脑卒中后肌痉挛的发生率及危险因素调查研究

发布时间：2018-06-29 12:22

本文选题：危险因素 + 痉挛　；参考：《福建中医药大学》2016年硕士论文

【摘要】：目的：通过对脑卒中患者肌痉挛的发生情况进行调查,探讨卒中后痉挛的发生率及其可能的危险因素,为临床脑卒中后痉挛的预防和早期治疗提供理论参考,从而减轻痉挛所造成的功能障碍,降低脑卒中患者的致残率,提高患者的生活质量。方法：通过查阅文献并结合专家、临床医生意见,自制脑卒中后肌痉挛发病情况调查表,并以此对2014年2月至2015年5月于福建中医药大学附属康复医院首次住院诊治的1228例脑卒中患者进行数据收集。根据改良Asworth量表(Modified Ashworth Scale, MAS)评分结果分为痉挛组和无痉挛组,选取性别、年龄、文化程度、职业；卒中次数、卒中类型、偏瘫侧、病程、相关颅内手术、既往病史、疼痛、偏身感觉减退、病变部位、病变大小、日常生活活动指数、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分共16个因素进行资料采集。以肌张力分级为应变量,以上述16个因素作为自变量进行单因素分析筛选出卒中后痉挛的影响因素,最后再将筛选出的因素行多因素Logistic逐步回归分析以确定卒中后痉挛的独立危险因素。结果：本次试验共纳入702例脑卒中患者,发生痉挛者共303例,卒中后痉挛的发生率为43.2%。其中,轻度痉挛(MAS=1或1+级)的发生率为26.2%,中度痉挛(MAS=2级)的发生率为12.0%,重度痉挛(MAS≥3级)的发生率为5.0%。通过单因素分析,本次研究发现性别、年龄、卒中次数、卒中类型、偏瘫侧、卒中病程、相关颅内手术、疼痛、偏身感觉减退、病变大小及NIHSS评分共11个因素影响卒中后痉挛的发生(P0.05)。通过多因素Logistic逐步回归分析,本次研究发现性别、年龄、卒中病程、疼痛、偏身感觉减退和NIHSS评分6个因素最终进入回归方程。其中,相对男性脑卒中患者,女性脑卒中患者(OR=0.631)的发生率更低；相对39岁及以下的脑卒中患者,随着年龄的递增,卒中后痉挛的发生率越低(40-49岁、50-59岁、60-69岁、70-79岁和80岁以上的OR值分别是0.761、0.697、0.492、0.525和0.241)；相对急性期(1个月以内)的脑卒中患者,随着卒中病程的进展,卒中后痉挛的发生率越高(亚急性期(1-3月)、恢复期(3-6个月)和后遗症期(6个月以上)的OR值分别是1.137、1.599和1.981)；相对无疼痛的脑卒中患者,伴有卒中相关性疼痛的脑卒中患者(OR=2.278)的痉挛发生率更高；相对无偏身感觉减退的脑卒中患者,伴有偏身感觉减退的脑卒中患者(OR=2.364)的痉挛发生率更高；相对NIHSS≤4的脑卒中患者,NIHSS评分越高的脑卒中患者痉挛的发生率越高(NIHSS得分为5-8、9-11和≥12的OR值分别是1.053、1.706和2.147)。结论：卒中后痉挛是多因素影响所致的致残性并发症,影响卒中后痉挛发生的预测因子包括：性别、年龄、卒中病程、疼痛、偏身感觉减退和NIHSS评分。其中男性、年轻、卒中病程长、伴有疼痛、偏身感觉减退及NIHSS评分高是卒中后痉挛的发生的危险因素。临床上,应重视卒中后痉挛预防,特别是对痉挛高危人群的健康宣教、解除痉挛诱发因素、应用抗痉挛姿势和早期抗痉挛治疗,以减少脑卒中后痉挛的发生及进一步加重。
[Abstract]:Objective: To investigate the incidence of spasticity in stroke patients and explore the incidence of post-stroke spasticity and its possible risk factors to provide theoretical reference for the prevention and early treatment of post-stroke spasticity, so as to reduce the dysfunction caused by spasticity, reduce the disability rate of stroke patients and improve the life of patients. Methods: 1228 cases of stroke patients who were first hospitalized in the affiliated rehabilitation hospital of Fujian University of traditional Chinese medicine from February 2014 to May 2015 were collected by consulting the literature and combining with the experts, the opinions of the clinicians and self-made questionnaire on the onset of muscle spasticity after stroke. According to the modified Asworth scale (Modified Ashwo) RTH Scale, MAS) scores were divided into spastic group and no spasticity group. Sex, age, education level, occupation; stroke number, stroke type, hemiplegic side, course of disease, related intracranial surgery, previous history, pain, partial hypothyroidism, lesion location, disease, daily living index, National Institutes of Health Stroke scale (Nationa) L Institute of Health Stroke Scale, NIHSS) score a total of 16 factors to collect data. Using the muscular tension classification as the strain, the factors that affect post stroke spasticity were screened out with the above 16 factors as independent variables. Finally, the selected factors were analyzed by the stepwise regression analysis of multifactorin Logistic to determine post stroke spasms. Results: 702 cases of cerebral apoplexy were included in this trial. There were 303 cases of spasticity in 702 cases. The incidence of spasticity after stroke was 43.2%., the incidence of mild spasticity (MAS=1 or 1+) was 26.2%, the incidence of moderate spasticity (MAS=2) was 12%, and the incidence of severe spasm (MAS > 3) was 5.0%. through single factor. This study found that sex, age, stroke number, stroke type, hemiplegic side, stroke course, related intracranial surgery, pain, hyposensation, lesion size, and NIHSS score were 11 factors affecting poststroke spasticity (P0.05). This study found sex, age, stroke course, pain, and pain through multiple factor Logistic regression analysis. The 6 factors of pain, hyposensation and NIHSS score finally entered the regression equation. Among them, the incidence of stroke patients (OR=0.631) was lower than that in male stroke patients and stroke patients (OR=0.631); the incidence of post-stroke spasmodic onset was lower (40-49, 50-59, 60-69, 70-79 and 80 years) with the increase of age and age. The OR values were 0.761,0.697,0.492,0.525 and 0.241 respectively; stroke patients in the relative acute period (1 months) had higher incidence of post-stroke spasticity (subacute (1-3 months), 3-6 months) and sequelae (more than 6 months) with OR values of 1.137,1.599 and 1.981, respectively, and relatively pain free brain. Stroke patients, cerebral apoplexy (OR=2.278) with stroke associated pain (OR=2.278) had a higher incidence of spasticity; stroke patients with unbiased apoplexy, with stroke patients with Apoplexy (OR=2.364) had a higher incidence of spasticity, and stroke patients with higher NIHSS scores compared with NIHSS less than 4 of stroke patients had spasticity in stroke patients. The higher the incidence of NIHSS (the OR value of 5-8,9-11 and > 12 is 1.053,1.706 and 2.147). Conclusion: post stroke spasticity is a residual complication caused by multiple factors. Predictors of post-stroke spasticity include sex, age, stroke, pain, hyposensation, and NIHSS score. Long course of disease, pain, hyposensation, and high NIHSS score are risk factors for spasticity after stroke. Clinically, attention should be paid to post stroke spasmodic prevention, especially for health education in high-risk groups of spasm, relieving spasmodic triggers, using antispasmodic postures and early anti spasmodic treatment to reduce the incidence of post-stroke spasticity and Further aggravation.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3;R49

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