早期康复治疗对脑梗死偏瘫患者脑血流的影响  

The Effect of Early Positive Rehabilitative Intervention on Cerebral Blood Flow of Patient with Hemiplegia Following Cerebral Infarction

作　　者：成祥林[1] 向明清[1] 熊勋波[1] 赵成三[1] 

机构地区：[1]荆州市第一人民医院神经科,湖北荆州434000

出　　处：《中国康复》2008年第5期319-320,共2页Chinese Journal of Rehabilitation

摘　　要：目的:探讨早期康复治疗对脑梗死偏瘫患者脑血流的影响,评价早期康复治疗的效果及指标。方法:脑梗死偏瘫患者87例,按入院顺序分为观察组48例和常规组39例,并选择46例同期体检的健康人(健康组)作为健康对照,观察组和常规组均在神经内科按脑梗死常规处理,以药物治疗为主。观察组在此基础上配合Bobath疗法。治疗前后和健康组均应用TCD检测双侧大脑中动脉(MCA)的平均血流速度(Vm),同时应用Fugl-Meyer法(FMA)评价瘫痪肢体的功能。结果:治疗30d后FMA评分与治疗前比较,观察组和常规组均有显著提高(P<0.01)。治疗前观察组和常规组MCA健患侧Vm均低于健康组(P<0.01或0.05);治疗后观察组有明显提高,与健康组比较差异无显著性意义;常规组患侧较治疗前明显提高,但仍低于观察组和健康组(P<0.05)。结论:早期康复治疗可以增加脑梗死偏瘫患者的脑血流量,促进功能恢复,TCD可以作为评价其早期疗效的指标,优于FMA评分。Ohjective： To observe the effect of early positive rehabilitative intervention on cerebral blood flow of patients with hemiplegia following cerebral infarction and evaluate the outcome and markers of early positive rehabilitative intervention. Methods： Eighty-seven patients with hemiplegia following cerebral infarction were divided into observation group （n= 48） and routine group （71 39） consecutively. Forty-six healthy volunteers at the same period served as healthy control groups. The patients in rehabilitation group were treated with drug and rehabilitative intervention （Bobath technique）, and those in control group only with drug. The average cerebral blood flow of both middle cerebral artery in rehabilitation group, control group and health control group was examined by using transcranial Doppler. The function of paralysis limbs was assessed by using Fugl-Meyer technique. Results： The scale of Fugl-Meyer was obviously increased in both groups after treatment for 30 days as compared with that before treatment （P（0.01）. The average cerebral blood flow of MCA on the abnormal and normal sides in observation and routine groups was less than in control group （P〈0.01 or 〈0.05） before treatment. After treatment, the average cerebral blood flow of MCA in observation group was increased obviously as compared with that before treatment, and there was no significant difference in comparison with control group.The average cerebral blood flow of MCA on the affected side in routine group was obviously increased after trcatmcnt in comparison with that before treatment, but less than in control group and observation group. Conclusion： The early positive rehabilitative intervention can increase the average cerebral blood flow of MCA in patients with hemiplegia following cerebral infarction and accelerate the functional restoration. TCD can be regarded as an early marker to evaluate the early outcome and is superior to the scale of Fugl-Meyer.

关 键 词：脑梗死 TCD 平均血流速度 FUGL-MEYER 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R49[医药卫生—临床医学]