系统化早期康复训练在重症颅脑损伤昏迷患者中的应用效果

目的　探讨系统化早期康复训练在重症颅脑损伤昏迷患者中的应用效果。方法　采取前瞻性研究，选取2020年1月至2022年1月南阳市中心医院收治的92例重症颅脑损伤昏迷患者，按随机数字表法分为对照组和观察组，每组46例。对照组男25例，女21例，年龄（45.69±3.18）岁，接受常规护理；观察组男24例，女22例，年龄（45.67±3.21）岁，在常规护理基础上实施系统化早期康复训练；两组均干预1周。比较两组患者的神经功能、日常生活能力、运动功能、并发症、生活质量和护理满意度。统计学方法采用t检验、χ²检验。结果　两组干预前的美国国立卫生研究院卒中量表（NIHSS）、日常生活能力量表（ADL）、Fugl-Meyer运动功能评价量表（FMA）、生活质量综合评定量表（GQOLI）评分比较，差异均无统计学意义（均P>0.05）。观察组干预后NIHSS评分低于对照组［（6.67±2.11）分比（9.79±2.18）分］，ADL评分高于对照组［（76.89±5.36）分比（65.95±5.32）分］，两组比较差异均有统计学意义（均P<0.001）；观察组干预后FMA中上肢运动功能评分为（54.70±4.15）分、下肢运动功能评分为（29.88±3.74）分，均高于对照组的（49.84±3.92）分、（25.96±3.62）分，差异均有统计学意义（均P<0.001）；观察组并发症总发生率低于对照组［4.35%（2/46）比17.39%（8/46）］（χ²=4.039，P=0.045）；观察组干预后GQOLI中的社会功能、物质生活、躯体功能、心理功能评分均高于对照组［（74.48±5.21）分比（67.75±5.52）分、（83.56±5.34）分比（70.86±5.27）分、（72.53±6.15）分比（66.50±6.13）分、（72.78±7.06）分比（65.94±6.07）分］，观察组护理满意度中的操作技术、护理态度、训练指导和安全管理评分均高于对照组［（82.97±3.35）分比（80.63±3.21）分、（82.99±3.42）分比（80.54±3.30）分、（82.94±3.53）分比（80.57±3.36）分、（82.98±3.62）分比（80.61±3.57）分］，差异均有统计学意义（均P<0.05）。结论　重症颅脑损伤昏迷患者接受系统化早期康复训练，可促进患者神经功能和运动功能改善，提升患者日常生活能力，降低并发症发生率，促进生活质量改善，从而获得更高的护理满意度。

Application effect of early systematic rehabilitation training in coma patients with severe craniocerebral injury

Objective　To explore the application effect of early systematic rehabilitation training in coma patients with severe craniocerebral injury. Methods　A prospective study was conducted on 92 coma patients with severe craniocerebral injury admitted to Nanyang Central Hospital from January 2020 to January 2022, and they were divided into a control group and an observation group according to the random number table method, with 46 patients in each group. The control group 21 females and 25 males, aged (45.69±3.18) years] received routine nursing, the observation group 22 females and 24 males, aged (45.67±3.21) years] received early systematic rehabilitation training on the basis of routine nursing, and the intervention lasted for 1 week. The neurological function, daily living ability, motor function, complications, quality of life, and degree of nursing satisfaction were compared between the two groups. t test and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the scores of National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living Scale (ADL), Fugl-Meyer Motor Function Assessment (FMA), and Generic Quality of Life Inventory (GQOLI) between the two groups before intervention (all P>0.05). After intervention, the NIHSS score of the observation group was lower than that of the control group (6.67±2.11) vs. (9.79±2.18)], and the ADL score of the observation group was higher than that of the control group (76.89±5.36) vs. (65.95±5.32)], with statistically significant differences between the two groups (both P<0.001). After intervention, the upper and lower limb motor function scores of the observation group were (54.70±4.15) and (29.88±3.74), which were higher than those of the control group (49.84±3.92) and (25.96±3.62)], with statistically significant differences (both P<0.001). The total incidence of complications in the observation group was lower than that in the control group 4.35% (2/46) vs. 17.39% (8/46)] (χ²=4.039, P=0.045). After intervention, the scores of social function, material life, physical function, and psychological function of the GQOLI in the observation group were higher than those in the control group (74.48±5.21) vs. (67.75±5.52), (83.56±5.34) vs. (70.86±5.27), (72.53±6.15) vs. (66.50±6.13), (72.78±7.06) vs. (65.94±6.07)], and the scores of operation technique, nursing attitude, training guidance, and safety management of the nursing satisfaction degree in the observation group were higher than those in the control group (82.97±3.35) vs. (80.63±3.21), (82.99±3.42) vs. (80.54±3.30), (82.94±3.53) vs. (80.57±3.36), (82.98±3.62) vs. (80.61±3.57)], with statistically significant differences (all P<0.05). Conclusion　Early systematic rehabilitation training can improve the neurological function and motor function in coma patients with severe craniocerebral injury, promote the improvement of daily living ability, reduce the occurrence of complications, and promote the improvement of quality of life, so as to obtain a higher nursing satisfaction degree.