脑卒中患者日常生活活动能力恢复水平的动态分析

Dynamic analysis of ADL recovery level in patients with stroke

目的研究脑卒中患者不同康复治疗阶段日常生活活动能力的恢复水平,为临床康复策略的制定提供理论基础。方法脑卒中患者90例,常规按照脑血管病康复治疗规范进行康复治疗,分别于入选时、第1月末、第3月末和第6月末进行日常生活活动能力评定(改良Barthel指数)。结果 (1)大便控制与小便控制功能在第1次访视与第2～4次访视之间有显著性差异(P<0.05),而第2～4次访视之间变化不明显(P>0.05);(2)除大便控制与小便控制外,改良Barthel指数各项目各次访视之间均有显著性差异(P<0.05);(3)第4次访视时,大便控制、小便控制、修饰和吃饭项恢复较好(百分比值>80%),用厕、转移、行走、穿衣和上下楼梯项恢复尚可(百分比值居于60%～80%之间),而洗澡项恢复较差(百分比值<60%)。结论脑卒中患者大小便控制功能早期即可基本恢复,而日常生活活动能力的其余项目在半年的访视期内均可以持续恢复,但需重点关注洗澡、用厕、转移、行走、穿衣和上下楼梯项。

Objective To explore ADL recovery level in patients with stroke during different rehabilitation phases,for providing the theoretical foundation to rehabilitation strategy.Methods Ninety cases of patients with stroke were given routine rehabilitation therapy.ADL test were assessed at addmission,the 1st month,the 3rd month and the 6th month with Barthel index.Results（1）There were significant differences in the control of defecating and urinating between the 1st visiting and the other visiting（P0.05）,but there was no significant differences among 2nd,3rd and the last visiting（P0.05）.（2）Except bowels and bladder,other items of Modified Barthel Index have significant difference during the four visiting.（3）During 4th visiting,items of bowels,bladder,grooming and feeding had a better recovery（80%）,items of toilet,transfers,mobility,dressing and stairs had a good recovery（from 60% to 80%）,but items of bathing had a poor recovery（60%）.Conclusions Function of the defecating control（bowels）and urinating control（bladder）in patients with stroke will recover soon after onset.The other items of ADL may have a continuous recovery during halfa year after stroke.We should still pay more attention to bathing,toilet,transfers,mobility,dressing and stairs.