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早期康复训练结合补钙对脑梗死偏瘫患者骨密度水平和神经功能的影响

2017-10-07 16:00:09    作者:admin    www.5alw.com
[摘要]  目的  观察早期康复训练结合补钙对脑梗死偏瘫患者骨密度水平和神经功能的影响。方法  选择在我科住院的起病后7天内入院的180例脑梗死偏瘫患者,随机分为对照组和试验组,两组在进行常规药物治疗的基础上对照组早期进行康复训练,试验组早期进行康复训练和补钙处理,两组分别于入院后第二天和治疗后4周进行骨密度水平(BMD)和神经功能缺损(NIHSS)测定,两组治疗前后进行比较,以及治疗后两组之间进行比较,采用SPSS 11.0统计学软件进行统计分析,以P<0.05为差异有显著性作为判断标准。结果  对照组治疗前后骨密度水平比较差异无显著性(P>0.05),神经功能缺损评分较治疗前降低,两者比较差异有显著性(P<0.05);试验组的骨密度水平和神经功能缺损治疗前后比较差异均有非常显著性(P<0.001)。两组治疗后骨密度水平和神经功能缺损比较差异有非常显著性(P<0.001)。 结论  对脑梗死偏瘫患者早期康复训练结合补钙,可明显提高患者的骨密度水平,降低卒中后骨质疏松的发生率,促进患者神经功能的恢复。
   
  [关键词]  脑梗死;康复训练;骨密度;神经功能
   
  Effect of rehabilitation therapy combined with calcium supplementation on the bone mineral density and the neural function of hemiparesis patients with cerebral infarction

  LIU Chuan-zhen,DING Xiao-gang, ZHANG Qi-mei,et al.

  Department of Neurology ,Yichang Central Hospital,the First Affiliated Hospital of Three Gorges University ,Yichang 443000,China

  [Abstract]  Objective  To study the effect of rehabilitation training combined with  calcium supplementation on the bone density (BMD) and the neural function of hemiparesis patients with cerebral infarction.Methods  180 hemiparesis patients with cerebral infarction,who were treated in our department in 7 days after stroke,were divided into 2 groups randomly. All patients were treated by routine medicine, after the first experiment group treated by rehabilitation training in the early stage, the second experiment group treated by rehabilitation training in the early stage combined with calcium supplementation. The bone density (BMD) and the National Institute of Health Stroke Scale (NIHSS) of 2 groups were assessed 2 days and 4 weeks after the treatment. Compare the two groups before and after treatment,respectively,and the two groups after treatment. The data was analyzed with SPSS 11.0 software, and P<0.05 singed if they have obvious differences.Results  Before and after treatment, BMD level of rehabilitation group were not significantly different (P>0.05) .The NIHSS of neuralgic impairmentis lower after treatment than that before treatment, the difference is statistically significant (P<0.05).The NIHSS and BMD of the group treated by rehabilitation training in the early stage combined with calcium supplementation  were significantly different (P<0.001).The NIHSS of the group treated by rehabilitation training in the early stage combined with calcium supplementation is the best after 4-week treatment (P<0.001).Conclusion  It will obviously add the BMD , decline the osteoporosis incidence rate after stroke and promote the recovery of NIHSS for hemiparesis with cerebral infarction patients supplementation treated by rehabilitation training combined with calcium supplementation in the early stage.

  [Key words]  cerebral infarction;rehabilitation training;bone mineral density;National Institutes of Health Stroke Scale
   
  康复训练对脑卒中患者的治疗作用已受到广泛关注,但有关康复训练结合补钙治疗对脑梗死偏瘫患者的骨密度水平和神经功能影响的研究较少。本文采用早期康复训练结合补钙对脑梗死偏瘫患者进行治疗,观察其疗效,并与单纯行早期康复训练者进行比较。

  1  资料与方法

  1.1  一般资料  2005年6~12月在我科住院的起病后7天内入院的180例脑梗死偏瘫患者经颅脑CT或MRI确诊为脑梗死,符合1995年全国第四届脑血管病会议诊断标准。意识障碍重、不能进食、长期补钙者,甲状腺和甲状旁腺疾病者,骨瘤和骨转移瘤者除外。将入选对象随机分为2组,对照组90例,男49例,女41例,平均年龄(59.98±7.76)岁;试验组90例,男47例,女43例,平均年龄(59.96±6.63)岁。2组病例在性别、年龄、卒中次数、诱发因素、绝经年龄,合并高血压、糖尿病、高脂血症、心脏病等慢性躯体疾病方面经统计学处理差异无显著性。

  1.2  方法  所有患者入院后按卒中指南给予相应的药物治疗:改善脑循环,保护脑细胞,抑制血小板聚集;大面积脑梗死患者给予脱水治疗。所有病例于入院第二天进行骨密度测定并由同一位物理治疗师进行神经功能缺损评定。同时对照组患者进行康复训练,包括床上良姿位、瘫痪肢体的主被动运动、斜床站立、针灸和中频治疗仪等物理治疗方法。试验组采用药物、补钙(迪巧片1500 mg,每日2次口服),早期康复训练三者结合治疗。2组分别于入院后第二天和治疗后4周进行神经功能缺损(NIHSS)评定和双能X线骨密度仪测定偏瘫侧股骨颈、WARD三角、股骨大转子的骨密度并取三者的平均值,所测数据采用SSPS 11.0统计学软件进行统计分析,以P<0.05为差异有显著性作为判断标准。

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