脑卒中6个月内上肢运动康复轨迹的纵向生存数据研究

关键词：脑卒中  上肢  预后  康复  生存分析

Keywords:stroke  upper extremity  prognosis  rehabilitation  survival analysis

摘要：

      摘要 目的：探讨脑卒中后上肢运动功能长期预后的影响因素。 方法：纳入61例脑卒中后存在上肢运动功能障碍的患者，收集一般资料，上肢运动功能评估采用Fugl-Meyer运动量表上肢部分（FMA-UE），基于头颅影像提取颅内病变位置，纵向获取入组、脑卒中后1月/3月/6个月的上肢运动功能恢复情况，并根据脑卒中后6个月的FMA-UE评分将患者分为良好预后组、不良预后组，通过χ2检验和Kaplan-Meier生存分析比较两组患者的临床及影像学数据异同。 结果：脑卒中患者的上肢运动功能预后与患者的年龄、性别、脑卒中类型和侧别无关，与患手主动运动恢复情况及病变位置相关。脑卒中后1个月、3个月出现手部主动运动者达到良好预后的平均恢复时间为2.100个月、3.313个月，且手部主动运动出现越早预后越好；病变位置涉及中央前回、侧脑室后部、内囊后肢等核心区域则提示长期预后差，病变位置不涉及核心区域者达到良好预后的平均时间为2.792个月。 结论：脑卒中后偏瘫上肢的长期预后与患手主动运动出现时间、颅内病变位置相关。

Abstract:

      Abstract Objective： To explore the prognostic factors for long-term upper limb motor function recovery after stroke. Method： Patients （n=61） with upper limb motor dysfunction after stroke were included. General demographic and clinical data were collected. Upper limb motor function was evaluated with the Fugl-Meyer assessment-upper extremity （FMA-UE）. Intracranial lesion locations were identified based on head MRI or CT. The recovery of upper limb motor function was monitored longitudinally at admission and at 1，3 and 6 months post-stroke. Patients were divided into a good prognosis group or a poor prognosis group according to the FMA-UE score at 6 months poststroke. Clinical and radiological data between the two groups were compared using the χ2 test and Kaplan-Meier survival analysis. Result： The prognosis of upper limb motor function in stroke patients is determined by the recovery of active hand movement and the location of the lesion， but not with age, sex, stroke type or affected side. The average recovery time to achieve good prognosis for those who experience active hand movement within 1 month and 3 months poststroke is 2.100 months and 3.313 months. Patients with earlier active hand movement had better prognoses. Poor long-term prognosis is associated with lesions affecting core regions such as the precentral gyrus， posterior horn of the lateral ventricular and posterior limb of the inner capsule. In contrast, patients with lesions not involving these core regions achieved good prognosis after an average of approximately 2.792 months. Conclusion： The long-term prognosis for hemiplegic upper limbs recovery after stroke is significantly influenced by the timing of active hand movement and the location of intracranial lesions.