高压氧联合核心稳定性训练在颅脑损伤后下肢功能障碍中的应用效果

doi:10.3760/cma.j.issn.1007-1245.2022.24.010

摘要/Abstract

摘要： 目的　探究高压氧联合核心稳定性训练在颅脑损伤后下肢功能障碍中的应用效果。方法　前瞻性选取威海市中心医院2020年1月至2022年1月收治的94例颅脑损伤患者作为研究对象，按照随机数字表法将其分为研究组及对照组。对照组女22例，男25例，年龄（60.02±8.52）岁；研究组男26例，女21例，年龄（61.02±8.68）岁。对照组47例予以常规核心稳定性训练，研究组47例在对照组基础上施以高压氧。比较2组患者干预1个月后的肢体功能Fugl-Meyer运动功能评定量表（FMAS）评分、简易精神状态检查量表（MMSE）评分、不良事件发生率。采用t检验、χ²检验。结果　2组患者训练前FMAS评分差异无统计学意义（t=1.530，P=0.128），训练后2组FMAS评分高于训练前（均P<0.05），且研究组FMAS评分高于对照组［（28.36±4.82）分比（24.96±3.52）分］（t=4.522，P=0.001）。2组患者训练前MMSE评分差异无统计学意义（t=1.204，P=0.232），训练后2组MMSE评分高于训练前（均P<0.05），且研究组MMSE评分高于对照组［（24.25±2.85）分比（19.56±2.56）分］（t=8.393，P<0.001）。研究组不良事件发生率低于对照组［6.38%（3/47）比23.40%（11/47）］（χ²=5.371，P=0.020）。结论　高压氧联合核心稳定性训练应用在颅脑损伤后下肢功能障碍患者中，有利于患者下肢功能恢复，改善精神状态，降低患者的不良事件发生率，值得推广应用。

关键词:

"> 高压氧, 核心稳定性训练, 颅脑损伤后下肢功能障碍, 精神状态, 不良事件发生率

Abstract: Objective　To explore the effect of hyperbaric oxygenation combined with core stability training on lower limb dysfunction after craniocerebral injury. Methods　A total of 94 patients with craniocerebral injury admitted to Weihai Central Hospital from January 2020 to January 2022 were prospectively selected as the study subjects. According to the random number table method, they were divided into a study group and a control group. In the control group, there were 22 females and 25 males, aged (60.02±8.52) years; in the study group, there were 26 males and 21 females, aged (61.02±8.68) years. The 47 patients in the control group were given routine core stability training, and the 47 patients in the study group were given hyperbaric oxygenation on the basis of the control group. The patients' limb function in the two groups were assessed by the Fugl-Meyer Motor Function Assessment Scale (FMAS), and the score of Mini-Mental State Examination (MMSE) and the incidence of adverse events after one month of intervention were compared between the two groups. t test and χ² test were used. Results　There was no statistically significant difference in the FMAS score between the two groups before training (t=1.530, P=0.128); the FMAS scores of the two groups after training were higher than those before training (both P<0.05), and the FMAS score of the study group was higher than that of the control group [(28.36±4.82) points vs. (24.96±3.52) points] (t=4.522, P=0.001). There was no statistically significant difference in the MMSE score between the two groups before training (t=1.204, P=0.232); the MMSE score of the two groups after training were higher than those before training (both P<0.05), and the MMSE score of the study group was higher than that of the control group [(24.25±2.85) points vs. (19.56±2.56) points] (t=8.393, P<0.001). The incidence of adverse events in the study group was lower than that in the control group [6.38% (3/47) vs. 23.40% (11/47)] (χ²=5.371, P=0.020). Conclusions　Hyperbaric oxygenation combined with core stability training is beneficial to the recovery of lower limb function in patients with lower limb dysfunction after craniocerebral injury, can improve the mental state and reduce the incidence of adverse events, and is worth popularizing and applying.

Key words: Hyperbaric oxygenation, , Core stability training, , Lower limb dysfunction after craniocerebral injury, , Mental state, , Incidence of adverse events

孟文文徐雅慧丛海铭于丰源李希岭. 高压氧联合核心稳定性训练在颅脑损伤后下肢功能障碍中的应用效果[J]. 国际医药卫生导报, 2022, 28(24): 3453-.

Meng Wenwen, Xu Yahui, Cong Haiming, Yu Fengyuan, Li Xiling. Effect of hyperbaric oxygenation combined with core stability training on lower limb dysfunction after craniocerebral injury[J]. International Medicine and Health Guidance News, 2022, 28(24): 3453-.

参考文献

[1] Harper NG, Esposito ER, Wilken JM, et al. The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments[J]. Clin Biomech (Bristol, Avon), 2014, 29(8):877-884. DOI: 10.1016/j.clinbiomech.2014.07.005.
[2] 黄的,钟颖,李雪健,等.经皮三叉神经电刺激及高压氧对脑卒中或颅脑损伤后昏迷的促醒效果[J].深圳中西医结合杂志,2022,32(5):76-79. DOI:10.16458/j.cnki.1007-0893. 2022.05.023.
[3] Tang L, Liu SS, Gao F, et al. Use of dry needling therapy to improve lower limb dysfunction in a patient with 10-year cerebral hemorrhage sequelae: a case report[J]. Acupunct Med, 2022, 40(3):270-271. DOI: 10.1177/09645284221076505.
[4] 冯真真,王德强,王群,等.重复经颅磁刺激联合高压氧对颅脑损伤后昏迷患者的促醒疗效观察[J].当代医学,2022,28(5):31-34. DOI:10.3969/j.issn.1009-4393.2022.05.011.
[5] Yu BF, Qiu YQ, Du MX, et al. Contralateral hemi-fifth-lumbar nerve transfer for unilateral lower limb dysfunction due to incomplete traumatic spinal cord injury: a report of two cases[J]. Microsurgery, 2020, 40(2):234-240. DOI: 10.1002/micr.30470.
[6] Ghayour-Najafabadi M, Memari AH, Hosseini L, et al. Repetitive transcranial magnetic stimulation for the treatment of lower limb dysfunction in patients poststroke: a systematic review with meta-analysis[J]. J Stroke Cerebrovasc Dis, 2019, 28(12):104412. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104412.
[7] Shariat A, Najafabadi MG, Ansari NN, et al. The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: a systematic review with meta-analysis[J]. NeuroRehabilitation, 2019, 44(3):389-412. DOI: 10.3233/NRE-182671.
[8] 曲东锋,李宏建,陈兴洲."第四届国际脑血管疾病研究进展学术交流会"纪要[J].国外医学(脑血管疾病分册),2003,11(6):477-478. DOI:10.3760/cma.j.issn.1673-4165.2003. 06.018.
[9] 陈瑞全,吴建贤,沈显山.中文版Fugl-Meyer运动功能评定量表的最小临床意义变化值的研究[J].安徽医科大学学报,2015,50(4):519-522. DOI:10.19405/j.cnki.issn1000- 1492.2015.04.025.
[10] 周小炫,谢敏,陶静,等.简易智能精神状态检查量表的研究和应用[J].中国康复医学杂志,2016,31(6):694-696,706. DOI:10.3969/j.issn.1001-1242.2016.06.019.
[11] Yasemin ULUS, Murat SAVLIK, Yeşim Akyol, et al. Association of knee muscle strength with lower extremity dysfunction in patients with osteoarthritis: a comparison with rheumatoid arthritis patients and healthy controls[J]. Turk J Rheumatol, 2013, 28(2):78-86. DOI: 10.5606/tjr.2013.2744.
[12] Farrokhi S, Piva SR, Gil AB, et al. Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis[J]. Arthritis Care Res (Hoboken), 2013, 65(4):544-551. DOI: 10.1002/acr.21866.
[13] Roshal LM, Valiullina SA, Sharova EA. The regional epidemiological characteristics of craniocerebral injury in children in Russia in 2003-2014[J]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med, 2019, 27(3):257-261. DOI: 10.32687/0869-866X-2019-27-3-257-261.
[14] Stocker R, Bürgi U, Keller E, et al. Acute craniocerebral injury. Pathophysiology, monitoring and treatment[J]. Anaesthesist, 2000, 49(10):913-926. DOI: 10.1007/s001010070050.
[15] Shai AN, Fedulova MV, Kvacheva YE, et al. The importance of marker proteins of the nervous tissue for morphological diagnostics of the craniocerebral injury[J]. Sud Med Ekspert, 2017, 60(4):40-45. DOI: 10.17116/sudmed201760440-45.
[16] Aleksandrova EV, Iusupova MM, Tenedieva VD, et al. Clinical and prognostic significance of genetic markers in craniocerebral injury (Part III) [J]. Zh Vopr Neirokhir Im N N Burdenko, 2014, 78(3):53-61.
[17] Du T, Jing X, Song S, et al. Therapeutic effect of enteral nutrition supplemented with probiotics in the treatment of severe craniocerebral injury: a systematic review and meta-analysis[J]. World Neurosurg, 2020, 139:e553-e571. DOI: 10.1016/j.wneu.2020.04.083.
[18] Beheshti F, Hosseini M, Hashemzehi M, et al. The effects of PPAR-γ agonist pioglitazone on hippocampal cytokines, brain-derived neurotrophic factor, memory impairment, and oxidative stress status in lipopolysaccharide-treated rats[J]. Iran J Basic Med Sci, 2019, 22(8):940-948. DOI: 10.22038/ijbms.2019.36165.8616.
[19] 王海涛,余志平,孙炳龙,等.电磁导航下踝关节骨折闭合复位克氏针内固定的临床报道[J].国际医药卫生导报,2020,26(10):1367-1369. DOI:10.3760/cma.j.issn.1007-1245. 2020.10.010.
[20] 李斌,王义刚,郗东锋,等.髂筋膜间隙阻滞对股骨骨折患者椎管内麻醉前摆放体位的镇痛作用[J].中国药物与临床,2015,15(7):1008-1010. DOI:10.11655/zgywylc2015. 07.049.
[21] Lee SY, Yoon BH, Beom J, et al. Effect of lower-limb progressive resistance exercise after hip fracture surgery: a systematic review and meta-analysis of randomized controlled studies[J]. J Am Med Dir Assoc, 2017, 18(12):1096.e19-1096.e26. DOI: 10.1016/j.jamda.2017.08.021.
[22] Costa ML, Achten J, Bruce J, et al. Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLLF randomized clinical trial[J]. JAMA, 2018, 319(22):2280-2288. DOI: 10.1001/jama.2018.6452.
[23] 冼晓琪,杨杰华,区大明,等.高压氧联合虚拟现实技术对脑梗死伴偏瘫患者运动协调能力的影响[J].广西医学,2021,43(4):413-416,425. DOI:10.11675/j.issn.0253-4304. 2021.04.06.
[24] 傅廷友,刘洋,高光凯.高压氧预处理对下肢骨折老年患者术后认知功能的影响[J].中华航海医学与高气压医学杂志,2019,26(6):575-578. DOI:10.3760/cma.j.issn.1009-6906. 2019.06.023.
[25] 柳尧花.高压氧对急性完全性前循环梗死患者下肢功能的影响[J].中华航海医学与高气压医学杂志,2019,26(2):150-152. DOI:10.3760/cma.j.issn.1009-6906.2019. 02.019.