三级康复治疗改善脑卒中偏瘫患者运动功能1365例临床研究

Clinical Outcome of Standardized Tertiary Rehabilitation Program in Promoting Motor Function in 1365 Stroke Patients with Hemiplegia

目的探索规范化三级康复治疗对脑卒中偏瘫患者运动功能的影响。方法本研究采用大样本、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,将患者在脑梗死和脑出血两个层次上区组随机化分成康复组和对照组,康复组688例,对照组677例,共计1365例,康复组给予规范的三级康复治疗,对照组不给予规范的三级康复治疗,但是一般的常规内科诊疗同康复治疗组。分别于入选时、发病后第1个月末、第3个月末和第6个月末采用功能综合评定量表运动项评分标准,进行评测。结果入选时,脑梗死组和脑出血组患者运动功能分布情况康复组和对照组无明显差别,但是入选后各阶段两组之间存在明显差别。患者入选后不论是脑梗死康复组、脑出血康复组或是总体康复组患者运动功能测评积分均明显优于对照组(P<0.01)。康复组患者入选后各阶段的运动功能改善明显优于对照组(P<0.01),康复组改善值积分的增长趋势明显快于对照组,早期尤为明显。6个月随访治疗后,脑梗死康复组、脑出血康复组和康复组总体患者的运动功能分别改善了38.44分、44.50分和40.10分,而对照组分别改善了24.41分、27.92分和25.34分。与对照组相比,脑梗死康复组多改善14.03分,脑出血康复组多改善16.58分,康复组总体上多改善14.76分。结论规范三级康复治疗对于脑卒中偏瘫患者各阶段运动功能的提高具有明显的促进作用。

Objective To investigate the effect of standardized tertiary rehabilitation （STR） on the motor function in patients with cerebral stroke accompanied by hemiplegia. Methods 1365 subjects were enrolled sequentially from the 22 hospitals .Vital life signs of the subjects were stabilized in the past week. They were classified into two groups of cerebral infarction and hemorrhage while being enrolled, and then randomly subdivided into two groups： experimental group（EG）and control group（CG）.The EG and CG were composed of 688 cases and 677 cases,respectively. There were 250 females and 438 males in the EG, and 269 and 408 in the CG. Those in the EG were administered STR in addition to routine interventions of neurological medicine, while those in the CG were only given the routine ones. All patients were assessed with the scale of Functional Comprehensive Assessment （FCA） at the time of the enrollment, and by the end of 1st, 3rd and 6th month after the stroke. Results There was no significant difference between the two groups in the distribution of the scores at the entering point. At each pest - stroke checking point, however, the differences in the distribution of scores between the two groups were significant. At each of the following pest- stroke checkpoints, however, the scores of the functions in the cerebral infarction or hemorrhage groups, or in the whole EG were higher than those in the CG （P 〈0.01）. At the end of 6th month, the scores went up by 38.44, 44.50 and 40.10 in the EG,respectively,whereas the scores in the CG increased by 24.41, 27.92 and 25.34, correspondingly. Therefore, the scores in EG increased 14.03, 16.58 or 14.76, respectively, as compared with that in CG. Furthermore, the motor function improved faster in the EG than in the CG, especially during the early stages. Conclusion Standardized tertiary rehabilitation program significantly improved the motor function in patients with cerebral strokes accompanied by hemiplegia.