摘要
目的观察高血压性脑出血(HICH)术后昏迷患者采用多种感知刺激疗法治疗的康复效果,探讨其对HICH术后昏迷患者的应用价值。方法2021年1月—2023年10月郑州市第一人民医院诊治HICH术后昏迷患者116例,随机分为常规治疗组和感知刺激组各58例,常规治疗组给予促醒药物、脱水、减轻脑水肿、抗感染、营养支持等常规治疗,感知刺激组在常规治疗基础上综合多感官刺激、运动刺激、物理刺激和耳穴压豆法的多种感知刺激疗法进行治疗。比较2组干预3个月内苏醒率、干预前后昏迷状况[格拉斯哥昏迷量表(GCS)]、生理状态[功能障碍评分量表(DFS)]、神经功能[美国国立卫生院卒中量表(NIHSS)]、脑功能状态(Grant氏二分法变量评分)及并发症发生情况。结果感知刺激组干预3个月内苏醒率(94.83%)高于常规治疗组(81.03%)(χ^(2)=5.199,P=0.023)。干预14、28 d时,感知刺激组GCS评分[(8.62±1.34)、(10.64±1.48)分]、Grant评分[(6.86±0.85)、(8.10±1.00)分]均高于常规治疗组[(7.38±1.37)、(8.84±1.39)分,(5.41±0.90)、(6.82±1.02)分](t=4.934、6.725、8.930、6.895,P均<0.05),DFS评分[(10.57±1.86)、(6.84±1.27)分]、NIHSS评分[(9.84±1.07)、(6.34±1.00)分]均低于常规治疗组[(15.31±2.29)、(10.31±1.34)分,(12.26±1.15)、(9.16±1.12)分](t=12.258、14.305、11.699、14.243,P均<0.05);干预前及干预7 d时,2组GCS评分、DFS评分、NIHSS评分、Grant评分比较差异均无统计学意义(t=0.223~1.897,P均>0.05);2组GCS评分、Grant评分均随干预时间延长而逐渐升高(P<0.05),DFS评分、NIHSS评分均随干预时间延长而逐渐降低(P<0.05)。感知刺激组干预期间总并发症发生率(17.24%)低于常规治疗组(39.66%)(χ^(2)=7.157,P=0.007)。结论多种感知刺激可缩短HICH术后昏迷患者苏醒时间,促进患者快速苏醒,有效改善患者昏迷状况和生理状态,减轻患者神经功能损伤,恢复患者脑功能,减少并发症发生率。
Objective To observe the rehabilitation effect of multiple sensory stimulation therapy in postoperative coma patients with hypertensive intracerebral hemorrhage(HICH),and to explore its value on postoperative coma in patients with HICH.Methods Totally 116 postoperative coma patients with HICH were diagnosed and treated in the First People's Hospital of Zhengzhou from January 2021 to October 2023,and were randomly and equally divided into a conventional treatment group and a sensory stimulation group.The conventional treatment group received standard therapy,including awakening-promoting drugs,dehydration,cerebral edema reduction,anti-infection,and nutritional support.The sensory stimulation group received additional multiple sensory stimulation therapy on the basis of standard therapy,including multi-sensory stimulation,motor stimulation,physical stimulation,and auricular seed therapy.The awakening rate within 3 months of intervention,the coma status[Glasgow Coma Scale(GCS)],physiological status[Dysfunction Scale(DFS)],neurological function[National Institutes of Health Stroke Scale(NIHSS)],cerebral function status(Grant's binary variable score)before and after intervention,and the occurrence of complications were compared between two groups.Results The awakening rate within 3 months of intervention was higher in the sensory stimulation group(94.83%)than that in the conventional treatment group(81.03%)(X^(2)=5.199,P=0.023).At 14 and 28 d of intervention,the GCS score(8.62±1.34,10.64±1.48)and Grant's score(6.86±0.85,8.10±1.00)were higher in the sensory stimulation group than those in the conventional treatment group(GCS score:7.38±1.37,8.84±1.39;Grant's score:5.41±0.90,6.82±1.02)(t=4.934,6.725,8.930,6.895;all P values<0.05),and the DFS score(10.57±1.86,6.84±1.27)and NIHSS score(9.84±1.07,6.34±1.00)were lower in the sensory stimulation group than those in the conventional treatment group(DFS score:15.31±2.29,10.31±1.34;NIHSS score:12.26±1.15,9.16±1.12)(t=12.258,14.305,11.699,14.243;all P values<0.05).Before intervention and at 7 d of intervention,the GCS,DFS,NIHSS and Grant's scores showed no significant differences between two groups(t=0.223-1.897,P>0.05).In two groups,the GCS and Grant's scores gradually increased with the prolongation of intervention time(P<0.05),and the DFS and NIHSS scores gradually decreased with the prolongation of intervention time(P<0.05).The total incidence of complications during the intervention was lower in the sensory stimulation group(17.24%)than that in the conventional treatment group(39.66%)(X^(2)=7.157,P=0.007).Conclusion Multiple sensory stimulation can shorten the awakening time,promote the rapid awakening,effectively ameliorate the coma condition and physiological status,mitigate the neurological function damage,restore the cerebral function,and reduce the probability of complications in postoperative coma patients with HICH.
作者
韩冰
姜艳丽
张明
杜娟
闫永芳
马旭东
王宇
HAN Bing;JIANG Yanli;ZHANG Ming;DU Juan;YAN Yongfang;MA Xudong;WANG Yu(Department of Surgery,the First People's Hospital of Zhengzhou,Zhengzhou,Henan 450004,China;Cerebrovascular Hospital,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2025年第6期550-554,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技攻关计划项目(242102310182)。
关键词
高血压性脑出血
昏迷
感知刺激
神经功能
苏醒时间
hypertensive intracerebral hemorrhage
coma
sensory stimulation
neurological function
awakening time
