孙瑞,田亚茹,张丹丹,等.基于床旁胃肠超声评估内脏松弛术对脑损伤后微意识状态患者胃肠功能障碍的影响[J].中华物理医学与康复杂志,2026,48(1):43-49
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| 基于床旁胃肠超声评估内脏松弛术对脑损伤后微意识状态患者胃肠功能障碍的影响 |
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| DOI：10.3760/cma.j.cn421666-20250627-00539 |
| 中文关键词: 内脏松弛术 床旁胃肠超声 脑损伤后微意识状态 胃肠功能障碍 |
| 英文关键词: Visceral manipulation Gastrointestinal ultrasound Minimally conscious states Brain injury Gastrointestinal dysfunction |
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| 中文摘要: |
| 目的 采用床旁胃肠超声动态评估内脏松弛术（VM）对脑损伤后微意识状态患者胃肠功能障碍的干预效果。 方法 采用随机数字表法将58例脑损伤后微意识状态合并胃肠功能障碍患者分为观察组及对照组，每组29例。所有患者均给予常规康复干预，在此基础上观察组同时辅以内脏松弛术治疗（包括膈肌-胃韧带松解、肠系膜牵拉、乙状结肠减压等），每次治疗20~30 min，每周治疗6 d，连续治疗4周。于治疗前、治疗4周后采用床旁胃肠超声对2组患者进行评估，具体评估项目包括胃窦运动指数（MI=收缩频率×幅度）、胃窦收缩频率（ACF）、胃窦收缩幅度（ACA）及空腹胃窦横截面积（CSA）；同时监测患者血清营养指标（白蛋白、前白蛋白、血红蛋白）、失匹配负波（MMN）波幅及修订版昏迷恢复量表(CRS-R）评分变化情况。 结果 经干预4周后，发现观察组营养达标率较对照组显著提高（P<0.05），吸入性肺炎发生率较对照组显著降低（P<0.05）；2组患者胃窦MI、ACF、ACA及CSA均较干预前明显改善（P<0.05），并且观察组上述胃肠超声指标亦显著优于同期对照组水平（P<0.05）。干预后２组患者血清白蛋白、前白蛋白、血红蛋白含量均较干预前明显提高(P<0.05)，并且观察组上述指标结果亦显著优于同期对照组水平(P<0.05)。干预后２组患者CRS-R评分及MMN波幅均较干预前明显改善（P<0.05），并且此时观察组患者上述指标结果亦显著优于对照组水平（P<0.05）。 结论 内脏松弛术可有效改善脑损伤后微意识状态患者的胃肠动力障碍，其作用机制可能与降低腹腔张力、促进迷走神经兴奋有关；床旁胃肠超声检查能通过量化MI、ACF等参数，为动态评估干预疗效提供了客观依据。 |
| 英文摘要: |
| Objective To evaluate the utility of visceral manipulation (VM) guided by bedside gastrointestinal ultrasound for gastrointestinal dysfunction patients minimally conscious after a brain injury. Methods Fifty-eight patients in a minimally conscious state after a brain injury with gastrointestinal dysfunction were divided at random into an observation group and a control group, each of 29. Both groups received conventional rehabilitation treatment, while the observation group was additionally provided with VM (including diaphragm-gastric ligament release, mesenteric traction, and sigmoid colon decompression). Each treatment session lasted 20 to 30 minutes, and the treatment was conducted 6 days per week for 4 consecutive weeks. Before and after 4 weeks of treatment, both groups were evaluated using bedside gastrointestinal ultrasound. Gastric antrum movement indexes (MI=contraction frequency × amplitude) were computed, and gastric antrum contraction frequency (ACF), gastric antrum contraction amplitude (ACA), and fasting gastric antrum cross-sectional area (CSA) were observed. Serum albumin, prealbumin and hemoglobin were monitored as nutritional indicators, and mismatched negative wave (MMN) amplitudes and any changes in revised coma recovery scale (CRS-R) scores were also recorded. Results After the 4-week intervention, the observation group′s nutritional compliance was significantly better than that of the control group, and its incidence of aspiration pneumonia was significantly lower. The MI, ACF, ACA, and CSA values had improved significantly in both groups, but there had been significantly greater improvement in the observation group. The prealbumin, serum albumin, and hemoglobin readings of both groups were significantly higher after the experiment, but those of the observation group were again significantly higher. There was also significant improvement in both groups′ average CRS-R score and MMN wave amplitude. Again, those results were significantly better in the observation group, on average. Conclusions VM can effectively improve the gastrointestinal functioning of patients in a minimally conscious state after a brain injury. It may reduce abdominal tension and promote vagus nerve excitation. Bedside ultrasound can provide an objective basis for dynamic evaluation of such an intervention′s efficacy. |
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