综合康复治疗对急性期中重度脑血管病患者预后的影响

目的:探讨综合康复治疗对急性期中、重度脑血管病患者预后的影响。方法:急性中、重度脑血管病患者397例,按照开始康复治疗的时间和治疗疗程分为A组(发病14d内开始康复治疗,疗程>14d)、B组(发病14d后开始康复治疗,疗程>14d)、C组(发病14d内开始康复治疗,疗程<14d)、D组(发病14d后开始康复治疗,疗程14d)、E组(无康复治疗),记录患者出入院时Barthel指数(BI)、改良Rankin量表评分(MRS)、美国国立卫生研究所脑卒中评分(NI HSS)及其改善值,记录出院时住院总费用和药费。发病后3、6、12、18个月随访记录BI及MRS评分。结果:5组患者经过康复治疗出院时NI HSS明显改善(P<0.005),其中A组患者瘫痪肢体神经功能恢复程度优于E组(P<0.05),出院后12个月神经功能可达到比较满意的恢复。短疗程组与无康复治疗组的疗效无明显差别。各组的医疗费用并无明显差异。结论:中、重度脑血管病患者应尽早开始康复治疗,且疗程要尽量>2周;综合康复治疗不增加住院总费用。

Influence of Combined Rehabilitative Treatments on Prognosis of Patients with Moderate-Severe Cerebral Vascular Diseases

Objective: To investigate how the combined rehabilitative treatments administered on early stage influence the prognosis of patients with moderate-sever cerebral vascular diseases. Methods: All the patients with acute cerebral vascular diseases admitted in 2001, whose NIHSS were higher than 7 and score for paralyzed limbs was higher than 2, have received combined rehabilitative therapy including acupuncture, exercise therapy and helium-neon laser therapy. The patients were assessed and documented with the Barthel Index, Modified Rankin Scale and NIHSS at admission, date of discharge, 3 months and 6 months after discharge and the final date at interview. The cases were divided into different groups according to the duration of committed rehabilitative therapy, the time when the treatment began. Results: All 397 patients were recruited. NIHSS scores at discharge in patients to whom rehabilitative therapy was applied at the acute phase was significantly lower than that of those on whom no rehabilitative therapy was employed (p<0.05). At 12th month of onset, the combined therapy on patients yielded a significant recovery. There was no significant difference between the costs of those received rehabilitative therapy and that of the control groups. Conclusion: The earlier and the longer the rehabilitative therapy could perform, the better effects on the patients of moderate-sever cerebral vascular diseases. It was suggested that the duration of the rehabilitative therapy should be longer than 2 weeks. The rehabilitative therapy will not increase the total medical costs.