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医学论文范文:偏瘫患者综合性神经康复治疗的疗效观察
【摘要】 目的 探讨综合性神经康复治疗对偏瘫患者神经功能缺损及抑郁障碍的疗效。方法 将62例首发偏瘫伴抑郁症状的患者随机分为治疗组和对照组，每组31例，治疗组给予规范的综合性神经康复治疗，包括运动疗法、心理治疗和神经科常规药物治疗，对照组予神经科常规药物治疗。用脑卒中患者临床神经功能缺损程度评分标准和汉密尔顿抑郁量表(HAMD)，分别于治疗前和治疗后2、4周末对患者进行疗效评定。结果 治疗组与对照组脑卒中患者临床神经功能缺损程度评分和HAMD评分在治疗前差异无显著性(P>0.05);治疗2周末治疗组评分低于对照组，但差异无显著性(P>0.05);4周末治疗组评分均低于对照组，差异有显著性(P<0.05)。结论 综合性神经康复治疗能显著改善偏瘫患者神经功能缺损，缓解患者的抑郁症状。
【关键词】 偏瘫;抑郁;神经功能缺损;康复治疗
Clinical observation of integral neurological rehabilitation in 62 cases with hemiplegia
WEI Jingang医.学全.在.线网站www.med126.com
(Gulou Hospital of Xuzhou, Xuzhou, Jiangsu 221005, China)
Abstract： Objective To probe into the effect of a comprehensive neurological rehabilitation regimen on the neurological impairment and remission of depression in patients with hemiplegia. Methods 62 cases of the initial hemiplegia with depression were randomized into two groups: the treatment group and the control group (n=31 ealch). The treatment group underwent standardized integral treatment of neurological rehabilitation, physical therapy, routine psychological and neurological medication; while the control group only received routine neurological drug administration. Patients with stroke were assessed for efficacy by clinical neurological impairment scoring criteria and the Hamilton Depression Rating Scale (HAMD), before treatment and 2 and 4 weeks after treatment, respectively. Results The clinical neurological impairment score and the HAMD scores had no differences between the treatment group and the control group before the treatment (P>0.05); and 2 weeks after the treatment, the scores in treatment group were slightly lower than those in the control group, but the difference had no statistical significance (P>0.05); the clinical degree of neurological impairments and HAMD scores of patients with stroke in the treatment group were lower than those in the control group, with significant statistical difference at the end of the 4th week (P<0.05). Conclusion The neurological rehabilitation therapy can significantly improve the neurological impairment and relieve the depressive symptoms in patients with hemiplegia.
Key words： hemiplegia; depression; neurological impairment; rehabilitation therapy
已换 引起偏瘫的原因很多，脑卒中、脑外伤最为常见，我国每年死于脑卒中者约130万，存活者约75%致残，给家庭和社会带来沉重负担。早期、积极康复治疗，将使80%的患者功能明显改善[1]。多数偏瘫患者出现应激性心理反应，包括情绪反应、行为反应、自我防御反应[2]，不能配合治疗，因此我们应用综合性神经康复治疗改善偏瘫患者的神经功能缺损，缓解抑郁症状，从而促进患者肢体功能康复。
1 对象和方法
1.1 对象 选取2008年5月—2009年4月在我院治疗的偏瘫患者62例，男32例，女30例，年龄29～72岁，平均(57.3±7.5)岁。其中脑外伤1例，脑梗死41例，脑出血20例。全部患者均经头颅CT或MRI确诊，生命体征平稳，意识清楚。按入院治疗顺序随机分为治疗组、对照组，每组31例。2组患者在性别、年龄、病种、神经功能缺损、抑郁等方面均有可比性。
1.2 方法 治疗组予以综合性神经康复治疗。①运动疗法：运用神经肌肉促进技术对患侧肢体进行被动活动、床上训练、起坐训练、站位平衡训练、步行训练、日常生活活动训练等[3]， 每天2次，每次40 min。②心理治疗，每天1次，每次30 min，采用认知疗法、支持疗法等进行心理疏导、积极心理暗示，促进患者保持良好心态[4]。心理治疗要注意沟通技巧，特别是谈话技巧、倾听的技巧、提问的技巧、反馈的技巧[5]。③药物按神经科常规药物治疗。对照组按神经科常规药物治疗。
