CAJ | 학술논문

目的探讨规范的三级康复治疗对脑出血后上肢痉挛和上肢运动功能的影响.方法将364例脑出血患者按随机数字表法分为对照组(181例)和康复组(183例),康复组接受规范的三级康复治疗,包括早期床旁康复介入、恢复期在康复专科病房进行、后期定期康复家访指导;对照组未接受规范的三级康复治疗,仅予以康复指导,并定期随访.分别于入组时、入组后1、3和6个月时,对2组患者患侧上肢进行改良Ashworth量表(MAS)评定和简化Fugl-Meyer运动功能(上肢部分)评定,并进行统计学分析比较.结果入组时,对照组和康复组患者肌肉痉挛的发生率分别为22.7％和23.5％;入组后6个月,对照组和康复组痉挛发生率分别为59.7％和43.2％,且对照组处于MAS 1+级和2级患者数量(50/181)明显高于康复组(25/183).无论在哪个阶段,2组MAS 0级患者数量均占很大比例.入组后6个月,2组患者的MAS分布和评分比较,差异均有统计学意义(P＜0.01).2组患者的Fugl-Meyer评分均随时间的推移逐渐明显提高(P＜0.01);入组后1、3和6个月时,康复组Fugl-Meyer评分分别为(24.71±19.80)、(39.83±19.50)和(48.87±18.25)分,对照组分别为(17.13±16.46)、(24.87±18.36)和(30.68±19.41)分,康复组各时间点评分均高于同时间点对照组(P＜0.01).结论规范的三级康复治疗有助于减轻脑出血后患者的上肢痉挛程度和改善上肢运动功能.
목적 탐토규범적삼급강복치료대뇌출혈후상지경련화상지운동공능적영향.방법 장364례뇌출혈환자안수궤수자표법분위대조조(181례)화강복조(183례),강복조접수규범적삼급강복치료,포괄조기상방강복개입、회복기재강복전과병방진행、후기정기강복가방지도;대조조미접수규범적삼급강복치료,부여이강복지도,병정기수방.분별우입조시、입조후1、3화6개월시,대2조환자환측상지진행개량Ashworth량표(MAS)평정화간화Fugl-Meyer운동공능(상지부분)평정,병진행통계학분석비교.결과 입조시,대조조화강복조환자기육경련적발생솔분별위22.7％화23.5％;입조후6개월,대조조화강복조경련발생솔분별위59.7％화43.2％,차대조조처우MAS 1+급화2급환자수량(50/181)명현고우강복조(25/183).무론재나개계단,2조MAS 0급환자수량균점흔대비례.입조후6개월,2조환자적MAS분포화평분비교,차이균유통계학의의(P＜0.01).2조환자적Fugl-Meyer평분균수시간적추이축점명현제고(P＜0.01);입조후1、3화6개월시,강복조Fugl-Meyer평분분별위(24.71±19.80)、(39.83±19.50)화(48.87±18.25)분,대조조분별위(17.13±16.46)、(24.87±18.36)화(30.68±19.41)분,강복조각시간점평분균고우동시간점대조조(P＜0.01).결론 규범적삼급강복치료유조우감경뇌출혈후환자적상지경련정도화개선상지운동공능.
Objective To evaluate the effectiveness of standardized three-stage rehabilitation program on spasticity and motor function in the upper extremities after cerebral hemorrhage.Methods A total of 364 patients were included and randomly assigned to a control group (n =181) and a rehabilitation group (n =183).The standardized three-stage rehabilitation program,which included early-stage bedside rehabilitation,specialized treatment in rehabilitation ward during recovery and rehabilitation follow-up at regular intervals was applied in the rehabilitation group,but only rehabilitation guidance and follow-up after discharge were provided for the control group.The modified Ashworth scale (MAS) and Fugl-Meyer assessment (FMA) were performed at the time of recruitment,1 month (M1),3 months(M3) and 6 months(M6) later.Results There was no statistical difference between the groups at recruitment.The occurrence rate of spasticity was 22.7％ in the control and 23.5％ in the rehabilitation group.At M6 the occurrence rate of spasticity was about 59.7％ and 43.2％ in control group and rehabilitation group respectively,and the number of patients grade 1 + and grade 2 on the MAS was 50/181 in the control group,significantly more than in the rehabilitation group (25/183).At all time points,MAS grade 0 accounted for a large proportion of both groups.At M6,both MAS distributions and scores of the two groups were different statistically (P ＜ 0.01).FMA scores in both groups increased significantly (P ＜ 0.01) with time,with the score being (17.13 ± 16.46),(24.87±18.36),(30.68±19.41) at M1,M3 and M6 in the control group and (24.71 ±19.80),(39.83 ± 19.50),(48.87 ± 18.25) in the rehabilitation group,but the average scores of the latter were consistently significantly higher than the former (P ＜ 0.01).Conclusions Standardized three-stage rehabilitation can alleviate spasticity and improve motor function of the upper extremities in cerebral hemorrhage patients.