超早期运动康复对轻中度急性缺血性脑卒中患者功能结局及下肢运动能力的影响

Effect of very early mobilization rehabilitation on functional outcomes and lower extremity motor ability in patients with mild to moderate acute ischemic stroke

目的探讨超早期运动(VEM)康复对轻中度急性缺血性脑卒中患者的功能结局及下肢运动能力的影响。方法将200例发病24 h内的轻中度急性缺血性脑卒中患者随机分为VEM组和早期康复组,每组100例。VEM组在发病24 h内开始第1次下床活动(直立坐姿或站立或行走);早期康复组在发病后3~7 d开始下床活动,内容和要求同VEM组;两组均治疗14 d或直至出院。比较两组入院时、发病后14 d、30 d和90 d神经功能美国国立卫生研究院脑卒中量表(NIHSS)评分、日常生活活动能力(ADL)、Barthel指数评分、下肢运动功能Fugl-Meyer评定量表评分、Berg平衡量表(BBS)评分及发病后30 d、90 d临床结局,记录患者恢复至可独立行走50 m所需时间。结果在发病后30 d、90 d,VEM组的NIHSS评分均低于早期康复组,Fugl-Meyer评定量表评分均高于早期康复组(均P<0.05),在发病后14 d、30 d、90 d,VEM组的Barthel指数、BBS评分均高于早期康复组(均P<0.05)。发病后30 d两组临床结局良好率差异无统计学意义(P>0.05);发病后90 d VEM组临床结局良好率高于早期康复组(P<0.05);VEM组恢复至可独立行走50 m的时间短于早期康复组(P<0.05)。结论VEM康复可以更好地改善和恢复轻中度急性缺血性脑卒中患者的神经功能、ADL、临床结局和下肢运动能力,具有较好的临床应用价值。

Objective To investigate the effects of very early mobilization(VEM)rehabilitation on functional outcomes and lower extremity motor ability in patients with mild to moderate acute ischemic stroke.Methods A total of 200 patients with mild to moderate acute ischemic stroke within 24 hours of stroke attack were randomly divided into VEM group and early rehabilitation group,with 100 cases in each group.The VEM group started the first out-of-bed activity within 24 hours of stroke attack(upright sitting or standing or walking);the early rehabilitation group started out-of-bed activity three to seven days after stroke attack,and its content and requirements were similar to those of the VEM group;both groups were treated for 14 days or until discharge from hospital.The National Institutes of Health Stroke Scale(NIHSS)scores,activities of daily living(ADL),the Barthel index scores,the Fugl-Meyer assessment scores for lower extremity motor function,the Berg Balance Scale(BBS)scores at admission,14,30 and 90 days after stroke attack,and clinical outcomes 30 and 90 days after stroke attack were compared between the two groups,in addition,the interval from patient recovery to being able to accomplish a 50-meter walk independently was recorded.Results Thirty and 90 days after stroke attack,the VEM group exhibited lower NIHSS scores,higher Fugl-Meyer assessment scores than the early rehabilitation group(all P<0.05),14,30 and 90 days after stroke attack,the VEM group had higher Barthel index and BBS scores than the early rehabilitation group(all P<0.05).There was no statistically significant difference between the two groups in good clinical outcome rate 30 days after stroke attack(P>0.05);the VET group reported a higher good clinical outcome rate than the early rehabilitation group 90 days after stroke attack(P<0.05);the interval from recovery to accomplishing a 50-meter walk independently was shorter in the VEM group than in the early rehabilitation group(P<0.05).Conclusion VEM rehabilitation can better improve and restore the neurological function,ADL,clinical outcome,and lower extremity motor ability of patients with mild to moderate acute ischemic stroke,and it has a favorable clinical application value.