脑卒中伴吞咽功能障碍患者的早期护理

目的探讨脑卒中患者吞咽功能障碍的早期护理干预方法。方法回顾性分析2011年3月至2012年12月在台州医院神经内科治疗的100例符合脑卒中伴吞咽功能障碍患者的临床资料,所有患者在常规护理基础上根据吞咽功能障碍轻、中、重程度实施相应的进食训练、各吞咽肌群的功能训练、管饲等康复与指导,并实施人文关怀。结果入院时,有36例患者为轻度吞咽功能障碍,42例为中度吞咽功能障碍,22例为重度吞咽功能障碍。出院2周后,轻度吞咽功能障碍53例、中度吞咽功能障碍35例、重度为吞咽功能障碍12例。结论对脑卒中伴吞咽功能障碍的患者进行早期护理干预能提高患者的治疗效果。     

住院康复脑卒中偏瘫患者出院后功能转归的回顾性分析

目的通过对住院脑卒中偏瘫患者出院后的去向与功能转归进行回顾性分析，以明确脑卒中三级康复的必要性。 方法以在我院接受脑卒中康复治疗出院一段时间后再次入院康复治疗的脑卒中偏瘫患者为研究对象，如患者出院后未转入其他康复机构进行治疗、仅进行家庭康复干预则纳入家庭组（共有患者121例），如患者出院后继续转至其它康复机构进行康复治疗则纳入康复组（共有患者47例）。对2组患者一般资料情况、出院及再次入院时Barthel指数（BI）评分、Holden步行功能分级等疗效指标进行分析比较。 结果康复组患者再次入院时其肩痛人次、活动受限关节数量、肌张力≥1+级的关键肌群数量均明显少于家庭组；通过相关性分析发现，家庭组患者再次入院时与初次出院时BI差值与患者发病年龄、合并症数量具有负相关性，与出院时BI评分、Holden步行功能分级具有正相关性；将家庭组BI差值与出院时BI评分、Holden步行功能分级进行曲线回归分析，发现如出院时BI评分≥45分，则患者出院回家后其BI评分可维持稳定，当出院时Holden步行功能分级≥2级，则患者回归家庭后步行功能不至于退步。 结论脑卒中偏瘫患者出院后继续接受机构内康复治疗，能进一步提高其BI评分及Holden步行功能分级，抑制并发症发生；如脑卒中患者出院时BI评分≥45分或Holden步行功能分级≥2级，则患者回归家庭后功能可基本维持，但患者仍需进行适当康复干预以促进功能恢复、预防并发症发生。     

强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。     

急性缺血性脑卒中脑白质疏松与认知功能、功能结局的关系研究

目的探讨急性缺血性脑卒中脑白质疏松与认知功能、功能结局的关系。方法我院收治的106例急性缺血性脑卒中患者,根据脑白质疏松程度分为轻度组(n=35)、中度组(n=39)和重度组(n=32)。比较三组的认知功能简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、汉密顿抑郁量表(HAMD)和功能结局美国国立卫生研究院脑卒中量表(NIHSS)、日常生活活动能力量表(BI)、改良兰金量表(mRS);分析影响急性缺血性脑卒中患者认知功能及功能结局的独立危险因素;分析急性缺血性脑卒中脑白质疏松与认知功能、功能结局的相关性。结果三组MMSE、MoCA、BI评分比较轻度组>中度组>重度组,HAMD、NIHSS、mRS评分比较轻度<中度<重度(P<0.05);年龄、吸烟史、糖尿病史、高血脂、脑白质疏松是影响急性缺血性脑卒中患者认知功能及功能结局的的独立危险因素(P<0.05);急性缺血性脑卒中脑白质疏松与HAMD、NIHSS、mRS呈正相关,与MMSE、MoCA、BI呈负相关(P<0.05)。结论急性缺血性脑卒中脑白质疏松越严重,患者认知功能及功能结局随之下降,可作为急性缺血性脑卒中患者认知功能及功能结局的预测因子。     

脑卒中偏瘫患者早期从脾论治对其运动功能及肌力的影响

目的：治疗脑卒中的方法很多，从脾论治法是其在的一种，探讨早期运用从脾论治法在脑卒中偏瘫患者康复治疗中的意义。方法：选择深圳市中医院收治的脑卒中偏瘫早期患者150例，随机单盲分组对照观察，对照组采用常规方法治疗，治疗组在此基础上运用从脾论治中药治疗，两组患者均采用Carr-Shepherd评定法进行评估。结果：在疾病恢复近期，治疗组患者的肢体运动功能、肌力恢复都明显好于对照组。经治疗后运动功能分吸情况治疗组重度有3例，中度有25例，轻度有48例，对照组重度有18例，中度有29例，轻度有27例，差异有显著性意义(x^2=-5．092，P&;lt;0．01)；肌力评定治疗组零、微缩、差、尚可、良好的例数分别为0，4，28，33，11例，对照组则为3，9，45，17，0例，差异有显著性意义(x^2=-3．271，P&;lt;0．05)。结论：从脾论治中药疗法对改善脑卒中偏瘫患者的运动功能和肌力的疗效肯定。     

早期康复对脑卒中后运动及认知功能的影响

目的研究早期康复对脑卒中后运动及认知功能的影响.方法107例脑卒中偏瘫患者随机分为康复组（51例）和对照组（56例）,均进行神经内科常规药物治疗,康复组加以正规早期康复治疗.两组患者分别在进入课题研究时和3个月后测试Bathel指数（BI）、Fugl-Meyer评定（FMA）分、简明精神状态检查（MMSE）分.结果治疗3个月后,康复组BI、FMA、MMSE积分均较治疗前改善（P＜0.05）;对照组BI、FMMS积分也较治疗前改善（P＜0.05）;BI、FMMS、MMSE积分在两组间有显著性差异（P＜0.05）.结论正规早期康复对脑卒中患者3个月后的运动及认知功能后遗症有明显的改善作用.     

脑卒中后抑郁状态程度对患者吞咽功能康复的影响

目的观察脑卒中后吞咽障碍患者抑郁程度对其吞咽功能康复的影响。 方法根据汉密顿抑郁量表(HAMD)评分将脑卒中后吞咽障碍患者60例,分为无抑郁组(15例)、轻度抑郁组(16例)、中度抑郁组（16例）和重度抑郁组(13例)。4组患者均接受神经内科脑卒中常规治疗,病情稳定后给予1个月的冰刺激法、针刺疗法、电刺激疗法、吞咽训练和摄食训练,并于治疗前和治疗1个月后（治疗后）采用藤岛一郎吞咽疗效评估标准进行吞咽功能评定。 结果治疗前,4组患者的吞咽功能评分组间差异无统计学意义（P&rt;0.05）。治疗后,无抑郁组、轻度抑郁组和中度抑郁组的吞咽功能评分与组内治疗前比较,差异均有统计学意义（P<0.05）;且无抑郁组和轻度抑郁组的吞咽功能评分分别为（9.24±0.35）分和（7.21±0.36）分,分别与中、重度抑郁组的（3.66±0.40）分和（3.05±0.35）分比较,差异均有统计学意义（P<0.05）。 结论脑卒中患者的抑郁程度对吞咽功能障碍患者的功能康复有明显影响,应引起临床医生足够重视。     

针刺结合六合治疗仪治疗脑卒中偏瘫

目的观察针刺结合六合治疗仪治疗脑卒中偏瘫的临床疗效。方法将74例患者随意分为针刺对照组和针刺加六合治疗仪治疗组,给予良好的护理,并对疗效和BI指数积分进行评估。结果治疗组的疗效和BI积分均优于对照组。结论针刺加六合治疗仪及配合良好的护理提高了脑卒中偏瘫患者的康复效果。     

手工艺制作训练对脑卒中后抑郁患者疗效的影响

目的：探讨手工艺制作训练对改善脑卒中后抑郁患者的负性情绪,提高认知功能和ADL能力的作用。方法：60例脑卒中后抑郁患者分为A、B 2组各30例,均按脑卒中常规治疗,并给予抗抑郁药物及常规康复训练等治疗。A组增加刺绣、剪纸及贴画等手工艺制作训练。治疗前后分别采用汉密尔顿抑郁量表（HAMD）、简易精神状态评定量表（MMSE）、Barthel指数（BI）对患者抑郁程度、认知功能和ADL进行评定。结果：治疗2个月时2组MMSE和BI评分均有明显提高（P〈0.05）;HAMD评分明显下降。治疗6个月后A组MMSE及BI评分继续上升;HAMD除体重、日夜变化及睡眠障碍单项分与2个月时比较变化不明显外,其余各单项分仍持续下降（均P〈0.05）。B组与治疗2个月时比较,仅BI有上升。结论：辅助手工艺制作训练有助于改善脑卒中患者抑郁症状及认知功能,增强患者康复治疗的主动性,进而整体康复疗效明显。     

社区康复训练对脑卒中疗效的观察

随着我国逐步进入老龄化的社会，社区居民中老年性疾病的增多，社区康复的需求日益得到有关部门的重视，而脑卒中患者的社区康复在社区医疗服务中占据着相当重要的地位。本文就对脑卒中患者进行社区康复功能障碍评估进行观察。１对象与方法所有患者均系１９９８年１月～２０００年９月在社区进行康复训练的脑卒中患者，共２６例，其中男１８例，女８例。２６例病人在康复训练前后均参照Bather指数记分法评估ADL。评价标准：自理生活＞９５分，轻度障碍＞６０分，中度障碍＞４１分，重度障碍≤４０分。方法：每例病人的康复训练周期为６个…     

Influence of admission functional status on functional change after stroke rehabilitation

OBJECTIVE: To determine whether the admission functional score influences the functional change after stroke rehabilitation. DESIGN: Two hundred forty-three patients who had received the Functional Independence Measure (FIM) assessment at admission and at discharge were enrolled in the study. The patients were stratified into three groups according to their FIM total scores at admission, i.e., < or =36, 37 to 72, and > or =73. RESULTS: The Scheffé's multiple comparison test showed that patients with FIM total scores of > or =73 at admission were significantly younger (58 +/- 11 [SD] yr) than those who had scores of 37 to 72 (64 +/- 11 yr) or < or =36 (66 +/- 12 yr). Patients with FIM total scores of 37 to 72 at admission showed significantly higher FIM gain (37 +/- 15) compared with those patients who had scores of > or =73 (20 +/- 10) or < or =36 (29 +/- 23). CONCLUSION: The functional levels of affected patients at admission stratified by the FIM scale roughly predict the degree of functional gain after rehabilitation in survivors with a first episode of ischemic stroke. Moderately affected patients will benefit from intensive rehabilitation. These findings may be useful for rehabilitation triage.     

脑卒中患者功能恢复的影响因素分析

背景:脑卒中患者的康复结局多种多样,哪些因素能够影响此类患者的功能恢复,文献报道有差异。目的:采用广泛应用的功能独立性评测来评定脑卒中患者康复前后的效果,分析入院时的运动功能、认知功能、年龄、从发病到康复机构的时间、性别、有无合并症、瘫痪侧别对脑卒中患者功能恢复的影响。设计:前后对照观察。单位:山东省立医院康复医学中心,首都医科大学康复医学院。对象:选择2000-03/2002-12山东省立医院收治的脑卒中住院患者55例。均为首次发病,排除双侧大脑半球均受累患者。方法:患者生命体征稳定、已渡过危险期(31～75d)后根据病情给予改善微循环及营养神经药物除外,还进行以Bobath技术、PNF技术、Rood方法为主的康复训练,每日一两个小时,每周训练5次。主要观察指标:患者入院7d内及出院前3d应用功能独立性评测评分进行初期和末期评定。功能独立性评测包括运动、认知等18项,总分126分,108～126分为基本至完全独立,72～107分为轻度依赖;54～71分为中度依赖;36～53分为重度依赖;18～35分为极重度至完全依赖。应用多元逐步回归分析上述因素与功能恢复(以FIM总分增长值表示)之间的关系。结果:55例全部进入结果分析。①患者出院时FIM总分显著高于入院时(93.8±12.0,68.8±11.6,P<0.001),运动、认知得分均高于入院时(P<0.001)。②功能独立性评测运动分的平均每天增长值与总分的增长值相似(0.56±0.21,0.59±0.21),但大于认知分的平均每天增长值(0.03±0.03)。③多元逐步回归方程提示入院时的功能独立性评测运动分、认知分、年龄和从发病到康复科的时间与功能独立性评测总分的增长值高度相关,但瘫痪侧别、性别、有无合并症则与其无相关性(P>0.05)。对功能恢复贡献由大到小的因素依次为入院时的运动功能、认知功能、年龄、从发病到康复科的时间。结论:脑卒中患者的功能恢复与入院时的运动功能、认知功能、患者年龄、康复开始时间的早晚呈显著相关性,其中入院时的运动分对功能恢复影响最大,呈正相关。因此在制定康复治疗方案时应考虑上述因素,因人而异。     

三级医院急性期脑卒中患者康复的临床经济学评价

目的：探讨三级医院急性期脑卒中患者康复对患者功能恢复的影响,并进行相关的临床经济学分析。方法：选取发病2周内在神经内科住院的脑卒中偏瘫患者50例,随机分成康复组与对照组。2组患者均进行药物对症治疗,康复组加入康复治疗手段,每组入选病例均于入组时及出院时采用Barthel指数(BI)、Berg平衡量表(BBS)、美国国立卫生院卒中量表(NIHSS)评定,并比较2组在住院病程中的相关费用,进行成本-效果分析。结果：①康复组评分较对照组患者的Barthel、Berg、NIHSS的改善程度比较,康复组优于对照组(P<0.05);②康复组住院平均费用15132.02±2815.66元,高于对照组13323.10±2341.02元(P<0.05);③康复组患者Barthel、Berg评分每增加1分、NIHSS评分每减少1分需分别花费人民币1200.95元、1136.04 元和7005.57元,而对照组则需分别花费1753.04元、1800.42元和12336.21元。结论：三级医院开展早期康复对急性脑卒中患者综合功能的恢复具有良好的促进作用,并具有更好的经济学效应。     

Functional outcome of ischemic stroke: a comparative study of diabetic and non-diabetic patients

BACKGROUND AND PURPOSE: Diabetes is associated with more ischemic strokes and diabetic patients have up to a three-fold increased risk for suffering a stroke, compared with non-diabetics. The aim of this study is to evaluate whether diabetes mellitus may also affect the functional outcome of patients with acute ischemic stroke, undergoing post-acute care rehabilitation. METHODS: A retrospective charts analysis of consecutive older patients with acute ischemic stroke admitted for rehabilitation at a tertiary hospital with post-acute care geriatric rehabilitation wards. Functional outcome of diabetics and non-diabetics was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analysed by t-tests, Pearson correlation, and Chi-square test, as well as by linear regression analysis. RESULTS: A total number of 527 patients were admitted, of whom 39% were diabetics. Compared with non-diabetics, diabetic stroke patients were slightly younger (p = 0.0001) but had similar admission FIM scores. FIM gain parameters (total FIM gain, motor FIM gain, daily total and motor FIM gains) upon discharge were similar in both groups. A linear regression analysis showed that higher MMSE scores (beta = 0.08; p = 0.01) and higher admission total FIM scores (beta = 0.87; p < 0.001) predicted higher total FIM scores upon discharge. Diabetes mellitus was not interrelated, whatsoever, with better total FIM scores upon discharge (beta = -0.03; p = 0.27). CONCLUSIONS: The findings suggest that there is no difference in the functional outcome of diabetic and non-diabetic patients, presenting for rehabilitation after acute ischemic stroke. Diabetes should not be considered as adversely affecting rehabilitation of such patients.     

早期认知功能训练对脑卒中康复的作用

目的评价缺血性脑卒中患者早期认知功能训练的效果,并探讨其作用。方法选择60例缺血性脑卒中患者,按入院顺序分为试验组和对照组各30例。从入院第3天开始,两组均接受常规康复训练,试验组在此基础上加强认知功能训练,训练时间为20d。分别在训练前、训练后第10天和第20天采用简明精神状态检查量表(Mini-mental State Examination,MMSE)评估认知能力,巴氏指数(Barthel Index,BI)评估日常生活活动能力(Activities of Daily Living,ADL)。结果训练前所有患者MMSE和BI评分普遍低下,两组差异没有统计学意义(P>0.05);训练后第10天和第20天,试验组MMSE和BI评分均高于对照组(P<0.05)和本组训练前(P<0.01);对照组训练后第20天的MMSE和BI评分高于训练前(P<0.05)。结论早期认知功能训练能够提高患者的认知能力,促进躯体运动功能恢复和心理康复,增强日常生活自理能力。     

The association between patients' cognitive status and rehabilitation outcome in a geriatric day hospital

PURPOSE: To assess whether and to what extent cognitive status affects functional gain in mobility and extended activities of daily living (ADL) in patients admitted to a geriatric day hospital. METHODS: During 2003, 135 older patients admitted to a rehabilitation day hospital were evaluated by the Mini Mental State Examination (MMSE) and the Cognitive Functional Independence Measure (FIM). On admission and at discharge, they were assessed by the Nottingham Extended ADL Index (NEAI) and the Timed Get Up and Go test (TUG). RESULTS: Orthopedic and stroke patients achieved significant functional gain in mobility regardless of their cognitive status. Nevertheless, cognitively intact stroke patients achieved higher admission and discharge NEAI scores, manifesting greater absolute functional gain than cognitively impaired patients. The patients' ability to extract their rehabilitation potential was significantly better. CONCLUSIONS: Cognitively impaired patients can improve in mobility and performance of extended ADL during day hospital rehabilitation. Evaluation of the patients' cognitive status may enable the multidisciplinary team to develop suitable individual programs and better allocate resources. Cognitively intact stroke patients may benefit from extended rehabilitation treatment compared to impaired stroke patients as they are more capable of utilizing their potential to achieve independence in daily tasks.     

Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology

Factors that describe the disability status of the stroke patient on discharge are important when starting a rehabilitation program, both from a psychosocial and a financial point of view. The objective of this study was to assess how comorbidity and serum albumin levels relate to rehabilitation outcome in geriatric stroke patients. Another aim was to assess whether stroke etiology (ischemic or hemorrhagic) influences these links. Medical records of 80 patients (68 ischemic and 12 hemorrhagic strokes) older than 65 years, who had suffered their first stroke, were investigated. Functional performance levels at admission and discharge were evaluated using the Functional Independence Measure (FIM). Length of stay in hospital was recorded. Serum albumin levels and comorbidity scores on admission were noted. Correlations between these variables and differences between the groups categorized according to stroke etiology were analyzed. In the group of geriatric stroke patients as a whole, serum albumin level was correlated with FIM score at admission and discharge. Comorbidity score was negatively correlated with length of stay. In the ischemic stroke subgroup, serum albumin level was positively correlated with length of stay and with functional gain, and comorbidity score was negatively correlated with functional gain. Analysis of the data for the hemorrhagic stroke subgroup revealed none of these correlations. It was concluded that serum albumin level and comorbidity are useful indices in geriatric ischemic stroke patients for predicting functional outcome and time spent in rehabilitation.     

The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture

OBJECTIVE: To evaluate whether a previous stroke may affect the functional outcome gain of elderly patients undergoing rehabilitation for a hip fracture. DESIGN: A retrospective cohort study. SETTING: The division of geriatric medicine with rehabilitation wards at a university-affiliated referral hospital. PARTICIPANTS: Patients with hip fractures (N=460) undergoing a standard rehabilitation course. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The functional outcome of previous stroke- and nonprevious stroke (NPS)-affected patients assessed by the FIM instrument at admission and discharge from the rehabilitation facility. Data were analyzed by t tests, Pearson correlation, chi-square tests, and linear regression analysis. RESULTS: Both admission and discharge total FIM scores were significantly higher in NPS compared with previous stroke patients (63.53+/-19.89 vs 52.19+/-19.37, P<.001) and (84.23+/-24.93 vs 71.37+/-25.03, P=.001), respectively. However, changes in total FIM (20.70+/-11.68 vs 19.17+/-13.32, P=.38) and in motor FIM (19.84+/-10.63 vs 17.96+/-11.21, P=.23) at discharge were not statistically significant between the 2 groups. A linear regression analysis showed that a previous stroke was not predictive of a worse total FIM gain at discharge (P=.58). CONCLUSIONS: NPS hip fracture elderly patients show higher admission and discharge FIM scores compared with previous stroke patients. Nevertheless, both groups achieve similar FIM gains during rehabilitation period. A previous stroke should not be considered as adversely affecting the rehabilitation of such patients.     

早期康复治疗对急性脑卒中患者日常生活能力的影响

目的 :探讨早期康复治疗对脑卒中偏瘫患者 1个月后日常生活活动能力的影响。方法 :将 12 9例脑卒中偏瘫患者随机分成康复组 (74例 )和对照组 (5 5例 ) ,进行临床对照性研究 ,两组均常规进行神经内科的药物治疗 ,康复组增加运动疗法和电疗等康复治疗方法 ,对每例患者在进入课题时和 1个月后分别测试ADL能力。结果 :康复组两次Barthel指数分别为 6 .36± 4.93、13.0 0± 4.91,对照组为 7.5 0± 6 .19、11.6 0± 6 .2 6 ;两组前后比较均有高度显著性差异 (P <0 .0 0 1) ;两组的变化均数比较康复组 1个月后ADL恢复优于对照组 (P <0 .0 0 1)。结论 :早期康复治疗对患者 1个月后的日常生活活动能力具有良好的促进作用。