不同年龄脑卒中患者躯体感觉功能与运动功能相关性及全周期康复思考:一项多中心横断面研究

Correlation between Somatosensory and Motor Function in Stroke Patients of Different Age Groups and Thoughts on Full-cycle Rehabilitation:a Multicenter Cross-sectional Study

背景躯体感觉功能和运动功能障碍是脑卒中后常见功能障碍,二者损伤均会导致患者日常生活活动、社会参与等受限,但仍缺乏研究证据从多角度分析二者间的关系。目的探讨脑卒中后1年内不同年龄患者整体、上肢和下肢躯体感觉功能与运动功能之间的关系。方法选取2022年10月—2023年4月于福建省内多家医院收治的脑卒中后1年内患者为研究对象,收集患者一般资料,使用Fugl-Meyer感觉功能评定子量表(FMA-S)、美国国立卫生研究院脑卒中量表(NIHSS)感觉子项目评估患者的躯体感觉功能,Fugl-Meyer运动功能评定子量表(FMA-M)、Brunnstrom运动功能评定、Berg平衡量表(BBS)、NIHSS运动子项目评估患者的运动功能,改良Barthel指数(MBI)评估患者的日常生活活动能力,医院焦虑抑郁量表(HADS)评估患者的焦虑抑郁情况。根据年龄将患者分为老年组(≥65岁)和青中年组(18~64岁),比较两组一般资料和康复评定指标的差异,分析躯体感觉功能与运动功能、日常生活活动能力和精神心理指标间的相关性。结果共纳入患者254例,平均年龄(61.0±12.3)岁;脑卒中中位病程30.0(17.0,65.5)d。老年组患者112例(44.1%),青中年组患者142例(55.9%)。两组FMA-S与FMA-M评分均呈正相关(r_(s)分别为0.313和0.171,P<0.05),NIHSS感觉子项目与FMA-M评分均呈负相关(r_(s)分别为-0.199和-0.177,P<0.05)。老年组FMA-S-上肢部分(UE)、FMA-S-UE轻触觉、FMA-S-UE本体感觉分别与FMA-M-UE、Brunnstrom上肢、Brunnstrom手评分呈正相关,分别与NIHSS上肢项目评分呈负相关(P<0.05);青中年组患者FMA-S-UE及FMA-S-UE轻触觉分别与FMA-M-UE、Brunnstrom手评分呈正相关,FMA-S-UE本体感觉与FMA-M-UE、Brunnstrom上肢评分呈正相关(P<0.05)。老年组患者FMA-S-下肢部分(LE)、FMA-S-LE轻触觉、FMA-S-LE本体感觉分别与FMA-M-LE、Brunnstrom下肢、BBS评分呈正相关,FMA-S-LE及FMA-S-LE轻触觉分别与NIHSS下肢项目评分呈负相关(P<0.01);青中年组患者FMA-S-LE、FMA-S-LE本体感觉分别与FMA-M-LE、Brunnstrom下肢、BBS评分呈正相关,FMA-S-LE轻触觉与Brunnstrom下肢、BBS评分呈正相关,FMA-S-LE、FMA-S-LE本体感觉分别与NIHSS下肢项目评分呈负相关(P<0.05)。老年组患者FMA-S与MBI评分呈正相关(r_(s)=0.270,P<0.05)。老年组患者FMA-S与焦虑评分项目(HADS-A)、抑郁评分项目(HADS-D)评分呈负相关(r_(s)分别为-0.300、-0.374,P<0.01),NIHSS感觉子项目与HADS-D评分呈正相关(r_(s)=0.235,P<0.01)。结论脑卒中后1年内患者躯体感觉功能与运动功能呈正相关,年龄可能对躯体感觉功能与运动功能、日常生活活动能力、精神心理功能之间的相关性存在影响。

Background Somatosensory and motor dysfunctions are common after stroke,both lead to limitations in activities of daily living and social participation,there is still a lack of research evidence to analyze the relationship between the two from multiple perspectives.Objective To investigate the relationship between somatosensory and motor function among overall,upper and lower extremities in different-age-group patients within one year after stroke.Methods This prospective study enrolled the poststroke patients within one year from several hospitals in Fujian Province from October 2022 to April 2023.The sensory subscale of the Fugl-Meyer assessment(FMA-S)and the sensory subitem of National Institute of Health Stroke Scale(NIHSS)were used to evaluate the patient's somatosensory function.The motor subscale of the Fugl-Meyer assessment(FMA-M),Brunnstrom assessment,Berg Balance Scale(BBS)and the motor subitem of NIHSS were used to evaluate the patient's motor function.Modified Barthel Index(MBI)was used to evaluate the patient's activities of daily living(ADL).Hospital Anxiety and Depression Scale(HADS)was used to evaluate the patient's psychosomatic function.They were divided into two groups(the elderly group/the young and middle-aged group)according to their age,we compared the differences in general information and rehabilitation assessments between the two groups.And we analyzed the correlation between somatosensory function and motor function/ADL/psycho-psychological function.Results A total of 254 patients were included,with an average age of(61.0±12.3)years and an average disease course of 30.0(17.0,65.5)days.There were 112 cases(44.1%)in the elderly group and 142 cases(55.9%)in the young and middle-aged group.FMA-S and FMA-M scores were positively correlated in both groups(r_(s)values were 0.313 and 0.171,both P<0.05),NIHSS sensory items were all negatively correlated with FMA-M scores(r_(s)values were-0.199 and-0.177,both P<0.05).In the elderly group,FMA-S-UE related scores were positively correlated with FMA-M-UE,Brunnstrom-UE,and Brunnstrom-HAND scores;they were negatively correlated with NIHSS-UE score(all P<0.05).In the young and middle-aged group,FMA-S-UE total and light-touch scores were positively correlated with FMA-M-UE and Brunnstrom-HAND scores;FMA-S-UE proprioception score was positively correlated with FMA-M-UE,Brunnstrom-UE scores(all P<0.05).In the older group,FMA-S-LE related scores were positively correlated with FMA-M-LE,Brunnstrom-LE,and BBS scores;FMA-S-LE total and light touch scores were negatively correlated with NIHSS-LE scores(all P<0.01).In the young and middle-aged group,FMA-S-LE total and proprioception scores were positively correlated with FMA-M-LE,Brunnstrom-LE,and BBS scores;FMA-S-LE light touch score was positively correlated with Brunnstrom-LE and BBS scores;FMA-S-LE total and proprioception scores were each negatively correlated with NIHSS-LE score(all P<0.05).In the elderly group,FMA-S was positively correlated with MBI(r_(s)=0.270,P<0.05),FMA-S score was negatively correlated with HADS-A and HADS-D scores(r_(s)were respectively-0.300 and-0.374,P<0.01),NIHSS sensory item was positively correlated with HADS-D score(r_(s)=0.235,P<0.01).Conclusion There is a positive correlation between somatosensory and motor function in different-age-group patients within one year after stroke,and age may affect the correlation between somatosensory function and motor function/ADL/psychosocial function.