年龄与缺血性脑卒中患者早期康复疗效的相关性分析

Correlation Analysis between Age and Early Rehabilitation Effect of Patients with Ischemic Stroke

摘要: 目的：探讨年龄对缺血性脑卒中患者早期康复疗效的独立影响，为分层康复策略提供循证依据。方法：采用回顾性单中心队列设计，连续纳入2024年1月至2025年5月珠海市中西医结合医院首次缺血性脑卒中患者96例，按年龄分为青年组(<45岁)、中年组(45~64岁)与老年组(≥65岁)，各32例。三组均在发病24 h内启动标准化早期康复，疗程14 d。以改良Barthel指数(MBI)较基线增加≥12分定义为临床显著改善，以美国国立卫生研究院卒中量表(NIHSS)较基线下降≥4分定义为神经功能有效恢复。采用χ²检验、线性趋势检验及重复测量方差分析评估年龄与疗效的量效关系。结果：青年组、中年组、老年组MBI显著改善率分别为68.75%、46.88%、25.00%，线性趋势χ² = 14.08，P < 0.01；NIHSS有效恢复率分别为78.13%、56.25%、31.25%，线性趋势χ² = 16.74，P < 0.01。重复测量示“时间 × 组别”交互效应显著(MBI：F = 12.40；NIHSS：F = 9.80，均P < 0.01)。校正性别、基线NIHSS及康复剂量后，年龄每增加1岁，MBI显著改善率降低6% (OR = 0.94, 95% CI 0.90~0.98)。14 d内均未发生康复相关不良事件。结论：年龄是缺血性脑卒中早期康复疗效的独立负向预测因子，65岁以上患者功能获益明显缩减，临床应制定个体化、低负荷渐进的高龄康复方案并加强可塑性监测。

Abstract: Objective: To explore the independent influence of age on the early rehabilitation effect of patients with ischemic stroke, and to provide evidence-based for stratified rehabilitation strategy. Methods: A retrospective single-center cohort design was adopted. From January 2024 to May 2025, 96 patients with the first ischemic stroke in Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine were included. They were divided into youth group (<45 years old), middle-aged group (45~64 years old) and elderly group (≥65 years old), with 32 cases in each group. All three groups started standardized early rehabilitation within 24 hours of onset, and the course of treatment was 14 days. The improved Barthel index (MBI) increased by ≥12 points compared with the baseline is defined as a significant clinical improvement, and the NIHSS decreased by ≥4 points compared with the baseline is defined as an effective recovery of neurological function. Χ² test, linear trend test and repeated measurement analysis of variance were used to evaluate the dose-effect relationship between age and curative effect. Results: The significant improvement rates of MBI in youth group, middle-aged group and elderly group were 68.75%, 46.88% and 25.00% respectively, and the linear trend was χ² = 14.08, P < 0.01. The effective recovery rates of NIHSS were 78.13%, 56.25% and 31.25% respectively, and the linear trend was χ² = 16.74, P < 0.01. Repeated measurements showed that the interaction effect of “time × group” was significant (MBI: F = 12.40; NIHSS: F = 9.80, all P < 0.01). After adjusting for gender, baseline NIHSS and rehabilitation dose, the significant improvement rate of MBI decreased by 6% for every one-year increase in age (OR = 0.94, 95% CI 0.90~0.98). No adverse events related to rehabilitation occurred within 14 days. Conclusion: Age is an independent negative predictor of the early rehabilitation effect of ischemic stroke, and the functional benefit of patients over 65 years old is obviously reduced. Clinically, an individualized, low-load and gradual rehabilitation program for the elderly should be formulated and plasticity monitoring should be strengthened.