急性缺血性脑卒中患者首次运动康复治疗时间对运动功能的影响研究

目的　探讨急性缺血性脑卒中患者运动康复治疗起始时间对运动功能预后的影响。方法　选取2015年9月—2017年8月在中国医科大学附属盛京医院急诊科就诊以及在神经内科病房接受治疗的67例急性缺血性脑卒中患者为研究对象。将纳入的67例患者随机分为两组：A组（n=35）：发病24~48 h给予患者首次运动康复治疗；B组（n=32，中途退出2例）：发病48~120 h给予患者首次运动康复治疗。发病90 d时为研究终点。通过查阅病历资料的方式，收集患者一般资料。在发病后第7、14、30、60、90天时，分别采用改良Rankin量表（MRS）评分和Fugl-Meyer运动功能评分评价患者运动功能。结果　两组患者基线水平、第7天MRS评分比较，差异无统计学意义（P>0.05）；A组患者第90天MRS评分低于B组，差异有统计学意义（P<0.05）。两组患者Fugl-Meyer上肢运动功能评分比较，差异无统计学意义（P>0.05）；其不同时间点比较，差异有统计学意义（P<0.05），组别和时间在Fugl-Meyer上肢运动功能评分上不存在交互作用（P>0.05）。其中，干预第7天时，A组患者Fugl-Meyer上肢运动功能评分高于B组，差异有统计学意义（P<0.05）。两组患者Fugl-Meyer下肢运动功能评分比较，差异有统计学意义（P<0.05）；不同时间点比较，差异有统计学意义（P<0.05），组别和时间在Fugl-Meyer下肢运动功能评分上不存在交互作用（P>0.05）。其中，干预第7、14、30、60、90天时，A组患者Fugl-Meyer下肢动功能评分高于B组，差异有统计学意义（P<0.05）。结论　对于MRS评分为3~4分的急性缺血性脑卒中患者，早期运动康复治疗提前至发病48 h内进行，能明显改善急性缺血性卒中患者运动功能。

Effect of Timing of Initiating Exercise Rehabilitation on the Prognosis of Motor Function in Acute Ischemic Stroke

Objective　To investigate the effect of timing of initiating exercise rehabilitation on the prognosis of motor function in patients with acute ischemic stroke（AIS）.Methods　We enrolled 67 cases of AIS from Emergency Department and Neurology Ward，Shengjing Hospital of China Medical University from September 2015 to August 2017 and randomized them into group A（n=35），and group B（n=32，2 patients withdrew from the study），receiving an exercise rehabilitation initiated within 24-48 h，48-120 h，respectively after the onset of AIS.The intervention for both groups ended on the 90th day after the onset of AIS.Baseline characteristics were collected by reviewing the medical records.The motor function was evaluated by both Modified Rankin Scale （MRS） and Fugl-Meyer Assessment（FMA） on the 7th，14th，30th，60th，and 90th days after the onset of AIS，respectively.Results　Two groups showed no significant differences in baseline characteristics and the mean MRS score measured on the 7th day after the onset of AIS （P>0.05），but group A demonstrated a significantly decreased mean MRS score on the 90th day after the onset of AIS （P<0.05）.Although the overall mean upper extremity FMA score did not differ significantly between the groups（P>0.05），the mean upper extremity FMA score varied substantially between the groups at different times during the rehabilitation period （P<0.05），in particular，it was much higher in group A than that of group B at the end of the 7th day of rehabilitation （P<0.05）.The overall mean lower extremity FMA score and mean lower extremity FMA score at different times during the rehabilitation period differed significantly between the groups（P<0.05），to be specific，group A showed much higher mean lower extremity FMA score than group B at the end of the 7th，14th，30th，60th，and 90th days of rehabilitation （P<0.05）.In addition，the FMA scores for both the upper and lower extremities were not influenced obviously by the interaction effect of the timing of initiating exercise rehabilitation and duration of the rehabilitation （P>0.05）.Conclusion　For AIS patients with an MRS score of 3-4，exercise rehabilitation initiated within 48 h after the onset of AIS can significantly improve the motor function.