梗死部位和体积对亚急性期缺血性卒中上肢功能康复的影响

doi:10.3969/j.issn.1673-5765.2025.11.010

摘要/Abstract

摘要： 目的探讨梗死部位和体积对亚急性期缺血性卒中患者上肢功能康复的影响。
方法前瞻性纳入2022年6月—2023年9月在首都医科大学附属北京天坛医院康复医学科、北京小汤山医院天坛小汤山康复中心住院治疗的亚急性期缺血性卒中患者。根据入院时头颅MRI检查所示梗死部位，将患者分为幕上皮质下组、幕下组和幕上混合组，并依据Fugl-Meyer运动功能评定量表上肢部分（Fugl-Meyer motor assessment-upper extremity，FMA-UE）评分评估患者上肢功能障碍的严重程度（0～22分为重度，23～50分为中度）。所有患者均接受每周5 d，每日2次，持续3个月的康复治疗。在不同程度上肢功能障碍患者中，分别比较不同梗死部位对上肢功能康复效果的影响，并采用多元线性回归分析探讨梗死部位、梗死体积和其他临床特征与上肢功能康复效果的关系。
结果重复测量方差分析显示，重度上肢功能障碍患者在治疗后1个月和3个月时上肢功能较基线均有改善，且幕下组上肢功能康复效果优于幕上混合组（治疗后1个月：P=0.020；治疗后3个月：P=0.002）。中度上肢功能障碍患者在治疗后1个月和3个月时上肢功能较基线均有改善。多元线性回归分析显示，性别（β=-0.223，P=0.016）、梗死体积（β=-0.257，P=0.005）、MoCA评分（β=0.394，P<0.001）与治疗后1个月的FMA-UE评分相关；性别（β=-0.243，P=0.008）、梗死体积（β=-0.281，P=0.002）、MoCA评分（β=0.370，P<0.001）与治疗后3个月的FMA-UE评分相关；而年龄、吸烟、饮酒、高血压、糖尿病、高血脂、梗死部位、偏瘫侧、康复开始时间与治疗后1个月和3个月FMA-UE评分的相关性均无统计学意义。
结论康复治疗可改善亚急性期缺血性卒中患者的上肢功能。对于重度上肢功能障碍患者，幕下梗死的上肢功能康复效果优于幕上混合梗死。性别、梗死体积和认知功能与治疗后1个月和3个月时的上肢功能康复效果相关。

文章导读： 本研究通过探讨梗死部位、体积及多种影响因素对卒中亚急性期患者上肢功能康复的影响，发现在重度上肢功能障碍的患者中，幕下梗死的功能康复效果优于幕上混合梗死；性别、梗死体积和认知功能与上肢功能康复效果相关。这为此类患者的精准化干预和预后评估提供了参考。

关键词: 缺血性卒中; 梗死部位; 梗死体积; 上肢功能康复

Abstract: Objective To explore the effects of infarct location and volume on upper limb functional rehabilitation in patients with subacute ischemic stroke.
Methods A prospective study was conducted on patients with subacute ischemic stroke who were hospitalized in the Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, and the Tiantan Xiaotangshan Rehabilitation Center, Beijing Xiaotangshan Hospital, from June 2022 to September 2023. Based on infarct locations identified by cranial MRI at admission, patients were divided into the supratentorial subcortical group, infratentorial group, and supratentorial mixed group. The severity of upper limb dysfunction in patients was evaluated using the Fugl-Meyer motor assessment-upper extremity (FMA-UE), with scores of 0-22 points indicating severe dysfunction and 23-50 points indicating moderate dysfunction. All patients received rehabilitation treatment twice daily, 5 days a week, for 3 consecutive months. Among patients with different degrees of upper limb dysfunction, the effects of different infarct locations on upper limb functional rehabilitation were compared, and multiple linear regression analysis was used to explore the relationships between infarct locations, infarct volumes, other clinical characteristics, and upper limb functional rehabilitation.
Results Repeated measures analysis of variance showed that patients with severe upper limb dysfunction had improved upper limb function at both 1 month and 3 months post-treatment compared with baseline, and the infratentorial group had better outcomes in upper limb functional rehabilitation than the supratentorial mixed group (1 month post-treatment: P=0.020, 3 months post-treatment: P=0.002). Patients with moderate upper limb dysfunction also showed improved upper limb function at 1 month and 3 months post-treatment compared with baseline. Multiple linear regression analysis revealed that gender (β=-0.223, P=0.016), infarct volume (β=-0.257, P=0.005), and MoCA score (β=0.394, P<0.001) were associated with FMA-UE scores at 1 month post-treatment. Gender (β=-0.243, P=0.008), infarct volume (β=-0.281, P=0.002), and MoCA score (β=0.370, P<0.001) were associated with FMA-UE scores at 3 months post-treatment. However, age, smoking, alcohol consumption, hypertension, diabetes mellitus, hyperlipidemia, infarct location, hemiplegic side, and onset time of rehabilitation had no statistically significant association with FMA-UE scores at either 1 or 3 months post-treatment.
Conclusions Rehabilitation therapy can promote upper limb function in patients with subacute ischemic stroke. For patients with severe upper limb dysfunction, the upper limb functional rehabilitation outcomes of infratentorial infarction are better than those of supratentorial mixed infarction. Gender, infarct volume, and cognitive function are associated with upper limb functional rehabilitation outcomes at 1 month and 3 months post-treatment.

Key words: Ischemic stroke; Infarct location; Infarct volume; Upper limb function rehabilitation

中图分类号:

吴娱倩, 臧大维, 逄文斌, 胡安明, 韩玉娟. 梗死部位和体积对亚急性期缺血性卒中上肢功能康复的影响[J]. 中国卒中杂志, 2025, 20(11): 1411-1419.

WU Yuqian, ZANG Dawei, PANG Wenbin, HU Anming, HAN Yujuan. Effects of Infarct Location and Volume on Upper Limb Functional Rehabilitation in Subacute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(11): 1411-1419.

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