出血性脑卒中术后偏瘫患者的早期康复治疗  

Early rehabilitation in postoperative patients with hemiplegia after hemorrhagic stroke

作　　者：褚闻来 褚正民 施明[2] 沈建国 周海航 田和平 

机构地区：[1]嘉兴市第二医院神经外科,314000 [2]嘉兴市第二医院康复中心,314000

出　　处：《浙江医学》2012年第8期631-634,共4页Zhejiang Medical Journal

摘　　要：目的 探讨早期综合康复治疗对出血性脑卒中术后偏瘫患者功能恢复的疗效及其安全性.方法 选取近5年间收治的出血性脑卒中术后偏瘫患者116例,分为早期康复组、晚期康复组和对照组,术后48h内GCS评分＞10分且病情不再进展,予神经外科常规药物治疗、护理,早期康复组及晚期康复组在常规治疗基础上分别在术后3～5d及2周左右开始综合康复治疗.术后4周对3组患者采用简化Fugl-Meyer动作量表（FMA）评价患肢运动功能,采用Barthel指数评价日常生活能力（ADL）缺陷程度,同时采用全国第四届脑血管病学术会议标准评价临床疗效.结果 术后4周时,早期康复组FMA评分及Barthel指数以及临床疗效均较其他两组明显提高（均P＜0.01）,晚期康复组分值虽较对照组好,但差异无统计学意义（P ＞0.05）.3组病死率的差异无统计学意义（P ＞0.05）,死亡患者多为高龄且合并严重脏器功能衰竭者.结论 对出血性脑卒中术后偏瘫患者尽早施行综合康复治疗,能安全、有效地改善其运动功能,提高其ADL.Objective To evaluate the early comprehensive rehabilitation in postoperative patients with hemiplegia after hemorrhagic stroke. Methods One hundred and sixteen postoperative patients with hemiplegia after hemorrhagic stroke ad- mitted over last 5 y were randomly selected for study; the selection criteria were GCS score 〉10 and no progress within 48h after operation. Patients underwent comprehensive rehabilitation in 3-5d （early rehabilitation group）, or 2 weeks after operation （late rehabilitation group） or no rehabilitation （control group）. All patients received conventional medication and care. The motor func- tion of the limbs was evaluated with simplified FugI-Meyer scale action （FMA） and the deficiencies of the ability of daily life （ADL） with Barthel Index 4 weeks after operation, and the Criteria from Fourth National Cerebrovascular Disease Conference were used for evaluation of the clinical efficacy. Results FMA score, Barthel Index and clinical effect in early rehabilitation group were im- proved more markedly than those in the other two groups （P〈0.01 }. There was no significant difference between late rehabilita- tion group and the control group （P 〉0.05 ）. There was no statistical difference in mortality among three groups and the death mostly occurred in elderly patients with severe organ failure. Conclusion The motor function and the ADL can be improved safely and effectively with early implementation of comprehensive rehabilitation in postoperative patients with hemiplegia after hemorrhagic stroke.

关 键 词：出血性脑卒中 术后 早期康复 临床疗效 

分 类 号：R743.3[医药卫生—神经病学与精神病学]