心理干预联合早期综合康复疗法用于脑梗死的效果观察  

Effects of psychotherapy combined with early comprehensive rehabilitation therapy on cerebral infarction

作　　者：庞学明 叶亮[1] 李嘉伟[1] 赵博 卢晓东[2] Pang Xueming;Ye Liang;Li Jiawei;Zhao Bo;Lu Xiaodong(Department of Neurology,Yuhang Fifth People's Hospital,Hangzhou 311100,Zhejiang Province,China;Department of Neurology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]杭州市余杭区第五人民医院神经内科,311100 [2]杭州师范大学附属医院神经内科,310000

出　　处：《中国基层医药》2021年第7期978-982,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省中医药科技计划项目(2019ZB112)。

摘　　要：目的观察心理干预联合早期综合康复疗法用于急性脑梗死的临床效果,并初步探讨其作用机制。方法选取杭州市余杭区第五人民医院2018年6月至2020年2月收治的急性脑梗死患者84例为观察对象,采用随机数字表法分为观察组(44例)和对照组(40例)。对照组采用常规治疗,观察组在常规治疗基础上进行早期综合康复治疗联合心理干预,干预1个月后,比较两组患者临床疗效及血清高度糖基化的i型跨膜糖蛋白阳性细胞与血管内皮生长因子受体2阳性细胞(CD34+KDR+)占单核细胞百分比、血清基质细胞衍生因子1(SDF-1α)含量。结果治疗后,观察组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和美国国立卫生研究院卒中量表(NIHSS)评分分别为(16.4±3.8)分、(17.9±5.2)分和(3.56±0.46)分,均低于对照组的(23.4±5.6)分、(23.7±6.4)分和(5.39±0.87)分(t=7.896、7.258、6.935,均P<0.05);观察组Barthel指数(BI指数)、Fugl-Meyer评分(FMA)和功能独立性测评得分(FIM)分别为(79.7±20.8)分、(54.6±17.2)分和(96.8±8.5)分,均高于对照组的(60.4±17.6)分、(39.6±14.8)分和(83.1±9.7)分(t=8.123、7.251、8.009,均P<0.05);治疗后观察组CD34+KDR+占单核细胞百分比、SDF-1α分别为(1.58±0.19)%和(1.84±0.11)μg/L,均高于对照组的(0.73±0.20)%和(1.34±0.09)μg/L(t=7.125、6.983,均P<0.05)。结论在常规治疗基础上,心理干预联合早期综合康复疗法可提高急性脑梗死患者的临床疗效,其机制可能与增加CD34+KDR+占单核细胞百分比、SDF-1α含量有关。Objective To investigate the clinical efficacy of psychotherapy combined with early comprehensive rehabilitation therapy in the treatment of acute cerebral infarction and the possible mechanism of action.Methods Eighty-four patients with acute cerebral infarction who received treatment in Yuhang Fifth People's Hospital,China between June 2018 and February 2020 were included in this study.They were randomly divided into an observation group(n=44)and a control group(n=40).The control group was treated with conventional therapy.The observation group was subjected to early comprehensive rehabilitation therapy combined with psychotherapy based on conventional therapy.All patients were treated for 1 month.Clinical efficacy,the percentage of highly glycosylated type I transmembrane glycoprotein-positive cells and vascular endothelial growth factor receptor-2-positive cells(CD34+KDR+)in monocytes,and serum level of stromal cell-derived factor-1αwere compared between the observation and control groups.Results After treatment,the scores of Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and National Institutes of Health Stroke Scale(NIHSS)were(16.4±3.8)points,(17.9±5.2)points,(3.56±0.46)points,respectively,which were significantly lower than those in the control group[(23.4±5.6)points,(23.7±6.4)points,(5.39±0.87)points,t=7.896,7.258,6.935,all P<0.05].Barthel Index,Fugl-Meyer score,and Functional Independence Score in the observation group were(79.7±20.8)points,(54.6±17.2)points,(96.8±8.5)points,respectively,which were significantly higher than those in the control group[(60.4±17.6)points,(39.6±14.8)points,(83.1±9.7)points,t=8.123,7.251,8.009,all P<0.05].After treatment,the percentage of CD34+KDR+in monocytes and serum level of stromal cell-derived factor-1αin the observation group were(1.58±0.19)%and(1.84±0.11)μg/L,respectively,which were significantly higher than those in the control group[(0.73±0.20)%and(1.34±0.09)μg/L,t=7.125,6.983,both P<0.05).Conclusion Based on conventional treatment,p

关 键 词：脑梗死 心理疗法 康复 单核细胞 蛋白质转运 血管内皮生长因子受体2 基质细胞衍生因子 表现焦虑量表 抑郁 治疗结果 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]