超早期下肢强化训练对缺血性脑卒中患者行走功能恢复的影响

摘要
图/表
参考文献
相关文章 (0)

全文: PDF (1327 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨缺血性脑卒中后超早期下肢强化训练对患者行走功能恢复的影响。方法：选取2015年12月至2016年12月温州医科大学附属第一医院神经内科急性缺血性脑卒中患者31例，分为常规治疗组（对照组）及超早期下肢强化训练组（实验组），实验组在对照组的基础上在卒中后24～48 h内在康复治疗师的指导下加强下肢主动活动，即采用床旁功率自行车加强下肢活动，同时协助患者早期练习坐和站立；采用功能独立性评测中能独立完成50 m的时间为主要观察指标，同时采用Barthel指数和改良Rankin评分（mRS）评估患者整体功能及预后。结果：2组在人口学资料和临床特征方面差异无统计学意义（均P＞0.05）。至3个月后77.4%（24/31）的患者恢复50 m独立行走能力；45.2%（14/31）的患者在2周内恢复50 m独立行走的能力，当校正基线期年龄、性别、NIHSS评分的影响后，实验组恢复独立行走时间明显较对照组快，分别为[10（5，55）]d和[39（11，84）]d（P=0.005）。按轻型和中重型卒中进行分层分析，显示校正相关因素影响后，在轻型卒中中实验组恢复独立行走时间较对照组明显缩短，分别为[6（5，10）]d和[23（9，39）]d（P=0.008）；而在中型卒中中，2组恢复独立行走的时间差异无统计学意义（P=0.303）。2组患者mRS评估和Bartherl指数较治疗前均有提高（F=164.170，P＜0.001；F=70.947，P＜0.001）；但2组间比较差异无统计学意义（F=0.001，P=0.997；F=0.291，P=0.594）。2组在下肢静脉血栓形成、肺部感染等并发症发生上差异无统计学意义（P＞0.05）。结论：超早期下肢强化训练模式可促进轻型卒中患者行走能力恢复，对中型卒中患者步行能力的改善未见明显影响，但并未增加不良反应。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	吴文秀
	王哲伟
	陈晓丽
	陈国钱
	金海敏
	何冬瑞
	周成业

关键词 ：缺血性脑卒中, 超早期强化训练, 步行功能

Abstract：Objective: To investigate the effect of very early mobilization of the lower extremity on the recovery of ambulatory function in stroke patients. Methods: We performed a randomized controlled clinical trial on thirty-one eligible patients who were divided as control and experimental groups. Both the groups received conventional treatments. However, the experimental group received additional interventions to intensify lower extremity motion within 48 hours after the stroke by using a leg cycle ergometer system while practicing sitting and standing under the guidance of the therapist. The primary outcome measure for this analysis was the number of days required for the patient to walk for at least 50 m unassisted. Further, the patients were evaluated based on the prognosis with Modified Rankin Score (mRS) and Barthel index score after 3 months. Results: There were no significant differences in demographic data and clinical outcomes between the two groups. After 3 months, 77.4% (24/31) patients recommenced walking unassisted for 50 m and 45.2% (14/31) of them were able to walk unassisted within 2 weeks. When age, gender, and NIHSS scores were corrected, the independent walking time was significantly shorter in the experimental group than in the control group (median 10 vs 39 days, P=0.005). Stratified analysis of mild and moderate-heavy strokes after correction for related factors showed that the recovery time of walking in the experimental group was significantly shorter than that of the control group (median 6 vs 23 days, P=0.008), while there was no significant difference in the time of independent walking in moderate stroke cases between the two groups (P=0.303). The mRS and MBI were significantly higher in patients after treatment than before treatment (F=164.170, P<0.001; F=70.947, P<0.001), but did not show any significant difference between the two groups (F=0.001, P=0.997; F=0.291, P=0.594). Of note, there were no significant differences in the occurrence of complications such as pulmonary infection and venous thrombosis in either group. Conclusion: Early enhancement training of the lower extremity after stroke can promote the recovery of ambulatory function in patients with mild stroke, but has no obvious effect on the improvement of walking ability in moderate-to-severe stroke patients. Our study concludes that very early mobilization is safe without any adverse effects, and it is effective in stroke patients.

Key words： ischemic stroke very early mobilization functional recovery

收稿日期: 2018-10-22

基金资助:温州市科技局科研基金资助项目（Y20150028）

通讯作者: 周成业，主任医师，硕士生导师，Email：zhoucy86@126.com

作者简介: 吴文秀（1988-），女，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I3/198

[1] ODONEELL M J, CHIN S L, RANGARAJAN S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study[J]. Lancet, 2016, 388(10046): 761-775.
[2] PAOLUCCI S, BRAGONI M, COIRO P, et al. Quantification of the probability of reaching mobility independence at discharge from a rehabilitation hospital in nonwalking early ischemic stroke patients: a multivariate study[J]. Cerebrovasc Dis, 2008, 26(1): 16-22.
[3] KWAKKEL G. Impact of intensity of practice after stroke: Issues for consideration[J]. Disabil Rehabil, 2006, 28(13-14): 823-830.
[4] BERNHARDT J, DEWEY H, THRIFT A, et al. A very early rehabilitation trial for stroke (AVERT) phase II safety and feasibility[J]. Stroke, 2008, 39(2): 390-396.
[5] BRIGGS D E, FELBERG R A, MALKOFF M D, et al. Should mild or moderate stroke patients be admitted to an intensive care unit?[J]. Stroke, 2001, 32(4): 871-876.
[6] ZEILER S R, HUBBARD R, GIBSON E M, et al. Paradoxical motor recovery from a first stroke after induction of a second stroke: reopening a postischemic sensitive period[J]. Neurorehabil Neural Repair, 2015, 30(8): 794-800.
[7] BERNHARDT J, ENGLISH C, JOHNSON L, et al. Early mobilization after stroke: early adoption but limited evi-dence[J]. Stroke, 2015, 46(4): 1141-1146.
[8] CUMMING T B, THRIFT A G, COLLIER J M, et al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial[J]. Stroke, 2011, 42(1): 153-158.
[9] VAN WIJK R, CUMMING T B, CHURILOV L, et al. An early mobilization protocol successfully delivers more and earlier therapy to acute stroke patients: further results from phase II of AVERT[J]. Neurorehabil Neural Repair, 2012, 26(1): 20-26.
[10] SUNDSETH A, THOMMESSEN B, RONNING O. Outcome after mobilization within 24 hours of acute stroke: a randomized controlled trial[J]. Stroke, 2012, 43(9): 2389-2394.
[11] Avert Trial Collaboration Group. Efficacy and safety of very early mobilization within 24 h of stroke onset (AVERT): a randomized controlled trial[J]. Lancet, 2015, 386(9988): 46-55.
[12] XU T, YU X, OU S, et al. Efficacy and safety of very early mobilization in patients with acute stroke: A systematic review and Meta-analysis[J]. Sci Rep, 2017, 7(1): 6550.
[13] SKARIN M, BERNHARDT J, SJOHOLM A, et al. ‘Better wear out sheets than shoes’: a survey of 202 stroke professionals’ early mobilization practices and concerns[J]. Int J Stroke, 2011, 6(1): 10-15.
[14] OLAVARRIA V V, ARIMA H, ANDERSON C S, et al. Head position and cerebral blood flow velocity in acute ischemic stroke: a systematic review and meta-analysis[J]. Cerebrovasc Dis, 2014, 37(6): 401-408.
[15] BERNHARDT J, CHURILOV L, ELLERY F, et al. Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)[J]. Neurology, 2016, 86(23): 2138-2145.
[16] BERNEY L, WASSERFALLEN J B, GRANT K, et al. Acute neurorehabilitation: Does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?[J]. Neurorehabilitation, 2014, 34(4): 809-817.
[17] 吴华, 李岩, 顾旭东, 等. 功率自行车运动训练对脑卒中偏瘫患者下肢运动功能及步行能力的影响[J]. 中华物理医学与康复杂志, 2011, 33(8): 599-601.