下肢康复机器人训练对截瘫患者膀胱和肠道功能的影响

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients

目的探讨下肢康复机器人结合综合康复训练对脊髓损伤截瘫患者膀胱和肠道功能的临床效果。方法选取在我院住院且符合纳入条件的脊髓损伤截瘫患者38例,根据患者入院编号的奇偶性进行分组,单数入常规训练组19例,双数入机器人训练组19例。常规训练组进行常规综合康复训练,机器人训练组患者在常规综合康复训练的基础上结合下肢康复机器人的适应期、训练期和巩固期三个阶段训练。2组治疗时间均为每次30min, 1次/日,5次/周,持续时间12周。分别于训练前和训练12周结束后(训练后),使用尿动力检查系统测定2组患者的最大尿流量、膀胱容量、残余尿量、膀胱压力和逼尿肌压力等尿动力学指标,用结肠传输实验法测定结肠传输时间,用平均直肠压测定法测定平均直肠压值,采用FIM量表评定肠道功能。结果机器人训练组患者训练后的膀胱容量、最大尿流率、平均尿流率、逼尿肌压力、膀胱顺应性、平均直肠压和分别为(357.4±13.2)ml、(20.43±4.05)ml/s、(18.09±4.24)ml/s、(60.16±16.13)kPa、(4.45±1.72) ml/cmH2O和(39.12±6.57)cmH2O,均明显高于组内训练前(P<0.05),而残余尿量和结肠传输时间分别为(105.5±7.9)ml和(90.83±7.22)h,明显低于训练前(P<0.05)。训练后,机器人训练组的膀胱容量、最大尿流率、平均尿流率、逼尿肌压力、膀胱顺应性、平均直肠压均明显高于常规训练组(P<0.01);残余尿量和结肠传输时间均明显低于常规训练组(P<0.01)。机器人训练组患者训练后FIM评分肠道部分改善>6分的改善率为31.6%,均高于常规训练组(10.5%),且差异有统计学意义(P<0.01)。结论下肢康复机器人结合综合康复训练可以有效地改善脊髓损伤截瘫患者的膀胱和肠道功能。

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group (n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages: adaptation, training and consolidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure (FIM) scale respectively. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32% of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury.