【作者】 汪亚群；

【导师】 宋水江；

【作者基本信息】 浙江大学 ， 神经病学， 2007， 硕士

【摘要】 前言脑卒中是一组急性起病的脑血液循环障碍疾病,以起病急骤,出现局灶神经功能缺失为特征。其引起的功能障碍主要表现在意识、运动、知觉、认知、语言、精神情绪方面,其大多发生在中老年人,发病率、死亡率及致残率、复发率均较高,致残后严重影响患者日常生活,增加社会及家庭负担。现代康复治疗的介入极大地改善了这种状况,使相当一部分患者生活自理、重返社会。目前多数学者主张脑卒中后应尽早进行康复治疗。为探讨早期康复干预对脑卒中偏瘫患者偏瘫侧肢体的肌张力、上下肢功能恢复及日常生活活动能力(activities of daily living,ADL)的影响,我们对脑卒中急性期的患者进行了研究。方法将108例急性脑卒中患者随机分为治疗组和对照组。两组患者均予以常规的药物治疗、心理治疗等,治疗组患者加以规范化的康复训练。所有病例均在入组时、脑卒中病程1个月、3个月时各评定1次肌痉挛、运动功能和日常生活活动能力。量表分别采用改良Ashworth量表(MAS)、简化Fugl-Meyer量表(FMA)和Barthel指数(BI)。结果在入组时两组患者间MAS评分、FMA评分和BI比较P＞0.05,具有可比性。1个月时治疗组患者的MAS评分,高于同期的对照组患者(P＜0.05);3个月时,对照组患者的MAS评分高于同期的治疗组患者(P＜0.05);两组患者的FMA评分和BI评分在脑卒中病程1个月、3个月时分别与其前一次评定时比较,均有明显改善(P＜0.001);在脑卒中病程3个月时,治疗组的FMA评分和BI评分均高于对照组(P＜0.01)。结论①早期康复训练可缩短脑卒中患者弛缓性瘫痪的时间,有利于肢体运动功能的恢复;②痉挛期,早期康复训练可减轻患者偏瘫侧肢体痉挛从而改善运动功能,提高日常生活活动能力。更多还原

【Abstract】 Background: Acute stroke is a group of diseases caused by sudden obstruction of cerebral blood circulation, which mainly presents with focal neurological deficiency including dysfunction of perception, cognition, speaking, and emotion. It occurs mainly in the elderly with high morbidity, mortality and recurrence, which will greatly change a patient’s daily life and increase social and family burdens if disability developed. Currently, early rehabilitation intervention after stroke has been advocated by many physicians. The aim of our study was to evaluate the effectiveness of such intervention in the acute stroke patients, in aspect of spasticity, activity of daily living (ADL) and motor function recovery of the affected limbs.Methods: One hundred eight patients with acute stroke were divided randomly into two groups: early rehabilitation group (intervention group) and control group. All the patients in the two groups were given routine treatment of medications and psychological support, but the patients in the intervention group were added early rehabilitation. The baseline of myospasm, motor function, and activities of daily living was recorded for all the subjects with Modified Ashworth table (MAS), Simplified Fugl-Meye table (FMA), and Barthel Index (BI), and then evaluated one month and three months after the treatment, respectively.Results: At the baseline, the scores of MAS, FMA, and BI between two groups have no significant difference (P>0.05). One month after stroke, the MAS score of the intervention group was higher than the one of the control group (P<0.05), and three months after stroke, the MAS score of the control group was higher than the one of intervention group. One month and three months after stroke, FMA and BI scores of both groups were much higher than their previous ones (P<0.001). Three months after stroke, FMA and BI scores of the intervention group were higher than the ones of control group (P<0.01).Conclusions: (1)Early rehabilitation for stroke patients can shorten the duration of flaccid paralysis. (2)Early rehabilitation can reduce spasticity of the affected limbs for stroke patients, thus, to improve patients’ motor function and then improve patients’ ADL.更多还原