呼吸训练对颈胸段脊髓损伤患者呼吸功能的影响

目的探讨呼吸训练对颈胸段脊髓损伤患者呼吸功能的影响。方法选取我院2018年3月至2019年9月收治的68例颈胸段脊髓损伤患者作为研究对象,采用随机数字表法将其分为观察组(34例,常规治疗和护理+常规康复训练+呼吸训练)和对照组(34例,常规治疗和护理+常规康复训练)。比较两组患者的膈肌移动度、肺功能指标及临床效果。结果干预后,两组的膈肌移动度均增高,且观察组高于对照组(P<0.05)。干预后,两组的呼气峰流速(PEF)、用力肺活量(FVC)、最大通气量(MVV)均增高,且观察组明显高于对照组(P<0.05)。观察组的临床治疗总有效率明显高于对照组(P<0.05)。结论呼吸训练能有效改善颈胸段脊髓损伤患者的膈肌移动度和肺功能指标,从而改善呼吸功能。     

高压氧联合呼吸训练对颈脊髓损伤患者肺功能的影响

目的:观察高压氧联合呼吸训练对颈脊髓损伤患者肺功能的影响。方法:选取2018年3月—2019年5月在我院住院的颈脊髓损伤患者共60例,用随机数字表法将上述60例患者随机分为对照组和观察组(每组各30例),对照组给予常规药物、康复治疗,并给予PT呼吸训练每日1次,观察组在对照组治疗的基础上同时给予高压氧治疗,每日1次,分别于治疗前及治疗4周后检查肺功能,重点评估用力肺活量(FVC),第一秒用力呼气容积(FEV1),最大通气量(MVV)的变化。结果:与治疗前比较,对照组的FVC、FEV1、MVV分别增加了0.45±0.41L、0.27±0.36L、16.53±22.06L/min,FVC%pred、FEV1%pred、MVV%pred分别提高了11.33±9.41%、8.85±10.38%、12.78±16.77%;观察组治疗前后FVC、FEV1、MVV分别增加了1.20±0.39L、0.86±0.29L、42.40±23.81L/min,FVC%pred、FEV1%pred、MVV%pred分别提高了24.27±7.70%、24.27±7.07%、33.47±19.75%。治疗前后比较,...     

Guidelines for routine respiratory care of patients with spinal cord injury. A clinical report

Pulmonary compromise is a leading cause of morbidity in patients with spinal cord injury (SCI). Because these patients have such complex and massive needs, routine respiratory care is not always given the priority it deserves in a rehabilitation program. Our institution established a committee to formulate guidelines for the routine respiratory care of patients in our interdisciplinary Acute Spinal Cord Injury Program. The guidelines consisted of evaluation, treatment, and teaching interventions. The purposes of the guidelines were to increase staff awareness of the need for routine, prophylactic respiratory care of patients with SCI; to be an effective teaching tool for staff, thus resulting in a reduction of respiratory complications; and also to be a teaching tool for patients and their families so that routine respiratory care could be continued in the home. After using the guidelines for over a year, we believe that the quality of the respiratory care we provide our patients with SCI has improved. The respiratory care is more comprehensive, consistent, and coordinated among disciplines.     

系统性呼吸训练对颈髓损伤患者膈肌运动及肺功能的影响

目的：探讨系统性呼吸训练对颈髓损伤患者膈肌运动及肺功能的影响。方法：将60例颈髓损伤患者随机分为观察组和对照组,每组各30例。对照组给予常规的康复训练和健康宣教,观察组在常规康复的基础上增加系统性呼吸训练,观察周期为6周,对比2组患者的肺功能指标、膈肌运动幅度及呼吸困难程度。结果：治疗6周后,2组患者的用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、峰值呼气流速（PEF）、每分钟最大通气量（MVV）及膈肌运动幅度均较治疗前有明显提高（P<0.01）;且观察组的FVC、FEV1、PEF、MVV值及膈肌运动幅度均显著优于对照组（P<0.05）。2组患者的Brog呼吸困难评分从第3周均较第1周明显降低（P＜0.05）,且从第4周开始,观察组较对照组降低更明显（P＜0.05）。结论：系统性呼吸训练联合常规康复训练可以有效改善颈髓损伤患者的膈肌运动及肺功能,在临床工作中应重视呼吸功能训练。     

多学科会诊模式下综合呼吸训练在脊髓损伤患者气道护理中的应用

目的 探讨多学科会诊(MDT)模式下综合呼吸训练在脊髓损伤患者气道护理中的应用效果.方法 选取100例患者为研究对象,依据入院顺序将患者随机分为实验组(采用MDT模式)和对照组(采用传统康复模式),每组50例.实验组采取MDT模式下综合呼吸训练方法,对照组采取传统气道护理方法.比较2组干预前、干预2个月患者肺部通气功能指标、数字评价量表(NRS)评分、Borg呼吸困难与疲劳程度评分及不良事件发生率.结果 与干预前相比,2组干预2个月时用力肺活量(FVC)、第1秒用力呼气量(FEV1)、用力呼出25％肺活量的呼气流量(FEF25％)和最大呼气流量(PEF)均升高,实验组干预2个月FVC、FEV1、FEF25％和PEF高于对照组,差异有统计学意义(P＜0.05).与干预前相比,2组干预2个月NRS及Borg评分均降低,且实验组NRS及Borg呼吸困难与疲劳程度评分低于对照组,差异有统计学意义(P＜0.05).结论 MDT模式下综合呼吸训练可获得更好的肺部通气功能指标,改善脊髓损伤患者的疼痛程度、呼吸困难和疲劳感,有利于促进患者康复.     

Acute respiratory infections in persons with spinal cord injury

Respiratory disorders are the leading cause of death for persons with both acute and chronic spinal cord injury (SCI), and much of the morbidity and mortality associated with respiratory disorders is related to acute respiratory infections. Pneumonia is the best recognized respiratory infection associated with mortality in this population. Recent evidence supports some management strategies that differ from those recommended for the general population. Upper respiratory tract infections and acute bronchitis may be precipitating factors in the development of pneumonia or ventilatory failure in patients with chronic SCI. This review emphasizes management principles for treatment and prevention of respiratory infections in persons with SCI.     

渐进抗阻吸气肌训练对颈脊髓损伤患者膈肌功能的影响

目的:观察渐进抗阻吸气训练联合常规呼吸训练对颈脊髓损伤患者膈肌功能的影响.方法:选取2018年6月—2019年12月在我院住院的颈脊髓损伤患者60例,采用随机数字表法随机分为对照组与观察组(每组各30例),观察组中ASIA分级为A、B级损伤的患者设为A组,ASIA分级为C、D级损伤的患者设为B组(每组15例).观察组和...     

The respiratory system in spinal cord injury

Respiratory complications are a leading cause of morbidity and mortality during the acute and chronic phases after spinal cord injury (SCI). This article reviews the respiratory impairments resulting from SCI and discusses a range of management strategies to be considered from the acute care phase through long-term follow up. The treatment of specific complications and preventive measures are reviewed.     

脊髓损伤病人综合膀胱功能训练的效果观察

脊髓损伤是脊柱损伤后的严重并发症,由于椎体骨折脱位,移位的椎体向后或骨片突入椎管,可压迫脊髓或马尾神经,产生不同程度的损伤。受伤平面以下的感觉、运动、反射完全消失,括约肌功能完全丧失,称完全性截瘫,部分丧失时称不完全截瘫[1],两者均可导致膀胱和排尿功能障碍,病人因尿潴留而需在一段时间内留置尿管。我科自2005年以来,对脊髓损伤病人进     

不完全脊髓损伤患者肠道功能康复训练和护理

目的探讨不完全脊髓损伤后肠道功能障碍的康复训练和专科护理。方法2008年6月～2008年7月抗震救灾中我们共收治12名不完全脊髓损伤患者,进行肠道功能康复训练和护理,使用Barthel指数记分法评估疗效。结果经过平均22d肠道功能康复训练和专科护理,9例患者可自排大便。3例患者在亲属的帮助下,也能自排大便。Barthel指数记分法均〉4分,疗效满意。结论不完全脊髓损伤后肠道功能障碍,采用药物与物理方法对患者进行肠道功能训练让患者能够早日控制大便,走出家庭,走入社会,提高患者的自尊心,改善患者的生活质量。     

Rehabilitation outcome for patients with spinal cord injury

A follow-up study of 58 patients with spinal cord injury was conducted. As measure of function the Barthel index was used. There was correlation between functional capacity and ability of self-care as well as some social determinants. However, no association was found with employment rate or certain other determinants of independent living, such as going on a holiday. We conclude that the severity of the lesion is a fundamental factor in determining the outcome, but factors related to personal and psychosocial variables, not easily measured, also have great influence on the rehabilitation process.     

Pain in patients with spinal cord injury

For this study of intractable pain after spinal cord injury (SCI), a questionnaire was developed, pilot-tested and mailed to 356 previously hospitalized SCI patients, 200 (56%) of whom returned the completed questionnaire. Of the respondents, 160 (80%) reported abnormal sensation and 96 (48%) called the discomfort painful. Abnormal sensations were first noted within 6 months of injury by 105 patients, from 7 months to 4 years after injury by 39, and longer than 4 years after injury or unknown by 16. Pain locations varied and were unrelated to the level of lesion. In 30% of those reporting abnormal sensation the location of pain remained stationary, whereas in 17% it changed over time. The intensity of pain was described as severe to extreme by 25%; 44% indicated that it interfered with daily activities. Increase of pain over time was noted by 41%. Activity, inactivity, weather change and overexertion were not frequently identified as aggravating circumstances. Rest and medication were cited as alleviating factors. Approximately 38% of those experiencing pain used medications but only 22% obtained consistent relief from their use. Patients with low level lesions were more willing to exchange a hypothetical chance of recovery and/or loss of reacquired physiologic functions for pain relief than were patients with higher lesions.     

综合直肠功能训练对脊髓损伤患者直肠功能重建的影响

目的运用综合直肠功能训练的方法对脊髓损伤患者进行治疗及护理,使患者最大程度地恢复直肠功能。方法将脊髓损伤患者80例分为试验组与对照组各40例,对照组行常规的康复治疗及护理,试验组在此基础上进行综合直肠功能训练,2个月以后将两组患者在便秘、腹胀、自主排便、排便次数、依从栓剂或药物等方面进行比较,同时将两组患者在以上方面进行自身前后对比,所得数据采用SPSS13.0统计学软件进行处理。结果两组患者2个月后在便秘、腹胀、自主排便、排便次数、依从栓剂或药物等方面差异均有统计学意义(P0.01);试验组患者以上方面自身前后对比,差异均有统计学意义(P0.01)。结论对脊髓损伤患者进行系统的综合直肠功能训练有显著效果,值得推广。     

生物反馈训练法用于52例脊髓损伤病人自主排尿训练的研究

目的提高脊髓损伤(SCI)病人瘫痪膀胱充盈度感觉代偿功能和自主排尿功能.方法 2002年11月至2003年12月,对52例SCI病人于伤后1周开始进行卧位、半坐卧位或坐位的生物反馈训练,观察病人对膀胱充盈度的感觉及代偿功能恢复情况,测定脱离导尿管后自主排尿恢复时间及膀胱残余尿量(RUV).结果本组全部于出院前完成自主排尿过程,拔除尿管时间为15～53d,平均30士15d;92.3%的病人对膀胱充盈度感觉代偿功能基本正常,76.9%的病人RUV≤100ml.结论 生物反馈训练法能有效提高SCI病人膀胱充盈度的感觉代偿功能和自主排尿功能.     

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.     

脊髓损伤患者的步行训练

步行训练是脊髓损伤患者重要的功能训练之一。在条件允许的情况下 ,应鼓励患者经常进行站立及步行训练 ,这不仅可以防止下肢发生骨质疏松 ,减少发生骨折的危险 ,减轻肌肉痉挛 ,同时还可以预防泌尿系感染等。1步行方式分类根据患者脊髓损伤平面的不同 ,可将步行训练分为治疗性步行和功能性步行。不同损伤平面的患者步行能力大致如下 :①C6 —T5损伤 :可佩戴躯体、骨盆托矫形器在平行杠内做治疗性站立 ;②T6 —T9损伤 :可佩戴骨盆托矫形器并使用拐杖进行治疗性站立步行 ;③T10 及以下损伤 :具有功能性步行能力。1.1治疗性站立步行训练　C6 …     

脊柱脊髓损伤伴膀胱功能障碍的综合训练及康复护理

目的探讨脊柱脊髓损伤伴神经源性膀胱功能障碍的综合训练及康复护理方法。方法收集2006年1月～2008年6月脊柱脊髓损伤伴神经源性膀胱患者32例。实验组采用Crede手法按摩、电针刺激、间歇性导尿术等综合训练及康复护理方法,对照组单纯采用留置导尿和间歇性导尿术。训练期间定期查尿常规和中段尿培养,进行尿路感染率比较;监测膀胱容量和残余尿量。结果（1）实验组、对照组尿路感染率分别为12．5％（2例）和25．0％（4例）,有统计学意义（P〈0．05）;（2）膀胱容量测定实验组明显大于对照组,残余尿量实验组少于对照组。结论脊髓损伤后早期综合训练及康复护理可以促进膀胱功能障碍的恢复、减少泌尿系感染的发生率,提高患者的生存质量。     

步行训练对外伤性脊髓损伤患者骨量丢失的影响

目的:通过观察骨密度和骨代谢相关指标的变化来评价步行训练防治外伤性脊髓损伤患者骨量丢失的临床疗效并探讨其作用机制。方法:选取23例外伤性脊髓损伤合并骨量丢失患者,随机分为观察组12例和对照组11例。2组均进行常规康复训练,观察组在此基础上进行步行训练。2组均每日治疗1次,连续治疗60d。治疗前、治疗1个月、治疗2个月分别测定患者的腰椎和股骨骨密度、抗酒石酸酸性磷酸酶5b(TRACP5b)、骨碱性磷酸酶(BALP)、25羟基维生素D[25(OH)D]、血钙、血磷、血清碱性磷酸酶(ALP)的变化情况。结果:治疗2个月后,观察组的TRACP5b治疗前后差异无统计学意义,对照组治疗2个月后TRACP5b值较治疗前明显升高(P0.05),且观察组低于对照组(P0.05)。治疗1及2个月后,2组患者的腰4椎体、腰1-腰4椎体骨密度均呈下降趋势,组内和组间比较,其差异并无统计学意义。治疗1及2个月后,2组患者的股骨颈、股骨全部骨密度均呈下降趋势(均P0.05),对照组治疗2个月后和治疗前相比明显下降(均P0.05)。治疗后1、2个月后,BALP、25(OH)D、血钙、血磷、ALP 5个指标组内及组间比较差异均无统计学意义。结论:步行训练能减轻外伤性脊髓损伤患者股骨颈和股骨全部骨密度下降的程度,但对损伤平面以下不同部位骨密度的影响不同,其作用机制可能和抑制骨吸收有关。     

Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training.

BACKGROUND: Functional loss of respiratory muscles in persons with spinal cord injury leads to impaired pulmonary function and respiratory complications. In addition, respiratory complications are responsible for 50-67% of the morbidity in this population. OBJECTIVE: To investigate the effects of normocapnic hyperpnoea training in acute spinal cord injury. PATIENTS AND METHODS: Fourteen patients were randomized between control (sham) and an experimental normocapnic hyperpnoea training group. Vital capacity, maximal voluntary ventilation, respiratory muscle strength and endurance, respiratory complications and symptoms were evaluated before, after 4 and 8 weeks of training and after 8 weeks follow-up. RESULTS: Maximal voluntary ventilation, respiratory muscle strength and endurance improved significantly in the experimental group compared with the control group (p < 0.05). Improvements in vital capacity tended to be different from the control group at 8 weeks of training. The Index of Pulmonary Dysfunction decreased after 4 weeks of training and respiratory complications were reported less frequently in the experimental group compared with the control group. CONCLUSION: Normocapnic hyperpnoea training in patients with spinal cord injury improved respiratory muscle strength and endurance. Respiratory complications occurred less frequently after training.