不同发病性质和部位的脑卒中对患者功能损伤和恢复的影响特点

The Features of Functional Impairment and Recovery in Stroke Patients with Different Properties and Hemispheres

目的:探讨脑卒中不同病变性质和半球损伤对患者早期认知、平衡能力和功能独立性的影响;早期康复治疗后功能恢复特点及其相关性。方法:将住院的75例脑卒中患者分为A组(左侧出血)14例;B组(左侧梗死)21例,C组(右侧出血)15例和D组(右侧梗死)25例,均进行针对性康复治疗1个月。治疗前后作认知功能评定(MMSE)、平衡能力评定(Fugl-Meyer,FMA)及功能独立评定(FIM)。结果:4组患者康复治疗前及康复治疗1个月后MMSE、FMA平衡及FIM评分均低于正常值。其中A组FMA平衡治疗前、FIM治疗前后评分均低于B组(P<0.01或0.05)。康复治疗后除D组MMSE评分无提高外,其它组评分均有提高(P<0.01,0.05)。相关性检验和多元线性回归分析显示,左脑出血患者功能独立性提高与平衡功能提高相关,右脑出血功能独立性提高与认知功能提高相关;而脑梗死患者无论左右侧病变,功能独立性提高与认知、平衡功能提高均有关。4组治疗后FIM评分分别与各自FMA平衡或MMSE呈正相关(P<0.05或0.01)。结论:脑卒中患者早期认知、平衡和功能独立性均有下降,其中左脑出血较左脑梗死患者表现更明显;早期康复均能提高患者的上述功能。脑出血患者早期平衡和功能独立性的能力能预测其康复后早期功能独立性的能力;左脑梗死早期认知功能和功能独立性、右梗死早期功能独立性恢复的程度能预测康复后早期功能独立性恢复的能力。

Objective： To discuss the influences of different properties and hemispheres on cognition, balance, functional independent ability of stroke patients, and the characteristics of functional recovery after early rehabilitation treatment. Methods： Seventy-five inpatient with stroke were divided into 4 groups： 14 cases in group A （left hemorrhages）, 21 in group B （left infarcts）, 15 in group C （right hemorrhages）, 25 in group D （right infarcts）. The patients were assessed by MMSE, Fugl-Meyer Balance, FIM before and after rehabilitation therapy. Results： The scores of MMSE, Fugl-Meyer Balance, and FIM in all stroke patients were decreased before and after therapy as compared with normal controls. The scores of Fugl-Meyer Balance, and FIM in group A were lower than in group 13 before and after therapy （P〈0.01,0. 05）. The scores of MMSE, Fugl-Meyer, and FIM in all 4 groups were increased after therapy except those of MMSE in group D （P〈0. 01,0.05）. Correlation analysis revealed that all 4 groups showed close relationships between FIM and Fugl-Meyer and/or MMSE after therapy （P〈0. 05,0.01）. Multi- ple linear regression analysis indicated that the scores of Fugl-Meyer Balance, and FIM were the independent variables in groups A and C, those of MMSE, and FIM in group B, and those of FIM in group D. Conclusion： The functions of cognition, balance, functional independence in early stroke patients are all decreased. The functions of balance and functional independence in patients with left hemorrhage are damaged more severe than in those with left infarction. All functions of them can be improved by early rehabilitation.