功能锻炼在脑卒中康复护理中的应用机制分析 |
| 张慧月 |
| 魏县中医医院，河北邯郸，056800 |
| 摘要：目的 观察功能锻炼在脑卒中（cerebral apoplexy 简写CA）患者康复护理中的实际应用效果。方法 纳入100 例脑卒中康复期患者，随机分为参考组（常规康复护理，n=50）和观察组（常规护理+专项功能锻炼，n=50）。干预1 个月后，采用静息态功能磁共振成像（rs-fMRI）分析感觉运动网络（SMN）、默认模式网络（DMN）、背侧注意网络（DAN）间的功能连接强度（FC）；通过弥散张量成像（DTI）评估患侧皮质脊髓束（CST）、上纵束（SLF）等白质纤维束各向异性分数（FA）和平均扩散率（MD）。结果 网络连接强度方面：SMN-DMN FC 值：观察组提升28.1%（0.32±0.05→0.41±0.08），显著高于参考组（0.31±0.06→0.35±0.07，增幅12.9%；t=3.952, P<0.001）；SMN-DAN FC 值：观察组提升27.6%（0.29±0.06→0.37±0.07），参考组仅14.3%（0.28±0.07→0.32±0.08；t=3.224, P=0.002）。白质完整性方面：患侧CST FA值：观察组提升14.3%（0.42±0.05→0.48±0.04），参考组仅2.3%（0.43±0.04→0.44±0.05；t=4.326, P<0.001）；患侧SLF MD 值：观察组降低6.3%（0.80±0.07×10? 3→0.75±0.06×10? 3），参考组无变化（0.79±0.08→0.78±0.07；t=2.056, P=0.042）。神经功能转化方面：白质修复与功能连接增强显著相关（CST FA 值与SMN-DMN FC 值相关系数r=0.73, P<0.01）。结论 功能锻炼能显著增强脑卒中患者运动相关脑网络功能连接，促进患侧运动及联络纤维束白质微结构修复，为优化康复护理策略提供神经机制证据。 |
| 关健词：脑卒中；功能锻炼；吞咽障碍；认知障碍；感觉认知障碍 |
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| Analysis of the Application Mechanism of Functional Exercise in Stroke Rehabilitation Nursing |
| Huiyue Zhang |
| Weixian County Hospital of Traditional Chinese Medicine，Handan Hebei 056800, China |
| Abstract: Objective To observe the practical application effect of functional exercise in the rehabilitation nursing of patients with cerebral apoplexy (abbreviated as CA). Methods A total of 100 patients in the rehabilitation period of stroke were included and randomly divided into the reference group (conventional rehabilitation care, n=50) and the observation group (conventional care + specialized functional exercise, n=50). One month after the intervention, resting-state functional magnetic resonance imaging (rs-fMRI) was used to analyze the functional connectivity strength (FC) among the sensorimotor network (SMN), default mode network (DMN), and dorsal attention network (DAN). The fractional anisotropy (FA) and mean diffusivity (MD) of white matter fiber tracts such as the affected corticospinal tract (CST) and superior longitudinal tract (SLF) were evaluated by diffusion tensor imaging (DTI). Results In terms of network connection strength: SMN-DMN FC value: The observation group increased by 28.1% (0.32±0.05→0.41±0.08), which was significantly higher than that of the reference group (0.31±0.06→0.35±0.07, with an increase of 12.9%; t=3.952, P<0.001); SMN-DAN FC value: The observation group increased by 27.6% (0.29±0.06→0.37±0.07), while the reference group only increased by 14.3% (0.28±0.07→0.32±0.08; t=3.224, P=0.002). In terms of white matter integrity: The CST FA value on the affected side: The observation group increased by 14.3% (0.42±0.05→0.48±0.04), while the reference group only increased by 2.3% (0.43±0.04→0.44±0.05; t=4.326, P<0.001); The SLF MD value on the affected side: It decreased by 6.3% in the observation group (0.80±0.07×10?3→0.75±0.06×10?3), while there was no change in the reference group (0.79±0.08→0.78±0.07; t=2.056, P=0.042). In terms of neural function transformation:White matter repair was significantly correlated with enhanced functional connectivity (the correlation coefficient r between CST FA value and SMN-DMN FC value was 0.73, P<0.01). Conclusion Functional exercise can significantly enhance the functional connectivity of movement-related brain networks in stroke patients, promote the repair of white matter microstructures in the motor and liaison fiber tracts on the affected side, and provide neural mechanism evidence for optimizing rehabilitation nursing strategies. |
| Keywords：Stroke Functional exercise Dysphagia Cognitive impairment Sensory cognitive impairment |
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