本文選題：腦卒中 + 運動功能障礙��； 參考：《復旦大學》2014年博士論文

【摘要】：第一部分 規(guī)范三級康復治療對腦卒中患者運動功能的影響目的探討規(guī)范的三級康復治療對腦卒中患者運動功能恢復的影響。方法259名腦卒中患者隨機分組為規(guī)范康復治療組和非規(guī)范康復治療組,用簡化Fugl-Meyer運動功能評分法(simplified Fugl-Meyer assessment, FMA), Brunnstrom分期評定(Brunnstrom motor function assessment),改良Ashworth分級(modified Ashworth scale, MAS)分別在入組即時,治療后1,2,3,6個月進行評定,并于評估和治療結(jié)束后12個月進行隨訪評估。其中Brunnstrom分期評定包括對肩、手和下肢的分別評分,改良Ashworth分級包括對肱二頭肌、股四頭肌的分別評定,并進行統(tǒng)計學分析。結(jié)果規(guī)范三級康復治療組和非規(guī)范康復治療組在入組時的一般情況及FMA評分、Brunnstrom分期、改良Ashworth評級等均無統(tǒng)計學差異。在治療2月、治療3月、治療6月、隨訪1年時,兩組的FMA評分、上肢Brunnstrom分期、下肢Brunnstrom分期、肱二頭肌改良Ashworth評級及股四頭肌改良Ashworth評級均隨著時間的推進而逐漸改善。規(guī)范三級康復治療組在治療2月、治療3月、治療6月、隨訪1年時的FMA評分、下肢Brunnstrom分期及下肢肌(股四頭肌)改良Ashworth評級均高于非規(guī)范康復治療組,組間差異具有統(tǒng)計學意義(P0.05)。而規(guī)范三級康復治療組和非規(guī)范康復治療組在治療2月、治療3月、治療6月、隨訪1年時的肩關(guān)節(jié)Brunnstrom分期、手Brunnstrom分期及上肱二頭肌改良Ashworth評級均無統(tǒng)計學差異。結(jié)論與非規(guī)范康復治療相比,規(guī)范的三級康復治療更有利于患者肢體運動功能障礙的恢復。第二部分規(guī)范三級康復治療對腦卒中患者認知功能的影響目的探討規(guī)范的三級康復治療對腦卒中患者認知功能恢復的影響。方法259名腦卒中患者隨機分組為規(guī)范康復治療組和非規(guī)范康復治療組,使用簡明精神智能狀態(tài)檢查量表(mini mental state examination, MMSE)在入組即時,治療后1,2,3,6個月進行評定,以及在治療結(jié)束12個月時進行隨訪評估。結(jié)果規(guī)范三級康復治療組和非規(guī)范康復治療組隨著治療時間的推進,在治療后1,2,3,6個月進行評定,以及在治療結(jié)束12個月,MMSE評分均有明顯增加的趨勢(P0.05)。但是規(guī)范三級康復治療組和非規(guī)范康復治療組之間各個時間點的評分均無統(tǒng)計學差異。結(jié)論本研究沒有明確證據(jù)表明規(guī)范三級康復治療在改善認知方面優(yōu)于非規(guī)范康復治療。第三部分規(guī)范三級康復治療對腦卒中患者日常生活活動能力和生存質(zhì)量的影響目的探討規(guī)范三級康復治療對腦卒中患者日常生活活動能力和生存質(zhì)量的影響。方法259名腦卒中患者隨機分組為規(guī)范康復治療組和非規(guī)范康復治療組,采用改良Barthel指數(shù)(Modified Barthel Index, MBI)對患者的ADL進行評分,采用SF-36健康調(diào)查量表(the MOS 36-item short form health survey, SF-36)對患者的生存質(zhì)量進行評分。在入組即時,治療后1,2,3,6個月進行評定,以及在治療結(jié)束12個月時進行隨訪評估。結(jié)果規(guī)范三級康復治療組和非規(guī)范康復治療組隨著治療時間的推進,治療后1,2,3,6個月進行評定,以及在治療結(jié)束12個月時,MBI評分均有明顯增加的趨勢(P0.05),SF-36評分亦均有明顯增加的趨勢(P0.05)。規(guī)范三級康復治療組和非規(guī)范康復治療組在治療1個月和2個月時MBI評分無顯著差異,但治療3個月、治療6個月、隨訪1年時,規(guī)范三級康復治療組的MBI評分均明顯高于對常規(guī)康復治療組(P0.05)；在治療1個月時,規(guī)范三級康復治療組和非規(guī)范康復治療組的SF-36評分無統(tǒng)計學差異,在治療2個月、治療3個月、治療6個月、隨訪1年時,規(guī)范三級康復治療組的SF-36評分均明顯高于對非規(guī)范康復治療組(P0.05)。結(jié)論規(guī)范三級康復治療在提高腦卒中患者ADL能力,改善患者生存質(zhì)量方面,比非規(guī)范康復治療有著更多的優(yōu)勢。第四部分規(guī)范的三級康復治療對腦卒中患者綜合功能能力的影響目的探討規(guī)范的三級康復治療對腦卒中患者綜合功能能力的影響。方法259名腦卒中患者隨機分組為規(guī)范康復治療組和非規(guī)范康復治療組,采用綜合功能評定量表(functional comprehensive assessment, FCA)作為評估標準,在入組即時,治療后1,2,3,6個月進行評定,并于評估和治療結(jié)束后12個月進行隨訪評估,對患者進行綜合功能能力評分。結(jié)果在入組時,規(guī)范三級康復治療組和常規(guī)康復治療組FCA評分無統(tǒng)計學差異。在治療1個月,2個月,3個月,6個月,及隨訪1年時,規(guī)范三級康復治療組的FCA評分隨著時間推移而增加；在治療1個月,2個月,3個月,6個月,及隨訪1年時,非規(guī)范康復治療組的FCA評分也隨著時間推移而增加。雖然在治療1個月,2個月和3個月時,規(guī)范三級康復治療組和非規(guī)范康復治療組FCA評分均無統(tǒng)計學差異,然而在治療6個月及隨訪一年時,規(guī)范三級康復治療組的FCA評分明顯高于非規(guī)范康復治療組。結(jié)論規(guī)范三級康復治療比非規(guī)范康復治療更有利于腦卒中患者綜合功能能力的提高。
[Abstract]:The first part was to standardize the effect of three level rehabilitation therapy on the motor function of stroke patients. Objective to explore the effect of standard three level rehabilitation therapy on stroke patients' motor function recovery. Methods 259 stroke patients were randomly divided into normal rehabilitation treatment group and non standard rehabilitation treatment group, and simplified Fugl-Meyer exercise function score (Simpli Fied Fugl-Meyer assessment, FMA), Brunnstrom staging (Brunnstrom motor function assessment). The improved Ashworth grading (modified Ashworth) was evaluated immediately after the treatment, and was evaluated at the end of the evaluation and 12 months after the end of the evaluation. The scores of hand and lower extremity respectively, the improved Ashworth classification included the evaluation of the biceps brachii muscle and the four head of the femoris respectively, and carried out statistical analysis. Results there were no significant differences in the general situation and the FMA score, the Brunnstrom staging and the improved Ashworth rating for the standard three level rehabilitation treatment group and the non standard rehabilitation treatment group. In the treatment of February, there were no statistical differences. After 1 years of follow-up, the two groups of FMA scores, the Brunnstrom staging of the upper limbs, the Brunnstrom staging of the lower limbs, the Ashworth rating of the biceps brachii muscle and the Ashworth rating of the four head muscle of the femur were gradually improved with the advance of time. The standard three rehabilitation treatment group was treated in February, March, June, and the follow-up of 1 years, FMA score, The Brunnstrom staging of lower extremity and the improved Ashworth rating of the lower extremities (four heads of femoris muscle) were higher than those in the nonstandard rehabilitation group. The difference between the groups was statistically significant (P0.05). The standard three level rehabilitation treatment group and the non normal rehabilitation group were treated in February, March, June, and the shoulder joint Brunnstrom staging and hand Brunnstrom staging at 1 years. There is no significant difference in the Ashworth rating of the upper brachial biceps. Conclusion compared with the nonstandard rehabilitation treatment, the standard three level rehabilitation therapy is more beneficial to the recovery of the patient's limb movement dysfunction. The second part of the standard three level rehabilitation treatment on the cognitive function of stroke patients is to explore the standard three level rehabilitation therapy for cerebral pawns. Methods 259 patients with cerebral apoplexy were randomly divided into normal rehabilitation therapy group and non standard rehabilitation therapy group. The mini mental state examination (MMSE) was used immediately after the treatment, the assessment was performed at 1,2,3,6 months after treatment, and at the end of the treatment at the end of 12 months. Results the standard three level rehabilitation treatment group and the non standard rehabilitation treatment group were evaluated at 1,2,3,6 months after the treatment, and the MMSE score increased significantly at the end of the 12 months of treatment (P0.05). However, the evaluation of the time points between the three level rehabilitation treatment group and the non standard rehabilitation treatment group was evaluated. There is no statistical difference. Conclusion there is no clear evidence in this study that standard three level rehabilitation is better than nonstandard rehabilitation in improving cognition. The third part of the standard three level rehabilitation therapy on stroke patients' daily living ability and quality of life Methods 259 stroke patients were randomly divided into the standard rehabilitation treatment group and the non standard rehabilitation treatment group. The modified Barthel index (Modified Barthel Index, MBI) was used to score the patients' ADL, and the SF-36 health survey scale (the MOS 36-item short form) was used. The patient's quality of life was scored. 1,2,3,6 months after the treatment was evaluated and followed up at the end of the treatment for 12 months. Results the standard three level rehabilitation group and the nonstandard rehabilitation group were evaluated with the treatment time, 1,2,3,6 months after treatment, and 12 months after the end of the treatment, MBI evaluation. There was a significant increase in the trend (P0.05) and a significant increase in the SF-36 score (P0.05). There was no significant difference in the MBI score between the standard three level rehabilitation treatment group and the non normal rehabilitation treatment group at 1 months and 2 months, but the treatment group for 3 months, 6 months, and 1 years of follow-up, the MBI score of the standard three rehabilitation group was significantly higher than that of the pair. In the routine rehabilitation group (P0.05), there was no significant difference in the SF-36 score between the standard three rehabilitation treatment group and the nonstandard rehabilitation group at 1 months. In the 2 month treatment, the treatment for 3 months, the treatment for 6 months, and the 1 years of follow-up, the SF-36 score of the standard three rehabilitation group was significantly higher than that of the non standardized rehabilitation treatment group (P0.05). Class three rehabilitation therapy has more advantages than non standardized rehabilitation in improving the ADL ability of stroke patients and improving the quality of life. The effect of the fourth part of the standardized three level rehabilitation therapy on the comprehensive functional ability of stroke patients is to explore the effect of standardized three level rehabilitation therapy on the comprehensive functional ability of stroke patients. Methods 259 stroke patients were randomly divided into the standard rehabilitation treatment group and the non standard rehabilitation treatment group. The functional comprehensive assessment (FCA) was used as the evaluation criterion. The assessment was conducted in the group immediately after the treatment, and the assessment was performed at the end of the assessment and 12 months after the end of the treatment. There was no significant difference in the FCA score between the standard three and the conventional rehabilitation groups in the group. The FCA score of the standard three rehabilitation group increased with the time lapse at 1 months, 2 months, 3 months, 6 months, and 1 years of follow-up; in the treatment of 1 months, 2 months, 3 months, and 6. The FCA score of the nonstandard rehabilitation group increased with the time of 1 years, and there was no significant difference in the FCA score between the standard three rehabilitation treatment group and the nonstandard rehabilitation treatment group at the 1 months, 2 months and 3 months. However, the FCA score of the three level rehabilitation treatment group was standardized in the 6 months of treatment and in the year of the visit. Conclusion three level rehabilitation is better than non standardized rehabilitation therapy in improving comprehensive functional ability of stroke patients.
【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R743.3

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