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醫(yī)學(xué)論文范文:偏癱患者綜合性神經(jīng)康復(fù)治療的療效觀察
【摘要】 目的 探討綜合性神經(jīng)康復(fù)治療對(duì)偏癱患者神經(jīng)功能缺損及抑郁障礙的療效。方法 將62例首發(fā)偏癱伴抑郁癥狀的患者隨機(jī)分為治療組和對(duì)照組，每組31例，治療組給予規(guī)范的綜合性神經(jīng)康復(fù)治療，包括運(yùn)動(dòng)療法、心理治療和神經(jīng)科常規(guī)藥物治療，對(duì)照組予神經(jīng)科常規(guī)藥物治療。用腦卒中患者臨床神經(jīng)功能缺損程度評(píng)分標(biāo)準(zhǔn)和漢密爾頓抑郁量表(HAMD)，分別于治療前和治療后2、4周末對(duì)患者進(jìn)行療效評(píng)定。結(jié)果 治療組與對(duì)照組腦卒中患者臨床神經(jīng)功能缺損程度評(píng)分和HAMD評(píng)分在治療前差異無(wú)顯著性(P>0.05);治療2周末治療組評(píng)分低于對(duì)照組，但差異無(wú)顯著性(P>0.05);4周末治療組評(píng)分均低于對(duì)照組，差異有顯著性(P<0.05)。結(jié)論 綜合性神經(jīng)康復(fù)治療能顯著改善偏癱患者神經(jīng)功能缺損，緩解患者的抑郁癥狀。
【關(guān)鍵詞】 偏癱;抑郁;神經(jīng)功能缺損;康復(fù)治療
Clinical observation of integral neurological rehabilitation in 62 cases with hemiplegia
WEI Jingang醫(yī).學(xué)全.在.線網(wǎng)站gydjdsj.org.cn
(Gulou Hospital of Xuzhou, Xuzhou, Jiangsu 221005, China)
Abstract： Objective To probe into the effect of a comprehensive neurological rehabilitation regimen on the neurological impairment and remission of depression in patients with hemiplegia. Methods 62 cases of the initial hemiplegia with depression were randomized into two groups: the treatment group and the control group (n=31 ealch). The treatment group underwent standardized integral treatment of neurological rehabilitation, physical therapy, routine psychological and neurological medication; while the control group only received routine neurological drug administration. Patients with stroke were assessed for efficacy by clinical neurological impairment scoring criteria and the Hamilton Depression Rating Scale (HAMD), before treatment and 2 and 4 weeks after treatment, respectively. Results The clinical neurological impairment score and the HAMD scores had no differences between the treatment group and the control group before the treatment (P>0.05); and 2 weeks after the treatment, the scores in treatment group were slightly lower than those in the control group, but the difference had no statistical significance (P>0.05); the clinical degree of neurological impairments and HAMD scores of patients with stroke in the treatment group were lower than those in the control group, with significant statistical difference at the end of the 4th week (P<0.05). Conclusion The neurological rehabilitation therapy can significantly improve the neurological impairment and relieve the depressive symptoms in patients with hemiplegia.
Key words： hemiplegia; depression; neurological impairment; rehabilitation therapy
已換 引起偏癱的原因很多，腦卒中、腦外傷最為常見(jiàn)，我國(guó)每年死于腦卒中者約130萬(wàn)，存活者約75%致殘，給家庭和社會(huì)帶來(lái)沉重負(fù)擔(dān)。早期、積極康復(fù)治療，將使80%的患者功能明顯改善[1]。多數(shù)偏癱患者出現(xiàn)應(yīng)激性心理反應(yīng)，包括情緒反應(yīng)、行為反應(yīng)、自我防御反應(yīng)[2]，不能配合治療，因此我們應(yīng)用綜合性神經(jīng)康復(fù)治療改善偏癱患者的神經(jīng)功能缺損，緩解抑郁癥狀，從而促進(jìn)患者肢體功能康復(fù)。
1 對(duì)象和方法
1.1 對(duì)象 選取2008年5月—2009年4月在我院治療的偏癱患者62例，男32例，女30例，年齡29～72歲，平均(57.3±7.5)歲。其中腦外傷1例，腦梗死41例，腦出血20例。全部患者均經(jīng)頭顱CT或MRI確診，生命體征平穩(wěn)，意識(shí)清楚。按入院治療順序隨機(jī)分為治療組、對(duì)照組，每組31例。2組患者在性別、年齡、病種、神經(jīng)功能缺損、抑郁等方面均有可比性。
1.2 方法 治療組予以綜合性神經(jīng)康復(fù)治療。①運(yùn)動(dòng)療法：運(yùn)用神經(jīng)肌肉促進(jìn)技術(shù)對(duì)患側(cè)肢體進(jìn)行被動(dòng)活動(dòng)、床上訓(xùn)練、起坐訓(xùn)練、站位平衡訓(xùn)練、步行訓(xùn)練、日常生活活動(dòng)訓(xùn)練等[3]， 每天2次，每次40 min。②心理治療，每天1次，每次30 min，采用認(rèn)知療法、支持療法等進(jìn)行心理疏導(dǎo)、積極心理暗示，促進(jìn)患者保持良好心態(tài)[4]。心理治療要注意溝通技巧，特別是談話技巧、傾聽(tīng)的技巧、提問(wèn)的技巧、反饋的技巧[5]。③藥物按神經(jīng)科常規(guī)藥物治療。對(duì)照組按神經(jīng)科常規(guī)藥物治療。
