三级康复治疗促进脑卒中偏瘫患者神经功能改善的前瞻性多中心随机对照研究

Effects study of standardized tertiary rehabilitation on promoting of the neurological functions in stroke patients with hemiplegia

目的探索三级康复治疗对卒中偏瘫患者神经功能的影响。方法研究采用大样本、多中心、前瞻性的随机对照研究方法。各分中心分别随机入选患者,然后在脑梗死和脑出血2个层次上区组随机分成康复组和对照组,康复组给予三级康复治疗,对照组不给予三级康复治疗,但是一般的常规内科诊疗同治疗组,分别于入选时,病后1个月、3个月和6个月采用临床神经功能缺损程度评分标准进行评测。结果 1209例患者入选,其中康复组610例,对照组599例。两组患者入选时的神经功能评分差异无统计学意义,康复后脑梗死和脑出血康复组神经功能测评分明显低于对照组的测评分(均 P<0.01)。康复组入选后各阶段的神经功能改善值明显优于对照组(均 P<0.01)。治疗6个月后,脑梗死和脑出血康复组的神经功能分别改善了12.79分和15.23分,而对照组分别改善了8.30分和10.65分。此外,康复组评分下降的趋势明显快于对照组,早期尤为明显。结论三级康复治疗对于卒中患者各阶段神经功能的提高具有明显的促进作用。

Objective To investigate the effects of standardized tertiary rehabilitation （STR） on promotion of the neurological functions in stroke patients with hemiplegia. Methods A large-sample, multi- center, randomized, controlled prospective study was conducted nationwide. 1209 stroke patients with semiplegia, aged 40-80, within 11 d ± 5 d after the onset, stabilized in vital life signs in the past one week, of 20 hospitals affiliated to medical colleges or of hospitals at the provincial level in China's Mainland were randomly allocated to one of the 2 baseline data-matched groups, control group （ n = 599,446 with cerebral infarction and 153 with cerebral hemorrhage） receiving routine intervention of internal medicine, and STR group （n = 610, 455 with cerebral infarction and 155 with cerebral hemorrhage ）, receiving routine intervention and STR including physical therapy and occupational therapy （OT） in addition. Evaluation was conducted by the time of enrollment, and by the ends of the first, third, and sixth months by the national clinical neurological function defects （CNFD） scoring. Results There were no significant differences in the baseline indexes between these 2 groups. The scores of CNFD at enrollment of the patients with cerebral infarction in the STR group was 21.55, not significantly different from that of the patients with cerebral infarction in the control group （22.16）, however, the scores of these patients with cerebral infarction in the STR group by the ends of the first, third, and sixth months were 16.32, and 11.48, and 8.63 respectively, all significantly lower than those of the corresponding patients in the control group （ 18.95, 15.57, and 13. 78 respectively, all P 〈 0.01 ）. The C NFD score at enrollment of the patients with cerebral hemorrhage in the STR group was 23.27, not significantly different from that of the corresponding patients in the control group （24.36）, however, the scores of the patients with cerebral hemorrhage in the STR group by the ends of the first, third, and sixth months were 17.61, 11.20, and 7.95 respectively, all significantly lower than those of the corresponding patients in the control group （20.36, 15.01, and 13.57 respectively , all P 〈 0. 01 ）. By the end of the sixth month, the CNFD score of the cerebral infarction and hemorrhage patients in the StIR group were improved by 12.79 and 15.23, both higher than the corresponding patients in the control group （8.30 and 10.65 respectively）. The trend of decrease of CNFD score moved faster in the STR group than in the control group, especially at the early stage. Conclusion STR significantly helps improver the neurological function in the patients with cerebral stroke accompanied with hemiplegia.