康复介入对急性缺血性脑卒中重症患者功能恢复及常见并发症发生的影响

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摘要目的探讨康复介入对急性缺血性脑卒中重症患者神经功能、运动功能及日常生活能力恢复、常见并发症肺部感染、肩痛发生情况的影响。方法选择2016年1月～2017年9月湖州市中心医院EICU内收治的急性缺血性脑卒中重症患者96例，依据随机数字表法分为重症康复组、早期康复组、常规康复组，每组各32例。重症康复组患者在入院第1天开始康复介入，早期康复组在生命体征稳定48 h后、常规康复组在入院2周后开始康复介入。三组患者在入院、治疗后1个月、治疗后3个月时分别进行美国国立卫生研究院卒中量表（NIHSS）、改良Barthel指数（MBI）、Fugl-Meyer运动功能评分量表（FMA）评定，并统计三组患者常见并发症肺部感染、肩痛出现频次。结果三组患者治疗后1、3个月时NIHSS、MBI、FMA评分与入院时比较，差异有高度统计学意义（P < 0.01）。重症康复组、早期康复组治疗后1、3个月时NIHSS、MBI、FMA评分与常规康复组比较，差异有高度统计学意义（P < 0.01）。3个月治疗过程中，重症康复组常见并发症肺部感染、肩痛出现频次分别为21、3次；早期康复组分别为28、9次、常规康复组分别为39、13次。结论急性缺血性脑卒中重症患者康复介入可以促进患者神经功能、运动功能及日常生活能力的恢复，并且能够降低并发症肺部感染、肩痛的发生。病情重笃的急性缺血性脑卒中患者，只要掌握好康复指征，规范、个体化的康复治疗方案是可行的。

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	付萍萍1 金培英2 蒋莹1 谢文龙1 何凤翔1

关键词 ：重症, 急性缺血性脑卒中, 康复介入, 功能恢复, 肺部感染, 肩痛

Abstract：Objective To research the effect of rehabilitation intervention for severe patients with acute ischemic stroke in neurological function, motor function , activities of daily living, and the occurrence of pulmonary infection and shoulder pain. Methods From January 2016 to September 2017, in EICU, Huzhou Central Hospital, 96 patients with were acute ischemic stroke treated were selected, according to random number table method, they were divided into three groups according to random number table method, with 32 cases in each group. The severe rehabilitation group received rehabilitation treatment when they were in hospital at the first day, the early rehabilitation group received rehabilitation treatment when the sign of life was smooth after 48 hours, the conventional rehabilitation group received rehabilitation 2 weeks after they came in hospital. The outcome measures included the National Institute of health stroke scale (NIHSS), modified Barthel index (MBI) and Fugl-Meyer motor assessment scale (FMA) performed seperately when they were in hospital first day, after treatment 1 month and 3 months. The common complications of pulmonary infection and shoulder pain were accumulated during 3 months. Results The NIHSS, MBI, FMA scores after treatment 1 month and 3 months in the three groups were compared with those at the time of admission, the differences were statistically significant (P < 0.01). The NIHSS, MBI, and FMA scores in the severe rehabilitation group and early rehabilitation group were compared with the conventional rehabilitation group after treatment 1 month and 3 months, the differences were statistically significant (P < 0.01). During the 3 months of treatment, the frequencies of common complications of pulmonary infection and shoulder pain in the severe rehabilitation group were 21 and 3, in the early rehabilitation group were 28 and 9, and in the conventional rehabilitation group were 39 and 13. Conclusion The rehabilitation intervention for severe patients with acute ischemic stroke can effectively improve the neurological function, motor function and activities of daily living, and decrease the occurrence of the common complications of pulmonary infection and shoulder pain. Mastering the indications, standard individual rehabilitation treatment is practicable, though the patients with acute ischemic stroke are especially severe.

Key words： Severe case Acute ischemic stroke Rehabilitation intervention Function recovery Pulmonary infection Shoulder pain

基金资助:浙江省湖州市科学技术局公益性技术应用研究B类（2016GYB60）。

引用本文:

付萍萍1 金培英2 蒋莹1 谢文龙1 何凤翔1. 康复介入对急性缺血性脑卒中重症患者功能恢复及常见并发症发生的影响[J]. 中国医药导报, 2018, 15(17): 52-55.
FU Pingping1 JIN Peiying2 JIANG Ying1 XIE Wenlong1 HE Fengxiang1. Effect of rehabilitation intervention on functional recovery and common complications in severe ischemic stroke patients. 中国医药导报, 2018, 15(17): 52-55.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I17/52

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