从事手工业者脑卒中后上肢功能恢复与心理障碍的关系

Relationship between the functional recovery of upper-limbs and the pyschological disorder in patients with stroke engaged in handicraft industry

目的:对不同职业脑卒中患者的肢体功能恢复与心理障碍情况进行测评,以了解此类患者在多大程度上需要个性化的医疗服务。方法:依是否从事手工业工作将符合纳入标准的85例患者分为A组40例,B组35例。两组在给予常规治疗和心理干预的基础上,均给予相同的上肢康复训练方法。结果:两组治疗前汉密顿抑郁量表(HAMD)评分(13.43±7.52)分、(14.35±8.02)分,神经功能缺损评分(19.56±6.12)分、(19.21±6.26)分,两项评分比较t=0.51,0.24,P>0.05,治疗后两组神经功能缺损评分(7.56±3.42)分、(8.12±3.56)分相比较t=0.69,P>0.05。治疗后两组HAMD评分为(11.46±2.12)分、(7.42±1.89)分,两组HAMD评分比较t=8.66,P<0.01。A组治疗前后上肢功能分级Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ分别为21,9,5,2,2,1例和8,7,10,5,4,6例,B组分别为18,6,3,6,1,1例和10,6,8,5,4,2例。两组治疗前后比较u=0.38,0.99,P>0.05。A组治疗前后比较u=3.55,P<0.01,B组治疗前后比较u=1.96,P<0.05。结论:临床医疗手段可促进脑卒中患者肢体功能的恢复,但非医疗因素对不同职业患者康复过程产生着不容忽视的影响。

AIM:To evaluate the conditions of the recovery of upper-limbs and psychological disorder in stroke patients of different occupations,and to understand how they need personal medical services. METHODS:According to whether they engaged in handicraft industry or not, a total of 85 patients, who were in accordance with the including standard, were divided into group A(n=40)and group B(n=35).On the basis of normal treatment and psychological intervention,patients in the two groups received the same rehabilitative training of upper-limbs. RESULTS:Before treatment,the Hamilton rating scale for depression(HAMD)scores in the two groups were 13.43±7.52 and 14.35±8.02 respectively,and the scores of neurological impairment were 19.56±6.12 and 19.21±6.26(t=0.51, 0.24, P >0.05).After treatment,the scores of neurological impairment in the two groups were 7.56±3.42 and 8.12±3.56(t=0.69,P >0.05),and the HAMD scores were 11.46±2.12 and 7.42±1.89 (t=8.66, P< 0.01).Before and after treatment,there were 21,9,5,2,2,1 and 8,7,10,5,4,6 cases who had the degree of upper-limbs function classification of Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴand Ⅵbefore and after treatment in group A(u=3.55,P< 0.01), and 18, 6, 3, 6, 1,1 and 10, 6, 8, 5, 4, 2 cases in group B(u=1.96,P< 0.05),and there was insignificance between the two groups before and after treatment(u=0.38, 0.99,P >0.05). CONCLUSION:The clinical medical methods can promote the recovery of upper-limbs of patients with stroke,but the influence of non-medical factors on the rehabilitation of patients in different occupations should not be neglected.