【摘要】 目的观察超早期神经康复联合阿替普酶对老年急性缺血性脑卒中患者的神经功能、继发障碍及生活能力的影响,为治疗老年急性缺血性脑卒中提供方法。方法选择2018年1月30日—2019年5月30日江苏省海安市人民医院神经内科收治的老年急性缺血性脑卒中患者120例,按随机数表法分为3组:A、B和C组,每组40例。A组接受常规急性缺血性脑卒中治疗;B组在A组治疗基础上加用阿替普酶治疗;C组在B组治疗基础上联合超早期神经康复训练。观察和比较3组患者治疗前、治疗6 h、14 d、30 d神经功能恢复情况(采取NIHSS评分)、日常生活能力(采取BI评分)、运动能力(采取FMA评分)、平衡能力(采取BBS评分)、疗效、不良反应发生率及继发障碍发生率等。结果治疗30 d,C组和B组总有效率均明显高于A组(<0.05)。治疗前3组NIHSS评分、BI评分差异均无统计学意义(>0.05)。A组治疗6 h NIHSS评分、BI评分与治疗前差异均无统计学意义(>0.05)。B、C组治疗6 h的NIHSS评分较同组治疗前明显降低(<0.05),BI评分较同组治疗前明显升高(<0.05)。治疗14 d及30 d,3组NIHSS评分均明显低于同组治疗前(>0.05),BI评分均明显高于同组治疗前(>0.05);治疗后B、C组NIHSS评分均明显低于A组(<0.05),而BI评分均明显高于A组(<0.05)。治疗30 d,C组NIHSS评分明显低于B组(<0.05),BI评分明显高于B组(<0.05)。治疗前3组FMA评分、BBS评分差异均无统计学意义(>0.05),3组治疗6 h的FMA评分、BBS评分与同组治疗前比较的差异均无统计学意义(>0.05)。治疗14 d及30 d,3组FMA评分和BBS评分均明显高于同组治疗前(>0.05),且B、C组FMA评分和BBS评分均明显高于A组(<0.05)。治疗30 d,C组FMA评分和BBS评分均明显高于B组(<0.05)。3组治疗不良反应发生率差异无统计学意义(>0.05)。C组总继发障碍发生率明显低于A组和B组(<0.05)。结论超早期神经康复联合阿替普酶不仅可提高老年急性缺血性脑卒中患者神经功能及生活能力,还可降低继发障碍发生率,安全性高且疗效显著。临床对老年急性缺血性脑卒中患者溶栓时,应重视超早期神经康复训练的重要性,以提高治疗效果。更多还原

【Abstract】 Objective o observe the effect of super early neurological rehabilitation combined with alteplase on the neurological function, secondary disorders and living ability of the elderly with acute ischemic stroke. Methods 120 elderly cases with acute ischemic stroke were randomly divided into 3 groups: group A, group B and group C, 40 in each; conventional treatment for acute ischemic stroke was given to all the cases in the 3 groups while alteplase was added to cases in group B and super early neurological rehabilitation combined with alteplase to cases in groups C; the neurological recovery(NIHSS score),daily living ability(BI score), exercise capacity(FMA score), balance ability(BBS score), curative effect and the occurrences of adverse reactions and secondary disorders were observed before treatment and at the time point of 6 h, 14 days and 30 days after treatment. Results 30 days after treatment, the total effective rates in group C and group B were much higher than that in group A( <0.05); before treatment, there existed no statistical differences in NIHSS scores and BI scores among the 3 groups( >0.05); 6 hours after treatment, the NIHSS scores and BI scores in group A were of no statistical difference from those before treatment while the NIHSS scores in group B and group C were much lower and the BI scores were much higher than those before treatment; 14 days and 30 days after treatment, the NIHSS scores in the 3 groups were lower while the BI scores were much higher than those before treatment( <0.05); after treatment, the NIHSS scores were lower while the BI scores were much higher in group B and group C than those in group A; 30 days after treatment the NIHSS scores were much lower and the BI scores were much higher in group C than those in group B; before treatment, the FMA scores and the BBS scores were of no statistical difference among the 3 groups( >0.05); the FMA scores and the BBS scores in the 3 groups 6 hours after treatment were of no statistical difference from those before treatment; 14 days and 30 days after treatment, the FMA scores and the BBS scores in the 3 groups were much higher than those before treatment and the scores in group B and group C were higher than those in group A( <0.05); 30 days after treatment, the FMA scores and the BBS scores in group C were much higher than those in group B( <0.05); there existed no statistical difference in the occurrence of adverse reactions among the 3 groups( >0.05); the occurrence of secondary disorder in group C was much lower than that in group A and in group B( <0.05). Conclusions Alteplase combined with super early neurological rehabilitation is a safe and effective method to improve neurological function and living quality and it can reduce secondary disorders in the elderly with acute ischemic stroke; the importance of super early neurological rehabilitation should be paid more attention when thrombolysis is given to the elderly with acute ischemic stroke.更多还原