静脉溶栓后早期康复治疗对急性脑梗死患者肢体运动功能的效果研究
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摘要
目的分析静脉溶栓(IVT)后早期康复治疗对急性脑梗死(ACI)患者肢体运动功能的影响。方法将南阳南石医院60例ACI患者随机分为对照组(30例)给予常规治疗和IVT治疗,研究组(30例)在IVT后24h内采取早期康复训练治疗,时间为2周。比较两组患者治疗前、治疗后2周及3个月时Barthel指数、Fugl-Meyer运动功能(FMA)、患肢关节改良Ashworth分级(MAS)、改良Rankin评分及并发症的发生情况。结果两组治疗后2周和3个月时Barthel指数与FMA量表评分较治疗前均明显升高(P<0. 05),研究组评分明显高于对照组(P<0. 05)。两组治疗后2周和3个月时患肢关节MAS量表和改良Rankin量表评分较治疗前均明显降低(P<0. 05),研究组较对照组均明显降低(P<0. 05)。研究组脑出血、肺感染总发生率明显低于对照组(P<0. 05)。结论 ACI患者早期康复训练治疗能够明显改善其肢体运动功能,缓解肌张力,明显降低脑出血、肺感染的发生率,有助于改善患者临床疗效,促进日常生活活动能力的提高。
Objective To analyze the effect of early rehabilitation after intravenous thrombolysis on limb motor function in patients with acute cerebral infarction.Methods 60 cases of ACI were randomly divided into control group( 30 cases) and research group( 30 cases).The control group Was given routine treatment and IVT treatment and the research group underwent early rehabilitation treatment within 24 h after IVT,with the time of 2 weeks.The Barthel index,Fugl-Meyer motor function( FMA),modified Ashworth grade( MAS),modified Rankin score before treatment,2 weeks and 3 months after treatment and the incidence of complications were compared between the two groups.Results The Barthel index and FMA score of the two groups after 2 weeks and 3 months were significantly higher than those before treatment( P <0. 05),and those scores in the research group were significantly increased in comparison of the control group( P< 0. 05). The MAS and modified Rankin scale scores of the two groups after 2 weeks and 3 months were significantly lower than those before treatment( P<0. 05),and those scores in the research group were significantly decreased in comparison of the control group( P<0. 05).The total rate of cerebral hemorrhage,pulmonary infection in the research group( 3.33%) was significantly lower than that of the control group( 16.67%)( P < 0. 05). Conclusion Starting rehabilitation treatment within 24 h after IVT treatment can significantly improve the limb motor function in patients with ACI,relieve muscle tension and reduce the incidence rate of cerebral hemorrhage and pulmonary infection,which can help to improve clinical effect,promote the activities of daily living ability and improve the quality of life,so it is worthy of clinical promotion and application.
Objective To analyze the effect of early rehabilitation after intravenous thrombolysis on limb motor function in patients with acute cerebral infarction.Methods 60 cases of ACI were randomly divided into control group( 30 cases) and research group( 30 cases).The control group Was given routine treatment and IVT treatment and the research group underwent early rehabilitation treatment within 24 h after IVT,with the time of 2 weeks.The Barthel index,Fugl-Meyer motor function( FMA),modified Ashworth grade( MAS),modified Rankin score before treatment,2 weeks and 3 months after treatment and the incidence of complications were compared between the two groups.Results The Barthel index and FMA score of the two groups after 2 weeks and 3 months were significantly higher than those before treatment( P <0. 05),and those scores in the research group were significantly increased in comparison of the control group( P< 0. 05). The MAS and modified Rankin scale scores of the two groups after 2 weeks and 3 months were significantly lower than those before treatment( P<0. 05),and those scores in the research group were significantly decreased in comparison of the control group( P<0. 05).The total rate of cerebral hemorrhage,pulmonary infection in the research group( 3.33%) was significantly lower than that of the control group( 16.67%)( P < 0. 05). Conclusion Starting rehabilitation treatment within 24 h after IVT treatment can significantly improve the limb motor function in patients with ACI,relieve muscle tension and reduce the incidence rate of cerebral hemorrhage and pulmonary infection,which can help to improve clinical effect,promote the activities of daily living ability and improve the quality of life,so it is worthy of clinical promotion and application.
引文
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[12] Ye L,Cai R,Yang M,et al.Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra? early thrombolytic therapy[J]. Exp Ther Med,2015,10(4):1 493-1 498.
[13]吴运景,刘晓霞,韩丽雅,等.早期康复干预对急性脑梗死溶栓患者运动功能的影响[J].中华物理医学与康复杂志,2016,38(5):362-363.
[14]方青,吴霞.健康教育及早期康复训练对脑梗死患者康复的疗效观察[J].中国基层医药,2015,(15):2 384-2 386.
[15] Pantoni L,Fierini F,Poggesi A. Thrombolysis in acute stroke patients with cerebral small vessel disease[J].Cerebrovasc Dis,2014,37(1):5-13.
[16] Yan Z,Yu T,Wang Y,et al.Literature review and case report of intravenous thrombolysis in acute cerebral infarction attributed to cervical arterial dissection[J]. J Stroke Cerebrovasc Dis,2015,24(9):e265-e269.
[17]郑娅.早期康复训练对急性脑梗死患者运动功能的影响[J].中国基层医药,2013,20(20):3 187-3 188.
[18] Tsivgoulis G,Zand R,Katsanos AH,et al.Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden:a meta-analysis[J]. JAMA Neurol,2016,73(6):675-683.
[2] Aaron S,Arthur A,Prabakhar AT,et al.Spectrum of visual impairment in cerebral venous thrombosis:Importance of tailoring therapies based on pathophysiology[J].Ann Indian Acad Neurol,2017,20(3):294-301.
[3]许向荣.早期康复训练对急性脑梗死患者肢体运动功能的影响[J].实用临床医药杂志,2016,20(14):14-16.
[4]张晓英.早期康复训练与延迟活动在急性脑梗死患者神经功能能力恢复中的差异性[J].检验医学与临床,2017,14(1):133-135.
[5] Naess H,Kurtz M,Thomassen L,et al. Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
[6] Wang J,Ning R,Wang Y. Plasma D-dimer level,the promising prognostic biomarker for the acute cerebral infarction patients[J]. J Stroke Cerebrovasc Dis,2016,25(8):2 011-2 015.
[7] Ahmed N,Kellert L,Lees KR,et al.Results of intravenous thrombolysis within 4. 5 to 6 hours and updated results within 3 to 4.5 hours of onset of acute ischemic stroke recorded in the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis Register(SITS-ISTR):an observational study[J]. JAMA Neurol,2013,70(7)837-844.
[8] Emberson J,Lees KR,Lyden P,et al.Effect of treatment delay,age,and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke:a meta-analysis of individual patient data from randomised trials[J].Lancet,2014,384(9958):1 929-1 935.
[9]庾建英,杨雪荣,刘继新,等.不同部位急性脑梗死康复治疗的效果[J].中国老年学杂志,2016,36(14):3 438-3 440.
[10]黄俊文,原花丽.康复护理在急性脑梗死患者肢体功能恢复中的作用[J].中国基层医药,2012,19(22):3 504-3 505.
[11]钱一鸣.早期认知训练对脑梗死伴认知功能障碍患者康复训练的临床效果[J].湖北民族学院学报(医学版),2018,35(4):32-34,38.
[12] Ye L,Cai R,Yang M,et al.Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra? early thrombolytic therapy[J]. Exp Ther Med,2015,10(4):1 493-1 498.
[13]吴运景,刘晓霞,韩丽雅,等.早期康复干预对急性脑梗死溶栓患者运动功能的影响[J].中华物理医学与康复杂志,2016,38(5):362-363.
[14]方青,吴霞.健康教育及早期康复训练对脑梗死患者康复的疗效观察[J].中国基层医药,2015,(15):2 384-2 386.
[15] Pantoni L,Fierini F,Poggesi A. Thrombolysis in acute stroke patients with cerebral small vessel disease[J].Cerebrovasc Dis,2014,37(1):5-13.
[16] Yan Z,Yu T,Wang Y,et al.Literature review and case report of intravenous thrombolysis in acute cerebral infarction attributed to cervical arterial dissection[J]. J Stroke Cerebrovasc Dis,2015,24(9):e265-e269.
[17]郑娅.早期康复训练对急性脑梗死患者运动功能的影响[J].中国基层医药,2013,20(20):3 187-3 188.
[18] Tsivgoulis G,Zand R,Katsanos AH,et al.Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden:a meta-analysis[J]. JAMA Neurol,2016,73(6):675-683.