摘 要
脑卒中是全球范围内导致成人残疾的主要原因之一，早期康复介入对改善患者预后具有重要意义。本研究旨在探讨不同时间窗内开始康复治疗对脑卒中患者功能恢复的影响，为临床实践提供循证依据。通过前瞻性队列研究设计，选取某三甲医院神经内科2018年1月至2021年1月收治的360例首次发病的缺血性脑卒中患者作为研究对象，根据入院后48小时内、48 - 72小时、72 - 96小时及96小时后开始康复治疗分为四组。采用随机数字表法分组，所有患者均接受常规药物治疗，在此基础上进行针对性康复训练，包括运动疗法、作业疗法等，持续干预12周。以Fugl - Meyer运动功能评定量表、Barthel指数、改良Ashworth痉挛量表为评估工具，分别于入院时、康复治疗4周、8周、12周时进行评定。结果显示，48小时内开始康复治疗的患者在各时间点的Fugl - Meyer评分、Barthel指数均显著高于其他三组(P0.05)，而改良Ashworth痉挛量表评分低于其他三组(P0.05)。这表明越早开展康复治疗，患者肢体运动功能、日常生活活动能力恢复越好，且发生肌肉痉挛的程度越轻。本研究创新性地将康复介入时机精确到具体时间段，并对比分析不同时间段康复介入的效果差异，为脑卒中患者的早期康复提供了新的思路与方向，有助于提高临床康复效率，改善患者生活质量。
关键词：脑卒中康复；早期介入时机；功能恢复；运动疗法；日常生活活动能力
Abstract
Stroke is a leading cause of adult disability worldwide, and early rehabilitation intervention plays a crucial role in improving patient outcomes. This study aims to investigate the impact of initiating rehabilitation treatment within different time windows on functional recovery in stroke patients, providing evidence-based guidance for clinical practice. A prospective cohort study design was employed, selecting 360 patients with first-onset ischemic stroke admitted to the neurology department of a tertiary hospital from January 2018 to January 2021. Patients were divided into four groups based on the initiation of rehabilitation treatment within 48 hours, between 48 and 72 hours, between 72 and 96 hours, and after 96 hours post-admission using a random number table method. All patients received standard pharmacological treatment along with targeted rehabilitation training, including physical therapy and occupational therapy, for a duration of 12 weeks. Functional assessments were conducted at admission and at 4, 8, and 12 weeks post-rehabilitation initiation using the Fugl-Meyer Assessment, Barthel Index, and Modified Ashworth Scale. The results demonstrated that patients who began rehabilitation within 48 hours had significantly higher Fugl-Meyer scores and Barthel Index values at all time points compared to the other three groups (P0.05), while their Modified Ashworth Scale scores were lower (P0.05). This indicates that earlier rehabilitation initiation leads to better recovery of limb motor function and activities of daily living, as well as reduced muscle spasticity. This study innovatively specifies the timing of rehabilitation intervention to precise time intervals and compares the effectiveness of interventions initiated at different times, offering new insights and directions for early rehabilitation in stroke patients, thereby enhancing clinical rehabilitation efficiency and improving quality of life.
Keywords：Stroke Rehabilitation；Early Intervention Timing；Functional Recovery；Exercise Therapy；Activities Of Daily Living
目 录
摘 要 I
Abstract II
引 言 1
第一章 脑卒中与康复介入基础 2
1.1 脑卒中概述 2
1.2 康复介入概念 2
1.3 早期康复介入意义 3
第二章 早期康复介入时机的选择 5
2.1 最佳介入时间窗口 5
2.2 不同阶段的康复需求 5
2.3 影响介入时机的因素 6
第三章 早期康复介入对功能恢复的影响机制 7
3.1 神经可塑性原理 7
3.2 运动功能恢复路径 7
3.3 日常生活能力改善 8
第四章 早期康复介入效果评估与优化 10
4.1 康复效果评价指标 10
4.2 不同时机介入对比分析 10
4.3 优化康复介入方案 11
结 论 12
参考文献 13
致 谢 14
