早期系统化康复干预对急性缺血性卒中患者吞咽功能障碍及神经营养指标的影响研究

目的 分析早期系统化康复干预对急性缺血性卒中患者吞咽功能障碍、血清白蛋白（serum albumin， ALB）、血清前清蛋白（serum fracti on preal bumi n，PA）、血红蛋白（hemogl obi n，Hb）、神经生长因子（nerve growth factor，NGF）及血清脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）的影响。 方法 前瞻性纳入首都医科大学附属北京同仁医院2017年1月-2019年1月收治的急性缺血性卒中患 者，随机分为对照组与观察组。对照组给予常规康复干预，观察组在对照组基础上进行早期系统 化康复干预，均为期3个月，比较两组患者干预前后神经功能缺损（NIHSS）情况以及血清营养学指标 （ALB、PA、Hb、NGF、BDNF）的变化情况，并观察患者吞咽功能障碍改善（洼田饮水试验）情况和运动 功能恢复情况（Fugl -Meyer量表）。 结果 纳入统计分析的共80例患者，对照组和治疗组各40例。干预3月后，观察组NIHSS评分低 于对照组（4.14±1.73分 vs 4.59±1.98分，P =0.027）；ALB（38.76±5.73 g/L vs 34.13±5.01 g/L， P＜0.001）、PA（279.63±35.47 mg/L vs 241.56±30.21 mg/L，P＜0.001）、Hb（140.38±18.36 g/L vs 131.57±16.42 g/L，P＜0.001）、NGF（68.73±8.92 pg/mL vs 54.28±6.39 pg/mL，P＜0.001）、BDNF （7.98±0.95 ng/mL vs 5.84±0.62 ng/mL，P＜0.001）等指标水平均高于对照组；Fugl-Meyer评分高于 对照组（72.28±22.39分 vs 50.17±16.48分，P＜0.001）；洼田饮水试验评价的吞咽障碍改善总有效 率高于对照组（95.0% vs 80.0%，P =0.001）。 结论 在急性缺血性卒中患者接受治疗的过程中，采用早期系统化康复干预的临床效果良好，可有 效改善患者的神经营养情况及吞咽功能，值得在临床治疗中推广。

Effect of Early Systematic Rehabilitation Intervention on Dysphagia and Neurotrophy in Patients with Acute Ischemic Stroke

Objective To analyze the early systematic rehabilitation intervention on swallowing dysfunction, serum albumin (ALB), serum fraction prealbumin (PA), hemoglobin (Hb), nerve growth factor (NGF) and serum brain-derived neurotrophic factor (BDNF) in patients with acute ischemic stroke (AIS). Methods AIS patients admitted to Beijing Tongren Hospital of Capital Medical University from January 2017 to January 2019 were included in this study, and all the patients were randomly divided into the control group and observation group. The control group received routine rehabilitation intervention, the observation group received early systematic rehabilitation intervention, and the treatment time was 3 months for both groups. The changes of NIHSS score, motor function, neurotrophic indicators (ALB, PA, Hb, NGF, BDNF) level, swallowing dysfunction improvement (water swallow test) of the two groups were compared before and after intervention. Results Finally, A total of 80 patients were included, with 40 in control group and 40 in treatment group. After the 3-month intervention, all the indicators improved in the observation group compared to the control group (control vs observation for all the following indicators): NIHSS score (4.59±1.98 points vs 4.14±1.73 points, P =0.027), ALB (34.13±5.01 g/L vs 38.76±5.73 g/ L, P <0.001), PA (241.56±30.21 mg/L vs 279.63±35.47 mg/L, P <0.001), Hb (131.57±16.42 g/L vs 140.38±18.36 g/L, P <0.001), NGF (54.28±6.39 pg/mL vs 68.73±8.92 pg/mL, P <0.001), BDNF (5.84±0.62 ng/mL vs 7.98±0.95 ng/mL, P <0.001) and the Fugl-Meyer score (50.17±16.48 points vs 72.28±22.39 points, P <0.001). The improvement rate of swallowing dysfunction in observation group was also higher than that in control group (95.0% vs 80.0%, P =0.001). Conclusions Early systematic rehabilitation intervention can effectively improve the AIS patient's neurotrophic condition and swallowing function.