脑卒中患者在不同等级医疗机构康复治疗的效果分析

Effect of rehabilitative therapy in stroke patients treated in hospitals of different grade

目的:探讨不同等级医疗机构脑卒中患者的康复治疗效果。方法:选择在三级及一级医院住院的急性及非急性期脑卒中患者,分为A,B两组,采用以神经促进技术为主的综合康复治疗方法,并加强日常生活活动能力的训练,45min/d,5次/周;同时指导家属或陪护人员进行训练。A组(三级甲等医院)平均治疗4周,B组(一级甲等医院)平均治疗2个月。于治疗开始前和结束时由专人用Barthel指数(简称BI)评定患者的日常生活活动能力。结果:A组41例,年龄(63.17±10.47)岁;病程(15.05±9.11)d;2例轻度构音障碍。B组53例,年龄(75.08±8.03)岁;病程(503.58±58.82)d;老年痴呆及血管性痴呆18例,失语14例。统计学分析两组性别、疾病分类构成、脑卒中次数均无明显差异;年龄和病程差异有显著性意义(P=0.000)。A组康复前后BI评定总分从31.71±18.08增加至68.78±23.82(P=0.000),除尿便控制功能外(排便无改变,排尿P=0.323),其余功能均有明显改善(洗澡P=0.023、活动P=0.003,其余P=0.000);B组康复前后BI评定总分从27.17±22.56增加至41.42±25.63(P=0.000),其中排尿、修饰、用厕、进食、转移、活动和穿衣功能有明显改善(排尿P=0.031、穿衣P=0.018、用厕P=0.004,其余P=0.000),两组患者日常生活活动能力的改善均有显著的统计学意义。康复治疗前两组,

AIM:To explore the curative effect of rehabilitation in stroke patients treate d in hospitals of different grade. METHODS:Forty-one patients with acute stroke in a class A, grade 3 hospital(g roup A)and 53 non-acute stroke patients in a class A,grade 1 hospital(group B)w ere treated with rehabilitation training procedure based on neuromuscular promot ion technique by the same physical therapists,45 minutes per day,5 days per week ,and their relatives or companions also received the training.The course was 4 w eeks in group A and 2 months in group B.Furthermore,the activities of daily life (ADL)were assessed with the Barthel index(BI)by special person before and after treatment in both groups. RESULTS:There were significant differences in average age and duration of trea tment between the group A [(63.17±10.47) years old and(15.05±9.11) days]and g roup B[(75.08±8.03)years old and(503.58±58.82) days](P=0.000).There were 2 ca ses of mild dysarthria in group A,18 cases of senile dementia and vascular demen tia and 14 cases of anepia in group B.Statistical analysis showed that there was no obvious significance in gender,classification and structure of diseases and stroke times between the two groups.The total score of BI was increased to 68.78 ±23.82 from 31.71±18.08 in group A after rehabilitation(P=0.000).Except the co ntrol function of urine(P=0.323)and stool(no change), other functions were all o bviously improved (bathing P=0.023, activity P=0.003, others P=0.000) .The total score of BI was increased to 41.42±25.63 from 27.17±22.56 in group B after re habilitation(P=0.000),the functions of urine(P=0.031),wearing(P=0.018),toileting (P=0.004)and others(P=0.000)were all obviously improved.The improvements of ADL in the two groups were all significant.Before rehabilitation, there was no marke d difference in all the functions except the control function of urine and stool . After rehabilitation, the total scores of BI were significantly different betw een the two groups(P=0.000),and there were significant differences in all functi ons except bathing. CONCLUSION:The effectiveness of rehabilitation training to stroke patients is significant,the earlier rehabilitation, the better results.How to initiate and c ontinue the rehabilitation procedure in community is of great importance to the elder patients with non-acute stroke.