脊髓损伤患者的泌尿系治疗与康复

脊髓损伤 (ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ ,ＳＣＩ)是一种常见疾病。脊髓损伤后的泌尿系治疗与康复是一个重要而复杂的问题 ,直接关系到患者的预后。脊髓损伤患者泌尿系并发症的死亡率在第一次世界大战期间为 80 % ,到第二次世界大战降至 4 0 % ,朝鲜战争降至 2 5 % ,越南战争则降至极低水平。由于脊髓损伤的类型和程度不同 ,引起的泌尿系统问题也有明显差异 ,因此 ,在进行泌尿外科处理与康复之前 ,必须对患者的下尿路功能有充分的了解 ,而尿流动力学检查在了解下尿路功能方面起着关键的作用。1神经原性膀胱尿道功能障碍的分类及ＳＣＩ…     

脊髓损伤患者的性功能康复及治疗

脊髓损伤是一种常见疾病。据不完全统计 ,我国目前大约有 30万脊髓损伤患者 ,并且每年新增大约 2万例。脊髓损伤最常见的病因为车祸伤与跌伤 ,最常见的损伤部位是颈部和颈胸椎结合部。脊髓损伤后 ,患者不仅有肢体感觉、运动功能障碍 ,而且排尿、排便及性功能也产生障碍 ,对其回归社会 ,享受人生产生很大影响。脊髓损伤患者伤后对性、性的感觉、性的乐趣以及对性行为的态度并没有本质上的改变 ,这就要求我们医护工作者要详细了解脊髓损伤患者残有的性功能 ,对他们进行性康复教育 ,帮助他们解除烦恼 ,在生理、心理、精神方面能以较好的状态面…     

脊髓损伤患者骨化性肌炎的预防及康复护理

骨化性肌炎最早由Guy Patin于1692年提出,1868年由Von Dusch命名.其实质是一种异位性骨化,是发病机制不明的少见的良性局限的骨化的软组织肿块,是肌肉及其邻近结构的局限性的、含有非肿瘤性的钙化和骨化的病变….脊髓损伤后骨化性肌炎据研究[2]报道其发病率为10%-53%,脊髓损伤患者的异位骨化属于神经源性,好发于髋关节前方,也可发生于膝、肩、肘关节等处.严重的骨化性肌炎可以限制关节活动,甚至造成关节强直,使关节丧失活动功能,因而加重了脊髓损伤患者的痛苦,影响其康复治疗的进展和效果.鉴于骨化性肌炎是一种可以防治的并发症,因此在临床护理工作中的预防和康复具有重要的意义.现报道如下.     

Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury

Stenson KW, Deutsch A, Heinemann AW, Chen D. Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury.

Objective

To examine the effect of obesity on change in FIM self-care and mobility ratings and community discharge for patients with traumatic spinal cord injury (SCI).

Design

Retrospective cohort study analyzing National Model Systems SCI Database data.

Setting

Fourteen Model Systems SCI programs.

Participants

Patients (N=1524) with a new traumatic SCI discharged from Model Systems rehabilitation centers between October 2006 and October 2009.

Interventions

None.

Main Outcome Measures

Change in FIM self-care and mobility ratings, discharge destination. Separate analyses were conducted by neurologic category: paraplegia incomplete, paraplegia complete, tetraplegia incomplete, and tetraplegia complete.

Results

Of all patients with traumatic SCI, approximately 25% were obese at admission. Patients who were obese were more likely to be married and slightly older than nonobese patients. In patients with paraplegia incomplete, obese patients had lower FIM self-care (−1.9; 95% confidence interval [CI], −3.4 to −.4) and mobility score gains (−1.5; 95% CI, −2.9 to −.1) than normal-weight patients. For patients with paraplegia complete, obese patients had significantly lower self-care (−2.2; 95% CI, −3.5 to −.8) and mobility score gains (−2.7; 95% CI, −3.9 to −1.5). For patients with tetraplegia incomplete and tetraplegia complete, FIM self-care and mobility ratings for obese patients were not significantly different from ratings for normal-weight patients. Within each neurologic category, the percentage of patients discharged to the community was not significantly different for nonobese and obese patients.

Conclusions

Obesity appears to be a barrier to meeting self-care and mobility functional goals for patients with paraplegia in inpatient SCI rehabilitation.     

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。     

Effectiveness of spinal cord injury rehabilitation

As in other areas of rehabilitation, relatively small numbers and diversity--both of condition and of patients' goals--hinder the assimilation of robust evidence for the effectiveness of rehabilitation. Patients with spinal cord injury (SCI) tend to be gathered together in a small number of regional services, each with their own philosophy and each with different attitudes to outcome measurement, and thus collection of the existing trials for meta-analysis is problematic. The marked improvement in outcome from SCI that has occurred with the development of specialist rehabilitation programmes argues strongly for the effectiveness of rehabilitation, and we have progressed beyond the point where randomized controlled trials that deny a group such intervention could be considered ethical. Current research is aimed at teasing apart the aspects of different care models that are most effective, or the evidence for the usefulness of interventions for control of symptoms such as spasticity and pain. This evidence is reviewed and discussed.     

创伤性脊髓损伤的早期康复效果

目的：确定创伤性脊髓损伤（SCI）的自然病程和早期康复的效果。设计：回顾性,多中心研究。环境：16所Rosai医院,1所医学院。参加者：123例SCI病人,其中男104例,女19例,平均年龄：(48.8±17.7）岁。干预：将病人分成早期康复组和延迟康复组。利用国际SCI分类表对差别进行测量。测量：利用美国脊髓损伤协会（ASIA）的分类标准将运动功能的康复率（MRR）表示为（出院时的ASIA运动分数－入院时的ASIA运动分数）/（100－入院时的ASIA运动分数）。利用MRR分期确定6个亚组（早期或晚期四肢瘫,中央脊损伤,偏瘫）的FIM和ASIA…     

Early rehabilitation effect for traumatic spinal cord injury

OBJECTIVE: To determine the natural course of traumatic spinal cord injury (SCI) and the effect of early rehabilitation on it. DESIGN: A retrospective, multicenter study. SETTING: Sixteen Rosai hospitals and 1 medical school. PARTICIPANTS: One hundred twenty-three SCI patients (104 men, 19 women; mean age, 48.8 +/- 17.7yr) enrolled. INTERVENTIONS: Dividing the subjects into an early rehabilitation group and a delayed group; differences were ensured by international classification of SCI. MAIN OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) classifications, the motor recovery rate (MRR) was defined as (ASIA motor score at discharge - ASIA motor score at admission)/(100 - ASIA motor score at admission). The regression lines for FIM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. RESULTS: Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. CONCLUSION: Early SCI rehabilitation contributes to good physical activities of daily living for motor function.     

脊髓损伤后膀胱康复护理病人的临床观察

脊髓损伤是一种严重的致残性损伤,往往造成病人不同程度的瘫痪,严重影响病人的生活自理能力和参与社会活动能力.脊髓损伤后,膀胱的神经支配中断,生理机能丧失,容易发生尿潴留、膀胱输尿管反流及尿路感染等并发症,以致产生肾衰竭,是康复护理的难题之一[1].     

脊髓损伤患者康复护理数据网络平台的建设

目的：建设一个应用于脊髓损伤患者康复护理数据收集平台,为建立脊髓损伤患者规范化的护理流程与指引提供数据。方法采用回顾性分析我科4年时间的患者资料及国内外对脊髓损伤患者的康复护理进展,确定平台系统的收集数据的项目并开发数据平台软件。结果开发脊髓损伤患者康复数据网络平台软件1套,并应用于临床进行数据收集。结论脊髓损伤康复护理数据网络平台的应用,通过各项护理数据的收集与分析,使护理成效评价由经验式转变到客观数据评价,为循证护理提供科学依据。     

Critical rehabilitation of the patient with spinal cord injury

Most healthcare practitioners have worked with patients with spinal cord injury at some point in their career, for some it is a specialty. The critical care area usually only has patient with spinal cord injury for a brief time before they are transferred. More recently, there are longer intensive care unit stays due to multiple trauma and lack of insurance. Nurses must be cognizant of indications, contraindications, and best practice interventions to contribute positively to patient's long-term outcomes. As part of the multispecialty team, nurses can be pivotal in preventing secondary complications, especially pressure ulcers. Rehabilitation team members can be consulted early to provide expertise in managing this complex diagnostic group.     

中央型颈段脊髓损伤的康复治疗

目的观察康复治疗对中央型颈段脊髓损伤患者的功能的影响。方法对7例中央型颈段脊髓损伤的患者进行6周针对性的康复治疗,治疗前、后采用Barthel指数法对患者的日常生活活动(ADL)能力进行评定。结果治疗后7例患者的ADL评分均明显高于康复治疗前(P<0.01)。结论本组患者评估结果提示,针对中央型颈段脊髓损伤所致功能障碍的特点,采取相应的康复治疗和训练有助于提高患者日常生活活动能力。     

个体化护理对脊髓损伤患者神经源性膀胱康复的影响

目的探讨脊髓损伤患者神经源性膀胱最佳康复训练方法,针对脊髓损伤后神经源性膀胱的不同特点,实施个体化护理。方法采取随机对照法将143例脊髓损伤患者随机分为两组,对照组65例脊髓损伤患者进行常规护理;实验组78例患者依照脊髓损伤平面不同进行个体化膀胱功能训练并予以间歇导尿。观察并记录两组患者自主排尿时间、残余尿量、泌尿系统感染等情况。结果实验组与对照组相比较残余尿量减少、自主排尿时间缩短、泌尿系感染发生率降低,差异均有显著意义。结论个体化护理能有效恢复膀胱生理功能,降低脊髓损伤患者泌尿系统并发症的发生。     

Patient-professional partnership in spinal cord injury rehabilitation

There has been considerable pressure from both patients and professionals for greater patient involvement in the delivery of health services in recent years, particularly in the domain of rehabilitation. However, it has been suggested that involvement by patients is limited to rehabilitation. Accordingly, this study aimed to explore and describe patients' and professionals' experiences of patient participation in team decision-making processes. This article presents findings from a larger ethnographic study, which employed interviews and participant observation to collect data. This article focuses on the results from semistructured interviews, which were conducted with 30 healthcare professionals and 20 patients in a spinal cord injury unit in the UK. Findings suggest that the experience of team membership and decision-making is shaped by professional paternalism. Patients and professionals perceive that they are involved in a partnership where patients make decisions. However, different levels of paternalism in the professional-patient relationship within team decision-making processes emerged from the data. These have been categorized as 'open paternalism' where power and control lies with professionals; 'they tell me what they are doing' where patients are informed of decisions; 'they can always say no' where patients can agree or disagree; 'making the right choice' where patients are steered towards the choice professionals consider as the 'right' choice; and 'active participation' where patients choose the course of action. It is suggested that professionals should examine their own practice and attempt to develop ways of working that empower patients to become equal members of the rehabilitation team.     

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.     

康复健康教育对脊髓损伤患者康复治疗依从性的研究

目的探讨康复健康教育对脊髓损伤(SCI)患者康复治疗依从性的临床意义。方法 2012年1月至2013年12月该院收治的SCI患者62例,随机分为观察组与对照组,各31例。对照组予以常规治疗与康复护理,观察组在对照组的基础上实施个性化康复健康教育,比较2组患者康复治疗的依从性。结果观察组患者对SCI疾病的认知水平和康复治疗的依从性评分显著高于对照组,差异有统计学意义(P0.05),观察组患者并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论对SCI患者实施康复健康教育,有利于提高患者康复治疗的依从性,降低其并发症发生率。     

脊髓损伤患者躯体功能恢复与心理护理的相关性研究

目的应用功能独立性评价量表(Functionalindependentmeasures,FIM)评估住院脊髓损伤(SCI)患者躯体功能恢复情况,同时进一步分析SCI患者躯体功能恢复与心理、直接护理的相关性。方法将39例SCI患者随机分成实验组18例和对照组21例,两组患者均进行常规的康复训练及康复护理,实验组另予以心理护理。并在入院时、出院时以及随访时对两组患者进行FIM评分,同时记录护理接触时间。结果实验组FIM评分较对照组有显著性差异(P<0.05),且入院时FIM评分与心理、直接护理所需时间呈显著负相关;出院时FIM评分与心理护理所需时间呈显著负相关,与给药、提供治疗等直接护理所需时间无显著负相关;随访时FIM评分与心理、直接护理所需时间均不存在显著相关。结论通过FIM评分可以预测护理工作需要量,躯体功能恢复和护理时间的关系不是线性关系,做好患者的心理疏导对提高康复治疗疗效,改善患者的生存质量有着积极的意义。     

脊髓损伤患者的心理问题及康复策略

脊髓损伤患者从正常状态到突然致残 ,再通过康复训练回归家庭和社会 ,心理方面会出现一系列问题[1] 。及时处理心理问题 ,不仅有利于患者的心理康复 ,而且可以促进整体康复的进程。特别是对那些身体已经残疾 ,不可能再恢复正常的患者而言 ,心理的康复比机体的康复更为重要。因此 ,了解脊髓损伤患者的心理问题 ,探讨进行心理康复的策略和方法 ,也是我们临床心理工作者的一项重要任务。1脊髓损伤患者常见心理问题1.1心理创伤　人的心理是一个动态的过程 ,当受到外界的强烈刺激时 ,会产生心理的应激[2 ] 。如果某种刺激过于强烈 ,就会产生个体…     

康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果

目的研究康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果。方法选取2016年10月至2018年10月我院收治的52例颈脊髓损伤伴呼吸功能障碍患者作为研究对象,随机分为对照组(26例,常规护理干预)和观察组(26例,常规护理干预+康复护理干预)。比较两组患者的护理效果。结果观察组患者的训练依从率显著高于对照组(P<0.05)。护理后,两组患者的FVC、FEV1、MVV水平、SCIM-Ⅲ评分、生活质量评分明显升高,且观察组显著高于对照组(P<0.05)。结论康复护理干预应用于颈脊髓损伤伴有呼吸功能障碍患者中可有效改善患者依从性和肺功能指标,促进患者呼吸功能和脊髓功能的恢复,提高患者生活质量水平,值得临床推广应用。