急性脑卒中早期康复的研究

A study of early rehabilitation of stroke

目的：探讨运动疗法在脑卒中康复中的作用，制定出适合我国国情的规范化康复治疗方案。方法：本研究为随机对照研究。按照统一的入选条件选取１９９６年６月至２０００年４月在１５家协作医院住院的脑卒中患者为研究对象，共有１０２７例早期康复患者和１３１例延迟康复患者入选。随机分为康复组和对照组，两组药物治疗基本相同。康复组每天进行以Ｂｏｂａｔｈ法为主的康复训练。分别采用神经功能缺损评分（ＣＮＳ ）、Ｆｕｇｌｅ－Ｍｅｙｅｒ运动功能评定（ＦＭＡ）、巴氏指数（ＭＢＩ）来评定疗效，并比较两组的继发合并症发生率。 结果：①早期康复：经过２８天的运动疗法治疗后，早期康复组在 ＣＮＳ，ＦＭＡ及ＭＢＩ评分上均明显优于对照组，有非常显著性差异；继发合并症的发生率明显较对照组低，有显著性差异。②延迟康复：延迟康复组在 ＣＮＳ，ＦＭＡ及ＭＢＩ评分上均明显优于对照组，有显著性差异；继发合并症的发生率明显较对照组低，有显著性差异。③早期康复和延迟康复比较：早期康复组在 ＣＮＳ，ＦＭＡ及ＭＢＩ评分上均明显优于延迟康复组，有显著性差异；早期康复组的康复效率高于延迟康复组；继发合并症的发生率两组之间无显著性差异。④优选康复治疗方案：康复治疗４５天与治疗?

Objective: To investigate the effect of physical therapy on stroke rehabilitation and institute a normative scheme of rehabilitation therapy which fits to China. Method: This was a randomly controlled test. 1027 patients in 15 hospitals from 1996 June to 2000 April were assigned to the rehabilitation group and control group randomly. The rehabilitation group was divided into two subgroups: early rehabilitation subgroup whom got rehabilitation 14 days after the onset and the delay rehabilitation subgroup received rehabilitation after 14 days of onset. The drug treatment in two groups was almost the same. The patients in rehabilitation group carried out physical therapy. By the end of therapy, the score of Clinical Nerve Function Limitation Score (CNS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) and incidence rate of complication were compared.Result: The patients in the rehabilitation group(both early and delay treated) got much better scores in CNS, FMA and MBI than the control group and the incidence rate of complication in the rehabilitation group was lower than in the control group. The difference was statistic significant. The early rehabilitation subgroup got much better scores in CNS, FMA and MBI than the delayed. The rehabilitation efficiency in the patients got 45 days rehabilitation therapy was better than in those got 28 days rehabilitation therapy. Conclusion: ①The early rehabilitation after stroke is effective. It can reduce the complications and improve the patients impairment, handicap and disabilities. The early rehabilitation after stroke should be spread into the whole country. ② The early rehabilitation after stroke is safety. It should be started as soon as possible. ③The rehabilitation should continue for a long time.