缺血性卒中后痉挛发生情况及预测因素分析  

Prevalence and Predictive Factors Analysis of Spasticity after Ischemic Stroke

作　　者：李宁[1] 滕飞[1] 陈玉辉[1] 聂志余[1] 胡斌[1] 陈晓宇[1] 王戈鹰[1] 靳令经[1] 

机构地区：[1]同济大学附属同济医院神经内科,上海200065

出　　处：《中国卒中杂志》2016年第6期443-448,共6页Chinese Journal of Stroke

基　　金：普陀区高层次人才科研创新项目资助(普人才2014-A-21)

摘　　要：目的了解国人缺血性卒中6个月后肢体痉挛的发生情况与危险因素。方法连续选取2013年4月1日-7月31日在我院神经内科住院的新发缺血性卒中患者,在缺血性卒中后6个月时评估其痉挛情况。痉挛评定采用改良Ashworth痉挛量表（modified Ashworth Scale,MAS）,所有患者的痉挛评定均由同一人进行。结果纳入患者185例,完成随访114例,32例发生痉挛,上下肢均发生痉挛的有22例。最易受累的是肘关节（26例）,其次为踝关节（22例）、指关节（20例）、腕关节（19例）、膝关节（18例）、肩关节（15例）和髋关节（7例）。统计分析发现,入院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）痉挛组（4.64,0-23分）显著高于无痉挛组（2.41,0-7分,P=0.001）;入院时NIHSS评分中瘫痪评分（3,2-6分）痉挛组明显高于无痉挛组（1,0-2分,P〈0.001）;出院时日常生活活动能力评分（Barthel Index,BI）痉挛组（71.2分,5-100分）明显低于无痉挛组（91.7分,45-100分,P〈0.001）。多因素回归分析后,发现入院时NIHSS评分中瘫痪评分及出院时BI评分与痉挛的发生存在相关性。结论缺血性卒中后,痉挛在上下肢同时发生最常见,上肢较下肢更易发生痉挛,其中肘关节最易受累,入院时NIHSS评分中瘫痪评分与出院时BI评分有助于预测痉挛的发生。Objective To investigate the prevalence and predictive factors of spasticity six months after onset of ischemic stroke in China. Methods All patients with acute ischemic stroke hospitalized in Affiliated Tongji Hospital of Tongji University between April 1st and July 31st 2013 were followed-up for six months after newly-onset of stroke. Spasticity was evaluated with the modiifed Ashworth Scale （MAS） by the same person. Results A total of 185 patients were recruited and 114 patients were followed-up, among whom, 32 patients showed spasticity. Among these 32 patients, 22 cases had both upper and lower limb spasm. Spasm appeared most frequently at the elbow （26 cases）, then at the ankle （22 cases）, the ifnger （20 cases）, the wrist （19 cases）, the knee （18 cases）, the shoulder （15 cases） and the hip （7 cases）. The NIHSS score on admission in the patients with spasticity （4.64, 0-23） was higher than the patients without spasticity （2.41, 0-7, P=0.001）. The paralysis part of NIHSS score in the patients with spasticity （3, 2-6） was higher than the patients without spasticity （1, 0-2, P〈0.001）. The Barthel Index （BI） at discharge in the patients with spasticity （71.2, 5-100） was lower than the patients without spasticity （91.7, 45-100, P〈0.001）. Multi-factor logistic regression analysis showed that the paralysis part of NIHSS score and the BI at discharge was related to the presence of spasticity.Conclusion Post-stroke spasticity often occurs in both the upper and the lower limb. The upper limb is more frequently involved than the lower limb, while the elbow is the most frequently involved joint. The paralysis part of NIHSS score and the BI could be used as a predictive factor of post-stroke spasm.

关 键 词：缺血性卒中 痉挛 分布情况 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]