【摘要】 背景:有研究表明日间医院的康复服务与综合医院康复门诊比较,患者的功能和生活质量方面差异无显著性意义,但两者间有关脑卒中患者慢性期肢体功能的差异及其影响因素却少有报道。目的:比较日本老年脑卒中患者慢性期分别在综合医院康复门诊和日间医院康复期间的肢体功能差异,分析影响功能差异的相关因素,以便改进老年脑卒中患者康复方案。方法:分别对医院门诊和日间医院进行康复训练的老年脑卒中患者119例(年龄60～75岁)实施为期1年的调查分析,比较两组入选时和1年后的肢体功能指标的差异,包括健侧和偏瘫侧的股四头肌肌力、患侧膝关节伸展和踝关节背屈的关节活动度和10m步行时间。采用逐步回归分析确定影响肢体功能指标变化的显著因素。结果与结论:医院门诊组患者肢体健侧和偏瘫侧股四头肌肌力在入选时和1年后均大于日间医院组(P<0.05),而两组的10m步行时间差异均无显著性意义。医院门诊组在入选时患者患侧膝关节伸展和踝关节背屈关节活动度均小于日间医院组(P<0.05),而1年后两组以上指标比较差异无显著性意义。逐步回归分析结果显示入选时健侧和偏瘫侧股四头肌肌力、患侧膝关节伸展和踝关节背屈关节活动度是其各自功能指标变化的显著影响因素,而偏瘫侧膝关节伸展、踝关节背屈的关节活动度越受限的患者,训练的效果越好。因此,日间医院组需要采取针对性的肌力增强或维持训练和膝关节活动度训练。更多还原

【Abstract】 BACKGROUND:Studies demonstrated that there are no significant differences between the general hospital and day care training center in functional maintenance and life quality of patients.However,there are few studies concerning the difference of limb functions and influencing factors in patients with chronic stroke.OBJECTIVE:Following up elderly patients with chronic stroke undergoing long-term rehabilitation treatment to compare the results from different facilities in order to take appropriate strategies for rehabilitation treatment for functional maintenance of elder patients with chronic stroke.METHODS:Totally 119 elderly patients(aged 60-75 years) with chronic stroke undergoing rehabilitation treatment at different facilities were recruited in present investigation research program.The differences of functional measurements,including muscle strength of the quadriceps on both paretic side and non paretic side,knee extension and ankle dorsiflexion on the paretic side,and time of 10 meters walking at both first measurement as baseline and second measurement after 1 year were compared between two groups to identify the influencing factors.RESULTS AND CONCLUSION:Muscle strength of the quadriceps on both paretic and non-paretic side in the hospital group was greater than that of the day care group at both first and second measurements(P < 0.05).The knee extension and ankle dorsiflexion on paretic side was smaller in the hospital group than that of the day care group at first measurement(P < 0.05),but the difference had no significance at 1 year after operation.The result of stepwise regression analysis showed quadriceps on both paretic and non-paretic side,knee extension and ankle dorsiflexion were shown to be significantly effective on improvement of themselves over a year in two groups.In general,muscle strengthening exercise and range of movement of knee extension exercise should be emphasized in specific patients at day care group.更多还原