规范三级康复治疗对脑卒中患者功能恢复影响的临床研究

发布时间：2018-05-17 00:46

本文选题：脑卒中 + 运动功能障碍　；参考：《复旦大学》2014年博士论文

【摘要】：第一部分规范三级康复治疗对脑卒中患者运动功能的影响目的探讨规范的三级康复治疗对脑卒中患者运动功能恢复的影响。方法259名脑卒中患者随机分组为规范康复治疗组和非规范康复治疗组,用简化Fugl-Meyer运动功能评分法(simplified Fugl-Meyer assessment, FMA), Brunnstrom分期评定(Brunnstrom motor function assessment),改良Ashworth分级(modified Ashworth scale, MAS)分别在入组即时,治疗后1,2,3,6个月进行评定,并于评估和治疗结束后12个月进行随访评估。其中Brunnstrom分期评定包括对肩、手和下肢的分别评分,改良Ashworth分级包括对肱二头肌、股四头肌的分别评定,并进行统计学分析。结果规范三级康复治疗组和非规范康复治疗组在入组时的一般情况及FMA评分、Brunnstrom分期、改良Ashworth评级等均无统计学差异。在治疗2月、治疗3月、治疗6月、随访1年时,两组的FMA评分、上肢Brunnstrom分期、下肢Brunnstrom分期、肱二头肌改良Ashworth评级及股四头肌改良Ashworth评级均随着时间的推进而逐渐改善。规范三级康复治疗组在治疗2月、治疗3月、治疗6月、随访1年时的FMA评分、下肢Brunnstrom分期及下肢肌(股四头肌)改良Ashworth评级均高于非规范康复治疗组,组间差异具有统计学意义(P0.05)。而规范三级康复治疗组和非规范康复治疗组在治疗2月、治疗3月、治疗6月、随访1年时的肩关节Brunnstrom分期、手Brunnstrom分期及上肱二头肌改良Ashworth评级均无统计学差异。结论与非规范康复治疗相比,规范的三级康复治疗更有利于患者肢体运动功能障碍的恢复。第二部分规范三级康复治疗对脑卒中患者认知功能的影响目的探讨规范的三级康复治疗对脑卒中患者认知功能恢复的影响。方法259名脑卒中患者随机分组为规范康复治疗组和非规范康复治疗组,使用简明精神智能状态检查量表(mini mental state examination, MMSE)在入组即时,治疗后1,2,3,6个月进行评定,以及在治疗结束12个月时进行随访评估。结果规范三级康复治疗组和非规范康复治疗组随着治疗时间的推进,在治疗后1,2,3,6个月进行评定,以及在治疗结束12个月,MMSE评分均有明显增加的趋势(P0.05)。但是规范三级康复治疗组和非规范康复治疗组之间各个时间点的评分均无统计学差异。结论本研究没有明确证据表明规范三级康复治疗在改善认知方面优于非规范康复治疗。第三部分规范三级康复治疗对脑卒中患者日常生活活动能力和生存质量的影响目的探讨规范三级康复治疗对脑卒中患者日常生活活动能力和生存质量的影响。方法259名脑卒中患者随机分组为规范康复治疗组和非规范康复治疗组,采用改良Barthel指数(Modified Barthel Index, MBI)对患者的ADL进行评分,采用SF-36健康调查量表(the MOS 36-item short form health survey, SF-36)对患者的生存质量进行评分。在入组即时,治疗后1,2,3,6个月进行评定,以及在治疗结束12个月时进行随访评估。结果规范三级康复治疗组和非规范康复治疗组随着治疗时间的推进,治疗后1,2,3,6个月进行评定,以及在治疗结束12个月时,MBI评分均有明显增加的趋势(P0.05),SF-36评分亦均有明显增加的趋势(P0.05)。规范三级康复治疗组和非规范康复治疗组在治疗1个月和2个月时MBI评分无显著差异,但治疗3个月、治疗6个月、随访1年时,规范三级康复治疗组的MBI评分均明显高于对常规康复治疗组(P0.05)；在治疗1个月时,规范三级康复治疗组和非规范康复治疗组的SF-36评分无统计学差异,在治疗2个月、治疗3个月、治疗6个月、随访1年时,规范三级康复治疗组的SF-36评分均明显高于对非规范康复治疗组(P0.05)。结论规范三级康复治疗在提高脑卒中患者ADL能力,改善患者生存质量方面,比非规范康复治疗有着更多的优势。第四部分规范的三级康复治疗对脑卒中患者综合功能能力的影响目的探讨规范的三级康复治疗对脑卒中患者综合功能能力的影响。方法259名脑卒中患者随机分组为规范康复治疗组和非规范康复治疗组,采用综合功能评定量表(functional comprehensive assessment, FCA)作为评估标准,在入组即时,治疗后1,2,3,6个月进行评定,并于评估和治疗结束后12个月进行随访评估,对患者进行综合功能能力评分。结果在入组时,规范三级康复治疗组和常规康复治疗组FCA评分无统计学差异。在治疗1个月,2个月,3个月,6个月,及随访1年时,规范三级康复治疗组的FCA评分随着时间推移而增加；在治疗1个月,2个月,3个月,6个月,及随访1年时,非规范康复治疗组的FCA评分也随着时间推移而增加。虽然在治疗1个月,2个月和3个月时,规范三级康复治疗组和非规范康复治疗组FCA评分均无统计学差异,然而在治疗6个月及随访一年时,规范三级康复治疗组的FCA评分明显高于非规范康复治疗组。结论规范三级康复治疗比非规范康复治疗更有利于脑卒中患者综合功能能力的提高。
[Abstract]:The first part was to standardize the effect of three level rehabilitation therapy on the motor function of stroke patients. Objective to explore the effect of standard three level rehabilitation therapy on stroke patients' motor function recovery. Methods 259 stroke patients were randomly divided into normal rehabilitation treatment group and non standard rehabilitation treatment group, and simplified Fugl-Meyer exercise function score (Simpli Fied Fugl-Meyer assessment, FMA), Brunnstrom staging (Brunnstrom motor function assessment). The improved Ashworth grading (modified Ashworth) was evaluated immediately after the treatment, and was evaluated at the end of the evaluation and 12 months after the end of the evaluation. The scores of hand and lower extremity respectively, the improved Ashworth classification included the evaluation of the biceps brachii muscle and the four head of the femoris respectively, and carried out statistical analysis. Results there were no significant differences in the general situation and the FMA score, the Brunnstrom staging and the improved Ashworth rating for the standard three level rehabilitation treatment group and the non standard rehabilitation treatment group. In the treatment of February, there were no statistical differences. After 1 years of follow-up, the two groups of FMA scores, the Brunnstrom staging of the upper limbs, the Brunnstrom staging of the lower limbs, the Ashworth rating of the biceps brachii muscle and the Ashworth rating of the four head muscle of the femur were gradually improved with the advance of time. The standard three rehabilitation treatment group was treated in February, March, June, and the follow-up of 1 years, FMA score, The Brunnstrom staging of lower extremity and the improved Ashworth rating of the lower extremities (four heads of femoris muscle) were higher than those in the nonstandard rehabilitation group. The difference between the groups was statistically significant (P0.05). The standard three level rehabilitation treatment group and the non normal rehabilitation group were treated in February, March, June, and the shoulder joint Brunnstrom staging and hand Brunnstrom staging at 1 years. There is no significant difference in the Ashworth rating of the upper brachial biceps. Conclusion compared with the nonstandard rehabilitation treatment, the standard three level rehabilitation therapy is more beneficial to the recovery of the patient's limb movement dysfunction. The second part of the standard three level rehabilitation treatment on the cognitive function of stroke patients is to explore the standard three level rehabilitation therapy for cerebral pawns. Methods 259 patients with cerebral apoplexy were randomly divided into normal rehabilitation therapy group and non standard rehabilitation therapy group. The mini mental state examination (MMSE) was used immediately after the treatment, the assessment was performed at 1,2,3,6 months after treatment, and at the end of the treatment at the end of 12 months. Results the standard three level rehabilitation treatment group and the non standard rehabilitation treatment group were evaluated at 1,2,3,6 months after the treatment, and the MMSE score increased significantly at the end of the 12 months of treatment (P0.05). However, the evaluation of the time points between the three level rehabilitation treatment group and the non standard rehabilitation treatment group was evaluated. There is no statistical difference. Conclusion there is no clear evidence in this study that standard three level rehabilitation is better than nonstandard rehabilitation in improving cognition. The third part of the standard three level rehabilitation therapy on stroke patients' daily living ability and quality of life Methods 259 stroke patients were randomly divided into the standard rehabilitation treatment group and the non standard rehabilitation treatment group. The modified Barthel index (Modified Barthel Index, MBI) was used to score the patients' ADL, and the SF-36 health survey scale (the MOS 36-item short form) was used. The patient's quality of life was scored. 1,2,3,6 months after the treatment was evaluated and followed up at the end of the treatment for 12 months. Results the standard three level rehabilitation group and the nonstandard rehabilitation group were evaluated with the treatment time, 1,2,3,6 months after treatment, and 12 months after the end of the treatment, MBI evaluation. There was a significant increase in the trend (P0.05) and a significant increase in the SF-36 score (P0.05). There was no significant difference in the MBI score between the standard three level rehabilitation treatment group and the non normal rehabilitation treatment group at 1 months and 2 months, but the treatment group for 3 months, 6 months, and 1 years of follow-up, the MBI score of the standard three rehabilitation group was significantly higher than that of the pair. In the routine rehabilitation group (P0.05), there was no significant difference in the SF-36 score between the standard three rehabilitation treatment group and the nonstandard rehabilitation group at 1 months. In the 2 month treatment, the treatment for 3 months, the treatment for 6 months, and the 1 years of follow-up, the SF-36 score of the standard three rehabilitation group was significantly higher than that of the non standardized rehabilitation treatment group (P0.05). Class three rehabilitation therapy has more advantages than non standardized rehabilitation in improving the ADL ability of stroke patients and improving the quality of life. The effect of the fourth part of the standardized three level rehabilitation therapy on the comprehensive functional ability of stroke patients is to explore the effect of standardized three level rehabilitation therapy on the comprehensive functional ability of stroke patients. Methods 259 stroke patients were randomly divided into the standard rehabilitation treatment group and the non standard rehabilitation treatment group. The functional comprehensive assessment (FCA) was used as the evaluation criterion. The assessment was conducted in the group immediately after the treatment, and the assessment was performed at the end of the assessment and 12 months after the end of the treatment. There was no significant difference in the FCA score between the standard three and the conventional rehabilitation groups in the group. The FCA score of the standard three rehabilitation group increased with the time lapse at 1 months, 2 months, 3 months, 6 months, and 1 years of follow-up; in the treatment of 1 months, 2 months, 3 months, and 6. The FCA score of the nonstandard rehabilitation group increased with the time of 1 years, and there was no significant difference in the FCA score between the standard three rehabilitation treatment group and the nonstandard rehabilitation treatment group at the 1 months, 2 months and 3 months. However, the FCA score of the three level rehabilitation treatment group was standardized in the 6 months of treatment and in the year of the visit. Conclusion three level rehabilitation is better than non standardized rehabilitation therapy in improving comprehensive functional ability of stroke patients.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3

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