连续规范化康复治疗对老年脑卒中患者生活质量和日常生活活动的影响 分层随机对照试验

Effects of the continuous and normative rehabilitation therapy on quality of life and activities of daily living in old patients with stroke:Stratified randomized controlled trial

目的:探讨早期连续规范化综合康复治疗对老年脑卒中患者功能变化和生活质量的影响。方法:以2001-11-27/2004-09-30在安徽医科大学神经内科连续入院,年龄>60岁的老年脑卒中患者54例为观察对象,将其按脑梗死和脑出血分层后随机分成康复组和对照组各27例。对照组进行常规的神经内科治疗,康复组患者在此基础上,在急性期(病后21d内,病情稳定48h)至病后6个月进行规范连续的康复治疗,分别在神经内科病房、康复科病房和社区或家庭进行,内容包括运动疗法、作业疗法和言语治疗等。所有患者在入组和6个月时采用神经功能缺损程度评分量表(0～45分,0～15分为轻度缺损,31～45分为重度缺损)评估神经功能缺损程度,改良巴氏指数评定表(共10项,满分100分,<60分为不能自理)评估日常生活活动能力,功能综合评定量表(18项,每项评分1～6分,6分为完全独立,1分为完全依赖或无法进行测试,总分108分)评估综合功能,采用WHOQOL-BREF中文版评价生活质量。结果:按意向处理分析,54例患者均进入结果分析。①功能综合评定量表得分:治疗前康复组和对照组无差异(43.93±14.67,52.41±18.92,P>0.05),6个月后康复组显著高于对照组(94.93±10.95,84.41±18.81,t=2.51,P<0.05)。②WHOQOL-BREF中文版评分:治疗前康复组和对照组无差异(58.07±12.20,59.30±12.70,P>0.05),6个月后康复组显著高于对照组(79.89±9.37,70.63±10.39,t=3.44,P<0.05)。③改良巴氏指数评分:治疗前康复组和对照组无差异(18.59±11.96,25.74±14.32,P>0.05),6个月后康复组显著高于对照组(78.85±16.57,68.33±20.89,t=2.27,P<0.05)。④神经功能缺损程度评分:治疗前康复组和对照组无差异(27.30±5.06,24.93±6.63,P>0.05),6个月后康复组显著低于对照组(10.63±6.63,14.70±6.54,t=2.05,P<0.05)。⑤未发现不良事件和副反应。结论:神经内科、康复科、社区及家庭连续规范化的综合康复模式治疗老年脑卒中患者是安全有效的,有助于提高患者的日常生活能力和生活质量。

AIM： To study the effects of early continuous normative comprehensive rehabilitation treatment on functional change and quality of life in old patients with stroke. METHODS： Totally 54 old patients with stroke aged more than 60 consecutively admitted in the Department of Neurology of Anhui Medical University between November 27^th, 2001 and September 30^th, 2004 were chosen and randomly divided into two groups according to the delamination of cerebral infarction and cerebral hemorrhage： rehabilitation group and controlled group with 27 in each group. Patients in control group were treated with routine treatment in department of neurology. Patients in rehabilitation group on this basis were given continuous normative rehabilitation treatment from acute period （within 21 days after getting ill, 48 hours with stable state of an illness） to 6 months after getting ill, and conducted in the ward of department of neurology and the ward of department of rehabilitation and community or family, respectively, the content including cinesiateics, occupational therapy and verbal psychotherapy etc. All the patients at the moment of entering the bundle and the 6^th month were assessed respectively with the clinical nerve function limitation score （CNS） （0-45 points, mild defection with 0-15 points, and severe defection with 31-45 points）. Activities of daily living ability was evaluated with Modified Barthel Index （MBI） （total 10 terms, full mark with 100 points, and less than 60 points for unable to self-care）. Comprehensive function was evaluated by Functional Comprehensive Assessment （FCA） （18 terms, 1-6 points in each term, 6 points for complete independence, 1 point for complete dependence or could not carry out the test, total score with 108 points）. The quality of life was evaluated by WHOQOL-BREF questionnaire of Chinese version. RESULTS： According to the intention-to-treat analysis, 54 patients were all involved in the result analysis. ①The score of Functional Comprehensive Assessment： There were no differences between rehabilitation group and control group pre-treatment （43.93±14.67, 52.41＋18.92, P〉 0.05）. It was significantly higher in rehabilitation group than control group after 6 months （94.93±10.95, 84.41＋18.81, t=251,P〈 0.05）. ② The score of WHOQOL-BREF questionnaire of Chinese version： There were no differences between rehabilitation group and control group pre-treatment （58.07±12.20, 59.30±12.70, P 〉 0.05）. It was significantly higher in rehabilitation group than control group after 6 months （79.89±9.37, 70.63±10.39, t=3.44, P〈 0.05）. ③ The score of Modified Barthel Index： There were no differences between rehabilitation group and control group pre-treatment （1859±11.96, 25.74±14.32, P 〉 0.05）. It was significantly higher in rehabilitation group than control group after 6 months （78.85±1657, 68.33±20.89, t=2.27, P〈 0.05）. ④ The score of nerve function limitation ： There were no differences between rehabilitation group and control group pre-treatment （27.30±5.06, 24.93±6.63, P 〉 0.05）. It was significantly lower in rehabilitation group than control group after 6 months （10.63±6.63, 14.70±6.54, t=2.05 ,P 〈 0.05 ）. ⑤ There were no mal-occurrence and subresponse. CONCLUSION： The continuous and normative treatment of general rehabilitation modality in department of neurology, department of rehabilitation, community and family is safety and operative for old patients with stroke, may improve the daily living ability and quality of life in patients.