早期功能训练对脑卒中急性下肢深静脉血栓形成的影响

Effect of early functional training on acute deep venous thrombosis of patients with stroke

目的:比较脑卒中后急性下肢深静脉血栓形成(DVT)早期康复治疗与卧床制动对下肢功能影响及并发肺梗死风险的差异。方法:脑卒中并急性下肢深静脉血栓形成患者60例,随机分为观察组和对照组各30例,2组均予常规抗凝及消肿治疗,对照组予卧床、弹力袜支持及患肢抬高治疗7～14d后开始行肢体功能康复,观察组予早期(下肢血栓形成后1～2d)弹力袜支持下行肢体功能康复治疗。比较2组患者3个月内肺梗死的累计发生率和功能恢复情况。结果:2组患者3个月内均无症状性肺梗死病例发生。治疗3个月后,2组患者下肢FMA评分均较治疗前明显升高(P<0.05,0.01),且观察组更高于对照组(P<0.01);治疗后,2组VAS评分及双侧小腿内踝上缘治疗前后周径差值均较治疗前明显下降(P<0.05,0.01),且观察组更低于对照组(P<0.01)。结论:脑卒中患者急性下肢深静脉血栓形成早期开始康复治疗较卧床治疗患肢功能改善更明显,且不增加肺梗死的发生率。

Obiective：To study the differences in the lower limb functions and risks of pulmonary infarction of early rehabilitation therapy vs. bed immobilization for acute deep venous thrombosis （ADVT） after stroke. Methods：Sixty patients with ADVT after stroke admitted to hospital were randomly divided into normal control group and experi- mental group （n= 30 each）,all receiving the routine therapy. The normal control group underwent the bed immobi- lization,elastic stockings support and limb elevation treatment for 7 to 14 days, then the rehabilitation of limb func- tion was given. The patients in experimental group were merely arranged to limb elevation treatment under the sup- port of elastic stockings in early stage （1-2 days after thrombosis）. The pulmonary infarction rate and functional re- covery in both two groups were compared within 3 months. Results：No one in each group was dead from symptom- atic pulmonary infarction during 3 months of the therapy. The FMA scores in both groups after treatment were sig- nificantly increased （P〈0. 05, and 0. 01）, more significantly in experimental group than in normal group （P〈 0.01）. The VAS scores and upper circumference of calf malleolus were obviously decreased after treatment in both two groups （P〈0.05 ,and 0.01） ,more significantly in experimental group than in normal group （P〈0.01）. Conclu- sion：The preliminary findings show that the lower limb function of patients with ADVT,who underwent early reha- bilitation therapy, had been improved more significantly and the speed of their recovery process is faster than in those only undergoing simply bed immobilization. The incidence of pulmonary infarction is not increased.