加。实验组缓解便秘的效果优于对照组。结论:维西医结合康复护理干预方法对废用综合征患者肌力,关节活动度,运动功能,日常生活活动能力,生活质量,30s站立坚持时间,便秘等指标有明显疗效,日常生活逐渐趋向自理,可以解决自己最基本的日常生活活动。肌力,关节活动度和生活质量得到明显的提高,减轻便秘效果较好,并且治疗效果可以维持较长时间,没有复发及不良反应发生,安全、经济、方便、快速有效。维西医结合康复护理方法可以让废用综合征患者生活去向自理,提高患者的生活质量,值得推广到养老护理领域
[Abstract]:Objective: to select the score below 54 long-term bedridden patients with disuse syndrome in ADL FIM nursing old-age welfare institute, through the investigation and analysis of the general situation of disuse syndrome, and the use of medicine in Weixi rehabilitation nursing intervention intervention in bedridden disuse syndrome joint contracture patients, to explore the the muscle strength, muscle tension, joint activity, motor function, 30 seconds standing time to adhere to the quality of life, activities of daily living, and the effect of constipation. Methods: long-term residence in Urumqi City old-age welfare institute, bedridden due to a variety of causes, muscle atrophy and joint contracture and the occurrence of low motion ADL scores using FIM score less than 54 points of disuse syndrome patients as the research object, carries on the disuse syndrome in general, muscle strength, muscle tension, joint. Mobility, 30s standing time to adhere to motor function, analysis, questionnaire survey and ADL baseline. 80 patients with disuse syndrome were randomly divided into experimental group 40 cases and 40 cases in the control group, the experimental group were given rehabilitation nursing intervention combined with medicine control group Sulawesi, treatment and rehabilitation the routine nursing, and the intervention before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the index (muscle strength and muscle tension, joint activity, 30s insisted on standing time, motor function, activities of daily living, quality of life score) for clinical evaluation. Results: 1. baseline results: (1) disuse syndrome: 80 cases of patients with baseline data of disuse syndrome patients for the average age (69.25 + 7.80) years old, including 50 cases of male, female 30 cases; degree of self-care: no self-care in 33 cases, 47 cases were not part of themselves. (2) the experimental group and the control group patients in the stem Comparison of baseline data pre of the two groups of patients with gender, age, duration of disuse syndrome in general statistically, there was no statistically significant difference (P0.05), with comparable changes in the experimental group and the control group before and after the intervention of.2.: (1) patients in the experimental group in muscle strength, shoulder joint, elbow joint (flexion), wrist, hip, knee, ankle joint (flexion) joint activity, motor function, activities of daily living, 30s standing time to adhere to the quality of life score, before intervention, after 4 weeks of intervention, the follow-up period was more than the end of 8 weeks, the differences were statistically significant (P0.05). The muscle tension of experimental group before intervention, after 4 weeks of intervention, compared with follow-up of 8 weeks after the end of the score, the difference was not statistically significant (P0.05). (2) patients in the control group in the muscle, shoulder joint, elbow joint, wrist joint (flexion) joint activity, motor function, activities the daily life ability score in intervention Before and after 4 weeks of intervention, the follow-up period was 8 weeks after the end of comparison, the difference was statistically significant (P0.05), the rest were not statistically significant (P0.05). (3) before the intervention group and the control group of patients had different symptoms of constipation, hand micro vibration nursing intervention, the experimental group there were no symptoms of constipation, 17 cases in the control group (43.6%). Two groups of patients with symptoms of constipation constipation were compared, the difference was statistically significant (2=20.775, P0.05).3. experimental group and control group in each index: (1) comparison of muscle strength and muscle tension scores of the experimental group and control group before intervention, after 4 weeks of intervention, comparison of follow-up end strength score after 8 weeks before the intervention, no significant difference after 4 weeks of intervention, the follow-up period was 8 weeks after the end of the comparison of strength, the difference was statistically significant (P0.05), the experimental group than the control group improved muscle force experiment is better. And the control group Group before intervention, after 4 weeks of intervention, comparison of follow-up end muscle tension scores after 8 weeks, in addition to differences in the follow-up period of 8 weeks after the end of the left upper limb muscle tension and right lower limb muscle tension scores was statistically significant (P0.05), the rest were not statistically significant (P0.05). No obvious the difference in muscle tension changes in experimental group and control group. (2) the shoulder joint, elbow joint, wrist joint activity score comparison: the experimental group and the control group of patients before intervention, after 4 weeks of intervention, the follow-up period end compare joint activity score after 8 weeks, in addition to the end of the 8 week follow-up period after the shoulder joint (flexion, abduction) there was a significant difference between the joint activity (P0.05), the rest were not statistically significant (P0.05). The experimental group and the control group in the patients with shoulder joint, elbow joint, wrist movement change is not obvious. (3) of hip joint, knee joint. The ankle joint. 鍔ㄥ害寰楀垎鐨勬瘮杈，

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