早期康复护理对脑卒中后肩手综合症患者的影响

论文编号:HL172  论文字数:8856.页数:21

论文题目：早期康复护理对脑卒中后肩手综合征患者的影响
摘 要
研究背景
    “脑卒中后肩手综合征”发病机制尚不明确目前较为公认的机制是脑血管病急性发作影响到运动中枢前方的血管运动中枢血管运动神经麻痹引发患肢的交感神经兴奋性增高及血管痉挛反应末梢血流增加产生局部组织营养障碍从而出现水肿疼痛疼痛刺激又进一步经末梢感觉神经传至脊髓引发脊髓中间神经的异常兴奋性刺激造成血管运动性异常的恶性循环。它是脑卒中偏瘫患者常见的并发症，如不及时处理和控制，可引起手部肌肉萎缩，甚至畸形。轻者导致生活不便，严重者可以造成患者生活不能自理。早发现且进行及时、有效治疗是至关重要的。但有时往往由于各种原因，导致治疗效果不佳。
    从理论上讲若能在未发生之前行早期康复护理干预，早预防、则可以减少该病的发病率，改善患者的生活质量。许多学者在此方面做了不少研究，笔者根据本科室实际情况，进行早期康复护理干预，旨在探讨出一种更科学，更简单，更方便，更快捷，更实用，易操作的护理方法，预防和/或减少该病的发生。
研究目的
 研究早期康复护理对脑卒中后肩手综合征（SHSAS）发生率，患者运动功能和日常生活活动能力的影响。
研究方法
 将2006年8月以后收治的脑卒中患者200例作为观察组，在给予神经内科常规治疗及护理的同时，进行早期康复护理干预；将2006年8月以前收治的199例脑卒中患者作为对照组，进行常规治疗和护理。比较两组患者脑卒中后肩手综合征的发生率，并采Fug1．Meyer评分法(FMA)对运动功能进行评分，采用改良Barthel指数(MBL)对日常生活活动能力进行评分。
研究结果
 观察组肩手综合征发生率为15.5％，对照组发生率为20.1％，两组比较差异有统计学意义(P<O.05)，观察组FMA评分和MBI评分均明显高于对照组(P<O.05)。
结论
 早期康复护理能明显改善脑卒中患者的运动功能和日常生活活动能力，减少脑卒中后肩手综合征的发生。
关键词：脑卒中；早期康复护理；发生率；肩手综合征
论文类型：研究报告

 Title: Effect of Early Rehabilitation Nursing on Patients with Shoulder-hand Syndrome after Stroke
ABSTRACT

Background
 The etiology of Shoulder-hand Syndrome after stroke is not clear now， more generally accepted mechanism is the acute cerebrovascular disease affecting the central movement in front of the vasomotor center，vasomotor paralysis. Lead to increased excitatory limb of the sympathetic response to peripheral blood flow and vascular spasm resulting increase in local tissue dystrophy. Thus give rise to edema, pain, pain stimulation further spread to the spinal cord after peripheral sensory nerve abnormalities caused excitement among the spinal cord stimulation caused by exercise-induced abnormal blood vessel vicious circle.. It is a common complication in patients with stroke, if not timely processing and control, may cause hand muscle atrophy, and even deformity. Light caused inconvenience to those serious cases, can cause life in patients unable to take care of themselves. Early detection and timely and effective treatment is essential. But sometimes, for various reasons, resulting in poor treatment.
 In theory, if before the occurrence of lines in the absence of early rehabilitation nursing intervention, early prevention can reduce the incidence of the disease and improve patient quality of life. In this regard, many scholars have done a lot of research, the author undergraduate room under the actual conditions of early rehabilitation care intervention, aims to explore the out of a more scientific, more simple, more convenient, faster, more practical, easy-care method to prevent and / or reduce the incidence of the disease.
0bjective
 To investigate the effect of Early Rehabilitation Nursing on patients with Shoulder-hand Syndrome after stroke. include the morbidity ,Motor function and
the ability of daily life. ．
Methods
 200 hospitalized patients after August 2006 as the study group and 199 hospitalized patients before August 2006 as the control group. Compare the incidence of the two groups, the efficacy was evaluated by Fugl—Meyer upper extremity exercise score and  modified Barthel scale score．
Results
 The morbidity of the study group is 15.5%,that the control group is 20.1%.  Observer Group FAM equally MBI score was significantly higher than that the control group. Conclusions
 Rehabilitation Nursing of stroke patients can significantly improve motor function and ability of daily life, to reduce the incidence of shoulder-hand syndrome after stroke.
 
KEY WORDS:  stroke,early rehabilitation nursing, morbidity ,Shoulder-hand Syndrome
TYPE OF THESIS: Research Report

 
 
 目  录
1前言 1
 1.1研究背景及意义 1
 1.2研究目的及目标 1
 1.2.1研究目的 1
 1.2.2研究目标 2
 1.3关键词及定义 2
     1.3.1脑卒中 2
     1.3.2早期康复护理 2
     1.3.3发生率 2
     1.3.4肩手综合征 2
 1.4文献回顾 2
 1.4.1肩手综合征发病机理 2
    1.4.1.1中枢损伤导致交感神经系统功能障碍 2
 1.4.1.2肩关节正常结构功能改变所致的局部损伤 3
 1.4.1.3“肩一手泵”机制受损 3
 1.4.1.4腕关节过度屈曲及长时间受压 3
 1.4.1.5外力不正确的牵拉过度 3
 1.4.1.6内分泌障碍、垂体一肾上腺系统功能失调 4
 1.4.1.7其他 4
 1.4.2早期康复护理措施 4
2研究设计与方法 6
 2.1研究设计 6
 2.2研究对象 6
 2.2.1研究对象 6
 2.2.2纳入标准 6
     2.2.3排除标准 6
 2.3研究步骤 6
 2.4判定标准 7
 2.5统计学方法 7
3结果 8
 3.1两组患者运动功能和日常生活活动能力评分比较 8
    3.2两组患者SHSAS发生率 8
4讨论 9
4.1适当的早期康复护理能明显改善脑卒中患者的运动功能和日常生活活动能力
 9
4.2早期康复护理可以减少SHSAS的发生率 9
 4.3脑卒中后早期康复护理干预的感受 10
5结论 11
 5.1研究结论 11
 5.2不足和建议 11
致谢 12
参考文献 13

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