运动疗法联合娱乐作业疗法对脑卒中患者执行功能的影响

Effects of exercise and entertainment therapy on executive function of patients with stroke

目的 探讨运动疗法联合娱乐作业疗法对脑卒中患者执行功能的影响.方法 选取2012年9月～2013年8月在华北石油总医院神经内科住院的符合纳入标准的患者80例,随机分为对照组和干预组,各40例,对照组进行常规的药物治疗,干预组在常规药物治疗的基础上增加1h/次、2次/周的运动锻炼和1h/次、2次/周的娱乐作业疗法,共干预3个月,分别于0、3个月运用执行缺陷综合征的行为学评价（BADS）（规则转换卡片测验、动作计划测验、找钥匙测验、时间判断测验、动物园分布测验、修订的六元素测验）对所有受试者执行功能（规则转换能力、计划能力、问题解决能力、判断能力、组织监督行为能力以及记忆能力）进行测试.结果 最终进入对照组32例,干预组35例.两组患者在年龄、性别、受教育程度、受损部位、是否首次患病等方面差异无统计学意义（P＞0.05）;两组在干预前BADS的单项评分及总分分值差异无统计学意义（P＞0.05）,具有可比性;对照组干预前后组内比较显示：除时间判断测验（t=2.609,P=0.026）和总标准分（t=2.589,P=0.027）外,其余单项分值干预前后无统计学意义（P＞0.05）;干预组干预前后组内比较显示：干预后规则转换卡测验（t=2.449,P=0.037）、动作计划测验（t=2.753,P=0.022）、找钥匙测验（t=3.007,P=0.011）、时间判断测验（t=3.973,P=0.003）、动物园分布图测验（t=2.689,P=0.025）,修订六元素测验（t=3.354,P=0.008）及总分（t=7.426,P=0.000）均高于干预前,差异有统计学意义（P＜0.05）;干预后两组组间比较显示：干预组在动作计划测验（t=2.739,P=0.013）、时间判断测验（t=2.929,P=0.009）、修订六元素测验（t=2.629,P=0.017）三方面的单项分及总分（t=4.545,P=0.000）均高于对照组,差异有统计学意义（P＜0.05）.结论 运动锻炼联合娱乐疗法可以增强慢性脑卒中患者的执行功能,改善其认知能力,提高生存质量.

Objective To investigate the effects of exercise and entertainment therapy on executive function of patients with stroke.Methods With the inclusion criteria,80 patients who were selected from the Department of Neurology in North China Petroleum General Hospital from September 2012 to August 2013 were randomly divided into the intervention group （n =40） and the control group （n =40）.Patients in the control group participated in the three months pro gram of exercise for two hours and recreation for one hour every time weekly.Executive functions of all subjects,which were constituted by rules transform ability,planning ability,problem solving ability,judgment ability,memory ability,organization ability and supervision ability,were assessed at baseline and three months by behavioral assessment of executive deficiency syndrome,including rules conversion card test,action plans test,find the key test,time judgment test,zoo distribution test,the revised test of six elements.Results There were no statistically significant differences between two groups in age,gender,education level,first/recurrent stroke,years since stroke,affected hemisphere,each score and total score of BADS （P ＞ 0.05）.Comparison before and after the intervention,except time judgment test score （t =2.609,P =0.026） and the total score （t =2.589,P =0.027）,the another score had no statistical significance in the control group （P ＞ 0.05）.After the intervention rules conversion card test score （t =2.449,P =2.449）,action plans test （t =2.753,P =0.022）,find the key test （t =3.007,P =3.007）,time judgment test （t =3.973,P =3.973）,zoo distribution test （t =2.689,P =0.025）,the revised test of six elements （t =3.354,P =0.008） and total score （t =7.426,P =7.426） were higher than before the intervention and the difference were statistically significant in intervention group （P ＜ 0.05）.Comparison between the group after the intervention,the action plan score （t =2.739,P =0.013）,time judgment test score difference （t =2.929,P =0.009）,revision of six elements test score （t =2.629,P =0.017） and total score （t =4.545,P =0.000） in the intervention group were higher than the control group,there were statistically significant differences （P ＜ 0.05）.Conclusion Exercise and entertainment therapy are able to improve the execution function of patients with stroke,to improve their cognitive ability,to enhance the quality of life.