早期康复干预对首发急性脑卒中患者出院时情感及日常生活活动能力的影响(英文)

背景:多数急性脑卒中患者在综合性医院诊治,但其中有相当部分的患者在发病早期仅局限于药物治疗。目的:探讨综合性医院早期综合康复治疗对急性脑卒中患者情感及日常生活活动能力的影响,并与未进行康复治疗的患者进行比较。设计:随机对照实验。单位:一所市级医院神经科。对象:选择2002-01/2003-08江苏省连云港市第一人民医院神经科住院入选的首发颈内动脉系统急性脑卒中患者80例,男51例,女29例,年龄(63.42±7.47)岁,随机分为康复组与对照组,每组40例。方法:两组急性期脑卒中患者入院后均给予神经内科常规药物治疗。康复组患者病情稳定后(脑梗死患者在入院后1周内,脑出血患者在入院后2周内)进行康复治疗,包括患肢康复训练(物理治疗或/和作业治疗)、理疗、针灸及心理疏导等。康复训练每天一两次,45min/次;理疗、针灸等1次/d,20min/次。对照组患者仅为临床医师查房时口头叮嘱其自行活动,或家属自行帮其活动。两组急性期脑卒中患者治疗前及出院时心理状况评估采用症状自评量表,日常生活活动能力的评定采用Barthel指数(共10项,每项0～15分不等,满分100分,<60分为不能自理)。主要观察指标:两组患者治疗前与其出院时症状自评量表、Barthel指数评分。结果:80例患者全部进入结果分析。①出院时康复组经治疗后症状自评量表各症状因子分均得到了明显的改善(P<0.05～0.01),对照组经治疗后躯体化、强迫、抑郁、焦虑及精神病性等也有明显的改善(P<0.05);康复组经治疗后躯体化、强迫、抑郁、焦虑、恐怖及精神病性评分明显低于对照组犤(1.55±0.43),(1.80±0.35);(1.48±0.39),(1.68±0.55);(1.54±0.43),(1.83±0.37);(1.32±0.39),(1.56±0.36);(1.46±0.43),(1.66±0.52);(1.12±0.38),(1.35±0.35),(t=2.11～2.24,P<0.05)犦。②两组患者治疗后Barthel指数均有提高(P<0.05～0.01),康复组明显高于对照组犤(73.24±4.64),(52.44±2.86),(P<0.05)犦。结论:进行康复治疗和未进行康复患者治疗后症状自评量表中各症状因子分、Barthel指数均有所改善,进行康复治疗患者改善尤为突出。说明早期综合康复治疗在急性脑卒中患者情感及日常生活活动能力方面影响起到了积极的作用。

Influence of earlier rehabilitative interventions on the emotions and the ability of daily living of patients following the first onset of acute stroke

BACKGROUND: Patients with acute stroke mostly receive treatment in the integrative hospital, but quite a large part of them were treated only with medication during the earlier stage.OBJECTIVE: To probe the influence of earlier integrative rehabilitations on emotions and daily life capability of patients with acute stroke with the outcomes compared with those unexposed to rehabilitative treatment.DESIGN: Randomized controlled study.SETTING: Neurological Department of a municipal Hospital.PARTICIPANTS: Eighty patients who received treatment due to the first onset of acute stroke of internal carotid system were selected from the Neurological Department of the First People's Hospital of Lianyungang City, Jiangshu Province between January 2002 and August 2003. Totally 51 males and 29 females aged (63.42±7.47) years were randomly divided into rehabilitation control group with 40 cases each.METHODS: Patients of the two groups received routine neurological medication in the hospital. When stroke was controlled, patients in the rehabilitative group (including patients with cerebral infarction who were hospitalized for less than 1 week and patients with cerebral hemorrhage who were hospitalized for less than 2 weeks) were subjected to rehabilitative treatment, including rehabilitative training of insulted limbs (physical treatment and/or exercise therapy), physical therapy, acupuncture and psychological consultation. Rehabilitative treatment was given 1-2 times a day and 45 minutes for each time. Physical therapy and acupuncture were given once a day and 20 minutes for each time. In contrast, patients in the control group were only asked in the doctor's round to do exercise themselves or with the assistance of others. Psychological states of all the patients were assessed with Symptom Self Rating Scale before treatment and discharge and daily life capability was also assessed with Barthel index (totally 10 items with scores of 0-15, full mark was 100, and patients who scored for ＜ 60were considered of self-incapability).MAIN OUTCOME MEASURES: Scores for symptom checklist (SCL)and Barthel index of the two groups before treatment and when patients were discharged.Scores for each symptom factors in SCL were significantly improved in the rehabilitation group when patients were discharged from the hospital (P ＜ 0.05-0.01), and somatization, obsessive-compulsive, depression, anxiety and psychoticism, etc. were also obviously improved in the control group (P ＜ 0.05); moreover scores for somatization, obsessive-compulsive,depression, anxiety phobic anxiety and psychoticism in the rehabilitation group after treatment were significantly lower than those in the control group [(1.55±0.43), (1.80±0.35); (1.48±0.39), (1.68±0.55); (1.54±0.43),(1.83±0.37); (1.32±0.39), (1.56±0.36); (1.46±0.43), (1.66±0.52); (1.12±0.38),creased aftertreatment (P ＜ 0.05-0.01), but those of the rehabilitation group were significantly higher than those of the control group [(73.24±4.64),(52.44±2.86), P ＜ 0.05].CONCLUSION:Scores for symptomatic factors in SCL and Barthel indexes were improved after treatment, especially in patients who received rehabilitative treatment, suggesting that earlier integrative rehabilitative treatment may play active influence on the emotions and daily life capability of patients following acute stroke.