丰富康复训练对短暂性脑缺血发作患者双重任务下步态障碍的影响  

Enriched rehabilitation improves dual-task gait disorder after a transient ischemic attack

作　　者：王鑫 全逸峰 汤小佳 周洪雨 吕艺宸 施楠 严萍 王俊雅 Wang Xin;Quan Yifeng;Tang Xiaojia;Zhou Hongyu;Lyu Yicheng;Shi Nan;Yan Pin;Wang Junya(Department of Rehabilitation,Clinical Medical College,Yangzhou University,Yangzhou 225009,China)

机构地区：[1]扬州大学临床医学院康复医学科,扬州225001

出　　处：《中华物理医学与康复杂志》2022年第5期402-406,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：江苏省高层次卫生人才"六个一工程"拔尖人才项目(LGY2018027);江苏省人兽共患病学重点实验室护馨基金(HX2003);扬州市科技局国际科技合作项目(YZ2020201);江苏省卫健委科研项目(Z2020055)。

摘　　要：目的观察丰富康复训练对短暂性脑缺血发作(TIA)患者双重任务下步态障碍的影响并探讨其作用机制。方法采用随机数字表法将60例TIA患者分为观察组及对照组(每组30例), 同期选取健康体检者纳入健康组。干预期间2组患者均给予常规降压、改善脑功能药物治疗, 观察组患者在此基础上辅以丰富康复训练。于治疗前、治疗12周后分别对3组对象进行双重任务步行时步态测试、认知功能测试、事件相关电位P300检测及血清脑源性神经营养因子(BDNF)含量测定。结果治疗前2组TIA患者步态各参数、总体认知功能、执行注意功能、P300潜伏期及波幅、血清BDNF浓度等指标与健康组间差异均具有统计学意义(P<0.05), 观察组与对照组上述指标间差异均无统计学意义(P>0.05)。治疗后对照组患者上述疗效指标均较治疗前无显著变化(P>0.05), 观察组步态各参数、总体认知功能、执行注意功能、P300潜伏期[(334.08±17.32)ms]及波幅[(19.98±3.88)μV]、血清BDNF浓度[(17.31±2.11)ng/ml]均较治疗前及对照组明显改善(P<0.05)。结论丰富康复训练能提高TIA患者双重任务步行时步态测试成绩, 其作用机制可能与上调TIA患者血清中BDNF浓度及改善患者认知功能有关。Objective To observe the effect of enriched rehabilitation on dual-task gait disorder after a transient ischemic attack(TIA)and explore its mechanism.Methods Sixty TIA patients were randomly divided into a control group and an observation group,each of 30.Another 30 healthy counterparts were selected to form a healthy control group.All of the TIA patients were given routine medication to lower blood pressure and improve brain function,while the observation group was additionally provided with enriched rehabilitation training for 12 weeks.Before and after the intervention,the gait and cognitive functioning of all of the subjects were quantified and their event-related potentials(P300s)and serum brain-derived neurotrophic factor(BDNF)levels were also measured.Results Before the treatment there were significant differences between the TIA groups and healthy controls in all of the measurements,but there were no significant differences between the control and observation groups.After the treatment,no significant improvement was observed in any of the control group′s results,but there was significant improvement in the observation group′s gait parameters,cognitive functioning,average serum BDNF concentration and in the average latency and amplitude of its P300 signals.Conclusions Enriched rehabilitation can improve the gait of TIA patients,perhaps through increasing their serum BDNF concentration and improving their cognition.

关 键 词：丰富康复训练 短暂性脑缺血发作 步态障碍 认知功能 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]