不同神经功能缺损程度老年急性缺血性脑卒中患者早期活动现状及分析  

Analysis on early mobilization of acute ischemic stroke patients with different degrees of neurological impairment

作　　者：汤观秀[1] 颜萍平[1] 雷俊[1] 曾晖[1] 刘倩 张秋香[1] 易灿文 Tang Guanxiu;Yan Pingping;Lei Jun;Zeng Hui;Liu Qian;Zhang Qiuxiang;Yi Canwen(Department of Geriatrics,The Third Xiangya Hospital,Central South University,Changsha 410013,China;Geriatric Department,The Third Hospital of Changsha,Changsha 410015,China)

机构地区：[1]中南大学湘雅三医院老年病科,长沙410013 [2]长沙市第三医院老年医学科,长沙410015

出　　处：《中华老年医学杂志》2023年第9期1029-1034,共6页Chinese Journal of Geriatrics

基　　金：湖南省自然科学基金(2021JJ40945)。

摘　　要：目的了解老年急性缺血性脑卒中患者的早期活动现状,并分析不同神经功能缺损程度患者早期活动的影响因素,为促进脑卒中患者早期活动、制定干预策略提供参考依据。方法选取2021年1-12月在长沙市两所三级甲等医院卒中中心就诊的老年急性缺血性脑卒中患者,于患者入院24 h内行神经功能缺损程度评估、日常生活活动能力及肌力评定,并记录患者早期活动情况。根据是否在入院48 h内进行床边坐位、床椅转移、床边站立、行走训练等离床活动,将患者分为早期活动组和非早期活动组,进一步采用单因素分析和Logistic回归分析比较轻中度神经功能缺损程度患者早期活动的影响因素。结果257例老年急性缺血性脑卒中患者中,60.7%(156例)患者完成早期活动;其中中度神经功能缺损患者早期活动实施率仅为12.9%(12/93),低于轻度神经功能缺损的患者(87.8%、144/164)(χ^(2)=139.571、P<0.001)。单因素分析结果显示,中度神经功能缺损的早期活动组和非早期活动组患者在日常生活活动能力、脑卒中史、患侧上肢肌力、患侧下肢肌力方面差异均有统计学意义(均P<0.05),轻度神经功能缺损患者的早期活动组和非早期活动组患者仅在日常生活活动能力方面差异有统计学意义(χ^(2)=11.907,P<0.001);Logistic回归分析结果显示,日常生活活动能力需要协助(OR=4.189、95%CI:1.724~10.668,P=0.002)、患侧下肢肌力≤3级(OR=9.605,95%CI:2.627~35.113,P=0.001)和中度神经功能缺损(OR=8.585,95%CI:3.216~22.913,P<0.001)是老年急性缺血性脑卒中患者早期活动的危险因素。结论中度神经功能缺损的急性缺血性脑卒中患者入院48 h内早期活动实施率低,日常生活活动能力、患侧下肢肌力和神经功能缺损程度是老年急性缺血性脑卒中患者早期活动的主要影响因素。Objective To understand the current situation of early mobilization in elder patients with acute ischemic stroke,and to analyze the influencing factors of early mobilization in patients with different degrees of neurological deficits,aiming to provide evidence for promoting early mobilization in patients with stroke and for formulating intervention strategies.Methods Patients with acute ischemic stroke admitted to the stroke centers of two class A tertiary hospitals in Hunan Province between January and December 2021 were enrolled.The degree of neurological impairment,activities of daily living and muscle strength were evaluated within 24 hours after admission,and patients'performance of early mobilization was recorded.Based on whether patients performed out-of-bed activities such as sitting at the bedside,standing or walking,transferring from bed to chair within 48 hours after admission,they were divided into an early ambulation group and a non-early ambulation group.Univariate analysis and Logistic regression analysis were then used to examine the influencing factors of early ambulation in patients with mild to moderate neurological deficits.Results Among 257 patients with acute ischemic stroke,60.7%(156 cases)conducted early mobilization.The rate of early mobilization for patients with moderate neurological deficits was only 12.9%(12/193),significantly lower than that for patients with mild neurological deficits(87.8%,144/164)(χ^(2)=139.571,P<0.001).Univariate analysis showed that there were significantly differences in the level of activities of daily living,stroke history,strength of the upper and lower limbs of the affected side between the early and non-early ambulation groups with moderate neurological impairment(all P<0.05),and there were significant differences in the level of activities of daily living between the early ambulation group and the non-early ambulation group in patients with mild neurological impairment(χ^(2)=11.907,P<0.001).Logistic regression analysis showed that requiring assistance i

关 键 词：卒中 早日下床活动 神经功能缺损 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]