【摘要】 目的探讨规范化康复治疗对脑梗死和脑出血后偏瘫患者日常生活活动能力(ADL)转归的影响。方法发病4周内的脑梗死(56例)和脑出血(22例)偏瘫患者共78例。按分层区组随机化方法分成脑梗死康复组(28例)、脑梗死对照组(28例)、脑出血康复组(12例)和脑出血对照组(10例)。对照组接受一般临床治疗,康复组在此基础上给予物理疗法和作业疗法。4组患者分别在入组时、发病后第1及第3个月末以简式Fugl-Meyer评定法(Fugl-Meyer Assessment,FMA)评估肢体运动功能,Barthel指数(Barthel Index,BI)评估ADL,并进行比较。结果①脑梗死康复组及对照组在入院时下肢FMA均为0~22分,1个月末时分别为2~22分和0~22分(P=0.039);3个月末康复组的上、下肢FMA分别为2~54分和8~22分,对照组分别为3~54分和3~22分(P上肢=0.014,P下肢=0.002)。脑出血康复组的上、下肢FMA与对照组比较差异无统计学意义。②脑梗死康复组1个月末的小便控制、床—椅转移及穿衣能力分别为5~10、0~15和0~10分,对照组均为0~10分(P小便控制=0.044,P转移=0.046,P穿衣=0.005);3个月末康复组小便控制、进食、用厕、床—椅转移、步行、穿衣及上下楼梯能力,分别为10~10、5~10、0~10、0~15、0~15、0~10和0~10分,对照组分别为0~10、5~10、0~10、0~15、0~15、0~10和0~10分(P小便控制=0.040,P进食=0.034,P用厕=0.001,P转移=0.000,P步行=0.000,P穿衣=0.000,P上下楼梯=0.001)。脑出血康复组和对照组3个月末的修饰能力均为0~5分,P=0.013,其他项目差异无统计学意义。结论规范化康复治疗有利于改善卒中偏瘫患者的大部分运动功能及ADL,脑梗死及脑出血患者具有相似的ADL康复转归。更多还原

【Abstract】 Objective To investigate the effects of standardized rehabilitation treatment on outcome of the activities of daily living (ADLs) in patients with hemiplegia after cerebral infarction and cerebral hemorrhage. Methods Hemiplegic patients with cerebral infarction (n=56) or cerebral hemorrhage (n=22) within 4 weeks after onset were assigned to cerebral infarction rehabilitation (n=28), cerebral infarction control (n=28), cerebral hemorrhage rehabilitation (n=12), and cerebral hemorrhage control (n=10) groups using a stratified blocked randomization. The patients in the control groups received routine clinical treatment, and the patients in the rehabilitation groups received physical therapy and occupational therapy except routine clinical treatment. The limb motor ability was assessed with Fugl-Meyer assessment (FMA) and the ADLs was assessed with Barthel index (BI) at the time of enrolment, the end of the first and third month after the onset of symptoms respectively in the four groups, and then they were compared with each other. Results The FMA scores of lower limbs at admission were 0—22 in both cerebral infarction rehabilitation and control groups, at the end of the first month were 2—22 and 0—22, respectively (P=0.039); FMA scores of upper and lower limbs at the end of the third month in the cerebral infarction rehabilitation and control groups were 2—54 vs 8—22 and 3—54 vs 3—22, respectively (upper limb P=0.014, lower limb P=0.002). There were no significant differences in the FMA scores of upper or lower limbs in the cerebral hemorrhage rehabilitation group as compared with the cerebral hemorrhage control group. The abilities of bladder control, bed-chair shifting, and putting on clothes at the end of the first month in the cerebral infarction rehabilitation and control groups were 5—10, 0—15, 0—10, and 0—10, 0—10, 0—10, respectively (bladder control P=0.044,shifting P=0.046,putting on clothes P=0.005); the abilities of bladder control, eating, getting on and off toilet, bed-chair shifting, walking, putting on clothes, and up and down stairs at the end of the third month in the cerebral infarction rehabilitation and control groups were 10—10, 5—10, 0—10, 0—15, 0—15, 0—10, 0—10, and 0—10, 5—10, 0—10, 0—15, 0—15, 0—10, 0—10, respectively (bladder control P=0.040, eating P=0.034,toilet P=0.001,shifting P=0.000,walking P=0.000,putting on clothes P=0.000,up and down stairs P=0.001). The ability of trimming at the end of the third month in both cerebral hemorrhage rehabilitation and control groups were 0—5.P=0.013 Conclusions The standardized rehabilitation treatment is benefit to improve most of motor performances and ADLs in stroke patients with hemiplegia, and the patients with cerebral infarction and cerebral hemorrhage may have the similar rehabilitation outcome of ADLs.更多还原