急性脑卒中患者辅助步态的影响因素及预测模型分析  

The analysis of influencing factors and prediction model of gait with physical assistance in patients with acute stroke

作　　者：范崇桂[1] 王云香[1] 张保朝[1] 付国惠[1] 闪海霞[1] 裴东超 张燕平 Fan Chonggui;Wang Yunxiang;Zhang Baochao(Department of Neurology,Nanyang Central Hospital,Nanyang Henan 473000)

机构地区：[1]河南省南阳市中心医院神经内科,473000

出　　处：《卒中与神经疾病》2021年第1期62-66,共5页Stroke and Nervous Diseases

基　　金：肾虚血瘀型偏头痛与脑白质损伤的相关性研究(编号为2017zy2042)。

摘　　要：目的探讨急性脑卒中患者辅助步态的影响因素,并建立预测模型。方法以2017年4月-2019年4月经本医院收治的首次发病的急性脑卒中患者作为研究对象,采用功能性步行(Functional ambulation category,FAC)量表对恢复早期患者的步行能力进行评估,其中FAC≥3分为不需要辅助行走,FAC<3分为需要辅助行走,即辅助步态;根据FAC评估分组后对2组患者的人口学资料及入院时临床资料进行单因素分析,对具有显著差异的因素进行二元Logistic逐步回归,将影响步态辅助的因素作为预测因子,通过绘制ROC曲线图对预测价值进行分析。结果 82例患者中出院时可独立行走(FAC≥3分)42例,步态辅助(FAC<3分)40例;与独立行走组比较,步态辅助组患者年龄增加,脑卒中至康复开始时间延长,入院时FM评分高,入院时FAC评分低(P<0.05);经二元Logistic逐步回归分析显示,年龄、脑卒中至康复开始时间以及入院时FM评分是影响脑卒中后步态辅助的风险因子(P<0.05);通过绘制ROC曲线显示,年龄、脑卒中至康复时间以及初始FM评分均可预测脑卒中后步态辅助,当年龄≥62.05岁、脑卒中至康复时间≥29.48 d或初始FM评分≥9.13分时卒中步态辅助的风险最高,而三项风险因子联合预测灵敏性、特异性均较单一因子预测增加,分别可达97.50%、90.05%,为最佳预测模型。结论综合评估急性脑卒中患者入院时年龄、FM评分并及早地给予康复治疗可为脑卒中患者早期的步行恢复提供准确的判断,以此为依据制定治疗和康复方案可能有助于改善脑卒中患者早期的步行恢复,合理计划院内治疗周期。Objective To explore the influencing factors of gait with physical assistance in patients with acute stroke and establish a prediction model.Methods 82 cases of acute stroke patients admitted to Hospital from April 2017 to April 2019 were selected as research objects, and Functional ambulation category(FAC) was used to evaluate the walking ability of early recovering patients. FAC≥3 points showed the patients could walk without physical assistance, and FAC<3 points showed patients could independent walking. After grouping according to the FAC evaluation, the demographic data and clinical data at admission of the two groups of patients were analyzed by single factor analysis, and the factors with significant differences were analyzed by binary logistic stepwise regression. The factors affecting gait assistance were taken as predictive factors, and the predictive value was analyzed by drawing ROC curve.Results Among the 82 patients, 42 were able to walk independently(FAC≥3 points) and 40 were walking with physical assistance(FAC<3 points). Compared with the independent walking group, patients in the gait assisted group had increased age, prolonged stroke to the beginning of rehabilitation, high FM score at admission, and low FAC score at admission(P<0.05). According to binary logistic stepwise regression analysis, age, stroke to the beginning of rehabilitation and FM score at admission were risk factors influencing poststroke gait assistance(P<0.05). By drawing ROC curves, age, stroke to recovery time and initial FM score could all predict poststroke gait assistance. The risk of stroke gait assistance was highest when age ≥62.05 years old, stroke to recovery time ≥29.48 days, or initial FM score ≥9.13 points. The sensitivity and specificity of combined prediction of the three risk factors were increased compared with that of the single factor, the sensitivity and specificity were respectively 97.50% and 90.05%, which were the best prediction models. Conclusion Comprehensive assessment of age, FM score at

关 键 词：脑卒中 步态 辅助 预测模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]