腹部高频深部振动疗法在颈、胸段脊髓损伤患者神经源性肠功能障碍康复中的作用

关键词：高频深部振动疗法  脊髓损伤  神经源性肠功能障碍  腹部按摩  便秘

Keywords:abdominal high-frequency deep vibration therapy  spinal cord injury  neurogenic bowel dysfunction  abdominal massage  constipation

摘要：

      摘要 目的：探讨腹部高频深部振动疗法在颈、胸段脊髓损伤（spinal cord injury， SCI）患者神经源性肠功能障碍（neurogenic bowel dysfunction， NBD）康复作用的效果评价。 方法：选取在我院住院治疗的颈、胸段SCI后NBD患者59例，采用随机对照设计，使用随机数字表法将患者分为对照组30例，观察组29例。两组患者均接受标准NBD康复护理，对照组额外进行了手动腹部按摩疗法，观察组接受腹部高频深部振动疗法，研究周期4周。比较两组患者入组前后国际脊髓损伤肠道功能评价（2.0版）、大便的性状（Bristol粪便分型法）、生存质量测定量表评分（QOL-BRE）及肠道相关并发症（药物依赖、腹痛/腹胀、漏粪发生、不完全性肠梗阻）发生率。 结果：观察组干预后国际脊髓损伤肠道功能评分分级优于对照组（P＜0.01）；观察组干预后排便性状Bristol粪便分型Ⅳ（理想型：香蕉状便）（62%）高于对照组（26.7%）（P＜0.01）；观察组干预后生存质量评分显著高于对照组评分（P＜0.05）；观察组干预后肠道相关并发症（药物依赖6%、腹痛/腹胀0、漏粪发生0、肠梗阻0）低于对照组（药物依赖50%、腹痛/腹胀30%、漏粪发生27%、肠梗阻17%）（P＜0.05）。 结论：腹部高频深部振动疗法可促进颈、胸段SCI神经源性肠患者肠道功能恢复，减少对药物依赖，降低肠道相关并发症，提高其生存质量，操作简易方便高效。

Abstract:

      Abstract Objective： To explore the effect of high-frequency abdominal deep vibration therapy in the rehabilitation of neurogenic bowel dysfunction （NBD） in patients with cervical and thoracic spinal cord injury. Method： A total of 59 hospitalized patients with NBD after cervical and thoracic spinal cord injury were selected and divided into control group （n=30） and the intervention group （n=29） by a randomized controlled trial design. The control group received the standard NBD rehabilitation nursing combined with manual abdominal massage therapy, while the intervention group received standard care supplemented with high-frequency abdominal deep vibration therapy. The study period was 4 weeks. The outcomes were assessed using the International Spinal Cord Injury Bowel Function Date Set （version 2.0），Bristol stool classification，quality of life brief questionnaire （QOL-BRE） and bowel-related complications （medication dependence， abdominal pain/bloating， fecal incontinence， and incomplete bowel obstruction） before and after the intervention. Result： After intervention, the international spinal cord injury bowel function scores in the intervention group were better than that of the control group（P<0.01）. The proportion of patients achieving ideal stool consistency (Type IV, banana-shaped stool) was higher in the intervention group(62%) compared to the control group (26.7%)(P<0.01). The quality of life score of the intervention group was significantly higher than that of the control group after intervention（P<0.05）； The bowel-related complications （medication dependence 6%， abdominal pain/ bloating 0%， fecal leakage 0%， intestinal obstruction 0%） in the intervention group were lower than those in the control group（medication dependence 50%， abdominal pain/bloating 30%， fecal leakage 27%， intestinal obstruction 17%）（P<0.05）. Conclusion： High-frequency abdominal deep vibration therapy is effective in promoting the recovery of bowel function, reducing medication dependence, lowering the incidence of bowel-related complications, and improving quality of life in patients with NBD after cervical and thoracic spinal cord injury.