【作者】 马彩云；

【导师】 张德甫； 王怀立；

【作者基本信息】 郑州大学 ， 儿少卫生与妇幼保健学， 2009， 硕士

【摘要】 目的分析家长参与住院康复模式对不随意运动型脑瘫患儿康复过程管理的效果,为本病的专业康复、社区康复与家庭康复网络体系建设提供新思路。方法以2007年3月～2009年5月在郑州市儿童医院住院、年龄在7个月～36个月的70名不随意运动型脑性瘫痪患儿为研究对象,随机分为管理组和对照组,后来每组各脱落5例,两组有效观察例数各30例。对照组采用中西医结合康复治疗;管理组除此之外,医院对家长培训、督导家长对患儿实施日常生活能力训练,按医院要求照料患儿生活,疗程内不得转院,协同医院实现康复目标。观察指标:GMFM(Gross Motor Function Measure Scale)总百分比分值、肌张力、侧弯反射。在入院时及康复治疗三个月后分别对上述指标测评。出院后随访10个月,统计重复住院继续治疗、在家治疗、放弃治疗、主动随访比例。评定方法:①GMFM评定患儿的运动功能;②改良式Ashworth量表评定肌张力;③脊柱侧倾角测量法评价侧弯反射;④婴儿-初中生社会生活能力量表评定患儿社会生活能力。疗效判定:以GMFM总百分比分值及社会生活能力评分变化为主要依据。显效:GMFM总百分比分值提高≥15%,社会生活能力评分≥2分;有效:GMFM总百分比分值提高＜15%,社会生活能力评分＜2分;无效:GMFM总百分比分值及社会生活能力评分均未提高。统计方法:采用SPSS12.0统计软件进行数据分析。其中GMFM分值以((?)±s)表示,采用t检验;两组在治疗前不同病情病例数的比较用χ~2检验、不同病因病例数的比较用校正χ~2检验,重复治疗病例数等指标的比较用精确概率χ~2检验;疗效比较用秩和检验。检验水准α=0.05。结果1一般情况管理组30例,平均年龄15.1±9.2个月。病情重度18例,中度7例,轻度5例。对照组30例,年龄15.0±9.0个月,重度15例,中度9例,轻度6例。两组年龄、病情具有可比性(P＞0.05)。2 GMFM总百分比分值管理组治疗后比治疗前增加13.97±7.01分,对照组增加7.34±5.65分,两组差异有统计学意义(t=4.030,P＜0.05)。3治疗前后侧弯反射治疗后两组均比治疗前减弱;两组间比较,治疗后管理组侧弯反射减弱更显著,差异有统计学意义(Z=-4.024,P＜0.05)。4治疗前后肌张力管理组治疗前肌张力强24例,弱6例;治疗后肌张力强8例,弱22例。对照组治疗前肌张力强25例,弱5例;治疗后肌张力强16例,弱14例。两组均比治疗前减弱;两组间比较,管理组肌张力波动状态的恢复优于对照组(Z=-2.091,P=0.037)。5疗效管理组显效率56.67%,对照组显效率16.67%,两组疗效差异具有统计学意义(Z=-2.991,P＜0.05)。6高低年龄段之间疗效比较两组7月～12月年龄段的显效率均高于各自12月~+～36月年龄段的显效率。7依从性随访十个月,管理组家长主动随访复查26人(86.7%),重复住院继续下一疗程23人(76.7%),在家康复治疗3人(10%),放弃治疗4人(13.3%)。对照组家长主动随访复查11人(36.7%),重复住院继续下一疗程6人(20%),在家康复治疗5人(16.7%),放弃治疗19人(63.3%)。两组差异有统计学意义(χ~2=20.248,P＜0.05)。结论家长参与住院康复模式对不随意运动型脑瘫患儿具有较好的管理效果:1显著提高患儿粗大运动功能,促使侧弯反射消失,缓解肌张力波动,加速康复。2增强患儿家庭的依从性,提高重复住院继续治疗率。更多还原

【Abstract】 ObjectiveTo anayze the effectiveness of the managing mode of inpatient rehabilitation participated by parents with dyskinetic cerebral palsy children,and to provide new ideas for promoting the establishment of network syesterms about the professional, community,home-based rehabilitation.Method70 dyskinetic cerebral palsy infants from 7 to 36 months as research object were hospitalized in rehabilitation center of Zhengzhou children’s hospital from 3months in 2007 to 5 months in 2009 and they were divided into two groups randomly:the management group and the control group.Each group had 30 infants after 5 ones dropped.Besides two groups of integrated Chinese and Western medicine with rehabilitation as a conventional treatment,the parents of management group were provided rehabilitation management and technical training guidance,were supervised the implementation of activities of daily living training and cared for children with life according to the requests of hospital to achieve rehabilitation goal.The infants couldn’t go to another hospital in the course of treatment.Observing indexes GMFM total percent score,muscular tension and trunk incurvation reflex were tested respectively in the admission and after three months’ rehabiitation treatment of infants.Post-discharge follow-up of 10 months,the proportions of re-hospitalization,home-based care,given up the treatment,and active follow-up were calculated.Evaluation method①To evaluate these infants’ motor function with Gross Motor Function Measure Scale.②To evaluate infants’ muscular tension with Improved Ashworth Measure Scale.③To evaluate infants’ trunk incurvation reflex with spine lateral bending measurement method.④To assess the social-life abilities of children with Infants-Junior Middle School Stundents Social-Life Ability Scale.Criteria for clinical efficacy According to GMFM total percentage and the marks of social-life abilities as the main basis.Signifantly effective:value rise of GMFM total pecentage≥15%and value rise of social-life abilities marks≥2; Effective:value rise of GMFM total pecentage＜15%and value rise of social-life abilities marks＜2;Ineffective:no value rise of GMFM total pecentage and social-life abilities marks.Statistical methods Statistical software SPSS12.0 was used to data processing. GMFM percent was showed as((?)±s),tested by t;Before rehabilitation therapy,the comparison of different cases was tested byχ~2,the comparison of different pathogenyes was tested by correctedχ~2,the comparison of re-therapy indexes,etc. was tested by exact probabilityχ~2 between the two groups.The clinical efficacy comparison was tested by rank-sum.Test level a was equal to 0.05.Results1.General conditons The management group consisted of 30 infants with average age 15.1±9.2 months,among them 18 infants were in serious conditions,7 moderate and 5 mild.In addition,the control group involved 30 infants with average age 15.0±9.0 months,among them 15 infants were in serious conditions,9 moderate and 6 mild.There was no statistical significance in age and pathogenetic condition between the two groups(P＞0.05).2.GMFM total percent score After rehabilitation therapy,the percent of the management group increases 13.97±7.01 than before.While the control group increases 7.34±5.65.The difference between the two groups is statistically significant(t=4.030,P＜0.05).3.Trunk incurvation reflex before treatment and afterwards The trunk incurvation reflex after treatment both became disappeared or weak than before in the two groups.Moreover,when comparison between the two groups was made the incurvation reflex of management group became weaker evidently than that of the control group.The difference was statistically significant(Z=-4.024,P＜0.05).4.Muscular tension before treatment and afterwards Before treament there were 24 of strong muscular tension and 6 of weak muscular tension and through treatment there were 8 of strong muscular tension and 22 of weak muscular tension in the management group;Before treament there were 25 of strong muscular tension and 5 of weak muscular tension in the control group.Through treatment there were 16 of strong muscular tension and 14 of weak muscular tension.The two groups were weaker than before treatment.When comparison between the two groups was made, the muscular tension rehabilitation of management group was better than that of control one(Z=-2.091,P＜0.05).5.Clinical efficacy The management group showed an obvious efficacy of 56.67%,whereas the control group showed an efficiency of 16.67%.The difference between management group and control group is statistically significant(Z=-2.991,P＜0.05).The obvious clinical efficacy of management group is superior to control group.6.The comparison of clinical efficacy between elder and younger age The obvious efficiency of the two groups of members aged from 7 months to 12 months was higher than members aged from 12 months to 36 months.7.Compliance After 10 months follow-up on the infants of the two groups,the active follow-up infant numbers of the management group reached 26(86.7%).In this group,23 infants received re-hospitalization(76.7%);3 proceeded family therapy (10%);4 abandoned treatment(13.3%).While the follow-up numbers of the control group only reached 11(36.7%).In this group,6 infants received re-hospitalization (20%);5 infants proceeded family therapy(16.7%);19 infants abandoned treatment (63.3%).Therefore,the differences between the two groups had statistical significance (χ~2=20.248,P＜0.05).ConclusionsThe mode of inpatient rehabilitation participated by parents with dyskinetic cerebral palsy children exerted a positive effect on the management of dyskinetic cerebral palsy children.1.It could enhance patients’ gross motor function and effectively prompt the disappearance of trunk incurvation reflex;moreover,It could help relieve patients’ muscular tension fluctuation.,and could speed up the recovery.2.It could effectively improve the compliance of patients’ parents and raised the re-hospitalization rates.更多还原