简易日常生活功能训练方案在急性脑梗死偏瘫患者中的初步应用

Trial Study of Early Functional Training for Simple Activities of Daily Living in Hemiplegic Patients with Acute Cerebral Infarction

目的对急性脑梗死偏瘫患者实施简易日常生活功能训练,观察其可行性、被接受度和患者依从性。方法 2015年9月,制定简易日常生活功能训练方案,便利抽样法选择急性期脑梗死偏瘫患者9例为研究对象,采用简易日常生活功能训练方案对其进行8周干预,并在干预前、干预后4周和8周进行功能评价,评价包括美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、患侧握力、"起立-行走"计时测试(timed up and go test,TUGT)和巴氏指数(Barthel index,BI)等。结果简易日常生活功能训练方案的执行过程和评价过程均顺利、安全完成,未出现任何意外、并发症或不良反应。从随访和训练日记中可见9例患者均有非常好的依从性。有3例在干预前握力为0。有4例在干预前测试时无法独自行走,将其结果定义为计时较多的60 s。干预后,患者神经功能缺损好转,上肢握力、动态平衡功能、步行能力和生活自理能力均改善。与干预前比较,在干预后4周和8周患者NIHSS评分、患侧上肢握力、TUGT和MBI均明显好转,差异均有统计学意义(均P<0.05)。结论简易日常生活功能训练方案对偏瘫患者切实可行、安全有效,患者接受度和依从性高。

Objective To apply an early functional training program for simple activities of daily living in hemiplegie patients and observe its feasibility,acceptability and patients＇ compliance.Methods Early functional training program was specifically made for ischemic stroke patients with hemiparesis to improve the function of upper and lower extremes.By convenience sampling,9 eases were selected and received early functional training intervention for 8 weeks.The effectiveness was assessed by using National Institute of Health stroke scale （NIHSS）,timed up and go test （TUGT）and Barthel index （BI） before （Pre） and after 4 （4W） and 8 weeks （8W） training.Results The early training program and all assessments were performed in these patients smoothly and safely without any unexpected accident,complication or adverse reaction.In addition,9 patients had a high compliance,3 cases with 0 grip strength on Pre,4 eases were unable to walk by themselves at Pre test,and the time was set for 60 s.After intervention, patients＇ neurologic impairment, upper limb grip strength, dynamic balance function,walking ability and self-care ability were all improved.The NIHSS score,hemiplegie upper limb grip strength,TUGT and MBI score were improved significantly at 4 and 8 weeks when compared with Pre （P〈0.05）. Conclusion This early functional training program for upper and lower extremes is proved to be safe,feasible and effective in acute ischemic stroke patients with hemiparesis and is accepted and performed well.