康复治疗及术后护理干预对高血压脑出血患者术后恢复的影响

刘雪英

doi:10.16766/j.cnki.issn.1674-4152.001850

康复治疗及术后护理干预对高血压脑出血患者术后恢复的影响

doi: 10.16766/j.cnki.issn.1674-4152.001850

刘雪英^,

广西医科大学第十附属医院(钦州市第一人民医院)神经外科，广西钦州 535099

基金项目:

广西壮族自治区卫生健康委员会自筹经费科研课题 Z20190570

详细信息

通讯作者:
刘雪英，E-mail：1848757985@qq.com

中图分类号: R473.5 R743.34
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出版历程
- 收稿日期: 2020-03-30
- 网络出版日期: 2022-02-19

Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage

LIU Xue-ying^,

Department of Neurosurgery, the Tenth Affiliated Hospital of Guangxi Medical University (the First People's Hospital of Qinzhou), Qinzhou, Guangxi 535099, China

摘要

摘要: 目的探讨康复治疗与护理干预在高血压脑出血(hypertensive intracerebral hemorrhage，HICH)患者术后恢复中的影响。方法回顾性分析2017年3月—2019年11月广西医科大学第十附属医院收治的78例HICH血肿清除术后的患者。对照组为28例接受常规治疗及护理的患者，康复训练组为27例在接受常规治疗及护理的基础上进行康复训练的患者，护理干预组23例为在常规治疗和护理的基础上进行康复训练和护理干预的患者。在术后(T1)、治疗后4周(T2)和治疗后12周(T3)分别比较收缩压、舒张压和Fugl-Meyer评分，比较3组患者T3时的总有效率和不良反应。结果 3组患者T3时收缩压、舒张压均明显低于T2、T1，T2时收缩压、舒张压均低于T1(均P < 0.05)。3组患者在T3时Fugl-Meyer评分明显高于T2和T1，T2时Fugl-Meyer评分高于T1(均P < 0.05)。康复训练组和护理干预组总有效率明显高于对照组，差异有统计学意义(均P < 0.05)，康复训练组和护理干预组总有效率比较差异无统计学意义(P>0.05)。对照组患者肩手综合征、褥疮、抑郁发生率高于康复训练组和护理干预组(均P < 0.05)，康复训练组中抑郁症发生率显著高于护理干预组(P < 0.05)。结论康复治疗及护理干预较常规治疗及护理干预更有利于HICH患者术后恢复，且术后不良反应率较低，值得临床推广。
- 康复治疗 /
- 护理干预 /
- 高血压脑出血 /
- 术后恢复
Abstract: Objective To investigate rehabilitation therapy combined with nursing intervention in postoperative recovery of patients with hypertensive intracerebral hemorrhage (HICH). Methods Retrospective analysis was carried out in 78 patients with severe HICH hematoma evacuation after treatment in the Tenth Affiliated Hospital of Guangxi Medical University from March 2017 to November 2019. The 28 patients who received routine treatment and nursing care were regarded as the control group, the 27 patients who underwent rehabilitation training based with routine treatment and nursing care were the rehabilitation training group. Moreover, the 23 patients who underwent rehabilitation training and nursing intervention based on routine treatment were regarded as the nursing intervention group. Systolic blood pressure, diastolic blood pressure, and Fugl-Meyer scores were compared immediately after surgery (T1), 4 weeks after treatment (T2) and 12 weeks after treatment (T3). During the period of T3, the total effective rate and adverse reactions were compared among the three groups of patients. Results The systolic blood pressure and diastolic blood pressure at T3 among the three groups were significantly lower than both T2 and T1, and the systolic and diastolic blood pressure of T2 was lower than T1 (all P < 0.05). Among the three groups of patients, the Fugl-Meyer score at T3 was significantly higher than both the T2 and T1, and the Fugl-Meyer score at T2 was higher than T1 (all P < 0.05). The total effective rate in the rehabilitation training group and the nursing intervention group were significantly higher than the control group, and the difference was statistically significant (all P < 0.05). There was no significant difference in total effective rate between the rehabilitation training group and the nursing intervention group (P>0.05). In the control group, the number of patients with shoulder-hand syndrome, hemorrhoids, and depression was significantly higher than both the rehabilitation training group and the nursing intervention group (all P < 0.05). The number of people with depression in the rehabilitation training group was significantly higher than the nursing intervention group (P < 0.05). Conclusion Rehabilitation therapy and nursing intervention are better than routine treatment and nursing for postoperative recovery of HICH patients, and has a lower adverse reaction rates after surgery, it is worthy of promotion clinically.
- Rehabilitation therapy /
- Nursing intervention /
- Hypertensive cerebral hemorrhage /
- Postoperative

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表 1 3组HICH患者临床资料比较[例(%)]

组别	例数	性别		年龄(岁)		体重(kg)
组别	例数	男性	女性	≤60	＞60	≤60	＞60
对照组	28	19(67.86)	9(32.14)	5(17.86)	23(82.14)	13(46.43)	15(53.57)
康复训练组	27	19(70.37)	8(29.63)	6(22.22)	21(77.78)	11(40.74)	16(59.26)
护理干预组	23	14(60.87)	9(39.13)	5(21.74)	18(78.26)	12(52.17)	11(47.83)
χ²值		0.532		0.191		0.655
P值		0.766		0.909		0.721

组别	例数	精神运动性激动		小动脉的病理变化		出血位置
组别	例数	是	否	玻璃样改变	纤维性改变	基底神经节	丘脑	大脑叶
对照组	28	4(14.29)	24(85.71)	22(78.95)	6(21.05)	18(64.29)	6(21.43)	4(14.29)
康复训练组	27	8(29.63)	19(70.37)	18(66.67)	9(33.33)	14(51.85)	7(25.93)	6(22.22)
护理干预组	23	6(26.09)	17(73.91)	16(69.57)	7(30.43)	11(47.83)	7(30.43)	5(21.74)
χ²值		1.990		1.042		1.659
P值		0.370		0.594		0.798

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表 2 3组HICH患者T1~T3时收缩压比较(x±s, mm Hg)

组别	例数	T1	T2	T3	F值	P值
对照组	28	173.72±22.61	164.56±16.5^a	156.25±8.13^ab	25.800	＜0.001
康复训练组	27	174.61±23.54^c	156.35±15.94^ac	149.36±7.48^abc	87.060	＜0.001
护理干预组	23	173.27±23.15^c	154.16±14.86^ac	148.21±7.73^abc	96.030	＜0.001
t值		0.129	1.256	2.348
P值		0.596	0.056	0.037
注：与T1比较，^aP < 0.05；与T2比较，^bP < 0.05；与对照组比较，^cP < 0.05。1 mm Hg=0.133 kPa。

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表 3 3组HICH患者T1~T3时舒张压比较(x±s, mm Hg)

组别	例数	T1	T2	T3	F值	P值
对照组	28	108.36±12.97	99.24±10.75^a	92.08±8.36^ab	23.700	＜0.001
康复训练组	27	107.24±13.02^c	94.11±9.28^ac	86.35±6.15^abc	85.040	＜0.001
护理干预组	23	107.82±12.63^c	92.86±8.84^ac	85.21±7.73^abc	93.500	＜0.001
t值		0.414	1.457	2.307
P值		0.669	0.067	0.045
注：与T1比较，^aP < 0.05；与T2比较，^bP < 0.05；与对照组比较，^cP < 0.05。

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表 4 3组HICH患者T1~T3时Fugl-Meyer评分比较(x±s, 分)

组别	例数	T1	T2	T3	F值	P值
对照组	28	26.83±5.79	34.17±8.61^a	43.51±8.84^ab	31.600	＜0.001
康复训练组	27	27.19±5.54	41.59±9.03^ac	58.37±10.15^abc	95.030	＜0.001
护理干预组	23	27.02±6.11	43.07±8.67^ac	60.08±10.45^abc	103.300	＜0.001
F值		0.027	7.825	23.100
P值		0.974	0.001	＜0.001
注：与T1比较，^aP < 0.05；与T2比较，^bP < 0.05；与对照组比较，^cP < 0.05。

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表 5 3组HICH患者治疗12周后总有效率比较[例(%)]

组别	例数	显著有效	有效	进步	无效	总有效
对照组	28	13(46.43)	8(28.57)	5(17.86)	2(7.14)	21(75.00)
康复训练组	27	16(59.26)	10(37.04)	1(3.70)	0(0.00)	26(96.30)^a
护理干预组	23	15(65.22)	7(30.43)	1(4.35)	0(0.00)	22(95.65)^a
注：3组总有效率比较，χ²=7.379，P=0.025。与对照组比较，^aP < 0.05。

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表 6 3组HICH患者不良反应发生情况比较[例(%)]

组别	例数	肩手综合征	褥疮压疮	抑郁症
对照组	28	21(75.00)	13(46.43)	23(82.14)
康复训练组	27	3(11.11)^a	5(18.52)^a	14(51.85)^a
护理干预组	23	4(17.39)^a	4(17.39)^a	5(21.74)^ab
χ²值		29.240	7.171	18.600
P值		＜0.001	0.028	＜0.001
注：与对照组比较，^aP＜0.05；与康复训练组比较，^bP＜0.05。

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