危害分析及关键控制点原则治疗方案对高血压脑出血患者神经、认知、肢体运动功能的影响

Effect of hazard analysis and critical control point principle-based treatment regimen on neurological, cognitive, and limb motor functions in patients with hypertensive intracerebral hemorrhage

    摘要
  • 摘要:
    目的 探讨危害分析及关键控制点（HACCP）原则的康复治疗方案对高血压脑出血患者神经、认知、肢体运动功能的影响。
    方法 纳入2020年6月至2023年6月在武汉市第四医院神经内科接受药物治疗的高血压脑出血患者420例，采用多级盲态机制，随机分为常规治疗组和HACCP组，每组212例。比较治疗前后两组神经、认知、肢体运动功能的变化。应用多因素logistic回归分析法筛选影响患者康复治疗效果的影响因素。
    结果 治疗后，与常规治疗组比较，HACCP组单纯Fugl-Meyer运动功能评分量表评分（FMA）（73.24±3.28） 比 （62.90±2.82）分，t=34.640、功能独立性评定量表评分（FIM）（106.75±17.82）比（99.64±20.03）分，t=52.491、Barthel（BI）指数（73.39±4.47）比（59.76±3.18），t=36.006、中文版简易智力状态检查量表（MMSE）评分（24.16±1.28）比（22.72±1.20）分，t=11.893、总体健康评分(58.23±6.61)比(49.65±5.94）分，t=13.991，均P＜0.001明显增加，美国国立卫生研究院脑卒中量表（NIHSS）评分（4.72±1.19）比（7.53±1.58）分，t=20.587，P＜0.001明显减小。与常规治疗组比较，HACCP组康复治疗总有效率较高（89.05%比71.90%，χ2=9.639），并发症发生率较低(3.33%比18.57%，χ2=24.999，均P＜0.001）。多因素logistic回归分析结果显示，入院时NIHSS评分＞15分（OR=2.282，95%CI 1.365～3.813）、年龄≥60岁（OR=1.857，95%CI 1.221-2.825）、脑干出血（OR=5.836，95%CI 3.141～10.841）、体重指数＞24.0 kg/m2（OR=1.314，95%CI 1.026～1.682）、合并并发症（OR=3.979，95%CI 2.113～7.494）是患者康复治疗效果的影响因素（P＜0.05）。
    结论 HACCP治疗方案能够改善高血压脑出血患者神经、认知、肢体运动功能。

     

    Abstract: Objective To explore the effects of a rehabilitation treatment program based on the principles of Hazard Analysis and Critical Control Points (HACCP) on neurological function, cognitive function and limb motor function in patients with hypertensive intracerebral hemorrhage. Methods A total of 420 patients with hypertensive intracerebral hemorrhage who received medication in the Department of Neurology, Wuhan Fourth Hospital from June 2020 to June 2023 were enrolled. Using a multi-level blinding mechanism, the patients were randomly divided into a conventional treatment group and an HACCP group, with 210 cases in each group. The changes in neurological, cognitive and limb motor functions between the two groups before and after treatment were compared. Multivariate logistic regression analysis was used to screen the influencing factors of rehabilitation treatment efficacy in the patients. Results After treatment, compared with the conventional treatment group, the HACCP group showed significant increases in the Fugl-Meyer Assessment (FMA) score (73.24±3.28) vs (62.90±2.82), t=34.640, Functional Independence Measure (FIM) score (106.75±17.82) vs (99.64±20.03), t=52.491, Barthel Index (BI) score (73.39±4.47) vs (59.76±3.18), t=36.006, Mini-Mental State Examination (MMSE) score (Chinese version) (24.16±1.28) vs (22.72±1.20), t=11.893, and general health score (58.23±6.61) vs (49.65±5.94), t=13.991, while the National Institutes of Health Stroke Scale (NIHSS) score was significantly decreased (4.72±1.19) vs (7.53±1.58), t=20.587 (all P＜0.001). In addition, the HACCP group had a higher total effective rate of rehabilitation treatment than the conventional treatment group (89.05% vs 71.90%, χ2=9.639) and a lower incidence of complications (3.33% vs 18.57%, χ2=24.999, both P＜0.01). Results of multivariate logistic regression analysis indicated that NIHSS score at admission OR=2.282, 95%CI (1.365–3.813), age OR=1.857, 95%CI (1.221–2.825), intracerebral hemorrhage location OR=5.836, 95%CI (3.141–10.841), body mass index OR=1.314, 95%CI (1.026–1.682) and complications OR=3.979, 95%CI (2.113–7.494) were the influencing factors of rehabilitation treatment efficacy in the patients (P＜0.05). Conclusion The HACCP-based rehabilitation treatment program can effectively improve neurological function, cognitive function and limb motor function in patients with hypertensive intracerebral hemorrhage.

     

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