CAJ | 학술논문

目的：探讨早期综合康复训练对急性脑梗死患者预后的影响及其预后结局的危险因素分析。方法：将120例急性脑梗死患者随机分对照组和观察组各60例，对照组给予常规药物治疗，观察组在此基础上再给予基础训练、言语训练、针灸等早期综合康复训练；比较2组的汉密尔顿抑郁量表（HAMD）评分、美国国立卫生院神经功能缺损量表（NIHSS）评分、简式Fugl-Meyer运动功能评分（FMA）、日常生活活动能力（ADL）评分；采用多因素分析法来筛选脑梗死患者预后不良的危险因素。结果：治疗3个月后，观察组的 HAMD评分、2组NIHSS评分均较治疗前明显降低（P＜0．01），且治疗后观察组HAMD、NIHSS评分更低于对照组（P＜0．01）；对照组 HAMD评分治疗前后差异无统计学意义。治疗后，2组 FM A及 ADL 评分均较治疗前明显提高，且观察组更高于对照组（ P＜0．01）。多因素分析显示，年龄、糖尿病、感染、晚就诊、未实施早期康复训练、NIHSS评分低均为脑梗死预后不良的危险因素（ P＜0．05，0．01）。结论：急性脑梗死患者实施早期综合康复训练后，可改善抑郁状态，促进神经功能恢复，提高日常生活质量；脑梗死预后的独立危险因素较多，应制定有针对性的有效预防措施，防治病情加重。
목적：탐토조기종합강복훈련대급성뇌경사환자예후적영향급기예후결국적위험인소분석。방법：장120례급성뇌경사환자수궤분대조조화관찰조각60례，대조조급여상규약물치료，관찰조재차기출상재급여기출훈련、언어훈련、침구등조기종합강복훈련；비교2조적한밀이돈억욱량표（HAMD）평분、미국국립위생원신경공능결손량표（NIHSS）평분、간식Fugl-Meyer운동공능평분（FMA）、일상생활활동능력（ADL）평분；채용다인소분석법래사선뇌경사환자예후불량적위험인소。결과：치료3개월후，관찰조적 HAMD평분、2조NIHSS평분균교치료전명현강저（P＜0．01），차치료후관찰조HAMD、NIHSS평분경저우대조조（P＜0．01）；대조조 HAMD평분치료전후차이무통계학의의。치료후，2조 FM A급 ADL 평분균교치료전명현제고，차관찰조경고우대조조（ P＜0．01）。다인소분석현시，년령、당뇨병、감염、만취진、미실시조기강복훈련、NIHSS평분저균위뇌경사예후불량적위험인소（ P＜0．05，0．01）。결론：급성뇌경사환자실시조기종합강복훈련후，가개선억욱상태，촉진신경공능회복，제고일상생활질량；뇌경사예후적독립위험인소교다，응제정유침대성적유효예방조시，방치병정가중。
Objective :To explore the effect of early comprehensive rehabilitation training on prognosis of acute cer-ebral infarction ,and risk factors .Methods :All 120 cases of acute cerebral infarction were randomly divided into con-trol group (n=60) and observation group (n=60) .The control group was given normal treatment ,and the inter-vention group given early comprehensive rehabilitation training measures (such like basic training ,speech training and acupuncture treatment) besides the control group .The indexes of HAMD score ,NIHSS score ,FMA score ,ADL score and total effective rate were compared between the two groups ,and risk factors of bad prognosis were screened by multiple factors analysis method .Results :After 3 months of rehabilitation treatment ,HAMD score in observation group and NIHSS score in both groups were lower than pretreatment (P<0 .01) ,HAMD and NIHSS scores in ob-servation group were significantly lower than those in control group (P<0 .01) .FMA score and ADL score in both groups were significantly higher than pretreatment (P<0 .01) ,and those in observation group were significantly higher than those in control group (P<0 .01) .Multiple factors analysis revealed that age ,diabetes ,infection ,late visit ,no early rehabilitation training and lower NIHSS score were the risk factors of unfavorable prognosis of cere-bral infarction(P<0 .05 ,P<0 .01) .Conclusions :Early comprehensive rehabilitation training measures for acute cer-ebral infarction can obviously improve depressive state ,promote recovery of nerve function and raise daily life quali-ty .There are many independent risk factors affecting the prognosis of patients with cerebral infarction ,so we should formulate effective preventive measures to aim directly at these risk factors .