良肢位及早期康复护理对脑卒中肢体功能恢复的影响

2003-02～2006-08我们对脑卒中患者进行良肢位摆放及早期康复护理，取得较好效果，总结如下。     

脑卒中吞咽障碍患者早期康复护理

吞咽障碍是脑卒中常见的症状之一,50％脑卒中患者发病后伴有不同程度的吞咽障碍。吞咽障碍常由球麻痹和假性球麻痹引起,轻者只有吞咽不畅感或者出现误咽,重者因水摄食一吞咽障碍,可导致窒息而危及生命,因此,吞咽障碍康复为当务之急,必须尽早改善其摄食一吞咽功能,以补充足够的营养和水分,增加机体抵抗力,对疾病的康复有重要意义。     

脑卒中患者的早期综合康复护理观察

为探讨早期综合康复护理对脑卒中患者功能恢复的影响，我科对40例脑血管患者实施了早期综合康复护理，取得了满意的效果．总结如下。     

急性脑卒中偏瘫患者早期康复的护理

目的：探讨急性脑卒中偏瘫患者早期康复护理的意义。方法：将现代康复的理念与早期临床护理相结合，对186例脑卒中患者入院6周内实施心理护理和康复措施。结果：早期介入康复护理，取得了较好的疗效。结论：急性脑卒中偏瘫患者给予早期康复护理对提高患者的活动能力和降低并发症和致残率有肯定效果。     

脑卒中患者早期康复护理探讨

目的：探讨脑卒中患者早期康复护理的意义。方法：将720例脑卒中患者随机分为观察组340例和对照组380例,对照组给予神经内科常规治疗和护理,观察组在此基础上实施早期康复护理。结果：观察组与对照组之间患侧上、下肢功能恢复程度差异有统计学意义（P〈0.05）。结论：对脑卒中患者早期康复护理可有效改善患者患肢功能,提高患者生活质量。     

脑卒中患者早期康复护理干预措施的研究进展

据卫生部~([1])统计,我国现有脑卒中幸存者700万例,每年新发患者约为150万例,发病率为每年219/10万人.脑卒中的致残率为86.5%~([2]),生活不能自理的比例达到了43.2%~([3]),严重影响了患者的生活质量.国外的研究~([4-5])显示,早期的院内康复对于脑卒中患者功能恢复是极其重要的,可以提高患者的感觉运动反应和运动功能,同时降低长期花费.多数急性脑卒中的治疗准则中指出,脑卒中的康复应该在早期开展.本文对近期脑卒中早期康复的研究做了回顾,以期为国内相关研究提供依据.     

脑卒中吞咽障碍患者的早期康复护理

目的 :探讨脑卒中吞咽障碍患者的早期康复护理。方法 :对 18例脑卒中吞咽障碍患者随机分为康复护理治疗组 9例(简称康复组 )和神经科常规护理治疗组 9例 (简称对照组 ) ,用藤岛一郎吞咽疗效评价标准和才藤氏提出的吞咽障碍 7级评价法为观察标准 ,康复治疗组进行系统康复护理训练治疗。结果 :早期康复护理治疗组藤岛一郎吞咽疗效评价平均得分和才藤氏吞咽障碍分级均明显高于对照组 (P <0 .0 1)。结论 :对脑卒中吞咽障碍患者进行早期吞咽功能训练 ,使患者恢复了经口吞咽进食 ,提高了患者的生活质量。     

脑卒中患者的超早期康复护理对功能恢复的影响

我科2002-03～2004-05对住院的脑卒中患进行超早期肢体康复护理,取得较好效果,现报告如下.     

早期康复护理对急性脑卒中患者并发症的影响

[目的]探讨早期康复护理对急性脑卒中患者并发症的影响。[方法]将2006年6月至2008年6月共72例急性脑卒中患者随机分为观察组和对照组，观察组37例，对照组35例，两组入院时性别、年龄、治疗方案、病情相比较无显著性差异，具有可比性，对照组采用常规内科护理，观察组采用常规内科护理结合早期康复护理，发病后3个月对其并发症发生情况进行评价分析。[结果]观察组压疮、肩关节脱位、肩手综合征、关节挛缩的发生率显著低于对照组（P〉0．05）。[结论]早期康复护理能显著减少急性脑卒中患者并发症的发生。     

早期康复护理改善脑卒中患者肢体运动障碍

对脑卒中患者进行神经内科治疗的同时,早期融入包括心理护理、皮肤按摩、被动运动、助力运动等康复护理,可促进偏瘫肢体运动功能的恢复。48例早期接受康复护理的脑卒中患者中38例于3个月内运动能力及生活自理能力完全恢复。     

脑卒中偏瘫患者的家庭康复干预

目的探讨家庭康复干预措施对脑卒中偏瘫患者肢体运动功能恢复的作用.方法对60例脑卒中偏瘫患者中的30例出院后施以康复干预(干预组),与其余30例出院后不给予干预的惠者(对照组)进行比较.结果干预组肢体运动功能、日常生活能力均明显高于对照组,差异有显著性.结论家庭康复干预能明显促进脑卒中偏瘫患者肢体运动功能的恢复.     

Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship

Objectives

To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group.

Design

Retrospective analysis of program evaluation data for treatment completers and noncompleters.

Setting

HCBR conducted in 7 geographically distinct U.S. cities.

Participants

Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion.

Intervention

HCBR delivered by certified professional staff on an individualized basis.

Main Outcome Measures

Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge.

Results

With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P<.001) with a moderate effect size (partial η²=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P<.001; partial η²=.08), Adjustment (F=99.67, P<.001; partial η²=.10), and Participation (F=69.15, P<.001; partial η²=.07).

Conclusions

Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.     

早期康复护理干预对脑卒中肢体运动功能的影响

目的：探讨早期康复护理干预对脑卒中肢体运动功能的影响。方法：８６例脑卒中患者分研究组及对照组,除常规治疗外,研究组患者从急性期开始即由康复护师制订并实施早期康复计划。结果：两组治疗前、治疗后一个月、治疗后三个月经Ｂｒｕｎｎｓｔｒｏｍ分级、Ｆｕｇｌ－Ｍｅｙｅｒ运动项目积分及ＡＤＬ评分比较,研究组均优于对照组（Ｐ＜０．０５,Ｐ＜０．０１）。结论：早期康复护理介入对降低脑卒中病死率、致残率、减少并发症等均有重要意义     

The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage

OBJECTIVE: To investigate the effect of early aerobic training on the aerobic and functional abilities of patients in the subacute stage of cerebrovascular accident (CVA). DESIGN: Randomized controlled trial. SETTING: Rehabilitation unit in Israel. PARTICIPANTS: Ninety-two patients who had a first CVA were randomly assigned to an exercise-training group or to a control group. INTERVENTION: Aerobic training with a leg cycle ergometer for 8 weeks. MAIN OUTCOME MEASURES: Workload, exercise time, resting and submaximal blood pressure and heart rate, and functional abilities. RESULTS: A trend toward improvement was found in all aerobic parameters for the experimental group, but only heart rate at rest (P=.02), workload, and work time (P<.01) improved significantly. A trend for improvement was also found in all parameters of function for the experimental group, but only stair climbing was significantly better (P<.01). An interaction (95% confidence interval, 1.7-17.21) was found between age and aerobic training on walking distance. Although no significant effect was found in the group of younger patients (aged <65y), a significant difference in favor of training was noted in the group of older patients. CONCLUSIONS: Patients with CVA in the subacute stage improved some of their aerobic and functional abilities after submaximal aerobic training.     

脑血管意外患者就诊情况的调查分析

目的探讨脑血管意外患者的就诊特点及规律,为脑血管意外的防治提供科学依据。方法采用回顾性调查研究的方法对我科2006年1月～12月986例脑血管意外患者的性别、年龄、好发季节、地区分布、一般患者和危重患者就诊时间进行统计分析。结果本组986例脑血管意外患者,男女之比为1．63：1,平均年龄57．63±19．53岁,高发年龄组为60岁～、70岁～两个组。24h就诊高峰时段为10：00～13：00,18：00～21：00,冬春季节的发病率明显高于夏秋季节。脑梗塞占脑血管意外患者的55．68％。结论急诊护理管理应根据就诊现状调查科学运作,合理安排人员,加强人员的培训,物资储备等;加强普及公众相关知识的健康教育和院前急救与搬运工作对脑血管意外的救治具有重要意义。     

心理分级护理干预对脑血管介入治疗患者的影响

目的:探讨心理分级护理干预对脑血管介入治疗患者的影响。方法:选取2017年3月1日~2019年1月31日收治的92例脑血管患者为研究对象,根据随机数字表法分为观察组和对照组各46例,对照组采用常规围术期护理,观察组采用心理分级护理干预;比较两组干预前后睡眠质量(采用SPIEGEL睡眠质量量表)、焦虑、抑郁程度[采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]、疼痛程度[采用视觉模拟评分法(VAS)]。结果:干预后,两组睡眠深度、醒后感觉评分及睡眠质量总分均低于干预前(P<0.05),且观察组上床入睡时间、夜醒次数、一夜总睡眠时间、夜间做梦情况、睡眠深度、醒后感觉评分及睡眠质量总分均低于对照组(P<0.01);干预后,两组HAMA、HAMD评分均低于干预前(P<0.05),且观察组均低于对照组(P<0.01);干预后,两组VAS评分均低于干预前(P<0.05),且观察组低于对照组(P<0.01)。结论:心理分级护理能显著改善脑血管介入治疗患者睡眠质量,缓解其焦虑、抑郁等不良情绪,还能减轻介入治疗疼痛感。     

出院指导对脑血管病患者家庭康复的影响

目的 为了探讨出院指导对脑血管病患者家庭康复的影响.方法 作者随机抽取1997年7月至9月实施出院指导的36例病人作为观察组,随机抽取1997年3月至7月未实施出院指导的30例病人作为对照组,进行随访调查和分析.结果 两组病例1年内再次发病和并发症的发生率、生活自理情况有显著性差异,观察组优于对照组,P<0.05.结论 出院指导对脑血管病患者家庭康复具有十分重要的作用.     

Effect of Different Walking Aids on Walking Capacity of Patients With Poststroke Hemiparesis

Allet L, Leemann B, Guyen E, Murphy L, Monnin D, Herrmann FR, Schnider A. Effect of different walking aids on walking capacity of patients with poststroke hemiparesis.

Objective

To examine the effects of 3 different walking aids on walking capacity, temporo-spatial gait parameters, and patient satisfaction.

Design

Observational study.

Setting

University Hospital of Geneva.

Participants

Hemiparetic inpatients (N=25) with impaired gait, at an early stage of rehabilitation, unfamiliar with any of the walking aids tested.

Interventions

On 3 consecutive days subjects used, in random order, 1 of 3 walking aids: 4-point cane, simple cane with ergonomic handgrip, and Nordic stick.

Main Outcome Measures

Maximal walking distance in 6 minutes, temporo-spatial gait parameters determined with a commercial electronic gait analysis system, and patients' preference on a subjective ranking scale.

Results

Walking distance was greatest with the simple cane with an ergonomic handgrip, followed by the 4-point cane and the Nordic walking stick. Walking velocity was highest with the simple cane, which was also indicated as the preferred walking aid by the patients. There was no significant difference in step length symmetry.

Conclusions

The simple cane with the ergonomic handgrip was not only preferred by patients, but was also the most efficient among 3 commonly used walking aids. It appears justified to take patients' subjective preference into account when prescribing a walking aid.     

循证护理指导脑血管病介入术后护理的研究

目的探讨运用循证护理思维指导经皮股动脉穿刺脑血管介入治疗术后患者的护理效果。方法回顾性分析病例120例,58例作为对照组,给予常规护理。观察组62例,采用循证护理方案,提出护理问题,针对问题查阅相关资料和文献的直接和间接实证,并进行分析、归纳、结合临床实践,制定出护理方案并实施。结果观察组24 h腰背酸痛、腹胀、入睡困难、尿潴留发生率显著低于对照组(P<0.01),两组均未发生并发症。结论运用循证护理可提高脑血管介入治疗术后患者的舒适度,预防并发症,提高护理质量。