康复治疗对中风后合并肌间静脉血栓患者运动功能恢复的影响研究

Effect of rehabilitation on motor function recovery in patients with MCVT after stroke

目的 探讨更主动的康复治疗方案是否对中风合并肌间静脉血栓患者的预后有积极的影响。方法 将2017年1月至2019年12月入院的中风患者分为对照组(44例)和血栓组(46例,合并肌间静脉血栓),并根据治疗方案不同将血栓组随机分为血栓1组26例和血栓2组20例。对照组进行常规康复治疗,血栓1组进行低分子肝素抗凝治疗,不进行康复治疗,卧床14天。血栓2组进行低分子肝素抗凝治疗,并执行积极的康复治疗方案。结果 与对照组相比,血栓1组和血栓2组患者在入院时的D-二聚体值均显著升高(P<0.05)。在入院、中期、出院时,对照组在治疗期的总体功能均优于血栓1组和血栓2组,血栓2组的功能介于对照组和血栓1组之间。三组患者的功能经过康复、药物或药物联合康复治疗后均较入院时有所改善;与血栓1组相比,血栓2组患者的运动功能、肌张力、MBI、坐位平衡、站位平衡等指标有所改善。结论 提供抗凝治疗和卧床休息对中风后合并肌间静脉血栓患者的运动功能恢复预后不佳;抗凝联合康复干预对于伴有肌间静脉血栓的中风患者的运动功能改善有其必要性,但康复方案有待进一步优化。

Objective To explore whether the more active rehabilitation program has a positive effect on the prognosis of stroke patients with muscular calf vein thrombosis.Methods Stroke patients admitted to hospital from January 2017 to December 2019 were divided into the control group(44 cases)and the thrombus group(46 cases).The thrombus group was randomly divided into the thrombus 1 group(26 cases)and the thrombus 2 group(20 cases)according to different treatment regimens.The control group received conventional rehabilitation therapy, and the thrombus group 1 received low-molecular-weight heparin anticoagulation therapy.All rehabilitation therapy was stopped and the patient was completely in bed for 14 days.Low molecular weight heparin(LMWH)anticoagulant therapy was performed in thrombus group 2 and active rehabilitation therapy was performed.Results Compared with the control group, the d-dimer values of patients in thrombus 1 group and thrombus 2 group were significantly increased at admission(P<0.05).At admission, mid-term and discharge, the overall function of the control group in the treatment period was better than that of the thrombus group 1 and thrombus group 2,and the function of the thrombus group 2 was between the control group and the thrombus group 1.The function of patients in the three groups was improved after rehabilitation, drug therapy or combined drug therapy.Compared with group 1,the motor function, muscle tension, MBI,sitting balance and standing balance of patients in group 2 were improved.Conclusion Anticoagulant therapy and absolute bed rest have a poor prognosis for motor function recovery in patients with MCVT after stroke.Anticoagulant combined rehabilitation intervention is necessary to improve the motor function of stroke patients with MCVT,but the rehabilitation scheme needs to be further optimized.