中西医结合康复治疗脑梗死恢复期患者多中心临床研究_张同锴.pdf

133第 2 5 卷 第 2 期 2023 年 2 月辽 宁 中 医 药 大 学 学 报JOURNAL OF LIAONING UNIVERSITY OF TCMVol.25 No.2 Feb.，2023中西医结合康复治疗脑梗死恢复期患者多中心临床研究张同锴1，马玉玺2，齐瑞3（1.复旦大学附属华东医院，上海 200040；2.上海市中西医结合医院，上海 200082；3.上海中医药大学附属岳阳中西医结合医院，上海 200083）基金项目：上海市三年行动计划项目（ZY3-LCPT-1-1008）；上海市十三五临床重点专科建设项目（shslczdzk04601）作者简介：张同锴（1992-），男，山东潍坊人，主治医师，硕士，研究方向：神经系统疾病的中西医康复。通讯作者：齐瑞（1966-），男，甘肃武威人，教授、主任医师，硕士研究生导师，博士，研究方向：神经系统疾病的中西医康复。摘要：目的 运用多中心临床研究，对比中西医结合康复与现代康复对脑梗死恢复期患者的临床疗效，优化脑梗死恢复期临床诊疗方案。方法 以岳阳中西医结合医院、华东医院、第三康复医院、岳阳医院崇明分院为多中心研究单位，收集162例符合脑梗死恢复期的患者随机分成两组。试验组采用中西医结合的康复治疗方案，对照组采用医院康复科正在实施的现代康复治疗方案。对比治疗前后两组在运动功能、独立性、神经功能缺损、日常生活能力的改善情况，并在3个月后对患者的运动功能、日常生活能力进行随访。结果（1）治疗14 d后两组患者NIHSS评分均明显低于治疗前，差异有统计学意义（P0.05）；且试验组较对照组降低更为显著，差异有统计学意义（P0.05）。（2）治疗14次后两组患者的日常生活能力BI指数评分较治疗前均明显增加，差异有统计学意义（P0.05）；且试验组患者日常生活能力BI指数评分明显高于对照组，差异有统计学意义（P0.05）。（3）治疗14次两组患者的独立性改良Rankin评分较治疗前均明显增加，差异有统计学意义（P0.05）；治疗14次后两组患者独立性患者的上下肢运动功能Fugl-Meyer评分较治疗前均明显增加，差异有统计学意义（P0.05）；且试验组患者上下肢运动功能Fugl-Meyer评分明显高于对照组，差异有统计学意义（P0.05）。（5）治疗14 d后两组患者Wolf完成时间较治疗前明显缩短，差异有统计学意义（P0.05）；且试验组较对照组缩短更为显著，差异有统计学意义（P0.05）。治疗14 d后两组患者Wolf评分较治疗前明显增加，差异有统计学意义（P0.05）；且试验组较对照组增加更为显著，差异有统计学意义（P0.05）。（6）3个月随访两组患者的日常生活能力BI指数评分与治疗前均明显增加，差异有统计学意义（P0.05）；且试验组患者日常生活能力BI指数评分明显高于对照组，差异有统计学意义（P0.05）。（7）3个月随访两组患者的独立性改良Rankin评分较治疗前均明显增加，差异有统计学意义（P0.05）；且试验组患者独立性改良Rankin评分明显高于对照组，差异有统计学意义（P0.05）。（8）3个月随访两组患者的上、下肢运动功能Fugl-Meyer评分较治疗前均明显增加，差异有统计学意义（P0.05）；且试验组患者上、下肢运动功能Fugl-Meyer评分明显高于对照组，差异有统计学意义（P0.05）。结论 中西医结合康复方案治疗效果较现代康复方案疗效更为显著，能更好地改善患者生活质量，值得进一步推广。关键词：脑梗死恢复期；中西医结合康复；临床观察中图分类号：R743 文献标志码：A 文章编号：1673-842X (2023)02-0133-07Multi-Center Clinical Study on Rehabilitation Treatment of Convalescent Patients with Cerebral Infarction with Integrated Traditional Chinese and Western MedicineZHANG Tongkai1，MA Yuxi2，QI Rui3（1.East China Hospital Affiliated to Fudan University，Shanghai 200040，China；2.Shanghai Integrated Traditional Chinese and Western Medicine Hospital，Shanghai 200082，China；3.Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200083，China）Abstract：Objective To compare the clinical efficacy of integrated traditional Chinese and Western medicine rehabilitation and modern rehabilitation on patients with cerebral infarction in convalescence，and optimize the clinical diagnosis and treatment plan of cerebral infarction in convalescence.Methods Taking Yueyang integrated traditional Chinese and Western medicine hospital，East China hospital，the third rehabilitation hospital and Chongming branch of Yueyang hospital as multi center research units，162 patients with cerebral infarction in convalescent period were randomly divided into two groups.The experimental group was treated with integrated traditional Chinese and Western medicine，and the control group was treated with the modern rehabilitation treatment program being implemented in the rehabilitation department of our hospital.The improvement of motor function，independence，nerve function defect and activities of daily living of the two groups before and after treatment were compared.The motor function and activities of daily living were followed up 3 months later.Results（1）After 14 days of treatment，NIHSS scores of the two groups were significantly lower than those before treatment，the difference was statistically significant（P0.05）；and the experimental group was more significantly lower than the control group，the DOI：10.13194/j.issn.1673-842x.2023.02.027134 辽宁中医药大学学报 25 卷difference was statistically significant（P0.05）.（2）After 14 times of treatment，the BI index scores of the two groups were significantly increased compared with those before treatment，the difference was statistically significant（P0.05）；and the BI index score of the experimental group was significantly higher than that of the control group，the difference was statistically significant（P0.05）.（3）After 14 times of treatment，the independent modified Rankin score of the two groups was significantly increased compared with that before treatment，and the difference was statistically significant（P0.05）.（4）After 14 times of treatment，the Fugl-Meyer scores of upper and lower limbs motor function of the two groups were significantly increased compared with those before treatment，the difference was statistically significant（P0.05）；and the Fugl-Meyer score of the upper and lower limb motor function of the experimental group was significantly higher than that of the control group，the difference was statistically significant（P0.05）.（5）After 14 days of treatment，the Wolf completion time of the two groups was significantly shorter than that before treatment，the difference was statistically significant（P0.05）；and the test group was more significantly shorter than the control group，the difference was statistically significant（P0.05）.After 14 days of treatment，the Wolf score of the two groups was significantly increased compared with that before treatment，the difference was statistically significant（P0.05）；and the increase in the experimen