中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
21期
2431-2436
,共6页
张京%吴海艳%韩淑玲%姚济荣%贺茂林
張京%吳海豔%韓淑玲%姚濟榮%賀茂林
장경%오해염%한숙령%요제영%하무림
卒中%脑梗死%血栓溶解疗法%康复%训练强度%功能恢复%预后
卒中%腦梗死%血栓溶解療法%康複%訓練彊度%功能恢複%預後
졸중%뇌경사%혈전용해요법%강복%훈련강도%공능회복%예후
Stroke%Cerebral infarction%Thrombolytic therapy%Rehabilitation%Training intensity%Recovery of
目的：探讨不同强度康复训练对急性缺血性卒中超早期溶栓治疗和非溶栓治疗患者远期康复效果的影响。方法选取2009年1月-2012年12月本院收治的急性缺血性卒中超早期溶栓患者87例（溶栓组）和非溶栓患者93例（非溶栓组），将两组患者随机分为4组，给予不同强度的康复训练，分别为溶栓低强度组（ A组，19例）、溶栓中强度组（B组，23例）、溶栓亚强度组（C组，21例）、溶栓高强度组（D组，24例）、非溶栓低强度组（E组，22例）、非溶栓中强度组（ F组，25例）、非溶栓亚强度组（ G组，24例）和非溶栓高强度组（ H组，22例）。溶栓组给予阿替普酶进行静脉溶栓治疗，非溶栓组常规给予抗血小板、抗凝、脑保护、神经营养治疗。两组患者均在症状、体征稳定48 h内开始康复训练治疗，包括：良肢位的摆放、床椅转移训练、坐位立位平衡训练、步态练习、上下楼梯练习和手功能作业训练，为期4周。训练前及训练后，采用简式傅格-梅尔运动功能评分量表（ FMA）、功能独立性量表（ FIM）、卒中专门生存质量量表（ SS-QOL）分别比较患者的运动功能、生活自理能力及生存质量。然后比较溶栓与康复训练强度两因素组成的8种条件下患者康复训练后的各项功能。结果（1）不论是溶栓组还是非溶栓组，不同强度康复训练者训练前FMA、 FIM、 SS-QOL评分间均无差异（ P＞0.05）。康复训练后， B、 C、 D组FMA评分高于A组； C、 D组FIM评分高于A组， D组FIM评分高于B组； C组SS-QOL评分高于A组， D组SS-QOL评分均高于A、 B、 C组（ P＜0.05）。康复训练后， G、 H组FMA评分及FIM评分均高于E组； H组SS-QOL评分高于E组和F组（P＜0.05）。（2）两因素多水平的方差分析显示，溶栓患者FMA、 FIM、 SS-QOL评分高于非溶栓患者（P＜0.05）；康复训练强度增加，患者的FMA、 FIM、 SS-QOL评分增加（ P＜0.05）。对于SS-QOL评分，溶栓与康复训练强度间有交互作用（ P＜0.05）； A组SS-QOL评分低于H组， B组SS-QOL评分高于E组， C组、 D组SS-QOL评分均高于E组、 F组、 G组（ P＜0.05）。结论不同强度的康复训练对于溶栓和非溶栓患者的远期功能改善均有一定的促进作用，溶栓患者对康复训练的运动敏感性更高。在最适训练强度范围内逐步提高训练强度，可以使溶栓患者和非溶栓患者获得更快的运动恢复速度和更好的生存质量。非溶栓患者在发病初期选择较溶栓患者更高的训练强度可显著改善远期预后并缩小与溶栓患者的差距。
目的：探討不同彊度康複訓練對急性缺血性卒中超早期溶栓治療和非溶栓治療患者遠期康複效果的影響。方法選取2009年1月-2012年12月本院收治的急性缺血性卒中超早期溶栓患者87例（溶栓組）和非溶栓患者93例（非溶栓組），將兩組患者隨機分為4組，給予不同彊度的康複訓練，分彆為溶栓低彊度組（ A組，19例）、溶栓中彊度組（B組，23例）、溶栓亞彊度組（C組，21例）、溶栓高彊度組（D組，24例）、非溶栓低彊度組（E組，22例）、非溶栓中彊度組（ F組，25例）、非溶栓亞彊度組（ G組，24例）和非溶栓高彊度組（ H組，22例）。溶栓組給予阿替普酶進行靜脈溶栓治療，非溶栓組常規給予抗血小闆、抗凝、腦保護、神經營養治療。兩組患者均在癥狀、體徵穩定48 h內開始康複訓練治療，包括：良肢位的襬放、床椅轉移訓練、坐位立位平衡訓練、步態練習、上下樓梯練習和手功能作業訓練，為期4週。訓練前及訓練後，採用簡式傅格-梅爾運動功能評分量錶（ FMA）、功能獨立性量錶（ FIM）、卒中專門生存質量量錶（ SS-QOL）分彆比較患者的運動功能、生活自理能力及生存質量。然後比較溶栓與康複訓練彊度兩因素組成的8種條件下患者康複訓練後的各項功能。結果（1）不論是溶栓組還是非溶栓組，不同彊度康複訓練者訓練前FMA、 FIM、 SS-QOL評分間均無差異（ P＞0.05）。康複訓練後， B、 C、 D組FMA評分高于A組； C、 D組FIM評分高于A組， D組FIM評分高于B組； C組SS-QOL評分高于A組， D組SS-QOL評分均高于A、 B、 C組（ P＜0.05）。康複訓練後， G、 H組FMA評分及FIM評分均高于E組； H組SS-QOL評分高于E組和F組（P＜0.05）。（2）兩因素多水平的方差分析顯示，溶栓患者FMA、 FIM、 SS-QOL評分高于非溶栓患者（P＜0.05）；康複訓練彊度增加，患者的FMA、 FIM、 SS-QOL評分增加（ P＜0.05）。對于SS-QOL評分，溶栓與康複訓練彊度間有交互作用（ P＜0.05）； A組SS-QOL評分低于H組， B組SS-QOL評分高于E組， C組、 D組SS-QOL評分均高于E組、 F組、 G組（ P＜0.05）。結論不同彊度的康複訓練對于溶栓和非溶栓患者的遠期功能改善均有一定的促進作用，溶栓患者對康複訓練的運動敏感性更高。在最適訓練彊度範圍內逐步提高訓練彊度，可以使溶栓患者和非溶栓患者穫得更快的運動恢複速度和更好的生存質量。非溶栓患者在髮病初期選擇較溶栓患者更高的訓練彊度可顯著改善遠期預後併縮小與溶栓患者的差距。
목적：탐토불동강도강복훈련대급성결혈성졸중초조기용전치료화비용전치료환자원기강복효과적영향。방법선취2009년1월-2012년12월본원수치적급성결혈성졸중초조기용전환자87례（용전조）화비용전환자93례（비용전조），장량조환자수궤분위4조，급여불동강도적강복훈련，분별위용전저강도조（ A조，19례）、용전중강도조（B조，23례）、용전아강도조（C조，21례）、용전고강도조（D조，24례）、비용전저강도조（E조，22례）、비용전중강도조（ F조，25례）、비용전아강도조（ G조，24례）화비용전고강도조（ H조，22례）。용전조급여아체보매진행정맥용전치료，비용전조상규급여항혈소판、항응、뇌보호、신경영양치료。량조환자균재증상、체정은정48 h내개시강복훈련치료，포괄：량지위적파방、상의전이훈련、좌위립위평형훈련、보태연습、상하루제연습화수공능작업훈련，위기4주。훈련전급훈련후，채용간식부격-매이운동공능평분량표（ FMA）、공능독립성량표（ FIM）、졸중전문생존질량량표（ SS-QOL）분별비교환자적운동공능、생활자리능력급생존질량。연후비교용전여강복훈련강도량인소조성적8충조건하환자강복훈련후적각항공능。결과（1）불론시용전조환시비용전조，불동강도강복훈련자훈련전FMA、 FIM、 SS-QOL평분간균무차이（ P＞0.05）。강복훈련후， B、 C、 D조FMA평분고우A조； C、 D조FIM평분고우A조， D조FIM평분고우B조； C조SS-QOL평분고우A조， D조SS-QOL평분균고우A、 B、 C조（ P＜0.05）。강복훈련후， G、 H조FMA평분급FIM평분균고우E조； H조SS-QOL평분고우E조화F조（P＜0.05）。（2）량인소다수평적방차분석현시，용전환자FMA、 FIM、 SS-QOL평분고우비용전환자（P＜0.05）；강복훈련강도증가，환자적FMA、 FIM、 SS-QOL평분증가（ P＜0.05）。대우SS-QOL평분，용전여강복훈련강도간유교호작용（ P＜0.05）； A조SS-QOL평분저우H조， B조SS-QOL평분고우E조， C조、 D조SS-QOL평분균고우E조、 F조、 G조（ P＜0.05）。결론불동강도적강복훈련대우용전화비용전환자적원기공능개선균유일정적촉진작용，용전환자대강복훈련적운동민감성경고。재최괄훈련강도범위내축보제고훈련강도，가이사용전환자화비용전환자획득경쾌적운동회복속도화경호적생존질량。비용전환자재발병초기선택교용전환자경고적훈련강도가현저개선원기예후병축소여용전환자적차거。
ObjectiveToinvestigatetheeffectsofdifferentintensitiesofrehabilitationtraininginacuteischemicpa-tients with thrombolysis or without thrombolysis .Methods From January 2009 to December 2012 in Beijing Shijitan Hospital , 87 cases of acute ischemic stroke patients administrated with ultra early thrombolytic therapy ( thrombolysis group ) and 93 cases of a-cute ischemic stroke patients without thrombolysis ( non-thrombolysis group ) were enrolled in this study , then every group were randomly divided into four groups and administrated with different intensities of rehabilitation training , named thrombolysis plus low intensity group (A group, 19 cases), thrombolysis plus moderate intensity group (B group, 23 cases), thrombolysis plus sub-high intensity group (C group, 21 cases), thrombolysis plus high intensity group (D group, 24 cases), non-thrombol-ysis plus low intensity group ( E group, 22 cases), non -thrombolysis plus moderate intensity group ( F group, 25 cases), non-thrombolysis plus sub -high intensity group ( G group, 24 cases ) and non thrombolysis plus high intensity group ( H group, 22 cases) respectively.Thrombolysis groups were given intravenous thrombolysis of alteplase and non -thrombolysis groups were given conventional treatments including antiplatelet , anticoagulant , brain protection , neurotrophic treatment .Rehabilitation training was started within 48 hours when the patients in stable condition .Every patients were received 4 weeks rehabilitation train-ing, which included: normal limb position, bed chair transfer, sitting and vertical position balance training , gait training, stair exercise and hand function training .Using 3 international stroke scales ( FMA, FIM, SS-QOL) to assess motor function , self-help ability and quality of life in eight groups before and after the training then compare the effect of training and thrombolys -is the 2 factors on the above scales in 8 groups.Results There was no significant difference in 3 stroke scales ( FMA, FIM, SS-QOL) between thrombolysis group and non -thrombolysis group (P>0.05) before training.However, after training, com-pared with group A the FMA score was higher in groups B , C, D.FIM score was higher in groups C and D than group A , com-pared with group B the FIM score was higher in group D .SS-QOL score was higher in group C than group A , there was signifi-cant difference in SS-QOL score in group D compared with group A , B and C ( P<0.05) .Among non-thrombolysis groups , after training FMA and FIM score both higher in group G , H than group E, SS-QOL score was obviously higher in group H than group E and F.Analysis of variance of two factors multilevel indicated that: FMA, FIM and SS -QOL scores were higher in thrombolysis groups than non -thrombolysis groups ( P<0.05 ) .Whether they were thrombolysis groups or non -thrombolysis groups, the higher intensity of training was , the more significant the improvement of three functions became (P<0.05) .With regard to SS-QOL score, there was interaction between thrombolysis therapy and intensity of training (P<0.05).It was high-er in group H than group A, group B than group E, group C and D than group E, F and G (P<0.05).Conclusion All groups got improvement of scores after rehabilitation training whether they were thrombolysis groups or non -thrombolysis groups.Compared with non-thrombolysis patients , thrombolytic patients showed better sensitivity to motor stimulation .All of pa-tients can get faster velocity and better assessment results by choosing the optimized intensity training .Non-thrombolysis patients can get satisfied prognosis by increasing the intensity according thrombolysis patients in early stages .
