目的 探讨以家庭为中心的护理干预对提高痉挛型脑瘫患儿佩戴踝足矫形器(AFO)依从性的效果。方法 2016年7月至12月,65例痉挛型脑瘫患儿分为对照组(n=32)和观察组(n=33),对照组采用常规护理,观察组采用以家庭为中心的护理模式。治疗3周后采用改良Ashworth量表(MAS)评价患儿肌张力,记录皮肤及软组织并发症的发生率、患者佩戴AFO的依从性及对护理服务的满意度。结果 观察组治疗后MAS评分明显低于对照组(t=3.298, P=0.002);观察组皮肤及软组织并发症的发生率低于对照组(χ2=7.386, P=0.007),佩戴AFO配合率、家庭康复方法掌握率及护理服务满意率均高于对照组(χ2>5.346, P<0.05)。结论 以家庭为中心的护理干预能增加痉挛型脑瘫患儿佩戴AFO的依从性,提高康复效果,降低并发症发生,提升对护理服务的满意度。
Objective To investigate the effect of family-centered care on wearing ankle-foot orthosis (AFO) in children with spastic cerebral palsy.Methods From July to December, 2016, 65 children with spastic cerebral palsy were divided into control group (n=32) and observation group (n=33). The control group accepted routine nursing, while the observation group accepted family-centered care. The children were assessed with modified Ashworth Scale (MAS), and the incidence of skin and soft tissue problems, the compliance for wearing AFO and the satisfaction for nursing service were recorded.Results The score of MAS decreased in the observation group compared with that in the control group (t=3.298, P=0.002), and the incidence of skin and soft tissue problems was less (χ2=7.386, P=0.007). The compliance of patients wearing AFO for rehabilitation, the rate that family performed the rehabilitation, the satisfaction for nursing service were all more in the observation group than in the control group (χ2>5.346, P<0.05).Conclusion The application of family-centered care can improve the compliance for wearing AFO in the children with spastic cerebral palsy, to improve the rehabilitation effect, reduce the incidence of complications, and promote the satisfaction for nursing service.
[1] Bar-On L, Molenaers G, Aertbeliën E, et al. Spasticity and its contribution to hypertonia in cerebral palsy [J]. Biomed Res Int, 2015, 2015: 317047.
[2] 金慧英,王慧,付钟敏,等. 超声定位注射肉毒毒素联合矫形器训练治疗脑瘫患儿下肢痉挛的疗效观察[J]. 中华物理医学与康复杂志, 2014, 36(11): 855-858.
[3] Wingstrand M, Hägglund G, Rodby-Bousquet E. Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children [J]. BMC Musculoskelet Disord, 2014, 15: 327.
[4] Hayek S, Hemo Y, Chamis S, et al. The effect of community-prescribed ankle-foot orthoses on gait parameters in children with spastic cerebral palsy [J]. J Child Orthop, 2007, 1(6): 325-332.
[5] Rha DW, Kim DJ, Park ES. Effect of hinged ankle-foot orthoses on standing balance control in children with bilateral spastic cerebral palsy [J]. Yonsei Med J, 2010, 51(5): 746-752.
[6] 赵正全,苏强,韩林. 关于矫形器副作用的分析及预防[J]. 中华物理医学与康复杂志, 2006, 28(12): 847-848.
[7] Kuo DZ, Houtrow AJ, Arango P, et al. Family-centered care: current applications and future directions in pediatric health care [J]. Matern Child Health J, 2012, 16(2): 297-305.
[8] 王英杰,李杨. 以家庭为中心的教育干预在儿科护理中的应用现状[J]. 中华护理杂志, 2016, 51(1): 98-102.
[9] Arcuri GG, McMullan AE, Murray AE, et al. Perceptions of family-centred services in a paediatric rehabilitation programme: strengths and complexities from multiple stakeholders [J]. Child Care Health Dev, 2016, 42(2): 195-202.
[10] Wang M, Petrini MA. Evaluation family-centred services from parents of Chinese children with cerebral palsy with the measure of processes of care [J]. Child Care Health Dev, 2015, 41(3): 408-415.
[11] King G, Chiarello L. Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice [J]. J Child Neurol, 2014, 29(8): 1046-1054.
[12] 中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,《中国脑性瘫痪康复指南》编委会. 中国脑性瘫痪康复指南(2015)：第一部分[J]. 中国康复医学杂志, 2015, 30(7): 747-754.
[13] 李红英. 脑瘫患儿家长焦虑和抑郁状况及其影响因素的研究[J]. 中华物理医学与康复杂志, 2014, 36(3): 174-175.
[14] 赵晓科,肖农,张跃,等. 踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响[J]. 中华物理医学与康复杂志, 2009, 31(5): 327-330.
[15] Mutlu A, Livanelioglu A, Gunel MK. Reliability of Ashworth and Modified Ashworth Scales in children with spastic cerebral palsy [J]. BMC Musculoskelet Disord, 2008, 9: 44.
[16] 戴黎黎. 学龄前肾病综合征患儿家庭功能的调查研究[J]. 护理研究, 2014, 28(7A): 2346-2347.
[17] 马明. 家庭中心式护理对脑瘫患儿家长生存质量的影响[J]. 中华现代护理杂志, 2014, 20(4): 421-425.
[18] 姜楠,李小寒,范玲. 以家庭为中心的护理模式在儿科的应用现状[J]. 护理研究杂志, 2016(30): 264-270.
[19] 杨陈,张学兵,敖伟,等. 以家庭为中心的护理模式在儿童慢性伤口中的应用[J]. 中国实用护理杂志, 2017, 33(8): 594-597.
[20] 曾莉,罗顺清,程婷,等. 以家庭为中心的护理模式对先天性心脏病患儿家庭照料者生活质量的影响研究[J]. 护理管理杂志, 2017, 17(1): 52-54.
