三级康复治疗对卒中患者上下肢运动功能恢复作用的临床研究  

Clinical study of standardized tertiary rehabilitation program in promoting upper and lower limbs motor function in stroke patients

作　　者：脑血管病三级康复治疗方案研究课题组(A组) 

机构地区：[1]脑血管病三级康复治疗方案研究课题组（A组）

出　　处：《中华医学杂志》2007年第33期2358-2360,共3页National Medical Journal of China

基　　金：国家科委"十五"攻关课题基金[2001BA703818(A)]

摘　　要：目的探索三级康复治疗对于卒中偏瘫患者上下肢运动功能的影响。方法本研究采用大样本的、多中心的、前瞻性的随机对照研究方法。各分中心分别随机人选患者,然后患者在脑梗死和脑出血二个层次上区组随机化地被纳入到康复组和对照组,康复组688例,对照组677例,共计1365例,康复组予以三级康复治疗,对照组不予以三级康复治疗,但是一般的神经内科常规诊疗同康复组,分别于入选时,病后1个月、3个月和6个月末采用简化 Fugl-Meyer 运动功能评定量表进行上下肢运动功能状态的评测。结果入选后脑梗死和脑出血康复组患者的上下肢运动功能测评积分均明显优于对照组(均 P<0.01)。脑梗死康复组入选时,病后1个月、3个月和6个月末评分分别是:28、47、65和75分,埘照组的评分分别是:26、37、48和55分。脑出血康复组入选时,病后1个月、3个月和6个月末评分分别是:23、44、67和80分,对照组的评分分别是:21、32、46和55分。各阶段肢体运动功能积分差值的比较发现,脑梗死和脑出血康复组患者入选后的功能改善程度均明显优于对照组(均 P<0.01)。6个月随访治疗后,脑梗死和脑出血康复组患者的上下肢运动功能分别改善了47分和56分,而对照组分别改善了29分和34分。即和对照组相比,脑梗死康复组则多改善18分,脑出血康复组多改善22分。结论三级康复治疗对于卒中患者上下肢运动功能的提高具有明显的促进作用。Objective To investigate the effect of standardized tertiary rehabilitation （STR） on the upper and lower limbs＇ motor function in the patients with cerebral stroke accompanied by hemiplegia. Methods 1365 patients with cerebral stroke accompanied by hemiplegia enrolled sequentially from 22 hospitals were classified into two groups： cerebral infarction group and hemorrhage group, and then randomly subdivided into two groups ： test group （ n = 688, administered with STR in addition to routine interventions of neurological medicine） and control group （n =677, given the routine interventions）. All patients were assessed with the scale of Modified Fugl-Meyer Motor Assessment （M-FMMA） at the time of enrollment and 1, 3, and 6 months after the stroke respectively. The evaluation was blind on the part of the physician. Results At each of the following post-stroke checkpoints, the scores of the functions in the cerebral infarction or hemorrhage test group were higher than those in the control （P 〈 0.01 ）. The M-FMMA scores at the enrolment, and 1, 3, and 6 months after stroke of the cerebral infarction patients in the test group were 28, 47, 65, and 75 respectively, and the M-FMMA scores at the enrolment, and 1, 3, and 6 months after stroke of the cerebral infarction patients in the control group were 26, 37,48, and 55 respectively. The M-FMMA scores at the enrolment, and 1, 3, and 6 months after stroke of the cerebral hemorrhage patients in the test group were 23, 44, 67, and 80 respectively, and the M-FMMA scores at the enrolment, and 1, 3, and 6 months after stroke of the cerebral hemorrhage patients in the control group were 21,32, 46, and 55 respectively. During the STR, the scores of functional improvement of both the cerebral infarction and hemorrhage test groups were higher than those of the control groups （ both P 〈0.01 ）. By the end of the 6th month after stroke, the scores of functional improvement of both the cerebral infarction and hemorrhage test groups went up by 47 and 56 r

关 键 词：脑血管意外 偏瘫 康复 

分 类 号：R49[医药卫生—康复医学] R743[医药卫生—临床医学]