术前运动对脑室-腹腔分流术患者的效果

doi:10.3969/j.issn.1006-9771.2025.08.012

摘要/Abstract

摘要：

目的观察术前运动训练对脑室-腹腔分流术患者的意识、肺功能及恢复效率的效果。

方法选取2024年10月至2025年3月在北京博爱医院择期进行脑室-腹腔分流术的患者54例，随机分为对照组(n = 27)和预康组(n = 27)，对照组进行术前常规治疗和护理，预康组在此基础上介入运动训练2周。住院当天和术后第3天采用昏迷恢复量表修订版(CRS-R)进行评估，采用超声检查观察膈肌移动度，比较两组术后首次下床时间和住院时间。

结果术后，两组CRS-R评分均显著提高(|t| > 5.451, P < 0.001)，预康组明显高于对照组(t = 2.812, P < 0.01)；对照组CRS-R的听觉和运动子量表分提高(|Z| > 2.000, P < 0.05)，预康组CRS-R的听觉、视觉、运动、言语和唤醒度子量表分均明显提高(|Z| > 2.282, P < 0.01)；预康组CRS-R运动和唤醒度子量表分较对照组提高(|Z| > 2.320, P < 0.05)。干预后，预康组膈肌移动度显著提高(t = -7.782, P < 0.001)，且大于对照组(t = 2.044, P < 0.05)。预康组术后首次下床时间和住院时间均明显短于对照组(|t| > 3.654, P < 0.01)。

结论对择期行脑室-腹腔分流术患者进行术前运动训练，能明显改善患者术后意识状态，尤其是运动和觉醒水平，提高患者肺功能，加速康复进程。

关键词: 脑室-腹腔分流术, 术前运动, 预康复

Abstract:

Objective To observe the effect of preoperative exercise on consciousness, lung function and recovery efficiency of patients undergoing ventriculoperitoneal shunt.

Methods A total of 54 patients undergoing elective ventriculoperitoneal shunt in Beijing Bo'ai Hospital from October, 2024 to March, 2025 were randomly divided into control group (n = 27) and prerehabilitation group (n = 27). The control group received routine preoperative treatment and nursing, while the prerehabilitation group additionally received exercise for two weeks. They were assessed with Coma Recovery Scale-Revised (CRS-R), and observed diaphragm mobility with sonography, before and three days after operation; and the time to first ambulation after surgery and length of stay in hospital were compared between two groups.

Results CRS-R scores improved in both groups after operation (|t| > 5.451, P < 0.001), and it was greater in the prehabilitation group than in the control group (t = 2.812, P < 0.01). CRS-R subscale scores improved in auditory and motor functions in the control group (|Z| > 2.000, P < 0.05), and they were improved in auditory, visual, motor, verbal and arousal functions in the prehabilitation group (|Z| > 2.282, P < 0.01). CRS-R subscale scores were greater in motor and arousal in the prehabilitation group than in the control group (|Z| > 2.320, P < 0.05). Diaphragmatic mobility improved in the prehabilitation group (t = -7.782, P < 0.001), and it was better than in the control group (t = 2.044, P < 0.05). The time to first ambulation after surgery and length of stay in hospital were shorter in the prehabilitation group than in the control group (|t| > 3.654, P < 0.01).

Conclusion Preoperative exercise for patients undergoing elective ventriculoperitoneal shunt can improve the consciousness after operation, especially the level of motor and arousal, as well as the lung function, and accelerate the recovery process.

Key words: ventriculoperitoneal shunt, preoperative exercise, prehabilitation

中图分类号:

R651.1

吕雪琴, 张通, 刘惠林, 刘建华, 李达, 王华伟. 术前运动对脑室-腹腔分流术患者的效果[J]. 《中国康复理论与实践》, 2025, 31(8): 958-964.

LÜ Xueqin, ZHANG Tong, LIU Huilin, LIU Jianhua, LI Da, WANG Huawei. Effect of preoperative exercise on patients undergoing ventriculoperitoneal shunt[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 958-964.

图/表 5

表1

表2

两组CRS-R总分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	27	前测	5.30±1.86	-5.451	< 0.001
		后测	6.19±1.49
预康组	27	前测	4.63±1.74	-16.189	< 0.001
		后测	7.44±1.78
前测两组均值差			0.67±0.49	-1.363	0.179
后测两组均值差			-1.26±0.45	2.812	0.007

表2

表3

表4

两组膈肌移动度比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	27	前测	1.33±0.29	0.727	0.474
		后测	1.33±0.27
预康组	27	前测	1.32±0.26	-7.782	< 0.001
		后测	1.47±0.25
前测两组均值差			0.01±0.07	-0.195	0.846
后测两组均值差			-0.14±0.07	2.044	0.046

表4

表5

两组术后首次下床时间和住院时间比较"

变量	组别	n	$x - ± s$	t值	P值
术后首次下床时间/h	对照组	27	33.19±4.67	-3.654	0.001
	预康组	27	28.81±4.10
住院时间/d	对照组	27	52.52±3.57	-6.123	< 0.001
	预康组	27	47.67±2.06

表5

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组别	n	性别(男/女)/n	年龄/岁	病程/d	GCS
对照组	27	16/11	44.33±10.10	94.00±4.45	7(6,8)
预康组	27	15/12	46.89±8.28	102.78±4.44	6(5,7)
χ²/t/Z值		0.076	1.016	1.396	-1.690
P值		0.783	0.314	0.169	0.091

子量表	组别	n	测试	M(Q_L, Q_U)	Z值	P值
听觉	对照组	27	前测	1(1, 1)	-2.000	0.046
			后测	1(1, 1)
	预康组	27	前测	1(0, 1)	-3.464	0.001
			后测	1(1, 2)
	前测两组差值			0(-1, 0)	-0.999	0.318
	后测两组差值			0(0, 1)	-1.044	0.297
视觉	对照组	27	前测	1(1, 1)	0.000	1.000
			后测	1(1, 1)
	预康组	27	前测	1(0, 1)	-2.282	0.005
			后测	1(1, 1)
	前测两组差值			0(-1, 0)	-0.708	0.479
	后测两组差值			0(0, 1)	-1.134	0.257
运动	对照组	27	前测	1(1, 2)	-3.464	0.001
			后测	2(1, 2)
	预康组	27	前测	1(1, 1)	-4.130	< 0.001
			后测	2(2, 2)
	前测两组差值			0(-1, 0.5)	-0.463	0.643
	后测两组差值			0(0, 1)	-2.849	0.004
语言	对照组	27	前测	0(0, 1)	-1.000	0.317
			后测	0(0, 1)
	预康组	27	前测	0(0, 1)	-3.464	0.001
			后测	1(1, 1)
	前测两组差值			0(-1, 0.5)	-0.595	0.552
	后测两组差值			0(0, 1)	-1.876	0.061
交流	对照组	27	前测	0(0, 0)	0.000	1.000
			后测	0(0, 0)
	预康组	27	前测	0(0, 0)	0.000	1.000
			后测	0(0, 0)
	前测两组差值			0(0, 0)	-1.030	0.303
	后测两组差值			0(0, 0)	-1.030	0.303
唤醒度	对照组	27	前测	1(1, 2)	-1.604	0.109
			后测	2(1, 2)
	预康组	27	前测	1(1, 2)	-4.185	< 0.001
			后测	2(2, 3)
	前测两组差值			0(-1, 0)	-0.621	0.534
	后测两组差值			0(0, 1)	-2.320	0.020