脑梗死患者康复介入时机与疗效关系的回顾性分析

The relationship between the timing of intervention and rehabilitation efficacy after cerebral infarction ： a retrospective analysis

目的通过对脑梗死后偏瘫患者的康复治疗介入时机与疗效之间关系的回顾性分析，探讨接受康复治疗时机对早期急性脑梗死偏瘫患者功能恢复的影响。方法选取符合标准的急性脑梗死后发病1周的偏瘫患者54例，按随机数字表法抽取18例脑梗死后在第1～2周接受康复治疗患者设为A组，18例脑梗死后在第2～4周接受康复治疗患者设为B组，18例脑梗死后在第4周后接受康复治疗患者设为C组。分别进行常规康复治疗，包括偏瘫肢体综合训练、电动起立床训练、功能性电刺激、偏瘫医疗体操等；采用FMA运动功能和平衡功能评定、改良Barthel指数（MBI）评定，观察所有患者在发病第1周（治疗前）和治疗3个月后（治疗后）的治疗效果，并将各组治疗前后数据进行统计学分析比较。结果治疗前，3组脑卒中偏瘫患者FMA运动功能和FMA平衡功能及MBI评定等各项功能指标评分比较，组间差异无统计学意义（P〉0．05），具有可比性。治疗后（疗程满3个月时），3组患者各项功能评定指标数据均较组内治疗前有明显提高（P〈0．01）；治疗后A组与B组患者的上述各项评定指标比较，组间差异无统计学意义（P〉0．05）；但治疗后A组与C组之间比较，上述指标组间差异均有统计学意义（P〈0．05），且治疗后B组患者的上述各项指标较C组患者治疗后提高更为显著（P〈0．01）。结论脑梗死后偏瘫患者接受康复治疗时机选在脑梗死后第2～4周要比在脑梗死后第2周以内及第4周以后接受康复治疗更能明显促进功能恢复，效果更佳。

Objective To conduct a retrospective analysis of the relationship between the time of rehabilitation intervention and its effectiveness among hemiplegic patients after cerebral infarction. Methods Fifty-four hemiplegic stroke patients within 1 week of onset were randomly divided into three equal groups of 18 ： In the A group rehabilitation was begun 1 to 2 weeks after onset ; in the B group it was started between 2 and 4 weeks ; in the C group rehabilitation was begun after four weeks. The patients all received comprehensive hemiplegic limb training, electric standing bed training, functional electrical stimulation and medical gymnastics for hemiplegia. Motor function was assessed using the Fugl-Meyer balance function assessment and the modified Barthel index before treatment, in the course of the first week of treatment and 3 months later. Results A group and B group made similar progress, but the curative effect in group C was significantly weaker. Conclusion Rehabilitation should be started within 1 month after the onset of cerebral infarction.