水针治疗脑瘫患儿智力障碍的临床研究

发布时间：2018-03-11 02:33

本文选题：水针　切入点：综合康复治疗　出处：《郑州大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:采用水针与常规康复结合疗法及常规康复疗法分别对脑性瘫痪伴智力障碍的患儿进行治疗,观察记录治疗过程中两组患儿的智力改善情况及大脑前、中、后动脉的血流学改变,并对其与疗效的关系进行观察和统计分析,以综合评价水针治疗脑瘫智力障碍的临床疗效,探讨水针改善脑瘫患儿脑血流动力学的作用,以进一步明确其作用机理,为判断水针治疗脑瘫伴智力障碍的预期效应提供依据,为治疗脑瘫智力障碍探索方法,同时提高水针治疗在小儿脑瘫康复治疗方面,尤其是在伴有智力障碍患儿治疗中的作用和地位。方法:本课题采用随机、对照、平行的研究方法进行试验,将80例脑瘫患儿,随机平均分为治疗组和对照组,每组40例。其中,治疗组患儿,采用常规康复方法与水针间隔交叉治疗,对照组患儿采用常规康复治疗,不进行水针治疗。对两组脑瘫患儿采取相同的康复治疗方案,具体为分别采用运动疗法、语言疗法、作业疗法以及引导式教育进行综合的康复训练治疗,治疗期间每23天为一个疗程,共计进行3个疗程。治疗前后分别从智力发育指数、脑血流动力学指标、不良反应3个方面进行评定,观察患儿智力改善情况、治疗前后的脑血流动力学变化情况及安全性分析,并于所有疗程结束后的一个月,进行临床随访,随访结束进行详细、规范的统计学分析,从统计分析结果来客观的评价疗效。结果:1.综合疗效的比较:经治疗,3疗程结束后,治疗组40例患儿,达到正常化患儿共30例,另有6例患儿效果显著,3例患儿有效,1例患儿治疗无效,正常化率为30/40=75%,总有效率为39/40=97.5%;对照组40例患儿中,达到正常化15例,显效10例,有效6例,无效9例,正常化率37.5%,总有效率77.5%;经Redit统计分析P=0.000(P0.05),差异有统计学意义。2.症状、体征评分比较:两组脑瘫患儿治疗前后分别进行MDI评分、PDI评分,其中,组内自身比较及治疗后组间比较,均具有统计学差异(p0.05);各疗程结束后与前一疗程相比较,比较组内大脑前、中、后动脉血流动力学参数的变化,其中Vs,Vm,Vd参数升高,RI参数降低,差异有统计学意义(均P0.05)。结论:1.水针治疗对脑瘫患儿脑血流有直接影响,脑血流动力学变化具有一定特征性,脑血流加快,血管阻力降低,且血流动力学变化早于形态学改变。2.水针结合综合康复治疗方法对于脑瘫患儿智力障碍的治疗临床疗效肯定,治疗组效果优于对照组(P0.05),可以明显改善患儿的智力障碍状态及综合能力,增强患儿的生活自主能力,为家庭、社会减轻负担。3.两组1-2岁患儿的疗效均优于2岁以上患儿的疗效(P0.05),治疗组改善更明显,说明治疗疗效与年龄大小密切相关,年龄越小,疗效越好。4.通过分别分析第1疗程末、第2疗程末以及第3疗程末的治疗效果,证明疗效与疗程的长短有关,且疗程越长的效果越好。5.治疗小儿脑瘫的关键在于早期诊断、早期干预治疗,并要持之以恒的坚持治疗;水针为主的综合治疗方法是安全有效的,无不良反应及毒副作用,值得推广。
[Abstract]:Objective: using the water needle and the conventional rehabilitation therapy and routine rehabilitation therapy of cerebral palsy children with mental disorders treatment, the two groups were observed during the treatment were recorded the improvement of intelligence and brain before, the change after arterial blood flow, and the relationship with the curative effect of observation and statistical analysis based on the comprehensive evaluation of water injection, the treatment of cerebral palsy with intellectual disabilities to explore the clinical curative effect, improve the water injection in children with cerebral palsy cerebral hemodynamic effects, in order to further clarify its mechanism of action, with intellectual disabilities to determine the intended effect of water injection in treatment of cerebral palsy should provide the basis for the exploration of methods for the treatment of cerebral palsy, mental retardation, and improve water treatment in needle rehabilitation treatment of cerebral palsy in children, especially the role and status in the treatment of children with mental disorders. Methods: This study used a randomized, controlled, parallel study to test 80 cases Children with cerebral palsy were randomly divided into treatment group and control group, 40 cases in each group. The treatment group, the treatment of conventional rehabilitation method and cross water injection interval, the control group were treated with routine rehabilitation treatment, without water needle treatment. Take the same rehabilitation treatment in two groups of children with cerebral palsy, specific respectively. With exercise therapy, speech therapy, occupational therapy and guiding education of comprehensive rehabilitation treatment, during treatment every 23 days for a course of treatment, a total of 3 courses. Before and after treatment respectively from the mental development index, index of cerebral blood flow dynamics, 3 aspects of adverse reactions were evaluated, observed improvement of intelligence. Analysis of cerebral hemodynamic changes and safety before and after treatment, and in all month after the end of treatment, clinical follow-up, follow-up detailed, standardized statistical analysis, from the statistical analysis Objective to evaluate the efficacy results. Results: compared with 1. comprehensive effect: after treatment, 3 after the end of treatment, the treatment group of 40 cases, to achieve normalization of 30 cases and 6 cases of children with significant effect, 3 cases effective, 1 cases ineffective treatment, the normalization rate of 30/40=75%, total efficiency 39/40=97.5%; the control group of 40 cases, 15 cases of normal, 10 cases were markedly effective, 6 cases effective, 9 cases ineffective, the normal rate of 37.5%, the total efficiency of 77.5%; statistical analysis by Redit P=0.000 (P0.05), the difference was statistically significant.2. symptoms, signs score: MDI score, respectively before and after two groups of children with cerebral palsy treatment PDI score, which, within the group itself and the comparison between the two groups after treatment, there was significant difference (P0.05); after the treatment compared with before treatment, were compared within brain before, changes of arterial blood flow mechanics parameters including Vs, Vm, Vd parameters increased RI parameters The number is reduced, the difference was statistically significant (P0.05). Conclusion: 1. water needle therapy has a direct effect on the cerebral blood flow in children with cerebral palsy, with certain characteristics of cerebral hemodynamic changes in cerebral blood flow, accelerate vascular resistance decreased, and the hemodynamic changes in early morphological changes of the.2. water needle combined with comprehensive rehabilitation therapy certainly treatment clinical curative effect for cerebral palsy children with intellectual disabilities, the treatment group is better than the control group (P0.05), can significantly improve the mental state and the comprehensive ability of children, enhance independent living ability, with the family, the efficacy of social burden.3. two group of 1-2 year old children were better than those of children over the age of 2 (P0.05), the treatment group the improvement is more obvious, indicating that the treatment effect and age are closely related, the younger the better curative effect by.4. were analyzed at the end of the first course, at the end of the second course and third course of treatment at the end of the treatment, proof The efficacy and duration on the length of the key, and the longer the duration the better the effect of.5. treatment for children with cerebral palsy is early diagnosis, early intervention, and to persevere adhere to treatment; comprehensive treatment method of water injection is safe and effective, no adverse reactions and side effects, worthy of promotion.

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R742.3

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