认知强化综合干预在脊髓损伤患者中的应用研究

doi:10.3761/j.issn.0254-1769.2023.22.006

摘要/Abstract

摘要：

目的运用前期构建的认知强化综合干预方案对脊髓损伤患者开展干预并评价其临床应用效果。方法采用非随机分组的类实验研究设计，通过便利抽样将2022年3月—9月在合肥市某三级甲等医院就诊的44例脊髓损伤患者纳入试验组，2021年11月—2022年2月就诊的53例脊髓损伤患者纳入对照组。使用认知强化综合干预方案对试验组进行干预，对对照组进行常规康复护理，两组干预均持续12周。分别于干预前、干预后1、3个月用长沙版蒙特利尔认知评估量表、社会支持评定量表、康复锻炼自我效能量表、脊髓损伤独立性评定量表、汉密尔顿焦虑量表对两组进行测评。结果试验组40例、对照组48例完成研究。重复测量方差分析显示，两组认知功能评分、焦虑水平评分的时间效应、交互效应、组间效应具有统计学意义（P<0.05）；两组主观支持维度得分、应对自我效能维度得分的时间效应、交互效应具有统计学意义（P<0.05）。干预后1个月，试验组认知功能评分高于干预前和对照组、焦虑水平得分低于干预前和对照组，差异具有统计学意义（P<0.05）；干预后3个月，试验组的认知功能评分、主观支持维度得分、应对自我效能维度得分高于干预前和对照组，焦虑水平评分低于干预前和对照组，差异具有统计学意义（P<0.05）。结论认知强化综合干预可改善脊髓损伤患者的认知功能，延缓患者认知障碍进程，提升自我信心，缓解焦虑，促进患者身心康复。

关键词: 脊髓损伤, 认知功能障碍, 认知强化综合干预, 康复护理

Abstract:

Objective To use the cognitive reinforcement comprehensive intervention program constructed by our team to intervene in patients with spinal cord injury and evaluate its clinical application effect. Methods A non-randomized trial design was adopted to select 97 patients with spinal cord injury from November 2021 to September 2022. Forty-four patients from March to September 2022 in a Grade A hospital in Hefei City were included in the experimental group，and 53 patients from November 2021 to February 2022 were included in the control group. The cognitive reinforcement comprehensive intervention program was used to intervene in the experimental group，and the conventional rehabilitation nursing was used to intervene in the control group.The intervention lasted for 12 weeks in both groups. The Changsha Montreal Scale，Social Support Rating Scale，Rehabilitation Exercise Self-efficacy Scale，Spinal Cord Injury Independence Rating Scale and Hamilton Anxiety Scale were used to measure the two groups before intervention，1 month after intervention and 3 months after intervention. Results 40 cases in the experimental group and 48 cases in the control group completed the study.Repeated measurement ANOVA showed that the temporal，interactive and intergroup effects of cognitive function scores and anxiety scores were statistically significant（P<0.05）. The time effect and interaction effect of the subjective support dimension score，coping self-efficacy dimension score of the two groups were statistically significant（P<0.05）. One month after the intervention，the cognitive function scores of test group were higher than before intervention and control group，and the anxiety scores were lower than before intervention and control group（P<0.05）. Three months after the intervention，the scores of cognitive function，subjective support dimension and coping self-efficacy dimension of experimental group were higher than those before intervention and control group，and the scores of anxiety level were lower than those before intervention and control group（P<0.05）. Conclusion Comprehensive intervention of cognitive reinforcement can improve the cognitive function of patients with spinal cord injury，delay the process of cognitive impairment，enhance self-confidence，relieve anxiety，and promote physical and mental rehabilitation of patients.

Key words: Spinal Cord Injury, Cognitive Dysfunction, Comprehensive Cognitive Reinforcement Intervention, Rehabilitation Nursing

袁昊炜, 李伦兰, 祁金梅, 戴晴, 廖晨霞, 高馨, 黄慧, 丁佩佩, 凤林生. 认知强化综合干预在脊髓损伤患者中的应用研究[J]. 中华护理杂志, 2023, 58(22): 2726-2733.

YUAN Haowei, LI Lunlan, QI Jinmei, DAI Qing, LIAO Chenxia, GAO Xin, HUANG Hui, DING Peipei, FENG Linsheng. Application of comprehensive cognitive reinforcement intervention in patients with spinal cord injury[J]. Chinese Journal of Nursing, 2023, 58(22): 2726-2733.

图/表 3

表1 两组一般资料的比较

Table 1 General demographic information

表2 两组认知功能的比较

Table 2 Comparison of cognitive function between the 2 groups

表3 两组社会支持、自我效能、焦虑水平、功能独立性水平的比较

Table 3 Comparison of the scores of social support，self-efficacy，anxiety and spinal cord independency between the 2 groups

参考文献 19

[1]	Ropper AE, Ropper AH. Acute spinal cord compression[J]. New Engl J Med, 2017, 376(14):1358-1369. DOI URL
[2]	Keeler BE, Liu G, Siegfried RN, et al. Acute and prolonged hindlimb exercise elicits different gene expression in moton- eurons than sensory neurons after spinal cord injury[J]. Brain Res, 2012, 1438:8-21. DOI URL
[3]	Zonfrillo MR, Durbin DR, Winston FK, et al. Residual cognitive disability after completion of inpatient rehabilitation among injured children[J]. J Pediatr, 2014, 164(1):130-135. DOI URL
[4]	Usman G, Jun-Hwan L, Keum-Shik H, et al. Effects of acupun-cture therapy on MCI patients using functional near-infrared spectroscopy[J]. Front Aging Neurosci, 2019, 30(11):237.
[5]	Maffei L, Picano E, Andreassi MG, et al. Randomized trial on the effects of a combined physical/cognitive training in aged MCI subjects:the train the brain study[J]. Sci Rep-UK, 2017, 7(1):39471.
[6]	李晨曦, 尚云峰, 王丽云, 等. 计算机认知训练对轻度认知障碍老年人认知功能的影响研究[J]. 中华护理杂志, 2021, 56(5):667-673. DOI
	Li CX, Shang YF, Wang LY, et al. Research on the influence of computer cognitive training on the cognitive function of the elderly with mild cognitive impairment[J]. Chin J Nurs, 2021, 56(5):667-673. DOI
[7]	Krebs J, Scheel-Sailer A, Oertli R, et al. The effects of antimus-carinic treatment on the cognition of spinal cord injured individuals with neurogenic lower urinary tract dysfunction:a prospective controlled before-and-after study[J]. Spinal Cord, 2018, 56(1):22-27. DOI PMID
[8]	廖晨霞, 李伦兰, 戴晴, 等. 脊髓损伤患者认知功能的影响因素分析[J]. 中华护理杂志, 2021, 56(7):1015-1022. DOI
	Liao CX, Li LL, Dai Q, et al. Influencing factors analysis of cognitive function in patients with spinal cord injury[J]. Chin J Nurs, 2021, 56(7):1015-1022. DOI
[9]	高馨. 脊髓损伤患者认知强化综合干预模式的构建[D]. 合肥: 安徽医科大学, 2022.
	Gao X. Construction of a cognitive reinforcement integrated intervention scheme for individuals with spinal cord injury[D]. Hefei: Anhui Medical University, 2022.
[10]	李建军, 王方永. 脊髓损伤神经学分类国际标准(2011年修订)[J]. 中国康复理论与实践, 2011, 17(10):963-972.
	Li JJ, Wang FY. International standards for neurological clas-sification of spinal cord injury(revised in 2011)[J]. Chin J Rehabil Theory Pract, 2011, 17(10):963-972.
[11]	涂秋云, 靳慧, 丁斌蓉, 等. 长沙版蒙特利尔认知评估量表的信度、效度检测与血管性认知障碍理想划界分值[J]. 中国神经精神疾病杂志, 2012, 38(6):339-345.
	Tu QY, Jin H, Ding BR, et al. The study on reliability,validity of Montreal Cognitive Assessment(Changsha Version) and preliminary exploration of its optimal cutoff score for detecting vascular cognitive impairment[J]. Chin J Nerv Ment Dis, 2012, 38(6):339-345.
[12]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2):98-100.
	Xiao SY. The theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychiat, 1994, 4(2):98-100.
[13]	Stevens M, van den Akker-scheek I, van horn JR. A Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale(SER):a first impression on reliability and validity[J]. Patient Educ Couns, 2005, 58(2):121-126. PMID
[14]	叶超群, 孙天胜, 刘智, 等. 脊髓独立性评定量表Ⅲ中文版的适用性研究[J]. 中国康复医学杂志, 2012, 27(6):529-532.
	Ye CQ, Sun TS, Liu S, et al. The validity and reliability of Chinese version of Spinal Cord Independence MeasureⅢ[J]. Chin J Rehabil Med, 2012, 27(6):529-532.
[15]	汤毓华, 张明园. 汉密顿焦虑量表(HAMA)[J]. 上海精神医学, 1984(2):64-65.
	Tang YH, Zhang MY. Hamilton Anxiety Scale,HAMA[J]. Shang-hai Archives of Psychiatry, 1984(2):64-65.
[16]	Montemurro S, Mondini S, Arcara G. Heterogeneity of effects of cognitive reserve on performance in probable Alzheimer’s disease and in subjective cognitive decline[J]. Neuropsycho-logy, 2021, 35(8):876-888.
[17]	Leila D, Ya-Huei W, Jean-Sébastien V, et al. Computerized cog-nitive stimulation and engagement programs in older adults with mild cognitive impairment:comparing feasibility,accep- tability,and cognitive and psychosocial effects[J]. Clin Interv Aging, 2017, 21(12):1967-1975.
[18]	戴晴, 李伦兰, 廖晨霞, 等. 脊髓损伤患者及其配偶二元应对体验的质性研究[J]. 中华护理杂志, 2021, 56(8):1180-1186. DOI
	Dai Q, Li LL, Liao CX, et al. A qualitative research on the dual coping experience of patients with spinal cord injury and their spouses[J]. Chin J Nurs, 2021, 56(8):1180-1186. DOI
[19]	Ditunno JF, Young W, Donovan WH, et al. The international standards booklet for neurological and functional classification of spinal cord injury[J]. Paraplegia, 1994, 32(2):70-80. DOI PMID