临床及部分社会相关因素对急性脑卒中偏瘫患者功能障碍影响的研究

The clinical and social factors associated with functional disturbance of acute hemiparetic stroke patients

目的 用标准化的量表对急性脑卒中偏瘫患者在发病后的48 h、5 d、90 d进行3个时间点的随访评估,探讨决定患者功能预后的早期因素.方法 对初次发作的急性脑卒中偏瘫住院患者118例的一般情况、相关危险因素、社会相关因素进行调查及运用包括Barthel指数（BI）、Rankin量表（RS）、Mortricity指数（MI）评定法、中文简易智能量表（MMSE）及Montgomery-Asberg抑郁量表（MADRS）在内的评估工具评测患者脑卒中发生时的自主生活能力、运动能力,脑卒中本身的临床特征,脑卒中发生后第48小时、第15天、第90天时的神经、运动和精神心理因素.结果 急性脑卒中偏瘫患者在发病后第48小时、第15天和第90天时BI、RS和MADRS评分不同（均P值＜0.05）.第48小时和第15天之间评分比较差异无统计学意义（P＞0.05）,第90天日常生活活动能力、独立生活能力和抑郁状态明显恢复（P＜0.01）.影响脑卒中患者第90天日常生活活动能力恢复的因素中,深感觉障碍、第48小时出现的肺炎和尿失禁为危险因素,第48小时的上肢肌力评分和第15天MMSE评分为保护因素.结论 急性脑卒中偏瘫患者第90天时临床因素、功能因素和社会因素明显改善.日常生活活动能力的恢复受到深感觉障碍、脑卒中后第48小时出现的肺炎和尿失禁、脑卒中后第48小时上肢肌力评分和第15天时MMSE的影响.

Objective To investigate the prognostic factors of life and functional outcome of the first hemiparetic stroke patients. Methods One hundred and eighteen stroke subjects were registered prospectively. The Barthel index （BI） , Rankin scale （RS） , Mortricity index（MI） , Mini-mental state examination （MMSE） , Montgomery-Asberg depression scale （MADRS） and a scale of general state and risk factors were used to evaluate at the 48th hour, the 15th day and the 90th day after stroke. Results The patients＇ performance, as demonstrated by their scores with all the evaluation instruments, changed significantly at all the time points of evaluation after stroke （P ＜0.05）. There was no significant difference between the performance at the 48th hour and the 15th day after stroke （ P ＞ 0.05 ）. But at the 90th day after stroke, the activity of daily living performance and the depression status recovered significantly （P ＜ 0.01 ）. Logistic regression analysis showed that, such factors as pneumonia, urinary incontinence within 48th hour and deep sensation disturbance might adversely influence patients＇ activity of daily living performance at the 90th day after stroke; the muscle strength of upper extremities at the 48th hour, and MMSE scores at the 15th day after stroke acted as the protective factors. Conclusions The stroke patients improved significantly with regard to their clinical and functional manifestations when evaluated 90 days after stroke onset. The main factors influencing the activity of daily living performance 90 days after stroke onset included deep sensation disturbance,pneumonia, urinary incontinence and muscles strength of upper extremities at 48th hour, and MMSE scores at the 15th days after onset.