摘要
目的:通过对不同时期脑卒中患者生活质量的观察,了解康复训练对脑卒中生活质量的影响。方法:选择2002-04/2003-08上海交通大学附属第一人民医院急诊科留院观察及神经内科住院的脑卒中患者70例,男40例,女30例,年龄42-79岁,脑梗死50例,脑出血20例,自愿参加本实验。按区组随机化原则分为康复治疗组35例,对照组35例。①康复治疗组:脑出血患者给予控制脑水肿、降低颅压等药物治疗,脑梗死患者给予活血化瘀,营养神经等药物治疗的同时于平均病程(12.2±9.2)d开始进行为期6个月一对一康复训练,训练内容主要包括良姿位的摆放;翻身训练;床上自我辅助练习(双手插握、桥式运动、床上转移、髋的控制);上肢、躯干及下肢的被动运动;坐卧位训练;面舌唇肌训练;呼吸控制训练;平衡控制训练;站位训练;各关节的协调性训练;步态训练及日常生活活动训练等。②对照组患者的神经内科常规治疗同康复治疗组,而康复治疗师对其不进行任何康复训练或指导。③两组患者于入选时及病程1,3,6个月由同一医生用世界卫生组织生活质量测定量表中文版进行评定(包括与生活质量有关的生理健康、心理状态、社会关系和与周围环境的关系、自身生活质量和健康状况的主观感受、生活质量综合自评分等共29个问题)。结果:①病程1个月时:纳入的70例患者中有66例患者进入结果分析,康复组32例(有2例脑梗死患者出院后拒绝随访,1例患者死亡),对照组34例(1例患者死亡),两组患者生活质量各项评分接近(P>0.05)。②病程3个月时:有64例患者进入结果分析,康复组30例(2例患者死亡),对照组34例,康复治疗组生活质量各项评分均高于对照组犤生理健康:12.94±1.58,11.00±2.30;心理状态:13.14±0.81,12.10±1.05;社会关系:14.92±0.74,14.25±0.87;与周围环境的关系:12.99±1.29,12.08±1.69;自身生活质量的主观感受:3.32±0.48,2.84±0.63;自身健康状况的主观感受:3.32±0.55,2.56±0.72;生活质量综合自评分:74.93±6.76,71.19±6.40,t=2.20～4.56,P=0.032～0.000犦。③病程6个月时:有63例患者进入结果分析,康复组29例(1例患者死亡),对照组34例。康复治疗组生活质量各项评分亦均高于对照组犤生理健康:13.50±1.69,11.98±2.31;心理状态:13.36±0.93,12.38±1.51;社会关系:15.01±0.78,14.37±0.81;与周围环境的关系:14.06±0.92,12.75±1.35;自身生活质量的主观感受:3.25±0.59,2.91±0.53;自身健康状况的主观感受:3.46±0.58,2.66±0.79;生活质量综合自评分:77.57±6.24,72.90±6.33,t=2.39～4.48,P<0.020～0.000犦。结论:早期全面进行康复训练的患者在病程3,6个月时的生活质量各项评分明显提高。
AIM： To explore effects of rehabilitation training on the quality of life in stroke patients by observing the quality of life in stroke patients during different duration. METHODS： Seventy patients with stroke, who were treated in Department of Emergency and Department of Neurology, First People＇s Affiliated Hospital, Shanghai Jiaotong University, were selected between April 2002 and August 2003, including 40 male eases, 30 female cases, aged 42-79 years old, and 50 cerebral infarction eases, 20 cerebral hemorrhage eases,taking part in this experiment voluntarily. All eases were divided into rehabilitation treatment group （n=35） and control group （n=35） in randomized block design. ①Rehabilitation treatment group： The drug treatment of controlling cerebral edema and decreasing cranium press etc. was performed in the patients with cerebral hemorrhage. The drug treatment of promoting blood circulation by removing blood stasis and nutrien nerve etc. was given in the patients with cerebral infarction. The one-to-one rehabilitation training was performed for 6 months at the average course of （12.2±9.2）days at the same time. The training content included mainly putting good posture, turning the body over training, self-assistance exercises on the bed （pluging the two hands, bridge-like movement, shifting on the bed, controlling the coax）, the passive motion of upper limb, trunk and lower limb, sit-deeubitus training, face, tongue, lip muscle training, breath control training, balance control training, standing training, concordant training of every joint, gait training and activities of daily living training etc.② The routine treat ment in the department of neurology in the patients of control group was the same as that in the rehabilitation treatment group, while the rehabilitative therapist did not do any rehabilitation training or instruction.③The patients in the two groups were assess by Chinese edition of the World Health Organization quality of life scale （including physiological health, psychological state, social relation and the relation with surroundings, selfquality of life, the subjective feeling of health status and synthetical selfassessment of quality of life etc., totally 29 questions） at the moment of selecting and 1, 3 and 6 months of progress by the same physician. RESULTS： ① The first month of progress： Sixty-six cases were involved in the result analysis among the 70 included patients, 32 cases in the rehabilitation group （2 patients with cerebral infarction refused to follow up after discharging, and 1 patient died）, 34 cases in the control group （1 patient died）, and the scores of every item of the quality of life in the patients of the two groups were similar （P 〉 0.05）,②At 3 months of progress： Sixty-four patients were involved in the result analysis, 30 eases in the rehabilitation group （2 patients died）, 34 patients in the control group, and the scores of every item of the quality of life in the patients of the rehabilitation treatment group was higher than that in the control group Iphysiologieal health： 12.94±1.58, 11.00±2.30;psychological state： 13.14±0.81, 12.10±1.05 ;social relation ： 14.92±0.74,14.25±0.87 ;relation with the surroundings：12.99±1.29, 12.08±1.69;subjective feeling of self-quality of life： 3.32±0.48, 2.84±0.63; subjective feeling of self-health status： 3.32±0.55, 2.56±0.72;synthetical self-assessment of quality of life：74.93±6.76, 71.19±6.40,t=2.20-4.56, P=0.032-0.000]. ③At 6 months of progress： Sixty-three patients were involved in the result analysis, 29 eases in the rehabilitation group （1 patient died）, 34 gases in the control group. The scores of every item of the quality of life in the rehabilitation treatment group were higher than that in the control group [physiological health： 13.50±1.69, 11.98±2.31 ;psychological state： 13.36±0.93, 12.38±1.51 ;social relation ： 15.01±0.78,14.37±0.81 ;relation with the surroundings： 14.06±0.92, 12.75±1.35;subjective feeling of self-quality of life： 3.25±0.59, 2.91±0.53; subjective feeling of self-health status： 3.46±0.58, 2.66±0.79; synthetical self-assessment of quality of 1ife：77.57±6.24, 72.90±6.33, t=2.39-4.48, P 〈 0.020-0.000] CONCLUSION： The scores of every item of quality of life in patients, who receive early and comprehensive rehabilitation training at 3 and 6 months of progress, are distinctly enhanced.
出处
《中国临床康复》
CSCD
北大核心
2005年第32期47-49,共3页
Chinese Journal of Clinical Rehabilitation
基金
"十五"攻关课题"急性血管病三级康复方案的研究"(2001BA703B18)~~
