脑卒中患者早期康复的前瞻性随机对照研究

Effect of the community-based rehabilitation unit on stroke: a prospective randomized. control study

目的:探讨社区脑卒中康复单元模式对脑卒中患者的康复效果。方法:收集2013年1月至2014年1月新发脑卒中患者136例,均存在肢体功能障碍。将患者随机分为对照组(50例)、随访宣教组(43例)和脑卒中单元组(43例)。对照组采用常规上门随访,随访宣教组定期予以康复评定和健康教育,脑卒中单元组通过建立社区脑卒中单元,涵盖居家康复、门诊康复、社区住院康复、实施肢体康复、心理干预、同伴教育等康复模式。采用脑卒中量表(NIHSS)、改良Barthel指数(MBI)、抑郁焦虑自评量表评分(SDS,SAS)等方法评价各组患者的康复效果。结果:干预后3、6个月,三组NIHSS评分均较入组时明显下降(P均<0.05),而脑卒中单元组的NIHSS评分优于随访宣教组和对照组(P均<0.05)。干预后3、6个月,各组MBI值均较入组时明显升高,由高到低依次为脑卒中单元组>随访宣教组>对照组,三组间差异有统计学意义(P均<0.05);干预期间,脑卒中单元组焦虑、抑郁的发生率均较随访宣教组和对照组显著降低(P均<0.05)。结论:社区脑卒中康复单元可实现连续性的早期康复,促进神经功能康复和肢体运动功能恢复,减少伤残,改善患者的生存质量。

Objective： To explore the rehabilitation efficacy of the community-based stroke rehabilitation unit model on the patients with stroke. Methods： One hundred and thirty-six new stroke patients with the limb dysfunction were collected from Jan. 2013 to Jan 2014 and randomly divided into a concurrent control group with 50 cases, a follow-up health education group with 43 ones and the stroke unit group with 43 ones. The routine follow-up visit was given to the concurrent control group. The regular rehabilitation evaluation and health education were given to the follow-up health education group. The communitybased stroke unit was established for the stroke unit group, which included the home physical rehabilitation, out-patient clinic rehabilitation, community hospitalization rehabilitation, limb rehabilitation, psychological intervention, peer education and other rehabilitation approaches. NHISS, MBI, SDS and SAS were performed to evaluate the rehabilitation efficacy of the patients in three groups. Results： After 3 and 6 months intervention, NIHSS scores in the three group all decreased obviously compared with those of the baseline（P〈0.05）, and NIHSS score in the stroke unit group was better than that in the follow-up health education group and the concurrent control one（P〈0.05）. The MBI value of each group increased obviously compared with the ones at the initiation, and their descending orders were the stroke unit group follow-up health education oneconcurrent control one. The differences among three groups had the statistical significance（P〈0.05）. During the intervention, the incidences of anxiety and depression in the stroke unit group were lower than those in the concurrent control one and the follow-up health education one（P〈0.05）. Conclusion： The community-based stroke rehabilitation unit can realize the continuous rehabilitation at the early stage, promote the neural function rehabilitation and limb movement function recovery, reduce the disability, and improve the patients＇ quality of life.