CAJ | 학술논문

目的：本研究旨在探讨卒中患者各项临床指标和卒中后反射性交感神经营养不良的关系。方法前瞻性登记2011年4月～2013年1月在成都市第三人民医院神经内科、神经外科及康复理疗科住院治疗的卒中患者。共纳入符合要求的病例127例，随访12周后分成两组：非卒中后反射性交感神经营养不良（reflex sympathetic dystrophy，RSD）组，即卒中后12周内未出现RSD的患者；RSD组，即12周随访期内出现RSD的患者。对影响卒中后RSD发生的相关因素进行单因素分析，再用COX回归模型分析卒中后RSD独立影响因素。结果 RSD组与非RSD组比较，年龄、性别、卒中类型、既往史评分、感觉障碍及焦虑没有显著性差异；两组之间合并症评分、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分、抑郁、运动功能障碍、肌张力变化及巴氏指数（Barthel Index，BI）存在显著差异；COX回归模型分析表明合并症评分[危险比（harzard ratio，HR）1.018，95%可信区间（confidence interval，CI）1.006～1.163]、NIHSS评分（HR 1.157，95%CI 1.062～1.261）、抑郁评分（HR 4.975，95%CI 1.839～13.460）、肩关节半脱位（HR 4.627，95%CI 2.383～8.984）及运动功能障碍（HR 0.577，95%CI 0.358～0.930）是RSD发生的独立危险因素。结论合并症评分、NIHSS评分、抑郁、肩关节半脱位及运动功能障碍是卒中后RSD发生的独立危险因素。
목적：본연구지재탐토졸중환자각항림상지표화졸중후반사성교감신경영양불량적관계。방법전첨성등기2011년4월～2013년1월재성도시제삼인민의원신경내과、신경외과급강복리료과주원치료적졸중환자。공납입부합요구적병례127례，수방12주후분성량조：비졸중후반사성교감신경영양불량（reflex sympathetic dystrophy，RSD）조，즉졸중후12주내미출현RSD적환자；RSD조，즉12주수방기내출현RSD적환자。대영향졸중후RSD발생적상관인소진행단인소분석，재용COX회귀모형분석졸중후RSD독립영향인소。결과 RSD조여비RSD조비교，년령、성별、졸중류형、기왕사평분、감각장애급초필몰유현저성차이；량조지간합병증평분、미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분、억욱、운동공능장애、기장력변화급파씨지수（Barthel Index，BI）존재현저차이；COX회귀모형분석표명합병증평분[위험비（harzard ratio，HR）1.018，95%가신구간（confidence interval，CI）1.006～1.163]、NIHSS평분（HR 1.157，95%CI 1.062～1.261）、억욱평분（HR 4.975，95%CI 1.839～13.460）、견관절반탈위（HR 4.627，95%CI 2.383～8.984）급운동공능장애（HR 0.577，95%CI 0.358～0.930）시RSD발생적독립위험인소。결론합병증평분、NIHSS평분、억욱、견관절반탈위급운동공능장애시졸중후RSD발생적독립위험인소。
Objective To investigate the relationship between reflex sympathetic dystrophy (RSD) and the clinical characteristics of patients with stroke. Methods Totally 127 cases of acute stroke, who were admitted at the Department of Neurology, Neurosurgery and Physiotherapy, the Third People's Hospital of Chengdu during April 2011 and January 2013, were consecutively recorded from admission to 3 months after hospitalization. The subjects were finally divided into 2 groups:one is the non-RSD group which included patients without RSD after stroke, and the other is the RSD group which included patients with RSD after stroke. The relationship between RSD and clinical characteristics of patients with stroke was evaluated by univariate analysis and multivariate COX regression analysis. Results No signiifcant difference was found between non-RSD group and RSD group regarding to age, gender, stroke type, past history, sensory disability and anxiety. RSD after stroke was related to complications, National Institutes of Health Stroke Scale (NIHSS) score, depression, Brunnstorm Improvement Stages, muscular tension and Barthel index (BI) by univariate analysis. Complication score (harzard ratio [HR] 1.018, 95% confidence interval [CI] 1.006~1.163), NIHSS score (HR 1.157, 95%CI 1.062~1.261), depression score (HR 4.975, 95%CI 1.839~13.460), shoulder subluxation (HR 4.627, 95%CI 2.383~8.984) and Brunnstorm Improvement Stages (HR 0.577,95%CI 0.358~0.930) were the independent risk factors of RSD after stroke. Conclusion Complication score, NIHSS score, depression, shoulder subluxation, and Brunnstorm Improvement Stages were the independent risk factors of RSD after stroke.