运动康复路径对颅脑损伤患者术后康复锻炼效果的影响

Influences of exercise rehabilitation pathway on postoperative rehabilitation effect in patients with craniocerebral injury

目的：探讨运动康复路径对颅脑损伤患者术后康复锻炼效果的影响。方法采用方便抽样法选取2012年7月—2014年6月河北省唐山市工人医院收治的颅脑损伤患者152例，根据随机数字表分为观察组和对照组，每组各76例。对照组给予常规的术后护理及康复指导，观察组在此基础上给予运动康复路径，以患者为中心制订个体化的康复锻炼计划。比较干预后4周两组的术后康复锻炼依从性量表、功能独立性评定量表（FIA）、改良 Barthel 指数（MBI）、颅脑损伤患者生活质量量表（QOLIBRI）的评分。结果干预后观察组患者康复锻炼依从性量表的知识掌握情况、训练依从性、主动寻求建议3个维度分别为（93．5±5．3），（92．2±5．7），（91．6±6．1）分，高于对照组的（87．2±6．7），（84．2±7．0），（83．5±7．8）分，差异有统计学意义（t 值分别为6．429，7．726，7．131；P ＜0．01）；干预后观察组患者 FIA的运动、认知评分、总分及 MBI 评分分别为（78．2±7．3），（32．3±2．5），（110．5±7．9），（88．2±7．3）分，高于对照组的（73．4±9．0），（30．8±3．1），（104．2±9．7），（81．9±9．1）分，差异有统计学意义（t 值分别为3．611，3．284，4．390，4．708；P ＜0．01）；干预后观察组患者观察组 QOLIBRI 的总体感觉、思考能力、情绪和自评、独立性和日常生活、人际关系5个方面的评分分别为（65．7±6．5），（60．7±5．2），（62．1±5．8），（61．4±4．5），（55．7±4．5）分，高于对照组的（61．2±7．2），（557．7±6．1），（59．0±6．1），（57．6±6．3），（52．9±6．0）分，差异有统计学意义（t 值分别为4．044，3．263，3．211，4．279，3．255；P ＜0．01）；而观察组 QOLIBRI 的消极感觉、身体状况、困扰3个方面的评分分别为（38．9±5．4），（44．7±6．1），（38．2±5．9）分，低于对照组的（43．1±6．5），（49．4±7．5），（41．8±7．3）分，差异有统计学意义（t 值分别为4．333，4．238，3．344；P ＜0．01）。结论运动康复路径提高了颅脑损伤患者术后康复锻炼的依从性，通过个体化的康复计划恢复了运动功能，从身体状况和心理状态2个方面提高了生活质量，值得临床推广。

Objective To explore the influences of exercise rehabilitation pathway on postoperative rehabilitation exercise effect in patients with craniocerebral injury.Methods A total of 1 52 patients with craniocerebral injury,who admitted in Tangshan Gongren Hospital from July 201 2 to June 201 4,were selected by convenience sampling as objects and were divided according to random number table method into observation group and control group,each with 76 cases.In the control group,patients were given routine postoperative nursing and rehabilitation guidance,while in the observation group,patients,on the basis of routine nursing, were given exercise rehabilitation pathway,which took the patients as the center and develop individualized rehabilitation exercise program.The scores of postoperative rehabilitation exercise compliance scale （PRECS）, functional independence measure scale （FIA）,modified Barthel index （MBI）,the quality of life after traumatic injury （QOLIBRI）were compared between the two groups 4 weeks after the interventions.Results After the interventions,the three dimensions scores of the （observation group in knowledge mastery of PRECS,exercise compliance,actively seeking advice）were （93.5 ±5.3）,（92.2 ±5.7）and （91 .6 ±6.1 ）points,higher than （87.2 ±6.7）,（84.2 ±7.0）and （83.5 ±7.8）points in the control group （t =6.429,7.726,7.1 31 ;P 〈0.01 ）;after the interventions,scores in the observation group in motor,cognition,total score of FIA,and in MBI were respectively （78.2 ±7.3）,（32.3 ±2.5）,（1 1 0.5 ±7.9）and （88.2 ±7.3）points,higher than that in the control group,（73.4 ±9.0）,（30.8 ±3.1 ）,（1 04.2 ±9.7）and （81 .9 ±9.1 ）points,with （t =3.61 1 ,3.284,4.390,4.708;P 〈0.01 ）;after the interventions,scores in the observation group in overall feeling,thinking ability,emotion and self-rating,independence and daily life,and interpersonal relationship of QOLIBRI were （65.7 ±6.5）,（60.7 ±5.2）,（62.1 ±5.8）,（61 .4 ±4.5）and （55.7 ±4.5）points,higher than that in the control group,（61 .2 ±7.2）,（557.7 ±6.1 ）,（59.0 ±6.1 ）,（57.6 ±6.3）,and （52.9 ±＆amp;nbsp;6.0）points （t =4.044,3.263,3.21 1 ,4.279,3.255;P 〈0.01 ）;scores in the observation group in negative feeling,physical condition and distress of QOLIBRI were （38.9 ±5.4）,（44.7 ±6.1 ）,and （38.2 ± 5.9）points,lower than （43.1 ±6.5）,（49.4 ±7.5）and （41 .8 ±7.3）points in the control group （t =4.333,4.238,3.344;P 〈0.01 ）.Conclusions Exercise rehabilitation pathway can improve the compliance of postoperative rehabilitation exercise for patients with craniocerebral injury.The individualized rehabilitation exercise program is beneficial to the rehabilitation of motor function.Quality of life is also improved from aspects of physical condition and mental state.It should be promoted.