神经功能损伤程度分级指导下的康复训练在脑出血患者中的应用研究

Study on the impact of rehabilitation training guided by the grading of neurological damage on the prognosis of cerebral hemorrhage

目的观察神经功能损伤程度分级指导下的康复训练对脑出血患者预后情况的应用效果。方法本研究为前瞻性研究,研究对象为信阳一五四医院2022年1月至2023年1月收治的130例脑出血患者,采用计算机随机分组将入组患者分为常规组(65例)和分级组(65例),常规组实施常规康复治疗配合常规康复训练,分级组采用神经功能缺损量表(NIHSS)评估其神经功能损伤程度后,依据评估结果制定分级康复训练措施,训练结束后随访1年,比较两组患者的康复依从性,躯体平衡功能[Berg平衡量表(BBS)、世界神经病联合国际合作共济失调量表(ICARS)],肢体运动功能[简化Fugl-Meyer运动功能评定量表上肢(FMA-UL)、下肢(FMA-LL)评分]及预后情况。结果在不同康复措施下,分级组的康复依从性优良率92.31%(60/65)高于常规组73.85%(48/65),P<0.05;分级组治疗1个月、3个月后的BBS评分分别为(42.23±10.46)分、(48.22±10.35)分,均高于常规组(37.66±10.23)分、(42.29±10.41)分,ICARS评分分别为(40.22±5.35)分、(32.49±5.42)分,均低于常规组(43.36±5.33)分、(35.28±5.41)分,差异有统计学意义(P<0.05);分级组治疗1个月、3个月后的FMA-UL评分为(48.22±10.61)分、(56.44±10.27)分,均高于常规组(43.36±10.22)分、(51.25±10.34)分,FMA-LL评分分别为(18.44±3.25)分、(22.29±5.33)分,均高于常规组(16.25±3.41)分、(19.35±5.44)分,差异有统计学意义(P<0.05);分级组的不良预后发生率4.62%(3/65)低于常规组18.46%(12/65),差异有统计学意义(P<0.05)。结论神经功能损伤程度分级指导下的康复训练能增强脑出血患者的康复依从性,对改善患者躯体平衡功能、肢体运动功能及预后情况均有积极意义。

Objective To explore the impact of rehabilitation training guided by the degree of neurological damage on the prognosis of cerebral hemorrhage.Methods This was a prospective study,with 130 patients with cerebral hemorrhage admitted to our hospital from January 2022 to January 2023.The computer randomization method was used to generate random sequences,and after allocation concealment,the enrolled patients were divided into a conventional group(65 cases)and a graded group(65 cases).The conventional group received conventional rehabilitation treatment combined with conventional rehabilitation training.Patients in the graded group were managed by rehabilitation measures graded based on the degree of neurological damage evaluated using the National Institute of Health stroke scale(NIHSS).After one year of follow-up after the training,the rehabilitation compliance and physical balance function of patients in the two groups were compared by the Berg balance scale(BBS),and the international cooperative ataxia rating scale(ICARS).Limb motor function was assessed by the simplified Fugl Meyer motor function assessment scale upper limb(FMA-UL),and lower limb(FMA-LL)score.Prognosis was compared between groups.Results Under different rehabilitation measures,the excellent and good rehabilitation compliance rate of the graded group was significantly higher than that of the conventional group(92.31%[60/65]VS 73.85%[48/65],P<0.05).The BBS scores of the graded group after 1 month([42.23±10.46]points VS[37.66±10.23]points)and 3 months([48.22±10.35]points VS[42.29±10.41]points)of treatment were significantly higher than those of the conventional group(P<0.05).The ICARS scores of the graded group after 1 month([40.22±5.35]points VS[43.36±5.33]points)and 3 months([32.49±5.42]points VS[35.28±5.41]points)were significantly lower than those of the conventional group(P<0.05).The FMA-UL scores of the graded group after 1 month([48.22±10.61]points VS[43.36±10.22]points)and 3 months([56.44±10.27]points VS[51.25±10.34]points)of treatment were significantly higher than those of the conventional group(P<0.05).The FMA-LL scores of the graded group after 1 month([18.44±3.25]points VS[16.25±3.41]points)and 3 months([22.29±5.33]points VS[19.35±5.44]points)of treatment were significantly higher than those of the conventional group(P<0.05).The incidence of poor prognosis was significantly lower in the graded group than that of the conventional group(4.62%[3/65]VS 18.46%[12/65],P<0.05).Conclusion Rehabilitation training guided by the grading of neurological damage can enhance the rehabilitation compliance of patients with cerebral hemorrhage,and has a positive impact on improving their physical balance function,limb movement function,and prognosis.