IPC对偏瘫病人上肢水肿的治疗.

IPC对偏瘫病人上肢水肿的治疗

In termitte nt Comp ressi on for the treatme nt of the oedematous hand in hemi plegic stroke: a ran domized con trolled trial

T. A. ROPER, SYLVIA REDFORDI, RAYMOND C. TALLIS

Elderly Services Directorate, St James's Hos pi tal, Beckett Street, Leeds LS9 7TF, UK

Dep artme nt of Physiothera py Ladywell Hos pi tal, Eccles New Road, Salford M5 2AA, UK

2Uni versity Dep artme nt of Geriatric Medi cine, Cli nical Sciences Buildi ng, Hope Hosp ital, Eccles Old Road, Salford M6 8HD, UK

Address coires pondence to: T. A. Roper Fax: (+44) I 13 242 9195

Abstract

Objective: to evaluate tile efficacy of intermittent pneumatic compression in treating oedema in tile hem ip legic hand of stroke p atie nts.

Desig n: sin gle-bli nd ran domized con trol trial.

Setting: acute and rehabilitation elderly care wards in a teaching district.

Subjects: 37 subjects with a first ever hemisphere stroke were randomized to treatment with sta ndard p hysiothera py either alone or comb ined with in termitte nt pn eumatic comp ressi on.

Main outcome measures: the effect of treatme nt on oedema was assessed using measures of the hand volume of the hemiplegic hand. The impact on function was assessedusing the motricity in dex. Results: the treated group showed no change in tile mean stroke hand volume, in the control group the mean stroke hand volume decreased by 3.2 mi. There was no statistically significant differe nces betwee n tile groups. The media n scores tot the motricity in dex in creased for both gro ups but there was no sig ni fica nt differe nee betwee n the groups and any imp roveme nt in motor function was independent of any treatme nt effects.

Conclusion: intermittent pneumatic compression at tile prescribed pressure and duration of this study is not an effective treatme nt for the oedematous stroke hand.

Keywords: hemi plegia, oedematous hand, pn eumatic comp ressi on, ran domized con trolled trial, stroke

In troducti on

In p atie nts with hem ip aresis or a hemi plegia followi ng hemis pheric stroke, swelli ng of the articled hand is a recog ni zed phenomenon. The freque ncy of arm oedema has not bee n determ ined in an unselected population of stroke patients, although one series reported a frequency of 15% [ 11. The mecha nism of the swelli ng is un certa in, but it has bee n attributcd to a comb in ati on of immobility and dependency, imp airi ng venous retur n, and p aralysis of the symp athetic con trol of vasculature [2]. Irrespective of the mechanism, oedema causes pain and disfigurement, and in chronic cases may predispose to contractures. This, combined with the increased weight of the arm, ma]' interfere with