早期康复对经机械取栓处理后急性前循环大血管闭塞性脑卒中患者的疗效观察

Therapeutic effect of early rehabilitation on patients with acute anterior circulation macrovascular occlusive stroke after mechanical thrombectomy

目的比较早期康复和常规康复对急性前循环大血管闭塞性脑卒中患者经机械取栓(MT)后的功能和活动影响。方法选取2017-06-01-2023-04-30晋江市中医院神经外科接受手术的前循环大血管闭塞性脑卒中患者142例,随机分为早期康复组(73例)和常规康复组(69例),早期康复组的患者在术后第2天开始介入康复治疗,常规康复组的患者在手术2周后开始介入康复治疗。分别在患者术后第2天、术后第2周、术后第4周采用美国国立卫生研究院卒中量表评分(NIHSS)、改良Barthel指数(MBI)和Fugl-Meyer评定量表(FMA)评估2组患者的神经功能受损程度、日常生活能力和运动功能。研究数据由临床相关评估取得,采用独立样本t检验和重复测量方差分析。结果干预前,2组NIHSS评分、MBI评分和FMA评分差异无统计学意义,均P>0.05。干预后,早期康复组的术后第2周和术后第4周的NIHSS评分分别为(7.56±1.41)分、(4.63±0.89)分,低于常规康复组的(8.75±1.13)分、(5.94±1.29)分,重复测量方差分析结果显示,差异无统计学意义,F_(交互)=1.667,P=0.204。早期康复组的术后第2周和术后第4周的MBI评分分别为(44.38±13.02)分、(59.06±12.14)分,高于常规康复组的(36.88±12.37)分、(44.38±12.76)分,重复测量方差分析结果显示,差异有统计学意义,F_(交互)=19.571,P<0.001。早期康复组的术后第2周和术后第4周的FMA评分分别为(37.19±6.84)分、(49.50±8.07)分,高于常规康复组的(33.50±8.30)分、(40.56±7.30)分,重复测量方差分析结果显示,差异有统计学意义,F_(交互)=69.977,P<0.001。结论早期康复能更好地改善经MT处理后急性前循环大血管闭塞性脑卒中患者的神经功能受损情况和日常生活能力。

Objective To compare the effects of early rehabilitation and routine rehabilitation on the function and activity of patients with acute anterior circulation macrovascular occlusive stroke after mechanical thrombectomy(MT).Methods A total of 142 patients who underwent surgery for anterior circulation large vessel occlusive stroke in the Department of Neurosurgery,Jinjiang City Hospital of Traditional Chinese Medicine,from June 1,2017 to April 30,2023,were randomly divided into early rehabilitation group(n=73)and routine rehabilitation group(n=69).The patients in the early rehabilitation group received rehabilitation on the second day after operation.Patients in the routine rehabilitation group received rehabilitation 2 weeks after operation.The National Institutes of Health Stroke Scale(NIHSS)score,Modified Barthel Index(MBI)and Fugl-Meyer Assessment scale(FMA)were used to evaluate the degree of neurological impairment,activities of daily living,and motor function of the two groups of patients at the 2nd day,2nd week,and 4th week after surgery.The research data was obtained through clinically relevant evaluations,and independent sample t-tests and repeated measures analysis of variance were used.Results Before intervention,there was no significant difference in NIHSS score,MBI score and FMA score between the two groups(All P>0.05).After intervention,NIHSS scores in the early rehabilitation group at the 2nd and 4th weeks were(7.56±1.41)and(4.63±0.89)respectively,lower than those in the standard rehabilitation group(8.75±1.13)and(5.94±1.29),with no statistically significant differences(F_(interaction)=1.667,P=0.204).MBI scores at the 2nd and 4th weeks in the early rehabilitation group were(44.38±13.02)and(59.06±12.14),higher than those in the standard rehabilitation group(36.88±12.37)and(44.38±12.76),with statistically significant differences(F_(interaction)=19.571,P<0.001).FMA scores at the 2nd and 4th weeks in the early rehabilitation group were(37.19±6.84)and(49.50±8.07),higher than those in the standard rehabilitation group(33.50±8.30)and(40.56±7.30),with statistically significant differences(Finteraction=69.977,P<0.001).Conclusion Early rehabilitation could better improve the neurological impairment and activities of daily living in patients with acute anterior circulation macrovascular occlusive stroke after mechanical thrombectomy.