脑卒中偏瘫患者躯干和下肢运动能力的预后分析

Predictive analyses of motor ability in trunk and lower limbs in stroke patients with hemiplegia

目的:通过分析影响脑卒中偏瘫患者躯干和下肢运动能力的相关因素,预测运动功能恢复程度。方法:53例脑卒中偏瘫患者均经临床和CT或MRI确诊入院治疗。评估内容包括躯干和下肢运动能力(MOA)、日常生活活动能力(ADL)以及包括病史和检查在内的20余项相关因素。结果:患者治疗前运动能力(MOA0)和治疗前ADL(ADL0)分别为(18.77±12.78)个月和(58.71±3.22)分;治疗后运动能力(MOA1)和治疗后ADL(ADL1)分别提高到(27.34±14.26)个月和(74.86±3.02)分,均有显著差异。多元回归分析显示,MOA0与年龄、发病到康复入院时间、合并吞咽障碍、弛缓性瘫痪、觉醒障碍等因素呈负相关,与痉挛性瘫痪、吸烟、发病后住院时间及ADL0等因素成正相关。影响MOA1预后的自变量包括发病到康复入院时间、弛缓性瘫痪、患肢腱反射的程度等负性因素,以及MOA0、痉挛性瘫痪等正性因素。结论:患者年龄越轻,接受康复治疗的时间越早,运动能力恢复越快。伴有肌张力低下的弛缓性瘫痪是运动能力恢复的阻碍因素,而表现为肌张力增高的痉挛性瘫痪,由于重视了抗痉挛治疗,反而成为有利于运动功能恢复的因素。

Objective:To explore influencing factors on motor ability of trunk and lower limbs to prognosticate motor functional recovery in stroke patients with hemiplegia.Method:Fifty-three stroke patients with hemiplegia diagnosed by clinical and CT or MRI were given rehabilitation therapy.The assessments for stroke patients included motor ability in trunk and lower limbs(MOA),activities of daily living(ADL),and other correlative factors over20items.Result:The motor ability and level of ADL in stroke patients increased significantly from18.77±12.78mon(MOA 0 )and58.71±3.22score(ADL 0 )in admission to rehabilitation to27.34±14.26mon(MOA 1 )and74.86±3.02score(ADL 1 )in discharge from hospital,respectively.As shown by stepwise multiple regression analysis,MOA 0 correlated negatively with age,period from onset to hospital,dysphagia,atony paralysis,hypoarousal and correlated positively with spastic paralysis,smoking,length of rehabilitation hospital stay,ADL 0 .The predictors for MOA 1 included negative factors as period from onset to hospital,atony paralysis and suffered tendon reflex,and positive factors as MOA 0 and spastic paralysis.Conclusion:The younger stroke patient who accepts earlier rehabilitation therapy is,the more quick motor ability recovery is.Atony paralysis can be a block factor for motor functional recovery.As paying attention to antispastic therapy,spastic paralysis may be a favorable to facilitate motor functional recovery in stroke patients with hemiplegia.Author's address First Affiliated Hospital of Nanjing Medical University,Nanjing,210029