推拿结合超早期运动对急性缺血性脑卒中患者康复效果的影响

目的探讨推拿结合超早期运动（VEM）对急性缺血性脑卒中（AIS）患者康复效果、脑源性神经营养因子（BDNF）及运动能力的影响。 方法纳入武警特色医学中心神经创伤与修复研究所自2019年1月至2020年6月收治的110例发病24 h内的AIS患者，按照随机数字表法分为2组，每组55例。对照组在发病24 h内开始第1次VEM（包括床下自主坐立、站立、行走），每日1次，每次10~30 min；观察组在对照组基础上，在发病24 h内开始第1次推拿治疗，每次20 min；2组均治疗2周。观察并比较2组患者入院时、发病后2周及1和3个月血清BDNF含量、美国国立卫生院脑卒中量表（NIHSS）评分、改良Barthel指数（MBI）评分、Fugl-Meyer运动功能（FMA）（上、下肢）评分、Berg平衡量表（BBS）评分、威斯康星步态量表（WGS）评分，发病后1、3个月改良Rankin量表（mRs）评分。 结果康复治疗后，2组患者NIHSS、MBI、上肢FMA、下肢FMA、BBS及WGS评分均显著改善（P<0.05），血清BDNF含量明显升高（P<0.05）；1、3个月时观察组NIHSS、上肢FMA评分显著优于对照组（P<0.05）；2周及1、3个月时观察组MBI、下肢FMA、BBS和WGS评分显著优于对照组（P<0.05），血清BDNF含量明显高于对照组（P<0.05）；3个月时观察组良好结局的比例显著高于对照组（P<0.05）。 结论推拿结合VEM可更好的提高AIS患者的康复效果、促进BDNF表达和运动能力恢复，增加远期良好结局。

Effect of massage combined with very early mobilization on rehabilitation in patients with acute ischemic stroke

ObjectiveTo explore the effects of massage combined with very early exercise (VEM) on the rehabilitation effect, brain-derived neurotrophic factor (BDNF) and motor ability of patients with acute ischemic stroke (AIS). MethodsOne hundred and ten patients with AIS within 24 h, admitted to Institute of Nerve Trauma and Repair, Characteristic Medical Center of PAP from January 2019 to June 2020, were randomly divided into 2 groups, with 55 cases in each group. The control group started the first VEM within 24 h (including self-sitting, standing or walking out of bed), once a day for 10-30 min each time; On the basis of the control group, the observation group started the first massage treatment within 24 h, each time for 20 min; both groups were treated for 2 weeks. Observe and compare the serum BDNF content, National Institute of Health stroke scale (NIHSS) score, modified Barthel index (MBI) score, (upper and lower limbs) Fugl-Meyer motor assessment (FMA), Berg balance scale (BBS) score and Wisconsin gait scale (WGS) score at admission, 2 weeks, 1 and 3 months after stroke; and the modifiedRankin scale score was observed at 1 and 3 months. ResultsAfter rehabilitation, the scores of NIHSS, MBI, upper and lower limb FMA, BBS and WGS were significantly improved (P<0.05), and the content of serum BDNF significantly increased (P<0.05); the NIHSS and upper limb FMA scores of the observation group were significantly better than the control group at 1 and 3 months (P<0.05); at 2 weeks, 1 and 3 months, the MBI, lower limb FMA, BBS and WGS scores of the observation group were significantly better than the control group (P<0.05), and serum BDNF content was significantly higher than the control group (P<0.05); the outcome of the observation group was significantly better than the control group at 3 months (P<0.05). ConclusionMassage combined with VEM can better improve the rehabilitation effect, the expression of BDNF and recovery of exercise capacity of AIS patients, and increase long-term good outcome.