摘要
目的探索规范的三级康复治疗对于脑卒中偏瘫患者认知功能的影响。方法采用大样本、多中心、前瞻性的随机对照研究方法。各分中心分别随机入选患者,各分中心患者在脑梗死和脑出血两个层次上区组随机化地纳入到康复组和对照组,康复组688例,对照组677例,共计1 365例,康复组患者予以规范的三级康复治疗,对照组不予以规范的3组康复治疗,但是一般的神经内科常规诊疗同康复组,分别于入选时、发病后第1个月末、第3个月末和第6个月末采用功能综合评定量表认知项评分标准进行评测。结果入选时脑梗死组或脑出血组患者认知功能分布情况康复组和对照组不存在明显差别,但是入选后各阶段两组之间存在明显的差别。患者入选后不论是脑梗死康复组,脑出血康复组,或是整个康复组患者认知功能测评积分明显优于对照组(P<0.01)。康复组患者入选后各阶段的认知功能改善值明显优于对照组(P<0.01)。6个月随访治疗后,脑梗死康复组、脑出血康复组和整个康复组认知功能分别改善了4.34分、6.34分和4.89分,而对照组分别改善了2.53分、4.27分和2.99分。即和对照组相比,脑梗死康复组则多改善1.81分,脑出血康复组多改善2.07分,整个康复组多改善1.90分。此外,从各阶段患者认知功能变化的线图上可以看出,康复组在入选后各阶段的积分明显优于对照组,积分增长的趋势明显快于对照组,早期尤为明显。结论规范三级康复治疗对于脑卒中患者各阶段认知功能的提高具有明显的促进作用。
Purpose To investigate the effect of standardized tertiary rehabilitation（STR） on the cognitive function in patients with cerebral stroke accompanied by hemiplegia. Methods One thousand three hundred and sixty-five subjects were enrolled sequentially from 22 hospitals across the country, but stabilized in vital life signs in the past week. They were classified into two groups of cerebral infarction and hemorrhage while being enrolled, and then randomly subdivided into two groups of test and control; the former was composed of 688 cases, and the latter, 677. Those in the test group were administered STR in addition to routine interventions of neurological medicine, while those in the con- trol group were only given the routine ones. All patients were assessed with the cognitive section＇s evaluation standard of the scale of Functional Comprehensive Assessment（FCA） at the time of the en-rollment, at the end of the 1st, 3rd and 6th month after the stroke, respectively. The evaluation was blind on the part of the physician. Results There was no significant difference between the two groups in the distribution of the scores at the entering point. At each post-stroke checking point, however, the differences in the distribution of scores between the two groups were significant. At each of the following post-stroke checkpoints, however, the scores of the functions in the cerebral infarction or hemorrhage test group, or in the whole test group were higher than those in the control（P〈0.01）. At the end of 6 th month, the scores went up by 4.34, 6.34 and 4. 89 in the test groups respectively, while in the control groups they increased by 2.53, 4.27 and 2.99 correspondingly. In other words, according to the control group, the test group scores went up by 1.81, 2.07 or 1.90. Furthermore, the trend of cognitive function increase moved faster in the test groups than in the control ones, especially at the early stages. Conclusions Standardized tertiary rehabilitation could significantly improve the cognitive function in the patients with cerebral strokes accompanied by hemiplegia.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2007年第1期6-11,共6页
Fudan University Journal of Medical Sciences
基金
国家科委"十五"攻关课题[2001BA703B18(A)]
关键词
脑卒中
三级康复治疗
认知功能
综合功能评定量表
stroke
standardized tertiary rehabilitation
cognitive function
the scale of functional comprehensive assessment
