急性脑梗死患者静脉溶栓联合超早期神经康复的疗效观察  

Curative effect of intravenous thrombolysis combined with super early neurological rehabilitation in acute cerebral infarction patients

作　　者：马灿灿[1] 张熙斌[2] 徐耀[1] 徐俊 李晓波[1] 李军[1] 陈蓓蕾[1] 景坚[1] 陈波[2] Ma Cancan;Zhang Xibin;Xu Yao;Xu Jun;Li Xiaobo;Li Jun;Chen Beilei;Jing Jian;Chen Bo(Department of Neurology,Northern J iangsu People＇s Hospital,Yangzhou 225001,Jiangsu Province,China)

机构地区：[1]江苏省苏北人民医院脑科中心,扬州225001 [2]江苏省苏北人民医院康复中心,扬州225001 [3]首都医科大学附属北京天坛医院神经内科

出　　处：《中华老年心脑血管病杂志》2018年第10期1049-1053,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81471215;81271211);江苏省自然科学基金(BE20151592);江苏省科技项目(BE2015665);江苏省"333工程"培养资金资助项目(2016-Ⅲ-0950)

摘　　要：目的探讨超早期神经康复对静脉溶栓的急性脑梗死患者神经功能缺损、运动功能、平衡能力和日常生活活动能力的影响。方法选择2016年9月~2017年12月江苏省苏北人民医院脑科中心接受重组组织型纤溶酶原激活剂静脉溶栓治疗的急性脑梗死患者50例,随机分为治疗组25例,对照组25例。2组均给予常规药物治疗。治疗组接受正规神经康复治疗方案。2组患者于溶栓前、溶栓6h、康复治疗前、康复治疗14d和30d分别采用美国国立卫生研究院卒中量表(NIHSS)评分进行神经功能缺损评估;于康复治疗前、康复治疗14d和30d分别进行Fugl-Meyer运动评估量表(FMA)、Berg平衡量表(BBS)及改良Barthel指数(MBI)评定,并记录并发症及继发障碍发生的情况。结果 2组溶栓6h、康复治疗前、康复治疗14d和30dNIHSS评分明显低于溶栓前(P<0.01)。2组康复治疗14d和30dFMA、BBS、MBI评分明显高于治疗前,差异有统计学意义(P<0.01);治疗组康复治疗30d NIHSS评分较对照组明显降低,FMA、BBS、MBI评分较对照组明显升高,差异有统计学意义(P<0.05)。治疗组肩痛1例,对照组坠积性肺炎2例,体位性低血压1例,肩痛2例,肩手综合征1例,治疗组并发症和继发障碍发生率明显低于对照组(4.0%vs 24.0%,P<0.05)。结论静脉溶栓联合超早期神经康复能改善急性脑梗死患者神经功能缺损,促进运动功能、平衡能力和日常生活活动能力的恢复,有效减少并发症及继发障碍发生。Objective To study the curative effect of super early rehabilitation on neurological dysfunction,motor function,balance ability,and daily life activities in acute cerebral infarction（ACI）patients after intravenous thrombolysis.Methods Fifty ACI patients who underwent intravenous thrombolysis with recombinant tissue plasminogen activator in our hospital were randomly divided into treatment group（n=25）and control group（n=25）.The patients in two groups underwent routine drug therapy and those in treatment group received regular neurological rehabilitation.The neurological dysfunction was assessed in two groups according to the NIHSS before thrombolysis,at 6hafter thrombolysis,before rehabilitation,on days 14and 30after rehabilitation respectively.The clinical effect of rehabilitation was assessed in two groups according to the FMA,BBS and MBI before rehabilitation and on days 14and 30after rehabilitation.The incidence of complications and secondary disorders was recorded.Results The NIHSS score was significantly lower in two groups at 6hafter thrombolysis,before rehabilitation,and on days 14and 30after rehabilitation（P〈0.01）.The FMA,BBS and MBI scores were significantly higher in two groups on days 14and 30after treatment than before treatment（P〈0.01）.The NIHSS score was significantly lower while the FMA,BBS and MBI scores were significantly higher in treatment group than in control group on day 30after treatment（P〈0.05）.Shoulder pain was diagnosed in 1patient of treatment group while hypostatic pneumonia,postural hypotension,shoulder pain and shoulder-hand syndrome were diagnosed in 2patients,1patient,2patients and 1patient respectively of control group.The incidence of complications and secondary disorders was significantly lower in treatment group than in control group（4.0%vs 24.0%,P〈0.05）.Conclusion Intravenous thrombolysis combined with super early neurological rehabilitation can improve the neurological dysfunction,speed up the recovery of motor function,balance ability and

关 键 词：脑梗死 认知障碍 组织型纤溶酶原激活物 血栓溶解疗法 康复 

分 类 号：R743.3[医药卫生—神经病学与精神病学]