基于渐进模式的运动处方治疗深度烧伤后下肢功能障碍老年患者效果的随机对照试验

赵海洋; 韩军涛; 胡大海; 周琴; 朱婵; 徐婧; 张博文; 齐宗师; 刘佳琦

doi:10.3760/cma.j.cn501225-20230721-00012

基于渐进模式的运动处方治疗深度烧伤后下肢功能障碍老年患者效果的随机对照试验

doi: 10.3760/cma.j.cn501225-20230721-00012

空军军医大学第一附属医院烧伤与皮肤外科，全军烧伤中心，西安　　710032

基金项目:

陕西省重点研发计划 2022SF-279

详细信息

通讯作者:
刘佳琦，Email：anlhw07@fmmu.edu.cn

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出版历程
- 收稿日期: 2023-07-21

A randomized controlled trial on the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China

Funds:

Shaanxi Provincial Key Research and Development Plan 2022SF-279

More Information

Corresponding author: Liu Jiaqi, Email: anlhw07@fmmu.edu.cn

摘要

摘要: 目的探讨基于渐进模式的运动处方治疗深度烧伤后下肢功能障碍老年患者的效果。方法采用随机对照试验方法。2021年1月—2023年1月，空军军医大学第一附属医院收治60例符合入选标准的深度烧伤后下肢功能障碍老年患者。将患者按照随机数字表法分为常规康复组［30例，男17例、女13例，年龄（65±3）岁］和联合康复组［30例，男16例、女14例，年龄（64±3）岁］。对2组患者于下肢创面愈合后或散在残余创面总面积<1％体表总面积时，开始进行红光治疗。于红光治疗2周后，对常规康复组患者行关节牵伸、抗阻及平衡训练等常规康复治疗；对联合康复组患者在常规康复治疗基础上进行每周3次的基于渐进模式的运动处方训练，主要包括哑铃推举、Bobath球水平支撑、高位下拉训练等。2组患者训练时间均为12周。于训练前（红光治疗2周后）及训练12周后，采用简易Fugl-Meyer量表评定患者上肢与下肢的运动功能，采用简易体能状况量表评定患者体适能，通过计时-起立行走测试耗时评定患者跌倒风险。记录患者训练期间发生的不良事件；训练12周后，自行设计满意度调查表调查患者对训练效果的满意度。对数据行独立样本 t检验、配对样本 t检验、Mann-Whitney U检验、Wilcoxon符号秩检验、 χ ²检验。结果训练前，2组患者上肢与下肢运动功能评分均相近（ P>0.05）。训练12周后，常规康复组、联合康复组患者上肢运动功能评分均较训练前明显升高（ t值分别为-11.42、-13.67， P<0.05），但2组间比较，差异无统计学意义（ P>0.05）；联合康复组患者下肢运动功能评分为（28.9±2.6）分，明显高于常规康复组的（26.3±2.6）分（ t=-3.90， P<0.05），且常规康复组、联合康复组患者下肢运动功能评分均较训练前明显升高（ t值分别为-4.14、-6.94， P<0.05）。训练前，2组患者体适能各单项评分及总评分均相近（ P>0.05）；训练12周后，常规康复组、联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均较训练前明显升高（ Z值分别为-4.38、-3.55、-3.88、-4.65与-4.58、-4.68、-4.42、-4.48， P<0.05），且联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均明显高于常规康复组（ Z值分别为-3.93、-3.41、-3.19、-5.33， P<0.05）。训练前，2组患者针对跌倒风险的计时-起立行走测试耗时相近（ P>0.05）。训练12周后，联合康复组患者针对跌倒风险的计时-起立行走测试耗时为（28.0±2.1）s，明显短于常规康复组的（30.5±1.8）s（ t=4.94， P<0.05）；且常规康复组、联合康复组患者针对跌倒风险的计时-起立行走测试耗时均较训练前明显缩短（ t值分别为14.80、15.86， P<0.05）。所有患者训练期间均未发生肌肉组织拉伤、水肿或跌倒等不良事件。训练12周后，联合康复组患者对治疗效果的满意度评分为（13.5±1.2）分，明显高于常规康复组的（8.5±1.4）分（ t=21.78， P<0.05）。结论基于渐进模式的运动处方训练可以明显促进深度烧伤后下肢功能障碍老年患者下肢运动功能、体适能恢复，可有效降低患者跌倒风险，且训练期间不引发不良事件，使得患者对训练效果的满意度较高。
- 烧伤 /
- 老年人 /
- 康复 /
- 运动处方 /
- 运动功能 /
- 体适能 /
- 渐进模式 /
- 跌倒风险
Abstract: Objective To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample ttest, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups ( P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group ( t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close ( P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group ( t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group ( t=21.78, P<0.05). Conclusions The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.
- Burns /
- Aged /
- Rehabilitation /
- Exercise prescription /
- Motor function /
- Physical fitness /
- Progressive mode /
- Falling risk
赵海洋：酝酿和设计试验、实施研究、分析并解释数据、撰写文章；韩军涛、刘佳琦：指导研究、修改论文、研究经费支持、对文章的知识性内容作批评性审阅；胡大海、周琴：指导研究、对文章的知识性内容作批评性审阅；朱婵、徐婧、张博文、齐宗师：采集和分析数据

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1 行常规康复联合基于渐进模式的运动处方训练治疗深度烧伤后下肢功能障碍老年患者的效果。1A.伤后2 d，患者双下肢皮肤焦痂形成，大部分发白；1B.伤后47 d，双下肢创面基本愈合，仅残留散在小创面；1C.康复治疗开始时，行双下肢红光治疗；1D.红光治疗2周后，行下肢弹力带抗阻训练；1E.康复训练第7天，行下肢Bobath球水平支撑训练；1F.康复训练第21天，行手握哑铃水平外展情况下下肢单腿站立训练；1G.康复训练第63天，行高位下拉训练；1H.治疗结束后1年半随访，患者能使用铁锹翻土

注：常规康复包括关节牵伸、抗阻及平衡训练，运动处方训练包括哑铃推举和高位下拉等

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表1 2组深度烧伤后下肢功能障碍老年患者临床资料比较

表1. Comparison of clinical data between two groups of elderly patients with lower limb dysfunction after deep burns

组别	例数	性别（例）		年龄（岁， x ¯ ± s ）	烧伤总面积（%TBSA， x ¯ ± s ）	下肢深Ⅱ度烧伤面积（%TBSA， x ¯ ± s ）	下肢Ⅲ度烧伤面积（%TBSA， x ¯ ± s ）	身体质量指数（kg/m ²， x ¯ ± s ）	伤后至开始康复治疗时间（d， x ¯ ± s ）
组别	例数	男	女	年龄（岁， x ¯ ± s ）	烧伤总面积（%TBSA， x ¯ ± s ）	下肢深Ⅱ度烧伤面积（%TBSA， x ¯ ± s ）	下肢Ⅲ度烧伤面积（%TBSA， x ¯ ± s ）	身体质量指数（kg/m ²， x ¯ ± s ）	伤后至开始康复治疗时间（d， x ¯ ± s ）
常规康复组	30	17	13	65±3	44±6	20±7	20±6	23±6	49±3
联合康复组	30	16	14	64±3	45±7	20±8	19±7	23±5	49±4
统计量值		χ ²=0.07		t=1.27	t=-0.59	t=0.17	t=0.63	t=0.65	t=0.67
P值		0.795		0.208	0.555	0.809	0.530	1.000	0.588
注：对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；TBSA为体表总面积

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表2 2组深度烧伤后下肢功能障碍老年患者训练前后上肢和下肢运动功能评分比较（分， x ¯ ± s ）

表2. Comparison of upper and lower limb motor function scores before and after training between two groups of elderly patients with lower limb dysfunction after deep burns

组别	例数	上肢运动功能评分		下肢运动功能评分
组别	例数	训练前	训练12周后	训练前	训练12周后
常规康复组	30	53.9±3.1	61.8±1.1 ^a	23.3±2.5	26.3±2.6 ^a
联合康复组	30	54.3±2.9	61.7±1.0 ^a	23.9±2.4	28.9±2.6 ^a
t值		-0.43	0.36	-0.98	-3.90
P值		0.666	0.723	0.330	<0.001
注：训练前为进行红光治疗2周后；对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；与组内训练前比较， ^a P<0.05

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表3 2组深度烧伤后下肢功能障碍老年患者训练前后体适能各单项评分及总评分比较[分， M（ Q ₁， Q ₃）]

表3. Comparison of the individual and total scores of physical fitness before and after training between two groups of elderly patients with lower limb dysfunction after deep burns

组别	例数	平衡能力评分		步行速度评分		椅子坐立评分		总评分
组别	例数	训练前	训练12周后	训练前	训练12周后	训练前	训练12周后	训练前	训练12周后
常规康复组	30	1.00（0，1.00）	2.00（1.00，3.00） ^a	1.00（1.00，2.00）	2.00（1.00，3.00） ^a	1.00（0.75，2.00）	2.00（1.00，3.00） ^a	3.00（2.00，4.00）	6.00（5.00，7.00） ^a
联合康复组	30	1.00（0，1.25）	3.00（2.00，4.00） ^a	1.00（0，2.00）	3.00（2.00，3.25） ^a	1.00（0.75，2.00）	3.00（2.00，4.00） ^a	3.00（2.00，4.00）	9.00（8.00，10.00） ^a
Z值		-0.98	-3.93	-0.88	-3.41	-0.72	-3.19	-0.27	-5.33
P值		0.328	<0.001	0.376	<0.001	0.467	<0.001	0.789	<0.001
注：训练前为进行红光治疗2周后；对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；与组内训练前比较， ^a P<0.05

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参考文献(26)

[1]	王晓东,马丽,王德洪,等.老年人身体形态、机能及素质与中医体质类型的相关性研究[J].中国运动医学杂志,2012,31(10):907-912.DOI: 10.3969/j.issn.1000-6710.2012.10.012.
[2]	陈伟,张梓晨,王若宇,等.471例老年烧伤住院患者的临床资料分析[J].昆明医科大学学报,2023,44(2):88-97.DOI: 10.12259/j.issn.2095-610X.S20230202.
[3]	杨长发,闵定宏,郭光华.老年烧伤感染的防治研究进展[J].中华烧伤与创面修复杂志,2023,39(3):285-289.DOI: 10.3760/cma.j.cn501225-20220321-00078.
[4]	WangW,ZhangJ,LvY,et al.Epidemiological investigation of elderly patients with severe burns at a major burn center in Southwest China[J].Med Sci Monit,2020,26:e918537.DOI: 10.12659/MSM.918537.
[5]	YangSX,ChengS,SuDL.Sports injury and stressor-related disorder in competitive athletes: a systematic review and a new framework[J/OL].Burns Trauma,2022,10:tkac017[2023-07-21].https://pubmed.ncbi.nlm.nih.gov/35702266/.DOI: 10.1093/burnst/tkac017.
[6]	KhaiyatOA,NorrisJ.Electromyographic activity of selected trunk, core, and thigh muscles in commonly used exercises for ACL rehabilitation[J].J Phys Ther Sci,2018,30(4):642-648.DOI: 10.1589/jpts.30.642.
[7]	佟琳,张万福,胡晓龙,等.腹部不同位置全厚皮片修复小儿功能部位皮肤软组织缺损的前瞻性随机对照研究[J].中华烧伤与创面修复杂志,2022,38(8):744-752.DOI: 10.3760/cma.j.cn501120-20210709-00243.
[8]	赵海洋,刘佳琦,韩军涛,等.渐进式核心肌群训练联合下肢智能康复训练对烧伤患者下肢功能障碍影响的前瞻性随机对照研究[J].中华烧伤与创面修复杂志,2022,38(12):1117-1125.DOI: 10.3760/cma.j.cn501225-20220616-00236.
[9]	中国老年医学学会烧创伤分会.烧伤后关节功能障碍的预防与康复治疗专家共识(2021版)[J/CD].中华损伤与修复杂志(电子版),2021,16(4):277-282.DOI: 10.3877/cma.j.issn.1673-9450.2021.04.001.
[10]	岳梦艳,袁淑娟.血流限制训练在神经系统疾病中的应用进展[J].中国康复,2023,38(6):380-384.DOI: 10.3870/zgkf.2023.06.013.
[11]	EmirzeoğluM,ÜlgerÖ.The acute effects of cognitive-based neuromuscular training and game-based training on the dynamic balance and speed performance of healthy young soccer players: a randomized controlled trial[J].Games Health J,2021,10(2):121-129.DOI: 10.1089/g4h.2020.0051.
[12]	陈适,郭晓湲,潘慧.循证化、精准化运动处方的制定和意义[J].中华行为医学与脑科学杂志,2023,32(6):488-492.DOI: 10.3760/cma.j.cn371468-20230221-00079.
[13]	中华医学会烧伤外科学分会,中国医师协会烧伤科医师分会.烧伤康复治疗指南(2013版)[J].中华烧伤杂志,2013,29(6):497-504.DOI: 10.3760/cma.j.issn.1009-2587.2013.06.001.
[14]	HuangZ,TangG,KumarA,et al.A kinematic data based lower limb motor function evaluation method for post-stroke rehabilitation[J].Annu Int Conf IEEE Eng Med Biol Soc,2021,2021:7288-7291.DOI: 10.1109/EMBC46164.2021.9629887.
[15]	Navarrete-VillanuevaD,Gómez-CabelloA,Marín-PuyaltoJ,et al.Frailty and physical fitness in elderly people: a systematic review and meta-analysis[J].Sports Med,2021,51(1):143-160.DOI: 10.1007/s40279-020-01361-1.
[16]	中华医学会老年医学分会护理学组,中国老年保健医学研究会老年医学护理分会,中国老年护理联盟,等.老年人失能预防运动干预临床实践指南(2023版)[J].中国全科医学,2023,26(22):2695-2710,2714.DOI: 10.12114/j.issn.1007-9572.2023.0223.
[17]	仲伟,史淑霞,秦沁悦,等.临床研究协调员工作能力与工作量的测量工具及合理性评估[J].中国临床药理学与治疗学,2023,28(8):937-947.DOI: 10.12092/j.issn.1009-2501.2023.08.010.
[18]	TongX,LuJ,ZhangW,et al.Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates[J/OL].Burns Trauma,2022,10:tkac045[2023-07-21].https://pubmed.ncbi.nlm.nih.gov/36518877/.DOI: 10.1093/burnst/tkac045.
[19]	TapkingC,PoppD,HerndonDN,et al.Cardiac dysfunction in severely burned patients: current understanding of etiology, pathophysiology, and treatment[J].Shock,2020,53(6):669-678.DOI: 10.1097/SHK.0000000000001465.
[20]	JeschkeMG,PhelanHA,WolfS,et al.State of the science burn research: burns in the elderly[J].J Burn Care Res,2020,41(1):65-83.DOI: 10.1093/jbcr/irz163.
[21]	胡敏,陈晓娟,任琳洁,等.成年烧伤患者恐动症发生现状及其影响因素的横断面调查[J].中华烧伤杂志,2021,37(6):575-581.DOI: 10.3760/cma.j.cn501120-20200618-00313.
[22]	《运动处方中国专家共识(2023)》专家组.运动处方中国专家共识(2023)[J].中国运动医学杂志,2023,42(1):3-13.DOI: 10.3969/j.issn.1000-6710.2023.01.001.
[23]	李翠查,徐蕊,宋淑华.渐进性抗阻运动对老年人体适能及跌倒风险的干预研究[J].中国老年保健医学,2022,20(5):41-45.DOI: 10.3969/j.issn.1672-2671.2022.05.011.
[24]	吴延,王广玲,聂作婷,等.2022年版《世界指南:老年人跌倒的预防与管理》解读[J].中国全科医学,2023,26(10):1159-1163,1171.DOI: 10.12114/j.issn.1007-9572.2022.0842.
[25]	罗曦娟,李新,张献博,等.慢性疾病运动处方新进展[J].中国运动医学杂志,2023,42(8):658-664.DOI: 10.3969/j.issn.1000-6710.2023.08.013.
[26]	杨延平,邱俊强,陈演,等.个性化渐进式运动处方对老年女性平衡能力和下肢肌肉力量的影响[J].中国慢性病预防与控制,2020,28(10):785-788.DOI: 10.16386/j.cjpccd.issn.1004-6194.2020.10.016.