早期综合康复训练对急性脑梗死患者预后的影响及危险因素分析

目的：探讨早期综合康复训练对急性脑梗死患者预后的影响及其预后结局的危险因素分析。方法：将120例急性脑梗死患者随机分对照组和观察组各60例，对照组给予常规药物治疗，观察组在此基础上再给予基础训练、言语训练、针灸等早期综合康复训练；比较2组的汉密尔顿抑郁量表（HAMD）评分、美国国立卫生院神经功能缺损量表（NIHSS）评分、简式Fugl-Meyer运动功能评分（FMA）、日常生活活动能力（ADL）评分；采用多因素分析法来筛选脑梗死患者预后不良的危险因素。结果：治疗3个月后，观察组的 HAMD评分、2组NIHSS评分均较治疗前明显降低（P＜0．01），且治疗后观察组HAMD、NIHSS评分更低于对照组（P＜0．01）；对照组 HAMD评分治疗前后差异无统计学意义。治疗后，2组 FM A及 ADL 评分均较治疗前明显提高，且观察组更高于对照组（ P＜0．01）。多因素分析显示，年龄、糖尿病、感染、晚就诊、未实施早期康复训练、NIHSS评分低均为脑梗死预后不良的危险因素（ P＜0．05，0．01）。结论：急性脑梗死患者实施早期综合康复训练后，可改善抑郁状态，促进神经功能恢复，提高日常生活质量；脑梗死预后的独立危险因素较多，应制定有针对性的有效预防措施，防治病情加重。

Influence of early comprehensive rehabilitation training on prognosis of acute cerebral infarction and risk factors

Objective ：To explore the effect of early comprehensive rehabilitation training on prognosis of acute cerebral infarction ,and risk factors .Methods ：All 120 cases of acute cerebral infarction were randomly divided into control group （n=60） and observation group （n=60） .The control group was given normal treatment ,and the intervention group given early comprehensive rehabilitation training measures （such like basic training ,speech training and acupuncture treatment） besides the control group .The indexes of HAMD score ,NIHSS score ,FMA score ,ADL score and total effective rate were compared between the two groups ,and risk factors of bad prognosis were screened by multiple factors analysis method .Results ：After 3 months of rehabilitation treatment ,HAMD score in observation group and NIHSS score in both groups were lower than pretreatment （P〈0 .01） ,HAMD and NIHSS scores in ob-servation group were significantly lower than those in control group （P〈0 .01） .FMA score and ADL score in both groups were significantly higher than pretreatment （P〈0 .01） ,and those in observation group were significantly higher than those in control group （P〈0 .01） .Multiple factors analysis revealed that age ,diabetes ,infection ,late visit ,no early rehabilitation training and lower NIHSS score were the risk factors of unfavorable prognosis of cerebral infarction（P〈0 .05 ,P〈0 .01） .Conclusions ：Early comprehensive rehabilitation training measures for acute cerebral infarction can obviously improve depressive state ,promote recovery of nerve function and raise daily life quality .There are many independent risk factors affecting the prognosis of patients with cerebral infarction ,so we should formulate effective preventive measures to aim directly at these risk factors .