不同时间康复介入对卒中患者运动功能的影响

Effect of Rehabilitation at Different Timing after Stroke on Motor Function of Stroke Patients

目的探讨不同时间康复介入对卒中患者运动功能康复的影响。方法选取2021年1月-2022年2月首都医科大学附属北京天坛医院康复医学科、北京市中关村医院康复医学科和神经内科符合入排标准的卒中患者,按照康复介入时间将患者分为早期康复组和延迟康复组。早期康复组的患者病情稳定后,发病7 d内立即开始进行康复训练,延迟康复组的患者病情稳定后,发病30 d以上开始进行康复训练。康复治疗前、治疗1个月±7天和治疗3个月±7天时由同一名评估者采用NIHSS、Fugl-Meyer运动功能评定(Fugl-Meyer motor assessment,FMA)量表、Berg平衡量表(Berg balance scale,BBS)、6分钟步行试验(6 minute walking test,6MWT)、功能性步态评价(functional gait assessment,FGA)、改良巴氏指数(modified Barthel index,MBI)对两组患者的神经功能、运动功能、平衡能力、步行能力及日常生活能力进行评定。结果共纳入70例患者,其中早期康复组35例,延迟康复组35例。治疗前,两组患者NIHSS、FMA、BBS、6MWT、FGA、MBI评分差异均无统计学意义。在治疗1个月±7天和3个月±7天,两组患者NIHSS较治疗前降低,FMA、BBS、6MWT、FGA和MBI评分均较治疗前提高,差异均有统计学意义(P<0.05)。康复治疗1个月±7天时,早期康复组NIHSS低于延迟康复组[1.0(0~2.0)分vs.2.0(0~6.0)分,P=0.030],6MWT高于延迟康复组[200.0(80.0~300.0)m vs.150.0(0~230.0)m,P=0.040],FMA、BBS、FGA及MBI评分差异无统计学意义(P>0.05)。康复治疗3个月±7天时,早期康复组NIHSS低于延迟康复组[0(0~0)分vs.1.0(0~4.0)分,P=0.001],BBS评分[54.0(49.0~56.0)分vs.49.0(33.0~54.0)分,P=0.013]、6MWT[320.0(200.0~430.0)m vs.210.0(80.0~360.0)m,P=0.009]、FGA评分[22.0(15.0~28.0)分vs.15.0(5.0~24.0)分,P=0.015]、MBI评分[100.0(95.0~100.0)分vs.90.0(70.0~100.0)分,P=0.003]均高于延迟康复组,FMA评分差异无统计学意义(P=0.053)。结论康复训练可以改善卒中患者的运动功能,早期康复与延迟康复相比,早期康复治疗的介入对卒中患者的神经功能缺损程度、平衡能力、步行能力及日常生活能力的提高更显著。

Objective To investigate the effects of rehabilitation at different timing after stroke on motor function of stroke patients.Methods Patients with stroke who met the inclusion criteria from Department of Rehabilitation Medicine,Beijing Tiantan Hospital,Capital Medical University,Department of Rehabilitation Medicine and Department of Neurology of Beijing Zhongguancun Hospital from January 2021 to February 2022 were prospectively enrolled in this study,and the patients were divided into early rehabilitation group and delayed rehabilitation group according to the time of rehabilitation intervention.Patients in early rehabilitation group started rehabilitation within 7 days of onset after stable condition,while patients in delayed rehabilitation group started rehabilitation more than 30 days after onset after stable condition.All the patients were assessed by the same assessor before the rehabilitation,at 1 month±7 days and 3 months±7 days of rehabilitation using NIHSS,Fugl-Meyer motor assessment(FMA),Berg balance scale(BBS),6-minute walking test(6MWT),functional gait assessment(FGA),and modified Barthel index(MBI)to assess the neurological fuction,motor function,balance,walking ability and activities of daily living.Results A total of 70 patients were included,with 35 cases in each group.Before rehabilitation,there were no statistical differences in the above scores between the two groups.At 1 month±7 days and 3 months±7 days of rehabilitation,NIHSS decreased and FMA,BBS,6MWT,FGA and MBI scores increased in both groups compared with those before rehabilitation,and the differences were statistically significant(P<0.05).At 1 month±7 days of rehabilitation,the NIHSS in early rehabilitation group was lower than that in delayed rehabilitation group[1.0(0-2.0)vs.2.0(0-6.0),P=0.030],and the 6MWT score was higher than that in delayed rehabilitation group[200.0(80.0-300.0)m vs.150.0(0-230.0)m,P=0.040],while there were no statistical differences in FMA,BBS,FGA and MBI scores between the two groups(P>0.05).At 3 months±7 days of rehabilitation,the NIHSS was lower in early rehabilitation group than that in delayed rehabilitation group[0(0-0)vs.1.0(0-4.0),P=0.001],BBS score[54.0(49.0-56.0)vs.49.0(33.0-54.0),P=0.013],6MWT[320.0(200.0-430.0)m vs.210.0(80.0-360.0)m,P=0.009],FGA score[22.0(15.0-28.0)vs.15.0(5.0-24.0),P=0.015],MBI score[100.0(95.0-100.0)vs.90.0(70.0-100.0),P=0.003]were all higher than those in delayed rehabilitation group,and there was no statistical difference in FMA score between the two groups(P=0.053).Conclusions Rehabilitation training can improve the motor function of stroke patients,and the early rehabilitation intervention can improve the neurological function,balance,walking ability and activities of daily living of stroke patients better than delayed rehabilitation.