首次中风后最初 6 个月痉挛的时间进程和决定因素。

Time-course and determinants of spasticity during the first six months following first-ever stroke.

机构信息

Department of Neuroscience, Neurology and Rehabilitation Medicine, Uppsala University Hospital, Uppsala, Sweden.

出版信息

J Rehabil Med. 2010 Apr;42(4):296-301. doi: 10.2340/16501977-0509.

DOI:10.2340/16501977-0509

PMID:20461330

Abstract

OBJECTIVE

To explore the occurrence of, and risk factors for, spasticity until 6 months after first-ever stroke.

METHODS

Forty-nine patients were examined at day 2-10, at 1 month, and at 6 months. The modified Ashworth Scale was used to assess resistance to passive movements. A comprehensive clinical examination was performed to identify other positive signs of upper motor neurone syndrome, in accordance with a broader definition of spasticity, and to evaluate whether spasticity was disabling. Neurological impairments were determined by use of the National Institutes of Health Stroke Scale and global disability by use of the modified Rankin Scale.

RESULTS

Spasticity was present in 2 patients (4%) at day 2-10, in 13 patients (27%) at 1 month, and in 11 patients (23%) at 6 months. Severe paresis of the arm at day 2-10 was associated with a higher risk for spasticity at 1 month (odds ratio = 10, 95% confidence interval 2.1-48.4). Disabling spasticity was present in one patient at 1 month and in 6 patients (13%) at 6 months.

CONCLUSION

Spasticity according to the modified Ashworth Scale usually occurs within 1 month and disabling spasticity later in a subgroup. Severe paresis of the arm is a risk factor for spasticity.

摘要

目的

探讨首次脑卒中后 6 个月内痉挛的发生情况和危险因素。

方法

49 例患者分别在第 2-10 天、第 1 个月和第 6 个月进行检查。采用改良 Ashworth 量表评估被动运动时的阻力。根据痉挛的广义定义，进行全面的临床检查以确定上运动神经元综合征的其他阳性体征，并评估痉挛是否导致残疾。采用国立卫生研究院卒中量表评估神经功能缺损，采用改良 Rankin 量表评估整体残疾。

结果

第 2-10 天有 2 例（4%）患者出现痉挛，第 1 个月有 13 例（27%）患者出现痉挛，第 6 个月有 11 例（23%）患者出现痉挛。第 2-10 天手臂严重无力与第 1 个月痉挛风险较高相关（比值比=10，95%置信区间 2.1-48.4）。第 1 个月有 1 例患者出现致残性痉挛，第 6 个月有 6 例（13%）患者出现致残性痉挛。