综合康复干预对脑卒中合并阿尔兹海默病患者认知能力和运动能力的影响
|
摘要
目的探讨综合康复干预对脑卒中合并阿尔兹海默病(AD)患者认知能力和运动能力的影响。方法选取2015年1月～2017年11月于青岛市市立医院就诊的62例已确诊为卒中合并AD的患者,随机分为观察组和对照组,各31例。对照组患者予以常规治疗和常规自我康复锻炼,观察组在对照组基础上予以多学科综合康复训练干预。观察比较两组患者干预前后认知功能、脑电特征、肌力水平、偏瘫功能和日常生活活动能力。结果治疗后观察组患者的简易精神状态检查量表(MMSE)评分、韦氏记忆测试(WMS)评分均较治疗前升高,对照组患者的MMSE评分、WMS评分均较治疗前下降,观察组患者MMSE评分、WMS评分的改变均较对照组高,差异具有统计学意义(P <0.05)。治疗后观察组患者的β1、β2均较治疗前升高,观察组的β1、β2增加值显著高于对照组,差异具有统计学意义(P <0.05);对照组患者的β1、β2与治疗前比较,差异无统计学意义(P>0.05)。治疗后,观察组患者的肌力明显好于对照组(P <0.05),观察组患者的FMA评分(35.94±5.41 vs. 21.15±3.16;22.92±5.97 vs. 15.18±2.80)、日常生活能力评定(Barthel指数)(69.47±15.25 vs. 51.13±12.31)均高于对照组,观察组FMA评分、Barthel指数增加值显著高于对照组,差异均具有统计学意义(P <0.05)。结论对脑卒中合并AD患者予以早期综合康复干预,可明显改善患者的认知能力与运动能力,提高患者的生活质量,值得临床推广和应用。
Objective To investigate the effects of comprehensive rehabilitation intervention on the cognitive ability and exercise capacity in stroke patients with Alzheimer Disease(AD). Methods 62 patients who had been diagnosed with stroke and AD in our hospital from January 2015 to November 2017 were randomly divided into the observation and the control groups,with 31 cases in each group. Patients in the control group received routine treatment and unsupervised self-rehabilitation exercise. The observation group received multidisciplinary comprehensive rehabilitation intervention after the vital signs were stable and the symptoms were controlled. The cognitive function,EEG characteristics,muscle strength,hemiplegia function and activities of daily living were compared before and after intervention between the two groups. Results After treatment,the scores of MMSE and WMS in the observation group were higher than those before treatment,and the scores of MMSE and WMS in the control group were lower than before treatment,the changes of the scores of MMSE and WMS in the observation group were higher than those in the control group,and the difference was statistically significant(P < 0.05). After treatment,the levels of β1 and β2 in the observation group were higher than those before treatment,the added value of the levels of β1 and β2 in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05). However,there was no significant difference between β1 and β2 in the control group compared with before treatment(P > 0.05). After treatment,the muscle strength in the observation group was significantly better than that in the control group(P < 0.05). After treatment,the score of FMA(35.94 ± 5.41 vs.21.15 ± 3.16;22.92 ± 5.97 vs. 15.18 ± 2.80) and Barthel index(69.47 ± 15.25 vs. 51.13 ± 12.31) in the observation group were higher than those in the control group,the increased value of the score of FMA and Barthel index in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05). Conclusion Early comprehensive rehabilitation intervention for stroke patients with AD can significantly improve the patients' cognitive ability and exercise capacity,and improve their quality of life,which is worthy of clinical promotion and application.
Objective To investigate the effects of comprehensive rehabilitation intervention on the cognitive ability and exercise capacity in stroke patients with Alzheimer Disease(AD). Methods 62 patients who had been diagnosed with stroke and AD in our hospital from January 2015 to November 2017 were randomly divided into the observation and the control groups,with 31 cases in each group. Patients in the control group received routine treatment and unsupervised self-rehabilitation exercise. The observation group received multidisciplinary comprehensive rehabilitation intervention after the vital signs were stable and the symptoms were controlled. The cognitive function,EEG characteristics,muscle strength,hemiplegia function and activities of daily living were compared before and after intervention between the two groups. Results After treatment,the scores of MMSE and WMS in the observation group were higher than those before treatment,and the scores of MMSE and WMS in the control group were lower than before treatment,the changes of the scores of MMSE and WMS in the observation group were higher than those in the control group,and the difference was statistically significant(P < 0.05). After treatment,the levels of β1 and β2 in the observation group were higher than those before treatment,the added value of the levels of β1 and β2 in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05). However,there was no significant difference between β1 and β2 in the control group compared with before treatment(P > 0.05). After treatment,the muscle strength in the observation group was significantly better than that in the control group(P < 0.05). After treatment,the score of FMA(35.94 ± 5.41 vs.21.15 ± 3.16;22.92 ± 5.97 vs. 15.18 ± 2.80) and Barthel index(69.47 ± 15.25 vs. 51.13 ± 12.31) in the observation group were higher than those in the control group,the increased value of the score of FMA and Barthel index in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05). Conclusion Early comprehensive rehabilitation intervention for stroke patients with AD can significantly improve the patients' cognitive ability and exercise capacity,and improve their quality of life,which is worthy of clinical promotion and application.
引文
[1]程蕊容,辛秀峰,刘章佩,等.卒中后认知障碍的研究进展[J].临床荟萃,2018,33(1):89-92.
[2]刘欣艳,刘闻莺,余雪君,等.营养状况与阿尔兹海默病的相关性研究[J].中国医药导报,2014,11(18):62-65.
[3]覃家华.康复综合治疗对阿尔茨海默病(AD)患者脑电特征的影响分析[J].中国继续医学教育,2017,9(6):129-131.
[4]Ciezki JP,Klein EA,Angermeier K,et al.A retrospectivecomparison of androgen eprivation(AD)vs.no AD amonglow-risk and intermediate-risk prostate cancer patientstreated with brachytherapy,external beam radiotherapy,or radical prostatectomy[J].Int J Radiat Oncol,2014,60(5):1347-1350.
[5]钱洪娟.系统康复训练在阿尔茨海默病患者临床治疗中的作用[J].世界最新医学信息文摘,2016,16(65):68-69.
[6]戴云飞,肖泽萍.中国精神障碍分类与诊断标准第3版与国际疾病分类第10版的比较[J].临床精神医学杂志,2013,23(6):426-427.
[7]Powers WJ,Rabinstein AA,Ackerson T,等.2018美国卒中协会/美国心脏协会急性缺血性卒中患者早期管理指南[J].中国脑血管病杂志,2018,15(5):267-281.
[8]郑华光,刘慧慧,董漪,等.2018美国心脏学会/美国卒中学会急性缺血性卒中早期管理指南新增推荐解读[J].中国卒中杂志,2018,13(1):81-85.
[9]Reiter K,Alpert KI,Cobia DJ,et al.Cognitively normalindividuals with AD parents may be at risk for developing aging-related cortical thinning patterns characteristicof AD[J].Neuro Image,2015,61(3):525-532.
[10]张英,杨颖华,武士勇,等.轻度认知障碍认知训练的研究进展[J].中国康复医学杂志,2018,33(2):249-253.
[11]许颖,杨坚,李洪丽,等.成人听力言语康复系统用于脑卒中后构音障碍患者言语训练的效果观察[J].现代医学,2017,45(10):1446-1449.
[12]赵春善,高玲,孟繁明.认知训练对老年轻度认知障碍认知功能影响的meta分析[J].中国老年学杂志,2018,38(22):5487-5492.
[13]孔晓明,王莹,吴晓平,等.认知训练对阿尔茨海默病患者情绪的影响[J].安徽医药,2014,18(11):2117-2119.
[14]高平,蔡晓杰,秦绍森.阿尔茨海默病和轻度认知功能障碍的神经心理学研究[J].中华老年医学杂志,2006,25(10):725-728.
[15]张旭,李瑞玲,王静杰,等.缺血性脑卒中患者残疾接受度及相关因素[J].中国心理卫生杂志,2018,32(4):314-318.
[16]陈洁,杨康,傅毅.卒中后认知功能障碍的流行病学,分型及诊断[J].上海医药,2018,39(17):3-4+42.
[17]Morimoto K,Horio J,Satoh H,et al.Expression profilesof cytokines in the brains of alzheimer's disease(AD)Patients compared to the brains of non demented pa-tients with and without increasing AD pathology[J].J Alzheimers Dis,2015,25(1):59-76.
[18]史静,王晶,石梦丹,等.神经功能重建系统结合运动意念在脑卒中早期患者康复治疗中的应用进展[J].海南医学,2017,28(9):1472-1474.
[19]徐武华,常铉.联合预防阿尔茨海默病与缺血性脑卒中的构想[B].医学与哲学,2014,35(7):76-77+82.
[20]徐俊,王伊龙.血管性认知障碍研究的突破口:《卒中后认知障碍专家共识》解读[J].中国实用内科杂志,2018,38(2):151-153.
[21]于晨,刘欣娟,黄菊,等.心理干预对脑卒中后抑郁治疗效果的系统评价[J].中国循证医学杂志,2011,11(6):670-680.
[22]李沫,吕继辉,郝智慧,等.脑电超慢涨落图技术对阿尔茨海默病脑功能状态的评估价值[B].医学与哲学,2016,37(12):50-52.
[23]李昕,谢佳利,侯永捷,等.脑电特征分析在阿尔茨海默症临床研究中的应用[J].中国生物医学工程学报,2016,35(2):234-240.
[2]刘欣艳,刘闻莺,余雪君,等.营养状况与阿尔兹海默病的相关性研究[J].中国医药导报,2014,11(18):62-65.
[3]覃家华.康复综合治疗对阿尔茨海默病(AD)患者脑电特征的影响分析[J].中国继续医学教育,2017,9(6):129-131.
[4]Ciezki JP,Klein EA,Angermeier K,et al.A retrospectivecomparison of androgen eprivation(AD)vs.no AD amonglow-risk and intermediate-risk prostate cancer patientstreated with brachytherapy,external beam radiotherapy,or radical prostatectomy[J].Int J Radiat Oncol,2014,60(5):1347-1350.
[5]钱洪娟.系统康复训练在阿尔茨海默病患者临床治疗中的作用[J].世界最新医学信息文摘,2016,16(65):68-69.
[6]戴云飞,肖泽萍.中国精神障碍分类与诊断标准第3版与国际疾病分类第10版的比较[J].临床精神医学杂志,2013,23(6):426-427.
[7]Powers WJ,Rabinstein AA,Ackerson T,等.2018美国卒中协会/美国心脏协会急性缺血性卒中患者早期管理指南[J].中国脑血管病杂志,2018,15(5):267-281.
[8]郑华光,刘慧慧,董漪,等.2018美国心脏学会/美国卒中学会急性缺血性卒中早期管理指南新增推荐解读[J].中国卒中杂志,2018,13(1):81-85.
[9]Reiter K,Alpert KI,Cobia DJ,et al.Cognitively normalindividuals with AD parents may be at risk for developing aging-related cortical thinning patterns characteristicof AD[J].Neuro Image,2015,61(3):525-532.
[10]张英,杨颖华,武士勇,等.轻度认知障碍认知训练的研究进展[J].中国康复医学杂志,2018,33(2):249-253.
[11]许颖,杨坚,李洪丽,等.成人听力言语康复系统用于脑卒中后构音障碍患者言语训练的效果观察[J].现代医学,2017,45(10):1446-1449.
[12]赵春善,高玲,孟繁明.认知训练对老年轻度认知障碍认知功能影响的meta分析[J].中国老年学杂志,2018,38(22):5487-5492.
[13]孔晓明,王莹,吴晓平,等.认知训练对阿尔茨海默病患者情绪的影响[J].安徽医药,2014,18(11):2117-2119.
[14]高平,蔡晓杰,秦绍森.阿尔茨海默病和轻度认知功能障碍的神经心理学研究[J].中华老年医学杂志,2006,25(10):725-728.
[15]张旭,李瑞玲,王静杰,等.缺血性脑卒中患者残疾接受度及相关因素[J].中国心理卫生杂志,2018,32(4):314-318.
[16]陈洁,杨康,傅毅.卒中后认知功能障碍的流行病学,分型及诊断[J].上海医药,2018,39(17):3-4+42.
[17]Morimoto K,Horio J,Satoh H,et al.Expression profilesof cytokines in the brains of alzheimer's disease(AD)Patients compared to the brains of non demented pa-tients with and without increasing AD pathology[J].J Alzheimers Dis,2015,25(1):59-76.
[18]史静,王晶,石梦丹,等.神经功能重建系统结合运动意念在脑卒中早期患者康复治疗中的应用进展[J].海南医学,2017,28(9):1472-1474.
[19]徐武华,常铉.联合预防阿尔茨海默病与缺血性脑卒中的构想[B].医学与哲学,2014,35(7):76-77+82.
[20]徐俊,王伊龙.血管性认知障碍研究的突破口:《卒中后认知障碍专家共识》解读[J].中国实用内科杂志,2018,38(2):151-153.
[21]于晨,刘欣娟,黄菊,等.心理干预对脑卒中后抑郁治疗效果的系统评价[J].中国循证医学杂志,2011,11(6):670-680.
[22]李沫,吕继辉,郝智慧,等.脑电超慢涨落图技术对阿尔茨海默病脑功能状态的评估价值[B].医学与哲学,2016,37(12):50-52.
[23]李昕,谢佳利,侯永捷,等.脑电特征分析在阿尔茨海默症临床研究中的应用[J].中国生物医学工程学报,2016,35(2):234-240.