下肢智能反馈训练系统对脊髓损伤患者膀胱功能的影响

发布时间：2018-07-18 12:15

【摘要】：目的本研究的目的是针对脊髓损伤伴有膀胱功能障碍的患者在采取常规药物、理疗、膀胱功能训练及护理等基础上试验组加用下肢智能反馈训练系统进行治疗,观察分析治疗前后两组间患者膀胱功能有无差别,进而探讨下肢智能反馈训练系统对脊髓损伤患者膀胱功能的作用及临床应用价值。方法选择经过磁共振成像(MRI)、临床表现及相关检查确诊为脊髓损伤并伴有膀胱功能障碍的40例住院患者,按照随机化原则和就诊时间先后的顺序进行相应分组,40例符合要求并愿意进行该项试验的患者中选取20例作为试验组,另20例患者作为对照组,两组患者两组均进行常规康复治疗,包括:①药物治疗:常规剂量的营养神经药物,存在尿路感染者,根据尿培养及药敏试验结果选用相应抗生素等;②运动疗法和理疗:肌力减弱或丧失肢体的主、被动活动,智能运动训练仪、神经肌肉电刺激、气压治疗仪和电动起立床训练,均为一天两次,每次30分钟;③膀胱功能的护理:由康复护理人员教会患者及其家属定时夹闭导尿管,制定合理的饮水、进食计划,进行排尿意识的训练,学会用伐尔沙耳法(Valsalva法)、克莱台法(Crede法)辅助排尿,同时对患者进行心理护理和健康教育。试验组在上述常规康复治疗的基础上加用下肢智能反馈训练系统进行训练。两组患者于进行该项试验治疗前及治疗四周达到一个疗程后分别进行导尿管膀胱残余尿测定,通过残余尿量多少反映膀胱功能状态。此外根据国际脊髓损伤数据集下尿路功能基本数据集表格记录并收集各组患者治疗前后的尿意、非自主漏尿频率、膀胱排空方法,进行相应比较。最后运用SPSS 17.0统计软件对上述采集的数据进行分析和综合处理,加以总结得出结论。结果40例患者均配合完成试验,未有发生体位性低血压等不良反应,两组患者的性别、年龄经过统计分析无明显差异。试验组和对照组患者膀胱残余尿量治疗前差异无统计学意义(P0.05),治疗后均减少,且差异有统计学意义(P0.05);试验组中有4例恢复尿意,3例膀胱排空方法发生改变,5例非自主漏尿频率发生改变;对照组有2例恢复尿意,1例膀胱排空方法发生改变,2例非自主漏尿频率发生改变。美国脊髓损伤协会(ASIA)损伤程度分级中以上各项观察指标低级患者的恢复数目多于高级患者。结论常规的药物治疗、运动疗法、理疗、膀胱功能训练及护理对促进膀胱功能的改善有一定的帮助,而试验组的数据表明在以上治疗的基础上加用下肢智能反馈训练系统能够进一步恢复膀胱功能。在整个治疗过程中未见患者发生相关不良反应,患者耐受性及适应性较好,有较广阔的应用前景。另外膀胱功能有所恢复的患者中ASIA分级程度低级患者的数目多于高级患者,两者似有相关性,推测ASIA损伤程度分级中低级患者的康复效果可能优于高级患者。
[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.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.2;R49

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