卒中单元模式下急性脑卒中早期康复的临床观察

A clinical observation on rehabilitation treatment at early convalescent stage of patients with acute stroke

目的 研究在卒中单元模式下急性脑卒中患者早期康复治疗的临床疗效.方法 采用前瞻性研 究方法，将131 例急性脑卒中患者按随机原则分为常规治疗组（64 例）和康复组（67 例），其中急性脑卒中后抑 郁（PSD）患者69 例，常规治疗组32 例，康复组37 例。两组患者均给予治疗脑卒中的常规药物，康复组在常规 治疗基础上于病情稳定48 h 开始进行卒中单元的肢体运动功能训练；对两组中诊断为PSD 的患者给予舍曲林 并进行心理疏导。于治疗前及治疗后14 d、30 d 采用美国国立卫生研究院卒中量表（NIHSS）评定神经功能缺损 程度评分（NDS），采用改良的Barthel 指数（MBI）评定日常生活活动能力、采用汉密尔顿抑郁量表（HAMD）评定 抑郁程度.结果 康复组和常规治疗组治疗前NDS、MBI 比较差异均无统计学意义（均P ＞0.05）；治疗后NDS 均有所下降、MBI 有所升高，治疗后14 d、30 d 康复组上述指标的改善程度明显优于常规治疗组（均P ＜0.05），以 治疗后30 d 更显著〔NDS（分）：11.3±7.6 比16.2±0.5，MBI ：71.4±12.5 比53.1±11.7，均P ＜0.05〕。两组PSD 患者治疗后NDS、MBI、抑郁评分（分）均有所改善，治疗前、治疗后14 d 上述指标比较差异无统计学意义（均 P ＞0.05）， 治疗后30 d 康复组改善程度明显优于常规治疗组（NDS ：11.3±10.6 比18.9±6.1，MBI ：61.4±12.8 比 47.6±11.1，抑郁评分：13.3±0.6 比18.1±0.8，均P ＜0.05）.结论 急性脑卒中患者早期康复治疗能有效促进神 经功能恢复，改善PSD 的临床症状.

Objective To study the clinical curative efficacy of rehabilitation treatment at early convalescent stage of patients with acute stroke under the mode of stroke unit. Methods A prospective study was adopted, 131 cases with acute stroke were divided into two groups randomly ： rehabilitation treatment group （67 patients）and conventional treatment group （64 patients） and in 131 cases, there were 69 cases with acute post-stoke depression （PSD）, 37 being in the former group and 32 in the latter group. Both groups took conventional anti-stroke medicine, and in the rehabilitation treatment group, additionally, after 48 hours of stabilization of the disease condition, early rehabilitation treatment was applied to begin the training of extremity movement in the stroke unit. For the PSD patients, sertraline was administered accompanied with psychological guidance. Before treatment and 14 and 30 days after treatment, the National Institute of health stroke scale （NIHSS）was used to generate the neuro deficit score （NDS）, the modified barthel index （MBI） to assess the activities of daily living and the Hamilton rating scale for depression to evaluate the scale of depression. Results The differences in NDS and MBI between the two groups had no statistical meaning before treatment （both P〉0.05） ; after treatment, both groups showed a decline of NDS and an increase of MBI ; 14 days and 30 days after treatment, the degrees of improvement of above indexes were more prominent in the rehabilitation treatment group than those in the conventional group （all P〈0.05）, and the result was more significant on the 30th day after treatment （NDS ： 11.3 ±7.6 vs. 16.2± 0.5, MBI ： 71.4± 12.5 vs. 53.1 ± 11.7, both P〈 0.05 ）. After treatment, the NDS, MBI and depression rating in PSD patients were improved in both groups, before treatment and 14 days after treatment, the differenees in above indexes between the two groups showed no statistical meaning （all P〉0.05）, but 30 days after treatment, the rehabilitation treatment group revealed better results （NDS ： 11.3± 10.6 vs. 18.9±6.1,MBI： 61.4±12.8 vs. 47.6±11.1,depression rating： 13.3±0.6 vs. 18.1±0.8,allP〈0.05）. Conclusion The rehabilitation treatment carried out at early stage for acute stroke patients can effectively foster the recovery of neurologieal function and relive the elinical symptoms of PSD.