早期康复对脑卒中患者活动能力及继发合并症的影响

Effects of early rehabilitation on activities of daily living and complications in acute stroke patients

目的 :探讨早期康复对脑卒中偏瘫患者发病 1个月时的日常生活活动能力及继发合并症的影响。方法 :将 5 7例脑卒中患者随机分为康复组和对照组 ,于患者脑卒中发病后 7～ 2 3d ,平均 (1 5± 4 )d ,用以Bobath为主的运动疗法 ,对康复组 30例偏瘫患者进行康复训练 ,至发病后 1个月时结束 ,对照组 2 7例偏瘫患者不接受康复训练。两组药物治疗方案一致 ,一般资料均衡可比。用临床神经功能缺损 (DDNF)、Fugl Meyer运动功能评定法 (FMA)和Barthel指数 (BI)进行评定。两组分别于康复前后各评定 2次。结果 :康复前 ,FMA上下肢评分、DDNF评分和BI评分除了修饰 1项外 (P =0 .0 4 ,康复组积分高于对照组 ) ,其余各项两组比较统计学差异均无显著性。康复后 ,(1 )在日常生活活动能力方面 :修饰项目由康复前差异有显著性变为差异无显著性 (P =0 .4 7) ;吃饭、床椅转移和步行活动 3项 ,康复组与对照组比较差异接近显著性水平 ;将此 3项康复前后的差值合并后 ,康复组与对照组比较统计学差异有显著性 (P =0 .0 5 ) ,康复组的分值较对照组高 ;两组康复后与康复前比较除了大、小便控制和洗澡 3项统计学差异无显著性以外 ,其余 7项统计学差异均有显著性 (P≤ 0 .0 1 ) ,两组康复后的分值较康复前高。 (2 )在合并症方面

Objective: To investigate the effects of early rehabilitation on activities of daily living (ADL) and complications in patients within 1 month after a first stroke. Methods: 57 stroke patients were randomly divided into rehabilitation group (30 cases) and control group (27 cases). Patients in rehabilitation group received rehabilitation intervention (the main methods were therapeutic exercises, especially Bobath method) starting on average (15±4) days after stroke. Patients in both groups received the similar pharmological treatments. The demographic information was similar in both groups. Using the degree of deficit of neural function (DDNF,Chinese version), Barthel index and Fugl Meyer Assessment (FMA) scale to assess all patients in pre therapy stage and post therapy stage. Results: The scores of DDNF,FMA and Barthel index except for the grooming item ( P =0.04, it is higher in rehabilitation group than in control group) in the 2 groups were similar at the pre therapy stage ( P >0.05). At the post therapy stage, there was no significant difference in the difference values in the grooming item between the pre and post stages in the 2 groups There were significant differences in the difference values between the pre and post stages in the 2 groups in eating, bed chair transfer and short distance walking activities items put together( P =0.05). The differences between the pre and post stages in both groups in Barthel index items except the control of feces and urine, and bath items were significant ( P ≤0.01). The effects on complications were as follows: At the pre therapy stage, the number of shoulder hand syndrome in rehabilitation group was higher than the one in control group( P =0.11), it was lower in rehabilitation group than in control group( P =0.09)at the post therapy stage. There were no significant differences about drop foot, interior deviation foot and ankle joint contracture conditions between the 2 groups at the pre therapy stage, but there were significant differences about the 3 conditions at the post therapy stage( P ≤0.01),and the number of 3 complications was lower in rehabilitation group than in control group. There was no significant difference in shoulder subluxation at the pre and post therapy stages between the 2 groups. Conclusion: Early rehabilitation can effectively improve stroke patients' ADL, especially in eating, bed chair transfer and short distance walking activities, and decrease the rate of complications' incidence within one month after stroke.