脑梗死后肢体运动功能恢复与康复训练依从性的相关性分析

Correlation Analysis of Limb Motor Function Recovery and Rehabilitation Training Compliance after Cerebral Infarction

摘要: 目的：探讨脑梗死患者中医护理技术依从性与肢体运动功能恢复之间的剂量-反应关系，为构建以依从性为导向的精准康复策略提供循证依据。方法：采用单中心回顾性队列设计，纳入2023年9月~2025年4月珠海市中西医结合医院卒中单元脑梗死患者80例。以《中医护理方案实施汇总表》双签字记录回溯量化依从性，将患者分为依从组(n = 34)、部分依从组(n = 28)和不依从组(n = 18)。主要结局为日常生活自理能力(Barthel指数，ADL)增益(ΔADL = 出院–入院)，次要结局包括显著改善率(ΔADL ≥ 20分)及并发症。运用单因素ANOVA、χ²检验及多元线性回归分析依从性对功能恢复的独立贡献。结果：三组基线特征均衡可比。依从组综合中医护理技术完成率91.06%，显著高于不依从组62.00% (P < 0.001)。出院时依从组ADL提高26.85分，显著改善率70.59%，不依从组仅15.28分与16.67% (P < 0.001)。综合依从率与ΔADL呈强正相关(r = 0.68, P < 0.001)；回归显示，控制年龄、入院NIHSS及基线ADL后，综合依从率每增加10%，ΔADL平均提高2.1分(β = 0.21, 95%CI: 0.15~0.27)，标准化系数高于NIHSS。结论：中医护理技术完成率是早期可干预、可量化的依从性替代指标，与脑梗死患者ADL恢复呈显著剂量–反应关系；临床通过提高完成率即可直接放大肢体功能获益，值得纳入卒中质量管理与延续护理路径。

Abstract: Objective: To explore the dose-response relationship between the compliance of traditional Chinese medicine nursing techniques and the recovery of limb motor function in patients with cerebral infarction, and to provide evidence-based basis for constructing a compliance-oriented precise rehabilitation strategy. Methods: A single-center retrospective cohort design was adopted, and 80 patients with cerebral infarction in the stroke unit of Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from September 2023 to April 2025 were included. The compliance was retrospectively quantified by double-signature records in the Summary Table of Implementation of Traditional Chinese Medicine Nursing Plan, and the patients were divided into the compliance group (n = 34), the partial compliance group (n = 28), and the non-compliance group (n = 18). The primary outcome was an increase in daily living self-care ability (Barthel index, ADL) (ΔADL= discharge-admission), and the secondary outcomes included a significant improvement rate (ΔADL ≥ 20 points) and complications. The independent contribution of compliance to functional recovery was analyzed using univariate ANOVA, χ² test and multiple linear regression. Result: The baseline characteristics of the three groups were balanced and comparable. The completion rate of comprehensive traditional Chinese medicine nursing techniques in the compliance group was 91.06%, significantly higher than that in the non-compliance group (62.00%, P < 0.001). At discharge, the ADL of the compliance group increased by 26.85 points, with a significant improvement rate of 70.59%, while that of the non-compliance group was only 15.28 points and 16.67% (P < 0.001). The comprehensive compliance rate was strongly positively correlated with ΔADL (r = 0.68, P < 0.001). Regression showed that after controlling for age, admission NIHSS and baseline ADL, for every 10% increase in the comprehensive compliance rate, ΔADL increased by an average of 2.1 points (β = 0.21, 95%CI: 0.15~0.27), and the standardized coefficient was higher than that of NIHSS. Conclusion: The completion rate of traditional Chinese medicine nursing techniques is an early intervenable and quantifiable alternative indicator of compliance, and it shows a significant dose-response relationship with the recovery of ADL in patients with cerebral infarction. Clinically, the benefits of limb function can be directly magnified by improving the completion rate, which is worthy of being included in the stroke quality management and continuous care pathway.