脑卒中恢复期常见并发症及其康复治疗

目的：综述有关脑卒中恢复期常见并发症的文献，力求为患者的康复治疗提供借鉴。 资料来源：应用计算机检索Ovid及中国医学期刊网1980—01／2004—01与脑卒中恢复期常见并发症相关的文章。检索词“stroke．painful shoulder”，“stroke，shoulder-hand syndrome”。“stroke，shoulder subluxation”。“脑卒中，肩痛”。“脑卒中，肩手综合征”。“脑卒中，肩关节半脱位”。并限定语种为“English”或中文。 资料选择：对资料进行初审，选取有关脑卒中恢复期常见并发症的相关文献，然后筛除明显不随机临床试验的研究。对剩余的文献查找全文，进一步判断是否为随机对照临床研究，无论是否为单盲，双盲或非盲法均纳入。 资料提炼：共收集到35篇关于脑卒中后常见并发症的相关文献，18个试验符合纳入标准。排除的17篇试验中，均为重复的同一研究。 资料综合：18个试验包括451例患者，分别对脑卒中恢复期出现的并发症，包括肩手综合征、脑卒中后肩痛、脑卒中后肩关节半脱位进行了论述。主要阐述了这3种并发症的发病机制、临床表现、评价方法和治疗及预防的方法。 结论：肩手综合征、脑卒中后肩痛、脑卒中后肩关节半脱位为脑卒中恢复期常见的并发症，明确其发病机制、预防措施及治疗，有助于提高脑卒中息者的生活质量。     

中西医结合治疗脑卒中后肩手综合征

为探讨中西医结合治疗脑卒中后肩手综合征的疗效,采用中药外洗、针灸合并康复训练治疗38例早期肩手综合征患者,37例均治愈或好转,患者的手功能得到明显的改善,仅1例无效,说明脑卒中后肩手综合征及时进行中西医结合治疗,有利于促进上肢运动功能的恢复,减少致残率。     

脑卒中后肩部问题

脑卒中后常见的肩部问题包括:肩关节半脱位、肩手综合征和肩痛。(1)肩关节半脱位治疗包括:矫正肩胛骨的位置,恢复肩原有的锁定机制;刺激肩关节周围固定肌的活动及张力;在不损伤关节及其周围结构的前提下,保持肩关节无痛性的全范围被动活动。(2)肩-手综合征治疗主要是减轻水肿和疼痛,改善手、腕关节的活动度。(3)肩痛的治疗包括改善肩胛骨活动度、体位摆放、增加被动活动度及指导患者采用正确的肩关节运动来逐步改善患者的症状。     

桂枝汤治疗脑卒中后肩手综合征50例

目的观察桂枝汤治疗脑卒中后并发肩手综合征(SHS)的临床疗效。方法以针灸配合康复功能训练SHS为对照组,桂枝汤加减结合针灸与康复功能训练治疗SHS为治疗组,治疗观察100例脑卒中后并发SHS患者。结果①治疗组总有效率90.0%,与对照组70.0%比较差异有显著性意义(P<0.05);②Fugl-meyer上肢运动功能评价:治疗组上肢总积分高于对照组12分。结论桂枝汤治疗脑卒中后SHS可有效缓解瘫痪侧肢体的疼痛,消除皮肤出汗、发紫、发凉等现象,缩短病程,减少脑卒中患者的致残程度,提高脑卒中患者的治愈好转率。     

针刺治疗在脑卒中并发症中的应用

根据大量文献,结合作者的临床经验,对针刺在脑卒中并发症的应用进行了分析总结,特别针对脑卒中常见的一些并发症如血管性痴呆、脑-心综合征、脑卒中合并应激性溃疡、呃逆、假性延髓麻痹、脑卒中后抑郁、癫痫、脑卒中后肩-手综合征等提出了针刺治疗的中西医理论依据、治疗原则和穴位选择。在文中指出:“神”是一切生命活动的外在表现。神源于精,代表人体的生命活动力。神是气的总概括,神能使气,气能助神。神伤不仅可导致神志方面的改变,更可直接影响各种器官,肢体筋肉的功能。既然神不导气是脑卒中病之根源,治疗脑卒中及其并发症之关键就在于治神。针刺治疗以上疾病之精髓在于治神、醒神、调神,进而达到气血阴阳调和、气复神使之目的。     

电针治疗脑卒中后肩手综合征疗效分析

脑卒中后肩手综合征可出现关节僵直、皮肤及肌肉萎缩或挛缩,患者因疼痛不敢活动患侧上肢,同时因固定肩关节的肌肉瘫痪,肩关节处于半脱位状态,严重影响瘫痪上肢的功能恢复。淄博市临淄区人民医院神经内科对30例脑卒中后肩手综合征患者进行电针治疗,疗效满意。     

肩封治疗脑卒中后肩手综合征的疗效观察

肩手综合征(shoulder-hand syndrome,SHS),亦称反射性交感神经营养障碍(reflex sympathetic dystrophy,RSD),是指脑卒中后瘫痪上肢的肩部及手指、腕关节的疼痛、肿胀、活动受限等临床症状群,如不及时有效治疗,最终导致手部肌肉萎缩,手指挛缩,是脑卒中后常见的并发症之一,也是脑卒中致残的重要原因.而目前SHS尚无特效治疗,常规方法疗效并不满意.我们采用肩关节周围封闭的方法治疗SHS,操作简单,风险小,疗效肯定,特报告如下.     

受限的被动训练预防脑卒中后肩-手综合征的疗效观察

选取160例脑卒中后进行康复的患者作为研究对象,将其分为研究组和对照组两组,每组80例患者。对研究组及其治疗师进行详细指导,在脑卒中后头4个月由患者和治疗师协作完成受限的被动训练,对照组没进行这种训练。让同一名医生对研究组和对照组进行肩-手综合征评价。结果显示:研究组肩-手综合征的发生率是19%(15/80),对照组肩-手综合征的发生率是32%(24/80)。研究组和对照组的肩-手综合征发生率的差异有显著性意义。提示脑卒中患者限制性的被动运动可以预防肩-手综合征的发展。     

脑卒中肩手综合征患者感觉障碍的定量分析

背景脑卒中偏瘫后肩手综合征(shoulder-hand syndrome,SHS)患者感觉减退已被证实,而感觉障碍的评估多用问卷式调查或仅为粗略临床检查来完成,难以精确评估.目的运用定量感觉检查技术(quantitative sensorytesting,QST)检查脑卒中后肩手综合征观察组和脑卒中对照组各15例患者的温度觉及振动觉,并进行定量分析,以了解小纤维神经功能状态及其与肩手综合征的关系.设计病例对照研究(case-control study).地点和对象研究地点为中南大学湘雅三医院,对象涉及2000-06/2001-04湘雅三医院门诊及住院脑卒中后瘫痪病例.方法用界限法分别检查观察组与对照组偏瘫侧上肢大鱼际掌侧温度觉阈值与拇指掌侧振动觉阈值.检查温度觉时,使用一个小的与检测区皮肤接触的热电极探头,探头温度以1℃/s速度递增(热觉、热痛觉)或递减(冷觉、冷痛觉),直至受检者产生感觉的那一刻由受检者本人按下按钮停止刺激.得到一个温度觉阈值,探头温度恢复到预置温度准备下一次刺激.重复4次得到平均温度觉阈值.在检测振动觉时,振动器的刺激强度以0.1～12 μm/s的速度递增,重复检测6次.主要观察指标感觉障碍发生率,温度觉、痛觉及振动觉的数据.结果SHS组中感觉障碍发生率为67%较对照组27%显著增高(P＜0.05).SHS组与对照组定量感觉比较,主要表现为冷觉阈值降低(分别为26.73±4.48,29.89±1 57,P＜0.05),热觉阈值增高(分别为36.83±1.90,35.40±0.89,P＜0.05).冷痛觉阈值、热痛觉阈值与振动觉阈值之间的差异无显著性意义.冷痛觉阈值与冷觉阈值的差值(P＜0.01)及热痛觉阈值与热觉阈值之间差值(P＜0.01)差异有显著性意义.结论脑卒中偏瘫后SHS患者感觉障碍发生率显著增高.主要形式为温度觉减退和痛觉过敏.C类和Aδ类神经纤维功能障碍可能在SHS发病中起重要作用.     

运动训练并水浴疗法减轻脑卒中患者手部水肿

肩-手综合征是指在原发病恢复期间,病侧上肢的手突然水肿、疼痛及病侧肩疼痛使手的运动功能受限,严重的可引起手部变形,手功能完全丧失。运动训练并水浴有减轻脑卒中后患者手部水肿的作用。     

急性脑卒中患者入院康复时的平衡能力对出院结局的预测价值

目的:评估脑卒中患者的平衡功能,有助于确定患者脑卒中严重程度及判断预后,本研究目的为探讨脑卒中偏瘫患者入院康复时平衡能力与出院时日常生活活动能力相关性。方法:37例脑卒中偏瘫患者于入院康复时采用脑卒中患者姿势评定量表中的姿势维持和变换姿势项目来评价姿势维持和变换姿势能力,采用Berg平衡量表来评价患者的整体平衡能力,在出院时采用Barthel指数来评估ADL能力。所得资料先以Pearsonr检验入院时的姿势维持、变换姿势、整体平衡能力及年龄等变量与出院时ADL的相关性;以入院时的姿势维持、变换姿势、整体平衡能力和年龄作为独立变量,并以出院时ADL为因变量,以逐步回归分析检验上述变量与出院时ADL的关联程度。结果:入院时患者的姿势维持、变换姿势和整体平衡能力与出院时Barthel指数呈高度正相关(r=0.682—0.758,P<0.001),其中变换姿势能力是出院时的ADL能力的显著预测因子(R2=0.574,P<0.001)。结论:平衡能力的缺失对脑卒中患者功能预后有显著的影响,平衡训练是早期康复治疗中最迫切需求的治疗内容之一。     

脑卒中急性期康复护理及康复训练的程序及特征

目的为使脑卒中患者最大限度地恢复受损的神经功能,回归社会,提高生活质量,制定急性期早期规范的康复程序.方法康复程序包括康复治疗、康复护理、体位处理、主动运动、被动运动、日常生活活动训练和失禁处理.结果急性期的早期康复能使脑卒中患者受损的神经功能最大限度地得到恢复,并发症减少.结论脑卒中患者早期康复有助于受损神经神经功能的恢复.     

脑卒中康复期的治疗探讨

脑卒中已成为危害我国中老年人身体健康和生命的主要疾病。作为现代社会的一种多发病,会使大多数患者留有不同程度的功能障碍,因此脑卒中康复期的治疗,给我们提出了更大的挑战。该文通过对脑卒中病因、发病机制的系统分析,将脑卒中的康复期治疗策略概括为四部分:一是针对脑卒中后机体各个部分的功能改变和脑卒中并存的多种疾病,考虑各种疾病的关联性和药物对人体的作用,主张用药少而精,尽量减少单剂药物用量;二是尽早依靠现代康复技术,中西医结合进行康复训练;三是改良饮食结构,有针对性地调整生活方式;四是加强心理疏导与护理,使患者保持一种良好的心理状态,倡导整个社会关注起来,参与进来。     

急性脑卒中偏瘫患者早期康复介入与并发症关系的临床研究

目的探讨急性脑卒中偏瘫患者早期康复介入与并发症的关系。方法选取2008年4月至2011年12月急性脑卒中患者患者220例,分为研究组和对照组,并分别评定治疗第1天、第14天及第28天的肢体运动功能(Fugl-Meyer)以及Barthel指数(BI)分数。两组患者均进行常规治疗,研究组同时给予康复训练。分析早期康复介入与临床运动功能评分、日常生活活动能力、并发症的关系。结果研究组Fugl-Meyer以及BI分数在第14天和第28天与对照组比较明显提高,差异有统计学意义(P<0.05)。研究组在第1天,第14天,第28天运动功能Fugl-Meyer评分与同时期ADL的BI评分有相关性(r值分别为0.59、0.63和0.58,P<0.01)。研究组与对照组比较并发症(呼吸道感染、泌尿系感染)较少,差异有统计学意义(P<0.05)。结论早期的康复介入能够促进偏瘫患者肢体功能的恢复,提高日常生活活动能力。接受早期的康复介入能够明显减少并发症的发生。未接受康复治疗的患者运动功能恢复慢,而且易患并发症。     

社区康复管理的老年脑卒中患者常见并发症分析

目的:分析老年脑卒中常见并发症,探讨并发症对老年脑卒中患者康复的影响和加强并发症管理的意义。方法:分析上海市长宁区遵义社区卫生服务中心康复科116例不同类型脑卒中患者的年龄、性别分布及常见并发症。所有患者符合脑血管病诊断标准,并有头颅CT或MRI证实,病程<6个月,年龄>60岁,排除颅脑损伤者。结果:老年脑卒中患者中缺血性脑卒中占86.3%,出血性脑卒中占11.2%,混合性脑卒中占2.7%。男性患者占54.3%,女性患者占45.7%。高血压、糖尿病和冠心病占老年脑卒中患者常见并发症的前3位。结论:老年脑卒中以缺血性脑卒中为主,男性患者较女性比例高,常见并发症高于女性;女性患者发病与年龄呈明显正相关;对老年脑卒中患者,要积极控制并发症,有效提高康复疗效,预防复发。     

老年人脑卒中早期康复介入疗效观察

Background:Early rehabilitative inervention is essential for improving quality of life in elders with stroke.32 patients received early rehabilitative intervention.We analyzed effect of early rehabilitative intervention in improving functional recovery,preventing and reducing disability. Objective:To investigate effect of early rehabilitative intervention on nerve function in elders with stroke. Unit:Intraneura Department,Tanghai County Hospital,Hebei Province. Subjects:62 patients(36 males,26 females,aged 60～ 78,mean age:70.4) were recruited from intraneural department during January,1999 ～ January 2000.All patients were confirmed by skull CT.Diagnosis was done according to diagnostic standards issued in 4th national cerebrovascular disease meeting.All patients experienced first onset of cerebrovascular disease.34 patients suffered from brain infarction,28 from brain hemorrhage.All patients were randomly divided into two groups,rehabilitation group(n=32),control group(n=30).There were no obvious differences in disease type,sex and age. Intervention:Two groups received routine drug therapy and nonoperational thrombolysis management.Rehabilitation management was initiated in rehabilitation group 48 hours after stable disease status was obtained.In the early phase,good limbs position training in bed,body position exchanges,limbs and passive movement,shift and turning over were carried out.Anti-resistant movement was performed from distal end of limbs to near end.Patients were helped to sit,stand and walk,once per day,40 min /once. Above movement was performed under direction of staffs.Acupuncture and physical therapy were also conducted. Main prognosis indexes:Fugl-meyer scoring was used to evaluate motor function before treatment and 2 months after treatment.Modified Barthel index was used to evaluate ADL. Results:Fugl-meyer score was (32.7± 23.2)and (66.2± 29.8) in rehabilitation group before and after treatment respectively.For control group,Fugl-meyer score was (31.9± 23.1) and (40.3± 23.2) before and after treatment respectively.ADL score was (28.2± 11.9) and (40.5± 8.7) in rehabilitation group before and after treatment respectively.In control group, ADL score was (27.2± 11.3) and (30.2± 10.3) in rehabilitation group before and after treatment respectively.Before treatment, two groups showed no significant difference in score,while posttreatment difference was significant(P< 0.05). Conclusion:Early rehabilitative management improves physiological function and quality of life in elders with stroke.     

Nuclear medicine in the rehabilitative treatment evaluation in stroke recovery. Role of diaschisis resolution and cerebral reorganization

There has recently been a tremendous increase in imaging technology and imaging methodology enabling noninvasive exploration of brain function to such an intricate degree as to enable measurements of very small spatial and short temporal cerebral operations responsible for neurological and functional recovery after stroke. This has allowed conceptualization of rehabilitation strategies designed to maximally enhance rehabilitation protocols tailored to the individual patient's deficits. Rehabilitation strategies may now be designed and optimized by employing methods to synchronize functional training of brain regions ascribed to those areas innately undergoing neuronal plasticity change responsible for stroke recovery. In order to effectively apply these noninvasive imaging methods, one must have a clear understanding of the physics and technique of the imaging methodologies and how these are best applied to understand brain physiology during the stroke recovery process to provide a solid rationale for development of rehabilitation protocols. Nuclear medicine imaging is first presented as a diagnostic method to assess the stroke process. The initial brain damage and resulting neurological disability can be primarily assessed in terms of changes in the vascular and hemodynamic status of the cerebral circulation in addition to alterations in the metabolic status around the infarction region. Techniques for assessing perfusion and metabolism include regional cerebral blood flow (rCBF), single photon emission computed tomography (SPECT), and F-18 2-Fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography (PET). In addition, hemodynamic vascular insufficiency can be assessed using O-15 O2 oxygen extraction PET and rest and Diamox rCBF SPECT. The status of the peri-infarction region can be characterized in terms of components of diaschisis and ischemia using proton magnetic resonance spectroscopy imaging ((1)H MRSI) and rest/stress rCBF assessment of cerebral vascular reserve. As the brain recovers from cerebral infarction, areas of reorganization and energy utilization by the brain can be measured using oxygen extraction methods with PET, F-18 FDG glucose utilization by PET, and functional magnetic resonance imaging (fMRI) measures using the blood oxygenation level dependent (BOLD) technique. In addition, high field MRI imaging of the brain is now able to provide detailed fractional anisotropy (FA) maps to characterize changes in white matter by fiber tracking mapping using diffusion tensor imaging. Imaging of the stroke recovery process focuses on the physiologic model of stroke characterized by rCBF, metabolism, 1H spectroscopic measures of N-acetyl aspartate (NAA), choline (Ch) and creatine (Cr) in the peri-infarction zone as well as in the extended stroke penumbra including areas of distant 'pure' diaschisis unencumbered with the confound of cerebral ischemia. Data is presented describing the results of application of imaging methodologies as the patient undergoes rehabilitation that demonstrates the importance of blood flow and metabolic changes in the contralesional frontal lobe both during the resting state and during motor and speech activation paradigms. The results of advanced imaging technologies on cerebral damage and cerebral reorganization during rehabilitation are presented in the context of furthering designs of rehabilitation strategies. Success can be monitored to assess the optimization of rehabilitation strategy design to maximize neurological recovery from stroke by employing facilitatory methods to maximally synchronize rehabilitation techniques with recovery of functionally counterpart areas of viable brain.     

住院脑卒中恢复期患者健康教育需求调查

目的:了解住院脑卒中恢复期患者对健康教育知识的需求状况,为临床干预提供依据.方法:采用自制健康教育需求调查问卷调查92例恢复期住院脑卒中患者的健康教育需求.结果:本组患者对健康教育主题需求评分由高到低依次为出院指导(3.92±0.26)分、家庭护理须知(3.87±0.29)分、疾病相关知识(3.67±0.34)分、心理干预需求(3.15±0.72)分、健康教育形式和方法(2.95±0.58)分.结论:住院脑卒中恢复期患者有强烈的健康教育需求,内容以出院指导及家庭护理须知为主,临床上应制定有针对性的个性化健康教育计划,以满足患者的健康教育需求.