摘要
目的 探讨规范的三级康复治疗对脑出血后上肢痉挛和上肢运动功能的影响.方法 将364例脑出血患者按随机数字表法分为对照组（181例）和康复组（183例）,康复组接受规范的三级康复治疗,包括早期床旁康复介入、恢复期在康复专科病房进行、后期定期康复家访指导;对照组未接受规范的三级康复治疗,仅予以康复指导,并定期随访.分别于入组时、入组后1、3和6个月时,对2组患者患侧上肢进行改良Ashworth量表（MAS）评定和简化Fugl-Meyer运动功能（上肢部分）评定,并进行统计学分析比较.结果 入组时,对照组和康复组患者肌肉痉挛的发生率分别为22.7％和23.5％;入组后6个月,对照组和康复组痉挛发生率分别为59.7％和43.2％,且对照组处于MAS 1＋级和2级患者数量（50/181）明显高于康复组（25/183）.无论在哪个阶段,2组MAS 0级患者数量均占很大比例.入组后6个月,2组患者的MAS分布和评分比较,差异均有统计学意义（P＜0.01）.2组患者的Fugl-Meyer评分均随时间的推移逐渐明显提高（P＜0.01）;入组后1、3和6个月时,康复组Fugl-Meyer评分分别为（24.71±19.80）、（39.83±19.50）和（48.87±18.25）分,对照组分别为（17.13±16.46）、（24.87±18.36）和（30.68±19.41）分,康复组各时间点评分均高于同时间点对照组（P＜0.01）.结论 规范的三级康复治疗有助于减轻脑出血后患者的上肢痉挛程度和改善上肢运动功能.
Objective To evaluate the effectiveness of standardized three-stage rehabilitation program on spasticity and motor function in the upper extremities after cerebral hemorrhage.Methods A total of 364 patients were included and randomly assigned to a control group （n =181） and a rehabilitation group （n =183）.The standardized three-stage rehabilitation program,which included early-stage bedside rehabilitation,specialized treatment in rehabilitation ward during recovery and rehabilitation follow-up at regular intervals was applied in the rehabilitation group,but only rehabilitation guidance and follow-up after discharge were provided for the control group.The modified Ashworth scale （MAS） and Fugl-Meyer assessment （FMA） were performed at the time of recruitment,1 month （M1）,3 months（M3） and 6 months（M6） later.Results There was no statistical difference between the groups at recruitment.The occurrence rate of spasticity was 22.7％ in the control and 23.5％ in the rehabilitation group.At M6 the occurrence rate of spasticity was about 59.7％ and 43.2％ in control group and rehabilitation group respectively,and the number of patients grade 1 ＋ and grade 2 on the MAS was 50/181 in the control group,significantly more than in the rehabilitation group （25/183）.At all time points,MAS grade 0 accounted for a large proportion of both groups.At M6,both MAS distributions and scores of the two groups were different statistically （P ＜ 0.01）.FMA scores in both groups increased significantly （P ＜ 0.01） with time,with the score being （17.13 ± 16.46）,（24.87±18.36）,（30.68±19.41） at M1,M3 and M6 in the control group and （24.71 ±19.80）,（39.83 ± 19.50）,（48.87 ± 18.25） in the rehabilitation group,but the average scores of the latter were consistently significantly higher than the former （P ＜ 0.01）.Conclusions Standardized three-stage rehabilitation can alleviate spasticity and improve motor function of the upper extremities in cerebral hemorrhage patients.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2014年第11期828-831,共4页
Chinese Journal of Physical Medicine and Rehabilitation
基金
国家科委＂十五＂攻关课题资助项目（2001BA703B21）
上海市科委自然基金（12ZR1404000）
上海市卫生局项目（20134124）
关键词
脑出血
痉挛
运动功能
上肢
三级康复
Cerebral hemorrhage
Spasticity
Motor function
Three-stage rehabilitation
