华西医院ICU地震伤员功能障碍特点的临床研究
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摘要
目的:了解ICU病房地震伤员的功能障碍的特点,为临床康复治疗提供依据。方法:运动功能评定应用MMT方法;运用关节角度尺评定关节活动度(ROM);利用被动关节活动法评定肌张力、痉挛评定选用改良的Ash-worth分级法;坐位平衡和站位平衡采用平衡反应试验评定;日常生活活动(ADL)能力选用国际通用的Barthel指数量表评定。由我科研究生作为评定人员。结果:①ICU病房地震伤员以骨折患者为主,占70%,神经系统损伤占20%,挤压综合症和肺挫伤各占5%;②女性骨折比例高于男性,为11∶3;神经系统损伤没有多大差异;截肢和瘫痪的患者中,男性高于女性,比例分别为4∶1和3∶2;肺部感染以女性更为明显,为7∶1;③47.6%的地震伤员关节活动受限(评定21人),93.3%的肌力下降(评定15人),15.8%肌张力下降(评定19人),36.8%肌张力增高(评定19人),30.0%的坐位平衡下降(评定10人),96.4%站立平衡下降;④ADL能力100%受限(评定20人),其中洗澡、修饰、如厕、平地行走45 m、上下楼梯受限均为100%,95%地震伤员进食能力下降,90%穿衣能力受限,35%大便失禁,60%小便控制能力下降,多数使用导尿管,95%地震伤员床椅转移能力下降;⑤40%出现肺部感染。结论:关节活动度受限、肌力下降、肌张力异常、平衡功能障碍、ADL能力受限及肺部感染是ICU地震伤员主要功能障碍。早期康复介入、维持和改善关节活动度、肌力训练、减张和牵伸训练、平衡训练、呼吸训练、站立和行走训练及ADL能力训练应当作为康复治疗的基本原则和方法。
Objective:To understand the motor function and activity of daily living(ADL) functional status of the earthquake injured in the Department of ICU,to provide the basis for clinical rehabilitation treatment.Methods: MMT method was used to evaluate muscle strength;joint angle scale was used to assess joint range of motion;passive joint activities was used to assess the muscle tension,and improved Ashworth to assess spasm;balanced response was used to assess sitting balance and standing balance;international generic Barthel Index Scale was used to evaluation ADL.The graduate students in the Department of Rehabilitation Medicine of West China Hospital were assessment staff.Results: ①Fracture patients accounted for 70% in the Department of ICU,nervous system injury accounted for 20%,both squeezing syndrome and pulmonary contusion accounted for 5%;②The ratio of female to male was 11∶3 for fracture,2∶2 for nervous system damage,1∶4 for amputation and 2∶3 for paralysis,7∶1 for lung infection;③47.6% with restricted joints activity(10/21),93.3% with muscle strength declined(14/15),15.8% with declined muscle tone(3/19),36.8% with increased muscle tension(7/19),30.0% with declined sitting balance(3/10),96.4% with declined standing balance(27/28);④100% with restricted ADL capacity(20/20),100% for bathing,grooming,toilet,the plains walk 45 meters,and stair activity,95% for the eatting capacity,90% for the ability to dress,35% for fecal incontinence,60% for urine control,95% for transfer from bed to chair;⑤40% with lung infection.Conclusion: Limited range of motion,muscle strength decline,abnormal muscle tone,balance dysfunction,ADL capacity limited and lung infection is the main dysfunction of the earthquake injured in the Department of ICU.Therefore,the early rehabilitation intervention to maintain and improve range of motion,strength training,reducing tension and drawing training,balance training,respiratory training,training to stand and walk,and ADL training as rehabilitation therapy should be the basic principles and methods to treat these patients.
Objective:To understand the motor function and activity of daily living(ADL) functional status of the earthquake injured in the Department of ICU,to provide the basis for clinical rehabilitation treatment.Methods: MMT method was used to evaluate muscle strength;joint angle scale was used to assess joint range of motion;passive joint activities was used to assess the muscle tension,and improved Ashworth to assess spasm;balanced response was used to assess sitting balance and standing balance;international generic Barthel Index Scale was used to evaluation ADL.The graduate students in the Department of Rehabilitation Medicine of West China Hospital were assessment staff.Results: ①Fracture patients accounted for 70% in the Department of ICU,nervous system injury accounted for 20%,both squeezing syndrome and pulmonary contusion accounted for 5%;②The ratio of female to male was 11∶3 for fracture,2∶2 for nervous system damage,1∶4 for amputation and 2∶3 for paralysis,7∶1 for lung infection;③47.6% with restricted joints activity(10/21),93.3% with muscle strength declined(14/15),15.8% with declined muscle tone(3/19),36.8% with increased muscle tension(7/19),30.0% with declined sitting balance(3/10),96.4% with declined standing balance(27/28);④100% with restricted ADL capacity(20/20),100% for bathing,grooming,toilet,the plains walk 45 meters,and stair activity,95% for the eatting capacity,90% for the ability to dress,35% for fecal incontinence,60% for urine control,95% for transfer from bed to chair;⑤40% with lung infection.Conclusion: Limited range of motion,muscle strength decline,abnormal muscle tone,balance dysfunction,ADL capacity limited and lung infection is the main dysfunction of the earthquake injured in the Department of ICU.Therefore,the early rehabilitation intervention to maintain and improve range of motion,strength training,reducing tension and drawing training,balance training,respiratory training,training to stand and walk,and ADL training as rehabilitation therapy should be the basic principles and methods to treat these patients.
引文
[1]MULVEY J M,AWAN S U,QADRI A A,et al.Profile of inju-ries arising from the 2005 Kashmir earthquake:The first 72 h[J].Injury,2008,39:554-560.
[2]ROY N,SHAH H,PATEL V,et al.Surgical and psychosocialoutcomes in the rural injured--a follow-up study of the 2001 earth-quake victims[J].Injury,2005,36(8):927-934.
[3]EMAMI M J,TAVAKOLI A R,ALEMZADEH H,et al.Strate-gies in evaluation and management of Bam earthquake victims[J].Prehosp Disaster Med,2005,20(5):327-330.
[2]ROY N,SHAH H,PATEL V,et al.Surgical and psychosocialoutcomes in the rural injured--a follow-up study of the 2001 earth-quake victims[J].Injury,2005,36(8):927-934.
[3]EMAMI M J,TAVAKOLI A R,ALEMZADEH H,et al.Strate-gies in evaluation and management of Bam earthquake victims[J].Prehosp Disaster Med,2005,20(5):327-330.
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