卒中后左侧偏瘫患者下肢步行能力预后的相关因素分析

目的 探讨影响左侧偏瘫患者下肢步行能力康复疗效的相关因素，为评测下肢步行能力的预后预 测提供临床依据。 方法 对64例卒中导致左侧偏瘫患者，进行常规康复训练1个月，治疗前对其采用简易认知功能评 定量表（mini-mental status examination，MMSE）、洛文斯顿作业疗法用认知评定成套测验（Loewenstein Occupational Therapy Cognitive Assessment，LOTCA）、运动保持困难（Motor Impersistence，MI）、 Schenkenberg等分线段量表、Albert划线、字母删除试验等量表进行认知功能评测。并于治疗前和治疗 后采用Brunnstrom运动功能分期、Berg平衡量表中的独立坐、立位平衡项目、Holden步行功能分级、改良 的Barthel指数等量表，对患者肢体功能等进行评分。应用多元逐步回归分析分析治疗前的上述因素与 下肢功能及步行能力恢复程度之间的关系。 结果 步行能力的恢复程度与训练前的LOTCA的思维运作能力评分及立位平衡能力呈正相关 （P <0.01）；与运动保持困难量表评分及注意力的障碍程度呈负相关（P <0.01）。 结论 训练前LOTCA的思维运作能力、立位平衡能力、注意力、运动保持困难量表评分对卒中后左 侧偏瘫患者的下肢步行能力的预后预测有帮助。

Analysis on Prognostic Factors on the Walking Ability of Lower Limb Function in Patients with Left Hemiplegia

Objective To explore the associated factors that influence the walking ability of lower limb inpatients with hemiplegia and to provide a basis of prognosis for walking ability of lower limbfunction.Methods Sixty-four stroke patients with left side hemiplegia were received comprehensiverehabilitation regularly for 1 month. The assessment procedure for cognitive function wereperformed by MMSE(mini-mental status examination), LOTCA(Loewenstein OccupationalTherapy Cognitive Assessment), MI(Motor Impersistence), Schenkenberg line bisection test beforetreatment. Brunnstrom stage, Modified Barthel Index, Berg balance assessment scale(sitting andstanding balance), Ueda, Bin hemiplegic finger function assessment scale, Holden walking functionclassification were graded for the lower limb function and the walking ability before and aftertraining. The multivariant logistic regression analysis was used to analyze the relationship betweenthose factors and the lower limb function and the walking ability.Results The results showed that the extent of resumption of walking ability of the lower limb waspositively correlated with the score of operational thinking ability in LOTCA before treatmentand also the standing balance ability in Berg balance scale(P <0.01) before training. However,it was negatively correlated with the score of the Motor impersistence and the extent of theattention(P <0.01).Conclusion The ability of operational thinking in LOTCA, the standing balance ability in Bergbalance scale, attention ability and the scores of MI before training were helpful in prognosis forthe walking ability of the lower limb function in patients with left side hemiplegia.