【摘要】 目的:探讨脑卒中患者开始康复介入时间和持续时间对运动功能恢复的影响。方法:选择1993-01/2000-12黑龙江省康复医院康复科住院脑卒中患者423例,将发病至开始康复时间分为0d～组(0～29d,n=196)、30d～组(30～89d,n=150)和90～180d组(90～180d,n=77)。采用Bobath,Brunnstrom,多感觉刺激疗法、本体感觉型神经肌肉促通术、心理康复,由专业治疗师与患者“一对一”地进行训练,45min/次,1次/d。入院7d内按Brunnstrom6级标准、手功能评定的5个动作、步行能力4级标准和日常生活活动能力的Barthel指数初评,以后每个月评测1次,连续进行3个月。结果:按实际完成处理,有423例患者纳入结果分析。运动功能恢复总有效率0d～组79.1%(155/196);30d～组47.3%(71/150);90～180d组26.0%(20/77),与前两组比较差异均有显著性(χ2=37.807,9.665,P=0.000,0.002)。0d～组和30d～组患者按不同的康复治疗持续时间(1个月、2个月和3个月)分别对运动功能恢复的总有效率进行组内对比,结果为持续时间3个月(0d～组:96.2%,78/81;30d～组:67.6%,25/37)比2个月(0d～组:78.8%,52/66;30d～组:47.8%,32/67)效果明显;2个月比1个月(0d～组:51.0%,25/49;30d～组:28.2%,13/46)效果明显(χ2=3.775～10.901,P均<0.05)。结论:脑卒中患者开始康复介入时间更多还原

【Abstract】 AIM:To investigate the influence of the starting time and duration of rehabilitation on the recovery of motor function in stroke patients.METHODS:A total of 423 hospitalized stroke patients in the Department of Rehabilitation Medicine,Rehabilitation Hospital of Heilongjiang Province from January 1993 to December 2000 were divided into three groups from the attack of stroke to the beginning of rehabilitation:group from 0 to 29 days(n=196),group from 30 to 89 days(n=150) and group from 90 to 180 days(n=77).All patients were exercised by therapists in a one to one manner according to Bobath,Brunnstrom,Rood,proprioceptive neuromuscular facilitation,psychological rehabilitation for 45 minutes once per day.The patients were first evaluated within seven days after hospitalization,and once a month subsequently for three months in their recovery of motor function using standards of Brunnstrom(six grades),hand function(five actions),walking ability(four grades),and activities of daily living using Barthel index.RESULTS:According to the actual management,all the 423 patients were included in the result analysis.The total effective rate of motor function restoration in the group from 90 to 180 days(26.0% ,20/77) was significantly different from that in the group from 0 to 29 days(79.1% ,155/196) and the group from 30 to 89 days(47.3% ,71/150)(χ 2=37.807,9.665,P=0.000,0.002).In the intra group comparison of motor function recovery in the group from 0 to 29 days and the group from 30 days to 89 days in different rehabilitation duration of 1,2 and 3 months,the total effective rate was higher in the duration of 3 months(96.2% ,78/81 in the former group,67.6% ,25/37 in the latter group) than in the duration of 2 months(78.8% ,52/66 in the former group,47.8% ,32/67 in the latter group),and also higher in the duration of 2 months than in the duration of 1 month(51.0% ,25/49 in the former group,28.2% ,13/46 in the latter group)(χ 2=3.775 to 10.901,all PCONCLUSION:The earlier the rehabilitation intervention for the stroke patients is,i.e.,early rehabilitation is performed in the patients who can accept rehabilitation or at the immediate time after treatment,the better the recovery of motor function is.Our study indicates that for the rehabilitation started within 1 month after stroke attack,the duration of 3 months induces the best outcomes,for the rehabilitation started between 1 and 3 months,the longer duration induces more effective outcomes,and for the rehabilitation started after 3 months,different duration has unobviously statistical difference in the influence on outcomes though longer duration induces higher total effective rate.更多还原