缺血性脑卒中康复结局ADL能力及其影响因素的Logistic回归分析  

Logistic Regression Analysis on ADL Ability of the Rehabilitation Outcomes and its Factors in Ischemic Stroke

作　　者：刘永丽[1] 李进元[2] 龚丛芬 唐莉[1] 王云甫[1] 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)神经内科,湖北十堰442000 [2]十堰市太和医院(湖北医药学院附属医院)急诊科,湖北十堰442000

出　　处：《世界中西医结合杂志》2015年第6期795-800,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：湖北省科技厅公益性科研项目(2012DCA12006)

摘　　要：目的分析缺血性脑卒中患者康复结局ADL能力的影响因素,为临床康复和预后判断提供一些客观指标及最佳治疗方案,指导康复治疗工作。方法选取2012年10月-2014年10月治疗和康复出院的缺血性脑卒中患者178例,采用回顾性分析方法,将研究对象的康复结局影响因素分为Ⅰ类不可干预影响因素(性别、年龄、偏瘫侧、类型、病变部位、医疗费用来源、文化程度),Ⅱ类可干预影响因素(康复治疗开始时间、疗程、患者对脑卒中认识、康复的愿望或主动性、康复治疗方法是否规范),Ⅲ类并发症影响因素(肩手综合征、肩痛、肩关节半脱位、心理障碍、言语障碍、认知障碍、下肢深静脉血栓)和Ⅳ类基础疾病的控制质量影响因素(卒中史、高血压、高血脂、高血糖、肥胖)四个类别,使用改良的Barthel指数评分(MBI≥60,MBI<60),判断患者ADL独立程度,并逐项分类统计后,采用二分类的Logistic多因素回归分析。结果缺血性脑卒中患者康复结局的ADL能力MBI评分与病变的类型、部位、康复治疗开展持续时间、患者对康复的愿望或主动性等有关,并受患者的年龄、医保费用来源、并发症、基础疾病控制质量等因素影响。结论早期重视缺血性脑卒中康复结局影响的关键因素,可有效预防不良因素影响,并为患者提供最佳康复治疗方案,提高日常生活活动自理能力。Objective To analyze the factors of ADL ability in the rehabilitation outcomes of the pa- tients with ischemic stroke so as to provide some objective indexes of clinical rehabilitation and prognosis judgment and the best therapeutic program. Methods The retrospective analysis was done for 178 patients of ischemic stroke,which were treated or had been rehabilitated and discharged from October 2012 to October 2014. The factors of the rehabilitation outcomes in the subjects were classified into 4 categories, named I category, the unchangeable influential factors （ age, gender,hemiplegia, type,lesion location, source of medical expense, educational background ） , II category, the interfered influential factors （ start time of rehabilitation, course of treatment, patient＇s cognition to stroke, willingness or initiative of rehabilitation, rehabilitation speci- fication）, 11I category, the influential factors of complications （ shoulder - hand syndrome, shoulder pain, shoulder subluxation, mental disorder, speech disorder, cognitive disorder, deep venous thrombosis of lower limbs） and 1V category, quality controlling factors of basic diseases （ stroke history, hypertension, hyperlipi- demia, hyperglycemia, obesity）. The modified Barthel index was used （ MBI ≥ 60, MBI 〈 60） to judge ADL in- dependent degree of the patients. The second classified logistic multifactor regression analysis was adopted af- ter the itemized statistical analysis. Results MBI score of ADL ability in the rehabilitation outcomes was re- lated to the lesion type and location, persistent duration of rehabilitation, willingness or initiative of patients to rehabilitation in ischemic stroke and they were impacted by patients＇age, source of medical expense, compli- cation, the control quality of basic diseases. Conclusion The early attention to the key influential factors of the rehabilitation outcomes in ischemic stroke may effectively prevent from the adverse factors, provide the best rehabilitation therapeutic programs a

关 键 词：缺血性脑卒中 康复结局 日常生活活动能力 改良BARTHEL指数 LOGISTIC回归分析 

分 类 号：R364.12[医药卫生—病理学]