急性脑血管病三级康复治疗的前瞻性多中心随机对照研究

目的　评价急性脑血管病三级康复治疗的疗效。方法　在全国一些城市建立以三级甲等医院神经内科、康复科及其所负责的社区医疗机构组成的三级康复网 ,对初发脑卒中患者进行为期半年的持续康复 ,并对其临床神经功能缺损、运动功能、日常生活活动能力及生活质量方面进行评定。在全国共建立了 15个三级康复网 ,各三级康复网按照统一的入选标准筛选急性脑血管病患者 ,并将患者随机分为康复组及对照组 ,按照统一的方法进行康复训练并在发病后 1周及 1、2、3、4、5、6个月末共进行 7次评价。结果　共有 10 78例患者入组 ,其中完成全部 7次评价者 90 2例 ,死亡19例 ,失访 15 7例。 90 2例中 ,康复组 4 39例 ,男性 2 6 6例 ,女性 173例 ;年龄 6 1岁± 11岁 ;脑梗死 2 78例 ;脑出血 16 1例。对照组 4 6 3例 ,男性 2 81例 ,女性 182例 ;年龄 6 0岁± 11岁 ;脑梗死 2 91例 ;脑出血172例。发病后第 2个月起 ,两组之间在临床神经功能缺损、运动功能、日常生活活动能力及生活质量评定等方面的评分差异均有显著意义 ,康复组明显优于对照组。 6个月时 ,康复组患者基本达到日常生活活动自理 ,Barthel指数平均值接近 85分。对照组也有所恢复 ,但恢复的程度低于康复组。康复组卒中后抑郁的发生率低于对照组。结论　脑卒中的

Effects of three-stage rehabilitation treatment on acute cerebrovascular diseases: a prospective, randomized, controlled, multicenter study

OBJECTIVE: To evaluate the effect of tertiary rehabilitation treatment on acute cerebrovascular diseases. METHODS: Fifteen tertiary rehabilitation networks were set up throughout the country. 1078 patients with acute cerebrovascular diseases were randomly divided into 2 groups: rehabilitation group and control group, out of which 19 patients died, 157 dropped out, and 7 successive evaluations were completed in 902 patients that. 439 of the remaining 902 patients in the rehabilitation group, 266 males and 173 females, aged 61 +/- 11, 278 cases with cerebral infarction and 161 with cerebral hemorrhage, received routine treatment and early rehabilitation for 28 days in the ward of neurology, and then went home and received community rehabilitation for 6 months or underwent specialized reinforcement training for 2 months and after that went home and received community rehabilitation for 4 months. The 463 patients in the control group, 281 males and 182 females, aged 60 +/- 11, 291 of which with cerebral infarction and 172 with cerebral hemorrhage, received only routine treatment and early rehabilitation for 28 days in the ward of neurology, and then went home to conduct rehabilitation training by themselves or their family members for 6 months. Evaluation was conducted 7 times, with National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer motor function scale, Barthel index, SF-36 scale, Lowenstein occupational therapy cognitive assessment (LOTCA), Westen aphasia battery, Hamilton depression scale, and modified Ashworth spasm scale, one week after the onset and by the ends of 1, 2, 3, 4, 5, and 6 months after the onset respectively. RESULTS: The scores of clinical neurological impairment, Fugl-Meyer scores, SF-36 scores, incidence of PSD, and modified Ashworth scores (for upper and lower limbs) were lower, and LOTCA scores and Barthel indexes were higher at different time points in the rehabilitation group than in the control group; and the differences were statistically significant since the 2nd month after the onset. By the end of the 6th month, the patients of the rehabilitation group basically re-achieved the ability of self-care in daily activities with a Barthel index of 84 +/- 33. The patients of the control group also recovered to a certain degree, however, to a smaller extent in comparison with the rehabilitation group. CONCLUSION: Tertiary rehabilitation treatment of cerebrovascular diseases is effective in improving motor function, ability of daily living activities, and quality of life and reducing the incidence rates of secondary complications.